When considering sugar consumption, diabetes is the most commonly associated disease. Eight years ago, a report confirmed that sugar is a primary driver of type 2 diabetes, validating every historical doctor who preached to lay off the soda and sugary sweets. But in recent years, the topic has become a contested issue. So where is the confusion coming from?
What's the Historical Background?
In a 2015 report published in Mayo Clinic Proceedings, a team of scientists compared the effects of different types of carbohydrates in food. They found that added sugar, primarily in the form of fructose, is significantly more harmful when it comes to diabetes.
Fructose can play a role in boosting fat accumulation in the liver, the researchers said, which leads to inflammation and insulin resistance. According to the National Diabetes Information Clearinghouse, insulin resistance increases the risk that a person will develop type 2 diabetes.
What’s the confusion?
But since the report, naysayers have tried to cast doubt on the direct correlation of sugar and type 2 diabetes. An article published earlier this year admits that there have been varying and inconsistent results from numerous prospective and retrospective studies. But the aggregation of the data shows a clear delineation.
Studies that found no relationship between sugar consumption and the development of type 2 diabetes largely investigated glucose or sucrose intake. The majority of research that shows a positive correlation between sugars and the risk of type 2 diabetes focuses particularly on fructose and sugar-sweetened beverages. The inconclusive studies also tended to have a shorter duration (four weeks to six years follow-up), while the conclusive fructose research tended to have a longer follow-up time (of 10 years or more).
Therefore, the data shows that when considering sugar’s effect on the body and its relationship to type 2 diabetes risk, fructose specifically and sugar-sweetened beverages especially are really what to watch out for.
What about artificial sweeteners?
Though it may seem like a good alternative to reach for a diet soda instead, the switch is not that simple. “Moving to artificial sweeteners is not necessarily the right option either,” says Paul Estabrooks, PhD, co-leader of the Driving Out Diabetes Initiative at University of Utah Health, “because we know that artificial sweeteners have carcinogenic effects."
He goes on to explain how artificial sweeteners can influence your appetite and your cravings, potentially prompting you to consume more sugar than you would have previously. So, drinking something “diet” could just lead you to seek out sugar later, even if you’re not drinking it in the soda, which could affect your overall habits of consumption.
What about sugar in fruit?
Calling out fructose as the primary driver in sugar-related diabetes risk comes with some complication. Some people can be quick to confuse natural fructose with its ugly sugar-sweetened-beverage counterpart. But actually, natural fructose (from fruit) may be associated with a reduced risk for type 2 diabetes. The culprit is specifically high-fructose corn syrup, which is found in soft drinks, candy, and fast-food items.
“When we’re talking about diabetes risk prevention, the sugars that you get from fruits are completely fine,” Estabrooks says. “In fact, you’re getting so many other good nutrients from fruits… that as long as you’re not eating things with added sugar, it’s going to be part of a well-balanced diet.”
What does healthy consumption look like?
The American Heart Association says that you should have no more than about six teaspoons of sugar per day for women (25 grams or 100 calories) and nine teaspoons or fewer for men (36 grams or 150 calories). But Estabrooks argues that hyper-focusing on your sugar intake may not be the best way to make positive changes in your diet.
“From a recommendation standpoint, sometimes just focusing on sugar… is a little bit tedious and difficult for people to do,” he says. So instead of focusing on what you can’t have, focus on seeking out the well-balanced foods that will improve your health. “Half of your food should be fruits and vegetables, a quarter of your food should be grains, primarily whole grains, and about a quarter of your food should be lean protein.”
When it comes to beverages, it's best to phase sugary sodas out of your life. If plain water doesn’t satisfy you, flavor it with lemon, cucumber, or other fruits. Remember, fructose (from fruit) is your friend. High-fructose corn syrup is a bully that puts you at risk.