Dietary information Topics
- No Added Sugar
- Blood Glucose Levels
- To Carb or Not to Carb?
- Healthy Eating
- Artificial Sweeteners
If you have diabetes you would no doubt have been told to stay away from sugar. Or it may be assumed that you have consumed too much sugar and that is why you developed diabetes. Let’s clear this one up!
There are various types of sugar derived from different sources. Sugars are found in the tissues of most plants but are only present in sufficient concentrations for efficient extraction in sugarcane and sugar beet. Sugar was a luxury in Western Civilisation prior to the 18th century when it became more widely available. It then became popular and by the 19th century it was considered a necessity. This evolution of taste and demand for sugar as an essential food ingredient unleashed major economic and social changes.
Scientifically, sugar loosely refers to a number of carbohydrates, such as monosaccharides, disaccharides, or oligosaccharides. Monosaccharides are also called “simple sugars,” the most important being glucose (or dextrose as it is also known), and there is also fructose and galactose. Fructose or fruit sugar occurs naturally in fruits, some root vegetables, cane sugar and honey and is the sweetest of the sugars. The table or granulated sugar most commonly used in tea and coffee is called sucrose, it is a disaccharide. Other disaccharides include maltose and lactose. Lactose is the naturally occurring sugar found in milk. As you may have noticed the names of typical sugars end with “-ose,” such as in “glucose”, “dextrose”, and “fructose”. Sometimes such words may also refer to any types of carbohydrates that are soluble in water.
Sugar has been linked to obesity and is suspected of causing diabetes, there are also links with high sugar intake and the development of cardiovascular disease, dementia, macular degeneration and tooth decay.
“No Added Sugar”
Often foods are labelled as having “no added sugar” and yet they make your blood glucose level rise! If you are wondering about why this happens consider the following:
Beware of Fruit Juices as they are loaded with sugar!
Although the manufacturer has not added any extra sugar to the juice, fruit contains fructose which is a kind of sugar and as such will increase your blood glucose level. For example, a 500ml bottle of 100% orange juice contains around 45g of carbohydrate, which is equivalent to 3 slices of bread or 3 spoons of sugar!
Beware of flavoured yogurts as they are often loaded with sugar!
Flavoured yogurts are often labelled as having “no added sugar”, but when you read the ingredients you’ll see they contain fruit concentrate (jam), which is a type of fructose and is exactly the thing that gives the yogurt a deliciously sweet taste (whilst increasing your blood glucose level). Remember this saying “if it tastes like dessert it is a dessert”, and therefore it should be avoided or used minimally, particularly for people with diabetes.
Blood glucose levels
Contrary to popular belief, eating excessive amounts of sugar does not seem to increase the risk of diabetes, although the consumption of extra calories (from large amounts of sugar) can lead to obesity, which in itself increases the risk of developing this metabolic disease. It used to be believed that sugar raised blood glucose levels more quickly than did complex carbohydrates such as starch, because of its simpler chemical structure. However, it turned out that white bread or French fries can have the same effect on blood sugar as pure glucose, while fructose, although a simple carbohydrate, seems to have a minimal effect on blood glucose levels. As a result, as far as blood sugar is concerned, carbohydrates are classified according to their glycaemic index, a system for measuring how quickly a food that is eaten raises blood sugar levels, and glycaemic load, which takes into account both the glycaemic index and the amount of carbohydrate in the food. This has led to a method commonly referred to as carbohydrate counting, which can help people living with diabetes in planning their meals.
To Carb or Not to Carb?
The concept of carbohydrates can be confusing. There is a plethora of conflicting advice out there about what type, how much, when, the good, the bad, and on top of all that, carbohydrate is an ‘umbrella’ word for a vast selection of foods and can impact on health in many different ways.
So let’s try and break this down for you. This group of foods can include high quality foods that have many important nutrient qualities that we should include in our diet every day and are linked to low cholesterol, good blood pressure and weight management. However there are also the poor quality carbohydrates that are linked to weight gain, poor dental health and chronic disease. So the real question here is not ‘if to carb?’, but ‘which carb?’
High quality carbohydrate includes fresh fruit and starchy vegetables, whole grain breads and cereals, dairy products with no added sugar, and all of your grains such as rice, pasta and the more exotic quinoa and freekah. Legumes are another important food group that are considered a carbohydrate including lentils, chick peas and baked beans. As a group these foods provide us with fibre, protein, folate, iron, calcium, potassium, vitamin A and C and a whole lot more. These foods and nutrients have been linked to reduced diabetes risks, effective weight management, good heart health, cancer prevention, good bowel health and improved blood sugar control.
The low quality carbohydrates are the foods to limit here. These foods tend to nutrient low and calorie high contributing to weight gain and poor sugar control. Of course these include confectionery, chips, cakes, soft drinks and take away foods. Not one diet fits all, and if you are attracted to the low carb diet for weight loss you could actually be risking poor bowel health, poor bone health, fatigue and muscle loss, nutrient deficiencies and limited weight loss success.
