Dr. Terry Simpson's Substack

Dr. Terry Simpson's Substack

Sugar on Trial: The Evidence, the Accusations, and the Diet Gurus

From insulin and obesity to Gary Taubes and the carbohydrate wars—what the science actually tells us.

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Dr. Terry Simpson
Oct 24, 2026
∙ Paid

Sugar, the ultimate villain. And we all want one. At any given time, I am sure you have heard that sugar is the cause of - well, every known problem facing humans on earth.

We like villains. Smoking is a good villain. We who don’t smoke, we hate the smell of it. That it can lead to cancer, heart disease, and bad breath means we can point to this and say - here is a cause of many problems.

We want to point to one thing that explains rising obesity, diabetes, and pick anything else. Sugar has been at the top of that list for years.

The sugar industry hasn’t helped. As you read in my last column, sugar is responsible for a large part of the Caribbean slave trade, overthrowing the Hawaiian monarchy, and bad teeth. So what else can we blame sugar for?

You probably heard people blame sugar for diabetes. It doesn’t cause diabetes, and that seems odd to most, because blood sugar levels rise with diabetes. Some blame sugar for heart disease, inflammation, premature aging. The sugar industry paid some researchers in the 1960’s and they wrote a piece saying that fats more than sugars are to blame for heart disease.

So what is the data about sugar in all its forms? Is it the pure white poison that makes cocaine look tame?

Yes, sugar has it’s share of the blame, but like Murder on the Orient Express, there is more than one guilty party. This week, we will go into the detail about the sugar wars.

So I promised my paid subscribers a short primer about sugar and biology. The arguments and the data about what sugar does - besides being delicious

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There is no doubt that most western countries consume too much sugar, and too much leads to more things than cavities. But sugar is the universal currency of your metabolism. Your body preferentially uses sugar for energy. That does not exonerate sugar, but let me give you a few facts:

Glucose is the form of sugar your body uses for metabolic currency.

Your brain relies on sugar. As much as the keto people would love to convince you that you don’t need sugar, and your brain can survive with ketones alone, that is misleading. If your brain glucose goes below forty mg/dl you will lose consciousness, no matter how many ketones you have in your blood stream.

Your body can make sugar out of almost every macronutrient, from carbohydrates, to protein, to fat, and even alcohol. Those metabolic pathways show how important sugar is to you.

Too much of a good thing isn’t a good thing. Too much sugar and there are consequences.

Let’s take apart the keto experts, the carb-insulin hypothesis, with the goal that you will not feel guilty about having dessert.

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The Most Misunderstood Hormone in Dieting

It is insulin. The keto enthusiasts concluded that insulin’s primary purpose is to make you fat. Time to learn its role, which is rather complex, unlike the pithy conclusions of a keto enthusiast.

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