Sugar and Diabetes

The American Diabetes Association (ADA) has issued new dietary guidelines in which all carbohydrates are treated alike, be they from whole wheat pasta, lentil soup, cookies or candy. The new guidelines published in the January Diabetes Care Journal do emphasize that more nutritious sources of carbohydrates should be emphasized.

According to the new guidelines, an occasional sugar-rich snack is okay as long as the total intake of carbohydrates is kept in balance with insulin or other medications, and with exercise, and does not exceed calorie needs. What is the rationale for this liberalization of the diet for those with diabetes? “We are continuing to try to lessen the burden for patients with diabetes,” states Dr. Clark, director of the ADA. The new guidelines largely ignore calorie density and the differences in blood-sugar responses caused by different types of carbohydrate. Essentially the ADA advocates counting the grams of carbohydrate rather than focusing on the type of carbohydrate. No doubt this approach does simplify the dietary treatment of people with diabetes. However, the most common type of diabetes (type 2 DM) is largely the result of genetically susceptible people adopting a typical American diet coupled with a sedentary lifestyle. All over the world it has been observed that the incidence of type 2 DM rises dramatically as more and more modern foods high in fat, sugar and refined grains displace more traditional, less-processed foods. A calorie-dense diet, high in fat, sugar and refined grains with relatively little fiber, provides less satiety than more natural foods. As a result, eating more of such foods leads most people to consume extra calories. It is well established that excessive calorie intake and weight gain promote insulin resistance, high levels of insulin in the blood (impaired glucose tolerance) and eventually type 2 DM. It should be noted that insulin resistance is now a well-established risk factor for heart disease in part because it adversely affects blood lipids. About 2/3 of all patients with diabetes die from heart disease. An increase in dietary sugar not only promotes excessive calorie intake and insulin resistance but it also tends to raise blood lipids when it replaces even refined starch in the diet. A diet higher in natural foods was shown to improve blood-sugar control, lower plasma lipids and reduce the need for medication to lower blood sugar in patients with type 2 diabetes.1By Dr James J Kenney, PhD, FACN1. N Engl J Med 2000;342:1392-8.