Good Calories, Bad Calories

The preferred explanation for how sugar, white flour, and white rice might perpetrate disease emerged from a great era of nutritional research in the early twentieth century. In 1912, the Polish-born biochemist Casimir Funk coined the term “vitamine” (the “e” was later dropped) and speculated that vitamins B₁, B₂, C, and D were necessary for human health. During the next quarter-century, researchers continued to discover new vitamins essential to health and identified a host of diseases—such as beriberi, pellagra, rickets, and scurvy—as caused by specific vitamin deficiencies. Beriberi results from a deficiency in thiamine (vitamin B₁), which is lost in the refining of polished rice and white flour. This led to the suggestion that even a disease like cancer could be a kind of deficiency disease, caused by vitamin starvation, as the journalist (and future homeopath) J. Ellis Barker called it in his book Cancer: How It Is Caused, How It Can Be Prevented (1924).

The Scottish nutritionist Robert McCarrison was perhaps the leading proponent of the hypothesis that the chronic illnesses of civilization could be attributed to “the extensive use of vitamin-poor white flour and to the inordinate use of vitamin-less sugar.” McCarrison had founded a laboratory in India that would later become the National Institute of Nutrition and had spent nine years working in the Himalayas, “amongst isolated races far removed from the refinements of civilization,” as he explained in a 1921 lecture at the University of Pittsburgh. “During the period of my association with these peoples,” he wrote, “I never saw a case of asthenic dyspepsia, of gastric or duodenal ulcer, of appendicitis, of mucous colitis, or of cancer, although my operating list averaged over 400 operations a year.” McCarrison attributed their good health to several factors, including a diet of “the unsophisticated foods of Nature.” “I don’t suppose that…as much sugar is imported into their country in a year as is used in a moderately sized hotel of this city in a single day,” he said.

McCarrison’s research included a comparative study of the diets and physiques of the disparate populations and religious groups on the Indian subcontinent. The “physique of northern races of India,” McCarrison wrote, “is strikingly superior to that of the southern, eastern, and western races.” Once again, he attributed the difference to the vitamins and nutrients present in the northern-Indian diet but not elsewhere. They ate well-balanced diets, with milk, butter, vegetables, fruit, and meat—and ate their wheat ground course as wholemeal flour, which “preserves all the nutrients with which Nature has endowed it.” “White flour, when used as the staple article of diet,” wrote McCarrison, “places its users on the same level as the rice-eaters of the south and east of India. They are faced with the same problem; they start to build up their dietaries with a staple of relatively low nutritive value.” He also fed rats and mice in his laboratory on diets of these different populations and reported that the rats fared best on those diets containing “in abundance every element and complex for normal nutrition” and fared worst on those “excessively rich in carbohydrates, and deficient in suitable protein, mineral salts and vitamins.”

By World War II, this rising tide of research on essential vitamins led the United States to decree that millers had to enrich white flour with vitamin B, iron, and nicotinic acid. In England, the government acted in similar fashion a decade later. The concept of “protective foods,” containing the requisite protein, vitamins, and minerals for a healthy diet—fresh meat, fish, eggs, milk, fruits, and vegetables—now became the orthodox wisdom. During a century of debate, no one seems to have considered whether the properties of these refined foods—flour, sugar, and white rice—could have an impact on human health other than through the protein, fiber, vitamins, and minerals removed. Thirty years later, that would turn out to be the case, but by that time much of this original research on diseases of civilization would have been forgotten.

Chapter Six

DIABETES AND THE CARBOHYDRATE HYPOTHESIS

The consumption of sugar is undoubtedly increasing. It is generally recognized that diabetes is increasing, and to a considerable extent, its incidence is greatest among the races and the classes of society that consume most sugar. There is a frequently discussed, still unsettled, question regarding the possible role of sugar in the etiology of diabetes. The general attitude of the medical profession is doubtful or negative as regards statements in words…. But the practice of the medical profession is wholly affirmative.

FREDERICK ALLEN, Studies Concerning Glycosuria and Diabetes, 1913