“The findings highlight why drinking your sugar is more problematic for health than eating it,” says the lead author, Karen Della Corte, a doctor of natural sciences and an associate professor of nutritional science at Brigham Young University in Salt Lake City.
A Daily Soda Raised Type 2 Diabetes Risk by 25 Percent
Dr. Della Corte and her team analyzed 29 long-term studies involving more than 500,000 healthy adults from around the world, including the United States, Europe, Asia, Australia, and Latin America. All the included studies tracked total sugar intake and intake of different types of sugar, including sucrose and fructose.
The researchers collected their data using surveys that asked how often participants ate or drank certain foods and beverages and in what amounts. The scientists then calculated how many grams of sugar were in those items.
Participants were followed for at least two years to see if they developed type 2 diabetes. Investigators looked at patterns in the amount and types of sugar consumed and a participant’s likelihood of getting diagnosed with diabetes.
After controlling for body mass index (BMI), daily calorie consumption, family history of diabetes, and lifestyle risk factors such as smoking and physical inactivity, the researchers found the following:
- For each additional 12-ounce (oz) serving of sugar-sweetened beverages per day, diabetes risk increased by 25 percent. The increased risk began from the very first daily serving, meaning there was no amount that didn’t raise risk.
- For each additional 8-ounce serving of fruit juice per day, diabetes risk increased by 5 percent.
The risks were relative and not absolute. For example, if the average person’s baseline risk of developing diabetes is about 10 percent, four sodas a day (with each drink adding 25 percent relative risk) could raise that to roughly 20 percent absolute risk — double the baseline risk.
The studies included in the meta-analysis were prospective, meaning the researchers tracked subjects rather than analyzing preexisting data. They were also observational, meaning the researchers didn’t ask participants to change their sugar intake in any way.
Instead, subjects recorded what they remembered eating and drinking.
That means the findings show a link between intake of sugary drinks and diabetes, but don’t prove that sugary drinks were the cause.
Here’s What Happens When You Drink Soda or Juice
The findings suggest that when it comes to diabetes risk, the form of sugar matters more than the sugar molecule itself, says Della Corte.
“That’s because sugars consumed in liquid form are absorbed rapidly, leading to sharp spikes in blood glucose and insulin. These beverages also lack fiber, protein, or fat, which would normally slow sugar absorption,” she says.
Over time, this can disrupt liver metabolism and increase insulin resistance, key mechanisms in the development of type 2 diabetes, says Della Corte.
This is especially true with fructose (which is found in the high-fructose corn syrup that typically sweetens soda) and table sugar, because they’re mostly processed in the liver, she says.
Although the liver is able to process low doses of sugar through normal energy pathways, when it’s hit with a sudden high dose of fructose (as often happens with sugary drinks), it can’t keep up, says Della Corte.
“When overwhelmed, it diverts more of the excess fructose into fat production, a process known as de novo lipogenesis. This buildup of fat in the liver can interfere with insulin signaling and contribute to metabolic dysfunction, leading to an increased risk of type 2 diabetes,” she says.
The Body Is Better at Processing Sugar Eaten With Fat or Protein
Given what’s known about how the body processes different types of sugar, it makes sense that sweet drinks would have a greater effect on diabetes risk than sweet foods, says Susan Spratt, MD, a professor of medicine who specializes in diabetes and metabolism at Duke Health in Durham, North Carolina. Dr. Spratt wasn’t part of this new research.
The sugar in food is less likely to spike blood sugar because, unlike soda and other beverages, food contains protein, fat, or both, which slows the breakdown of carbohydrates like sucrose and fructose.
“Higher amounts of fat and protein decrease stomach emptying, slowing the rate at which carbohydrates are digested and are absorbed from the intestine. This blunts the glycemic rise. Additionally, insulin secretion can be enhanced by the amino acids in protein,” says Dr. Spratt.
Should Sugary Drinks Be Paired With Food, or Avoided Altogether?
Do the findings mean that if you are going to drink a soda or another sweet beverage, you should eat a meal along with it? Maybe, Spratt says, “but it’s best to drink water and save your calories for food.”
Even though a meal can blunt the glycemic spike, consumption of sugary drinks is still associated with increased long-term risk of type 2 diabetes, says Della Corte.
The Bottom Line: Sugar Is Safest When It’s Part of a Minimally Processed Diet
Focus on the form and context of sugar in your diet, not just the total amount, says Della Corte.
“Avoid sugary drinks like soda, energy drinks, and even fruit juice, because these are clearly harmful, even at moderate intake. Instead, the safest bet is to opt for replacing sugary drinks with water or naturally flavored drinks, sparkling water, or drinks lightly infused with fruit or herbs,” she says.
“Sugar has been a part of the human diet for thousands of years,” she adds, “whether from fruits, honey, or dairy. It’s not sugar itself that’s new or problematic, but the modern food environment. Today, we’re consuming sugar in highly processed, isolated forms, often in liquid form and without the beneficial nutrients that accompany it in whole foods. That’s where the health risks start to emerge,” she says.
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