Surprise: More Sugar, More Diabetes

February 28 2013 by in Diabetes, Dr. Robert Lustig, Sugar/fructose

Can sugar cause diabetes? Has the increase in sugar consumption caused the worldwide epidemic of type 2 diabetes? Ask the sugar industry and the answer is a definite NO. Ask a random scientist in the field and the answer is likely to be “probably”, “possibly”, or “maybe”.

Ask dr Robert Lustig and the answer is emphatically yes. And I think he’s absolutely right.

A new study adds more support. Looking at the available sugar during the last decade in 175 countries the relationship is clear: The more sugar available, the more diabetes. Less sugar, less diabetes.

One extra can of soda per day corresponds to an extra 1.1 percent prevalence of diabetes. If correct this would mean a single extra can of soda per day would cause 3,500,000 more people to suffer from diabetes – just in the US. A relationship that rivals the disease-causing effects of smoking.

This relationship is clear even when correcting for other possible causes like obesity. In other words: Here’s more support for the theory that excess sugar does not just make you fat. Sugar can probably make you sick even before you get fat.

To be fair, this study is just about statistical correlations: it does not prove causality. But it’s another smoking gun for the sugar industry to try to explain away.

The evidence of harmful effects of extra sugar in our diets is piling up. And there’s no need to consume it, there’s nothing nutritionally necessary about pure sugar in excessive amounts. Let’s just get rid of our sugar addiction and stop this disaster.

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21 comments

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Reply to comment #6 by Renaud
Dr. Andreas Eenfeldt, MD
February 28 2013 4
I'm sorry if my scientic worldview is not black-and-white enough for you. I do believe that a study can be meaningful and interesting even if it does not supply proof of causation. We simply need to always keep the limitations in mind.

Obviously RCTs with hard endpoints are much preferable whenever they are available. Unfortunately they're hugely expensive and take a long time to do. When it comes to low-sugar diets and diabetes prevention we're still waiting for them. Although when it comes to treating diabetes typ 2 with low carb we already have a few RCTs showing drastic improvements in weight and health factors like blood sugar.

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1
Tytti
February 28 2013
Most likely more obesity and type 2.

But do You think sugar is the cause of type-1 too?

Type-1's need sometimes desperately sugar to treat hypoglykemia.

I think the diffrent types need to to be made clear.

Type-1's are usually very thin when diagnosed, because they don't have insulin which is the key for sugar to enter cells. All sugar runs out.

Reply: #9
2
LDL-Richard
February 28 2013
Here's Pritikin's landmark article "High-carbohydrate diets maligned and misunderstood" from 1978. Inter alia, Pritikin refers to studies which have tested what happens when diabetics are put to 80% sucrose, pure table sugar diets. Their condition is improved, atleast jugged by oral glucose test. Obviously no one is recommending pure sugar to diabetics, but these feeding experiments enhance our understanding on the mechanisms of diabetes. When diabetics are fed complex carbohydrates (80% of calories) their condition improves on every measurable parameter.

http://www.drmcdougall.com/misc/2013nl/feb/pritikinpdf3.pdf
3
Renaud
February 28 2013
So your mantra "association does not mean causation" is only valid for refutation of studies you dislike, but dont apply to those going your way ?

Replies: #4, #10
4
Reply to comment #3 by Renaud
Dr. Andreas Eenfeldt, MD
February 28 2013 2
Of course not. I never claimed this study proves causation, it just adds support to earlier studies. I even specifically point out that it does not prove causation. Please read the entire post.
5
Paul C
February 28 2013 1
erm LDL-Richard... when I eat complex carbohydrates in such quantities (80% of calories), my blood glucose level rockets wildly over the safe limits for diabetics...

T2 controlled by diet & exercise only... a LCHF diet...

All I can tolerate in any one meal is at most 20 grams of carbs... any carbs.
6
Renaud
February 28 2013
I did Doc, and just saw a casual mention of the thing, but the overall tone is that this study is meaningfull and important. When there is some study at odd with your beliefs, ADNMC become a major argument to shred it to pieces.

Basicaly, you put the label "smoking kills" on your pack, but sell it nonetheless.

I'm not against everything paleo, far from it, but reading overly biased interpretation of studies is hard on my nerves : for anyone with a functioning mind and minimal slice of obectivity it could cause throwing out the baby with the bath water. And there are some babies worth keeping in the paleo world.

Reply: #7
7
Reply to comment #6 by Renaud
Dr. Andreas Eenfeldt, MD
February 28 2013 4
I'm sorry if my scientic worldview is not black-and-white enough for you. I do believe that a study can be meaningful and interesting even if it does not supply proof of causation. We simply need to always keep the limitations in mind.

