The not-so-sweet truth about blood sugar
We all need blood sugar. Commonly called blood glucose, it’s the source of energy for our bodies’ cells, muscles, and other organs including our brains. We need it to survive.
When we eat, our bodies digest the food to break it down into glucose. The glucose enters our bloodstream and is delivered to each of our bodies’ cells by insulin. Normal glucose levels change throughout the day from between 70 to 100 milligrams per deciliter (mg/dL) in the morning before eating to up to between 135 to 140 one to two hours after eating.
When our circulatory and metabolic systems are working well, we have energy, stamina and health.
When we consume too much sugar or too many simple carbohydrates, we overload our bodies and put ourselves at risk for lethargy and disease.
Even if we just ate whole, natural foods without adding any sugar, our bodies could make all the glucose needed for optimal health and well-being.
But, as a society, we, Americans love our sugar.
The average American eats 156 pounds of sugar a year. That’s well over the American Heart Association’s daily recommendation of 6 teaspoons or 20 grams of added sugar for women; 9 teaspoons or 36 grams for men; and 3 teaspoons or 12 grams for children.
If all those sugar calories consumed in a year were turned to body weight, the average American would gain and extra 78 pounds each year.
But it’s not just added weight. All that extra sugar has a damaging impact on our bodies.
Sugar affects our brains. Our brains cannot store glucose and without a continuous supply, brain cells can die. As a matter of fact, our brain cells require two times the glucose needed by the other cells in our body. Glucose in the right amount is good for the brain – it’s the added sugar that is deadly.
Too much glucose in the bloodstream can compromise brain cells’ ability to communicate. It can affect memory, idea processing and mood.
Studies show that a high-sugar diet reduces the production of brain-derived neurotrophic factor or BDNF, which inhibits the brain’s ability to form new memories and makes it difficult to learn. Diabetics and pre-diabetics have lower amounts of BDNF, these levels correspond with their decreased ability to metabolize sugar.
Recent studies by Suzanne de la Monte, MD a neuropathologist at Brown University, show a link between insulin resistance and brain cells, which creates a condition similar to diabetes in the brain. She has called this condition type 3 diabetes. Her work points to a theory that Alzheimer’s may be a metabolic disease, though more research is needed.
Added sugar ages your skin. Sugar contributes to aging by producing radicals that attach to proteins to form advanced glycation-end products or AGEs, which damage collagen and elastin. AGEs, aptly named, also deactivate the body’s natural antioxidant enzymes which interferes with the cells ability to repair themselves. This often leads to cell damage and cell death. When this happens in your skin, dry brittle protein fibers will cause wrinkles that make you look older. AGEs also may make your skin more prone to sun damage.
Sugar increases your risk of heart attack. Sugar’s empty calories can cause weight gain. With an increase in weight, people will also experience an increase of heart disease. The American Heart Association cites a JAMA article, stating:
“those who got 17 to 21 percent of calories from added sugar had a 38 percent higher risk of dying from cardiovascular disease compared to those who consumed 8 percent of their calories from added sugar. The risk was more than double for those who consumed 21 percent or more of their calories from added sugar.”
Increased sugars may feed some cancer. Research from the University of Copenhagen shows increased sugar may feed some cancers. It may also have an impact on the development of breast and colon cancers. Some of the tumors may have insulin receptors that need glucose to survive.
Sugar can cause tooth decay. Sugar has a major impact on your overall oral health, but consuming sugar laden drinks like soda or juices, allows it to get into every nook and cranny of your teeth. The longer sugar remains in your mouth, the easier it is for bacteria to grow and cause cavities.
Sugar can lead to nonalcoholic fatty liver disease. This condition was virtually unheard of before 1980. A fat liver does not perform as well as a healthy liver. This forces the pancreas to make extra insulin – and you won’t always notice this effect. According to the American Journal of Clinical Nutrition, eating more than 1,000 calories of sugar a day increased the body weight of 16 subjects by just 2 percent, but increased liver fat 27 percent in just three weeks.
