The Case Against Sugar

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

The author begins with an attention-getter:  Sugar is not only the root cause of today’s diabetes and obesity epidemics (had these been infectious diseases, the Centers for Disease Control and Prevention would have long ago declared an emergency), but also is probably related to heart disease, hypertension, many common cancers and Alzheimer’s.  The author goes on to state that bad science and the processed-food industry have colluded to make fat public enemy No. 1 — all the while neglecting carbohydrates, especially the highly processed and easily digested kind. And these are the real culprits in the expansion of our waistlines.  In “The Case Against Sugar,” Taubes, in his thoroughly researched book, distills the carbohydrate argument further, zeroing in on sugar as the true villain. He implicates scientists, nutritionists and especially the sugar industry in what he claims amounts to a major cover-up.

Note:  Eleven 12oz cans of Pepsi contain a pound of sugar (454 grams equal a pound, each 12 oz. Pepsi contains 41g).

My Notes:

Author’s note P. xi:  The purpose of this book is to present the case against sugar—both sucrose and high-fructose corn syrup—as the principal cause of the chronic diseases that are most likely to kill us, or at least accelerate our demise.  The book's goal is to explain why these sugars are the most likely suspects, and how we arrived at the current situation: a third of all adults are obese, two-thirds overweight, almost one in seven is diabetic, and one in four to five will die of cancer; yet the prime suspects for the dietary trigger of these conditions have been, until the last decade, treated as little worse than a source of harmless pleasure.

Pg. 5:  The World Health Organization reports that obesity rates have doubled worldwide since 1980:  in 2014, more than 500 million adults were obese, and more than 40 million children under the age of five were overweight or obese.  (World population is 7 billion).

Pg. 6ff:  Through the mid-nineteenth century, diabetes remained a rare affliction.  In 1934, based on studies done in New York, Massachusetts, and elsewhere—it was estimated that only two to three Americans in every thousand had diabetes.  Times have changed: In 2012 one in every seven to eight adults in the US had diabetes—12 to 14 percent, depending on the criteria used to diagnose it.  Among US military veterans, one in every four admitted to VA hospitals suffers from diabetes.  The market for diabetic drugs and devices in the US is over thirty billion dollars yearly.  What changed?  It appears that whenever and wherever populations began eating Western diets and living Western lifestyles, diabetes epidemics followed.

Pg. 15:  An 800 percent increase (in diabetes) from 1960 to the present day coincides with a significant rise in the consumption of sugar or what the FDA calls ‘caloric sweeteners’—sucrose, from sugarcane or beets, and high-fructose corn syrup.

Pg. 18:  Chronic diseases that ultimately kill us in modern Western societies tend to cluster together in both populations and individual patients.  Diabetes, heart disease, cancer, stroke, and Alzheimer’s account for five of the top ten causes of death in the US.  All of these diseases have now been linked to a condition known as ‘insulin resistance.’  It is a reasonable possibility that the same thing that causes one of these diseases—type 2 diabetes in particular—causes all of them. 

Pg. 35:  Sugar is still a critical ingredient in the American blended-tobacco cigarette, the first of which was Camel, in 1913.  This marriage of tobacco and sugar allowed easy inhaling and addiction. 

Pg. 42ff:  Annual global production of sugar increased exponentially from the 1600s onward.  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.  (Anthropologists believe that sugarcane was first domesticated in New Guinea about ten thousand years ago.  Sugar came to Europe with the Crusades in the eleventh century).  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. 57).

Pg. 53:  By the 1830s, when the British emancipationists finally put an end to the slave trade, some twelve and a half million Africans had been shipped off as slaves to the New World; two-thirds of them worked and died growing and refining sugar.

Pg. 88:  As late as 1900, only a single medical school in the US—Johns Hopkins—required that applicants to their medical school have a college degree.  Many schools, at the time, did not even require that their students finished four years of high school.  What counted most was a willingness to pay the tuition.

Pg. 108:  Until recently, most influential experts believed that the problem of obesity, diabetes, and heart disease in western countries was that dietary fat was the problem and carbohydrates have identical effects on the human body, whether starches or sugar.  This was a gift to the sugar industry: the idea that we get obese or overweight because we take in more calories than we expend.  (The calorie is a calorie myth).

Pg. 119:  It is now clear that type 2 diabetes is not a disease of insulin deficiency (as type 1)—at least not at first—but of insulin resistance. 

Pg. 136:  Saccharin had been discovered in 1879, a derivative of coal tar that would be marketed as a sugar alternative.  It was more than five hundred times sweeter than sugar, and it could be purchased for one-tenth the cost.  Saccharin apparently passed through the body without being metabolized, which made it ideal for diabetics. 

Pg. 138:  Sodium cyclamate was discovered in 1937 and was thirty times sweeter than sugar, as was calcium cyclamate, a sister compound, and they both lacked the bitter aftertaste that some individuals notice with saccharin.  No-calorie soft drinks first appeared in 1952—sweetened by cyclamate or the cyclamate-saccharin mixture they were sold ostensibly for diabetics, but used widely.  Coke and Pepsi released artificially sweetened diet sodas in 1963.  The sugar industry responded with an advertising campaign claiming that artificially sweetened sodas failed to meet the nutritional needs of growing children.

Pg. 139:  In 1958 the sugar industry got the weapon they needed in an amendment to the Pure Food and Drugs Act that had been passed by Congress twenty years earlier.  The original act had mandated that the FDA approve any new ingredient in processed foods as safe before it could be used, specifying that the only criterion for approval was safety.  If a product had a safety risk, no amount of benefit from its use would work in its favor.  The amendment came with what would come to be called the ‘Delaney clause,’ specifying that no additive shall be deemed to be safe if it is found to induce cancer when ingested by man or animal.

