Sugar. It’s so nice, isn’t it? No wonder it’s a pet name for our most-loved companion – our “sweetheart”. Sugar is a positive, a life enhancer. Not something that could be associated with blindness, kidney failure, heart attacks, stroke and lower limb amputation, surely?
The World Health Organisation really knows how to ruin the mood. That said, the mood needs ruining. Problems with blood sugar kill nearly four million people a year. According to Gary Taubes’s polemic, a fierce work that he explicitly describes as “the case for the prosecution”, we need to wage war on the sweet stuff. As he concedes, however, we have very few weapons in our armoury, and sugar may already have won.
This victory is manifest in the epidemic of diabetes sweeping the planet. The number of people with the condition has nearly doubled since 1980: it is now heading towards 450 million globally. Roughly 18 million people in the UK are “pre-diabetic”, with elevated blood glucose and a similarly elevated chance of developing type 2 diabetes. You could be among them.
You probably doubt that, though. Sugar’s killer strategy is that it is always someone else’s problem – until it’s too late. For most of us, diabetes is almost an abstract idea: we have a vague notion of people who get a bit wobbly if their blood sugar goes awry, a problem that can be fixed by an injection. Few people without diabetes appreciate the appalling truth of the illness.
When sugar enters the bloodstream, the body responds by releasing insulin from the pancreas. Insulin is a hormone that tells the muscle cells to mop up and use blood glucose. Evolution has done us a service here: ignoring elevated blood sugar leads to a host of inflammatory responses that cause damage to the veins and arteries, leading to heart disease and blindness and, sometimes, complications that can require amputation.
About one in every 20 diabetics is born with type 1 diabetes, which means that their body does not produce insulin. They have to inject artificially produced insulin to keep their blood sugar at manageable levels. Far more common is type 2; with this, the body develops a resistance to the signals from insulin and blood glucose levels remain high unless artificial means of removing it are used. Both of these kinds of diabetes have a hereditary element but type 2 seems much more strongly associated with a genetic predisposition. If you are born to a mother and father who both have type 2 diabetes, your risk of developing the illness increases by 75 per cent. It is type 2 diabetes that is the growing risk. So, what causes this life-threatening insulin resistance to develop? The evidence points to one culprit besides genetics: high sugar intake.
Diabetes was rare until the world became hooked on sugar. Taubes cites ample supporting evidence, taken from myriad population groups and many contexts. In 1920s Kenya and Uganda, for instance, diabetes was virtually unknown in the population, which consumed a high-fat, low-sugar diet. By 1970 obesity had become a grave problem, and every big city had a large diabetic clinic. What had changed? The newly Westernised East African diet was replete with copious helpings of sugar.
The island nation of Tokelau, a group of three coral atolls in the South Pacific, provides a near-perfect case study. In the 1960s the Tokelau diet consisted largely of coconut, fish, pork, chicken and breadfruit. Over 50 per cent of the islanders’ calories came from fat, much of it saturated. Just 2 per cent came from sugar and processed white flour (which converts to sugar during digestion). Three per cent of Tokelauan men and 9 per cent of Tokelauan women were diabetic.
Tokelau now has the highest prevalence of diabetes by population density of any nation in the world. “As of 2014, almost 38 per cent of all Tokelauans had been diagnosed with diabetes,” Taubes writes. “More than two-thirds were obese.” What had happened was that they gradually embraced a Western, sugar-saturated diet. The average per capita consumption of sugar had risen from eight pounds’ weight a year to roughly 54 pounds a year.
When in the West we first began to ingest sugar in large quantities, diabetes was relatively little known here, too, but by the turn of the 20th century that was no longer the case. Frederick Madison Allen of Harvard Medical School was among the first to notice the link between sugar and the illness. In 1913 he noted: “It is generally recognised that diabetes is increasing, and to a considerable extent, its incidence is greatest among the races and the classes of society that consume [the] most sugar.”
By the mid-1920s deaths from diabetes were nearing “epidemic” proportions and the battle to escape blame was in full swing. Trade associations and medical experts have been batting accusations, evidence and insults back and forth for decades now. Yet the end result is exactly what the sugar industry, and all who profit from it, had hoped for: public confusion (abetted by a sugar habit that has spun out of control), a policy vacuum and a convenient scapegoat.
In the 1960s, nutritionists, physicians and laboratory researchers published a stream of reports suggesting that consumption of sugar was causing metabolic abnormalities linked with diabetes and heart disease. The trade bodies associated with sugar rose to the commodity’s defence and pointed the finger at obesity – and a different source of calories. Dietary fat has yet to recover from the smear campaign designed solely to get sugar off the hook.
