Atkins Diabetes Revolution (34 page)

Similarly,don’t fall for misleading food labels.Beware of words like
no sugar added
or
contains only natural sugars.
Always check the label. The product may still contain a lot of carbs in the form of some sort of natural sugar that can upset your insulin/blood sugar levels and start the roller coaster again.

Be aware of serving sizes,too.Products that claim to be low in sugar are—but the portion size might be unrealistically small. You could end up eating a lot more carbs than you realize. The bottom line is this: Eat no foods with any ingredients listed in “Spot the Sugar.”

SPOT THE SUGAR

Food manufacturers have a lot of different ways to sneak sugar into their products under another name. If you spot any of these words on the ingredients list,the product contains added sugar:

Brown sugar

Brown syrup

Cane juice

Corn sweetener

Corn syrup

Corn syrup solids

Crystallized cane juice

Dextrose

Evaporated cane juice

Fructose

Fruit juice concentrate

Fruit syrups

Galactose

Glucose

Glucose-derived syrup

Golden syrup

High-fructose corn syrup

Honey

Invert sugar

Lactose

Levulose

Malt

Maltose

Malt syrup

Maple sugar

Maple syrup

Molasses

Rapadura

Raw sugar

Rice syrup

Sucrose (table sugar—not to be confused with sucralose,a substitute sweetener marketed as Splenda)

Sweetened carob powder

Treacle

Turbinado

No matter what it’s called, added sugar is unacceptable on any phase of the ANA or ABSCP—especially for those of you with impaired insulin/blood sugar metabolism.

JUST ANOTHER CARBOHYDRATE?

For many years, people with diabetes were told not to eat sugar because it would raise their blood sugar. In 1993, however, the American Diabetes Association (ADA) modified its stance, based on a lack of any real scientific evidence that small amounts of sugar in the diet— as long as it was part of a regular meal plan and eaten along with other foods—raised blood sugar. In other words, sugar was now to be treated as “just another carbohydrate”in the official diabetic diet.

There’s a big problem with that approach. It’s true that a teaspoon of table sugar contains only 4 grams of carbohydrates, and that simply eating a spoonful of sugar as part of a larger meal is unlikely to have much effect on your blood sugar. Unfortunately, it’s pretty unlikely that you’ll have just a teaspoon of sugar. If you’re like most Americans, your diet contains the equivalent of about 20 teaspoons of pure sugar every day (not counting the natural sugars in fruits and other foods). That works out to 80 grams of nutritionally empty carbohydrates every day. A lot of that sugar is contained in high-carb baked goods made with bleached flour and manufactured trans fats.The rest might come from candy and soft drinks, products that are about equal in their abundance of carbs and lack of nutrition.A typical 12-ounce can of cola contains about 9 teaspoons of sugar in the form of high- fructose corn syrup, about the same amount of sugar found in a candy bar.

Realistically, if you know you’re “allowed” to eat sugar on your ADA-approved diabetic diet, you will. And if you’re a sugar addict, even a small amount will get you started again. Even if you are not addicted, why waste your carb grams on sugar, when you could be using those same carb grams to enjoy foods that are much more nutritionally valuable and will allow you to be more comfortably in control of your blood sugar? Once you are in control, your chances of long-term success will improve dramatically.

SUITABLE ALTERNATIVES

Today’s substitute sweeteners are very useful tools in the controlled- carb approach.They let people enjoy sweet flavors without adding significant carbs to the diet and without raising blood sugar in most people. You still have to watch out for other carbohydrates, however. For example, controlled-carb ice creams, including the Atkins brand, do not include added sugar, but they do contain naturally occurring sugars in the form of lactose. Moreover, most cookies made with artificial sweeteners are still loaded with carbs from bleached white flour—and they’re often full of trans fats as well. But for making lowcarb sweet treats such as puddings, cheesecake, and gelatin desserts, and for use at the table instead of sugar,substitute sweeteners are ideal.

