BF Basics: Sugar Shock (Part Four)

Smoke and mirrors: how the food industry tries to confuse us about sugar

So we’ve all seen it. “No sugar added!,” “Sugar free!” What does it all mean?

Here’s the breakdown:

• Sugar free means there is no sugar of any kind (no sucrose, no lactose, no fructose, no maltose). Usually there is a sugar substitute in these products and the ingredients list should tell you which. If Splenda is included, usually it is on the front label with the Splenda symbol.
• No Sugar Added – means that the product only uses naturally occurring sugars and no table sugar. For these foods, you really need to check the nutritional label to find out how much sugar there is per serving, because no sugar added foods can still have quite a bit of sugar in them.

How to know if something is safe

Unfortunately, since everybody’s body is different, there is no hard and fast rule. Some folks do fine with sugar and sugar alcohols, some only dump on table sugar and some dump on every and any kind of sugar.

We advise the following:

1. If you don’t know if you dump, always go for a relatively low sugar count and use products with naturally occurring sugars
2. With things like flavored yogurt or cottage cheese (and both varieties that list "fruit on the bottom") check the label (well...always check the label...but still...). These products are usually fairly high in sugar.
3. Wherever possible, get plain products and sweeten them yourself (such as yogurt and cottage cheese. The cottage cheese with fruit added usually has added sugar)
4. When buying canned fruits, look for ones packed in water. The food industry uses the term “light syrup” sometimes. While light syrup has less sugar than regular canned fruit syrup, it probably still has more than you want. Fruits packed in water will have a sugar count on the nutrition label, but the sugar is most exclusively likely from the fructose in the fruit.
5. When buying things like jelly, look for the Splenda symbol, or for it to say "No Sugar Added." We, personally, would be suspicious of any product that claims it is made with real fruit but is also sugar free. As you remember from part two, fruit contains fructose, or fruit sugar, so if your fruit products say they are sugar-free, go STRAIGHT to the label and investigate!
6. If you have done all your investigating and STILL can’t tell where the sugar comes from, DON’T BUY IT!!!

So in summary, here are the most important things to remember about being on guard for sugar in food:

• If something is sugar-free, it should have no sugar of any kind in it, but it still may have sugar alcohols, which can still affect the body
• If something is no-sugar added, it should ONLY have naturally occurring sugars (usually from fruit or milk) in it, and it still may have sugar alcohols, which can still have an effect on the body

Next: Sugar Substitutes

Previous: Part Three - the Nutrition Label

BF Basics: Sugar Shock (Part Three)

So what does this all mean? The Nutrition Label.

Dumping. For those who dump, it's a horrid experience. For those that don't, you live in fear that someday, by pure accident, you'll find that you do. Because it's unavoidable, right?

WRONG!

For fellow RNYers at least, everything you need to know to protect yourself from a sugar dump is right on the very food you eat. For other surgery types, perhaps you don't live in mortal fear of sugar, but want to avoid it because it might hinder your weight loss. So what exactly does the label have to say?

If you look at the Nutrition Facts label on your food, you will see a section on carbohydrates. That is where sugar content is listed because sugar is a carbohydrate. Now if you see a number next to the sugars – don’t freak out! That doesn’t necessarily mean it’s bad for you or that it has table sugar (sucrose, honey or molasses) in it.

But anything other than zero (and even some things with a zero) warrants further investigation. Here is our easy, three-step system for investigating the sugar in your food and making a healthy decision about it.

Step One: Look at the ingredients list. If there is table sugar in the product, it would be one of the first 3-5 ingredients listed. Now remember: table sugar operates under assumed names like “cane sugar,” “beet sugar,” "fruit syrup" and, most infamously “high fructose corn syrup.” You see any of those and you know that there is table sugar there.

If there is lactose, it’ll most often say “milk” instead of lactose. If there is fructose, sometimes it will say fructose or sometimes the product will simply list the fruit included.

Step Two: Go back to the nutrition label. What is the serving size? Now, look at the amount of sugar. Remember when we said sometimes even natural sugar isn’t always safe? A lot of that has to do with the amount of sugar relative to the portion size. For example, if a serving size of a bowl of cereal is 1 cup and the amount of sugar is 7g, that’s different than if the serving size was a half cup with the same amount of sugar.

Some people dump no matter what. For others, if there is a small amount of sugar in a large serving size, they are fine whereas if there is the same amount of sugar in a smaller serving size, they dump. Again, the science of it all is perplexing and we’re ech different!

