Review: The Case Against Sugar by Gary Taubes

Gary Taubes’ new book shows that sugar and its industry’s tale is not a sweet one.

You may have heard of Gary Taubes and his writings before.  This is not his first rodeo in upsetting the status quo and rattling the cage of conventional wisdom when it comes to diet and nutrition.  Gary first made waves back in 2002 when he wrote an article for the New York Times called “What If It’s All Been a Big Fat Lie?” http://www.nytimes.com/2002/07/07/magazine/what-if-it-s-all-been-a-big-fat-lie.html  In this piece he questioned some cornerstones of conventional wisdom by asking what if fat wasn’t the dietary devil it was made out to be, and what if carbohydrate consumption wasn’t as benign, either.  This article laid the groundwork for his 2007 tome Good Calories Bad Calories.  This 640 page behemoth was as persuasive as it was dense.  This book opened up the debate on whether a calorie is truly a calorie, or if there were other factors, namely the hormone insulin, at play.  It also peeled back the curtain on the history of nutrition science, as well as the political pressures and policies that lead to where we are today. In 2011, Taubes followed up GCBC with a lighter, condensed, more casual reader-friendly version called Why We Get Fat.

In his 3rd outing of nutritional journalism, The Case Against Sugar, he argues that the sweet powder we put in so many of our daily indulgences is the smoking gun that traces back to epidemics of chronic diseases (obesity, diabetes, heart disease, stroke, and cancer) that plague societies worldwide today.  In this book, he makes the case that sugar, namely sucrose and high fructose corn syrup, is uniquely toxic and its consumption leads to a cascade of possible and unfortunate events of ill health.  He shows this through two ways.  First, he dives into the science and research, both past and present, behind dietary consumption of sugars, as well as the metabolic effects of its consumption.  Second, much like in his previous books, he goes into the history of the rise of sugar, the industries that rose and profited, and pressures from both politicians and corporations that lead to weak science and biased nutritional guidelines.  As he states as almost a mission statement of the book: “…I hope to continue to restore this history to the discussion of how our diets influence our weight and health, and to do so in the context of the vitally important question of sugar in the diet.”

Let’s be clear right out of the gate:  this book does not show with 100% certainty that sugar is toxic or that it is the sole trigger that started the snowball of metabolic derangement leading to the epidemiological buffet of chronic diseases we now face.  And that is because it is 100% IMPOSSIBLE to do so.  The type of science that would be needed to achieve this feat would be insanely expensive, and would have to span decades and over multiple generations.  In other words, if you’re waiting for this causation level evidence to come before making up your own mind about whether sugar is uniquely detrimental to our health, don’t hold your breath.  I do give Taubes credit where credit is due, he addresses this elephant in the room right away, and without hesitation.  What Taubes does do is gives thorough evidence that very few others, even leading experts in the respective fields, have before.

If you have read either of his previous two books, you will see some overlap here.  But if you haven’t, don’t fear that you need a primer on his other works as this book stands fine on its own. Taubes goes on to lead the charge against sugar by focusing on two of the biggest health crises we face today: obesity and diabetes.  How did conditions that were at one time very rare, especially diabetes as documented in the 1800s and early 1900s, become so prevalent today?  How did we go from 10 patients out of 35,000 being diagnosed with diabetes (as documented by famed physician William Osler in his textbook The Principles and Practice of Medicine) to 1 out of every 7 to 8 adults according to the CDC in 2012?  Some have blamed dietary fat.  Some have pointed the finger at technological advances reducing the need for physical labor, transportation methods leading to less movement, and longer commute times.  Taubes believes it is the consumption of sugar, and the argument he lays out in this book is a particularly strong one.

I’m not going to ruin some of the surprises that his book holds, but I have to give a couple of head-nods.  The history of the intertwined fates of the sugar and tobacco industries was fascinating and was one I had never been exposed to before.  Secondly, as a practicing dentist, I appreciated the clinical, anthropological, and epidemiological evidence showing sugar consumption to be the chief cause for tooth decay.  Yes, that is old hat to a lot of folks, but for some reason its importance is lost on the masses, probably because cavities (dental caries) are so common.  But it’s important to note that just because something is common doesn’t mean it’s normal.  One of my favorite quotes from the book summarizes this well:

“‘It would be an extraordinary coincidence,’ as Peter Cleave wrote and we’ve already quoted, ‘if these refined carbohydrates, which are known to wreak such havoc on the teeth, did not also have profound repercussions on other parts of the alimentary canal during their passage along it, and on other parts of the body after absorption from the canal.'”

