Sugar and Diabetes: The Myth That Won't Die

John Bantle, MD, puts it in real-world terms:

| Jun 26, 2008

Years ago, John Bantle, MD, gave brownies to people with diabetes. Brownies made with real sugar. And their blood glucose levels…did not skyrocket.

Bantle and his colleagues were comparing two meal plans. Both plans had the same amount of carbohydrate. In one, much of the carb was from sugar. In the other, the carb came mainly from starches. Participants ate one meal plan for 28 days and then switched to the other.

Participants’ blood glucose levels were essentially the same when they ate the high-sugar meals as when they ate the high-starch meals. Conclusion: Sugar is just another carbohydrate. It’s the amount of carb, not the source, that determines blood glucose levels.

That was 15 years ago. Yet today, people who have diabetes still hear, “You can’t eat that. It has sugar.”

Will the myth ever die?

“Old ideas that are wrong do die,” says Bantle, a professor of medicine at the University of Minnesota, Minneapolis. “It just takes them a long time. People spent 60 years drumming it into people with diabetes. It was in all the textbooks. And if your blood sugar is high, intuitively it makes sense that you shouldn’t eat sugar.”

But starch is a string of glucose molecules. When people know that, they can see that starches will raise blood glucose levels just as sugar will.

“A lot of people who are up-to-date in diabetes consider this old news,” says Bantle. “But if you go to the primary care arena, I think they’re much less aware. I was talking to some medical students last week, and they thought sugar was a bad thing. But they’re just a product of their culture. As I talk to patients, some people seem to know it, and for others it comes as a surprise.”

For years, the American Diabetes Association’s Nutrition Recommendations have included their version of  “Sugar is just another carb.” In the 2008 position statement, the wording is: “Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications. Care should be taken to avoid excess energy intake.”

Bantle puts it in real-world terms: “Foods that contain sugar don’t produce a greater rise in blood glucose than bread, rice, and potatoes, if the calories are the same. If you add dessert to a meal, increasing the amount of carbohydrate, your blood sugar will be higher. But you’d have the same effect if you had a double helping of mashed potatoes or an extra roll.”

Readers, what has been your experience with sugars versus starches? Does your meter tell you that a dinner roll is the same as a piece of cake?

Marie McCarren is the author of A Field Guide to Type 2 Diabetes and ADA Guide to Insulin & Type 2 Diabetes.

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Categories: Blood Glucose, Blood Sugar, Desserts, Diabetes, Diabetes, Food, Insulin, Nutrition Advice, Nutrition Research, Type 2 Issues

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Posted by jertut on 26 June 2008

My experience is oatmeal, orange juice,bannas
raise my blood sugar faSTER AND HIGHER THAN CANDY BARS.

Posted by pogoberg on 26 June 2008

I have the same experience with jertut. Bread, rice, and potatoes raise my blood sugar more than simple sugars like candy or fruit.

Posted by Better Cell on 26 June 2008

Artificial Sweeteners will do more damage and harm to your Body than will *sugar.*
Even-though it has 0 nutritive use, it is still not as destructive as artificial sweeteners provided like everything else, its use is not overdone.

Posted by Green Lantern on 27 June 2008

I'm actually truly appalled to see this argument in 2008, with what we know now about how carbs (sugars and starches) cause weight gain and mess with BG control. This advice ("sugar is the same as starches, so go ahead and have chocolate cake!") is what the ADA came out with in the early '80s (I was working in a hospital at the time), and I thought it was idiocy then. (It was!)

Since that time, obesity and type 2 DM have become epidemic. Sure, there's high fructose corn syrup & trans fats in our food supply now, but most of the nation's weight gain can be traced directly to the advice to eat a low-fat, high-carb diet. They fatten cattle with grain for a reason--it WORKS. (NO study has actually managed to find that fat makes you fat, because, in fact, it doesn't. This so-called "common sense" approach doesn't match what happens in the body.)

Dr. Bernstein & Dr. Rosedale are on the right track, IMHO. NON-starchy vegetables, moderate protein, and lots of healthy fats (nuts, avocados, olive oil, salmon...) keep us healthy, help us lose weight, and allow insulin-dependent folks to use less insulin.

