''Pure, White and Deadly'' is a 1972 book by

John Yudkin John Yudkin Fellow of the Royal Society of Chemistry, FRSC (8 August 1910 – 12 July 1995) was a British physiology, physiologist and nutritional science, nutritionist, and the founding Professor of the Department of Nutrition at Queen Elizabe ...

, a British nutritionist and former Chair of Nutrition at

Queen Elizabeth College Queen Elizabeth College (QEC) was a college in London. It had its origins in the Ladies' (later Women's) Department of King's College, London, England, opened in 1885 but later accepted men as well. The first King's 'extension' lectures for l ...

, London. Published in New York, it was the first publication by a scientist to anticipate the

adverse health effects An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complica ...

, especially in relation to

obesity Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...

and

heart disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, hea ...

, of the public's increased

sugar Sugar is the generic name for sweet-tasting, soluble carbohydrates, many of which are used in food. Simple sugars, also called monosaccharides, include glucose, fructose, and galactose. Compound sugars, also called disaccharides or double ...

consumption. At the time of publication, Yudkin sat on the advisory panel of the British

Department of Health A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their ow ...

's Committee on the Medical Aspects of Food and Nutrition Policy (COMA). He stated his intention in writing the book in the last paragraph of the first chapter: "I hope that when you have read this book I shall have convinced you that sugar is really dangerous." The book and author suffered a barrage of criticism at the time, particularly from the

sugar industry The sugar industry subsumes the production, processing and marketing of sugars (mostly sucrose and fructose). Globally, most sugar is extracted from sugar cane (~80% predominantly in the tropics) and sugar beet (~ 20%, mostly in temperate cli ...

, processed-food manufacturers, and

Ancel Keys Ancel Benjamin Keys (January 26, 1904 – November 20, 2004) was an American physiologist who studied the influence of diet on health. In particular, he hypothesized that replacing dietary saturated fat with polyunsaturated fat reduces card ...

, an American physiologist who argued in favour of restricting dietary fat, not sugar, and who sought to ridicule Yudkin's work. In later years, Yudkin's observations came to be accepted. A 2002 cover story about sugar by

Gary Taubes Gary Taubes (born April 30, 1956) is an American journalist, writer, and low-carbohydrate / high-fat (LCHF) diet advocate. His central claim is that carbohydrates, especially sugar and high-fructose corn syrup, overstimulate the secretion of insu ...

in ''The New York Times Magazine'', "What if It's All Been a Big Fat Lie?", attracted attention, Taubes, Gary (7 July 2002)
"What if It's All Been a Big Fat Lie?"
''The New York Times''. and the following year a

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...

report recommended that added sugars provide no more than 6–10% of total dietary intake. In 2009 a lecture on the health effects of sugar by

Robert Lustig Robert H. Lustig (born 1957) is an American pediatric endocrinologist. He is Professor emeritus of Pediatrics in the Division of Endocrinology at the University of California, San Francisco (UCSF), where he specialized in neuroendocrinology and ...

, an American

pediatric endocrinologist Pediatric endocrinology (British: Paediatric) is a medical subspecialty dealing with disorders of the endocrine glands, such as variations of physical growth and sexual development in childhood, diabetes and many more. By age, pediatric endocrinol ...

, went viral.Lustig, Robert (26 May 2009)
"Sugar: The Bitter Truth"
University of California Television
uploaded to YouTube
on 20 July 2009). The subsequent interest led to the rediscovery of Yudkin's book and the rehabilitation of his reputation. Two further editions of the book were published, the second after Yudkin's death in 1995. An expanded version appeared in 1986, revised by Yudkin himself, to include much additional research evidence. In 2012 the book was re-published by

