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Dr Coy’s sugars and diabetes

Diabetes is a condition where blood sugar levels are not well controlled and often too high. Dr Coy’s research is concerned with sugars that produce a lower blood glucose rise, and this page sets out the reasoning behind it.

Understanding diabetes

Diabetes happens when the body fails to produce enough insulin, or can’t produce it at all, the so called diabetes type 1. Another type of diabetes, diabetes type 2, is the result of low levels of insulin or a reduced effect of insulin (insulin resistance). Without insulin, glucose can’t get into the cells, which means too much of it stays in the blood, causing damage to surrounding cells in the blood vessels. There are several different types of diabetes:

Type 1 diabetes

Type 1 diabetes often occurs in childhood and adolescence. The body’s own immune system attacks the cells in the pancreas that produce insulin, so none is produced. This most likely results from an autoimmune reaction, though the precise causes are unknown. Suspected triggers include environmental factors, gluten and viral infections. Because the body doesn’t produce insulin, the blood sugar level has to be regulated through daily insulin injections.

Type 2 diabetes

Type 2 diabetes develops over time, when the pancreas doesn’t produce enough insulin, and the body becomes resistant to insulin’s effects. Obesity, genetic predisposition and lack of exercise increase the risk for type 2 diabetes. Although it’s known as ‘elderly or adult diabetes’, it’s increasingly common in children. Many people live with type 2 diabetes without even knowing it, with only half ever actually diagnosed. Blood sugar is managed through diet, medication or insulin injections.

An HbA1c test can measure the amount of glucose that’s attached to haemoglobin, which is the protein that transports oxygen to the bloodstream. This represents the glucose damages resulting from high blood glucose levels over the previous three months. A prolonged increase in blood glucose can lead to insulin resistance, which prompts the body to create more and more (hyperinsulinemia).

Gestational diabetes

Gestational diabetes occurs during pregnancy, with potential health consequences for mother and baby. Diabetic mothers are more likely to need a Caesarean section. Babies born to diabetic mothers have an increased risk of type 2 diabetes and obesity. Diet is one of the things managed during pregnancy, under the care of a midwife or doctor.

A new type of diabetes?

Type 3 diabetes is a recently suggested description for Alzheimer’s disease, which results from insulin resistance in the brain. High blood glucose levels and HbA1c correlate with early onset memory loss and Alzheimer’s.

Dr Coy’s research and the lower blood glucose rise

For people with diabetes, sugar awareness is often essential, along with regular blood monitoring, a balanced diet and regular exercise. Avoiding too many foods that are high in classic sugars and glucose starch is part of standard dietary guidance.

Even foods we think of as savoury, like bread, pasta, potatoes, rice and grains, contain hidden sugars in the form of glucose starch. This raises blood sugar levels significantly and forces the pancreas to release more insulin to stabilise it.

This is where Dr Coy’s thinking starts. The usual advice is to cut down on sugar, but the pancreas does not taste anything. It measures blood glucose. A slice of bread and a spoonful of sugar look very different on a plate, and to the pancreas they look much the same. So a diet built around avoiding sweet things can still produce the same insulin response, meal after meal.

His conclusion is that the question worth asking is not whether a food is sweet, but how high it pushes blood glucose and how quickly. That is why his work concentrates on sugars that take different routes through the body and produce a lower rise. The following describes how each behaves.

Galactose:

Research shows that after consuming galactose, the amount of sugar in the blood rises more slowly than with classic sugars. It supplies energy to cells without the sharp rise and fall produced by glucose.

A 2011 study compared galactose with glucose and looked at what the body did with its fat. When we eat glucose, insulin rises, and one of insulin’s jobs is to switch the body from burning fat to storing it. So for a while after a sugary meal, fat burning stops. Galactose produces much less insulin. In the study, the women carried on burning fat while they ate.

Galactose can be used as a sweetener in drinks, desserts and ice cream.

Tagatose:

Consumption of foods and drinks containing tagatose instead of sugar induces a lower blood glucose rise after their consumption compared to sugar-containing foods and drinks.

Tagatose has been studied in relation to diabetes over a number of years. Trials have examined its effect on HbA1c and on blood lipids, with one reporting a rise in HDL cholesterol, the form associated with lower cardiovascular risk. Several of these studies are listed below.

Trehalose:

Trehalose is a fully digestible natural sugar consisting of two glucose sugars, with a lower calorie content than classic sugars. It produces a lower blood glucose rise and a lower insulin response than classic sugars, and supplies the brain with glucose more gradually. Dr Coy applies the same reasoning here as with galactose: a smaller insulin response means less of the signal that tells the body to stop drawing on its fat stores.

Isomaltulose:

Consumption of foods and drinks containing isomaltulose instead of sugar induces a lower blood glucose rise after their consumption compared to sugar-containing foods and drinks.

Non-sweet starches

The same reasoning applies to starch. Classic starches have the same effect on blood glucose levels as classic sugars, which is why Dr Coy treats them as the same problem. Alternatives include resistant dextrin, psyllium husk flour, glucomannan, and low sugar flours from oil seeds, such as almond flour.

Resistant dextrin (long chains of glucose which are resistant to digestion)

Resistant dextrin is made from glucose starch, but the body cannot digest it. Ordinary flour is broken down into glucose in the small intestine and absorbed into the blood. Resistant dextrin is a fibre, so it passes straight through and ends up in the large intestine, where gut bacteria feed on it. Very little of it reaches the blood as glucose, so it has far less effect on blood sugar than ordinary flour. Combined with gluten free flour, it can be used to make pasta, pizza and bread.

Glucomannan

Glucomannan is another long-chain starch, consisting of glucose and mannose. It is a water-soluble fibre made from elephant yams, also known as konjac. It absorbs a very large amount of water for its weight and forms a thick gel, so a teaspoon is enough to thicken a whole dish. That is why it is used in such small quantities, and why so little glucose reaches the blood from it.

Our recipes page is packed with ideas for incorporating Dr Coy’s sugars into your diet.

View Recipes

If you have diabetes, any change to your diet should be discussed with your diabetes team, since it may affect your medication or insulin.

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If you have a question about a specific health condition, please speak to your doctor.