Sweetness and blight: the mounting case against sugar

[BadHare]

theguardian.com/society/201...

My mantra was: all things in moderation. But as the evidence against sugar stacks up, I’m growing anxious. Although I won’t give up fruit…

One day earlier this month, I opened The Oxford Companion to Food, for so long a bible to me, and looked up sugar. The entry ran to several pages, taking me from its composition (carbon, hydrogen, oxygen) to the various forms it takes (dextrose, fructose and so on), and then to its sources in nature (honey, cane, beet). Finally, there was a section titled “Sugar as a Food”. This dealt, in a way that already seems rather old-fashioned (the book, edited by the late Alan Davidson, was published in 1999), with the difference between white sugar and brown. The latter, the writer stressed, is not healthier than the former; and while overconsumption of both kinds may lead to obesity, this is not the fault of sugar, but of those who eat too much of it.

It’s been a long time since I heard anyone suggest that brown sugar is healthier than white; it’s the kind of thing my granny might have said in 1979. But it wasn’t this that caught my attention. What surprised me was the writer’s firm placing of the blame for sugar-related weight gain on human beings rather than on, say, the industries that relentlessly push sugar our way in the form of fizzy drinks and ready meals. Nor had he mentioned the now well-established connection between the overconsumption of sugar and type 2 diabetes, cancer and even, it is thought, Alzheimer’s disease. Having registered this, I was then surprised by own surprise. Once, I would have read the words “the fault of the people who eat too much of it” and nodded my head. Now I was shaking it instead.

My mantra used to be: all things in moderation. But I have to accept that this is no longer the case. Thanks to the American journalist Gary Taubes, a long-time opponent of the old dietary advice that insisted healthy eating involves avoiding fat, and to those others who’ve since taken up his cause, I’ve grown, slowly but surely, ever more anxious about sugar. Thanks to my mantra, I never believed fat was bad in the first place. Even as everyone began spreading St Ivel Gold on their toast, I stuck doggedly with butter. But when, more than a decade ago, Taubes set out to prove it was sugar and refined carbohydrates that were doing people the most harm – a heresy in public health circles – it was impossible not to listen. You had only to visit a supermarket to see how bodies were changing. You had only to open a newspaper to read what a deleterious effect this mutation was having on the nation’s health.

Taubes’s latest book (the reason why I looked up sugar in the Oxford Companion) takes his argument one step further. In The Case Against Sugar, he has no time for my enduring conviction that a calorie is a calorie, irrespective of where it comes from. Sugars, he believes, have a “unique physiological, metabolic and endocrinological effect” on our bodies. They trigger “insulin resistance”, the condition that leads to diabetes and other diseases, for which reason we should avoid them. I thought about this quite a lot as I finished the last of the season’s Roses. I eat relatively few processed foods, a happy by-product of the fact that I like to cook, and I’ve never been one for fizzy drinks. Still, I’m a sucker for cake, that very British treat, and I often add sugar to things to make them taste better: a dash in salad dressing, a pinch in tomato sauce. Plus, I eat fruit, which I gather Taubes regards as an indulgent treat. (I won’t ever give up fruit: eating has as much to do with pleasure as with health.)

It’s not all about me, though, is it? I used not to be able to picture it, the white stuff that was going down people’s necks in such seemingly vast quantities. Then I began reading labels. Sugar is in everything, from stock cubes to roasted peanuts to salami (I won’t ever give up eating salami, either). If I’m eating this much hidden sugar, what are others consuming? Quite a lot, is the answer. Perhaps you had the misfortune, last week, to watch ITV’s egregious reality show, Sugar Free Farm. As the series began, one of those who was consuming the most sugar was the actor Peter Davison, a charming, sensible-seeming man who did not appear to me to be vastly overweight. He eats (or ate – we shall see) 52 kilos of sugar a year. Just imagine it. Piled up, it would fill your downstairs loo. Two days into cold turkey, it was Davison, rather than, say, Gemma Collins from Towie, who came over all dizzy. The paramedics took him away in an ambulance, just another pitiful, trembling addict.

