Sugars
Eliminating concentrated sweeteners and high-glycemic index foods is one of the most important step in creating a healing diet (for CF and everyone else). By sugars I mean any concentrated sweetener including cane sugar (in all its forms), high-fructose corn syrup, beet sugar, agave syrup, maple syrup, artificial sweeteners, and brown rice syrup. Some of these are more harmful than others, so as we ween ourselves off of our sugar addictions (most Americans have a sugar addiction, I did even though I ate "healthfully" by conventional standards) some sweeteners may act as bridge-substances to help us make the transition to a "sugar-free" diet. I chose to use honey (raw and local only), and you can see I put it on the "replace it with" list on the previous page because it is the least harmful of all of the sweeteners, except for stevia. However, honey still has a high glycemic index and will still spike our blood sugars if eaten alone or in excess, so it must only be eaten with other foods and in very small quantities. Eliminating sweeteners has helped me recognize and enjoy the natural sweetness of many whole foods. At one point I was a slave to my sugar addiction and it made me feel really bad about myself. Now, my cravings for sweets are long gone, and it feels incredibly liberating! Be aware that sugars are not just in foods, they're in drinks too. Sugary drinks are where a lot of Americans get most of their sugar (and calories in general). Even fruit juice is high in sugar and relatively low in nutrition, plus it's pasteurized and often contains many additives. I do not recommend drinking juice at all, except for low-sugar home-made vegetable juices (in moderation). Check your labels and drink only unsweetened and low-sugar beverages. Water with lemon is the best choice. Also, avoid artificially sweetened drinks as those are toxic for other reasons.
But why is honey (in moderation) okay? It's my only sweetener and here is why. Raw, local, unfiltered, organic honey is actually medicinal when used in small quantities. It contains antimicrobial compounds that bees use to prevent infection in the hive, including hydrogen peroxide, bee defense-1, and propolis. In fact, if you're making kombucha you can't use raw honey because the antibacterial properties of it will kill the scoby. Wow, powerful stuff! Researchers have actually conducted studies on honey's antibacterial effects, including against MRSA and Pseudomonas [1]! It is increasingly used in medical applications to hasten wound healing, especially for things like bed sores, burns, and skin infections from drug-resistant pathogens. In addition, honey is almost a 50/50 balance of glucose and fructose with a tiny bit of maltose in there, and almost no sucrose. As I discussed in CF201, some people with severe digestive problems have issues with the enzymes that break down disaccharide sugars (e.g. lack enough sucrase to break down sucrose) so it is very important to use a sweetener that is already broken down into monosaccharides, glucose and fructose. It's important to have the glucose fraction equal to or greater than fructose in a food in order to optimize fructose absorption. I will discuss fructose malabsorption more in the fruit section below. Furthermore, raw honey is the only sweetener that is essentially unprocessed - you scoop it out of the hive and eat it, that's it. Good honey has gone through no heating or filtering process, so it is a whole food that the bees have created for themselves (and kindly share with you). Honey is still pretty much pure sugar (monosaccharides) however, so we must watch our blood sugars accordingly. You can check out the sugar breakdown of sweeteners and other foods here. Maple syrup is pretty much 100% sucrose and agave syrup is mostly fructose, so for those with sensitive digestion, both of those can cause digestive upset.
In the pages under CF 201, I touched on carbohydrate malabsorption and blood sugar irregularities in CF and how these can lead to many other problems, including pulmonary exacerbations. But there are many other problems with eating refined sugars and concentrated sweeteners including tooth decay and bone malformation, bone demineralization and osteoporosis, systemic inflammation, and heart disease. Of concern in the greater Western population is development of type 2 diabetes. Type 2 diabetes is epidemic in the US due to excessive carbohydrate consumption, and a recent study estimates that almost half of the American population is diabetic or pre-diabetic.