Penguin Books Penguin Books is a British publishing, publishing house. It was co-founded in 1935 by Allen Lane with his brothers Richard and John, as a line of the publishers The Bodley Head, only becoming a separate company the following year. The book was first published in 1972 in New York by the publisher Peter H. Wyden under the title ''Sweet and Dangerous'', and a few weeks later in London by Davis-Poynter as ''Pure, White and Deadly: The Problem of Sugar''. ''Pure, White and Deadly'' was used for subsequent editions and is the title by which the book became known. At the time of publication, it was generally accepted that the alarming recent increase in the incidence of coronary heart disease (CHD) was due to the excessive consumption of

animal fat Animal fats and oils are lipids derived from animals: oils are liquid at room temperature, and fats are solid. Chemically, both fats and oils are composed of triglycerides. Although many animal parts and secretions may yield oil, in commercial p ...

. Yudkin believed that this view was wrong and that, instead, an important cause of CHD was the excessive consumption of sugar (i.e.

sucrose Sucrose, a disaccharide, is a sugar composed of glucose and fructose subunits. It is produced naturally in plants and is the main constituent of white sugar. It has the molecular formula . For human consumption, sucrose is extracted and refined ...

). More generally, he argued, excessive sucrose consumption provokes a metabolic disturbance that has several undesirable results. The author makes the initial case that sucrose is a dangerous food by emphasising the contrast between

starch Starch or amylum is a polymeric carbohydrate consisting of numerous glucose units joined by glycosidic bonds. This polysaccharide is produced by most green plants for energy storage. Worldwide, it is the most common carbohydrate in human diets ...

and sucrose. Both of these are

carbohydrates In organic chemistry, a carbohydrate () is a biomolecule consisting of carbon (C), hydrogen (H) and oxygen (O) atoms, usually with a hydrogen–oxygen atom ratio of 2:1 (as in water) and thus with the empirical formula (where ''m'' may or may ...

, but starch occurs as a bulk constituent of cereals (such as

rice Rice is the seed of the grass species ''Oryza sativa'' (Asian rice) or less commonly ''Oryza glaberrima ''Oryza glaberrima'', commonly known as African rice, is one of the two domesticated rice species. It was first domesticated and grown i ...

wheat Wheat is a grass widely cultivated for its seed, a cereal grain that is a worldwide staple food. The many species of wheat together make up the genus ''Triticum'' ; the most widely grown is common wheat (''T. aestivum''). The archaeologi ...

and

maize Maize ( ; ''Zea mays'' subsp. ''mays'', from es, maíz after tnq, mahiz), also known as corn (North American and Australian English), is a cereal grain first domesticated by indigenous peoples in southern Mexico about 10,000 years ago. Th ...

legumes A legume () is a plant in the family Fabaceae (or Leguminosae), or the fruit or seed of such a plant. When used as a dry grain, the seed is also called a pulse. Legumes are grown agriculturally, primarily for human consumption, for livestock fo ...

and a few root crops like

potatoes The potato is a starchy food, a tuber of the plant ''Solanum tuberosum'' and is a root vegetable native to the Americas. The plant is a perennial in the nightshade family Solanaceae. Wild potato species can be found from the southern United ...

, while sucrose is present in large quantities in

sugar cane Sugarcane or sugar cane is a species of (often hybrid) tall, perennial grass (in the genus ''Saccharum'', tribe Andropogoneae) that is used for sugar production. The plants are 2–6 m (6–20 ft) tall with stout, jointed, fibrous stalks t ...

sugar beet A sugar beet is a plant whose root contains a high concentration of sucrose and which is grown commercially for sugar production. In plant breeding, it is known as the Altissima cultivar group of the common beet (''Beta vulgaris''). Together wi ...

and ripe fruits. It used to be thought that sucrose and starch are metabolised in similar ways, and so are interchangeable from the nutritional point of view, but more recent evidence had shown that their

metabolism Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...

is significantly different. The need for carbohydrate as a component of the diet can be entirely satisfied by starch (often in the form of bread or pasta), which is broken down in the body to

glucose Glucose is a simple sugar with the molecular formula . Glucose is overall the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, using ...

