Does Sugar Cause Diabetes? It’s Complicated.

by Erica Julson, MS, RDN, CLT

Since diabetes is a disease characterized by high blood sugar levels, many people wonder whether eating sugar can cause it.

While it’s true that eating large amounts of added sugar may increase your risk of diabetes, sugar intake is just one piece of the puzzle.

Many other factors — including overall diet, lifestyle and genetics — also impact your risk.

This article reviews sugar’s role in developing diabetes and provides tips for preventing the disease.

What is Diabetes?

Diabetes occurs when your body is no longer able to effectively regulate blood sugar levels.

This can happen when your pancreas stops producing enough insulin, when your cells become resistant to the insulin that is produced or both (1).

Insulin is the hormone required to move sugar out of your bloodstream and into your cells — so both scenarios result in chronically elevated blood sugar levels.

High blood sugar levels over a long period can lead to complications like an increased risk of heart disease, as well as nerve and kidney damage, so it is important to keep them in check (2).

There are two main types of diabetes, each with different causes:

  • Type 1: Occurs when your immune system attacks your pancreas, destroying its ability to produce insulin.
  • Type 2: Occurs when your pancreas stops producing enough insulin, when your body’s cells no longer respond to the insulin it produces or both.

Type 1 diabetes is relatively rare, largely genetic, and only accounts for 5–10 percent of all diabetes cases (3).

Type 2 diabetes — which will be the focus of this article — accounts for more than 90 percent of diabetes cases and is mainly triggered by diet and lifestyle factors (4).

How Sugar is Metabolized

When most people talk about sugar, they’re referring to sucrose, or table sugar, which is made from sugar beets or sugarcane.

Sucrose is made up of one molecule of glucose and one molecule of fructose bonded together.

When you eat sucrose, the glucose and fructose molecules are separated by enzymes in your small intestine before being absorbed into your bloodstream (5).

This raises blood sugar levels and signals your pancreas to release insulin. Insulin shuttles glucose out of the bloodstream and into your cells where it can be metabolized for energy.

While a small amount of fructose can also be taken up by cells and used for energy, the majority is carried to your liver where it is converted to either glucose for energy or fat for storage (6).

Since fructose can be converted to fat, high intakes tend to increase triglyceride levels, which may increase your risk of heart disease and fatty liver (78).

Fructose metabolism also raises uric acid levels in your blood. If these uric acid crystals settle in your joints, a painful condition known as gout can develop (9).

If you eat more sugar than your body can use for energy, the excess will be converted into fatty acids and stored as body fat.

Does Sugar Increase Your Risk of Diabetes?

A large number of studies have found that people who regularly drink sugar-sweetened beverages have a roughly 25 percent greater risk of type 2 diabetes (10).

In fact, drinking just one sugar-sweetened beverage per day increases your risk by 13 percent, independent of any weight gain it may cause (11).

Additionally, countries where sugar consumption is highest also have the highest rates of type 2 diabetes, while those with the lowest consumption have the lowest rates (12).

The link between sugar intake and diabetes still holds even after controlling for total calorie intake, body weight, alcohol consumption and exercise (13).

While these studies do not prove that sugar causes diabetes, the association is strong.

Many researchers believe that sugar increases diabetes risk both directly and indirectly.

It may directly increase risk because of the impact fructose has on your liver, including promoting fatty liver, inflammation and localized insulin resistance (91415).

These effects may trigger abnormal insulin production in your pancreas and increase your risk of type 2 diabetes (1416).

Eating large amounts of sugar can also indirectly raise diabetes risk by contributing to weight gain and increased body fat — which are separate risk factors for developing diabetes (17).

What’s more, animal studies suggest that eating a lot of sugar may disrupt the signaling of leptin, a hormone that promotes feelings of fullness, leading to overeating and weight gain (1819).

To reduce the negative effects of high sugar consumption, the WHO recommends getting no more than 10 percent of your daily calories from added sugars that are not naturally found in foods (20).

Natural Sugars Don’t Have the Same Effect

While eating large amounts of added sugars has been linked to diabetes, the same is not true for natural sugars (21).

Natural sugars are sugars that exist in fruits and vegetables and have not been added during manufacturing or processing.

Since these types of sugar exist in a matrix of fiber, water, antioxidants and other nutrients, they’re digested and absorbed more slowly and less likely to cause blood sugar spikes.

Fruits and vegetables also tend to contain far less sugar by weight than many processed foods, so it is easier to keep your consumption in check.

For example, a peach has approximately 8 percent sugar by weight, while a Snickers bar contains 50 percent sugar by weight (2223).

While research is mixed, some studies have found that eating at least one serving of fruit per day reduces diabetes risk by 7–13 percent compared to eating no fruit (2425).

What About Fruit Juice?

Research is mixed on whether drinking 100 percent fruit juice increases diabetes risk.

Several studies have found a link between drinking fruit juice and developing diabetes, perhaps due to juice’s high sugar and low fiber contents (2627).

However, not all studies have replicated these results, so more research is needed (28).

What About Natural Sweeteners?

Though natural sweeteners like honey, maple syrup or agave are made from natural plant sources, they’re still highly refined — much like sucrose or table sugar.

These products contain large amounts of sucrose and fructose and are considered sources of added sugar when used in cooking.

Therefore, they should be consumed in moderation like all added sugars, ideally making up less than 10 percent of your daily calories (29).

Do Artificial Sweeteners Increase Diabetes Risk?

Artificial sweeteners are man-made, sweet-tasting substances that cannot be metabolized by humans for energy. As such, they provide sweetness without any calories.

