Dear Readers,
Today’s question comes from Donna who wrote “I thought it added to confusion today when you were critical of giving young people fruit as a snack. Your previous point was that real food is always better than processed. As usual, the food industry is riddled with inconsistency. Children are not having weight issues or diabetes because of an apple or grapes! Sometimes, these points seem quite elitist and not related to real people's lives.
Thanks for the opportunity to share my thoughts on this important topic.”
It’s important for me to know if I’ve caused confusion, so thank you, Donna, for writing in. To clarify, I don't work for the food industry. I provide my column as a free service to the community to get nutrition information that is external to the food industry to those who can't otherwise access professional nutrition services. And, while I’ve written about fruit before, I want to cover it again to make sure I’m clear.
Fruit is far superior to processed foods as a snack! Always! We want to consume food that is as natural as possible, as fruit falls into that category. If you’ve got a choice between a bag of chips or a bar or fruit, fruit is a better option. It’s filled with vitamins, minerals, and fiber and it’s very easy to pack to go.
But there is a caveat here. Fruit is not optimal for anyone struggling with weight issues or type 2 diabetes - young or old. And at present that number is growing exponentially. And, while type 2 diabetes used to be an adult disease, it’s now common in children, as is fatty liver, which is related. For numbers and healthcare outcomes as well as costs to the healthcare system, readers can go here. Let’s be clear: there is no disease that causes more downstream health woes and costs the healthcare system more than type 2 diabetes.
So how is diabetes related to fruit? Surely eating fruit doesn’t cause us to develop type 2 diabetes! So what am I talking about? This is where nutrition is more complex than a one size fits all recommendation and where a good understanding of metabolism and hormones kicks in. For a healthy, active person the sugar in fruit (fructose) is used up by the muscles and brain for energy. Yay! For a sedentary person who is consuming too much starch or sugar already, fructose adds to the burden on the liver and adds to insulin resistance - which drives type 2 diabetes and weight gain.
So no, fruit is unlikely to cause diabetes. But once a person is insulin resistant or is on their way there, eating fruit on an empty stomach triggers the same cascade of hormones that a candy bar does.
Say what? Yes, it’s true. It used to be thought that fructose was a healthier sugar - being from fruit. However, that has been debunked by the work of pediatric endocrinologist, Dr. Lustig. Fructose is a particularly dangerous sugar when consumed in high doses and even in low doses it can contribute to diabesity (diabetes and obesity) when there is insulin resistance.
This is part of the reason it’s so very difficult for people to reverse type 2 diabetes and lose that excess weight. Once they are insulin resistant (meaning the insulin production has become desensitized due to too much glucose coming in) their bodies store all the glucose they eat as fat. And of all that glucose, none does more damage to the liver than fructose - because it is stored in the liver.
You may not realize it, but raisins contain up to 72% sugars by weight. One mango has about 45g of sugar. A cup of grapes has about 23g of sugar. A medium just-ripe banana has about 14g of sugar and this increases as the banana ripens. But a ripe avocado only has about 1.33g of sugar. So not all fruit is equal either! We can see though, that eating several servings of sweet fruit a day can have a serious, undesirable impact on blood sugar.
So the blanket idea that fruit is healthy is problematic if there is insulin resistance at play. Well how do you know if that’s the case? A quick measurement of the waist to hip ratio should tell you. If the measurement around the belly button is larger than the largest part around the bum (and you’re not pregnant) and there is a sedentary lifestyle - even in slim people - there is a high likelihood that there is insulin resistance. It’s a simple test that can be done at home. To verify your findings if you are concerned your doctor can do a fasting blood sugar test and the HbA1c blood test, which looks at your blood sugar over the last 3 months. If this is too high, it can indicate the beginning of insulin resistance.
The other problem with a blanket statement that fruit is healthy is that a lot of people take that to mean that fruit products by extension are also healthy. Most are not. Processed fruit foodstuff is still processed foodstuff. Even the juices that say all natural and no sugars added are concentrated. Even when they say not from concentrate - if you check the label you will see they have natural flavours added. The snack aisle at the grocery store is filled with these rolled up, boxed up, gummied, mashed, juiced fruit products. And all of them are much sweeter than natural fruit with a much higher fructose content. None of them are optimal snacks for anyone, fit or not.