I will admit that I almost felt bad for Taubes when Good Calories Bad Calories came out.  Yes, he was praised by many for his unapologetic take down of mainstream nutritional thought.  To those people who felt estranged by the government’s dietary guidelines, and their healthcare providers’ sincere but misguided advice to “eat less and move more,” his book was breath of fresh air.  However, it did not come without its critics.  Health professionals, nutrition professors, and government officials booed in unison as Taubes broke the cardinal rule of questioning the official dietary guidelines and the dogma of conventional wisdom.  And some of these criticisms got ugly, attacking Taubes on a personal level.  Well, now I don’t feel so sorry for Gary.  He has moved from the position of David taking on Goliath to one of hardened authority whose sole purpose is slapping the wrist of those who cling to the notion “a calorie is a calorie” and that sugar is nutritionally benign or even beneficial.  This book will certainly be less controversial most people will agree that excess consumption of refined sugar is not a good thing.  I’m sure his advice to abstain from all sugar consumption (except those small trace amounts naturally occurring in vegetables and fruits) will fall on deaf ears.

At the end of the day, this book will add fuel to the anti-sugar movement’s fire, but it is unlikely to change otherwise decided minds.  If a person already believes sugar is the devil, this will cement their opinion further.  If a person has already toed the “a calorie is a calorie is a calorie” line and believe calling sugar a “toxin” is sensationalism, like suggested in The Gluten Lie by Alan Levinovitz, this book is unlikely to sway their beliefs.  True change will come from those folks who are on the fence about the “Calories In, Calories Out” hypothesis and are open to new evidence.  The real question is: Will the newfound knowledge of the evidence lead to personal change, or will people shrug their shoulders and proceed to put that hip Sugar in the Raw into their Starbucks?  Will people go back to consuming sugar as long as it’s in “moderation”, or will people adapt an abstinence like they might from tobacco?  That is up to the individual.

 

What is Ketosis? Pt. 3

Welcome back to part 3 of our basic series explaining what ketosis is and how it can be beneficial.

In parts 1 & 2, we reviewed what ketones are, how our body makes them, and how they are used as a fuel source.  Today, we will talk about the $10,000 Question:  Why would a person want to be in ketosis?  This answer is multifactorial, as people have used nutritional ketosis for a myriad of different reasons.  Most people dip their toes into the “Keto Diet” because they want to lose weight.  However, there are numerous other reasons people adapt to a ketogenic lifestyle.  Some use it to help mitigate various symptoms of inflammation such as arthritis or acne.  Some people use it for an advantage in sports performance, namely endurance sports like marathons, cycling, triathlons, etc.  Some people use it to help their mental clarity and mood.  And some folks find better sex drive and fertility (Note: I’ve been working on a post for resources and scientific studies about these very topics.  Feel free to keep an eye out as the list continues to grow).

As I stated in part one, a ketogenic diet (aka “keto”) is a low carbohydrate diet.  However, it differs from other popular low carb diets like Atkins (www.atkins.com) and Protein Power (www.proteinpower.com).  Where those are indeed lower carb compared to the Standard American Diet (SAD), they may not be low enough in carbohydrates to induce ketosis.  The 1st phase of Atkins is very low carb (under 20 net grams) to promote ketosis, however in the actual Atkins guidelines this phase is only meant to be done for 2 weeks.  This differs from a truly ketogenic diet, as this carb restriction is meant to last indefinitely (unless utilizing a modified keto diet like the cyclical or targeted ketogenic diets, which we’ll explain later).

 

When carbohydrates are reduced enough (sometimes 5% or less of calories consumed) and more natural fat is consumed in its stead, your body enters the metabolic state of ketosis.  This state causes your body to become more efficient at using fat as a fuel source (instead of just constantly storing it).  Also, the liver coverts fats into ketones (as we explained in Part 2) that can act as an alternative source of energy for the brain (1,2).  Ketogenic diets have shown to help lower and improve blood sugar and insulin levels.  Also, the increased levels of ketones have shown to have other health benefits as well.  (1,3,4,5)

 

Side Note:  If you want to geek out on science and metabolism of ketones/ketosis, I’m going to recommend you check out Dr. Peter Attia’s blog over at The Eating Academy.  He does a deep dive that I think science enthusiasts will really appreciate.  These two articles are of significant value:

http://eatingacademy.com/nutrition/ketosis-advantaged-or-misunderstood-state-part-i

http://eatingacademy.com/nutrition/ketosis-advantaged-or-misunderstood-state-part-ii