[benwl]

Since that article is heavily based on the writings of Gary Taubes it's worth reading this review of one of his books

sciencebasedmedicine.org/ga...

[BadHare in reply to benwl]

Good read, thanks!

Background

I reviewed his earlier book Why We Get Fat and explained my objections:

Low carb diets work, but if Taubes’ thesis is correct, they should overwhelmingly outperform other diets, and they don’t. And people who lose weight on low-carb diets reduce their calorie intake.

The clinical evidence isn’t yet sufficient to convincingly prove his thesis. (He himself admitted this.)

He strongly recommended that everyone adopt a low-carb diet, essentially insisting that we act on insufficient evidence. And this was after he had devoted whole chapters of his books to demonizing the low-fat diet advocates for doing exactly that: acting on insufficient evidence.

Taubes objected to my review in a rather offensive and condescending e-mail, saying I had failed to understand what he wrote. I thought I understood very well, and I thought he had failed to understand my arguments.

Calories in/calories out

We exchanged some words, but we were talking at cross purposes based on our different understandings of the meaning of the calories in/calories out (CI/CO) model. Taubes wrote:

[restricting carbohydrates]…leads to weight loss and particularly fat loss, independent of the calories we consume from dietary fat and protein. We know that the laws of physics have nothing to do with it.

He sees CI/CO as a false explanation of why people get fat, essentially an attempt to blame the victim for sloth and gluttony. I see it simply as an incontrovertible fact of physics that weight increases when calorie intake exceeds expenditure; it doesn’t even attempt to explain why people get fat, why their calorie intake exceeds expenditure. Whatever the underlying cause, whatever the individual’s metabolism, even if Taubes is right, and sugar is the cause of obesity, the laws of physics ensure that any obese person will lose weight if calorie intake is reduced sufficiently (not that that’s easy to accomplish!).

Of course, what we really want to know is what causes some people to take in more calories than they expend. Once they do that, the laws of physics take over: the laws of physics have everything to do with why the weight goes up. Gary Taubes thinks he has found the one true cause of weight gain: sugar. I suspect it’s not quite so simple.

The obesity epidemic

There is plenty of epidemiologic evidence for a correlation between the rising consumption of sugar and the rising prevalence of obesity and diabetes. But correlation doesn’t establish causation. I can’t help but wonder if increasing prosperity and the increased availability and affordability of food have allowed more people to eat more of everything and to change their lifestyle in other ways. Some experts discourage sugar consumption simply because it consists of “empty calories” that replace other, more nutritious elements of our diet and add to the total calorie intake. Taubes thinks the “empty calories” arguments are misguided. He thinks sugar has unique physiological, metabolic, and endocrinological effects that directly trigger obesity, diabetes, and many other chronic diseases. He thinks sugars are long-term toxins that act over decades and affect future generations through epigenetic effects. Sugars cause insulin resistance, which causes metabolic syndrome and probably triggers a host of diseases including diabetes, heart disease, cancer, liver disease, Alzheimer’s, rheumatoid arthritis, asthma, inflammatory bowel disease, gout, polycystic ovary syndrome, and even varicose veins! He says Occam’s razor favors the idea that a single cause underlies all of these. In his previous books, he recommended limiting carbs, but now he thinks people can be healthy on a carbohydrate-rich diet, even a grain-rich diet, if they consume relatively little sugar. He suggests that sugars may have killed more people prematurely than cigarettes or all wars combined.

Big Sugar and bad science

He devotes many pages to the history of sugar, the economics and lobbying efforts of the sugar industry, and the misguided science that led to misguided official recommendations for a low-fat diet. He explains that experts were fixated on energy balance and were slow to consider the effects of genetics and hormones and to realize that all calories are not equal. History may help us understand how we got to our current level of sugar consumption and how doctors got things wrong, but that doesn’t mean Taubes got things right. We can’t be sure his low-sugar diet won’t be discredited by future evidence just as the low-fat diet was.

