Frequently Asked Questions
Obesity
I am desperate to lose at least 10 kg. Please send me a low-carb diet.
If you need to lose 10 kg in weight, then it is not wise or sensible to use a low-carb diet, because they are automatically high-protein, high-fat diets. This means that you will be exposing yourself to high intakes of fat, saturated fat and cholesterol, which are all related to an increased risk of heart disease and certain types of cancer. In addition, diets low in carbohydrate do not contain adequate amounts of dietary fibre to ensure regularity, thus causing constipation. Rather use a balanced diet that includes all the major food groups (carbohydrates, proteins, fats, and dietary fibre), but cut down on your total energy intake by reducing how much fat you eat and also increase your energy output by doing at least 30 minutes of aerobic or cardio exercise every day.
Must I cut out all sugar if I want to lose weight? I miss having a teaspoon of sugar in my coffee.
If you are using a well balanced slimming diet which is low in fat and high in dietary fibre for weightloss, then you can certainly use some sugar in your tea and coffee or on your breakfast porridge or cereal to improve the taste. Moderate intakes of sugar can help to make low-fat diets taste better and therefore prevent cravings which can sabotage your diet. Research has indicated that overweight individuals often consume less sugar than people of normal weight.
Hyperactivity
My son suffers from ADHD. Must I put him on a sugar-free diet?
If your son has Attention Deficit Hyperactivity Disorder (ADHD) then it is important to cut out certain colourants and preservatives that are commonly used in foods. A recent well controlled scientific study conducted at the University of Southampton found that even children without hyperactivity exhibited negative and excitable behaviour when they ate foods that contained the following colourants: Sunset Yellow (E110), Quinoline Yellow (E104), Carmoisine (E122), Allura Red (E129), Tartrazine (E102) and Ponceau (E124), as well as the preservative called Sodium Benzoate. Prior studies with children suffering from ADHD showed that moderate sugar intakes did not make these children more hyperactive. So although your son may have to cut out sweets and cold drinks which contain the above mentioned colourants and sodium benzoate as a preservative, he can still have some sugar over his porridge and in hot beverages like rooibos tea. In contrast to popular belief, sugar does not cause aggressive or hyperactive behaviour in children. Sugar also does not affect attention span or cognitive performance.
My hyperactive child gets totally impossible in the late afternoon even if he does not have any sugar or sweets. What can I do?
Children with ADHD or hyperactivity tend to use up a lot more energy than children without this condition. Because they have used up so much energy, hyperactive children need to have more energy-rich snacks in between meals. Make sure that your son eats a well balanced lunch (Low-GI bread with cottage cheese or peanut butter or lean meat or a boiled egg; a fresh fruit or fruit juice or some dried fruit and nuts) and has a snack that combines high- and low-GI foods around mid-afternoon, especially on days when he does sport. Foods with a high glycaemic index (GI) like energy drinks, sugar or jam, are not taboo and they can be used successfully in combination with a low-GI food like rye bread or yoghurt to refuel your cranky teenager. After all, top athletes use high-GI foods for the same purpose after exercise to replenish their energy stores. Well controlled research studies with children who were classed as ‘sensitive to sugar’ by their parents, showed that sugar may even have a calming effect on hyperactive behaviour.
Dental Caries
My child has holes in all her teeth. Is this due to sugar and sweets?
The most important thing you can do to prevent or limit tooth decay is to teach your child to brush her teeth after every meal. If this is not possible, show her how to rinse her mouth with water after eating. If possible use a fluoride toothpaste and ask your dentist to treat her teeth with fluoride when she goes for her 6-monthly check-up. Any food that remains in contact with the teeth after eating can cause tooth decay. So it is not just sugars and sweets that contribute to tooth decay, but also all sticky carbohydrates like bread and rusks, fruit, especially dried fruit, and fruit drinks (fruits and fruit products also contain acid that can attack tooth enamel and cause decay), that adhere to the surfaces of the teeth after eating. So no matter what your child eats, make sure that she rinses or brushes her teeth after a meal or a snack. Good dental hygiene and the use of fluoride will do more to protect your child’s teeth for her whole life, than forcing her to never have a sweet.