Even the packaged, all natural just fruit fresh squeezed juices are problematic. These contain huge amounts of glucose by volume and are pasteurized - which means the vitamins in it have been damaged and are not working for the body as they should. Wearing a glucose meter and consuming these is an eye opening experience.
Compared to all these, real fruit is better. But my recommendation is to pair it with a small portion of healthy protein or to consume it after a meal, to stop it from spiking the blood sugar too much. We need to remember, modern fruit has been bred for sweetness. It really doesn’t resemble the earlier, more natural fruits much at all. To mitigate this, adding a handful of nuts or seeds, or a nut butter to dip the fruit into, a piece of cheese, or hemp nuts or chia pudding, or adding the fruit to a quality protein shake is a better choice.
When is it optimal just to eat fruit? For active children and youth of a healthy weight who need a quick snack, whole, fresh fruit is far superior to processed or packaged snack foods. For athletes who need to get or keep their carbohydrates up for energy stores and performance, whole, fresh fruit is superior to many processed pre-workout products.
For clients with digestive woes and leaky gut or serious autoimmune issues, fruit can be nutritive and often well tolerated and can replace dessert with a healthier option. This is because most fruits require very little digestive energy and don’t require the same enzymes in the intestine to break them down. They also don’t have the anti-nutrients veggies have. So if the intestinal lining is compromised, fruit still gets digested and absorbed. And they are far superior to baked goods in terms of their nutrient density. In these cases fruit can be very healthy. But they are used therapeutically to help heal the digestive lining then cut back.
But anyone with blood sugar issues needs to really monitor fruit intake. Ditto anyone trying to lose weight. So it’s problematic to say that across the board, fruit is the best snack.
We also should remember that some fruits are very high in sugars and others are lower. Berries tend to be lower than larger, sweeter fruits like pineapple and bananas. So these are considerations, too.
The primary concern I see in clients today is blood sugar dysregulation and insulin resistance, usually (but not always diagnosed) as diabetes or pre-diabetes. I would go so far as to say it’s epidemic. And these diseases are a recipe for chronic health deterioration and disease risk, even when “managed” by medications. The optimal diet to control and even reverse type II diabetes and the underlying blood sugar issues is a very low carb, whole foods, omnivore or carnivore diet. In essence, a whole foods ketogenic diet. And on this diet, most fruit is a deal breaker. It summons insulin, which needs to rest to be resensitized. The exception is low glycemic berries.
When consuming fruit in the case where a person struggles with blood sugar or weight issues, it’s important that fruit follows a meal. This is helpful when we want a sweet after a meal and are having a hard time getting over that. A cup of whole fruit can help us move towards less sweets. Or you can try a cup of fruity herbal tea that is unsweetened. But stay away from dried fruit, processed fruit snacks, and fruit juices! Even “healthy” fresh smoothies made with a lot of fruit can spike blood sugar. And incessantly spiking blood sugar in the absence of lots of exercise ultimately sets us up for diabetes.
Eating fruit after a meal or in the presence of proteins and fat ensures it will not be digested too quickly, which means it will not spike your blood sugar. If you want to add a little to a smoothie, keep it to a cup and make sure there is ample protein in the smoothie. Fibre, fat, and protein slow the absorption of sugar and help us avoid blood sugar spikes that drive insulin resistance. It’s also a good idea to learn which fruits are higher and lower in sugar and stick to the lower ones except as a treat.
I hope this helps to clarify what I was trying to convey, Donna. I do not want to dissuade readers by making things overly complex, but nor do I want to oversimplify issues. I want readers to be empowered by the information I share to make better health decisions for themselves and their families.
If readers have their own questions they can email me at nonienutritionista@gmail.com. You can also find me online at askthenutritionist.ca. Have a lovely week!
Namaste!
Nonie De Long
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