January 31, 2018

Book Review: The Case Against Sugar

Gary Taubes wrote another book.

Gary Taubes! (*Fangirl squee!*)

Do I really need to say more?

I don’t, but since this is my blog, I will.

TL;DR: I loved this book and you will too. READ IT.

If you don’t read a lot of blogs and websites outside the low carb bubble, then allow me to tell you that there’s a large contingent of people who loathe Taubes. He takes a boatload of criticism, as does anyone who writes something that condemns or exonerates something other people love or hate (e.g., red meat and saturated fats, refined carbohydrates, and raw milk). But put me squarely in the camp that loves his work and is grateful for his meticulous research. (The endnotes and bibliography of Good Calories, Bad Calories are almost as large as my entire book.) I’m not saying he’s right about everything, nor that I agree with him on everything. I’m only saying I’m a big fan and have been for several years.

I had the pleasure of meeting Gary in spring 2017, first at a reading and book signing in Washington, DC, and then a few weeks later at a literary event in Charlottesville, VA. I actually drove him from Charlottesville back up to Dulles airport in my neck of the woods, so we had some time to chat and shoot the low carb breeze. Let me tell you, folks: I read GCBC during my deployment in Iraq, circa 2008. Having always been a sucker for salt & pepper hair, intellect, and a wry and somewhat dark sense of humor, I developed an immediate nerd crush on Gary. Never in my wildest imagination—and mine is pretty wild—did I think nine years later, I’d have him all to myself on the road for two hours.

Get your minds out of the gutter. Nothing happened except good conversation and Gary being an exceptionally good sport about the fact that my decade-old car has seen better days. (He assured me that his car is older and in even worse disrepair. We writers don’t exactly break the bank; not even ones like Gary, who garner big advances and have multiple bestsellers to their names.) Without revealing too much, I’ll say that it was really nice to talk with a writer of Gary’s caliber, and to find out that many of the emotional demons that plague me are not unique to me. Gary deals with his by throwing himself into work; I deal with mine by avoiding work. Neither strategy is all that healthy, long term. But I can look to Gary as someone with a lot of dark thoughts and inner turmoil who still manages to get shit done produce great work. It helps that he has a wife and two sons depending on him, so he sort of has to bring home the proverbial (and literal) bacon. 

As an aside, Gary has spent time in France, and he longs for it. As he talked about it, his desire to be there—and, maybe, to be the person he was when he was there—was palpable. He has also written and spoken a lot about his history as a smoker. I could totally see him as the quintessential ex-pat, sitting at a roadside café in Paris, sipping coffee and reading poetry, complete with a black turtleneck and a cigarette.  

But enough about Gary. On to the book!

As I said in a past post, you know if Gary Taubes writes a book, I’m gonna read it. Good Calories, Bad Calories was the first place I’d ever read about a connection between glucose, insulin, and Alzheimer’s, and you all know where that little morsel led. His latest book, The Case Against Sugar, was equal parts fascinating, educational, and infuriating. Why infuriating? Well, Taubes goes back a few centuries—centuries—to show us that doctors in the 1600s and 1700s had already recognized that sugar was up to no good in terms of people’s health and their body weight. He points out that many of the “modern” or “Western” diseases, or “diseases of civilization” actually started to pop up in the 17th and 18th centuries, long before the advent of soybean and corn oils, long before GMOs, grain-fed meats, pesticides, EMF, automobiles, video games, TVs, cell phones, or anything else that is typically used as the scapegoat for the current epidemics of obesity, type-2 diabetes, and metabolic illness. So none of that was an issue back then, but what there was, was refined sugar—large amounts of it for the first time in human history.

Doctors way back then had already recognized that people who were becoming overweight, had gout, joint pain, or diabetes were all eating a lot of sugar. At one point, all of those conditions were once the sole purview of royalty and other very wealthy people—because they were the only ones who could afford sugar. And it was recommended that rail-thin women who wanted a fuller figure should drink sugar water, because it was known that sugar helped put weight on. HUNDREDS OF YEARS AGO. This was largely taken for granted. Taken as obvious. Because the quantity of sugar in people’s diets was really the only thing that had changed significantly, so of course it was the main driver of all these new, weird health problems no one had ever had before. (Well, actually, some of them were observed and recorded in ancient Egypt, so let's amend that to very, very few people had ever had them before.)