Grains and dairy were the last food groups added to the human food supply (if you don't count chemical "foods") when we switched over from being hunter-gatherers to doing agriculture 10,000 years ago. Our bodies haven't had time to adjust, and these foods are still the most likely causes of allergies. Tropical fruits (except coconut) are high in sugars, but berries are worth their carb load. Sensible eating--not sugars and starches--would help so many...

Posted by Richard157 on 27 June 2008

I was diagnosed with Type 1 in 1945. I used a lot of saccharin in my early years. The experimentd conducted in Canada showed that saccharin caused cancer in rats. It was later found that the amount of saccharin fed to the rats was so large that a human would have to use an enormous amount of it if the experiment ws to be duplicated for humans. The experiment in Canada was conducted inappropriately and the results were misleading. Another example of how to lie with statistics. Saccharin is safe if used in reasonable amounts. So are many other artificial sweetrners. I have used them for 62 years and I am exceptionally healthy with no diabetes complications. I never hesitate to use foods containing artificial sweeteners.

Posted by YODA on 27 June 2008

Sugar raises blood glucose as much as starches, so sugar is OK?

Baloney! Both sugar AND starches are POISON to diabetics!!

Try Dr. Bernstein's regimen (see Green Lantern above). You'll feel a lot better and last a lot longer.

Posted by Seymour on 27 June 2008

From reading these comments, it looks like the myth is still alive. SUGAR is a carbohydrate. It is the amount rather than the type that controls blood sugar.

Each carbohydrate has an absorption time associated with it. Table sugar is pretty quick to get into the blood but it has the same overall effect as other carbs. Peanuts actually cause me more control problems due to their very slow conversion to blood sugar.

You should not depend on anyone's regimen, but rather monitor your blood sugar and maintain the balance. Eating a healthy diet is for everyone, not just diabetics. When your sugar is not controlled, it does not much matter what you are eating, you are wrong.

Posted by Anonymous on 27 June 2008

What this says to me is that starch is just as bad as sugar when it comes to controlling blood glucose. My glucose meter confirms that, at least for me. I totally agree with Green Latern and YODA. By cutting out both sugar & starch, I have lost over 100 lbs and am maintaining an A1C under 6%.

It was imposible for me to lose weight on a low fat, high carb (with plenty of "healthy complex" carbs) diet. I eventually developed type 2. As Seymore said, "When your sugar is not controlled, it does not much matter what you are eating, you are wrong." It should be simple common sense.

The real myth here is that diabetics should eat starch.

Posted by Anonymous on 27 June 2008

I'm no Doctor, but I have been a type 1 diabetic for 20+ years, and relate closely with the medical field.

It is obvious that sugar and "breads" raise blood sugars, so having more of it every day is not a good idea.

I am discouraged by what the 'medical community' says is right. I now go with what makes common/logical sense. As an 8 year old, I was told to have several "breads" a day (3 for breakfast, 2 for lunch and 2 for dinner, with snacks in between). Today, the advice is totally opposite - eat less starch/carbs/bread and you will be able to control your diabetes better. So who was right - the Dr's in the 80's or the Dr's of today? 2 very opposite view points.

However, anyone who's diabetic will need sugars (in either form) several times during their diabetic lives. When I experience low blood sugar, do I go for the fruit stand? Hell no, I grab something that is fast acting, that will help me push through my "normal" day. At work there are chocolates and other junk food. Do I think twice when I need a pick me up? Nope - I go right for what will help me right then.

I do agree with the article that a Diabetic can have a piece of birthday cake - if that Diabetic is able to calculate what this will do to his/her blood sugar. You can compensate for that cake with increased insulin/exercise, or, as the article states, by substituting other foods that can raise your blood sugar in a similar way.

Is this the smartest thing for a diabetic to do? Not if they are doing it all the time. But for special occasions (when and where they are able to compensate for the added sugars - via insulin or exercise) - by all means. We are diabetics, normal people with an added complication trying to lead normal lives.

The advice given is not for every diabetic out there - not everyone can handle the balance in a healthy way. The medical community releases info that the "masses" can abide by - 'diabetics should not eat sugar', but just like any advice the medical community gives to the masses, it does not apply to each individual. Everyone is different. (I, for example, am told to eat more red meat due to iron deficiencies. Does this sound like something that will be advice for everyone? Of course not.)

