The statistics are sobering. Almost 11% of the population has diabetes and many don’t know it. An even larger number have prediabetes where blood glucose levels are elevated but not yet in the diabetic range. The most common form of diabetes is type 2 diabetes, a condition where cells become less responsive to the hormone insulin that helps get glucose into cells.
Why be concerned about diabetes? Over time, insulin resistance and elevated blood sugars can damage almost every organ in the human body, including blood vessels, leading to complications like blindness, heart attacks, and kidney failure. Type 2 diabetes is on the rise in Western countries, and so are complications associated with it. In 2017, diabetes was the seventh leading cause of death.
Why is the number of people with this serious health problem going up? The epidemic of high blood sugar is fueled by obesity, poor diet, and lack of exercise. There may also be environmental factors driving the increase, including exposure to hormone-altering chemicals in the environment, but it’s best to focus on controllable factors.
Lifestyle plays a major role in who develops type 2 diabetes. If you have it, lifestyle also affects blood sugar control and the risk of developing complications. No matter how you look at it, blood glucose control matters. More encouraging is the fact that people who develop type 2 diabetes can sometimes reverse the condition through diet and weight loss. The success rate is highest in people who lose weight and change their lifestyle within the first year of developing diabetes.
According to ObesityAction.org, losing only 5 to 10% of your body weight, if you’re overweight, improves how insulin functions and leads to better blood sugar control. If there’s one thing you can do to lower your risk of type 2 diabetes, it’s to stay a healthy body weight.
The Role of Dietary Sugar in Type 2 Diabetes
People, including some experts, often blame the rise in type 2 diabetes on diets high in sugar. Sugar is devoid of nutrients and a source of empty calories, yet the average American eats 17 teaspoons of sugar every day, almost three times the amount that the American Heart Association recommends. Instead, they propose limiting sugar to six teaspoons or fewer daily. Eating sugar isn’t healthy, but is it the underlying driver of type 2 diabetes?
The answer isn’t so clear-cut. The main factor that boosts type 2 diabetes risk and contributes to diabetes-related complications is obesity. People who eat a lot of sugar are more likely to be overweight or obese. Therefore, sugar indirectly contributes to the risk of type 2 diabetes by increasing the odds of becoming obese. However, some research suggests there is a direct link between sugar and type 2 diabetes risk.
A 2013 study found that even when you control for body weight, physical activity, and how many calories a person eats, the incidence of type 2 diabetes is still greater in people who eat more sugar. Other research demonstrates a strong link between drinking sugar-sweetened beverages and a higher risk of type 2 diabetes.
This research doesn’t show that sugar causes type 2 diabetes, but there is a strong association between the two. In fact, the risk of developing type 2 diabetes rises when people drink as little as one sugar-sweetened soft drink per day. Beverages sweetened with artificial sweeteners aren’t much better. Studies show these sweeteners also contribute to insulin resistance.
How Sugar Directly Contributes to Type 2 Diabetes
How might sugar directly increase the risk of type 2 diabetes? Table sugar, also known as sucrose, is half glucose and half fructose. Your body processes fructose in a different way than glucose. Although fructose doesn’t directly cause a rise in blood sugar, it travels to the liver where the liver converts it to fat. Fructose also raises blood triglycerides, a type of fat carried in the bloodstream, and promotes insulin resistance, a risk factor for type 2 diabetes.
Refined Carbohydrates Are Harmful Too
Sugar isn’t the only bad guy that affects insulin sensitivity and raises the risk of type 2 diabetes. Ultra-processed foods and refined carbohydrates, the basis for most of the junk food people eat, are just as harmful as sugar. These foods, like sugar, are high in calories and low in nutrition and increase the risk of obesity. Plus, sugary foods and refined carbs crowd out healthier foods out of your diet.
The Bottom Line
At the very least, there’s an indirect link between sugar and type 2 diabetes. However, there’s also some evidence of a more direct association between munching on sugary foods and refined carbs and type 2 diabetes, due to the way the human body handles fructose in table sugar. However, sugar isn’t the full story. Gaining weight and becoming obese increases the risk of type 2 diabetes, regardless of diet.
The riskiest type of fat is visceral fat, deep belly fat, and fat that builds up around organs like the liver. Lack of exercise combined with weight gain further boosts the odds of gaining body fat, including deep visceral fat. A combination of a diet high in sugar and a lack of exercise magnifies the risk further. Plus, as with most health problems, genetics are a factor too.
Therefore, it’s too simplistic to blame sugar on rising rates of type 2 diabetes or say that eliminating sugar means you’ll never develop it. However, reducing dietary sugar and refined carbs is one of the smartest steps you can take for weight control and better health. Take advantage of it!
References:
- Merck Manual. Eighteenth edition. 2012.
- org. “Diabetes Statistics”
- PLoS One. 2013; 8(2): e57873.
- J Diabetes Investig. 2015 May; 6(3): 360-366.
- org. “Obesity and Type 2 Diabetes”
- J Family Med Prim Care. 2020 Jan; 9(1): 69–71.Published online 2020 Jan 28. doi: 10.4103/jfmpc.jfmpc_329_19
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