Seth Yoder, in his post "The Case Against the Case Against Sugar" fully convinced me that Gary Taubes displays a serious lack of reportorial honesty in his book The Case Against Sugar. And Seth somehow made reading through the trainwreck of how Gary Taubes routinely misquotes or otherwise misrepresents dead people's views perversely entertaining.
Seth's devastating demonstration of Gary Taubes's lack of reliability as a historian means I need to examine places where I have relied on information from Gary, much as I had to reassess my reliance on Carmen Reinhart and Ken Rogoff when the shoddiness of their statistical analysis came to light. (The spreadsheet error was only the tip of the iceberg. See "An Economist’s Mea Culpa: I Relied on Reinhart and Rogoff," "After Crunching Reinhart and Rogoff’s Data, We Find No Evidence That High Debt Slows Growth" and "Examining the Entrails: Is There Any Evidence for an Effect of Debt on Growth in the Reinhart and Rogoff Data?")
Fortunately, in the area of diet and health, Jason Fung is my guy (see "Five Books That Have Changed My Life"), not Gary Taubes. And I always took Gary Taubes's reasoning with a grain of salt. For example, in my post "The Case Against Sugar: Stephan Guyenet vs. Gary Taubes," I write:
First, I should say that I start out expecting less from journalists like Gary Taubes than the standard that Stephan Guyenet wants to judge them buy. Stephan mentions repeatedly the "Igon Value Problem," which refers to a term "coined by Steven Pinker in a review of Malcolm Gladwell's book What the Dog Saw." Malcolm Gladwell did not know what an eigenvalue was, and so misheard it as an "Igon value." Similarly, Gary Taubes is not himself a scientist and so does not fully understand everything he is talking about.
It was also pretty obvious to me that Gary Taubes was tilting his selection of what to tell and what not to tell toward things that helped his case against sugar. But I thought the "facts" that he did tell about would be accurate. Just after the passage above from "The Case Against Sugar: Stephan Guyenet vs. Gary Taubes," is this:
But [Gary Taubes] does give us a tour through the history of thought about nutrition and what he felt he learned by talking to many scientists, with an emphasis on what the more contrarian scientists said. This is a useful service.
After seeing the misquotations and misrepresentations that Seth Yoder identifies, I no longer know which bits of this history of nutritional though are true and which are false. But let me attempt to examine where I stand, post by post where I was in danger of relying too much on Gary Taubes. Using my blog search box identified only four posts where I mention Gary Taubes other than in referring to the title of another blog post. Below I analyze my degree of reliance on Gary Taubes for each. After that, I register a couple of disagreements with Seth.
In "The Case Against Sugar: Stephan Guyenet vs. Gary Taubes," I summarized what I thought I had learned from The Case Against Sugar thus:
- Sugar is very, very bad. I will say more below on why convincing people of that is an important accomplishment.
- What the nutrition establishment is telling us needs to be closely examined and cross-checked by scientists outside the nutrition establishment. It is very unwise to simply trust the nutrition establishment.
I think I could have gotten this much from Jason Fung alone. The basic reason sugar is very, very bad is that most foods with a substantial sugar content are quite high on the insulin index. See "Forget Calorie Counting; It's the Insulin Index, Stupid."
In "The Case Against Sugar: Stephan Guyenet vs. Gary Taubes," I actually disagree with Gary Taubes a lot. Here are some examples of my words in that post that disagree with Gary:
- Gary argues that other than Western diets adding sugar and flour, every other aspect of Western diets was duplicated by at least some indigenous diet, so sugar and flour must be the culprit. This is a strong argument. However, I would add in the possibility that people in almost every indigenous population had substantial chunks of time when they had no food consumption. Whether their fasts were involuntary or not, they probably fasted reasonably frequently. So in my view, the key aspects of Western diets that brought Western Diseases were sugar, flour and a reduction in periods of time with no food consumption.
- Gary Taubes is at his most confused when discussing calories in/calories out. This is one of the first things I had to straighten out theoretically in my own mind after readings Gary's books. That effort is reflected in the title of my early foray into a Twitter discussion on diet: "How the Calories In/Calories Out Theory Obscures the Endogeneity of Calories In and Out to Subjective Hunger and Energy."