The dentist says my baby’s teeth are bad. How can this be if I never gave him any sugar?
If you allowed your baby to have a bottle of milk or formula when he went to sleep at night or if he used his bottle of milk as a comforter (“dummy”) while sleeping, then it is possible that your young son is suffering from what is called “Baby Bottle Tooth Decay”. The fact that your son’s teeth were exposed to milk for long periods during the night, has probably caused the tooth decay. Dentists warn that mothers should not allow their babies to suck on a bottle of milk all night as this can result in multiple holes in the enamel of the baby’s teeth. Other liquids like rooibos tea with milk will have a similar effect. By all means give your son a bottle of milk before bedtime, but teach him to rinse his mouth or even how to brush his teeth before he goes to sleep, but never use a bottle of milk as a dummy. This can not only lead to tooth decay, but disrupt the normal growth of the baby’s palate (the roof of the mouth) and the angle of the teeth. Plain boiled and cooled water is best if baby is thirsty at night.
Sports Nutrition
I am trying to build lean muscle mass and a super six-pack for summer. My diet mainly consists of proteins, including high-protein shakes and whey. I exercise for an hour a day, but am not losing fat and some days I am too exhausted to go to the gym. What must I do?
Many athletes and body builders make the mistake of eating only proteins when they want to build lean muscle mass and reduce their body fat%. It is important to realise that our bodies need readily available fuel to be able to do strenuous exercise. The best readily available and preferred fuel for exercise is carbohydrate. Top athletes who have their own personal trainers know this and in some cases these athletes obtain up to 70% of their energy from carbohydrates. By avoiding carbohydrates and sugars and eating large quantities of protein, you actually prevent your body from building lean muscle tissue because in the absence of sufficient carbohydrates, the body will start using proteins, including your muscle protein, as fuel. Carbohydrate, therefore, has what is known as a “protein sparing effect” and all athletes should ensure that they eat at least 2-3 carbohydrates at each meal, and top up on carbs with sports drinks before, during and after training. If you pay more attention to your carbohydrate intake you will not feel so tired and be able to do more exercise to ensure that you will achieve that six-pack by summer.
Should I use a sports drink when I run a marathon? Can’t I just drink plain water?
No, drinking plain water during a strenuous event like a marathon will expose you to the risk of electrolyte imbalances and without topping up your fuel supply you will “hit the wall” much sooner and may have to give up the race. At a recent conference on “What is an Ideal Sports Beverage?” experts concurred that an ideal sports beverage should contain: Water (for hydration), Carbohydrate (for energy and to ward off fatigue), Electrolytes such as sodium and potassium (to prevent electrolyte imbalances) and a small amount of highly soluble protein. You should experiment with the different sports drinks that are available on the market to find out which product best agrees with you. According to Dr Andrew Bosch of the UCT/MRC Research Unit for Exercise Science and Sports Medicine, athletes can use sports beverages in quantities of 400 ml before exercising and 100 ml every 15 min during exercise, or as dictated by your thirst.
Sugar is a No-No for Diabetics
The debate regarding the use of sugar by people who suffer from type 1 (insulin-dependent) and type (non-insulin dependent) diabetes has raged for years. Diabetics cannot be blamed for being confused because one set of dietary advice will state that diabetics should not eat any sugar whatsoever, while other diet guidelines say that some sugar can be included in diabetic diets.
Balanced advice can be found on the Websites of the American Diabetes Association (ADA)(1) and the Diabetes Association of South Africa (DASA)(2). The South African Diabetes Association states that diabetics should “Limit sugar intake because sugar (cane sugar) has a medium GI rating and so having diabetes does not mean a total ban on sugars. It means you can eat small amounts without making your blood glucose levels rise excessively. However, eating too much sugar is not a good idea as it adds to your total carbohydrate and kilojoule intake and will replace the nutritionally better and more filling carbohydrate foods”(2) (www.diabetessa.co.za ).
