Cannabis & Blood Sugar

What is Sugar? 

Simply put, sugar is a type of carbohydrate that is naturally found in many foods and is also added to others. Chemically, it consists of molecules called saccharides. Simple sugars consist of single saccharides while complex sugars consist of two or more saccharides. The most common types of sugar are:

1. Glucose: A simple sugar that serves as the primary source of energy for the body's cells. It is found in many carbohydrates, such as bread, rice, and pasta.

2. Fructose: Another simple sugar found in fruits, honey, and some vegetables. It's sweeter than glucose and is often used in processed foods and sweetened beverages.

3. Sucrose: A disaccharide made up of glucose and fructose. This is what we commonly refer to as table sugar, derived from sugar cane or sugar beets.

4. Lactose: A disaccharide composed of glucose and galactose, found in milk and dairy products.

How Our Body Processes Sugar

When you consume sugar, your body processes it through several steps involving digestion, absorption, and metabolism:

1. Digestion:

The digestion of sugar begins in the mouth, where an enzyme called salivary amylase starts breaking down some starches (complex carbohydrates) into simpler sugars. In the stomach, acidic conditions halt the activity of salivary amylase. Sugars and carbohydrates remain mostly unchanged at this point. Sugar then moves to the small intestine, the primary site of sugar digestion. Enzymes like maltase, sucrase, and lactase break down disaccharides (like sucrose and lactose) into monosaccharides (like glucose, fructose, and galactose).

2. Absorption:

The small intestine absorbs the monosaccharides (glucose, fructose, and galactose) into the bloodstream. Each sugar is transported by specific mechanisms. Glucose and Galactose are absorbed via active transport using a sodium-glucose transport protein. Fructose is absorbed via facilitated diffusion.

3. Metabolism:

Once in the bloodstream, glucose is transported to cells throughout the body. Insulin, a hormone produced by the pancreas, helps cells absorb glucose to be used for energy. Excess glucose can be stored in the liver and muscles as glycogen or converted into fat for long-term storage. Fructose and Galactose are first transported to the liver. Fructose is converted into glucose or fatty acids. Galactose is also converted into glucose. The newly formed glucose can either be used for energy or stored as glycogen.

4. Energy Production:

Inside cells, glucose undergoes glycolysis, a series of biochemical reactions that break it down into pyruvate, producing ATP (adenosine triphosphate), the cell’s energy currency. If oxygen is present, pyruvate enters the mitochondria for further energy production through the Krebs cycle and oxidative phosphorylation.

5. Excess Sugar:

If there is more sugar in the bloodstream than the body needs for immediate energy, it can lead to elevated blood sugar levels. The liver and muscles store some of this excess as glycogen. When glycogen stores are full, additional glucose is converted into fatty acids and stored as body fat.

6. Hormonal Regulation:

Insulin plays a critical role in sugar processing. It is responsible for moving the sugar from the bloodstream to the cells, effectively lowering blood sugar levels by helping cells take up glucose.

Alternatively, Glucagon raises blood sugar levels by stimulating the release of stored glucose from the liver when blood sugar levels are low.

These two hormones help keep blood sugar levels balanced.

7. Potential Issues with Sugar Processing:

Insulin Resistance occurs when cells become less responsive to insulin, leading to elevated blood sugar levels. This condition is often associated with type 2 diabetes. It is generally caused by excessive sugar consumption and can be exacerbated by stress and lack of sleep as well as genetics and certain medications. Insulin resistance leads to high blood sugar levels which can cause a host of symptoms, including weight gain, fatigue, chronic inflammation and hormonal imbalances.

Lactose Intolerance is caused by a deficiency in lactase, the enzyme that digests lactose, and can lead to digestive discomfort when consuming dairy products. Lactose intolerance can affect anyone, but generally affects individuals that stopped consuming dairy after breastfeeding as their bodies stopped producing lactase due to the lack of necessity. Many Asian countries have large proportions of lactose intolerant people due to a lack of dairy consumption after the breastfeeding phase of child development, usually 0-3 years old.

How too much sugar negatively affects the gut

Microbiome

A diet high in sugar can reduce the diversity of gut bacteria. A diverse microbiome is associated with better health and resilience against pathogens and chronic diseases. High sugar intake can disrupt the balance of the gut microbiota by promoting the growth of harmful bacteria and fungi like Candida, while reducing beneficial bacteria like Bifidobacteria and Lactobacilli. This imbalance, known as dysbiosis, can lead to digestive issues, inflammation, and even systemic health problems. 