- [Contrary to what Gary Taubes claims,] I am inclined to agree with Stephan that rodent data do not support the idea that sugar is more harmful than fat (though it does seem to support the idea that fat plus sugar is worse than fat alone). But I am struck by the possibility that rodents might be much better adapted to highcarb diets than humans are.
- Gary goes overboard in talking down the benefits of exercise.
- After catching Gary in a serious misquotation, Stephan begins to wind down ...
Seth Yoder promises to write a post in the future focusing on salt. (Is it out already? I couldn't find it.) I will be eager to read it.
The heart of my post "Salt Is Not the Nutritional Evil It Is Made Out to Be" is discussing chunks of Gary Taubes's earlier book Good Calories, Bad Calories. These ideas are reprised in The Case Against Sugar. Readers of my post pointed me to very recent research about salt reported in Gina Kolata's May 8, 2017 New York Times article "Why Everything We Know About Salt May Be Wrong." This makes me continue to doubt that salt is the nutritional evil that standard advice says it is.
Although Seth thinks the connection to sugar is tenuous, he does take seriously the idea that insulin resistance is an important factor in hypertension. Seth writes:
Taubes eventually gets to some positive evidence for a link between sugar and hypertension, though it’s rather murky and kind of contradicts his point about sodium. It turns out that hyperinsulinemia may lead to an increase in blood pressure by increasing sodium retention.(87–89) So what causes hyperinsulinemia? The cited literature makes the case for insulin resistance as the primary factor. Taubes would have you believe that sugar intake causes insulin resistance and diabetes, but the evidence for that claim just is not very abundant nor is it mentioned as a risk factor in the texts. However, you might imagine someone who is constantly swilling sodas all day, every day to have elevated insulin levels.
To think that sugar is the only cause of insulin resistance and obesity is, of course, a straw man—that Gary Taubes has chosen to personify. In "The Case Against Sugar: Stephan Guyenet vs. Gary Taubes," I push these as the main reasons for the rise in insulin resistance and obesity:
- The shift toward consumption of foods that are high on the insulin index. (See "Forget Calorie Counting; It's the Insulin Index, Stupid.") Many of these are high in sugar, but some are not. For example, processed "lowfat" foods are higher on the insulin index than the corresponding full fat foods. So the spread of lowfat foods could be contributing to the rise in obesity even in a period when sugar consumption itself is declining somewhat.
- The expansion of the "eating window" within each day, with the corresponding shortening of the biggest chunk of time with no food consumption. (See "Stop Counting Calories; It's the Clock that Counts.")
If insulin resistance tends to lead to high blood pressure, then these would be contributing factors towards high blood pressure as well.
Despite including large pro-meat quotations from Gary Taubes in my post "Meat Is Amazingly Nutritious—But Is It Amazingly Nutritious for Cancer Cells, Too?" I end up being somewhat negative about meat. Here is the somewhat nuanced view I put forward:
In other words, meat, dairy and eggs, by providing an abundance of complete proteins may help build strong cancer cells, but there is no good evidence that they make people fat.
Since I wrote those words, my own experience and that of some of my fellow experimenters in our own lives has been that we often get hungry after eating things that are between 30 and 50 on the insulin index. This is a range that many types of meat fall into. (See "Forget Calorie Counting; It's the Insulin Index, Stupid.) As far as the insulin kick is concerned, it isn't as bad as eating pancakes, rice, bananas or orange juice, but it isn't a nothing either. I continue to eat meat when I go to restaurants, but I often need to eat nuts afterwards to stave off the hunger induced by the medium-high insulin index of that meat.
In any case, even when I wrote that post, my position was very different from Gary Taubes's position on mat, and since then has moved a bit further away.
In "Obesity Is Always and Everywhere an Insulin Phenomenon" I am embarrassed to have the word "excellent" in this phrase:
Gary Taubes, in his excellent history of nutritional thought Good Calories, Bad Calories ...