Obviously RCTs with hard endpoints are much preferable whenever they are available. Unfortunately they're hugely expensive and take a long time to do. When it comes to low-sugar diets and diabetes prevention we're still waiting for them. Although when it comes to treating diabetes typ 2 with low carb we already have a few RCTs showing drastic improvements in weight and health factors like blood sugar.
8
Dana
February 28 2013 1
Yes, I think obesity is a symptom of whatever underlying condition eventually makes you diabetic or causes you to have a heart attack. It's a symptom, not a cause, and you can get type 2 diabetes or that heart attack without ever becoming obese. And there are many people who do.

Richard, oral glucose tolerance test is not a good measure of diabetes. Most of us don't go around eating pure sugar all the time, for starters, and the important thing with diabetes is blood sugar control with normal food. So that's the hemoglobin A1C (check for anemia first, it skews the results) and the regular postprandial sugar an hour after the meal. OGTT will give a false positive for diabetes if you have a certain level of insulin resistance or if you are just plain not used to handling that much sugar. Those diabetics got better OGTT scores because sugar was most of what they were eating. Bet their eyes and kidneys were glycating, too.

and Tytti? Type 1 diabetes not only prevents sugar from getting into cells but also prevents fat being stored (which is important--you wouldn't have energy between meals if you could not store fat at all, and all people store it temporarily, even the slender) and prevents amino acids from getting into the lean tissues. Type 1s at diagnosis are not only slender, they are wasting away.

Usually the type 1 condition is an autoimmune disease, though technically any time the pancreas stops working it's pretty much a type 1 situation, since the diabetes wasn't caused by insulin resistance, as in type 2s.

But eating sugar just to eat sugar doesn't *help* type 1s. If they're hypoglycemic it's one thing, but they're not always hypoglycemic.

You can low-carb as a type 1 and do pretty well most of the time. You'd still need insulin shots though, for those other purposes I mentioned. You just wouldn't need as many. Low-carb was how they treated type 1 before insulin was discovered.
9
Reply to comment #1 by Tytti
FrankG
February 28 2013
The common scenario is that Type 2 Diabetics are obese (around 80% of us) at the time of diagnosis but as Dana points out: it makes more sense to see this as a pair of symptoms due to the same underlying metabolic disorder/dysfunction, than to apply the all too common assumption of obesity causing Type 2. Not all diagnosed with Type are obese at the time of diagnosis nor are all obese Type 2.

Remember that a type 2 did not suddenly develop the disorder overnight, it was probably creeping up over many months, years or possibly decades.

For Type 1 the story is still unclear: as Dana mentions it is generally considered to be an autoimmune response but they are still far from having the full picture. There is an alarming increase in the incidence of Type 1 that parallels the rise in Type 2 and for my common sense it stands to reason that if a diet high in sugar and refined starches stresses the pancreas (from where the insulin is secreted) then any autoimmune assault on the pancreas would find it already vulnerable.

There is overlap between Type 1 and Type 2 (also MODY, LADA, or Type 1.5) in that some with Type 2 have the same antibodies as those diagnosed with Type 1 (showing an autoimmune response) and at the time of diagnosis a Type 2 may have already lost upwards of 50-80% of their insulin secretion capability.

---

As for Pritikin's "landmark" article... in whose opinion! Hah :-)

Speaking as someone WITH Type 2 and not having just read a "landmark" article, I know EXACTLY what a diet of 80% complex carbohydrates would do to my Blood Glucose, my health and my prospects for a long an healthy life. Veggietrollians like you would literally be the death of me!
10
Reply to comment #3 by Renaud
PatrickP
February 28 2013 1
"To be fair, this study is just about statistical correlations: it does not prove causality. But it’s another smoking gun for the sugar industry to try to explain away."
11
yuma
February 28 2013
Although there is no direct correlation, yet, the pattern is clear that as humanity increases sugar consumption, humanity develops many more ailments.

