23 ms·

Type 2 Diabetes and cardiovascular disease attributable to sugar beverages

432 points by tchalla 2y ago

D-Coder 2y ago
Does this mean that soft-drink companies could be facing tobacco-company-style lawsuits?
lakomen 2y ago
What else will they find out, that sugar is sweet?
SMP-UX 2y ago
Trying to attribute it to just one cause is always fallacious. In truth the modern Western diet is probably the worst of it. Highly processed seed oils that are chemically extracted and used for frying and baking. I'm not one of those people who believes that they are genuinely toxic but they have too much omega-6. Inexpensive sources of sugar everywhere. Conditioners and preservatives in everything. Most vegetables and fruits are sprayed with pesticides to some degree. Low variety and diversity of vegetables in traditional diets. Combine this with exceedingly high levels of misinformation both from the government and various dietitians, celebrities, medical journals, doctors, Facebook groups and users, conspiracy theorists etc. It's hard for people to know what is actually going to kill them and what isn't. All I can tell you is is that I got a pair of 90-year-old grandparents who always eat eggs and bacon for breakfast, cook their food the old fashioned way, drink plenty of tea and always seek out the highest quality ingredients for their foods.
sitkack 2y ago
> Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries https://www.nature.com/articles/s41591-024-03345-4.pdf https://www.nature.com/articles/s41591-024-03345-4.pdf The data and the code used for the analysis appears to be available. ---- One of the reasons that we don't have Universal Healthcare in the US is that things that are categorically unhealthy would be prohibited from being sold. Afterall, it would benefit not only the receivers of care but also the people funding the healthcare system. The sellers of those things will fight (to their death) to prevent that environment from existing. Not allowing something to be mass produced, marketed and sold is different than banning it outright. I personally think mass scale tobacco and soda should not be sold, at the same time I think people can hand roll and pack a pipe into the grave. Same for their at home bathtub soda.
- malux85 2y ago
  I think you strike a good balance between personal freedoms and health of the population. You’re right in that availability is the problem. If I go across the road to the store, there’s a whole WALL covered in hundreds, maybe thousands, of sugar drinks, all very very cheap. You know what there isn’t any of in the whole store? Something healthy and low sugar / high protein. I have the luxury of time and a little bit of money so I can choose, but what about the busy parent who just needs energy? The busy office worker with a bunch of projects due, or just the poor individual with not much money, I don’t think it’s fair to setup these kind of situations and then blame the individuals for their choices, we have to step in at a governmental level
  - firesteelrain 2y ago
    FWIW - the convenient stores near me sell the Core Power Elite Protein drinks. I have picked them up and it helps make my protein goals on days where I come up short. They do taste pretty good but more expensive than a soda. It's possible people are depressed and looking for the most tasty option.
    - ElevenLathe 2y ago
      One thing 7-11s have started stocking in recent years is packaged hard boiled eggs. The price is insane if you compare it to boiling your own, and they are a bit tasteless, but you don't have to peel them and the price is reasonable compared to other stuff there if you're stuck eating lunch from 7-11.
      - firesteelrain 2y ago
        It is more than twice the price of Wal-Mart! Well, I guess that's the price of convenience. 2/hard boiled eggs - $2.09 @ 7/11 6/hard boiled eggs - $2.96 @ Wal-Mart 6/raw eggs - $2.62 @ Wal-Mart
        lithocarpus 2y ago
tomcar288 2y ago
It's good to see more studies come on this but it's not exactly news. Researchers have known for quite some time now that there's an entire constellation of diseases (diabetes, stroke, certain cancers, fatty liver disease, heart disease, etc, etc) known as metabolic syndrome that are all caused by diet and lifestyle.
- lithocarpus 2y ago
  What's new to me is that it's becoming newsworthy, more people are talking about it. To my current understanding, metabolic syndrome caused by sugar / glucose spikes is by far the biggest root cause of physical health issue in the US. Most people I know personally who are suffering from physical ailments, it's most likely metabolic syndrome at the root of it. How to shift culture on this? When I'm in civilization in the US I'm constantly confronted with foods I have to turn down. It doesn't have to be that way. Furthermore, because of what is in my opinion bad science and propaganda, a lot of people still think they need to stay away from saturated fat, which pushes them toward processed high glycemic index foods. Sure, you can eat a low saturated fat and low glycemic diet but it's not so easy. I'm serious it's shocking the number of people suffering from metabolic syndrome / diabetes who have told me they are trying to stay away from saturated fat but are eating crazy amounts of sugar. I hope this continues to be talked about more and more so the people I love can turn down sugar without feeling like they're radical and countercultural. Partly I think there's a taboo on talking about health and diet, that would be good to shift. I'm not about fat shaming but diabetes is really just bad, and preventable and reversible, and I'd like for that to be widely agreed on and talked about. Will also be interesting to see how lawsuits like this play out: https://chat.google.com/dm/wQTk3gAAAAE/WPNwzCxw9sI/WPNwzCxw9sI https://chat.google.com/dm/wQTk3gAAAAE/WPNwzCxw9sI/WPNwzCxw9...
  - Mistletoe 2y ago
    It's not propaganda. Saturated fat is bad. That's a common internet belief that runs rampant because saturated fat tastes good and it sounds awesome to believe some conspiracy against it. https://www.heart.org/en/news/2019/10/21/advisory-replacing-saturated-fat-with-healthier-fat-could-lower-cardiovascular-risks https://www.heart.org/en/news/2019/10/21/advisory-replacing-... Most of it always tracks back to Nina Teicholz. I wonder how many people she is sending to the grave? https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31886-5/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
dotcoma 2y ago
Really? I thought it was salad’s fault.
siliconc0w 2y ago
