It’s Not the Same Without Sugar

Essay by Marc Gregory Y. Yu Posted online 3:14 AM, November 19, 2017; First published in September 2017

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FIRST PRIZE. Dr. Marc Gregory Yu (right) with fellow contestants at the 2016 International Speaking Competition for Young Endocrinologists. Photo by Marc Gregory Yu 

My family loves to eat. My grandmother enjoys rice with mangoes; my sister cannot live without ice cream; and as for my dad,

you can catch him with a candy stick after dinner (two sticks if my mom’s not looking).

Unfortunately, all that “sweetness” comes at a price. Three generations, seven family members – all of them with Type 2 diabetes. We used to buy my grandmother boxes of sugar-free chocolate chip cookies and tubs of frozen yogurt. Sometimes, however, I would hear her say ever so slightly: “It’s not the same without sugar.”

For Valentines’ Day this year, my diabetic patient told me that her husband gave her a small, heart-shaped cake with three words written on it. I love you? Nah. It’s actually “No Sugar Added.”

She was happy because her husband turned out to be super romantic, and I was happy because her A1C turned out to be super on target. But then she gave a little sigh and said, “You know, doc, it’s not the same without sugar.”

Fellow doctors, colleagues, and friends, everybody who’s had sugar in their coffee this morning: As specialists who deal with diabetes day after day, we often take for granted this tiny, seemingly insignificant privilege that we possess and our patients don’t: our guilt-free, portion-free sugary privilege – without the consequences of having your leg cut off or ending up in a dialysis center for the rest of your life. You may say that hey, we now have all sorts of artificial sweeteners available (and yes, we know, the guidelines recommend them) but in the same way that meals are not complete without this vital condiment, in the same way that glucose is the basic building block of every metabolic process, life is certainly not the same without sugar. 

In the past, patients with diabetes not only endured a life without sugar, they had to endure starvation diets. Starvation diets, can you imagine? As a patient of my attending declared, “Don’t tell me not to eat my cake.

Tell me how to eat my cake.” Lucky for her (and for us), insulin came to the rescue, along with its first cousin metformin, several second-cousins, and now even more third cousins. Decades of painstaking, backbreaking research transformed into simple, practical solutions for patients. 

But sugar is more than just tickling the taste buds. “Sugar” is anything that adds flavor to our field.

It is the art that complements our science, the nephrologists who see our nephropathies, the neurologists who see our neuropathies, the dietitians and nutritionists who counsel our obese patients.

One afternoon, after seeing a particular patient in the clinic, our training officer called my attention. I felt a rush of panic and started to run everything through my mind. Did I make the wrong diagnosis? Had I forgotten to order some labs? Did the pharmacist complain about my handwriting…again?

She had three words for me: “Your patient’s overweight.”

I looked at my patient – a Filipino version of a lightweight sumo wrestler – and realized that in spite of carefully attending to his different problems – diabetes, hypertension, and even erectile dysfunction – I had forgotten to simply take his weight: the last spoonful of sugar that could have otherwise painted a picture of holistic care. Having sugar alone is not enough; you have to use it in the right places. That means looking for the right clinical signs, applying the right evidence to practice, and referring your patients to the right comanaging specialists.

If Taiwan has bubble tea, the Philippines has a native dessert called “halo-halo”, a sinful concoction of shaved ice, milk, and various other ingredients. Perfect for the tropical weather back home, and also perfect for jacking up your blood glucose levels. The result? There are now over 3 million Filipinos with Type 2 diabetes, with the number projected to swell up to 8 million by 2030.

And yet, there are only 300 Filipino endocrinologists who stand at the forefront of this imminent epidemic.

Because of this, I hope to become a piece of “sugar” in return – contributing to scientific advancement and making an impact in the lives of patients and the community.

If my grandmother were still alive today, I would tell her that yes – life is definitely not the same without sugar.

*This speech was delivered and won First Place at the 2016 International Speaking Competition for Young Endocrinologists in Taipei, Taiwan.

Dr. Marc Gregory Y. Yu graduated from the UP College of Medicine and finished his Internal Medicine and Endocrinology trainings at the Philippine General Hospital.

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