Whether to eat fruit should be a decision between the person with diabetes and his or her health care professional.
In general, it is a good idea for everyone to limit sugar (see the chapter “Diabetes and Obesity”) because it is often one of the causes of excess weight gain.
But eating fruit can be advantageous to everyone, including many people who have diabetes (they should check with their health care professional if there are any doubts).
This is because whole fruits have plenty of healthful antioxidants, along with other nutrients, and are high in fiber.
Fruits also have sugars, and the body’s digestive enzymes must break down the fruit cells, releasing the sugars slowly into the bloodstream.
This is why it is much better to eat the actual whole fruit than to drink fruit juice, in which the crushed fruit juice squeezes the cells, releasing the sugars.
This puts the sugar into the bloodstream much faster than when the whole fruit is eaten and may even make a person hungry sooner.
What sweetener is known to be potentially toxic to dogs, especially in terms of affecting their blood glucose levels?
R ecently, the U.S.
Food and Drug Administration (FDA) issued a stronger warning about a common sweetener and its effect on dogs: xylitol, which tastes similar to sugar and is found in such products as chewing gum, mints, baked goods, cough syrup, children’s chewable vitamins, mouthwash, toothpaste, and other products.
The warning is based on the effects of the sweetener on dogs.
In particular, if a dog ingests xylitol, then the sweetener is quickly absorbed into its bloodstream, causing a dramatic release of insulin in the pancreas. (Xylitol does not stimulate the release of insulin from the pancreas in humans.) This causes a drop in blood sugar, causing the dog to become hypoglycemic (the reaction can occur within ten minutes to an hour after ingestion).
If the ingestion is caught in time, then the dog may recover; others less fortunate can often experience too-low blood sugar, seizures, coma, liver damage, and sometimes death.
A prior warning was issued in 2011 by the FDA’s Center for Veterinary Medicine, mentioning how the sweetener can affect not only dogs but also ferrets.
The stronger warning in 2016 came because of an increase in xylitol-related illnesses reported by pet poison control centers, with one report noting that xylitol is estimated to be 100 times as toxic as chocolate to dogs.
The biggest concern is how many xylitol-containing products dogs can ingest.
The most common source is sugar-free gum.
Other sources include specialty nut butters that owners often give their pets as a treat or to administer medications.
The FDA reports that ingesting a few pieces of gum can poison even a large dog.
So far, the FDA notes that xylitol toxicity in cats has not been well documented.
One suggestion is that a cat is less apt to eat sweets left out on a table than is a dog.
What is the difference between fructose and glucose?
Glucose and fructose are both considered sugars, but glucose tends to dampen a person’s appetite, whereas fructose increases the appetite.
In addition, a person’s body turns more fructose than glucose into fat, and does it faster.
If a person is already overweight or obese, then fructose tends to speed up the sugar’s fattening process.
These facts are also why there is so much controversy, and concern, about high-fructose corn syrup found in many foods including fruit juices, ketchup, high-fiber cereals, salad dressings, baked beans, canned goods, regular soda, and salad dressings. (For more about the controversy surrounding high-fructose corn syrup, see below.)
Canned, boxed, and otherwise processed foods often have high-fructose corn syrup added to them. The additive is cheaper than regular sugar, but some people believe high levels of it can promote diabetes.
Why is high-fructose corn syrup so controversial?
High-fructose corn syrup is formed by changing the simple sugar glucose into another simple sugar called fructose.
Fructose is cheap to produce and acts as a preservative to extend the shelf life of many sweets and baked goods.
Unfortunately, it is high in calories and low in nutrition.
And because it is in so many beverages and processed foods, it is linked to obesity.
But not everyone agrees.
For example, the Mayo Clinic notes that there is “insufficient evidence to say that high-fructose corn syrup is less healthy than any other type of sweetener.” But Mayo does add that any added sugar, not just high-fructose corn syrup, can contribute many unnecessary calories.
Those calories are linked to health problems such as weight gain, type 2 diabetes, and metabolic syndrome, all of which increase the risk of heart disease, too.
How can sugar affect the body’s immune system?
Ingesting too much sugar can have a negative effect on the body, especially in terms of suppressing the immune system.
In particular, eating or drinking around eight tablespoons (100 grams) of sugar, equivalent to about two and a half 12-ounce cans or bottles of soda, can reduce the ability of white blood cells to kill germs in the body by almost 40 percent.
This weakening of the immune system occurs less than 30 minutes after a person ingests the sugar-laden foods or drinks; the effects on the immune system last close to five hours.
This is important to a person with diabetes, as he or she already has a compromised immune system from high blood glucose levels.
How much sugar is too much?
S ugar consumption, no matter what the type, is yet another one of those hotly debated subjects when it comes to overall health.
One study conducted by the Food and Nutrition Board of the National Academy of Medicine concluded that there is no scientific evidence that any level of sugars increases the risk of dental cavities, changes in behavior, cancer, the risk of obesity, or high cholesterol.
