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How Sugar Disables Immunity with Amie Skilton

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How Sugar Disables Immunity with Amie Skilton

It's abundantly clear that in our 21st century diet, we consume far too much sugar. We're well aware of it's role within metabolic processes including obesity, diabetes and cardiovascular disease. But what are the effects on immunity?

Does excess sugar influence our immunity, and it if so, in what ways?

In today's podcast we're joined by Amie Skilton who takes us through how, at a cellular level, sugar is compromising our immune resilience. Amie discusses what an acceptable level of sugar and carbohydrate is for daily consumption and how quickly simple, standard dietary habits can add up to double, or more, of our daily limit. Amie also shares with us some of her own clinical strategies to coach clients out of their sugary habits and why it's not always just about what they're putting in their mouth. 


Covered in this episode:

[00:44] Welcoming back Amie Skilton
[01:48] Is sugar really that bad?
[03:53] Sugar consumption impacts Vitamin C status
[07:54] Can we cheat and slow sugar impact?
[09:22] What are we missing out on with refined foods?
[11:05] What are the average daily levels of sugar consumption?
[13:51] Making sense of GI vs. GL
[16:36] Cellular-level impacts of sugar on immunity
[19:39] Is it as simple as taking more Vitamin C to compensate?
[24:41] What is the phagocytic index?
[26:30] Breaking the addictive nature of sugar is a lot of the battle
[29:08] The ketogenic diet influences hunger cues
[36:20] Can genes point to who is less resilient to the effects of sugar?
[38:08] Has evolution made sugar our enemy?

Andrew: This is FX Medicine, I'm Andrew Whitfield Cook. Joining us again in the studio today is Amie Skilton. Amie's a naturopath, nutritionist and herbalist of 15 years, who specialises in several areas of clinical practice including weight management, gut restoration, and food sensitivities, women's hormonal imbalances, and what she's famous for; skin disorders.  
She's the founder of whatthenaturopathsaid.com, and she's regularly appeared on TV, showing people how to regain and maintain healthy glowing skin, and she's also recently released her new book, Clear Skin Secrets

Welcome back to FX Medicine, Amie, how are you? 
Amie: I am fantastic. Thank you so much for having me.  
Andrew: I should say welcome back to Australia, not just FX Medicine. You've just recently traveled back from the US, haven't you? 
Amie: I have. I've had a couple of trips there this year actually to some really exciting workshops and conferences and certainly looking forward to sharing what happened over there a little bit further down the track.  
Andrew: Beautiful. We'll do that. 

But today we're talking about how sugar disables immunity. Now sugar, the scourge of our society, but it tastes so good. Is all sugar bad though? Isn't there some level that's okay?  
Amie: So I guess you really have to determine what you are categorising sugar as. So when I talk about sugar, I'm talking about sugar in its refined form. So that does, unfortunately, include things like honey and maple syrup... 
Andrew: That's not refined?
Amie: Well, unfortunately, if it's not refined, it's simple. So even though it may not have been, you know, mechanically refined, it's in its very simple form. What I'm not referring to when I talk about sugar disabling the immune system, is sugar naturally found in whole foods.  
So consuming fruit is not being demonised here today, and you can sort of park that off to the side. But anywhere you have added white sugar, so things hidden in bread or barbecue sauce, or even adding things like honey and maple syrup to your drinks, is going to be a problem if your immune system is trying to fight anything off.  
Andrew: So what level? Obviously, this has got to do with level because like one of the things I'm really aware of and I was quite surprised about was the Hadza tribe and, you know, the first of the last. They're the true hunter-gatherers. They move with the herds. They don't live in one place. But what was really interesting to me was that they consumed quite a large amount of honey, and like it was a huge amount of their caloric intake.  
However they moved, with the herd, i.e. they moved. And they don't have 21st-century stress, and they don't just sit on their bum and stew. So there's this whole lifestyle thing that goes with that that we never think about. We just think about that's what they eat, so therefore it's good or bad. We never really think about how it's intrinsic to their lifestyle.  
Amie: Well, this is the thing. When you are physically active or physically moving, your body doesn't require insulin to uptake carbohydrate, and the insulin transport system is one of several ways that sugar actually blocks vitamin C uptake into the cell. Because it's competing with insulin for entry into the cell. 