An imbalanced gut microbiome can also lead to the overproduction of inflammatory compounds like lipopolysaccharides (LPS), which can enter the bloodstream and contribute to systemic inflammation. Chronic inflammation is associated with various health issues, including metabolic disorders, cardiovascular disease, and autoimmune conditions. Overgrowth of pathogens like Clostridium difficile and fungi like Candida albicans can lead to infections, gut inflammation, and conditions such as small intestinal bacterial overgrowth (SIBO).

Beneficial gut bacteria ferment dietary fiber to produce short-chain fatty acids (SCFAs), such as butyrate, which support gut health and help regulate the immune system. High sugar intake reduces the abundance of these beneficial bacteria, leading to lower SCFA production, which can compromise gut health and function. Excessive sugar can cause or exacerbate symptoms like bloating, gas, and diarrhea, increasing the permeability of the stomach lining and also creating an unpleasant feeling. Fructose, in particular, is poorly absorbed by some individuals, leading to a condition known as fructose malabsorption, which can cause digestive discomfort.

The gut microbiome has a significant impact on mental health through the gut-brain axis. Dysbiosis and inflammation caused by excessive sugar intake can affect neurotransmitter production and contribute to mood disorders such as anxiety and depression. Diets high in added sugars have been linked to a higher risk of developing inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis. They can also exacerbate symptoms of irritable bowel syndrome (IBS), causing pain, cramping, and irregular bowel movements.

The gut microbiome has a significant impact on mental health through the gut-brain axis. Dysbiosis and inflammation caused by excessive sugar intake can affect neurotransmitter production and contribute to mood disorders such as anxiety and depression. About 90-95% of the body’s serotonin is produced in the enterochromaffin cells of the gastrointestinal tract.  Dysbiosis, or an imbalance in gut bacteria, can influence this serotonin production, consequently affecting mood and gastrointestinal health. Low serotonin levels are linked to depression, anxiety, sleep disorders, and certain digestive issues like irritable bowel syndrome (IBS).

High sugar intake can also disrupt the gut-brain axis by affecting the release of hormones like ghrelin and leptin, which regulate hunger and satiety. This disruption can lead to overeating, weight gain, and a further negative impact on gut health.

Leaky Gut Syndrome

The stomach lining is permeable, especially when stretched or irritated. High sugar diets can lead to the weakening of the gut epithelial barrier, which is crucial for protecting against harmful substances. This weakening can result in increased intestinal permeability and the entry of unwanted substances into the bloodstream, leading to chronic inflammation and other health issues. Simply put, the contents of the stomach leach into the body. Excess sugar, especially in the form of fructose or high-fructose corn syrup, can compromise the integrity of the intestinal lining, making it more permeable. This condition is commonly referred to as “leaky gut.” When the gut lining is compromised, toxins, undigested food particles, and harmful bacteria can leak into the bloodstream, triggering inflammation and immune responses. This immune response usually causes fatigue and sleepiness. We’ve all felt this in the feeling you get after eating a huge meal such as thanksgiving dinner is due to your body resolving the issue of your leaking gut.

Oral Health

Excess sugar in the mouth leads to increased bacterial growth, resulting in an acidic environment that promotes bad breath, dry mouth, and tooth decay. We’ve all heard that sugar is bad for your teeth, but what is happening at the microscopic level that causes this? Bacteria in the mouth eat the excess sugar and multiply, while at the same time excreting acidic waste in the form of lactic acid. This acid wears away the enamel on your teeth, eventually eating away at the tooth itself. This is what we call a cavity. These bacteria also strip the minerals from your saliva to produce their own little house, called tartar. Tartar is a biofilm made from the minerals in your saliva, which the teeth need to re-enamel and stay strong, effectively robbing the teeth of their nutrition.

All of this is somewhat mostly avoidable by eating less sugar, especially processed sugar, and timing your consumption. Eating processed sugar on a regular basis, especially outside of meal time gives a sugar boost to these bacteria. 

Cardiovascular Health

Excess sugar in the bloodstream can lead to serious health risks, primarily by overburdening the body's ability to manage blood sugar levels. When people frequently consume high amounts of sugar, the pancreas is forced to produce more insulin to help cells absorb the excess glucose. Over time, cells can become less responsive to insulin, a condition known as insulin resistance. As insulin becomes less effective, glucose builds up in the bloodstream, leading to hyperglycemia (high blood sugar). This chronic elevation of blood glucose can eventually result in type 2 diabetes, a condition that significantly impairs the body's ability to regulate sugar and leads to further complications.

