Intended for healthcare professionals

Feature Essay

What if sugar is worse than just empty calories? An essay by Gary Taubes

BMJ 2018; 360 doi: (Published 04 January 2018) Cite this as: BMJ 2018;360:j5808
  1. Gary Taubes, cofounder
  1. Nutrition Science Initiative, San Diego, California, USA
  1. gataubes{at}

Doctors have long suspected sugar is not simply a source of excess calories but a fundamental cause of obesity and type 2 diabetes. Gary Taubes argues we must do more to discourage consumption while we improve our understanding of sugar’s role

Discussions about the global epidemics of obesity and type 2 diabetes tend to assume that these are new phenomena, products of changes in the way we eat and live that go back perhaps 50 years. For some populations with diets and lifestyles that are only recently westernised that may be true. In the United States, however, the origins of the diabetes epidemic may be found in hospital records from the 19th century.

In 1898, the physician Elliot Joslin and the Harvard pathologist Reginald Fitz published an analysis of 74 years of case records from Boston’s Massachusetts General Hospital. They identified only 172 cases of diabetes among the 48 000 inpatients documented, but prevalence of the disease seemed to have been increasing almost exponentially since the mid-1850s. At the time, they attributed the increase to the “wholesome tendency of diabetics to place themselves under careful medical supervision.”1

By 1921, though, Joslin was using the word “epidemic” to describe what he was witnessing. “Statistics for the last thirty years show so great an increase in the number [of patients with diabetes] that, unless this were in part explained by a better recognition of the disease, the outlook for the future would be startling,” he wrote.2

Joslin’s observations were corroborated three years later by the Columbia University researchers Haven Emerson and Louise Larimore. Mortality from diabetes in some North American cities, they reported, had increased almost 15-fold since the civil war years.

Sucrose as prime suspect

“Better recognition of the disease,” as Joslin had put it, may have played a part in explaining these large …

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