Month 2

Month 2: Say goodbye to Sugar and Artificial Sweeteners.  Instead, eat several servings of fruit per day.

Human beings are hardwired to like sweet foods.  This is not an unfortunate side effect; a preference for sweet foods offers a distinct evolutionary advantage.  Our caveman ancestors obtained the majority of their calories by foraging for foods – the bounty of meat from a successful hunt was a rare treat, rather than a daily staple.  Foraging carries a risk of accidental poisoning and cavemen dedicated a significant amount of energy toward learning which foods could be safely eaten and which should be avoided.  In nature, there are no foods that contain fructose that are poisonous.  A sweet taste denotes a food that is safe to eat.  Children carried the highest risk of accidental poisoning due to their small size and lack of experience with foraging, explaining why children are particularly interested in sweets over all other foods.

Thankfully, accidental poisoning is a rare event in our modern world, however, our inborn preference and drive toward sweet foods persists.  Many diet plans unfairly vilify fruit due to its sugar content and restrict or limit it.  Many patients are surprised when I encourage them to eat as much fruit as they possibly can both before and after surgery, even higher sugar varieties like bananas, grapes, mangoes and cherries.

First, there are no studies that I am aware of that demonstrate that increased fruit intake causes weight gain.  However, there are many studies that demonstrate the opposite.  Second, when we look at life after surgery, it’s important that we draw our battle lines appropriately.  Success after surgery is not dependant on reducing sugar intake, it’s dependent on reducing refined sugar intake.  This is a battle against cherry pie, not cherries and banana splits, not bananas.  Making your postoperative diet too restrictive is a recipe for failure.  It’s important to set yourself up for success by satisfying your prehistoric drive for sweets with fruit to ensure that you don’t give into temptation and eat foods that contain refined sugar.

Eliminating refined sugar from your diet seems like a daunting task at first, but after a few weeks becomes quite manageable.  Once you are through the first week or two of your sugar detox, you will find that fruit easily satisfies your sweet cravings and you can limit your intake of refined sweets to once a week or less.  

Sugar sweetened beverages, especially pop, require particular attention.  Our body has two separate methods for regulating hunger and thirst.  Food makes us less hungry, and water makes us less thirsty, but food does not address our thirst and water does not make us less hungry.  The only crossover between these two systems is for watery food like watermelon, or thick liquids like protein shakes.  Sugar containing beverages are thin liquids that address our thirst, but do not impact our hunger.  The result is that the calories in sugar sweetened beverages like soda-pop, fruit juice, sports drinks, sweetened coffee drinks, sweet tea, lemonade and fruit punch slide in under the radar of our metabolic thermostat.  Our metabolic thermostat works very aggressively to match our calorie expenditure to our calorie consumption, but is not dialed into the calories in thin liquids.  This defect is understandable since there are no thin liquids that exist naturally and contain calories.  

Because these calories do not impact our hunger, they don’t trigger the metabolic adjustments that occur when the same number of calories are consumed as food.  A 12 ounce can of Pepsi contains 150 calories.  If you consume one can daily and these calories are stored, rather than burned, these 150 calories daily can result in as much as 15 lbs of weight gain per year.  When I see patients in the office who report weight gain (not regain) of more than 10 lbs. per year, there are only a few factors that can drive this much weight gain and sugar sweetened beverages is at the top of this list.  Sugar sweetened beverages are the most fattening substances on the planet and result in more weight gain than Big Macs and Snickers bars combined.  Success after surgery is not possible without eliminating these drinks from your diet forever.  When I see patients who has regained a significant amount of weight after surgery, sugar sweetened beverages are the most common culprit.

Artificial sweeteners present a much more significant threat to your long term success than most patients appreciate.  Since the majority of dieting advice focuses on either calorie restriction, or carbohydrate restriction, artificial sweeteners have been given a free pass.  Recently, there have been many well publicized scientific studies that demonstrate that artificial sweeteners play a significant role in weight gain, despite not containing calories.  There are two mechanisms by which these substances contribute to weight gain.

The first way that artificial sweeteners cause weight gain is by hijacking your tastebuds so they are only sensitive to super sweet foods.  On a sweetness scale, artificial sweeteners are much sweeter than fruit.  The result of consuming large amounts of artificially sweetened foods and drinks is that fruit is no longer perceived as sweet, increasing your drive for sweeter foods like those that contain refined sugar.  This process is known as “taste adaptation” and explains why those who consume artificially sweetened foods and beverages regularly also struggle more with foods that contain real sugar.  As you progress through this month of sugar detoxification, you will begin to appreciate the sweetness of fruit as your taste buds adjust to naturally sweet foods.  Many patients report to me that they cannot believe how sweet the apples, peaches or cherries are this year, compared to last year.  It’s likely that this is not due to a good year in the orchard, but rather a new found ability to taste and appreciate fruit after eliminating artificial sweetness from their diet.  

The second mechanism that artificial sweeteners cause weight gain becomes clear only after we recognize that it’s our metabolic thermostat that drives weight gain and loss, rather than excess calories.  As we’ve pointed out in Part One, our body has an extremely tight system of regulating our calorie expenditure, based on our calorie consumption.  When we dig into the physiology of how this happens, we find that taste plays a major role in the inner workings of our metabolic thermostat.  Our sweet taste buds let our brain know that a load of sugar is coming, triggering our pancreas to release sugar metabolizing enzymes and allowing the rest of our body to feel comfortable that food is present so it can run at full capacity.  Artificial sweeteners trigger our sweet tastebuds but don’t deliver the calorie load that our body is expecting.  As a result, our normally tight system of matching calorie expenditure to calorie consumption begins to break down.  The result of this that our metabolism loses it ability to respond appropriately to other sweet foods with refined and natural sugar.  The net result shifts your metabolic thermostat toward weight gain.

Stevia deserves an extra comment since it is a topic of so many questions and is frequently misunderstood.  Because Stevia is marketed as a natural sweetener, many think that it does not cause the same negative effects that other artificial sweeteners do.  This is not true, Stevia is as dangerous as the blue, pink and yellow artificial sweeteners.  While a stevia plant does represent a natural, unprocessed food, the white powder that is sold is far from natural.  Artificial sweeteners that come from refining a stevia plant are no more natural of a sweetener than table sugar that comes from refining sugar cane.

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