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Was there ever really a "sugar conspiracy"?

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Over the past quarter-century, histori- cal research has revealed how major industries from tobacco to lead to pe- troleum have meddled in science to conceal the hazards of their products. Drawing on secret industry docu- ments, these studies have shown how special interests have used financial incentives to in- fluence scientists, fabricate doubt, and delay regulation (1). Recently, similar allegations have been made against the sugar industry, with claims that prominent industry-backed researchers in the 1960s downplayed or sup- pressed evidence linking sugar and heart disease. Building on a newly popular narra- tive holding that the low-fat campaign of the 1980s was not based on solid science, these allegations have suggested that if not for the machinations of the sugar industry and its cadre of sponsored research- ers, the history of U.S. dietary policy might have unfolded very differently. In this article, we argue that the his- torical evidence does not support these claims. Although we do not defend the sugar industry and can- not address every aspect of this his- tory, we believe recent high-profile claims come from researchers who have overextended the analogy of the tobacco industry playbook and failed to assess historical actors by the norms and standards of their time. Our analysis illustrates how conspiratorial narratives in science can distort the past in the service of contemporary causes and obscure genuine uncertainty that surrounds aspects of research, impairing ef- forts to formulate good evidence- informed policies.
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By David Merritt Johns1
and Gerald M. Oppenheimer1,2
Over the past quarter-century, histori-
cal research has revealed how major
industries from tobacco to lead to pe-
troleum have meddled in science to
conceal the hazards of their products.
Drawing on secret industry docu-
ments, these studies hav e shown how special
interests have used financial incentives to in-
fluence scientists, fabricate doubt, and delay
regulation (1). Recently, similar allegations
have been made against the sugar industry,
with claims that prominent industry-backed
researchers in the 1960s downplayed or sup-
pressed evidence linking sugar and heart
disease. Building on a newly popular narra-
tive holding that the low-fat campaign of the
1980s was not based on solid science, these
allegations have suggested that if not for the
machinations of the sugar industry
and its cadre of sponsored research-
ers, the history of U.S. dietary policy
might have unfolded very differently.
In this article, we argue that the his-
torical evidence does not support
these claims. Although we do not
defend the sugar industry and can-
not address every aspect of this his-
tory, we believe recent high-profile
claims come from researchers who
have overextended the analogy of
the tobacco industry playbook and
failed to assess historical actors by
the norms and standards of their
time. Our analysis illustrates how
conspiratorial narratives in science
can distort the past in the service of
contemporary causes and obscure
genuine uncertainty that surrounds
aspects of research, impairing ef-
forts to formulate good evidence-
informed policies. In the absence of
very strong evidence, there is a seri-
ous danger in interpreting the in-
evitable twists and turns of research
and policy as the product of malevolent play-
books and historical derailments. Like scien-
tists, historians must focus on the evidence
and follow the data where they lead.
The current controversy over sugar has its
origins in the rise of obesity as a policy issue
near the turn of the 21st century and concom-
itant concerns that existing dietary guide-
lines were not achieving their intended ends.
As nutrition scientists increasingly acknowl-
edged benefits of “healthy fats” and possible
metabolic dangers of added sugars, critical
new accounts questioned whether the archi-
tects of the low-fat campaign had placed too
much faith in weak epidemiologic findings
and brushed aside countervailing evidence.
Some scientists particularly lamented the fate
of John Yudkin, a British nutrition scientist
from the 1960s who they noted had “preached
in the wilderness” about the dangers of
sugar, only to be sidelined and ignored (2).
One article called this historical failure by low-
fat enthusiasts to heed Yudkin’s Cassandra-
like warnings “the sugar conspiracy” (3).
The case for industrial malfeasance builds
on this revisionist foundation, expanding
and enlarging the size and seriousness of
the “sugar conspiracy.” In September 2016,
researchers with the University of Califor-
nia, San Francisco (UCSF), announced that
they had uncovered archival documents
showing that in the mid-1960s, the sugar
industry secretly paid nutrition scientists
at Harvard to write a key literature review
downplaying the evidence linking sugar
and coronary heart disease (CHD) (4). As
the UCSF authors recounted, “By the 1960s,
2 prominent physiologists were champion-
ing divergent causal hypotheses of CHD:
John Yudkin identified added sugars as the
primary agent, while Ancel Keys identified
total fat, saturated fat, and dietary choles-
terol.” But according to the authors,
after the sugar industry “paid off ” a
Harvard review team led by D. Mark
Hegsted, the effect was to “derail”
scientific discussions of sugar’s po-
tential role in heart disease, with the
dietary fat hypothesis subsequently
coming to dominate the field.
Marion Nestle, a nutrition pro-
fessor and authority on corporate
influence, suggested that the docu-
ments were a “smoking gun” (5).
The Harvard scientists “knew what
the funder expected, and produced
it,” she said, accepting a “bribe” that
may have shaped the field for years.
A New York Times report asserted
that, “five decades of research into
the role of nutrition and heart dis-
ease, including many of today’s di-
etary recommendations, may have
been largely shaped by the sugar in-
dustry.” Recently, a new study by the
UCSF group claimed that the sugar
industry “suppressed” damaging re-
search it had funded.
We believe that these narratives
are wrong. There was no “smok-
ing gun.” There was no “sugar con-
spiracy”—at least not one which we
have identified. Here, we offer a brief
HISTORY OF SCIENCE
Was there ever really a “sugar conspiracy”?
Twists and turns in science and policy are not necessarily products of malevolence
POLICY FORUM
1Department of Sociomedical Sciences, Columbia
Unive rsity, New York, NY, USA. 2School of Public
Health, City University of New York, New York, NY,
USA. Email: dmj2119@columbia.edu
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review of postwar nutrition research on fat
and sugar and attempt to explain the emer-
gence of these conspiratorial stories.
