True or false?

* Eating too much sugar causes diabetes.

* For people with diabetes, sugar and sugary foods are off-limits.

* Anyone with diabetes should be following the standard diabetic diet.

They're all false. But don't feel bad if you got any of them wrong. Many doctors do, too, according to experts.

It's a good idea to become more knowledgeable about the disease, however. More than 15 million Americans have diabetes, and that number is expected to rise. The more educated people become about the condition, the better they'll be able to work with their physicians to control diabetes or even to prevent it in the first place.

Here's a number of corrections to prevalent eating myths about diabetes.

Myth: Eating too much sugar causes diabetes.

Fact: Sugar per se has nothing to do with it. For people with type 2 diabetes, the kind that tends to come in middle age and accounts for just about all cases of the disease, "it's excess calories and inactivity" that are the biggest culprits, explains Bruce Zimmerman, president of the American Diabetes Association and a physician at the Mayo Clinic in Rochester, Minn. "At least 80 percent of those with type 2 are overweight," he says.

Excess weight and a sedentary lifestyle make the cells more resistant to the hormone insulin, which regulates sugar use by the body. That means the cells resist the efforts of insulin to get sugar out of the bloodstream and into the various organs, where they're used for energy. The result: The level of sugar in the blood remains high--the hallmark of diabetes.

For the fewer than 1 million people with type 1 diabetes, the type that generally starts in childhood or young adulthood, the problem is that the pancreas simply doesn't manufacture the insulin.

Myth: For people with diabetes, sugar and sugary foods are off-limits.

Fact: No foods are forbidden for people who have diabetes, sugar-filled ones included. The faulty thinking has been that the sugar in food raises the level of sugar in the blood more precipitously than all other foods. But it's carbohydrates in general that raise blood sugar, and sugar is only one type of carbohydrate. Indeed, the carbohydrates found in starches such as potatoes, pasta and bread can be at least as likely to cause undesirable spikes in the blood sugar levels of people with diabetes as the sugary carbohydrates in candy, cake and ice cream.

What people with diabetes are supposed to do is to count how many grams of carbohydrate they're eating, not how many grams of sugar. That includes the carbohydrate in milk (milk has more sugar, in the form of lactose, than protein), fruits, desserts, rice, cereal, etc.

That makes the diet much more palatable than people suppose it is. Consider, for instance, that a potato could have as many grams of carbohydrate as a candy bar. "The potato is more healthful, of course, but it won't affect blood sugar any differently," says Karen Chalmers, a dietitian and certified diabetes educator at Boston's Joslin Diabetes Center. So if someone wants to have a candy bar instead of a potato once in a while, it won't be any worse for him or her. That knowledge, she says, "allows people [with the condition] to relax more around food."

Unfortunately, Chalmers comments, a lot of doctors tell their patients with diabetes to "go home, stay away from sugar and lose weight." The patients try, she explains, "and then they get burnout" and end up overeating the wrong things. If they weren't misguided into being so strict with themselves in the first place, they'd have an easier time sticking to an appropriate diet.

Myth: Anyone with diabetes should be following the standard diabetic diet.

Fact: There isn't any standard diet for people with diabetes. The one-size-fits-all approach went out years ago.

It used to be that everyone with diabetes was instructed to eat a certain amount of calories from carbohydrate, a certain amount from protein and a certain amount from fat. Now, researchers know that the proportions of carbohydrate and fat can vary considerably depending on the person's condition. (Protein should account for 10 to 20 percent of calories.) For instance, someone with diabetes who also has heart disease might be advised to eat less fat and more carbohydrate.

How many grams of carbohydrate one should eat daily and how many grams of fat also depends on such factors as weight, physical activity and whether the person takes insulin injections.

Myth: If a food is sugar-free, it's safe in unlimited quantities.

Fact: This one harks back to the sugar-is-verboten myth. People automatically assume that "they can eat as much as they want" of sugar-free foods, says Chalmers. "And with diet soda, you can," she explains. "There are zeroes all the way down the label. But when you get into the ice cream, the cookies--they all have carbohydrates."

Chalmers uses Eskimo Pie pops as an example. They say "no sugar added," she explains. But they have "13 grams of carbohydrate. Regular chocolate-covered pops also have 13," so one is no better for you than the other. "Get the one that tastes better to you," Chalmers counsels.

Myth: If you're on insulin, it doesn't matter what you eat because the injections will take care of it.

Fact: "You still have to help the medication work," Chalmers notes. "We call it the triangle: diet, exercise, medication. You can't do one without the other." It's much like taking a cholesterol-lowering drug. That doesn't mean you can eat fried foods every day, she says.

Myth: It's possible to have "a touch of" diabetes that doesn't require much treatment or change in diet.

Fact: You can no more have a touch of diabetes than you can be a little bit pregnant. The concept of "mild diabetes or borderline diabetes or a touch of diabetes--patients get that from their physicians," the American Dietetic Association's Zimmerman says.

"That's a real tragedy," he points out, because "it's easy to treat diabetes effectively if one treats it aggressively from the outset. [But] when patients and physicians persist in not paying attention . . . the complications can be severe."

Diabetes is the country's leading cause of irreversible blindness, foot amputations and advanced kidney disease. People with diabetes are also two to four times more likely than others to get heart disease or suffer a stroke. But often they don't even know they have the disease.

That's why the American Diabetes Association recommends routine screening for diabetes every three years for everyone 45 and older.

Resources

For more information about diabetes, contact the American Diabetes Association in Alexandria at 1-800-342-2383 or the Web at www.diabetes.org.