This is echoed by the American Diabetes Association on their Website (www.diabetes.org), where it is pointed out that having diabetes does not mean that “you will never have birthday cake again.” By planning your daily food intake you can eat small helpings of your favourite pudding or have a slice of cake on special occasions.(1)
The ADA advise that diabetics can keep their blood glucose levels at desired levels by “substituting small portions of sweets for other carb-containing foods in your meals and snacks.” They suggest that these portions of sweets or sugar should be approximately 45 to 60 grams. The trick is to identify other carbohydrate foods in a given meals (bread, rice, potato, cereal, fruit juice, corn on the cob or peas for example) and to substitute your small serving of sweets or sugar for one serving of carbohydrates (1).
The ADA also warns diabetics against falling into the trap of believing that foods labelled as ‘sugar-free or no added sugar’ do not contain any carbohydrates (1). This is not true. For example the labels on many packaged fruit juices state “No added sugar” and create the impression that diabetics can use these products indiscriminately. If you check the Nutritional Information on the carton you will find that pure apple juice, for example, contains 25,4 g of carbohydrates per 200 ml serving. The carbohydrate in apple juice consists mainly of fructose and other simple sugars. So although no sugar/sucrose has been added to the apple juice, the product inherently has a high concentration of carbohydrates and simple sugars. The statement “No Added Sugar” on such products, is therefore, misleading to the public.
The International Food Information Council Foundation (IFIC) of America, which is regarded as one of the leading sources of balanced nutrition information in the world, states that “sugars do not cause diabetes mellitus.”(3) Research in recent years has discovered that the idea that simple sugars like sucrose are digested and absorbed rapidly, thus causing a greater increase in blood sugar levels than other carbohydrates, is not true. Many different factors such as the type of food, type of processing of the food and the amount of dietary fibre in the sweetened food will determine how high the blood sugar levels of both diabetic and non-diabetic subjects will be after eating the food.
Scientific investigations have found that simple sugars like sucrose will not necessarily cause hyperglycaemia in diabetics (3}. For example many foods that contain sugars such as ice cream (GI 50) and chocolates (GI 49 - high fat) have a lower glycaemic index (GI) than foods like white and wholewheat breads (GI 72 and 70, respectively)4. Adding sugar (GI 65) to foods like cornflakes (GI 89) will lower the GI of the combination to about 67 (an intermediate GI). This means that the cornflakes on their own will cause a greater increase in blood sugar and insulin levels than the combination of cornflakes and a moderate amount of sugar. In addition, the high blood sugar levels will drop within one hour to levels that will increase hunger, while the combination of cornflakes and a moderate quantity of sugar will keep blood sugar levels steady for 2 hours.(5)
With this modern approach diabetics can, therefore, use moderate amounts of sugar as part of their diet prescription. Consult a clinical dietitian for the correct diet prescription for your individual condition (type 1 or type 2 diabetes, type of medication you are using, body weight, amount of physical activity, etc) and you will be able to have sweet treats on special occasions and use moderate amounts of sugar or jam to make your diet more tasty and interesting.
As the IFIC say, “Given their important taste contribution, sugars in the diets of persons who must restrict fat intake, such as people with diabetes, may offer important benefits in terms of satisfaction with and ultimate adherence to prescribed diets.”(3)
References - Diabetes:
1 American Diabetes Association (2008). Sweets & Desserts. http://www.diabetes.org (Accessed on 7 October 2008).
2 Diabetes SA (2008). Managing Diabetes. http://www.diabetessa.org (Accessed on 7 October 2008).
3 IFIC (2008). Sweet Facts about Sugars & Health. IFIC Review. http://www.ific.org/nutrition/sugars/index.cfm (Accessed on 10 October 2008).