A NEW FOCUS ON NUTRITION
In the United States, a new movement to de-
velop knowledge about nutrition emerged in
the context of World War II, at a time when
health officials believed deficiency diseases
posed a threat to economic productivity and
military fitness. Concurrently in late 1941,
the Rockefeller Foundation gave $100,000
(~$1.6 million in 2018, adjusted for inflation)
to Harvard to create a nutrition unit, and 15
food firms amassed nearly $1 million (~$16
million in 2018) to launch a research orga-
nization called the Nutrition Foundation to
fund studies and prepare for rationing. At
the center of both was Frederick J. Stare, a
clinician and biochemist hired by Harvard to
chair its new department and by the Nutri-
tion Foundation to edit its journal.
Nutrition research thus began at Harvard
at a moment when the interests of nutrition-
ists and food executives seemed to be aligned;
deficiency diseases presumably would be ad-
dressed through fortified products or efforts
to increase distribution and consumption.
Initially, the department focused on war-
related research commissioned by the U.S.
Army and other federal agencies. But in the
years after the war, with circulatory diseases
accounting for roughly 40% of U.S. deaths,
Stare decided to focus on two conditions
commonly linked with the “rich” American
diet: obesity and heart disease (6).
By 1951, Stare had secured 27 funders, in-
cluding the U.S. Public Health Service, the
Nutrition Foundation, the American Meat
Institute, the National Dairy Council, the
American Cancer Society, the Eli Lilly Com-
pany, and the Sugar Research Foundation
(SRF). According to Bernard Lown, a cardi-
ologist hired by Stare in 1958, it was “natural”
and “proper” for Stare to turn to the food in-
dustry in accord with the mores of the time.
“There was no sense of ‘being bought,’” re-
called Lown, who later accepted, along with
a Soviet colleague, the 1985 Nobel Peace Prize
awarded to International Physicians for the
Prevention of Nuclear War. Nor were there
demands from journals that authors provide
financial disclosures, Lown said. “It wasn’t
required. It never entered my mind!” (7).
DEVELOPING THE LOW-FAT PARADIGM
As nutrition scientists at Harvard began
to examine the possible link between diet
and heart disease, the group initially looked
askance at the claims of researchers such as
Ancel Keys, an eminent physiologist, who
believed heart attack prevention should
begin with a diet low in fat. Such beliefs
threatened the “sound American diet,
where nutritional adequacy is built around
meat, milk and eggs.
But within a few years, the Harvard team
became deeply engaged in research contrib-
uting to a new causal paradigm in which
heart attacks were the end result of a long-
term accumulation of fatty material in the
coronary arteries, suggesting possibilities
for prevention. Many heart disease suffer-
ers had high serum cholesterol levels, and
various investigators had produced arterial
disease in animals by feeding foods such
as eggs. Wartime data appeared to show
European populations deprived of fatty
animal foods experienced a decline in coro-
nary deaths. Influential early studies of this
emerging dietary fat hypothesis were sup-
ported by the U.S. dairy industry.
During the 1950s, Harvard nutritionists
participated extensively in collaborative field
investigations: a study involving four research
centers to test the predictive value of blood
lipid assays by examining 15,000 workers at
Chrysler, Kodak, Met Life, and two dozen
other organizations; international studies
examining the diets and cholesterol levels of
populations in Guatemala, Costa Rica, and
Nigeria. These investigations added to in-
sights gained from ambitious cohort studies
such as Framingham that would eventually
identify multiple “risk factors” (such as el-
evated blood cholesterol) by following thou-
sands of individuals prospectively over time.
Despite broad agreement that more evi-
dence was needed, the dietary fat hypoth-
esis seemed scientifically plausible to many
researchers. As the media queried experts
for guidance in the wake of U.S. President
Eisenhower’s heart attack in 1955, some ten-
tatively backed the low-fat diet. Stare himself
did so in a 1956 magazine column, joining
with the President’s eminent heart consul-
tant, Paul Dudley White, in recommending
that, “perhaps less fat in the American diet...
would be desirable.
By 1960, a dominant paradigm was form-
ing around the belief that replacing satu-
rated “animal fats” with vegetable oils could
lower serum cholesterol levels and possibly
fight heart disease. Reflecting this view was
a new statement from the American Heart
Association (AHA), coauthored by Stare, rec-
ommending that the “coronary-prone” con-
sider limiting intake of foods such as whole
milk, butter, and meat (8). Hoping to demon-
strate causality, scientists began organizing a
pilot study for a large “definitive” trial.
THE SUGAR HYPOTHESIS
By the time John Yudkin emerged as an
outspoken critic of the fat theory, he was
well aware he was fighting an uphill battle.
Trained in medicine and biochemistry like
Stare, Yudkin had taught nutrition at Lon-
don University since 1946. Situated in a
college of household science, however, he
was initially unable to obtain funding from
the government’s Medical Research Coun-
cil (MRC). Yudkin thus turned to industry
for support. “I’ve always been a consultant
to the food industry,” said Yudkin in a 1979
interview, arguing that it would be “highly
illogical” for a nutrition scientist to refuse to
work with food companies.
Yudkin’s entry in the diet-heart debates
began with a 1957 paper challenging prevail-
ing interpretations of the widely discussed
hypothesis that countries that consumed
more fat had higher rates of coronary mor-
tality. He argued that several modern expo-
sures correlated with coronary deaths as well
or better than fat, including animal protein,
sugar, and access to radio and television. Fo-
cused on writing a popular diet book, Yudkin
did not initially implicate sugar in heart dis-
ease, seeking merely to establish that his rec-
ommended low-starch slimming regimen,
rich in meat and cheese, was not a recipe for
cardiac arrest. (He actually endorsed satu-
rated fat restriction for the coronary-prone.)
