Pure, White, and Deadly: How Sugar Is Killing Us and What We Can Do to Stop It

195 Pages·2013·1.2 MB·English

by  John Yudkin

John Yudkin
,
PURE WHITE AND DEADLY
How Sugar is Killing Us and What We Can Do to Stop It
With a new introduction by Robert H. Lustig, MD
Contents
‘Prophecy and Propaganda’: introduction to the 2012 edition by Robert H. Lustig, MD
Introduction to the 1986 edition
1. What’s so different about sugar?
2. I eat it because I like it
3. Sugar and other carbohydrates
4. Where sugar comes from
5. Is brown sugar better than white sugar?
6. Refined and unrefined
7. Not only sugar is sweet
8. Who eats sugar, and how much?
9. Words mean what you want them to mean
10. Sugar’s calories make you thin – they say
11. How to eat more calories without eating real food
12. Can you prove it?
13. Coronary thrombosis, the modern epidemic
14. Eat sugar and see what happens
15. Too much blood sugar – or too little
16. A pain in the middle
17. A host of diseases
18. Does sugar accelerate the life process – and death too?
19. How does sugar produce its effects?
20. Should sugar be banned?
21. Attack is the best defence
References
Acknowledgements
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PURE, WHITE AND DEADLY
John Yudkin (8 August 1910–12 July 1995) was a British physiologist and
nutritionist, whose books include This Slimming Business, Eat Well, Slim Well
and This Nutrition Business. He became internationally famous with his book
Pure, White and Deadly, first published in 1972, and was one of the first
scientists to claim that sugar was a major cause of obesity and heart disease.
Robert H. Lustig, MD, is Professor of Pediatrics in the Division of
Endocrinology at the University of California, San Francisco. He combats
obesity through his efforts in basic science, clinical research, patient care and
policy analysis. Dr Lustig is the editor of the academic volume Obesity Before
Birth and the author of the book Fat Chance: Beating the Odds Against Sugar,
Processed Food, Obesity and Disease.
For Benjamin, Ruth and Daniel
Prophecy and Propaganda
Introduction to the 2012 edition by Robert H. Lustig, MD
Everything old is new again. Take fashion, for example: bell-bottoms, culottes,
miniskirts, wedge heels, thin ties and fancy lingerie are back. A silent film won
the Oscar for Best Picture in 2012. The bubblegum rock band ABBA and swing-
dancing are in vogue again. Speciality cocktails are making a comeback:
martinis are the rage, and now there are eighty varieties. Even phonographs and
vinyl LPs have a new following.
Ideas come and go as well. Someone is always on the cutting edge. The
argument seems inescapable. It gains a following, sometimes a bit too zealous a
following. Then it falls out of fashion, due sometimes to philosophy, sometimes
to experience, sometimes to competing world events, and sometimes to dark
forces attempting to maintain the status quo for their own purposes.
But science should be based in fact, not fashion. And policy should be based
on science. Facts shouldn’t change. And indeed, they don’t. But their
interpretation does. Consider the idea that inflammation causes heart disease.
First espoused in the late 1800s after the invention of aspirin by Bayer, this idea
was relegated to the dustbin of medical science in favour of the cholesterol
hypothesis, which reigned for the second half of the twentieth century. But over
the last decade, the ‘inflammation hypothesis’ has made a decided comeback,
and is now thought to be the primary factor in the genesis of atherosclerotic
plaques and thrombosis.
Sadly, interpretation of medical science is frequently influenced by the dark
forces of industry, out to make a killing. And when there is money to be made,
there will be big winners, but also big losers – including those killed. Witness
the tobacco debacle. The risks of smoking have been known since the 1930s; the
US surgeon general report of 1964 squarely faced down the tobacco industry.
That put the tobacco propaganda machine into overdrive to squelch the science
and any scientists who stood in their way. My colleague at the University of
California, San Francisco, Dr Stanton Glantz was (and to this day still is) Public
Enemy Number One of the tobacco industry. For twenty-five years he was a
‘prophet in the wilderness’. Stan warned about Big Tobacco’s tactics at every
level: the political buy-offs, the marketing, the advertising to children, product
placement in movies. He even uncovered blatant fabrication of data by the
industry to exonerate their product. What did it get him? Twenty-five years of
constant battles, both in the courtroom and in the court of public opinion. He was
painted as a ‘false prophet, a zealot’. But Stan had the courage of his
convictions. More importantly, he had the data. Of course he was, and still is,
right on target.
Indeed, who determines the difference between a prophet and a heretic?
Whoever gets to write the history. It’s only with our retrospectoscope that we
seem to have twenty-twenty vision. Ask Galileo.
