March 25, 2015

Ask the Doctors

As a type 2 diabetes patient, I was told not to eat fruit because of the high sugar content. What do you advise?

We regularly recommend a diet that is balanced and includes whole fruits, vegetables, grains, nuts, legumes, and modest amounts of low-fat dairy or dairy equivalents. Dairy equivalents are vitamin B12-fortified soy drinks and egg replacements.

We emphasize “whole” foods because such foods contain a natural balance of fiber and nutrients such as thiamine (vitamin B1) and avoid unnatural concentrations of one kind of nutrient over another.

Some years ago, when the world took note of proponents of a vegetarian diet, much criticism arose arguing that vegetarians could not obtain sufficient protein in their diet. This has long been shown to be an unfounded concern. It’s almost impossible to find a diet that is low in protein if it’s balanced among the types of foods we have recommended.

For the diabetic patient, however, the question revolves around the carbohydrate intake. It’s here that particular attention to the refined-sugar content of the diet becomes important. Granulated sugar, honey, molasses, maple syrup, and corn syrup contain concentrated sugars that are dangerous for a person with diabetes. When consumed in any quantity, they can prove very troublesome to healthy persons as well.

Table sugar is called sucrose, and each molecule of sucrose contains a molecule of glucose and one of fructose. The fructose is increasingly recognized as being difficult for the liver to cope with, and may be a key factor in a condition called “fatty liver,” which may predispose to a type of cirrhosis. The increase in dietary sugar of the types here referred to is felt to be a key component of the current epidemic of obesity. Obviously, a person with diabetes should be careful with refined sugars.

Many people enjoy fruit juices, and while one might consider the increased vitamins, such as vitamin C in orange juice, the concentrated nature of the juice means it too is high in sugar. A glass of orange juice, fresh-squeezed and natural, might contain the liquid from four oranges—yet without the full fiber content of these fruits.

By recommending “whole” fruits, we are encouraging the fiber intake of the fruit itself. The same logic holds for whole grains, whole legumes, and whole vegetables. One of our concerns is with the processing of foods, because it almost inevitably results in a concentration of one or another element of the whole food with a loss of some other ingredient. A “balanced” vegetarian diet refers not only to the variety of foods but the balance found within a whole food itself. In whole foods we find a wondrous balance encapsulated in each product, as it has come from the hand of the Creator.

A study published on March 5, 2013, in Nutrition Journal (online)* suggests that a limitation of fruit intake among patients with diabetes did not result in better blood sugar control. Patients were divided into two groups: one group of “low-fruit” and the other of “high-fruit” intakes. The high group consumed about 320 grams of fruit per day, and the low group about 135 grams. After three months both groups had similar AIC levels. The AIC is a fraction of hemoglobin that has been bound with glucose, and is an excellent indicator of blood-sugar control over a three-month period. In addition, the increased fruit intake did not seem to affect body weight or abdominal girth.

As always, we recommend that you see your health-care provider before making changes to your management of a medical condition. Our inclination, however, is to believe that whole fruit—in moderation—may not adversely affect one’s diabetes. Blood-sugar profiles show a much slower rise in blood glucose when whole foods, with complex carbohydrates rather than processed foods, are consumed. 

So, we would caution about fruit juices, but suggest a whole apple or orange may actually be very good for you, even if you do have diabetes.

* www.nutritionj.com/content/pdf/1475-2891-12-29.pdf

Send your questions to Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or e-mail them to [email protected] While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend you consult with your personal physician on all matters of your health. 

allan r. handysides, a board-certified gynecologist,
is the director of the Health Ministries department of the General Conference.

peter n. landless, a board-certified nuclear cardiologist, is an associate director of the Health Ministries department of the General Conference.

 

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