The nutrition goal with carbohydrate is to reduce the poor choices, and to include a daily intake of high quality choices in the right amount to suit your requirements.
Have you often wondered about your eating habits?
Most of us are prone to “eat on the run” or to “go for the take-away” simply because we feel its quicker and easier or that we feel that we do not have the time to eat well or we have never really understood what healthy eating is about.
If this is you then the following link may be of interest to you:
I recently read an article about “the sour side of “natural” sweeteners” (published in http://www.6minutes.com.au/nutritionupdate/latest-news/). In this article sugar substitutes were compared and explained and I just could not keep this information from you.
With your regular table sugar getting such a bad rap and natural sugar substitutes being believed as healthier options we should understand what is “natural” and how “healthy” are these substitutes really?
The term “natural” is inaccurate to say the least, and in the case of sweeteners generally applies to anything derived from a plant rather than a laboratory. The processes required to extract the natural sweet substance from these plants and to produce a commercially worthwhile product are unnatural. Additionally, many natural substances are harmful if taken in large doses.(1)
To understand the difference between the sugars and their health effects we first have to understand that natural sweeteners can be divided into 2 main groups:
- Non-nutritive sweeteners – they provide few, or no, kilojoules, carbohydrates or any other nutrient and are used most commonly around the world.(1)(2) Most non-nutritive sweeteners are artificial, the most well-known natural non-caloric sweetener is stevia, derived from a South American plant leaf.
- Nutritive sweeteners – When we consider a “sugar-free” product, it usually means “contains no sucrose (table sugar)” but these so-called “health foods” and sugar-free recipes can contain as much sugar – and calories or kilojoules – as sucrose-containing foods.(1)
So what should you consider before buying natural sweeteners?
Most sugar in the Australian diet is sucrose from sugar cane(4) whilst most sugar in mainland Europe is sucrose from sugar beets.
Sugar beets grow exclusively in the temperate zone, in contrast to sugarcane, which grows exclusively in the tropical and subtropical zones. Sugarcane belongs to the grass family Poaceae, an economically important seed plant family that includes maize, wheat, rice, and sorghum and many forage crops. The sugar beet on the other hand has a white, conical, fleshy root with a flat crown. The plant consists of the root and a rosette of leaves. Sugar is formed by photosynthesis in the leaves, and is then stored in the root.
As explained above, nutritive sweeteners have the same number of kilojoules as (or in some cases even more kilojoules than) regular table sugar. Or in other words: “Sugar-free” does not mean “calorie free”. As most “natural” sugar substitutes have as many kilojoules as table sugar they must be counted as part of daily energy intake.(1)
Some sweeteners, such as honey and molasses, also provide small amounts of micronutrients above and beyond their sweetening effect. It is therefore advisable to always read food labels.
Some natural substitutes, such as sucrose, honey, molasses, and maple syrup can contribute to tooth decay.(1)
Some sweeteners are poorly absorbed by people with Irritable Bowel Syndrome (IBS), causing abdominal pain, bloating, gas, distension and altered bowel habits.(1)
It mostly involves those sweeteners containing FODMAPS (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) and examples include: fructose (usually found in fruit and honey); lactose (found in milk products); and polyols such as sorbitol and mannitol (often used in processed foods). Did you know that a low-FODMAP diet could improve gastro-intestinal symptoms for up to 75% of people with IBS?
Sugar alcohols (polyols), such as sorbitol, mannitol, maltilol and xylitol, have fewer calories and less of an impact on blood glucose levels than sucrose, but they may have a laxative effect.(1)
Effects on blood glucose levels
One of the main issues with the nutritive sweeteners is their effect on blood glucose levels, which is of course particularly important for people with diabetes.(1)
Glucose and maltose-rich sweeteners like rice syrup generally have a high Glycaemic Index (GI), sucrose and sucrose-rich sweeteners like brown sugar are moderate in GI, and fructose-rich sweeteners have a low GI.(1)
We should note that all sweeteners have benefits and disadvantages and people with diabetes can include some sugar in their diet. Particularly when replacing large amounts of sugar, non-caloric sweeteners can be used in place. Either way foods high in added sugars are best consumed only occasionally, whether one has diabetes or not.(4)
1. Barclay A et al. The Ultimate Guide to Sugars & Sweeteners. The Experiment LLC, New York, 2014.
2. Suez J et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature 2014; 514:181–6.
3. Food Standards Australia and New Zealand. Intense sweeteners. Available online: http://www.foodstandards.gov.au/consumer/additives/intensesweetener/Pages/default.aspx. Accessed 17/6/16.
4. Diabetes Australia. What should I eat? Available online: https://www.diabetesaustralia.com.au/what-should-i-eat. Accessed 17/6/16.
The information on this page is guide only and not medical advice. As individual circumstances vary, please consult your healthcare professional before acting on any of this information.