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The Problem with Sugar

Sugar, Starch, and Glycation: The Not-So-Sweet Science of Aging
High-glycemic foods are chief among the engines driving premature degeneration
by Nicholas V. Perricone, M.D.

If you are a long-time Perricone reader you know that I am no fan of sugar or other foods that rapidly convert to sugar in the blood stream (bread, desserts, chips, rice and corn cakes, pasta, potatoes, baked goods, fruit juices, etc.).  Yet sugar, in its many forms, is everywhere. 


While it might be easy to walk past the sugar in its obvious forms—such as the products in the candy, baked goods, soda, cereal and cookie aisles of your supermarket—sugar, in one form or another, is in everything from yogurt to condiments such as salad dressing, mayonnaise, ketchup, relish, mustard, and barbecue sauce. 

In addition to the usual natural sweeteners—sugar (white or brown), honey, maple syrup, cane syrup, and molasses—there are many hidden sources of sugars, including corn syrup, high fructose corn syrup, fructose, fruit juice concentrate, maltose, galactose, lactose, polydextrose, mannitol, sorbitol, xylitol, maltodextrin, and invert syrup.  Most “processed” foods contain one or more of these forms of sugar, or high-glycemic carbohydrates such as corn starch and white flour.


As a physician, I am against sugary and starchy foods because they cause an inflammatory response in the body—a reaction that's proven to accelerate aging and promote dangerous degenerative conditions and diseases.  We are also in the midst of a major obesity epidemic affecting all age groups, from pre-schoolers and teens to adults and seniors.  Even our pets are pudgy!


As a dermatologist, I am against sugary and starchy foods because the inflammation they induce (which takes place on a cellular level) shows up on the skin as a loss of radiance, dark circles under the eyes, the loss of tone, puffiness, an increase in fine lines and wrinkles, the loss of facial contours and increased pore size.  These foods can also exacerbate acne, which is a systemic, inflammatory disease.   I am not exaggerating when I say that sugar can rob you of your youth, health, and beauty.


We have all had it drummed into our heads that sugary, starchy foods are bad for us.  In this newsletter I want to let you know exactly what effect they have on our skin.  Once we understand this, that doughnut or bagel may lose some, if not all, of its allure.


Glycation: The age-accelerating reaction to excess blood sugar

When foods rapidly convert to sugar in the bloodstream—as both sugar and high glycemic carbohydrates do—they bond to the protein in your tissues, via a process known as glycation. This is the same chemical reaction that browns meats and toughens food in storage.  Glycation can occur in skin as well, creating detrimental age-related changes to collagen—and that means deep wrinkles.


When glycation occurs in your skin, the sugar molecules attach themselves to the collagen fibers, where they trigger a series of spontaneous chemical reactions.  These reactions culminate in the formation and gradual accumulation of irreversible “cross-links” between adjoining collagen molecules.  This extensive cross-linking of collagen causes the loss of skin elasticity. 


Healthy collagen strands normally slide over one another, which keeps skin elastic.  If a young person smiles or frowns, creating lines in the face, the skin will snap back and be smooth again when she stops smiling or frowning.  But the skin of a person whose collagen has been cross-linked from years of eating carbs and sugars does not snap back and smooth out.  Those deep grooves remain, because that is where the sugar molecules have attached to collagen, making the fibers stiff and inflexible.


Besides being visible in our faces, we can easily see the aging properties of carbohydrates in the laboratory.  Fibroblasts are the cells that produce collagen and elastin fibers, the strands of tissue that give the skin its strength and flexibility.  If just a drop of sugar is added to a cell culture of fibroblasts, within a minute or two we can measure a sharp rise of inflammatory chemicals in the cells.


Sugar can also attach to components in the cell plasma membrane forming chemicals called “advanced glycation end products”, appropriately known as AGEs.  Accumulation of AGEs in a cell can lead to malfunction and, as the acronym indicates, aging.  In addition to producing wrinkled, sagging skin, glycation degrades other vital organs, including your kidneys, lungs, and brain.


