More on Sugar

For those not yet convinced about the dangers of sugar, look no further than today's New York Times op-ed page with Mark Bittman's column "It's the Sugar, Folks." Bittman cites a study from the journal PLoS, released yesterday, strongly linking higher sugar consumption with higher levels of diabetes (the study deals with type 2, not type 1). "The study demonstrates this with the same level of confidence that linked cigarettes and lung cancer in the 1960s," Bittman writes.

In the study the authors found that when comparing the diets of people from 175 different countries, each 150 calorie per day increase in sugar consumption--that's one twelve-ounce can of soda--resulted in a 1.1% increase in the rate of diabetes. (By contrast, each 150 calorie increase of non-sugary foods resulted in a statistically insignificant 0.1 increase in the diabetes rate.)

One of the study's authors, Robert Lustig, is the same scientist whose work formed the basis of Gary Taubes's argument in his New York Times Magazine piece "Is Sugar Toxic?"

For Bittman, this latest study answers that question definitively. "The next steps are obvious, logical, clear and up to the Food and Drug Administration. To fulfill its mission, the agency must respond to this information by re-evaluating the toxicity of sugar, arriving at a daily value--how much added sugar is safe?--and ideally removing fructose (the “sweet” molecule in sugar that causes the damage) from the 'generally recognized as safe' list, because that’s what gives the industry license to contaminate our food supply."

So it may be that Bisi is ahead of the curve, and that things will change more quickly than I'd thought. I hope so.

The Trouble with Sugar

A few mornings ago, at Jamie’s third grade breakfast share, about half of the items had chocolate, or some other ingredient that in another context could be classified as dessert. Chocolate chip waffles, chocolate chip shortbread, mini chocolate chip raspberry muffins (delicious!), chocolate chip bread, and donuts with sugary pink icing and candy dots sprinkled on top. We brought the low-carb, low glycemic, gluten free blueberry muffins that I mentioned in a previous post. Only three out of the dozen I brought were left, but I know for a fact that Bisi ate three of the muffins and Mark ate two, so they were not a popular item outside our family. Now, I love a good chocolate croissant or chocolate chip scone as much as the next person, but it’s kind of shocking once you start really thinking about how much sugar most of us consume, how integral it is to our daily lives, and how “special occasions”—like a breakfast share, or a birthday party, or valentine’s day, or family dinner at a friend’s house, or…, or…---almost always involve an extra helping or two. I’m not saying anything new here, but sugar is everywhere—many kids eat it at breakfast, lunch, and dinner, and at snacks in between. It’s in some of our bottled water and it’s in our bread. This last is something I never thought about until an Australian friend mentioned to me that he and his family had started making their own bread while in the U.S., since all the bread here tasted too sweet. The food writer Marion Nestle wrote that anything with more than about 15 carbs of sugar should be considered dessert; and by that standard, many kids eat dessert more than five times a day. (This was passed along to me by my friend Gina, who has been researching and thinking  about this issue for years, but, as she says, railing against how much sugar we all eat is a lonely battle that makes you seem like a kill-joy, not least to your kids.)

Sugar consumption is something I was vaguely worried about before Bisi was diagnosed, but it wasn’t something I thought about a lot—unless Gina and I were talking about it. As I’ve written before, type 1 diabetes, as opposed to type 2, is an auto-immune disorder; it’s not caused by eating too much sugar. But there’s no doubt that refined sugar spikes Bisi’s blood glucose high and fast, and that she needs extra insulin to cover it. (Lower glycemic sweeteners such as agave and coconut nectar have a gentler effect on her.) And I also wonder whether someone who’s pancreatically challenged like Bisi could stave off the onset of diabetes by drastically cutting down on their sugar intake.

So it’s clear why I’m now worried about sugar. But according to an article by Gary Taubes that ran in The New York Times Magazine a couple of years ago, all of you should be too.  I’m summarizing a long article into a couple of sentences here—you should read the article if you haven’t—but he posits that refined sugar and high fructose corn syrup, not fat, are responsible for increases over the past century in obesity, diabetes, some cancers, and heart disease. And an article in this month’s Sky magazine talks about the links between consuming sugar and disease, and cites a 2009 study by the American Heart Association that men should eat a total of nine teaspoons of sugar per day and women only five. At four carbs per teaspoon, that's the amount in a half-cup to a cup of ice cream.

The mechanism is complicated, but essentially it involves overtaxing the liver by asking it to process more and more fructose, which in turn means that the body becomes resistant to insulin and must produce more and more to combat the sugar. So it’s a vicious cycle. Scarily, for the parent of a diabetic, Taubes argues that it’s the excess insulin that spurs tumor growth and heart disease. It’s easy not to think about how much insulin your body needs to process the sugar you’re eating when everything works seamlessly and internally. But if I have to give Bisi an extra unit of insulin so she can eat a pink-frosted donut with candy on top at her brother’s breakfast share…well, maybe I’ll just give her the low-carb not very sweet muffin I made instead. (Of course, since she’s gluten-free, she can’t have the donut anyway—now you see one of the reasons why the gluten-free diet comes in handy.) Eating the healthy muffin rather than the tempting donut requires real willpower on Bisi’s part. I asked her recently how she thinks about sugar and she said, “I like to eat sweets but I know it’s bad for me.” “So what do you think the solution is?” “To cut down on sweets and to not always eat them even if your friends are.” And here’s one of the hard things: because of our society’s sugar obsession, when Bisi cuts down on it for her health, that becomes another thing that sets her apart from her peers.

