Mendosa Interview with Dr. Andrews

Interview with Sam S. Andrews, M.D.

This interview with Sam S. Andrews, M.D., one of the authors of Sugar Busters!, was conducted by telephone on May 25, 1998, with Rick Mendosa, a freelance writer specializing in diabetes who was writing an article about Sugar Busters! for Diabetes Interview magazine. That article was published in the September 1998 issue.

RM: One of the things I wanted to do was have a little sidebar in this article about the different types of sugar and say just what is it that you don’t want people on the Sugar Busters! diet to eat. You mentioned a few basic ones: refined sugar, corn syrup, molasses, honey, sugared colas, and beer and other places you talk about maltodextrin, malted barley, polydextrose, maltitol, sorbitol, or sugar alcohol in small amounts. Then you say they you say that high-fructose corn syrup is another no-no.

SA: Yeah, but sugar alcohols are okay.

RM: Those are sorbitol and maltitol.

SA: If you look at the glycemic index of those, those are virtually zero.

RM: What about dextrose?

SA: Same as glucose.

RM: What about levulose?

SA: It’s a left-handed sugar. I think it’s pretty low on the glycemic index, but I don’t know exactly what it is.

RM: And of course there are the various types of sugar I want to mention. I would like to get a quote from you that raw sugar, brown sugar, turbinado sugar, molasses, date sugar.

SA: They are all sugars. Look at the glycemic rankings of sugars. You have maltose, glucose, sucrose, and fructose in descending order. Fructose is significantly lower than sucrose.

RM: Except you don’t want us to use crystalline fructose or high-fructose corn syrup.

SA: Right.

RM: What’s invert sugar syrup. I saw that in a product in a supermarket.

SA: I’m not sure. There is a lot of stuff out there.

RM: Cane syrup is another one I saw in a supermarket.

SA: That’s sugar.

RM: Malt syrup is another one. Are there any others. I’m just looking for a fairly comprehensive list to warn people away from.

SA: Of course, maltose is present in beer. There is grape sugar in maltose. These are basically the ones. Oh, lactose is in milk. Lactose would be okay.

RM: As an endocrinologist do you have any specific recommendations for the Sugar Busters! diet for blood sugar control versus for weight loss? Are there any differences?

SA: No. I use it especially with my overweight diabetics and on my type 1 diabetics too, even though they are not overweight. I use it there to control their blood sugars a little better. A lot of people are going to need insulin or oral hypoglycemics. Type 1s are never going to get off insulin. Type 2s with weight loss following this diet are going to be able to get off insulin and pills.

RM: I have been able to get off of pills just with diet and a little exercise.

SA: Exercise helps your own insulin become more efficient. Are you the guy on sweetalk?

RM: Yes, I participate on sweetalk.

SA: I’ve seen your name there.

RM: I also have some Web pages on the glycemic index and on your Web site you are kind enough to link my pages.

SA: That’s good. So you write for magazines. Other magazines besides Diabetes Interview?

RM: I started out as a business journalist, but when I was diagnosed with diabetes four years ago I started segueing into writing about diabetes because I found it so interesting. My wife has diabetes too....

SA: Insulin is the dominant hormone in metabolism of foods. It’s much more significant than glucagon. There are a whole bunch of counter-regulatory hormones that come into play when the blood sugar drops. But insulin moves not only sugar but moves, amino acids, that kind of thing into the cells. One thing that we’ve noticed is that people on this diet drop their triglycerides a lot. Triglycerides are becoming in the way some people think a significant cardiovascular risk factor if they are elevated. We used to say 200 was the cut-off. People are beginning to think it might even be lower than that as far as risk. When you store fat, especially in the abdominal area, or anywhere really, but insulin tends to store the fat in the abdominal area, it’s stored as triglycerides. All that stuff around your gut, that’s trigylcerides. And if you have a lot of gut there and you also have high circulating trigylcerides you are going to have increased cardiovascular risk. That’s partly genetic and partly environmental, diet. So dropping your glycemic index of foods will help you drop your sugar, your insulin level, and your triglycerides significantly.

