Just Read: The Case Against Sugar

One of my earliest memories was the rush to the grocery store by my family to stock up on saccharin sweetened beverages when it was feared they would be pulled off the market, in 1977. The shelves were bare (it was as much an emergency as any I remember in the household)…

This was the headline (behind paywal, if you have library access):

By, Tom Shales. 1977. “Tears & Fears: Threat to Saccharin Spurs New Hoarding! Diet-Rite Dementia, Tab Teetotaling in the Offing?” The Washington Post (1974-Current File), Mar 15, 2..

I looked this piece of history up online after I read Gary Taubes’ The Case Against Sugar, and amazingly, in this piece from March, 1977, they seemed to express some of the wisdom that’s now being discussed 40 years later (almost to the day):

From Pending FDA Saccharin Ban A Bitter Dose for Many in U.S. – The Washington Post, April 4, 1977

There are various problems with the high current levels of consomption, according to food experts. Measured in calories, sugar and other sweeteners – the main other sweetener is corn syrup – now provide about a fifth of the average American’s daily diet. But sweeteners contain none of the protein, vitamins and minerals the average person needs. These things must come from the other four-fifths of the diet: in this sense, the sugar fifth is wasted.

A second problem is the more familiar and simpler one, that sweetened foods are fattening. A third, related problem is the pervasiveness of sweeteners. A high percentage of our food today is processed, as opposed to fresh, and a high percentage of processed food is sweetened.

More than two-thirds of our daily sugar and other sweeteners comes to us in processed foods, including soft drinks and other processed beverages.

The wisdom they may have not had, at least in popular thought, was that sugar is more than wasted calories. There’s evidence that it is a metabolically active distinct subtance that changes the chemistry of our bodies in ways other forms of calories do not.

And actually, many scientists already knew that, however that science wasn’t promoted or supported by various interests….

Exonerating Fat, Arguing Against Sugar

This book continues a series of works by Taubes and others calling into question a 40 year experiment (see: Just Read: Why Eating Fat May Not Make You Fat (The Big Fat Surprise) in changing American (and global) eating habits to banish fat, which by definition means promoting carbohydrates (you have to eat something).

And promote they did, according to the record –

et tu, Consumer reports? American Heart Association?

In our lifetimes…

The magazine Consumer Reports may have captured this logic perfectly (of creating sugar sweetened cereals) in 1986 when it claimed, “Eating any of the cereals would certainly provide better nutrition than eating no breakfast at all.”

(By the mid-1990s, even the American Heart Association was recommending we have sugar candies for snacks, rather than foods that contained saturated fat.)

Bringing Occam’s Razor

The book adopts a philosophy that is used in medicine widely – Among competing hypotheses, the one with the fewest assumptions should be selected. Otherwise quoted as “if it swims like a duck, sounds like a horse, etc etc.”

In doing so, the possible causes of what are known as “Western Diseases” (read location 3729 on kindle to see the list) are reviewed through a lens that involves insulin metabolism, and specifically insulin resistance, which is known to be central to diabetes and probably a requirement for obesity. The counter-discussion is that obesity is a cause of insulin resistance, this is what we were taught in medical school, and this is extensively reviewed in the book.

In any event, everything from gout to hypertension is recast in an Occam’s mindset, in that the things we’ve been taught about what causes these diseases (purines for gout, salt for hypertension) may actually link back to insulin resistance as causing the causes we were taught about.

Which happens to track the increase in consumption of sugar in society.

In fact, a review of my own postings from social media in 2012 reveals that I was unsure about the causes of hypertension, based on my own medical training and extensive review of the literature. That says something: (7) Ted Eytan’s answer to Does weight loss cause blood pressure to go down, or are both the result of something else (like more physical activity)? – Quora

The People and the Science

As with Nina Teicholz’ book, there’s a discussion of the people and personalities involved in the science and sociology of our diet, and like most humans, they are fallible, imperfect beings. It is true now that when I read a paper involving nutrition, I now have to study who the authors are and which institution they are from so that I can track back to the potential conflicts they may have. We always have done that with medical literature (review the science and relate it to the person doing the science), this book just gives a roadmap (along with Teicholz’) to the nutritional science community.

Where we came from

I have always believed that we have to know where we came from to know where we’re going, and there’s a ton of history in here. It’s a marvel to think about what was going on in Washington, DC, and even my home state of Arizona, when I was growing up, that would shape our country’s health destiny.

(side story: while I was an undergrad in Tucson, Arizona, I did some data entry on a nutritional study to get research experience, and I remember that the software that we were using didn’t have entries for the new “fat free” foods being marketed. My faculty sponsor told me, “Fat free salad dressing is really just sugar and water, so code it like that”)

The question of whether artificial sweeteners are healthy or not is not fully addressed in the book, because it’s not fully addressed in the science. What they (sweeteners) did, though, was raise the cry for a healthier life and a freedom from obesity and diabetes. Just read the quotes from the above Washington Post article:

“Please . . .” a woman from Dallas implores. “I don’t know what we would do for grandma if saccharin is banned.”