Step Three: If something is truly sugar-free, it can still have sugar alcohols. These are substances added to foods to make them sweet, but that our bodies cannot digest. Sugar alcohols are listed under carbohydrates (usually under the sugar count, which usually is zero). They are also easily detected in ingredients lists. Look for foods that end in “itol” (malitol, xylitol, etc.). Sugar alcohols can affect the body to varying degrees.

For some, eating sugar alcohols causes mild stomach cramps, for others it causes explosive gas and diarrhea. And this is just not for our altered systems. Non-ops often experience these things too. I recall a trip to Cold Stone with the kids last spring where I got a kids cup of their sugar-free ice cream and discovered very quickly the effect of sugar alcohols on the wonder pouch!

Using all three pieces of information you are now well equipped to make a decision about your food. You may want to proceed with caution if:

• The serving size is small but there is a good amount of sugar (of any kind) per serving
• There is table sugar of any kind in the product
• The product is sugar-free but there is a high amount of sugar alcohols per serving

So, in summary, the most important things to remember about the nutrition label and sugar are:

• Sugars will be listed under the carbohydrate count, because sugar is a carbohydrate
• Sucrose can also be listed as cane sugar, beet sugar or high-fructose corn syrup. These are all different forms of sucrose and all carry the risk of Dumping Syndrome
• It's important to read BOTH the nutrition label AND the ingredients list to determine if a food product is a good choice.

Next: Smoke and Mirrors - how the food industry tries to confuse us about sugar


Previous: Part Two - Naturally Occuring Sugars 

BF Basics: Sugar Shock (Part Two)

Three Common Natural Sugars: Lactose, Fructose, Maltose

It is a little known fact that sucrose is actually NOT a naturally occuring sugar. The three major, naturally occurring sugars are lactose, fructose and maltose. Here's the down-low on each.

Lactose

I cannot count how many times I’ve answered posts or e-mails from a new post-op with the following exclamation: “there’s sugar in my MILK????”

Yes, there is sugar in your milk. But it’s not table sugar. It’s lactose. Well...unless you're drinking flavored milk (chocolate or strawberry), in which case there probably IS sucrose in there.

Lactose is a naturally occurring sugar found in milk. If you think about it, the fact that there is sugar in milk makes sense. Milk is, after all, intended for newborn babies (humans or animals). They need to grow and they need to grow fast. Their bodies can't sit around waiting to convert complex carbs into energy. They need that energy now! As such, lactose is also on the simpler carb spectrum, although it doesn't have quite the same effect on the body as sucrose.

Now that doesn’t mean it’s automatically ok for you post-op. Some people develop what is called “lactose intolerance” which means their body doesn't produce an enzyme (called lactase) required to break down lactose.

And for others still, while they are not lactose intolerant, too much lactose makes them dump too. Many surgeons still aren’t sure why this happens, but we’ve heard it enough that we are inclined to believe it.

Fructose

Now most of us know there is sugar in fruit. Mostly because we associate sugar with sweetness and, since fruit is sweet, it translates well to our minds that there is sugar in it. Again, fructose is a natural sugar but that doesn’t necessarily mean you’ll do well with it.

After all, fructose is the mother of high fructose corn syrup AND honey (whose father is glucose, by the way...). This is not to scare you about fruit. There are lots of fruits that sit perfectly fine with a lot of post-ops. And some that don't.

For a long time after surgery, I couldn’t do certain fruits. Some are still iffy (for instance, my pouch seems to hate oranges. I always dump when I eat oranges for some reason). Because fructose contributes to the sweetness of fruit, it’s easy to find fruit products with no table sugar in them, which is a plus.

How do you judge for yourself whether a fruit is good to try? Well, we each have to decide for ourselves, but your best bet, in my humble opinion, is to use the glycemic index. If you are, or were, diabetic, you probably already know what this is. For others, it's an international index of foods, ranked by how fast they cause your blood sugar to rise. While the rising of blood sugar and dumping syndrome are two different things, foods with a low G.I. number (meaning they make your sugar rise more slowly) can often sit better than higher G.I. foods.

All this is to say, the glycemic index is a tool that you can use to determine if you want to try a fruit. But the only real way to know if it will affect you is to try it.

Maltose

You ever wonder where the carbs in beer come from? Mostly from maltose, another naturally occurring sugar. Now I KNOW I don’t have to talk to any of our Poucher newbies about beer, do I????

There’s a few other sources of maltose in our diets, but mostly it is a sugar found in wheat. I haven’t heard many stories about the effect of maltose on our systems, but then again what post-op is going to cop publicly to drinking a bunch of beer??? ;)

For those interested in reading more about maltose, here is a good link to everything you ever wanted to know (and about seven things you didn't).