As a result of insulin resistance, persistently high blood sugar levels can damage blood vessels and organs over time. Chronic high blood sugar can lead to atherosclerosis (hardening of the arteries), increasing the risk of heart disease, stroke, and kidney damage. The hardening and swelling of the arteries leads to the body's protective response of bringing plaque into the affected areas to keep them open, almost like a scaffolding system. This plaque is what leads to clogged arteries, which can cause chest pain, high blood pressure, and heart attacks. High cholesterol levels on a blood test are usually due to this protective measure used by the body to protect the arteries.

Nervous System Health

Consistent high blood sugar and insulin resistance can also affect the nervous system, leading to nerve damage (neuropathy), which is particularly common in diabetics and can cause numbness, pain, and poor circulation, especially in the extremities. The cumulative effects of excess sugar intake also contribute to weight gain, since excess glucose that is not used for energy is stored as fat, further increasing the risk of metabolic disorders. In short, unchecked sugar consumption can lead to a cascade of negative health outcomes, impacting nearly every system in the body.

Pre-Diabetes & Sugar/insulin cycle

According to the CDC, About 98 million American adults (more than 1 in 3) have prediabetes, a condition where blood sugar levels are higher than normal but not high enough to be diagnosed as type 2 diabetes. It’s essentially an early warning sign that the body’s ability to regulate blood sugar is impaired, and if left unchecked, it can progress to full-blown diabetes. People with pre-diabetes often have insulin resistance, where their cells don’t respond properly to insulin. This condition can also lead to damage in the blood vessels, heart, and kidneys, even before diabetes develops. Fortunately, pre-diabetes is often reversible through lifestyle changes such as improved diet, increased physical activity, and weight loss.

The sugar-insulin cycle refers to how the body normally processes and regulates blood sugar (glucose). In a healthy individual, when sugar is consumed, it is absorbed into the bloodstream, causing blood sugar levels to rise. The pancreas then releases insulin, a hormone that helps cells absorb glucose for energy or storage, thus lowering blood sugar to normal levels.

However, in pre-diabetes, this cycle begins to malfunction due to insulin resistance. In this condition, the body’s cells—particularly in the muscles, fat, and liver—become less responsive to insulin, so they do not absorb glucose efficiently. As a result, the pancreas compensates by producing even more insulin to try to lower blood sugar. While this may keep blood sugar from rising too high initially, the system becomes strained. Over time, the pancreas can no longer produce enough insulin to meet the body’s needs, leading to elevated blood sugar levels.

This leads to a vicious cycle where high blood sugar after eating triggers more insulin release. Insulin resistance makes cells less responsive to insulin, so glucose remains in the bloodstream. The pancreas overworks to produce more insulin, but eventually it cannot keep up. Elevated blood sugar becomes more persistent, progressing to pre-diabetes and eventually diabetes. Without intervention, pre-diabetes can progress to type 2 diabetes, where insulin production declines further, and blood sugar levels rise uncontrollably. However, with dietary adjustments, exercise, and weight management, the sugar-insulin cycle can be improved, potentially reversing pre-diabetes.

Is Fruit Better Than Processed Sugar?

The effects of whole fruits and processed sugars on the body are markedly different due to their composition and nutrient content.

Whole fruits are rich in vitamins, minerals, antioxidants, and dietary fiber. The natural sugars in fruits are absorbed more slowly due to their fiber content, leading to gradual increases in blood sugar and insulin levels. This promotes stable energy levels and reduces the risk of insulin resistance and type 2 diabetes. Additionally, the fiber and water in fruits contribute to a feeling of fullness, aiding in appetite control and weight management. Fruits also support digestive health by acting as prebiotics, promoting a balanced gut microbiome.

While fruits contain natural sugars, their high water and fiber content help protect teeth by stimulating saliva production. However, consuming acidic fruits in moderation is advisable to prevent enamel erosion.

Processed sugars, such as table sugar and high-fructose corn syrup, provide “empty calories” with no nutritional value. They are rapidly absorbed, causing sharp spikes in blood sugar and insulin levels, leading to energy crashes, increased cravings, and a higher risk of developing obesity, type 2 diabetes, and heart disease. Unlike whole fruits, processed sugars lack fiber, promoting overeating and contributing to weight gain. Most processed foods are high in processed sugars and should be avoided as much as possible.

High intake of processed sugars can also disrupt the gut microbiome, leading to digestive issues and increased inflammation. Additionally, sugary foods and drinks can significantly increase the risk of tooth decay and cavities, especially without proper oral hygiene.

Having said this, not all fruit is created equal. Many fruits have been engineered to be higher in sugar and lower in fiber than their ancestors. Grapes, for example, originally had seeds and far less fruit per grape. Eating a handful of grapes took minutes, as opposed to the seconds it takes with our modern grapes. Excessive fruit consumption is something to be avoided. Fruit in general should be treated as a dessert, not a meal or a meal substitute.

