As a dietician and certified diabetes educator, I am frequently asked about sugar, artificial sweeteners, and how they relate to carbohydrate counting and the Exchange List for Meal Planning. Here are some answers to questions I’ve heard often over the years.
Does eating too much sugar cause diabetes?
Satisfying your sweet tooth does not cause diabetes. If you have diabetes, however,
learning to tame a sweet tooth will help you reach your blood sugar goals.
I’ve heard that people with diabetes should not eat sweets.
Is this true?
In the old days, people with diabetes were told to avoid sweets. Now we have
learned that white table sugar (sucrose) has the same effect on blood sugar
as an equal amount of any carbohydrate. Sugary foods can be substituted for
other carbohydrates in your diabetes meal plan, but remember that foods high
in sugar are often high in fat and calories, too. Use them in moderation as
part of a healthy diet.
I
gave up all sugar. Now, instead of cookies for a snack, I eat a pound of grapes.
This is better for me, right?
Grapes, indeed all fruits, have more nutritional value than traditional sweets,
but you can have too much of a good thing! Remember that your total carbohydrate
intake is what matters. One pound of grapes equals approximately 80 grams of
carbohydrate. If you use the Exchange Lists for Meal Planning you know that
one fruit, one bread/starch, or one milk exchange equals 15 grams of carbohydrate.
A pound of grapes is more than 5 exchanges, which is probably more carbohydrates
than you have allowed for a snack. I recommend that you have fewer grapes. You
could also check the label on your favorite cookies and figure out how many
you could have for a snack. It is sometimes okay to have cookies!
Is honey a better choice than white sugar?
Honey is still sugar. One teaspoon of sugar has 4 grams of carbohydrate while
1 teaspoon of honey has 5. If you prefer the taste of honey, go ahead and enjoy.
Whichever you choose, use a measuring spoon so you can accurately count the
carbohydrates.
What are sugar alcohols?
Alcohol in this term refers to the chemical structure of this type of sweetener.
Sugar alcohols are used to sweeten foods in the same way artificial sweeteners
are used. Sugar alcohols do not contain the alcohol that is found in beer, wine
and spirits. Compared to sugar, they have fewer calories and less impact on
blood sugar. But, unlike artificial sweeteners, they need to be accounted for
in your meal plan. This process is described below. A disadvantage to sugar
alcohols is that eating too much of them can cause bloating and diarrhea.
What does “net carb” or “impact carbs” mean
on a food package?
These terms do not have a standardized definition and are not approved for use
on food labels by the FDA. Sometimes, they may lead you to believe that a product
is lower in carbohydrates then is actually true. You can find the most accurate
information on the nutrition facts label. Since dietary fiber is not digested,
you can subtract it from the total carbohydrates on the label. Also, if a product
contains sugar alcohols, you can subtract half of the sugar alcohols from the
total carbohydrates. For example, if a food contains 20 grams of total carbohydrate
per serving with 2 grams of fiber and 8 grams of sugar alcohol, you can adjust
the total carbohydrates to 14 grams.
I’ve heard that artificial sweeteners can cause things like cancer
and multiple sclerosis. Is this true?
The Food and Drug Administration has approved 5 artificial sweeteners for use
in the U.S. They are saccharin, aspartame, sucralose, acesulfame-k and neotane.
Scientists have studied these food additives extensively and found them safe.
The FDA has established an Acceptable Daily Intake for each sweetener. This is the amount that can safely be eaten on average each day over a lifetime. For example, the ADI for aspartame (brand name NutraSweet, Equal) for an average adult is approximately 18 cans of diet soda. Few, if any, people would drink more than that in a day.
What is Stevia?
Stevia is an herb whose extract is much sweeter than sugar. It is used as a
sweetener in various parts of the world. The Food and Drug Administration has
not approved Stevia as a sweetener in the U.S. because of concerns over its
potential ill effects on the kidneys, heart and reproductive system. However,
it is available as a dietary supplement with claims to improve blood pressure
and blood sugar. Dietary Supplements are not regulated by the FDA. Consult with
your physician or dietitian before you use Stevia or any other dietary supplement.
I eat sugar free cookies, ice cream and pie. These are better for me
aren’t they?
Be careful. Some people have the misconception that “sugar free”
foods will not affect their blood sugar. This is not always true. Sugar free
does not mean carbohydrate free. These products may contain flour, milk, fruit
or sugar alcohols, all of which contribute carbohydrates. Read the nutrition
facts label to get the real story.
What about fructose? That is better than sucrose for me, isn’t
it?
Not necessarily. You may have seen foods sweetened with fructose (fruit sugar)
in the “diabetic” food section of the grocery store, and it is true
that fructose used as a sweetener does cause blood sugar to rise more slowly
than sucrose (white sugar). However, it can negatively affect your heart health.
For this reason, the American Diabetes Association has recommended avoiding
the use of fructose as a sweetener. This is not the same as fruit itself, which
has many benefits.
I hate diet soda. Will it hurt me to have a regular soda only a couple
times a week?
Don’t write off diet sodas because you disliked one brand. Try a variety
of diet drinks to find one that you do like. Water is another great choice.
If you still want to drink regular soda, do so wisely. A can of regular soda
contains approximately 45 grams of carbohydrate (3 bread/starch exchanges).
For most women, this would use your total amount of carbohydrate for a meal.
Avoid sipping on a regular soda throughout the day because it will provide a
constant source of carbohydrate that will affect your blood sugar. If you drink
regular soda, check your blood sugar 2 hours afterwards to see if you are still
in your blood sugar target. If your sugar is high, cut back on regular soda
or drink something different.
I have heard that high fructose corn syrup makes people overweight.
What is it and should I avoid it?
High fructose corn syrup is sweeter and cheaper than sucrose (white sugar) and
extends product shelf life, so it is widely used in fruit-flavored drinks, regular
soda and a variety of processed foods. The rate of obesity in the United States
increased at the same time as our increased consumption of high fructose corn
syrup. However, it is unclear whether or not it is to blame. Regardless, foods
that contain high fructose corn syrup are often high in calories and low in
nutrients. So read food labels and select wisely.
About
the Author
Lynn Baillif has been a registered dietitian for 15 years and a certified diabetes
educator for 7 years. She has been a member of the National Federation of the
Blind since 1987 when she was a national scholarship winner.