The Case Against Sugar

by Gary Taubes

Fifty years ago, one in eight American adults was obese; today the number is greater than one in three.

As far back as the sixth century B.C., Sushruta, a Hindu physician, had described the characteristic sweet urine of diabetes mellitus, and noted that it was most common in the overweight and the gluttonous.

In 1890, Robert Saundby, a former president of the Edinburgh Royal Medical Society, presented a series of lectures on diabetes to the Royal College of Physicians in London in which he estimated that less than one in every fifty thousand died from the disease.

Those afflicted with diabetes will die at greatly increased rates from heart disease or stroke, from kidney disease—the disease is now considered the cause of more than 40 percent of cases of kidney failure—and diabetic coma.

Knowing this, did these other fatal conditions depress the number of people recorded by Robert Saundby as dying from diabetes or where they included in his numbers as well?

In fact, anywhere populations begin eating Western diets and living Western lifestyles—whenever and wherever they’re acculturated or urbanized, as West noted in 1978—diabetes epidemics follow.

Meanwhile, the latest surge in this epidemic of diabetes in the United States—an 800 percent increase from 1960 to the present day, according to the Centers for Disease Control—coincides with a significant rise in the consumption of sugar. Or, rather, it coincides with a surge in the consumption of sugars, or what the FDA calls “caloric sweeteners”—sucrose, from sugarcane or beets, and high-fructose corn syrup, HFCS, a relatively new invention.

This book makes a different argument: that sugars like sucrose and high-fructose corn syrup are fundamental causes of diabetes and obesity, using the same simple concept of causality that we employ when we say smoking cigarettes causes lung cancer.

In this book, the focus is specifically on the role of sugar in our diet, and the likely possibility that the difference between a healthy diet and one that causes obesity, diabetes, heart disease, cancer, and other associated diseases begins with the sugar content. If this is true, it implies that populations or individuals can be at the very least reasonably healthy living on carbohydrate-rich diets, even grain-rich diets, as long as they consume relatively little sugar.

This makes some intuitive sense. I've never understood all the craze about paleo diets. Europe for a long time has had heavy amount of grain in the typical diet. Rice is the largest staple food throughout the world and has been so for a very long time.

Students of any science need to know why they are being asked to believe a particular idea, or why not, and on what grounds.

This can be generalized further. Everyone needs to know why they are being asked to believe a particular idea and on what grounds.

I’m going to concede in advance a key point that those who defend the role of sugar in our diet will invariably make. The sugar industry and purveyors of sugar-rich products are right when they say that it cannot be established definitively, with the science as it now stands, that sugar is uniquely harmful—a toxin that does its damage over decades. The evidence is not as clear with sugar as it is with tobacco. This isn’t a failure of science but, rather, an issue of its limits.

As is later pointed out, this is a function of how pervasive sugar is in our society and how unfeasible it would be to run a sufficiently large, controlled study to come up with definitive evidence.

Our bodies appear to respond the same way to both sucrose and HFCS. In a 2010 review of the relevant science, Luc Tappy, a researcher at the University of Lausanne in Switzerland, who is considered by biochemists who study fructose to be among the world’s foremost authorities on the subject, said there was “not the single hint” that HFCS was more deleterious than other sources of sugar.

Fine, but I still think cane sugar tastes better.

The critical question, what scientists debate, as the journalist and historian Charles C. Mann has elegantly put it, “is whether [sugar] is actually an addictive substance, or if people just act like it is.”

The removal of the cocaine in the first years of the twentieth century seemed to have little influence on Coca-Cola’s ability to become, as one journalist described it in 1938, the “sublimated essence of all that America stands for,” the single most widely distributed product on the planet and the second-most-recognizable word on Earth, “okay” being the first.

Is this because Coke is just that good or because Coke is the king of marketing?

consuming sugar will allow adults to work through pain and exhaustion and to assuage hunger pains.

Hungry? Why wait? Grab a snickers

Sugar does induce the same responses in the region of the brain known as the “reward center”—technically, the nucleus accumbens—as do nicotine, cocaine, heroin, and alcohol.

As does using social media!

The more we use these substances, the less dopamine we produce naturally in the brain, and the more habituated our brain cells become to the dopamine that is produced—the number of “dopamine receptors” declines. The result is a phenomenon known as dopamine down-regulation: we need more of the drug to get the same pleasurable response, while natural pleasures, such as sex and eating, please us less and less.

Is this true of anything that stimulates dopamine production?

The twelve-step bible of Alcoholics Anonymous—called the Big Book—recommends the consumption of candy and sweets in lieu of alcohol when the cravings for alcohol arise.

As evidence that it was revered even then, creation myths in New Guinea have the human race emerging from the sexual congress of the first man and a stalk of sugarcane.