When to eat sugar?

There is a difference between eating sugar before or after a meal, and it can affect how your body processes sugar, your blood glucose levels, and your overall health. 

Eating sugar on an empty stomach can cause a rapid spike in blood glucose levels. This happens because there is no other food in the stomach to slow down the absorption of sugar. The rapid rise in blood sugar triggers a quick and substantial release of insulin, the hormone that helps transport glucose into cells. This can lead to a sudden drop in blood sugar levels, potentially causing a “sugar crash” characterized by fatigue, hunger, and irritability. Eating sugar before a meal can also stimulate your appetite by triggering a release of the hormone ghrelin, which increases hunger. This may lead to overeating or a preference for high-calorie, carbohydrate-rich foods during the meal. This can contribute to weight gain over time, especially if it becomes a regular habit. 

Regularly consuming sugar on an empty stomach can increase the risk of developing insulin resistance over time, as the repeated spikes in insulin can reduce the body’s sensitivity to it. This is particularly concerning for individuals at risk for type 2 diabetes or metabolic syndrome. Eating sugary foods before a meal can also lead to rapid digestion and absorption, potentially causing gastrointestinal discomfort in some people, such as bloating or diarrhea, especially in individuals with sensitivities like fructose malabsorption. 

Consuming sugar after a meal, especially one that contains fiber, protein, and healthy fats, results in a slower rise in blood sugar levels. The presence of other macronutrients slows down the digestion and absorption of sugar, leading to a more gradual increase in blood glucose and a more controlled insulin response. This can help maintain steady blood sugar levels, prevent extreme spikes and crashes, and help to maintain better metabolic health and reduce the risk of insulin resistance. Sugar consumed after a meal provides a slower and more sustained energy release, as it is digested along with other nutrients. This can help maintain steady energy levels without the dramatic highs and lows associated with consuming sugar on an empty stomach.

Consuming a small amount of sugar after a balanced meal may have less impact on overall hunger and satiety signals because the stomach is already full, and the body's immediate need for nutrients has been addressed. This may reduce the likelihood of overeating compared to consuming sugar before a meal. Consuming sugar after a meal, especially one high in fiber, can slow down the rate of gastric emptying, potentially aiding digestion and minimizing digestive discomfort. The fiber and other nutrients in the meal can help buffer the impact of sugar on the digestive system. A small amount of sugar after a meal, especially in the form of fruit or a low-calorie dessert, can satisfy sweet cravings without significantly impacting total calorie intake. It can help with weight management by preventing binge eating and reducing the likelihood of overindulging in high-calorie snacks later on.

If you are going to consume sugary foods, it is generally better to do so after a balanced meal that includes protein, fiber, and healthy fats. This can help moderate the body’s response to sugar, reduce cravings, and maintain more stable blood sugar levels. For people with diabetes or prediabetes, or those trying to manage blood sugar levels, it’s especially important to avoid consuming large amounts of sugar on an empty stomach and to be mindful of overall sugar intake.

How Does Cannabis Play a Role?

Some recent studies suggest that regular cannabis users may have lower fasting insulin levels and better insulin sensitivity compared to non-users. The standard blood test performed to check sugar levels is done after fasting for a period of time and measuring the amount of insulin remaining in the blood. Then a sugary drink is consumed and the levels are checked again.

Improved insulin sensitivity means that the body’s cells are better able to respond to insulin, helping to regulate blood sugar more effectively. This could potentially lower the risk of developing insulin resistance, a precursor to type 2 diabetes mentioned earlier in this article.

Despite the common association between cannabis use and increased appetite (the "munchies"), some research has shown that regular cannabis users tend to have lower rates of obesity and lower body mass index (BMI). Since obesity is a major symptom associated with insulin resistance and type 2 diabetes, this may contribute to a lower risk of blood sugar imbalances. 

Cannabis use, particularly in high doses, can cause short-term increases in heart rate and fluctuations in blood pressure, which may impact blood sugar levels. In some cases, cannabis can lead to hypoglycemia (low blood sugar), especially in individuals who already have blood sugar regulation issues, such as those with diabetes. This may help explain why some people crave sugar while using cannabis, as well as how the blood sugar levels of cannabis users tend to be lower.

For individuals with diabetes, the effects of cannabis use on blood sugar need to be carefully considered. While some users report better blood sugar control, others may experience unpredictable blood sugar swings. Additionally, cannabis can impair judgment and reduce the ability to recognize early signs of hypoglycemia (such as dizziness, sweating, and confusion), making it riskier for people with diabetes.