Sugar In The Diet

The link between sugar and diabetes is largely the same as the link between high levels of carbohydrates, including starches and sugars, and the risk of developing type 2 diabetes, prediabetes or gestational diabetes. Research is clear that the consumption of sugar is not related in any way to the development of type 1 diabetes since this an autoimmune disorder or caused by direct damage to the pancreas.

High total energy levels for foods consumed, also know as a glycemic load, will result in spikes in blood glucose levels. The energy or glycemic load may come from sugars or starches and there is little evidence to show that one is more harmful than the other. Testing does show that glycemic load from refined sugars and natural sugars is faster to enter the blood than in starches, but the overall result is the same with regards to the cells. Instead the total energy intake is more relevant to the spikes in blood sugar that are linked to increasing insulin resistance, obesity and the development of prediabetes and type 2 diabetes.

Sugar Chemistry

Sugar is found in all foods that contain carbohydrates. There are two different forms of sugars found in foods including monosaccharides and disaccharides. The monosaccharides include fructose, galactose and glucose. Fructose is found in fruits, galactose is found in dairy products and sugar beets, and glucose is blood sugar but also exists in dietary carbohydrates. The disaccharides include sucrose, lactose and maltose in which sucrose comes from sugar cane or sugar beets, lactose is from dairy products and maltose is derived from specific grains and cereals, particularly during fermentation.

Sugar is most commonly used to indicate the presence of sucrose, which is found in almost all commercially prepared food products. The other types of monosaccharides and disaccharides are naturally occurring in all other foods, so it is literally impossible to eliminate the consumption of all sugar in the diet. Limiting sugar intake can result in a decrease in weight gain and a corresponding weight loss, but only if total energy intake is also decreased.
Not all types of sugars are equally sweet in taste. Commercial food preparation tends to include the very sweet sugar options, including fructose, which may lead to rapid weight gain even with small increases in consumption. In a study of middle-aged and young women it was found that increasing consumption of fruit punches and soft drinks by one or more sugar sweetened drink per day over a four year period resulted in a higher rate of type 2 diabetes as well as increased weight gain. The change was most noticeable in women that had previously consumed one or fewer of the sweetened drinks per week. 1 Interestingly women that maintained stable consumption patterns showed no increase in either weight gain or development of type 2 diabetes.

Recent large population studies of 310, 819 individuals with 15, 043 diagnosed cases of diabetes at the start of the study linked the consumption of sweetened beverages, including energy drinks, vitamin water, sweetened iced tea and soda to the development of type 2 diabetes . In this study, those individuals that reported drinking more than two of these drinks per day had a 26% greater chance of developing type 2 diabetes, which was also directly related to increased rates of obesity. 2

Sugar Alcohols

Sugar alcohols are sweeteners that are added to many processed and pre-packaged foods to allow the companies to market them as “sugar-free” or “reduced sugar”. Sugar alcohols have approximately half the calories as actual sugar but they do impact on blood glucose levels. The American Diabetes Association recommends that sugar alcohols, in amounts greater than 5 grams in the food item, be divided by two and then subtracted from the total carbohydrate value to estimate carbohydrate intake.

It is important to carefully determine if the sugar free variety of the product you are considering is equal to the sugar containing option. Many of the products that use sugar alcohols to cut sugar have higher levels of fat or other carbohydrates that can lead to carbohydrate miscalculation if the label is not carefully checked.

While sugar alcohols do provide fewer calories than foods with refined or natural sugars there are some additional considerations. Many cause digestive disorders including diarrhea and excessive bloating and gas which can be excessive in people that are sensitive to these products. Common names for sugar alcohols include mannitol, maltitol, isomalt, sorbitol, xylitol and lactitol.

Sugar And Diabetes  

Sugars are not directly linked to the development of type 2 diabetes, but are potentially indicated to an indirect link. In research where groups of people that normally consumed high fructose diets were studied it was found that the rate of obesity and type 2 diabetes was significantly higher than in groups that ate lower fructose diets. This high fructose group was also more at risk for developing cardiorenal disease and higher levels of uric acid, which is also linked to kidney and heart disease development. 2

Counting carbohydrates, which includes both sugars and starches, is seen by the American Diabetes Association as the best option for managing sugar levels in the diet and helping to maintain healthy weight. Sugar does not have to be completely removed from the diet, nor does an occasional dessert or sweet treat. Instead, diabetics need to carefully consider the high sugar option since it will contribute more to the total carbohydrate content for the meal.

People with diabetes may want to consider opting for the use of artificial sweeteners, taking into consideration the possibility of additional fats or carbohydrates from starches found in the item. It is also possible to simply reduce portion size of high sugar foods to ensure that carbohydrate ranges are maintained without the need to completely give up the items you enjoy. Making sweet foods a treat rather than a daily food item is recommended, as is consuming tea, water or unsweetened beverages in lieu of artificially sweetened or sugar sweetened options.4

References

1 Schultze, M. B., Manson, J. E., Ludwig, D., et al. (2004). Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes in Young and Middle-Aged Women. The Journal of the American Medical Association , 927-934.

2 Malik, V. S., Popkin, B. M., Bray, G. A., et al. (2010). Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes. Diabetes Care , 477-483.

3 Johnson, R. J., Segal, M. S., Sautin, Y., et al. (2007). Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. The American Journal of Clinical Nutrition , 899-906.

4 Sugar and Desserts. (n.d.). Retrieved from American Diabetes Association: http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/sweeteners-and-desserts.html

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.