Food Politics

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One of the saner responses. Much better than “OMG! Sugar is toxic!”

Agree that we all need to eat much less sugar. But I don’t think this means we should all run out and start chowing down on blocks of butter, either.

Part of the problem is the “hidden” sugar – in foods that you do not even realize it is in such as baked beans and ketchup. We need to pay much more attention to what we are eating!

The lead author clarified a little why they went the fancy statistical route in their study:

“In the ideal scientific world, we would take two groups of people and give them very carefully calculated diets, in which one diet had higher sugars but otherwise identical total calories, and the other diet had low sugars and otherwise identical total calories. We would have the two groups exercise the same amount and maintain the same weights, then see if the high-sugar group got diabetes more or less than the low-sugar group.

Of course, such a study would not be very ethical. Hence, we had to do some fancier statistics with the data we have available…”

But if the prevailing notion is that a calorie is a calorie in the human body, and this is actually corroborated by some evidence, I’m not clear why something like this proposed study would be unethical.

The real problem is practical. In order for you to get decent data, you need people to not only closely follow the diet you’ve assigned them, but to accurately calculate exactly how much sugar and calories go into their mouths, so that you know they’ve followed the diet. Long term diet studies routinely run into this problem.

Which means the ethical issue comes up because the only way you can keep people on the diet you want to study is if you can control everything they eat, meaning institutions like prisons and orphanages, where finding genuine volunteers is tough.

Thank you for such a sensible conclusion. Studies like the one you referenced only adds to people’s anxiety about eating and their black and white approach to food, vilifying categories of foods, restricting them and ultimately overeating them.

Lori Lieberman, RD, MPH, CDE, LDN
food-2-eat.com

We continue to hear how bad sugar is for us. There are plenty of reasons to avoid sugar and eat natural healthy whole foods.

SAO – It seems like any diet proposed, even the generic “eat less calories, burn more calories” approach, would run into similar design, adherence, and long-term ethical issues in trying to demonstrate its degree of effectiveness or lack thereof.

I wonder what kind of studies or evidence could be used to fully validate whether a calorie is a calorie in the context of developing type 2 diabetes.

Thanks for both parts 1 and 2, esp about the IOM and RDA/DRI. Since obese nations tend to consume LOTS of fructose we need to look at how our body uses this sugar. What we do know from biochemistry is that fructose is not regulated the way other sugars are through the small intestine. Fructose works more on a pressure gradient, so it will move from an area of high concentration to an area of low concentration. When we ingest fructose (in all its forms), we get a high concentration in the lumen of the gut which will be absorbed until there is more inside the body than in the gut. Other sugars (some of which must be broken down first) are transported through a ‘gate.’ The only fructose that is really good for us is that in the form of fruits and vegetables.
And on another note, something that frustrates me about the RDA is that those are set to prevent deficiency. The IOM presents the DRI and AI (adequate intake) to recommend levels that healthy people consume. Maybe we need to look to studies to see how much nutrients one should consume to promote long-term health and prevent disease. Instead of looking at what ‘healthy’ people consume. Given that most people die of heart disease, cancer and stroke, our dietary recommendations are definitely not preventing disease.

When they did this study did the specify what form of sugar they were using for example granulated, high fructose corn syrup etc?? This is a really interesting study.

What about the studies that show if you test people for POPs and categorize them as high and low levels that the relationship between sugar and diabetes and obesity disappears. This can be tested for by doing a serum GTT. Those with low GTT don’t have the same problems that those with high GTTs do.

Don’t get me wrong–I am not pro-sugar and don’t think we should consume it anywhere at the level we do. I think it is a more complicated problem.

GAW

Not sure if you have caught up with this from David Katz – very rational discussion of the study: http://www.linkedin.com/today/post/article/20130302143554-23027997-sweet-nothings-bitter-truth

Have there been any studies done looking at the response to sucrose at an epigenetic level? I was interested to see the diabetes prevalence in Figure 1 was for countries. I’m from New Zealand (37% obesity; 5% diabetes). Our population has significant ethnic diversity with major groupings of Europeans, Polynesians and Asians. We know those three groups alone have different BMI criteria for obesity – given that frank difference at a macro level, it would be fascinating to know what’s happening at the cellular level.

Thank you for this post on the PLOS study. When looking at the Academy of Nutrition and Dietetics position statement on nutritive and non-nutritive sweeteners there just isn’t evidence from human studies to support a connection between consumer consumption patterns and sugar. As a dietitian in private practice I have to tell people on a daily basis that simply eating sugar did not cause their diabetes to develop. Articles published in a paper like the Times makes it look like I am wrong. As you know, dietary intake is collected in so many different ways-food frequency vs 24 hr recalls. It will be interesting to see future human studies that look at metabolic hormal responses to nutritive as well as non-nutritive sweeteners and to see if intake is linked to mechanisms that promote chronic diseases. But for now I just don’t think we have the evidence.

