1 July 2010

Busting Food Myths with Nicole Senior

Myth: Sugar causes diabetes.

Nicole Senior

Fact: Sugar intake is not associated with diabetes. Type 2 diabetes is not caused by one food but from a combination of diet and lifestyle risk factors.
Of all the nutrition myths around, this one is the big daddy of them all. I used to work for a diabetes organisation and this old chestnut came up time and time again. Eating sugar is not implicated in the development of either type 1, or type 2 diabetes. At this stage type 1 diabetes is not preventable.

Type 2 diabetes is one of the fastest growing diseases in the world. So what do we know about preventing it? We know a healthy diet and lifestyle is crucial. The biggest risk is being overweight or obese. Diabetes Australia says up to 60% of diabetes cases could be prevented by staying in the healthy weight range. Carrying fat around your middle is particularly risky. The excess fat makes insulin resistance – the underlying cause of type 2 diabetes – worse. Smoking increases the risk of everything, including diabetes.

Keeping fit and active is protective – we all need to manage more movement in our day (I’m currently trying to stand up every time I’m on the phone). Large scale population studies show when it comes to food, those with the lowest risk eat the most cereal fibre and polyunsaturated fats, and eat diets low in glycemic load and trans fats. A meta-analysis authored by our own Dr Alan Barclay found those eating the highest GI diet had a 40% higher risk of type 2 diabetes than those with the lowest GI diet. Selecting lower GI and wholegrain foods in a balanced diet is a positive step toward a future free of diabetes.

Why has the ‘sugar causes diabetes’ myth persisted? Probably in part because diabetes is simply explained as ‘too much sugar in the blood’, and was even called ‘sugar diabetes’ in the past. The leap of logic is obvious. However what is not obvious is that eating table sugar (sucrose) does not dramatically increase the sugar (glucose) in the blood. The effect of foods on blood glucose levels – we now know – is described by the glycemic index (GI). The GI of table sugar is in the medium range at 65 and dwarfed by high GI foods such as Turkish bread (86), mashed boiled potato (91) or jasmine rice (89). Not that I’m suggesting we avoid high GI foods and eat lots of sugar, but we can stop avoiding added sugar totally and demonising it as a cause of diabetes.

We can enjoy added sugar in moderation: a spoonful of sugar can help nutritious foods go down. I love a drizzle of honey (just another form of sugar) over my low fat natural yoghurt, a spread of marmalade on my wholegrain toast, and the ability of sugar to produce delightfully light and airy low fat ice cream. I still add half a teaspoon of sugar to my morning coffee which – to my tastebuds – provides just the right balance to the bitterness of the coffee. I see no reason to change. It’s simply another case of ‘a little bit of what you fancy’ is OK.

Nicole Senior MSc (Nut&Diet) BSc (Nut) is an Accredited Practising Dietitian and Nutritionist and author of Eat to Beat Cholesterol and Heart Food containing evidence-based, trustworthy advice about eating well for your heart. Check out her website HERE.


Anonymous said...

I have been reading this website and has almost always been in agreement with most of the things written until now......
I am a practising physician who treats many thousands of diabetics per year and is a large advocate of the low GI diet and avoidance of all refined foods including white sugar!!!, white flour, white bread, biscuits, cakes etc,
So I am a little bit disappointed with this article. Many of my patients benefit greatly once they stopped putting sugar in their beverages(some replacing with artificial sweeteners) and replacing white bread with low GI breads. The GI of sugar is 65 and that is high in my opinion cos we are aiming to have most foods in below the 55 range.
White sugar is probably one of the worst things one can take in the diet, read any article on how white sugar is produced and the numerous processes and bleaching the sugar needs to go through before it is white will convince most people it is definitely not good for health, nothing cause great distress to the pancreas as much as white sugar in my opinion. The best sugars are in whole fruits(not juices) and should be taken at least 3 to 4 times daily, the reason most people do not have 3-4 serving of fruits daily is because they have their "sweet" fix from sweetened beverages already.