I'd bet a dollar per gram additive sugar tax in excess of 5g would immediately flatten the chronic disease curve. Maybe double that if it's marketed towards kids. There are a lot of problems besides sugar/HFCS but it's easily towards the top of the list.
- jopsen 2y ago
  Shops will just sell the sugar and the soda separately, mix it yourself :) Or people will pay more.
  - bitmasher9 2y ago
    I bet adding the sugar yourself would reduce consumption considerably. Which would be the goal of the tax.
    - llamaimperative 2y ago
      Unfortunately Internet people like to point out the hypothetical 99th percentile person who would evade/be immune to such incentives and suggest that therefore, it would not be worth doing. It’s such a common and lazy pattern on HN :(
      - Someone1234 2y ago
        When I read those, I don't actually think those people believe their own arguments. They started with a conclusion, like "sugar taxes are bad," and then worked backwards to find an argument to fit it. That's why when you challenge them they just shift the goalposts.
  - PaulRobinson 2y ago
    Not what has happened in the UK, where sugar tax has been a thing since 2018. It's now actually quite hard to find a sweetened drink - almost all soda-style beverages now are "zero sugar", sweetened with artificial sweeteners. Nobody is buying sugar and pouring it in. Nobody. It's a little too early to determine if this has slowed the prevalence of diabetes in the population. One problem is that other studies have shown that drinking artificially sweetened beverages with foods means many people end up eating more calories of food - the brain is looking for calories indicated by the sweet taste its not getting from the beverage, so compensates. It's a complex picture, but sugar taxes seem to be a reasonable way to get sugary drinks off the shelves.
caseyy 2y ago
If A causes diabetes, then it causes C outcome of diabetes. It’s a tautology. ((A → B) ∧ (B → C)) → (A → C)
- dekhn 2y ago
  That's not how biology works. In biology, instead of "necessary but not sufficient", we have "sufficient but not necessary".
neom 2y ago
Interesting. I think folks in the comments here maybe missed this paper is way more about the beverages part making it important. The research is around sugar sweetened beverages (SSBs). If I'm reading it right, the SSBs have a differentmetabolic effect. "Due to their liquid form, SSBs are rapidly consumed and digested, resulting in lower satiety, higher caloric intake and weight gain. High doses of rapidly digested glucose also activate insulin and other regulatory pathways, which can result in visceral fat production, hepatic and skeletal muscle insulin resistance and weight gain. High doses of rapidly digested fructose directly activate hepatic fat synthesis, leading to ectopic fat deposition and metabolic dysfunction in liver and muscle" Unfortunately I can't find where they define high dose, but if you look at what they say is high elsewhere, it seems to be around 9 servings a week of "any beverage with added sugars and >50 kcal per 8 oz serving, including commercial or homemade beverages, soft drinks, energy drinks, fruit drinks, punch, lemonade and aguas frescas." - A can of coke is 12oz I believe?
- KittenInABox 2y ago
  I'm curious what is the number of added sugars and above 50kcal peer 8 oz serving. You can get away with saying fruit drinks have no added sugar and still be insanely sugary.
  - athenot 2y ago
    Fruit drinks have a neat trick to increase sugar content. Take apple juice for example: you can evaporate water out of it till it's a sugary syrup, then add it to regular apple juice, and it's still called "100% pure apple juice no sugar added". (This is also done with various flavor essences from the juice, so they can recombine them in such a way as to produce a uniform flavor all throughout the year regardless of where the fruits are coming from.)
    - ricardobeat 2y ago
      Not in the EU: > It should be clearly indicated when a product is a mixture of fruit juice and fruit juice from concentrate https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A32001L0112 https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A...
busyant 2y ago
I know several people who’ve undergone bariatric surgery. One of the post-surgery ‘rules’ is … “Don’t drink your calories.”
- hombre_fatal 2y ago
  It's odd to me that zero-calorie sodas aren't the default by now.
  - tasty_freeze 2y ago
    I used to drink a lot of soda but stopped 15 years ago and have had a total of three or four cans since. I switched to unsweetened green tea instead of a zero-calorie soda because I don't like the taste of artificial sweeteners, and I am somewhat suspicious of the unknown long-term consequences of their use.
    - busyant 2y ago
      > I am somewhat suspicious of the unknown long-term consequences of their use. Can you elaborate on what you mean? You're suspicious that sweetened drinks are more harmful than advertised? Less harmful? Something else?
      - gitaarik 2y ago
        A lot of sweeterers used are synthatically created, and their long-term health effects are not well studied. They could cause various diseases, or could confuse your metablic system, because your body thinks it is getting calories because the food is sweet, but then the calories are not there so you could actually get an energy drop from it.
      - tasty_freeze 2y ago
        sorry, I didn't check my comment history to see if there were any replies. Aspertame, stevia, whatever else have been around for a just a few decades and in heavy use for less than that. My fear is it isn't just adding sweetness but doing other metabolic things we don't yet appreciate.
pelagicAustral 2y ago
I only ever drink coke when I'm mixing with whisky... not sure which one is worse...
- schroeding 2y ago
  Same, but with rum. Just doesn't work as well with the diet stuff for some reason, too. Classic coke + Cuban rum + lime == very good time. :D
- hilux 2y ago
  The Coke is definitely worse, unless you're flying an airliner, of course.
  - MichaelDickens 2y ago
    People who have serious health issues from drinking soda are usually drinking 1+ liters per day. A liter of whiskey per day would be extremely bad for you.
    - hilux 2y ago
      My goodness – I've been doing it all wrong! Also, you are quite wrong on the amount of soda. Depending on your genetics, it takes a lot less than that to mess up your A1c.
- f1shy 2y ago
  I drink coke in very small dose, mixed with Fernet branca. And I know positively, that if somebody upvotes this, is coming from a very specific country, where I’ve been, where it is very popular :) I do not think is so bad, as I drink it a couple of times a month (tops).
