The Nutrition Debate #232: “A spoonful of sugar”

"A spoonful of sugar" is the title of a 9-year old and still very popular post on the blog of Dr. Michael R. Eades, a “sort of traditional M.D. with an eye to what works to get patients well whether it is traditional or not,” in his own words (comment #12). He and his physician wife, Mary Dan Eades, are the authors of “The Protein Power LifePlan,” one of the first and best of the almost 50 books I have read on the subject of optimal health, low carb eating and type 2 diabetes.

The one-teaspoon-of-sugar metric refers to the amount of “sugar” (glucose) that is dissolved in the 5 liters of blood in the circulatory system of a typical human. In the article he goes through the calculations to demonstrate that, a blood glucose reading of 99mg/dl, “the highest fasting blood sugar you can have and not be diagnosed as pre-diabetic,” means that you would have just 4.95 grams of grams of sugar in your blood. One teaspoon of sugar is equivalent to (weighs) just 5 grams.

The American Diabetes Association established these diagnostic thresholds in 2009. They are based on a “normal” fasting blood glucose being 70-99mg/dL, a prediabetic fasting blood glucose being 100-125mg/dL, and a fasting blood glucose reading of 126mg/dL or higher being “frank” type 2 diabetes. See The Nutrition Debate #228, “A1c and your estimated Average Glucose (eAG),” to see how the inexpensive A1c test has more recently become a more reliable standard for diagnosing pre-diabetes and type 2 diabetes status.

“If you run the calculations for 126 mg/dl, the amount of sugar in the blood of someone just over the line into the diagnosis of diabetes, you find out that it is 6.25 grams, or 1 1/4 teaspoon. So, the difference between having a normal blood sugar and a diabetic blood sugar is about a quarter of a teaspoon of sugar,” Dr. Eades tells us. He goes on to slam home his point:

“What really gets kind of scary is when you look at the amount of carbohydrate in, say, a medium order of McDonald’s fries compared to the sugar in your blood. Remember, it is the job of your digestive tract to breakdown the starch and other complex carbohydrates, which are nothing more than chains of sugar molecules, into their component sugars so that they can be absorbed into the blood. An order of medium fries at McDonald’s contains 47 grams of carbohydrate*. 47 grams of carbohydrate converts to about 47 grams of sugar, which is almost 10 teaspoons. So, when you eat these fries you put 10 times more sugar into your blood than that required to maintain a normal blood sugar level. If you figure, as we did above, that one quarter of a teaspoon is all the difference between a normal blood sugar and a diabetic blood sugar, the 10 full teaspoons would be 40 times that amount.”

And if that isn’t scary enough, he then hits you with this coup de grâce:

“Since your metabolic system has to work very hard indeed to deal with the sugar load from an order of fries, imagine what it has to do when you add a large soft drink, a hamburger bun, and maybe an apple turnover for dessert.”

I have to admit I never thought about my pancreas and its declining ability to make insulin (and my body’s declining ability to process that insulin and the “sugar” attached to it in my blood) when I drove up and ordered my large order of fries (as a side order!) to my meal at McDonalds. For 16 years (before my doctor suggested I try low-carb eating to lose weight and help with my type 2 diabetes), I just relied on him to deal with my progressively worsening blood sugar condition. I didn’t know, frankly, that I could treat my own diabetes by the choices I made in what I ate.

Boy, what a difference it made, both in my weight (at one point I had lost 170 pounds) and in my diabetes status. Although I have since regained some of that lost weight (I continue to maintain a 125 pound weight loss), I am still able to stay off almost all of the diabetes meds I had been taking. (I had been maxed out on two orals (metformin and glyburide) and had been started on Avandia). Today, I just take 500mg of metformin once a day. And my blood sugars are “under control,” according to my doctor and the ADA standard of care, so long as I continue to eat low carb.

The takeaway? Just remember that, in a person with a “healthy” metabolism, your body gives itself a shot of insulin the moment you see or even think about eating. A metabolism compromised by impaired glucose tolerance (IGT) no longer can do that. Then, when something sweet or sugary (carbs) contacts your saliva, the brain signals the pancreas to prepare to secrete more insulin… but it’s too late. Your damaged pancreas can no longer make as much insulin as it did before, and the insulin that it does make is not “taken up” by the cells as it circulates around your body. You have insulin resistance (IR).

The result: Your body is overwhelmed by the sugar (glucose) your body has made by digesting the carbs you just ate, and your blood sugar rises above healthy levels, and the damage to your organs and microvascular system inexorably begins…

 * The McDonalds table has been updated. A medium French fries is now 44g of carbs. A large French fries is 67 grams.         Check the sugar content of your McDonalds choices at http://nutrition.mcdonalds.com/getnutrition/nutritionfacts.pdf.