A few days ago, a new study on sugar and diabetes risk hit the news and BOY has it been exciting! Mark Bittman ran an op-ed piece titillatingly titled ‘It’s the Sugar, Folks‘ that has been widely circulated among the Real Food, carb-gnostic, and fad diet communities. It sure sounds, based on the press this study has received, that we’ve definitively proven that sugar is the culprit behind diabetes and other ‘diseases of Western Civilization’. Hooray! We have our answer. And a path forward is clear, lets simply eradicate sugar and all our problems will go away!
I’m not going to pick apart the study (you can read it for yourself here). I suspect others will do that better than I could (Alan Aragon, I’m lookin’ at you). And truth be told, this is the kind of study I like. It’s large and mathy. The study authors put a lot of thought into it and controlled for multiple factors that are frequently ignored. I’m willing to accept their conclusions at face value, because I think their conclusions are fair and well supported. What I’m going to do is put those conclusions into perspective so you can decide how to apply them to your life.
First, lets talk about what those conclusions are and what they’re based on. This study examined the statistical correlation between sugar availability (availability, not consumption. Although it stands to reason that consumption is probably reflected by availability) and diabetes prevalence on a population scale. That means that they measured how much sugar was available in a population’s food supply and correlated it with diabetes rates in that population. Lets frame that with something you’re familiar with: the BMI scale. The BMI scale measures the statistical correlation between weight-to-height ratio and mortality risk. Most people know that the BMI scale is actually a very poor indicator of an individual person’s risk because it takes only two data points (out of thousands) into account. On a zoomed out, population scale level, a pattern emerges that as a population’s average BMI increases so does it’s mortality risk, but it’s very difficult to apply that statistical correlation at an individual level because so many other factors come into play in determining an individual’s risk (such as genetics, physical activity, body composition, diet quality, medications, epigenetics, gut microbiota, etc). This study is showing exactly the same kind of zoomed out, statistical correlation.
The main conclusion of the study was that for each 150 calories of sugar availability per person in a population’s food supply, there was an increase of roughly 1% in diabetes prevalence in that population. 150 calories of sugar is about 1 soft drink, so basically, for every soft drink’s worth of sugar per person per day, diabetes risk went up 1%. Remember though, this is at a population level. It’s very difficult to apply this at an individual level because of mitigating factors (like genetics and physical activity and weight and body composition etc), but lets imagine that we can. Lets pretend that we can safely say that for every soft drink you consume a day, your diabetes risk increases by 1% (we can’t say that based on this study, we’re pretending here). Got that? Your diabetes risk increases by 1%.
Lets put that risk into perspective. This study found that low levels of physical activity conferred a 71% increased risk of impaired glucose tolerance (a precursor to diabetes) over high levels of physical activity across ethnicities, cultures and genders. In this study, inactive individuals had more than a 100% increase in prevalence of diabetes over those who got 150 minutes or more of exercise a week. In this study, inactive lean women were at twice (100% more) the risk of diabetes as lean active women, and obese inactive women had 16 times (1600%) the risk of lean active women. This study on almost 6000 men showed that for every 500 calories expended per week on physical activity (that’s like an hour of brisk walking), diabetes risk decreased by 6%. This study suggests that inactivity confers a 30% increased risk of Type 2 diabetes in women. These risk ratios make that 1% increase from sugar look pretty measly, don’t they?
My take on the whole thing? Sugar may be relevant. This study certainly raises some questions that should be further explored in clinical and epidemiological settings. I suspect, though, that sugar only becomes problematic under certain conditions and in certain individuals. That is certainly what my research has led me to believe. If you are metabolically healthy, regularly physically active, eat a nutritious diet and maintain a healthy weight and body composition, you probably don’t need to worry about having some sugar here and there. If you are NOT metabolically healthy, are obese, are sedentary or have a genetic predisposition to diabetes, you should probably be mindful of your sugar consumption (but you should ALSO be mindful of increasing your activity level, losing excess body fat, and optimizing your energy balance, as those things will improve your metabolic function and may ultimately make sugar much less of an issue for you).
Here’s the big problem with the way this study is being interpreted in the media: sugar is not THE problem. Sugar may be (and probably is, under some circumstances) A problem, one of many. But if we’re going to treat sugar as THE problem, and then ‘solve’ that problem by simply eliminating sugar, we’re missing the forest for the trees. Well, for one tree. A bush really. Inactivity is a bigger problem than sugar, and fixating on sugar gives the inactivity a free pass. To improve metabolic health we really need to address all the problems. Don’t get hung up on Sugar As The Bad Guy. You cheat yourself out of vibrant good health, and miss out on some yummy and perfectly appropriate desserts.