Sugar increases bad cholesterol. A study in the Journal of the American Medical Association found that normal weight and healthy people who ate the highest levels of added sugars recorded the highest increase in LDL (bad) cholesterol, triglyceride blood fats, and the lowest increase in HDL (good) cholesterol levels.
Sugar irritates your blood vessels. Sugar damages the endothelium, a sheath of cells that coats in the inside of your veins and arteries. It makes your blood vessels less sensitive and more prone to an increase in plaque deposits as the finger-like extensions inside the vessel stick together. This often leads to cardiovascular disease.
Simple sugars slow down your workout. Your muscles get their fuel from carbohydrates, which is why bikers and runners often will carb-load the night before a big race. Simple sugars, especially fructose, are not metabolized by the muscles, but are metabolized in the liver. They will not produce added energy.
Sugar creates a voracious appetite. Most of us realize that eating too much sugar, especially in the form of high fructose corn syrup, will make us gain weight, but we may not realize that those sweet treats may also cause us to eat too much. Fructose interferes with the production of leptin, a hormone that tells the brain we have eaten enough. Without this critical communication component working properly, we will have a tendency to eat not only the first portion, but a second and maybe even a third helping before we feel satiated. Sugar in all of its forms will inhibit leptin production.
Sugar by any other name is still sugar.
Many “healthy foods” actually have more added sugar than a sugar-glazed donut. Many times we don’t even know we are eating sugar. It’s well hidden in the foods that we eat – especially in processed and pre-packaged foods. We can even find sugar in foods that we don’t think of as “sweet,” foods like salad dressings, crackers, spaghetti sauce, whole wheat bread, yogurt, frozen dinners, frozen meats, bagels and baked beans. Sugar is even in beef jerky and healthy sounding smoothies. Sugar hides in many foods under many assumed names.
But, sugar by any other name is still a simple carbohydrate that turns to glucose in your body. That includes natural sugars like honey, maple syrup, agave nectar and sugar cane. Your body reacts to sugar in the same way whether it’s refined white sugar or a natural sugar like honey and maple syrup.
Always read the nutrition labels and remember every four grams of sugar listed equals one teaspoon. You may not see sugar itself listed; it might be disguised as nectar, syrup, dextrose, glucose, lactose, sucrose, fructose, barley malt, sorghum, maltose or molasses. If sugar or one of its other names appear in the first five ingredients, you should put the package back on the shelf and look for a healthier alternative.
Don’t be fooled by the term whole grain in the name of a product. Look at the nutrition label to make sure that the first ingredient is actually a whole grain. Some products are made with flours that have been processed to the point that they are digested in the same way as their “white-flour” counterparts.
Be cautious of natural sweeteners; many of them have high fructose content—even higher than high-fructose corn syrup. If your sweet tooth needs a treat, use less that a teaspoon or honey or “real” maple syrup once a day.
Cooking from scratch can help you limit the amount of sugar added to your food.
Glucose regulation is critical for health
Our bodies need balanced blood sugar levels. Too much or too little sugar creates serious health risks.
The added sugar and the high sugar content in processed foods can start the body on a blood-sugar roller coaster ride, filled with ups and downs.
What is normal blood sugar? Blood sugar, glucose, or A1C (hba1c) levels ranging from 4.5 to 6 percent are considered normal and can provide the energy that our bodies need.
Levels higher than that can cause people to develop type 2 diabetes, metabolic syndrome and other health problems, which may be difficult or impossible to reverse.
High or low, blood sugar levels can affect how you feel.
Hyperglycemia, or high blood sugar, is diagnosed as 180 to 200 milligrams per deciliter (mg/dL). At this level, it exceeds the capacity of the kidneys to re-absorb the glucose and we begin to spill glucose into the urine. If glucose levels rise to 400 or 500, mental function may be impaired. If these high levels persist for a long time, mental changes may occur.
Hypoglycemia, or low blood sugar, can create a medical emergency. When glucose levels drop below 60 or 65 milligrams per deciliter (mg/dL), even people who are not diabetic may experience symptoms of low blood sugar. They may feel their hearts race or they may feel shaky, hungry and irritable.