But after learning of a study that attrib-
uted elevated rates of heart disease among
some immigrants to their transition from a
meaty diet to more sugar-laden fare, and new
claims suggesting a sugar-sensitive constitu-
ent of the blood called triglycerides might
predict heart attacks better than serum cho-
lesterol, Yudkin sought to refine his hypoth-
esis. In 1964, he performed a case-control
study that used questionnaires to assess the
sugar intake of 25 men without known heart
disease, 20 coronary patients, and 25 men
with arterial disease. Finding a significant
difference in sugar intake between his cases
and controls, Yudkin proposed in the Lan-
cet that “people who take a lot of sugar—for
example in their tea or coffee—are far more
likely to have a heart attack than those who
take little” (9).
The publication stimulated 20 letters to
the editor, several of them with questions
about Yudkin’s failure to adjust for factors
such as smoking and body weight. MRC sci-
entists asked why Yudkin’s controls averaged
77 grams of sugar per day when his own data
suggested the typical Englishman ate 139.
But Yudkin’s sugar theory attracted wide
press attention, as well as new offers from
book publishers.
AN INDUSTRY-SPONSORED REVIEW
Despite Yudkin’s work, the central focus of
diet-heart research remained on fat. At Har-
vard in 1962, Stare’s top scientist, Mark Heg-
sted, launched a controlled feeding study at
Danvers State Hospital, a Massachusetts psy-
chiatric institution. Backed by a new dairy
industry fund created to give producers a
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firsthand look at the possible role of dairy
fats in disease, the Danvers study involved
feeding 20 schizophrenic men various diets
in which intake of vegetable oils, butterfat,
eggs, starch, sugar, and lactose were manipu-
lated so as to quantify their impact on blood
cholesterol levels.
Over his 20 years at Harvard, Hegsted had
earned a reputation as a data-driven scien-
tist. Among his first Harvard studies was
an analysis of adult protein requirements
that disappointed its sponsor, the Ameri-
can Meat Institute, by concluding that the
National Research Council’s recommended
daily allowance was much too high and that
even vegetarian diets could supply adequate
protein. Under the Reagan administration,
Hegsted would be fired from his job devel-
oping the first U.S. Dietary Guidelines after
his low-fat approach provoked the ire of the
beef industry.
The Danvers study would become another
example of Hegsted’s independence. In a talk
on 6 May 1965, at a meeting of the Nutrition
Foundation, Hegsted began by addressing re-
cent findings linking carbohydrates with heart
disease, acknowledging that Yudkin’s claims
were “worth considering” but hard to credit
“without controlled laboratory data” (10). He
expressed skepticism about new claims that
triglycerides might be a better risk indica-
tor than cholesterol. Moving to the Danvers
data, Hegsted said the results suggested that
the link between dietary carbohydrates such
as starch or sugar and serum cholesterol el-
evation was “rather minimal” compared with
the “abundant evidence implicating dietary
fat.” The Danvers data buttressed the case
against saturated fats, providing the basis for
a new formula relating fat intake to serum
cholesterol that came to be called the “Heg-
sted equation.” The findings helped nudge the
AHA to extend its warning about dietary fat
to the entire U.S. population.
It was a disaster for the dairy industry. But
for sugar executives—one attended Hegsted’s
talk—the findings appeared to constitute a
scientific basis for countering the claims of
Yudkin. One month after Hegsted’s presenta-
tion, an SRF executive reached him by phone
to discuss his research and the prospect that
SRF might hire him to conduct a review
of those articles “which find some special
metabolic peril in sucrose.” Hegsted agreed
to cover SRF’s “particular interest,” but only
within the context of a review “sufficiently
broad to make it worth doing.”
For Hegsted, the sugar review was but
one of several Danvers-related articles to
be written, including one that expanded on
his Nutrition Foundation talk—a draft of
which he shared with SRF. In it, he argued
that practical manipulations of the Ameri-
can diet should focus on dietary fat, not-
ing that the “potent role” of fats had been
“amply demonstrated,” but that such a role
for carbohydrates had “not yet been shown.
The SRF-sponsored review, published in the
New England Journal of Medicine in 1967,
expanded on these themes and reviewed ad-
ditional studies but did not disclose that it
had been commissioned by SRF (11).
THE BATTLE OVER SUGAR AND FAT
Increasingly challenged by his scientific
peers, Yudkin continued to gather evidence
on sugar: examining national patterns in
diet and disease, refining his questionnaire-
based study linking sugar and heart disease,
and conducting clinical studies of the effect
of elevated sugar intake on insulin and plate-
let adhesiveness. Assisting him in amplifying
his ideas was a group of powerful commer-
cial entities whose interests aligned with his
beliefs. In 1966, Yudkin reported that he was
receiving ~£25,000 per year (~$530,000 in
2018) from “the big food manufacturers.”
Yudkin was an asset because he brought
scientific legitimacy to events such as the
high-protein breakfast promotion organized
in 1966 by the British Egg Marketing Board.
The next month, for International Milk Day,
he joined the National Dairy Council to pub-
licize its new “seventeen day milk diet.” He
conducted research showing the “value of
taking milk before alcoholic drinks”—an im-
plicit test of the “Drive Safely on Milk” slogan
the dairy industry had used since 1961. As a
dairy consultant, he toured the United States,
promoting his sugar theory and an industry
statement he had written titled “Sense and
Nonsense about Dairy Foods.” In one indus-
try meeting, Yudkin would later note that his
research on sugar could also be viewed as “di-
version tactics” that might “prove beneficial
by freeing butterfat from any ‘guilt.’”
By the eve of the 1970s, Yudkin had ac-
quired some critics. “I regard Yudkin as a
menace and a deterrent to good nutrition
policy,” wrote Hegsted to a colleague in 1969.
