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Eating Sugar doesn't Cause Diabetes!

"Really? Eating sugar doesn't cause diabetes? Can I consume more sugar henceforth and not be prone to diabetes?" I am sure you asked your self a lot of questions when you read the caption of this article. I am certain that after reading this article, you will get to understand the actual information I seek to relay.

It was a very busy day at La General Hospital where I was undertaking my clinical internship. I was stationed at the Nutrition Department. My duty was to assist the lead nutritionist in dietary counseling of a diabetic patient who had been referred by her consultant doctor to receive nutrition assessment and management advice at the Nutrition Department.

The patient looked desperate when she entered the Department. Her health record showed that she had been newly diagnosed with diabetes. She complained that she couldn’t believe the diagnosis to be correct and even if so, suspected it to be a 'spiritual disease' her evil relatives had probably cursed upon her.

She simply didn’t understand why became diabetic overnight. Per her narration, she was someone who didn’t eat sugar the least bit. She explained further that for several years (more than a decade), she had been avoiding the intake of high sugar-containing foods and under no circumstance added table sugar (sucrose) to her breakfast meals. From her explanation, she seemed to be the kind of person that feared sugar (a saccharophobian) hence considered it impossible and counter-logic to be diagnosed with a sugar-related disease.

From the little information she had about the causes of diabetes, her perception was that it is solely caused by eating sugar. Thus, it seemed ironic that after several years of strictly avoiding sugar intake, she goes to the hospital for a check-up and is entangled by the unsuspecting tentacles of diabetes.

The patient's confusion was so visible on her face that you could touch. Madam Agatha, the nutritionist, calmed the anxious patient down. She tried to clarify to her the reason behind her sudden diabetes development and the ways she could manage it. During the counseling session, the nutritionist emphasized that simply consuming sugar isn’t the root cause of diabetes. She looked surprised to listen to such an announcement for the very first time in her life. The nutritionist noticed the confusion on her face and clarified that it had been rather regular EXCESS intake of sugar (indirectly) that had caused her ailment.

The patient was now sober, listening carefully to the counsel of the nutritionist. The nutritionist added that if a person eats sugar in moderation, there was no cause for alarm in getting diabetes.

Despite Madam Agatha's clarification, the diabetic patient was still confused. She argued that her issue was different from what the nutritionist was saying: she had been 'abstaining' from table sugar. Per her reasoning, the nutritionist didn't understand her narrative hence had totally deviated from the situation at hand. "If I got diabetes without taking the least bit, wouldn’t it have been worse if I consumed sugar sparsely or whatever?” She must have thought.

As an intern, my duty was to check the anthropometric measurements of patients. Before the nutritionist continued her counseling session with this patient, she made me do this for our desperate patient who was dissatisfied and quite angry. Right from the time she entered the nutrition unit office and began complaining about the diagnosis to be unbelievable, I already knew why contrary to her assertion, the diagnosis was credulously true!

For a woman with a short height with weight above 75 kilograms in her mid-thirties, low metabolic rate and Body Mass Index (BMI) within the obesity range, she was vulnerable to getting diabetes whether or not she avoided eating table sugar and took an over-sized portion of carbohydrate foods.

I handed the small print of the measurement to the nutritionist. She checked it out and smiled. “Aha! This must be why”, the nutritionist said suggestively to the patient. When the nutritionist queried to find out what the patient normally ate, she answered that she liked to eat 'Hausa koko' (millet porridge) without the addition of table sugar, but with bread during the morning; rice in the afternoon and 'banku', 'fufu' or 'kenkey' [all carbohydrate-based foods] during the evening which confirmed our (the nutritionist and me) suspicion of the reason behind her ailment.

She confessed that she indeed ate heavy meals within the later hours of the day and slept straight away without any physical activity. In fact, she never engaged in any form of physical exercise. She also confessed that she liked eating a lot and in large quantities too. She could eat three balls of 'kenkey' and in but half-hour’s time, she ate fried yam. She was asked if she liked eating vegetables and she answered no. She joked that salad is for weaklings and herbivores.

