In recent years, there has been growing awareness about the negative health effects associated with excessive sugar consumption. From public health campaigns to updated dietary guidelines, reducing sugar intake has become a central strategy in disease prevention. This document explores the relationship between low sugar diets and the prevention of various diseases, highlighting the mechanisms, benefits, and practical considerations involved, particularly in women through the menopause transition.

The Role of Sugar in the Body

Sugar, in its various forms (such as sucrose, fructose, and glucose), as well as refined starch, is a primary source of energy for the body. However, when consumed in excess, it can contribute to a range of adverse health outcomes. The majority of added sugars in modern diets come from processed foods, sugary drinks, and confectionery, which often provide little nutritional value beyond calories.

High Sugar Intake & Its Associated Health Risks

1. Obesity: Consistently high sugar consumption can lead to incremental fat stores and obesity, as excess sugar is stored as fat in the body.

2. Type 2 Diabetes: Elevated blood sugar levels over time can impair insulin sensitivity, increasing the risk of developing type 2 diabetes.

3. Cardiovascular Disease: Studies have linked high sugar diets to increased blood pressure, inflammation, and higher levels of unhealthy blood fats, all of which are risk factors for heart disease.

4. Dental Health: Sugar is a leading cause of tooth decay and cavities, particularly in children.

5. Non-Alcoholic Fatty Liver Disease (NAFLD): Excessive intake of fructose, commonly found in sweetened beverages, has been associated with NAFLD.

   
   

Benefits of Low Sugar Diets

Adopting a low sugar diet can yield multiple health benefits, including:

• Weight Management: Reducing sugar intake helps control fat stores centrally, around the liver and in general.

• Improved Metabolic Health: Lower sugar diets help regulate blood sugar levels and improve insulin sensitivity, reducing the risk of metabolic syndrome and diabetes.

• Heart Health: Less sugar means lower risk of hypertension, inflammation, and unhealthy cholesterol & triglyceride levels.

• Better Dental Health: Cutting down on sugar significantly reduces the risk of cavities and gum disease.

• While sugar itself doesn’t directly cause cancer, high sugar intake contributes to obesity and chronic inflammation, which are known risk factors for several cancers.

• Diets high in sugar have been linked to impaired memory and a higher risk of Alzheimer’s disease, possibly due to insulin resistance and inflammation.

• Enhanced Overall Well-being: Many individuals report increased energy levels, improved mood, and better sleep quality after reducing sugar intake.

  
  

Low sugar diets during perimenopause and beyond

During menopause, declining oestrogen levels affect how the body processes glucose, fat, and insulin. This often leads to:

1. Increased abdominal fat

2. Higher risk of insulin resistance, type 2 diabetes, and metabolic syndrome

3. Changes in lipid profiles (higher LDL, lower HDL) impacting cholesterol and triglyceride levels

4. Increased inflammation, which contributes to heart disease and other chronic conditions

5. Osteoporosis – while sugar doesn’t directly cause bone loss, excess sugar can lead to inflammation that worsens bone health.

6. Cognitive Decline – high sugar intake linked with dementia/Alzheimer’s risk, especially in postmenopausal women.

7. Hot flushes & mood swings - some women report more stable energy, less flushing and fewer mood fluctuations when blood sugar is steady

    

A note on the impact of HRT in the prevention of chronic disease during perimenopause and beyond

Hormone Replacement Therapy (HRT) significantly reduces all-cause mortality (a term used to describe all deaths within a population group) and cardiovascular disease (CVD) whereas other primary CVD prevention therapies such as lipid-lowering fail to do so. The extent and type of HRT-associated risks, including breast cancer, stroke and blood clotting (including deep vein thrombosis) are rare (<10 events/10,000 women), not unique to HRT and comparable with other medications (1)

Timing of initiation of HRT has significant biological and clinical consequences for women since clinical consequences of most aging-related diseases manifest in women on average 10 years after menopause. Timing of initiation of HRT before tissue damage appears and clinical consequences manifest, appears to be the key for successful prevention and amelioration of further tissue and organ deterioration due to aging .

Implementing prevention strategies at the start of menopause presents a valuable opportunity for primary heart disease prevention in women. (2)

Diabetes has immense health implications, concerning poor health & illness as well as mortality, especially for women as menopause serves a marker of increased risk for insulin resistance and glucose intolerance as well as new onset diabetes mellitus (3) HRT improves insulin resistance, increases glucose tolerance, and reduces new onset diabetes mellitus by 20%–30%. (4,5)

When initiated in women in their 50s and continued for 5–30 years, HRT cost-effectively increases quality of life. (6)

In Summary

Low sugar diets are a powerful tool in the prevention of numerous chronic diseases, including obesity, diabetes, heart disease, and dental problems. By making informed choices and adopting practical strategies to reduce sugar consumption, individuals can significantly improve their long-term health and quality of life. As public health initiatives continue to emphasise the dangers of excessive sugar, embracing a low sugar lifestyle has never been more relevant or beneficial.

A low-sugar diet in the run up to and after menopause is one of the most effective lifestyle strategies to reduce chronic disease risk, stabilize energy and mood, and support healthy aging in women.

Practical Strategies for Reducing Sugar Intake

• Read food labels: Be vigilant about the sugar content in packaged foods and drinks. Look for hidden sugars under names such as corn syrup, dextrose, and maltose. Focus on whole foods: vegetables, lean proteins, healthy fats, nuts, seeds, and low-glycaemic fruits

• Swap refined carbs (white bread, sweets, sugary drinks) for high-fibre carbs (lentils, quinoa, legumes)

• Look out for hidden sugars in sauces, yogurts, cereals, and “healthy” snacks and limit sugary drinks: Replace soft drinks, energy drinks, and sweetened teas with water, herbal teas, or unsweetened beverages.

• Limit alcohol: especially sugary cocktails and wine, which can spike glucose initially with crashes that induce hunger

• Prioritise gut health: fermented foods and fibre support better glucose regulation, whilst sugars reduce gut bacteria diversity

• Cook at home: Preparing meals at home allows greater control over ingredients and sugar content.

• Gradual reduction: Slowly decrease sugar intake to allow the palate to adjust, making the change more sustainable.

References

4 Salpeter SR, Walsh JME, Ormiston TM, et al. Meta-analysis: effect of hormone- replacement therapy on components of the metabolic syndrome in postmenopausal women. Diabetes Obes Metab 2006;8:538–564.

5 Pereira RI, Casey BA, Swibas TA, et al. Timing of estradiol treatment after menopause may determine benefit or harm to insulin action. J Clin Endocrinol Metab 2015;100:4456–4462

6 Salpeter SR, Buckley NS, Liu H, et al. The cost-effectiveness of hormone therapy in younger and older postmenopausal women. Am J Med 2009;122:42–52

1 Hodis HN, Mack WJ. Menopausal Hormone Replacement Therapy and Reduction of All-Cause Mortality and Cardiovascular Disease: It Is About Time and Timing. Cancer J. 2022 May-Jun 01;28(3):208-223. doi: 10.1097/PPO.0000000000000591. PMID: 35594469; PMCID: PMC9178928.

3 Slopien R, Wender-Ozegowska E, Rogowicz-Frontczak A, et al. Menopause and diabetes: EMAS clinical guide. Maturitas 2018;117:6–10

2 Lobo RA, Pickar JH, Stevenson JC, Hodis HN, Mack WJ. Back to the future: hormone replacement therapy as part of a prevention strategy for women at the onset of menopause. Atherosclerosis 2016:254:282–290