About sugars and (dis-)metabolism


So, if you have been trough my previous post “About sugars and addiction“, you might now be wandering why that matters… And what it means that glucose and fructose behave differently in our body… And why that matters too… Brace yourself and enjoy the ride on the next part of the post, where I hope you will find your answers (and hopefully raise more questions for my next posts)…!

Once foods enter the body (any food), they get broken down (mechanically by the teeth, chemically by enzymes and digestive juices secreted by the salivary glands, stomach, pancreas and liver and again mechanically by the stomach and intestine movements) into their smallest constituents. Guess what? All digestible carbohydrates (not the pre-biotics for example, which as you know by now, are non-digestible carbohydrates) will eventually end up in glucose, fructose or galactose. After being broken down to their smallest parts, the mono-saccharides get absorbed. Absorption requires a passage through the liver where the first major difference between glucose and fructose becomes evident (and this matters to your health!).

While glucose can in fact be metabolised both in the liver and in other tissues and is rapidly released into the bloodstream (causing release from the pancreas of the hormone insulin of which I will detail soon), fructose is almost completely metabolized in the liver. Here it goes broadly into three pathways: 1. It is used for energy by the liver (more efficiently than glucose); 2. It is converted glucose (and released into the bloodstream) or glycogen (and used as storage); 3. It is converted into fats through a process called “de novo lipogenesis” (formation of lipids from scratch…) and released as either tryglicerides (TG) or low-density lipoproteins (LDL) or kept in the liver for storage.

The diagram below shows schematically the fate of fructose once into the liver… As you will see, the numbers show the average amount that take each of the described pathway. Numbers can only be a simplistic estimation, as they depend on a number of factors, including: the person age and gender, the liver health, the amount of other nutrients absorbed in the meal, the body state (rest, activity, recovery, etc…), the general body health (insulin sensitivity, etc…), etc…


The fate of fructose in the liver
The fate of fructose in the liver


At this point I believe it is essential to reinforce one aspect of modern diets: if it was estimated that in the early part of the 20th century (forget all the paleolithic stories, no need to go that far…) we were ingesting fructose mainly from natural unrefined sources (whole fruits and vegetables) and in big part in the form of sucrose (50% fructose and 50% glucose), nowadays most fructose is ingested in its simplest form as high fructose corn syrup (in the case of the more and more average diet, consisting of little produce and much ready made meals, sweets and soft drinks…). The reason why this is relevant is that the amount of fructose the liver has to deal with has significantly increased, together with an increased speed of delivery from the intestine to the liver (due to the absence of other nutrients that slow down the absorption, thus giving time to the digestive system to deal with the workload) and a reduction in all other nutrients that in nature are associated with it (fibers, vitamins, minerals, proteins, etc…). This has been extensively proposed as one reason for the “toxicity” of fructose. High amounts of fructose in the liver (and potentially the innate or acquired inability of the liver to deal with it effectively) have in fact been linked not only to increased blood cholesterol and triglycerides (simply speaking, some fats that increase the risk of cardiovascular disease), but also to a liver condition similar to that caused by alcohol (and for that reason called non-alcoholic fat liver disease, or NAFLD). In the link page, under the “About sugars and metabolism” heading, you will find a number of scientific papers published in peer-reviewed (i.e. good quality) journals, talking about this…

The key points to understand about fructose until now then, are: 1. Fructose is only metabolized in the liver, as opposed to glucose that can be metabolized in almost every cell in the body; 2. When high doses of fructose hit the liver at a high rate (as when drinking HFCS-sweetened beverages for example), the liver capacity to deal with it can be challenged and taken past its limits. When this happens, fructose is turned into fats, potentially increasing the risk of cardiovascular disease and non-alcoholic fat liver disease. In addition, the presence of fructose will inhibit the use of already present fats (both because you are already getting energy from fructose, and because fructose can be turned into fats if needed) and if also high doses of glucose are ingested concurrently, they will end up in storage (because fructose is used at a faster rate).

