Chapter 6 Diabetes 

There was the initial belief in sugar and carbs as the culprit. This was based on the observations in native peoples as their diet changed. 

Then the USA started blaming fat and encouraging carbs. The hypothesis that sugar and refined carbohydrates were responsible might have survived past the 1930s, but Elliott Joslin refused to believe it, and Joslin's name was by then "synonymous" with diabetes in the United States. Joslin achieved lasting fame by pioneering the use of insulin as a treatment. 

Meanwhile, overseas they were still implicating sugar! 

In 1966 a book was published by British physicians claiming all common chronic Western diseases were the manifestations of a single disorder that they named saccharine disease. 

There was a great among of info also gleaned from the World Wars and their ensuing temporary changes of diet on populations (rationing). SCAN IN pp 116 CHART 

Peter Cleave would later be disparaged for suggesting that all chronic diseases of civilization have a single primary cause, but he insisted that it was naive to think otherwise. Though it  may seem odd, he considered dental cavities the chronic-disease equivalent of the canary in the mine. If cavities are caused primarily by eating sugar and white flour, and cavities appear first in a population no longer eating its traditional diet, followed by obesity, diabetes, and heart disease, then the assumption, until proved otherwise, should be that the other diseases were also caused by these carbohydrates. 

Diabetes, obesity, coronary heart disease, gallstones and gall-bladder disease, and cavities and periodontal disease are intimately linked. 

Had sugar consumption been charted separately from that of all carbohydrates, this may have eliminated a fundamental flaw that led to our current understanding of our modern nutrition and chronic-disease epidemiology. Greater affluence inevitably takes populations through a nutrition transition that represents a congruence of fundamental changes in diet. Meat consumption tends to increase, and so saturated fat increases as well. Grain consumption decreases, and so carbohydrate consumption as a whole decreases. BUT the carbohydrates consumed are more highly refined: white rice replaces brown, white flour replaces wholemeal; sugared beverages and candy spark a dramatic increase in sugar consumption. As a result, whenever investigators tested the hypothesis that chronic disease was caused by high fat intake or even high animal-fat intake or low carbohydrate intake, the refinement of the carbohydrates would confound the results. This led Ancel Keys and others to insist that fat caused heart disease. But the greatest single change in the American diet was in fact the spectacular increase in sugar consumption from the mid-nineteenth century onward, from less than 15 pounds a person yearly in the 1830s to 100 pounds by the 1920s and 150 pounds (including high-fructose corn syrup) by the end of the century. In effect, Americans replaced a good portion of the whole grains they ate in the nineteenth century with refined carbohydrates. 

When Keys linked the low-fat, high carb diet of the Japanese in the late 1950s to the extremely low incidence of heart disease, he paid no attention to sugar consumption, but the consumption of sugars in Japan was very low - less than forty pounds per person in 1963, and still under fifty pounds in 1980 - equivalent to the yearly per-capita consumption recorded in the United States or the UK a century earlier. 

Also the health of the islanders of Crete - and the supposed effects of the Mediterranean diet itself - could also be explained by the lack of sugar and white flour. The Cretan diet included only ten pounds a year of sugar and sweets, and their bread was all wholemeal. The reported benefits could be attributed to the fish, olive oil, and vegetables consumed, but they could also be due to the minimal uantities of sugar and the absense of white flour. 

This same lack of concern for any potential health-related difference between vegetables and starches, on the one hand, and refined starches and sugars, on the other, has haunted cancer research as well. 

In 1975, a seminal analysis of diet and cancer reported that the higher the sugar intake in different nations, the higher both the incidence of and mortality from cancer of the colon, rectum, breast, ovary, uterus, prostate, kidney, nervous system, and testicles. Still, epidemiologists fixated on the fat-cancer hypothesis and made no attempt to measure the refined carbohydrates in the populations they studied. 

John Yudkin entered the heart-disease debate in 1957, and he decided that sugar itself was the fundamental problem. By the early 1970s, the medical-research community was taking Yudkin's hypothesis seriously. But now the very existence of Keys's hypothesis was the primary obstacle to the acceptance of Yudkin's. If one was right, then the other was very likely wrong! Although European researchers tended to be open-minded, in the USA Keys's hypothesis ruled. By the early 1970s, his dietary-fat hypothesis of heart disease, despite the ambiguity of evidence, was already being taught in textbooks and in medical schools as most likely true. Yudkin's theory mostly retired with him, but he wrote a book called "Sweet and Dangerous", but at the late 1970s, to study the potentially deleterious effects of sugar in the diet was to endanger your reputation!!