The Case Against Sugar

by Gary Taubes

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.

And on those very rare occasions when sugar consumption declined—as it did, for instance, during World War I, because of government rationing and sugar shortages—diabetes mortality invariably declined with it.

“The only trouble with the American diet,” as Fred Stare, the founder and head of the nutrition department at Harvard University, said in 1976 on national television, is that “we eat too damn much.”

“This is not about demonizing any industry,” as Michelle Obama said in 2010 about “Let’s Move,” her much-publicized program to combat childhood obesity. 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.

These sugars are not short-term toxins that operate over days and weeks, by this logic, but ones that do their damage over years and decades, and perhaps even from generation to generation. In other words, mothers will pass the problem down to their children, not through how and what they feed them (although that plays a role), but through what they eat themselves and how that changes the environment in the womb in which the children develop.

And also the fathers whose dietary choices impact sperm quality.

It has led some Alzheimer’s researchers to refer to Alzheimer’s as type 3 diabetes.

We are clearly doing something different from what we did fifty years ago, or 150 years ago, and our bodies and health reflect it. Why?

The goal of this book is to clarify the arguments against sugar, correct some of the misconceptions and preconceptions that have dogged the debate for the hundreds of years during which it’s been ongoing, and provide the perspective and context needed to make reasonable decisions on sugar as individuals and as a society. People are dying today, literally every second, from diseases that seemed virtually nonexistent in populations that didn’t eat modern Western diets or live modern Western lifestyles. Something is killing them prematurely. This book will document the case against sugar as the prime culprit.

the first necessary step in preventing or avoiding these diseases is to remove the sugars from our diets.

The sweet shop in Llandaff in the year of 1923 was the very center of our lives. To us, it was what a bar is to a drunk, or a church is to a Bishop. Without it, there would have been little to live for….Sweets were our life-blood. ROALD DAHL, Boy: Tales of Childhood, 1984

Imagine a moment when the sensation of honey or sugar on the tongue was an astonishment, a kind of intoxication. The closest I’ve ever come to recovering such a sense of sweetness was secondhand, though it left a powerful impression on me even so. I’m thinking of my son’s first experience of sugar: the icing on the cake at his first birthday. I have only the testimony of Isaac’s face to go by (that, and his fierceness to repeat the experience), but it was plain that his first encounter with sugar had intoxicated him—was in fact an ecstasy, in the literal sense of that word. That is, he was beside himself with the pleasure of it, no longer here with me in space and time in quite the same way he had been just a moment before. Between bites Isaac gazed up at me in amazement (he was on my lap, and I was delivering the ambrosial forkfuls to his gaping mouth) as if to exclaim, “Your world contains this? From this day forward I shall dedicate my life to it.” MICHAEL POLLAN, Botany of Desire, 2001

Imagine a drug that can intoxicate us, can infuse us with energy, and can do so when taken by mouth. It doesn’t have to be injected, smoked, or snorted for us to experience its sublime and soothing effects. Imagine that it mixes well with virtually every food and particularly liquids, and that when given to infants it provokes a feeling of pleasure so profound and intense that its pursuit becomes a driving force throughout their lives. Overconsumption of this drug may have long-term side effects, but there are none in the short term—no staggering or dizziness, no slurring of speech, no passing out or drifting away, no heart palpitations or respiratory distress. When it is given to children, its effects may be only more extreme variations on the apparently natural emotional roller coaster of childhood, from the initial intoxication to the tantrums and whining of what may or may not be withdrawal a few hours later. More than anything, our imaginary drug makes children happy, at least for the period during which they’re consuming it. It calms their distress, eases their pain, focuses their attention, and then leaves them excited and full of joy until the dose wears off. The only downside is that children will come to expect another dose, perhaps to demand it, on a regular basis. How long would it be before parents took to using our imaginary drug to calm their children when necessary, to alleviate pain, to prevent outbursts of unhappiness, or to distract attention? And once t...

sugar appears to be a substance that causes pleasure with a price that is difficult to discern immediately and paid in full only years or decades later.

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.

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. The

The yearly amount of sugar consumed per capita more than quadrupled in England in the eighteenth century, from four pounds to eighteen, and then more than quadrupled again in the nineteenth. In the United States, yearly sugar consumption increased sixteen-fold over that same century.

Along the way, sugar and sweets became synonymous with love and affection and the language with which we communicate them—“sweets,” “sweetie,” “sweetheart,” “sweetie pie,” “honey,” “honeybun,” “sugar,” and all manner of combinations and variations. Sugar and sweets became a primary contribution to our celebrations of holidays and accomplishments, both major and minor. For those of us who don’t reward our existence with a drink (and for many of us who do), it’s a candy bar, a dessert, an ice-cream cone, or a Coke (or Pepsi) that makes our day. For those of us who are parents, sugar and sweets have become the tools we wield to reward our children’s accomplishments, to demonstrate our love and our pride in them, to motivate them, to entice them. Sweets have become the currency of childhood and of parenting.

