Another day, another dollar, and another headline touting misleading claims about new research. This time, a new study published in the European Journal of Endocrinology is connecting drinking two or more servings of sweetened beverages a day with an increased risk of latent autoimmune diabetes (LADA) in adults.
Let’s break it down to get a better understanding of what the new research says and what you need to know.
First of all, what is LADA?
LADA is a subset of diabetes which is a metabolic disease where the body no longer properly breaks down food for energy. For example, carbohydrate metabolism (i.e. breaking down carbs for energy) requires that carbohydrates are broken down into glucose. Glucose then enters the bloodstream to be used as energy throughout the body. Its namesake indicates that it is an autoimmune disease, meaning that a person’s immune system has been hijacked and begins to attack a person’s healthy cells and organs, in this case, the pancreas, by mistake.
The proper production and use of insulin (a hormone made in the pancreas) is required for glucose to be used by your muscles. Diabetes develops when the body does not make the proper amounts of insulin, does not use the insulin properly, or a combination of both.
How was the study conducted?
This population-based study in Sweden included individuals with LADA, type-2 diabetes and healthy controls. Sweetened-beverage intake was derived from a validated food frequency questionnaire (FFQ). We’ve gone on (at great length!) about the limitations of using such methodology. As a refresher, here are some of those limitations:
- Reliance on memory leads to systematic errors. Just think: can you remember what you ate yesterday? Probably. What about last week? Maybe. Last month? Nope. Six months ago? Not a chance.
- The study used a FFQ to report their “habitual food intake during the preceding year.” Does that seem like a big limitation? Consider this: those who have diabetes were “specifically instructed to report their average intake during the year before diagnosis.” This means they were asked to report from memory their average intake during the year before their diabetes diagnosis. Considering the age range of participants was between 58-63, this means they could have been asked to report their average intake from years, possibly even decades, ago.
- Additionally, FFQs do not accurately reflect eating patterns of a given population since FFQs use a pre-selected food list, in this particular study, the FFQ included 132 items.
While the study included more than 2,800 participants, the study’s main findings were only based on six percent of the participants who consumed two or more sweetened beverages per day (~172 participants). This group was further broken down into three groups: those with LADA, those with type-2 diabetes, and healthy controls. This is especially important since the study specifically examined the effects of consuming two or more sweetened beverages a day.
- For example, the study also examined the impact of five sweetened beverage servings a day and found a significant increase in risk. However, it’s important to note that in this group, the data were only from 13 total participants: seven with diabetes and 6 without diabetes, especially since the authors’ state the there is a “20 percent risk increase per serving”. I’m less inclined to accept statements such as these from a sample size of 6 or 7.
And finally, the findings were similar for sugar-sweetened and non-sugar-sweetened beverages indicating that these effects cannot be directly linked to either caloric or non-caloric sweeteners.
It’s also important to note that people who consume sugar-sweetened beverages are documented to have poorer diet and exercise habits than non-sugar-sweetened beverage consumers. It is acknowledged as a limitation in this study that it might have impacted the results.
Bottom line: The new study by Löfvenborg et al. does not establish a causal relationship between diet drink consumption and the risk of developing diabetes.
All in all, diabetes is a complex disease that has many different subsets and is caused by a variety of factors including genetic, environmental, hormonal, and lifestyle factors. Given that LADA is an autoimmune disorder, it’s difficult to see a large connection between sugar-sweetened and non-sugar-sweetened beverage intake and increased risk of this disease. If you are diagnosed with diabetes, especially type-2 diabetes, there are a variety of lifestyle changes you can make to improve your health, including managing your calorie and carbohydrate intake, developing a healthy eating style, and making sure you get at least 150 minutes of moderate-intensity physical activity per week.