4 Steenkamp G & Delport L (2002). The South African Glycemic Index Guide. GIFSA Publication.5 Steenkamp G (2008). Master Class - The Glycaemic Index. 22nd Biennial Nutrition Congress “Evidence Based Nutrition Leading the Way in Innovation”, University of Pretoria, 28 September -2 October 2008.
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Natural Fructose is Better for Health than Sucrose Most people believe that table sugar or sucrose should be avoided at all costs, but that fruit, fruit juice and fructose are healthy alternatives. Mothers are convinced they should give their infants and children as much fruit juice as they can drink, “Because fruit juice is healthy and good for children!”
Recently researchers have turned their attention to fructose and are studying its effect on health. Fructose is the major sugar that is found in fruit and fruit juices. Fructose is also used as a sugar or sucrose substitute, especially by diabetics and individuals on low glycaemic index (GI) diets. Interestingly enough, some studies have found that fructose is not as healthy as the public believe and that the use of pure fructose as a sweetener to replace sugar/sucrose can have negative effects on health.
The reason why scientists have started to investigate fructose and its effect on health is that the consumption of fructose has increased dramatically in the last decade. On the one hand this is due to the belief that fructose and foods that contain high levels of fructose are “healthier options” than sucrose, and the fact that in the USA sweetened cold drinks are made with high-fructose corn syrup (HFCS) instead of sucrose (in SA HFCS is not widely used). According to statistics, fructose intake in the USA has increased by 30%, while sucrose intake has dropped by 50% in the period from 1997 to 20001.
An American study found that 53% of 5-year-old children who drank about half a glass of fruit juice a day, which has a high fructose content, were obese, compared to 42% of children who did not consume fruit juice daily2. The young children who had high intakes of fruit juice were also more prone to stunted development (42%) in contrast to the 5-year-olds who did not drink so much fruit juice. So although fruit juice may contain protective nutrients like vitamin C, it also has a high fructose content which appears to have a negative effect on body weight resulting in overweight and obesity. Experts believe that fruit juices are used to replace milk in the diet and that this can lead to stunted development in toddlers.
The use of fructose sweetened cold drinks by children and teenagers in the USA has increased exponentially. In one study, 12% of American pre-school children and 32% of schoolchildren drank a glass or more of fructose-rich cold drink every day, and 22% of teenagers consumed 2 or more glasses of fruit juice a day3.
In 1970 Americans were on average ingesting 0.31 kg of fructose/ person/year. By 2000 this intake had risen to 33,4 kg/person/year - an increase of more than 100%. It is therefore not surprising that this change in fructose intake is believed to affect body weight, diabetes, heart disease, high blood pressure, kidney disease, gout, metabolic syndrome and other diseases of lifestyle 1. 4.
Diabetics often use pure fructose to replace table sugar in their diets, because they regard fructose as “safer” than sucrose due to its lower GI. The GI values of fructose and sucrose are 23 (low-GI) and 65 (intermediate-GI), respectively6. In a Finnish study published last year, researchers found that the incidence of diabetes in more than 4000 subjects, who were diabetes-free at the start of the study, could be predicted by how much fructose they consumed in a 5-year period7.
This year researchers at the University of California compared the effects of high fructose vs high glucose intakes in obese adults. High fructose intakes were linked to an increase in the amount of intra-abdominal fat that these subjects developed. Intra-abdominal fat deposits are in turn linked to increased risks of diabetes and heart disease5. The participants who increased their intake of glucose did not develop intra-abdominal fat deposits despite a gain in overall body weight.
Fructose intake is also held responsible for raising blood triglyceride levels5. Triglycerides are fats found in the blood that are associated with an increased risk of cardiovascular disease.
In addition, fructose is the only sugar that is known to increase uric acid levels in the body4. High uric acid levels are found in patients suffering from gout.
