Carbohydrate and sugar are recurring themes in the history of diet and disease. After the agricultural revolution 10,000 y ago, nutrition changed from a hunter-gatherer way of life to one in which food could be grown in one locale, avoiding the challenges of continuing to move to find food. The domestication of animals and the development of many grains and other crops allowed civilizations to develop and reduced most effects of seasonality on food supplies for many countries (1, 2). The agricultural revolution also led to the growth of cities and, with it, a group of infectious diseases that dominated the health of people for thousands of years and led to the continued development of many new caloric foods and beverages over the last 10,000-12,000 y (3). With the advent of the industrial revolution several hundred years ago, the techniques for growing and processing foods changed again, with a more varied food supply being one consequence of industrial techniques. After World War 2, as infectious diseases were claiming fewer lives, the focus on how the foods we ate could influence the progress of noncommunicable diseases such as diabetes, heart disease, cancer, and obesity came to be the focus of nutrition and public health. The concept that sugar consumption might be related to the onset of diabetes was suggested more than a century ago by Sir Richard Havelock Charles (4), who noted its relation to the increasing incidence of diabetes among natives of Calcutta, India. This idea and the concept that diabetes was the result of "overnutrition" or obesity, proposed by Elliott Joslin the eminent diabetologist in the early 20th century (5), became competing concepts. The idea that sugar intake is related to the high incidence of diabetes and obesity has been a recurrent theme of Indian medicine as Gulati and Misra noted (6). Similarly, John Yudkin (7, 8) pushed this idea in the 1950s and 1960s. But it is only in the past several decades that many scientists have studied sugar, it components, its role in our metabolism, and its impact on human health in great detail. Because obesity has increased rapidly in the past 40 y, diabetes has followed in its footsteps. Like other noncommunicable diseases, nutritional factors, in addition to obesity, play an important role. One of these nutrients is sugar. The diet Supported by NIH grants R01DK108148 and R01DK098072. BMP reports no food or beverage industry funding.