The case against sugar

Review by Choice Review

Taubes, an investigative science and health journalist, serves as a forceful "prosecutor" in The Case against Sugar, alleging this nutrient to be responsible for the current epidemics of diabetes and obesity. The work helpfully begins with an introduction to the most recognized sweeteners (glucose, fructose, and, when these two are combined, sucrose). It then follows sugar's introduction into the Western world. As sugar became more available, its mass consumption increased and supplier profits swelled. But, over the centuries, there has been a noticeable correspondence between growing levels of sugar consumption and increasing Western health issues such as hypertension, diabetes, non-alcoholic fatty liver disease, heart disease, gout, and perhaps extending into dementia. Compelling arguments suggest that sugar, especially high-fructose forms, may be responsible for long-term health effects that have led to the increasing emergence of debilitating afflictions. This work's engrossing details emphasize the need for a shift in nutritional research to the lasting consequences of the temptingly sweet, but possibly toxic, sugar addiction. Summing Up: Recommended. All readers. --Rita A. Hoots, Sacramento City College

Copyright American Library Association, used with permission.

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Review by New York Times Review

SAY YOUR CHILD petitioned for permission to smoke a pack of cigarettes a week. Say his or her logic was that a pack a week is better than a pack a day. No dice, right? O.K., now substitute sugar for cigarettes. Comparing the dangers of inhaling cigarettes with chowing down on candy bars may sound like false equivalence, but Gary Taubes's "The Case Against Sugar" will persuade you otherwise. Here is a book on sugar that sugarcoats nothing. The stuff kills. Taubes begins with a kick in the teeth. Sugar is not only the root cause of today's diabetes and obesity epidemics (had these been infectious diseases, the Centers for Disease Control and Prevention would have long ago declared an emergency), but also, according to Taubes, is probably related to heart disease, hypertension, many common cancers and Alzheimer's. Name a long-term, degenerative disease, and chances are Taubes will point you in the same direction. Taubes has written extensively about diet and chronic illness, notably in a 2002 New York Times Magazine cover article that challenged the low-fat orthodoxy of the day. Taubes expanded the piece into two books, "Good Calories, Bad Calories" and, several years later, "Why We Get Fat," in which he argued that the American medical establishment had bungled this century's biggest health crisis. Bad science and the processed-food industry have colluded to make fat public enemy No. 1 - all the while neglecting carbohydrates, especially the highly processed and easily digested kind. And these are the real culprits in the expansion of our waistlines. In "The Case Against Sugar," Taubes distills the carbohydrate argument further, zeroing in on sugar as the true villain. He implicates scientists, nutritionists and especially the sugar industry in what he claims amounts to a major cover-up. Taubes's writing is both inflammatory and copiously researched. It is also well timed. In September, a researcher at the University of California, San Francisco, uncovered documents showing that Big Sugar paid three Harvard scientists in the 1960s to play down the connection between sugar and heart disease and instead point the finger at saturated fat. Coca-Cola and candy makers made similar headlines for their forays into nutrition science, funding studies that discounted the link between sugar and obesity. It's tempting to predict that Taubes's hard-charging (and I'll add game-changing) book will diminish sugar's dominance, sealing the fate that no ingredient could evade after such public relations disasters. But the history of sugar in this country suggests it won't be that easy. Here is where Taubes is at his most persuasive, tracing sugar's unique and intractable place in the American diet. Start with World War II as an example, when the government smoothed the way for sugar rationing by arguing that sugar was not part of a healthy diet. The American Medical Association agreed and recommended severely limiting consumption. Alarmed by the possibility of an American public that could learn to live without sugar, the industry founded the Sugar Research Foundation to proselytize its benefits. As Taubes sees it, the S.R.F. may have been created in the spirit of other industry-funded research programs - to promote and defend a product - but it helped establish relationships with scientists like the ones recently reported on at Harvard in the 1960s, and it institutionalized an aggressive, attack-dog public relations strategy that remains prevalent and pernicious to this day (tactics that the tobacco industry would also adopt). With the rise of new calorie-counting dieting fads in the 1950s, the industry responded with a coordinated offensive. Blanketing daily newspapers with advertisements, it argued, successfully it turned out, that since obesity was caused by