As if we need another reason to stay away from sugar, an
interesting one was recently provided by a team from California that includes
Robert Lustig, a professor of clinical pediatrics at the University of
California, San Francisco. Because this
study concerns sugar and diabetes, it has an important message for cancer
patients: type 2 diabetes is one of the major risk factors for getting cancer.
In addition, we know that the nutritional processes involved in diabetes have
implications for cancer patients.
Lustig and his colleagues assessed the relationship between sugar availability, obesity, economic development and diabetes prevalence in 175 countries around the world between 2000 and 2010; they also included data on several other food types, as well as variables like aging and urbanization. Rather than using data on individual patients, like clinical trials, they used data that applied to entire countries. For instance, the Food and Agriculture Organization has data on availability of sugar (including all types, sucrose, fructose and others), as well as things like fruit, meat or calories eaten per day. Other country-level data that the authors used included: how much of the population was obese or overweight, gross domestic product (a measure of overall economic development), and percentage of elderly people in the country. All these variables have previously been correlated to diabetes.
The study combined all the variables in a statistical model that allowed them to determine how much each of them contributed to diabetes prevalence in a country, which they obtained from the International Diabetes Federation. They checked on the data in several ways to make sure their results made sense. Here is some of what they found:
- Worldwide prevalence of diabetes increased by 27% from 2000 to 2010. That’s a frightening statistic if ever there was one!
- Sugar availability on its own accounted for a quarter of this increase. If a country experienced an increase of 150 calories per person per day in sugar availability (that’s the amount of sugar in a single can of soda!), its rate of people with diabetes increased by 1.1%. This was much more than any other food contributed to diabetes, and more than even total caloric consumption, which increased diabetes by only 0.1% with an increase of 150 calories per day per person of total food consumed.
- The other major contributors to increasing diabetes prevalence were obesity and gross domestic product.
We know that obesity is related to diabetes, especially type 2 diabetes (this study does not distinguish type 1 from type 2 diabetes, but type 1 makes up only 10% of all diabetes). Gross domestic product is rather interesting: it’s a complex variable that impacts everything from the prevalence of desk jobs to dietary changes to stress. Every increase of 1% in gross domestic product resulted in a 1.07% increase in diabetes prevalence.
Some other interesting findings from the study confirm these major trends:
- In some countries, such as the Philippines, Sri Lanka and Bangladesh, diabetes rose rapidly but obesity did not. In these countries, it turned out, sugar availability rose by at least 20% in the 10 years surveyed in the study.
- The longer a country was exposed to high sugar availability (over 300 calories worth of sugar per person per day), the more its diabetes prevalence increased.
- If a country’s sugar availability decreased (usually due to changes in trade agreements) its diabetes prevalence decreased significantly.
The authors point out that changing the details in the variables used (for instance, adding alcohol or physical inactivity or smoking), did not change the sugar relationship to diabetes, and these variables did not make a statistically significant difference in diabetes prevalence.
So what can we conclude from this study?
Mainly, we see that sugar consumption contributes much more to diabetes prevalence than we had thought. However, sugar consumption is not the only dietary concern when it comes to diabetes prevention – fiber intake, the consumption of healthy fats, and total caloric intake also play a role. (In addition, it should be noted that regular exercise can also help in the prevention of diabetes.) But if we were to select a single food to target for population-wide reduction or elimination, sugar looks like the one to go after!
If you are a cancer patient, it’s important to know that type 2 diabetes, and even pre-diabetes, can result in high insulin levels in your blood as well as high blood sugar levels. And elevated levels of insulin in the blood have been found to increase the risk of several cancers.
We know it isn’t easy to break long-standing dietary habits, but hopefully understanding the link between sugar and diabetes will help inspire you in your efforts to eliminate unhealthful sugars from your diet!
Reference: Basu et al. PLOS One. 2013; 8(2) e57873.
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