Andrew: Right. 

Amie: Sorry, competing with vitamin C via the insulin transport system into the cell.  
But in answer to your question about how much? I think it's difficult to put an exact figure on it, although I am going to share an exact figure from the studies with you. But before I do, the reason I'm putting it that way is you have to take into account, of course, stress levels, white blood cell count, overall immunity, vitamin C repletion, nutrient repletion.  
Andrew: What bugs are going around, what season, population density?  
Amie: All of that, and so there are several factors that will impact your immunity. Which could mean people may experience a disabled immune system at less than the levels that we're about to talk about. 

However, if someone's really well, really well-nourished and really active, they may be able to get away with consuming the levels I'm about to share with you, maybe even more, with much less impact than on your average human being. 

But to be specific, one particular study was looking at carbohydrates, including glucose as well as fructose, sucrose, honey, and orange juice. And the portions that were delivered of these substances was 100 grams. 

Andrew: Right, okay. 

Amie: So 100 grams of honey is quite a bit. I don't see someone commonly consuming that amount. However, if they are drinking things like soft drink or fruit juice, you would easily get a hundred grams. And what they found was the greatest effects were in the first one to two hours, in fact, suppression of immune activity was measured as quickly as 30 minutes after ingestion, which was quite interesting.  
Out of those carbohydrates that were sampled, fructose was the worst, probably no surprises there. It was able to reduce phagocytosis, which we'll talk about more in a minute, by 45%, where all the other sugars suppressed activity by more than 40% still. So they were all pretty bad. 

The effects of those oral 100-gram doses of those various types of carbohydrates actually lasted for at least five hours, and it took another five or six hours for vitamin C levels to return to their original intracellular concentration.  
Now, if you think about how many people who perhaps consume a standard western diet might sit down for a meal and have a glass of fruit juice or even a soft drink at each meal, you can end up suppressing your immune system all day long, and all evening long.  
Andrew: So this is... I'm just going to guess here that this is most pertinent for those people that are consuming these fruit juices day in, day out, all day long, massive amounts... 
Amie: Yes, and soft drinks.  
Andrew: Soft drinks, of course. But with regards to what we would term “natural”, you know, the orange juice, laden with sugar, no slowing down of response, straight in and its fructose and it's got added sugar if it's reconstituted.  
Amie: Often. Yeah, often. And then it's usually, you know if it's a morning tea or afternoon tea, it's often accompanied by a muffin. Which would be delivering around 50 grams of sugar on top of the beverage that you're having. 

Interestingly thought starch ingestion did not have the same effect on immunity. So, slow release, low GI to moderate GI carbohydrates should not be counted in this either. It really is that refined sugar.  
Andrew: Does that mean therefore that people can cheat? They can slow down the sugar response, and modify their impact on immunity by cheating and maybe having a little bit of fat with their muffin?  
Amie: Yeah, just thinking out loud, certainly anything you can do to lower the glycemic load and slow down the release would certainly reduce the impact or the demand on insulin for transporting vitamin C and sugar into the bloodstream. And so like I would tell my clients, I mean, I'm still, I'm not going to sit here and say it's okay to have sugar if you have it with fat. 

But what I do tell my clients is if they want to have a vegetable juice, and often that might take, say half an apple, a little bit of fruit to take the bitterness off, always consume it with a meal and have that meal be rich in protein, rich in fats and high in fiber. And to really cut down or remove any starch or complex carbohydrates to accommodate that macronutrient, but also having the fat and the protein slow down the carbohydrate uptake from the gut. 