Indeed, I am embarrassed enough that I intend to update the word "excellent" out as soon as I have a few minutes to do that update. But although Gary Taubes is overly certain about what the key aspect of Westernization is the passage I actually quote is mainly focused on the remarkable transition to Western diseases itself, which I have not seen seriously disputed:
On April 16, 1913, Albert Schweitzer arrived at Lambaréné, a small village in the interior lowlands of West Africa, to establish a missionary hospital on the banks of the Ogowe River. Attended by his wife, Hélène, who had trained as a nurse, he began treating patients the very next morning. Schweitzer estimated that he saw almost two thousand patients in the first nine months, and then averaged thirty to forty a day and three operations a week for the better part of four decades. The chief complaints, at least in the beginning, were endemic diseases and infections: malaria, sleeping sickness, leprosy, elephantiasis, tropical dysentery, and scabies.
Forty-one years after Schweitzer’s arrival, and a year and a half after he received the Nobel Peace Prize for his missionary work, Schweitzer encountered his first case of appendicitis among the African natives. Appendicitis was not the only Western disease to which the natives seemed to be resistant. “On my arrival in Gabon,” he wrote, “I was astonished to encounter no cases of cancer…. I can not, of course, say positively that there was no cancer at all, but, like other frontier doctors, I can only say that if any cases existed they must have been quite rare.” In the decades that followed, he witnessed a steady increase in cancer victims. “My observations inclined me to attribute this to the fact that the natives were living more and more after the manner of the whites.”
As Schweitzer had suggested, his experience was not uncommon for the era. In 1902, Samuel Hutton, a University of Manchester–trained physician, began treating patients at a Moravian mission in the town of Nain, on the northern coast of Labrador, or about as far from the jungles of West Africa as can be imagined, in both climate and the nature of the indigenous population. As Hutton told it, his Eskimo patients fell into two categories: There were those who lived isolated from European settlements and ate a traditional Eskimo diet. “The Eskimo is a meat eater,” he wrote, “the vegetable part of his diet is a meager one.” Then there were those Eskimos living in Nain or near other European settlers who had taken to consuming a “settler’s dietary,” consisting primarily of “tea, bread, ship’s biscuits, molasses, and salt fish or pork.” Among the former, European diseases were uncommon or remarkably rare. ...
Most of these historical observations came from colonial and missionary physicians like Schweitzer and Hutton, administering to populations prior to and coincidental with their first substantial exposure to Western foods. The new diet inevitably included carbohydrate foods that could be transported around the world without spoiling or being devoured by rodents on the way: sugar, molasses, white flour, and white rice. Then diseases of civilization, or Western diseases, would appear: obesity, diabetes mellitus, cardiovascular disease, hypertension and stroke, various forms of cancer, cavities, periodontal disease, appendicitis, peptic ulcers, diverticulitis, gallstones, hemorrhoids, varicose veins, and constipation. When any diseases of civilization appeared, all of them would eventually appear. This led investigators to propose that all these diseases had a single common cause—the consumption of easily digestible, refined carbohydrates. The hypothesis was rejected in the early 1970s, when it could not be reconciled with Keys’s hypothesis that fat was the problem, an attendant implication of which was that carbohydrates were part of the solution. But was this alternative carbohydrate hypothesis rejected because compelling evidence refuted it, or for reasons considerably less scientific?
That is the only context where Gary Taubes appears in "Obesity Is Always and Everywhere an Insulin Phenomenon"
Two Points Where I Disagree with Seth
My first disagreement with Seth over the point he is trying to make in this passage:
- Is anyone under the impression that we need MORE sugar in our diets? That we would be healthier if people drank MORE high-calorie sugar water and ate MORE Oreos? Are doctors and nutritionists and policy-makers saying things like “In order to fight this obesity epidemic, all we need to do is get people to start adding cokes, cookies, candy, cake, cream-puffs, and corn syrup into their diet”? Of course not.
I really don't think people realize how bad sugar is. To me, the key test is how many people would agree with the statement "For health, reducing sugar intake is more important than reducing fat intake." If that statement was conventional wisdom, I think it would be a huge step forward in public health.
