The Case Against Sugar by Gary Taubes (June 2017)
Taubes's latest book is another well-intended attempt to answer a deceptively simple question- why is obesity so prevalent in modern society? Part of the issue, of course, is the impossibility of answering such a question with the decisiveness required by modern scientific standards. Taubes does the next best thing, I suppose, by simply laying out the case for the reader to consider. As he puts it, the book is written in the manner of a prosecutor laying out an argument before a judge and jury during a hypothetical 'trial' against sugar.
Most of this book is not so much an eye-opener as a head-nodder: I found what he wrote illuminating rather than shocking. He reminds readers how the eight-fold increase in diabetes prevalence within the US coincided with a rise in sugar consumption. The increase was made possible when sugar refining began in the mid-nineteenth century (perhaps the most significant nutritional change to ever occur in human history).
Since then, the way humans have experienced health problems as they age has changed at an unprecedented rate. Sugar as the cause is, again, a hypothesis, but when he cites how immigrant populations to the USA 'catch up' to American lifestyle disease prevalence within two generations or explains why low-sugar yet high-carb diets like those of the traditional Japanese lead to healthy outcomes, it is harder to dismiss the larger suggestion of his work.
Taubes does not explicitly make the case for sugar's addictive properties. However, he points out Coca-Cola's founding purpose: to wean an addicted morphine user off the drug. The idea was to trade an uncontrollable addiction for one more easily managed. This lines up with the experience a friend of mine had while quitting cigarettes on the umpteenth attempt; he simply ate sugar, almost nonstop, for two months.
Of course, all this does not make 'sugar' the answer to the opening question. But it does support the case for sugar being the answer to the question I posed on Wednesday- what will be considered the 'cigarette of our lifetime'? The key properties for the answer are addictiveness and slow-accumulation of harm. Combining what I've read over the years with what I've experienced in my lifetime, I have little remaining doubt that excessive sugar consumption is my answer.
One up: I'm always excited to see an author mirror or echo one of my beliefs. One such feeling I have involves the way medicine will change in my lifetime. I'm pretty certain over the next few decades a highly-personalized 'threshold model' will come to dominate treatment planning.
What do I mean by 'threshold model'? Think about sunburns- the 'dosage' of sunlight resulting in a burn differs for all. Over time, as science better understands the body and the way the outside world impacts it, the type of thinking taking us away from the current 'one size fits all' approach to medicine and instead bringing individual tolerance levels to determine nutritional needs or medical solutions will become the standard of high quality care.
In terms of sugar, if people indeed have unique consumption thresholds, one way we will see this manifest is in delayed disease development. Much like how some burn in the sun after an hour while others can bake for days, folks who eat sugar beyond their threshold might initiate the incubation period for Western diseases ahead of those who stay below their threshold. Such thresholds might turn out to be influenced more heavily by genetics, early childhood, or even womb-environment factors than currently understood.
One down: One of the more ridiculous Onion articles I ever read was titled 'Experts: Ebola Vaccine At Least 50 White People Away'. The article takes a dig at two generally unstated beliefs, one of which is the obvious (and in this example, race-based) assertion of how people tend to worry about smaller problems closer to home than larger issues impacting communities abroad (1).
The second belief is less direct: the need to defend against infectious outcomes outside our control while doing little to influence the outcomes known to be in our control. Taubes points out how if people became overweight or obese as a result of some infectious disease, the research community would attack the problem in a far different way than it is doing today when it is considered a reflection of individual decision making. Nutrition research has simply not taken on the urgency of disease research, a historical reality I suspect reflects a preference to find new cures while leaving existing solutions under-implemented.
Just saying: I'm not here to sugar-coat (!) anything for you, sweet reader. The reason why I'm writing about all this sugar stuff on my little-read blog is because it remains merely a hypothesis. Such is the state of the science, so to speak, when it comes to the difficult problem of isolating influences on the human body over decades-long periods.
It is simply too difficult using current methods to study nutrition with the robustness required because most diet studies involve two factors that are just as likely to impact the person as the nutrient being studied. The first is a version of the substitution effect: a person who eats less sugar will eat more of something else. So, is the effect from reducing sugar or increasing the replacement?
The second is time. Does a twenty-five year old respond to a diet in the same way a fifty-five year old does? It is unclear (though I suspect it is unlikely). It could also be that different bodies develop 'tolerance' to sugar over time at different rates.
An added factor here is how, though researchers in general are taught to challenge authority and seek truth, in medicine researchers generally give authority an undue weight. From Taubes's point of view, this reality explains some of the field's tendency to start from unproven conclusions as fact instead of seeking to refute those assumptions through experimentation.
Ultimately, Taubes makes a usable conclusion about the matter. The limits of science mean regulation of sugar in a way akin to that of tobacco is unlikely in our lifetimes. This does not excuse readers from gathering information and making the healthiest possible decisions for themselves and their bodies.
Footnotes / imagined complaints
1. Wait, not talking about race?
Trust me, reader, it is killing me not to go more into this. But race is not what this post is about. If I thought of a non-race example, I would have used it here.
While on the topic, might as well share my favorite Onion piece: it is about Boston. Click here for the link.