. On the other hand sucrose, which is broken down to equal quantities of glucose and

fructose Fructose, or fruit sugar, is a Ketose, ketonic monosaccharide, simple sugar found in many plants, where it is often bonded to glucose to form the disaccharide sucrose. It is one of the three dietary monosaccharides, along with glucose and galacto ...

, is not an essential dietary component even in small amounts. Evolutionary history suggests that our pre-

Neolithic The Neolithic period, or New Stone Age, is an Old World archaeological period and the final division of the Stone Age. It saw the Neolithic Revolution, a wide-ranging set of developments that appear to have arisen independently in several parts ...

ancestors ate a diet that consisted largely of meat, with some nuts, berries, leaves and root vegetables, and we can presume that a taste for sweet fruit developed because it directed people to a rich source of

vitamin C Vitamin C (also known as ascorbic acid and ascorbate) is a water-soluble vitamin found in citrus and other fruits and vegetables, also sold as a dietary supplement and as a topical 'serum' ingredient to treat melasma (dark pigment spots) an ...

, an essential nutrient. The development of agriculture during the

Neolithic Revolution The Neolithic Revolution, or the (First) Agricultural Revolution, was the wide-scale transition of many human cultures during the Neolithic period from a lifestyle of hunting and gathering to one of agriculture and settlement, making an incre ...

(from c. 10,000 BCE) led to a large increase in the consumption of starch, to which humanity adapted well. By contrast, it is only since the early 19th century that greatly improved methods of cultivation of sugar cane and sugar beet, and improved technology of refining, led to sucrose becoming readily available and remarkably cheap. Yudkin refers to these developments as the separation of

palatability Palatability (or palatableness) is the hedonic reward (i.e., pleasure) provided by foods or fluids that are agreeable to the "palate", which often varies relative to the homeostatic satisfaction of nutritional, water, or energy needs. The palatabil ...

from nutritional value. As a result the quantity consumed has increased about 50-fold in the past 150 years, with sucrose increasingly used not only in the home and in cafés but also by the manufacturers of soft drinks and as a sweetening agent for many pre-prepared foods. The human species has not had time to adapt to this extremely rapid change. Three problems result. First, unlike glucose, which is metabolised throughout the body, the fructose produced from the breakdown of sucrose is metabolised almost exclusively in the

liver The liver is a major Organ (anatomy), organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of proteins and biochemicals necessary for ...

, where much of it is converted to fat. Secondly, since it is not uncommon for people to take as much as 30% of their daily caloric intake as sucrose, this consumption crowds out more desirable foods and can sometimes lead to deficiencies of certain

nutrient A nutrient is a substance used by an organism to survive, grow, and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi, and protists. Nutrients can be incorporated into cells for metabolic purposes or excret ...

s. Thirdly, since many people find sucrose appetising, it is often taken in excess of caloric requirements, thus leading to obesity. The author then turns to the evidence that the consumption of sucrose is associated with certain specific disorders other than obesity. Some of this evidence is

epidemiological Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population. It is a cornerstone of public health, and shapes policy decisions and evidenc ...

and some experimental. Both types have limitations, which the author discusses in a chapter called ''Can you prove it?'', but both are strongly indicative of an involvement of sucrose in the

aetiology Etiology (pronounced ; alternatively: aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek (''aitiología'') "giving a reason for" (, ''aitía'', "cause"); and ('' -logía''). More completely, e ...

both of CHD and of what used to be called maturity-onset

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

(

type 2 diabetes Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, ...