Although research into the impact of fructose on human health is still in the early stages, concerned nutrition experts in many parts of the world suggest that we should beware of unlimited and high intakes of fructose as found in fruit, fruit juices, preserves, and cold drinks sweetened with high-fructose corn syrup. Mothers are advised to not give their children indiscriminate amounts of fruit juice and cold drinks. Plain, clean water is still the best thirst quencher for young and old alike, while encouraging your child to drink milk and have moderate intakes of whole fruit are recommended.
References - Fructose:1) Bray et al (2004). Am J Clin Nutr, 79:537-43.2) Dennison et al (1997). Pediatrics, 99(1):15-22.3) Harnak et al (1999). J Am Diet Assoc, 99:436-441.4) Johnson et al (2007). Am J Clin Nutr, 86:899-906.5) Stanhope et al (2008). Am J Clin Nutr, 87(5):1194-203.6) Steenkamp & Delport (2003). The SA Glycemic Index Guide. GIFSA Publication.7) Montonen et al (2007). J Nutr, 137:1447-1454.
Sugar Causes Wrinkles and Kills
At the present moment a variety of health and beauty Websites are devoting a great deal of space to broadcasting the idea that eating sugar will not only turn you into a wrinkled crone, but will ultimately kill you
This latest anti-sugar campaign seems to have started with a BBC Discovery programme on aging that was released in 1989. In a subsequent interview, one of the researchers, Dr Anna Furth explained that aging was associated with damage that is done to body proteins by a process called glycation(1). The damaged proteins, also known as Advanced Glycation End products (AGEs) (a most appropriate abbreviation) are increasingly being linked to various degenerative conditions such as heart disease and diabetes.
According to Dr Furth, the damage to body proteins is caused by sugar that circulates in the blood. Damaged proteins have a reduced ability to transport fats and cholesterol, which then leads to fat and cholesterol being deposited in the body to cause cardiovascular disease and obesity(1).
In his book “10 Minutes/10 Years: Your Definitive Guide to a Beautiful and Youthful Appearance” Dr Fredric Brandt also blames wrinkle formation on a loss of skin elasticity caused by glycation products(3).
This is just what the anti-sugar lobby were waiting for to brand sugar as the leading factor in aging, and to ultimately hold sugar responsible for wrinkles and death. Headlines like “At Last - Why Sugar Kills!”(1) and “Want to look younger? Give up sugar”(3) are scary to say the least.
However, if one looks a little further in the scientific literature, then it is evident that aging is not just due to sugar. A collaborative team of scientists working at Medical Schools in Athens and Mount Sinai in New York, recently wrote an in-depth review on how human beings age. Dr Peppa and co-workers state that aging and the degenerative diseases associated with aging go hand in hand with an increase in oxidative stress (OS) and accumulation of AGEs. They suggest that long-term exposure to dietary AGEs (dAGEs) overloads the anti-AGE receptors in the body and uses up all our oxidant reserves(2).
Constant AGEs levels in the blood are believed to be the result of a balance between formation inside the body, supplies from outside (AGEs taken in with a standard diet or because of smoking, exposure to industrial pollutants, etc), the breakdown of tissues in the body, and excretion through the kidneys. Any one of these factors or a combination of all four, can contribute to a build-up of AGEs and cause premature aging in humans(2).
Peppa and co-authors agree that an interaction between reducing sugars like glucose and parts of protein molecules, nucleic acids in cells, and fat molecules will ultimately produce AGEs(2). So far, the sugar alarmists and scientists are still in agreement. However, what should never be forgotten is that the glucose that circulates in our blood is obtained from a variety of sources:
* directly via absorption of simple sugars
* by absorption after digestion of complex carbohydrates
* from the breakdown of proteins and fats in the body
Our brains cannot survive for longer than 3 minutes without a supply of glucose and glucose is the most important fuel for the body that allows us to work and exercise, and provides energy for all our body processes. It is, therefore, impossible to function without blood glucose and even if you go on a zero-carb diet your body will still make glucose.
