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[IPk] sugar, sugar, everywhere

So when the cousin, Molly, was in Crumlin (the Dublin southside children's 
hospital, for those of you beyond the pale) her parents were, surprise 
surprise, told no sugar, no chocolate. The good news is that the sheet the 
dietician gave them said that she shouldn't have these things initially. The 
bad news is that the ward nurses were as ignorant about how food works in 
the body as I dreaded: when we were visiting they brought Molly's tea 
(horrible thing number one) chips, two slices of white bread, and a scoop of 
beans. And then (horrible thing number two) a ward nurse came in and told 
Tina (the mother) that Molly shouldn't eat the beans because 'they have 
sugar in them'. I didn't follow her out of the room and set her straight, 
which I should have done. Tina is a chef by trade and knew how rediculous 
this was, so we had a brief discussion about it. But to top it off, the 
sheet the dietician gave her of 'eat one of these at every meal' had beans 
on it! So, dietician and ward nurses : never the twain shall meet.

Despite the open-ended promise on the dietician's info sheet, Molly is now 
on 'no sweets, no chocolate, no ice cream'. And in her first week of managed 
diabetes, she left a party early because she 'couldn't' eat the ice cream 
cake. And this is what this advice creates: a situation where people with 
diabetes say 'can't'. I can't because I have diabetes. Additionally, our 
culture celebrates with processed and refined sugar, whether it be 
confectionary or alcohol. So, because of this advice, children like Molly 
are being denied participation in our culture's celebration. Or, they do it 
anyway, don't tell their medical team, and don't have the tools for managing 
the celebration.

So, in a search for evidence for the 'no chocolate' rule, I collared a 
diabetologist (who shall remain nameless) as he left the diabetes centre 
today. And I asked him, what is the justification for telling people they 
can't eat chocolate? And he said, it has sugar in it. And I said, well, lots 
of food has sugar in it, and all carbohydrate including sugar is converted 
to glucose in the body. And he said, but sugar is converted differently. And 
I said, but starches actually convert to glucose faster than sucrose, so 
what is the justification? And, like many doctors when challenged about 
something, he got angry and said in an angry tone, look, eat chocolate if 
you want, but you shouldn't... I stopped him at the shouldn't and said, I'm 
not trying to make you angry, I'm just looking for the science to support 
this advice. And he said, I have read any research on this, so you should 
talk to the dietician, but you shouldn't eat sugar.

When I was at the INPUT open day in manchester, a woman whose name I forget 
(sorry!) was passing out questionnaires on her research into how diabetes 
management is not, in fact, evidence-based, even though they claim it is. 
And indeed it is not: research on glycaemic impact demonstrates that 
starches raise blood sugars more quickly than many things 'with sugar in' 
(sugar generally meaning sucrose). However, this doctor and most local 
diabetes specialists are passing on advice that is based on nothing more 
than medical tradition.

I know that part of the reason for this tradition is that on-average 
seventeen year lag behind research findings and application in clinical 
practice. However, this particular issue makes me very angry because of the 
cultural impact it has.

I won't make this too much longer. I'll finish asking for some research 
suggestions: if you know of any studies explaining why people with diabetes 
shouldn't eat chocolate or ice cream cake, please send me details of them. 
If you know of research explaining why people with diabetes should enjoy 
these things as occasional treats in a well balanced diet (just like eveyone 
else), please send me details. I took the doctor's advice and I've made an 
appointment with the dietician for the 29th January. I'm sure she'll be 
sorry she met me, but I have to start somewhere.

Tony, I've added an article for _identity_ about carbs, glucose, and GI to 
my long-term to do list. I move so slowly it probably won't happen until 
next year, but it's coming.


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