). The epidemiological evidence that sucrose contributes to CHD had started to accumulate in 1957; in that year Yudkin showed that a comparison of data from several countries indicated an association between coronary mortality and the consumption of sucrose, and that the association with sucrose consumption was stronger than with fat consumption. Subsequent studies from South Africa and Israel found that sub-populations that had historically consumed only small quantities of sucrose had much less CHD than those who consumed large quantities, but that as their sucrose consumption increased so too did their incidence of CHD. Experimental evidence from animal studies showed that consumption of a sugar-rich diet leads to biochemical changes that are associated with CHD, such as an increase in blood

triglyceride A triglyceride (TG, triacylglycerol, TAG, or triacylglyceride) is an ester derived from glycerol and three fatty acids (from ''tri-'' and ''glyceride''). Triglycerides are the main constituents of body fat in humans and other vertebrates, as w ...

, an increase in

platelet Platelets, also called thrombocytes (from Greek θρόμβος, "clot" and κύτος, "cell"), are a component of blood whose function (along with the coagulation factors) is to react to bleeding from blood vessel injury by clumping, thereby ini ...

stickiness, and an accumulation of fat in the liver. Results similar to some of these were found in human subjects. Epidemiological evidence similarly pointed to excess sugar consumption as a contributory factor in the development of type 2 diabetes. As before, the evidence relied on a comparison between different countries in the incidence of type 2 diabetes and the consumption of sucrose, and also on within-country differences between sub-populations that consumed less or more sucrose. Moreover, in developed countries, the increase in sucrose consumption that had occurred over the past several decades appeared to run parallel to the increase in the incidence of type 2 diabetes. Experiments with rats showed that the feeding of sucrose led to

impaired glucose tolerance Prediabetes is a component of the metabolic syndrome and is characterized by elevated blood sugar levels that fall below the threshold to diagnose diabetes mellitus. It usually does not cause symptoms but people with prediabetes often have obesit ...

(results with human subjects were more equivocal). The author mentions several other conditions that he believed were caused by or exacerbated by the consumption of sucrose: dyspepsia (indigestion), dental caries,

seborrhoeic dermatitis Seborrhoeic dermatitis, sometimes inaccurately referred to as seborrhoea, is a long-term skin disorder. Symptoms include red, scaly, greasy, itchy, and inflamed skin. Areas of the skin rich in oil-producing glands are often affected including the ...

, changes in the refractive index of the eye, and various forms of

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

. With the exception of dental caries, none of these conditions showed as strong a link with sucrose consumption as CHD and type 2 diabetes did. How does the consumption of sucrose lead to these deleterious effects? For dental caries the answer is clear: it is converted to

dextran Dextran is a complex branched glucan (polysaccharide derived from the condensation of glucose), originally derived from wine. IUPAC defines dextrans as "Branched poly-α-d-glucosides of microbial origin having glycosidic bonds predominantly C-1 ...

, which is extremely adhesive and promotes the growth of acid-producing

bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...

. For the general metabolic effects that lead to CHD and/or to type 2 diabetes, the author suggests that alterations either in the rate of production of

insulin Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the ''INS'' gene. It is considered to be the main anabolic hormone of the body. It regulates the metabolism o ...

or in the body’s sensitivity to it may be one of the early effects of excessive sucrose consumption. This suggestion foreshadows the subsequent widespread recognition of insulin resistance and the

metabolic syndrome Metabolic syndrome is a clustering of at least three of the following five medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL). Metabolic syndrome ...

, and the condition known as

non-alcoholic fatty liver disease Non-alcoholic fatty liver disease (NAFLD), also known as metabolic (dysfunction) associated fatty liver disease (MAFLD), is excessive fat build-up in the liver without another clear cause such as alcohol use. There are two types; non-alcoholic ...

(NAFLD). NAFLD is believed to result from the accumulation of fat in the liver—often as a consequence of excess dietary sucrose. A chapter called ''Sugar should be banned'' suggests that sooner or later legislation will be needed to prevent people from consuming so much sucrose (this time foreshadowing the UK’s Soft Drinks Industry Levy or "sugar tax"). Yudkin concludes his book with some examples of the ways in which organisations connected with the sugar industry, and with the manufacturers of processed foods that use sugar, sought to interfere with his research or with its publication.