Because it is a nutrient, and because the conspicuous sequelae of its consumption are relatively benign compared with those of nicotine, caffeine, and alcohol—at least in the short term and in small doses—it remained, as Sidney Mintz says, nearly invulnerable to moral, ethical, or religious attacks. It remained invulnerable to health attacks as well.

“I know not why we should blush to confess that molasses was an essential ingredient in American independence,” wrote John Adams in 1775. “Many great events have proceeded from much smaller causes.”

The New York Times noted that more than half a billion dollars had been collected in sugar taxes by the federal government in the 1880s alone.

With sugar becoming so cheap that everyone could afford it, the manner in which we consumed it would change as well. Not only did we add sugar to hot beverages and bake it into wheat products or spread it on top—jams and jellies were two foods that cheap, available sugar made ubiquitous, since fruit could now be preserved at the end of the growing season and provide nutrition (sweetened, of course) all year round—but the concept of a dessert course emerged for the first time in history in the mid-nineteenth century, the expectation of a serving of sweets to finish off a lunch or dinner.

by the mid-nineteenth century onward, sugar had become the currency of childhood.

Flour milling was one of the many technological revolutions in the nineteenth century, for instance, and as the mills ground the flour ever more pure and white, even the yeast bugs saw little benefit from eating it. Sugar was added by the bakers to make the yeast rise, and rise faster, and to make palatable otherwise tasteless flour.

Four industries in particular emerged beginning in the 1840s to contribute directly to the sugar saturation of our diets and our lives by producing and marketing foods and beverages in which sugar was the primary or defining ingredient. We can think of these foods and beverages as doing for sugar what cigarettes did for tobacco (and all of them would eventually be targeted to children).

By 1903, The New York Times was estimating yearly candy industry sales at $150 million in the United States alone, up from “almost nothing” a quarter century earlier.

Milton Hershey, among others, had begun mixing the chocolate with milk to make it sweeter, more delicately flavored, and thus more appealing to children. A remarkable proportion of the chocolate staples of the twentieth century and today were first created and mass-produced between 1886 (the Clark bar) and the early 1930s—Tootsie Rolls (1896), Hershey’s Milk Chocolate bar (1900), Hershey’s Kisses (1906), Toblerone (1908), the Heath bar (1914), Oh Henry! (1920), Baby Ruth (1921), Mounds and Milky Way (1923), Mr. Goodbar (1925), Milk Duds (1926), Reese’s Peanut Butter Cups (1928), Snickers (1930), Tootsie Roll Pops (1931), and the Mars and 3 Musketeers bars (1932).

Ice cream had been a treat for the wealthy since it was first invented—apparently in Italy—in the late seventeenth century.

Coca-Cola was the conception of John Pemberton, an Atlanta maker of patent medicines, whose revelation was to mix the formulation for Vin Mariani—an exceedingly popular French wine (among its fans were Thomas Edison, H. G. Wells, President William McKinley, and six French presidents), infused with the powdered leaves of the coca plant (cocaine)—with kola nuts, another popular ingredient in patent medicines, and the carbonated water being dispensed in soda fountains. Pemberton removed the wine from his formula in 1885, when local counties in Georgia voted to ban the sale of alcohol. That’s when he added sugar to disguise the natural bitterness of the kola and the coca leaves.

Orwell observed, sales of what he called “cheap luxuries” had surged. “The peculiar evil is this,” he wrote. “A millionaire may enjoy breakfasting off orange juice and Ryvita biscuits; an unemployed man doesn’t….When you are unemployed, which is to say when you are underfed, harassed, bored and miserable, you don’t want to eat dull wholesome food. You want something a little bit ‘tasty.’ There is always some cheaply pleasant thing to tempt you.” This observation alone may be enough to explain the resiliency of the sugar industry, regardless of how hard the times, and of the “depression-proof” nature of candy, ice cream, and soft drinks. Annual per capita sugar consumption in the depth of the Great Depression was sixteen pounds higher than it had been in 1920. Candy consumption climbed steadily through the Depression.

Soft drinks, candy, and ice-cream sales would regularly hit new highs—ice-cream consumption alone doubled between 1940 and 1956—but now sugar would become a mainstay of breakfasts as well, first in fruit juices and then in sugar-rich breakfast cereals.

The dried-cereal industry had its roots in Battle Creek, Michigan, and the health-food movement of the late nineteenth century. The pioneers were John Harvey Kellogg, a physician who was a follower of the Seventh-day Adventist Church, and his competitor and former patient, C. W. Post.

sugar had what the British physician Willoughby Gardner, writing in the British Medical Journal in 1901, would call “unexpected stimulating properties.” This observation distinguished sugar from other carbohydrates and suggested that it was, literally, a stimulant—the late-nineteenth- and early-twentieth-century version of a performance-enhancing drug.

