Insulin Resistance – Our Love Affair With Sugar

by Marcelle Pick, OB/GYN NP

Most women I talk with at the clinic and in my personal life have experienced sugar cravings, no matter what time of year — or time of the month. Whether it’s having a taste for something sweet after dinner each night or speeding to your local supermarket for the biggest bag of Swedish Fish you can buy, I know craving sugar can be a powerful urge. And the disappointing truth is that once we start to include sugar into our daily routine, it becomes more and more difficult to stop.

As humans we’ve evolved to appreciate the instant energy sugar provides us, but food is a highly emotional topic, especially when it comes to sweets. We often associate sweet foods with love and acceptance, and scientists have looked at our brain chemistry to understand how food can directly affect our “feel-good” neurotransmitters like serotonin. There are many other physical causes for sugar cravings, too, like hormonal fluctuations, intestinal yeast, and stress, to name a few.

Pre-tox before you party

Sugary treats are almost always available at parties and special events, as well as other celebratory hazards that can disrupt even the healthiest lifestyle. If you’re planning to celebrate, there are some simple steps to take before you indulge to help pre-tox your system, and keep you feeling energetic and healthy.

Sadly, we’ve been told for far too long that indulging in sweets is connected with a lack of self-will or some other character flaw. This is just not true! Craving sugar is not simply about willpower, nor is it simply about emotions. There may be several underlying physiologic causes feeding your desire for sugar, and it may take some perspective and investigation to get to the bottom of it. Let’s take a closer look at what might be behind your sugar cravings and how you can develop a healthy, loving relationship with sweets.

Why does sugar feel so good?

There is so much contributing to the positive feelings we associate with sugar. For many of us, the smell of homemade cookies or a cake fresh out of the oven reminds us of our childhoods, evoking fond memories of past holidays, birthdays, or special occasions. Others remember being rewarded with candy or other sugary delights when they did something “good.”

These positive associations are deeply ingrained in our brains. I once had a patient named Jillian who broke down into tears when I suggested she cut sugar from her diet for a week — it was as if I was taking away her most intimate friend! But the more research I did, the more it made sense. Our brains “reward” us by releasing serotonin and beta-endorphins when we eat sugar or other refined carbohydrates that are easily converted to glucose (the simplest sugar). The release of these mood-enhancing neurotransmitters explains in part why Jillian and many other patients of mine feel such an intense emotional connection to sugar.

Let’s look at serotonin. Serotonin has many responsibilities in our bodies, but overall, it is best known as the neurotransmitter that makes us feel good. Neurotransmitters act by sending messages from the nervous system to the rest of the body, and serotonin levels are what several antidepressants manipulate to improve mood and anxiety. Made from the essential amino acid tryptophan, serotonin’s roots are in protein. So what does sugar have to do with it? The reason sugar can lead to increased serotonin in the brain has to do with insulin. I’ll explain this in more detail below, but the bottom line is that we need insulin to help tryptophan get into the brain so it can produce serotonin. And sugar — or any carbohydrate for that matter — causes us to release insulin. Refined carbohydrates, such as sugar, white bread, pasta and white rice, lead to a more intense insulin surge than do complex carbohydrates like vegetables and whole grains.

Beta-endorphin is another neurotransmitter we release when eating sweets or refined carbohydrates. This is the neurotransmitter typically associated with a “runner’s high” because it acts as a natural painkiller, produces a sense of well-being, increases self-esteem, and settles anxiety. Our brains naturally release beta-endorphin when we are in any kind of physical pain — and when we eat sugar.

It’s no wonder sugar feels so good! Physiologically, sugar “feeds” our brains with two neurotransmitters that send positive messages to the rest of the body. The problem is that the lift we experience after a can of soda, a bowl of noodles, or a chocolate chip cookie doesn’t last very long, and eating these foods, especially without combining them with some protein, can set us up for cyclical cravings. We will find ourselves wanting more and more.

Is sugar addictive?

So many of my patients ask whether sugar is truly addicting, but the answer differs depending on the individual. Sugar certainly can be addictive, but this is more of a problem for some women than others, because we all have different levels of neurotransmitters and receptors in our brains. These levels vary and change over time depending upon our genetics and lifestyle — what we eat, drink and feel; where we are hormonally; whether we exercise; how well we sleep; and so on. Some practitioners believe that a portion of the population is “sugar-sensitive.” These individuals may be operating with naturally lower levels of serotonin and beta-endorphin, leaving them more vulnerable to sugar cravings.

