September 19, 2016

How 'big sugar' helped make fat the bad guy

Daily Briefing

A review of newly unearthed documents reveals that the sugar industry in the 1960s paid prominent nutrition researchers to downplay sugar's connection to heart disease and cast blame on saturated fat—a move that may have had a considerable effect on Americans' diets for decades.

Following the money

The review, published last week in JAMA Internal Medicine, looks at decades-old correspondence from the Sugar Research Foundation, a trade group known today as the Sugar Association.

In a Sugar Research Foundation internal memo from 1964, then-VP John Hickson suggested that the group "embark on a major program" to counteract "negative attitudes towards sugar." He said the sugar industry could achieve this goal in part by funding research to "refute our detractors."

He then asked three Harvard University scientists in 1965 to write "a review article of the several papers which find some special metabolic peril in sucrose."  

According to the documents, the Sugar Research Foundation paid the three Harvard scientists about $50,000 in today's dollars to produce the reviews. The funding source was not publicly disclosed at the time; NEJM started requiring financial disclosures only in 1984. 

Hickson provided articles for the review at one of the Harvard researcher's requests. Hickson also saw drafts of the paper and discussed them with the researchers—though it's unclear whether he or the Sugar Research Foundation made edits.

Ultimately, the Harvard researchers completed two reviews, published in the New England Journal of Medicine (NEJM) in 1967, which claimed to refute studies that suggested a link between sugar and coronary heart disease. They also suggested that the only dietary change that could prevent coronary artery disease was reducing fat and cholesterol intake.

Days before the reviews were sent to publication, Hickson received final drafts and told a Harvard scientist, "Let me assure you this is quite what we had in mind and we look forward to its appearance in print."

Reaction

In an editorial accompanying the new paper, Marion Nestle, a professor of nutrition, food studies, and public health at New York University, wrote that the documents provide "compelling evidence" that the sugar industry sought research "expressly to exonerate sugar as a major risk factor for coronary heart disease."

She said, "You just never see examples that are this blatant."

Walter Willett, chair of the nutrition department at the Harvard T. H. Chan School of Public Health, noted that academic conflict-of-interest rules are significantly different today than they were in the 1960s. However, he said that the industry papers were a reminder of "why research should be supported by public funding rather than depending on industry funding."

Further, Willett, who knew Mark Hegsted, one of the Harvard researchers, described him as a principled scientist, noting that he lost a job at the U.S. Department of Agriculture for standing up to the beef industry. He said, "I very much doubt that he changed what he believed or would conclude based on industry funding."

What it means today

Five decades later, some nutritionists view sugar as a risk factor for coronary heart disease, but there's no consensus, STAT News reports.

Stanton Glantz, a professor of medicine at the University of California-San Francisco and a co-author of the new paper, said that having the reviews published in a major journal "helped shift the emphasis of the discussion away from sugar onto fat." He added, "By doing that, it delayed the development of a scientific consensus on sugar-heart disease for decades."

Hegsted, who went on to serve as USDA's head of nutrition, in 1977 helped write the precursor to the federal dietary guidelines. According to Nestle, he's regarded as "a hero of nutritionists."

Willett noted that the researchers in the 1960s had limited data for assessing the relative risks of sugar and fat. He said, "Given the data that we have today, we have shown the refined carbohydrates and especially sugar-sweetened beverages are risk factors for cardiovascular disease, but that the type of dietary fat is also very important" (O'Connor, "Well," New York Times, 9/12; Bailey, STAT, 9/12; Husten, MedPage Today, 9/12).

How healthy food can be medicine—and what providers need to do

Unhealthy foods are a major problem, but so is the fact that nearly 15 percent of Americans live in food insecure households.

Given the prevalence of the problem and the clear link between hunger, food insecurity, obesity, and other poor health outcomes, providers are uniquely positioned to provide targeted support to patients to address these challenges.

Join us for a webconference on Wednesday, October 19, where we'll share actionable insights for hospitals and clinics seeking ways to identify patients in need of supplemental food assistance and provide services as part of the traditional patient care plan.

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