The reaction of glucose with proteins and fats to form glycation products also occurs externally during food processing and preparation. Peppa and coworkers2 state that, “Foods cooked at high temperature for long periods of time in dry conditions, especially those with a high fat content”, contain the greatest quantity of AGEs.
So although we may be able to control how much fatty food we eat and avoid cooking our food at high temperatures for long periods, the AGEs process cannot be stopped simply by cutting out all carbohydrates and sugar.
Moderation and a balanced diet which combines minimally processed carbohydrates with moderate amounts of sugar, plenty of fresh vegetables and fruit, low-fat proteins and poly- or monounsaturated fats, plus daily exercise and avoidance of smoking and stress, will keep you and your skin young and healthy.
References - Aging:
1) Nutri.com (2008). At last - Why sugar kills? http://www.nutri.com/wn/bbc.html (Accessed on 7 Oct 2008)
2) Peppa M et al (2008). Aging and glycoxidant stress. Review. Congress of Endocrinology, Nov 8-12, 2008. Rio de Janeiro, Brasil (http://hormones.gr/preview.php?c_id+215 (Accessed on 7 October 2008)
3) Rediff News (2008). Want to look younger? Give up sugar. http://www.rediff.com/ getahead/2007/jun/20sugar.htm (Accessed on 8 Oct 2008)
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Sugar Addiction is Just a Bad Habit Many people will tell you that they are ‘totally addicted to sugar and sweets, especially chocolates!’, or they will say, ‘When I feel down, all I need to do is have a sweet or chocolate and I feel fine again!’
But are these statements actually true or just myths. Do we humans really get addicted to sugar, sweets and chocolate, or is this ‘just a bad habit’? And does eating sweets or chocolate lift the mood and counteract depression?
Nutrition researchers have been puzzling over these questions for quite a long time, but it is only recently that actual studies have been carried out to determine if sweet foods are actually addictive and if sugar and/or chocolate can improve one’s mood.
There is no longer any doubt that the intake of carbohydrates, particularly easily digestible and absorbable carbohydrates like sugars, improve mood very rapidly especially when there is a need for a fast energy supply as is the case during strenuous exercise. Diets that restrict carbohydrate intake on the other hand are known to cause a deterioration in mood and evoke negative feelings1. Anyone who tends to feel fatigued or listless would, therefore, crave easily absorbable carbohydrates like sugar and sweets to counteract their lack of energy.
Why humans react this way to sugar intake has not yet been determined. We don’t yet know if people feel better because their blood sugar values increase or if the good feeling is linked to an increase in brain serotonin levels.
In the human brain, the chemical serotonin is associated with positive feeling and a reduction in depression. Carbohydrates are known to increase brain serotonin levels by making more tryptophan (an amino acid) available. If high levels of brain serotonin are linked to improved mood, it would be understandable that people who tend to feel ‘blue and out of sorts’ would use any mechanism, such as eating more carbohydrates or sugar, to relieve their depression.
Other theories suggest that carbohydrates and/or sugar stimulate the so-called opioid receptors in the human nervous system(1) producing a feeling of happiness and satisfaction.
What we do know, is that if you eat a diet that does not provide enough carbohydrates to fuel your everyday metabolic processes and physical activity, you will develop cravings for sugar. The best solution is to eat adequate quantities of carbohydrates with a low glycaemic index (GI) to keep your blood sugar levels steady for long periods and to have some high-GI carbohydrates like sugar, sweets or an energy drink when you need a fast supply of energy (e.g. during or after exercise).
As regards ‘chocolate addiction’, some researchers3 found that eating chocolate did not improve mood in 20 ‘addicted’ and 20 non-addicted women who kept a food diary for 7 days. But a study conducted in Finland5) with more than 1300 older men, did show that those men who preferred chocolate above other sweets, felt significantly less lonely and depressed than the men who were not fond of chocolate. Interestingly enough the chocolate-loving older men also had lower Basic Metabolic Indexes (BMIs) and waist circumference values (i.e. less abdominal obesity).