As someone who is quite active, healthy weight and eats a relatively good diet overall but who has a pretty big sweet tooth, I’ve often wondered about my likeliness for diabetes. With that said, I was very interested to read this study and I think you are right that the biggest problem is media interpretation (isn’t that so often the case! I find this particularly interesting because one of the authors wrote on his blog the day it came out about this very thing, noting,
“The study was conducted to understand a statistical theory, using a statistical approach. It doesn't say anything about any specific person's diabetes risk or provide any kind of dietary advice. This data cannot distinguish between types of sugars (like high fructose corn syrup versus other types of sugars), nor does it establish more insight into the mechanisms that are at play, which need to be pieced together in laboratory and experimental research studies. This study also can't inform any specific policies like the New York City ban on large soft drinks, since the real-world effects of specific policies weren't evaluated in this experiment.”
If you’d like to read his whole blog post, it’s here: http://epianalysis.wordpress.com/2013/02/27/sugardiabetes/#more-1095
I eat quite a bit more sugar than I’m ‘supposed to’ and my blood sugar always tests in the optimal range. The more I learn about this stuff, the less I worry about sugar and the more emphasis I place on staying active. I’d rather maintain my healthy metabolic function through exercise than have to eat a restrictive diet for the rest of my life!
Thanks for the link, good stuff!
As a type 1 diabetic, diagnosed about ten years ago, my experience matches your thesis. I am constantly monitoring my blood sugar, and I can say with certainty that my insulin sensitivity responds much more quickly to increased activity than it does to changes in my diet. That is, regardless of how I change my macro-nutrient ratio, the amount of insulin I take per gram of carbs remains pretty constant. I increase my activity, however, and suddenly I need way less insulin per carb. Ergo, my body is using fuel more efficiently and I’m at less risk for developing complications or additional health problems.
Thanks for the input, Monica. I’m hearing this story more and more as people find my blog, how closely people’s insulin sensitivity/glucose regulation is tied to their physical activity level.
Hi, how are you? This is not related with diabetes or sugar but I wanted to ask you if you took any birth control pills to regulate your period during your transformartion? I am asking because I have pcos and I am on the pill to regulate my period but I am having a hard time losing weight and I think the pill can be the reason since I exercise 5 times a week and eat pretty healthy at a slight deficit but I cant seem to lose anything, I tried quitting the pills but my period didnt come, do you have any advice pleeeeasee?
See her articles on calories and check out the calorie calculator she recommends. You are probably undereating. I know it sounds crazy but consider that if you eat below what your maintenence calorie needs would be for your healthy weight, your body is going to peoject that out and see it can’t make it at full speed on these rations. So it starts cutting corners and ratcheting down output to a level that is sustainable and since it perceives lean times, it wants to keep the fat it has. Eat at maintenence for your goal weight (and be sure your goal weight is high enough, with fully mineralized bone and lots of muscle figured in). I’m a little shy of 5’5″ and I’m going to be doing some physical work today and I’m needing to eat 3200 calories. The weight should come off slow. A lb every week or two and get slower as you near goal weight. If you find you can’t lose you may be at goal weight and not know it, body recomp can make a big difference in size at the same weight.
We often make excuses for our mistakes. Being in healthy and fit position is our duty and is in our hands. For this we don’t have to depend on the statistics and any doctor’s advice as you can surely get an acknowledgement by yourself only.
Thank you for posting this. I first saw the sugar article, as posted by others, “Sugar is Toxic!” And thought, here we go again…And then I read your post and thought “finally, someone who makes sense.” It seems like every week, we’re being told a new food group is bad for you. We need to listen to our bodies and make healthy choices based on that (and what you can afford – unfortunately, so much of the healthier options in grocery stores are super expensive). What works for one person won’t work for someone else. The media, and others, who focus on the fad of the week and sensationalize this type of study make it difficult to figure out what will work for each person.
While I agree that insulin resistance is more complicated than the article leads us to believe, it should be fairly obvious that high levels of sugar are the most direct dietary cause of diabetes. It seems pretty intuitive to assume that which releases the most insulin is the most likely candidate for insulin resistance. Or am I wrong that simple carbs by far have the most drastic affect on insulin release?
