The Case Against Sugar

Gary Taubes

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Worth a read if you are interested in an honest look on the history of nutrition and its connection to dietary fat and sugar. Much of the common knowledge the public seems to “know” is more a result of the tools they had to measure things or the power of different industries trying to keep their stake in consumerism. Taubes does a great job with his research, felt very well backed-up.

The tools scientists have available drive what they can measure and research. Nutrition research started in the 1860s in Germany, but tools to measure hormone levels weren’t invented until the 1960s. So, research was focused mainly on studying the balance of energy (calories in vs calories out) vs particulars around how foods impact hormones. This has driven much of the national discussion on nutrition even today.

  • The large and powerful sugar industry (through the Sugar Research Foundation) supported this movement and funded researchers that always agreed that sugar wasn’t any worse than the calories it included, despite evidence elsewhere showing the contrary.

Sugar can be a problem in the short term, but the real problem is extended consumption (over 15-20+ years). A good analogue is cigarettes. While smoking a few cigarettes likely won’t cause much harm, if you smoke a pack a day for 15 years you have a much higher likelihood of developing lung cancer. Similarly, if you have soft drinks, chocolates, fruit juices and sweets multiple times each day, you have a much higher likelihood of developing diabetes, obesity and heart disease.

  • Similarly, genetics can have a large impact on likelihood to contract these diseases. The unfortunate part is that much of that is likely to come from how much sugar your mother ate and how her blood sugar looked when she was pregnant with you. This makes the problem even tougher across generations

Notes

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 is was most common in the overweight and the gluttonous.

When the New York City health commissioner Haven Emerson and his colleague Louise Larimore published an analysis of diabetes mortality statistics in 1924, they reported a 400 percent increase in some American cities since 1900 – almost 1,5000 since the Civil War

When the New York City health commissioner Haven Emerson and his colleague Louise Larimore published an analysis of diabetes mortality statistics in 1924, they reported a 400% increase in some American cities since 1900 – almost 1,500% since the Civil War.

With sugar, the best researchers can do is compare individuals all of whom have consumed tremendous amounts of sugar…If they compare sugar consumers with those who abstain, they’re looking at individuals who have vastly different philosophies about how to lead a healthy life and so will differ in many meaningful ways other than just how much sugar than consume.

Kinds of Sugar

Sucrose

  • White crystalline variety
  • Composed of equal parts glucose and fructose

Fructose

  • Found naturally in honey and fruits
  • This is what makes sucrose particularly sweet

Glucose

  • Carbohydrate-rich foods like bread and potatoes break down into glucose

High-Fructose Corn Syrup (HFCS)

  • Most common: HFCS-55 (55% fructose, 45% glucose)

Because we never consume the fructose without the glucose, though, the appropriate question is whether sucrose, the combination of roughly equal parts fructose and glucose, is toxic, not one alone.

…the USDA reports that 114 pounds of sugar and HFCS were delivered to retailers in 2014, that number can be meaningfully compared with the 153 pounds delivered in 1999, when deliveries (and so we assume, consumption) peaked in the United State, and both can be compared with the few tens of pounds delivered per capita two hundred years ago.

Nutritionists usually answer by saying that in nature a sweet taste signaled either calorically rich fruits or mother’s milk (because of the lactose, a relatively sweet carbohydrate, which can constitute up to 40% of calories in breast milk)…But if caloric or nutrient density is the answer, the nutritionists and evolutionary biologists have to explain why fats do not also taste sweet to us. They has twice as many calories per gram as sugars do (and more than half the calories in mother’s milk comes from fat).

[About sugar] 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 receptor” 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

By 1775, “king Sugar,” or “white gold,” as it was known, constituted almost a fifth of all British imports, five times that of tobacco. The result…both the British and U.S. governments came to be vigorous promoters of the sugar industry because of the revenues they could garner by taxing it…The British government began taxing sugar imports from the Caribbean, along with tobacco, in the late seventeenth century. The Americans followed a century later, after the Revolution, and after realizing how much money could be raised from sugar to help get a fledgling country on its feet.

Two factors ultimately drove this final transformation of sugar from a luxury for the wealthy to a pleasure for all. One was the development of the beet-sugar industry…by 1880, beet sugar had surpassed cane sugar…The second factor in the transformation of sugar into a dietary staple- one of life’s necessities – was technology. The industrial revolution…transformed sugar production and refining just as it did virtually every other existing industry in the nineteenth 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.

