A new study finds that reducing your sugar intake doesn’t actually improve blood sugar control–unless you actually have diabetes.
A new study finds that reducing your sugar intake doesn’t actually improve blood sugar control–unless you actually have diabetes.
Nutrition Diva is hosted by Monica Reinagel, MS, LDN. Transcripts are available at Simplecast.
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Welcome to the Nutrition Diva podcast.I’m your host, Monica Reinagel and today’s episode was inspired by a recent study that–on its face–may surprise a lot of people. But maybe it shouldn’t.
The study found that reducing the amount of sugar in the diet of healthy people did not improve their HA1C levels, which are a measure of blood sugar control over time. There’s more I want to say about this specific study. But I want to start by talking about why this outcome seems so surprising and counter-intuitive.
The statement that “sugar is bad for” us is one of the most uncontroversial positions you can take these days. In fact, the only people that are going to push back against you are the trade organizations that represent sugar refiners and sugar-sweetened beverage manufacturers. They've been feeling for a long time that they are being unfairly blamed and scape-goated for the rise in obesity and other diet- and lifestyle related illnesses.
There's no question that people with diabetes need to carefully plan and manage their intake of sugar and other carbohydrates. That's because this disease disrupts the body's ability to regulate blood sugar levels in response to dietary intake of carbohydrate foods.
For people with diabetes, eating too much sugar can result in high blood sugar levels and over time, that can lead to all kinds of other problems, everything from increased risk of heart disease to nerve damage, vision loss, and even amputation of limbs.
Because people with Type 2 diabetes are usually advised (and rightfully so) to limit their consumption of sugar, it might seem logical that limiting sugar consumption would also be a way for healthy people to reduce their risk of developing Type 2 diabetes in the first place. However, this may not be the case.
On the surface, there appears to be a lot of research showing that sugar intake is absolutely correlated with Type 2 diabetes risk. But when you really look at these studies, they are usually describing a dietary pattern that might be high in sugar but is also high in fat or saturated fat, or of poor nutritional quality.
When you strip away all these confounding factors (including things like overall nutritional quality, body weight, smoking, and physical activity) and you look only at sugar intake and Type 2 diabetes risk, the relationship is not at all so clear.
For example, researchers looked at the association between total sugar intake and the risk of developing Type 2 diabetes or cardiovascular disease in almost 100,000 women who were part of the Women’s Health Initiative Observational Study. And while sugar intake was correlated with increased risk, sugar intake alone was not a significant predictor. In other words, once they adjusted for everything else that contributes to Type 2 diabetes risk, the link between sugar consumption and risk disappeared.
Dietary sugar is problematic for people with Type 2 diabetes because their ability to regulate their blood sugar is impaired. Their blood sugar goes up and then stays up. But people who do not have Type 2 diabetes, by definition, have not lost their ability to regulate their blood sugar. When they consume a lot of sugar, their bodies just deal with it. Their blood sugar goes up but then it comes back down.
With that in mind, the study I mentioned at the beginning of the episode makes sense. This was a bunch of people who did not have Type 2 diabetes, meaning that their bodies were able to properly regulate their blood sugar levels in response to whatever sugar they ate. Reducing the amount of sugar in their diet didn’t improve their blood sugar control because their blood sugar was reasonably well controlled already.
It’s important to point out that this study was not originally designed to look at the impact of a lower sugar diet on blood sugar control.The original goal was to see if reducing the amount of sugar in the diet would improve symptoms of gum disease. But because they collected data on blood sugar control during the original study, researchers decided to use that data to test a second hypothesis–namely, that reducing the sugar content of diet in people who did not have Type 2 diabetes would result in improved measures of glycemic control. And, as it turned out, the data did not support their hypothesis.
However, if this study had been intended to test the impact of a low sugar diet on glycemic control it probably would have been structured a little differently. For one thing, it might have been longer than just two weeks. They might also have tested a more significant reduction in sugar. In this study, the baseline diet contained an average of 67 g of sugar per day. The lower sugar diet contained an average of 44 grams per day. They also did not distinguish between naturally occurring sugar and added sugar.
And this is the problem with doing secondary analysis on studies that were actually intended to look at something else. You’re often stuck with a study design or data that are not ideally suited to your question. And the findings are usually considered to be preliminary or exploratory and not definitive. A secondary analysis like this is a reason to do a better-designed study to see if these findings hold up.
And what if they do? If reducing your sugar intake doesn’t reduce your risk of developing Type 2 diabetes, should we still be advising everyone to limit their intake of added sugars? Or should that advice be limited to those who already have Type 2 diabetes or prediabetes?
In my view, there are still good reasons to limit your intake of added sugars. Sugary foods and beverages often displace other healthier foods from the diet. If we eat sweets instead of foods that are more nutritious, our overall nutrition suffers. And if we eat sweets in addition to more nutritious foods, it may add up to more calories than we need.
That’s especially true of sugar-sweetened beverages. Drinking a soda with your meal might add 200 or 300 extra calories but it doesn’t make you feel any fuller and doesn’t tend to decrease how much you eat. Those excess calories can lead to weight gain.
Ideally, the attempt to limit added sugars will have the the effect of reducing empty calories and increasing your intake of more nutritious options. And this is why I also encourage you to limit your intake of zero-calorie sweeteners, as well. Artificially sweetened drinks and desserts may be lower in sugar than their sugar-sweetened counterparts but they usually aren’t adding that much to the nutritional quality of your diet. If you’re not eating or drinking those all day, perhaps it will make room for something that offers more nutritional value.
Finally, if reducing your risk of developing Type 2 diabetes is a priority, here are some other strategies that may be even more effective:
If you’re looking for more support for healthy weight management, please check out the tools and resources at weighless.life, where our goal is to help people create habits, mindset, and lifestyle that help them weigh less without dieting.
If you have a question you'd like me to answer, you can email me at nutrition@quickanddirtytips.com You can also leave me a message at 443-961-6206
Nutrition Diva is a Quick and Dirty Tips podcast and is supported by a fantastic team, which includes Brannan Goetschius, Nathan Semmes, Davina Tomlin, Holly Hutchings, Morgan Christianson, and Kamryn Lacy.
Thanks for listening