The most important things to remember about these three naturally occurring sugars is:

• Although all three can be quickly converted to energy, making them simpler carbs, they are not the same as sucrose (table sugar) and don't work the same way in the body
• Some people may be lactose intolerant after weight-loss surgery, meaning their bodies no longer produce the hormone, lactase, necessary to break down milk sugar
• With fructose, different fruits have different levels of sugar and different amounts of fiber, both of which affect how fast your blood sugar rises as a result of eating them. Doctors use the glycemic index to rank foods based on how fast your blood sugar rises after eating them. Some foods, like bananas, have a very high glycemic index, while others, like berries, are lower. Here is a good list of fruits by G.I. ranking. This is helpful not only to diabetics, but to those wishing to limit the sugars in their food plans.
• Naturally occurring sugars DO make some people dump (by their own accounts). So be careful when starting to try any kind of sugar, even naturally occurring ones.

Next: What the nutrition label has to say about sugar
Previous: Part One - Sucrose

BF Basics: Sugar Shock (Part One)

Ok, let’s start with what we all think of when we think “sugar.” We think of this guy:

This is table sugar, or sucrose. Now, he isn't by himself in our collective consciousness. When we talk about sugar we could also be talking about this guy:

Or this guy:

And even this guy:

All of these things can make up sugar content in food. But for the purposes of THIS post, we're going to talk mainly about sucrose, which is the base for maple syrup, but not for high fructose corn syrup or honey (we'll talk about that more in the next post).

Sucrose is usually derived from sugar cane or sugar beets and is refined to give it a pristine, white color. We won’t get into the deep-down science of this guy, but we will say this—this guy? Is an outlaw on most post-operative eating plans.

Why?

Well, table sugar is an extremely simple carbohydrate and it doesn’t give you good nutrition. Aside from that sugar is a trigger for that phenomena in bypass patients known as “Dumping Syndrome” (I personally call it hell). Here’s a good explanation of dumping syndrome for those who want to learn more.

Now, getting back to those other guys up there. We're going to talk about naturally occurring sugars tomorrow, but know that when looking at ingredients on a nutrition label (which we'll discuss on Wednesday), the following ingredients, while not always sucrose, can cause just as bad a reaction post-RNY gastric bypass:

• High fructose corn syrup
• Anything that has the word "syrup" in it

In terms of cooking, the most challenging thing about not using table sugar post-op, in my experience, is in baking. Sugar lends texture and color to baked foods that can be difficult to achieve with sugar substitutes. But it can be done! Check out part five for more information on the various types of sugar substitutes. And check out the "dessert" tag on this blog for ideas of making fabulous desserts without sugar!

The most important things to remember about sucrose:

• It is a very simple carb. Meaning it can be easily converted to energy. HOWEVER, if you aren't using that energy, it is stored as body FAT. We don't like body fat.
• Because sucrose is so easily convertible, it raises your blood sugar level very fast...but then it crashes...and you are hungry again way sooner than you should be.
• While there are other natural sweetners besides table sucrose out there, they too are very simple carbs as well, including honey and molasses. Many people use natural sweeteners (meaning not man-made) like Stevia to sweeten things. I can't vouch for Stevia as I've never tried it. I'd love to hear from anyone that does, especially someone who would normally dump on table sugar.
• Be on guard! Simple sugars can hang out on ingredient lists under assumed names. If you learn nothing else from this series, learn this: ALWAYS look at the ingredients list!
  

Next: Naturally Occuring Sugars

BF Basics: Sugar Shock

Sugar. From our experience it’s one of the most widely misunderstood substances among post-ops in general. Whether you’ve had bypass, band, DS, VSG…many folks seem perplexed by sugar—what it is and what it means to US!

No fear…Bariatric Foodie is here!

In this BF Basics series, we’re going to give you a good primer on sugar that will help you understand what you see on a food label, what’s generally ok for consumption and what to avoid.

Starting tomorrow, and through Friday, we're going to post each part of the series. Not to worry, though, we'll still be posting the recipes you love this week!

Here is a summary of the topics covered in this BF Basics:

Part One: The #1 Suspect: Sucrose!

Part Two: Lactose, Fructose Maltose – Naturally Occurring Sugars

Part Three: So what does this all mean? The nutrition label

Part Four: Smoke and Mirrors – how the food industry tries to confuse us about sugar

Part Five: Sugar Substitutes

So tune in tomorrow, sweet thangs, and let's talk sugar!