1986 edition

Fourteen years after the first publication of ''Pure, White and Deadly'', Yudkin decided that the book was out of date in important respects, and in 1986 he published a new edition to incorporate more recent experimental results. The 1986 edition has many more references, and a much fuller index. In Chapter 12 of the new edition (''Can you prove it?'') he wrote about several experiments with human subjects in which fat intake had been manipulated by the reduction of animal fat; the results had not supported the fat hypothesis. Chapter 14 (''Eat sugar and see what happens'') described further experiments from Yudkin’s department at Queen Elizabeth College, both with experimental animals and with human volunteers fed on diets rich in sugar. Chapter 17 (''A host of diseases'') introduced a new section on disease of the liver. The inclusion of these additional results is one reason why the new edition (published by Viking in 1986 and by Penguin in 1988) is substantially longer than its predecessor. In addition, the author rearranged and expanded a good deal of the material in chapters 3, 4 and 5 of the 1972 edition, so that these three chapters (which largely concerned the chemistry of sucrose, methods for its production, and the difference between white and brown sugar) now became seven. In the last chapter, Yudkin gave many additional examples of the ways in which his research and the publication of his results had been impeded by the sugar industry and by organisations influenced by it.

2012 edition

The 2012 edition was published by Penguin under the title ''Pure, White and Deadly: How Sugar Is Killing Us and What We Can Do to Stop It''. Yudkin's text is identical to that of the 1986 edition. In addition the new edition has an introduction by

, who had, independently of Yudkin, discovered some of the deleterious effects of sucrose, particularly in the aetiology of obesity in childhood. This edition of ''Pure, White and Deadly'' has been translated into German and Korean.

Reception

After half a century, it has become clear that ''Pure, White and Deadly'' was a transformative book, both because it re-shaped the scientific understanding of sugar and because it stimulated practical action for sugar reduction. The initial reception was very different. For decades after the book's initial publication in 1972, despite its sales and translations (into Finnish, German, Hungarian, Italian, Japanese and Swedish), Yudkin's arguments were rejected not just by the food industry but also by most of his scientific peers. Because of the lengthy delay caused by opponents (described below under Rejection), and the further time involved as others slowly began to appreciate the significance of sugar (described under Transition), sugar emerged as the principal nutrient of global concern only in the early years of the 21st century.

Rejection

When ''Pure, White and Deadly'' was first published, Yudkin was a member of the panel on diet and cardiovascular disease of the Committee on the Medical Aspects of Food Policy (COMA), then the principal scientific advisory body on nutrition for the UK government. It seemed an ideal opportunity to translate science into policy. In the event, Yudkin's colleagues on the panel did not accept his arguments, so he wrote a brief “note of reservation” for the final report suggesting they had paid too much attention to fat and too little to sucrose. That a COMA panel had for the first time been asked to consider cardiovascular disease was itself a sign of the changes with which ''Pure, White and Deadly'' was concerned. As wartime privations receded and industrialised nations prospered, diets changed and the focus of nutrition changed too – from deficiency diseases to problems of excess, what Yudkin called the “diseases of civilisation”. In many countries, governments and medical organisations began publishing dietary recommendations. Some included sugar among their concerns, but without specific reference to ''Pure, White and Deadly'', or to Yudkin at all. Fat remained the principal issue. A review of 100 international nutrition reports up to 1991Cannon, Geoffrey (1992). Experts Agree: an Analysis of One Hundred Authoritative Scientific Reports on Food, Nutrition and Public Health Published Throughout the World in Thirty Years, Between 1961 and 1991. Consumers' Association, London found that 70 included quantitative targets for fat and only 23 for sugar. In the UK, the 1984 update of the COMA report on diet and cardiovascular disease did not mention ''Pure, White and Deadly'' or Yudkin. And despite the much expanded 1986 edition of the book with new evidence, the separate COMA panel on “Dietary Sugars and Human Disease” in 1989 explicitly dismissed any links between sugar and obesity, type 2 diabetes or heart disease. The first WHO report on “Diet, Nutrition and the Prevention of Chronic Diseases” in 1990 acknowledged sugar's role in the causation of dental caries, but not in obesity or CVD. Keys was referenced but not Yudkin. Similarly, the 1994 version of the COMA report on cardiovascular disease lists 414 references, but does not include ''Pure, White and Deadly'' among them.