And what about glucose then? Is fructose the only villain? Unfortunately not… As mentioned earlier, when glucose enters the bloodstream, the hormone insulin is released by the pancreas to help maintaining blood sugar levels within a tight range. Blood glucose is in fact a highly controlled parameter (by itself something that should make you think that nature does not want uncontrolled boood sugar levels…). If it is true that glucose is essential for the cell metabolism, high circulating amounts can have deleterious effects on the cardiovascular system (arteries walls in particular) too. When insulin is released, it allows glucose to exit the blood stream and be absorbed by the cells, where it can be used to produce energy (or be stored as glycogen). Not only by doing this insulin controls the amount of circulating glucose (essentially reducing blood glucose), but insulin also sends a satiety message to the brain, informing your body that it has now enough available energy and does not need to eat anymore. Because insulin is cosidered the hormone of energy storage (as it is mainly released in the presence of glucose and proteins in the meal), nature also made it the hormone that prevents the burning of fats as energy sources (why should you use fat if you need to reduce the amount of glucose in the blood already?). Up to this point, everything would be as nature intended… You eat a balanced meal, your body breaks down the food into its most basic constituents and absorbs them while telling your brain that it has had enough.


Metabolic fate of glucose
Metabolic fate of glucose


However, as with fructose, problems arise when the amount of glucose to be dealt with becomes too high (as it is the case with overconsumption of sugars). Constantly high amounts of glucose in the blood cause a constant release of high amounts of insulin by the pancreas. In a similar way to how you stop hearing the train passing by if you live near the railway, the cells stop responding to insulin presence when it is constantly high… This is what doctors would call insulin-resistance. Because your body needs to lower blood sugar levels somehow and does not know other ways, it causes the pancreas to release more insulin (like a baby crying louder when the exhausted parents ignore the early screams…). At this point a blood test would likely show increased blood insulin levels and you would be diagnosed with hyper-insulinaemia. At this stage you are already facing a serious issue, because food that in normal conditions would cause a minor release of insulin, now has a much amplified insulin-response. That means less fat-burning, less feeling of satiety and more fatigue (so even when you start limiting sugars intake, that might not be enough to lose fat as you were hoping…). In addition, as the word gets nastier and less pronounceable, you get closer and closer to the point of no return… Even more problems arise when despite the increased release of insulin (hyper-insulinaemia), your blood sugar levels remain high, a situation called hyper-glycaemia (even the loudest cries of the baby have no more effect on the parents, your cells). At this point the doctor will probably label you as diabetic (after confirming other signs like the increase in blood sugars after a meal or their fasting levels)… Not only your insulin levels will be constantly elevated, your blood sugar out of control and your fat stores only increasing; your body will now be under a metabolic attack and molecules related to inflammation will start spreading into your system… It seems this low-level inflammation (measured via the presence of high-sensitive C-Reaction Protein – hsCRP – in your blood) is ultimately what causes (or at least is involved with…) the number of medical conditions that are often (scientifically or anecdotally) associated with diabetes or (see next…) the Metabolic Syndrome.

If up until here increasing activity (exercising more…!) and modifying your diet (reducing sugar intake) have scientifically proven chances of bringing you back to the right path (your cells can still get back to “hearing” the presence of insulin, therefore reducing the release of it from the pancreas while still lowering your blood sugar levels to a safe range), if left ignored, the constant hyper-activity of the pancreas to produce more and more insulin will end up causing the cells in the pancreas to burn out… This is a sort of a tipping point… Your pancreas would now be unable to produce insulin, so that the only way for you to stay alive would be to inject yourself with insulin any time you have food… You would be now labelled as insulin-dependent diabetic, and your life would be changed forever…