hilux 2y ago
It's "good" that this is in Nature, but does any health-aware person not already know this? Our real problem is that most people aren't health-aware, and advertising (including the pharma-funded healthcare system) absolutely overwhelms common-sense truths about health. Over the past few years I have improved my own health by greatly limiting my intake of sugars, including by cutting out "healthy" smoothies, but I learned all this from Dr Internet, and NOT from any physician who was being paid to treat me. US physicians' knowledge of nutrition is stuck at whatever they were taught in med school, which was probably 20+ years behind the research at that time.
- pama 2y ago
  The HN title shortening is a bit misleading. The paper systematically analyzes the burden of this known effect on 184 countries.
xnx 2y ago
There is almost nothing* like sugar drinks in the natural world our bodies evolved in. Sugar drinks are about as different as tea leaves and pure cocaine. It's is no coincidence that both are refined white powders. *honey
- ricardobeat 2y ago
  I take it you haven’t tried a nice ripe mango from subtropical regions, or a pineapple, white grapes (or grape juice), watermelon, navel oranges? They can be sweeter than Dr. Pepper. Sugarcane also exists and you can chew it. They just tended to 1) come with fiber, 2) not be as easy to acquire or eat in large quantities 3) not available all year, or all at once
  - gitaarik 2y ago
    Yes, but when you eat fruit, you also eat the fibers. That slows down your uptake, and will prevent a sugar spike. You don't want your blood sugar level to spike, because then your body will create insulin. The insulin's job is to move the sugar out of the blood. It does this by sending the sugar, which is fuel, to the muscles that need it. If there are no muscles needing fuel, it goes to fat cells for storage. Then after that, sugar levels drop below normal levels. And then you get cravings for a quick snack or sugary drink, and the cycle starts over again. If you eat your sugar with fibers, like in fruit, you don't get a sugar spike, and you don't get an insuline spike, and a sugar drop. Also fruit contains a lot more healthy things aside from the sugar. Vitamins, minerals, anti-oxidants. So yeah, it really is a world of difference whether you drink a cola or eat an apple.
  - Ensorceled 2y ago
    This is nonsense: 100g of mango has 14g of sugar 100g of watermelon has 6.2g of sugar 100g of navel orange has 12g of sugar 100g of sugar has 100g of sugar, 1 can of Dr Pepper has 40g of sugar It's both pure sugar AND more sugar. You have to eat more than half a pound of mango to get to the same sugar as a Dr Pepper.
    - 2y ago
tpoacher 2y ago
"Tendency to manifest consumption of sugar beverages attributable to predisposition to type 2 diabetes and cardiovascular disease." Hm. I thought the "switcheroo test" would create an obviously false "what if" statement in this case, but not so sure.
znpy 2y ago
Tangentially related: a while ago i used to drink aspartame-sweetened drinks (sugarfree coke) but I did quit that as well after reading thst the sweet taste is still going go stimulate insulin production. Speaking with a relative eho is a medical doctor they told me that yes, that’s a thing. I’m not sure to what degree this might fit into the discussion, but just wanted to write this down. Nowadays i just drink water. I still have the occasional beer or the occasional glass of proper wine if i’m out with friends.
- EasyMark 2y ago
  I've known multiple with glucose monitors and all of them told me they saw no increase after drink a diet soda. I think the "aspartame causes sugar spikes" is an urban legend. I never get the sugar rush from them like I do if I drink a sugary soda.
  - snvzz 2y ago
    Wouldn't the insulin w/o sugar cause a drop, instead?
    - TuringNYC 2y ago
      >> Wouldn't the insulin w/o sugar cause a drop, instead? In the short term, but as I understand, the constant insulin response would also cause insulin resistance over time.
      - snvzz 2y ago
        Yeah, long term. But I understood parent as doing immediate measurements and expecting blood sugar increase despite insulin produced with no carb intake.
  - afarviral 2y ago
    Yeah absolutely taking artificial sweetener can't cause a glucose spike itself (no glucose or minimal amount to be derived), but maybe it could contribute to spikier glucose in general (due to sweetness contributing to hormonal dis-regulation/lack of satiety and overeating)
mrcwinn 2y ago
My father was Type 2 and for decades drank sweet tea; sweet tea that progressively became sweeter and sweeter. If you were to let it settle, you would see a thick layer of sugar sitting at the bottom of the glass. Eventually, he lost both of his legs beneath the knee due to infections that festered. He spent his last few years in a wheelchair and then eventually died of a heart attack. Bad habits, bit by bit, over the course of years. As a photojournalist, he won a Pulitzer for earthquake footage in 1989, saw the shuttle take off and land countless times, and took an incredible photo at a NASCAR event of a car, engulfed in flames, flying directly at his lens. (He got the shot and then dove out of the way.) Which I guess is to say... life is ups and downs. Be wary of sugary stuff.
- mc3301 2y ago
  That sounds like an epic photo, indeed.
- underlipton 2y ago
  Your father sounds similar to mine: high-achiever, running every which way. Question: how was his sleep? My father's career was in a field that required annual physical fitness certification; his diet probably could have stood to include less salt and sugar when I was very young, but he cleaned it up, especially by the time he was diagnosed with T2. Something his job also required, however: early mornings. Late nights. And, evidently, not enough time to stop for a moment and determine if he might have sleep apnea (he did). So, I think it's a three-part issue. Diet (sugar), obviously. Exercise, too, and whether or not you're getting it regularly throughout the day, every day. But I think it all goes to shit if you're getting bad sleep, especially if that "bad sleep" is "miniature bouts of asphyxiation." It completely screws with your body's ability to regulate itself, hormonally, and to recover from the day's damage.
  - mrcwinn 2y ago
    Agree about sleep. He managed a newsroom and “put the paper to bed” so he worked from 7pm to 4am. I’m sure it didn’t help. For myself, I’m physically built very differently (leaner) and I don’t care much for sweet tea, so I’m lucky I guess. But as an achiever, sleep is always my battle. Comes and goes!
