Asheville’s ambivalent relationship with sweeteners

Julia Cassell, a weightlifting trainer in Asheville, stepped on the scale after giving birth to her last child in 2009 and saw that she weighed 200 pounds. That’s when she knew she would have to make better choices about sugar.

“I was drinking Coke every day,” Cassell recalls. “There was no doubt; if I had a drink, it was a Coke.”

Cassell is not alone in struggling with sugar and how to combat its effects. From weightlifters to naturopathic doctors to pediatricians to dietitians, local professionals grapple with the sugar question every day: whether to cut its consumption a lot, a little or not at all.

Sugar and inflammation

Dr. Leslie Meyers, a naturopath at Asheville’s Waterleaf Naturopathic Medicine, says she primarily treats patients with a holistic blend of herbs, homeopathy, diet and lifestyle. Sugar, she says, is a common link in many symptoms patients report. “Sugar triggers an immune response in the gut and causes inflammation all over the body. It makes anything worse — joint pain, ADHD, energy levels, mood, digestion, weight, heart disease,” Meyers says. “If people with back pain take sugar out of their diets, two weeks later they’ll notice that it has noticeably lessened. If they eat sugar again, within 15-20 minutes they would have the pain again. I see it over and over.”

Meyers names a cluster of symptoms, any three of which qualify as metabolic syndrome, that are high-risk factors for Type 2 diabetes and heart disease — insulin resistance, high triglycerides, low HDL cholesterol (the beneficial kind), hypertension and obesity. “Some inflammation occurs inside the blood vessels, contributing to diabetes and atherosclerosis,” she continues. “I believe that sugar intake is a bigger contributor to atherosclerosis than cholesterol intake.”

Meyers and her wife, Dr. Emily Colwell, who represents the other half of the practice at Waterleaf Naturopathic, are especially careful with the amount of sugar they allow their children to consume. “We stay away from highly processed foods because they’re more likely to have added sugar,” Meyers says. “But we do have times we enjoy sugar. When we go to a party, we tell the kids to go nuts and enjoy. We occasionally go to The Hop for ice cream with friends, and since these events occur weekly, I don’t feel like we are depriving the kids.”

Not having sugar as part of her family’s daily routine helps prevent colds and the flu and puts them at lower risk for ADHD, anxiety, behavioral issues, sleep issues, gut issues and obesity, Meyers says.

“The trail of health issues that sugar leaves behind is enormous,” Meyers adds. “We need to get a hold of this in our country, particularly for our kids. We are training their taste buds at an early age and teaching them how to eat for the rest of their lives.”

A pediatrician’s experience with overweight children

Dr. Lauren Keely Carlisle, a pediatrician at French Broad Pediatrics in Woodfin, remembers the 12-week outpatient weight management program for kids that she worked in all the way through medical school and residency at LSU New Orleans from 1992 to 2005. The severely to morbidly obese children, ages 6-16, were put on a diet of protein and fats, similar to the ketogenic diet, which is a low-carb, high-fat diet. The children also spent time with a dietitian, a behavioral psychologist and an exercise physiologist. “We were pretty successful,” Carlisle says. “We told them they couldn’t have any carbs at all.”

However, the main culprit wasn’t starchy carbohydrates. “The No. 1 thing for Americans is sugar drinks,” Carlisle says, referring to soda, juice, sports drinks and energy drinks. “A can of Coca-Cola is about 15 teaspoons of sugar. Imagine making an iced tea and putting 15 teaspoons of sugar in it. You would never do that.”

Carlisle treated young children with Type 2 diabetes, among other conditions. “The youngest with Type 2 diabetes was in the 8-10 age range,” she says. “I also saw polycystic ovarian syndrome and precocious puberty, which is when children develop early, and fatty liver disease, which is directly correlated with weight.”

The research hasn’t definitively linked all those conditions with being overweight, Carlisle says, but the national conversation is ongoing, particularly because it took decades to dispel old nutritional myths.

“When I was a kid, fat was the evil thing, not sugar, and it took us a long time to figure out that it is sugar and carbs,” she says. “Our bodies are still programmed that if we think we’re going to go through starvation, we hold on to the fat. If we eat a bunch of sugar, the body says, ‘We’re going to burn some of this for energy, but we’ll store the rest as fat, because who knows where your next meal is coming from?'”

According to Carlisle, every day children should eat five or more servings of fruit and veggies; they should have two or fewer hours of recreational screen time; they should participate in at least one hour of physical activity; and they should consume no sugary drinks.

Still, even though Carlisle says she thinks we are giving children way too much sugar, she concedes it’s difficult to take it away completely. “I go through it with my own kids,” she admits. “We’re from the South. Culturally, dessert is a part of life.”

But, Carlisle says, the children shouldn’t always get to choose what they eat. Her advice to parents: “You are the parent. You make the decisions. If you don’t want your kid to have chocolate, they don’t have to have chocolate. And it’s OK.”

The key, Carlisle says, is choosing the times kids can enjoy sugar. “What are things we can have as a treat that we know we’ll get once a week?” she asks parents to consider for their children. “Is it ice cream? Should we make a special trip to The Hop on Fridays? That will give them motivation — Friday’s right around the corner.”