I’ve read that once you start to eat less sugar, your taste for it shrinks too. I feel like I’ve seen that in Bisi, and in myself. That Ben and Jerry’s Mint Oreo that used to be my favorite flavor now tastes too sweet, and I prefer Breyer’s mint chocolate chip (23 grams of sugar versus 17 grams). But I don’t want to pretend that we’re healthier or more virtuous than we are. We’ve cut out the occasional Dunkin Donuts snack; we’ve cut out the weekly trip to JP Licks for ice cream. We’ve cut out the big glob of maple syrup on the oatmeal in the morning. But our kids still eat sugar—probably much more than American kids of a century ago, or than present day kids in other countries. According to one estimate, Americans in 1822 consumed an average of 6.7 pounds of sugar a year. Today, it’s over a hundred pounds. Again, it’s a balancing act. Sugar is such an integral part of U.S. society today that keeping Bisi from eating it would not only make her miserable, but make her feel like something of an outcast. Maybe at some point society will move in our direction; or, when Bisi’s older, maybe she’ll make a choice on her own to strictly limit her sugar intake. But for now, we’ll try to eat sugar wisely, and when we have it, we’ll make sure that it tastes good enough that the choice is worth it.

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When Bisi was in the hospital, one of the nurse educators we met with suggested that we spend some time in the supermarket aisle, looking at labels to see which treats are a good fit for someone who should be limiting her carbs. Here are a few of the ones we’ve found and like. None of these listings are sponsored—I wish they were. Buying healthy food is expensive!

Yogurt: I always used to give the kids Brown Cow yogurt, but the brand I tend to buy now is Oikos Organic. Their strawberry and blueberry yogurts, at 16 carbs, are less than half what some other yogurts are. And the smaller Oikos vanillas, at 9 carbs, are even better.

I was thrilled one day to find Siggi’s Icelandic yogurt—11 carbs each, and sweetened with agave, which has a much lower glycemic level than sugar. But, unfortunately Bisi doesn’t really like them—they’re too sour. Maybe if I can get her sugar needs down further I’ll try again. Stay tuned for Mark’s efforts to make our own yogurt—the machinery has arrived, but the experiments have yet to begin.

Ice cream, yes, ice cream. I’ve found that ice creams, too, vary considerably in terms of how much sugar/how many carbs they have. If Bisi’s going to a birthday party, Hoodsie’s are a good thing to send with her, since she can’t have the cake. They seem special, since they come in those cute little cartons. And the portions of them are relatively small—about half a cup. I’ve found that Breyer’s ice cream tends to be lower carb than many other brands. Note that some sorbets have more than double the amount of sugar that many ice creams do (because they’re all fruit and sugar, rather than dairy and sugar).

Popsicles:  We like the Smooz fruit pops, at 11 carbs. And Lifeway’s 13-carb frozen kefir pops, with probiotics.

Kind Bars:  The carb counts of these vary widely, but some of them are as low as 14 carbs, and they’re a great snack since they’re full of nuts (protein), they aren’t very sweet (usually about 5 grams of sugar), and they’re high in fiber--fiber counteracts carbs. Unfortunately, whether Bisi likes these is mood-dependent.

Cereal:  Purely Elizabeth: a gluten free granola sweetened with coconut sugar with various ingredients that are supposed to be great for you, like chia seeds, amaranth, and quinoa.

I recently discovered Seitenbacher gluten-free muesli #6. I like it because Bisi likes it and because it’s low carb, high in protein, and high in fiber. 

Also, at a farmer’s market in Seaside, Florida, we tried and bought an incredibly delicious cereal/snack called Veronica’s Health Crunch, including pecans, pumpkin seeds, coconut flakes, a little sweetening, and a little salt. It’s gluten free, very low carbs, high protein, high fiber—ie, a perfect snack for Bisi. Now we just have to get her to like it.

Gluten-free baking products:  As I mentioned in a previous post, I love the products made by Bob’s Red Mill. But, as my friend Emily Moore, author of the diabetes blog Icarus and Daedalus, commented on that same post, gluten-free products often have as many if not more carbs than regular products. Fortunately, Bob’s sells several nut-meals that are very low carb, and that can be substituted for most other flours (though the consistency is moister). The one we’ve used the most so far is almond flour, though hazelnut is also good.

Breads:  Some of the gluten-free breads (I won’t name names) really shouldn’t be called bread. Instead, think of something that has the consistency of flavorless, unsweetened pound cake. But so far I’ve found two brands that Bisi really likes: Udi’s and Glutino. You have to check the labels of each kind, some are higher carb than others, but the ones we buy have 10 or 11 carbs per slice. That’s half the amount of the regular bread I buy for Jamie. Often, if I’m making a grilled cheese for myself, I’ll voluntarily choose the gluten free.