When German researchers studied the effects of eating an apple, a chocolate or nothing on the mood of 37 healthy women of normal weight, they found that both the apple and the chocolate improved the mood of the women for about 90 minutes, but that those participants who ate the chocolate felt significantly more positive than the women who ate the apple or those who did not eating anything(4).
Chocolate does not just contain sugar, but a whole host of other potentially addictive biological compounds. For example chocolate contains compounds such as methylxanthines, phenyl ethylamine, serotonin, endorphins and some caffeine, which are all more or less addictive. This has led some researchers to question if cacao that is used to make chocolate is possibly a psychotropic drug.(2) A French study with 15 self-confessed ‘chocolate addicts’ aged from 18 to 49 years, showed that on average these individuals ate 50g of cacao a day and 87% of them had been doing this since childhood or their teens. The chocoholics reported that eating chocolate made them feel more energetic, improved their concentration and reduced anxiety when they were stressed. Despite their chocolate addiction these individuals did not display other addictive behaviours or suffer from eating disorders. 13 of the 15 participants did, however, suffer from major depression, which lead the researchers to conclude that people who are addicted to chocolate may “represent a population of psychologically vulnerable and depression- or anxiety-prone people.”(2)
In view of these new findings it would seem that sugar addiction is not ‘just a bad habit’ and that some people do feel happier and more positive when they eat carbohydrates, including sugar. It has even been suggested that this could be a form of ‘self-medication’1. Research also indicates that chocolate does have the potential to be addictive primarily because it contains a number of compounds that may counteract depression. The high fat content of chocolate makes it an energy-rich food which can lead to weight gain if eaten in excess. So if you are a ‘chocolate addict’, make sure that you do plenty of exercise to prevent weight gain. The good news is of course that chocolate is also rich in antioxidants which will protect you against degenerative diseases.
References - Sugar Addiction is Just a Bad Habit:
1) Arbor (2007). Sweet foods and mood. Arbor Clinical Nutrition Updates, Issue 281:1, July 2008.
1) Dallard I et al (2001). Is cacao a psychotropic drug? Psychopathological study of a population of subjects self-identified as chocolate addicts. Encephale, 27(2):181-6.
1) Macdiarmid JI, Hetherington MM (1995). Mood modulation by food: an exploration of affect and cravings in ‘chocolate addicts’. Br J Clin Psychol, 34(Pt 1):129-38.
1) Macht M, Dettmer D (2006). Everday mood and emotions after eating a chocolate bar or an apple. Appetite, 46(3):332-6.
1) Strandberg TE et al (2007). Chocolate, well-being and health among elderly men. Eur J Clin Nutr, 62(2):247-53.
Sugar is a No-No for Diabetics
The debate regarding the use of sugar by people who suffer from type 1 (insulin-dependent) and type (non-insulin dependent) diabetes has raged for years. Diabetics cannot be blamed for being confused because one set of dietary advice will state that diabetics should not eat any sugar whatsoever, while other diet guidelines say that some sugar can be included in diabetic diets.
Balanced advice can be found on the Websites of the American Diabetes Association (ADA)(1) and the Diabetes Association of South Africa (DASA)(2). The South African Diabetes Association states that diabetics should “Limit sugar intake because sugar (cane sugar) has a medium GI rating and so having diabetes does not mean a total ban on sugars. It means you can eat small amounts without making your blood glucose levels rise excessively. However, eating too much sugar is not a good idea as it adds to your total carbohydrate and kilojoule intake and will replace the nutritionally better and more filling carbohydrate foods”(2) (www.diabetessa.co.za ).