Cleave had been arguing in the pages of The Lancet since 1940 that the more a food changes from its natural state, the more harmful it’s going to be to the animal that consumes it—in this case, humans—and that sugar and refined flour were the most dramatic examples of this.

To Cleave, the refining of sugar and white flour and the dramatic increase in their consumption since the mid-nineteenth century were the most significant changes in human nutrition since the introduction of agriculture roughly ten thousand years before. “Such processes,” he wrote about the refining of sugar and wheat, “have been in existence little more than a century for the ordinary man and from an evolutionary point of view this counts as nothing at all.”

Depending on how it’s calculated (what proportion of the sugar and HFCS sold is then actually consumed), by 1999 we were now eating and/or drinking from two to three times the dose of sucrose and HFCS that Glinsmann and his FDA colleagues had officially defined as safe just thirteen years earlier.

Over the years, as the research on metabolic syndrome has accumulated, it has generated an ever-growing list of metabolic and hormonal abnormalities that accompany insulin resistance and are thus found in the obese, and which precede both heart disease and diabetes. These include large numbers of LDL particles in the circulation (not the cholesterol itself, but the particles that carry the cholesterol) and elevated blood levels of uric acid, a precursor of gout. They also include a state of chronic inflammation, marked by a high concentration in the blood of a protein known as C-reactive protein and other inflammatory molecules.

High cholesterol isn’t among the cluster of metabolic abnormalities, nor is elevated LDL cholesterol, the “bad” cholesterol. Rather, the key factors are high triglycerides, low HDL cholesterol, high blood pressure, overweight, glucose intolerance, and, more than anything, the condition of being insulin-resistant and thus oversecreting insulin, day in and day out. All of these abnormalities happen to be related to the carbohydrate content of the diet, not to the fat content.

Today one in every ten adolescents is thought to have nonalcoholic fatty liver disease, as are an estimated seventy-five million adults (perhaps not coincidentally, the same number as are estimated to have metabolic syndrome). The condition has now been diagnosed in infants.

some of us can only tolerate a little sugar; some of us can tolerate a lot—and

Women who are glucose-intolerant during their pregnancies will have children who are born larger and fatter than women who aren’t, and those children will carry a greater risk of obesity and diabetes as they themselves reach adulthood. This includes not just women who are diabetic before pregnancy or become diabetic during pregnancy—a condition known as gestational diabetes—but obese women or women who gain a lot of weight in pregnancy. All these women will have higher blood sugar on average than women who remain lean and healthy; their triglycerides will be higher as well. This would explain why maternal obesity, as has been documented repeatedly, is a strong risk factor for childhood obesity and among the strongest predictors of metabolic syndrome and obesity in adulthood.

In other words, if your blood pressure is elevated, that’s a sign that you’re insulin-resistant and have metabolic syndrome; it also means you’re likely to be overweight, or at least getting fatter, and your triglycerides are elevated, you’re glucose-intolerant, and your HDL cholesterol is low.

In 2003, epidemiologists from the Centers for Disease Control, led by Eugenia Calle, published an analysis in The New England Journal of Medicine reporting that cancer mortality in the United States was clearly associated with obesity and overweight. The heaviest men and women, they reported, were 50 and 60 percent more likely, respectively, to die from cancer than the lean. This increased risk of death held true for a host of common cancers—esophageal, colorectal, liver, gallbladder, pancreatic, and kidney cancers, as well as, in women, cancers of the breast, uterus, cervix, and ovary. In 2004, the CDC followed up with an analysis linking cancer to diabetes, particularly pancreatic, colorectal, liver, bladder, and breast cancers. Cancer researchers trying to make sense of this association would later say that something about cancer seems to thrive on the metabolic environment of the obese and the diabetic.

As the University of California, Berkeley, authority Michael Pollan has so memorably put it, we should “eat food. Not too much. Mostly plants.”

The traditional response to the how-little-is-too-much question is that we should eat sugar in moderation—not eat too much of it. But this is a tautology. We only know we’re consuming too much when we’re getting fatter or manifesting other symptoms of insulin resistance and metabolic syndrome. At that point, the assumption is that we can dial it back a little and be fine—drink one or two sugary beverages a day instead of three, or, if we’re parenting, allow our children ice cream on weekends only, say, rather than as a daily treat. But if it takes years or decades, or even generations, for us to get to the point where we manifest symptoms of metabolic syndrome, it’s quite possible that even these apparently moderate amounts of sugar will turn out to be too much to reverse the situation and return us to health. And if the symptom or complication of metabolic syndrome and insulin resistance that manifests first is something other than getting fatter—cancer, for instance—we’re truly out of luck. The authorities (or self-appointed authorities) who argue for moderation in our eating habits tend to be those who are relatively lean and healthy; they define moderation as what works for them. This assumes that the same approach and amount will have the same beneficial effect on all of us (and that it will continue to work for them as well). If it doesn’t, of course, if we fail to remain lean and healthy or our children fail to do so, the assumption that, naturally again, follows fr...