Generally, which is more vital: Reducing your total intake of sugar, or modifying how it’s ingested?
Scenario 1#: Someone eats 80 grams of sugar every day, but it’s always divided into several meals, accompanied by a lot of fat/protein/fiber etc. (i.e., part of a big meal, not alone by itself) which slows down the glycemic index effect, and the speed at which the blood sugar "spikes;
Scenario 2#: Someone downs a can of Coca Cola with 40 grams of sugar on an empty stomach every morning (supposedly one of the worst things you can do to your pancreas), but otherwise consumes almost no sugar for the rest of the day;
Which is better/worse for the body?
IANAD, but I would bet that scenario #1 is better for you when compared to scenario #2, but eating a lot of sugar, in any form, on a regular basis is probably not that good for your overall health. However eating a lot of anything, saturated fats, carbs, sugar would probably be bad for most people. As the saying goes, everything in moderation.
Okay everybody will “know” that scenario #2 is worse. I tried to find at least a somewhat medically trustworthy cite.
Here’s a Mayo Clinic link on glucose tolerance, specifically, glucose tolerance testing.
Obviously scenario #2 will cause a higher glucose spike.
If you’re young and healthy, no difference. Your body can and will deal with glucose spikes.
If you’re “a little bit” diabetic (pre-diabetic), your body will be slow to deal with the glucose spike and scenario #2 will cause a higher blood glucose for longer. That’s bad.
If you’re diabetic you have to deal with the glucose spike in either case with appropriate insulin doses. Scenario #2 will leave you with less margin for error.
More vital to what? Weight control? Lipid levels? Blood glucose control? Overall health? Satiety? Diabetes management?
For non-diabetics, any outcome differences between the two scenarios is trivial assuming all other factors remain equal (i.e., we are only manipulating the timing of simple carbohydrate intake within two diets that are otherwise similar).
I am not aware of evidence showing #2 is “bad for your pancreas,” and not aware of much evidence showing that co-ingesting foods with low glycemic indices along with simple carbohydrates will substantially change insulin response or blood sugar levels whether or not you have diabetes.
Having said that, I should point out that even though I am a doctor, we don’t really know that much either, and tend to make a lot of stuff up because it seems reasonable.
I thought I saw a cite for this, but only in passing, at the Mayo Clinic but can’t find it now.
Does eating a lot of sugar “cause” Type 2 diabetes?
Of course Type 2 diabetes, if you already have it, will result in poorly controlled blood glucose. But I’m asking about the other way around. Has medical science shown a correlation between “eating a lot of sugar” (whether or not being overweight) and an increased chance of getting Type 2 diabetes?
I don’t see it listed under common causes or risk factors.
Any medically credible evidence?
I do not believe it has. As far as diet goes, it’s been found that eating so many calories as to cause weight gain is a risk factor, but there’s no good evidence pointing to any types of calories being causative.
Expert summary on the current thinking of the cause of diabetes from UpToDate:
Kinda, sorta, overall, yes.
“There are plausible mechanisms and research evidence that supports the suggestion that consumption of excess sugar promotes the development of cardiovascular disease (CVD) and type 2 diabetes (T2DM) both directly and indirectly.”
OTOH, w/ sugar beverages in particular, no.
“…recent reports conclude that there are no adverse effects of consuming beverages containing up to 30% Ereq sucrose or HFCS…”
OTOH, as a general epidemiologic observation, yes.
" There are plausible mechanisms and research evidence that supports the suggestion that consumption of excess sugar promotes the development of cardiovascular disease (CVD) and type 2 diabetes (T2DM) both directly and indirectly."
OTOH,
“There is also little data to determine whether the form in which added sugar is consumed, as beverage or as solid food, affects its potential to promote weight gain…”
You can see why QtM and I tend to fudge our answers when we get asked your question. If we emphasize no hard-evidence link between sugar consumption and diabetes, our patients get the wrong idea about how to stay healthy. If we emphasize how important it might be to control how you approach sugar in your diet, we stray from being strictly scientific.
Shouldn’t medical science have sorted all this out by now? Well, sure; but you try studying humans, diet and behavior. It’s damn near impossible to do double-blind, prospective, long-term studies singling out one specific variable:
“It will be very challenging to obtain the funding to conduct the clinical diet studies needed to address these evidence gaps, especially at the levels of added sugar that are commonly consumed.”
