The Case Against Sugar

Gary Taubes “The Case Against Sugar,” Alfred A. Knopf, 2016, 286 pgs.

This book receives my “Education” label as I deem it important that everyone become familiar with its contents.  Their health may depend on it.

The hypothesis addressed in this book is that sugar is the dietary trigger of obesity and diabetes and, if so, the diseases such as heart disease that associate with them.  But this hypothesis is ultimately about what happens to us over decades—the time it takes chronic diseases to manifest themselves--not months, as is the case with vitamin-deficiency diseases scurvy or beriberi. (p. 185).  Author Taubes compares the dangers of inhaling cigarettes with consuming sugar—both cause chronic diseases that only develop over time, sometimes decades.  Of course, sugar cannot be totally avoided, even milk contains it.  The problem is that we are evolutionarily developed to handle a lot less than western society began to consume by the middle of the nineteenth century.

However awareness of the danger of sugar is negligible, you can examine labels on foodstuffs containing sugar and the emphasis is on ‘fat-free’ with minimal notice of the sugar content.  (Did you know that 11 cans of soda contain a pound of sugar?).   People are dying today from diseases that seemed virtually nonexistent in populations that did not eat modern Western diets.  Something is killing them prematurely.  This book documents the case against sugar as the culprit.

I encourage readers of this review to read the book.  It was rather difficult for me to adequately convey the nuance and thoroughness of the book's content in my relatively short notes that follow.

My Notes:

Pg. 5:  Fifty years ago, one in eight American adults was obese; today the number is greater than one in three.  The World Health Organization reports that obesity rates have doubled worldwide since 1980; in 2014 more than forty million children under the age of five were overweight or obese.  However, the epidemic of diabetes is a more intriguing and a more telling phenomenon.

Pg. 8:  In 2012 the Centers for Disease Control (CDC) estimates that one in every seven to eight adults in America has diabetes—12 to 14 percent depending on the criteria used to diagnose it.  Another 30 percent are predicted to get diabetes at some point during their lives.  Among US military veterans, one in every four admitted to VA hospitals suffers from diabetes.  The great proportion—perhaps 95 percent—have what is now known as type 2 diabetes, the form of the disease that associates with overweight and obesity.  (Type 1 is the acute form, generally found in children, and it kills far more quickly if untreated.)

Pg. 18:  Five of the top ten chronic diseases in modern Western societies that tend to kill us cluster together in both populations and individual patients: diabetes, heart disease, cancer, stroke, and Alzheimer’s.  (Because of this clustering, the author looks for a common cause: Sugar.)

Pg. 40:  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. 

Pg. 43:  From the 1980s onward the sugar industry helped to convince the public that saturated fat in food was the hazard, not sugar.  Fat was removed from candy bars, sugar added, or at least kept, so that they became health-food bars.  Fat was removed from yogurts and sugars added.  Along the way, sugar and sweets became synonymous with love and affection.

Pg. 57:  By the 1920s, sugar refineries were producing as much sugar in a single day—millions of pounds—as would have taken refineries in the 1820s an entire decade.

Pg. 64:  Just as diabetes was an exceedingly rare disease prior to the industrial revolution and the steep rise in sugar consumption that followed, lung cancer was an exceedingly rare disease until cigarettes surged in popularity and transformed an uncommon disease eventually into a scourge.

Pg. 64:  THE MARRIAGE OF TOBACCO AND SUGAR is the name of chapter 3.  Sugar played, and still does, an absolutely critical role in the tobacco epidemic.  The business of sugar in tobacco leaf is little appreciated and were it not for sugar, the American blended cigarette would not have achieved such tremendous development as it did in the first half of the twentieth century.  Until the early twentieth century, Americans mostly smoked cigars or pipes, rarely inhaling the smoke of either, or they chewed plug tobacco.  It took the blending of sugar with tobacco to make deep inhalation possible.  By 1939 40 percent of all the maple sugar produced in the US and almost all of the imports from Canada were being used to sauce tobacco.

Pg. 108:  Two erroneous ideas dominate conventional nutritional wisdom about the impact of foods: (1) that fat in our diet causes the chronic diseases that tend to kill us prematurely in modern Western societies, and (2) that a calorie is a calorie no matter the source.  By this energy-balance logic, the close association between obesity, diabetes, and heart disease implies no profound revelations to be gleaned about underlying hormonal or metabolic disturbances, but rather that obesity is driven, and diabetes and heart disease are exacerbated, by some combination of gluttony and sloth.  We just need to eat in moderation and exercise more.  Thus is sugar exonerated except for its contribution to calories.

Pg. 125:  In 1940, when the military draft began, 40 percent of the first million men called up for service were rejected for medical reasons, of which the primary one was extensive tooth decay. 

Pg. 142:  The Sugar industry was successful in 1970 banning the sugar substitute cyclamates.  By 1972 they almost got saccharin barred as well.  They had found that rats living in a saccharin-rich environment equivalent to a human drinking 800 twelve-ounce diet sodas daily for a lifetime could develop cancer.  However, now the National Cancer Institute acknowledges that neither cyclamates nor saccharin is carcinogenic.  But by now, artificial sweeteners have been irrevocably tainted. 

