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.