That year, the sugar industry convened a
panel of heart disease consultants, including
a National Institutes of Health (NIH) scien-
tist, which debated a possible “anti-Yudkin”
effort because “although British scientists
are critical of him and his flimsy data, he
does have the interest of the press.” Indeed,
British government scientists had become
sufficiently concerned about Yudkin’s sugar
hypothesis that they decided to put it to an
authoritative test. Multiple government re-
search teams, some of them part of a mul-
ticenter working party organized by MRC,
tried without success to replicate Yudkin’s
finding that heart attack sufferers tended
to be heavy sugar users. The eminent MRC
panel reported in 1970 that the evidence in
favor of the sugar hypothesis was “extremely
slender” (12).
These publicly funded studies, along
with other forceful critiques, marked the
beginning of the end for Yudkin’s sugar hy-
pothesis. In 1971, he retired and began sum-
marizing his case against sugar in a popular
book. Proponents of the fat hypothesis soon
faced disappointment as well: NIH declined
to fund the “definitive” trial, despite persis-
Enjoying ice cream in the 1960s, when battle lines were being drawn over the roles of dietary fat and sugar.
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tent exhortations that if strong trials could
not be mounted, then dietary advice would
have to be promulgated based on the best
existing evidence.
By the 1970s, nutrition had become a sub-
ject of heated public discussion, and a U.S.
Senate committee—after extensive expert
testimony and stern warnings from several
well-credentialed skeptics who simply did
not believe the evidence was sufficient to
warrant the issuance of high-profile congres-
sional recommendations for dietary change—
embraced the low-fat concept as one aspect
of a broad program of healthy eating (13).
The committee’s 1977 report Dietary Goals
for the United States, which set the model for
the low-fat policy paradigm, mentioned Yud-
kin’s theory only in passing. Written by com-
mittee staff but edited mainly by Hegsted,
the Dietary Goals did not, however, overlook
sugar. Taking note of sugar’s link with tooth
decay and possibly diabetes, the report rec-
ommended a 40% reduction in sugar intake.
CAUGHT IN THE CROSS FIRE
As we have shown, by the 1960s the para-
digm that dietary fat was a likely risk factor
for heart disease prevailed among a coali-
tion of scientists closely linked with NIH and
AHA and was based on extensive research.
By contrast, the sugar theory was developed
by a small number of researchers, was sup-
ported by limited evidence, and was not ac-
cepted by key authorities. Normal science
is a social project in which a community of
scientists develops consensus over theory.
Heart disease epidemiology, in adopting a
multifactorial model, could plausibly have
accommodated sugar if the theory had with-
stood testing. But Yudkin’s claims were seen
as weak and antagonistic, and his signature
finding could not be replicated. Moreover,
sugar did not appear to meaningfully affect
serum cholesterol—the only then-accepted
lipid pathway to coronary disease.
As we have also shown, the sugar industry
approached Hegsted only after learning of
the results of his dairy industry–backed study
suggesting that fat and not sugar was a fac-
tor in heart disease. “There was no, ‘We’ll get
money from them and make the results come
out this way,’” recalled Lown, who worked in
the department. “It didn’t happen that way,
he said. “The sugar industry didn’t find re-
searchers at Harvard who would make up a
story they didn’t believe in order to cash in
on the sugar industry money,” asserted Gary
Taubes, author of The Case Against Sugar, a
2016 book that delves deeply into the sugar
industry’s involvement in nutrition research.
“What industry does is find people who al-
ready believe something that that industry
finds convenient, and then they pay those
people to make those beliefs known” (14).
During the period in question, food in-
dustry funding of nutrition research was
routine, and disclosures were “rarely re-
quired,” as Marion Nestle has written. When
NIH moved to defund Framingham in 1968,
its former director rescued it by soliciting
grants from the Oscar Mayer Foundation
and other private entities—none of which
were routinely disclosed in publications.
Today, food industry funding of research
remains common, although most journals
require disclosure of conflicts of interest.
Compliance is inconsistent, however, and
some argue existing policies do not address
important sources of bias such as investiga-
tors’ dietary habits and beliefs.
Our study raises questions about how to
assess the historical influence of special in-
terests on nutrition science and policy. Cer-
tainly, there is ample evidence that various
sectors have tried to influence scientists, and
we agree with those who suggest that food
companies fund research with an eye to-
ward marketing. (Indeed, an internal sugar
industry document states that SRF was cre-
ated “for the basic purpose of increasing the
consumption of sugar.”) We do not claim the
sugar industry had no influence on nutrition
work at Harvard, nor on the field in general.
But we believe that there is no good reason
to conclude that SRF’s sponsorship of a liter-
ature review meaningfully shaped the course
of dietary science and policy. Moreover, we
think it is an error to demonize, almost as
a reflex, scientists and their research when
there is evidence of private funding. Such a
response can create an intellectual template
that short-circuits a fuller investigation of
alternative explanations. For example, argu-
ments that the sugar industry “suppressed”
evidence should be tested against alterna-
tive hypotheses.
Our history also underscores the fallacy
of emphasizing the machinations of one
commodity sector when multiple food in-
dustries were deploying similar techniques
of influence in the battle for market share.
It is notable that during the low-fat era of
the 1980s, when suspicion fell heavily on
the meat and dairy industries, it was argued
that, “The ‘fat lobby’ has not only influenced
our nation’s food and nutrition policies, it
has determined those policies” [empha-
sis original] (15). Nearly 40 years later, at
a moment when some have said “butter is
back” and sugar is toxic, “Big Sugar” is the
behemoth accorded these dramatic powers.
Caught in the cross fire of these “diet wars”
have been the reputations of historical nu-
trition scientists, whose statures have risen
or fallen based on the extent of their contri-
bution to current theories.
Interpreting history requires attention to
the logic and tools of the period under study.
Over the course of the diet-heart debates,
the techniques of epidemiology and causal
inference evolved substantially. The random-
ized controlled trial had not yet attained the
hegemonic “gold standard” status it is often
accorded today. It is thus peculiar to reject as
unscientific the beliefs of those who pressed
for action on the basis of then cutting-edge
epidemiologic theory and research. As the
great historian of science Thomas Kuhn once
wrote, “Out-of-date theories are not in prin-
ciple unscientific because they have been
discarded.
