The science journalist Gary Taubes starts his book The Case Against Sugar with the following argument: we live in a society where two conditions that used to be rare—obesity and type 2 diabetes—are now depressingly common. The most likely cause is our skyrocketing consumption of sugar, which is now in everything from soup to ketchup to crackers. Until recently, sugar was considered by most to be a “harmless pleasure.” Instead, Taubes argues that “It is the principal cause of the chronic diseases that are most likely to kill us, or at least accelerate our demise.”
The problem is, not only has sugar become a common part of our diet—both as an additive and as part of things like sweet cereals, desserts, and sodas—but society has become viscerally addicted to it. Whether the addiction is physical or just psychological, we crave it. We use it as a way to “communicate love and celebrate happiness,” says Taubes. We give it to our children as a way to soothe them and make them smile.
Taubes and I talked in late February, about sugar, the case against it, and how its ubiquitousness affects both those with type 2 and those with type 1 diabetes.
Could you explain your argument in a nutshell? What is it that is particularly dangerous about sugar, versus other carbohydrates?
I am trying to find the culprit for these epidemics of diabetes and obesity that occur everywhere in the world after a population transitions from a traditional diet to a Western diet. The numbers are often tragic. Populations go from having diabetes being a relatively rare disease to 1 in 4 or 1 in 2 adults. Sometimes this change happens over the course of 20 or 30 years. So it’s ridiculously fast. It’s as though 30-50 years from now 1 in 11 Americans had multiple sclerosis or muscular dystrophy. That kind of remarkable change, and you want to explain it; we have to explain it. We have to understand the cause so we can stop this from happening and reverse it. The conventional wisdom is that diabetes is more or less caused because people get fatter; and people get fatter because they take in more calories than they expend. I’m arguing that that’s naïve.
Sugar is always at the scene of the crime. It’s one of the few most dramatic changes that happen to traditional diets when the population is Westernized or becomes more affluent. And on a physiological level, the type 2 diabetes is a disorder of insulin resistance, and there is pretty good evidence that insulin resistance begins with fat accumulation in the liver. The fructose component of sugar is metabolized in the liver, and it’s often converted into fat when the liver has to deal with it in high doses, so sugar is at the scene of the crime in the body as well.
You argue that there are many parallels between tobacco and sugar, including the rise in disease as each became popular, and the efforts by each industry to try to persuade people that its product wasn’t harmful. Do you see this parallel going further? Very high taxes for sugar, suits against companies that sell sugary products, and general acceptance that sugar is bad for you?
The easy narrative is that the sugar industry is playing by the tobacco industry playbook, and that both industries worked to obfuscate what is clearly very damning science. I don’t actually believe that’s the correct narrative, though people have read my book and taken that from it.
The sugar industry is taking what the nutritionists and the obesity and heart disease researchers gave them. The obesity researchers are arguing that a calorie is a calorie. The nutrition and heart disease people are arguing that dietary fat causes heart disease. So when the sugar industry gets attacked they say, “Look, a calorie is a calorie, and dietary fat causes heart disease. It’s not sugar.” Then they pay researchers to basically write reviews to make those points.
That’s a very different scenario from what the tobacco industry did. The question was, did the industry know that cigarettes were addictive, and did they hide the fact that cigarettes were addictive, and did they try to maximize the addictive nature of the cigarettes. I think all those things are true. That’s why we had these huge tobacco settlements.
Where I really home in on the cigarette metaphor is in terms of causality. When we say cigarettes cause lung cancer, basically we mean lung cancer would be a very rare disease if not for cigarettes, and most people who get lung cancer get it because they smoke cigarettes. I’m arguing that the same causality is very likely true for sugar and diabetes and sugar and obesity. So sugar is the necessary ingredient, the environmental trigger of these epidemics. Without the sugar, these diseases would be very rare diseases.
But do you see society turning on sugar in the same way that society has turned on tobacco? Not that people don’t smoke, but there’s this idea that when you smoke you know what you’re doing to yourself.