Sugars feed infection
The first and most important point that I need to make in this section is that pathogens such as bacteria and yeasts thrive on sugar. These pathogens are very simple organisms and need simple energy sources. The simplest energy source is monosaccharides. As I discussed in the CF201 section, ingesting certain carbohydrates that you cannot fully digest and absorb can travel into the lower intestines where they feed pathogenic bacterial growth. This can cause a bunch of digestive issues, and if continued long enough will develop into leaky gut syndrome (a.k.a. compromised intestinal permeability). Leaky gut causes chronic systemic inflammation and can trigger autoimmune disorders, food allergies/sensitivities, neurological disorders, and many other syndromes. Since most CFers are battling chronic inflammation due to bacterial infections in the lungs and sinuses, we need to make sure that we take extra precautions to eliminate the risk of gut infection as well. The solution is to become very conscious of the quantity and quality of carbohydrates we consume, cutting out unnecessary and potentially harmful sugars, and replacing them with beneficial nutrients.
Secondly, eating a lot of carbohydrates and sugars raises our blood sugar, feeding the organs throughout our body with extra sugar and ensuring that pathogens are well-fed, wherever they may be. This means that having sugary blood can cause our other bodily fluids to have a higher sugar content. I have mentioned before but I will mention it again, because it is such an incredibly important point, that CF lung fluid is more sugary than normal, and even more sugary in folks with CFRD. In a 2007 study, people with CF had significantly higher levels of glucose in their lung fluids (i.e. mucus) than normal people, and patients with CFRD and hyperglycemia had even more glucose in this fluid that non-diabetic CFers [2]. Having extra sugar in the lung fluid could mean that that sugar is fueling bacterial proliferation in the lungs. Not only that, but the inflammation caused by the hyperglycemia causes the junctions between our epithelial cells to weaken, allowing further infiltration of glucose into lung fluid [2]. Since all CFers with pancreatic issues have irregular insulin secretion to a varying degree (that gets worse with age), our ability to keep our blood sugars low and under control is compromised [3,4].
Thirdly, having chronic inflammation, infection, and stress causes insulin resistance. This means that if you're battling a particularly bad infection, when you eat sugar your cells will not respond to insulin normally and will not absorb as much glucose from your blood, leaving your blood extra sugary and causing hyperglycemia [5]. I've written more on hyperglycemia and glucose intolerance in this section of CF201 section and this Blog post. So if we've got impaired insulin secretion, chronic bacterial infection, plus insulin resistance from an acute episode of that infection, we want to stay the hell away from sugars!
Refined sugars cause vitamin and mineral imbalances
One issue is that carbohydrates require the presence of B vitamins in order to be digested, however if we eat refined sugars and carbohydrates in the form of white sugar or white flour which have been stripped of all vitamins and minerals in their processing, in order to digest these things we must draw on our body's stores of B vitamins [6]. This is a problem because most Americans are deficient in B vitamins to begin with, as the Standard American Diet (SAD) is so lacking in adequate nutrition, vitamins and minerals. Furthermore, sugar consumption causes bone loss and tooth decay because it disrupts the ratio of phosphorus to calcium in the blood. Because sugar is acidic, the presence of excess sugar in the blood requires calcium (which is alkaline) to be drawn into the blood vessels from the bones to counterbalance its acidicty, de-mineralizing the bones and leading to osteoporosis and low bone density [6]. As you know, adult CFers are at higher risk for osteoporosis than our peers because of our malabsorption problems, so adding sugar to the equation is simply asking for trouble. Furthermore, the drop in phosphorus levels in the blood relative to calcium reduces calcium's absorption into our cells, making it unusable and setting us up for other issues, such as heart disease. Heart disease is a sugar disease in a number of ways, and this is just one more; calcium deposits in the arteries of the heart cause heart attacks [7]. Not that CFers are particularly high risk for heart disease, but you undoubtedly know someone who is, so share this info! Eating whole foods that contain sugars, such as fruits and grains, does not contribute to the problem of demineralization because these foods also contain dietary cofactors (other vitamins, minerals, fiber, fats, proteins) that regulate sugar metabolism. But when sugars are refined and stripped of these nutrients, as with white sugar and corn syrup, there are no beneficial cofactors to help you regulate your blood sugar, and you can get hyperglycemia and all of its nasty consequences.