…the concept of a dessert course emerged for the first time in history in the mid-nineteenth century…The industrial work break also emerged, as a new era of factory workers learned to partake of come combination of nicotine caffeine and sugar; cigarettes, coffee and tea, and sweetened biscuits or candy could all be purchased inexpensively.

Four industries emerged beginning in the 1840s. We can think of these foods and beverages as doing for sugar what cigarettes did for tobacco. (Fruit juices, sports drinks and especially breakfast cereals would appear in the market nad the explode in popularity a century later.

Candy

In 1847 a Boston druggist named Oliver Chase launched the candy industry with the invention of a machine to pump out perfectly formed candied lozenges by the thousands.

Chocolate

  • Chocolate bar dates to 1840s
  • Lindt brothers figured out the trick of solidifying chocolate powder into a bar that could be mass-produced.
  • Until then, chocolate had been consumed as a hot beverage; only high end French confectioners had known the secret of making edible chocolate in solid form.
  • Chocolate bars that started around that time period:
  • Clark bar – 1886
  • Tootsie Rolls – 1896
  • Hershey’s Milk Chocolate Bar – 1900
  • Hershey’s Kisses – 1906
  • Toblerone – 1908
  • Baby Ruth – 1921
  • Mounds, Milky Way – 1923
  • Goodbar – 1925
  • Reese’s Peanut Butter Cups – 1928
  • Snickers – 1930

Ice Cream

  • Invented in Italy in late seventeenth century for wealthy
  • It went viral with the reliable supply of ice / a freezer
  • Wholesale invented in the 1850s

Soft Drinks

  • Pepper, Coca-Cola and Pepsi were all launched in the 1880s.

American cigarette blends:

Flue-cured Virginia tobacco

  • This kind was invented in the 1860s and allowed for inhalation
  • When tobacco is flue-cured, the harvested tobacco leaves are suspended over iron flues that heat the surrounding air to progressively higher temperatures. Tobacco that begins with a relatively high carbohydrate content (up to 50% of dry weight) but is low in sugar (3%) ends up as much as 22% sugar, sucrose specifically.
  • The high sugar content results in tobacco smoke that is acidic rather than alkaline…Alkaline smoke irritates the mucous membranes and stimulates the coughing response. Acidic smoke can be inhaled without doing either.

Air-cured Kentucky tobacco

  • Results in a tobacco that’s relatively nicotine-rich
  • Smoke is alkaline and thus hard to absorb
  • Camel would “candy up” its tobacco by immersing the leaves in a “sugar sauce”. This would enhance the flavor of the aroma, and so R.J Reynolds blended it into Camel cigarettes.

Technological advances throughout history promoted the consumption of sugar-rich products

  • Vending machines in the 1930s
  • Refrigerators became accessible to the masses by 1935.
  • For the first time in history, consumers could easily indulge in ice-cold soft drinks and ice cream without leaving their houses.
  • Distributed to military personnel (3x more than the amount allotted to non-combatants on the home front)

Canned breakfast juices had first appeared during Prohibition, motivated by grape growers who could no longer sell their products as wine, and by orange growers in California and Florida burdened with surplus oranges during years of glut.

  • In 1920, a cooperative of California growers (selling under the now familiar brand name Sunkist) began taking advantage of what nutritionists of the era called the “new nutrition” – the awareness of the importance of vitamins in preventing deficiency diseases – and took to advertising their products as a healthy way to get necessary vitamins, particularly vitamin C, a proposition that’s still with us today.

Dried cereal started off as a health-food industry driven by physicians

  • Pioneers were John Harvey Kellogg and C.W. Post
  • Post Grape Nuts created the single largest, fastest legitimate fortune in America for C.W. Post. It was sugar-free.
  • Kellogg’s first product was also sugar-free, but W.K. (Kellogg’s younger brother) added sugar to the cornflakes to improve the taste while Kellogg was out of town.
  • It took 35 years for dried cereals to begin the successful transformation into sugar-coated cereals, a hugely profitable breakfast candy.

[Referring to developing a technique called radioimmunoassay, which measures hormone levels] As a result, nutritionists had a 90-year head start in thinking about diet in terms of its effect on “energy balance” – on the energy consumed and expended by the human body – rather than on the internal secretions, the hormones, that regulate such fundamental properties as how much fat we accumulate in our cells and the “partitioning” or “allocation” of the fuels we consume, whether we store them as far, carbohydrate (glycogen), or protein, or burn them for fuel.

