Retrospective #28: “I don’t eat sugar,” she protested.

I ran into a friend at the supermarket the other day and asked her how she was. She replied, “Fine…tired a lot.” Not wanting to miss an opportunity to proselytize, I suggested, “Sugar crash.” “I don’t eat sugar!” she protested. So, I asked her what she ate for breakfast. Therein lies a tale of folly and self-deception that deserves to be debunked.

Sugar, as she and virtually the whole world thinks, is just table sugar, as in “added sugar” such as that sprinkled on cereal. It’s also a major ingredient in candy, ice cream and, formerly, soft drinks (high fructose corn syrup, today).

Table sugar, the “added sugar”, is cane sugar and is chemically known as sucrose. It is a disaccharide, meaning it is composed of two simple sugar molecules: fructose and glucose. All chemical compounds ending in “ose” are sugars. Most break down in the digestion process to glucose, some to fructose, and a few to galactose, the third monosaccharide (single molecule sugar), before entering the blood stream through the wall of the small intestine.

Sugars in this “added sugar” sense do not include those found in fruit. But sugar in fruit is a combination of free (single-cell) fructose, free glucose and sucrose, a disaccharide. Fruit sugars are thus not regarded as “added sugar” because they are an inherent or integral component of this “real” or whole food found in nature. Forget that for centuries, to appeal to our sweet tooth, hybridizers have been making fruit sweeter than those found in nature.

All carbohydrates are saccharides. Sugars, as found in fruit, are the simple, single and double-celled saccharides. Other carbohydrates, including cereals, bread, potatoes, rice and pasta, are more complex compounds, called polysaccharides, meaning composed of many molecules, most of them glucose. Nevertheless, these long chains of glucose molecules all break down in the digestion process to the simple sugar glucose. Glucose goes to the cells for energy. Fructose goes directly to the liver and is stored, if there’s room, as glycogen, or as fat. That’s right, fat!

Back to the question I asked my friend: “What did you eat for breakfast?” Her answer: “A glass of orange juice, a whole grain cereal ‘with 3 grams of protein’ [in reduced-fat milk], toast and jelly.” “That’s all sugar,” I exclaimed!

I continued, explaining, “If you eat a lot of “sugars” – carbohydrates → glucose, thus ANY FOOD EXCEPT FAT AND PROTEIN -- all at once, your blood stream will, sooner or later (1 to 2 hours, generally, depending on the food and condition of your metabolism, be flooded with “sugar” (glucose). Then, after the glucose gets delivered to muscles and organs by the hormone insulin, your blood sugar will CRASH and you will ‘feel tired’ (and hungry) again.”

So, when your “all sugar” breakfast is digested, in mid-morning your body will again crave “sugar” (i.e., anything that will break down to glucose) to “feed the beast.” A “sugary snack” doesn’t mean a candy bar; It means any carbohydrate, including fruit, or a glass of milk (lactose), all of which will break down to glucose and again raise the level of “sugar” (glucose) in the blood. It will also overwork your pancreas to produce more insulin. A vicious cycle.

Over a course of years, the cellular receptors of “destination” cells in many people will develop Insulin Resistance, requiring more insulin to get the job of delivering glucose energy to our muscles done. Eventually, in many people, the pancreas will slowly burn out. The beta cells in the pancreas that produce insulin will stop working. They will clog up or die. By the time your doctor discovers this, up to 80% of your pancreatic function will probably already have been lost. That was the stunning conjecture made by Dr. Ralph DeFronzo, in his 2008 keynote address to the American Diabetes Association at their annual meeting in San Francisco.  You will be diagnosed with full-blown Type 2 Diabetes and likely drug dependent for the rest of your life. You will then be watchful for, or worse still, diagnosed with a “dreaded complication”: neuropathy, retinopathy, and nephropathy (end-stage kidney disease).

The “new” (2010) diagnostic standard for T2 diabetes is an A1c of 6.5%. Previously (from 2002), the diagnostic standard for Pre-diabetes was a FBG of 100-125mg/dl and for Type 2, ≥126mg/dl (cut from 140mg/dl in 1997). Some endocrinologists today use a lower standard, regarding an A1c of 5.7% as indicating full-blown Type 2.

So, to stay healthy, watch your total “sugars” and remember: All carbohydrates are saccharides (“sugars”). Your body breaks all carbs down into glucose, or “blood sugar.” If you still think you “don’t eat “sugar,” read this again!