Sugars are inflammatory and damage your cells
The structure of a monosaccharide (single-sugar molecule) is such that when it travels through your blood vessels it acts as an oxidant (the opposite of an antioxidant) just like free radicals, breaking down the electron fields of the atoms in your cells, and damaging cell walls. Sugars can actually cling to cells like leaches, and you can examine the rate of the clinging with a blood test called a hemoglobin A1c, which is given regularly to diabetics. If you have a chronically high blood sugar, your HA1c is going to become higher. When sugar has clung to a cell the body attempts to tear it away with an immune response. In the blood vessels, after the body tears the sugar away it patches the hole in your cell with cholesterol. Again, heart disease is a sugar disease: a high blood cholesterol count has nothing to do with how much cholesterol you consume in animal foods, but has everything to do with the rate at which sugar is damaging your arteries [6].
Besides contributing to heart disease, sugar has a similar deleterious effect on all of our cells. What I am particularly concerned about are the cells in our stressed-out digestive tracts, and the cells of our distal bronchial arteries and the lung cells connected to them. If our digestive tract is already inflamed and unhappy from poor nutrition and malabsorption, the presence of sugar to further inflame our gut cells is not going to help the situation. I have been struggling most recently with hemoptysis (coughing up blood) and I believe this issue is exacerbated by high blood sugar. As an oxidant, sugar weakens the fragile cellular linings of the smallest of the arteries in the lungs, called the distal bronchial arterial capillaries, which exchange oxygen to our lung tissue. It may be that the problem of hemoptysis can be caused from both sides: one is from the lung side through bronchiectasis (dilation and scarification of the airways) and breakage of the airway, and the other is from the artery side through degradation and inflammation of the artery wall from sugar oxidation. So then when the artery breaks into the airway, you get a lung bleed. Having chronic high blood sugar also damages certain organ systems with a lot of capillaries, such as the eyes and kidneys; that's why diabetics are routinely tested for eye and kidney disease. Severe diabetes (usually type 2) also can result in nerve damage and limb amputation because the nerves and capillaries in the outer extremities are destroyed by sugar, causing tissue death. We're not really at risk for that (unless we eat lots of carbs and have untreated diabetes), but it is one example of how powerfully destructive sugar really is.
Next Section: Grains and Starches
But why is honey (in moderation) okay? It's my only sweetener and here is why. Raw, local, unfiltered, organic honey is actually medicinal when used in small quantities. It contains antimicrobial compounds that bees use to prevent infection in the hive, including hydrogen peroxide, bee defense-1, and propolis. In fact, if you're making kombucha you can't use raw honey because the antibacterial properties of it will kill the scoby. Wow, powerful stuff! Researchers have actually conducted studies on honey's antibacterial effects, including against MRSA and Pseudomonas [1]! It is increasingly used in medical applications to hasten wound healing, especially for things like bed sores, burns, and skin infections from drug-resistant pathogens. In addition, honey is almost a 50/50 balance of glucose and fructose with a tiny bit of maltose in there, and almost no sucrose. As I discussed in CF201, some people with severe digestive problems have issues with the enzymes that break down disaccharide sugars (e.g. lack enough sucrase to break down sucrose) so it is very important to use a sweetener that is already broken down into monosaccharides, glucose and fructose. It's important to have the glucose fraction equal to or greater than fructose in a food in order to optimize fructose absorption. I will discuss fructose malabsorption more in the fruit section below. Furthermore, raw honey is the only sweetener that is essentially unprocessed - you scoop it out of the hive and eat it, that's it. Good honey has gone through no heating or filtering process, so it is a whole food that the bees have created for themselves (and kindly share with you). Honey is still pretty much pure sugar (monosaccharides) however, so we must watch our blood sugars accordingly. You can check out the sugar breakdown of sweeteners and other foods here. Maple syrup is pretty much 100% sucrose and agave syrup is mostly fructose, so for those with sensitive digestion, both of those can cause digestive upset.