Notice currently existing hunter-gatherer societies (i.e. Kitavans) do not consume these gargantuan amounts of sugar and do not have these modern life ailments.
12
paulc
March 1 2013
and when hunter-gatherer societies start eating a "modern" Western style diet, they do start showing all the ailments of "modern life"...
13
Insulin?
March 1 2013
http://www.youtube.com/watch?v=JTRIWxIq6fE
It's not insulin, stupid.
14
eleventeen
March 2 2013
Tytti, I'm pretty sure that many became type 1 because of a diet. I suppose body tries to get rid of enormous ammount of insulin by killing beta cells instead of developing insulin resistance. Here's an example of a type 1/LADA cured with a diet: http://www.meandmydiabetes.com/?taxonomy=series&term=my-2-hour-g... . My own story - year before diagnosis sugars were normal. Disease developped pretty fast. After switching to ketogenic diet disease progression magically stopped.
15
Tytti
March 2 2013
I am a mother of a 14 year old who got his type-1 diagnosis at age of 10. And yes low carb helps a lot in managing the daily balance and even lenghtens the honeymoon period. He is a very fit karateka.

Because Finns have the most type-1 in the world, I have wondered what is the cause here?And what happens to Finns abroad (many have moved to USA in the end of 1900th century and to Sweden in the 70s). Or do immigrants get type-1 here? I know Somalis get type-2 for sure (stress and food?).

Finnish food has traditionally contained a lot of potato and bread and babies start solid foods with loose porridge. It was only late 90s when pickling of seeds with mercury was banned for good. We are recommended to use canola because it is produced here (and sprayed with neonicotinoids). Cows milk has been studied as one possible reason.

Kids get quite a load of vaccinations.
We have ticks too and borrelia could be one reason to cause pancreas damage. He has recovered of a facial palsy, borrelia was a possible cause.
16
Tytti
March 2 2013
In type-1 sugar at least speeds up the inflammation/autoimmune reaction whatever the original cause.

Glucose is tightly bound with C-vitamin intake to cells and when imbalance there: increased inflammation and problems in clotting.
17
LDL-Richard
February 28 2013
Pritikin's landmark article "High-carbohydrate diets maligned and misunderstood" from 1978. Inter alia, Pritikin refers to studies which have tested what happens when diabetics are put to 80% sucrose, pure table sugar diets. Their condition is improved, atleast jugged by oral glucose test. Obviously no one is recommending pure sugar to diabetics, but these feeding experiments enhance our understanding on the mechanisms of diabetes. When diabetics arefed complex carbohydrates (80% of calories) their condition improves on every measurable parameter.

http://www.drmcdougall.com/misc/2013nl/feb/pritikinpdf3.pdf

Reply: #19
18
paulc
March 3 2013 2
LDL-Richard... you're off your rocker... There's no way that feeding me complex carbs works... my glucose numbers are outside the NICE guidelines when I try to eat complex carbs,... Pritikin does NOT work... full stop.
19
Reply to comment #17 by LDL-Richard
FrankG
March 4 2013
Have you any idea how many diabetics have lived shorter lives and died painful deaths with amputations, blindness and/or kidney failure based on the kind of advice you are peddling!

Take you veggietrollian dogma elsewhere jackass, I'm done being polite with you!
20
Kari
March 4 2013 2
I'm a type 2 diabetic who has "cured" herself with a lchf diet. Well, that and intermittent fasting. When I was diagnosed, my blood sugar was well over 300. I think the doctor said 360. But anyway, now, completely off medicine (metformin), my A1c is 4.6.

I have tried eating a whole grain diet. I thought, hey, everybody's always saying they're so healthy, they must be. Then, I read the nutrition information for myself, and saw that they were nothing more than extremely high carb with very little fiber. It's sad when something with 50 grams of carbs or more per serving only has 5 grams of fiber.

So, while I'm certainly not willing to start eating an 80% carbohydrate diet, just to see, I can tell you that even when I eat products that supposedly don't count, i.e. pure fiber like flax seeds, it spikes my blood sugar. Gets into the blood stream slower? Not with me, sorry. Just like I had to learn, in the early days, that sugar alcohols still counted as carbs, so too I've now had to learn that fiber still counts, as well.

In the end, anybody can eat whatever they want. You can live on processed foods, vegetables and fruit, meat, whatever. But you have to accept the consequences of your actions. If diabetes kills - and it does! - then I'm willing to do whatever it takes to stop it. If that means learning to live on an "extreme" diet, so be it. To those of you who think you can control your blood sugar with whole grain rice and whole grain corn, good luck to you. You've probably been told that's the best you can do, gain some small improvements in your numbers and take your medicine. If you choose to believe that, because it is convenient to believe that and keep eating potatoes, then that is your choice.

As for me, thank God I found out about low carb high fat diets.
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23
Susanne
February 2 2017
Kari, that is how I feel and think, I love your reply, I am only new at this, this is my third try, i am sure I will stick to the LCHF diet this time with all the wonderful information and reassurance of this site.

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