So certainly if someone is trying to boost their phytonutrient intake, and they are juicing fresh vegetables with a little bit of fruit, it is definitely going to be less impactful on the immune system if it's drunk alongside a meal with protein and fat and fiber, than if it was consumed on an empty stomach.  
Andrew: You mentioned phytonutrients, polyphenols, all of the other flavonoids and things which are obviously the savior that we commonly miss out on. Is it these polyphenols and phytonutrients that are the real missing magic from these purified, refined foods?  
Amie: Well, certainly, the more refined a food, the more we're getting away from its natural state and all of its constituents that we know to be so beneficial. And in the case of juicing fruits and vegetables, whilst it's a great way to increase the nutrient amount that you're ingesting, you are removing one of those mechanisms by which the carbohydrate release is slowed down. And so I'm not a fan of that. Although there is a place for occasional vegetable juices, but I would be really staying away from the fruit juices.  
Just in addition to that, there are a lot of people out there who would also consume, under the belief that it's a healthy breakfast, cereal with low-fat milk. And this is another way in which people can consume far too much sugar in one sitting. Especially if they're using low-fat milk, which tends to be sometimes even double the sugar content of full-fat milk.  
Andrew: Really?  
Amie: It can be, the really skim stuff. And if they're having it with a refined cereal or even a muesli that's been baked in sugar, sorry, honey, or with added sugar in addition to that, plus dried fruit, you can very quickly see how someone on an average diet can be really wreaking havoc with their immune system every single day.  
Andrew: What sort of levels of sugars, added sugars or refined sugars, are people consuming in the western, let's say the standard Australian diet? “S.A.D”. What sort of level are we going up to?  
Amie: I see people consuming well in excess the carbohydrate that they should be having in relationship to what they do every day for a job. You know, you and I sit at a desk and so our carbohydrate requirement is far less than that of somebody who has a physical labouring job for example. Or who you know, perhaps outside of office hours as an athlete or someone who's extremely physically active.  
So when I say this, I'm saying it of course in the context of individual requirement. But for someone like myself, there really is no need for me to be having any more than 80 grams of carbohydrate a day. And if you look at that like a bank balance for example, and you're going to spend that 80 grams of carbohydrate, or for you, it could be 120, for example.  
Andrew: I don't think so. I think you would need far more carbs than I.  
Amie: Well, you know what? When you look at where you're going to spend those carbohydrates, and you have all of the fruits and all of the vegetables and whole grains, if you consume grains and are okay with them to spend that on, why would you spend it on refined carbohydrates that doesn't have any nutrition to offer? You're going to want to opt for the most nutrient dense, low GI polyphenol-rich foods that you can choose.  
Now, obviously, I don't live a purist lifestyle. Most people don't and it would be pretty tough if you wanted to follow that route. So I'm not suggesting that they...everyone should be, you know, I guess pure all of the time is what I'm going for. However, it's what we do on a daily basis and 80%, 90% of the time that really directs our health outcomes down the track. And so you want to be thinking very carefully about where you allocate your carbohydrate allowance in a day. 

Now I see many women consuming at least 150 to 200 grams of carbohydrate a day, which is far in excess of what they need in relationship to their physical activity level and the type of job that they do. And it would be very easy for someone to consume 300 to 400 grams in a day if they ate cereal for breakfast, sandwich for lunch, had a muffin, or a Muesli bar during the day, had pasta for dinner, or, you know, potatoes and peas and other starchy vegetables plus dessert. It adds up very, very quickly.  
Now it's the refined sugar, or the overall sugar load that has the impact on the immune system, but it adds up very, very quickly.  
Andrew: When we're talking about the sugar's impact on the immune system. You mentioned two types of measurement there. Glycemic index, glycemic load. 

There was very interesting work by Jennie Brand-Miller, Professor Jennie Brand-Miller. So glycaemic index for instance, or in glycemic index, carrots, watermelon are bad. They're high. "Bad". But the glycemic load of these fruits, vegetables are low. Do we therefore only look at glycemic load? Can that also trick us into a false sense of security?  
Amie: I think you have to consider it from several angles. The glycemic index for standardisation purposes uses a set volume of food, and in many cases, the volume that was tested to be equivalent to the rest is in excess of what we would consume in one sitting. 

Andrew: Right. 

Amie: So there's that element to consider and then you have the glycemic load, which of course can be manipulated very easily by adding fat or protein to the diet.  
Andrew: French fries, for instance, would have a lower glycemic load. That doesn't make them healthy.  
Amie: Totally. And I still don't think their glycemic load would be at a level at which they'd be considered okay for blood sugar anyway. 

However, there's a difference of course between sitting down and eating a bowl of mashed potatoes to, you know, sitting down and eating the same serving alongside say a steak and a large leafy green salad with lots of olive oil and, you know, other elements. 
Andrew: And perhaps some laughter.  
Amie: And of course. Well, there are a lot of things outside the actual substances that we eat that impact the way in which our body responds. And of course, stress, social networks, all of those things come into the play as well. 