KWxIUElW8Xt0tD9 2y ago
There is a classic book about the effects of sugar named "Sugar Blues" for the interested. I have a bad reaction to sugar so have to avoid certain foods -- e.g. bananas are a no-no for me.
bentt 2y ago
Fruit smoothies are an interesting case of a "sugar beverage" which doesn't quite act how you'd think. Intuitively, you'd think that speedy ingestion of that much fructose with all its fiber obliterated in a blender could potentially cause spikes in blood glucose. However this study showed that when the fruits had seeds, like blackberries and raspberries, the glucose peak was lower with blended fruit than whole. https://pmc.ncbi.nlm.nih.gov/articles/PMC9657402/ https://pmc.ncbi.nlm.nih.gov/articles/PMC9657402/
- kart23 2y ago
  fiber isn’t ’obliterated’ in a blender, it’s only removed with juices. in juice you strain all the pulp and seeds out, smoothies retain the seeds and fiber.
ketarnath 2y ago
Yet another article implying causation from association. The theory that sugar CAUSES diabetes type 2 fails when you look at people that eat a ton of carbs but keep the fats low: low fat vegans, fruitarians. Find one that's diabetic. They should be dropping like flies. But look at people that eat high fat >40% of calories, and the rest in carbs, and there you'll find the population of the metabolically compromised.
- aziaziazi 2y ago
  I’m not an expert but pretty sure fibers helps a lot regarding diabetes 2, microbiote and many other thing related. Vegans and fruitarians usually gets a lot more fibers than others regimes. But a diverse omnivorous diet including many vegetable is better than tofu+potatoes only. I recommend tempeh (0) instead tofu. I agree with you sugars can’t be seen as the only one cause. 0 http://tempeh.info/ http://tempeh.info/
- spot5010 2y ago
  Can you please cite sources for your claims?
jodosha 2y ago
Not a native English speaker but, isn’t the word “attributable” in the title at least misleading? Shouldn’t it be “linked” instead? The paper indicates correlation, not causality.
- omnicognate 2y ago
  Based on the abstract it's not a study showing that "Type 2 Diabetes and cardiovascular disease [are] attributable to sugar beverages", it's a paper quantifying the "[Amount of] Type 2 Diabetes and cardiovascular disease [that are] attributable to sugar beverages [in various countries]". The link and causation is already well established. This is trying to determine how much harm it's doing in different parts of the world.
gigatexal 2y ago
Well this article scared me. Guess I will have to quit Mountain Dew. But what if I switched to the sugar free one? (Am I swapping diabetes and heart disease for cancer?)
- lm28469 2y ago
  First you should take a few long minutes and think hard about why you drink this shit in the first place.
  - gigatexal 2y ago
    Cuz it tastes good? Because I’m addicted? Because the caffeine is great. Because I hate the taste of coffee. Because I can? I dunno.
    - gitaarik 2y ago
      Hehe ok, next question: do you think those are positive reasons for drinking sodas?
    - aembleton 2y ago
      If you're addicted to the sugar, then the sugar-free version won't satisfy your cravings.
    - lm28469 2y ago
      The human experience is all about controlling your urges. I also like to eat until I feel stuffed and sleep 12 hours a day, but I don't because I value my long term health above short term pleasures. Sadly for us modern life is all about short term pleasures and convenience, if you're not careful you can lose yourself real quick Try sparkling water, home made water kefir, herbal teas, &c.
      - greenie_beans 2y ago
        why are you lecturing somebody on the internet about personal lifestyle choices? as if the whole world doesn't know what they consume can negatively affect their health...
gigatexal 2y ago
What was hard to read from the article was if there’s a weekly or daily intake of sugar from SSB’s that’s “safe”?
rauljordan2020 2y ago
I'm from latam. I never saw anyone drink water growing up. Anytime you try to drink water, people label you as boring, even your parents. Whenever we go to a restaurant, the first thing you ask the waiter is "what sodas do you have?". If you're not feeling like drinking soda and want something "healthier", you ask what kinds of fruit juices they have. If you don't like the options, you settle on a hyper-sweetened tea. I frequently ask my parents to drink more water, and they get defensive saying they drink a lot of water but I just don't see it. The truth is they only drink half a small cup in the middle of the night...
- ninininino 2y ago
  Is there a lack of education on nutrition? Growing up in the 1990s and early 2000s in the United States in a middle class suburban environment, it was definitely considered "boring" to get a water instead of a soda when going out for dinner at a restaurant as a family, but at home it was not. I think we had some awareness that it wasn't healthy to drink soda for every single meal or just when hanging out, but it absolutely was considered normal to have it every day, to drink several cans at a party, to drink several cans at work. If you had drank it at breakfast you would have been looked at like you were crazy though. Now, living in a coastal, cultural capital city as an adult, I don't know anyone who drinks soda in their normal day-to-day life, at home, at restaurants, etc. except in special situations. If anything flavored sparkling water is common. But if I visit my hometown, I do see that people still drink soda heavily, but its diet soda.
- owebmaster 2y ago
  It is very common and nobody will shame you for asking water in Brazil. Some cities even have laws mandating that filtered water should be served for free.
- batushka5 2y ago
  And how are latam's doing? From your writeup seems to be enjoying life
- mmustapic 2y ago
  Latin America is very big, I don’t think you can generalise your experience to a whole subcontinent.
ashtami8 2y ago
How did this article get past the sugar mafia? That too in nature! Yudkin [1] must be chortling ;) Warren Buffett, have your boys been slacking off? Somebody is gonna get really hurt...bad! [1] https://en.wikipedia.org/wiki/Pure,_White_and_Deadly https://en.wikipedia.org/wiki/Pure,_White_and_Deadly
- draw_down 2y ago
  [dead]
havella 2y ago
I drink 270g of pure sugar during a hard 3h bike ride. While allowing me to complete the hard work, it also helps with not feeling empty afterwards and eating uncontrollably. As long as I don’t gain weight It’s all good.