Addressing Diabetes Control: What Clinicians Must Know
http://www.todayswoundclinic.com/addressing-diabetes-control-what-clinicians-must-know

The Academy of Nutrition and Dietetics position on sugar frustrates me terribly, and there is no transparency that the organization promotes the USDA with their “My Plate” guidelines, which were developed as one of the marketing arms for commodities agriculture. Even the position that sugar is neutral in moderation for Diabetics is a lie. A harmful lie. Consumption of sugars, “natural” or otherwise makes it far more difficult to manage (spiking) blood glucose, and requires more medication to offset consumption. Managing blood glucose is far more effective and safer when the goal is to minimize spikes or decreases. Sugar counteracts these efforts. I am furious as a T2D that I couldn’t obtain this information from a CSE or R.D. YEARS ago. Thank goodness for the diabetes communities to be found on the web and social media.

And while I’m at it, AND’s position on consumption of starches and grains is dishonest and harmful as well to Diabetics.

The study does show some correlations, but I know plenty of people who eat tons of sugar and are not diabetic. Option A – calories/obesity/diabetes makes the most logical sense. Often those calories come from the excess sugar that is eaten, so for those who can’t burn off the calories, there’s the possible progression to diabetes.

With that said, one other topic for consideration is all the ‘fake’ sugar products on the market. Many try to cut calories by eating so called diet foods that have artificial sweeteners – you have to wonder how healthy those are and what long term effects they have on the body. Personally, I prefer to just eat natural sugar because not only does it taste better, but it isn’t full of chemicals.

[...] There has been a lot of data and reporting flying about trying to directly link sugar intake to diabetes. And while almost everyone agrees that most people should eat less sugar, the direct linkage to diabetes is still hazy. Marion Nestle at Food Politics has a concise breakdown of correlation and causation and suggests that we not jump to conclusions (at least, not yet). But if you want to understand how to break down the data from the flood of nutrition studies out there, this article is a useful tool. Link here. [...]

I read all above post comments all true about diet. my point of view all people who have diabetes to control diet and take regular exercise.
PANCREATITES

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Charlie L, SAO:

I’m sure that what they meant about the study being unethical relates to the fact that the whole hypothesis motivating the study would be that sugar is, in fact, metabolically harmful, and a driver of diabetes. It’s ethical to run a trial where you give people “usual care” or a placebo (in a diet trial, usually a standard American Heart Association-style diet) and another group something you expect to benefit them (a drug, or a food that is presumptively going to improve their health), but not to intentionally design a study where the idea is to see if you can cause one group to develop diabetes where they would not have otherwise.

It makes sense to me to just eliminate as much sugar from your diet as possible and exercise often.

It’s amazing the degree of rationalizing people will go to in order to defend their addictions to sugar and carbs.

Hi

A calorie is not a calorie, that is the first issue.

Sugar is also not sugar. Sugar is made up from 2 compounds- glucose and fructose. Glucose the body can handle, but fructose gives the body a problem, and it is the fructose that is causing the issues, not necessarily the glucose. Fructose seems to be in everything from can soda all the way through to bread- Yoghurt is awful for it yet it is classed as a “healthy food”. Fructose is not recognised by insulin, it increases fat production and increases hypertension by creating uric acid which attacks NO- the chemical which reduces hypertension.

Then we have exercise. You can not exercise off a hamburger, that is just a silly thought. What exercise does do is remove the building blocks that cause weight gain- but it also boosts the power of insulin- insulin works more effectively at the muscle site.

This has been known for some time, since the 1970s, but hopefully gets more traction now.

Many thanks for this great information, I agree with what you’ve said, if we eat less sugar everyone would be healthier. By the way I wanna add some great info here about Chia seeds. It can help balance blood sugar levels and even improve digestion! Also, Chia Seeds can be used in any of your favorite foods. They are tasteless and make a great snack.

Hi there,
This is a great but inconclusive study. In my personal experience, getting rid of sugar and sodas in my diet really helped stabilize my moods and left me with boundless energy. I’ve also replaced white sugar with brown sugar, which is better tolerated by my body’s insulin receptors. Sugar has no nutritional value, so less is more in this case. Just my opinion!
Alana

Hi there,
This is a great but inconclusive study. In my personal experience, getting rid of sugar and sodas in my diet really helped stabilize my moods and left me with boundless energy. I’ve also replaced white sugar with brown sugar, which is better tolerated by my body’s insulin receptors. Sugar has no nutritional value, so less is more in this case. Just my opinion!
Alana

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