So I would prefer people if they were to choose one or the other, to more look at the glycemic load. Consider each meal to be made up of several components that will set you up for ideal blood sugar balance, and that would be the best way to approach it. And then, you know, this way if you are someone who's fond of desserts, and you want to have dessert once a week, all you would do simply is look at your meal plate and remove the starchy carbohydrate portion. Maybe bump up the fats a little bit and that way after you've had your protein and fibrous vegetable intake, you can have a small amount of a dessert. You know, maybe homemade ice cream or frozen yogurt or whatever it might be.  
You might have made icy poles with coconut water and lime juice, and you're going to lower dramatically the impact that's going to have on your blood sugar and therefore your insulin levels, which will then flow onto the immune system as well.  
Andrew: So regarding the immune system and regarding sugar's impact on immunity, what impacts are we seeing? You know, we know, for instance, diabetics get recurrent thrush and things like that. But what about things like a higher risk of contracting the flu, for instance, we've seen a horrible flu season.  
Amie: So with regards to the impact of vitamin C on the immune system, sorry, sugar on the immune system, I should say. It's primarily driven by the way it impacts cellular uptake of vitamin C. 

So one of the primary things there is the impact on what's called phagocytosis, and the ability of white blood cells to conduct Phagocytosis can be measured by the phagocytic index, the number of bacteria that they can consume and destroy in a given period of time. And we'll talk a little bit more about the reason sugar blocks vitamin C. But when it comes to phagocytosis, this is one of the key ways in which it disables the immune system. 

So white blood cells, especially phagocytes and T cells actually accumulate vitamin C between 50 to 80 times higher concentration than that of our serum, or in our bloodstream. And they do this for a very good reason. One of the ways, primary ways white blood cells destroys pathogens is by producing highly-toxic free radicals which destroy these bugs. So things like superoxide radicals, hypochlorous acid, so, bleach and paroxetine nitrite. Now, these reactive oxygen species kill microorganisms very well, but they will also destroy the white blood cell. If the white blood cell is left defenseless. And so the accumulation of vitamin C in high concentrations within the white blood cell is actually to protect themselves from the oxidative damage that these chemicals they manufacture do. And one of the ways vitamin C is utilised by the white blood cell is it actually secretes a layer of vitamin C across its cell membrane.  

Andrew: Yep. 
Amie: So it's almost like a force field or a shield of protection. And in this way, it can continue to produce these really poisonous compounds that are deadly to pathogens without destroying themselves like a kamikaze pilot in the first place. 

And so really what it comes down to is if you are consuming sugar, what it does is due to its molecular structure being so similar to vitamin C, it's preferentially uptaken into the white blood cell, but of course, it doesn't have the same protective effect. 

So as the white blood cell goes about its business and producing these superoxide free radicals, it destroys itself in the process. Not to mention its ability to consume the bacteria is dramatically down-regulated, in some cases by up to 75%.  
Andrew: Wow. Okay, so I'm going to then guess that it's not going to be as simple as just saying, "Oh, well, I'll just take some more vitamin C and that will upset the balance of the sugar." No?  
Amie: No, unfortunately not. And let's talk about why that is the case. So vitamin C uses a lot of the same transportation methods as sugar, and glucose actually competitively wins against sugar...sorry, vitamin C when it comes to cellular uptake, particularly with white blood cells. 

So I've touched on the fact that their molecular structure is very similar and as a result, they compete for the same receptors, so GLUT1 via insulin. And this was first discovered back in the 70s by a gentleman by the name of Dr John Ely, and he dubbed it ‘Glucose Ascorbate Antagonism’, or GAA.  
So insulin, of course, moves both sugar and vitamin C into the cells. And through this GAA, we actually find that sugar gets preferential entry into white blood cells. Which then, of course, impacts the ability of the white blood cells to not only consume pathogens at a particular rate, but they also ended up destroying themselves very easily.  
In addition to that however, vitamin C stimulates a system called the hexose monophosphate shunt or HMP. Whereby sugar inhibits it. Now HMP is really important to actually reduce or produce a chemical reaction and with NADP and NADPH production. Now phagocytes actually need NADPH to be able to create superoxide and other reactive oxygen species and therefore destroy pathogens.  
So the minute sugar blocks vitamin C getting into the cell, we actually see the ability of the white blood cell to produce those immunological free radicals to destroy pathogens, cut down. 

