Ode to the Sugar Article in the NY Times

There is a hum over the internet regarding an article which appeared in the New York Times on February 28th that began, “Sugar is indeed toxic.” A correction was printed on March 6th.

“This post has been revised to reflect the following correction:

Correction: March 6, 2013

Mark Bittman’s column on Thursday incorrectly described findings from a recent epidemiological study of the relationship of sugar consumption to diabetes. The study found that increased sugar in a population’s food supply was linked to higher rates of diabetes — independent of obesity rates — but stopped short of stating that sugar caused diabetes. It did not find that “obesity doesn’t cause diabetes: sugar does.” Obesity is, in fact, a major risk factor for Type 2 diabetes, as the study noted.”

This kicked off blogs and social network comments regarding opinions about the study, but they were based on the comments from Bittman’s article. So, I decided to go back to the original study from PLoS One.

PLOS ONE  I have a limited understanding of the study, but I know enough to understand what it was they were looking for and what they found. Roughly. There were a few things which I found unusual for a study. I thought a researcher controls the study by eliminating as many variables as possible. If, for example, we wanted to know if shrimp caused an allergic reaction in someone we would control all other allergic foods so we would know if the shellfish did cause the reaction. Taking that a step further we would eliminate the environmental factors which may cause any response — as well as keeping the patient subdued if anxiety caused a reaction. That said, I felt overwhelmed by the number of variables considered in this study. I highlighted the factors they considered in bold-faced type and found the amount of information staggering.

“Using econometric models of repeated cross-sectional data on diabetes and nutritional components of food from 175 countries, we found that every 150 kcal/person/day increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1% (p <0.001) after testing for potential selection biases and controlling for other food types (including fibers, meats, fruits, oils, cereals), total calories, overweight and obesity, period-effects, and several socioeconomic variables such as aging, urbanization and income. No other food types yielded significant individual associations with diabetes prevalence after controlling for obesity and other co-founders. The impact of sugar on diabetes was independent of sedentary behavior and alcohol use, and the effect was modified but not confounded by obesity or overweight. Duration and degree of sugar exposure correlated significantly with diabetes prevalence in a dose-dependent manner, while declines in sugar exposure correlated with significant subsequent declines in diabetes rates independently of other socioeconomic, dietary and obesity prevalence changes. Differences in sugar availability statistically explain variations in diabetes prevalence rates at a population level that are not explained by physical activity, overweight or obesity.

Citation: Basu S, Yoffe P, Hills N, Lustig RH (2013) The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data. PLoS ONE 8(2): e57873. doi:10.1371/journal.pone.0057873
 Editor: Bridget Wagner, Broad Institute of Harvard and MIT, United States Of America
 Received: November 8, 2012; Accepted: January 29, 2013; Published: February 27, 2013″
 Copyright: © 2013 Basu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.”

I’m not saying this discredits the study, I am simply pointing out the huge undertaking — over a long period of time — in an enormous area (175 countries). The first sentence actually says a lot about the findings, “While experimental and observational studies suggest that sugar intake is associated with the development of type 2 diabetes, independent of its role in obesity, it is unclear whether alterations in sugar intake can account for differences in diabetes prevalence among overall populations.”

It further states:

“The observed relationship between dietary sugar exposure and diabetes in this statistical assessment was not mitigated by adjusting for co-founders related to socio-economic, aging, physical activity, or obesity. This suggests that sugar should be investigated for its role in diabetes pathogenesis apart from its contributions to obesity.

In summary, population-level variations in diabetes prevalence that are unexplained by other common variables appear to be statistically explained by sugar. This finding lends credence to the notion that further investigations into sugar availability and/or consumption are warranted to further elucidate the pathogenesis of diabetes at an individual level and the drivers of diabetes at a population level [13].”

Which came first Obesity or Sugar — which in turn led to Diabetes? Are they independent or is it a “Metabolic Triangle”?
map showing the location of the Bermuda Triangle

As we discuss in The Zen of Weight Loss there is a basic truth regarding the body’s metabolism and how fuel is processed. You, however, are responsible for ascertaining how your body handles specific foods. Sugar is poison in excess — everything is poison in excess, but bodies handle food differently. That is one reason why the study found that in some countries the incidents of diabetes rose with increased sugar consumption, but obesity did not. Discover for yourself what foods do to your body. You owe it to yourself.

Be Well!

Love Yourself as much as God does!

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