There is a widespread belief that sugar is the sole cause of diabetes. After all, the disease is characterised by high levels of sugar in the blood.

Diabetes was first identified through the sweet smell of urine, and it later became apparent that sweet, sugary urine signified a high level of blood sugar. Over time, diabetes treatment has swung from eating primarily sugar (to replace what is lost), to avoiding sweetness (to limit high sugar levels).

Today, the debate on amounts and thresholds of sugar and its role in diabetes seems as fierce as ever.

Type 1 diabetes is an autoimmune disease, where genetics and environmental factors interact. Some research suggests that sugar intake may play a role in the development of type 1 diabetes, but the research isn’t conclusive.

For type 2 diabetes, a diet high in sugar could, in principle, influence or accelerate the progression of the disease depending on the pattern of consumption. But to suggest that dietary sugar might cause or contribute to type 2 diabetes needs strong scientific evidence that demonstrates that either sugar increases body weight and body fatness (necessary for type 2 diabetes), or that sugar has some kind of unique effect that leads to 2 diabetes, irrespective of weight or body fatness.

What we mean when we talk about sugar

What most people understand to be sugar is sucrose: a mix of glucose and fructose. A common misunderstanding is that blood glucose is derived solely from dietary sugar. Almost all of the sugar in the body, including the blood, is in the form of glucose – one of many sugars belonging to the family of carbohydrates.

Sugars typically form a small part of the diet, not all of them are equally effective at increasing blood glucose levels, and other carbohydrates, as well as fats and protein, influence glucose levels, too.

Animal studies show that high sugar diets lead to rapid weight gain and impair the body’s ability to effectively regulate blood glucose. But these effects are mainly due to the fructose component of sucrose and not glucose.

In people, diets high in sugar have also been shown to increase weight as well as risk factors for cardiovascular disease. But these effects only seem to occur when calories are not being controlled; simply exchanging extra sugar with calories from another source won’t prevent these negative effects. Also, observational studies have failed to show a harmful association between dietary sugar and type 2 diabetes.

Type 2 diabetes has arisen through rising body weights. Fatter people eat more of many things – not only sugar – and extra calories from any nutrient will lead to weight gain. Most sugary processed foods, such cakes and chocolate, contain large amounts of fat which contribute heavily to the calorie content.

Nothing special about sugar

Recently, the debate has turned to sugar-sweetened drinks, such as fizzy drinks. Sugars in drinks are less satiating than sugars in solid foods, and this may drive our appetite to eat more. Sugary drinks have been linked to type 2 diabetes, independent of body fatness. But so have artificially sweetened low calorie drinks. Fruit juices, though, have not been linked to type 2 diabetes despite having similar sugar contents to fizzy drinks.

There is nothing special about sugar that sets it apart from other foods, and sugar does not cause type 2 diabetes on its own. Generally, people eating lots of sugar tend to have poorer diets and unhealthier lifestyles. These, as well as other factors including urban growth patterns, the built environment, the food environment, stressful jobs, poor sleep and food pricing probably contribute more to the rising incidence of type 2 diabetes than dietary sugar.

Folk medicine has favoured apple cider vinegar for centuries and many claims are made for its supposed benefits.

Apple cider vinegar is made by chopping apples, covering them with water and leaving them at room temperature until the natural sugars ferment and form ethanol. Bacteria then convert this alcohol into acetic acid.

Strands of a “mother” will form in the cider. These are strained out of many products but left in others, and are often the target of health claims. The “mother” can also be used to start the production of the next batch of cider.

But will apple cider vinegar really help you lose weight, fight heart disease, control blood sugar and prevent cancer? And what about claims it is rich in enzymes and nutrients such as potassium?

Read more: The long, strange history of dieting fads

Weight loss

The evidence that apple cider vinegar helps fight fat is weak.

A short-term study in Japan added two daily drinks of 15 millilitres of apple cider vinegar mixed with 250 ml of water to the usual diet of overweight men and women. Their weight fell by about one kilogram over 12 weeks, but returned to usual levels within four weeks.

