Sugar Doesn’t Cause Diabetes

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Enjoy today’s lovely 180DegreeHealth slideshare from the izzle of diabizzle Matt Stone…

24 Comments

  1. If the eating of sugar and other highly refined carbohydrates doesn’t cause type 2 diabetes, then how is it that taking those ingestibles out of your diet tends to reverse the symptoms of the disease?

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    • Don’t see that too often, other than perhaps a transient and temporary improvement due to decreased blood sugar in the short-term before an eventual worsening. There are lots of faux ways to “cure diabetes” in the short-term, but they are short-lived and more like parlor tricks. Only interventions that result in superior glucose clearance offer true improvement in the condition. Having said that, I have nothing against eating primarily, or even exclusively unrefined food as long as people are eating enough calories to keep metabolism up and not suffering from digestive problems or a psychological compulsion to eat what they’ve forbid themselves from eating.

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      • Reduced carbohydrate intake has been shown to be beneficial to people with diabetes in long term studies like http://www.nutritionandmetabolism.com/content/5/1/14 for example.

        That is beyond ” a transient and temporary improvement”. It ays nothing about the *cause* of diabetes but if you can’t regulate blood sugar then creating less of it has to have some merit, given that chronic elevated blood sugar has well defined bad consequences.

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      • Long terms studies like http://www.nutritionandmetabolism.com/content/5/1/14 show benefit of reduced carbohydrate intake to people with diabetes well beyond any “transient and temporary improvement”

        If you have a problem regulating blood sugar, and chronic high blood sugar has well known bad outcomes, then does it not make sense to reduce the amount of blood sugar created by ingesting carbs ?

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        • Possibly, but that kind of assumes that ingesting carbs is a significant contributor to chronic high blood sugar, whereas research has found that relative insulin deficiency and hepatic insulin resistance appear to be the main culprits. More on this here.

          To play devils advocate for a second, it would be possible for a low fat proponent could construct a similar argument. People with diabetes have elevated levels of free fatty acids (FFA) and reduced clearence. Elevated FFA are a major cause of insulin resistance in skeletal muscle and liver and cause impaired glucose tolerance. So wouldn’t it make sense to reduce the amount of FFA in the bloodstream by reducing fat intake?

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        • If you don’t know a solution to fixing the blood sugar regulation problem, then yes. It could very well be better to avoid carbs if you can’t fix the problem, which is exactly what I wrote in 180 Diabetes (currently unpublished until updated).

          But what makes more sense is to fix the blood sugar regulation problem.

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          • When will 180 Diabetes be released? I try to apply Eat for Heat and Food Ninjas to family meals, but hubs is sick and tired of me screwing with his diet. He wants a succinct answer to eating/exercising with diabetes. And so do I.

            The doctor and dietician want him to exercise regularly (I get that but do we rest and refeed first), avoid fat (really?), and eat a 2:1 carb to protein diet (ok, they like a few carbs).

            I feel like I’ve read all the hip diet dogma over the last year (yup, that includes cross fit, Paleo and WAPF). I feel I can trust you, and really just want your answer to helping hubs lose fat and treat his diabetes without drugs.

      • Low carb diets don’t necessarily just improve diabetes ‘markers’, they may also improve the underlying condition (loss of insulin sensitivity). as stephan guyenet noted about this study – http://www.ncbi.nlm.nih.gov/pubmed/15331548
        in his article here – http://wholehealthsource.blogspot.com.au/2009/09/diabetics-on-low-carbohydrate-diet.html

        “It’s interesting to note in the graph above that fasting blood glucose (18-24 hours) also fell dramatically. This could reflect improved insulin sensitivity in the liver. The liver pumps glucose into the bloodstream when it’s necessary, and insulin suppresses this. When the liver is insulin resistant, it doesn’t respond to the normal signal that there’s already sufficient glucose, so it releases more and increases fasting blood glucose. When other tissues are insulin resistant, they don’t take up the extra glucose, also contributing to the problem.”

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        • Firstly, I think Guyenet’s views have probably matured tremendously since 2009 when that was written. I concede that if one cannot fix their diabetes, eating a low-carb diet is usually a better option than just continuing on with out-of-control blood sugar issues. The whole “if glucose is poison, it’s better to eat fat” idea. However, I’ve seen countless times that fasting and postprandial glucose levels can be improved without resorting to a low-carb diet, and that they can be brought even lower on a higher-carb diet than a low-carb diet.

          This study is completely irrelevant however (as 99% of studies are), as it is only 5 weeks long and doesn’t take into account the study subjects’ response to a normal meal (what 95% of people will gravitate towards eventually no matter what any study on earth claims) after the test period (a better test of how a diet affects glucose control/clearance/the root of the problem).

