The case against sugar

So here’s another way to frame what is now the imperative question: is the energy-balance hypothesis of obesity correct? Is it the right paradigm to understand the disorder? The competing hypothesis has existed for over a century: in this paradigm, obesity is not an energy-balance disorder but a disorder of excess fat accumulation and so, clearly, a hormonal and metabolic disorder – the result of an ‘endocrine disturbance’, as it was phrased in the 1930s by Eugene Du Bois, then the leading American authority on metabolism. By this logic, the foods we eat influence fat accumulation not because of their caloric content but because of their macronutrient content, the proteins, fats and carbohydrates they contain. This paradigm attends to how organisms (humans, of course, in particular) orchestrate the careful ‘partitioning’ of the macronutrient fuels they consume, determining whether they will be burned for energy or stored or used to rebuild tissues and organs. It proposes that dysregulation of this exquisitely-evolved, finely-tuned homeostatic system (a system that is biologically balanced) is the necessary component to explain both the excessive storage of calories of fat – obesity – and the diabetes that accompanies it.

This alternate hypothesis implies that sugar has unique effects in the human body leading directly to both diabetes and obesity, independent of the calories consumed. By this way of thinking, refined sugars are indeed toxic, albeit over the course of years or decades. We get fat and diabetic not because we eat too much of them – although that is implied tautologically merely by the terms ‘overconsumption’ and ‘overeating’ – but because they have unique physiological, metabolic and hormonal effects that directly trigger these disorders. If all this is right, then thinking of obesity as an energy-balance disorder is as meaningless as calling poverty a money-balance problem (caused, of course, by earning too little or spending too much, or both). By conceiving of obesity as a problem caused by the behaviours of excessive consumption and physical inactivity, researchers not only took a physiological defect – the excess accumulation of fat, often to a massive extent – and turned it into a behavioural problem. But they made a critical error, one that has grown over the course of decades into an idea that seems too big to fail.