Are Small Amounts of Sweets OK?

Doctors used to think sugars were terrible for diabetes. Then the American Diabetes Association (ADA) changed their minds. They said it’s the carbs that matter, and sugars were just another carb. Now some scientists are saying sugar is poison. Who’s right?


In 2006, Amy Campbell laid out the official ADA position here, in a piece subtitled “fitting sugar into your meal plans.” “We now know,” she wrote, “that for the most part, it’s the total amount of carbohydrate, not the type of carbohydrate that you eat, that affects blood glucose levels. This means that the same amount of carbohydrate from any carbohydrate-containing food affects blood glucose levels in pretty much the same way.”

ADA’s own Web site says something similar: “The total amount of carbohydrate you eat affects blood glucose levels more than the type. Now experts agree that you can substitute small amounts of sugar for other carbohydrate-containing foods into your meal plan and still keep your blood glucose levels on track.”

They give the example of taking a slice of bread off your turkey sandwich to make room for some cookies. ADA does caution that “drinking sugary drinks is linked to Type 2 diabetes, and the ADA recommends that people limit their intake of sugar-sweetened beverages to help prevent diabetes.”

Is sugar really just another carb? Some experts say no way. Quinn Phillips wrote here in 2011 about how researchers like Dr. Robert Lustig, an obesity expert at the University of California, San Francisco, School of Medicine, are saying sugars, especially fructose, have toxic effects in the kidneys and liver. Lustig believes our high sugar intake is responsible for the recent increases we have seen in the prevalence of the metabolic syndrome (the coexistence of insulin resistance, hypertension, obesity, and abnormal blood lipid levels).

Let’s see how much of this we can sort out. It’s true that all sugars are carbohydrates, and all carbs except fiber break down into glucose in your blood. But they do this at different rates and in different ways. To say sugars are just another carb ignores the glycemic index (GI) of foods. Carbs with a high GI raise blood glucose levels faster than low-GI foods, so put more of a strain on the pancreas and are perhaps more likely to increase insulin resistance.

Most sugars are very high-GI foods. But some starches, like white breads, break down so quickly that they put glucose into the system as fast as or even faster than most sugars!

So why would sugars be worse? If you take the right amount of insulin, timed precisely to cover the glucose from sugar or starch, everything should go smoothly. Right? Well, maybe a well-controlled Type 1 with no insulin resistance could do that, although it’s difficult to get the numbers exactly right. But a person with insulin resistance, like all people with Type 2 and many people with other types of diabetes, will still suffer from the rapid sugar dose. Their cells may say, “Oh, no, here comes another load of glucose and I’m not ready for it,” and they may become more insulin resistant.

Also, while sugars make your glucose climb rapidly, they also tend to make them drop fast on the other side. So an hour later you might be hungry again, and tend to crave more sweets.

Third, there seems to be good evidence that sugars and other high-GI foods can be addictive. In a recent article in Psychology Today, Alexis Conason, PsyD, wrote that “[MRI scans show that] sugar activates the same brain regions that are activated when a person consumes drugs like cocaine.” She also quotes Eric Stice, PhD, a neuroscientist at the Oregon Research Institute, who found that “heavy users of sugar develop tolerance” (needing more and more to feel the same effect), which is a symptom of substance dependence.

Lastly, sugars don’t have much nutritional value besides the energy rush. So they’re good for a boost when you need to be physical, but don’t do much for you in the long run.

So there are at least three problems with the theory that “sugar is just another food.” It can increase insulin resistance, lead to low blood glucose after the initial rush, and can addict you so that you can’t “eat just one.”

Not all sugars are the same. There are many different naturally occurring sugars, and we now have a number of manufactured ones. Most prominent is high-fructose corn syrup, or HFCS. HFCS is Dr. Lustig’s enemy number one, and other scientists agree.

Just as I was writing this piece, a new study came to my inbox reporting that “countries that use HFCS in their food supply had a 20% higher prevalence of diabetes than countries that did not use HFCS.” Run by scientists at Oxford University and the University of Southern California, the analysis also revealed that HFCS’s association with the “‘significantly increased prevalence of diabetes’ occurred independent of total sugar intake and obesity levels.”

The article, “High Fructose Corn Syrup and Diabetes Prevalence: A Global Perspective,” appeared in the journal Global Public Health online.

I personally think sugars and refined flours should be avoided as completely as possible. They’re just not good for us. But what do you think?

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13 thoughts on “Are Small Amounts of Sweets OK?

  1. Excellent column and thoughts.

    In my first 26 years as type 2; I cut out candies, jams, snacks, sugars, cookies and cakes. Did not have em around – nope.

    In the end, I had missed the grains/flours, rice breads and the massive carb load thrown at problem.

    Candies/treats are bad simply that they are attractive to body and we overeat them.

