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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
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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