Sugar Sweetened Beverages – Hormonal Obesity XXX

The epidemiological evidence linking sugar consumption and diabetes as well as obesity is overwhelming.  Very little controversy surrounds this fact.  Another demonized food – salt, by contrast is far more controversial.  Many people argue that salt is not as bad as advertised – myself included.  But sugar, alas, has few defenders, only pushers.  This doesn’t mean that sugar consumption necessarily will decrease, only that recognition is finally spreading.decreasing-childhood-obesity1

Sugar consumption in North America seems to have peaked in 2000 under the influence of the Atkins Onslaught.  The Low-Carb movement seems to have refocused our eyes upon dietary carbohydrates, of which the sugars were the most egregious offenders.  With no nutritional redemptive properties, sugar quickly raised the ire of all nutritionists from Low Calorie adherents to Low Carb to Paleo to Raw Food.  Under the previous Low-Fat regime, we ‘took our eyes off the ball’ by allowing sugar consumption to stealthily increase while we were watching the fat in our diets.  Ten years later, we are celebrating the rarest taste of victory in the Battle of the Bulge.Rising consump

But the sugar pushers would not be so easily defeated.  With the knowledge they were fighting a losing battle in much of the first world, they took aim at the Third World to make up profits.  The areas of the world that consumed the least sugar – Asia and Africa were particularly targeted.  As sugar consumption stabilized in much of the world, or even fell, it increased quickly in Asia and Africa.

The result?  A diabetes catastrophe.   A report published in the Journal of the American Medical Association in September 2013, estimates that 11.6% of adults have type 2 diabetes eclipsing even the long time champion – the USA at 11.3%.  22 million new diabetes were added since 2007 – approximately the population of Australia.  Things are even more shocking when you consider that only 1% of Chinese had type 2 diabetes in 1980.  A horrifying 1160% rise within a single generation.  This is despite the fact that the Chinese had an average Body Mass Index of 23.7 (normal weight) compared to 28.7 (overweight) in the USA.  How is this even possible?  Even if China had doubled its 2006 sugar consumption, it would not reach levels seen in North America.  The answer, which we will get to, lies in its relatively high consumption of other carbohydrates.Juice and child obesity

Sugar sweetened beverages, as noted previously deserve much of the blame.  Juice have long been connected to childhood obesity.  Prospective studies such as “Fruit juice intake predicts increased adiposity gain in children from low-income families” show a close correlation between intake of juice and childhood obesity over the 48 month follow up period.  Of note, whole fruit, with its protective fibre component bears no relationship to obesity.SSB NHS

The same relationship holds in adults, where data from the large Nurse’s Health Study shows the damage.  Weight gain was slightly higher among the group with a higher intake of sugar sweetened beverages (SSB).  However, if you analyze the group that changed from drinking little SSB to higher amounts, the amount of weight gain almost doubles.

That group that went from drinking lots of SSB to virtually cutting it out managed to reduce their weigh gain over the years to almost nothing.  Amazing.DM and NHS

The risk of diabetes clearly increases with higher levels of consumption of SSBs.  This is shown clearly in the large Nurse’s Health Study which followed 51, 603 women.

There are many who argue that it is total caloric intake rather than sugar specifically that is the problem.  Since sugar is an ’empty’ calorie, this may make some sense.  Since sugar also contributes to obesity, its specific role in type 2 diabetes was investigated by Dr. Lustig in his paper “The Relationship of Sugar to Population-Level Diabetes Prevalence“.  For every extra 150 kcal/person/day of sugar, the prevalence of diabetes rose by 1.1%.  No other food group showed significant relationship to diabetes.  Diabetes correlates with sugar, not calories.

This, of course, makes perfect sense.  Type 2 Diabetes, at its very core, is a disease that is about excessive sugar storage in the body.  Not blood sugar, mind you, but total body sugar, if you will.  The problem with most treatments for type 2 diabetes is that they only control the blood sugar by forcing it into the body (usually the liver).  These treatments, such as insulin, have been proven to be ineffective at reducing the health complications of diabetes.  In other words, insulin only treats the blood sugars, not the diabetes since it does not remove the sugar from the body.Intermap1

Sugar is a highly refined carbohydrate just like white flour and white rice and potatoes.  Yet the effect on diabetes and obesity is much, much higher than either one.  Why?  How can we fit this into our understanding of Hormonal Obesity?  It turns out that sugar is, in fact, bad in several different ways – only one of which is as a refined carbohydrate.  After all, the INTERMAP study showed that the Asian diet up to the 1990s was extremely high in carbohydrate, but very low in sugar.  Obesity and diabetes were extremely rare.  The main toxicity in sugar lies in the fructose.  This is an area that has received increasing attention in recent years.