Though artificial sweeteners don’t spike blood sugar levels, they have still been linked to the development of insulin resistance and type 2 diabetes (30).

Drinking just one can of diet soda per day has been associated with a 25–67 percent increased risk of type 2 diabetes, compared to drinking no diet soda at all (1130).

It’s unclear why artificial sweeteners increase diabetes risk, but there are a variety of theories.

One thought is that artificially sweetened products increase cravings for sweet-tasting foods, leading to higher sugar consumption and weight gain, which increases diabetes risk (31).

Another idea is that artificial sweeteners disrupt your body’s ability to properly compensate for calories consumed from sugar since your brain associates the sweet taste with zero calories (32).

Some research has found that artificial sweeteners can change the type and number of bacteria that live in your colon, which may contribute to glucose intolerance, weight gain and diabetes (33).

While there does appear to be a link between artificial sweeteners and diabetes, more research is needed to understand exactly how they’re related.

Other Risk Factors for Diabetes

While consuming large amounts of added sugar is linked to an increased risk of diabetes, many other factors are at play, such as:

  • Body weight: Research shows that obesity is one of the main risk factors for type 2 diabetes but that losing just 5–10 percent body weight can reduce the risk (34).
  • Exercise: People who live sedentary lifestyles have nearly twice the risk of developing type 2 diabetes compared to those who are active. Just 150 minutes per week of moderate activity can reduce the risk (3536).
  • Smoking: Smoking 20 or more cigarettes per day more than doubles your risk of diabetes, but quitting brings the risk nearly back to normal (37).
  • Sleep apnea: Sleep apnea, a condition in which breathing is obstructed during the night, is a unique risk factor for diabetes (3839).
  • Genetics: The risk of developing type 2 diabetes is 40 percent if one of your parents has it and nearly 70 percent if both parents have it — suggesting a genetic link (40).

How to Eat to Lower Your Risk of Diabetes

In addition to cutting back on added sugars, there are many other dietary changes you can make to reduce your diabetes risk:

  • Follow a whole-foods diet: Diets rich in nuts, fruits, vegetables and whole grains have been linked to a reduced risk of diabetes (364142).
  • Drink coffee: Drinking coffee may reduce your risk of type 2 diabetes. Each daily cup is associated with a 7 percent lower risk of diabetes (43).
  • Eat green leafy vegetables: Eating a diet rich in green leafy vegetables has been linked to a 14 percent lower risk of diabetes (44).
  • Drink alcohol in moderation: Moderate alcohol consumption of up to four drinks per day is linked to a roughly 30 percent lower risk of diabetes, compared to completely abstaining or drinking heavily (45).

If reducing your intake of added sugars feels overwhelming, you can start by simply reducing your intake of sugar-sweetened beverages, which are the primary source of added sugars in the standard American diet (46).

This one small change could make a big impact.

Carefully reading nutrition labels is another must, since there are over 50 different names for sugar used in food products. Learning to notice them is the first step in reducing your consumption.

Thankfully, there are many ways to cut back on sugar while still enjoying a flavorful and nutrient-dense diet, so you don’t have to feel deprived.

The Bottom Line

Excessive amounts of added sugars have been associated with an increased risk of type 2 diabetes, likely due to negative effects on the liver and a higher risk of obesity.

Natural sugars like those found in fruits and vegetables are not linked to diabetes risk — whereas artificial sweeteners are.

In addition to sugar consumption, overall diet quality, body weight, sleep quality, exercise and genetics all play a role in the development of this disease.

Eating a diet rich in fruits, vegetables, nuts and coffee, consuming alcohol in moderation, maintaining a healthy body weight and exercising regularly can help reduce your risk of type 2 diabetes.

Related at Care2

Image via Thinkstock

29 comments

Aba Comms
Aba Comms21 days ago

America’s beverage companies agree that it’s important for people to be mindful of their sugar intake, and we’re offering many choices: bottled water, beverages with zero sugar or less sugar, and smaller packages. It’s important to note, though, that neither beverages with or without sugar uniquely cause diabetes.

Contrary to the claims here, low- and no-calorie sweeteners and the beverages that use them have proven to be an effective tool for weight loss and management. In fact, a study published in the American Journal of Clinical Nutrition in 2013 confirms that beverages that contain these ingredients can be an important tool in helping reduce calories, and also helped with sweet cravings. Moreover, a two-part study published in the journal Obesity showed that dieters who drank low- and no-calorie beverages lose as much, if not more, weight (and were able to keep more off) than those who were restricted to water only.

America’s beverage companies are committed to being part of real solutions to public health challenges with initiatives like Balance Calories - an initiative to reduce the calories Americans consume from beverages nationally by 20 percent by 2025. Learn more here: BalanceUS.org.

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Ruth S
Ruth S22 days ago

Thanks.

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Mona M
Mona M22 days ago

Thank you, always surprised that no one ever mentions the connection between sicknesses and all the mental attitudes and emotions which are the root of so many illnesses and when Groddeck in 1902 was considered as the founder of The Psychosomatic Medicine !

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Glennis W
Glennis W23 days ago

Is also heridity Runs in my sons family side Thank you for caring and sharing

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Glennis W
Glennis W23 days ago

Very informative Thank you for caring and sharing

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Glennis W
Glennis W23 days ago

Great information and advice Thank you for caring and sharing

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Glennis W
Glennis W23 days ago

Very interesting article Thank you for caring and sharing

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Elizabeth M
Past Member 23 days ago

great article many thanks.

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hELEN h
hELEN h23 days ago

tyfs

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Donna T
Donna T23 days ago

thank you

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