More, Yet More, on Pure, White and Deadly

Yes, the more you eat and the fatter you become, and the more likely you are to get diabetes. Subsidiary questions:

  1. Are some diets more likely to make you fat than others? Yes, sugar is worse than other diets in making you fat (see previous posts). I think this is because they are less satiating, but they also have worse metabolic effects (again, see previous posts).
  2. At a given level of weight gain, is a high intake of sugar more likely to cause diabetes?

A recent meta-analysis of prospective studies of sugar-sweetened beverages in seventeen cohorts including no less than 38,253 people were analysed. Each extra ‘serving’ of sugar-sweetened beverage was associated with an 18% increase in the risk of diabetes even after correcting for adiposity.[1]

The CLAHRC WM Director says “think carefully before you correct for a variable on the causal chain between exposure and outcome because you will likely mask a true association.” These results are therefore impressive because they show an increased risk of diabetes with sugary drinks, net of the increased risk of obesity itself. Sugary drinks cause a very high spike of glucose, which may predispose to diabetes over a more gradual increase following, for example, a rice meal. Sugar is made up of a glucose and fructose molecule, and fructose increases insulin resistance. It is therefore likely to be more diabetogenic than the carbohydrate found in rice, wheat and potatoes, which is pure glucose. The astute reader will have noted that fruit juice will also cause a severe spike in glucose levels and also contains sugar, and hence fructose. Unlike whole fruit, which protects against diabetes, fruit juice also seems to be diabetogenic net of weight gain. Incidentally, this is a beautifully conducted and analysed study from Japan, the USA and the UK, which is worth reading for this reason alone.

— Richard Lilford, CLAHRC WM Director


  1. Imamura F, O’Connor L, Ye Z, et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ. 2015; 351: h3576.

3 thoughts on “More, Yet More, on Pure, White and Deadly”

  1. Yes, the study is good, as it may be in this field: it is a meta-analysis of the cohort studies. Well, they found the association. While carefully wording that this is only association and the causality is not proven, author went to the calculation of the attributable fraction – under specified assumptions. Altogether it is a good example of the formally correct exercise leading to the wrong readers’ conclusion – if we deprive our children from Coke they will not get diabetes.
    Readership of this blog should not be reminded about the limits of the cohort studies, but one parallel is teaching. For long years the salt consumption was accepted the risk factor for hypertension and cardiovascular diseases. From the cohort studies, of course. After controlled trials we know, that to limit the salt consumption is a useless exercise (in sense of disease prevention).
    Potential COI: I am not slim, and fond of deserts, especially choclate and cheese based.

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