432 points by tchalla 2y ago

D-Coder 2y ago

Does this mean that soft-drink companies could be facing tobacco-company-style lawsuits?

lakomen 2y ago

What else will they find out, that sugar is sweet?

SMP-UX 2y ago

Trying to attribute it to just one cause is always fallacious. In truth the modern Western diet is probably the worst of it. Highly processed seed oils that are chemically extracted and used for frying and baking. I'm not one of those people who believes that they are genuinely toxic but they have too much omega-6. Inexpensive sources of sugar everywhere. Conditioners and preservatives in everything. Most vegetables and fruits are sprayed with pesticides to some degree. Low variety and diversity of vegetables in traditional diets. Combine this with exceedingly high levels of misinformation both from the government and various dietitians, celebrities, medical journals, doctors, Facebook groups and users, conspiracy theorists etc. It's hard for people to know what is actually going to kill them and what isn't. All I can tell you is is that I got a pair of 90-year-old grandparents who always eat eggs and bacon for breakfast, cook their food the old fashioned way, drink plenty of tea and always seek out the highest quality ingredients for their foods.

sitkack 2y ago

> Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries https://www.nature.com/articles/s41591-024-03345-4.pdf https://www.nature.com/articles/s41591-024-03345-4.pdf The data and the code used for the analysis appears to be available. ---- One of the reasons that we don't have Universal Healthcare in the US is that things that are categorically unhealthy would be prohibited from being sold. Afterall, it would benefit not only the receivers of care but also the people funding the healthcare system. The sellers of those things will fight (to their death) to prevent that environment from existing. Not allowing something to be mass produced, marketed and sold is different than banning it outright. I personally think mass scale tobacco and soda should not be sold, at the same time I think people can hand roll and pack a pipe into the grave. Same for their at home bathtub soda.

malux85 2y ago
I think you strike a good balance between personal freedoms and health of the population. You’re right in that availability is the problem. If I go across the road to the store, there’s a whole WALL covered in hundreds, maybe thousands, of sugar drinks, all very very cheap. You know what there isn’t any of in the whole store? Something healthy and low sugar / high protein. I have the luxury of time and a little bit of money so I can choose, but what about the busy parent who just needs energy? The busy office worker with a bunch of projects due, or just the poor individual with not much money, I don’t think it’s fair to setup these kind of situations and then blame the individuals for their choices, we have to step in at a governmental level
- firesteelrain 2y ago
  FWIW - the convenient stores near me sell the Core Power Elite Protein drinks. I have picked them up and it helps make my protein goals on days where I come up short. They do taste pretty good but more expensive than a soda. It's possible people are depressed and looking for the most tasty option.
  - ElevenLathe 2y ago
    One thing 7-11s have started stocking in recent years is packaged hard boiled eggs. The price is insane if you compare it to boiling your own, and they are a bit tasteless, but you don't have to peel them and the price is reasonable compared to other stuff there if you're stuck eating lunch from 7-11.
    - firesteelrain 2y ago
      It is more than twice the price of Wal-Mart! Well, I guess that's the price of convenience. 2/hard boiled eggs - $2.09 @ 7/11 6/hard boiled eggs - $2.96 @ Wal-Mart 6/raw eggs - $2.62 @ Wal-Mart
      - lithocarpus 2y ago

tomcar288 2y ago

It's good to see more studies come on this but it's not exactly news. Researchers have known for quite some time now that there's an entire constellation of diseases (diabetes, stroke, certain cancers, fatty liver disease, heart disease, etc, etc) known as metabolic syndrome that are all caused by diet and lifestyle.

lithocarpus 2y ago
What's new to me is that it's becoming newsworthy, more people are talking about it. To my current understanding, metabolic syndrome caused by sugar / glucose spikes is by far the biggest root cause of physical health issue in the US. Most people I know personally who are suffering from physical ailments, it's most likely metabolic syndrome at the root of it. How to shift culture on this? When I'm in civilization in the US I'm constantly confronted with foods I have to turn down. It doesn't have to be that way. Furthermore, because of what is in my opinion bad science and propaganda, a lot of people still think they need to stay away from saturated fat, which pushes them toward processed high glycemic index foods. Sure, you can eat a low saturated fat and low glycemic diet but it's not so easy. I'm serious it's shocking the number of people suffering from metabolic syndrome / diabetes who have told me they are trying to stay away from saturated fat but are eating crazy amounts of sugar. I hope this continues to be talked about more and more so the people I love can turn down sugar without feeling like they're radical and countercultural. Partly I think there's a taboo on talking about health and diet, that would be good to shift. I'm not about fat shaming but diabetes is really just bad, and preventable and reversible, and I'd like for that to be widely agreed on and talked about. Will also be interesting to see how lawsuits like this play out: https://chat.google.com/dm/wQTk3gAAAAE/WPNwzCxw9sI/WPNwzCxw9sI https://chat.google.com/dm/wQTk3gAAAAE/WPNwzCxw9sI/WPNwzCxw9...
- Mistletoe 2y ago
  It's not propaganda. Saturated fat is bad. That's a common internet belief that runs rampant because saturated fat tastes good and it sounds awesome to believe some conspiracy against it. https://www.heart.org/en/news/2019/10/21/advisory-replacing-saturated-fat-with-healthier-fat-could-lower-cardiovascular-risks https://www.heart.org/en/news/2019/10/21/advisory-replacing-... Most of it always tracks back to Nina Teicholz. I wonder how many people she is sending to the grave? https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31886-5/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

dotcoma 2y ago

Really? I thought it was salad’s fault.

siliconc0w 2y ago

I'd bet a dollar per gram additive sugar tax in excess of 5g would immediately flatten the chronic disease curve. Maybe double that if it's marketed towards kids. There are a lot of problems besides sugar/HFCS but it's easily towards the top of the list.

