When I decided to live with diabetes but without sugar, I had no idea how hard reaching my goal would be. Three-fourths of all the foods for sale in America have added sweeteners, according to an analysis of 85,451 foods that Dr. Barry Popkin of the University of North Carolina and his team studied.
As a careful shopper, I thought that I could kick added sugar right out of my life. After all, I buy all my groceries at Whole Foods and at an even more selective local natural foods store. As Humphrey Bogart said in the film Casablanca, "I was misinformed."
Ever since 2007 I have followed a very low-carb lifestyle. You might call it my diet, but I prefer to think of it as the way I prefer to eat for the rest of my life. On this so-called "diet" I have kept my A1C and weight levels right where I want them to be.
Added sugar doesn't fit in my life. Sugar is not only empty calories, which people might think of as being neutral, neither good nor bad. But one sugar in particular can also be hard for our bodies to handle.
When we talk about the dangers of sugar, we have to be clear what we are referring to.
Several types of sugar exist, and they aren't all created equal.
The most dangerous sugar is fructose, which ironically has the lowest glycemic index. That fact has misled many people into thinking that sweeteners like agave nectar, which is almost pure fructose, is "safe for diabetics," as you can often see it advertised. Scientists now realize that more than the minimal amounts of fructose found in fruit can lead to insulin resistance, weight gain, and high triglyceride levels. Ever since 1972 when John Yudkin published his seminal work on the subject, Pure, White, and Deadly, we have know that fructose uniquely raises serum triglycerides and insulin levels. I know from my own experience before I started eating low-carb foods, my triglyceride level dropped from 160 to 42. One of the best predictors of the risk of developing heart disease is the ratio of triglycerides to HDL. "If you have a ratio of around 2, you should be happy, indeed, regardless of your cholesterol levels," while a ratio of 5, "is problematic," write Drs. Johnny Bowden and Stephen Sinatra in The Great Cholesterol Myths, which I reviewed here. My triglycerides were up in my most recent lipid profile, but only to 51, and my HDL level was 64, giving me a ratio of less than 1.
We get most of our fructose in table sugar, which is half fructose and half glucose (also known as dextrose), as well as in high-fructose corn syrup (or HFCS), which has about the same ratio. Other sugars include galactose, maltose, and lactose, but we don't get enough of them to be concerned about nor do they have the same consequences as eating a lot of fructose.
Years ago I gave away my sugar bowl, and the only sweetener I have in my apartment is stevia. I thought doing this would settle the matter.
Since what I eat is mostly fresh vegetables, fruit, eggs, yogurt, fish, and a little red meat and chicken, I don't give food processors much opportunity to add sugar to my meals. But I do eat some prepared foods, and that's the rub.
I have unknowingly been starting most of my days with an unnecessary and perhaps unhealthy dose of sugar. The smoked wild salmon on most days and the sausage patties on other days all had added sugar. Had I read the Nutrition Facts label carefully I would have know that. Now that I have learned how to read, I have discovered one sugar-free brand each of wild smoked salmon (Echo Falls) and sausage patties that Whole Foods prepares in house.
Of course, I've given up avoiding sugar when I eat out. That will remain hopeless in any Western country for the foreseeable future.
But I thought that at least I could avoid sugar at home. I do make one exception: balsamic vinegar. But the amount I use each day on my salad is less than one-fourth of the amount of fructose in a medium apple, according to the USDA National Nutrient Database. Actually, a little fructose is probably a good thing, according of Dr. Robert Lustig, the most outspoken fructose skeptic, writing in his new book Fat Chance.
"Like alcohol, a small dose of fructose has been shown in some studies to have a beneficial effect on insulin secretion," he writes. "For alcohol, we have empiric evidence that in most people, a maximum dose of 50 gm/day is the threshold for toxicity. This is likely the threshold for fructose as well (slightly less than a quart of orange juice)."
The dangers of sugar are indeed big news these days because of a study by Dr. Lustig and his colleagues at the University of California and Stanford University published on February 27. The full text of this study, "The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data" is free online.
The new study strongly suggests that sugar may be one cause of diabetes. Since my friend and colleague Gretchen Becker analyzed the study at Does Sugar Cause Diabetes? I don't need to here, especially because this information comes too late for those of us who already have diabetes. But I need to put the study in the context of the what the experts have been telling us about eating sugar.
Until 1994 the American Diabetes Association told us that we should avoid sugar. But in May of that year the ADA published a new position statement, "Nutrition Recommendations and Principles for People with Diabetes Mellitus," that focused instead on the total amount of carbohydrates in our diet.
We were misinformed about sugar, the ADA said in essence. "For most of this century, the most widely held belief about the nutritional treatment of diabetes has been that simple sugars should be avoided and replaced with starches," the statement says. "This belief appears to be based on the assumption that sugars are more rapidly digested and absorbed than are starches and thereby aggravate hyperglycemia to a greater degree. There is, however, very little scientific evidence that supports this assumption.
Sucrose produces a glycemic response similar to that of bread, rice, and potatoes.
The use of sucrose as part of the total carbohydrate content of the diet does not impair blood glucose control in individuals with Type 1 or Type 2 diabetes. Sucrose and sucrose-containing foods must be substituted for other carbohydrates gram for gram and not simply added to the meal plan."
Many of us think that the ADA is still misinformed about sugar. Not about sugars in general but about fructose in particular, whether it is in table sugar, HFCS, agave nectar, or other big sources of added fructose.
The ADA's changed position about sugar may not have been beneficial for those of us who have diabetes. But it certainly made that organization's fundraising a lot easier.
Let's follow the money, the wise counsel popularized in the movie All the President's Men. Two examples may be enough.
Food and pharmaceutical companies gave the ADA more than $23 million in 2005, according to The New York Times. Of particular concern, the article continued:
"A three-year, $1.5 million sponsorship deal with Cadbury-Schweppes, the world's largest confectioner. Under the deal, which meets the new guidelines, Cadbury is promoted as an A.D.A. sponsor in several settings, and has permission to use the A.D.A. logo on its Diet-Rite sodas, Snapple unsweetened tea and Mott's Apple Sauce, among other products."
Confectioners use tons of sugar. But sugar companies actually make it.
This January, Domino Foods announced it was pleased "that it is now a National Strategic Partner of the American Diabetes Association." Domino Foods is a subsidiary of American Sugar Refining, the world's largest cane sugar refining company, and it markets sugar under the labels Domino, C&H, Florida Crystals, and Redpath. The ADA doesn't say how much it will get from Domino Foods, but to be a National Strategic Partner you've got to give them at least $400,000 each year.
With all this support from Big Sugar and the ADA's acceptance of sugar for almost two decades, the new study about the dangers of sugar puts the ADA in a bind. The smart thing to do when you're caught between a rock and a hard place is to keep your mouth shut.
The people at the ADA may be misinformed but they aren't dumb. And they aren't talking.
I couldn't find any response to the new study on the ADA's website, so I wrote ADA spokesperson Sarah Bradley.
"We are not issuing a comment on this study," she replied.
Another ADA spokesperson, Anna S. Baker, manager of communications and social media, replied, "We have no comment about this study at this time."
I don't have time to wait for the ADA to resolve whatever internal contradictions the organization may have. I intend to live my diabetes life with a minimum of sugar.