The juice or sap from the cane, at least the modern variety, is mostly water and as much as 17 percent sugar. This makes the cane sweet to chew but not intensely so.

It also makes it crazy expensive to grow at scale. Sugar cane requires huge amounts of water to grow.

The greater the refining effort, the whiter and more pure is the end product.

Sugar. We are talking about sugar. Not cocaine.

When the first Crusaders made it back home, they told stories about the fields of sugarcane they had seen and the locals, as Albert of Aachen recorded, “sucking enthusiastically on these reeds, delighting themselves with their beneficial juices, and seem[ing] unable to sate themselves with the pleasure.”

For the next five hundred years, sugar would be ingested medicinally as much as for any other use.

A spoon full of sugar makes the medicine go down?

The conquistadors also came upon the natives drinking chocolate, although unsweetened and spiced with chili peppers.

Mmmm...mole. Now I'm hungry.

From the seventeenth through the nineteenth centuries, sugar was the equivalent, economically and politically, of oil in the twentieth.

What is the equivalent economically and politically of these two in the 21st century?

Sugar was added by the bakers to make the yeast rise, and rise faster, and to make palatable otherwise tasteless flour. Through the decades of the twentieth century, the sugar content in bread rose steadily, feeding what might have been an ever-more-demanding sweet tooth.

(As Sugar: A User’s Guide explained in 1990, white bread—the Wonder Bread of American childhoods, for example—can have a sugar content greater than 10 percent, compared with roughly 2 percent in European breads.)

That does explain a lot. No wonder kids prefer it.

“flue-curing may well be the deadliest invention in the history of modern manufacturing. Gunpowder and nuclear weapons have killed far fewer people.”

The “closest parallel” to what happens in the tobacco leaves during flue curing, notes the 1950 SRF report, is “the massive conversion of starch into sucrose” that happens when bananas are harvested and allowed to ripen.

The leaves of Burley tobacco are porous and absorbent, a quality that prompted the earliest tobacco farmers in Missouri and Kentucky to realize that Burley leaves could easily absorb sugar. These tobacco farmers had taken to sweetening their tobacco after curing with a process that immersed the leaves in a “sugar sauce,” marinating them, in effect, in a concentrated sugar solution that might also typically include honey, maple syrup, molasses, fruit syrups, licorice, and other sweeteners.

In 1937, C. W. Barron, then the owner of The Wall Street Journal, made the pithy observation that if we want to make money in the stock market, we should invest in companies that provide us with our vices. “In hard times [consumers] will give up a lot of necessities,” he said, “but the last thing they will give up is their vices.”

An investor who purchased Coca-Cola stock at its highest price in the summer of 1929, held it through the Crash and the ensuing Depression, and then sold it in 1938 at its lowest price, as Barron’s reported at the time, would have made a profit of 225 percent.

The idea of a breakfast flake that would aid digestion supposedly came to Kellogg in a midnight revelation, and he set to work on it the following morning. Post beat him to it, though, with his Grape Nuts, which by 1900 had earned him what was then the single largest, fastest legitimate fortune in America.

Grape nuts takes some getting used to but has sufficient fiber content it certainly aids in digestion. I've done my research on this one.

General Mills executives worried about the “possible dietary effects” of sugar-coated cereals, and its in-house nutritionist delayed the company’s entry into the pre-sweetened market for years, but eventually they were overruled. The marketing team at General Mills argued that if the company didn’t compete, it wouldn’t survive.

Public health is always trying to get in the way of capitalism. Thankfully, this is murica.

The magazine Consumer Reports may have captured this logic perfectly in 1986 when it claimed, “Eating any of the cereals would certainly provide better nutrition than eating no breakfast at all.”

Nuitrition science; Scientists not needed

Discussions on the value of sugar, the risks and benefits of consuming it in quantity, were informed by the science of nutrition, which was in its infancy.

"science"

“The pissing evil,” he called it, and became the first European physician to diagnose the sweet taste of diabetic urine—“wonderfully sweet like sugar or hon[e]y.”

So was he literally tasting his patients urine? Yes, yes he was. Apparently it was common practice for medical practitioners to do so. https://www.washingtonpost.com/posteverything/wp/2014/07/11/what-a-doctor-can-learn-by-tasting-a-patients-urine/

He would argue that all carbohydrates were, in effect, the same—starch, grains, sugars. Joslin was the first of the many influential medical authorities who literally didn’t know what they were talking about when talking about sugar; his beliefs and his ultimately successful defense of sugar in the diet would be based largely on this misconception.

When blood-sugar (glucose) levels rise, the pancreas secretes insulin in response, which then signals the muscle cells to take up and burn more glucose. Insulin also signals the fat cells to take up fat and hold on to it. Only when the rising tide of blood sugar begins to ebb will insulin levels ebb as well, at which point the fat cells will release their stored fuel into the circulation (in the form of fatty acids); the cells of muscles and organs now burn this fat rather than glucose.