Was it too much red meat? Too much fatty pork? No, people had been eating those for ages. Too much grain? Too much rice, corn, or wheat? No, people had been eating those for ages, too, although probably in smaller quantities than we do today. Same goes for potatoes and beans.

“As for diet, by far the most significant and consistent change in human diets as populations become Westernized, urbanized, or merely affluent is how much sugar they consume. Some populations also have the opportunity to consume more animal products and particularly red meat, but other populations—the Inuit, Native American tribes of the Great Plains, and African pastoralists like the Masai—were already living predominantly on animal products, and they, too, get obese, diabetic, hypertensive, and atherosclerotic as they become Westernized.” (p.153)   

There wasn’t a whole lot of hand-wringing back then about exercise, or “calories,” or dietary fat, and it doesn’t seem like there was a whole lot of moral judging going on, either. Not much condemnation of the overweight or people with diabetes or gout for lacking willpower and discipline. It was pretty straightforward: they just needed to lay off the sugar.

Compare that with the state of the research today:
“The National Institutes of Health and other research agencies fund thousands or tens of thousands of researchers to answer thousands or tens of thousands of small questions, and the hope is that out of these pieces a coherent picture will emerge. Instead, what we have is a cacophony and the assumption that if so many researchers are studying so many different pieces of the puzzle, it must be a very complex problem.” (p.271)

The Case Against Sugar takes us through the fascinating history of centuries-ago medicine, when none of the aforementioned confounders researchers contend with today were a factor. Some of this nutritional archaeology is a revisiting of things Taubes covered in GCBC, but it’s been several years since I read that, so it felt new to me. New, and shocking. I really can’t stress how floored I am that many of the detrimental effects of a high sugar intake—and, in many people, the resultant chronic hyperglycemic and hyperinsulinemia—were identified centuries ago. (The high blood glucose more so than insulin, since insulin wasn't “discovered” until the 20th Century.) Sugar was the simplest, most obvious culprit, and yet, here we are, a few hundred years later, still debating whether it does anything more sinister than cause tooth decay.

I don’t want to steal Gary’s thunder by sharing too many quotes from the book, although I’ll give you some zingers in a bit. Just read it. If you’re into this stuff—low carb, keto, Paleo, metabolism, or nutrition and health in general—this book is well worth your time, even if you think you know this all already. You will probably still find yourself riveted, as I was. (Only a gigantic nerd like me would consider this kind of book a page-turner!)

What makes TCAS different from GCBC? Well, GCBC was a tome of epic proportions, in my opinion, and it went far beyond carbohydrates. It talked about fat, cholesterol, calories, and a bunch of other issues. TCAS, as you might have guessed, is mostly about sugar. In TCAS, Taubes explores whether there’s something unique about and particular to refined sugar, itself (as sucrose, high fructose corn syrup, etc.) that is detrimental for health. Something either not present in, or not a downstream effect of, starches and other carbohydrates, such as those we find in beans, potatoes, and even in grains. (Robert Lustig, MD, would argue that there most definitely is.) Because if you go back to the quote above about the Masai and the Inuit, suggesting that red meat and animal fat, per se, are not harmful for health, we could say the same regarding populations that historically consumed large amounts of fruit and starch—these things seem okay since people ate them and were healthy and robust, but when these groups added refined sugar to their diets, they got sick and fat just like everyone else. 