I say something similar in "The Case Against Sugar: Stephan Guyenet vs. Gary Taubes":
... Stephan writes:
The Case Against Sugar is a journey through sugar history and science that argues the point that sugar is the principal cause of obesity, diabetes, coronary heart disease, and many other common noncommunicable diseases. This differs from the prevailing view in the research and public health communities that obesity and noncommunicable disease are multi-factorial, with refined sugar playing a role among other things like excess calorie intake, physical inactivity, cigarette smoking, alcohol and illegal drug use, and various other diet and lifestyle factors. I side with the latter view.
Here Stephan seems to be saying "Sensible people like me realize that sugar is one of several coequal causes of obesity, diabetes, heart disease etc., not the only cause." But walking down the aisles of any grocery store and comparing the number of "lowfat" offerings to the number of "no sugar added" offerings makes it clear that in the popular imagination the dangers of sugar are rated far, far below the dangers of dietary fat. So there is a lot of work to be done to get people's perception of the dangers of sugar up to the level of being "sugar is bad on a par with four or five other things" that Stephan seems to give as his own view.
My other disagreement with Seth is that he writes as if one should be controlling for overall calorie consumption when judging the harms of sugar. In my view, one of the main harms of sugar (along with other foods high on the insulin index) is that it makes people hungry a couple of hours later so they eat more total. In addition, sugar adds a heavy dose of instant gratification to many many foods, causes people to eat more total in the first place when sugar is added. So with sugar, it isn't just the calories of the sugar, it is the calories of the other things the sugar encourages you to eat—both now and later—that is the issue.
Another way to say this is that holding total calories constant statistically when looking at the effects of sugar is not appropriate if the typical eater doesn't hold calories constant when shehe eats more sugar. Here are the two hypotheses I am putting forward in relation to sugar and fat:
- In addition to the extra calories of the sugar itself, eating sugar tends to make people eat more nonsugar calories as well.
- By contrast, if one avoids all foods that are high on the insulin index, eating more fat calories tends to make people reduce nonfat calories more than one-for-one.
Don't miss these other posts on diet and health:
- Forget Calorie Counting; It's the Insulin Index, Stupid
- Stop Counting Calories; It's the Clock that Counts
- Obesity Is Always and Everywhere an Insulin Phenomenon
- How Sugar Makes People Hangry
- The Case Against Sugar: Stephan Guyenet vs. Gary Taubes
- The Case Against the Case Against Sugar: Seth Yoder vs. Gary Taubes
- The Keto Food Pyramid
- Mass In/Mass Out: A Satire of Calories In/Calories Out
- Carola Binder: The Obesity Code and Economists as General Practitioners
- Jason Fung: Dietary Fat is Innocent of the Charges Leveled Against It
- Faye Flam: The Taboo on Dietary Fat is Grounded More in Puritanism than Science
- Sugar as a Slow Poison
- Katherine Ellen Foley—Candy Bar Lows: Scientists Just Found Another Worrying Link Between Sugar and Depression
- Ken Rogoff Against Sugar and Processed Food
- Kearns, Schmidt and Glantz—Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents
- Salt Is Not the Nutritional Evil It Is Made Out to Be
- Whole Milk Is Healthy; Skim Milk Less So
- How the Calories In/Calories Out Theory Obscures the Endogeneity of Calories In and Out to Subjective Hunger and Energy
- Putting the Perspective from Jason Fung's "The Obesity Code" into Practice
- Julia Belluz and Javier Zarracina: Why You'll Be Disappointed If You Are Exercising to Lose Weight, Explained with 60+ Studies (my retitling of the article this links to)
- Meat Is Amazingly Nutritious—But Is It Amazingly Nutritious for Cancer Cells, Too?
- Diana Kimball: Listening Creates Possibilities
- On Fighting Obesity
- Analogies Between Economic Models and the Biology of Obesity
- Debating 'Forget Calorie Counting; It's the Insulin Index, Stupid'
Also see the last section of "Five Books That Have Changed My Life."