Any time the body is running low on a neurotransmitter, the brain tries to catch up by opening up more receptors for this neurotransmitter, essentially to increase the odds of a connection. You can think of it in terms of supply and demand: when there’s less of something available, the demand for it goes up. With so many open receptors, if a sugar-sensitive person does have sugar, alcohol, or anything that causes a release of serotonin or beta-endorphin, it intensifies the resulting sugar “high.” This in turn can lead to more cravings.

Some of my patients have experienced withdrawal symptoms when they stop eating sugar. This makes sense because when we’re eating large amounts of sugar at regular intervals, the brain becomes accustomed to frequent beta-endorphin bursts, and when we take them away, it naturally wants more. This, like withdrawal from a caffeine habit or drug addiction, can lead to headaches, shakiness, nausea, fatigue, and even depression.

Your body needs carbohydrates

It may be tempting for women who feel they have a problem with sugar to simply cut out all carbohydrates. But an all-or-nothing approach just isn’t healthy — it takes all four food groups to regulate insulin and quell sugar cravings. Here is an explanation why:

Whenever we eat foods that contain complex carbohydrates, our bodies convert them into a simple sugar known as glucose. Glucose is the main source of fuel for our cells. The brain in particular cannot use any other source of energy (like fat or protein) aside from glucose, so it is absolutely essential to eat carbohydrates.

As I mentioned earlier, carbohydrates are also important in helping tryptophan get into the brain to be converted to serotonin. When we eat food containing protein, the body breaks it down into subcomponent amino acids — one of which is tryptophan.

Key nutrients to enhance your serotonin production

  • Vitamin C. Among other important duties, vitamin C helps to convert tryptophan (from the food you eat) into serotonin.
  • B-complex vitamins. This group of vitamins is helpful in metabolizing carbohydrates for the body to use. Niacin in particular is essential in converting tryptophan to serotonin.
  • Zinc. Zinc aids insulin in doing its job and generally helps with digestion.

— Adapted from Potatoes not Prozac, p. 141

The tryptophan molecule is relatively small compared to other amino acids. Those larger amino acids can block tryptophan’s path across the tightly-regulated barrier between the blood and the brain. When carbohydrates are consumed and insulin is released, insulin pairs up with larger amino acids to help build muscle, leaving tryptophan a clearer path to cross into the brain. And there are important micronutrients, such as vitamin C, the B vitamins, and zinc (see box at right), that can help with the conversion from tryptophan to serotonin.

What’s interesting is that Mother Nature did not provide our bodies with the information to distinguish between man-made sugars and natural sugars. Instead, this information is available to us in everything else that surrounds natural sugars — in the antioxidant-rich skins of grapes and apples, for example, or the fiber and protein-rich germ of whole grains. Therefore, eating any kind of sweet or refined carbohydrate will satisfy the brain and increase serotonin — but it won’t trigger the signals that tell our brain we’ve had enough, that we are now fully sated. The more refined a food is, the more it’s been stripped of this natural, information-rich fibers, fats, proteins, vitamins, and antioxidants.

The carbohydrates in white flours, white rice, white sugar, and the majority of pastas and breakfast cereals are all highly refined, so it takes less time for the body to break them down, therefore leading to a quicker response all around. This may sound good, but in the long run, quick spikes in insulin and glucose can damage your metabolism and lead to insulin resistance and more cravings. There are so many delicious complex carbohydrates to choose from that will gently increase blood sugar and insulin.