And so it is with Dr John Yudkin. Let’s set the stage. In 1955 President
Eisenhower experienced a heart attack while in office. The issue of heart disease
and its prevention was thrust into public consciousness. What component of diet
caused heart disease? This was the seminal issue in public health, disputed in
academic circles and the media throughout the 1960s and 1970s. Two factions
sprang up. Dr Yudkin was a University of London physiologist, nutritionist and
physician, and the primary exponent for the idea that sugar was the dietary factor
promoting heart disease, and several others as well. First published in 1972, and
updated with new science in 1986, Pure, White and Deadly was, is and remains,
a prophecy. Yudkin foresaw the sugar glut that ultimately arrived with the
advent of high-fructose corn syrup. He preached in the wilderness, and no one
listened. In the other corner, Ancel Keys was a University of Minnesota
epidemiologist who, in 1953, first espoused the argument that saturated fat was
the primary cause of heart disease, culminating with his volume Seven
Countries: A Multivariate Analysis of Death and Coronary Heart Disease
(Harvard University Press, Cambridge, 1980). The debate grew beyond the
academic; the rancor got up close and personal, with Keys declaring in 1971: ‘It
is clear that Yudkin has no theoretical basis or experimental evidence to support
his claim for a major influence of dietary sucrose in the etiology of [coronary
heart disease]; his claim that men who have CHD are excessive sugar-eaters is
nowhere confirmed but is disproved by many studies superior in methodology
and/or magnitude to his own; and his “evidence” from population statistics and
time trends will not bear up under the most elementary critical examination.’
(Keys, A., Atherosclerosis, 14: 193–202, 1971)
Three scientific findings of the 1970s undid Yudkin’s case and sealed his fate.
Firstly, by studying the genetic disease familial hypercholesterolemia (victims
experience heart attacks as early as eighteen years old), Michael Brown and
Joseph Goldstein discovered low-density lipoproteins (LDL) and the LDL
receptor (which won them the Nobel Prize), leading to the hypothesis that LDL
was the bad actor in heart disease. Secondly, dietary studies showed that dietary
fat raised LDL levels. Thirdly, large epidemiological studies showed that LDL
levels correlated with heart disease in populations. Slam dunk, right? It’s the fat,
stupid.
The Pharisees of this nutritional holy war declared Keys the victor, Yudkin a
heretic and a zealot, threw the now discredited Yudkin under the proverbial bus
and relegated his pivotal work to the dustbin of history, as this book went out of
print and virtually disappeared from the scene. The propaganda of ‘low-fat’ as
the treatment for heart disease was perpetuated for the next thirty years. And the
cluster of diseases (obesity, diabetes, hypertension, lipid problems, heart disease)
collectively termed the ‘metabolic syndrome’ increased in a parabolic fashion
under the canopy of the sugar industry and their propaganda machine.
But good ideas die hard. Larger studies started to demonstrate that serum
triglyceride levels correlated with heart disease, with sugar consumption being
the primary driver. And there wasn’t one type of LDL, there were two: large
buoyant LDL, driven by dietary fat, but which was neutral in terms of heart
disease; and small dense LDL, driven by dietary carbohydrate, and which
oxidizes quickly, driving atherosclerotic plaque formation (hardening of the
arteries). The Atkins diet was now being taken seriously. Carbohydrates started
to assume centre stage in promoting metabolic disease, with sugar consumption
implicated as the most notorious carbohydrate.
I stumbled upon Dr Yudkin quite by accident in 2008. I was in Adelaide,
Australia, giving a talk at the Australasian Association of Clinical Biochemists
on my research into the role of sugar in the pathogenesis of metabolic syndrome.
Dr Leslie Bennett said to me, ‘Surely you’ve read Yudkin,’ and I admitted I
hadn’t. When I got home, I looked for Pure, White and Deadly, and couldn’t
find it in our UCSF library or in any bookstore in San Francisco. Eventually I
got it by interlibrary loan. I opened the book, and it opened my eyes. I already
knew from my own work that sugar at our current rate of consumption is a
medical disaster. But to learn that Yudkin foresaw what a problem sugar was
thirty-six years earlier, and at a much lower dose (i.e. before the advent of high-
fructose corn syrup and the two-litre bottle) was a true revelation. Indeed, I was
a Yudkin disciple and I hadn’t even realized it.
Yudkin didn’t have the voluminous data that exist today. He had correlation,
but not causation. He didn’t have mechanism. He didn’t know that sugar caused
insulin resistance by being turned into fat in the liver through the process of de
novo lipogenesis, or that sugar induced protein damage through the Maillard or
browning reaction. He didn’t know that sugar was weakly addictive, although he