It wasn’t funny so I wondered why she laughed at her joke and her countenance had suddenly changed with a change of topic to her delicacies. We were confused to find out that somebody who asserted to be 'saccharophobian' often drunk soft drinks. Questioning to find out if she was aware of the fact that 250 ml of original coca-cola (for instance) contains 26.5 g, about six (6) teaspoons of added (nutritive) sugar, she answered sharply, "Of course! I do know there’s some sugar in it since it's sweet.

Since I am aware sugar is not good, I dilute Coke, Pepsi and other soft drinks with water before drinking. This reduces the mass of sug…” She barely finished talking when my madam cut in, "Interesting. You are misinformed about the actual link between nutrition (consumption of carbohydrates) and diabetes. Adding water to soft drinks will in no possible way to take the sugar within the drink away.

It only makes the sugar concentration low so that it doesn't taste very sugary. If a 100 ml drink contains say, 10 grams of sugar, even adding an extra 100 ml water won’t reduce the sum-total mass of sugar in the drink at all…! There'ill still be 10 grams of sugar within the diluted drink (now 200 ml) which will only tasteless sugary due to a change in sugar concentration from 0.1 % to 0.05 %. That's it… so I’m very shocked about what you're saying and that I do not know where you learned that idea from…”

Need I exaggerate to you how quiet the once-worrisome patient was, now? The nutritionist took advantage of her quiet mood and explained very simply to her that with such a dietary pattern, it's not strange that she had diabetes withing the long term. It had been a pity that the patient had misinformed knowledge of diabetes and tried to avoid it via the wrong practices. Her counseling had kept long and other patients were in wait to be attended to. The nutritionist ended her long talk up by explaining to her practical nutrition tips to manage her type II diabetic condition.

As a start, she needed to accept the diagnosis as valid and work towards it's management. This includes (but not limited to) eating less refined foods, avoiding the addition of sucrose to her food (something she had apparently been practicing), eat more vegetables (especially onion which has bio-active compounds helpful for diabetes management), roughage containing/ high-fiber foods. She could drink zero-sugar soft drink alternatives like 'diet coke' or 'coke zero'. Additionally, she was advised to consume corn porridge (without the fiber being extracted from the corn dough) in place of the ‘Hausa koko’ which was more refined. The patient questioned if she could eat fruits. In reply, she was advised to eat fruits with lots of roughage and less sugar content; not more than three fingers of banana, for instance.

At last, the counseling was over. The formerly aggrieved and bitter patient left the office with a much better countenance and much more enlightened. She had come to understand that her case was not mere diabetes but diabesity (obesity coupled with diabetes). Madam Agatha looked at her as she left and gave a deep sigh of relief and fulfillment.

The message is clear! Sugar intake is not necessarily the cause of diabetes but rather, the regular excess consumption, whether directly or indirectly. As a substance, sugar is good so far as glycolysis (cellular energy generation and utilization) is concerned. The ball game changes and diabetes sets in only when the sugar intake is high whereas the hormone in charge of regulating the blood sugar level (insulin) activity or concentration is low. The main types of diabetes will be explained in the subsequent article.

We must try the maximum effort to avoid junk food addition (the impulsive habit of eating lots of refined foods due to stress or boredom). Whether our table sugar is the brown sugar type or not, it must be taken in moderation. Too much everything is definitely bad! If you choose to avoid table sugar intake, it is a plus. However, make sure you don’t take foods that will contribute to a high blood sugar level after all.

Carbohydrate-based foods are digested (broken down) into monosaccharides (simple sugars) upon complete digestion hence it's the same as eating table sugar (sucrose). This is often why a balanced diet with as much vegetables as carbohydrates is recommended. You do not need to be one who fears sugar to avoid diabetes. According to the American Heart Association, all it takes is a balanced dietary pattern that ensures a daily recommended intake of sugar being 25 g for women and 37.5 g for men.

More often than not, our misunderstanding of issues is usually the cause of our predicaments but we do realize this truth only when it's too late!

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La General Hospital Nutrition Department

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