Читать книгу 16 Myths of a Diabetic Diet - Karen Hanson Chalmers - Страница 9
ОглавлениеPeople with diabetes must avoid all foods that contain sugar.
JUDY: I was just diagnosed with diabetes right before moving to this area. My former doctor told me to stay away from any foods with sugar—I can’t even eat carrots! She also told me to see a registered dietitian but didn’t tell me how to find one.
DIETITIAN: You must be feeling completely overwhelmed by your new diagnosis. You must also feel very limited with your food choices. The good news is that the main goal of medical nutrition therapy for those with diabetes is not to avoid sugar, but to eat a healthy balance of foods spread out over the day.
JUDY: I remember that my grandmother had diabetes for years and could never eat desserts or foods with sugar. Even after depriving herself for years, she still had many complications related to diabetes. And to make matters worse, I’m addicted to sugar!
DIETITIAN: Actually, new nutrition guidelines were introduced by the American Diabetes Association in the 2000s. Each year, the nutrition guidelines are updated based on the most current research. So, not only can sugar be added into any healthy eating plan, but we now have many new treatment options for people with diabetes to prevent or delay the complications of diabetes. There are two other pieces of good news. One is that you can certainly eat carrots! The second is that although people do like and desire foods with sugar, this does not qualify as an addiction.
WHAT’S NEXT?
The need to avoid sugar is one of the biggest misconceptions in diabetes management today. Like Judy, many people with diabetes mistakenly work extremely hard to eliminate all foods with sugar. Judy learned that this was nearly an impossible task because many healthy foods have some form of sugar in them. Some foods contain “added sugars,” whereas other foods naturally contain sugar. Many research studies completed over the past 30 years have shown that foods containing sugar can be part of a healthy diet, even for those people with diabetes, and can be fit into an eating plan, just like any other carbohydrate food.
After several diabetes appointments with the dietitian, Judy learned that sugar is not forbidden or harmful and began to feel more comfortable about fitting many new foods that contained sugar into her eating plan. Instead of feeling guilty about eating sugar and trying to avoid it at all costs, Judy was able to take control of her situation and manage to fit some foods with sugar into her eating plan.
THE OLD AND THE NEW
Nutrition therapy has always been the cornerstone in the self-management of diabetes; however, some people with diabetes have had little training in medical nutrition therapy and may have been told to “watch their diet” and to “stay away from sugar.”
A brief historic review reveals that hundreds of years ago, diabetes was attributed to eating an excessive amount of food with sugar and flour. This meant that mostly all carbohydrate foods were restricted and that those with diabetes were put on a “starvation diet” of mostly fat and some protein. From that time, until insulin was discovered in 1921, a person’s carbohydrate content came only from vegetables, such as onions, lettuce, radishes, cabbage, and mustard greens. Eventually, insulin was isolated in 1921, and the “starvation diet” took a giant step backward, while various nutritious food choices started taking baby steps forward. Although fruits were mostly restricted, carbohydrate intake was on the upswing, from 20% of calories from carbohydrate in 1921 to what the American Diabetes Association now recommends as that amount of carbohydrate based on each individual’s blood glucose, weight, and lipid goals. However, it wasn’t until the 1980s, when home blood glucose monitoring was introduced, that health professionals started to understand how certain carbohydrates really affected blood glucose levels.
For years, people with diabetes were taught to avoid concentrated sweets, known as simple sugars, because they were thought to overload the blood with sugar much faster than starches, which were known as complex carbohydrates. Dr. Elliot Joslin stated the general consensus about starch and sugar best in his early editions of Joslin’s Diabetic Manual for Doctor and Patient:
• Sugar enters the blood as fast as a child runs.
• Starch enters the blood as fast as a child walks.
• Starch in vegetables enters the blood as slowly as a child creeps.
