Diabetes, Metabolic Syndrome and Sugary Drinks

Chapter summary

Sugar plays a starring role in hypertension, poor blood lipids, inflammation and coronary heart disease.
One in three Australians over 25 has metabolic syndrome (MetS), the precursor to diabetes and cardiovascular disease.
One in ten adults has diabetes: about 1 million in Australia and 371 million globally.
One sugar-sweetened beverage (SSB) a day is linked to an 83% greater risk of type 2 diabetes in one study, and a 39% to 43% greater risk of MetS.
The author’s advice: do not drink SSBs.

Global prevalence was estimated at 2.8% in 2000 and is projected to reach 4.4% in 2030, with cases rising from 171 million to 366 million.
Diabetes takes about 10% of the UK NHS budget, so even people without it pay for it.
Type 1 needs insulin from early in life. Type 2 is linked to insulin resistance. Gestational diabetes appears in pregnancy and often resolves after birth.
2014 research suggests both type 1 and type 2 involve toxic clumps of the hormone amylin that destroy insulin-producing cells. Drugs that stop clumping might slow or reverse both.
Australian data (June 2013): about 937,000 people with type 2 diabetes, 73,000 new registrations in a year, 67% aged over 60, and 23% needing insulin.

50,000 women, 8 years: 83% higher type 2 risk for one or more SSB a day versus less than one a month. BMI explained about half of the excess.
40,000 Black women, 10 years: 24% higher risk for more than one SSB a day. BMI explained most of the effect.
70,000 women, 18 years: 31% higher risk for 2 to 3 SSBs a day, even after adjusting for BMI and energy intake.
12,204 men and women, 9 years (ARIC): no link found.

Weight explains it: Part of the SSB effect runs through weight gain. If SSBs make you fat and fat causes diabetes, the drink is the indirect cause.
Direct harm: The author argues SSBs raise risk independently of weight, through high glycaemic load and fructose, causing insulin resistance, beta cell dysfunction, inflammation, hypertension, visceral fat and abnormal blood fats.
The null study: Participants in ARIC were older and heavier, which probably masked any effect.
Open question: Scientists debate whether glucose from starch or fructose from sugar is the greater villain. Genes and gut bacteria also shape how each person responds.

Defined by the International Diabetes Federation as central obesity (waist circumference, by ethnicity) plus any two of: raised triglycerides, reduced HDL cholesterol, high blood pressure, or high fasting glucose.
It affects 20% to 25% of the world’s adults.
People with MetS are up to three times more likely to develop cardiovascular problems and up to five times more likely to develop type 2 diabetes.
In the Framingham Offspring Study (about 6,000 people, 4 years), one or more soft drinks a day gave a 39% higher MetS risk. That analysis mixed diet and regular drinks.
A single serving of cola carries about 16.3 kU of advanced glycation end products (AGEs), which raise insulin resistance and inflammation.

Eliminate SSBs and added sugar, and a large share of the problem should disappear.
Food, bacteria and genetics interact, so individual results vary.

Malik, V., Popkin, B., Bray, G., Despres, J. and Hu, F. (2010) Sugar-sweetened beverages, obesity, type 2 diabetes and cardiovascular disease risk. Circulation 121(11):1356-1364.
Schulze, M. et al. (2004) Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 292:927-934.
Palmer, J. et al. (2008) Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch Intern Med 168:1487-1492.
World Health Organization (2012) New data highlight increases in hypertension, diabetes incidence. World Health Statistics.
Wikipedia. Diabetes mellitus.