In the pages under CF 201, I touched on carbohydrate malabsorption and blood sugar irregularities in CF and how these can lead to many other problems, including pulmonary exacerbations. But there are many other problems with eating refined sugars and concentrated sweeteners including tooth decay and bone malformation, bone demineralization and osteoporosis, systemic inflammation, and heart disease. Of concern in the greater Western population is development of type 2 diabetes. Type 2 diabetes is epidemic in the US due to excessive carbohydrate consumption, and a recent study estimates that almost half of the American population is diabetic or pre-diabetic.
Sugars feed infection
The first and most important point that I need to make in this section is that pathogens such as bacteria and yeasts thrive on sugar. These pathogens are very simple organisms and need simple energy sources. The simplest energy source is monosaccharides. As I discussed in the CF201 section, ingesting certain carbohydrates that you cannot fully digest and absorb can travel into the lower intestines where they feed pathogenic bacterial growth. This can cause a bunch of digestive issues, and if continued long enough will develop into leaky gut syndrome (a.k.a. compromised intestinal permeability). Leaky gut causes chronic systemic inflammation and can trigger autoimmune disorders, food allergies/sensitivities, neurological disorders, and many other syndromes. Since most CFers are battling chronic inflammation due to bacterial infections in the lungs and sinuses, we need to make sure that we take extra precautions to eliminate the risk of gut infection as well. The solution is to become very conscious of the quantity and quality of carbohydrates we consume, cutting out unnecessary and potentially harmful sugars, and replacing them with beneficial nutrients.
Secondly, eating a lot of carbohydrates and sugars raises our blood sugar, feeding the organs throughout our body with extra sugar and ensuring that pathogens are well-fed, wherever they may be. This means that having sugary blood can cause our other bodily fluids to have a higher sugar content. I have mentioned before but I will mention it again, because it is such an incredibly important point, that CF lung fluid is more sugary than normal, and even more sugary in folks with CFRD. In a 2007 study, people with CF had significantly higher levels of glucose in their lung fluids (i.e. mucus) than normal people, and patients with CFRD and hyperglycemia had even more glucose in this fluid that non-diabetic CFers [2]. Having extra sugar in the lung fluid could mean that that sugar is fueling bacterial proliferation in the lungs. Not only that, but the inflammation caused by the hyperglycemia causes the junctions between our epithelial cells to weaken, allowing further infiltration of glucose into lung fluid [2]. Since all CFers with pancreatic issues have irregular insulin secretion to a varying degree (that gets worse with age), our ability to keep our blood sugars low and under control is compromised [3,4].
Thirdly, having chronic inflammation, infection, and stress causes insulin resistance. This means that if you're battling a particularly bad infection, when you eat sugar your cells will not respond to insulin normally and will not absorb as much glucose from your blood, leaving your blood extra sugary and causing hyperglycemia [5]. I've written more on hyperglycemia and glucose intolerance in this section of CF201 section and this Blog post. So if we've got impaired insulin secretion, chronic bacterial infection, plus insulin resistance from an acute episode of that infection, we want to stay the hell away from sugars!
Refined sugars cause vitamin and mineral imbalances
One issue is that carbohydrates require the presence of B vitamins in order to be digested, however if we eat refined sugars and carbohydrates in the form of white sugar or white flour which have been stripped of all vitamins and minerals in their processing, in order to digest these things we must draw on our body's stores of B vitamins [6]. This is a problem because most Americans are deficient in B vitamins to begin with, as the Standard American Diet (SAD) is so lacking in adequate nutrition, vitamins and minerals. Furthermore, sugar consumption causes bone loss and tooth decay because it disrupts the ratio of phosphorus to calcium in the blood. Because sugar is acidic, the presence of excess sugar in the blood requires calcium (which is alkaline) to be drawn into the blood vessels from the bones to counterbalance its acidicty, de-mineralizing the bones and leading to osteoporosis and low bone density [6]. As you know, adult CFers are at higher risk for osteoporosis than our peers because of our malabsorption problems, so adding sugar to the equation is simply asking for trouble. Furthermore, the drop in phosphorus levels in the blood relative to calcium reduces calcium's absorption into our cells, making it unusable and setting us up for other issues, such as heart disease. Heart disease is a sugar disease in a number of ways, and this is just one more; calcium deposits in the arteries of the heart cause heart attacks [7]. Not that CFers are particularly high risk for heart disease, but you undoubtedly know someone who is, so share this info! Eating whole foods that contain sugars, such as fruits and grains, does not contribute to the problem of demineralization because these foods also contain dietary cofactors (other vitamins, minerals, fiber, fats, proteins) that regulate sugar metabolism. But when sugars are refined and stripped of these nutrients, as with white sugar and corn syrup, there are no beneficial cofactors to help you regulate your blood sugar, and you can get hyperglycemia and all of its nasty consequences.
