Sweet Lies: How the Sugar Industry Tricked Us Into Worrying About Fat
In 2007, Cristin Kearns was a general manager at Kaiser Permanente, where she ran a large group of dental practices. She was working with medical doctors at Kaiser to figure out ways they could provide better care for patients with diabetes, who are more likely to have gum disease. The work took her to a conference in Seattle focused on the links between the two diseases. As she watched the talks, attended the panel discussions, and read the materials handed out, she was struck by one thing: No one seemed to be talking about sugar. Even a pamphlet intended for diabetic dental patients didn’t suggest cutting back on sugar.
“I had this experience, which I found to be very strange, and I was wondering whether the sugar industry had an influence” on what was included in those patient materials, Kearns said in an interview. So she started digging. “I had a full-time job—research journalism wasn’t part of my job. I just was Googling at night after work.”
Today, as a postdoctoral researcher at the University of California, San Francisco, Kearns is publishing research based on the documents that her casual Googling led to: a trove of confidential documents, correspondence, and other materials that detail the relationship between the sugar industry and medical researchers in the 1960s and ’70s that UCSF has taken to calling the “Sugar Papers.”
Last year, she and her colleagues revealed that the sugar industry worked with the National Institutes of Health during those years to create a federal program to combat tooth decay in children that did not recommend limiting sugar consumption. On Monday, in a paper published in The Journal of the American Medical Association, Kearns detailed how in the 1960s, the leading sugar industry trade group paid three Harvard researchers nearly $50,000 in today’s dollars to publish a literature review that would link fat and cholesterol—and not sugar—to increased risk of heart disease.
The Sugar Research Foundation, which is now called the Sugar Association, “set the review’s objective, contributed articles for inclusion, and received drafts,” according to the paper. When the New England Journal of Medicine published the two-part review in 1967, the foundation’s funding and involvement were not disclosed.
“The review concluded there was ‘no doubt’ that the only dietary intervention required to prevent CHD [coronary heart disease] was to reduce dietary cholesterol and substitute polyunsaturated fat for saturated fat in the American diet,” Kearns and her coauthors wrote.
In 1980, the federal government released the first-ever Dietary Guidelines, which recommended that Americans limit consumption of saturated fats and cholesterol. Americans were advised to “avoid too much sugar” but not because of diet-related disease: “The major health hazard from eating too much sugar is tooth decay,” according to the guidelines. Throughout the ’80s and ’90s, low-fat foods and diets dominated the American consumer landscape—no one, it seemed, was paying attention to the role of sugar, which was increasingly sneaking its way into a host of products both savory and sweet to make up for the flavor that was lost when fats were removed. Despite all the tubs of margarine, boxes of Snackwell’s cookies, and egg-white omelets, Americans did not get healthier as they astutely tried to avoid fats; rates of obesity, diabetes, metabolic syndrome, and other diet-related disease have instead spiked as sugar consumption has increased.
Today, there’s a growing consensus that sugar, not fat, was the problem all along—and policy makers, researchers, and public health experts are focused on curtailing Americans’ sweet tooth. When the FDA’s new Nutrition Facts requirements—printed on all packaged foods in the U.S.—go into effect in 2018, the label will include a line for “added sugars”; the American Heart Association recently announced strict intake recommendations for children; and soda tax measures have passed in both Berkeley, California, and Philadelphia, with a number of other cities to vote on their own measures in November. In 2016, it isn’t too hard to find someone who will tell you that sugar is addictive, poisonous, or both.
But if sugar’s ills have found a place in the zeitgeist, that was far from the case in the late 1950s, when a British nutritionist named John Yudkin began pursuing the idea that sugar, not fat, was responsible for the rising rates of heart disease. “If only a small fraction of what we know about the effects of sugar were to be revealed in relation to any other material used as a food additive,” Yudkin wrote in his 1972 book Pure, White, and Deadly, “that material would promptly be banned.”