The evidence against sugar

Taubes presents a lot of evidence. For instance:

In animal models of obesity, as animals grew fatter they were hungrier and ate more; some would remain fat even if they were prevented from eating more. This suggests some kind of dysregulation of fat storage that is likely influenced by genetic factors.

Diabetes is not just a matter of too little insulin. Some type 2 diabetics have too much insulin. Diabetes is a disease of insulin resistance.

The evidence that a high fat diet was unhealthy was confounded by the fact that people who ate a lot of fat tended to also eat a lot of sugar.

Eating sugar seemed to shorten the life span of some strains of rats (but not others).

Feeding animals large amounts of fructose results in fatty liver, insulin resistance, and metabolic syndrome (but animals are not humans, humans eat a mixture of sugars, not fructose alone, and they don’t eat as much sugar as the animals got).

The Pima tribe had practically no diabetes until they started following a Western-type diet and lifestyle. Their sugar intake skyrocketed, and so did the incidence of obesity and diabetes.

There is evidence for “metabolic imprinting”: diabetic mothers have babies who are fatter and more likely to develop diabetes.

Medical missionaries in Africa have documented a paucity of obesity, diabetes, and other “diseases of civilization” in their patients followed by a surge in those conditions after their patients underwent Westernization.

But Taubes admits that “research…couldn’t establish whether or not sugar was truly the cause of these chronic diseases, or whether people (and the laboratory animals used in the experiments) simply ate too much of the stuff, and so got fat first and sick second.”

One cause or many?

Can the host of chronic diseases that cluster together and are associated with Western diets and lifestyles be explained by a single dietary trigger, or are there multiple triggers? Does Occam’s razor apply here, or Mencken, who said “For every complex problem there is an answer that is clear, simple, and wrong”? Taubes’ answer is clear and simple, but it could be wrong. He admits:

Because the kind of observational evidence researchers deal with is incapable of establishing beyond reasonable doubt that sugar…is the factor in Western diets and lifestyles that triggers the aforementioned cluster of chronic diseases, the best we can do is ask whether this is a likely possibility, and if so, whether it is, indeed, the most likely.

Taubes thinks the recent revelations about metabolic syndrome and insulin resistance make sugar the most likely candidate. Maybe. Maybe it’s sugar but not just sugar alone. Maybe genetics, psychology, cultural traditions, food cost, availability, lifestyle, and other factors are involved.

The if/then problem

He devotes two whole chapters to what he calls the if/then problem. If sugar causes insulin resistance and makes us fat, then it very likely causes hypertension, at least indirectly. And it very likely causes all the so-called diseases of civilization, including cancer and Alzheimer’s. He presents evidence and reasoning to implicate it in:

Gout: the incidence of gout paralleled the availability of sugar, and fructose increases serum levels of uric acid.

Hypertension: high blood pressure increases with age and weight in Western populations, but in indigenous populations it remains low throughout life.

Salt sensitivity

Kidney disease

Cancer: He considers cancer to be a metabolic disease. He cites the Warburg effect, the observation that cancer cells preferentially metabolize large amounts of sugar. Warburg thought the metabolic changes were the cause of the cancer; but they are just as likely to be a result, as Dr. Gorski explained here.

Alzheimer’s and other types of dementia: he admits the evidence is weaker here.

Complications of diabetes such as kidney disease, retinopathy, neuropathy, arteriosclerosis, and premature aging of skin and other tissues.

Changes in gut bacteria: still not known whether these result from insulin resistance or contribute to its development.

[Zest]

I remember watching 'Sugar Free Farm', which was an interesting programme, and I'm glad I've cut out/reduced my consumption of refined sugar.

Zest

[Penel]

Worth reading Robert Lustig on sugar (and calories) if you haven’t already.

robertlustig.com/2017/04/a-...

