The truth about sugar

Can having that extra doughnut give you diabetes? Is there a difference between good sugar and bad sugar? And should you even be eating good sugar if you're diabetic? This week, we answer some questions and bust some myths - so you can control your cravings in peace

Love it or hate it, sugar is an unavoidable part of our daily diets. We consume it every single day, be it with that innocent cup of tea we have every morning or thanks to a large can of sauce that's more savoury than sweet. Sugar can be found in ubiquitous stuff, like your morning coffee, cakes, chocolates, cookies, diet sodas, white bread, salad dressings or cereals boasting about their 'low fat' contents. And then, there are sugars that simply sneak into your diet without you noticing - through fruits, honey and even milk. But as you may have actually guessed, not all sugars are the same. So, is there a 'right' kind, and if so, how do we ensure we have it?
"While natural sugars are found in fruit as fructose, refined sugars are extracted from sugar cane or sugar beets," says Dr Bara'a Osama Al-Ries, a dietician at Burjeel Hospital Abu Dhabi.  
To explain the difference between the two, she gives an example: "If you're having a simple snack of a medium-sized orange, you're consuming roughly 60 calories, 15 grams of carbs, 3 grams of fibre, 250 milligrams of potassium and 13 per cent of your daily required amount of vitamin C. But when you add just one teaspoon of sugar to your daily tea or coffee, that's 16 calories, 4 grams of carbohydrates you're adding to your drink - without any fibre, vitamins or minerals."
Before you vow to simply cut out all refined sugar from your life, know that the body cannot actually differentiate between the sugar in fruits and ordinary table sugar. So if you are actually thinking of cutting down, your best bet would be to be far more picky about what you're buying and putting in your mouth. And that includes everything from eating in moderation to reading your labels.  
Go online these days and you'll undoubtedly be accosted by numerous articles titled 'What happens to your body when you give up sugar?' These headlines may be catchy but dietician Shambhavi Prasad Joshi of International Modern Hospital claims that we have so much sugar indirectly through sources such as fruits, milk and grain, that our body might not even miss it. According to The American Heart Association, women must consume no more than 6 tsps of sugar or 100 calories daily while men can consume no more than 9 teaspoons or 150 calories daily. The bottom line is that, try as we might, having a sugar deficiency is almost impossible in a developed country.  
According to Dr Shambhavi, one of the reasons we have such an issue shaking the sweet stuff off is because we are conditioned, from an early age, to respond to it. "Sugar stimulates the opiate receptors in our brain, which go on to activate the reward centre. This leads to a compulsive need for sugar despite its many negative effects such as weight gain and hormonal imbalance," she says. "Whenever we eat sugar, we reinforce those neuropath ways, causing the brain to crave even more."
This, in turn, can lead to sugar addition, and that is a growing concern. A recent study conducted by Australia's Queensland University discovered that sugar consumption elevates dopamine levels, which controls the brain's reward centres very much like morphine or tobacco. However, long-term consumption leads to a reduction in dopamine levels, said neuroscientist Selena Bartlett from QUT's Institute of Health and Biomedical Innovation. And this 'leads to a higher consumption of sugar to get the same level of reward'.
It gets worse: once  'addicted' to the sweet stuff, being 'weaned off' is no small task. A 2002 study, conducted at Princeton University, found that rats that had undergone a sugar dependence protocol then underwent 'sugar withdrawal'. The symptons? Teeth chattering, paw tremors and head shaking.
Sugar addiction may be alarming, but while many people equate it with diabetes, the truth is that the relationship between diabetes and sugar is not as clear-cut as one may think. And to understand how the two are related, one has to first understand exactly what causes diabetes.