Historical investigations of “merchants of
doubt” have been invaluable in showing that
scientific uncertainty is sometimes the prod-
uct of deliberate acts of deception. Such stud-
ies underscore the essential insight that the
existing evidence base is powerfully shaped
by social forces and political choices, and
that had decisions unfolded differently, our
areas of knowledge (such as genomics) and
blind spots (such as obesity prevention or
gun violence) would be shifted. But ahistori-
cal accounts thwart our ability to critically
evaluate the often long and zigzag process
of scientific conjecture and refutation. They
provide spurious cover for changes to policy
by suggesting that old ideas are illegitimate.
And, they advance a false impression that
doing the “right” kind of science will some-
how avert the messy business of making
policy based on incomplete evidence, public
values, and democratic politics (16). j
REFERENCES AND NOTES
1. S. A. Glantz, L. A. Bero, J. Slade, P. Hanauer, D. E. Barnes, Eds.,
The Cigarette Papers (University of California Press, 1998).
2. R. H. Lustig, in Pure, White, and Deadly: How Sugar Is Killing
Us, and What We Can Do to Stop It, J. Yudkin (Penguin, 2013),
p. 12.
3. I. Leslie, The Guardian, 7 April 2016;
www.theguardian.com/society/2016/apr/07/
the-sugar-conspiracy-robert-lustig-john-yudkin.
4. C. E. Ke arns, L . A. Schm idt, S . A. Glant z, JAMA Intern. Med.
176, 1680 (2016).
5. M. Nestle, JAMA Intern. Med. 176, 1685 (2016).
6. F. J. Stare, Adventures in Nutrition (Christopher Publishing
House, 1991).
7. D. M. Johns, Interview of B. Lown, Chestnut Hill, MA, 12
December 2016; https://www.mailman.columbia.edu/
sites/default/files/pdf/lown.pdf.
8. I. H. Page et al., Circulation 23, 133 (1961).
9. J. Yudkin, J. Roddy, Lancet 284, 6 (1964).
10. D. M. Hegsted, box 11, folder 14, D. Mark Hegsted Papers,
1952–1999 (inclusive), 1960–1978 (bulk), H MS c54,
Harvard Medical Library, Francis A. Countway Library of
Medicine.
11 . R. B. M cGan dy, D. M. Hegs ted, F. J. Stare, New Engl. J. Med.
277, 186 (1967).
12. L. Pl att, et al., Lancet 7686, 1265 (1970).
13. G. M. O ppen heime r, I. D. Benru bi, Am. J. Pub. Health 104, 59
(2014).
14. G. Taubes, The Livin’ La Vida Low-Carb Show (February
2017); http://bit.ly/2DU2JIc.
15. M. F. Jacob son, in , Jack Sprat’s Legacy: The Science and
Politics of Fat and Cholesterol, P. Hausman (Richard Marek
Publi sher s, 1981 ), p. 16.
16. Suggested further reading is provided in the supplementary
materials.
SUPPLEMENTARY MATERIALS
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Was there ever really a ''sugar conspiracy''?
David Merritt Johns and Gerald M. Oppenheimer
DOI: 10.1126/science.aaq1618
(6377), 747-750.359Science
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... Differential metabolic contributions of energy-yielding macronutrients were recognized early on. However, the debate continues to-date regarding an optimal macronutrient ratio for weight-control [6][7][8][9][10][11]. Back in 1977, a Senate committee report on "Dietary Goals for the United States" recommended a low-fat, low-cholesterol diet for Americans [12]. ...
... Limitations of the research data used to develop nutrition policies and guidelines were also being discussed [14,16,17]. The quality of commonly utilized observational nutrition research designs and those involving dietary recall have been questioned over the years [6][7][8][9][10][11]18]. Such controversies can potentially erode public trust in nutrition advice. ...
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Overweight and obesity are global health problems that contribute to the rising prevalence of non-communicable diseases, such as type 2 diabetes, heart disease, and certain cancers. The World Health Organization recognizes obesity as a primarily diet-induced, preventable condition, yet losing weight or keeping weight loss permanent is a universal challenge. In the U.S., formal dietary guidelines have existed since 1980. Over the same time-period, the incidence of obesity has skyrocketed. Here, we present our perspective on why current dietary guidelines are not always supported by a robust body of scientific data and emphasize the critical need for accelerated nutrition research funding. A clear understanding of the interaction of dietary patterns with system-level biological changes in a precise, response-specific manner can help inform evidence-based nutrition education, policy, and practice.
... It should be borne in mind that industrial gi-ants at the global level, from food to tobacco and oil, have habitually meddled with scientific research in order to conceal the dangers of their products, cast doubt on otherwise clear evidence or delay the implementation of effective regulation. This has been facilitated by the collaboration of pseudoscientists, custom-made "academic journals" (some of which are considered high-impact), and the complicity of some supranational bodies, and has been reinforced by the channels of leverage at their service, such as lobbying and widespread corruption (Johns & Oppenheimer, 2018;Luque & Herrero-García, 2019). This exemplifies once again the lack of ethics and the existence of normative asymmetries that point to the existing reality of a sham globalizing idealism (Beck, 2008). ...
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This study analyzes the traffic light signpost labeling that is included in processed foods, through which consumers are informed about added fat, sugar, and salt levels. At the same time, the awareness and use that the public make of this labeling, introduced by the Ecuadorian government as part of their Good Living health program, was also studied. A questionnaire was given to some 419 students from Ambato, Ecuador of both genders and from different economic circumstances. Subsequently, a descriptive analysis of the collected data was carried out, and through inferential statistics, relationships were established between the responses to the questionnaire and the factors identified. The results showed that most people are aware of traffic light signpost labeling at the time of purchase, although some consumers tend to mistakenly associate the indicators (green, yellow, red) with the food-hazard levels of the products. The opinions surveyed demonstrated a vague meaning and usefulness associated with the traffic light system.