excess consumption of calories - a calorie was a calorie, dogma at the time - all foods should be restricted equally. Sugar has only 16 calories a teaspoon; why should it be disproportionately demonized? The 1960s and 70s saw a similar pattern: another threat in the form of new evidence implicating sugar, another coordinated response. Just when it looked as if the sugar industry, for all its campaigning, could no longer overrule scientific fact, it was saved by saturated fat. The rising belief that dietary fat consumption was the cause of obesity and heart disease - which had been written about sporadically for decades - suddenly coalesced into fact, shifting the public's attention away from sugar. This wasn't planned or paid for. It was just dumb luck. The American Heart Association, long considered unbiased and authoritative, played a crucial role by blaming fat and cholesterol for heart disease. The press, Congress and the Department of Agriculture followed suit. Then things went totally bananas. High-fructose corn syrup, which is just as deleterious as sugar, got a passing grade from scientists (especially for diabetics!) and went mainstream in the '80s and '90s. Same killer, new disguise: Americans were seduced by the sweet stuff all over again. A new category of products presented as health foods, like sports drinks and low-fat yogurt, played a sort of shell game by advertising that the bulk of their calories came from high-fructose corn syrup, without letting on to consumers that this was just another form of sugar. Learning about this made my heart hurt. So, after decades of scrambled and spurious dietary advice, where are we now? There is a growing consensus in the medical community that a condition known as "metabolic syndrome" is perhaps the greatest predictor of heart disease and diabetes. Signs of the syndrome include obesity, high blood pressure and, more than anything, insulin resistance - which puts a particularly heavy strain on the body. And what causes insulin resistance and metabolic syndrome? Taubes blames sugar, the "dietary trigger" hiding in plain sight for over half a century. And if he's right, he could prove its guilt once and for all. But is he right? Taubes, who no doubt finds the answer blindingly obvious, nonetheless poses the question himself. Is sugar "the primary cause of insulin resistance and metabolic syndrome and therefore obesity, diabetes and heart disease"? His answer: "It certainly could be." I know, I know - it's the prosecutorial equivalent of a deflating balloon. But Taubes explains his caution by reminding us that we are no longer dealing with deficiency diseases, like scurvy, which can be solved with a single magic bullet like vitamin C. We're talking about degenerative diseases, which take a long time to develop - a lifetime of sweets, in other words - and (frustratingly, if you're out to prove the hypothesis) don't develop in everyone. IF YOU'RE LIKE ME, you've read this review just as I read Taubes's book - respectfully interested in the history and the facts, but really wanting to be told how much sugar is too much. Taubes anticipates our selfinterest, ending the book with a chapter just for us: "How Little Is Still Too Much?" But like some cryptic oracle, he answers the question with still more questions: How many cigarettes are too many cigarettes? What if the person who smoked a pack a week outlived the person who smoked a pack a day? Would we conclude that inhaling a pack of cigarettes a week is safe? Herein lies Taubes's key point, and it's sort of a life lesson. We will never know for certain. Sugar may once again get off scot-free, because there is no definitive experiment or algorithm that can be developed to remove all doubt, no practical way to know for sure to what extent it's killing us. The only certainty is that Big Sugar will continue to fight for its exoneration. Faced with more damning evidence, the industry will obfuscate rather than enlighten. It will insist that there are "two sides" to the story, and will corral skeptical scientists - readily available on any subject - to invalidate or at least cast doubt on solid medical consensus. There's another certainty, too - one that Taubes doesn't acknowledge. When it comes to our health, sugar itself might be largely to blame, but the story can't end there. It's tempting to think - and Taubes insinuates - that if we managed to cut sugar out of our diets altogether, the chronic diseases discussed in this book would disappear. But that ignores a whole ecosystem of issues - our patterns of eating and excess, our poisoned environment - that informs our wellbeing. Put simply: Remove sugar and we'll still be sick. Our job here - and not only here, but with everything from tobacco to global warming - is to override the imperfect, long haul to scientific certainty and instead follow the precautionary principle, which means recognizing what's staring us in the face and acting on it as if our health hangs in the balance. Because it does. Would we ask how many cigarettes are too many? We shouldn't treat sugar differently. DAN BARBER is the chef and co-owner of Blue Hill and Blue Hill at Stone Barns, and the author of "The Third Plate."