Possible causes for sugar cravings

As I mentioned earlier, sugar cravings often have many facets. Because eating is so intimately connected with our biochemistry and our emotions, we “digest” sugar on many levels. You may notice there’s a pattern to when you crave sugar — for so many of my patients it is cyclical, occurring nightly after a stressful day at work, monthly just before their periods, or seasonally when the days grow short. For others, sugar binges may be connected to the kinds of foods they have already eaten that day, or with a daily ritual. Here are some of the common causes for sugar cravings I see at the clinic:

  • Hormonal fluctuations. Just before menstruation, when estrogen is low and progesterone is on its way down, beta-endorphin levels are at their lowest. These cyclical hormonal and neurotransmitter fluctuations may explain why many women who experience PMS also have cravings — and the accompanying serotonin–endorphin bursts that high-sugar foods can provide.
  • Stress. Any stressful situation can lead to less than optimal eating habits. Stress itself increases cortisol levels, which initially dampen hunger. Once the stress has abated, our hormones of hunger ramp up — “Refuel!” the body cries. This can lead many women with stressful jobs and lifestyles to a pattern of nighttime cravings, over-eating, and unwanted weight gain. Over time, chronic stress can lead to adrenal imbalance, eventually resulting in extreme exhaustion. So many women I see have reached a state of adrenal imbalance, and find the only way to get through the day is by drinking lots of caffeine and consuming sugar for quick energy bursts. But this only sets them up for further cravings and more energy depletion. There are lots of simple ways to support your adrenal health by what and how you eat. For more information, see our articles about eating for your adrenal glands.
  • Insulin resistance. When you are resistant to insulin (which can happen as a result of a long-term diet high in refined carbohydrates and low in micronutrients), glucose is not able to enter your cells and ends up staying in your blood as a result. This means your cells are starved for the fuel they need to operate, and signals are therefore sent to your brain to increase insulin. This results in cravings for sugar because even though you may be eating enough, your cells aren’t able to access the food. For more information, see our article on preventing type 2 diabetes and metabolic syndrome.
  • Food sensitivities. Food sensitivities are often the result of a situation known as “leaky gut,” where partially digested food particles can make their way into the bloodstream through a damaged, inflamed mucosal lining in the digestive tract. The body regards these food particles as foreign antigens and mounts an immune response by sending antibodies. Combined antibodies and antigens in your bloodstream, known as immune complexes, can lead to intense cravings. Gluten may be at the root of this type of sugar craving because it is often combined with sugar in the foods we eat, and so women think they’re craving sugar when really they might be craving gluten.
  • Intestinal yeast or systemic candidiasis. Yeast thrives on sugar (a connection easy to make when you look at the Latin name for this group of organisms — Saccharomycotina — or “sugar fungi”). If your intestinal (and vaginal) bacteria are out of balance, they are less likely to keep yeasts like Candida in check. An overgrowth of yeast in the intestine or system-wide can lead to increased cravings for sugar. You can help keep these organisms — and cravings — in check by taking a high-quality probiotic that includes a competitive yeast.
  • Excess acid-forming foods. Some women I talk with notice that after eating a lot of red meat, their cravings for sugar increase. Red meat is high in a pro-inflammatory molecule called arachidonic acid. Eating a lot of meat tends to upregulate the oxidative–inflammatory cascade in our bodies. If left unchecked, this inflammatory condition can become chronic and cause abnormal glucose metabolism, ultimately leading to insulin resistance. Choosing anti-inflammatory foods high in omega-3 fatty acids, as well as those that are alkalizing and antioxidant-rich, such as fruits and vegetables, can offset the metabolic damage and the cravings associated with this dynamic.
  • A lack of sweetness in your life. As I mentioned before, many things in life can affect our serotonin and beta-endorphin levels — exercise, balanced nutrition, rewarding work, a positive relationship, even a sunny day. The joy we find in our lives speaks to our biochemistry. So when we are lacking positive energy and happiness, it’s not surprising that we seek to fill that void with sugar.

Strive for a sweet balance — the Women to Women approach

There are several ways to diminish sugar cravings, but just as there are different causes for them, different steps work for different women. For my patient Jillian and others who are addicted to sugar, multiple steps may need to be taken for lasting results. Other women may find that simply avoiding sugar for a few days does the trick. Still others find that once they reach menopause and their hormonal swings become a thing of the past, so do their cravings. But the best approach is to find a good balance. I’ve seen too many women put sugar in the “forbidden fruit” category and end up binging because they feel so deprived. You deserve treats in your life, and sugar can be enjoyed without the “carb hangovers” and guilt that are too often associated with it.

Here are some suggestions to help you find a healthy middle ground between no sugar and sugar binges.