Minor late edit:
OTOH, as a general epidemiologic observation, yes.
“The epidemiological data suggest that these direct effects of fructose are pertinent to the consumption of the fructose-containing sugars, sucrose and high fructose corn syrup (HFCS), which are the predominant added sugars.”
Note that Chief Pedant’s cites say things like “There are plausible mechanisms and research evidence that supports the suggestion” and “The epidemiological data suggest that these direct effects of fructose are pertinent”. Hardly definitive statements.
This is not a knock on his cites, it is showing that the evidence is not yet so good as to draw solid conclusions, IMHO. As CP noted, the high quality research needed to really settle the question is hard to do on people.
Agreed. “Hardly definitive” might even be generous. 
“plausible”…“supports the suggestion…”
As I said in my first reply, we tend to make stuff up b/c it seems reasonable.
(But maybe lay off a high sugar diet for now, whether or not we can definitively link it to diabetes?)
Definitely the smart thing to do, since a high sugar diet is associated with weight gain, and weight gain is associated with diabetes. That much we do have decent evidence for, that any diet that causes weight gain does increase the risk of developing DM II.
Hopefully not too much of a hijack, but I’ve wondered something similar about alcohol. Compare these two scenarios:
- On an empty stomach, I guzzle 3 glasses of wine every day at 4pm.
- At 4, I slowly drink a glass of wine accompanied by a handful of nuts or an ounce or two of cheese. I have two more glasses, sipped between the hours of 6pm and 7pm, while eating dinner.
Intuition tells me scenario 1 is worse for my liver, but I don’t really know. All I know from health recommendations is that 3 glasses of wine a day is too much for someone of my size and gender.
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Thank you, Qadgop the Mercotan and Chief Pedant!
Good to see solid info.
I am of course aware of the inherent difficulty of doing this kind of research.
We’re not even that long past the era where there would be blatant biases and gross design errors in medical research (e.g., where the all subjects would be old white males or young white males or they’d all be from some small village in Finland). Things have gotten better.
At least I can try to eliminate the additional layer of distortion caused by sensationalist reporting, idiot reporters, clickbait driven media, agenda driven activists, Russian fake news troll bot accounts and whatever those kids think of next.
So is the converse true? If weight gain can lead to type 2 diabetes can weight loss (and associated weight maintenance and exercise) “cure” you of T2DM? Or once you get T2DM do you have it for the rest of your life?
Not a doctor, but my understanding is that prediabetes can be reversed through weight loss and a healthier lifestyle, but once you actually hit Type II diabetes itself, it is almost impossible to reverse naturally. Hopefully **Qadgop **or some real doctor can come set things straight.
I don’t know what counts as “curing” diabetes, but I know individuals who were diagnosed as diabetic, and who have lost weight and made other dietary changes and have maintained normal blood sugar levels for extended times without additional intervention.
Also, with regards to the OP: There’s a surprising variety of metabolic responses among different people, which is almost certainly at least partly due to genetics. So I would guess that most people are better with scenario 1, but a few people might be better with scenario 2, and there are likely lots of people who would tolerate either without significant harm.
That’s a grey area, and more due to variable definitions of what diabetes is and means and how it’s socially and economically accepted, etc.
Many people who meet the criteria for DM 2 who then go on to lose weight and exercise end up no longer meeting the criteria for DM 2, or even for the diagnosis of glucose intolerance. Are they still diabetic? Well, some health insurers will charge them diabetic rates to sign them up, or refuse to insure them. Their doctors may consider them people with diabetes who are under excellent control on lifestyle modifications only. They may get told that their diabetic control is so good that it’s the same as a non-diabetic. But on a microscopic and molecular level, there have probably been some fundamental diabetic changes to their kidneys, neurons, retinas, and arteries. They are probably still at a bit higher risk for premature heart attack, stroke, renal and neuron and optical disease than someone who was never diabetic. Does that mean they still have diabetes? In my mind, they still bear the consequences of having had diabetes.
I tell these types of patients in my practice that they are presently functionally non-diabetic, but are still at very high risk for a return to diabetes, even if they continue their healthy habits. So they still should have regular diabetic followup with a practitioner every 6 to 12 months to ensure they haven’t lost that wonderful control they were in.
Probably not the clear cut black and white answer so many want to get to this question, but that’s how I handle it.
That’s a very good answer. Thanks.