Sugars & Diabetes

Sugars & Diabetes

SUGARS & DIABETES

by Madelyn Wheeler and
Marcia Levine Mazur

Recently, "Diabetes Forecast"
received a letter about a subject that concerns many people with diabetes: sugar.
The writer wanted to know why a magazine for people with this disease would
publish a recipe (March 1996, p. 34 "Coconut Pineapple Compote") that
had 20 grams of sugars in one serving.

It's an excellent question and one that "Forecast"

would like to answer in print, not only for the writer, but

for all our readers who have similar "sugar" concerns.

Reader Is Right

First, we agree. The sugar content in the recipe is

high. But that's not the whole story.

The sugars in the compote come mainly from the fructose

(fruit sugar) in the pineapple, while a small percentage

comes from the lactose (milk sugar) found in the milk and

yogurt.

Clearly, many nutritious foods have some form of sugar

or a combination of sugars in them. Fruits, in fact, are

particularly high in sugar. That means that virtually any

fruit we eat--if it had a food label--would list a large

quantity of sugar on that label. (To be more scientific, it

would list most of its carbohydrates as sugar, but more

about carbohydrates later.)

If "Forecast" could not print recipes that contained a

large quantity of sugars--such as the 20 grams of sugars per

serving in the Pineapple Compote--it could not print recipes

that had fruit in them.

But "Forecast" does print such recipes, because sugars-

-when used appropriately--are not forbidden foods for people

with either type of diabetes.

What's Wrong With Sugar?

It's understandable that people with diabetes worry

more about sugar than about any other food. For centuries,

sugar has been considered the enemy, the worst possible

thing people with diabetes could ever consume.

Why? The very name of the disease for one thing. For

years diabetes mellitus was commonly referred to as "sugar

diabetes." (Mellitus roughly translates as "sweet.")

That name came about because doctors once diagnosed

diabetes by tasting the urine of the affected person. A

sweet urine meant diabetes. (The urine of people with

uncontrolled diabetes contains glucose.) Doctors then

erroneously concluded that eating too much sugar had to be

the cause of this disease.

In fact, one of the great pioneers of diabetes

research, Dr. Frederick Allen, reported in 1920 in "The

Journal of Experimental Medicine" that "sugar is a more

dangerous food for human beings with any predisposition to

diabetes than starch."

Dr. Allen didn't have the equipment and methods today's

scientists have. And his conclusion has been disproved.

But he was certainly not alone in telling people with

diabetes to stay away from all sugars.

Researchers in more recent times have given the same

advice. They knew that sugars such as sucrose (table

sugar), fructose, lactose, and maltose (a sugar found in

cereals, grains, and legumes) have simple molecular

structures and have been called simple carbohydrates. (The

scientific name is monosaccharides or disaccharides.)

They also knew that foods such as pasta, potatoes,

bread, and crackers have complex molecular structures and

have been called starches, or complex carbohydrates. (The

scientific name is polysaccharides.)

They then reasoned that the body must digest and absorb

foods with a simple molecular structure faster than it does

foods with a complex molecular structure. They also

concluded that quickly absorbed foods must raise blood

glucose faster than more slowly absorbed foods.

Relying on these assumptions, they reinforced the

message that sugars are harmful for people with diabetes.

But few nutritionists actually experimented to see if these

conclusions were true.

No Evidence

In the 1970s, several researchers were no longer

satisfied with these assumptions. They began asking: How

do we really know that sugars affect blood glucose levels

faster than any other foods? Where is the evidence that

proves sugars are especially harmful for people with

diabetes?

The resulting research served to challenge long-held

"truths" about the connection between diabetes and sugars.

Within the American Diabetes Association, a consensus began

to develop that it was time to take a closer look at the

subject.

In 1993 the American Diabetes Association convened a

panel of experts to review all the recently published

scientific literature on nutrition and diabetes.

The panel's findings were a surprise. It uncovered no

scientific evidence to support the belief that people with

diabetes should eat little or no sugar of any kind.

In fact, the panel concluded that sugars, when used as

part of a regular meal plan and when consumed with other

foods, do not harm blood glucose control in people with

either type I or type II diabetes.

Just Another Carbohydrate

The reason is that sugars are not a special kind of

food. They are carbohydrates. And the body processes all

carbohydrates--simple and complex--in the same way.

("Forecast"'s nutrient listings, which accompany each

recipe, and Nutrition Facts on commercial food labels

actually list sugars under Total Carbohydrates.)