Suggestions Needed: Do you have any suggestions for good, gluten-free, relatively low carb snacks and/or desserts? Either sweet or not? If so, please pass them along. Bisi is constantly deciding that she doesn’t like a snack she once liked, so we are in constant need of new ideas.

The Sibling's Side of the Story

I haven’t talked all that much about Jamie, our 8-year-old son, in these posts, but not because Bisi’s diagnosis doesn’t affect him. He has had to deal with the fear of Bisi and me suddenly disappearing to go to the hospital; with the attention before meal times shifting dramatically in her direction, as we talk about what she’s going to eat, test her blood sugar, and give her some insulin, and with the worry and sense of fragility her diagnosis has brought into our lives (even if he wouldn’t express it that way). He asked me once if Bisi’s diagnosis meant that he could get diabetes too. I told him that anyone can get T1D, but that it’s not likely that he will. The truth is, he is at greater risk, because he has a first-degree relative with T1D. But if you had sat me down a year ago, explained T1D to me, and asked me which one of my children seemed more likely to get it, I would have immediately said Bisi, because of the way her moods fluctuate when she’s hungry. This is not based on anything scientific, but it just means that I am not going to spend my time worrying that this will happen to Jamie.

I think it’s probably a good thing that all of us are eating less sugar than we used to. But I also don’t want to limit Jamie just because there are limits on what and when his sister can eat. My very possibly imperfect solution so far has been to let Jamie have some treats when he’s not with Bisi. He and I have a standing date at the local frozen yogurt shop while Bisi’s otherwise occupied; and we follow a don't tell, hope she won't ask policy. Or, when he’s having something that she can’t have at home, I try to come up with a substitute she’ll be excited about, or excited enough about. So, say, if he’s getting a hot chocolate, I’ll make her one with stevia (a natural sugar substitute made from the leaf of the stevia plant, which to me seems more inherently healthy than aspartame or saccharine). 

Yet still, nothing drives Bisi crazier than the feeling that Jamie is getting something that she can’t have—even if it’s something she doesn’t want. Whatever food-related anger she has—and she must have a fair amount—she focuses intensely on Jamie. She’s furious if he starts eating before she does, while she’s still waiting for her insulin to kick in. She can’t stand it if he gets a more appealing dessert than she does. I feel like Mark or I could be across the table eating an ice cream sundae with whipped cream and sprinkles and she wouldn’t care, as long as her brother is eating the same 13 carb frozen yogurt that she is. These are typical sibling dynamics in action: if something is happening to you, you want it to happen to your sibling too. (I remember when my sister once got a hair cut she hated and kept on pointing at me and yelling, “Cut her hair!”, as if my having a terrible hair cut were the only thing that would make hers bearable.) Yet the fights over food feel especially fraught, because what they’re really about is that Bisi’s facing something difficult that Jamie doesn’t have to.

Jamie usually reacts to Bisi’s food outbursts with a look of detached bemusement.  But he loves her and occasionally he does something very sweet for her. One day we were sitting having snack, and Jamie ran up to his room and came down with $10 from his stash and handed it to Bisi. (We give both kids $3 of allowance each week, and expect them to use that money to buy themselves the things they want, in between Christmas and their birthdays. Jamie never spends his; whereas Bisi almost always spends hers the moment she gets it.) I asked him why he’d given her this unsolicited gift and he said, “Well, because she’s going through a hard thing. Diabetes is hard, isn’t it?” Another time, he decided he wanted to bake cookies, and  said he wanted to make them gluten free, so Bisi could have them. We looked through some recipes and settled on one from Bob’s Red Mill (whose products I love—more on that in another post), printed on the back of a package of teff flour,  made from the seeds of a type of grass native to North Africa.  Jamie completed every step of the process himself, and in the end, the cookies were delicious—nutty-tasting and not too sweet. The only person who didn’t like them was …  Bisi. But even a six year old can understand the idea that it’s the thought that counts. And for that day, at least, sibling harmony reigned.

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Jamie’s Cookies for Bisi

(I altered the recipe I found on the back of the package of Bob’s Red Mill teff flour; the orginal recipe is from www.lesliecerier.com)

1 1/2 cups teff flour

½ teaspoon sea salt

½ cup coconut nectar (the original calls for maple syrup, but coconut nectar is supposed to be better for diabetics because it causes a more gentle spike in blood sugar)

½ cup coconut oil (Bob’s Red Mill package calls for canola oil, which a naturopath recently told me is terrible for everyone.)

1 teaspoon vanilla

1 cup peanut butter

Preheat oven to 350°F. Set aside an ungreased cookie sheet.

In a large bowl combine dry ingredients, set aside.

In a food processor blend coconut nectar, oil (you’ll have to melt it first), vanilla and peanut butter. Add the wet ingredients to the dry ingredients; blend well. Shape dough into walnut size balls. Place on cookie sheet and flatten gently with the tines of a fork. Bake about 13-15 minutes. Cool on wire rack.

Yield: 24 cookies