Bottom line - know yourself and know your body. If you read this article and are tempted to want to believe it so that you can eat more dessert - you are probably part of the "masses" that is targeted to not eat sugar for a reason. However, if you are a responsible person that can take responsibility for your calculated, once in a while indulgences – more power to you!

Posted by Anonymous on 27 June 2008

I have had type 1 diabetes for 46 years. For me just a sugar cube or two (one cube contains 4 grams of sugar) is THE fast remedy for feeling shaky. Normally I avoid foods with corn syrup or other sugars added, but corn syrup and other sugars are added to canned beans, canned tomatos, etc., so I have to read labels on everything I buy. My experience? Sugared foods increase my blood glucose needlessly so I refuse to buy them. Type 2 diabetes is genetically a totally different disease from what I have.

Posted by Anonymous on 27 June 2008

I have Type 2 diabetes, use Metformin and have an A1C that usually sits in the 5.7 to 5.9 range (and has been creeping lower), even though I eat a dark chocolate bar or two or similar sweet several times a week. I've also dropped 50 pounds in the past two years.

When I worked with a dietitian after my diagnosis, she lumped the sweets in with other starches and didn't give me the sugar-is-poison speech. She trained me to increase my fruits and vegetables consumption (sometimes hard to do in rural Alaska because of the quality and expense of fresh produce), and to reduce my use of all starches.

As long as I reduce my overall carbs and starches, she said the occasional sweet won't hurt me, just so long as I do things in moderation. She said it was more important for me to eat a healthier diet in general and get regular physical activity than it was to worry about having the occasional dark chocolate bar or a cookie. I just make wiser choices, such as having an oatmeal-raisin cookie instead of a sugar cookie.

Posted by dandbcollier on 27 June 2008

It's nice to see that so many people have figured it out. The good ole' ADA is saying that sugar isn't any worse than other carbs, so go ahead and eat both. But we know the truth...other carbs are JUST AS BAD as sugar, so don't eat any of them!

With regard to rice/bread/potatoes seemingly raising BG more than candy bars and other sugary sweets...a lot of that will have to do with the fat content of the food. A high fat, high sugar food like a candy bar will not digest as fast as bread, so BG will not rise as quickly. But 30 grams of carbs are still 30 grams of carbs, no matter where they come from.

Posted by Anonymous on 27 June 2008

Okay. I loved the article. Bottom line, type 1 diabetes means your body recognizes how to use insulin - althought it does not make it. Therefore, you CAN eat what you want including SUGAR provided you know your correct insulin to carb ratio. A carb is a carb. If sugar was the issue, we would be looking at sugar grams, not carbs. The difference is simply how fast it hits the blood stream. If someone with type 2 cuts down on sugar, perhaps that is a good thing because although their bodies produce insulin, their bodies do not know how to use it - so eating sugar may not be the best decision. The ADA is guilty of NOT properly differenciating the differences between type 1 and type 2. Is sugar good for you? Perhaps not but there is no reason to not eat it because you have type one diabetes if you are diligent in counting carbs and dosing the correct amount of insulin. For those of you who are knocking the article, it shows your ignorance as it relates to the true differences between type 1 and type 2.

Posted by Anonymous on 27 June 2008

The article was awesome. If you knock the article, you need to educate yourselves.

Posted by Anonymous on 28 June 2008

Hooray! Finally, a blow to the myth at last! I am a Type I teenager who has to deal with that every single time I go to a camp or new program. Whenever it's time to eat lunch or have a snack, everyone always says, "You can't have those brownies. You're diabetic. Here, eat this mushy banana instead." However, the banana had more carbs than the brownies! Some have been so insistent that they've refused me any sugary snacks. Besides being annoying, it's also infuriating, because they've got the wrong information. A carb is a carb, as many people have said, and furthermore, only Type IIs NEED to watch their carbohydrates. Everyone SHOULD, but it is only DEEPLY health-threatening with Type II diabetics.