Can it get worse? Sure it can…! If you remember the part on fructose and its role in increasing circulating fats (LDL cholesterol and triglycerides) and you consider the post on sugar addiction, good chances are that once you get to the stage of diabetes (and even worse when insulin-dependent), you are overdoing on anything sweet… And unfortunately for you, once you past the early stage (your body starts to become less sensitive to insulin – you have been labelled insulin-resistant) you do not even really need to be gorging on sweets, because even little amounts of sugars now will cause a storm-like reaction…! It might even be the case (because you are addicted, it is convenient, it is present everywhere and maybe you think it is not that bad either…) that you are also overindulging in processed foods, sweets, soft drinks and all the rest (pasta, rice, pizza, bread, crackers and most bakery products should also be on your black list by now)… That means you are probably overloading your system with both fructose (that increases circulating fats, makes you overeat by not releasing insulin and loads you with calories) and glucose (that keeps your insulin levels too high for you to burn fats and adds more calories).

You are now likely to be overweight to say the least… And guess what? High LDL cholesterol, high triglycerides and high blood sugars are already three major risk factors for cardiovascular disease… Add a large waist line (you have been adding more and more calories while burning less and less fats…) and high blood pressure (the reasons for this are less known, but likely to be at least in part related to the hardening of blood vessels caused by elevated circulating sugars and the low-grade inflammation discussed above) and you are in full-on Metabolic Syndrome… If you also recall the systemic inflammation burning you from the inside (the high-sensitve C-Reaction Protein test), you are now in the front line to suffer from cardiovascular disease… Does that not scare you? Think heart attack and stroke, that might work better…


Dis-metabolism of excessive sugar intake
Dis-metabolism of excessive sugar intake


Because the scope of my blog is not just to scare people, what I really wanted to highlight with this post (and the previous ones) is that we are ultimately in control of our body. We are the only responsible for our health and with the exception of a minority of cases, genes play only a partial role, our behaviour (the so called epi-genetic) ultimately is what brings us down the healthy or ill path.

And the reason why I felt (and I hope) that my knowledge and experience could help you is that as I read in a textbook on basic human nutrition, we live in a “toxic, obesogenic society”. I am not joking, nor exaggerating. And that is why I do not even blame people for being overweight, diabetic, having the Metabolic Syndrome or all the rest… Going to the supermarket nowadays is truly like entering a drug store. We are so surrounded by unhealthy foods (and drinks), even marketed as “healthy”, packaged in beautiful green boxes, etc… that we end up believing what they tell us… Beware of the words “organic”, “natural”, “low-fat”, just to mention some… They mean nothing in terms of health…! An organic product (certified organic) only means that its making process has followed some specific standards… A jar of jam with 60% sugars can be organic, is that healthy? Or a chocolate bar in which no more than 40% is cocoa (it leaves most of the remaining 60% to sugar…) can be organic… Even worse for “natural”… A stone is natural… Would you have that? What is not natural actually? And low-fat was the big thing during the years of the nutritional war on fats… These years are quickly becoming a thing of the past (now that we know that some fats are not just good, but even essential and that we have seen that eating “low-fat” foods made people fat…), but unfortunately the low-fat claims resist and very often hide the “high-sugar” label…

But, eventually, what is the ultimate goal of the food industry? To take care of your health or to sell you more of their stuff? Have a thought, I do not think I need to help you find the answer… What I would like to help you doing, is to make sure you know how to avoid falling into the “Big Food” trap, how to make healthy choices and to realize that you can still enjoy great food and experience delicious tastes and flavors (even more that you do now!) while maintaining a good health…

For this, my next post will be on practical tips and how to put the theory into practice (how do you reduce sugar intake?). I have come to realise that even if the theory is there, it is often not easy to know what to actually choose while at the supermarket, or in the kitchen… How much sugar is there in bread? And what is the proportion of sugars, fibers, fats and proteins? Are white bread, sourdough bread, brown bread or multi-grain bread all the same? And what about pasta? And fruits? Are all desserts equally bad? Do you think you are doing yourself good by eating cereals in the morning? Have you seen that most of them are packed with sugar? And did you know that one tablespoon of ketchup contains at least one teaspoon of sugar? This and more is what you will hopefully come to know soon, so stay tuned…!