... Another factor to their advantage is that they are based on global production chains which can take advantage of unlimited relocation processes with the purpose of usurping all labor links between overseas installations and the parent company. In addition, TNCs in-house reports on the impacts of their production processes, such as pollution, often lack all scientific credibility compared to independent studies by, for example, public research institutions and should be seen more pseudo-studies sponsored by industry to serve its particular interests (Alier and Jusmet, 2015;Johns and Oppenheimer, 2018;Luque and Jiménez-Sánchez, 2019). This is why SSE processes are being promoted, in the face of the preponderant lack of transnational corporate ethics. ...
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The capitalist economic-social system―and its neoliberal trend in particular―has produced numerous economic breakdowns, especially for the poorer classes in the countries of the “Global South” which were placed outside the commercial and lucrative logic. The Social and Solidarity Economy (SSE) has been able to counter this by using the polar opposite logic, fighting against inequality from the opposite side in order to tackle the many challenges posed at the global level, as this is one of the most effective ways―perhaps the most effective―of combating the repeated economic crises, which are also social, political and even cultural. It operates effective and deep transformative processes of the current economic system and confronts “global and faceless” capitalism in a radical and massive way in order to generate socioeconomic, political and cultural counter-alternatives different from those experienced. The SSE can be succinctly defined as an alternative mode of production, distribution and consumption, with the aim of building “another economy” in order to transcend the mere pursuit of monetary gain. In other words, a more inclusive, solidarity-based and “human” economy. Its immediate goals are: to ensure basic food supply, to eradicate poverty, and to promote decent work by providing equal opportunities (Coraggio 2012, 27; Lisandro, and Marques 2009; Pizzi, and Brunet Icart 2014, 49).
... It then continues in examining how Keys through his multitude of interventional and epidemiological studies evolved in his concepts about the mechanisms underlying the dietheart hypothesis, amid hot debates about the role of sugar versus fat in coronary mortality; this has somehow created confusion that in later decades gave rise to "sugar conspiracy" theories that have now been deconstructed. 16 ...
Article
Several areas of research into the prevention and treatment of obesity today can be traced to one or more of the scientific works pioneered by Ancel Keys between the 1930s to 1970s in fields that cut across the physiology of extremes and public health nutrition. These range from his classical studies into how body and mind respond to chronic exposure to hypoxia in "The Physiology of Life at High Altitudes" or to simulated famine under controlled laboratory conditions in "The Biology of Human Starvation", the impact of diet and lifestyle on cardiovascular morbidity and mortality in "The Seven Countries Study," to the "Indices of Relative Weight and Obesity" in which he identified what has since been the most widely utilized diagnostic tool to monitor obesity across populations worldwide and which he coined as the body mass index. The contribution of Ancel Keys to medical sciences through his observations, analytical approaches, and research output of his classic studies, and how these have (and continue) to impact on a plethora of current concepts in obesity research today, are embodied in the eight review articles that constitute this supplement reporting the proceedings of the 10th Fribourg Obesity Research Conference. The aim of this introductory paper is to put into perspective the legacy of Ancel Keys to current concepts that are encapsulated in these review articles that cover research areas that include (i) the diagnosis of obesity for health risks; (ii) the role of dietary fat types in the pathogenesis of obesity and cardiometabolic diseases; (iii) the rationale, efficacy and safety of low carbohydrate ketogenic diets, or the therapeutic potential of hypoxic conditioning, in weight management programs; (iv) the psychological and physiological basis of the "famine reaction" that counters therapeutic dieting and facilitates weight regain; and (v) the potential impact of weight cycling and yoyo dieting on risks for later obesity and cardiometabolic diseases.
... At the public level, the regulatory architecture of each Latin American country contributes to the advancement or regression of the processes of consolidation and social development. In addition, practices of greater environmental sensitivity, such as sustainable development or evidence-based regulations grounded in the findings of independent research centers and universities, can be included in their policies [42]. According to Baños [43], "It is well-proven that there are vested interests in fostering certain areas of knowledge. ...
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Over the past four decades, Latin American states have drafted relatively new constitutions in comparison with other regions of the world. These transformations, in some cases, have helped governments leave behind the former authoritarian regimes, or in others, have simply established a more democratic system incorporating a forward-looking approach to rights. For example, stronger individual and collective rights have been forged, together with new avenues for citizen participation. Certainly, many of the new constitutions grant a much broader base of rights, including collective political and territorial rights for indigenous communities, protections against ethnic, racial, and gender discrimination, and greater guarantees of privacy and control over information. Consequently, some Latin American constitutions are held up as among the best in the world. For this study, the constitutional texts of 22 Latin American countries were analyzed with the aim of understanding their regulatory changes and impacts, pointing out the existing inequalities they address, as well as the clear positive trend established in terms of the generation of greater social engagement.
... relative intake from fat, protein, and carbohydrate) have been especially controversial in the last few decades [2][3][4]. Despite a lack of robust empirical evidence from randomized trials on the long-term effects of macronutrient restriction on body weight and health [5][6][7], dietary recommendations have shifted from low-fat to low-sugar and, more recently, lower animal-protein diets [8][9][10][11][12][13]. Connections between diet and mental health are also increasingly recognized [14]. ...