Copyright (c) The New York Times Company [January 1, 2017]

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Review by Booklist Review

*Starred Review* Taubes takes the topic of his best-seller, Why We Get Fat and What to Do about It (2011), one step further in his latest. Beyond implicating carbohydrates as the enemy in modern diets, Taubes lays out, as his title suggests, the prosecution's argument if sugar alone were to be tried in criminal court, charged for causing the Western World's plagues of diabetes and obesity. Imagined concept aside, Taubes deals in science and fact, and what he relays is staggering. Namely, that the refutable calories in versus calories out theory of weight management has taken responsibility for illness away from sugar for more than a century; that the twentieth-century decision to blame fats and salt for heart disease is an overly assumptive and sadly immovable one; and that modern studies of the manifestation of diabetes and obesity in recently Westernized populations suggest that we're likely to be facing grave new problems moving forward if our sugar use isn't dramatically curbed. Acknowledging that responsible public-health policy and good nutrition science won't always overlap, as well as the difficulty in testing the effects of any single food in our diets, Taubes confidently recommends giving a severe reduction in sugar intake a try. HIGH-DEMAND BACKSTORY: Taubes' brilliant and accessible science writing has won him many fans, and, on a hot topic like this, demand will be huge.--Bostrom, Annie Copyright 2016 Booklist

From Booklist, Copyright (c) American Library Association. Used with permission.

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Review by Publisher's Weekly Review

The latest offering from health journalist Taubes (Why We Get Fat) prosecutes the case against sugar, in particular sucrose and high fructose corn syrup. His hypothesis is that "sugar is the dietary trigger of obesity and diabetes" and of related illnesses like heart disease. The author traces the history of sugar, delves into its biochemistry, explores false starts in the research into sugar's health effects, and examines current developments in knowledge of chemistry and metabolism to bring home his point. Recognizing that condemning sugar is "the nutritional equivalent of stealing Christmas," Taubes begins with an examination of whether sugar is addictive. (Short answer-yes, and it's in cigarettes!) Fittingly, he ends with a discussion of how little is too much. (Short answer-probably very little.) Reiterating a point he makes throughout about the limits of research, the author concludes that "the evidence against sugar is not definitive, compelling though I may personally find it to be." His study is itself compelling, as well as meticulously explained and researched. Readers will hate to love this book, since it will cause them to thoroughly rethink the place of sugar in their diets. Agent: Kris Dahl, ICM. (Dec.) © Copyright PWxyz, LLC. All rights reserved.

(c) Copyright PWxyz, LLC. All rights reserved

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Review by Library Journal Review

If The Case Against Sugar were a criminal case, it would be a case for the prosecution, Taubes writes. Like a skilled attorney, he puts on the stand a litany of expert witnesses, including doctors and scientists and their centuries of research on the relationship between sugar consumption and chronic Western diseases, such as diabetes, insulin resistance, and even gout. Taubes also debunks the arguments that sugar is harmless, by carefully laying out the history behind sugar and how it evolved, thanks to technology, marketing, and (bad) science. But he acknowledges there's still reasonable doubt on whether the evidence "would stand up in a court of law and allow governments to regulate sugar, as they already do tobacco and alcohol." Taubes argues that the lack of scientific research on the effects of sugar fuels that uncertainty. Although Taubes is unable to build an airtight case against sugar as a culprit that warrants government regulation, he presents a convincing argument that makes one think seriously about limiting the amount of sugar we consume. VERDICT Narrator Mike Chamberlain's steady voice helps drive the point home without getting in the way of the information. ["This accessible book will be of particular interest to historians and health-conscious readers": LJ 10/15/16 review of the Knopf hc.]-Gladys Alcedo, Wallingford, CT © Copyright 2017. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

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Review by Kirkus Book Review

The award-winning journalist once again takes up the cudgel in defense of health.In his latest book, Taubes (Why We Get Fat and What to Do About It, 2010, etc.) makes the provocative contention that sugar, rather than fat, is the primary cause of obesity and a major culprit in a spectrum of chronic diseases. While it is now recognized that a drastic increase in the consumption of sugar and refined starches correlates to a dramatic rise of obesity in populations that adopt a Western diet, the author argues that nutritionists have yet to pinpoint its significance. He points out that obesity is a marker for the overconsumption of carbohydrates responsible for the onset of Type 2 diabetes. The problem, he writes, is not the number but the kind of calories consumednor is it necessarily a diet high in saturated fats. Taubes compares sucrose and high-fructose corn syrup to toxinsthat do their damage over years and decades, and perhaps even from generation to generation. Furthermore, diabetics and obese people are more likely to have fatty liver disease as well as other degenerative diseases due to elevated carbohydrate intake. For this reason, Taubes is dismissive of advice (from Michael Pollan, among others) that urges an across-the-board reduction in the total amount of calories we consume. The author buttresses his provocative contention with population studies showing the increase of chronic disease in populations that subsist on a Western diet. An example is the increase since 1960 of chronic disease among the indigenous population of a New Zealand protectorate that substituted a carbohydrate-rich diet for the saturated fats they formerly consumed. Taubes makes a convincing, well-documented case against the modern carbohydrate-rich diet. Limiting their intake is an important factor in longevity, not merely as a matter of weight control. An important book that meritsand will likely receivebroad circulation and discussion. Copyright Kirkus Reviews, used with permission.