My Detox Experience – Part 3 – Objective changes

They are here, they are plain, they are numbers… And they are finally coming…!!! The physiological markers, the health parameters… All the geeky part of the experiment that will hopefully shed some “scientific” light on the adaptations of the body to a sudden and rather significant diet change. In this section, I will discuss the most relevant findings, in addition to publishing some of the raw (yep, even numbers can be used raw…!) data on myself (not on the other people in order to respect their privacy).


As you can see from my PRE-detox numbers, if there was a reason I wanted to try the detox diet, it was to see whether I would feel “refreshed” or “energised”, or what it would feel to be “detoxified” (I evetually ended up doing it as part of a group activity and an experiment on myself, but that is another issue…). I was not aiming at losing weight nor body fat, and in fact, I was more concerned about not losing fat free mass than anything else. Starting at 70.77 Kg (by 1.75 m tall, giving a BMI of 23.1 Kg/m2 for those who believe in it…), I ended at 67.46 Kg (BMI 22.03 Kg/m2), with a total loss of 3.31 Kg (or 4.68% of my starting weight). Considering that total body weight is a very poor marker of health or fitness (as is the BMI, on which so many guidelines are based…) my next question was: where did this weight come from? If the numbers don’t lie, 1.14 Kg were fat-free mass, while 2.14 were body fat.

Anthropometric data PRE vs POST
Anthropometric data PRE vs POST

Before celebratory parties get started, I would like to make a couple of considerations:

  • I said if, for the simple reason that at such low level, minimal changes in the machine reading (the so-called reliability of the measuring device), would show as major changes in percentage points. Did my body fat really went from 9% to 6.8%? If I am sure I lost weight (I felt it, I could see it and the scale is much more “reliable” than the BodPod), I can think that most of it was fat, but certainty would need much more data (if it was ever to achieve…). And even then, was it a good thing? With minimum body fat recommended to stay above 5% in elite male athletes, I would leave the answer to you…
  • As mentioned previously, I was not aiming at losing weight or body fat, but rather at maintaining fat free mass while feeling the benefits (if any…) of a plant-based, raw, juiced dietary regime. My fat-free mass went from 64.42 Kg (91%) to 63.25 (93.8%). Maintaining the same consideration as above, this was an unwelcome adaptation, that will lead me to the next part of my data analysis about energy deficit.

For those out there who love playing with numbers, we can indeed see that to lose over 3 Kg in such a short time, a few things need to happen. First and foremost, you must be kept in quite a significant energy deficit (more of that in a moment). This was somehow a pleasant surprise for my brain… I was not just a wimp (if you read Part 2 of my detox experience you will understand), my body was actually paying a rather heavy bill, on a daily basis… Secondly, considering that the mathematical idea of 2.14 Kg of fat equaling 19,260 Cal would give a daily energy deficit of 3,852 Cal (even ignoring the other 1.13 Kg of fat-free mass, a rather unlikely occurrence), my glycogen stores were likely to have been depleted carrying water away with them (pure speculation on this point, if you can suggest any other explanation, I would love to read it in the comment box…). Another pleasant surprise for my brain: my legs and arms were feeling so heavy for a reason!

On another note, I did indeed question the validity of the nutritional information I was given, and would surely recommend the Detox Delight nutritionists to double check their data. So, I lost weight… But how did the rest of my body adapt?


This was a big one indeed…! If there is one test I would recommend to anyone interested in looking at their cardiovascular disease risk (CVD, essentially the risk you have of suffering from a heart attack or similar, the number one causes of death in the Western World), it would be the LPP. Without going too much into details (I might in future posts, but if you cannot wait I would strongly recommend Dr Peter Attia’s blog) the LPP measures not only the classic total cholesterol, HDL-cholesterol (HDL-C), TG and LDL-cholesterol (LDL-C), but it also measures LDL particle number (LDL-P), LDL subclasses, HDL2b, insulin, high sensitive CRP (the most accurate marker of inflammation) and it gives you a Metabolic Syndrome risk score (what you should essentially be concerned about).

