Book Review: 'The Case Against Sugar'

Jed Stuber  ·  Sep 28, 2017

Sugar is bad. Really bad.

Most of us intuitively understand that sugar is problematic… probably best avoided… for the most part. The Case Against Sugar by Gary Taubes argues that it is much more serious than that.

  • Sugar, even a little bit, dramatically affects our hormones, metabolism, digestion, and brain. Consumed regularly, it will wreak havoc on our health, bring on nasty diseases, and take us to an early grave. 
  • We consume massive amounts, but not just in the form of sweet treats we know are bad. Most processed and packaged foods are now laced with sugar and high fructose corn syrup. Soft drinks and juices are loaded. The average American consumes 150 pounds per year according to some estimates.
  • Overwhelming evidence points to it as the cause of obesity and diabetes, and more researchers are becoming convinced it also drives heart disease, cancer, and dementia.
  • Amazingly, a scientific consensus laying the blame on sugar has never emerged.

In the opening chapter Taubes makes an attention getting claim: there is a credible case to be made that sugar deserves to be classified as a drug. Anthropologists observe that societies have viewed it as similar to a drug. It is a highly refined substance. Although the science of the brain is only beginning to develop, we do know that sugar affects the region known as the “reward center” in much the same way as nicotine, cocaine, heroin, and alcohol. And yet health authorities will blame modern health problems on any other aspect of diet or environment before conceding that it’s even possible that sugar played a unique role.

The reviews of history in this book are alone worth the price, even though Taubes is mostly known for explaining science in a way that is accessible to everyone. Wars have been fought over sugar, and empires rose and fell with the industry. Historians say it was once as significant in world affairs as oil is today. It drove the slave trade for a couple centuries. The first American law protecting politically connected sugar producers from competition dates back to 1789.

A little known historical episode is the tobacco-sugar connection. The key ingredient that makes tobacco  produce smoke that is slightly acidic rather than alkaline, allowing it to be more easily inhaled so that more nicotine can be absorbed is—you guessed it—sugar. Tobacco is marinated in sugar sauce as part of the production process and often ends up as high as 22 percent sugar by volume. This story is a minor sidelight for Taubes, so he points readers to Golden Holocaust by Stanford researcher Robert Proctor for more.

Sugar is connected to many of the developments of the 20th century. The technology to produce and distribute candy, ice cream, and soft drinks became available. The number of products in a supermarket ballooned to tens of thousands. Wartime disruptions in the sugar supply were considered a national crisis. On the other hand, there were sometimes gluts caused by overproduction. Suppliers were considered too big to fail, so import quotas and subsidies bailed them out. The New York Times reported that FDR called the sugar lobby “the most powerful pressure group that had descended on the national capital.” In 1945 Time inveighed against “unhealthy economics and unholy politics” of sugar. Coca-Cola became a key military contractor and a multinational corporation. Breakfasts were radically transformed with the introduction of frozen fruit juice concentrate and cereal, which hooked unsuspecting millions on unprecedented sugar levels. Frozen TV diners sold by the millions and became the topic of a Seinfeld routine. Food science, done in chemistry labs, became a field in its own right.

Taubes devotes much of the book to explaining how the academic and medical communities have managed to miss or reject the idea that sugar is so detrimental to our health. It is not controversial that the incidence of diabetes took off in the late 1800s as sugar consumption rose, and both have increased dramatically and concurrently ever since. In the early 20th century it was not uncommon for some medical journals, doctors, and news reports to pin the blame on sugar for obesity and diabetes. Why didn’t this notion ever catch on?

Ever since the 1860s, when German scientists figured out how to measure energy precisely, the paradigm of energy—essentially the concept of the calorie—has dominated. Nutrients are only evaluated in terms of how much energy they provide, and obesity is considered a matter of taking in more calories than we expend. Consequently, the quality of certain macronutrients in our diet—protein, fat, carbohydrates—and their potentially different effects on our metabolism and health is given little attention, or worse, considered totally irrelevant. 

It wasn’t until the 1960s that radioimmunoassay technology was developed so that certain molecules in the blood could be detected and the effects of nutrients on the hormones in the body could be studied. Part of the problem was researchers studying metabolism never actually practiced medicine. Doctors who were actually treating people were disconnected from the research community. The European medical community did take an interest in sugar and insulin resistance as a major cause of obesity and diabetes in the first half of the 20th century, but their influence greatly diminished during World War II, then virtually disappeared.

Taubes explains another problem: “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.” The first doctor in America to specialize in diabetes, Elliot Joslin, wrote a textbook first published in 1916 that is still in use today. After initially considering dietary sugar and carbohydrates as the primary cause of diabetes, he instead concluded it was overeating and dietary fat. His view won the day, and we are still suffering for it.

Taubes also tells the story of how the sugar industry, at every turn, prevented a consensus against sugar from emerging. Millions of dollars were spent attempting to throw the scent off sugar and onto anything else. At first it was the idea that a calorie of sugar is no different than any other. Then it was that sugar provides “quick energy” that helps us not eat too much of other things. Another tactic was to point the blame at artificial sweeteners as potentially carcinogenic, to distract from research implicating sugar in diabetes. Another was to beat the drum that disease is “multifactorial” and “complex,” so sugar shouldn’t ever be considered a main cause of chronic degenerative disease. Most of all, it was supporting the notion that dietary fat is where all the focus should be.

A significant minority of researchers and doctors have always maintained that the majority has gotten the story terribly wrong. They say that counting calories tells us nothing about the quality of the calories, and how different nutrients affect our health. Obesity isn’t caused by overeating. In fact, it’s caused by not getting enough nutrition. Obesity doesn’t cause diabetes and heart disease. In fact, a diet high in sugar and carbs causes all three. As insulin resistance develops, wrecking our metabolism, obesity is the natural consequence and eventually, diabetes and heart disease. The fats in our diet aren’t a problem. The sugars and carbs are. Even small amounts, given time, will ruin our health. This is familiar territory for readers of Taubes’ previous books.

The final chapters of The Case Against Sugar are downright scary. There is very good evidence, based on Native American populations, that insulin resistance is passed from generation to generation, and each successive generation is more susceptible to diabetes. It’s happening to America right before our eyes. Our grandparents and parents died mostly from heart disease, a much preferred way to go than the nasty complications of diabetes, cancer, or dementia. We are farther along the insulin resistance continuum now.

If this thesis is correct, what is to be done? Taubes is brutally honest. There’s no science to give us hope that the trend is reversible, even if we were willing to radically change our diets, which we clearly aren’t. This matter deserves more attention from the medical community, but it would be costly, and there’s very little interest in doing anything more than handing out drugs to manage symptoms.

Taubes has started a national conversation. See his previous books, this article, and a companion documentary for his advice on facing the challenge.

This article is for educational purposes and not meant as medical advice.

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