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We conducted genome-wide association studies (GWAS) of relative intake from the macronutrients fat, protein, carbohydrates, and sugar in over 235,000 individuals of European ancestries. We identified 21 unique, approximately independent lead SNPs. Fourteen lead SNPs are uniquely associated with one macronutrient at genome-wide significance (P < 5 × 10⁻⁸), while five of the 21 lead SNPs reach suggestive significance (P < 1 × 10⁻⁵) for at least one other macronutrient. While the phenotypes are genetically correlated, each phenotype carries a partially unique genetic architecture. Relative protein intake exhibits the strongest relationships with poor health, including positive genetic associations with obesity, type 2 diabetes, and heart disease (rg ≈ 0.15–0.5). In contrast, relative carbohydrate and sugar intake have negative genetic correlations with waist circumference, waist-hip ratio, and neighborhood deprivation (|rg| ≈ 0.1–0.3) and positive genetic correlations with physical activity (rg ≈ 0.1 and 0.2). Relative fat intake has no consistent pattern of genetic correlations with poor health but has a negative genetic correlation with educational attainment (rg ≈−0.1). Although our analyses do not allow us to draw causal conclusions, we find no evidence of negative health consequences associated with relative carbohydrate, sugar, or fat intake. However, our results are consistent with the hypothesis that relative protein intake plays a role in the etiology of metabolic dysfunction.
... Moreover, a recent meta-analysis by Reynolds et al. [56] found out that the acceptance increases when the effectiveness of a policy is communicated and vice versa. Moreover, nutrition policy is a controversial topic with strong competition from various lobby groups, which often refer to (perceived) public opinions [57][58][59]. ...
Article
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The evidence for the effectiveness of nutrition policy interventions is growing. For the implementation of such interventions, social acceptability is crucial. Therefore, this study provides insight into public support for nutrition policy measures such as labelling and taxation. Further it analyses the level of acceptance in a quantitative segmentation approach. A new element to our approach is the comparison of different policy instruments, focusing on the interaction between policy acceptance and the perceived individual struggle to eat healthily. The survey was conducted in November 2017 and a total of 1035 German consumers are included in the data. The results indicate that the majority of German citizens accept nutrition policy interventions. Based on a cluster analysis, five different target groups according to the general acceptance of policy interventions and their own struggle to eat healthily are derived. The five-cluster solution reveals that both consumers who tend to eat a healthy diet as well as those who have problems with their diet support nutritional interventions. This shows that the perceived own struggle to eat healthily does not predict whether consumers accept nutrition policy interventions.
... Iborra and Peris (2010, p.106) Fig. 3. Offenses and sequelae the volume of economic resources available to textile TNCs, has unpredictable consequences for human health and the environment. These circumstances can be amplified by "scientific research" according to particular interests, in many cases in the service of TNCs (Johns & and Oppenheimer, 2018). This paradigm reveals unilateral CSR action to have no real control or enforceability, only the self-promotion of their interests. ...
Article
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The main purpose of this article is to analyze from a quantitative perspective, the textile transnational corporations (TNC) relationship with environment through a Delphi analysis. Our analysis has been applied with two panels composed of 55 experts with two multidisciplinary questionnaires with open questions, regarding the degree of affinity (test) to the proposals made. The presentation of the results obtained shows the lack of ethics on the part of companies within their relation with the environment. The incessant appropriation of natural resources but not of their impacts and sequels as well as the lack of diligence when pursuing environmental crimes bring out the delicate situation between the ETN and everything that stands in the way of their interests. Hence, it is necessary to know the risks and relationship of corporate social responsibility from a scientific methodology in order to reflect and modify future behaviors by production companies when interacting with the natural environment and assume real responsibilities through the proposal of action guides presented here ------------- El objetivo de esta investigación es analizar desde una perspectiva cuantitativa la rel-ación que tienen las empresas transnacionales (ET) textiles con el ambiente a través de un análisis Delphi. Se han estudiado las respuestas de dos paneles de 55 expertos por medio de cuestionarios multidisciplinares de preguntas abiertas, atendiendo al grado de afinidad (prueba) de las proposiciones planteadas. La presentación de los resultados obtenidos evidencia la falta de ética por parte de las empresas en su relación con el ambiente. La apropiación incesante de recursos naturales pero no de sus impactos y secuelas así como la falta de diligencia a la hora de perseguir delitos ambientales ponen de manifiesto la delicada situación existente entre las ET y todo lo que se interpone a sus intereses. De ahí que sea necesario conocer los riesgos y su relación con los procesos de A. Luque González and J. Hernández Zubizarreta 178 responsabilidad social empresarial desde una metodología científica con la finalidad de reflexionar y modificar futuras conductas por parte de empresas productoras a la hora de relacionarse con el entorno natural y asumir así responsabilidades reales mediante la propuesta de guías de acción aquí presentadas.
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The term knowledge society brings together many of the transformations that are taking place in today's society, and its definition serves as an indicator of these changes. The related concentrations or asymmetries that arise from the phenomenon are also the subject of analysis and dispute. Its development and scope have been uneven, constantly incorporating new meanings to the existing terminology, hence the need to analyze 82 concepts of the knowledge society through a frequency count in Google Scholar, with a subsequent categorization saturating in six dimensions, in order to analyze their framing. The methodology used a higher-order association, establishing the most significant combinations and weight-ings. From these results, the concept of the knowledge society is defined by the dual economic-social category, according to its frequency of use in Google. This shows economic influences as a determining factor in the knowledge society, engendering processes far from the common good or the general interest.
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Policy Points For more than 40 years, most research by epidemiologists, social scientists, and alcohol policy experts found that moderate alcohol consumption was cardioprotective. In the early 2000s, that consensus was shaken by new critics who subjected the previous research to vigorous methodological and empirical analysis, precipitating a bitter controversy, seemingly unresolvable despite numerous observational epidemiological studies. The effort to finally put that debate to rest through a large, multiyear randomized controlled trial under the aegis of the National Institute on Alcohol Abuse and Alcoholism, generated external criticism and adverse newspaper coverage, particularly because the trial was largely funded by the alcohol industry, forcing National Institutes of Health leadership to abruptly terminate the study shortly after it started. In the absence of definitive evidence and given the contentious debate over the risks and benefits of moderate alcohol consumption, those who formulate health policy have a responsibility to clearly acknowledge to the public the existence of evidentiary uncertainty when making recommendations.