Balancing act

Catherine Beck, a dietitian in Asheville, recalls studying sugar at the University of Georgia — from the chemical reaction that occurs in baking with sugar (the Maillard reaction) to the science behind the body’s breakdown and metabolism of carbohydrates into sugars.  “It was never truly categorized as healthy or unhealthy,” she says. “We were taught that a balanced diet full of a variety of nutrient-dense foods is important and that complete elimination or restriction of any one food or food group is unnecessary.”

Beck, who works part time at Nutritious Thoughts, points out that the 2015-2020 Dietary Guidelines for Americans recommend limiting intake of added sugars to no more than 10 percent of total calories, but not because of negative health effects related to sugar; rather, keeping added sugar intake at this level allows sufficient room to include other important nutrients.

Sugar is found in all kinds of foods, Beck says, “including fruits, vegetables and dairy. When you consume sugar, whether that be from a potato, banana, muffin or yogurt, it is broken down in the body and absorbed. In fact, the preferred source of fuel for your entire body is a simple sugar known as glucose,” she notes.

Beck disputes the notion that sugar should be minimized greatly or eliminated from the diet altogether. “The phrase ‘quitting sugar’ sounds a lot like we are equating sugar to substances like alcohol or drugs. Blaming sugar as the root cause for modern disease is entirely too simplistic,” she adds. “The idea that sugar in and of itself will cause disease is false. One’s lifestyle — including diet, movement, mental status and overall health — should be considered when looking at disease risk and development.”

Beck concedes, however, that certain diseases demand a closer look at sugar intake: “There are certain chronic or physiological conditions like diabetes that may require closer monitoring of the carbohydrates and sugars consumed on a daily basis. But even in those cases, sugar can still be incorporated regularly as part of a complete diet.”

The natural foods approach

JoAnne Kushi, a whole foods cooking instructor, counselor and chef in Asheville, remembers a childhood beset with illness. “I used to eat the supermarket shelf diet,” she says. “Pop-Tarts for breakfast, doughnuts, white bread with butter and sugar. We ate sugar cereal and added scoops of sugar, and it sounded like sand when you scraped the bottom,” she recalls.

Repeated hospitalizations for chronic infections, headaches, allergies and digestive issues made her want to change her diet. “The more natural I ate, the healthier I got,” she says. “Every time I went back, all the problems came back. After five years, I said, ‘Enough!’ I couldn’t believe food could matter that much. I ended up eliminating sugar, dairy, all flour products, and I was eating hardly any meat, so I went vegan.” After spending several years studying whole foods and learning in her own kitchen, she began teaching cooking classes to show people how to cook sugar-free, plant-based and natural cuisines.

Kushi’s diet isn’t as restrictive anymore, but she still doesn’t consume sugar. “It’s toxic,” she says. “It creates an acidic condition in the blood, where most diseases thrive. It interferes with your body processing, producing and utilizing vitamins and minerals, and contributes to everything from arthritis, gum diseases, hypertension, diabetes, mood swings and cancer,” she continues. “It’s the No. 1 enemy of your immune system, so you’re much more prone to diseases and infections. You can see why people get sick so much.”

High fructose corn syrup, found in soft drinks like Coca-Cola and many other foods on every aisle of conventional grocery stores, is especially pernicious, Kushi says. “High fructose corn syrup is the No. 1 toxic form of sugar. It’s in a high concentration that isn’t recognizable by the body — it’s like a foreigner,” she says. “And because it’s made from corn, it’s also genetically modified.” Some health-minded grocery stores such as Earth Fare and Whole Foods don’t allow it, she adds.

Kushi recommends alternative sweeteners. “Honey is good, but raw is better than pasteurized,” she says. “But the two best choices are stevia, which is the leaf of a plant that is 200-300 times sweeter than sugar, and it has a glycemic index of one, the lowest you can go. And coconut sugar, which comes from the flowers of the coconut plant and is also low-glycemic. It’s delicious, and it doesn’t give you the hypoglycemia roller coaster.”

A 40-pound bodybuilding makeover

In 2010, the only pants Cassell could fit into were a pair of her ex-husband’s jeans. At 5 feet 6 inches and 200 pounds post-pregnancy, she was home-schooling her four children and couldn’t leave the house to exercise. “I had a very carb-centric diet — always bread, pasta, cereal,” she says. “The standard American diet ensured that I was overweight for most of my life.”

So Cassell got involved in an online weightlifting community, participating for the first year with the help of Tom Venuto’s book, Burn the Fat, Feed the Muscle. As she lifted, she followed his food recommendations, which took sugar and carbs off her plate and out of her glass.  The new diet and weightlifting helped her gain muscle and drop body fat. In five months, her weight fell to 160, completely changing her physique.

The before pictures she took remind her just how far she has come. “For me, being at 50 percent body fat and bringing it down to 18-20 percent, I didn’t want to take the pictures at the time, but I’m so glad I have them today. It’s incredibly motivating,” she says.

Although Cassell now stays away from sugars most of the time, she says she makes allowances once in a while for comfort foods, tweaking them for healthier versions, as her tastes have changed. “When I was a kid, a Hershey bar couldn’t be better,” she says. “But now, I eat 90 percent dark chocolate. If the kids are doing s’mores and I try one, I don’t enjoy the flavor. I never thought I would see that day.”