Trick or treat: Does sugar really cause diabetes?

Halloween is upon us today, and with it comes the excitement of costumes, parties and bags filled with candy and chocolates. As children eagerly sort through their sweet treasures, a familiar warning comes to mind: “Don’t eat too much candy, or you’ll get diabetes!”

But is that really true?

In the clinic, I often hear a similar question. “Doc, did I get diabetes because I ate too many sweets?” Others are puzzled because they rarely eat candy. Then comes an especially Filipino concern: “What about rice? Do I have to stop eating it?”

The answer is not as simple as blaming sugar.

Type 1 diabetes is an autoimmune condition and is not caused by eating sweets. Type 2 diabetes develops when the body becomes resistant to insulin and the pancreas can no longer keep up with the demand. Genetics, excess body fat, physical inactivity, age, and other factors influence risk. Some people develop diabetes even when they seldom touch dessert.

Still, this does not mean sugar is harmless.

Consider soft drinks. A regular 355-milliliter can contains roughly nine to 10 teaspoons of sugar. Sweetened iced tea, milk tea, bottled coffee, energy drinks and some fruit drinks can contain just as much. They deliver large amounts of sugar and calories quickly, often without making us feel full. As one of my professors used to say, “A moment on the lips, forever on the hips.”

Research has found that each additional daily serving of sugar-sweetened beverages was associated with a 25 percent higher relative risk of developing type 2 diabetes. This does not mean soda will give one in four drinkers diabetes. It means habitual consumption is linked with higher risk over time.

The World Health Organization recommends limiting free sugars to less than 10 percent of daily calories, ideally below 5 percent. For someone consuming 2,000 calories daily, that lower target is about 25 grams, less than the sugar in one regular soda.

Candy is different from an everyday habit of drinking soda. One Halloween chocolate or a slice of cake at a party does not suddenly cause diabetes. But frequent sweets, especially when added to an already calorie-rich diet, can contribute to weight gain and poor metabolic health. How much, how often, and what else we eat all matter.

And what about the Filipino love affair with rice? Rice is not sweet, but its starch is broken down into glucose. (Actually all food is eventually broken down into glucose in the body). Large portions of white rice can raise blood sugar. Studies have associated higher white rice consumption with increased diabetes risk, particularly in Asian populations.

We also have a special fondness for kakanin: biko, suman, sapin-sapin, palitaw, and other treats made with malagkit, or glutinous rice. They remind us of merienda, fiestas and family gatherings with loved ones. But sticky rice remains a concentrated source of starch, and many recipes add sugar, coconut milk, or sweet toppings. A dessert made from rice is not automatically healthier than candy simply because it is traditional or homemade.

For someone already living with diabetes, both ordinary rice and sticky rice desserts can raise blood glucose, regardless of how sweet they taste.

That does not mean giving up kakanin or rice altogether. Enjoy a small serving of biko rather than several generous slices. Choose a smaller portion of rice at meals, add vegetables and protein, or try replacing some white rice with higher-fiber grains. There is room for favorite foods in a balanced eating pattern. Reheating white rice rather that eating freshly cooked rice can also alter the glycemic index of the rice, reducing the rise in glucose levels.

Another mistaken belief is that avoiding sugar guarantees protection against diabetes. Someone may skip dessert yet have a strong family history, spend most days sitting, or regularly consume oversized portions of refined starches. Conversely, having diabetes is not proof that a person lacks discipline or self-control.

The most useful advice is straightforward: Eat more whole and fiber-rich foods rather than processed foods, move regularly, choose water more often, get adequate sleep, and seek screening if you have risk factors. Small habits repeated consistently matter more than one celebration where you indulge in dessert.

So when the Halloween candy comes out, there is no need to turn a little sweetness into a scare story. Enjoy a treat, share the rest, and remember that diabetes prevention is about the whole pattern of living, not one piece of candy, one can of soda, or one piece of kakanin.