“We can use sugar sweetened beverages sort of as a tool to really understand the mechanisms that are specific to added sugar consumption, but also because sugar sweetened beverage consumption is so disproportionately affecting Black and Hispanic communities in the United States.”
In this episode, Dr. Candice Price talks about her research on the effects of sugary drinks on type 2 diabetes and heart disease and her recent focus on this topic in Sub-Saharan Africa.
Dr. Candice Price is an Assistant Professor at the University of California, Davis with seven years of experience as a cardiometabolic research scientist focused on understanding the physiological and molecular mechanisms of type 2 diabetes and cardiovascular disease development. Her primary research investigates the impact of sugar-sweetened beverage consumption on cardiometabolic health in Black women.
Shireen: Dr. Candice Price talks about her research on the effects of sugary drinks on type two diabetes and heart disease, and her recent focus on this topic in Sub Saharan Africa.
Podcasting from Dallas, Texas. I am Shireen and this is the Yumlish Podcast.
Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.
Dr. Candice Price is an Assistant Professor at the University of California, Davis, with seven years of experience, as a cardiometabolic research scientist, focused on understanding the physiological and molecular mechanisms of type two diabetes and cardiovascular disease development. Her primary research investigates the impact of sugar, sweet and beverage consumption on cardio metabolic health in Black women.
Welcome Dr. Price.
Candice: Hello, thank you for having me.
Shireen: An absolute pleasure. So Dr. Price, can you talk a bit more about how you became interested in researching type two diabetes and heart disease with a specific focus in Black women?
Candice: Yeah. So, you know, my story is really full circle. It started as a child. Um, I had a big sweet tooth when I was a kid.
And I remember my dad coming into my room and finding the bowl of ice cream that I had hidden under my bed. And saying to me, if you keep eating so much sugar, you're gonna get diabetes. And I said, well, how do you know that? I mean, and you're not a scientist, you're not a doctor. You, I don't know where, where did you get this information?
Is this fact or is this hearsay? And so that really sparked my curiosity into a career path in research. Although at the time I didn't actually know that that was even a career and it wasn't until later in college, that that was even exposed to me as an option. And I eventually went to grad school directly out of undergrad.
Um, I got my PhD in endocrinology and I was focused really a lot on insulin resistance and obesity and trying to understand the mechanisms, that one causes obesity and causes insulin resistance and how they're linked together. Um, and my ultimate goal is really to understand these mechanisms, as a bench scientist and take that knowledge back into the community.
You know, I was born and raised in the south and that's where a lot of the diabetes and obesity epidemic really started and has continued. Um, and so my goal was always to go back into those communities and teach what I've learned as a scientist in my research in real time, and use that to educate people, to make better choices or figure out what they can do to improve their own behaviors and habits and learn about their environment and how their environment is impacting their health.
Um, and then I eventually, long story short, landed a position as a postdoc in the laboratory of Dr. Peter Havel and Dr. Kimber Stanhope at UC Davis, they were focused on sugar, sweet and beverage.
And for me, sugar was the reason I wanted to become a scientist. And now I had the opportunity to study these mechanisms specifically focusing on sugar and using that as my platform to impact our community.
Shireen: I'm smiling over here because when you talked about that incident with your dad, it seems to me that you were a researcher even before then, calling out your dad and asking him, well, how does he know this?
Candice: Yes, yes. And I was always the type of child that never wanted to follow the crowd. I wanted to figure out things for myself. And I think that served me well as a researcher because you're constantly asking questions, the ‘why’ questions, the ‘how’ questions.
Shireen: Interesting. So how did you pinpoint sugar sweetened beverages as a factor to investigate in type two diabetes and heart disease prevalence?
Candice: Yeah, so, you know, my interest was added sugar consumption. I mean, really diet. And then I ended up honing in on added sugar, I think maybe from a personal experience standpoint. And we also know that sugar sweetened beverages. Are the single largest source of added sugar that we consume in the United States, meaning that it is the one source of sugar that contains only sugar so we can study it very easily.