According to a UK study, it may be that vinegar can suppress appetite. When offered a pleasant-tasting vinegar drink, one that was less palatable, or a non-vinegar drink with their breakfast, volunteers who downed both vinegar drinks felt slightly nauseated. Not surprisingly, this depressed their appetite, with the least palatable vinegar drink having the greatest effect.

 

Others claim taking apple cider vinegar with meals will help digest proteins faster and therefore generate higher levels of growth hormone. This is claimed to break down more fat cells. Unfortunately, there’s no evidence to support such ideas.

Claims that pectin – a type of viscous dietary fibre – in cider vinegar will help weight loss by making you feel full for longer ignores the fact that the pectin in apples is not found in apple cider vinegar.

Heart disease

Pectin is again credited for cider vinegar’s supposed benefits for heart disease, with claims it “attracts bad LDL cholesterol”.

However, the Japanese study referred to for weight loss found no difference in LDL cholesterol with either a low or higher amount of cider vinegar over a 12-week period.

Read more – Heart disease: what happens when the ticker wears and tears

Others claim that cider vinegar works like a broom to clean toxic wastes out of the arteries. Sadly, there’s no evidence for that one either.

Blood sugar and diabetes

Several studies have reported on the effects cider vinegar can have on blood glucose levels. One small study of healthy volunteers found that adding vinegar to a meal reduced glucose and insulin levels – at least for 45 minutes – and increased satiety for up to two hours.

Another small study of people with type 2 diabetes reported adding vinegar to a high carbohydrate meal reduced the subsequent rise in the blood glucose level.

However, this effect was only apparent for a high glycaemic index carbohydrate, such as mashed potatoes. When the carbs came from a lower GI food such as wholegrain bread, the vinegar had no effect.

Read more – Explainer: what is diabetes

A word of warning for those with type 1 diabetes who also have damage to the vagus nerve (a common co-problem): when taking apple cider vinegar in water before a carb-rich meal, the delay in the stomach contents passing to the small intestine may alter the quantity of insulin so the usual daily injection may be inappropriate.

Other diseases

As for allergies, acne, arthritis, hiccups and leg cramps, there is no evidence that apple cider vinegar prevents or cures any of these conditions.

Nor is there evidence from any studies that cider vinegar has benefits for preventing or curing cancer. Unproven cancer cures can waste valuable time in seeking reliable treatments.

So is it worth taking?

Some sites promoting unrefined cider vinegar claim it is a good source of potassium. We certainly need potassium to help regulate the balance of water and acidity in the blood.

But with apple cider manufacturers declaring their products have just 11 milligrams per 15 ml serve (and a recommendation for two serves a day) it is a negligible source. The recommended dietary intake of potassium is 2,800 mg/day for women and 3,800 mg/day for men. Bananas have around 400 mg.

 

In Australia, products cannot claim to be a source of any nutrient unless a reasonable daily intake provides at least 10% of the recommended daily intake (RDI). A “good source” must have 25% of the RDI.

There is also no evidence to support the idea that apple cider vinegar makes it easier to absorb calcium.

On the good side, like all vinegars, it has virtually no kilojoules and, mixed with extra virgin olive oil, makes an excellent salad dressing.

Finally, a word of warning: don’t drink apple cider vinegar “neat”. It can damage the throat and oesophagus. Even diluted, its acidity can damage tooth enamel.

The alcohol industry has been misleading the public about the real link between alcohol and cancer, with tactics similar to those used by the tobacco industry. This is the finding from research published today in the Drug and Alcohol Review journal. The misleading information is being passed off as health messaging to a public largely unaware that it’s coming from the industry itself.

For nearly three decades, we have known cancer risk increases with alcohol consumption levels, on a dose-to-response basis. That is, the more we drink the greater the risk.

Back in 1988, the World Health Organisation’s cancer research arm concluded that alcohol consumption was a group one carcinogen – a direct cause of cancer in humans. In Australia in 2010, about 3,200 cases of cancer were attributable to alcohol consumption.

And it doesn’t matter if you’re swilling shiraz at the Mosman Park Dinner Society or downing lager at the Bullamakanka Darts Club, it’s the alcohol, not the type of beverage, that does the damage.

Read more: Does alcohol cause cancer?

