Low-sugar diets are a specialized form of low-carbohydrate diets for diabetes management or weight loss. Some are derived from general guidelines drawn up by such organizations as the AHA and the American Diabetes Association (ADA). Others, such as Sugar Busters and Nothing White diets, are weight-loss plans published by individuals or groups for the general public. Some low-sugar diets are based on reducing the total amount of sugar obtained in the diet from fruits, starches, and other foods, not just from table sugar and such other sweeteners as honey, molasses, or corn syrup. Other plans take the form of nutritional guidelines: recommendations include reducing the intake of added sugars that are found in products such as sugar-sweetened beverages and baked goods.
During the 1920s and 1930s, the public exhibited much interest in diets that promised quick weight loss. These fad diets included weight-loss plans where people ate a grapefruit with every meal or ate meat but avoided certain food groups like vegetables. Some of these diets evolved into low-carbohydrate eating plans, which have been popular since the 1960s. Low-sugar diets, however, did not gain much attention from the general public until the 1990s, after growing awareness of the significance of the glycemic index (GI). The concept of the glycemic index was introduced by David Jenkins, a Canadian physician, in 1981. The GI is a classification of foods according to the speed at which the body converts carbohydrates to glucose (sugar). Glucose itself is assigned a value of 100 on the glycemic index, and other foods are measured against it. Any food below 55 is considered to have a low GI. The first version of the Sugar Busters diet, which is based on the glycemic index, was published in 1998, with a revised version following in 2003. This diet has not been revised or republished since 2003.
Sugars are sweet, water-soluble carbohydrates that occur naturally in some foods and are added to others. Fructose occurs naturally in fruit, and lactose occurs naturally in milk. Specific types of dietary sugars include the following:
According to the AHA, the average American consumes 355 calories per day (22.5 tsp. or 122.5 g) in the form of sugars added to foods. The major sources of added sugars are:
Sugars are also added to many condiments and canned foods, including ketchup, duck sauce, tomato sauce, barbecue sauce, marinade, salad dressing, and soup.
A 12 oz. (0.35 L) can of sugar-sweetened soda contains 8 tsp. (40 g) of sugar, which represents 130 calories and is near the daily limit of sugar recommended by the association. In 2015 the World Health Organisation (WHO) recommended that the intake of free sugars be reduced from no more than 10% of total energy intake to less than 5% of total energy intake. Based on this the AHA recommends that women consume no more than 6 tsp. (30 g) of sugar daily, equal to about 100 calories from added sugar. For men, the limit is about 9 tsp. (0.43 kg), or about 150 calories. The recommended limits for children vary based on stage of development but average around 3–4 tsp. (15–20 g) daily.
Most diabetic diet plans are based on some form of carbohydrate counting or carbohydrate measurement, because carbohydrates are the nutrients with the greatest impact on blood glucose levels. Some low-sugar diets are based on the glycemic index, an approach to carbohydrate counting based on the knowledge that the body does not convert all carbohydrates in food to glucose with the same speed or efficiency.
The American Diabetes Association (ADA) provides numerous resources to help people customize low-sugar plans that work for them. People can refer to the “What Can I Eat” or the “Understanding Carbohydrates” sections of the ADA website for information about how foods fit into plans that track carbohydrates or the glycemic index. For example, one cup (0.237 L) of milk or yogurt is equal to one small piece of fruit for carb counters or one slice of bread for those who use the glycemic index.
The Sugar Busters diet is a popularized version of a low-GI diet. There is a child's version of the diet available as well as a book for adults, written by a team of three doctors and the CEO of a Fortune 500 energy company (who is listed as the first author).
The Sugar Busters diet is essentially a diet that eliminates sources of sugar and other high-GI carbohydrates in order to lower blood insulin levels. It requires the dieter to eliminate all refined sugar, honey, and molasses; white flour and products made with it (white bread, cake, bagels, crackers, and tortillas); potatoes; most forms of white rice; corn flour; sugared soft drinks; beer; and other foods that are high on the glycemic index. The general rule is that any permissible food must contain 3 g (0.10 oz) of sugar or less per serving. The published book contains little information on tailoring the diet to individual needs—a common criticism of it is that it is a one-size-fits-all approach to carbohydrate counting.
Nothing white diets, also known as “no white food” diets, are based on the elimination of so-called white foods, usually defined as foods that are white in color because they have been processed and refined. White foods include bread, pasta, flour, rice, cereal, crackers, and simple sugars like table sugar and high-fructose corn syrup. Processed foods containing these ingredients are also avoided. Unprocessed vegetables that are white in color, such as cauliflower, potatoes, parsnips, some beans, turnips, and onions are not considered white foods for the purposes of this diet.
