John Yudkin , c. Pure, White and Deadly was used for subsequent editions and is the title by which the book became known. 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 and sucrose. Both of these are carbohydrates , but starch occurs as a bulk constituent of cereals such as rice , wheat and maize , legumes and a few root crops like potatoes , while sucrose is present in large quantities in sugar cane , sugar beet and ripe fruits. It used to be thought[ timeframe?
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John Yudkin , c. Pure, White and Deadly was used for subsequent editions and is the title by which the book became known. 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 and sucrose.
Both of these are carbohydrates , but starch occurs as a bulk constituent of cereals such as rice , wheat and maize , legumes and a few root crops like potatoes , while sucrose is present in large quantities in sugar cane , sugar beet and ripe fruits. It used to be thought[ timeframe? 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. On the other hand sucrose, which is broken down to equal quantities of glucose and fructose , is not an essential dietary component even in small amounts.
The development of agriculture during the Neolithic Revolution from c. 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 from nutritional value.
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 , where much of it is converted to fat.
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 and some experimental. Both types have limitations, which the author discusses in a chapter called Can you prove it?
The epidemiological evidence that sucrose contributes to CHD had started to accumulate in ; 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 , an increase in platelet 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 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 , changes in the refractive index of the eye, and various forms of cancer. 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 , which is extremely adhesive and promotes the growth of acid-producing bacteria. This suggestion foreshadows the subsequent widespread recognition of insulin resistance and the metabolic syndrome , and the condition known as non-alcoholic fatty liver disease NAFLD.
NAFLD is believed to result from the accumulation of fat in the liver—often as a consequence of excess dietary sucrose. 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.
The edition has many more references, and a much fuller index. In Chapter 12 of the new edition Can you prove it? 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 and by Penguin in 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 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. In addition the new edition has an introduction by Robert Lustig , who had, independently of Yudkin, discovered some of the deleterious effects of sucrose, particularly in the aetiology of obesity in childhood.
Reception[ edit ] After almost 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. 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.
It seemed an ideal opportunity to translate science into policy. 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. 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 international nutrition reports up to  found that 70 included quantitative targets for fat and only 23 for sugar. Keys was referenced but not Yudkin. Similarly, the version of the COMA report on cardiovascular disease  lists references, but does not include Pure, White and Deadly among them.
Transition[ edit ] For the general public, the most significant development was the increasing popularity of low-carbohydrate diets from the mids 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. The trend continues in the 21st century in varied forms, including ketogenic and paleolithic diets. Yudkin received little acknowledgement for this development, even though he had published five books on weight loss, all emphasising sugar restriction, from to , before any of the other popular low-carbohydrate diets were written.
See separate Wikipedia entry on John Yudkin for a bibliography. There was a similar lack of recognition in the scientific community. Also food health advocacy NGOs became more visible during the s, raising awareness of dietary problems. 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 Gary Taubes in The New York Times Magazine in Today, articles, columns and programmes on sugar have become ubiquitous and are too numerous to count. These grounds specifically included obesity. 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 , 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.
Every scientist stands on the shoulders of giants. For a man of relatively diminutive stature and build, Dr John Yudkin was indeed a giant. Knopf, 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.
For example, Heinz UK, an early responder to nutritional concerns, has been cutting sugar gradually across its range since 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. At the time of writing, some 59 countries have adopted some form of charge on sweetened drinks. Their effectiveness varies. In many cases the charges are small, the data on sales and consumption are imperfect, and consequently the effects are disputed.
It was structured with the intention not of suppressing consumption but of stimulating reformulation. It was effective: most mass market drinks have reduced their sugar content to evade the levy. 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.
In , recognising that the public argument had been lost, they closed it down. The prevalence of obesity remains high in most developed countries. Indeed, for all the attention to new policies to control demand for sugar, agricultural and trade policies continue to stimulate its production.
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. As a result, new mass-market products with much reduced sugar contents, or even sugarfree, may become widespread. Bray Journal of Diabetes Science and Technology , : "The worldwide consumption of sucrose , and thus fructose , has risen logarithmically since Many concerns about the health hazards of calorie-sweetened beverages, including soft drinks and fruit drinks and the fructose they provide, have been voiced over the past 10 years.
These concerns are related to higher energy intake, risk of obesity, risk of diabetes, risk of cardiovascular disease, risk of gout in men, and risk of metabolic syndrome. Fructose appears to be responsible for most of the metabolic risks, including high production of lipids, increased thermogenesis, and higher blood pressure associated with sugar or high fructose corn syrup. Some claim that sugar is natural, but natural does not assure safety.
John Yudkin: the man who tried to warn us about sugar
Lustig, the bestselling author of Fat Chance. Scientist John Yudkin was the first to sound the alarm about the excess of sugar in the diet of modern Americans. He explores the ins and out of sugar, from the different types—is brown sugar really better than white? In , Yudkin was mostly ignored by the health industry and media, but the events of the last forty years have proven him spectacularly right. Brought up-to-date by childhood obesity expert Dr. Robert H. Lustig, this emphatic treatise on the hidden dangers of sugar is essential reading for anyone concerned about their health, the health of their children, and the wellbeing of modern society.
The same year, he started research at the Dunn Nutritional Laboratory in Cambridge, working principally on the effects of dietary vitamins. His studies of the nutritional status of school children in Cambridge showed that supplementation of the diet with vitamins had little effect on their general health. Moreover, children from three industrial towns in Scotland were, on average, inferior in the same four measurements to the average Cambridge child, and the children from the poorer families in the Scottish towns were inferior in these measurements to those from the wealthier families. What was needed was a UK Nutrition Council with oversight of food policy. While there he studied a skin disease that was prevalent among local African soldiers and discovered that it was due not to an infection, as had been believed, but to riboflavin deficiency. This diet was, on paper, adequate in all nutrients — including riboflavin, which was supplied predominantly from millet.
Pure, White, and Deadly