Pg. 158:  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. 

Pg. 199:  The medical research community came to recognize that insulin resistance and a condition now known as ‘metabolic syndrome’ is a major, if not the major, risk factor for heart disease and diabetes.  Before we get either heart disease or diabetes, we first manifest metabolic syndrome.  The CDC now estimates that some seventy-five million adult Americans have metabolic syndrome.

Pg. 200:  Metabolic syndrome ties together a host of disorders that the medical community typically thought of as unrelated—getting fatter (obesity), high blood pressure (hypertension), high triglycerides, low HDS cholesterol (dyslipidemia), heart disease (atherosclerosis), high blood sugar (diabetes), and inflammation—as products of insulin resistance and high circulating insulin levels (hyperinsulinemia).  It’s a kind of homeostatic disruption in which regulatory systems throughout the body are misbehaving with slow, chronic, pathological consequences everywhere.

Pg. 211:  Diabetes was still a rare disease at the beginning of the Second World War but no population was exempt whether Indian or White.  Times have changed.  The prevalence of diabetes in the US is now closer to one in eleven Americans than to the three or four in a thousand prior to the war. 

Pg. 229:  When populations underwent Westernization, chronic diseases emerged with it, whether rapid or not, and typically in the same order, beginning with periodontal disease (tooth decay), gout, obesity, diabetes, and hypertension, and eventually encompassing all of them. 

Pg. 231:  Thomas L. Cleave (1906-83) on what he called the saccharine disease, suggested that tooth decay provided the obvious clue to the causality of this clustering of Western diseases.  Appearing early in life, he said, it was the equivalent of the canary in the coal mine and foretold the coming of the entire spectrum of Western disease.  Since tooth decay was caused by refined grains and perhaps sugar most of all, Cleave argued, didn’t that imply that the same would be true of all these Western diseases?

Pg. 236:  What makes sugar the leading candidate by far in Western diets that triggers the aforementioned cluster of chronic diseases is the revelations about metabolic syndrome and insulin resistance.  These shifted the obesity/diabetes/heart-disease paradigm from the conventional thinking of the 1970s—obesity is caused by eating too much, diabetes by being too fat, and heart disease by some combination of the two plus the saturated fat in our diets—to the current perspective, according to which metabolic syndrome is the critical player in obesity, heart disease, and diabetes.  And if insulin resistance and metabolic syndrome are ultimately caused by the sugars we consume, then so are, to some extent, all these other diseases as well.  This is why sugar should be at the top of any list of dietary suspects.

Pg. 249:  For those not hopelessly wedded to the hypothesis that salt is the cause of hypertension, it has become increasingly difficult to believe that consuming too much salt is why we become hypertensive and why our blood pressure rises inexorably with age.  Studies show that reducing our average salt intake by half will decrease blood pressure by 4 to 5 mm Hg mercury on average.  (Kind of negligible).  If not salt, then what?  Not surprisingly there’s a long history of evidence implicating sugar.

Pg. 253:  Among the most provocative of the implications of the sugar/insulin-resistance hypothesis is that cancer may well be caused or exacerbated by sugar.  The supposition starts with the observation that cancer seems very much to be a disease of Western diets and lifestyles and increases in prevalence as populations become Westernized.  Although cancer has been with us since ancient times, its increasing prevalence is strongly associated with Westernized diets.  However, from the 1950s onward, popular thinking on the link between Western lifestyles and cancer focused on industrialization and carcinogens in the environment even though only a very small part of the total cancer burden could be laid on industrial chemicals.  Systematic reviews led epidemiologists to conclude that some significant percentage of cancers had to be lifestyle or diet-induced. 

Pg. 263:  Dementia has a long history, and we’re unlikely ever to answer the question of whether it is more common now than it once was The risk of getting Alzheimer’s disease roughly doubles every five years past the age of sixty—or at least it does in modern Western societies—and so, the longer a population lives, the greater the burden or prevalence of Alzheimer’s.  Although several studies have compared the prevalence of Alzheimer’s disease in various populations and suggested that it might be a product of Western diets and lifestyles, this evidence is not nearly as clear as it is with diabetes or even cancer.  Yet, Alzheimer’s, like cancer, is associated with type 2 diabetes, an observation that began to emerge from studies in the mid-1990s of eight hundred elderly residents of Hisayama, Japan; of seven-thousand senior citizens in Rotterdam, the Netherlands and of fifteen hundred type 2 diabetics in Rochester, Minnesota.

Pg. 273:  In 1986 when the FDA concluded that most experts considered sugar safe (at least at the annual level of forty-two pounds per capita that we were then consuming), and when the relevant research communities settled on caloric imbalance as the cause of obesity and saturated fat as the dietary cause of heart disease, the clinical trials necessary to begin to answer such a question were never pursued.