Of course, you’re right to point out that a observational study does not illustrate causation; a poorly done study back in the 50s is why saturated fat has been demonized despite very little (if any) clinical data to support that assertion. This is merely the first step. The next would be a controlled, clinical trial. It might even be interesting to see which is more effective at addressing diabetes — exercise while eating the same diet or a reduction in carbs/sugar while keeping activity level the same. I would imagine the latter would be more effective especially in the real world, but I would assume you would think exercise would be more effective because 100% is greater than 1%, right?
There was a study published not long ago that showed modern hunter-gatherer populations are no more active than Westernized populations. These are populations which eat their traditional diet (ie; even those which aren’t primarily meat contain almost no sugar) and have little to no incidence of the diseases of civilization. This seems to implicate that diet, even if each gram of sugar counts less than each hour of workout, is more important for the well being of humans in their most “natural” state than physical activity is. Again, this does not really give us causation either, but if traditional societies were no more active than westernized societies, what is there that leads to diabetes? Again, sugar seems the most guilty change between traditional and western societies in terms of what could lead to diabetes.
Yes, when you compare per workout (which may take up to an hour or more) and per 150 calories of sugar (which would take me about 30 seconds) consumed, exercise most definitely is more effective. But anyone who has diabetes, are they only drinking one 12oz can of soda per day? I know when I was in my “prime” of being fat I was drinking nearly 64oz of the stuff per day, not even including all the carby stuff I ate. That means I should have definitely had diabetes by the year’s end. I probably had the favorable end of that genetic spectrum; nobody in my family has had diabetes that I’m aware of.. unless you count my grandmother who died of Alzheimers. You talk as if those who succumb to sugar’s temptation are only a small subsection of those who suffer from diabetes. You talk as if it’s easier to be active than give up sugar. This doesn’t compute in my mind. Being active should be the ends in itself, as you seemed to realize back when you decided to “ditch” the fad diets and do something you enjoy. The fact remains that the additive (and addictive) nature of sugar to insulin resistance means that 1% quickly escalates to much more than that with the amount of sodas the average American consumes today. Not only that, what is added to food that naturally has fat in it to make those great “low fat” frankenfoods actually taste good? Yep, sugar.
To reiterate your point about activity, the fact I have been at least slightly active because I’ve been working retail the majority of my adult life and have been walking to work for the last two and a half years is likely a large part of why I’ve minimized the effects of the terrible food I used to put in my body. I’ve never been active in an exercise sense except for a 6 month stint where I got interested in running. While I’ve never gotten properly tested (no insurance for most of my adult my life, yay America) for it, I have little doubt that I would have gotten diagnosed with pretty heavy insulin resistance. I’ve found that my well being is pretty much inversely proportional to the amount of dietary carbs I have. You may call it a “fad diet,” but I’ve been eating all meat (and all red meat) for the last three months and I don’t think I’ve ever felt better. I might be part of that minority of people who are so slothy that I can’t eat carbs and be healthy, but it seems a little counterproductive to be active JUST so you can eat sugar or even carbs in general.
I don’t really understand the defense of sugar. It may be true those who are active are MUCH less prone to the deleterious effects of it, but that doesn’t minimize the harmful effects of sugar on someone who is predisposed to insulin resistance. I should assume as much because my dad is a VERY active marathoner (ran 8 marathons in the last 6 months) and until I got him interested in VLC as a potential way to increase his endurance, he ate and drank basically whatever he wanted and is still lean.
It’s not that I disagree with your assertion that activity, if performed consistently, can be a powerful tool for health, but someone who has no physiological impulse to be active is very unlikely to do so at the behest of their doctor, especially if they’re still indulging in the very food which made them insulin resistant in the first place. Someone with insulin resistance doesn’t want to be active because their cells cannot access the glucose. Obesity/diabetes is a physiological problem, not a psychological one. For these people, it not only “may” be relevant, it seems irresponsible to disregard getting rid of something that has no nutritional value in most cases, and is, because of insulin resistance, utterly useless in a diabetic’s case. Framing their disease as a psychological disorder — that they simply won’t exercise enough to warrant their consumption of sugar seems counterproductive to me.
In the end, this is a vegetarian/vegan perspective on a sensationalized article (I agree on that point), not on the actual study.
I wasn’t defending sugar kagayaki, I was putting it’s dangers in perspective.
I think you have read a great many things into my post that aren’t really there.
She didn’t say exersize is easier, rather she said it was far more important.
I avoid processed sugars as much as possible, and stick to getting my sugars from fruits and whole foods. If I aim for about 2200 cals a day, how many grams of sugar would you suggest I consume? Is 33 grams too low?
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