The no-white diets combine elements of low-glycemic index diets and low- or no-refined sugar plans. Some versions of the diet allow people to drink milk. Measured portions and exercise are not required. Among the promoters of this plan is Paul Array, author of the 2007 book No White Diet. Like the Sugar Busters book, this book has not been updated since its initial publication. Another version of the no-white diet is the “no flour, no sugar” diet popularized by Peter Gott, M.D., the author of a nationally syndicated medical advice column.
The AHA recommendations for reducing sugar intake are targeted at helping people lose weight and improve or maintain good health. Instead of rules about portions and prohibited foods, the AHA wants people to be aware of how much sugar is in the food and beverage products they consume. Once they have this awareness, people can adjust their eating plans so that their consumption of sugar is within the daily limit that the AHA recommends.
Low-sugar diets generally result in weight loss because fewer calories are consumed. According to the American Heart Association, the body does not need sugar to function properly. Calories from food provide energy for the body; a physically inactive person does not burn off excess calories. The AHA cautioned that products with added sugar have many added calories and zero nutrients. The purpose of low-sugar diets is to assist in the long-term management of diabetes mellitus, to enable weight loss or weight management, or both.
The results of a properly designed low-sugar diabetic diet include improved stability in blood glucose levels, weight loss (if needed), lowered risk of the complications of diabetes, and patient satisfaction with the food choices and dishes allowed on the diet. An additional benefit of low-sugar diets is improved oral health, as refined sugar and sugary drinks are recognized factors in tooth decay.
Anyone interested in using a low-sugar or any other diet plan for weight loss should first consult their primary care physician. Preparation for following a low-sugar or any other diabetic diet may involve meeting with a dietitian or diabetes counselor as well as a doctor in order to plan a diet that will work well with the individual's food preferences and lifestyle. Children and adolescents, athletes, and people with type 1 diabetes need to take particular care regarding the timing of their meals as well as the total calories and specific foods included in the diet.
Consulting with a healthcare or nutrition professional is especially important because low-carbohydrate diets that allow unlimited consumption of foods ignore the calorie content and the nutritional value of these foods. Furthermore, the Mayo Clinic cautions that the glycemic index did not factor in the nutritional value of a food. The clinic noted that ice cream and potato chips have a lower GI than a baked potato.
In addition, people wishing to try the Sugar Busters diet should read the introduction to the book first and understand the theory underlying this diet before making food purchases and meal plans based on the diet. Some people who have tried the diet note that it complicates eating out in restaurants because many restaurant chefs use processed food in their recipes. In addition, the Sugar Busters diet does not accommodate vegetarians and vegans, as it recommends consuming at least some animal protein.
The most important precautions for low-sugar diets, as for any other diet intended for weight control or diabetes management, are making sure that the diet is based on accurate medical information and sound nutritional advice, and that it includes foods and recipes that the individual enjoys for the sake of longterm compliance.
The major problem with low-sugar diets, as well as low-carbohydrate diets in general, is the difficulty most patients have in sticking with them over the long term because of the many restrictions. Researchers at the Mayo Clinic have noted that the dropout rate for these diets is the same as that for low-fat diets and other restrictive diet plans.
There are no risks in following the AHA's and other organizations' recommendations for sugar intake. Diets like the “nothing white” diet, however, are not realistic and may be difficult to follow in the long term.
One group of people who should be particularly careful in trying a low-sugar diet is athletes, particularly long-distance or marathon runners. Athletes (or people who exercise vigorously for long periods of time) require more high-glycemic index foods in the diet that supply large quantities of glucose quickly to meet the body's needs for energy.
In addition, people with diabetes are at risk of complications from their disease if they try extreme fad diets for rapid weight loss or if they fail to stay within their individual dietary guidelines.
In the Mayo Clinic evaluation of glycemic index diets, the clinic noted that the index could help guide a person to healthier food choices. Yet, results from studies were mixed about the effectiveness of glycemic index diets. Some research showed little difference in the sensation of hunger after subjects consumed a high-GI food or a low-index eating plan. Other research indicated that a person was more likely to lose weight on a glycemic index diet than on a traditional weight-loss plan, according to the clinic.
Some evidence indicates that dietary trends in the United States as measured by the AHA diet score have improved since 2010. A research team at Tufts University in Massachusetts reported in 2016 that Americans are eating more whole-grain foods and whole fruits, and decreasing their consumption of sugary drinks. Another study also stated that young people in the United States have lowered their intake of sugar-sweetened sodas and fruit juices since 2010.
See also American Diabetes Association ; Diabetes mellitus ; Diabetic diet ; Fad diets ; Glycemic index diets ; Insulin ; Obesity ; Sugar .
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Rebecca J. Frey, PhD