Pure, White and Deadly
Pure, White and Deadly
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Pure, White and Deadly

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Pure, White and Deadly

Pure, White and Deadly is a 1972 book by John Yudkin, a British nutritionist and former Chair of Nutrition at Queen Elizabeth College, London. Published in New York, it was the first publication by a scientist to anticipate the adverse health effects, especially in relation to obesity and heart disease, of the public's increased sugar consumption. At the time of publication, Yudkin sat on the advisory panel of the British Department of Health'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, processed-food manufacturers, and Ancel Keys, 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 in The New York Times Magazine, "What if It's All Been a Big Fat Lie?", attracted attention, and the following year a World Health Organization 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, an American pediatric endocrinologist, went viral. 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 with a new introduction by Robert Lustig to reflect the changed nutritional context that the book had helped to create.

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. Yudkin believed that this view was wrong and that, instead, an important cause of CHD was the excessive consumption of sugar (i.e. sucrose). 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?] that sucrose and starch are metabolised in similar ways, and so are interchangeable from the nutritional point of view, but more recent evidence[timeframe?] had shown that their metabolism 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. 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. Evolutionary history suggests that our pre-Neolithic 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, an essential nutrient.

The development of agriculture during the Neolithic Revolution (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 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, 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 nutrients. 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?, but both are strongly indicative of an involvement of sucrose in the aetiology both of CHD and of what used to be called maturity-onset diabetes (type 2 diabetes).

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