Though it slows the pace of the middle section of his book – in the main, Taubes’s prose is perfectly judged, as compelling as a slow-motion car crash – the insertion of this history is necessary. The decades of collusion between science, governments and the sugar industry has long needed to be exposed for the avaricious and sociopathic strategy that it is. You could even call it passive ethnic cleansing. After all, failure to act on the dangers posed by sugar, which are well documented and well known, has hit certain groups disproportionately hard.
Worst off is the Native American population: indigenous Americans and Alaska Natives are over twice as likely to have diabetes as non-Hispanic whites in the United States. In 2008 the federal Indian Health Service estimated that 30 per cent of Native Americans and Alaska Natives had pre-diabetes; teenagers in this population suffered a 68 per cent increase in the incidence of diabetes between 1994 and 2004. African Americans aren’t much better off: they are 1.7 times more likely to suffer the condition than non-Hispanic whites. More than one in every seven black Americans over the age of 20 has been diagnosed with it.
Would the US government act if the prevalence in the general population were as high? We may soon find out. The US Centres for Disease Control and Prevention predicts that one in three Americans will have diabetes by 2030. The rest of us won’t fare much better: the International Diabetes Federation forecasts that, across the world, one adult in ten will have diabetes by 2030.
Yet it is unlikely that governments will act. They are paralysed by the economic dominance of what British colonialists called “white gold”. The sugar industry, like financial services, is too big to fail.
It might be difficult to understand how, in a scientific age, this has been allowed to happen. The simple answer is that the science can never be conclusive enough. Those who do not want to believe it, for ideological or economic reasons, can excuse themselves. We have seen this happen in the case of pesticides that wiped out species, with the chemicals that destroyed the ozone layer, with the deadly effects of tobacco and with global warming. Science can be twisted, co-opted or ignored by those who hold the reins of power. And those who rely on financial support from those in power will acquiesce and toe the line of doubt.
Even the American Diabetes Association has decided to sit meekly within the scientific consensus, saying that type 2 diabetes is caused by “genetics and lifestyle factors”; the culpability of sugar is a “myth”. As Taubes observes, “The organisation accepts the role of fat accumulation in the liver as quite possibly a causal factor . . . but ignores the evidence building steadily since the 1980s that implicates sugars as the cause . . .”
So, what should we do? It is not easy to cut our intake. “Any discussion of how little sugar is too much also has to account for the possibility that sugar is a drug and perhaps addictive,” Taubes notes. “Substantial sugar consumption is the norm and virtually unavoidable and everyone does it. Trying to consume sugar in moderation, however it’s defined, in such a world is likely to be no more successful for some of us than trying to smoke cigarettes in moderation.”
The comparison is apposite, given that cigarette addiction is in large part also a triumph of sugar. Adding sugar to tobacco made the smoke less harsh and enabled us to inhale it fully. Smoke-filled lungs are much better absorbers of nicotine than a smoke-filled mouth; suddenly, the hit became bigger and better, and smokers craved another one as soon as the effects wore off.
Arguably, the sugar business has been even more successful than the tobacco industry. As Taubes points out, sugar has “assimilated itself into all aspects of our eating experience”. It is impossible to single out one area – soft drinks, or ready-meals, or confectionery – as the principal problem. It’s in everything. Bread, ice creams, canned foods, fruit juice, energy drinks and pretzels are all pumped with the stuff, as are low-fat foods that were meant to save us from obesity. In the past few decades, sugar became “an ingredient avoidable in prepared and packaged foods only by concerted and determined effort, effectively ubiquitous”, Taubes writes. “It was as though the food industry had decided en masse . . . that if a product wasn’t sweetened at least a little, our modern palates would reject it.”
That said, he clearly thinks a special place in hell should be reserved for breakfast cereal manufacturers. Sweetened cereals, some of which derive one-third or more of their calories from sugar, are marketed directly at children using animated characters – Tony the Tiger et al – in what is surely one of the most cynical industries on Earth. Sugar is to children what alcohol is to adults. And if you can get them hooked before they’re out of nappies, you’ve got a customer for life.
This is a book to make you put your head in your hands and wonder how humanity has endured so long. We see ourselves as the pinnacle of evolution, and yet we seem to be the dumbest, most self-destructive species on the planet. The sugar industry is certainly far cleverer than we are. It has survived a century-long prosecution and survived it well. On Valentine’s Day, millions of us will buy sugar-stuffed chocolates for our sweethearts. We habitually express love and appreciation to children through toxic treats, giving them sweets as a reward for good behaviour. Can Taubes’s expertly written and disturbing book change that culture? It is unlikely, but all the same, full marks – and a big red lollipop – for making a valiant and vital attempt.
Michael Brooks’s books include “At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise” (Profile)
The Case Against Sugar by Gary Taubes is published by Portobello Books (365pp, £14.99)
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This article appears in the 26 Jan 2017 issue of the New Statesman, The eclipse of the West