When nutritionists say that sugar is “empty calories,” they’re defining the problem posed by sugar in the science of the early twentieth century – in terms of the amount of energy (calories) and vitamins and minerals (empty) they contain – and ignoring the research, and an entire field of medical science, that came after.”

“One of the common themes in the history of medical research is that a small number of influential authorities, often only a single individual, can sway an entire field of thought. In science, young researchers are taught to challenge authority and to be skeptical of all they’re taught, but this isn’t the case in medicine, where the opinion of figures of authority carry undue weight.” A man named Elliot P Joslin was this figure in the diabetes world, but had the idea that sugar was not the cause of diabetes

During the 1930s and 1940s, Joslin and Harold Himsworth would cite each other as they continued to “research” the topic. They would use stronger and stronger language to create a “house of cards in support of their beliefs, each citing the other’s observations as evidence, only to be cited in turn as the support for that evidence. Both ultimately based their conclusions largely on the incorrect assumption that sugar and other carbohydrates were equivalent in their chemical composition and thus their effect on the human body.”

The Inuit, for instance, pastoral populations like the Masai in Kenya, or South Pacific Islanders like those on the New Zealand protectorate of Tokelau, consumed less fat (and in some cases less meat) over the course of their relevant nutrition transition, and yet they, too, experiences more obesity diabetes and heart disease (and cancer as well).

That all populations without exception…would occasionally be considered as a competing hypothesis, as Joslin did early in his career. Until recently, though, it would typically be rejected on the basis that (1) most influential experts believed dietary fat was the problem, and (2) carbohydrates have identical effects on the human body, whether starches or sugar, and therefore on chronic-disease states, as Joslin and Himsworth believed.

This thinking [energy balance] renders effectively irrelevant the radically different impact that different macronutrients – the protein, fat, and carbohydrate content of foods – have on metabolism and on the hormones and enzymes that regulate what our bodies do with these foods: whether they’re burned for fuel, used to rebuild tissues and organs, or stored as fat.

Positive energy balance – more energy in than out – occurred when any system grew, Bergmann pointed out: it accumulated mass. Positive energy balance wasn’t an explanation but, rather, a description…It was a statement that described what happens but not why. It seems just as illogical, wrote Bergmann, to say children grow taller because they eat too much or exercise too little, or they remain short because they’re too physically active. “That which the body needs to grow it always finds, and that which is needs to become fat, even if it’s ten times as much, the body will save for itself from the annual balance.”

Much of the research on hormonal regulation was being done in Germany, and evaporated after WWII.

Insulin…can be thought of as orchestrating how the body uses or “partitions” the fuel it takes in…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 burns this far rather than glucose.

The one biological factor necessary to get fat out of fat cells and have it used for fuel, as Yalow and Berson noted in 1965, is “the negative stimulus of insulin deficiency.”…It is clear that what we now call type 2 diabetes is not a disease of insulin deficiency (as type 1 is) – at least not at first – but of insulin resistance. It is preceded by an excess of insulin in the circulation, and that in turn may be a compensatory effect of the body’s resistance to the action of that insulin.

The big question then: what causes insulin resistance and thus elevated levels of insulin? It could be gluttony and sloth…Another possibility is that these elevated levels of insulin and the insulin resistance itself were caused by the carbohydrate content of our diets, and perhaps sugar in particular. Insulin is secreted in response to rising blood sugar, and rising blood sugar is a response to a carbohydrate-rich meal. That somehow this system could be disregulated such that too much insulin was being secreted and that this was causing excessive lipogenesis – fat formation – was a simple hypothesis to explain a simple observation. And it would support an observation that had been made for millennia – that sugar was capable of providing quick energy but also inducing corpulence in those so predisposed.

By 1952, the University of Minnesota nutritionist Ancel Keys was arguing that high blood levels of cholesterol caused heart disease, and that it was the fat in our diets that drove up cholesterol levels. Keys had a conflict of interest: his research had been funded by the sugar industry…since 1944.

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 the studies had been done in adults.

Many authorities believed that cars and mechanization had made our lives less physically active…but it was (and is) easy to identify populations with high levels of obesity, diabetes, and hypertension that also worked very hard for a living.

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. Some populations also have the opportunity to consume more animal products and particularly red meat, but other populations – the Inuit, Native American tribes of the Great Plains, and African pastoralists like the Masai – were already living predominantly on animal products, and they, too, get obese, diabetic, hypertensive, and atherosclerotic as they become Westernized.

