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[IP] NYTimes.com Article: New Guidelines Permit Some Sweets for Diabetics
This article from NYTimes.com
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This is on today's FRONT page of the NY Times. It should help to alter the public's view of diabetic diets. Hummm...maybe
Type 1 47 years
Minimed 507 3+ years
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New Guidelines Permit Some Sweets for Diabetics
December 27, 2001
By JANE E. BRODY
The American Diabetes Association issued new dietary
guidelines yesterday saying people with the disease could
eat sweets occasionally as long as they kept their blood
sugar levels under control.
The new guidelines are intended to improve the treatment
and prevention of diabetes and to simplify the lives of
Americans who have it, an estimated 16 million people.
Although many diabetes specialists have advised patients
for years that they can consume sugar-laden foods if they
control their blood sugar levels, there is still widespread
belief that a person with diabetes should never eat
concentrated carbohydrates like sweets.
All carbohydrates, be they from pasta, potatoes, cake or
cookies, are treated alike under the new guidelines,
although they emphasize that people should eat more
nutritious foods like fruits and vegetables. Occasional
sweet treats are permissible under the guidelines, as long
as the total intake of starches and sugars is kept in
balance with insulin or other medications and exercise and
does not exceed caloric needs.
"We are continuing to try to lessen the burden for patients
with diabetes," Dr. Nathaniel Clark, director of the
association, said in an interview.
Dr. Judith Fradkin, director of the diabetes division at
the National Institutes of Health, praised the new
guidelines as "well thought through."
"A lot of people have misconceptions about diabetes and
dieting," Dr. Fradkin said. "Some people think sugar is the
absolute worst thing for diabetics and that leads to a lot
of problems such as diets that are extremely high in fat or
The report emphasizes that there is no one diet for
everyone with diabetes. Rather, dietary plans must be
individualized, usually with the aid of a dietitian, to
accommodate preferences, circumstances and medical factors
like the need to lose weight or lower blood cholesterol or
blood pressure, said Dr. Christopher Saudek, president of
the association and an endocrinologist specializing in
diabetes at the Johns Hopkins Medical Center in Baltimore.
Dr. Saudek said that Medicare was considering covering
medical nutrition therapy and that other insurers were
likely to follow its lead.
The guidelines disregard consideration of a food's
"glycemic index," how much a carbohydrate-containing food
raises blood sugar when eaten alone. The glycemic index of
a baked potato, for example, is the same as that of a Mars
bar; when eaten alone both result in a precipitous rise in
blood sugar. Knowledge of this ranking has prompted some
people with diabetes either to quit eating potatoes or to
start eating candy, forgetting that how these foods are
usually consumed can have very different effects on blood
While snacking on a candy bar may have the same effect on
blood sugar as snacking on a plain potato, a potato is
rarely eaten that way.
The new guidelines, which are in the January issue of
Diabetes Care, say studies found no significant differences
in blood sugar response to sugary or starchy foods as long
as the total amount of carbohydrates was similar. Dr.
Saudek cautioned, however, that it can be difficult to
calculate the amount of carbohydrates in some foods. The
guidelines note that many factors can influence a food's
effects on blood sugar, including the type of sugar and
starch it contains, how it is processed and whether it is
The report does condone the use of the four nonnutritive
sweeteners approved for use in the United States -
saccharin, aspartame, acesulfame potassium and sucralose.
But it cautions against using added fructose, a caloric
sweetener that has a lesser effect than sucrose on blood
sugar, since fructose can raise levels of fats in the
The goal in treating diabetes is to keep blood sugar levels
stable all the time since high blood sugar levels increase
the risk of complications like heart attacks, strokes and
kidney, nerve and blood vessel damage that can result in
amputations or loss of vision.
To aid in blood sugar control, the association has added a
recommendation: exercise. Not only does moderate exercise
lower blood sugar, thus reducing insulin requirements for
people with Type 1, or insulin- dependent, diabetes, but it
also is a vital element in permanent weight control for the
millions of people whose diabetes is caused by obesity.
Of the 16 million Americans with diabetes, about one
million have Type 1, once called juvenile diabetes, in
which the pancreas's insulin-producing cells fail,
necessitating injections of this vital hormone one or more
times a day so that blood sugar can be used by cells
instead of accumulating in the blood and spilling into the
But the association is especially concerned about the
approximately 15 million people with Type 2 diabetes,
formerly called adult-onset diabetes, which is now reaching
epidemic proportions among American adults and causing an
unprecedented rise in diabetes among children.
In Type 2 diabetes, cells that need blood sugar are
resistant to the effects of insulin. Studies have shown
that insulin resistance most often results from overweight
and obesity, the prevalence of which has been soaring. As a
result, the incidence of Type 2 diabetes has risen 33
percent since 1990 with 10 million Americans at high risk
for developing it. This year nearly 800,000 cases of
diabetes will be diagnosed. The disease costs the nation
more than $98 billion and claims 187,000 lives a year.
Insulin resistance can be reduced or overcome by weight
loss, which can also lower blood fat levels and blood
pressure, both of which increase the risk of serious
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