If blood sugar levels drop below 50 mg/dL people may begin to experience a loss of mental function. Levels lower than this may cause unconsciousness and seizures.
To avoid the effects of hypoglycemia, be sure to eat protein with carbohydrates.
What is a sugar crash? It is the bottom of a spiraling blood-sugar cycle. For instance, you eat a high-sugar snack or choose a donut for breakfast. The simple sugar/simple carbohydrate enters your bloodstream quickly giving you a jolt of energy. At the same time, the high-sugar food prompts the brain to release serotonin, your feel good hormone.
As your body quickly digests the sugar, the glucose quickly leaves your bloodstream and leaves you feeling tired and worn out. You may even feel shaky and irritable. So, you reach for another sugar snack to lift you up. It’s a vicious cycle. Sometimes you can go from sugar rush to sugar crash in 30 minutes or less.
Is there a connection between sugar and diabetes?
While sugar is not reported to cause diabetes, there is a strong association between sugar and diabetes that is not found with any other food type. A PLoS One study authored by Sanjay Basu et al, found that for every extra 150 calories (9 teaspoons) from sugar available per person each day, diabetes prevalence rises by 1.1 percent.
Even though sugar itself may not cause diabetes, the empty calories most likely contribute to weight gain. There is no doubt that people who are overweight or obese are at risk for metabolic syndrome, which also increases the risk of pre-diabetes and diabetes.
You don’t just wake up one morning with type 2 diabetes. Usually there is a progression. You first might be told that you have a metabolic syndrome.
One in six people have metabolic syndrome. According to WebMD, metabolic syndrome is not a disease, but a set of risk factors including high blood pressure, high blood sugar, high cholesterol and abdominal fat. These factors double your risk of cardiovascular disease and increase your risk of diabetes five-fold.
Losing weight and controlling the other factors that you have through diet, exercise and medication if necessary, are the best treatments for metabolic syndrome. If you do nothing, you could be diagnosed with pre-diabetes.
Pre-diabetes is another warning sign on the path to type 2 diabetes. People who have been diagnosed with pre-diabetes have impaired glucose tolerance which contributes to fasting blood sugar levels between 100 and 126 mg/dL. Individuals with a pre-diabetes diagnosis may also be at risk for eye problems, kidney disease, heart disease and stroke.
Diabetes occurs when the body can no longer process sugar efficiently. Your cells need insulin to allow the glucose to enter and be used as fuel.
This may occur because sugar dulls the brain’s receptors so it takes more sugar to satisfy the craving.
However, more research is needed to determine sugar’s role.
However, more research is needed to determine sugar’s role.Since the evidence shows that sugar affects dopamine (the feel good hormone) in our brains, it may be the reason why people show dependency-like behaviors that include cravings, losing control (eating the whole bag of cookies instead of just one or two), and eating more than they planned.
Diabetes is diagnosed if your fasting blood glucose level is over 126 mg/dL.
You may be able to reduce your risk by making healthy lifestyle and food choices, becoming more active and watching your weight.
For more information on the symptoms of diabetes, click here.
Is sugar addictive?
It may be. People who consume large amounts of sugar may show dependency-like behaviors that include cravings and overeating. This may occur because sugar dulls the brain’s receptors so it take more sugar to satisfy the craving.
Real-time brain scans show that sugar is a catalyst to dopamine and opioid release in an area of the brain associated with reward. This same area is activated by cocaine and heroin. While evidence is inconclusive that sugar is the cause, studies show similarities in the brain images of obese people and people who are addicted to drugs and alcohol. More research is needed to determine sugar’s role.
There is evidence that sugar affects dopamine (the feel good hormone) in our brains, which causes people to show dependency-like behaviors that include cravings, losing control (eating the whole bag of cookies instead of just one or two), and eat more than you planned to eat.
Some food pairs help regulate blood sugar
The quick conversion of simple carbohydrates (like pasta) to sugar can be delayed when mixed with vinegar. The acetic acid slows the digestive process so that glucose is not absorbed as quickly. For a healthy alternative, enjoy pasta (whole wheat, of course) with two tablespoons of balsamic vinegar and olive oil.