We can use sugar sweetened beverages sort of as a tool to really understand the mechanisms that are specific to added sugar consumption, but also because sugar sweetened beverage consumption is so disproportionately affecting Black and Hispanic communities in the United States. And I saw that there was a need there in terms of increasing research in that space.
Shireen: And so what have been your most important conclusions so far in your research in this space?
Candice: Yeah. So some of the most important conclusions related to sugar sweetened beverages. And when I talk about sugar sweetened beverages, I mean, things that are beverages that contain added sugar.
So we're not talking about naturally sweetened beverages, which I think that gets conflated a little bit, but some of the research that was conducted prior to me even getting into this area really focused on the fact that a lot of the mechanisms that links to the sweet and beverage intake to cardiometabolic disease is really all about the fructose content and the fructose driving those increases in lipids in total cholesterol, we recently published a paper showing that both high fructose corn syrup and sucrose sweetened beverages increases all of these lipid risk factors for cardiovascular disease, including low lipoprotein, which isn't thought to be the bad cholesterol. But we also found that insulin sensitivity is reduced as a result of consuming sugar sweetened beverages.
As well as probably one of the more surprising facts is the fact that we found increases in the amount of fat stored in the liver. And we know that the liver is such an important organ. We don't want fat stored there. We need it to help metabolize our fat, but we don't want that fat to come back and get stored in the liver that really impacts its function.
And, and I think one of the reasons why that's one of the most important research findings is because I don't know if you remember a few years back, the soda industry, basically when everybody knew that hyper corn syrup was bad for us now, but then this idea that table sugar was actually a healthier option.
Well, now we are showing you that that's not the case. They behave similarly in terms of how they impact our bodies. And so it's really important to get that research out there to say, Hey, no, this is actually what you were told years ago by the industry is actually a complete lie.
And then one of the other more recent publications looked at naturally sweetened beverages. So orange juice, a hundred percent orange juice. And we compared that to sucrose sweetened beverages. And we found that naturally sweetened orange juice, meaning a hundred percent no added sugar, had a protective effect on raising uric acid concentrations. Increasing uric acid concentrations is the risk factor for cardiometabolic disease and gout.
And we've seen this time and time again with sugar sweetened beverage studies where sugar sweetened beverages increase your acid production, but orange juice does not do that. And orange juice also did not increase total cholesterol and, and lipoproteins associated with cholesterol, but it did actually increase the triglyceride levels after a meal.
And it reduced insulin sensitivity. And this reduction in insulin sensitivity was not different from the reduction that we saw with the sugar sweetened beverage group. That's important because we always think of a hundred percent food juice as being the healthy option. And our study shows that, well, it might be healthier than a sugar sweetened beverage, but there are still limitations.
Moderation is important, right? This study, we gave people 25% of their calories as orange juice or as a sucrose sweetened beverage. And the guidelines for Americans, dietary guidelines for Americans recommends that we consume no more than 10% of our calories as added sugar. And so there is a large percentage of the population that consumes as high as 25%.
On average, it's around 15% of our calories is added sugar. And so this study really demonstrates that when you over consume these beverages, you're really increasing your risk for metabolic disease.
Shireen: So that's interesting Dr. Price. Um, more recently you began doing work on the role of sugar sweetened beverages on the increasing rates of type two diabetes in Sub-Saharan Africa.
What was your process in deciding to study this area?
Candice: Yeah, so this actually just came about sort of as a fluke in a conversation that I was having with a colleague that I had just met. She's in civil engineering at UC Davis as well. But we were meeting at this, uh, Black faculty social hour, basically.
And I remember having this conversation about how I really would love to study different populations that have been exposed to added sugar consumption over several generations and compare them to populations that have more recent exposure to added sugar consumption due to an increase in westernization and this nutrition transition to more, a greater exposure of westernized diet, basically.
And the person that I was talking to, happened to have a study that she was conducting in Kenya that had nothing to do with diet, but she was saying, well, I have this study so if you maybe have an idea of how you can incorporate your questions into my work, which she was focused on something completely different, looking at menstrual cycle issues and water sanitation in Kenyanq`, adolescents, they were young girls and I thought, oh, well, that's great. We could just do something simple survey study just to understand what sugar sweetened beverage consumption looks like in a rural setting.