The bond between the sugar and collagen generates a continuous stream of free radicals, which damage our cells and tissues and stimulate even more inflammation.  When glycation occurs in the skin, the ultimate effect is not unlike tanning a leather hide.  Over time, skin begins to resemble a cross between beef jerky and an old boot, unevenly discolored and heavily striated with deep lines and grooves. 


Excess sun makes matters worse

Excessive exposure to the sun produces a damaging double-whammy.  Sun damage to your skin accelerates the glycation process, while skin proteins modified by glycation sensitize your DNA to the damaging effects of the sun’s ultraviolet rays. 


Sun exposure also helps reduce collagen levels in the skin over time. The sun’s UV-A rays generate free radicals that oxidize the proteins, lipids, and DNA in the skin, while, UV-B rays absorbed by DNA promote the cross-linking of adjacent proteins.  The end result is an increase in a destructive enzyme known as matrix metalloproteinase and a shortage of the molecule the body uses to make collagen.  Limit unprotected sun exposure to 20 or 30 minutes per day, and protect your skin from the sun (with hats, clothes and UVA/UVB-blocking sunscreen) at other times: especially during the peak sun-intensity hours of 10 am to 2 pm.


Repairing the damage

We all are guilty of eating sugar and high glycemic foods, and most of us can also lay claim to our share of skin-damaging sun worship.  The good news is that it is never too late to begin the repair process.

Start with the Three-Day Anti-Inflammatory Diet for a quick fix.   Everyone who tries it reports that they not only feel rejuvenated, their skin starts to reclaim the radiant, healthy glow of their younger days.  It is a great motivator to change your way of eating for the long-term.

Next, log onto www.glycemicindex.com to learn which carbs are our best bets to reduce inflammation.  If we can keep our carb choices under 55 on the glycemic index we will greatly ameliorate the health and beauty destroying effects of the carbs on the upper end of the scale.  Fruits and vegetables that score under 55 (on a scale of 0-100) on the index are the best way to satisfy your craving for sweet food. 


The fiber in the fresh fruit helps slow down the absorption of the sugars.  These foods also contain anti-oxidants—which act as natural anti-inflammatories—as well as all kinds of amazing ”phytoceutical” compounds that provide protective, healing therapy to the skin and entire body.


Protein first!

Eat some protein at the start of any meal, and try to avoid eating fruit on an empty stomach, to prevent any rapid rise in blood sugar.  Remember this simple fact.  A rapid rise in our blood sugar from eating sweets and the wrong types of carbs is pro-inflammatory and results in a sharp rise in our insulin levels, after which the insulin drops to below normal levels.  This results in the cravings of more carbohydrates, creating a vicious cycle.  In addition to disease prevention and skin rejuvenation, you will quickly discover that you are eating less food because low glycemic carbs eliminate food cravings.  This can result in the loss of excess weight—an added benefit.


When you want to reward yourself with a sweet treat other than fruit, try a little ice cream.  The fat in the ice cream will slow down the absorption of the sugar.  Just remember to have it after your meal and not on an empty stomach.

Vitamin C ester restores a youthful look

As a dermatologist, I always like to have topical interventions to help keep the skin looking radiant and healthy.  The effects of a high-glycemic diet and sun damage can rapidly destroy the skin.  Along with the right diet and nutritional supplements, topical anti-oxidants can also help.


Vitamin C Ester, the fat soluble, non-irritating from of vitamin C is just such a candidate.  Topical vitamin C ester can help increase the appearance of firmness, radiance, refinement of texture, evening out of skin tone and color, decrease in the appearance of pore size, resulting in a porcelain-like look to the skin. 