Transition

For the general public, the most significant development was the increasing popularity of low-carbohydrate diets from the mid-1990s onwards. These created a generalised sense that there was something harmful about sugar and that people should eat less of it. Low-carbohydrate diets at that time were most strongly associated with Robert Atkins, himself a cardiologist who also suffered rejection by his medical peers. But many others produced variations on the theme, most notably

Arthur Agatston Arthur Agatston (born January 22, 1947) is an American cardiologist and celebrity doctor best known as the developer of the South Beach Diet, but also as the author of many published scholarly papers in the field of noninvasive cardiac diagnostics ...

Barry Sears Barry Sears (born June 6, 1947) is an American biochemist and author best known for creating and promoting the Zone diet, a low-carbohydrate fad diet that is not supported by good medical evidence.Cataldo, Corrine Balog; DeBruyne, Linda Kelly; ...

, Leslie Kenton,

Patrick Holford Patrick Holford is a British author and entrepreneur who endorses a range of controversial vitamin tablets. As an advocate of alternative nutrition and diet methods, he appears regularly on television and radio in the UK and abroad. He has 36 b ...

and

Jennie Brand-Miller Janette Cecile Brand-Miller (born 1952), also known as Jennie Brand-Miller, Janette Cecile Brand and GI Jennie, is an Australian academic who holds a chair in human nutrition in the School of Life and Environmental Sciences at the University o ...

. The trend continues in the 21st century in varied forms, including

ketogenic Ketogenesis is the biochemical process through which organisms produce ketone bodies by breaking down fatty acids and ketogenic amino acids. The process supplies energy to certain organs, particularly the brain, heart and skeletal muscle, unde ...

and

paleolithic The Paleolithic or Palaeolithic (), also called the Old Stone Age (from Greek: παλαιός ''palaios'', "old" and λίθος ''lithos'', "stone"), is a period in human prehistory that is distinguished by the original development of stone too ...

diets. Yudkin received little acknowledgement for this development, even though he had published five books on weight loss, all emphasising sugar restriction, from 1958 to 1990, before any of the other popular low-carbohydrate diets were written. (See separate Wikipedia entry on

for a bibliography). There was a similar lack of recognition in the scientific community. As we have seen, from the first edition of ''Pure, White and Deadly'' onwards Yudkin drew attention to the “metabolic disturbance” caused by excessive sugar intake, i.e. its effect on the production of insulin or on people’s sensitivity to it. But it was

Gerald Reaven Gerald M. "Jerry" Reaven (July 28, 1928 – February 12, 2018) was an American endocrinologist and professor emeritus in medicine at the Stanford University School of Medicine in Stanford, California, United States. Reaven's work on insulin re ...

, another academic medical specialist, whose work stimulated research on and clinical attention to insulin, who later became known as the “father of insulin resistance”. Reaven also linked this condition to broader health consequences, including heart disease, in what was known in those early days as “Syndrome X” (now more formally designated as the metabolic syndrome). Also food health advocacy NGOs became more visible during the 1990s, raising awareness of dietary problems. Some were particularly active on sugar – notably the

Center for Science in the Public Interest The Center for Science in the Public Interest (CSPI) is a Washington, D.C.-based non-profit watchdog and consumer advocacy group that advocates for safer and healthier foods. History and funding CSPI is a consumer advocacy organization. Its f ...

(CSPI) in the US and Action and Information on Sugars (AIS) in the UK, now succeeded by the more prominent

Action on Sugar Action on Sugar is a registered UK charity formed in 2014 by a group of specialists concerned about sugar and its impact on health. Through research and lobbying the group works to highlight the harmful effects of a high sugar diet and desirabilit ...