This is echoed by the American Diabetes Association on their Website (www.diabetes.org), where it is pointed out that having diabetes does not mean that “you will never have birthday cake again.” By planning your daily food intake you can eat small helpings of your favourite pudding or have a slice of cake on special occasions.(1)
The ADA advise that diabetics can keep their blood glucose levels at desired levels by “substituting small portions of sweets for other carb-containing foods in your meals and snacks.” They suggest that these portions of sweets or sugar should be approximately 45 to 60 grams. The trick is to identify other carbohydrate foods in a given meals (bread, rice, potato, cereal, fruit juice, corn on the cob or peas for example) and to substitute your small serving of sweets or sugar for one serving of carbohydrates (1).
The ADA also warns diabetics against falling into the trap of believing that foods labelled as ‘sugar-free or no added sugar’ do not contain any carbohydrates (1). This is not true. For example the labels on many packaged fruit juices state “No added sugar” and create the impression that diabetics can use these products indiscriminately. If you check the Nutritional Information on the carton you will find that pure apple juice, for example, contains 25,4 g of carbohydrates per 200 ml serving. The carbohydrate in apple juice consists mainly of fructose and other simple sugars. So although no sugar/sucrose has been added to the apple juice, the product inherently has a high concentration of carbohydrates and simple sugars. The statement “No Added Sugar” on such products, is therefore, misleading to the public.
The International Food Information Council Foundation (IFIC) of America, which is regarded as one of the leading sources of balanced nutrition information in the world, states that “sugars do not cause diabetes mellitus.”(3) Research in recent years has discovered that the idea that simple sugars like sucrose are digested and absorbed rapidly, thus causing a greater increase in blood sugar levels than other carbohydrates, is not true. Many different factors such as the type of food, type of processing of the food and the amount of dietary fibre in the sweetened food will determine how high the blood sugar levels of both diabetic and non-diabetic subjects will be after eating the food.
Scientific investigations have found that simple sugars like sucrose will not necessarily cause hyperglycaemia in diabetics (3}. For example many foods that contain sugars such as ice cream (GI 50) and chocolates (GI 49 - high fat) have a lower glycaemic index (GI) than foods like white and wholewheat breads (GI 72 and 70, respectively)4. Adding sugar (GI 65) to foods like cornflakes (GI 89) will lower the GI of the combination to about 67 (an intermediate GI). This means that the cornflakes on their own will cause a greater increase in blood sugar and insulin levels than the combination of cornflakes and a moderate amount of sugar. In addition, the high blood sugar levels will drop within one hour to levels that will increase hunger, while the combination of cornflakes and a moderate quantity of sugar will keep blood sugar levels steady for 2 hours.(5)
With this modern approach diabetics can, therefore, use moderate amounts of sugar as part of their diet prescription. Consult a clinical dietitian for the correct diet prescription for your individual condition (type 1 or type 2 diabetes, type of medication you are using, body weight, amount of physical activity, etc) and you will be able to have sweet treats on special occasions and use moderate amounts of sugar or jam to make your diet more tasty and interesting.
As the IFIC say, “Given their important taste contribution, sugars in the diets of persons who must restrict fat intake, such as people with diabetes, may offer important benefits in terms of satisfaction with and ultimate adherence to prescribed diets.”(3)
References - Diabetes:
1 American Diabetes Association (2008). Sweets & Desserts. http://www.diabetes.org (Accessed on 7 October 2008).
2 Diabetes SA (2008). Managing Diabetes. http://www.diabetessa.org (Accessed on 7 October 2008).
3 IFIC (2008). Sweet Facts about Sugars & Health. IFIC Review. http://www.ific.org/nutrition/sugars/index.cfm (Accessed on 10 October 2008).
4 Steenkamp G & Delport L (2002). The South African Glycemic Index Guide. GIFSA Publication.5 Steenkamp G (2008). Master Class - The Glycaemic Index. 22nd Biennial Nutrition Congress “Evidence Based Nutrition Leading the Way in Innovation”, University of Pretoria, 28 September -2 October 2008.
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