RM: Looking at it maybe a little more philosophically, the Sugar Busters! diet is not just low glycemic. It is also low sugar, as I read it. What I mean but that is that some people say, well, if you have popcorn and you put butter on it that as a mixed food the fat will bring the glycemic index down. Or you add Metamucil, fiber, to bring it down. Aren’t their good reasons to practically eliminate the amount of sugar anyway so that you lose your taste for the sugar.

SA: If you eliminate sugar from your diet, you do lose your taste for sugar. It takes a week or so. Once you do that you don’t have to rush to the cookie jar after you eat supper. Decreasing your sugar intake helps. There are other things that sugar does. It makes people nervous, hyperactive. I think Sugar Busters! is also a high-fiber diet, because of the grain. We encourage people to eat whole grain, and whole grain is really high fiber. By increasing fiber you do several things. You decrease the glycemic index, you promote good intestinal function, the fiber itself can help lower your triglycerides, cholesterol, and blood sugar, maybe even contribute to some weight loss. In this country we probably eat 15 grams of fiber a day. In Africa people eat 60 grams of fiber a day. I don’t know how much fiber I eat. I eat oatmeal every day for breakfast.

RM: Now, oatmeal is high in soluble fiber. Are you making much distinction between soluble and insoluble fiber.

SA: I think the are both important. Metabolically soluble fiber is more important that insoluble fiber for prevention of colon diseases like diverticulosis and colon cancer.

RM: You are not recommending that people add a little Metamucil or guar gum?

SA: ...the natural way.

RM: You can bring down the glycemic index of a meal by adding some fiber to it. But that’s not what you are talking about?

SA: I would rather not do it that way. Eat the foods that are naturally high in fiber. Those are typically the ones that are also low-glycemic foods.

RM: A lot of beans...

SA: All the legume family is high in fiber, especially lentils. Are you familiar with the study that was done last year that was published in JAMA about the incidence of diabetes in nurses?

RM: Yes.

SA: It was published in February. They studied 65,000 nurses over a six-year period. They said, what do you eat? And have you developed diabetes? And they found out that the nurses who had the highest incidence of developing type 2 diabetes, because they were all nurses, they were not children, those who had a diet that was high in cola drinks, French-fried potatoes, baked potatoes, white bread, and white pasta, and low in cereal fibers. So you had high-glycemic foods and you had breakfast that was low-cereal fiber. So if you increase your cereal fiber intake and lower your glycemic index you have less chance of developing diabetes, according to this study. They did the same thing with 40,000 men, it was identical. About 2.5 times of those who ate those high-glycemic foods and not much cereal fiber had 2.5 times as much diabetes as those who ate the right way.

RM: Your book is off to a resounding success. I saw it’s up to number 3 on the New York Times how-to bestseller list yesterday.

SA: Yeah, that was kind of nice. Number 2 next week, they tell us.

RM: The paradox of this diet is that it comes out of the part of the country where people probably eat the worst.

SA: They eat a lot and it’s a big part of their life to go out to dinner. Eating and cooking out. They eat a lot of high-fat foods down here. A lot of starch though. They eat a lot of rice and potatoes, white bread, French bread, of course French bread has a very high glycemic index, 95. The combination of high-fat food and a high starchy food is a terrible combination.

RM: Maybe it was met to be that you doctors in New Orleans are finding a readier response there than any place else -- and it’s spreading of course beyond New Orleans, I know -- just because the people there are in so much trouble. I don’t know how to say it. How would you say it?

SA: I would say that being the most obese city in the country people are trying to do something. And it is interesting that a lot of the black population has picked up on this too. I see patients who come to me and say, we are on Sugar Busters!, and we are trying to do something about our weight. Blacks have a very high incidence of diabetes, not as high as American Indians, still they are probably twice as high as Caucasians.