You know, I do. It’ll be interesting to see what happens. Clearly that’s what I’m trying to provoke with this book. But again there are a lot of issues which make you think it will never get as far as it will with tobacco. One of the things that allowed us to win the smoking battle, by the way, was second-hand smoke. You could ban smoking in public places and restaurants on the basis that if you’re smoking you’re harming your colleagues. And there is really no direct equivalent to second-hand sugar consumption.
But there is serving your kids sugar.
Yeah, that’s the issue. If we start saying that sugar causes diabetes, it changes the way parents have to think about this. I clearly think sugar can be what it once was, a luxury and a treat, instead of an every day constant aspect of the diet, from the moment you wake up to the moment you go to sleep. But serving sugar to kids is a difficult decision to make, if you establish that sugar really causes diabetes.
Reading the book, I kept on becoming frustrated, because you make a good argument, and it seems like there’s a clear link between sugar consumption and type 2 diabetes. It’s frustrating that the medical and nutritional establishments haven’t recognized this link and have put forward other ones instead. So I’m wondering what’s gone wrong with those two establishments that they haven’t recognized it?
This is why I take a historical approach to these books, because I have to explain why this argument is being made now when clearly these epidemics have been building for 150 years. The nutrition/obesity research community has embraced two ideas that work against the sugar hypothesis. The first, from earlier than the 20th century, was this naïve idea that obesity is just an energy imbalance disorder that’s caused by taking in more calories than we expend. And according to this argument, there’s nothing unique about sugar that could cause obesity except that maybe people eat too much of everything, and they eat a lot of sugar because they like it. But if you look at obesity as a problem of hormonal regulation and of how much fat we store in our body, then sugar becomes a prime suspect again.
And then in the 1950s and 1960s, researchers obsessively focused on this idea that dietary fat causes heart disease. So instead of answering the question of why do we have obesity and diabetes epidemics everywhere in the world following this transition to Western diets they wanted to answer the question, Why do we have a lot of heart disease in the United States, where we happen to eat a lot of fat. Wrong question. They got the wrong answer. But this was the complete and utter focus of the nutrition research community until the 1980s, when the idea that we should eat a low-fat diet became institutionalized. When I started writing about this topic in the late 1990s, the number one clause in the definition of a healthy diet was that it was low in fat. And all our public health efforts went to getting Americans to eat low fat diets, even to the effect of taking natural foods like full fat yogurt, removing the fats, so they can appear to be heart healthy, and then replacing those calories with sugar and high fructose corn syrup. And the government was telling companies to do that. As long as we were focusing on fat, those nutritionists who argued that sugar was the problem were viewed as quackish.
How did so many intelligent people make what now seems to be the wrong argument—that eating fat causes obesity and diabetes?
I’m borrowing this from the Nobel laureate physicist Richard Feynman, but the first principle of bad science is that people get an idea and they convince themselves that it’s right, and that they can’t possibly be fooled. And in this case, a lot of different factors merged to convince the community that they were likely enough to be right about the dietary-fat hypothesis that they had to act as though they were right. After all, people are dropping dead from heart disease, we have to tell them something. We think dietary fat is the problem; we’re going to tell them it’s fat, and in the meantime we’re going to do the studies. So when the studies are done and they don’t support the idea that dietary fat is the problem, it’s easier to assume you did the studies wrong. And now you’re committed: you’ve got a whole nation following your advice.
So then it becomes hard to turn the ship around?
Yes. Now it becomes virtually impossible to acknowledge that the advice was wrong, not without ruining your credibility, if you’re a public health institution. Public health institutions can’t acknowledge they made a mistake, because then the natural question is: why should we take your advice on anything? Why do we think you’re not going to make another mistake? So you get this institutionalized dogma or group think that just becomes virtually impossible to overturn.
Why do you focus specifically on sugar consumption, and not on carbohydrate consumption? Doesn’t the body need to release insulin when someone eats starches, and not just sugars? I know that for my daughter with type 1 diabetes we need to give her insulin for any carbohydrate that she eats, not just for sugars.
On some level the answer is, this book is about sugar. What I want to know is, what’s triggering these epidemics in populations. Getting rid of carbs in general is a separate question. Once you have someone who has diabetes, now you have disregulated insulin signaling, and you’ve got to get rid of everything to fix it.
