Saturday, March 28, 2015

The Nutrition Debate #300: ‘Sugar’ in Food and Blood: a primer on carbohydrates

I heard an ad on TV last night for a diabetes drug. The ad explains that, “It (the drug) removes some sugar from your body.” I asked (I think audibly to the TV), “How did the sugar (that the drug removes) get into your body in the first place!!!?” And that suggested the corollary question, “If you didn’t eat so many carbohydrates, wouldn’t you have less “sugar” to “remove…from your body”? And this brings me back to the basic question: What foods become “sugar,” in the sense of the ad, in the first place? What foods convert to glucose? The answer, basically, is all carbohydrates.

“Sugar” is in quotes because I am not referring to cane (or table) sugar; I and the ad copywriter are referring to “blood sugar” (glucose), the compound that most carbohydrates break down into by digestion. It’s true that some carbs break down into fructose and glucose, and a few (dairy carbs) into galactose and glucose, and starches are all long-chain glucose molecules, but it is the simple monosaccharide glucose, commonly called “blood sugar” or just “sugar,” to which we refer.

If you have been diagnosed with pre-diabetes or Type 2 diabetes, it is because you first developed a precursor condition called Insulin Resistance (IR). Insulin from your pancreas is required to move the glucose and “open the door” to your cells to “take up” the glucose for energy. IR means the ‘door’ is blocked; glucose can’t get into your cells. It continues to circulate and builds up to high levels, damaging your organs and small blood vessels. You are at high risk for a multitude of diseases.

Most people who are newly diagnosed pre-diabetics or Type 2 diabetics are surprised to learn the “sugar” (glucose) content of common foods. But how much “sugar” (glucose) do carbohydrates make? To understand the answer in context you need to know how much blood “sugar” is “normal,” that is, normally circulating in the blood of a person (before a meal) who has a normal glucose metabolism. The answer is surprisingly low; it’s 1 teaspoon (5 grams equivalent) of “sugar.” See The Nutrition Debate #232, “A spoonful of sugar,” and, for an explanation of the math, the blog of Michael Eades, MD.

As Dr. Eades points out, a diagnosis of Type 2 diabetes is having a “sugar” (glucose) level in your blood equivalent to just 1¼ tsp. Yet, a McDonald's“small” Coke (16oz) has 8 tsp of “sugar,” a Big Mac 9 tsp of “sugar,” a large fries 13 tsp of “sugar,” a large chocolate McCafé shake (22oz) 28 tsp of “sugar,” a bagel 10 tsp of “sugar,” a low-fat chocolate milk 5 tsp of “sugar,” a baked potato 7 tsp and an 8 oz container of low-fat fruit yogurt 9 tsp of “sugar.”  There are hundreds more examples here.
If the door to your cells is partially closed by Insulin Resistance, can you really afford to eat 30, 40, 50 times more “sugar” in one meal (carbohydrates → glucose) than your body can handle? Do you really want to become more and more dependent on drugs to take the “sugar” out of your body that you put into it? You really do have a choice, you know. Self management works. You don’t have to go crazy. You just need to be aware of what your body can handle (by testing your blood sugar), and then be guided accordingly in your food choices. If you don’t, the disease you have acquired by eating too many foods too high in carbohydrates for too long (on the government’s advice!) will surely damage your body, and shorten your life… 

That’s the choice you have to make. I’m not trying to scare you. I’m trying to educate and inform you about how you can make better choices. You probably know this. I hope you feel more empowered now to take the steps you need to take. 

If you’ve read this blog to the end, it’s a safe bet that you’re a neophyte to diabetes, or at least to diabetes self-management. If that’s true, welcome. You might also want to visit Jenny Ruhl’s website, Blood Sugar 101. It’s excellent.

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