This same amendment had also allowed the FDA to exempt some seven hundred existing substances from the approval process on the grounds that they were generally recognized as safe.  These substances, which included both cyclamates and saccharin, had what would come to be known as GRAS (generally recognized as safe) status: the industry could freely use and sell them as food additives, but if new evidence came along to raise questions about their safety, the FDA would have to reassess these as well. The Sugar Association began research designed to force the FDA to remove cyclamates from the GRAS list and have them banned.  If nothing else, the reports from these studies would keep cyclamates and saccharin in the news as a potential health hazard. 

Pg. 142:  Then in 1965, the Sugar Association announced that cyclamates could stunt the growth of rats—at least when the rats consumed these non-caloric sweeteners in quantities equivalent to hundreds of twelve-ounce cans of diet soda daily.  The Delaney clause did not account for whether the dosage required to cause cancer was a realistic one.  So, in 1970 the FDA banned all use of cyclamates.  The sugar industry almost succeeded in barring saccharin as well.  It was found that rats could get cancer if they lived their entire lives in a saccharin-rich environment, ‘in excess of the amount a consumer would receive from drinking 800 twelve-ounce diet sodas daily for a lifetime. However, the ban never happened because the FDA succumbed to a letter-writing campaign and settled for a warning label.  (To confuse matters, the Canadians banned saccharin but left cyclamates on the market, so Sweet ‘N Low in the US is made from saccharin and in Canada from cyclamates.)

Pg. 143:  The FDA now considers neither cyclamates nor saccharin to be carcinogenic In December 2000, the FDA removed the requirement that Sweet ‘N Low carry a warning label but by that time artificial sweeteners had been irrevocably tainted. 

Pg. 152f:  As far back as 1978 the dietary-fat/heart-disease relationship was considered an unproved hypothesis (and still is).  But the press and the US Congress and the US Department of Agriculture treated the hypothesis as almost assuredly true.  This unproven hypothesis filled a vacuum supplying a viable and seemingly reasonable answer to the question of what aspect of diet caused heart disease.  Sugar entered the discussion of causation because it seemed an obvious culprit, at least to nutritionists and researchers who had not already embraced the notion that fat was to blame.  It appeared that whatever the causal factor for diabetes, obesity, and hypertension was likely to be something that accompanied affluence and was an integral part of Western diets or life-styles, and something that could cause all these diseases, not just heart disease alone.  As for diet, by far the most significant and consistent change in human diets as populations become Westernized, urbanized, or merely affluent is how much sugar they consume.  We now eat in two weeks the amount of sugar our ancestors 200 years ago ate in a whole year.  Sugar provides about 20 percent of our total intake of calories and nearly half of our carbohydrates.

Pg. 157:  Research by Campbell concluded that most people could tolerate as much as seventy pounds per capita of sugar per year—roughly what Americans were consuming in the 1870s—before diabetes prevalence would begin an epidemic increase.  Also, diabetes had an incubation period similar to the time it took lung cancer to appear in cigarette smokers—eighteen to twenty-two years.

Pg. 211:  At the beginning of WWII diabetes in the US diabetes was still a relatively rare disease in the US:  it was present in about three to four people per thousand.  Times have changed—it is now closer to one in eleven Americans.

Pg. 229:  When populations underwent Westernization, chronic diseases emerged with it, and typically in the same order, beginning with periodontal disease (tooth decay), gout, obesity, diabetes, and hypertension, and eventually encompassing all of them.  It seemed a good bet that if a cluster of associated diseases appeared at the same time in a population, those diseases had a common cause.

Pg. 237:  If/then hypothesis:  If Western diseases associated with obesity, diabetes, insulin resistance and metabolic syndrome, which many of them are, then whatever causes insulin resistance and metabolic syndrome is likely to be the necessary dietary trigger for the diseases.  Because there is a significant reason to believe that sugars—sucrose and high-fructose corn syrup in particular—are the dietary trigger of insulin resistance and metabolic syndrome, it’s quite likely they are a primary cause of all these Western diseases, including cancer and Alzheimer’s disease.

Pg. 249:  Cutting our use of salt in half will decrease blood pressure by only 4 to 5 mm Hg mercury, on average.  This reduction is essentially of not much use yet public-health authorities continue to disseminate the message that salt is a deadly white powder.

Pg. 263:  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.  Alzheimer’s, like cancer, is associated with type 2 diabetes, an observation that began to emerge from studies in the mid-1990s.

Addenda:

(Flawed dietary guidelines up until 2005) led hundreds of millions of people to bet the quality and length of their lives on their belief about the merits of a low-fat diet.  Led by advice drawn in part, from research secretly funded by the sugar industry, Americans in one generation cut a quarter of caloric intake from fat, replacing it with carbohydrates, with the US government food pyramid confirming this misinformation.  Contrary to prediction, total calorie intake increased substantially, the prevalence of obesity tripled, the incidence of type 2 diabetes increased many-fold, and the decades-long decrease in cardiovascular disease plateaued and may reverse, despite greater use of preventive drugs and surgical procedures.  "Thinking In Bets" by Annie Duke, C2018: pg. 54f

Back in 1967 three Harvard scientists conducted a comprehensive review of the research to date to determine whether sugar or fat was the culprit in the increasing rates of heart disease.  They published their results in the highly respected New England Journal of Medicine, which firmly pointed the finger at fat as the culprit.  It was later discovered, in 2016, that the sugar industry had paid all three professors (they are now all dead).  This journal now, since 1984, requires any conflict of interest to be made known. "Thinking In Bets" by Annie Duke, C2018: pg. 164