(AoS). But even these groups made little public reference to ''Pure, White and Deadly'' or to Yudkin. Throughout this period, both print and broadcast media gave increasing coverage to sugar. But the single most influential article was a cover story on the sugar v fat debate by

in ''The New York Times Magazine'' in 2002. His work also encouraged other journalists, including cookery writers, to publish articles on sugar. Today, articles, columns and programmes on sugar have become ubiquitous and are too numerous to count. The Wikipedia article on

includes references to several articles on ‘’Pure, White and Deadly’’ in both the medical press and the lay press down to the year 2016. A more recent example, ''Fat didn’t have a lobby'', appeared in December 2017 in ''Süddeutsche Zeitung Magazin''. The developing case against sugar was also manifest in the 2003 version of WHO's "Diet, Nutrition and the Prevention of Chronic Diseases", which recognised that there were good reasons for restricting sugar intakes to less than 10% of total calories, not just because of dental caries, but “on nutritional grounds alone”. These grounds specifically included obesity. The subsequent controversy with the food industry over the global strategy to achieve this target was a turning point for some companies, who recognised that sugar and sweet products were now irremovably on the nutrition agenda. The real breakthrough came in 2009 with the lecture “Sugar: the Bitter Truth”, by the paediatric endocrinologist

, broadcast on

YouTube YouTube is a global online video platform, online video sharing and social media, social media platform headquartered in San Bruno, California. It was launched on February 14, 2005, by Steve Chen, Chad Hurley, and Jawed Karim. It is owned by ...

and viewed almost eight million times. Lustig's contribution was significant in several ways. First, it drew widespread public attention to the serious scientific case against sugar. It also broadened the nutritional concerns about sugar beyond obesity to all the diseases in the metabolic syndrome. Finally, it recognised the role that Yudkin had played in this long history, and hence was a major inspiration for the re-publication of ''Pure, White and Deadly'' in 2012, for which Lustig wrote an introduction. While he came to his clinical understanding of sugar independently, Lustig was more generous than any previous scientific workers in acknowledging his debt to Yudkin. Lustig ends his introduction to ''Pure, White and Deadly'': “I’m proud to be a Yudkin disciple, to contribute to resurrecting his work and his reputation, and to assist in the advancement of his legacy and public health message. Every scientist stands on the shoulders of giants. For a man of relatively diminutive stature and build, Dr John Yudkin was indeed a giant.”

