The Case Against Sugar

Has as a study

Canonical title*

Contro lo zucchero. Processo al peggior nemico della salute (e della linea) (e della linea)

Original title

The Case Against Sugar

Original publication date

2016

Epigraph

We are, beyond question, the greatest sugar-consumers in the world, and many of our diseases may be attributed to too free a use of sweet food.

The New York Times, May 22, 1857

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I am not prepared to look back at my time here in this Parliament, doing this job, and say to my children's generation: I'm sorry, we knew there was a problem with sugary drinks, we knew it caused disease, but we ducked the d... (show all)ifficult decisions and we did nothing.

GEORGE OSBORNE, U.K. chancellor of the exchequer, announcing a tax on sugary beverages, March 16, 2016

Dedication

To Gaby, for keeping the family together

First words

AUTHOR'S NOTE

The purpose of this book is to present the case against sugar—both sucrose and high-fructose corn syrup—as the principal cause of the chronic diseases that are mostly likely to kill us, or at least ac... (show all)celerate our demise, in the twenty-first century.

Quotations

If this were a criminal case, The Case Against Sugar would be the argument for the prosecution.

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As far back as the sixth century B.C., Sushruta, a Hindu physician, had described the characteristic sweet urine of diabetes mellitus, and noted that it was most common in the overweight and the gluttonous. By the first centu... (show all)ry A.D., the disease may have already been known as "diabetes"—a Greek term meaning "siphon" or "flowing through"

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Almost two million Americans were diagnosed with diabetes in 2012—one case every fifteen to sixteen seconds.

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From the seventeenth through the nineteenth centuries, sugar was the equivalent, economically and politically, of oil in the twentieth. It was the stuff over which wars were fought, empires built, and fortunes made and lost.

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The greatest advertising minds in the country would not only create animated characters to sell the cereals to children—Tony the Tiger, Mr. MaGoo, Huckleberry Hound and Yogi Bear, Sugar Bear and Linus the Lionhearted, the F... (show all)lintstones, Rocky and Bullwinkle—but give them entire Saturday-morning television shows dedicated to the task of doing so.

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Only when the rising tide of blood sugar begins to ebb will insulin levels ebb as well, at which point the fat cells will release their stored fuel into the circulation (in the form of fatty acids); the cells muscles and orga... (show all)ns now burn this fat rather than glucose. Blood sugar is controlled within a healthy range, and fat flows in and out of fat cells as needed. The one biological factor necessary to get fat out of fat cells and have it used for fuel, as Yalow and Berson noted in 1965, is "the negative stimulus of insulin deficiency." These revelations on the various actions of insulin led Yalow and Berson to call it the most "lipogenic" hormone, meaning fat-forming. And this lipogenic signal has to be turned down, muted significantly, for the fat cells to release their stored fat and the body to use it for fuel.

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Obesity has a genetic basis.

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it was clear that what we now call type 2 diabetes is not a disease of insulin deficiency (as type 1 is)—at least not at first—but of insulin resistance.

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Another possibility is that these elevated levels of insulin and the insulin resistance itself were caused by the carbohydrate content of our diets, and perhaps sugar in particular. Insulin is secreted in response to rising b... (show all)lood sugar, and rising blood sugar is a response to a carbohydrate-rich meal.

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The glucose we consume—in starch or flour, or as half of a sugar molecule—will be used directly for fuel by muscle cells, the brain, and other tissues, and can be stored in muscles or the liver (as a compound called glyco... (show all)gen), but the fructose component of sugar has a much different fate. Most of it never makes it into the circulation; it is metabolized in the liver. The metabolic pathways through which glucose passes when it is being used for fuel—in both liver and muscle cells—involve a feedback mechanism to redirect it toward storage as glycogen when necessary. This is the case with fructose, too. But the metabolism of fructose in the liver is "unfettered by the cellular controls," as biochemists later put it, that work to prevent its conversion to fat. One result is the increased production of triglycerides, and thus the abnormally elevated triglyceride levels that were observed in many research subjects, though not all, when they ate sugar-rich diets.

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one possibility is that it's the accumulation of fat in the liver that actually causes the insulin resistance that is at the heart of metabolic syndrome.

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if your blood pressure is elevated, that's a sign that you're insulin-resistant and have metabolic syndrome; it also means you're likely to be overweight, or at least getting fatter and your triglycerides are elevated, you're... (show all) glucose-intolerant, and your HDL cholesterol is low. They all go hand in hand and are probably caused by the same thing. By Occam's Razor and Burkitt's logic, if sugar causes insulin resistance and elevates triglycerides and makes us fat, then it very likely causes hypertension, too—if not directly, then at least indirectly, through its effect on insulin resistance and weight. Sugar is the culprit.

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Because there is significant reason to believe that sugars—sucrose and high-fructose corn syrup in particular, the nearly fifty-fifty combinations of glucose and fructose—are the dietary trigger of insulin resistan... (show all)ce and metabolic syndrome, it's quite likely they are a primary cause of all these Western diseases, including, as we'll discuss, cancer and Alzheimer's disease.

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By the 1990s, Gerald Reaven at Stanford, among others, was reporting that insulin resistance and hyperinsulinemia raised uric acid levels, apparently by decreasing the excretion of uric acid by the kidney.

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The higher their levels of circulating insulin, and that of a related hormone known as insulin-like growth factor, the greater the likelihood that they would get cancer.

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these breast-cancer cells seemed to be "addicted to" insulin, and when weaned off it in the laboratory they responded by dying.

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If the sugars we consume—sucrose and HFCS specifically—cause insulin resistance, then they are prime suspects for causing cancer as well, or at the very least promoting its growth.

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They suggest that type 2 diabetics have from one and a half to two times the risk of Alzheimer's dementia of nondiabetics, suggesting in turn, as the Rotterdam investigators did in 1999, that "direct or indirect effects of in... (show all)sulin could contribute to the risk of dementia."

Last words

(Click to show. Warning: May contain spoilers.)A similar experience is likely to be true of sugar—but until we try to live without it, until we try to sustain that effort for more than days, or just a few weeks, we'll never know.