This was the explanation used when emphasizing to people with diabetes how important it was to strictly avoid sugar, to carefully measure starchy foods, and to eat vegetables more freely. We followed the assumption that sugar was harmful to people with diabetes until the 1970s, when scientists started to look for clear evidence of how sugar and diabetes interacted. In the latter part of the 20th century, the American Diabetes Association and prominent researchers in the field of diabetes studied the published findings from many scientific studies on nutrition and diabetes. They concluded that there was little scientific evidence to suggest that sugar is more quickly digested and absorbed into the bloodstream or that sugar elevates blood sugar more than starch. Sugar, we learned, has an impact on blood glucose similar to that of any other carbohydrate. Therefore, the use of sugar as part of the total carbohydrate content of the diet is okay for people with diabetes as long as these sugar-containing foods are substituted for other carbohydrate foods as part of a balanced meal plan. Nutrition therapy is no longer about avoiding sugar but rather about well-controlled blood glucose levels. Finally, people with diabetes started being taught how to eat realistically instead of ideally.
WHAT IS SUGAR?
The three types of carbohydrate are sugar, starch, and fiber. These carbohydrates are all made up of a certain number of “sugar blocks.” Some are single blocks, some are double, and some are many blocks connected together in long chains. Carbohydrates do, however, vary in their chemical structure and in the number of units (or sugar blocks) that are put together to make them. The carbohydrates with only one or two sugar blocks are called simple carbohydrates. The carbohydrates with many sugar blocks connected together are called complex carbohydrates (see Chapter 3).
There are six important sugars in nutrition. Three are single sugars (monosaccharides) and three are double sugars (disaccharides).
The single sugar blocks are the monosaccharides: glucose, fructose, and galactose. The double sugar blocks are the disaccharides: maltose (glucose + glucose), sucrose (glucose + fructose), and lactose (glucose + galactose).
Starch and fiber are called polysaccharides and are composed of straight or branched chains of the single sugars called monosaccharides. In this chapter, we are mostly talking about sugars (or simple carbohydrate) because these are the carbohydrates that many people with diabetes think they have to avoid.
The Monosaccharides
Glucose is the largest, the most common, and the most complicated of all of the sugars. Glucose is always found as one of the two sugars in disaccharides and is the basic unit of starch and fiber. Glucose is simply the form that carbohydrate takes in the body as our fuel.
When carbohydrates are digested, they are converted into glucose and our blood sugar levels rise. Almost 100% of carbohydrate foods break down into glucose and are available as fuel. Therefore, carbohydrate is our main source of energy. We do not always use all of the blood sugar from carbohydrate right away. With insulin’s help, some glucose is stored in the liver, where is it changed into a storage form of glucose called glycogen. This glycogen can give you quick energy if you should need it and takes care of your energy needs while you are sleeping. Fuel is also stored in muscle as glycogen, but this storage does not last long, especially during exercise.
Fructose is the sweetest of the sugars and, in combination with glucose, is a component of table sugar (sucrose). Fructose occurs naturally in fruits, berries, vegetables, and honey. It is also used as an additive in products sweetened with high-fructose corn syrup, a food additive that people with diabetes should cut down on. Although many people with diabetes believe fructose may be a better choice as a sweetener, the American Diabetes Association states that the “use of added fructose as a sweetening agent in the diabetic diet may have no overall advantage over other sweeteners.”
Galactose is not as common as glucose and fructose. It is one of the three monosaccharides common in foods but its sugar block is always connected to another sugar block to form lactose, the sugar in milk.
The Disaccharides
The disaccharides are double sugar blocks of the three sugars above, with glucose being a part of all three sugars.
Maltose consists of two glucose units and is only a part of a few foods. Maltose appears when starch is broken down, such as during digestion, when seeds germinate, and when alcohol is fermented.
Sucrose consists of fructose and glucose and forms what we know as table sugar. This is the most common of all the sugars and gets its sweet taste from fructose. The main food sources of sucrose are the juice from sugar cane and sugar beets. Sucrose is processed to make brown, white, or powdered sugar. Today, sucrose can be part of an eating plan for anyone with diabetes. It is no longer forbidden or restricted for people with diabetes, although it should be used in moderation.
Lactose consists of galactose and glucose and is a disaccharide found in the milk of mammals. Lactose is the main carbohydrate found in milk and often referred to as milk sugar.
WHERE IS IT FOUND?
Natural or Added?