Considering the attention I pay to my diet and the amount of physical activity I undertake, I did not expect any major surprise here. And indeed my Metabolic Syndrome risk score started from 0…! And not just that, my HDL-C (the so called “good cholesterol”) was very high with an LDL-C (the “bad boy”) defined as “above optimal”. First sign that my usual lifestyle already works…

Unfortunately though, you might notice a flashy red number next to my LDL-IV particle number… If initially that was a surprise and a concern (recent studies have shown a much higher atherogenic risk of LDL-IV and LDL-III over the bigger LDL-I and LDL-II), it also sparked an almost insatiable hunger for more knowledge and understanding of this part of lipidology. Hours and hours of reading and discussing with other practitioners later, this ultimately let me understand the even higher importance of LDL-P (the actual number of LDL particles, rather than their size) over LDL-subclasses, and even more so, the importance of “concordance” between LDL-C (in my case low) and LDL-P (also low). In this situation, essentially, the mere size of my LDL was irrelevant, as there were so few of them, carrying so little cholesterol, that everything else did not matter…

I would strongly suggest you to refer to other websites and blogs here or from my links page (The Eating Academy or DocsOpinion to just mention a couple of the most useful in my opinion and in my personal journey to understanding these not so widely addressed topics) if you want to know more. It would be not just out of the scope of this page, but surely it would be way far from my competence and knowledge at this stage.


If I defined the LPP test as the one not to miss to measure your CVD risk, the Organix was supposed to be one not to miss to see the effects of the detox diet… If indeed changes in blood lipids and aminoacids might take some time to happen and be recorded, the Organix Profile measures a number of metabolic markers that can be affected by shorter dietary interventions. Not only this, it also measures markers for a number of situations relevant to the so called “functional medicine”, that discipline that deals with sub-clinical insufficiencies or higher concentrations of molecules and minerals that could potentially represent non-optimal health (as much as we know about it at least) or lead to clinical conditions if left untreated. I would like here to stress this point: I am now discussing about biomarkers used in functional medicine, a very different area from the more common concepts of medicine where abnormal indicators are almost invariably associated with a clinical condition or at least prompt some intervention. These biomarkers per se mean hardly anything. More than in other scientific fields, a clinical connection between these markers and clinical symptoms have to be made before considering an intervention. After this short intro, these were my findings, before and after my detox diet:


Wow, I thought after seeing this…! I don’t think there is much to explain when a rapid look at the summary shows such a marked change from various abnormal findings to an almost perfect sheet of “no abnormality found”… If as I explained in the previous paragraph, I and the consulting functional medicine practitioner were not concerned by the PRE findings anyway (I did not present any symptom that would require additional investigations or treatment anyway, as for example if I had sleeping issues associated with my high neurotransmitter metabolism markers), the “normalization” of almost all markers was still a pleasant surprise.

In particular, if the detox diet was meant to help my body somewhere, I should have expected to see some changes in the oxidative stress and detoxification processes… And guess what? My liver seemed to fully reap the benefits of the diet indeed…! My corrected levels of p-hydroxyphenillactate possibly meant a reduced cellular oxidative damage, while the improved detoxification indicators showed that my liver was now working under less pressure.

If until now the effects of the detox diet was just marginally showing some positives, the Organix profile test, surely tilted the balance towards its likely effectiveness, at least into doing what the name suggests: help the body detoxification system…

My Detox Experience – Part 1 – Introduction

Here it is, the drop that made me start my personal blog. My 5-day “detox” juice-only diet. I will start by clarifying that I have no personal interest in any of the companies or tools mentioned in this post. The only reason I will put links, names and comments is to give you a better understanding of the process and if you are interested, to get more information about the topics.