Rescue remedies: My top anti-glycation supplements

There are two important nutritional supplements that can help prevent and reverse the negative effects of glycation:

Alpha Lipoic Acid:

Alpha Lipoic Acid (ALA) has long been one of my favorite nutritional supplements.  Known as the “universal” antioxidant because of its ability to reach all portions of the cell, ALA is also a super star glycation fighter.  ALA actually helps curtail glycation and enhances the transfer of blood sugar into the cells by stimulating glucose uptake.  ALA reduces the potential for glycation and blunts its effects in several ways:

1)       ALA increases the cells’ uptake of glucose, thus reducing the amount of free glucose available for damaging glycation reactions.

2)       ALA reduces the formation of advanced glycation end products (AGEs)

3)       ALA mops up many of the free radicals generated by AGEs, and prevents them from activating pro-inflammatory nuclear transcription factors (NF-kappaB)

4)       The human brain uses the glyoxalase system to eliminate glycation products called dicarbonyls, which produce much of the damage associated with Alzheimer’s. However, this system needs the tripeptide glutathione to work, and availability of this critical anti-oxidant enzyme is limited by overall levels of oxidative stress and inflammation. Supplementation with ALA—which recycles depleted glutathione—indirectly strengthens the brain’s anti-glycation defense system.



Benfotiamine is one of the most exciting new nutritional defenses against the effects of skin and body destroying glycation.  This fat-soluble, highly absorbable form of vitamin B-1 is one of the most effective anti-glycating nutrients available because it blocks three of the major biochemical pathways through which hyperglycemia (high blood sugar) does its pro-inflammatory damage.


In addition to blocking inflammatory pathways, benfotiamine also enhances the activity of an enzyme called transketolase, which (like alpha lipoic acid) prevents activation of the pro-inflammatory cellular compound NF-kappa B.  It also converts harmful blood sugar metabolites (glucose breakdown products) into harmless chemicals.


Benfotiamine is also a very safe supplement. I highly recommend it as a safe and effective method of combating the negative effects of glycation.



These supplements can help decelerate aging caused by dietary sugars and starches, but there are no magic bullets.  This is why I recommend a three-tiered approach: follow the anti-inflammatory diet, take targeted nutritional supplements, and apply topical treatments with anti-oxidant properties.

Lose Wrinkles and Weight with a “Low-GI” Diet
Study finds that low-glycemic diet rivals low-calorie, low-fat diet
by Nicholas V. Perricone, M.D.

According to the results of a year-long study released this month from the Children's Hospital in Boston, Massachusetts, obese people who consume as many low-glycemic carbohydrates as they want can lose just as much weight as people who stick with a conventional, calorie-restricted low-fat diet.


Carbohydrates with a low glycemic index include non-starchy vegetables, fibrous fruits, legumes, nuts, and dairy products.  These are the carbohydrates that do not cause a pro-inflammatory rise in blood sugar.  When we eat carbs that are high on glycemic index, such as sugar, pasta or baked goods, they cause a burst of inflammation in the body. (See our feature story on dietary sugars and starches.)  This has many negative effects, including the fact they cause food cravings—thus leading to overeating and unwanted weight gain.


A good rule of thumb is to choose carbs that rank 55 or under on the glycemic index—which are low glycemic.  Foods 56-70 are medium and 70+ are high glycemic.


The lead researcher noted that even though the participants who ate low-glycemic carbohydrates had no calorie limits, they likely didn't overeat because they felt less hunger after eating foods that take longer to digest.  Think about it?  When was the last time you sat down and demolished an entire 5 lb. bag of apples?


I didn’t think you could!  However, when was the last time you opened a bag of chip or cookies and had just one?  Most likely you discovered that that you had eaten the entire bag (or most of it!).


And weight loss wasn’t the only benefit the low-glycemic dieters received.  They also enjoyed a significant decrease in fatty substances in the blood linked to cardiovascular disease, as well as a drop in a protein that interferes with the body’s ability to break down blood clots.


It seems that every day, scientists discover new benefits from following the anti-inflammatory diet and lifestyle.


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