So now you know that sugar—any kind of sugar—is just a type of carbohydrate and is only one type of sugar among several that are found in foods. Although we now know that sugar has a similar impact on blood sugar as do many other carbohydrates, let’s think about how sugar occurs in food: is it found naturally in food or is it added to the food? Natural or added sugars still have the same effect on blood sugar levels; however, the foods that contain these sugars may not be equally healthy or nutritious.
For instance, an apple contains carbohydrate in a natural sugar (fructose), whereas a candy bar contains its carbohydrate from an added sugar (sucrose). You know the apple is healthier because it is a good source of many vitamins, minerals, and fiber. The candy bar, on the other hand, is what we call an empty-calorie food, which means that although it may taste good, it doesn’t offer any health benefits. It also contributes a great deal of fat and calories. Remember, though, that you can choose to occasionally have an empty-calorie food as long as you substitute that food for another carbohydrate food. This is because your body does not necessarily recognize the natural or added sugars, but instead reacts to the total amount of carbohydrate you have eaten.
Finding the Sugar
One way to find the sugars in food is to look at the Nutrition Facts on a food label, under the Sugar category. But generally, you should look at the grams of Total Carbohydrate instead. Here’s why.
If you look in the ingredient list, the sugars in the product will be individually listed, but often listed under an alias that most consumers do not recognize as sugars. The sugar listed on the label could include any of the following:
| Brown sugar | Honey |
| Confectioners’ | Invert sugar |
| sugar | Lactose |
| Carob | Maltose |
| Corn syrup | Maple syrup |
| Dextrose | Molasses |
| Fructose | Sucrose |
| Galactose | Turbinado |
| Glucose |
Some sugars listed in the ingredient list, but not necessarily listed next to sugar on the upper part of the label, include the sugar alcohols—hydrogenated starch hydrolysate, sorbitol, mannitol, maltitol, isomalt, and xylitol. The manufacturer is not required to list these sugar alcohols on a food label unless the food product clearly states that the food is “sugar-free.” These may be listed next to “Other” or “Sugar Alcohols,” directly under “Sugar,” or they may be found only in the ingredient list. However, all sugars must be added to the grams of Total Carbohydrate. So overall, it is more important to look at grams of Total Carbohydrate than the grams of Sugar.
Some of the foods listed below will give you an idea of what one serving of a “sugar” food can look like:
| 2-inch square brownie | 1 Tbsp 100% fruit spread |
| 1/2 cup nonfat chocolate | 1/2 cup regular gelatin |
| milk | 1 Tbsp regular syrup |
| 2-inch square unfrosted | (no fat) |
| cake | 1 granola bar |
| 1/4 cup sherbet or | 1/2 sweet roll or Danish |
| sorbet | 1/2 cup light or regular ice |
| 2 Tbsp light syrup | cream |
| (no fat) | 2 sandwich cookies |
WHY DO WE NEED IT?
We don’t really need sugar; however, sugar is found in many healthy foods and it tastes good. Natural sugars, such as those found in fruit, vegetables, and milk, make up about one-half of the sugar intake in the U.S. Added sugars, such as those found in cookies, soda, cakes, and candy, make up the other half of our sugar intake.
THE UPSIDE AND THE DOWNSIDE OF SUGAR
Sugar has received bad press for many years. Aside from the sweet taste that sugar adds to food, the only proven information that we have about sugar is that it contributes to tooth decay if eaten in excessive amounts. But we also know that, if eaten in moderation, when blood sugar control and weight are maintained, sugar is not necessarily harmful to our health. Let’s clear up some of the confusion about sugar by looking at the upside and the downside of this controversial carbohydrate.
The Downside
Extra calories
Many empty-calorie foods such as candy, cake, and ice cream give you fuel and pleasure but none of the benefits of vitamins, minerals, fiber, and protein. If you are taking in 15–20 grams of carbohydrate from a candy bar instead of from a piece of fruit, then you will not only be taking in more calories (from fat), but you are also trading a healthy food for a not-so-healthy food. Even the fat-free versions of many of these empty-calorie foods will give you extra calories, because food manufacturers have to add more carbohydrate (sugar and/or starch) to stabilize the product when the fat is removed. Therefore, dessert foods should not replace healthier foods on a regular basis, regardless of whether you have diabetes.