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Early warning signals of the coronary heart disease (CHD) risk of sugar (sucrose) emerged in the 1950s. We examined Sugar Research Foundation (SRF) internal documents, historical reports, and statements relevant to early debates about the dietary causes of CHD and assembled findings chronologically into a narrative case study. The SRF sponsored its first CHD research project in 1965, a literature review published in the New England Journal of Medicine, which singled out fat and cholesterol as the dietary causes of CHD and downplayed evidence that sucrose consumption was also a risk factor. The SRF set the review’s objective, contributed articles for inclusion, and received drafts. The SRF’s funding and role was not disclosed. Together with other recent analyses of sugar industry documents, our findings suggest the industry sponsored a research program in the 1960s and 1970s that successfully cast doubt about the hazards of sucrose while promoting fat as the dietary culprit in CHD. Policymaking committees should consider giving less weight to food industry–funded studies and include mechanistic and animal studies as well as studies appraising the effect of added sugars on multiple CHD biomarkers and disease development.
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For decades, public health advocates have confronted industry over dietary policy, their debates focusing on how to address evidentiary uncertainty. In 1977, enough consensus existed among epidemiologists that the Senate Select Committee on Nutrition and Human Need used the diet-heart association to perform an extraordinary act: advocate dietary goals for a healthier diet. During its hearings, the meat industry tested that consensus. In one year, the committee produced two editions of its Dietary Goals for the United States, the second containing a conciliatory statement about coronary heart disease and meat consumption. Critics have characterized the revision as a surrender to special interests. But the senators faced issues for which they were professionally unprepared: conflicts within science over the interpretation of data and notions of proof. Ultimately, it was lack of scientific consensus on these factors, not simply political acquiescence, that allowed special interests to secure changes in the guidelines. (Am J Public Health. Published online ahead of print November 14, 2013: e1-e11. doi:10.2105/AJPH.2013.301464).
Article
Industry-sponsored nutrition research, like that of research sponsored by the tobacco, chemical, and pharmaceutical industries, almost invariably produces results that confirm the benefits or lack of harm of the sponsor’s products, even when independently sponsored research comes to opposite conclusions.¹ Although considerable evidence demonstrates that those industries deliberately influenced the design, results, and interpretation of the studies they paid for,² much less is known about the influence of food-company sponsorship on nutrition research. Typically, the disclosure statements of sponsored nutrition studies state that the funder had no role in their design, conduct, interpretation, writing, or publication. Without a “smoking gun” it is difficult to prove otherwise.
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In May 1994, a box containing 4,000 pages of internal tobacco industry documents arrived at the office of Professor Stanton Glantz at the University of California, San Francisco. The anonymous source of these "cigarette papers" was identified in the return address only as "Mr. Butts" - presumably a reference to the Doonesbury cartoon character. These documents provide a shocking inside account of the activities of one tobacco company over more than thirty years. Cigarette Papers shows that the tobacco industry's conduct has been more cynical and devious than even its harshest critics have suspected. For more than three decades, the industry has internally acknowledged that smoking is addictive and that use of tobacco products causes disease and death. Despite this acknowledgment, based on the industry's own internal and contract research, the industry has engaged in a variety of tactics to deny its own findings and to convince the public that there is still doubt about the harmful effects of tobacco or that the effects have been exaggerated. These campaigns of disinformation have been designed to maintain company profits, to block government regulation, and to defeat lawsuits filed by individuals with tobacco-caused illnesses. The Cigarette Papers quotes extensively from the documents themselves while analyzing what they reveal. The book gives us a sense of what the tobacco industry says when it thinks no one is listening. Written by experts with the scientific and legal knowledge to understand the meaning of the documents and explain their importance, Cigarette Papers will forever alter our perspective of tobacco industry tactics. It will have an enormous impact on public health debates about tobacco and will greatly influence legislation regarding its use.
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This article has no abstract; the first 100 words appear below. THERE is considerable evidence relating nutrition, presumably through its influence on the levels of circulating lipids, to the relentless progression of atherosclerotic vascular disease and to the well known clinical sequelae that plague contemporary, highly developed societies. Unfortunately, it is difficult to unravel the precise and unique role of diet or of blood lipids in a disease in which a great many other factors are known to be involved — a severe limitation to descriptive clinical and epidemiologic studies. On the other hand, since dietary alterations can significantly influence blood lipids, nutrition may be of some importance in the treatment . . . *From the Department of Nutrition, Harvard School of Public Health (requests for reprints should be addressed to Dr. Stare at Harvard School of Public Health, 665 Huntington Avenue, Boston, Massachusetts 02115). The researches referred to in this review that have come from the authors' laboratories have been supported in part by the John A. Hartford Memorial Fund, various grants from the National Institutes of Health, the Nutrition Foundation, Incorporated, the Special Dairy Industry Board and the Fund for Research and Teaching, Department of Nutrition, Harvard School of Public Health. Source Information BOSTON †Assistant professor of nutrition, Harvard School of Public Health. ‡Professor of nutrition, Harvard School of Public Health. §Professor of nutrition and chairman, Department of Nutrition, Harvard School of Public Health.
How Sugar Is Killing Us, and What We Can Do to Stop It
  • R H Lustig
  • Pure
  • Deadly White
  • Lustig R. H.
R. H. Lustig, in Pure, White, and Deadly: How Sugar Is Killing Us, and What We Can Do to Stop It, J. Yudkin (Penguin, 2013), p. 12.
  • C E Kearns
  • L A Schmidt
  • S A Glantz
C. E. Kearns, L. A. Schmidt, S. A. Glantz, JAMA Intern. Med. 176, 1680 (2016).
  • M Nestle
M. Nestle, JAMA Intern. Med. 176, 1685 (2016).