Sugar Papers Reveal Industry Role in Shifting Focus from Heart Disease to Saturated Fat
By Sugar Editor
It all started with a secret PR campaign dating back to the 1970s. For forty years, the Sugar Association, key trade group for sugar producers, deflected all threats to its multi-billion dollar empire, while sweetening the world’s food supply. As obesity, diabetes, and heart disease rates skyrocket, doctors are now treating the first generation of children suffering from fatty liver disease. The sugar industry is once again under siege.
When the doors closed at the Great Western Sugar Company in Colorado in 1976, someone forgot to sweep the floor. Gathering dust in the archives were 1500 pages of internal documents exposing how the Sugar Industry used Tobacco-style tactics to dismiss troubling health claims against their products. Denver dentist turned postdoctoral scholar at the UCSF School of Medicine, Cristin Kearns, knew she’d stumbled on something big: the industry’s secret playbook. Her story is vividly captured in the Canadian documentary, Sugarcoated, now available on Netflix.
Along with her mentors, Stan Glantz and Laura Schmidt, Kearns has produced another powerful peer-reviewed paper on sugar industry tactics.
It reveals that the sugar industry began working closely with nutrition scientists in the mid-1960s to single out fat and cholesterol as the dietary causes of coronary heart disease and to downplay evidence that sucrose consumption was also a risk factor. This analysis appears September 12, 2016, in JAMA Internal Medicine.
The internal industry documents showed that a sugar industry trade organization recognized as early as 1954 that if Americans adopted low-fat diets, then per-capita consumption of sucrose would increase by more than one-third. The trade organization represented 30 international members.
Meanwhile, evidence linking sugar consumption to high blood cholesterol and triglyceride levels – both thought to be risk factors for coronary heart disease – began to emerge in the scientific literature and popular press.
After a 1965 spike in media attention to the heart disease risks of sucrose, the sugar industry commissioned Project 226, a literature review written by researchers at the Harvard University School of Public Health Nutrition Department, which was published in the highly respected New England Journal of Medicine (NEJM) in 1967. It concluded there was “no doubt” that the only dietary intervention required to prevent coronary heart disease was to reduce dietary cholesterol and substitute polyunsaturated fat for saturated fat in the American diet.
“The literature review helped shape not only public opinion on what causes heart problems but also the scientific community’s view of how to evaluate dietary risk factors for heart disease,” said lead author Cristin Kearns, DDS, MBA, who discovered the industry documents.
The UCSF researchers analyzed more than 340 documents, totaling 1,582 pages of text, between the sugar industry and two individuals: Roger Adams, then a professor of organic chemistry who served on scientific advisory boards for the sugar industry; and D. Mark Hegsted, one of the Harvard researchers who produced the literature review.
To conduct the literature review, the sugar industry paid the Harvard scientists the equivalent of $50,000 in 2016 dollars, then set the review’s objective, contributed articles to be included, and received drafts. Yet the industry’s funding and role were not disclosed in the final NEJM publication.
The literature review heavily criticized studies linking sucrose to heart disease, while ignoring limitations of studies investigating dietary fats. The review argued that blood cholesterol levels were the only significant risk factor for coronary heart disease, which made the high sucrose content of the American diet seem less hazardous than if blood triglycerides were also considered to be a risk factor.
The authors emphasized that this analysis demonstrates the importance of having scientific reviews written by people without conflicts of interest, as well as the need for financial disclosure in nutrition science.
“As the saying goes, he who pays the piper calls the tune,” said senior author Stanton A. Glantz, PhD, UCSF professor of medicine and director of the UCSF Center for Tobacco Control Research and Education. “There are all kinds of ways that you can subtly manipulate the outcome of a study, which industry is very well practiced at.”
Co-author Laura Schmidt, PhD, who is also principal investigator on the UCSF-led SugarScience initiative and Professor of Health Policy at the Philip R. Lee Institute for Health Policy Studies, noted that after decades of focusing on saturated fat as the dietary culprit in heart disease, the science is building around sugar’s role, but health policy has only just begun to catch up.
“There is now a considerable body of evidence linking added sugars to hypertension and cardiovascular disease, which is the No. 1 cause of premature death in the developed world,” Schmidt said. “Yet, health policy documents are still inconsistent in citing heart disease risk as a health consequence of added sugars consumption.”
JAMA Internal Medicine: Author Interview
CNN Video: Sugar raises heart concerns
Associated Press: Study details sugar industry attempt to shape science
Business Insider: The sugar industry funded one of the biggest misconceptions in modern nutrition
New York Times: How the Sugar Industry Shifted Blame to Fat
San Francisco Chronicle: UCSF-led study details sugar industry’s attempt to shape science
CNN: How the sugar industry sweetened research in its favor
International Business Times: What Causes Heart Disease? Sugar Industry Funded Research To Prove It Didn't Contribute to Heart Disease
Live Science: Sugar Industry Tried to Bias Heart Research, Study Says
Daily Mail: Revealed: How the sugar industry paid prestigious Harvard researchers to say fat (NOT sugar) caused heart disease
Helio: Sugar industry sponsored research to downplay sugar's role in heart disease
Conflicts of interest
Researchers have conflicts of interest when their work is significantly dependent on a funding source that holds a vested interest in the outcome of their research.SugarScience Glossary
A broad term for a group of chronic diseases of the heart, these diseases include problems with blood supply to heart muscle, problems with heart valves and the electrical system of the heart. Another term you will see used to mean the same thing is cardiovascular disease.SugarScience Glossary
A broad term meaning any bodily process in which the liver is injured or does not work as it is supposed to. In this website we focus on liver diseases in which the diet hurts the liverSugarScience Glossary
Usually shortened to just diabetes. Sometimes called sugar diabetes. Look at Type 1 Diabetes and Type 2 Diabetes for more informationSugarScience Glossary
Also called table sugar. Your body breaks sucrose into glucose and fructose to use them as fuel.SugarScience Glossary
The most common type of fat in our body and in our food. We can eat triglycerides, our bodies can make triglyceride, and our livers can turn excess sugar into triglycerides. If we do not burn triglycerides as fuel, they are stored as fat in the liver and elsewhere in the body.SugarScience Glossary
Sugars are chemicals made of carbon, hydrogen, and oxygen found which taste sweet and are found in food. They are an important part of what we eat and drink and of our bodies. On this site, sugar is used to mean simple sugars (monosaccharides) like fructose or glucose, and disaccharides like table sugar (sucrose). Sucrose is two simple sugars stuck together for example (see Table sugar). Sugars are a type of carbohydrate. Carbohydrates are energy sources for our bodies Sugars enter the blood stream very quickly after being eaten.SugarScience Glossary
One of the three major groups of nutrients we eat. Much of this website is related to problems associated with too much fat storage in the body. Each gram of fat produces 9 calories of energy if burned by the body as fuel. Fat can be stored in many places in the body. We generally think of fat as under the skin (subcutaneous), but the fat that may be most damaging to us is the fat stored in the liver and around the organs of the abdomen (intrahepatic and visceral or abdominal or intra-abdominal)SugarScience Glossary