The primary concern for diabetics is carbohydrate intake. In brief, carbohydrates are classified as simple or complex, depending upon the food's chemical structure and how fast it gets absorbed into your bloodstream. Simple carbohydrates have one or two sugars: fructose, in fruit, is a single sugar; lactose, found in dairy products, is a double sugar. Sucrose, in the sugar bowl, is also a double sugar. So is honey, though it has a number of other nutrients as well. Complex carbohydrates include whole grain breads and cereals, starchy vegetables and legumes. But it all gets broken down into glucose.
Insulin, secreted by the pancreas when you eat, allows glucose to enter your cells. But if you don't secrete enough insulin (type one diabetes), or your cells are insulin resistant and can't make proper use of it (type two diabetes), the amount of glucose in your blood stream rises. When this situation becomes chronic, a host of ills ensues. It's not entirely clear why this happens in some people and not in others; there's probably a genetic component among many other causes.
For someone struggling with severe blood sugar problems, sugar substitutes may have a place in one's diet. But not without a serious caveat. As a dietitian, I tell people I understand white sugar and its effects on the body, but as for artificial sweeteners, we have not had enough time to study the effects of these chemicals. A "sugar free" label sends a specific message - it's low in calories and it's not sugar so it's good for people with diabetes and it helps people who are trying to control their weight - it's healthy, innocuous and harmless. Or is it?
The skinny on sugar substitutes
Saccharin, aspartame (NutraSweet/Equal), and sucralose (Splenda) are everywhere. You see these sugar substitutes on restaurant tables, stacked next to the salt and pepper. Savvy marketing has color coded them so everyone knows the difference between the blue and the pink packets.
Consumers love "free" foods; fat free, carb free, and sugar free foods are the darlings of the diet industry. But sugar free foods do not necessarily help in weight loss. The Los Angeles Times reported that 160 million people ate artificially sweetened foods in 2000, up from 70 million in 1987, and adult obesity doubled during the same time period. Certainly statistics can be manipulated to show almost any result, but it would seem convincing that artificially sweetened foods are not helping people lose weight.
In the February issue of the Journal of Behavioral Neuroscience, a study on saccharin found that the artificial sweetener may actually cause weight gain. Test rats fed saccharin gained more weight than rats fed conventional sugar in their food. Calories signal satiety and saccharin is calorie free. The scientists observed the sugar free rats eat more food and subsequently gain more weight than their counterparts because there was less caloric signaling to the body that it was full.
Lyn M. Steffen, an associate professor of epidemiology at the University of Minnesota, said in the Journal of the American Heart Association that one reason the rats fed artificial sweeteners gained more weight is because the consumption of artificial sweeteners "impairs the body's ability to predict the caloric content of foods, and may lead to increased intake and body weight." Steffen also conducted a study that found that people who drink diet soda to accompany meat and fried foods are more likely to become insulin resistant and obese than people who drink regular soda with the same foods.
If you do not want to be a public health experiment, eliminate or severely limit your intake of artificial sweeteners. Marcelle Pick, a nurse practitioner who writes about Splenda on www.womentowomen.com, terms the sweetener a "public health experiment" because the effects of sucralose have been so poorly studied on humans. Sucralose was found in the mid 1970s while scientists were researching pesticide formulas. There is a dispute among the scientific community regarding whether sucralose is more like sugar or is closer to its bad cousin, pesticides. But, hey, it's calorie free, so manufacturers and consumers like it.
Aspartame is also being marketed in the absence of comparative human studies. Known as Nutrasweet and Equal, it is comprised of aspartic acid, phenylalaine and methanol. When aspartame breaks down in the body, the phenylalanine yields diketopiperazine, and the methanol yields formaldehyde, both toxic and potentially carcinogenic substances. Aspartame is particularly dangerous for people with a genetic condition called phenylketonuria who are unable to metabolize phenylalanine. The FDA also recommends that pregnant and lactating women and people with liver disease avoid aspartame due to the concern surrounding its metabolites.
A further concern is that aspartame, unlike sucralose, is metabolized by our bodies. Scientists at the National Institute of Environmental Health Sciences think that there is a carcinogenic risk from aspartame and recently urged the FDA to reevaluate its position that aspartame is safe. WebMd cites side effects of aspartame consumption as skin rashes, headaches, and stomach cramps, while anecdotal side effects are reported to include dizziness, nausea, weight gain, depression, fatigue, anxiety, and joint pain.
Saccharin, the familiar pink packet that has become a permanent fixture on the dining table, years after being declared harmless by the FDA, is now confirmed to be carcinogenic in rats and probably in humans. In 1977 the FDA required that all food containing saccharin display the warning: "Use of this product may be hazardous to your health. This product contains saccharin, which has been determined to cause cancer in laboratory animals." In the late 1970s, researchers showed that drinking sixteen ounces of saccharin-containing diet soda, or consuming six or more packets of saccharin per day, increases the risk of bladder cancer. It is still offered in almost every dining establishment.
So who needs the artificial stuff? Real food tastes better. The science of how food works in our bodies is an evolving field; until we know more, small tastes of a known quantity - real sugar in tiny amounts - and reasonable portions of fiber-rich foods (grown locally, of course) may be the safest way to control weight and maintain health. Don't forget to exercise.++