Led by the London School of Hygiene and Tropical Medicine, the latest study concluded:

The [alcohol industry] appears to be engaged in the extensive misrepresentation of evidence about the alcohol-related risk of cancer. These activities have parallels with those of the tobacco industry.

The authors pointed to three main strategies the industry uses to do this:

• denying, omitting or disputing the evidence that alcohol consumption increases cancer risk
• distorting the evidence by mentioning cancer but misrepresenting the link, such as implying risk is present only with higher levels of drinking
• distracting or diverting discussion away from the independent effects of alcohol on common cancers, such as mentioning alcohol is one of many causes. Breast and bowel cancer appeared to be particular targets for this type of misrepresentation.

Dodgy public health messages?

The study assessed key messages provided by 27 organisations run, funded or controlled by the alcohol industry in English-speaking countries. Known as social aspects and public relations organisations, these bodies seek to shape consumer messaging about alcohol and seem to be gaining increasing resources and prominence.

One example of such an entity is the International Alliance for Responsible Drinking. The research paper states that its members include some of the world’s leading beer, wine and spirits producers.

The Australian example included in the study is DrinkWise. Its 13-member board includes six alcohol industry representatives from groups such as the Distilled Spirits Industry Council of Australia, the Brewers Association of Australia and New Zealand and the Australian Hotels Association. DrinkWise says its “primary focus is to help bring about a healthier and safer drinking culture in Australia”.

A recent survey showed that, of the one in two people who had heard of DrinkWise, only around a third (37%) knew the alcohol industry funded it.

Drinkwise’s message on alcohol’s impact on cancer opens by saying alcohol is “one of a number of factors that contribute to the risk for developing certain types of cancer”. This is true. But some might consider this “distraction”.

The second message is:

Cancer risk associated with the consumption of alcohol is related to patterns of drinking, particularly heavy drinking over extended periods of time.

Again, technically true. But it avoids the fact low levels of consumption lead to low levels of risk increase. The research out today classified this as “distortion”.

Learn more about cancer risk: Interactive body map

The way information is framed is essential to the message people take from it. And there’s little doubt the alcohol industry are masters of communication.

Information such as that given by DrinkWise may invite a drinker looking to avoid the thought their own drinking might increase their risk of cancer to think: “but other things are more important causes of cancer” and “I am not a heavy drinker over a long period of time so I am OK”. Conveniently, “heavy drinker” is not clearly defined.

Too few people know alcohol is a significant contributor to cancer, and this is a problem.

Not enough know the link

A survey conducted in 2008 in Western Australia found over 55% of adult women, when prompted, recognised a link between alcohol consumption and cancer risk. In the same survey, around 42% of women reported believing red wine consumption helped to prevent cancer.

A more recent national survey found 53% of adults linked alcohol with cancer risk. And funnily enough, just over half (52%) of those drinking at high or very high risk levels did not perceive their drinking to be harmful.

Read more: Social acceptance of alcohol allows us to ignore its harms

In 2010-11, the WA government ran an education campaign to show how alcohol increased the risk of breast cancer. This improved community awareness of the link from 62% to 87%. It also led to more women reporting the intention to reduce their drinking.

Before the campaign, 10% of those who drank fewer than two standard drinks per day reported they intended to reduce drinking. This rose to 25% after seeing the campaign. Among those who drank more than two drinks a day, the figure went from 28% to 38.5%.

If these effects play out in the wider community through a national campaign, it may well result in a meaningful reduction in alcohol sales. Obviously, this is not in the industry’s interest.

Cancer is the most feared illness. This is particularly so for middle-aged and older people who see their peers increasingly getting cancer diagnoses. And yet new research shows people in the baby boomer generation are the group least likely to be reducing their consumption.

Research on health warnings on alcohol labels suggests messages about the link between booze and bowel cancer have the greatest effect on making drinkers think twice. So should we be surprised the industry selling the product is keen to muddy the waters about what is a clear connection between drinking and cancer?

For too many people, the alcohol and cancer story is new news. The more we drink the more we increase the risk of cancer.

This is another inconvenient truth to add to the list. But we must all have the information to allow us to make the choice. And the alcohol industry is clearly not the best source of that information.