The studies cited above (and more that I haven’t linked to) have shown to be an effective strategy for losing weight and reducing disease risk.  Also, there are numerous studies showing that the ketogenic diet out performs low-fat diets (6, 7, 8, 9).  In fact, a ketogenic diet has shown that it’s possible to lose weight without cumbersome calorie counting or food journaling as shown in a study published by the American Journal of Clinical Nutrition (http://ajcn.nutrition.org/) in 2008 (8).   A 2007 study published in Diabetic Medicine (the journal of the British Diabetic Association; http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1464-5491) showed that those on a low carb, ketogenic diet lost 3 times more weight than those on the Diabetes UK’s recommended diet.  That is pretty darn substantial!

Yet another study showing significant results is a 2003 study published in The Journal of Clinical Endocrinology & Metabolism (http://press.endocrine.org/journal/jcem) (11).  This study showed that participants lost 2.2 times more weight and 2.4 times more body fat than those on the calorie restricted, low-fat diet.  This study also had another interesting finding, as stated in the discussion section:

” Another unexplained, but important, observation was the spontaneous restriction of food intake in the very low carbohydrate diet group to a level equal to that of the control subjects who were following a prescribed restriction of calories. This raises the possibility that the very low carbohydrate diet may have been more satiating”

 

In a nutshell, what this observer is saying is that the participants did not feel the need to eat regular full meals, possibly even refusing to finish what was in front of them, because they didn’t feel the need to continue eating; they were full.  And what they did end up eating during the day counted up to about the same number of calories as the others who were restricting their calorie intake.

 

Ok, its effectiveness in losing weight has been covered.  But HOW do you DO the keto diet?  A buddy of mine and fellow ketonian, Larry Lustig, summed it up well in one sentence:  “Replace the carbohydrates you eat with fat.”   https://www.ketogenicforums.com/t/the-entire-ketogenic-diet-in-one-sentence/497

 

The following is going to be MY recommendation based on what I’ve learned from studying the topic, as well as my personal experience.  Other Keto proponents might disagree with what I say, and that’s perfectly fine.

It’s important to remember that each person is different, so these ratios of fat:protein:carbs needs to be individualized.  The breakdown of a typical keto diet is about 70-75% calories from fat, 20-25% from protein, and 5-10% from carbohydrates.  It can be beneficial to count calories and track your food when you first start, as there can be hidden carbs and sugars in foods that you wouldn’t expect (sugar in cured meats for example).  I for one HATE counting calories, so now that I’ve been doing this long enough, I have a good grasp on the macros of the foods I generally eat.  I don’t count calories or journal; I just go by hunger levels and how I feel.

 

Note that it can take an average of 21 days to become keto adapted!!! Some folks take less time, some can take more.  And it can take a few days to a week of strict carb restriction before you start turning those pee sticks (Ketostix) colors. These are used to monitor ketosis when you first start out. When you do start going into ketosis, you are going to lose retained water and with that you will lose sodium.  It’s important to make sure you are getting enough salt.

 

Example meal plan when I was eating 3 times a day:

Breakfast:  3 eggs, 2 slices of bacon, 1/2 of an avocado

Lunch: BAS (Big Ass Salad) with bleu or feta cheese, whatever full cut meat I wanted (usually what I had for leftovers, just diced up.  Do NOT go for lean meats.  You need the fat.), and a high-quality dressing, like something from Newman’s Own or my new favorite by Primal Kitchen (http://www.primalkitchen.com/shop/)

Dinner:  Grilled Pork Steak and Green Beans or Broccoli cooked in Butter

 

Now that I’m keto/fat-adapted, my hunger is blunted, so I usually only eat lunch (my new Break-Fast) and dinner.  I might have a Keto drink (a shake or coffee with exogenous ketone supplement, another subject for another day) in the morning, but often I’m just not hungry.

 

Common mistakes I see (and have learned from experience):

 

Not enough salt:  When going from fat-burning after being a sugar-burner for so long, you will lose water and sodium.  Some people report a feeling of brain fog and fatigue.  Often this is because they are low on salt.  Feel free to add salt to your meals, and consider a cup of bullion or bone broth once every 1-2 days.