As Price reported, and other researchers would confirm, isolated populations—including Swiss mountain villages, pastoral populations in Central Africa, the Inuit and First Nations people of North America, South Pacific Islanders—had nearly cavity-free teeth and retained their teeth for life, as long as they consumed their traditional diets and avoided the sugar and white flour that had come to dominate diets in the United States and Europe. “It is true that dental caries was not a major health and economic hazard until refined sugar was made available,”

Brushing immediately after meals was known to be relatively effective at preventing cavities, but not nearly as good as avoiding sugar entirely.

In the 1980s, when food-industry analysts were predicting a surge in diet-soda sales that failed to last, one explanation was that consumers continued to think of these substances as far more noxious than sugars and so drank sugar-sweetened beverages instead.

Over the next decade, researchers on both sides of the Atlantic would carry out a series of increasingly elaborate clinical trials designed to test the hypothesis that a diet that lowered our cholesterol levels would prevent heart disease and, more important, allow us to live a longer and healthier life. The results would be, at best, ambiguous.

By 1970, the AHA was advocating low-fat diets for every American, including “infants, children, adolescents, lactating and pregnant women, and older persons,” despite the continued failure of the various clinical trials actually to confirm the hypothesis, or the fact that all these studies had been done in adults—particularly adult men (who are at high risk for heart disease).

Fat consumption may have increased in the United States since the early twentieth century, according to USDA statistics, but the reported increase was not nearly as dramatic or as certain as it had been for sugar since the 1850s.

Four years later, when Keys and his wife, Margaret, co-authored a diet book based on their belief in the healing powers of Mediterranean eating patterns, they insisted that Yudkin was “alone in his contentions,” at least among academic researchers, and added, “Yudkin and his commercial backers are not deterred by the facts; they continue to sing the same discredited tune.”

And there is limited evidence that the Mediterranean diet has any positive effect on heart health. One thing the Mediterranean diet has in common with basically every other diet that has been shown to help people in weight loss is that it also promotes people eating less sugar even if it doesn't place an emphasis on it.

During the Korean War, for instance, pathologists doing autopsies on American soldiers killed in battle noticed that many had significant plaque buildup in their arteries, even though they were only teenagers. The Koreans killed in battle did not. This was later attributed to the fact that the American soldiers ate plenty of butter, meat, and dairy products—all rich in saturated fat—and the Korean soldiers did not. But disparities in sugar consumption could also, obviously, have explained what was seen (as, of course, could other factors as well):

I've heard this exact same anecdote cited for why we should eat less meat.

Some researchers, Bierman and West acknowledged, had “argued eloquently” that refined carbohydrates such as sugar could be a precipitating factor in diabetes (citing Peter Cleave and Aharon Cohen, but not Yudkin). They did not find the idea compelling, however, and omitted any further study of the role of sugar from their research recommendations. “A review of all laboratory and epidemiologic evidence,” they wrote, “suggests that the most important dietary factor increasing the risk of diabetes is total calorie intake, irrespective of source.”

Why is it that again and again scientists did not see compelling evidence on this research that sugar was the cause? What am I missing?

The revised version of the SCOGS review, released a year later, concluded that reasonable evidence existed to conclude that sugar caused tooth decay, but not that it was a “hazard to the public” in any other way, at least not at the levels then being consumed. It described the evidence linking sugar to diabetes as “circumstantial,” and said there was “no plausible evidence” that it was related to the disease, other than as a source of excess calories.

How were these studies structured to be conclusive about the link between tooth decay and sugar but not diabetes and sugar? Is this because tooth decay happens on a more rapid time scale than diabetes? The author has been diligent in pointing out all the cases where research has massive conflicts of interest but I wish there were footnotes here pointing me to the original studies so that I can evaluate them myself.

Instead, it stated unambiguously that “too much sugar in your diet does not cause diabetes,” even though much of the significant research published in the intervening years had come out of the USDA’s own Carbohydrate Nutrition Laboratory and supported the notion that sugar consumption was, indeed, a cause of diabetes, and that even “modest” amounts of sugar could increase the risk of heart disease in a significant proportion of the population.

In the United States, Ancel Keys and his colleagues at the University of Minnesota first fed high-sugar diets to middle-aged men and also reported that their cholesterol levels rose. Keys then repeated the studies with college students and reported that the sugar-rich diets seemed benign to them, reaffirming to Keys that he was right and Yudkin was wrong. But it is possible, if not likely, that men in their forties and fifties respond differently to sugar than they would have in their late teens and early twenties.

Something to think about as I head into my thirties