A detox diet is often defined as a nutrition plan lasting a limited amount of time (it varies between a few days and a few weeks), during which most providers will claim that you “flush your system from toxins” or “detoxify your body” from the toxins normally ingested with your diet, or by smoking, etc… In other instances, you will be promised to “alkalize” your system, starting from the principle that too much “acidity” in your system is deleterious and today’s environment will most likely cause your body to be acid. To my knowledge, none of these claims is scientifically proven. However, talk to anyone in a detox plan and you are likely to hear one of these effects… Depending on the company (there is indeed no standard on the program, or on the final objective, apart being “detoxified”) you will be told to avoid certain foods (most commonly animal products and alcohol) and you will only be allowed to eat certain others (usually plant-based only, sometimes only in juiced form, some other times salads are included), often only in their raw form. [Future blog posts will discuss the reasons behind all these restrictions and the potential benefits of raw food (from a scientific point of view)]. The chapter of nuts would also deserve a full dissertation on its own [and it will soon be discussed], as in some programs they are totally banned, while in others they are the major source of proteins and fats, although they will probably be soaked or somehow treated before eating [you will learn why in one of my future posts, just stay tuned].

Detox Delight Middle East is the Dubai franchise of a company headquartered in Germany. In brief, they offer several “detox programs” in which they deliver food to your door at regular intervals for a certain period, so that you do not have to do anything more than just read the information provided and eat what they serve. No shopping, no cooking and no cleaning is required. One of their (very valid) selling point, is indeed their convenience. The foods and drinks come in an ice-box and are freshly made in their own local kitchen, using organically grown and locally sourced products (in Dubai their main provider is Greenheart Organic Farms). Normally the products will have a shelf life of two to three days, so that you have enough food before the next delivery. They offer plant-based raw food only and depending on their programs, they might offer a juice-only package or include salads and snacks. Out of their deliveries you are recommended to only drink water and herbal teas (which they also provide), while you should abstain from any other food, alcohol, caffeine and smoking. Detox Delight Middle East is run by two incredibly passionate women, Claudia and Nicole. They will make sure everything works smoothly and you have all the support you need to make a change (often a big one) in you diet.

Active Detox
Active Detox


Following the positive results achieved by some of our friends with one of the detox program offered by Detox Delight ME (weight loss, improved general wellbeing), I and six other physically active friends decided to try the Active Detox program. It involves having a juice-based only diet of 8 x 500ml juices (mixed fruits, vegetables and nuts) for 5 days. On top of that we also received a daily 250ml bottle of nut milk to take after training.

Before fully throwing ourselves into the program, we agreed to make it in a more “scientific” way. Through Diagnostika Laboratories in Dubai we had the Spectracell Lipoprotein Particles Test and the Metametrix Organix Comprehensive ProfileAmino Acid Profile and Plasma Fatty Acids Profile tests done, in addition to measuring our body height, weight and body composition, using the Cosmed BodPod. All these tests and measurements were taken on the day we started our detox program and then repeated the morning after the end of it, in order to see whether the detox would show any changes in any of the parameters observed. The main parameters to look for were related to cardiovascular risk factors, including blood insulin and inflammatory markers (Lipoprotein Particles), macronutrients metabolism (Organix Profile), plasma pool of amino acids (Amino Acids Profile) and fatty acids (Fatty Acids Profile) and body composition (mainly weight and body fat %, via the BodPod, recognized as one of the most accurate measuring tool by the scientific literature). In a less scientific approach, I also decided to run my regular distance and perform a set workout the night before the start, and then repeat it on the last night of the program, to see whether my performance, personal feel or heart rate would be affected. We agreed not to change our training routine during the program (despite it is recommended to “take it easy” during the detox) as we love training and changing other parameters would have added confounding variables to our results.

Wanna know about the results of our experiment and my personal feedback and review of all parties involved?  I will divide them into personal feelings (what I felt, energy, cravings, good and bad feels, etc..), training and performance changes (HR, running times, fatigue, weight sessions results, etc…), objective health parameters modifications (bloods, urine and body composition) and final review and comments… So, for now… Stay tuned, there is plenty to come…!