Is Sugar Mostly Responsible for Causing Diabetes?

Author: Dr. Macquin Anduwan

Is sugar mostly responsible for causing diabetes? As the heading implies, it is not unusual to find people believing that sugar is the main causative agent in developing diabetes. After all, the elevated blood sugar levels should be an indicator of the role sugar plays in the aetiology of the disease. However, as more research and studies are conducted to understand the process of how diabetes develops, several factors have been found to play an influential role in increasing the risks of an individual developing the disease.

Diabetes is defined as a chronic metabolic condition in which the body’s ability to convert glucose or blood sugar for energy is impaired [1], [2].

There are three main types of diabetes – type 1, type 2, and gestational diabetes. Often when diabetes is talked about, it is referred to as type 2 diabetes, the most common affecting about 90-95% of patients diagnosed [1].

Type 2 diabetes is linked to insulin resistance and pancreatic failure [3]. Often patients with type 2 diabetes present elevated levels of glucose in the blood. Since insulin aids in the storage and use of glucose by cells, a lack of insulin, or resistance to insulin causes elevated levels of glucose circulation which may eventuate in serious health problems [1]. Insulin resistance is simply, the condition in which cells are no longer responding appropriately to circulating insulin [4].

The genesis of insulin resistance is believed to start in the hypothalamus with a disruption of the body’s normal balance of hunger and satiety signals [4]. This increase in hunger leads to an increase in calorie intake. Any excess fat calories, including those converted from carbohydrates in the liver, are stored in adipose tissues. However, these fat cells have a limited capacity to expand. An over-expansion of these fat cells can create inflammation, limiting the capacity of the fat cell thereby creating insulin resistance within the fat cells [4].

The development of inflammation and insulin resistance within adipose tissues causes free fatty acids (FFAs) to leave these storage sites to be circulated by the blood. These FFAs are then taken up by other organs such as the liver and skeletal muscles that are not as efficient in safely storing large amounts of fat [4]. This may eventuate in these cells developing inflammation and insulin resistance, reducing their ability to utilize insulin and efficiently convert circulating glucose into energy [4].

As aforementioned, the high levels of circulating glucose lead many to believe sugar as one of the most important aetiological factors in the development of diabetes. In particular – type 2 diabetes. Yet, the genesis and development of insulin resistance suggest that a high calorie, the high fat diet would be important agents in this condition.

An article written in 2015 on the role of fatty acids had in insulin resistance concluded their findings and stated that the levels of fat in the diet and the compositions of those fatty acids can have a significant role in the development of insulin resistance [4].

Other studies have also looked into the role of red meat and processed meat had on diabetes. Results showed that a greater consumption of unprocessed and processed meat consistently increased the risk of diabetes with processed meat being the highest at about 19% increased risk for 100g/day [5]. On the other hand, a substitution of one serving of nuts, low-fat dairy, and whole grains for one serving of red meat per day was seen to lower type 2 diabetes by 16-35% [5].

Some studies have also looked not on sugar overall but on sodas and sugar-sweetened beverages. This study found that there was a 13% increased risk in developing diabetes [6].

Generally, sugar is not believed to be a direct cause of type 2 diabetes and that there are other more influential factors. That being said, much of the articles to date have shown and suggest that regular consumption or the occasional substitution of meat with a more plant-based diet can reduce the risks of developing diabetes. This is further evidenced by a study done comparing an omnivorous diet with a plant-based diet [7]. After accounting for differences in body weight, physical activity, and other factors, their results showed nearly double the risk of diabetes in the latter compared with a diet omitting animals.

Presently, the aetiology of diabetes is still being studied. In reference to the question asked above – ‘Is sugar mostly responsible for diabetes?’ – the answer may not be as straight forward as this article may imply. Yet what can be ascertained is that there are several influencing factors, much of which relates to our lifestyle choices. Sugar may not be as influential in increasing the risks of type 2 diabetes when compared to a fatty diet or a daily diet of red meat and processed foods, however, it is used to fuel the body and as long as we receive it from healthier sources like fresh fruits and plant-based produce, we may be more confident in being one step closer to leading a healthier lifestyle.

References

[1]

"What is Diabetes?," Centers for Disease Control and Prevention, 11 June 2020. [Online]. Available: https://www.cdc.gov/diabetes/basics/diabetes.html#:~:text=Diabetes%20is%20a%20chronic%20(long,your%20pancreas%20to%20release%20insulin.. [Accessed 17 October 2020].

[2]

O. Ojo, "Dietary Intake and Type 2 Diabetes," Nutirents, vol. 11, no. 9, p. 2177, 2019.

[3]

"Does Sugar Cause Diabetes?," Good Nutrition, 7 August 2017. [Online]. Available: https://www.pcrm.org/news/blog/does-sugar-cause-diabetes. [Accessed 16 October 2020].

[4]

B. Sears and M. Perry, "The role of fatty acids in insulin resistance," Lipids in Health and Disease, vol. 14, p. 121, 2015.

[5]

A. Pan, Q. Sun, A. M. Bernstein, M. B. Schulze, J. E. Manson, W. C. Willet and F. B. Hu, "Red meat consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis," The American Journal of Clinical Nutrition, vol. 94, no. 4, pp. 1088-1096, 2011.

[6]

F. Imamura, L. O'Connor, Z. Ye, J. Mursu, Y. Hayashino, S. N. Bhupathiraju and N. G. Forouhi, "Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction," BMJ, vol. 10, p. 351, 2015.

[7]

S. Tonstad, T. Butler, R. Yan and G. E. Fraser, "Type of vegetarian diet, body weight and prevalence of type 2 diabetes," Diabetes Care, vol. 32, pp. 791-796, 2009.