Which Sugar is Dangerous for Type 2 Diabetes
It is well accepted that sugar plays a major role in type 2 diabetes and other metabolic diseases. But do you know which sugar is more dangerous than others? One expert recently explained which sugar gets the prize and why.
Blame it on fructose
In a recent videotaped interview, Richard J. Johnson, MD, chief of the Division of Renal Diseases and Hypertension at the University of Colorado School of Medicine reported there is evidence that “fructose in the primary problem.” He named fructose as the sugar that is the force behind insulin resistance, the development of fatty liver, and metabolic syndrome.
Americans are no strangers to fructose. In the Standard American Diet (SAD), highly processed foods are commonplace, and they are an important (and unfortunate) source of high fructose corn syrup (HFCS).
Johnson explained that such added sweeteners “probably are playing a major role in driving fatty liver and insulin resistance.” Insulin resistance is a hallmark of type 2 diabetes, obesity and metabolic syndrome.
When it comes to HFCS, he noted that the liquid form is “probably more dangerous” than solid forms when it comes to the liver. Why? Because it is the concentration of the HFCS that has a greater impact on detrimental changes in the liver cells.
But what about other forms of sugar, like glucose? What is its role in type 2 diabetes?
Johnson pointed out that glucose is the force behind insulin and that it also has a role in weight gain, but it is not as powerful a player in insulin resistance as is fructose. In addition, the body can convert glucose to fructose, so the ultimate culprit is still fructose.
In fact, the reason high glycemic carbohydrates drive insulin resistance and fatty liver may be explained by the conversion of these carbs into fructose in the body.
Why do I keep mentioning fatty liver? This disease affects about 25 percent of adults in the United States, and among those most likely to develop the disease are people with diabetes, individuals who are overweight or obese, or those who have high lipid values (cholesterol and triglycerides).
Fatty liver, which is also known as nonalcoholic fatty liver disease, occurs when the liver accumulates excessive fat in its cells that is not associated with alcohol consumption. People with fatty liver have twice the risk of dying from coronary heart disease than from liver disease.
More bad news about fructose
In an earlier study conducted by Johnson and his colleague Takahiko Nakagawa, MD, they explored the role of fructose in high blood pressure and kidney disease, two conditions that are commonly associated with type 2 diabetes. They found that in addition to the impact of fructose in diabetes and metabolic syndrome, the sugar could be a player in these two diseases as well.
In fact, Johnson noted that “excessive fructose intake could be viewed as an increasingly risky food and beverage additive.”
In another study, a team looked at HFCS consumption in 43 countries. According to Michael I. Goran, PhD, co-director of the Diabetes and Obesity Research Institute at the Keck School of Medicine at the University of Southern California in Los Angeles, they discovered that the prevalence of diabetes was 20 percent higher in places that had a greater intake of HFCS when compared with countries that had a low availability.
Goran also explained the difference between fructose that is present in fruit (which also contains fiber that slows the body’s absorption of sugar) and fructose in HFCS, which has no fiber. He noted that “there are lots of other aspects of the way fructose is handled by the body which are different than glucose that make it metabolically dangerous for the body.”
The take-home message
Both fructose and glucose are not diabetes-friendly, but fructose is more dangerous than the latter. Since the body can convert glucose to fructose, this sugar remains the more hazardous of the two.
If you have type 2 diabetes, it is best to avoid refined foods that contain high fructose corn syrup as much as possible. Overall, intake of sugar in any form should be limited.
Goran M et al. High fructose corn syrup and diabetes prevalence: a global perspective. Global Public Health 2012 Nov. DOI:10.1080/17441692.2012.736257
Richard J. Johnson, MD video interview