Michael Birnbaum steps to the Starbucks counter and tries to ignore all the frappulicious things he cannot order.
Since the 52-year-old medical educator was diagnosed with diabetes last winter, he has learned to weigh beverages and foods for their effect on his blood sugar. A coffee bar like this one, with its sensuous squirts of mocha and seductive hisses of frothing cream, can seem like a minefield of enticements.
Birnbaum holds firm. He gets tea and hurries past the milk and sweetener station to a table.
Every now and then you still hear people speak of “sugar diabetes,” as if sweetness were a disease.
Medical researchers have disproved the once-conventional wisdom that sugar itself causes diabetes. Yet the belief remains widespread.
“We deal with that myth all the time,” says Mary Ransbotham, manager of Atlanta’s Piedmont Hospital Diabetes7 Resource Center, where patients such as Birnbaum learn that the truth is more complicated.
Most nutrition professionals are hesitant to single out sweets. At the same time, studies have associated sugar-heavy diets with some cancers, high cholesterol and obesity, which raises the risk factor for diabetes.
“What you believe about sugar depends on who you last talked to and who’s funding the study,” says New York University nutrition professor Marion Nestle, author of the book “Food Politics.”
A history of worry
Over the years, excessive sweets have been blamed for everything from cancer and high blood pressure to hyperactivity and violent behavior.
Sucrophobia reached a crescendo during the early days of the health food movement in the 1970s. Activists unsuccessfully lobbied the federal government to ban TV commercials for sweetened cereals the way it had cigarette ads. William Dufty, in his best-selling “Sugar Blues,” took the demonizing to new heights when he wrote: “The sugar pushers are our predators, leading us into temptation, peddling a kind of sweet, sweet human pesticide.”
The rhetoric has cooled since then, as many of the more strident accusations have been disproved. Now most of the attention has to do with overconsumption and its ambiguous link to obesity and related diseases.
“Forget about the other health claims; the reason to be concerned is calories,” Nestle says. “Sugar keeps bad company. It often appears in foods that have a lot of calories and little nutritional value.”
Almost two out of three Americans are now obese or overweight, according to the Atlanta-based Centers for Disease Control and Prevention–a rise of 36 percent over two decades. The nation’s spreading girth underlies a similar increase in Type 2 diabetes, which used to be called “adult-onset” diabetes until it showed up more often in young people. The disease inhibits the body’s ability to regulate blood sugar, with potentially tragic consequences for vision, circulation, the kidneys, heart and other organs.
Almost 16 million Americans suffer the condition, with millions more on the borderline. Public health officials regard the obesity trend as a slow-motion disaster that will produce ever higher diabetes rates in the coming years.
Dealing with diabetes
Once diagnosed, diabetics have to learn to manage the disease by redefining their relationship with sugar, starches and carbohydrates in general. As Birnbaum knows, it isn’t easy.
He suspected something was wrong.
Late last year, Birnbaum noticed that his joints ached when he walked up the stairs. He was busy at work, exercising too little, eating too much ice cream and junk food, putting on weight.
“I was thirsty all the time,” he says. “I had a jug of water next to my nightstand. It was nothing for me to wake up and drink a quart.”
Any diabetic could have ventured a diagnosis. Fortunately, Birnbaum was about to see one. During a business trip to South Carolina, his district manager watched Birnbaum quaffing water in an unconscious effort to lower his blood sugar and insisted he take a test. He measured over 300, three times his optimum blood sugar level of 90 to 130.
“I was a Coke addict,” he says. “When I do these seminars, I have to be up for them eight hours at a stretch. I’d have a Coke in the morning and another one at 10 and another one with lunch and another one at 2, and by the end of the day, it was nothing for me to have drunk five or six Cokes.”
The sodas alone added 700 empty calories to his daily diet. Then he’d go home and heap on more, enjoying some dessert after dinner–chocolate cake was his favorite–and maybe finishing the evening with a pint of Cherry Garcia or the flavor of the month from Baskin-Robbins, where his son Mitch had taken a job.
“I felt happier after I had some sugar,” Birnbaum says. It’s easy to see how the preoccupation with sugar as the cause of diabetes became lore. But all carbohydrates have to be on a patient’s radar screen, because the body breaks them down into simple sugars.
The sugar regulator
The main reason Birnbaum felt hungry was insulin. The hormone that regulates blood sugar also regulates hunger in ways that science does not yet fully understand. Years of overeating and underexercising had flooded Birnbaum’s bloodstream with so much of the hormone that his body no longer responded to it.
“He was insulin-resistant,” says endocrinologist Dr. Spencer Welch of Atlanta Diabetes Associates. “The carbs he was eating weren’t getting into his cells as energy.”
Many of the carbs were instead being converted into fat, leading to weight gain. By the time Welch diagnosed his patient in February, Birnbaum was carrying 244 pounds on a 5-foot-6 frame.
The connection between insulin and weight is the source of much debate and investigation. Some researchers believe it will be one of the keys to solving America’s obesity problem.
“We wanted to get Mike off refined carbs,” Welch says.
On the other hand, the nutritionists advised him not to dwell on sugar and turn it into a forbidden fruit. Chemically, all carbohydrates break down to form the simple sugar, glucose, in the bloodstream.
Birnbaum learned to concentrate instead on total carbohydrates, regardless of source, and to reduce overall calories by controlling portion sizes.
He also learned something that might seem counterintuitive: Sweets are not prohibited for diabetics as long they fit into the total carb allowance.
“I told that to one patient,” says Piedmont dietitian Sandy Gillespie, “and he figured out that if he eliminated some other carbs, he could have a Coke and a candy bar every day. I had to tell him that we preferred he get more nutrition from his calories.”
Birnbaum got the message. His regimen afforded him so few carbohydrates initially that he had little choice but to stop sweets cold turkey. The first week was miserable.
“I didn’t have any energy,” he remembers. “It was like quitting smoking.”
Rationing carbs
It’s 8 o’clock in the morning, and a dozen men and women have gathered at a Buckhead Publix supermarket for Piedmont Hospital’s monthly class on shopping for diabetics. It has been half a year since Birnbaum was diagnosed, and from the looks of it, he probably doesn’t need much more schooling. After two weeks on the diet, his sweet desires began to subside. Rationing his carbs like a runway model, allowing himself only small servings of fruit or a Sugar-Free Popsicle, he has lost 40 pounds and counting.
Near the end of the tour, Birnbaum’s expression softens as he spies a freezer case full of pies.
“Banana cream pie,” he says. “I used to buy those. I’d practically down them on the spot.”
He smiles the way you smile when you see a photo of yourself wearing some ridiculously out-of-date fashion–with amusement and nostalgia, but not with longing.
“I see it,” he says, “but I’ve lost the taste.”