jopsen 2y ago
Shops will just sell the sugar and the soda separately, mix it yourself :) Or people will pay more.
- bitmasher9 2y ago
  I bet adding the sugar yourself would reduce consumption considerably. Which would be the goal of the tax.
  - llamaimperative 2y ago
    Unfortunately Internet people like to point out the hypothetical 99th percentile person who would evade/be immune to such incentives and suggest that therefore, it would not be worth doing. It’s such a common and lazy pattern on HN :(
    - Someone1234 2y ago
      When I read those, I don't actually think those people believe their own arguments. They started with a conclusion, like "sugar taxes are bad," and then worked backwards to find an argument to fit it. That's why when you challenge them they just shift the goalposts.
- PaulRobinson 2y ago
  Not what has happened in the UK, where sugar tax has been a thing since 2018. It's now actually quite hard to find a sweetened drink - almost all soda-style beverages now are "zero sugar", sweetened with artificial sweeteners. Nobody is buying sugar and pouring it in. Nobody. It's a little too early to determine if this has slowed the prevalence of diabetes in the population. One problem is that other studies have shown that drinking artificially sweetened beverages with foods means many people end up eating more calories of food - the brain is looking for calories indicated by the sweet taste its not getting from the beverage, so compensates. It's a complex picture, but sugar taxes seem to be a reasonable way to get sugary drinks off the shelves.

caseyy 2y ago

If A causes diabetes, then it causes C outcome of diabetes. It’s a tautology. ((A → B) ∧ (B → C)) → (A → C)

dekhn 2y ago
That's not how biology works. In biology, instead of "necessary but not sufficient", we have "sufficient but not necessary".

neom 2y ago

Interesting. I think folks in the comments here maybe missed this paper is way more about the beverages part making it important. The research is around sugar sweetened beverages (SSBs). If I'm reading it right, the SSBs have a differentmetabolic effect. "Due to their liquid form, SSBs are rapidly consumed and digested, resulting in lower satiety, higher caloric intake and weight gain. High doses of rapidly digested glucose also activate insulin and other regulatory pathways, which can result in visceral fat production, hepatic and skeletal muscle insulin resistance and weight gain. High doses of rapidly digested fructose directly activate hepatic fat synthesis, leading to ectopic fat deposition and metabolic dysfunction in liver and muscle" Unfortunately I can't find where they define high dose, but if you look at what they say is high elsewhere, it seems to be around 9 servings a week of "any beverage with added sugars and >50 kcal per 8 oz serving, including commercial or homemade beverages, soft drinks, energy drinks, fruit drinks, punch, lemonade and aguas frescas." - A can of coke is 12oz I believe?

KittenInABox 2y ago
I'm curious what is the number of added sugars and above 50kcal peer 8 oz serving. You can get away with saying fruit drinks have no added sugar and still be insanely sugary.
- athenot 2y ago
  Fruit drinks have a neat trick to increase sugar content. Take apple juice for example: you can evaporate water out of it till it's a sugary syrup, then add it to regular apple juice, and it's still called "100% pure apple juice no sugar added". (This is also done with various flavor essences from the juice, so they can recombine them in such a way as to produce a uniform flavor all throughout the year regardless of where the fruits are coming from.)
  - ricardobeat 2y ago
    Not in the EU: > It should be clearly indicated when a product is a mixture of fruit juice and fruit juice from concentrate https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A32001L0112 https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A...

busyant 2y ago

I know several people who’ve undergone bariatric surgery. One of the post-surgery ‘rules’ is … “Don’t drink your calories.”

hombre_fatal 2y ago
It's odd to me that zero-calorie sodas aren't the default by now.
- tasty_freeze 2y ago
  I used to drink a lot of soda but stopped 15 years ago and have had a total of three or four cans since. I switched to unsweetened green tea instead of a zero-calorie soda because I don't like the taste of artificial sweeteners, and I am somewhat suspicious of the unknown long-term consequences of their use.
  - busyant 2y ago
    > I am somewhat suspicious of the unknown long-term consequences of their use. Can you elaborate on what you mean? You're suspicious that sweetened drinks are more harmful than advertised? Less harmful? Something else?
    - gitaarik 2y ago
      A lot of sweeterers used are synthatically created, and their long-term health effects are not well studied. They could cause various diseases, or could confuse your metablic system, because your body thinks it is getting calories because the food is sweet, but then the calories are not there so you could actually get an energy drop from it.
    - tasty_freeze 2y ago
      sorry, I didn't check my comment history to see if there were any replies. Aspertame, stevia, whatever else have been around for a just a few decades and in heavy use for less than that. My fear is it isn't just adding sweetness but doing other metabolic things we don't yet appreciate.

pelagicAustral 2y ago

I only ever drink coke when I'm mixing with whisky... not sure which one is worse...

schroeding 2y ago
Same, but with rum. Just doesn't work as well with the diet stuff for some reason, too. Classic coke + Cuban rum + lime == very good time. :D
hilux 2y ago
The Coke is definitely worse, unless you're flying an airliner, of course.
- MichaelDickens 2y ago
  People who have serious health issues from drinking soda are usually drinking 1+ liters per day. A liter of whiskey per day would be extremely bad for you.
  - hilux 2y ago
    My goodness – I've been doing it all wrong! Also, you are quite wrong on the amount of soda. Depending on your genetics, it takes a lot less than that to mess up your A1c.
f1shy 2y ago
I drink coke in very small dose, mixed with Fernet branca. And I know positively, that if somebody upvotes this, is coming from a very specific country, where I’ve been, where it is very popular :) I do not think is so bad, as I drink it a couple of times a month (tops).