In my opinion, sugar = higher risk of diabetes is definitely not a myth and I hope your article have not done more damage than good. It is this kind of article and sentence that sugar does not cause diabetes that many diabetics use as an excuse to continue to fuel their sugar addicitions that create so much more work for health professionals in their fight against the metabolic disease crisis that we are facing now......

GI Group said...

We have passed your comments on to Nicole and will post her reply as soon as possible.

GI Group said...

Nicole Senior and Dr Alan Barclay reply: 'Thanks for your comments and we appreciate your taking the time to post them.

We believe the messages in the article do not encourage excessive refined sugar consumption but rather reassure people that a little bit of added sugar in the context of healthy foods does no harm and the scientific evidence supports this.

Your advice to avoid refined flour in favour of wholegrain cereals is supported by the scientific evidence, however your advice to avoid all white sugar is not. Incidentally the GI of white, brown and raw sugar is essentially the same (medium).

For reasons of calorie (kilojoule) control, it is a good idea to moderate refined sugar intake and ensure it is consumed in nutritious foods, especially in diabetic or pre-diabetic patients, so switching to a low calorie sweetener in drinks is appropriate.

Aiming to consume most foods in the below 55 range can be limiting and dietary studies do not support this blanket approach. In practice (and reality) glycemic improvements are achievable by switching to lower GI versions of regularly consumed high carbohydrate foods such as bread, breakfast cereals and the starchy component of the evening meal. for example, using this approach, it is possible to reduce the average GI of the Australian diet from its current level of 57, down to below 50. We know from both epidemiological and experimental studies that this will decrease the risk of diabetes and significantly improve its management.

Your statement that white sugar is one of the worst things to have in your diet is not supported by the scientific evidence. Besides a potential for contribution to excess energy intake, sugar per se is not implicated in chronic disease (see the WHO report on carbohydrates in human nutrition at http://www.fao.org/docrep/w8079e/w8079e00.htm). There is no evidence that white sugar (or any other kind) causes “distress to the pancreas”. A high GI diet might, but sugar and GI are not the same thing.

Eating sugar cannot be termed an addiction – and this goes for any food. It is not a psychoactive substance like alcohol or drugs. We require blood glucose to survive and the body does not distinguish where it came from (sugar or starch).

Counselling people with diabetes and pre-diabetes toward a healthier diet and lifestyle is difficult and complex, however we must be guided by the evidence. We need to focus on weight management, increasing physical activity, lowering saturated fat and GI and increasing wholegrains and fibre. Banning sugar altogether is not necessary and can make the diet less enjoyable and less likely to be followed long term.'

Anonymous said...

Thanks for your reply,

I will stand by my advise to patients that no white sugar is allowed in drinks. Patients will usually follow up to 70 to 80% of what you advise tham and if you tell them putting sugar is okay, they will definitley take the liberty to do so.
I do not agree that sugar is not an addiction, it takes many of my patients many months to slowly wean themselves off sugar in their beverages. I remembered reading many diet articles that there is such a thing as "sugar rush" which makes patients feel high after a sugary meal and the subsequent glucose dip after the rush makes them crave for sugary drinks again, no wonder the "sugared" beverages industry in the world is a multi-billion business.... Many of my patients only started taking whole fruits after stopping their sugared beverages and that did them a whole lot of good.
I do not agree that white and brown sugar are the same, even though the GI of both may almost be the same, but the minerals like chromium, magnesium, manganese found in raw unrefined sugar does help the the body's metabolism of carbohydrates, the effect may be minute but it is there. Thats why in the days before whole grain breads were popular, diabetic patients benefitted from wholemeal bread even though both wholemeal bread and white bread almost have the same GI, its the trace minerals in the wholemeal bread that made the difference. Of course now we have whole grain low GI bread and thats even better!
The last point I want to make is that even when patients do not put sugar in their drinks, they would already have consumed at least 10 tablespoons of white sugar in other foods that they eat throughout the day, there's added white sugar in fried dishes, cereals, soups,processed meats, almost everything, so why add anymore in your drinks???
There's a ancient concept in korean eating and that is in a balanced meal, the four main tastes of sweet, sour, bitter, salty has to be balanced for a healthy mind and body, thats why a cup of tea or coffee should be taken bitter to balance all the excessive sweet and salty tastes of today's "modern" diet.

