In Focus
Book
Sugar: the prime suspect in poor health
Even leaving aside sugars part in
diabetes, obesity, and tooth decay,
and altogether denying its agency in
gout, heart disease, and hypertension,
the sugar industry would still have
a lot to answer for. For example,
consider the historical links to the
slave trade. From the 15th to the
19th century, 125 million Africans
were chained and transported to the
Americas, two-thirds of whom were
put to work in sugar plantations.
If nothing else, the intimate
relationship between slavery and
sugar would demonstrate what
atrocities our ancestors were willing
to tolerate for the sake of their sweet
tooth, points out science journalist
Gary Taubes, early in The Case Against
Sugar. It was sugar that caused the
US cigarette industry to flare into
life, after producers realised that
dousing tobacco in a sugary solution
rendered it far easier to inhale. The
marriage of tobacco and sugar made
possible both the astounding success
of American cigarettes worldwide
and the lung cancer epidemics that
followed, writes Taubes.
So much for the sins of the past.
Taubes major concern is the public
health havoc the short-chain
carbohydrate wreaks today. The
purpose of this book is to present the
case against sugar as the principal
cause of the chronic diseases that
are most likely to kill us, explains
the author in an introductory note.
If this were a criminal case, The Case
Against Sugar would be the argument
for the prosecution. He builds this
argument methodically. The key
question is what has caused the spikes
in obesity and type 2 diabetes seen
in western populations since roughly
the second half of the 19th century
and, more recentlyand typically far
more dramaticallyin populations
www.thelancet.com/diabetes-endocrinology Published online October 4, 2017 http://dx.doi.org/10.1016/S2213-8587(17)30338-8 1
that shifted to western dietary habits
during the 20th century?
If this was a criminal investigation,
the detectives assigned to the case
would start from the assumption that
there was one prime suspect, writes
Taubes, warming to his theme. They
would only embrace the possibility
that there were multiple perpetrators
when the single-suspect hypothesis
was proved insufficient to explain all
the evidence. That suspect, needless
to say, is the same substance the British
nutritionist John Yudkin (191095)
dubbed pure, white and deadly.
Taubes patiently debunks the notion
that all calories are created equal,
delineates the evidence for sugars
causative role in type 2 diabetes
and obesity, and surveys the more
speculative theories addressing its
potential for prompting conditions
such as cancer and dementia. He
explains the biology with precision and
clarity, and his prosecutorial zeal does
not extend to overstating his case or
failing to acknowledge the limitations
of the evidence. Perhaps for fear of
labouring his point, Taubes does not
call witnesses to the stand and incite
them to issue lavish condemnations
of the defendant. He opts instead
for a sober assessment of a welter of
research and empirical evidence. It is
all set within a concise account of the
history of the sugar industry and the
development of nutritional science.
Indeed, the historical detailing is one
of the strongest elements of the book.
The author notes that for most of the
19th and 20th centuries, nutritionists
regarded sugar exclusively in terms
of energy and vitamin and mineral
content, chemists examined how
it was metabolised in animals
without a thought for public health,
and physicians focused solely on
patients (interestingly, doctors would
commonly disavow any connection
between sugar and diabetes, while
simultaneously cautioning against its
consumption).
The USAs first diabetes specialist,
Elliot P Joslin (18691962), whose
textbook on the condition has now run
to 14 editions, offers an intriguing case
study. Joslin simply did not understand
that carbohydrates in sugar had unique
properties that other carbohydrates
did not. He was a physician not a
Lancet Diabetes Endocrinol 2017
nutritionist, contends Taubes. He
Published Online
would argue that all carbohydrates October 4, 2017
were, in effect, the same. Joslin was the http://dx.doi.org/10.1016/
first of the many influential medical S2213-8587(17)30338-8
authorities who literally did not know The Case Against Sugar
Gary Taubes
what they were talking about when
Portobello Books, 2017.
talking about sugar. The industry Pp 365. 1499.
would go on to establish troubling ISBN 978-1-84627-637-8
links with experts in nutrition, most
notably Harvard Universitys Fred Stare
(19112002), who argued in favour
of the sugar-laden breakfast cereals
that exploded in popularity after
World War 2.
Taubes outlines how early mis
conceptions about sugar lingered
throughout the 20th century, and
many continue to prevail today. This
is partly because of the impossibility
of performing the kind of clinical trials
that could offer definitive answers
to some of the questions he wrestles
with. I have argued here that enough
evidence exists for us to consider sugar
very likely to be a toxic substance,
and to make an informed decision
about how best to balance the likely
risks with the benefits, concludes
Taubes. He makes a compelling case
indeed. But whether policy makers
will be convinced is another matter
entirely. For most politicians, taking
meaningful action against the sugar
industry is too bitter a pill to swallow.
Talha Khan Burki