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 6

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

Sugar and candies do not cause diabetes, but contribute to the burden on the pancreas and so should be used sparingly…. Carbohydrates are best taken in starchy forms: fruits, vegetables and cereals. The absorption is slower and the functional strain minimal.

GARFIELD DUNCAN, Diabetes Mellitus and Obesity, 1935

OF ALL THE DISEASES OF CIVILIZATION that may have been linked to the consumption of sugar and the refining of carbohydrates, diabetes was certainly a prime suspect. Here is a disease in which a conspicuous manifestation is the body’s inability to use for fuel the carbohydrates in the circulation—known as blood sugar or, more technically, glucose or serum glucose. This glucose accumulates in the bloodstream, effectively overflows the kidneys, and spills over into the urine, causing a condition referred to as glycosuria. One symptom is a constant hunger, specifically for sugar and other easily digestible carbohydrates. Another is frequent urination, and the urine not only smells like sugar but tastes like it. For this reason, diabetes was often known as the sugar sickness. Hindu physicians two thousand years ago suggested it was a disease of the rich, caused by indulgence in sugar, which had only recently arrived from New Guinea, as had flour and rice.