But that’s not what the American Diabetes Association is recommending. When Bisi was diagnosed with type 1, and again, it’s different from type 2, but I still have the dietary recommendations they gave me, which say that she should have 45-60 carbs per meal. My husband and I had to figure out ourselves that actually that makes diabetes much harder to manage than someone who’s eating fewer carbs. But it’s hard when the doctors aren’t pushing you to cut down the carbs, and of course society’s not either.
There’s this belief system that no one wants to stay on that restrictive of a diet, and that it’s too hard to do. And we don’t want to set people up to fail. My argument is, What’s wrong with this idea that we go back to these 1950s diets for obesity, which I discussed in my book Why We Get Fat. Those diets basically advise people to avoid carbs and sugar and to eat as much as you want of green leafy vegetables and of foods with protein and fat.
I’m arguing you want to set people up to succeed, and in order to do that people need to be fully informed.
On the flip side of things, partly because of how sugar obsessed our society is, it IS hard when every other kid is having brownies and whatever else. It does become a battle with certain children. I think the diabetes organizations should recommend low carb, but I do think it’s hard to get everyone to follow those recommendations.
The last chapter of the book, which is my meditation on the concept of moderation, I keep thinking, we live in a world where it’s virtually impossible to imagine life without sugar, or that we should even contemplate life without sugar, that somehow that’s cruel, and unusual, and puritanical, and rigid. I get it. And yet, if sugar is a drug, one with long-term rather than short-term side effects, that’s why we think like that, because we’ve all been addicted.
The working title for my book all along was “Stealing Christmas: The Case Against Sugar.” But there were enough people who didn’t get the Grinch reference that I was willing to give it up.
I feel like that all the time—that taking away sugar is equated with being a Grinch. A lot of candy is served in my kids’ middle school, and I had a meeting with the principal about that, and my son told me, “You’re going to ruin everything, Mom. We’re not going to be able to have sugar day in Spanish class anymore!” There’s this idea that you’re taking away joy.
Yeah, but if your daughter had a peanut allergy, they would completely get it. But something like diabetes is harder to accept. They should know better than to have a sugar day, and that’s the kind of thing I’m hoping to solve in my book, is to get rid of things like sugar days in schools.
How have you dealt with the question of whether to eat sugar yourself?
I find it easier not to eat sweets. If we go to someone’s house and there’s a dessert, or if we go out and my wife orders a dessert, I’ll be virtuous, but then I’ll have two bites and be obsessed with hers. I used to be a smoker; when you’re a smoker basically everything you do is looking forward to your next cigarette. It’s your reward for writing a paragraph, or doing an interview, or having sex, whatever. I finally broke that addiction. I don’t need to look forward to my next sweet. That is how drug addicts think. One thing becomes the place where there’s pleasure in life.
Is there a crucial group you’re trying to persuade with your argument? Nutritionists? Parents? Doctors? Or are you going for all of them?
I guess I’m going for everyone. But when I was writing it, and when I pitched it, I thought, this is a book that needs to be written because we need to change the public debate on sugar. We have to go from this idea that it’s empty calories, that we can eat in moderation, to talking about what the case really is, right or wrong, and what the stakes really are, right or wrong. So in that sense, I was going after the public health authorities and the nutritionists and the influential thought leaders who have been defining this debate up until now. My goal when I set out to write it was to redirect the public health discussion about this compound and what I think it should be. Then we can all debate whether what I think should matter.
You describe this book as the latest offensive in the “war on sugar.” Even though it’s hard to judge things when you’re in the middle of them, do you have any sense of where we are in that war? Is there any tipping of the balance that’s happening?
Yeah, I think we’re winning. Sugar consumption has been coming down in this country since 1999, when it was at unparalleled heights. I don’t know if any population had ever seen that much sugar. But as soon as we realized there was an obesity epidemic, which happened as a nation between 1995 and 1998, things started to peak. So we’re winning, and I think it’s going to continue to come down. I think industry sees the writing on the wall. I think they are going to delay the inevitable, because they make a lot of money selling sugar-sweetened products, and we clearly have an appetite for them. But I think we see where it’s going.