This finding was, of course, countered by the World Health Organization and the Food and Agriculture Organization of the United Nations.
They stated that sugar leads to obesity, and eventually type 2 diabetes in many people, especially when it replaces other, more nutritious foods in the diet and that sugar definitely does cause dental problems.
More recent studies seem to agree.
For most people, the intake of sugar affects them on an individual basis.
What is a good intake for one person may lead to obesity in another.
And thus the debate continues.
What sweetener name should already be removed from ingredient lists?
In 2009, the FDA stopped the food industry from using many names on a label’s ingredient list.
For example, they asked that the term “evaporated cane juice” be removed from all food labels, as it is a misleading name.
After all, it is merely sugar syrup dried into crystals, not something special and “wholesome” as many companies tried to make the public believe.
But to date, there are still manufacturers who use the term, and several consumer advocacy groups are bringing lawsuits against these food producers, calling the term deceptive.
If a food shopper sees this label, then he or she should understand that evaporated cane juice is just another name for sugar.
Why are artificial sweeteners of concern to many health care professionals, and people with diabetes, too?
Artificial sweeteners are added to many foods and usually give the food a sweet taste without the calories.
For most people with diabetes, artificial sweeteners are the answer to eating less or no sugar in their diet.
But there are concerns, especially for people who consume large quantities of artificial sweeteners or have allergies or severe reactions after ingesting certain sweeteners.
For example, the artificial sweetener aspartame often gives susceptible people a headache about ten to 20 minutes after it is consumed.
It also may be a problem for the part of the brain that senses when a person is full, thus causing some people to gain weight.
In one study, people who drank artificially sweetened beverages also began to ingest more fat (especially saturated fats) as part of their daily calorie intake.
And for people with diabetes who need to keep their weight in check, artificial sweeteners can lead to an inability to control their blood glucose levels.
DIABETES AND SODIUM (SALT)
Does salt affect a person’s blood pressure, especially if he or she has diabetes?
Most health care professionals agree that, for most people, ingesting too much salt can cause the body to develop high blood pressure over time.
In fact, when a person eats too much salt, it causes the body to hold extra water in order to eliminate the salt from the system.
For some people, this causes extra pressure in the blood, which results in a rise in blood pressure and stress on the blood vessels and heart.
Thus, the American Heart Association suggests that people with high blood pressure, or a tendency toward developing it, should eat foods lower in fat, salt, and calories.
And in general, for people with diabetes, most research indicates that salt intake should be low since diabetics are more likely to have high blood pressure than people without diabetes. (For more about blood pressure, see the chapter “How Diabetes Affects the Circulatory System.”)
Why is there a controversy over how much salt should be eaten daily?
The average daily intake of salt, in terms of milligrams, has recently become a much-debated subject.
For example, the recommendation for daily sodium intake given by the government (Food and Drug Administration, or FDA) for the general population is a maximum of 2,300 milligrams (mg) per day (or about 1 teaspoon of salt).
The American Heart Association number is lower; the group recommends a daily sodium intake of no more than 1,500 milligrams for most people.
For comparison, the average American diet contains around 4,000 milligrams of sodium a day.
There is good reason for the discrepancies in recommendations.
One of the major problems lies in scientific methods.
Determining with finality just how much sodium should be consumed daily would require conducting a randomized, controlled trial.
In this case, half of a large population would have to consume a high-sodium diet and half a low-sodium diet for a long period. (If some participants ended up with high-sodium diets and were susceptible to sodium in terms of blood pressure, heart problems, and strokes, then few people would want to participate, or even should participate.) In addition, every meal, piece of food, and beverage would have to be measured for sodium content over the entire study period, and for such a study, that would mean following the participants for months or even years.
Thus, instead of conducting that somewhat impossible trial, scientists have had to make recommendations based on other “indirect” studies.
The majority of them show that an excessive sodium intake is associated with high blood pressure, heart attacks, and strokes, all of which people with diabetes often develop.
Where do most people get their daily intake of sodium?
The most familiar source of sodium is table salt that is added in cooking and/or at the table. But in reality, it is estimated that most people consume around 25 percent of their daily sodium from this source. The other 75 percent commonly comes from processed grocery items and fast foods.
How can a person with diabetes reduce sodium intake?
Instead of adding salt to food, try a mix of other spices to make your dish savory without the sodium.
If a person with diabetes is told to cut back on salt for health reasons, here are some suggestions:
• Pack a homemade meal for lunch instead of eating fast-food takeout.
• Always taste cooking food before adding any salt, and if it needs salt, add it sparingly.
• Use other no-salt-added seasonings in place of salt from the salt shaker, and eliminate (or use less of) those seasonings that contain salt. Look into salt substitutes, or use fresh herbs and spices instead of salt in cooking.