GI Group said...

Dietitian Nicole Senior replies:

'Dear Anonymous,
We’ll just have to agree to disagree about the addiction thing - the scientific literature simply does not support it.

There is no such thing as a ‘sugar rush’, any more than there is a ‘basmati rice rush’ – they have the same glycemic impact (very similar GI).

The nutrition data does not support your assertion that raw sugar contains significantly higher nutrients. To compare white and raw sugar to white and wholegrain bread is inappropriate. Any minerals and trace elements in raw sugar are present in miniscule and biologically insignificant amounts. And if we’re meant to enjoy sugar in small amounts, the type of sugar is even less relevant.

The USDA nutrient database lists the content as follows per teaspoon:

White sugar
Chromium: 0
Magnesium: 0
Manganese: 0

Raw sugar (turbinado)
Chromium: Not listed in USDA (35-45ug AI)- if you have reliable data on the chromium content of raw sugar I would be happy to receive it.
Magnesium: 0.023mg (vs 320-420mg RDI)- 1 teaspoon of raw sugar provides 0.0000718% of the RDI
Manganese: 0.000714mg (vs 5-5.5mg AI)- 1 teaspoon provides 0.000143% of the ADI

We do agree that sugar-free drinks are a good recommendation for patients with pre-diabetes and diabetes.

Best wishes,


Anonymous said...

Is sugar a sweet old friend that is secretly plotting your demise?

There is a vast sea of research suggesting that it is. Science has now shown us, beyond any shadow of a doubt, that sugar in your food, in all its myriad of forms, is taking a devastating toll on your health.

The single largest source of calories for Americans comes from sugar—specifically high fructose corn syrup. Just take a look at the sugar consumption trends of the past 300 years:[1]

* In 1700, the average person consumed about 4 pounds of sugar per year.
* In 1800, the average person consumed about 18 pounds of sugar per year.
* In 1900, individual consumption had risen to 90 pounds of sugar per year.
* In 2009, more than 50 percent of all Americans consume one-half pound of sugar PER DAY—translating to a whopping 180 pounds of sugar per year!

Sugar is loaded into your soft drinks, fruit juices, sports drinks, and hidden in almost all processed foods—from bologna to pretzels to Worcestershire sauce to cheese spread. And now most infant formula has the sugar equivalent of one can of Coca-Cola, so babies are being metabolically poisoned from day one if taking formula.

No wonder there is an obesity epidemic in this country.

Today, 32 percent of Americans are obese and an additional one-third are overweight. Compare that to 1890, when a survey of white males in their fifties revealed an obesity rate of just 3.4 percent. In 1975, the obesity rate in America had reached 15 percent, and since then it has doubled.

Carrying excess weight increases your risk for deadly conditions such as heart disease, kidney disease and diabetes.

In 1893, there were fewer than three cases of diabetes per 100,000 people in the United States. Today, diabetes strikes almost 8,000 out of every 100,000 people.[1]

You don’t have to be a physician or a scientist to notice America’s expanding waistline. All you have to do is stroll through a shopping mall or a schoolyard, or perhaps glance in the mirror.

Anonymous said...

I comment as a non-scientist but as a type 2 diabetic. I consume soy milk that has added sugar, and it has only a minor effect on my BGL, however, oat milk with no added sugar, sends my BGL sky high. Interestingly, if I eat protein first,it lowers the BGL response of my meals. Is this because the overall glycemic load being lower ? hence the protein in the soy milk with the small amount of added sugar doesn't produce a BGL spike ?

GI Group said...

Re soy and oat milks: We will pass this on to our dietitians for comment. However, you may be interested in this piece we ran a month or so ago on various 'milks' including non dairy milks: http://ginews.blogspot.com/2010/04/food-of-month.html

Oat milk has a GI of 69, while soy milk's is nearly half that at around 36.

Anonymous said...

Have any of the "professionals" on Gi Blogspot read Richard K. Bernstein's The Diabetes Solution?