          Okay, too many parentheses, sorry.

          There is also no mention of how satisfied the subjects were, how they felt, what other problems they might have developed, whether or not they experienced carbohydrate cravings or whether they will in the future if they are to continue, on so on ad infinitum.

          It’s just an isolated look at blood glucose in a very crude, shallow, and superficial way. From experience, I can tell you that what sends many people’s blood sugar down in the short-term induces all kinds of problems such as insomnia, reduced metabolic rate, mood disorders, constipation, sexual dysfunction, and on and on.

          Ultimately, this study shows that reducing carbohydrate intake can lower blood glucose in diabetics over a 5-week period. Tell me something I don’t know. That’s obvious. Everyone knows this.

          But an intervention that makes people increasingly crave carbohydrates and tolerate them more poorly over time is not a solution, it’s a recipe for disaster, which is exactly why people shouldn’t settle for these kinds of temporary band-aids for their problems, but should really address the root cause and see if they can get to the bottom of it.

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          • I basically agree with you and i dont think that very low carbohydrate diets are healthy or sustainable by any means. However it seems like you are saying that low carb diets only lower glucose levels by reducing glucose intake. The point i was making is that they also appeared to improve hepatic insulin sensitivity and stopped the liver pumping out more glucose.

  2. I think I noticed some benefits in glucose clearance from supplementing B3 because I think that ever since I have an even greater sweet tooth :P.

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  3. No offence but your slide show was pretty much meaningless since all you really did was make a series of rudimentary assertions without providing any evidence or offering an alternative explanation. Im not saying you’re wrong but maybe you should have written a convincing article and left the slides to dr.oz and play-school

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  4. One issue with the study Phil linked was that they appear to be reducing the calories for the test subjects and adding exercise. It’s not exactly clear if that was done for the control or not (there was a slight mention of being “advised on a diet of similar calories” but nothing about exercise). Either way, i don’t know why studies change 3 variables and then attribute the results to only one of them. Granted, i’m at work and only skimmed the study so i may have missed something.

    Second, to Matt’s point, diabeties is a program with sugar metabolism. Too much blood sugar is a symptom. Restricting carbohydrates doesn’t cure a Type 2 anymore than an eye doctor cured my eyesight by giving me glasses. With that said, there does seem to be evidence that carb restriction helps the obese in some cases.

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  5. Whats up everybody. Just to let you know Matt, you’re awesome, but I just typed out a decent sized comment and forgot the captcha and all my shit was gone. Might wanna make it so people don’t lose their content if they forget that OR get it wrong accidentally. I’m not going to type what I typed again right now…It’s irritating..Crap it was good too =\

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  6. I think this post is a bit misleading. It’s important to distinguish between sugar consumption and carbohydrate consumption in general. For one thing, sugar (unlike starch) is 50% fructose. Even moderate consumption of fructose can cause hepatic insulin resistance in humans and has been shown to increase circulating free fatty acids – http://www.ncbi.nlm.nih.gov/pubmed/22933433
    Increasing circulating free fatty acids in humans appears to induce insulin resistance –
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC370462/
    http://www.ncbi.nlm.nih.gov/pubmed/1885781
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC293539/
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC407880/
    http://www.ncbi.nlm.nih.gov/pubmed/15919784
    while reducing circulating free fatty acids restores insulin sensitivity in obese and diabetic subjects – http://www.ncbi.nlm.nih.gov/pubmed/10480616

    Insulin resistance has also been associated with fructose consumption in adolscents – http://www.ncbi.nlm.nih.gov/pubmed/22190023

    Fructose overfeeding (but not glucose overfeeding) can induce insulin resistance in humans in as little as a week, albeit that is an unnaturally high intake of fructose – http://www.ncbi.nlm.nih.gov/pubmed/6986758

    Fructose (but not glucose) exacerbates insulin sensitivity in overweight/obese humans – http://www.ncbi.nlm.nih.gov/pubmed/19381015
    http://www.ncbi.nlm.nih.gov/pubmed/20029377

    It’s also important to note that added sugars increase caloric intake via their effects on food reward / palatability. Cellular calorie overload induces cellular insulin resistance – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2764908/
    and excess calorie consumption contributes to obesity and type 2 diabetes – http://www.ncbi.nlm.nih.gov/pubmed/20547978
    http://www.ncbi.nlm.nih.gov/pubmed/4881681
    http://www.ncbi.nlm.nih.gov/pubmed/4750591

    Since added sugars promote overeating, and since both overeating and fructose overfeeding can induce metabolic syndrome, I think it’s quite likely that the huge intake of sugar in the standard western diet is contributing to the pathogenesis of type 2 diabetes.