And maybe we can compare that to some more urban places in Kenya. And so that's really how it started is just this casual conversation and happened to run into someone that was already doing a study. And it seemed like an easy enough feat to accomplish in a short time, just to get sort of a lay of the land, like is the sugar sweetened beverage consumption similar as it is in the United States where more low income low resource neighborhoods have a higher consumption of sugar sweetened beverage. And just the study planning, and we're still trying to gear up to get the study going. And I'm collaborating with someone at the University of Nairobi to conduct this study.
I've learned a lot in terms of just before I even went there, how sugar sweetened beverages are consumed differently there than they are here.
And here, for example, you know, I mentioned that individuals that live in low resource neighborhoods have this greater access and greater consumption of sugar sweetened beverages, but it seems that over there, it may not be the case actually, because the difference is those living in urban areas and that have more wealth, if you will have greater access to commercial beverages that are sweetened with sugar, but those living in rural settings seem to have greater access to homemade beverages containing added sugar. Right. And I've heard that. They're very sweet. And so now it's, it creates a bigger challenge, right? Because here it's, the focus is largely not on homemade beverages, but let's try to get people to stop buying beverages in the store that contain so much added sugar. Whereas there seems like we might have to have a two pronged approach that includes a lot more education so that people that are making these beverages at home understand the importance of trying to reduce their added sugar consumption.
And another reason why this is such an important areas, areas like Kenya. Other countries within Sub-Saharan Africa are having a rise in diabetes rates. And this is something that didn't exist so much before. And now it's predicted that there's gonna be a 98% increase in type two diabetes prevalence in Sub-Saharan Africa by 2030.
That's not that far from now. And they largely attribute this to an increase in sugar sweetened beverage consumption.
Shireen: And, you know, there's, there's some research that actually shows how these sugar sweetened beverages go to certain parts of the world and almost immediately you see sort of that obesity.
Candice: Exactly and the industry, now, seeing that there's more awareness in the United States, still not enough, but more.
They're targeting these other countries that don't know the impact of added sugar. And, you know, Mexico is a really great example of that, of, you know, taking advantage of these communities that have poor access to clean water and utilizing that to now push the intake of sugar sweetened beverage consumption as the healthy alternative to dirty water conversion.
Shireen: That's unfortunate. Um, you certainly seem to have a very diverse research portfolio, Dr. Price. Um, can you briefly tell us about some of your other research projects related to sugar sweetened beverages and black women's health?
Candice: Yeah. So my main study right now is a pilot study that I'm just wrapping up. Um, this is a small pilot studying, in which we were comparing sugar sweetened beverage intake in Black and white women. And some of my preliminary data from that study is demonstrating that there seems to be a different metabolic response to the sugar sweetened beverage in Black women with a more detrimental impact on carbohydrate metabolism and lesser of an impact on lipid metabolism, which is what we tend to see in previous studies that contain mostly Caucasian participants.
We see that a lot of these mechanisms are driven by a dysfunction in lipid metabolism pathway, but that may not be the case in Black women, which is really important to understand when trying to understand disease prevention and how diet is influencing that.
One of my other studies that we just published was a study looking at the gut microbiome.
This is a, a really interesting area of work that I'm not trained in. I'm not a microbiologist by training, but over the years, due to my interest, I've just gotten a lot of, sort of informal training if you will, in this area. And so we, I'm a co-investigator on the NHLBI, National Growth and Health Study, which is a longitudinal study that started back in 1987 and it followed these women.
They were, uh, recruited into the study as adolescents and they followed them over 10 years, years. We recruited them back into the study at around age 30 years old and, or excuse me, 30 years into the study. So their, their first cohort ended at age 19. That was year 10. So now at year 30, we collected stool samples at just a single time point.
And we wanted to see, can we use the gut microbiome to better understand differences in insulin sensitivity that we typically see based on the prevalence being higher in Black women. And so with this study, we were looking at race differences in, in gut bacteria, as well as race differences by insulin sensitivity.