Balance your diet. Nourish your body with a balanced diet, full of the healthy fats, quality protein, complex carbohydrates, and fruits and vegetables that all together help keep cell-signaling on an even keel. The food you prepare for yourself should be yummy and rewarding, not something you have to force down. So many fad diets are set up to deprive women of basic food groups, like fat and carbohydrates, but our bodies need all of these food groups to carry out basic functions. Treat yourself to satisfying foods, and I promise you’ll see a difference in your cravings. For more on preventing insulin resistance with nutrition, see our articles on this topic.

Try eliminating sugar for three to five days and see how you feel. I know how hard it can be, but avoiding sugar for just three days can make a huge difference for some women. For others, it may take longer for the cravings to diminish, but eliminating the cyclical crash-and-burn bursts of serotonin and beta-endorphin your brain gets from sugar and refined carbohydrates can help your body normalize its receptors and neurotransmitters, so that your brain isn’t constantly sending the message that it needs more sugar.

Incorporate a high-quality multivitamin–mineral complex, plus omega-3’s. A good supplement is essential to cover your nutritional bases, especially in our modern society of fast food and industrial farming. Micronutrients like zinc, vitamin C and the B vitamins are particularly helpful in calming sugar cravings by influencing serotonin production. Equally important are omega-3’s, which are crucial for regulating mood and inflammation — factors that are both associated with cravings.

Eat a baked potato three hours after dinner. This concept was born when Dr. Kathleen DesMaisons published her famous book, Potatoes not Prozac. We recommend you read the book for specifics, but the theory is that potatoes not only stimulate the release of insulin needed for tryptophan to cross into the brain, but also contain potassium, a nutrient needed for insulin to do its work. Potatoes, with their fiber and micronutrient content, also offer a more sustained insulin response than most refined carbohydrates. The only stipulations are that you eat the potato as an evening snack, that you do not eat it with any kind of protein (otherwise, you can top it as you wish), and that you include its skin. You may notice that this runs counter to our advice to combine protein and carbs in meals and snacks — keep in mind that eating a baked potato in this specific way, three hours after a meal containing protein, is one particular method of reducing cravings and preventing mood swings. The following is our more general recommendation about controlling insulin surges.

Mix protein with pleasure. We can all indulge ourselves in sugary treats once in a while if we want to. Combining these treats with a stick of cheese, some nuts, or even a glass of milk will help balance the sugar and insulin surge and allow a gentler increase in blood sugar and insulin. We also recommend desserts that include protein, like custards or meringues or even a bowl of berries and cream. You can sweeten these delights with natural sweeteners like stevia or xylitol instead of sugar. With a less spiky sugar surge to the brain, you’ll likely experience a less precipitous crash as well. See our articles about carbohydrates for an alternative explanation about the concepts of glycemic index and glycemic load.

Avoid sugar patterns. Just like those who smoke or drink may associate smoking or having a glass of wine with certain activities, we may come to associate sugary treats with times of the day or ritualized rewards. Take a moment to notice whether this might be true of your cravings. Your brain is quick to pick up on associations — particularly anything having to do with its “reward cascade” — and may have you craving sugar every day at three o’clock, or each time you go for a run, for example. If you’re ready to break the pattern (or prevent it from forming), this might be a good time to enjoy that baked potato or some alternative “reward.”

Enhance the sweetness in your life. One of my favorite prescriptions for my patients reads: Go have some fun! I have written this prescription several times for patients who seem buried in their work or the day-to-day responsibilities of raising a family, taking care of elderly parents, managing a household — whatever it may be. As women, we rarely take the time to nurture ourselves, and it is so important to your health to do so on a regular basis. Take a step back to figure out what makes you happy, and examine the things that are doing the opposite. It may be time make a change.

Cultivate lasting bliss

I know it doesn’t feel good to be a slave to sugar. The ups and downs can be intense and exhausting overall. But it doesn’t have to be this way. Look at the whole picture — biochemically, physically, and emotionally — to pinpoint where you might benefit from change and release yourself from your cravings. The more balance you can offer yourself through quality nutrition and emotional wellness, the more you’ll find your cravings start to shift away from quick fixes like sugar to the things that provide a lasting and natural bliss.

I absolutely know that craving sugar or binging on sugar is not a reflection of your willpower or your individual strength. It most likely has physical roots, and those roots can be restored to set the foundation for a healthy, lifelong relationship with sugar!