Jan 25, 2017 NY Times
Over the past half-century, the rate of obesity in America has nearly tripled, while the incidence of diabetes has increased roughly sevenfold. It’s estimated that the direct health care costs related to obesity and diabetes in the United States is $1 billion a day, while economists have calculated the indirect costs to society of these epidemics at over $1 trillion a year.
In recent years, some researchers have focused on the particular role refined sugar may play in these epidemics. Perhaps the most comprehensive analysis of this research has been put forth by the science journalist, Gary Taubes, author of the recent book, “The Case Against Sugar.” I spoke with Taubes about his research and what people should know about sugar to make better choices in their diets.
— David Bornstein
David Bornstein: What’s the essence of the case against sugar?
Gary Taubes: To understand the case against sugar, using a criminal justice metaphor, you have to understand the crimes committed: epidemics of diabetes and obesity worldwide. Wherever and whenever a population transitions from its traditional diet to a Western diet and lifestyle, we see dramatic increases in obesity, and diabetes goes from being a relatively rare disorder to a common one. One in 11 Americans now has diabetes. In some populations, one in three or four adults have diabetes. Stunning numbers.
So why sugar? Well, for starters, recent increases in sugar consumption are always at the scene of the crime on a population-wide level when these epidemics occur. And sugar is also at the scene of the crime biologically, and it’s got the mechanism necessary. But the evidence is not definitive; what I’m arguing is still a minority viewpoint.
D.B.: What’s the common explanation?
G.T.: The conventional wisdom is that obesity is a problem of energy imbalance. We eat too much, we’re too sedentary, so we get fatter — and this in turn causes the diabetes, Type 2, which is the common form. I don’t find this energy balance concept meaningful. It’s like saying when somebody gets richer, they make more money than they spend; they accumulate wealth. It’s a tautology; it tells you nothing about why it happens.
Still, it’s this energy balance thinking that leads us to blame the food industry for providing too much tasty food, and the individual who’s afflicted for not being able to eat in moderation and not being suitably active.
D.B.: Can you explain what you call the alternative hypothesis?
G.T.: Simple. Obesity is a hormonal/regulatory disorder just like any other growth defect. And the hormone that primarily drives fat accumulation is insulin, the same hormone that is disregulated in diabetes. Just as growth hormone is the primary driver of skeletal and muscular growth, insulin is the primary driver of our horizontal growth, the expansion of our fat tissue.
We secrete insulin in response to carbohydrates in our diet and there’s a condition called insulin resistance that is the fundamental defect in Type 2 diabetes and is so closely associated with obesity that we can speculate that it might be the cause. The Centers for Disease Control and Prevention estimates that 75 million American are insulin resistant.
D.B.: What is insulin resistance?
G.T.: Insulin is a hormone secreted by the pancreas that can be thought of as orchestrating how the body uses or partitions its fuel. It tells your cells to take up blood sugar and burn that sugar, technically glucose, for fuel. But it also tells your fat tissue to take up fat and inhibits the release of fat; it tells your muscles, your lean tissue, to use protein for rebuilding.
If you’re insulin resistant, your pancreas needs to secrete more insulin to control blood sugar, and that insulin will increase your fat accumulation as a consequence.
Researchers studying insulin resistance believe it begins in the liver, beginning with the accumulation of fat in the liver cells. As it turns out, the fructose constituent of sugar — half of cane or beet sugar, 55 percent of high fructose corn syrup — is metabolized primarily in the liver, and when it is delivered to the liver in high doses, the liver converts it into fat. So that’s what I mean when I say sugar is at the scene of the crime both in populations and biologically, in the body itself.
D.B.: Given the rates of obesity and diabetes in the United States, what do you think is called for today?
G.T.: I’m arguing the reason we’ve failed to curb the obesity and diabetes epidemics is we’ve misunderstood the cause. We blame eating too much and exercising too little, rather than the carbohydrate content of the diet, specifically sugar.
We need better research that asks the correct questions and rigorously, methodically and skeptically identifies the precise dietary causes of these disorders so we know what has to be removed to reverse or stop them. We need studies that can disassociate the physiological or toxic effects of sugar — on body fat, on insulin resistance status — from the calories it contains.
D.B.: Let’s say that happens. Then what?
G.T.: Then we have to get the message right. If we believe that sugar is just empty calories, then it’s reasonable to say eat it in moderation and balance the calories in sugary snacks by exercising more. We don’t have to steal Christmas, in effect, by removing sugar from our diets and our lives.
But I’m arguing that if sugar causes obesity and diabetes, then we should drop the “too much of,” or “overconsumption of,” or “excess of,” and just say sugar causes these diseases. (We could say added sugars, or refined sugars, if we don’t want to implicate fruit). We know that smoking too many cigarettes will cause lung cancer, but we don’t say “too many cigarettes” cause lung cancer; we say “cigarettes cause lung cancer.” The message is fundamentally different.
D.B.: What do you think the sugar industry should do?
G.T.: The sugar industry and its defenders argue that the evidence is ambiguous; therefore we should continue to believe that sugar is no more than empty calories at the very worst. What I would like them to do is suggest tests that could exonerate sugar, if it’s really harmless. It’s not enough just to say the evidence is ambiguous. And I think the industry now has an obligation to fund those tests.
D.B.: Do you think we should regulate sugar?
G.T.: I prefer education. Government regulation makes me nervous, as my books have documented how the ill-conceived efforts to limit our fat consumption, beginning in the 1970s and 1980s, may have helped put us in this situation. And government regulation based on ambiguous evidence makes me very nervous. It can set precedents for regulating other food products that might not be harmful or might even be beneficial to our health.
D.B.: What would help advance that education?
G.T.: We can put warning labels on sugary beverages as we’re trying to do in California. We can drop sugary drinks from kids’ menus at restaurants, as some chain restaurants already are. There are government campaigns, in various cities, and funded by the C.D.C. to discourage sugary drink consumptions. There are nonprofits creating ads and YouTube videos that help us understand quite how much sugar we’re consuming.
One possibility is that the Food and Drug Administration could reassess whether sugar should still be listed as “generally recognized as safe.” Foods need to have GRAS status to be used as additives. The F.D.A. granted sugar GRAS status in 1986, when most experts did generally recognize it as safe. But now they probably wouldn’t.
Clearly, we have to lower the sugar content in foods. Sugar is in virtually every processed food: peanut butter, salad dressing, white bread, ketchup, processed meats, barbecue sauces, canned soups, cold cuts, hot dogs, canned tomatoes, to name just a few.
One idea I like comes from a law professor at the University of California named, coincidentally, Stephen Sugarman, who has suggested a cap and trade approach for sugar. The idea is basically to have the markets and food industries agree to reduce the sugar that crosses the point of sale by, say, 5 percent every year. The idea is that we give food companies time to adapt to putting less sugar in their products, just like we give car companies time to reach higher gas mileage targets in their fleets.
D.B.: Do you have any advice to offer from personal experience?
G.T.: Clearly, the best approach is to learn to live without the obvious sources of sugar, in the sugary beverages, the candies and treats. But you have to do it long enough so that you can really know how you feel without it.
What’s it like to enjoy a meal without a dessert, or to drink water instead of juice or soda, to have a snack of nuts rather than a candy bar? When we try, and we can all do this as an experiment, we have to do it for long enough that we get over the initial cravings and get to the point where we can really experience what life is like without it. Only then can we decide if a healthy life without sugar is worth the apparent sacrifice.