Further to that HMP is also important for maintaining proper cellular antioxidant status in immune cells. Which is involved in cell-mediated immunity. Which is why sugar consumption is correlated with higher cancer rates.  
Andrew: And what about autoimmunity then?  
Amie: Totally, totally. It plays a huge role there. And get this, in addition to creating NADPH, vitamin C is able to deactivate excess quantities of NADPH and oxidative substances that could harm normal tissues. Like in the case of autoimmunity.  
Andrew: There we go, right. 
Amie: And so the minute sugar blocks vitamin C, which is regulating and playing a huge role in these enzyme systems. You start to see issues with genetic material, DNA and RNA replication. And of course, immune-mediated activity starts to become dysregulated.  
Andrew: So this to me might have some answer as to the impact of sugar on disorders like cancer, not because of the Warburg effect, but because of another pathway. Because I think the Warburg effect is oversimplified.  
Amie: I think so too. There are so many nuances to our cellular function. But regardless of how it's working, we know that it is a problem. You know, high intake of sugar and even refined carbs and elevated blood sugar are strongly associated with the risk of cancer. High carbohydrate intake is associated with poorer survival after diagnosis for early breast cancer. High blood sugar, of course, we know how that impacts vitamin C, which affects immune effectiveness and hinders cancer survival.  
But it's interesting also to note that a statistically significant lower average blood sugar is found in those in remission. 

Andrew: Right. 

Amie: So, you know, whatever way you look at it, it's really important to be mindful of your carb intake. Further to that, we know because refined sugars affect vitamin C uptake and its ability to function with the phagocytic index, we need to also be mindful of the fact that vitamin C's actually been shown to stimulate the production of white blood cells.  
So if it's being interfered with, we're actually not going to be able to produce sufficient numbers of soldiers in the case of an immunological provocation. Vitamin C also stimulates the function of white blood cells. We also know that it helps with natural killer cell activity, lymphocyte proliferation and specific measures of functions that are stimulated by vitamin C include cellular motility. So how spontaneously active white blood cells actually are, chemotaxis, so how well white blood cells are able to move in response to pathogens that are presenting themselves. And of course phagocytosis, which we've already talked about.  
Andrew: Okay. So phagocytic index though, I've never heard of this. How do we measure it?  
Amie: It's actually, it is serum and it's something, it's a count that's done under a microscope and you can see phagocytic cells ingesting and digesting pathogenic bacteria. And the phagocytic index is the measure of basically how many bacteria in the space of an hour that a white blood cell can clear out. 

And so they've done studies that have shown normal phagocytic index and the study that we were talking about before, after an oral dose of 100 grams of refined carbohydrate, seeing that phagocytic index drop dramatically.  
Andrew: Wow. How is this done? Like this is a normal path test, or is this an integrative path test? How's it done? I've never heard of this.  
Amie: No. It's not a test that's available either diagnostically or around functional pathology at all. It's more of an academia research study that has been done. Yeah, look, it would be interesting to, I guess, do a blood spot and check in with your phagocytic index. But I think that can vary so much throughout the day because our blood sugar fluctuates so much throughout the day. Irrespective sometimes, even of what we're eating, depending on our stress levels and our physical activity.  
So I'm not sure that even if it was available, it would be particularly practical to do. 

Andrew: Right. 

Amie: But what's useful about this study is that it shows the impact of refined carbohydrate on immunity. And it's undeniable. It's significant. And really points to one of a plethora of problems of our current standard Australian Diet.  
Andrew: So let's say somebody has pre-diabetes, they've already got this metabolic syndrome going on. It's obviously driven by excess carbs, glycation issues, all of that sort of arena of pathology. What do we do? 