[About the Natal Indians in South Africa] “…the poorer members of the community were subsisting on as little as sixteen hundred calories a day…Yet some were still “enormously fat and suffered from undoubted diabetes proven by blood tests.””

…triglycerides in the bloodstream, in particular, remain elevated when we eat carbohydrates, not fat. From this perspective, dietary fat seems to have little or nothing to do with heart disease.

…sugar would raise some combination of triglycerides, cholesterol, and insulin levels.

In 1957 Yudkin had implicitly attacked Keys’s work in a paper demonstrating that, among other things, sugar consumption or even the number of TVs and radios per capita tracked with heart disease in the U.K. better than the amount of dietary fat consumed.

…French had relatively low rates of heart disease despite a diet that was rich in saturated fats…At the end of the eighteenth century, French per capita sugar consumption was less than a fifth of what it was in England. At the ened of the nineteenth century, even after the beet-sugar revolution, France was still lagging far behind both the British and the Americans – 33 pounds for the French compared with 88 for the English and 66 for Americans.

[Women’s Health Initiative (published 2006)] “Once again, it failed to confirm the hypothesis. The roughly twenty thousand women in the trial who had been counseled to consume low-fat diets (and to eat more fruits, vegetables, and whole grains, and less red meat) saw no health benefits compared with the women who had been given no dietary instructions whatsoever.”

The more refined or processed a carbohydrate, and the less fat and fiber accompanying it to slow its digestion, the great the blood-sugar response, and thus the more insulin required to metabolize it; or, as Cleave might have phrased it, the great the strain on the pancreas.

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.

[In regards to risk of heart disease] 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 over secreting insulin, day in and day out. All of the abnormalities happen to be related to the carbohydrate content of the diet, not to the fat content.  [Goes on to explain that sugar is the cause of insulin resistance P204)

But if sugar actually causes insulin resistance – as the biochemistry and the animal experiments suggest – then it also is the very likely trigger of excess fat accumulation and thus obesity. Remove the sugar, and the insulin resistance improves and weight is lost, not because the subjects ate less, which they may have, but because their insulin resistance resolved. The sugar industry doesn’t see it this way.

[Good summary of overall problem on P209]

Pima Native Americans in Arizona:

  • “Largely bypassed by the socioeconomic developments in the rist of the United States,” until the Second World War, when they were drafted into the military and began the process of integration into “white society”.
  • Before the integration, children would be considered lean or very lean by today’s standards, and the average weight of men being 158. Along a similar note, diabetes was extremely rare.
  • By 1954-1955, there were 283 cases of among the Pima; at least one in every twenty-five Pima was clearly diabetic.
  • In 1963, researchers found diabetic levels of blood sugar in 30 percent of Pima and among those older than thirty, one in every two appeared to be an undiagnosed and untreated diabetic.
  • By 1971, Bennett, Burch, and their colleagues were confirming, using “conservative criteria,” the highest rates of diabetes ever recorded in a population, while also noting that two-thirds of the Pima men and over 90% of the women were at least overweight, if not obese.
  • This continued for generations. The theory that women can pass down risk if they are obese and have high blood sugar while pregnant is a likely explanation for this. “Each successive generation includes more and more children predisposed – preprogrammed, in effect – to become obese and diabetic adults and obese and diabetic mothers.”

Case of Tokelauan population reacting poorly to sugar despite activity or instead of from increased fat consumption (P233-235)

The fact that many of the Western diseases in Burkitt and Trowell’s list, these chronic disorders that associate with Western diets and lifestyles, are also diseases that associate with obesity and diabetes puts the focus, in turn, on insulin resistance and metabolic syndrome as a mechanism or at least a critical precursor. 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.

Research has shown a link between food intake / lifestyle and cancer. Populations that don’t adopt a Western diet and lifestyle have much lower rates of cancer. In addition, a 1976 report said that “insulin intensely stimulated cell proliferation in certain tumors,” and another, by researchers at the National Cancer Institute, described one particular line of breast-cancer cells as “exquisitely sensitive to insulin.” This implies that there could be a connection between sugar and cancer.

And if these children never ate ice cream, would they miss it any more than would a child who never takes up the habit of smoking miss the opportunity as an adult to indulge occasionally in a cigarette?

If the goal is to get off sugar, then replacing it with artificial sweeteners is one way to do it. Whether consuming artificial sweeteners for years or decades brings on its own noxious effects, or prevents us from benefiting fully from a sugar-free diet, is something that the existing research cannot say.

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