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The Villages
Thursday, April 22, 2021

Sugared drinks linked to several health issues

Dr. Gabe Mirkin

A study from the University of Zurich found that drinking sugared drinks three times a day more than doubles the amount of fat produced by your liver, to increase chances for suffering from a fatty liver that markedly increases risk for Type II diabetes, obesity, heart attacks and certain cancers (J Hepatol, Mar 5, 2021;S0168-8278(21)00161-6). The study found that sugared drinks (80 grams/day) did not increase the total calories taken in, since those who took the sugared drinks ate fewer calories from other sources. Table sugar contains sucrose, formed by glucose and fructose bound together in a single molecule. The authors found that drinks containing fructose and table sugar (glucose bound to fructose), but not glucose by itself, caused this marked increase in fat production by the liver. For a more complete discussion on glucose and fructose, see How Eating and Drinking Sugar Can Cause Diabetes

Sequence from Sugared Drinks to Fatty Liver
• After you eat, your blood sugar level rises
• Your pancreas releases insulin
• Insulin lowers blood sugar by driving sugar from your bloodstream into your liver and muscles
• Your liver and muscles can store only a limited amount of sugar
• So all extra sugar that cannot be stored immediately is converted to triglycerides, which are pure fat
• Extra triglycerides damage your blood vessels, so insulin drives triglycerides (fat) from your bloodstream into your liver, fat cells and muscles
• Your fat cells fill up with fat and you can become obese
• Your liver cells fill up with fat and you develop a fatty liver
• Fat in your liver prevents your liver from accepting sugar from your bloodstream, so you stop responding to insulin and become insulin insensitive (Gastroenterology, 2008;134(5):1369–1375)

• The more fat you have in your liver, the greater your insulin resistance (Gastroenterology, 2008;135(1):122–130)

• The higher your insulin levels, the more fat you deposit in your liver (Hepatology, 2014;59(6):2178–2187), because insulin resistance causes even more fat to be deposited in your liver (J Clin Invest, 2020;130(3):1453–1460)

• Insulin resistance causes you to deposit fat in your belly so you end up with a large belly

• Since sugar can’t get into a fatty liver, your blood sugar rises higher and higher and you become diabetic.

Why Skinny Buttocks and Thighs are Signs of Diabetes
A study from Cambridge University in England showed that not being able to store excess fat in your buttocks and thighs can cause diabetes (Nature Genetics, November 14, 2016). An international team studied more than two million genetic variants in 200,000 people and found 53 regions of genes associated with insulin resistance, diabetes and heart attacks. They then did CT scan X rays on 12,000 people to see where they stored fat and found that people who are genetically susceptible to diabetes lack the ability to store much fat in their thighs and buttocks. That means that if you genetically lack the ability to store much fat in the lower part of your body, you are at increased risk for storing most of your fat in your liver and becoming diabetic if you gain any excess weight at all.

Overweight people who are shaped like pears, with a flat belly and large buttocks, are at far less risk for heart attacks and diabetes than people who are shaped like an apple, with a big belly and small buttocks. You are likely to be prediabetic or diabetic if you:
• can pinch more than three inches of fat under the skin at the front of your belly, even if you are thin everywhere else
• have a high fasting blood sugar (>95)
• have high blood sugar one hour after eating (>145)
• have high triglycerides (>150)
• have low good HDL cholesterol (<40)
• have a high HBA1C (>5.5), a test that shows too much sugar stuck on cells
• have a lot of fat in your liver (shown on a sonogram)

Skinny People Can Store Too Much Fat in the Liver
If you have excess fat in your liver, you can be at great risk for Type II diabetes, even if you are not overweight. Several recent articles show that:
• Storing fat in your belly is a stronger risk factor for diabetes than just being overweight, and is arguably the most common cause of diabetes in North America today (BMC Public Health, November 18, 2019). Eleven percent of 5,228 non-obese people had excess belly fat and these normal-weight people with big bellies had significantly higher levels of blood pressure, fasting blood sugar, total cholesterol and triglyceride levels, indicating increased risk for diabetes and heart attacks.
• Measuring a person’s waist circumference is a simple and efficient way to see if people who are not overweight are still at increased risk for diabetes (Arch Med Sci Civil Dis, July 22, 2019;4:e64–e71). Men are at increased risk for being diabetic if their waist circumference is greater than 38 inches, and women if it is greater than 36 inches.
• People with excess fat in the liver are at increased risk for being deficient in iron, which causes them to become anemic and have less energy, be less active and far less likely to exercise than people with normal amounts of liver fat (Clinical Gastroenterology and Hepatology, Dec 1, 2019).
• Diets that restrict added sugars and other refined carbohydrates in foods such as bakery products, pastas and most dry breakfast cereals, help people to reduce the amount of fat in their liver, decrease insulin resistance and lower triglycerides and cholesterol (Metab Syndr Relat Disord, 2019;17(8):389-396).

My Recommendations
More than seventy percent of North Americans adults will become diabetic or prediabetic, diseases that are curable with lifestyle changes and are not curable by drugs alone. Insulin insensitivity (failure to respond to insulin) causes the majority of all cases of type II diabetes and prediabetes, and insulin insensitivity is caused by excess fat in the liver (J Clin Invest, May 19, 2020). The ability of insulin to lower high blood sugar levels is best in people who are skinny and do not have a fatty liver. As people gain weight, they become insulin insensitive. When they have both excess body fat and a fatty liver, they are insulin insensitive and therefore are diabetic or prediabetic.

Dr. Gabe Mirkin is a Villager. Learn more at www.drmirkin.com.

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