“I am . . . a former fat person!” another woman, from Huntington Beach, Calif., exclaim. “I use saccharin every day in cooking.”

“As the mother of a 12-year-old diabetic child, I appeal to you . . .” writes a third petitioner, from Dunwoody, Ga.

And this commercial from 1979, when a calorie was a calorie, and people were so…thin*.

*As a former fat person, the intent of sharing this bit of history is not to fat shame, it’s to explore the history of obesity and causes that might be reversible or preventable in the interest of health, with the recognition that health is multi-dimensional and factorial 🙂

9 Replies to “Just Read: The Case Against Sugar”

  1. Did you say you’re a former fat person?? Got pix?? How did you undo that?

    Thank you again for your considered perspectives.

    1. Dave,

      The post reads correctly :). Depending on the person and the change involved, it’s typically not polite to ask for photographs, so I’ll ignore that question.

      On the “how” I’d answer by saying that I’ve done my best to follow the most science-based approaches as you would expect. Unfortunately, we are now learning that what we thought was science-based (that eating low-fat prevented obesity) was an experiment based on a questionable hypothesis. Now, I use an approach that’s closer to that described in this paper, that I posted on previously (link),


  2. (For the benefit of other readers who don’t know how long (and how well) Ted and I have been friends, I’ll note re the “impolite” question that I would indeed not have asked it of a less-familiar person, and that I’m completely happy with his response.:-))

  3. Having now read both Big Fat Surprise and <The Case Against Sugar, I see the importance of whether one is insulin resistant. I’ve never heard of a test so I googled, Beyond BMI and A1c: Measuring Insulin Resistance seems informative but I worry about wording that I now know is incautious, like the cited doctor who talks only about “elevated cholesterol,” instead of distinguishing between LDL and HDL cholesterol.

    For those who don’t know, I was diagnosed pre-diabetic in Nov 2014 … there’s no diabetes in my family history that I know of (Type 1 or 2), which that article says is a factor to look for. But I still want to understand my body, and this new realization about the endocrine / metabolic issues here has been gripping my thinking.

    Medscape says “patients are screened based on the presence of comorbid conditions.” But what a pile of lab work THAT is! What would you do (or do you do) as a PCP?

    If I understand correctly, though, anyone (resistant or not) can make use of the basic principle that carb intake triggers insulin which cues the system to lay down some fat, yes? And that sugar is distinctively guilty of this (though I don’t recall specifically how … somehow that didn’t come through clearly in the book.)

    Do I understand correctly?

    1. Hey Dave,

      The first thing I would do as a family medicine specialist is not give medical advice in a blog comment 🙂 .

      I would, in general, be wary of any instruction to get tested for anything without speaking to a health professional who knows your medical situation. Everything is dependent on the person, and I wouldn’t drift to a recommendation of more medical intervention. I think what authors in this space are trying to point out is that Americans have been changing their diets over the past 40 years (ie it’s a myth that they haven’t been listening to health messaging, they have been), and the results are striking.

      The last part of your comment makes sense to me, that fat storage is to a large part dependent on having too much insulin around and it’s a lot more complicated than calories in-calories out. This book is not designed to help a person change their diet, just to explain the science,


  4. A new post by Taubes on the NYTimes Well blog yesterday talks more about Why cutting carbs is so tough. This excerpt gives the core issue in a nutshell.

    The conventional thinking … is that obesity is caused by caloric excess … an “energy balance” disorder, and so the treatment is to consume less energy (fewer calories) and expend more. When we fail to maintain this prescription, the implication is that we simply lack will power or self-discipline.

    In other words, obesity has become viewed as a problem of gluttony or sloth. The bitter irony is that, as this next piece notes, since we started following the resulting dietary guidelines, Type 2 diabetes has increased 655%. How sick is that … in any sense of the word “sick”?

    That next piece is Taubes’s January piece in the Times’s Sunday Review, Big Sugar’s Secret Ally: Nutritionists, which is a potent & compact summary of the sugar story, including the genesis of those disastrous guidelines. Excerpts:

    [Sugar industry] ads explained that there was no such thing as a “fattening food”: “All foods supply calories and there is no difference between the calories that come from sugar or steak or grapefruit or ice cream.” … When it comes to weight gain, the sugar industry and purveyors of sugary beverages still insist, a calorie is a calorie, regardless of its source.emphasis added

    By the 1960s, researchers in [endocrinology and biochemistry] had clearly demonstrated that different carbohydrates, like glucose and fructose, are metabolized differently, leading to different hormonal and physiological responses, and that fat accumulation and metabolism were influenced profoundly by these hormones.

    Big Fat Surprise and Taubes’s books do a really solid job of establishing that, regardless of the source of the problem, we’ve been fed a big sweet lie for two generations now.

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