Sucrose intake for diabetics, against all logic, was not considered bad for diabetics.  Dr. J. Bantle a prominent endocrinologist proclaimed to the New York Times in a July 7, 1983 article “Study insists Diabetics can have some sugar” that  “The message is that diabetics may eat foods containing ordinary sugar, if they keep the amount of calories at the same constant level”.  The FDA’s review in 1986 stated that “Other than the contribution to dental caries, there is no conclusive evidence on sugars that demonstrates a hazard“.  Yes, they were only worried about cavities.  There seemed to be no concern that eating more sugar would raise blood sugar.  Even today, in 2014 the American Diabetes Association own website states that “experts agree that you can substitute small amounts of sugar for other carbohydrate containing foods into your meal plan”. 

HOT vinegar

In other words, despite the overwhelming evidence that there is something particularly toxic about sugar, the ADA only considers sugar as a refined carbohydrate and no worse than flour or rice.  In fact, sucrose has a lower glycemic index which they think may even make it better than other refined carbohydrates.

Sucrose is composed of equal parts glucose and fructose.  The glucose portion will raise blood sugars and drive the insulin response.  But the fructose will not.  Fructose does not raise blood sugars.  Therefore, it has an extremely low glycemic index.  Furthermore, fructose produces only a mild rise in insulin compared to glucose.  For many years, this led many people to regard fructose as a benign form of sweetener.

Adding to its halo was the fact that the main sugar in fruit is fructose.  An all natural fruit sugar that doesn’t raise blood glucose levels?  Sounds pretty healthy to me. Sounds pretty healthy to the good people of the ADA as well.  A wolf in sheep’s clothing?  You bet your life.  The difference between sugar and rice/flour/potatoes will very literally kill you.  They don’t realize the deadly effect of fructose.

Continue here for The Deadly Effects of Fructose – Hormonal Obesity XXXI

Start here with Calories 1 – How Do We Gain Weight?

See the entire lecture – The Aetiology of Obesity 4/6 – The Fast Solution

11 Responses

  1. I lost the thread about the Chinese a little. They had a low diabetes level and low sugar consumption, diabetes sky-rocketed but sugar consumption did not. I doubt Lustig’s paper corrected for carbohydrates, so I’m left looking for evidence.

    The EU recently allowed health claims for substitution of 30% or more of fructose into products to replace other carbohydrates in order to reduce their glycemic impact.

    • I doubt there is much hard evidence anywhere. The sugar consumption did skyrocket, but from a very low baseline level. Sugar consumption is stable to slightly decreasing in the United States, but rising quickly in Asia and Africa. However, consumption levels are still much lower. The problem is that the Chinese are eating more sugar, and have always eaten more carbohydrates in total (rice, mostly). This appears to be a deadly combination based on their diabetes rates. The substitution of fructose is a recipe for a diabetes disaster. I’ll be expanding on why that is the case in later posts.

  2. Greetings Dr. Fung! I am so enjoying all your postings and videos. Thank you for sharing this knowledge that can literally save lives.

    Diabetes runs in my family, and I suspect I have PCOS (I had symptoms 30 years ago when I was overweight that are basically gone now that I lost weight and have kept it off). So while I don’t have diabetes, and my lifestyle lessens my risk significantly, I still try to do anything I can to avoid the illness. I started IF years ago, and I am thrilled to see science backing it up. 🙂

    I read a posting in another blog pointing to this study that a very sensitive test picks up the protein troponin in low levels in diabetics, showing a damage to the heart that’s unrelated to cholesterol. Certainly, it is n early and small study, but intriguing. After reading all your postings on insulin, I can’t help but wonder if it is not the blood glucose but the high levels of insulin that might be behind the heart damage.

    http://www.medicalnewstoday.com/releases/282417.php

    I look forward to your comment on it, and I hope there are follow up studies on this.

    Thank you again for your altruistic work in helping people live healthier, better, longer lives.

    K2

    • Thanks K2. The article is certainly interesting, but very preliminary. I agree that the high insulin levels might be a culprit, but it is too soon to tell. Of course, there is a simple solution – decrease insulin levels.

  3. I’ve heard, too, that some artificial sweeteners may also trigger an insulin response. Which would be a bombshell considering how many people guzzle diet soda and other artificially sweetened beverages and food, including diabetics and the obese.

  4. Dr. Fung,

    Is liquid Stevia acceptable?

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  7. Clare Clifton

    What about children? How many of each macronutrient should kids have, i.e. Carbs, fat, protein? I’ve been keto’ing since May and absolutely love it, my 10 year old daughter is overweight and I’m trying to incorporate her diet to mimic mine but I also don’t want to miss anything when it comes to her nutrition and what her growing body needs. Any insight would be great! Thanks so much!

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