John Yudkin wrote about the effects of sugar in his 1972 book “Pure, White and Deadly”. He was pilloried by the sugar industry and, unfortunately for us all, his work was dismissed.

[BadHare in reply to Penel]

I posted about this a while ago when this article was written: theguardian.com/society/201... though the post seems to have gone missing. Appalling that one US doctor's arrogance has caused the ill health of millions, & our government & health service was daft enough to follow. I'm not sure if Yudkin's book is now available again, though there's plenty of current research replicating his findings that sugar not fat is the cause of so many health issues.

"John Yudkin, said the scientist, was a British professor of nutrition who had sounded the alarm on sugar back in 1972, in a book called Pure, White, and Deadly.

“If only a small fraction of what we know about the effects of sugar were to be revealed in relation to any other material used as a food additive,” wrote Yudkin, “that material would promptly be banned.” The book did well, but Yudkin paid a high price for it. Prominent nutritionists combined with the food industry to destroy his reputation, and his career never recovered...

...For at least the last three decades, the dietary arch-villain has been saturated fat. When Yudkin was conducting his research into the effects of sugar, in the 1960s, a new nutritional orthodoxy was in the process of asserting itself. Its central tenet was that a healthy diet is a low-fat diet. Yudkin led a diminishing band of dissenters who believed that sugar, not fat, was the more likely cause of maladies such as obesity, heart disease and diabetes."

[Penel in reply to BadHare]

Yudkin’s book has been reprinted because of the interest in Lustig’s book / articles.... I’m old enough to remember it from the first time round.

[BadHare in reply to Penel]

Sssh! A lady never mentions her age!

[Cooper27 Administrator]

It's only when you cut out sugar that you notice how much food it's added to. It really does frustrate me how difficult it is to avoid it, even while considering yourself to be eating a healthy diet. Stock cubes are my biggest gripe, but I don't see a need to add it to salami either (I buy salami once a month), or cooked chicken, or nut milks.

Even watching people on their January diets is pretty strange when you're more aware of the ingredients in their food. Too much focus on calories and fat, and none on actual health.

[BadHare in reply to Cooper27]

Sugar's a natural preservative that acts in the same way as salt/ In some instances, I prefer it to chemical preservatives. Try nutritional yeast instead of stock, which is tasty, vitamin B nutritious, & low in both S's.

If you've ever had unsweetened nut milk after drinking the usual commercial stuff, you'd likely realise how tasteless it is & you're paying >£2 for 95% water, non-recyclable packaging & a handful of of almonds. My gripe is how many things are marketed as healthy & that so many people don't question this. >

[Cooper27 Administrator in reply to BadHare]

I've been making my own stock lately! I'm on an auto-immune paleo diet, so no sugar, soya, grains or gluten. There's no stock cubes that comply

I usually buy nut milk on offer, and use it to substitute milk in baking. It's on offer about 8 times a year...

I do know what you mean about the foods marketed as healthy though! I could go one for ages about breakfast biscuits (that contained 50% of your GDA for sugar in the beginning), or Nutella being marketed as a healthy breakfast.

[BadHare in reply to Cooper27]

I got two freebies last month, a new oat milk & a new almond milk. Both are easy to make, & I've also tried coconut milk.

[Scooby17 in reply to BadHare]

Hi BadHare

Do you then make your own nut milk instead?

I use shop bought unsweetened almond milk for my porridge.

Thanks

[BadHare in reply to Scooby17]

Hi Scooby17 ,

I have made it, but not for a while as I use kefir.

It just takes soaking 50g of almonds, flaked coconut, oats etc. overnight. Removing the outer layer for nuts, then blending with filtered water & straining a few times.

Lots of instructions on the internet: culturesforhealth.com/learn...

[Scooby17]

Many thanks BadHare, May fine it a whirl when I have time. I’m sure it’s far superior and worth the effort.