Monday, October 07, 2013

Sugar And Diabetes, Part II

Here are 5 metabolic studies comparing sugar to starch in people with diabetes. None of them found a difference between the two in any diabetic parameter - fasting glucose, insulin, glucose tolerance, even body weight.  There is not a lot of evidence that, as many people persist in saying, sugar causes diabetes.

Sucrose Taken During Mixed Meal Has No Additional Hyperglycaemic Action Over Isocaloric Amounts Of Starch In Well-controlled Diabetics, Lancet, 1984

Two groups of patients received mixed meals. One group received 20 grams (about 5 teaspoons) of sugar in place of starch.
"The meals contained equal amounts of calories and of carbohydrate. There was no difference between the meals in plasma glucose curves and plasma insulin or insulin infusion rate variations whether in peak values, peaking times, or areas under the curves, in either group of patients."
Sucrose Or Honey At Breakfast Have No Additional Acute Hyperglycaemic Effect Over An Isoglucidic Amount Of Bread In Type 2 Diabetic Patients, Diabetologia, 1985

A crossover design tested three types of mixed breakfasts, including either white bread, honey, or sucrose (same amounts of carbohydrate).
"Mean plasma glucose and insulin levels were comparable on the three occasions. ... We conclude that, in acute conditions, simple sugars have no additional hyperglycaemic effect over an isoglucidic amount of bread in well and in badly controlled Type 2 diabetic patients, even at breakfast."
Sucrose In The Diet Of Diabetic Patients - Just Another Carbohydrate?, Diabetologia, 1986

Two diets, each lasting 6 weeks, were compared in a cross-over design. In one diet, 45 g of complex carbohydrate was replaced by 45 g of sucrose.
"There were no significant biochemical differences* between the two diets in either Type 1 or Type 2 patients.

We conclude that a moderate amount of sucrose taken daily at mealtimes does not cause deterioration in metabolic control in diabetic patients following a high fibre/low fat diet."

* No differences in ... fasting plasma glucose, glycosylated hemoglobin, mean daily plasma glucose and diurnal glucose profile, cholesterol (total and in lipoprotein fractions), triglyceride profile, plasma insulin. There were also no changes in medication or body weight.
Metabolic Effects Of Dietary Sucrose In Type II Diabetic Subjects, Diabetes Care, 1993

Two groups of patients consumed a 55% carb diet for 28 days. One group received 19% of energy as sucrose, the other less than 3% (remainder starch).
"No significant differences were noted between the study diets at any time point in mean plasma glucose. ... Also, no significant differences were observed between the study diets in urine glucose; fasting serum total, HDL, or LDL cholesterol; fasting serum [triglycerides]; or peak postprandial serum [triglycerides].

Conclusions — A high sucrose diet did not adversely affect glycemia or lipemia in type II diabetic subjects."
Metabolic Effects Of Dietary Sucrose And Fructose In Type II Diabetic Subjects, Diabetes Care, 1996

Three isocaloric diets were studied in a group of well-controlled diabetics for 18 weeks. One diet provided 20% of calories from fructose, one 19% from sucrose, one only 5% from any sugar. This was a crossover design, so all subjects consumed each diet.

"No significant differences were observed between either the fructose or the sucrose diet and the control polysaccharide diet in any of the measures of glycemic control, serum lipid levels, or insulin and C-peptide secretion."

Here are 3 more quotes from that last study:
"After decades of instructing diabetic patients to avoid carbohydrate in all forms, associations of diabetes all over the world have been advocating a high carbohydrate diet.

All of the literature agrees that sucrose per se does not adversely affect diabetes control and that individuals with diabetes may be allowed to include it in their meals without deleterious effects. Indeed the present recommendations of the American Diabetes Association state that "restriction of sucrose in the diabetic diet because of concern about adverse effects on glycemia can no longer be justified."

Many studies are now showing the inverse relationship between sugar and fat in normal and diabetic diets. In practice, low-sugar diets are generally higher in fat and vice-versa, and a low-sugar, high-fat diet may be more dangerous than the reverse."
Time and again, studies show that increasing the amount of sugar one eats neither increases the risk for diabetes nor worsens the metabolic condition of those already diagnosed. It's notable, though, that increasing the amount of red meat and processed meat has been found to increase the risk for diabetes, here too.

If it's not the sugar raising the risk for diabetes, what is it? As I've been saying for years ... the standard American diet presents a one-two punch. Its high fat increases insulin resistance, and its highly-refined carbs dump glucose quickly and abundantly into a blood stream that can't clear it.

An alternative to a high-fat, highly-refined carb diet is a low-fat, whole food, plant-based (WFPB) diet. That would include minimally processed carbs the likes of ... squashes, pumpkins, broccoli, carrots, yams, peaches, apples, zucchini, corn, watermelon, potatoes, peas, green beans, oats, lentils, cantaloupe, rice, kale, onions, tomatoes, peppers, spinach, bananas, cucumbers, blueberries, quinoa, cabbage, turnips, oranges, beets, kidney beans, cauliflower, cherries, garbanzos, mangoes, etc.

Sugar And Diabetes
Study: People Who Eat More Sugar Weigh Less
Is Sugar All That Bad?
I found these graphics from a great site called South Asian Generation Next: Diabetes Myths Busted. Why is it that the most sensible health advice is found outside of the US?

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