hilux 2y ago

It's "good" that this is in Nature, but does any health-aware person not already know this? Our real problem is that most people aren't health-aware, and advertising (including the pharma-funded healthcare system) absolutely overwhelms common-sense truths about health. Over the past few years I have improved my own health by greatly limiting my intake of sugars, including by cutting out "healthy" smoothies, but I learned all this from Dr Internet, and NOT from any physician who was being paid to treat me. US physicians' knowledge of nutrition is stuck at whatever they were taught in med school, which was probably 20+ years behind the research at that time.

pama 2y ago
The HN title shortening is a bit misleading. The paper systematically analyzes the burden of this known effect on 184 countries.

xnx 2y ago

There is almost nothing* like sugar drinks in the natural world our bodies evolved in. Sugar drinks are about as different as tea leaves and pure cocaine. It's is no coincidence that both are refined white powders. *honey

ricardobeat 2y ago
I take it you haven’t tried a nice ripe mango from subtropical regions, or a pineapple, white grapes (or grape juice), watermelon, navel oranges? They can be sweeter than Dr. Pepper. Sugarcane also exists and you can chew it. They just tended to 1) come with fiber, 2) not be as easy to acquire or eat in large quantities 3) not available all year, or all at once
- gitaarik 2y ago
  Yes, but when you eat fruit, you also eat the fibers. That slows down your uptake, and will prevent a sugar spike. You don't want your blood sugar level to spike, because then your body will create insulin. The insulin's job is to move the sugar out of the blood. It does this by sending the sugar, which is fuel, to the muscles that need it. If there are no muscles needing fuel, it goes to fat cells for storage. Then after that, sugar levels drop below normal levels. And then you get cravings for a quick snack or sugary drink, and the cycle starts over again. If you eat your sugar with fibers, like in fruit, you don't get a sugar spike, and you don't get an insuline spike, and a sugar drop. Also fruit contains a lot more healthy things aside from the sugar. Vitamins, minerals, anti-oxidants. So yeah, it really is a world of difference whether you drink a cola or eat an apple.
- Ensorceled 2y ago
  This is nonsense: 100g of mango has 14g of sugar 100g of watermelon has 6.2g of sugar 100g of navel orange has 12g of sugar 100g of sugar has 100g of sugar, 1 can of Dr Pepper has 40g of sugar It's both pure sugar AND more sugar. You have to eat more than half a pound of mango to get to the same sugar as a Dr Pepper.
  - 2y ago

tpoacher 2y ago

"Tendency to manifest consumption of sugar beverages attributable to predisposition to type 2 diabetes and cardiovascular disease." Hm. I thought the "switcheroo test" would create an obviously false "what if" statement in this case, but not so sure.

znpy 2y ago

Tangentially related: a while ago i used to drink aspartame-sweetened drinks (sugarfree coke) but I did quit that as well after reading thst the sweet taste is still going go stimulate insulin production. Speaking with a relative eho is a medical doctor they told me that yes, that’s a thing. I’m not sure to what degree this might fit into the discussion, but just wanted to write this down. Nowadays i just drink water. I still have the occasional beer or the occasional glass of proper wine if i’m out with friends.

EasyMark 2y ago
I've known multiple with glucose monitors and all of them told me they saw no increase after drink a diet soda. I think the "aspartame causes sugar spikes" is an urban legend. I never get the sugar rush from them like I do if I drink a sugary soda.
- snvzz 2y ago
  Wouldn't the insulin w/o sugar cause a drop, instead?
  - TuringNYC 2y ago
    >> Wouldn't the insulin w/o sugar cause a drop, instead? In the short term, but as I understand, the constant insulin response would also cause insulin resistance over time.
    - snvzz 2y ago
      Yeah, long term. But I understood parent as doing immediate measurements and expecting blood sugar increase despite insulin produced with no carb intake.
- afarviral 2y ago
  Yeah absolutely taking artificial sweetener can't cause a glucose spike itself (no glucose or minimal amount to be derived), but maybe it could contribute to spikier glucose in general (due to sweetness contributing to hormonal dis-regulation/lack of satiety and overeating)

mrcwinn 2y ago

My father was Type 2 and for decades drank sweet tea; sweet tea that progressively became sweeter and sweeter. If you were to let it settle, you would see a thick layer of sugar sitting at the bottom of the glass. Eventually, he lost both of his legs beneath the knee due to infections that festered. He spent his last few years in a wheelchair and then eventually died of a heart attack. Bad habits, bit by bit, over the course of years. As a photojournalist, he won a Pulitzer for earthquake footage in 1989, saw the shuttle take off and land countless times, and took an incredible photo at a NASCAR event of a car, engulfed in flames, flying directly at his lens. (He got the shot and then dove out of the way.) Which I guess is to say... life is ups and downs. Be wary of sugary stuff.

mc3301 2y ago
That sounds like an epic photo, indeed.
underlipton 2y ago
Your father sounds similar to mine: high-achiever, running every which way. Question: how was his sleep? My father's career was in a field that required annual physical fitness certification; his diet probably could have stood to include less salt and sugar when I was very young, but he cleaned it up, especially by the time he was diagnosed with T2. Something his job also required, however: early mornings. Late nights. And, evidently, not enough time to stop for a moment and determine if he might have sleep apnea (he did). So, I think it's a three-part issue. Diet (sugar), obviously. Exercise, too, and whether or not you're getting it regularly throughout the day, every day. But I think it all goes to shit if you're getting bad sleep, especially if that "bad sleep" is "miniature bouts of asphyxiation." It completely screws with your body's ability to regulate itself, hormonally, and to recover from the day's damage.
- mrcwinn 2y ago
  Agree about sleep. He managed a newsroom and “put the paper to bed” so he worked from 7pm to 4am. I’m sure it didn’t help. For myself, I’m physically built very differently (leaner) and I don’t care much for sweet tea, so I’m lucky I guess. But as an achiever, sleep is always my battle. Comes and goes!

