There is not a day that goes by when a nurse is asked to advise about diet.

In particular, about how much fat and sugar should we eat.

Gary Taubes is the author of Why We Get Fat and What to Do About It and Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health.

Recently, he published The Case Against Sugar.

In a peer-reviewed essay in the British Medical Journal, he argues that the science around the effects of sugar is ambiguous and uncertain.

Because of this ambiguity and uncertainty, public authorities should strongly recommend against the consumption of sugar.

Changes in the way we eat and live sway the discussion about obesity and type 2 diabetes.

But this discussion is not a modern phenomenon.

In the late 19th century, there was an analysis of the medical records going back 74 years.

The incidence of diabetes was documented in only 172 cases out of 48,000 examined.

However, the prevalence of diabetes exponentially increased from the mid-1850’s.

This coincided with the introduction to Western diets of confectionary, chocolate and ice cream.

In the United States during the 19th century, there was a 16-fold increase in the consumption of sugar.

The evidence then was pointing at a fundamental cause of diabetes being sugar.

(And the large consumption of sugary foods and beverages in the USA continues to this day.)

There is an anecdotal argument that sugar does have a role in the development of obesity and type 2 diabetes.

Fat consumption and total energy balance dominate the discussion about obesity and health.

And the recommendations about the consumption of sugar focus only on the calories.

When the focus about sugar should be that it is a potential causal agent of disease.

Have nutritionists and public health authorities been asking the wrong question?

The consequence of asking the wrong question is that the answer will also be wrong.

The question they have been asking was what aspect of diet led to an increase in heart disease.

When the question they should have been asking was why did the change in diet lead to obesity and diabetes?

As Taubes argues,

”The saturated fat content of diet was an answer to the heart disease question. But it’s not necessarily the answer to questions about obesity and diabetes.”

The US National Institutes of Health spent US$750 million investigating dietary fat consumption.

And failed to put a similar amount into answering a simple question, “would we live longer and be healthier if we were given dietary advice to avoid sugar?”

Reducing sugar is hard with many hidden sugars present in processed foods.

Sugar is addictive – ask anyone who has tried to restrict the amount they consume.

The craving for sugar can be strong.

Slowly reducing the amount over time will assist in adjusting to a lower consumption of sugar.

Until there is a clear answer, a prudent nurse would encourage people to reduce the consumption of sugar.

To find out more about the effect of sugar,

Taubes, Gary. “What if sugar is worse than just empty calories? An essay by Gary Taubes.” BMJ 360 (2018): j5808.