Posted by rumford on 28 June 2008

"Participants’ blood glucose levels were essentially the same when they ate the high-sugar meals as when they ate the high-starch meals. Conclusion: Sugar is just another carbohydrate. It’s the amount of carb, not the source, that determines blood glucose levels." But isn't it blood glucose that you are trying to control?
Other research shows that sugar is actually better than starch but that is because starch is terrible. Of course, as the ADA says, you can "cover it with insulin." Is there any other disease where health agencies recommend you do something that will make things worse so that you can take more medication.

Posted by volleyball on 30 June 2008

I don't believe a carb is a carb. The all foods with the same number of carbs would have the same GI. Excluding the fat/protein, we know that is not the same.
I would take 40 grams of sugar over 40 grams of enriched flour or corn syrup any day.
Whole grain slower acting carbs get processed at a different speed than pulverized quick acting grain powder.
I have no problem with artificial sweeteners either. I don't stick to one as I feel consuming a variety hedges your bets. And it is a bet. Everything here suggested is a sort of bet. We are betting that we know whats best. And for us it may very well be. As there is no one type of diabetic, there is no one type of person. We offer an infinite variety so there is no rubber stamp course of treatment.

Posted by Anonymous on 7 July 2008

Rice hits my blood glucose levels faster than table sugar ever did, yet rice is touted as a healthy food, yet sugar is claimed to be used only in moderation ... ironic, considering the same carb concentration with table sugar and rice, the rice contains significantly more calories!

Posted by Anonymous on 9 October 2008

My blood pressure goes up when people try to tell me what to eat. We are all individuals. Each food acts differently in each of us. I now have a pump and have tested how different foods effect my blood sugar and for me eating sugar is the same as eating a vegetable if you take into account the fiber. Now I would never eat just sugar and I believe in a balanced diet but I would like people to stop trying to dictate what I should eat to "cure" my diabetes. I am an adult onset type I and I will always be a diabetic so don't try to change me. Your relative may have had fantastic results becoming a vegan or vegetarian but for me this does not work so don't preach to me.

Posted by Anonymous on 12 October 2008

My husband has been diagnosed as a type II diabetic, and he also has high blood pressure. It seems like foods for diabetics and foods for people with high blood pressure are conflicting, high carbs for one
and low carbs for the other, I do not know what he can eat that is safe for him, I really need some help, I do not want him to give up trying because of all the conflicting
properties associated with the two health issues. Anyone have any ideas?

Posted by Anonymous on 19 October 2008

I control my diet with little carbs or sugars. It keeps my sugar low normal even without meds I have experimented for over 6 years. no regular carbs, complex vegetables,salads, fish, chicken, nuts as snack, fruits selected. apples, plums, grapes and limited too. My A1c is between 5-6
it works. Also exercise for 10 -15 mins reduces sugar levels by 20 points.
Sugar free.

Posted by Anonymous on 8 November 2008

suger is ok YODA

Posted by Anonymous on 8 November 2008

the pump tipe 1 and if you have tipe 1 you can eat carbs

Posted by Anonymous on 16 November 2008

Reducing carb will help blood glucose and blood pressure.

Posted by Anonymous on 5 December 2008

This is new news to me. I'm not a diabetic, but both my parents are. I remember seeing them go crazy not being able to eat sugar stuff, but they were still baffled when their blood sugar was high after having a lot of starch.

Posted by Anonymous on 7 January 2009

I have read all the postings. Being a diabetes educator, I agree that it is a balance of what you eat. A candy bar has protein and fat. It will cause your BG to raise slower than if you eat starches.
Use your common sense. If you check your BG often, monitor your food intake and take your insulin properly, you will do well.

Posted by Anonymous on 17 March 2009

I am an RD, CDE. I agree with Green Lantern and the others. Yes, starch is just as bad as sugar. So that doesn't mean eat more sugar, it means eat less starch. Check your blood sugar afterwards. If your blood sugar is really high then don't eat that food often. I am never one to say people should NEVER eat anything. You have to allow self to get away from the "forbidden" trap, BUT A high carb diet will only lead you to need more medicine to control your glucose The endocrinologist I work with says he has type I's who follow the Adkins diet and they don't even need bolus insulin. Just lantus. So you decide do you want more medicine or less carbs? The choice is yours.

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