Affirmation

Two major books have taken up the theme developed by Yudkin: ''Fat Chance'' by

(Hudson Street Press, 2013) and ''The Case Against Sugar'' by

(Alfred A. Knopf, 2017). These two books have added momentum to Yudkin’s call in ''Pure, White and Deadly'' for a substantial reduction in the consumption of sugar. In recent years, most major multinational food and drink manufacturers have begun implementing “health and wellness” programmes which, amongst other actions, review and reformulate their product portfolios (thousands of products) to reduce sugar. Nestlé, Unilever, Danone, General Mills, Kellogg's, Mars, Kraft Heinz, Mondelez and others have such plans, as well as, most significantly, Coca-Cola and PepsiCo. The results are variable across companies, markets and product categories, and often criticised as inadequate or too slow. But significant reformulations in foods normally take many years. They have to be done gradually and imperceptibly, so as not to shock people's expectations and so as to carry established customers with them. For example, Heinz UK, an early responder to nutritional concerns, has been cutting sugar gradually across its range since 1986 and is still doing so. Sugar reduction in mass market foods is a transformative process that will take a long time. Government plans and policies on sugar are also changing. Earlier, the consensus target for sugar consumption was 10% of calories. In 2015, Yudkin's home country, the UK, set a goal of 5% of dietary energy, and WHO made this a “conditional recommendation” for all countries. Explicit anti-sugar policies are being set in place. The most obvious manifestation has been taxes on “sugar-sweetened beverages”. At the time of writing, some 59 countries have adopted some form of charge on sweetened drinks. This is still a minority among nation states, but the number is growing. Their effectiveness varies. In many cases the charges are small, the data on sales and consumption are imperfect, and consequently the effects are disputed. The most powerful to date is again in the UK, with the Soft Drinks Industry Levy. It was structured with the intention not of suppressing consumption but of stimulating reformulation. So it took the form of a “levy” on manufacturers, not an excise tax at retail level. It was effective: most mass market drinks have reduced their sugar content to evade the levy. The UK has also begun a programme to reduce the sugar content in popular sweetened foods (biscuits, breakfast cereals, cakes, chocolate, ice cream, pastries, puddings, sugar confectionery, sweet spreads and yoghurts). It is too early to tell if this will be effective – many lower sugar products are still being developed and, in foods more than in drinks, reformulation is a long process. And it remains to be seen how many items will be commercially successful, which is a prerequisite for the success of reformulation as a public health strategy. Ironically, the most significant measure of Yudkin's increasing influence has come from the sugar industry itself. In 1964, aware of his arguments even before ''Pure, White and Deadly'' was published, the two big UK sugar producers (AB Sugar and Tate & Lyle) set up the Sugar Bureau (later Sugar Nutrition) to provide scientific counter-arguments on the health effects of sugar. In 2016, recognising that the public argument had been lost, they closed it down.

Influence

Although excessive sugar consumption is recognised as a major health issue, it is likely to remain a problem for decades ahead. The prevalence of obesity remains high in most developed countries. It is also rising in many developing societies, even those with widespread deficiencies, where it produces the “double burden” of malnutrition. As yet, “not one single country has managed to turn around its obesity epidemic in all age groups”. The burden of illness has shifted, in rich and poor countries alike, towards “non-communicable diseases”, including those of the metabolic syndrome associated with sugar. From a global perspective, sugar consumption is also rising, through growth in Asia and Africa, with India as the world's largest consumer in absolute amounts. It may not be falling even in the UK, despite all the government's efforts. Estimating real intakes is difficult, because diet surveys are flawed by “under-reporting”. Unsurprisingly, sugar production is rising in parallel, not only through more cane and beet, but also because of increased production of

high fructose corn syrup High-fructose corn syrup (HFCS), also known as glucose–fructose, isoglucose and glucose–fructose syrup, is a sweetener made from corn starch. As in the production of conventional corn syrup, the starch is broken down into glucose by enzym ...

/“isoglucose”, made from other starchy crops, like maize and wheat. Indeed, for all the attention to new policies to control demand for sugar, agricultural and trade policies continue to stimulate its production.Richardson, Ben and Winkler, Jack (2019) ''Sugar reduction in post-Brexit UK: A supply-side agenda'' FRC Food Brexit Briefing, Food Research Collaboration, Centre for Food Policy, City University, London. Nonetheless, the reformulation programmes of governments and companies should, over the longer term, gradually reduce consumption. One consequence of the emphasis on reformulation has been to stimulate the development of new food ingredients that may be used in place of sugar, especially in the technically more difficult changes to foods. These go well beyond the familiar “artificial” sweeteners to include new “natural” sweeteners, superior

polyols In organic chemistry, a polyol is an organic compound containing multiple hydroxyl groups (). The term "polyol" can have slightly different meanings depending on whether it is used in food science or polymer chemistry. Polyols containing two, thre ...

, better dextrins, improved oligo/poly-saccharides, sweet proteins, flavour enhancers, modifiers of taste receptors, and even new forms of sugar itself. As a result, new mass-market products with much reduced sugar contents, or even sugarfree, may become widespread.

Notes

References

{{sugar 1972 non-fiction books American non-fiction books Books about food and drink Diets English-language books Nutrition in the United Kingdom Sugar