 

Too much protein in relation to your amount of activity and/or level of insulin resistance: This is more likely for highly insulin-resistant folks like myself.  Excess protein cannot be stored, and will be broken down to glucose via gluconeogenesis.  This rise in glucose can kick you out of ketosis.  You might not have that problem with your training, but it’s something I had to learn the hard way. Please note that, IN MY OPINION, excess protein is only a problem if you are SEVERELY insulin resistant (like yours truly).  If you have less than 50 lbs to lose, of if you’re doing a lot of strength or muscle work like bodybuilding, strongman training, or Crossfit, this is unlikely to be the case.  This area of study is still in its infancy, and there seems to be a lot of disagreement in the LCHF camp.  My $0.02:  If you are not morbidly obese and you live a semi-active lifestyle, you’re probably not going to be consuming too much protein.  If you are very insulin resistant and are sedentary, you can skip the 20 oz steaks and protein shakes.

 

Too many carbs:  Carb levels are so individualized that it’s almost moot to talk about.  Some folks can stay in ketosis around 100 grams of carbs a day.  Some folks do better on 50 grams.  I, myself, because of my insulin resistance, must stick between 20-30 or fewer grams. A general guideline is the more weight you need lose, the lower your carb count needs to be.  I’m a rip-the-band-aid-off kind of guy, so I’m all about just dropping down to 20 grams, get adapted, and then play with number of carbs based on YOUR situation.

 

Side Note:  In the low carb community, a constant debate is how to count carbs.  Some people count Net carbs (Total carbs – fiber- sugar alcohols = net).  This is what Dr. Atkins recommended in his protocols.  However, I am in the count total carbs camp.  If you look at some of these “low carb” treats and protein bars, you might see a bar have 23 grams of total carbs, but, after subtracting fiber and sugar alcohols, it might only have a net carb count of 6.  I’ve had trouble with this for a couple reasons.  First, this type of leniency can lead to overindulgence of these foods.  Second, sugar alcohols can still raise the blood sugar of some people and kick them out of ketosis, lead to cravings, or both (which was my personal experience as well).

 

“I feel kinda crappy for the first few days, so it must not be good for me”:  What a ridiculous excuse. Personal note:  I used to smoke, and it sucked quitting.  I was irritable, I’d get headaches, blah blah blah.  Doesn’t mean it was BAD for me, my body was just in transition.  Same thing here.  When you are changing the fuel that your body utilizes (fat burner vs sugar burner), it’s going to take an adaptation process (we talked about how your body needs to get better at creating beta-hydroxybutyrate dehydrogenase in Part 2).

 

So what CAN you eat?   Check this list out for a good breakdown of Low Carb Approved Foods

http://www.ketogenic-diet-resource.com/low-carb-food-list.html

Basically it comes down to plenty of meat (don’t shy away from the fatty cuts), and green leafy or non-starchy vegetables.   Also remember that you want to keep your net carbs (total carbs minus fiber) under 20 grams starting out. And if you’re more insulin resistant (like yours truly),  you may need to keep TOTAL carbs under 20 grams.

 So there you have it:  Why a person can benefit from nutritional ketosis and how to do it.  That was a long post, thanks for hanging in there with me.  I hope that it brought you a lot of value.  In my next post, I will be discussing the effect of ketosis on special situations such a diabetes, cancer, Alzheimer’s disease, heart disease, polycystic ovary syndrome (PCOS), and more.  Also, I’ll be working on a book review for Gary Taubes’s new book, The Case Against Sugar.   Stay tuned!

 

 

1: https://www.ncbi.nlm.nih.gov/pubmed/14525681

2:https://www.ncbi.nlm.nih.gov/pubmed/6865776

3: https://www.ncbi.nlm.nih.gov/pubmed/14769489

4: https://www.ncbi.nlm.nih.gov/pubmed/11122785

5:https://www.ncbi.nlm.nih.gov/pubmed/14769483

 

6: https://www.ncbi.nlm.nih.gov/pubmed/23632752

7: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633336/

8: https://www.ncbi.nlm.nih.gov/pubmed/18175736  (This one shows can lose without Counting Calories or food journaling)

9: https://www.ncbi.nlm.nih.gov/pubmed/15466943

10:  https://www.ncbi.nlm.nih.gov/pubmed/17971178  (lost 3x more weight than Diabetes UK’s recommeneded diet)

11: https://www.ncbi.nlm.nih.gov/pubmed/12679447 (showed keto lost 2.2 times more weight than CR, Low fat; along with improved Tri and HDL levels)