In a story The Guardian published in April on Yudkin’s work and its echoes in today’s growing anti-sugar movement, Ian Leslie wrote that when Yudkin was conducting his research in the 1960s, “a new nutritional orthodoxy” built around a low-fat diet was being established in both the U.S. and the United Kingdom. “Yudkin led a diminishing band of dissenters who believed that sugar, not fat, was the more likely cause of maladies such as obesity, heart disease and diabetes.” But by the time Yudkin’s book was published a decade later, “the commanding heights of the field had been seized by proponents of the fat hypothesis.”
Leslie wrote that Yudkin’s research is being redeemed by Robert Lustig—a pediatric endocrinologist at UCSF whose 2009 talk “Sugar: The Bitter Truth” has pop-star levels of views on YouTube—but he concludes that sugar lost out to fat in the ’60s because of “the unscientific way in which the field of nutrition” operates. “This is not a mistake that can be laid at the door of corporate ogres,” Leslie wrote.
But with the publication of the new paper from Kearns and her coauthors, Lustig said in an interview with TakePart, “it actually can.” As Kearns outlined in her JAMA paper, the New England Journal of Medicine review was designed to marginalize the work of Yudkin and other researchers looking at sugar’s role in heart disease.
According to the JAMA paper, in 1964 John Hicks, the SRF’s vice president and director of research, “proposed that the SRF ‘could embark on a major program’ to counter Yudkin and other ‘negative attitudes toward sugar.’ ” Funding of research on heart disease was part of Hicks’ proposal.
“An important piece of it is that reviews like the one we looked at from the ’60s can influence the type of questions that researchers ask” in future studies, Kearns said. “When the focus is put on fat, that’s where the money goes, that’s where the attention goes,” despite there being “important evidence” linking both sugar and fat to heart disease.
“For years,” Lustig said in an interview, “we’ve been trying to focus physicians’ attention on triglycerides,” which increase in the bloodstream when sugar intake goes up, “as something that’s important in heart disease. But everyone has been caught up with LDL [cholesterol],” which high levels of dietary fat can increase. The industry-funded review from 1967 “was the one that made them do that.”
The Sugar Association did not respond to a request for comment but noted in a statement in response to Kearns’ paper that disclosure and transparency standards have changed since the 1960s. (All of those involved in the ’67 review are now deceased.) “We acknowledge that the Sugar Research Foundation should have exercised greater transparency in all of its research activities,” the statement reads, “however, when the studies in question were published funding disclosures and transparency standards were not the norm they are today.” The New England Journal of Medicine did not require funding and conflict-of-interest disclosures until 1984.
“We question this author’s continued attempts to reframe historical occurrences to conveniently align with the currently trending anti-sugar narrative,” the statement continues, “particularly when the last several decades of research have concluded that sugar does not have a unique role in heart disease.”
“It is true that disclosure was not the norm in 1967, that industry-funded research has (sometimes) been informative, and that sugars do not have a unique role in heart disease,” Marion Nestle, a professor of nutrition, food studies, and public health at New York University, wrote in an email to TakePart. Nestle has written extensively about the questionable role that the food industry plays in funding health research, and JAMA published a commentary by her alongside Kearns’ paper.
“It is also true that industry funding tends to skew research results,” she continued, “and that diets high in sugar raise the risk for heart disease—and that the Sugar Association’s main purpose is to promote the interests of [sugar] producers—not the health of the American public.”
Even if funding disclosures have become the norm, that enlightened ethical standard has not made public health research a field free of conflicting interests. As Nestle noted, “numerous studies show that many authors fail to fully disclose financial ties to industry.” Just last year, Coca-Cola was forced to detail its extensive involvement in funding both research and public health advocacy after The New York Times reported on the company’s funding and continued support for the Global Energy Balance Network, a nonprofit that promoted exercise over diet as the solution to the obesity crisis.
Despite reporting on the industry’s involvement in establishing dietary standards in both the past and the present, and the growing focus on limiting sugar consumption, Lustig said that the medical science community has yet to come around to seeing sugar as a problem outside obesity. “And until medical science is on board, we will not see a true tipping point,” he said. “People are catching on—there has been a sea change; there is a movement afoot—but we haven’t reached a tipping point yet.”