And I'll tell you just briefly, one of the key findings from that study was that Black women, regardless of their levels of insulin sensitivity had much greater levels of this bacteria called actinobacteria, which in other studies has been shown to be associated with obesity and insulin resistance. Um, and importantly, one of the mechanisms that might be linking this bacteria to insulin resistance is its role in perhaps promoting inflammation.
There are some differences in the literature and some suggesting that it might be protective against inflammation. Some say it promotes inflammation. So that piece of the puzzle isn't completely clear, but based on our findings, it suggests that at least in our cohort, It may be playing a role in promoting inflammation and that may be driving the increased risk, uh, increased prevalence for insulin resistance in this population.
And we also found differences in, in the diversity of bacteria, between race groups, which is important because basically the more diverse your bacteria, the greater your, the health of your gut. And, you know, we know that the gut bacteria plays such a big role. in driving our metabolism and it's linked to metabolic disease and obesity and insulin resistance and diabetes, et cetera, and even cancer.
And so if we can better understand why there's race differences in bacteria, we can maybe utilize that information to understand that our environment, our social environment is impacting us literally from the inside out. Right. We have these little microorganisms inside of us. And that seems to be impacting us.
Our environment is impacting us, skin deep down to our gut.
Shireen: Powerful. Um, and, and it's, so it's not only part of the puzzle is the lifestyle and all of that. But the other part is there's so many different things going on within our gut microbiome that we are not even aware of.
Shireen: That's been such a huge role, uh, for sure.
What, what do you think the direction of future research and public health policy, uh, should be concerning sugary beverages?
Candice: Yes. So first and foremost, there are a lot of successful policies that have been implemented. Most people may be familiar with the term soda tax, basically attacks on sugary beverages, beverages that contain added sugar.
This has been passed, started in Berkeley was the first city to pass it, but it's been passed nationwide in places, not nationwide, but in places within, the other places that the United States and also other places globally, I think there certainly needs to be, maybe better collaborations between scientists and policy makers and community members that can create more effective sugar sweetened beverage related bills, because I think there is some pushback from individuals and, and that's due to a lack of understanding why the bill is even focusing on sugar sweetened beverages.
And I think we need to maybe do a better job of educating our community members as to why this is important. We're basically doing the same thing that, that we did with the tobacco company. Right. We know cigarettes were detrimental to our health. And so we implemented taxes, raise prices to reduce smoking.
Right. We're trying to do the same thing with sugar sweetened beverages. And then the last thing I'll just say is just having more diverse research studies. So that we can understand mechanisms in all different types of populations, but specifically, really the populations that are most impacted by a sugar sweetened beverage consumption, which are Black and Hispanic populations.
And oh, one thing I'll add to the policy piece is we really need to find a way to hone in on this targeted marketing, targeted marketing is a, is a huge driver of sugar sweetened beverage consumption in Black and Hispanic communities because we're disproportionately targeted by these industries. Um, and so we need to figure out a way to reduce that marketing and to increase better access to healthier things in neighborhoods and health and marketing of healthier things to all of our young kids, especially.
Shireen: Thank you so much for sharing that Dr. Price. And, uh, with that, unfortunately we are toward the end of the episode, uh, at this point, how can our listeners connect with you and learn more about your work?
Candice: Yes, you can find me on Twitter @DrScientistCAP that's Dr. Scientist, capital C capital A capital P. I also would like to put in plugin for the diabetes prevention program.
I'm a diabetes prevention program coach. My program is sponsored through Touro University. So you can find out more information about that at tourotacklesdiabetes.org. That's Touro, is T O U R O or you can also Google the National Diabetes Prevention Program CDC and you can find a DPP program in your area.
Shireen: With that thank you so very much, Dr. Price, for your time.
Candice: Thank you.
Shireen: And to our listeners here, head over to our social media next and answer this next question. Have you considered cutting out soda and other sugary beverages from your diet? And what has that been like? Head over to our Facebook, head over to our Instagram and let us know and we'll find you there after the episode and thank you Dr. Price.
Candice: Thank you.
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