WHICH SWEETENER TO USE?

So many different sweeteners are available today that the array on the grocery shelves can be a little confusing. To a certain extent, your choice of sweetener depends on what you want to do with it. Some sweeteners, such as aspartame, lose their sweet taste when heated, so you wouldn’t use them in cooked foods. Beyond that, follow your personal preferences. Some people can detect an aftertaste from some sweeteners, while others don’t notice it; you may also be concerned about possible health effects from certain substitute sweeteners. Try the following different sweeteners until you find the ones you like:

• Sucralose
  (Splenda). The only noncaloric sweetener made from sugar, sucralose is 600 times sweeter than sucrose (table sugar). It is highly stable and doesn’t break down in heat, so it is widely used in cooking and baking.
  
• Acesulfame K
  (acesulfame potassium) (Sweet One, Sunett). A noncaloric sweetener that is about 200 times sweeter than sucrose, acesulfame K holds up to heat and can be used in cooking and baking.
  
• Saccharin
  (Sweet’n Low). A noncaloric sweetener that has been in use for nearly a century and is about 300 times sweeter than sugar, saccharin turns bitter when heated and should not be used in cooking and baking. In 2000, the FDA removed saccharin from the list of carcinogenic products, citing the lack of evidence that it causes cancer in humans. Products containing saccharin no longer have to carry a warning label, although many still do.
  
• Stevia.
  Extracted from the leaves of a plant called
  Stevia rebaudiana,
  stevia is about 300 times sweeter than sucrose.Although stevia is safe and has been widely used around the world since its discovery in 1931, in the United States it can be sold only as a dietary supplement. It can be found in any natural foods store.
  
• Aspartame
  (NutraSweet, Equal). A low-calorie sweetener that is about 180 times sweeter than sucrose, aspartame is used very widely in sugar-free beverages and foods. It breaks down when heated, so it cannot be used in cooking or baking. Atkins Nutritionals does not use aspartame in its products.
  

All of the preceding sweeteners are often described as intense because they are so much sweeter than sugar. Very small amounts are needed, but even so they do add small amounts of carbohydrates to the products that contain them.FDA regulations allow food manufacturers to say a product has no carbs when it has less than 1 gram of carbohydrate per serving—but even fractions of grams can add up. We recommend that you count each packet of sweetener as 1 gram of Net Carbs so that you do not exceed your carb threshold.

SUGAR ALCOHOLS

Sugar alcohols don’t contain alcohol in the conventional sense of rubbing alcohol or alcohol you can drink. Sugar alcohols, also known as polyols, are carbohydrate-based caloric sweeteners; if it ends in
-ol,
it’s a sugar alcohol. The most commonly used sugar alcohols in low-carb foods are mannitol, sorbitol, xylitol, lactitol, and maltitol. Isomalt and hydrogenated starch hydrolysates (HSH) are also sugar alcohols. (Al- though glycerol and glycerin are not sugar alcohols, they also have minimal impact on blood sugar.)

Sugar alcohols are found naturally in many foods.Mannitol,for instance,is found in carrots,pineapples,olives,asparagus,and sweet potatoes.Sorbitol is in many fruits and vegetables.Xylitol is also found in fruits and vegetables—as well as mushrooms and even corncobs.

Sugar alcohols aren’t as sweet as sugar, and they contain only about one-half to one-third the calories. What makes sugar alcohols so useful as sweeteners is that the carbs in some of the sugar alcohols are absorbed very slowly by your body—so slowly that they don’t really have an impact on your blood sugar. In others, such as lactitol and xylitol, there is little or no conversion to glucose.
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Most of the carbs from sugar alcohols will pass out of your body before they’re absorbed, so sugar alcohols don’t add much to your daily carb count. On the glycemic index, sugar alcohols are extremely low. Xylitol, for instance, is ranked at 7—compare that with table sugar, which is ranked at 100.