Small portion sizes
Often if you eat a food that has a lot of its carbohydrate coming from sugar, you may have to eat a smaller quantity. For example, 1 cup of Cheerios contains about 22 grams of total carbohydrate:
1 gram comes from sugar
3 grams come from fiber
18 grams come from starch
However, if you decide to eat 1 cup of Frosted Cheerios instead of the regular Cheerios, you will get 25 grams of total carbohydrate:
13 grams come from sugar
1 gram comes from fiber
11 grams come from starch
So, if you are taking in 30 grams of carbohydrate from a cereal, you could have about 1 3/4 cups of Cheerios but only 1 1/4 cups of the Frosted Cheerios. You can leave it up to your appetite to decide which one you want.
Dental caries (cavities)
The digestive process begins in the mouth as soon as we start chewing food. Both sugar and starch break down into glucose in the mouth and equally contribute to tooth decay. Bacteria in the mouth thrive on food and ferment the sugars in carbohydrate foods. During the fermentation process, the bacteria produce and leave behind an acid that eats away at tooth enamel. The whole decaying process actually depends on how long the food stays in the mouth. However, regular brushing and flossing along with limiting large amounts of sticky carbohydrate foods will help prevent dental cavities.
The Upside
Moderation is the key
Moderation is the key When eaten in moderation, sugar does not cause health problems such as obesity, hyperactivity, diabetes, and heart disease. However, sugar can contribute to weight gain and obesity if eaten in excess. It has actually been documented that obese people eat less sugar than do thin people.
Sugar does have positive traits as an additive
Sugar serves as a food additive to enhance and balance flavor and aroma by adding color and texture (that brown, crusty texture in baked goods). Sugar also acts as a preservative by keeping foods fresh. It adds bulk to ice cream and baked goods, helps to retain air in light-textured products, balances acidity, and lowers the freezing point of foods. Sugar also softens acidity and prolongs shelf life.
HERE’S WHAT YOU CAN DO
1. Use sugar as part of your total carbohydrate intake. This does not mean that you should eat unlimited amounts of sugar or dessert foods, but rather eat these foods in moderation. Totally eliminating sugar is unnecessary and impossible.
2. Reduce the amount of sugars and dessert foods in your diet, whether you have diabetes or not. Relate the amount of these foods in your diet to your level of activity and exercise.
3. Read food labels to determine how much of that food’s carbohydrate is coming from sugar and if the food is nutritious rather than just an empty-calorie food. For instance, instead of chocolate cookies, eat oatmeal cookies; instead of frosted cereals, eat plain-type cereals and add berries for sweetness.
4. Use the Serving Size as your guide when eating high-sugar foods. Most average-size cookies list one or two cookies as a serving size, whereas ice creams list 1/2 cup as a serving size. Most people eat at least twice as much.
5. Be sensible, but enjoy your new food choices. You are not “cheating” if you eat foods that have sugar in them as long as your meals are within the context of healthy eating, meaning that you balance those foods with your carbohydrate intake. You are not a bad person for enjoying all foods. You are a normal person who happens to have diabetes and who has to live in the real world.
SUMMARY
Although it has been many years since nutrition guidelines for diabetes have become more realistic, people with diabetes still believe that avoiding sugar is the main goal of nutrition therapy. After years of educating people with diabetes about the dangers of sugar and giving them lists of “good” and “bad” foods, we now know that sugar is just a form of carbohydrate. With proper education from a registered dietitian, you can learn how to choose your carbohydrates wisely.
YOUR TURN
Now it’s your turn to recall some key points from this chapter. Let’s see how you do!
1. Natural sugars found in fruits, vegetables, and milk make up about one-half of the sugar intake in the U.S. Added sugars such as those in cookies, soda, cakes, and candy make up the other half. True or false?
2. The primary naturally occurring sugar found in milk is called ____________ and is often called milk sugar.
3. Three examples of “empty-calorie foods” include:
_____________________
_____________________
_____________________
4. You are “cheating” on your meal plan if you eat foods that have added sugar in them. True or false?
See APPENDIX A for the answers.