Is it just as simple as saying, "Okay, you're off the sugar." I'm getting the feeling that we've got a lot more support to give these people rather than just taking away the ‘baddy’.  
Amie: Totally. Look, sugar is a real problem for the whole population. It is very addictive and, of course, once we start to see changes in the gut microflora, we are compelled to consume refined carbohydrates driven by something external to even us. If you consider the gut lumen to be, you know, technically it's external.  
Further to that, there are of course mental and emotional reasons why people are pulled for carbohydrate consumption. And, you know, most people know what to do, but they don't do what they know. And the support may be less about instructing them what to do, but figuring out what it is that's driving their behavior. 

But especially when it comes to pre-diabetes, a large portion of that population, it is lifestyle. And the interventions required to reverse what's going on are simple. I'm not going to say they're easy, but they're simple, they're simple.  
However, there can be underlying metabolic issues that are impacting insulin sensitivity, that are independent of diet and lifestyle choices and possibly even body composition around their muscle mass and body fat mass. And so as is always the case with our patients, you've got to really dig deep if they aren't responding to standard treatment. To figure out what else might be driving that prediabetes state that they're in, or metabolic syndrome or syndrome X, whatever you want to call it. 

And in actual fact, it's quite interesting to note that levels of what is considered to be ‘healthy blood sugar’ in some circles are being lowered even further than what is currently textbook acceptable.  
And so, you know, given our current lifestyle, which is far less active than it ever was back in caveman days. And then, of course, the refined food, the processed food, the stored food, the imported food, and the excess of carbohydrate we're consuming, we're gonna be seeing more and more immune problems as a result of just that fact alone. And so it really is going to take a multifactorial approach to get people back in the right direction. 

I think there has been a resurgence recently of the popularity of ketogenic diets for this reason. And even though there are a number of challenges around following that way of eating, one of the advantages of it is that when you're in Ketosis, you don't have the same kind of hunger cues. And so if you're well prepared and you've had a great program put together for you by a savvy physician or practitioner, you shouldn't ever feel hungry and once you've actually gotten into Ketosis, which could be, you know, 48 hours to up to sort of five days, you shouldn't be compelled to consume sugar, from that point on. And so for some people, it may take going to that extreme to turn the ship around.  
Andrew: With regards to the ketogenic diet. I'm told that long term, it's really hard to stick to it.  
Amie: Absolutely. 
Andrew: It’s a lot of fat. 
Amie: I don't agree with it being applied long-term unless there's a medical indication for that. What I do with my patients, I really recommend a modified ketogenic diet, so not as super high fat, but reasonable fat, adequate protein, very low carbohydrate. Depending on the end goal, why we're doing it, what's going on with that patient. Once we approach the goal, which is typically fat loss for my patients, although not always. What I start to do is incrementally increase their carbohydrate intake by 5 grams a day, and when I say 5 grams a day, what I say is, let's say they were initially on less than 20 or 30 grams of carbohydrate a day.  
When it comes time to increasing the carbohydrate intake, I'll take them up to 25 or 30 or 35, whatever is 5 grams above where they've been. Sit them there for a week. Get them to continue to measure their ketone levels. The following week bump it up by another 5 grams. So start to reintroduce more vegetables, more variety in the fruits. As you get a little bit higher up. Find the ceiling at which point they start to come out of ketosis, and either duck them down below if they've got body fat still to continue, or they're someone who is insulin sensitive, blood sugar sensitive and needs to stay burning fat for fuel rather than carbohydrate. Or let them know that that's the ceiling at which point their body will not put on extra weight and will not trigger an insulin response and they can kind of hover back and forth at that point knowing that that's a healthy level for them to be at.  
Andrew: When you say 80 grams, 60 grams, increasing it by 5 grams, 10 grams, that's a weight, but you know, that's great in a cup of refined sugar. How do you then translate this to dietary applications? 

Amie: Sure.

Andrew: To basically show patients what they're eating. Do you use a palm method or anything like that with regards to how they teach you how much protein to have?  
Amie: You can, you definitely have to do the thinking for them. Because even if someone has got kitchen scales at home, they're not going to want to be weighing everything, that's just too hard. 
Andrew: That's type A personality. 
Amie: Yeah, absolutely. And we're also talking about net carbohydrate here as well. So taking out the fibre content. 