When you think about things from an evolutionary perspective, it kind of makes sense that fructose—present in fruit and “table sugar” (sucrose) but either absent from or in much smaller quantities in starchy roots, tubers, grains, and legumes/pulses—should help us fatten up a bit. Fruit would have been available in abundance in warm seasons—at least, at certain latitudes and altitudes—and maybe eating a lot of it would have induced a temporary “insulin resistance” and/or fatty liver for the helpful and protective purpose of fattening us up to make it through the coming winter. And as long as that winter came—a prolonged period of time during which sweet foods would not have been available, and during which insulin would have been low and we would have mobilized that stored fat, all was well. The problem now, as you know, is that “metabolic winter” never comes. In a world where you can go to a supermarket in North Dakota in January and buy pineapples and mangoes, our livers (and the rest of our bodies) get the signal to store, store, store energy all year long, but the signal to mobilize it rarely comes. If you’re interested in more on this topic, Lights Out: Sleep, Sugar, and Survival, is a seriously excellent read.

But of course, accumulating excess body fat is not the only outcome when we consume more sugar than is right for our individual constitution. Taubes masterfully covers links to gout, type 2 diabetes, cancer, and dementia. After reading this book, you’ll have a hard time not believing sugar is a big factor in many of the chronic, non-communicable diseases that afflict millions (billions?) of people today. Maybe not the only factor, but certainly a big one. Maybe the biggEST. 

I think this is where Taubes takes a lot of criticism. People probably think he’s pointing the finger at sugar and nothing else. But this isn’t true. Nowhere in the book does he say that sugar is the only contributor to our modern chronic disease epidemic. He makes a damn good case for sugar as a contributor—the strongest and most obvious one—but he never says it’s the only one.

Like I said, I loved this book and you probably will too. My copy is a little worse for wear, what with all the dog-eared pages and notes in the margin. In the interest of full disclosure, there are a couple of not-so-great things about it.

One: Gary’s writing is not for the non-intellectual. He is, in my opinion, a fantastic writer, but his prose is often dense and meandering. (I’m saying this about another writer? Hi, kettle? This is the pot. You’re black. I’m well aware I have the same problem, thank you.) That’s not necessarily a bad thing; that’s just his style. It makes some passages difficult to get through, but his work is so meticulous and compelling that it’s worth it. The stunning zingers he drops here and there are well worth the occasional verbal slog to get there.

Two: I could be wrong about this, but I felt like Gary was implying a causal link between obesity and type 2 diabetes. I have written over and over on this blog—because it is a personal pet peeve of mine—that there is a causal link between obesity and T2D, but it isn’t that the former causes the latter; it’s that chronic hyperinsulinemia causes both. I am so tired—so tired—of people who should know better continuing to say these two things together (obesity and T2D) as if they go hand-in-hand because one causes the other. There’s even a new word for how closely they track together: diabesity. And it’s a great word, except that it misses the millions of people with T2D who are not obese. We could just as easily call it “goutbesity,” or “cardiobetes,” or any other portmanteau word connecting the myriad conditions caused by hyperinsulinemia that have nothing to do with body weight. (Gout, cardiovascular disease, T2D, erectile dysfunction, BPH, PCOS, hypertension, and, in my opinion, Alzheimer’s.) Obesity is the whipping boy and easy target only because it’s the one that’s plainly visible. But as someone who battled and still battles my weight, but am far healthier than many people slimmer than I, I am beyond tired of body weight being blamed for everything from heart attacks to cancer to hangnails, when these things happen to people of all sizes. And again, if obesity and these other issues do happen to cluster together, it’s not because being heavier causes them, but rather, a common factor is behind all of them. (See here for one of my favorite blog posts on this issue.)

I’m not sure if Gary meant to imply a causal relationship. That’s just the impression I got. In skimming through TCAS for quotes, though, I did come across these gems: “It’s a vicious cycle in which secreting too much insulin can cause insulin resistance, and insulin resistance will cause the body to secrete still more insulin. Diabetes and heart disease are likely to follow. Getting ever fatter may be a cause, but it could be a result as well.” (p,201, my emphasis.)

“By assuming that hyperinsulinemia and insulin resistance were caused by obesity, they [obesity researchers in the U.S.] could continue to believe that obesity itself is caused merely by taking in more calories than expended. This thinking left a host of problems unsolved or unexplained—insulin resistance or hyperinsulinemia, for instance, in lean individuals—but it would become widely accepted nonetheless.” (p.120) 

Y’all know this goes right to my anger center—putting everything down to weight as the cause of all the other issues it often clusters with. I’ve ranted written about hyperinsulinemia in individuals who through some stroke of physiological luck do not become overweight. (Summary: they’re not immune to the other effects of chronically elevated insulin. Slinking into skinny jeans or fitting into your varsity jacket from high school sports 25 years ago is no guarantee that you are not very, very metabolically ill.)  