Sugar alcohols don’t raise blood sugar in most people, but there are exceptions. Some people seem to be sensitive to sugar alcohols, especially mannitol,and do get a rise in their blood sugar after eating foods containing them, especially if they eat large amounts. Sugar alcohols in large amounts (more than 25 grams a day) can also cause gas and cramping or have a laxative effect in some people. Xylitol and lactitol are generally the worst culprits in these cases; maltitol and erythritol are the least likely to cause problems. In some people, sugar alcohols may elevate blood sugar. If you are diabetic, be sure to check your blood sugar approximately 90 minutes after eating foods that contain sugar alcohols. If there is an abnormal increase in your blood sugar, discontinue such foods. You can try reintroducing them when your metabolism improves.

SUGAR ALCOHOLS AND FOOD LABELS

Chemists don’t classify sugar alcohols as carbohydrates, but the Food and Drug Administration does.That’s because the law says that after the fat, protein, ash (minerals), and water are removed from a product, what’s left is carbohydrate and has to be listed as such on the food label. There’s logic but not a lot of common sense behind this, because sugar alcohols aren’t really metabolized and don’t usually have an impact on your blood sugar. To comply with the FDA, the manufacturers of controlled-carb products that contain sugar alcohols have to list them as total carbs on the food facts label, just as they do for fiber. When calculating the Net Carbs of a food, simply subtract the grams of fiber and sugar alcohols.

An interesting fact: The sugar alcohol xylitol inhibits the growth of bacteria in the mouth, so products that contain it, such as chewing gum and breath mints, are allowed to claim that they can help prevent tooth decay.

In low-carb products, sugar alcohols not only add sweetness, they also add bulk and texture and help the products retain moisture.Sugar alcohols hold up well to heat, so they can be used in commercial cooking and baking. They are not marketed for home use.

FRUCTOSE: THE DIABETES CULPRIT?

Back in 1975, the annual per capita consumption of refined sugars (as opposed to natural sugars) in the United States was about 117 pounds a year. Of that, almost all was sucrose, or table sugar. Twenty years later, the annual per capita consumption of refined sugars in the United States had zoomed to 149 pounds a year. Of that, 66 pounds was sucrose; the other 83 pounds was in the form of high-fructose corn syrup.
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This inexpensive sweetener is very widely used in soft drinks, baked goods, candy, and other sugary foods. It’s possible that this huge increase in the amount of fructose in the average American’s diet is one of the major culprits behind both the obesity and diabetes epidemics.

When you consume fructose—by swallowing 12 ounces of a soft drink sweetened with high-fructose corn syrup, for example—your blood sugar, of course, goes up. Technically, fructose doesn’t immediately stimulate your pancreas to release insulin, but the breakdown products of fructose do stimulate insulin release. We know from human and animal studies that consuming a high-fructose diet leads to increased appetite, increased body weight, and increased fat—and we know from animal studies that fructose brings on insulin resistance and high blood pressure. At the same time, fructose can raise your blood lipids by making your liver produce more triglycerides and possibly by increasing insulin resistance in other cells in your body. If your cholesterol is high to begin with, or if you have the metabolic syndrome, prediabetes, or diabetes, this could cause your total cholesterol, your triglycerides, and your LDL cholesterol to go even higher.
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When you follow the Atkins Blood Sugar Control Program you give up all those foods sweetened with high-fructose corn syrup, so fructose will be less of a problem for you. Fructose is naturally found in fruit, but in combination with fiber, pectin, and other substances; therefore whole fruit is less likely to have these negative effects. Even so, you need to be aware of the carbohydrates in the fruit you consume. Even low-GI fruits such as strawberries have carbs—be very aware of portion size. If you’re having trouble getting your blood sugar down, you may need to eliminate fruit from your diet completely. Once your blood sugar is under control, however, you can slowly reintroduce fruit in moderation, depending on your individual metabolic response. (See Chapter 16 for more on this.)