Sugars are inflammatory and damage your cells
The structure of a monosaccharide (single-sugar molecule) is such that when it travels through your blood vessels it acts as an oxidant (the opposite of an antioxidant) just like free radicals, breaking down the electron fields of the atoms in your cells, and damaging cell walls. Sugars can actually cling to cells like leaches, and you can examine the rate of the clinging with a blood test called a hemoglobin A1c, which is given regularly to diabetics. If you have a chronically high blood sugar, your HA1c is going to become higher. When sugar has clung to a cell the body attempts to tear it away with an immune response. In the blood vessels, after the body tears the sugar away it patches the hole in your cell with cholesterol. Again, heart disease is a sugar disease: a high blood cholesterol count has nothing to do with how much cholesterol you consume in animal foods, but has everything to do with the rate at which sugar is damaging your arteries [6].
Besides contributing to heart disease, sugar has a similar deleterious effect on all of our cells. What I am particularly concerned about are the cells in our stressed-out digestive tracts, and the cells of our distal bronchial arteries and the lung cells connected to them. If our digestive tract is already inflamed and unhappy from poor nutrition and malabsorption, the presence of sugar to further inflame our gut cells is not going to help the situation. I have been struggling most recently with hemoptysis (coughing up blood) and I believe this issue is exacerbated by high blood sugar. As an oxidant, sugar weakens the fragile cellular linings of the smallest of the arteries in the lungs, called the distal bronchial arterial capillaries, which exchange oxygen to our lung tissue. It may be that the problem of hemoptysis can be caused from both sides: one is from the lung side through bronchiectasis (dilation and scarification of the airways) and breakage of the airway, and the other is from the artery side through degradation and inflammation of the artery wall from sugar oxidation. So then when the artery breaks into the airway, you get a lung bleed. Having chronic high blood sugar also damages certain organ systems with a lot of capillaries, such as the eyes and kidneys; that's why diabetics are routinely tested for eye and kidney disease. Severe diabetes (usually type 2) also can result in nerve damage and limb amputation because the nerves and capillaries in the outer extremities are destroyed by sugar, causing tissue death. We're not really at risk for that (unless we eat lots of carbs and have untreated diabetes), but it is one example of how powerfully destructive sugar really is.
Next Section: Grains and Starches
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[1] http://www.ncbi.nlm.nih.gov/pubmed/20228250
[2] Hyperglycemia and cystic fibrosis alter respiratory fluid glucose concentrations estimated by breath condensate analysis. <http://jap.physiology.org/content/102/5/1969.full>
[3] Identification of insulin secretory defects and insulin resistance during oral glucose tolerance test in a cohort of cystic fibrosis patients. <http://www.eje-online.org/content/165/1/69.full.pdf>
[4] Insulin secretion, glycosylated haemoglobin and islet cell antibodies in cystic fibrosis children and adolescents with different degrees of glucose tolerance. <http://www.ncbi.nlm.nih.gov/pubmed/1761281>
[5] Cystic Fibrosis-Related Diabetes and Abnormal Glucose Tolerance: Overview and Medical Nutrition Therapy. <http://spectrum.diabetesjournals.org/content/15/2/124.full>
[6] Nourishing Traditions. Sally Fallon.
[7] http://www.sciencedaily.com/releases/2013/05/130502142657.htm
