Is sugar really the enemy?

Many associate sugar with diabetes, but this common chronic condition is more complex than that.

WHEN it comes to diabetes, most people know the basics – namely, cutting down on sugar and carbohydrates – but with sweet drinks, rice and noodles as the mainstay of local foods, it can be a lot more difficult than it sounds.

Managing this chronic condition is a lifelong effort.

For some, it can be frustrating when medication and lifestyle adjustments don’t seem to be effective.

This may be partly caused by the assumptions we have about the food we eat.

Indeed, these mistaken assumptions may be to blame for our poor blood sugar control.

Let’s take a look at some common beliefs about our diet and eating habits to see if we are making the right choices.

> I’ve already cut out sugar from my diet

“Contrary to what many people think, sugar is not the enemy, nor is it the sole cause of diabetes,” says International Medical University (IMU) Nutrition and Dietetics senior lecturer Dr Lee Ching Li.

“Type 2 diabetes – the most common kind – is caused by insulin resistance, where the body is unable to use insulin effectively to process the sugar we consume.

“The main reason for insulin resistance is obesity, especially abdominal obesity or fat that accumulates around your belly due to poor dietary habits, lack of exercise, insufficient sleep and other factors.

“This accumulated fat interferes with the body’s ability to use insulin affectively.”

> I prefer savoury foods, so I don’t need to worry about sugar

You may not think you have a sweet tooth, but most foods contain a mixture of sweet and salty flavours, with one or the other being dominant.

This makes it easy to think that salty-tasting foods such as oyster sauce and curries, don’t contain sugar, when in fact they do.

Taking less sauces and gravies can help – try putting your favourite curry or sauce in a separate dish so that you can control how much you eat.

> Sugar-free options still taste sweet, so I think it’s just a scam

Some foods labelled as sugar-free do taste sweet as manufacturers may add sugar substitutes instead. Some of these substitutes are plantbased or made from amino acids that mimic the flavour of sweetness without adding calories, hence they are free from sugar and not a scam.

> I just choose low-gi foods to be safe

GI stands for Glycaemic Index, which is a measurement for how quickly blood sugar levels rise after eating a certain food, relative to a standard such as glucose or white bread.

Normally, insulin works to reduce the effect of sudden spikes in blood sugar after eating, but for people with type 2 diabetes, insulin resistance keeps blood sugar levels high.

If their condition is not managed well and blood sugar levels remain persistently high, this can lead to complications such as heart and kidney disease, loss of vision, and nerve damage in the legs and feet, among others.

However, it is not as simple as just choosing foods that are low in carbs and simple sugars, as a person’s glycaemic response to eating a low- or high-gi food can be affected by how the food is prepared and what you eat it with.

Dr Lee explains with this example: short-grained rice has higher GI than long-grained rice like basmati.

But when long-grained rice is cooked into a porridge, it is more quickly digested, hence it will have a higher glycaemic response than steamed long-grained rice.

However, when longgrained rice is made into nasi kandar and eaten with meat and vegetables, the glycaemic response is smaller because of the fat and fibre from the meat and vegetables.

While fat helps to moderate the glycaemic response, too much foods that are high in fat – such as in nasi kandar and nasi lemak – can contribute to obesity and make it harder to manage diabetes.

But it’s not all bad for nasi kandar or nasi lemak lovers – you can still enjoy your favourite dish on occasion, you just have to make sure to load up on vegetables.

Aim to cover half your plate with vegetables cooked in a low-fat manner, advises Dr Lee.

> Nutrition tables and ingredient lists are just too confusing and difficult to read, so I don’t bother

Instead of squinting at the small print, you can snap a picture on your handphone and zoom in to see it clearly.

Here’s another handy tip from Dr Lee: the ingredients are listed according to their weight in the product.

This means that the food or drink item contains more of the ingredients that are listed first, so if you see sugars listed among the first few ingredients, that means it contains high levels of sugar.

While it is easy to spot common names like “cane sugar”, you also need to look for any words that end in “-ose”, which means it contains a form of sugar.

This includes fructose and sucrose. Bear in mind that nutrition tables must show energy, protein and carbohydrates; sometimes, sugars are not listed and may be concealed under “carbohydrates”.

Making better choices

“Diabetes is known as a determinant of premature death so it’s worthwhile to be proactive in keeping it at bay, to reduce the medical and financial burden of treatment and prevent future complications,” says Dr Lee.

Here is some practical advice to help:

> Get tested

One in five Malaysians have elevated blood sugar levels.

To put this in perspective, that means one family member out of five, one person in a group of five friends catching up over a meal, or one person in a working team of five.

In short, many people you know are likely to have diabetes, or it could even be you.

Getting tested and being aware of your condition means that you can take action early, when lifestyle adjustments and treatment are more likely to be effective, and before possible organ damage occurs.

> There is no “good” or “bad” food

“Thinking of foods as good or bad is very common – this keeps things easier for us, but it’s often not that simple,” says Dr Lee.

“Dividing foods that way often leads to people going to extremes, such as eating too much of one type because they think it is good for them.

“But this can cause them to neglect other types of food that are also beneficial!

“We all need a variety of nutrients from different sources, so I want to stress that all foods are good, especially whole foods or foods that are minimally processed.

“All you need to do is control your portion and how frequently you eat it.”

> Be persistent

Simple steps to take charge of what you eat, done consistently, can have significant impact. Dr Lee recommends following the Healthy Plate Model.

This means that half your plate should consist of vegetables and fruits; one quarter of grains or whole grains such as brown rice; and the final quarter of protein such as fish, poultry, meat, egg or legumes.

A significant amount of sugar is consumed in sweetened drinks such as teh tarik, soft drinks and fruit-flavoured beverages.

In addition to cutting back on these drinks, you can also ask for less sugar or no sugar at all.

While the drink may taste as if something is lacking at first, it is possible to train your tastebuds to get used to it over time, she says.

Whatever steps you take to prevent or manage diabetes, be firm in your conviction, she adds.

“Some people may feel ashamed to ask for less sugar or smaller portions because people would tease them for it.

“Others feel discouraged at the thought of all the things they have to give up, or feel deprived when they see other people enjoying their favourite foods.

“Instead of feeling this way, be empowered – you are making these choices to be a healthier person.

“Rather than focusing on what you are giving up, remind yourself of what you gain by changing the way you eat and your approach to food,” she says.

> Be SMART

The best intentions can fail, so you need to set SMART goals, which are Specific, Measurable, Assignable, Realistic and Time-related.

For example, instead of just saying “I want to eat less fast food”, try “Instead of having fast food every week, I will only have it once a month”.

You can also practice Implementation Intention – this means having a planned strategy for dealing with challenges.

For instance, your plans to go jogging every evening can be derailed by bad weather, social engagements and other disruptions.

To improve your chances of sticking to your exercise regime, plan for how you will deal with each of these scenarios, so that you have no excuse to simply give up on your jog.

Lastly, “Don’t run away from diabetes; do something about it,” says Dr Lee, who is also the programme director for IMU’S Postgraduate Diploma in Diabetes Management.

“When it comes to managing your blood sugar, especially for people with diabetes, think of it as driving a ‘diet car’ – sometimes you might take a detour or lose your way, but you can always get back to the main road.

“So, if you happen give in and indulge, don’t give up!

“Just find your way to the ‘road’ and get back on track.”