Sugary Soft Drinks Contribute To Diabetes

Women who drink higher amounts of sugar-sweetened drinks are likelier to gain weight and develop type 2 diabetes, according to a report in the Journal of the American Medical Association.

The study adds new fuel to the debate on the sources of weight gain and their ultimate impact on the ever-growing diabetes epidemic.

Both the study's authors and its critics agree that caloric intake is crucial to the problem.

Type 2 diabetes and its partner, obesity, are among the top public health crises in the world today, with over 17 million US adults suffering from type 2 diabetes.

According to the study authors, soft drinks are the leading source of added sugars in the US diet.

Soft Drinks Contributed To Weight Gain

Moreover, the increase in the prevalence of diabetes and obesity has coincided with a 61 percent increase in the consumption of soft drinks by adults, and a doubling in consumption by children and adolescents between the late 1970s and the mid-1990s.

This prospective study looked at over 91,000 women participating in the ongoing Nurses' Health Study II, all of whom were free of diabetes and other major chronic diseases in 1991.

During the eight-year course of the study, however, 741 cases of type 2 diabetes were confirmed.

Weight gain over two four-year periods (1991 to 1995 and 1995 to 1999) turned out to be highest among women who increased the number of sugar-sweetened soft drinks they consumed from one or fewer per week to one or more per day.

Women who increased their consumption of fruit punch also gained more weight than those who decreased their consumption.

In this study, women who drank high levels of sugar-sweetened soft drinks also smoked more, were less physically active, and had lower intakes of fiber and magnesium.

Even after adjusting for other factors, women who consumed one or more sugar-sweetened soft drinks per day had an 83 percent increased risk of developing diabetes compared to those who drank less than one per month.

Women who drank one or more fruit punches a day had twice the risk for diabetes as women who drank less than one a month.

Diet cola and fruit juice was not associated with type 2 diabetes.

Weight gain was only one way that these beverages seemed to increase the incidence of type 2 diabetes, according to the researchers.

"About half of the increase in the risk of type 2 diabetes is due to the weight gain that occurs with sugar-sweetened beverages, but the other half may be related to the fact that these sugars are rapidly absorbable," said Dr. JoAnn Manson, a study co-author.

"High-fructose corn syrup leads to fast and dramatic rises in glucose and insulin levels, and that can lead to insulin resistance and the development of type 2 diabetes," adds Dr. Manson, chief of preventive medicine at Brigham and Women's Hospital in Boston.

There may also be an issue of how satisfied and full these beverages make consumers feel. Women who drank large amounts of these beverages also tended to eat more, although it was not entirely clear why.

"Drinking something that has calories is not going to fill you up," said Elisabetta Politi, nutrition manager at Duke University's Diet and Fitness Center in Durham, N.C.

"That's what we need to be vigilant about," Politi says. "It's definitely a good recommendation for people struggling with weight control to not consume caloric drinks."

"Calories In, Calories Out" a Factor

The findings drew criticism from the soft drink industry. "Frankly, I think the conclusions are scientifically unsound," said Richard Adamson, vice president for scientific and technical affairs at the American Beverage Association.

"It has nothing to do with a particular macronutrient. Basically, it's calories in and calories out," Adamson says.

Dr. Manson agreed with the last part of that statement.

"I agree that it's calories in and calories out in terms of weight gain," Dr. Manson says.

"Sugar-sweetened soft drinks are not single-handedly causing the epidemic of obesity and type 2 diabetes, but they are important contributors," she says.

"Sedentary lifestyle, high intake of fast foods, large portion sizes, and high calorie intake overall are very important factors, [but] there is still an independent contribution for sugar-sweetened beverage intake," Dr. Manson explains.

Always consult your physician for more information.

Online Resources

American Diabetes Association

Centers for Disease Control and Prevention (CDC)

October 2004

Sugary Soft Drinks Contribute To Diabetes

Soft Drinks Contributed To Weight Gain

"Calories In, Calories Out" a Factor

What Causes Obesity?

Online Resources

Other Resources:

Find a St. John's Mercy Physician

Diabetes Services at St. John's Mercy

Diabetes Health Information

St. John's Mercy Classes and Programs

What Causes Obesity?

In many ways, obesity is a puzzling disease. How the body regulates weight and body fat is not well understood. On one hand, the cause appears to be simple in that if a person consumes more calories than he or she expends as energy, then he or she will gain weight.

However, the risk factors that determine obesity can be a complex combination of genetics, socioeconomic factors, metabolic factors, and lifestyle choices, as well as other factors. Some endocrine disorders, diseases, and medications may also exert a powerful influence on an individual’s weight.

Factors which may influence the occurrence of obesity include, but are not limited to, the following:

genetics - Studies have shown that a predisposition toward obesity can be inherited. The chance of being overweight increases by 25 percent if one or both parents are obese. Where a person carries weight - the hips or around the middle - is also strongly influenced by heredity.

metabolic factors - How a particular person expends energy is different from how someone else’s body uses energy. Both metabolic and hormonal factors are not the same for everyone, but these factors play a role in determining weight gain. Recent studies show that levels of ghrelin, a peptide hormone known to regulate appetite, and other peptides in the stomach, play a role in triggering hunger and producing a feeling of fullness (satiety).

socioeconomic factors - There is a strong relationship between economic status and obesity, especially among women. Women who are poor and of lower social status are six times more likely to be obese than women of higher socioeconomic status. The occurrence of obesity is also highest among minority groups, especially among women. Sixty percent of African-American women 45 years old or older are overweight.

lifestyle choices - Overeating, along with a sedentary lifestyle, contributes to obesity. These are lifestyle choices that can be affected by behavior change.

Eating a diet in which a high percentage of calories come from sugary, high-fat, refined foods promotes weight gain. And, as more US families eat on the go, high-calorie foods and beverages are often selected.

Lack of regular exercise contributes to obesity in adults and makes it difficult to maintain weight loss. Many of the strategies that produce successful weight loss and maintenance help prevent obesity. Improving eating habits and increasing physical activity play a vital role in preventing obesity.

Recommendations for adults include:

• Eat five to six servings of fruits and vegetables daily. A vegetable serving is one cup of raw vegetables or one-half cup of cooked vegetables or vegetable juice. A fruit serving is one piece of small to medium fresh fruit or one-half cup of canned or fresh fruit or fruit juice.
  
  
• Choose whole grain foods such as brown rice and whole wheat bread. Avoid highly processed foods made with refined white sugar, flour, and saturated fat.
  
  
• Weigh and measure food in order to be able to gain an understanding of portion sizes. For example, a 3-ounce serving of meat is the size of a deck of cards. Avoid supersized menu items.
  
  
• Balance the food “checkbook.” Taking in more calories than are expended for energy will result in weight gain. Regularly monitor weight.
  
  
• Avoid foods that are high in “energy density,” or that have a lot of calories in a small amount of food. For example, a large cheeseburger with a large order of fries may have almost 1,000 calories and 30 or more grams of fat.
  
  
• Remember that much may be achieved with proper choices in serving sizes.
  
  
• Accumulate at least 30 minutes or more of moderate-intensity activity on most, or preferably all, days of the week. Examples of moderate intensity exercise are walking a 15-minute mile, or weeding and hoeing a garden.
  
  
• Look for opportunities during the day to perform even ten or 15 minutes of some type of activity, such as walking around the block or up and down a few flights of stairs.

Always consult your physician for more information.