In this age of glucometers, ketone meters, heart rate monitors, home blood pressure cuffs, and more, we are awash in endless data. And some of us in the low carb/keto community, in particular, seem to want to make things as complicated as possible. What exact ratio of omega-6 to omega-3 should I am for? Exactly how much more autophagy will happen in my cells if I fast for 17 hours instead of 16? If I’m doing high intensity training, should my rest interval be 60 seconds or 62? But things are often far simpler than we make them out to be.

I’m not going to argue that cutting back on (or altogether eliminating) refined sugar will be a miracle solution for everyone who’s carrying extra weight or dealing with any of the conditions we currently believe stem from too high a sugar intake. But for the love of all that’s holy, it’s a damn good place to start.

I’ll leave you with this:

“…well over half a million articles have been published in the peer-reviewed medical literature on the subjects of obesity and/or diabetes, while the prevalence of those diseases in our society has inexorably climbed. The implication is that if this were a simple problem we surely would have solved it by now, so it must be multifactorial and complex—two words that are invoked so consistently to explain the genesis of these diseases that we have to question whether the terms imply an explanation or a simple lack of understanding of the problem.” (p.270)

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to amazon.com, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.


  1. Another big Taubes fan here! I actually really like his "dense" writing style and intellectual meanderings, and hope he doesn't change that. But then again, I am a bit of a nerd that way.

    I would have been curious to know what he thought about honey, but he didn't really go there. I know Robert Lustig pretty much lumps it together with sugar. I'm not so sure about that.....it's been in the human diet for a long time, and hunter gatherer groups also ate honey- (and many of them were very healthy). Many people claim there are health benefits to honey- (for instance, that it's anti-viral, anti-inflammatory, etc.) I actually stopped eating it along with sugar- (now all that stuff seems too sweet for me, just because I'm not used to it anymore). Still, it interests me as an intellectual question. Somehow I tend to think it's not as bad as sugar....In any case, I guess Gary Taubes wanted to just mainly focus on sugar. I hope he writes more books on this, and similar topics; there's a lot more to be said about it, and more research to be done.

  2. Well, Taubes is how I got started on this whole line of thinking- Why We Get Fat. Then of course I had to get Good Calories Bad Calories. Not having an analytical mind, I tend to believe whatever I read, but when I found out how much criticism he has taken, I figured he had to be onto something here. With Why We Get Fat well in my thinking, I went on to discover Lustig, Perlmutter, Wm Davis (Wheat Belly), etc. And of course it all led me to your blog and book. Yeah! When used copies of this most recent tome are less expensive, I'll be getting a copy, and in the meantime, I'll check the library. So allow me to plug another I just found- Denise Minger's book Death by Food Pyramid. She's very thorough and well documented like you are. If you should have time to check it out, I'd be interested in your thoughts.

    1. Ye, I've read Denise's book. She's a very meticulous researcher and does a lot of the "heavy lifting" so lazy people like me don't have to. ;-) I don't agree with her on everything, but generally, I'm a fan of her work and her writing.

  3. GCBC is such an important book that needed to be written. The world will be forever grateful that someone with the tenacity of,Taubes took the job on.

    I'm not a fan of his style of writing, but that is not a problem as i buy his books for information on nutrition.

  4. Physician who has done a great deal of reading about the cause of diabetes here. Taubes is close to being accurate many times. He should take a basic course in biochemistry and read even more and deeply into studies with a more critical understanding! Like a grenade and atom bombs, close enough is good enough if he convinces readers to cut their sweeteners, (guess he doesn't go that far) okay, sucrose intake.

  5. Just got my copy from the local library - thanks for the heads up, Amy!

    PS: Have I told you how much I love your blog? Well, I love your blog. So there. Keep up the great work.