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Diabetes Type 2
Diet and Nutrition
Sometimes for people with diabetes it feels like sugar is the enemy, and for years this was a cornerstone of the dietary philosophy for managing diabetes.
InteliHealth Medical Content

Reviewed by the Faculty of Harvard Medical School

For people with diabetes, it is helpful to avoid heavily sweetened foods. Sugar in your diet adds carbohydrates and calories, and scientists now understand that sugar can change your metabolism. If you are going to consume sugar, you must plan carefully.
Refined sugar is the ultimate refined carbohydrate. It's absorbed very quickly into the bloodstream. A drink, snack or meal that is mostly refined carbohydrates can lead to a high peak in your blood sugar soon afterward. Your body may respond with a large spike of insulin. Some nutrition experts think that frequent insulin spikes can cause your body to become more resistant to the effects of insulin.
Sweeteners may change metabolism. That's the rate at which our bodies use energy or burn calories. In human and animal studies, fructose leads to:
  • Higher triglyceride levels
  • Low HDL ("good cholesterol") levels
  • High blood pressure
People with a lot of sugar in their diets are more likely to have insulin resistance (the cause of type 2 diabetes), fatty liver and fat around the middle (abdominal obesity). This collection of conditions, which has been linked with heart disease, is called the metabolic syndrome.
How does your metabolism change? Some experts point to chemical changes. Fructose digestion depletes our supply of a cell fuel known as ATP. They think that this could be what shifts metabolism.
Other scientists think sweeteners are a message to the brain. They say that changing our metabolism when our diet is at its sweetest may be key to survival of the fittest. These scientists point out that in harvest season, sweet taste tells the brain "it's time to store fat." For example, eating berries at the end of summer helps bears store up fat for the winter.
The problem for Americans is that our sweet diet is year-round. If sweetness is a message to the brain, we need less of the "store fat" message in our bodies.
In 2009, the American Heart Association issued advice about "added sugars." These are the sweeteners that are added to processed foods and beverages, as well as the sugar you might use at home in baking and at the table. These include corn syrup, cane sugar, brown sugar and honey.
The AHA recommends Americans cut their daily "added sugar" intake to the following:
  • Women — no more than 5 teaspoons
  • Men — no more than 9 teaspoons
  • Children 4 to 8 years old — no more than 3 teaspoons
Adults who aren't active or drink alcohol regularly should have less than these amounts.
The most effective way to have less sugar in your diet is to stop drinking sweetened beverages on a regular basis. Americans get 33% of their added sugar from soft drinks. A single 12-ounce soda has about 8 teaspoons of sugar.
Sodas are a major cause of new diabetes. Data from the Nurses' Health Study showed this risk dramatically. This study looked at the habits of more than 50,000 American women over an eight-year stretch. Women who had one or more sugary drinks daily were almost twice as likely to develop diabetes as women who did not have this soda habit. The soda drinkers also were about 10 pounds more obese.
Calories are more concentrated in table sugar than in other carbohydrates. A single tablespoon of sugar has as many calories as a 3-ounce plain baked potato! In addition, the calories in sugar are "empty." They do not supply vitamins or nutrients.
There are many different kinds of sugar and natural sweeteners. They differ mainly in how fast and how fully they are digested.
Table sugar, brown sugar, honey and molasses are pure or near-pure forms of sucrose. This type of carbohydrate is digested quickly and completely.
Fruit, fruit juice and corn syrup contain the sugar fructose. It is digested more slowly than sucrose but has about the same number of calories. Large amounts of fructose can affect cholesterol and metabolism. Whole fruits and vegetables are healthy parts of your diet. The amount of fructose they contain is not a concern, especially since they are gradually digested and contribute healthy fiber along with their natural sugar.
However, fruit juices have highly concentrated fructose. People with diabetes do best if they avoid fruit juices and stick with whole fruits instead.
Sugar Alcohols
Sugar alcohols are other sweetening agents. They include:
  • Sorbitol
  • Xylitol (birch sugar)
  • Mannitol
  • Maltitol
  • Lactitol
  • Isomalt
  • Erythritol
Sugar alcohols are only partly digested. Therefore, they provide sweetening with somewhat fewer calories. These products can cause diarrhea, gas or abdominal cramps in some people. Doctors do not know whether using sugar alcohols instead of table sugar will help in long-term control of weight or blood sugar. However, they appear reasonably safe as long as you don't use enough to cause frequent diarrhea.
Non-Nutritive (Zero Calorie) Sweeteners
Four artificial sweeteners are available. They are:
  • Aspartame (NutraSweet)
  • Saccharin
  • Acesulfame potassium (Ace-K, Sunette)
  • Sucralose (Splenda)
These products are many times sweeter than sugar. They contain no calories. For this reason, they are named non-nutritive sweeteners. These sweeteners can be used in cooking. They also are found in many processed foods and drinks. People with diabetes can use these sweeteners with minimal short-term effect on blood glucose or weight.
Still, it is still not a good idea to cultivate a sweet tooth if you have diabetes or a high risk of diabetes. As mentioned, some researchers believe sweet taste — even with zero calories — may be a signal that drives the body toward an unhealthy metabolism. Using artificial sweeteners instead of other sugars has not been proven to help control weight or glucose. Long-term effects have not been studied.
Many foods contain hidden sweeteners — sometimes where you least expect them. Be careful to read nutrition labels.
Choose spicy or tangy foods rather than sweet ones if you are diabetic. If you are in good control of your diabetes, it is not a problem to have an occasional sweet. However, this can raise blood sugar unless you reduce other sugars or starches or use extra medicine at mealtime to lower glucose. Regularly eating a lot of sweets can interfere with your glucose control. In particular, you should avoid sugared drinks such as sodas.


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Last updated November 03, 2014

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