Combat post-workout hypoglycemia with a banana and yogurt.* The mix of carbohydrates and protein keeps blood glucose balanced.
Steeped green tea* with toast at breakfast can give you a workout boost without a blood sugar spike. A 2012 Pennsylvania State University study found that Epigallocatechin gallate (EGCG) in green tea lowers blood-sugar spikes caused by starchy foods by up to 50 percent.
Long workout? Recover faster with whole grain cereal and milk, which increases muscle glycogen stores and protein synthesis and helps regulate blood sugar.
* Read labels for sugar content when choosing yogurt, tea and cereal.
What about sugar substitutes?
Use caution when using sugar substitutes. Some report that they are unhealthy, while others report that they actually cause you to eat more.
If you have questions about substitutes, you can conduct your own research and note how you feel after you use a substitute. Keep a journal and see if you feel irritable, tired or hungry. If so, you can stop. Remember that whole, unprocessed foods are always the best natural nutrition choice.
What is a good diet for someone who has diabetes?
There are more than a few misconceptions about eating and diabetes. Peter Gintner, PA-C, a physician assistant with Ministry Medical Group in Thorp, provides some facts to counter these misconceptions:
FACT: Diabetes is not caused by eating too much sugar.
Yes, the disorder was once known as sugar diabetes because it involves high levels of sugar or glucose in the blood. But this happens not because a person eats too much sugar but rather because the body becomes unable to process carbohydrates.
All carbohydrates that are eaten — potatoes as well as cookies — are converted into glucose during the digestion process. Glucose in the blood triggers the release of insulin by the pancreas to allow this glucose to be taken into cells to be used for energy or stored as fat.
Type 1 or insulin-dependent diabetes occurs because the pancreas becomes unable to produce insulin. Without insulin, cells fail to get the energy they need and glucose accumulates in the blood, causing damage to blood vessels and nerves in the heart, eyes, kidneys and virtually every part of the body.
Type 2 diabetes develops because the pancreas becomes unable to produce enough insulin or because cells are resistant to the action of insulin. As a result, glucose tends to accumulate in the blood unless action is taken to control it.
Eating dessert does not cause the pancreas to malfunction, but eating too many desserts, with their empty calories, will certainly contribute to weight gain, which in turn can lead to insulin resistance. Most type 2 diabetics carry excess weight, particularly around the abdomen.
Although diabetic diets in the past were restrictive regarding sugar and concentrated sweets; that is no longer the case. People with both type 1 and type 2 diabetes can and do eat desserts in moderation as part of a healthy meal plan.
FACT: There are no “special diabetic” foods or meals.
Whether you have type 1 or type 2 diabetes, you can and should eat regular meals with your family and friends. Coronary artery disease and high blood pressure are major complications of diabetes. As a result, a good diabetic diet is heart healthy — low in saturated and trans fats but with adequate quantities of omega-3 fatty acids (from fish) and monounsaturated fats (from nuts and olive oil).
Many people are familiar with the DASH diet to control hypertension (DASH stands for Dietary Approaches to Stop Hypertension). It is a healthy eating plan that includes five servings of fruits and five servings of vegetables every day plus whole grains and low-fat dairy products, and is a suitable plan for people with diabetes.
FACT: Carbohydrates raise blood sugar, but they are an important source of nutrients and energy.
There is no reason to restrict intake of carbohydrates, although type 1 diabetics must monitor how many carbohydrates they eat at any one meal.
Blood sugar control requires a delicate balance among carbohydrate intake, insulin injections and physical activity. If you’re on a fixed dose of insulin, the number of carbohydrates you consume at each meal and snack should be consistent as well.
Particularly for children, special occasions like birthdays or Halloween may mean extra sweet treats. That’s okay as long as there is a comparable adjustment in the number of carbohydrate grams from other sources (potatoes, rice, pasta) consumed during the rest of the day.
Nutritionists point to an important distinction between simple carbohydrates such as those in candy, fruit and milk and complex carbohydrates such as beans, chick peas, cereal and starchy vegetables such as potatoes. Most of the latter are high in fiber, and studies have found that eating a high-fiber diet can improve blood sugar control and cholesterol.