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  7. Matt, I admire you for being willing to spend this much time fielding questions on a simple blog. If I were you I’d disable comments. Of course, maybe you enjoy it. It’s still a lot of work. Hey, here’s a comment ….. THANK YOU. I’m going to go get some ice cream with my daughter. Guilt free.

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    • I wouldn’t do it if it was “work.” Work is against my religion, lol. I do this because it is fun and interesting.

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  8. Hi Matt, my dad just got diagnosed with diabetes… How do I help him ???

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    • What were his sugar readings? You can start by getting a glucose meter and some test strips and establishing a baseline for where he’s at right now. What is his 1, 2, and 3-hour postprandial readings after a mixed meal with 100 grams of carbohydrates? What is his typical morning fasting level?

      When you get to know that kind of thing, then you can begin working on improving his glucose clearance.

      Let’s say his fasting right now is 130, and after a mixed meal his 1, 2, and 3 hour readings are 210, 180, and 120.

      An improvement would be to see his fasting go to 110, and 1, 2, and 3 hour readings go to maybe 150, 120, and 100… And to be able to achieve this WITHOUT reducing calorie or carbohydrate intake. Anyone can temporarily starve their blood sugar down, but it’s not a solution, and that doesn’t address the root problem.

      Hopefully that can provide you with a good start and a good framework in your attempts to actually improve the condition instead of just “treat” it.

      If all else fails, you can always take the “treatment” approach (low-carb), but that shouldn’t be a first course of action in my opinion unless his condition is quite severe.

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      • So I’m in Canada and we have a different system from the states as far as I can tell. My glucose meter tells me my fasting blood sugar was 7.4 this morning then 8.9 after breakfast, 7.0 an hour later and 5.6 an hour after that. Seems pretty good to me except for the fasting glucose which is high according to my doctor who tells me I am in the pre-diabetes range. Do you know how these readings compare to the ones you gave above and any ideas how to improve my fasting levels?

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        • This sounds like stress-induced high blood sugar, which is greatly improved by ingesting food. As you can see, you have no problem clearing glucose, it just seems your nervous system is hyperactive in the morning hours. Do you have bad sleep with an adrenaline surge in the middle of the night? Feel really funky in the morning? If you give me a few more details, I’m happy to continue trying to get to the bottom of this. How old are you? How long has this elevated fasting sugar thing been going on?

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  9. Thanks Matt!

    I’m 40 and switched from the GAPS diet to RRARF in February after being low carb (as well as orthorexic) on and off for many years. I gained 30 in the first two months of RRARFing but my weight has now been stable for the last twoish months. I really struggled with sleep the first few months, but it seems to finally be settling down – I’m not lying awake anymore for 1.5 – 2 hours per night. At first I would make sure I had a snack right before bed as well as something beside my bed for when I woke up in the middle of the night, but haven’t had to do that for the past week and have been sleeping much better. Still waking up around 1:30/2:00 but going right back to sleep without any problems.

    I’m not sure how long the fasting sugar thing has been going on as I had my first blood test in 4 years done after I started RRARFing, but my first test came back 6.4, second test 3 months later (at end of June) was 6.5 and then I just started taking my own tests yesterday which showed the 7.4 and this morning it was 8.8 – doesn’t make sense since it’s getting worse as my sleep improves…

    I actually feel pretty good in the morning – having had Gestational Diabetes 5 years ago, I don’t have that yucky feeling that I associated with high blood sugar at that time. But I’ve been crashing in the early afternoon all this week – have had to take naps every day, which could be the result of being much busier than usual in the mornings or the heat, but regardless, it’s a pain.

    I haven’t been tracking calories for a long time, just eating to appetite and not purposely avoiding grains, but not eating much of them – more salads & fruit, smoothies etc. as I’ve started following Jon Gabriel’s stuff and adding in nutrients as well as starting to walk more and a little bit of time on my elliptical (less than 5 min so far) I’m never feeling hungry and although I haven’t tracked my temp since my thermometer broke, I’m usually feeling quite hot after eating anything.

    Thanks for any suggestions you can give!
    Lisa

    Reply
    • That is definitely odd that it’s worsening as your sleep improves, but it is promising at the same time that you don’t seem to have much of a glucose clearance problem at all. 8.8 is quite high for a fasting level. It’s also quite abnormal to see it jump up and down between 6.4 and 8.8. Perhaps we can shift this conversation over to my email address. Email me at: matt@180degreehealth.com and we can keep an eye on it a little bit. But this sounds peculiar enough, as well as serious enough, that you should consider working with Dr. Garrett Smith.

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  10. Thanks Matt, will do!

    Reply

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