RM: One of the interesting things to me is that you, as an endocrinologist, have been able to appreciate the glycemic index.

SA: One of few.

RM: Yes, there are very few in this country. In fact, I have started to make a list of those who are and it is a very short list. People write me because of my glycemic index pages and occasionally one or two will. When I reviewed Jennie Brand Miller’s book a couple of years ago for Diabetes Interview I wrote that maybe it was the NIH factor -- not invented here, it is in Canada and Australia where the glycemic index has been the most accepted.

SA: Sure. Dr. Jenkins in Canada.

RM: And Dr. Wolever.

SA: Yes, they did a lot of the original work and they are quite prolific.

RM: But the interesting thing is that you are out of step with your peers!

SA: Yes.

RM: Are you working on persuading them, or the American Diabetes Association, which I also write for.

SA: I belong to ACE, which is the American College of Clinical Endocrinologists, and I went to a leadership meeting last year and I said, why don’t we do something to cover diet to diabetic patients. And essentially they said they didn’t know if they wanted to take on that fight. We have other things to do. Why take on that battle? The American Diabetes Association is very political. They have addressed it in the nutrition section. They have looked at the glycemic index and decided that it was not worth anything. Yeah, they acknowledge the existence of it, but they didn’t think it was helpful. And not being there, I don’t know what the thinking is. So I think that the fact that diabetics are eating a 60-70 percent carbohydrate diet is ridiculous.

RM: What would you bring it down to?

SA: 40 percent carbohydrate. 30 percent fat, maybe a little higher, and 30 percent protein. Keep the total calories to 10 percent saturated fat, within the guidelines of the American Heart Association. Increase your fat if you want to by adding mono and [poly]unsaturated fats, proteins, use a lot of vegetable proteins, like lentils, that sort of thing. But get the carbohydrate down so you can control the sugar.

RM: The total amount of the carbohydrate and the glycemic index of that carbohydrate.

SA: Right.

RM: Tell me about breads. You are going to make some breads. [End of side a]

SA: ...They have come up with a formula for a six-grain bread that really is delicious and we think is going to be great.

RM: If you can market that nationwide, you’ve got to get it out here to Santa Cruz for me too!

SA: It will be a heavier bread, so you don’t have to eat as much. It will be thin slices, but it will be a low-glycemic bread.

RM: Bread is the hard thing for me to find. I eat GG Bran Crispbread from Norway. That is about 5 grams of carbohydrates per slice, of which 4 grams are fiber.

SA: That sounds good.

RM: That’s the only thing I can find. I need some real good bread. I look forward to your marketing it.

SA: Let me ask you something. How are we going to get the ADA to jump on this thing?

RM: I think it’s up to folks like to you to do that -- the endocrinologists.

SA: A lot of the endocrinologists around here recommend the diet to diabetic patients. So it is starting. Once you have a couple of diabetic patients who are doing well on it, it is hard to ignore it.

RM: I maintain the links page -- called the Internet Resources -- on the ADA Web site. And with a lot of trepidation I put up a link to my own glycemic index page, and they let that stand.

SA: Good.

RM: I say right there, "The Glycemic Index may be a difficult diet concept to follow. Officially, the American Diabetes Association has questioned its clinical utility and recommends that priority should be given to the amount rather than the source of carbohydrate. Nevertheless, many people with diabetes can benefit from a knowledge of the Glycemic Index." The ADA a few years ago said, yeah, you can have sugar now, it doesn’t make any difference.

SA: That’s the thing. When I give my talk I say this is what they are saying. They are saying that potatoes and sucrose have about the same glycemic index so you can eat both of them. Their thinking is really strange!

RM: It is true that sugar is no worse than potatoes. But it doesn’t follow that you should be able to have both!

SA: I know. It’s ridiculous.

RM: Thank you very much, Dr. Andrews.