Monday, November 20, 2017

Diabetes Month Tip of the Workday


Question
What about these products marketed to diabetics like sugar substitutes, “low carb” ice cream or “sugar free” cookies?  Are they helpful?
Answer
This is one of my favorite topics to rant about, so get ready for a sarcastic ride.
The short answer to your question is maybe, maybe not, you only know if you look at the label and compare the serving size and carbohydrate content of the “new” product to the “original” product.  Sometimes you might see a huge difference in carbohydrate content per serving--like if you compare the label of a diet soft drink to a regular soft drink—52 grams of carbohydrate per can versus zero, but most likely you only see a difference in the price (and maybe half a gram different in carbohydrate).

A lot of the candies and other baked goods that are labeled “sugar free” also contain sugar alcohols; these are fermented starches that have a sweet taste and only about half of them are absorbed in the intestine—so only half of those carbohydrate grams change to blood glucose. They also tend to have a powerful laxative effect if you eat too much. And by too much, the threshold depends on the individual. Some people can eat a handful of the "sugar free" candies without issues, other people start having cramping with one or two pieces. One of the more amusing examples of this in popular culture is the reviews left on Amazon.com about the Haribo sugarfree gummy bears. If you have Irritable Bowel Syndrome (IBS) or any other digestive condition, like I do, I wouldn’t go near anything with sugar alcohols (erythritol being the one exception).
Now for the real question that you were hemming and hawing about.  Sugar substitutes….

Q: I heard that Equal/Splenda/Sweet and Low give you “the cancer.”

A:  There are many, many, different kinds of cancer, with many, many different kinds of causes.  If you are referring to the “the cancer” that the rats got from saccharine (Sweet and Low)—it was because they ate about 60-70 times their own body weight in saccharine. There haven’t been any real scientific studies that link “the cancer” to the intake of aspartame or sucralose as well.  Keep in mind that too much of anything will probably contribute to some kind of illness in some way, shape, or form. Michael over at Skeptical Raptor has also written extensively about the safety of aspartame in particular.

Q: I heard that Splenda “causes” diabetes and/or problems with the “good” bacteria in the gut.

A:  First of all, most of those studies were done in rats, and rats aren’t humans (I know, you are surprised! J).  Second of all, the amount of sugar substitute fed to the rats was rather large (about 11-12 cans of diet soda per day!), and doesn’t necessarily reflect “real life.” Third, when human studies were done, the amount of people studied was so small we can’t actually apply them to the larger population. In short, if you use a little bit of Splenda, etc. to sweeten your coffee in the morning, you are probably ok.  If you have Splenda in the coffee, Splenda on the cereal, Splenda in your yogurt, Splenda in your Cole-slaw (yes really), and drink diet drinks all day long (you know who you are), it wouldn’t be a bad idea to start reducing your consumption. And even then, it's not really the Splenda that you need to cut down on, it might be the stuff that you're putting sucralose on that you need to reduce to keep your overall calorie and/or carbohydrate intake down.

Q: But I heard that diet sodas were actually worse for you than regular sodas!

A: Go back and read what I just wrote about “the cancer” and “portion control” please.  I’ll wait. (Plays hold music)

Ok, first of all, if someone cuts out all that sugar and drinks something less acidic—they are likely going to have better control of their blood glucose, take in fewer calories, and have something that is less harmful to their teeth, they are probably going to do better with the health goals. As far as “diet sodas make you gain weight” trope—it appears as though people usually drink diet sodas to justify not changing any other habits besides their soft drink habit.  Remember that joke about the dude who orders the extra-large fast food meal with a diet coke?  The thing is….we humans are masters of rationalizing the choices that we make.  If you are really and truly going for a carbohydrate and calorie reduction….you probably need to look at other sources of such besides your soft drinks.  Now, to be fair, some people have claimed that they have increased hunger when they drink a lot of diet sodas—there might  actually be something to that—however, it’s the overeating on other foods that causes the weight gain, not the actual diet soda themselves.

Q: So I can drink diet sodas all day long?

A: No really, go back and read what I just wrote about portion control.  For everything. Really. I’ll wait, again.  (Plays hold music again)

In addition, for those us (me) that need the whole "portion control" thing reinforced in our brains, most bottled products will have sodium in them, and some of us don’t need the extra on that either, particularly the population that I work with--those that already have cardiac and renal (kidney) issues.  There is also that whole "hard on the teeth" thing that can happen (even without the sugar) in the cola type beverages.  Some people might also have conditions, along with the diabetes, that make them super sensitive to caffeine.  And then, for me, there's always been the issue of cost.  I like a good diet ginger ale sometimes, and the bubbly feel of sparkling water, but I also like the lower cost of tap water or tea I make myself.

Q: What about “natural” things like stevia? Or could I use honey/agave nectar/brown sugar/maple syrup, etc.?

A: “Natural” does not mean better.  Getting mauled by a bear is “natural” but not something you want to do on a regular basis (or at all, really).  The evidence says Stevia hasn’t been shown to cause any problems when used in moderation, so if you find a product you like (some products have a bitter taste) you can probably use it safely in small amounts. There are also some other plants, like monk fruit, that seem to be safe if you are watching the amounts. Some formulations of stevia also have a bitter taste, or some people (me) forget that stevia is much sweeter than sugar and get a sharp realization about that once they take that first sip of coffee.

Honey, agave nectar, maple syrup brown sugar, etc. are still all carbohydrates so each tablespoon will provide 15 grams of carbohydrate.  If you use these items you will need to “count” them toward your carbohydrate intake. I personally would rather just take my coffee black or dump in a packet of Splenda so I have one less thing to think about, but again, that’s my personal choice of where I want to spend my carbohydrates.

Want to keep reading?

For a humorous take on this (he’s a little sweary too): http://www.bodyforwife.com/does-diet-soda-increase-belly-fat/

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