So what I would say, for example, a small to medium size apple has 20 grams of carbohydrate. An average size banana is 30 grams of carbohydrate. So if it's a small lady finger, it'll probably be more like 10 to 15 grams. And so what I… but, you know, if you're looking at a cup of strawberries or berries, for example, it's really only 5 to 10. And so what I would say usually when they're on really low carbohydrate, all they're really having as leafy greens with things like mushrooms, onion, sprouts, you know, really low GI, leafy watery, high fibre veggies.  
And so it's kind of a step by step process where I get them in to introduce things. And so I might bring in tomatoes and other salad vegetables first, before then bringing in berries, before I then bring in pumpkin, which is actually reasonably low. A cup of pumpkin's 12 grams of carbohydrate. And so if it was a man who was recently physically active, I'd probably increased by 10 grams a week. And so I'd say, "Okay, at dinner, start having a cup of pumpkin in addition to your dinner, or you could have half at lunch and half at dinner." Or other equivalents of 10 grams of carbohydrate might be half a cup of peas or, you know, a small dinner roll if they're really missing bread, for example. 

And so you've got to give them what that looks like in real life, rather than giving them the maths tools unless they really want that. But even those who do want to understand it, the novelty wears off pretty quickly.  
Andrew: Is it vegetables? Really are the savior of what we need in a healthy diet. A little bit of fruit and some protein and some fat. 
Amie: Yup. Like Michael Pollan said, fish, vegetables, laughter, and sex. They're like the four pillars of well-being. 
Andrew: Really? 
Amie: Yeah, 100%. And totally, if you're looking gram for gram, what vegetables deliver phytonutrient fibere… obviously generalizing here, but and versus its sugar or carbohydrate intake, vegetables win almost every time. And so definitely you want to be getting the bulk of your plant matter from vegetables. Berries are, you know, really happily recommend them at any time, but be mindful... 
Andrew: Yeah, high in polyphenols.  
Amie: Yeah, absolutely. 
Andrew: Great for you but not too much.  
Amie: Not too much. 
Andrew: Go with the veggies first. 
Amie: Well, again, you know, graduating people's carbohydrate intake up to where they just sort of hover on Ketosis is a great way for them to figure out where their blood sugar and insulin will stay balanced. And from there you're really heading towards more of like a zone diet, like what Dr Barry Sears talks about where you're going to stay in that ideal blood sugar and insulin balance.  
Andrew: That's the 40/30/30? 
Amie: Yeah. So you’re just gradually nudging people back up to that balance, which is, of course, a lot more sustainable.  
Andrew: How do you rationalise the zone diet with the evidence-based diet, Mediterranean Diet?  
Amie: Well, you've got to look at what constitutes or what constituents in the Mediterranean diet are offering those health benefits. There's no reason that those two things are mutually exclusive. And again, it does come down to bio-individuality. And you can do the zone diet wrong too, by the way. You really can, if you're doing 40/30/30 of protein, carbs and fat, you can easily choose poor quality choices of protein. 
Andrew: Transfat. 
Amie: Transfat. You know, really refined carbohydrates and not go out of your macros. So a professional to guide someone, of course, is the ideal way to do this. And I think, you know, looking at your genetic lineage, your lifestyle, your own bio-individuality, you can really craft something that's great for you.  
Andrew: So genetics, everywhere I look now, it just seems to be that, I mean, we obviously know, we’re imprinted with genes, right, we have them. But the usefulness of genetic testing rears its head. I know we're not... I know it's not proven, I get it. But it just rears its head as a potential. Do you find that there are some people for whom sugar is a real devastating issue with their immunity, whether that be autoimmune or infection related? And do you find that there are some people who have more of a resistance? They can handle more carbs, more sugar, and it doesn't seem to affect their resilience so much?  
Amie: It's such an interesting question because genes, they should never be taken out of context.  
Andrew: I think this is the key isn't it. 
Amie: Yeah, and I'm all for furthering genetic testing and understanding the role they play. But we also have to keep in mind there are only ever responding to our environment, which includes our diet and so... 
Andrew: This is epigenetics.  
Amie: Exactly. And so yes, in answer to your question, absolutely, there are people who are genetically less able to manage higher carbohydrate levels than others. 

I'll never say that there's going to be a gene out there that says you can eat sugar because that just isn't going to be the case. I would be willing to bet my life on it. But we do know that some people are more able to get away with consuming more refined carbs or a greater amount with less of a toll on the body. 

