A 'Spoonful of Sugar' May Be Acceptable for Some Diabetics

Medically Reviewed by Gary D. Vogin, MD
From the WebMD Archives

Feb. 16, 2001 -- People with diabetes know the drill: No sugar in the diet. It's hard to resist, though, when you live and work in the real world, where people celebrate holidays and special occasions, and someone's always bringing a treat to the office. So most people "cheat" and pay the price in guilt. But could it be that a little sugar isn't really cheating?

For people with type 2 diabetes, some sugar in the diet may be tolerable, according to a Canadian study published in the February issue of the journal Diabetes Care. Type 2 diabetes also is known as "adult-onset" or "noninsulin-dependent" diabetes, even though some people with type 2 also use some insulin and children also can be afflicted with this disease. The investigators found that type 2 diabetics can include a moderate amount of sugar in their diets without consuming more calories and without compromising glycemic control.

"Many people with diabetes, even when taught the traditional approach of avoiding sugar, do eat some," lead author Jean-François Yale, MD, tells WebMD. "They may feel guilty for doing so. This study suggests to them that if they learn how to do it -- for example, by replacing other carbohydrates such as a slice of bread with sugar -- they can do it in a manner that will not be harmful to them. People living with type 2 diabetes should discuss this topic openly with their dietitians."

In other words, the study does not recommend unrestricted sugar consumption, or a "free for all," Yale says. He is an associate professor of medicine at McGill Nutrition and Food Science Centre in Montreal, Quebec, Canada, where he is the director of the Metabolic Day Centre at Royal Victoria Hospital.

The investigators followed 48 patients with type 2 diabetes who were living in the community. The so-called "sugar group" was taught how to use and incorporate sugar choices into their meal plans, according to the Canadian Diabetes Association's guidelines. These guidelines help patients substitute a sugar choice for a carbohydrate choice; for example, two teaspoons of honey may take the place of a serving of fruit. The sugar group also was told that such choices could comprise as much as 10% of their total caloric intake, that sugar choices should be distributed throughout the day, and they should be vigilant for hidden fats in such choices.

At the end of the study, the average blood sugars, measured with a test called hemoglobin A1c, were not statistically different. The total cholesterol for the sugar group was higher, and the conventional group's LDL, or "bad," cholesterol had decreased more than the sugar group's. Changes in triglycerides and HDL, or "good," cholesterol were negligible.

The possibility of including some sugar may apply to children as well, Yale says. "However, our study looked at how patients with diabetes apply the teaching received, and for adults, this may be different from how parents try to apply these guidelines to their children's diet and how the message gets interpreted by the children themselves," he says.

Experts have differing perspectives on the study's value and whether patients should adopt the Canadian so-called "sugar guidelines." "Sugar by itself is not bad. Incorporating glucose or sugar products into a healthy meal plan does not raise [average blood sugar]," A. Jay Cohen, MD, FACE, tells WebMD, noting the emphasis on healthy eating. "Spending the time learning how to eat properly can lead to significant positive consequences." Cohen, who is on the board of directors of the American Association of Clinical Endocrinologists, is an endocrinologist in Memphis, Tenn., where he is a clinical professor of medicine at the University of Tennessee.

Even so, the sugar guidelines should be viewed with caution, says Lawrence Phillips, MD, who also provided WebMD with an objective assessment of the study. "Most dietary plans today allow for some incorporation of simple sugars," says Phillips, a professor of medicine in endocrinology and metabolism at Emory University School of Medicine in Atlanta. "Should it be 10% of total calories? I'm not convinced yet. ... I would advise caution. I would not recommend [such a diet] for patients with type 2 diabetes."