    Now that I watch whole dietary load of carbs and have my body finally under control, I eat small amounts of chocolat and some candy just to lever up the body on lows. The joke is I eat more candies/chocolat than I did in first 30 years and yet I am under tigher control.

    Grains, flours, rice, breads, High fructose corn sugar are the real sneak attack requiring rigid control, counting and tight control.

  2. looks like do and be damned and don’t do and be damned situation-everyone is focusing extremes edge of situations to engage attention

  3. I think it all depends on your Diabetes control & how little is the so called “small amount”. If your HbA1c is more than 7%…..better avoid.

  4. I do not necessarily agree with some of the comments no matter how well intended.

    The real issue is energy balance and ensuring one does not exceed the burn versus intake.

    So for some, dropping sweets may be good answer.

    It is just not the whole story!

  5. While I agree that sugar, especially in more highly processed forms, is a negative force to be reckoned with, the studies leave out the human element of the equation.

    There is just no way I would stick to a diet that required total elimination of sweet treats. I have a sugar tooth, or several of them. 🙂

    Like Jim says, it’s all about balance. I think refined white sugar is not more evil than so many of the hyper-processed junk foods, even “low carb” labeled foods, that frequently make it onto our pantry shelves.

    Striking the balance between occasional treats and a regular diet of wholesome, unprocessed foods is critical to longevity, I think. You have to have a light at the end of the tunnel to keep plowing through.

  6. Excellent article!!! All carbs are not =!!!. Any time you overload your system with hi-GI sweeteners you are causing insulin resistance!! Good article.

  7. Megan states even better. Her comments neatly catch the issues and meaning.

    i couldn’t agree more.

    Best wishes and good luck with your health.

  8. For me, it’s a matter of minimizing carbs in general, and high-GI carbs particularly. Ironically, that seems to mean that I can satisfy my sweet tooth more easily than I can my “starchy tooth”. In fact, I’ve found an erythritol-sweetened chocolate that’s about 97% cacao, tastes better than any other chocolate I’ve ever tasted, and doesn’t raise my glucose at all.

    Only wish I could find a no-carb pretzel that tasted nearly as good.

  9. It all depends on the individuals’ system as to the type and amount of carbs, over-all, our system will tolerate daily.

    If it’s going to be, it’s up to ME!

    There is no one answer that fits every diabetic in the same way! People living with diabetes are individuals dealing with a complex disease.

    We need to become smart!

    There are many factors to consider:

    * Is every Carbohydrates equal for every diabetic! No!

    * Can every diabetic enjoy a sweet now and then or daily? It depends on the individual. I can occasionally

    * Can every diabetic indulge just a bit during the holidays? It depends on the individual. I can; tiny amounts!

    * Does diabetics need to adjust their Ratio based on stress level and/or exercise on a temporary basis? I do!

    * As diabetics age our method of control may change. Mine has!

    What any diabetic does today to help ourselves depends on what kind of life we will lead from tomorrow and the years to come! Healthy or limited?

    Hopefully we become wiser.

    Happy Holidays!

  10. About: “countries that use HFCS in their food supply had a 20% higher prevalence of diabetes than countries that did not use HFCS.”

    I remeber seeing research that showed Type 2 increasing since 1982. The same year HFCS’s were
    added to soda nationwide, instead of cane sugar. Very interesting orrelation if true and verifiable.
    I never use any drinks with HFCS. A1c is usually
    below 7. Occasionly partake in sweets in small amounts.

  11. I’ve been a Type1 diabetic since 1971. Initially I eliminated all sweets. I have kept good control over my BG levels and my HbA1C test results are great. But, I do regularly indulge in having regular ice cream and an occasional chocolate bar. I will eat a donut or have a slice of apple pie or even a regular piece of cake. Whenever I do I usually follow up, within an hour or two, with a blood test and sometimes with a little extra insulin. Can every diabetic do this? It depends on their level of control and activity. I have been fortunate and have not developed any serious problems generally associated with being a diabetic. A little indulgence every once in a while is good for morale.

  12. Very interesting article and comments. After 53+ years as T1D, I am finding it more difficult to level out after a sweet indulgence. My endo. thinks I am becoming more insulin resistant, so the treats are fewer and less frequent. Frustrating, but it is better than the alternative. My plan is to be a part of Joslin Clinic’s 75 year study…

  13. To Rick who wrote he found a erythritol-sweetened chocolate that’s about 97% cacao, tastes better than any other chocolate I’ve ever tasted, and doesn’t raise my glucose at all. I wish you would have shared with everyone who makes the chocolate and where we could find it. Like what store so you buy it from? Maybe you could share with all of us other diabetics if you get this message as it would be greatly appreciated. My fiance is a type II diabetic and also loves sweets and its all I can do to keep him away from the sweets and sometimes he gets away with me not finding out he ate the sweets until after the damage is already done. THX Andrea

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