FACT: Protein and fat take longer to be converted into glucose and have a less powerful effect.
Although this is true, people with diabetes do need to remember that most foods that are high in protein are laden with saturated fat and cholesterol. And, both protein and fat are associated with insulin resistance. A low carbohydrate/high protein regimen has been found effective for weight loss, and some studies have found it conducive to good blood sugar control as well. Over the long term, though, there are questions about the safety of such a diet for a person with diabetes.
Gintner concluded, “There is no one diabetic meal plan that’s best for everyone. It’s up to the patient to work out a sensible plan with his or her healthcare provider — a plan that is flexible while bringing about good control of blood glucose.”
What Is the Best Heart-Healthy Diet?
The concept of a heart-healthy diet has changed somewhat over the past two decades, but the low-fat diet plan recommended first by Nathan Pritikin and then by Dean Ornish still has considerable support from medical experts.
Although the Ornish diet is not strictly vegetarian, it is strongly oriented toward fruits, vegetables and whole grains with very little meat, butter or other fat. For any extended period of time, a diet that allows only 10 to 15 percent of calories to come from fat becomes extremely Spartan. In practice, many nutritionists consider 25 percent fat to be a more reasonable low-fat goal.
Some experts today, on the other hand, believe that even the 25 percent goal is too strict and fails to take into account the health benefits of some fats. People parsimoniously measuring fat grams are likely to ignore fish, nuts, unsaturated fats and omega-3 fatty acids -- all now considered beneficial to heart health.
Observational studies have shown that people who eat fish, particularly fatty fish such as salmon, trout and mackerel, have a lower risk of heart attacks. To get adequate quantities of omega-3 fatty acids, the American Heart Association recommends that you eat fish at least twice a week.
Dan Gilles, PA-C, a physician assistant with Ministry Medical Group in Stanley, said, “Nuts were once avoided as high-fat foods, but they too are high in omega-3 fatty acids as well as protein, fiber, minerals, vitamins and antioxidants.”
One review of 25 randomized, controlled studies found that subjects assigned to eat half a cup a day of nuts registered decreases of 11 mg/dL in their total cholesterol and 10 mg/dL in LDL. Gilles advises, “If weight loss is your goal, you should limit yourself to a quarter-cup of nuts per day.”
Rather than throwing out all fats, most experts today focus more specifically on eliminating the fats known to be bad for the heart — saturated fats and trans fats -- and replacing them with healthy monounsaturated fats that are known to lower LDL cholesterol while raising levels of the beneficial HDL.
According to Betsy Wacker, PA-C, a physician assistant with Ministry Medical Group in Stanley, “For incorporating these healthy fats, the Mediterranean diet -- focusing on vegetables, fruits, fish protein and healthy oils -- is an excellent choice. It’s even better when it includes whole grain, rather than white pastas.”
Another heart-healthy plan that focuses on the pleasure of eating rather than deprivation is the TLC (Therapeutic Lifestyle Changes) diet. This diet recommends six or more servings a day (adjusted for calories) of whole grain breads and cereals; three to five servings a day of vegetables, dry beans or peas; two to four servings of fruits; and two to three servings of low-fat dairy products. Whereas the Ornish plan recommends avoiding or severely limiting all meat, the TLC diet allows five or less ounces a day of lean cuts of meat.
What about cutting carbs? Losing or maintaining weight is a crucial part of any heart healthy lifestyle, and low carbohydrate diets have been found effective at trimming excess pounds, even when such diets involve relatively high amounts of fat and protein. Dr. Ornish’s recent article in the New York Times takes an aggressive stance against such diets, and most medical experts agree although research so far has not reached definitive conclusions.
Wacker advises, “Rather than choosing one diet or another, the best approach may be to follow some basic heart-healthy principles endorsed by the American Heart Association: cut back or avoid saturated and trans fats; increase your intake of healthy unsaturated fats, omega-3 fatty acids, nuts and fish; focus on getting plenty of fruits, vegetables, whole grains, fiber, potassium and antioxidants.”