KWxIUElW8Xt0tD9 2y ago

There is a classic book about the effects of sugar named "Sugar Blues" for the interested. I have a bad reaction to sugar so have to avoid certain foods -- e.g. bananas are a no-no for me.

bentt 2y ago

Fruit smoothies are an interesting case of a "sugar beverage" which doesn't quite act how you'd think. Intuitively, you'd think that speedy ingestion of that much fructose with all its fiber obliterated in a blender could potentially cause spikes in blood glucose. However this study showed that when the fruits had seeds, like blackberries and raspberries, the glucose peak was lower with blended fruit than whole. https://pmc.ncbi.nlm.nih.gov/articles/PMC9657402/ https://pmc.ncbi.nlm.nih.gov/articles/PMC9657402/

kart23 2y ago
fiber isn’t ’obliterated’ in a blender, it’s only removed with juices. in juice you strain all the pulp and seeds out, smoothies retain the seeds and fiber.

ketarnath 2y ago

Yet another article implying causation from association. The theory that sugar CAUSES diabetes type 2 fails when you look at people that eat a ton of carbs but keep the fats low: low fat vegans, fruitarians. Find one that's diabetic. They should be dropping like flies. But look at people that eat high fat >40% of calories, and the rest in carbs, and there you'll find the population of the metabolically compromised.

aziaziazi 2y ago
I’m not an expert but pretty sure fibers helps a lot regarding diabetes 2, microbiote and many other thing related. Vegans and fruitarians usually gets a lot more fibers than others regimes. But a diverse omnivorous diet including many vegetable is better than tofu+potatoes only. I recommend tempeh (0) instead tofu. I agree with you sugars can’t be seen as the only one cause. 0 http://tempeh.info/ http://tempeh.info/
spot5010 2y ago
Can you please cite sources for your claims?

jodosha 2y ago

Not a native English speaker but, isn’t the word “attributable” in the title at least misleading? Shouldn’t it be “linked” instead? The paper indicates correlation, not causality.

omnicognate 2y ago
Based on the abstract it's not a study showing that "Type 2 Diabetes and cardiovascular disease [are] attributable to sugar beverages", it's a paper quantifying the "[Amount of] Type 2 Diabetes and cardiovascular disease [that are] attributable to sugar beverages [in various countries]". The link and causation is already well established. This is trying to determine how much harm it's doing in different parts of the world.

gigatexal 2y ago

Well this article scared me. Guess I will have to quit Mountain Dew. But what if I switched to the sugar free one? (Am I swapping diabetes and heart disease for cancer?)

lm28469 2y ago
First you should take a few long minutes and think hard about why you drink this shit in the first place.
- gigatexal 2y ago
  Cuz it tastes good? Because I’m addicted? Because the caffeine is great. Because I hate the taste of coffee. Because I can? I dunno.
  - gitaarik 2y ago
    Hehe ok, next question: do you think those are positive reasons for drinking sodas?
  - aembleton 2y ago
    If you're addicted to the sugar, then the sugar-free version won't satisfy your cravings.
  - lm28469 2y ago
    The human experience is all about controlling your urges. I also like to eat until I feel stuffed and sleep 12 hours a day, but I don't because I value my long term health above short term pleasures. Sadly for us modern life is all about short term pleasures and convenience, if you're not careful you can lose yourself real quick Try sparkling water, home made water kefir, herbal teas, &c.
    - greenie_beans 2y ago
      why are you lecturing somebody on the internet about personal lifestyle choices? as if the whole world doesn't know what they consume can negatively affect their health...

gigatexal 2y ago

What was hard to read from the article was if there’s a weekly or daily intake of sugar from SSB’s that’s “safe”?

rauljordan2020 2y ago

I'm from latam. I never saw anyone drink water growing up. Anytime you try to drink water, people label you as boring, even your parents. Whenever we go to a restaurant, the first thing you ask the waiter is "what sodas do you have?". If you're not feeling like drinking soda and want something "healthier", you ask what kinds of fruit juices they have. If you don't like the options, you settle on a hyper-sweetened tea. I frequently ask my parents to drink more water, and they get defensive saying they drink a lot of water but I just don't see it. The truth is they only drink half a small cup in the middle of the night...

ninininino 2y ago
Is there a lack of education on nutrition? Growing up in the 1990s and early 2000s in the United States in a middle class suburban environment, it was definitely considered "boring" to get a water instead of a soda when going out for dinner at a restaurant as a family, but at home it was not. I think we had some awareness that it wasn't healthy to drink soda for every single meal or just when hanging out, but it absolutely was considered normal to have it every day, to drink several cans at a party, to drink several cans at work. If you had drank it at breakfast you would have been looked at like you were crazy though. Now, living in a coastal, cultural capital city as an adult, I don't know anyone who drinks soda in their normal day-to-day life, at home, at restaurants, etc. except in special situations. If anything flavored sparkling water is common. But if I visit my hometown, I do see that people still drink soda heavily, but its diet soda.
owebmaster 2y ago
It is very common and nobody will shame you for asking water in Brazil. Some cities even have laws mandating that filtered water should be served for free.
batushka5 2y ago
And how are latam's doing? From your writeup seems to be enjoying life
mmustapic 2y ago
Latin America is very big, I don’t think you can generalise your experience to a whole subcontinent.

ashtami8 2y ago

How did this article get past the sugar mafia? That too in nature! Yudkin [1] must be chortling ;) Warren Buffett, have your boys been slacking off? Somebody is gonna get really hurt...bad! [1] https://en.wikipedia.org/wiki/Pure,_White_and_Deadly https://en.wikipedia.org/wiki/Pure,_White_and_Deadly

draw_down 2y ago
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havella 2y ago

I drink 270g of pure sugar during a hard 3h bike ride. While allowing me to complete the hard work, it also helps with not feeling empty afterwards and eating uncontrollably. As long as I don’t gain weight It’s all good.