Copyright (c) Kirkus Reviews, used with permission.

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INTRODUCTION WHY DIABETES? "Mary H--an unmarried woman, twenty-six years of age, came to the Out Patient Department of the Massachusetts General Hospital on August 2, 1893. She said her mouth was dry, that she was "drink- ing water all the time" and was compelled to rise three to four times each night to pass her urine. She felt "weak and tired." Her appetite was variable; the bowels constipated and she had a dizzy headache. Belching of gas, a tight feeling in the abdomen, and a "burning" in the stomach followed her meals. She was short of breath." --Elliott Joslin's diabetes "case no. 1," as recorded in the case notes of his clinic. Elliott Joslin was a medical student at Harvard in the summer of 1893, working as a clinical clerk at Massachusetts General Hos- pital, when he documented his rst consultation with a diabetic patient. He was still a good three decades removed from becom- ing the most in uential diabetes specialist of the twentieth century. The patient was Mary Higgins, a young immigrant who had arrived from Ireland ve years previously and had been working as a domestic in a Boston suburb. She had "a severe form of diabetes mellitus," Joslin noted, and her kidneys were already "succumbing to the strain put upon them" by the disease. Joslin's interest in diabetes dated to his undergraduate days at Yale, but it may have been Higgins who catalyzed his obsession. Over the next ve years, Joslin and Reginald Fitz, a renowned Har- vard pathologist, would comb through the "hundreds of volumes" of handwritten case notes of the Massachusetts General Hospital, looking for information that might shed light on the cause of the disease and perhaps suggest how to treat it. Joslin would travel twice to Europe, visiting medical centers in Germany and Austria, to learn from the most in uential diabetes experts of the era.  In 1898, the same year Joslin established his private practice to specialize in the treatment of diabetics, he and Fitz presented their analysis of the Mass General case notes at the annual meeting of the American Medical Association in Denver. They had exam- ined the record of every patient treated at the hospital since 1824. What they saw, although they didn't recognize it at the time, was the beginning of an epidemic. Among the forty-eight thousand patients treated in that time period, a year shy of three-quarters of a century, a total of 172 had been diagnosed with diabetes. These patients represented only 0.3 percent of all cases at Mass General, but Joslin and Fitz detected a clear trend in the admissions: the number of patients with diabetes and the percentage of patients with diabetes had both been increasing steadily. As many diabetics were admitted to Mass General in the thirteen years after 1885 as in the sixty-one years prior. Joslin and Fitz considered several explanations, but they rejected the possibility that the disease itself was becoming more common. Instead, they attributed the increase in diabetic patients to a "wholesome tendency of diabetics to place themselves under careful medical supervision." It wasn't that more Bosto- nians were succumbing to diabetes year to year, they said, but that a greater proportion of those who did were taking themselves off to the hospital for treatment. By January 1921, when Joslin published an article about his clinical experience with diabetes for The Journal of the American Medical Association, his opinion had changed considerably. He was no longer talking about the wholesome tendencies of diabetics to seek medical help, but was using the word "epidemic" to describe what he was witnessing. "On the broad street of a certain peaceful New England village there once stood three houses side by side," he wrote, apparently talking about his hometown of Oxford, Massachusetts. "Into these three houses moved in succession four women and three men--heads of families--and of this number all but one subsequently succumbed to diabetes."  Joslin suggested that had these deaths been caused by an infec- tious disease--scarlet fever, perhaps, or typhoid, or tuberculosis-- the local and state health departments would have mobilized investigative teams to establish the vectors of the disease and prevent further spread. "Consider the measures," he wrote, "that would have been adopted to discover the source of the outbreak and to prevent a recurrence." Because diabetes was a chronic dis- ease, not an infectious one, and because the deaths occurred over years and not in the span of a few weeks or months, they passed unnoticed. "Even the insurance companies," Joslin wrote, "failed to grasp their significance."  * We've grown accustomed, if not inured, to reading about the ongoing epidemic of obesity. Fifty years ago, one in eight American adults was obese; today the number is greater than one in three. The World Health Organization reports that obesity rates have doubled worldwide since 1980; in 2014, more than half a billion adults on the planet were obese, and more than forty million children under the age of ve were overweight or obese. Without doubt we've been getting fatter, a trend that can be traced back in the United States to the nineteenth century, but the epidemic of diabetes is a more intriguing, more telling phenomenon. Diabetes was not a new diagnosis at the tail end of the nine- teenth century when Joslin did his rst accounting, rare as the disease might have been then. 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 it was most common in the overweight and the gluttonous. By the rst century a.d., the disease may have already been known as "diabetes"--a Greek term meaning "siphon" or " owing through"--when Aretaeus of Cappodocia described its ultimate course if allowed to proceed untreated: "The patient does not survive long when it is completely established, for the marasmus [emaciation] produced is rapid, and death speedy. Life too is odious and painful, the thirst is ungov- ernable, and the copious potations are more than equaled by the profuse urinary discharge. . . . If he stop for a very brief period, and leave off drinking, the mouth becomes parched, the body dry; the bowels seem on re, he is wretched and uneasy, and soon dies, tormented with burning thirst."  Through the mid-nineteenth century, diabetes remained a rare af iction, to be discussed in medical texts and journal articles but rarely seen by physicians in their practices. As late as 1797, the British army surgeon John Rollo could publish "An Account of Two Cases of the Diabetes Mellitus," a seminal paper in the history of the disease, and report that he had seen these cases nineteen years apart despite, as Rollo wrote, spending the intervening years "observ[ing] an extensive range of disease in America, the West Indies, and in England." If the mortality records from Philadelphia in the early nineteenth century are any indication, the city's resi- dents were as likely to die from diabetes, or at least to have diabetes attributed as the cause of their death, as they were to be murdered or to die from anthrax, hysteria, starvation, or lethargy. In 1890, Robert Saundby, a former president of the Edinburgh Royal Medical Society, presented a series of lectures on diabetes to the Royal College of Physicians in London in which he estimated  that less than one in every fty thousand died from the disease. Diabetes, said Saundby, is "one of those rarer diseases" that can only be studied by physicians who live in "great cent[er]s of popula- tion and have the extensive practice of a large hospital from which to draw their cases." Saundby did note, though, that the mortality rate from diabetes was rising throughout England, in Paris, and even in New York. (At the same time, one Los Angeles physician, according to Saundby, reported "in seven years' practice he had not met with a single case.") "The truth," Saundby said, "is that diabe- tes is getting to be a common disease in certain classes, especially the wealthier commercial classes." William Osler, the legendary Canadian physician often described as the "father of modern medicine," also documented both the rarity and the rising tide of diabetes in the numerous editions of his seminal textbook, The Principles and Practice of Medicine . Osler joined the staff at Johns Hopkins Hospital in Bal- timore when the institution opened in 1889. In the first edition of his textbook, published three years later, Osler reported that, of the thirty- ve thousand patients under treatment at the hospital since its inception, only ten had been diagnosed with diabetes. In the next eight years, 156 cases were diagnosed. Mortality statistics, wrote Osler, suggested an exponential increase in those reportedly dying from the disease--nearly doubling between 1870 and 1890 and then more than doubling again by 1900. By the late 1920s, Joslin's epidemic of diabetes had become the subject of newspaper and magazine articles, while researchers in the United States and Europe were working to quantify accurately the prevalence of the disease, in a way that might allow meaningful comparisons to be drawn from year to year and decade to decade. In Copenhagen, for instance, the number of diabetics treated in the city's hospitals increased from ten in 1890 to 608 in 1924--a sixty-fold increase. 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 1,500 percent since the Civil War. Despite all this, the disease remained a relatively rare one. When Joslin, working with Louis Dublin and Herbert Marks, both statis- ticians with the Metropolitan Life Insurance Company, examined the existing evidence in 1934, he again concluded that diabetes was rapidly becoming a common disease, but only by the stan- dards of the day. He conservatively estimated--based on what he considered careful studies done in New York, Massachusetts, and elsewhere--that only two to three Americans in every thousand had diabetes.    Excerpted from The Case Against Sugar by Gary Taubes All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

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