So I definitely think there it's worth looking at, but again, a lot of the stuff we can really test out in real time and our own bodies...  
Andrew: Family history. 
Amie: Family history. 
Andrew: Patient history. 
Amie: All of those things.  
Andrew: Why has this sugar issue come about just recently? Is there a resurgence here?  
Amie: Look, I think in terms of the timing of sugar being a problem, it's more that we are more and more stressed. I think it's probably one of the biggest factors. 

Andrew: Huge. 

Amie: Of course, becoming more and more sedentary. We're automating and outsourcing so many more things. We're commuting longer, working harder. 

But in terms of where the vitamin C sugar issue comes from, I wanted to share a theory that I have. When you look at most animals and plants, they're actually able to synthesize their own vitamin C from sugar. 

Andrew: Right. 

Amie: And it's done through a biochemical pathway that depends on four key enzymes which actually converts glucose into vitamin C. Cats are a great example of this. 

So in mammals, the glucose is of course taken from stored sugar or consumed in the case of human beings. And the liver was actually responsible for converting sugar into vitamin C. And there's a gene called G-U-L-O for short, but stands for L-gulonolactone oxidase. And this is actually the enzyme that catalyzes the reaction to convert sugar into vitamin C. 

Now, human beings, along with primates and guinea pigs are the only organisms unable to do this. It actually looks like we used to be able to convert glucose into vitamin C. 
Andrew: Oh? Well, from an evolutionary perspective, or are you talking as Homosapiens?  
Amie: Correct. As Homosapiens.  
Andrew: Really?  
Amie: Yes, so scientists have seen… what they think possibly due to an abundance of readily available sources of vitamin C, like fruit. Natural selection saw this gene deleted. And other scientists think it may be because it was designed to enhance the fattening effects of fructose for survival during winter. Because of course the highest fructose... 
Andrew: The horde of the old Bob gene. 
Amie: Totally, those fruits that are highest in sugar are the late summer fruits to fatten us up before winter. But research studies suggest that humans would have produced somewhere between 2,000 to 4,000 milligrams of vitamin C a day under normal conditions, and 15,000 milligrams a day when under stress. 

Andrew: Wow. 

Amie: Just to put that into context.  
Andrew: That's amazing. Okay, so what were these scientists... Sorry, I have to look this up. We're going to have to put this up on FX Medicine.  
Amie: Absolutely. The study was called Ascorbic Acid In the Immune System published in the Journal of Orthomolecular Medicine in 2005 by Ottoboni
Andrew: Wow. I'm giving that one a read.  
Amie: Yeah, so there you go.  
Andrew: Amie, that's really interesting. From an evolutionary perspective, a recent evolutionary perspective. That's a real issue of redundancy.  
Amie: Yes, and I do wonder whether some of the pull to sugar might be harking back to that primal time where you could convert it into vitamin C, and maybe one of many potential messages of sugar cravings is actually a request from the body for vitamin C. 

It's just an idea, but I'm putting it out there.  
Andrew: Yeah, so heed with the idea, listen to the message and take vitamin C. 

Amie: Yeah, see what happens. 

Andrew: Preferably in vegetables, some fruit and from other sources as well.  
Amie, thank you so much for taking us through. That seems to be more of a complex issue than what I think we've touched on today. I think there's going to be a lot more to learn. 
Amie: I think so. 
Andrew: But thanks very much. 
Amie: My pleasure.  
Andrew: This is FX Medicine. I'm Andrew Whitfield Cook. 

Additional Resources

Amie Skilton
eBook: Clear Skin Secrets
Prof Jennie Brand-Miller
Dr John Ely: Glucose Ascorbate Antagnoism Theory

Research explored in this podcast

Sanchez A, Reeser JL, Lau HS, et al.  Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr 1973. Vol. 26(11):1180-1184.


Ottoboni F, Ottoboni A. Ascobic Acid and the Immune System. J Orthomol Med. 2005 20(3):179-183

Other podcasts with Amie include:


The information provided on FX Medicine is for educational and informational purposes only. The information provided on this site is not, nor is it intended to be, a substitute for professional advice or care. Please seek the advice of a qualified health care professional in the event something you have read here raises questions or concerns regarding your health.



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