Pure, White and Deadly is a 1972 book by John Yudkin, a British nutritionist and former Chair of Nutrition at Queen Elizabeth College, London.

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).

", attracted attention,[7] and the following year a World Health Organization report recommended that added sugars provide no more than 6–10% of total dietary intake.

[11] 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.

[13] 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.

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.

Experiments with rats showed that the feeding of sucrose led to impaired glucose tolerance (results with human subjects were more equivocal).

The author mentions several other conditions that he believed were caused by or exacerbated by the consumption of sucrose: dyspepsia (indigestion), dental caries, seborrhoeic dermatitis, changes in the refractive index of the eye, and various forms of cancer.

This suggestion foreshadows the subsequent widespread recognition of insulin resistance and the metabolic syndrome, and the condition known as non-alcoholic fatty liver disease (NAFLD).

Fourteen years after the first publication of Pure, White and Deadly, Yudkin decided that the book was out of date in important respects, and in 1986 he published a new edition to incorporate more recent experimental results.

In the last chapter, Yudkin gave many additional examples of the ways in which his research and the publication of his results had been impeded by the sugar industry and by organisations influenced by it.

In addition the new edition has an introduction by Robert Lustig, who had, independently of Yudkin, discovered some of the deleterious effects of sucrose, particularly in the aetiology of obesity in childhood.

For decades after the book's initial publication in 1972, despite its sales and translations (into Finnish,[16] German,[17] Hungarian,[18] Italian,[19] Japanese and Swedish),[citation needed] Yudkin's arguments were rejected not just by the food industry but also by most of his scientific peers.

When Pure, White and Deadly was first published, Yudkin was a member of the panel on diet and cardiovascular disease of the Committee on the Medical Aspects of Food Policy (COMA), then the principal scientific advisory body on nutrition for the UK government.

In the event, Yudkin's colleagues on the panel did not accept his arguments, so he wrote a brief “note of reservation” for the final report[20] suggesting they had paid too much attention to fat and too little to sucrose.

In the UK, the 1984 update of the COMA report on diet and cardiovascular disease[22] did not mention Pure, White and Deadly or Yudkin.

The first WHO report on “Diet, Nutrition and the Prevention of Chronic Diseases”[24] in 1990 acknowledged sugar's role in the causation of dental caries, but not in obesity or CVD.

Similarly, the 1994 version of the COMA report on cardiovascular disease[25] lists 414 references, but does not include Pure, White and Deadly among them.

But many others produced variations on the theme, most notably Arthur Agatston, Barry Sears, Michael and Mary Dan Eades, Leslie Kenton, Patrick Holford and Jennie Brand-Miller.

Yudkin received little acknowledgement for this development, even though he had published five books on weight loss, all emphasising sugar restriction, from 1958 to 1990, before any of the other popular low-carbohydrate diets were written.

As we have seen, from the first edition of Pure, White and Deadly onwards Yudkin drew attention to the “metabolic disturbance” caused by excessive sugar intake, i.e. its effect on the production of insulin or on people’s sensitivity to it.

But the single most influential article was a cover story on the sugar v fat debate by Gary Taubes in The New York Times Magazine in 2002.

[8] The subsequent controversy with the food industry over the global strategy to achieve this target was a turning point for some companies, who recognised that sugar and sweet products were now irremovably on the nutrition agenda.

The real breakthrough came in 2009 with the lecture “Sugar: the Bitter Truth”, by the paediatric endocrinologist Robert Lustig, broadcast on YouTube and viewed almost eight million times.

Finally, it recognised the role that Yudkin had played in this long history, and hence was a major inspiration for the re-publication of Pure, White and Deadly in 2012, for which Lustig wrote an introduction.

Lustig ends his introduction to Pure, White and Deadly: “I’m proud to be a Yudkin disciple, to contribute to resurrecting his work and his reputation, and to assist in the advancement of his legacy and public health message.

Nestlé, Unilever, Danone, General Mills, Kellogg's, Mars, Kraft Heinz, Mondelez and others have such plans, as well as, most significantly, Coca-Cola and PepsiCo.

[34][35] The burden of illness has shifted, in rich and poor countries alike, towards “non-communicable diseases”, including those of the metabolic syndrome associated with sugar.

From a global perspective, sugar consumption is also rising, through growth in Asia and Africa, with India as the world's largest consumer in absolute amounts.