EXPERT SPEAK: (from left to right) Dr Ajith Kumar, Dr Bara'a Osama Al-Ries and Dr Shambhavi Prasad Joshi
"Type 1 diabetes occurs in a genetically susceptible individual when unknown environmental factors trigger the condition," explains Dr Ajith Kumar, specialist endocrinologist, Aster Clinic, Al Qusais. "Type 2 diabetes, on the other hand, is caused by genetic factors as well as lifestyle habits."
Type 2 is the more common of the two, accounting for about 85-90 per cent of all cases diagnosed, and is caused due to a variety of reasons including a sedentary lifestyle, high blood pressure or even a history of diabetes in the family. While it's important to know that reaching for that second doughnut won't directly give you diabetes, weight gain and obesity, on the other hand, are actual concerns.
"Sugar alone doesn't cause diabetes," agrees Dr Shambhavi. "That being said, increased intake of sugar directly affects weight gain. The extra sugar is stored by the body and converted to a fatty deposit around the liver. This creates a resistance for insulin produced by the body. When there is insulin resistance, the risk of diabetes increases."
And since the body can't really differentiate between good sugar and bad sugar, diabetic patients have to be doubly careful about everything they're eating. You may think fruits are healthy, but bingeing on bananas, melons and stone fruit, for instance, are an absolute no-no.
But the good news, as you all know, is that it is possible to manage diabetes with some lifestyle tweaks. Dr Shambhavi recommends spacing meals properly, eating less processed foods and adding herbs such as coriander and mint and spices like cinnamon to your food to manage those cravings better. Also, maintain a food diary - not only can this help you recognise the unnecessary foods you have on a daily basis, it will make you enjoy the taste of certain foods since you know what's in them.
Most health experts also insist that the most important step is getting past the mental block - once you know what your body needs and have accepted that it's time to make the change, everything else will fall into place.

DIABETES: WHAT'S TRUE AND WHAT'S NOT
. The most dangerous belief about diabetes is the idea that the condition can be easily dealt with using minimal attention and care. In fact, diabetes is a serious, chronic disease. Two out of three people with diabetes die from cardiovascular-related episodes, such as a heart attack or stroke. However, diabetes can be controlled with proper medications and lifestyle changes.
. A lot of people believe that if someone is overweight, he/she will automatically get Type 2 diabetes. This is not true for every individual. In fact, most overweight people never develop Type 2 diabetes, and many people with Type 2 diabetes have an average weight or are only moderately overweight.
. Diabetics cannot eat sweets at all. There is no reason people with Type 2 diabetes cannot eat sweets, as long as they fit it into a normal meal plan, or make sure the intake is combined with exercise. Eating small portions and including them with other foods can help slow down digestion, stopping them from wreaking havoc on your blood sugar levels. The key is to have a very small portion and save sweets for special occasions.
. It's not true that everyone who has diabetes needs to have insulin shots. Diabetes can be controlled with many oral and injectable medications, of which, insulin is the most effective. But not all people suffering from diabetes need to take it. The oral medications are safe and effective, but they are to be carefully chosen to suit the needs of the patient.
. Many patients claim that they know when their blood sugar is high or low, leading to the myth that regular testing is not needed. In fact, you cannot rely on how you are feeling when it comes to your blood sugar level. You may feel shaky, lightheaded, and dizzy because you're coming down with a cold or the flu. The longer you have diabetes, the less reliable those feelings become. The only way to know for sure is to check your blood sugar regularly.
- Dr Ajith Kumar
How to cut down on your sugar consumption
. Eat three main meals and two snacks in-between. When we go without food for a long time, the blood sugar levels in our body drop. This makes us hungry and we are far more likely to crave sugary snacks.
. The more fresh or organic the food, the less processed sugar it contains.
. Have a balanced diet. Eat a variety from all food groups. Don't miss a meal or food group.
. Be more active. Exercising daily boosts your energy and decreases your need for  the sweet stuff.
. Sleep enough - when we're tired, we eat more sugar for energy to counteract the exhaustion.
. Keep sugary snacks out of your house and office.
. Learn to read labels. The longer the list of ingredients, the more likely sugar is going to be included on that list. Try to check the grams of sugar, and choose products with the least sugar per serving (1 teaspoon of sugar is roughly equivalent to about 4 grams). For example, if the products contain 12 gm sugar, that means it contains 3 teaspoons of sugar.
. Become familiar with sugar terminology so you can recognise sweeteners. For example, watch out for agave, corn syrup, corn sugar, high fructose corn syrup, sucrose, dextrose, honey, cane sugar, cane crystals, fruit juice concentrates, molasses, turbinado sugar and brown sugar.
. Make that decision to change your lifestyle for the better. You can visit a dietitian if you need advice or tips.
- Dr Bara'a Osama Al-Ries

janice@khaleejtimes.com