It is the total amount of carbohydrates that you eat

that affects your blood glucose levels, not where they come

from.

But the sugar story is even more complex. Scientists

now know that many factors besides the food itself affect

blood glucose levels. For example, how has the food been

processed? Cooked? What other foods are being eaten before

or at the same time? How quickly is the meal consumed?

Different Sugars

Various sugars, too, have different effects on blood

glucose levels, because sugars themselves have different

components.

Sucrose (table sugar), for example, is actually made of

glucose and fructose in equal parts. That is why nutrition

labels list "sugars" rather than "sugar."

However, these differences tend to equalize when you

consume sugars in combination with other foods. For this

reason, dietitians recommend that you have your sugary foods

as part of a total meal.

Wait A Minute

But wait. This does not mean to go ahead and have all

the sugars you want. It does mean that you can have sugars

as part of your diabetic diet if, like any other foods, you

work them into your total daily food plan.

Also, although it's not the case with the compote

recipe that prompted our reader's letter, many foods high in

sugars, particularly sucrose, are also often high in

calories and fat.

It's important to limit high-calorie, high-fat foods

when you have diabetes. High fat diets have been linked to

heart attack and stroke, and either type of diabetes is also

an additional risk factor for these diseases.

Finally, sugars are not particularly healthy additions

to the diet. While they add flavor and can fill a good

percentage of your day's quota of carbohydrates and calories

(they contain four calories per gram), sugars don't add any

vitamins, minerals, or fiber.

Naturally Occurring Versus Added
Sugars

Some people divide sugars into two categories:

"naturally occurring" (such as the fructose in fruit) and

"added" (such as the sucrose in a cookie). They think there

is a significant difference between the two. There isn't.

To date, there is no scientific evidence showing that

our bodies make a distinction between sugars that grew in

the food, or sugars that are added by the cook or the

processor.

Wait a Minute

Don't be misled. The latest findings on sugar do not

give people with either type of diabetes a green light to

consume all the sugars they want.

Rather, they let people with diabetes know that they

can substitute sugar for other carbohydrates in their total

daily food plan, and that sugary foods are best eaten with

the meal.

For example, if you wanted to have a small piece of

cake after a meal, you would substitute it for a food or

foods that have approximately the same number of total

carbohydrates. You might, for instance, have the cake

instead of a bread roll or a portion of pasta. The key word

is "substitute."

That's why it's important to know the number of sugar

grams as well as the total number of carbohydrate grams in a

food or recipe.

They All Mean Sugar

Here are some of the terms you'll see on a label that

translate into "sugar."

Beet Sugar

Brown Sugar

Cane Sugar

Carob Powder

Confectioner's Sugar

Corn Sweetener

Corn Syrup

Dextrose

Fructose

Galactose

Glucose

Granulated Sugar

Honey

Invert Sugar

Lactose

Levulose

Maltose

Maple Sugar

Molasses

Powdered Sugar

Raw Sugar

Sucrose

Sorghum

Sugar Cane Syrup

Table Sugar

Turbinado

Sugar Alcohols

The human body does not process (metabolize) sugar

alcohols the same way it processes sugar. For that reason,

The U.S. Food and Drug Administration (FDA) generally does

not require them to be listed on a food label. They must be

listed only if the product makes a specific sugar claim, say

that it is sugar free.

However, when sugar alcohols are on the label, they are

placed in a separate line under Total Carbohydrates. The

following example is from a label for hard candies that

contain sugar alcohol and claim they are sugar free:

Total carbohydrates 13

Dietary Fiber 0 grams

Sugars 0 grams

Sugar Alcohol 12 grams

Sugar alcohols have a minimal effect on blood glucose

levels. But although the FDA counts sugar alcohols at two

to three calories per gram (rather than the four calories

per gram for other sugars), they are not problem free.

Because sugar alcohols are not completely digested in

the stomach, many people find that eating too much sugar

alcohol causes cramping and gas in the lower intestine.

Some sugar alcohols you'll find on labels:

Hydrogenated Starch Hydrolysate Isomalt
Lactitol Mannitol Malitol Sorbitol Xylitol

Madelyn Wheeler, MS, RD, CDE, is coordinator for

research dietetics at the Diabetes Research and Training

Center of Indiana University Medical Center in Indianapolis.

Marcia Levine Mazur is senior editor of "Diabetes Forecast."

Reprinted with permission from "Diabetes Forecast,"

February 1997. Copyright 1997 American Diabetes

Association. For information on joining ADA and receiving

Diabetes Forecast, call 1-800-806-7801.