Sugar industry's propaganda campaign exposed a half-century later
In the 1960s, British scientist John Yudkin challenged the popular belief that saturated fat and cholesterol were the main dietary factors involved in the pathogenesis of coronary heart disease (CHD). Citing epidemiological data and other evidence, Yudkin argued that refined sugar (which at the time was primarily sucrose) was the most important dietary culprit. In the ensuing years, additional research solidified the link between dietary sugar and CHD. We now know that consumption of large amounts of sucrose or other refined sugars by humans can cause adverse changes in various cardiovascular disease risk factors, including an increase in serum levels of triglycerides, insulin, and uric acid; a rise in blood pressure; an increase in platelet adhesiveness; and a decrease in HDL-cholesterol levels. We also know that feeding experimental animals (rabbits and monkeys) a high-sucrose diet results in the development of coronary and aortic atherosclerosis. In rabbits, the atherosclerotic lesions were more severe than those resulting from a high-cholesterol diet.
By 1965, the sugar industry had recognized that Yudkin’s work was a threat to sugar sales and, through its Sugar Research Foundation, began a secret campaign to discredit the proposed link between sugar and CHD. Recently obtained Sugar Research Foundation documents from the mid-1960s have revealed that the Foundation paid large sums of money to well-known scientists in exchange for their writing an apparently biased review article that downplayed the negative effects of refined sugar.
The Sugar Research Foundation’s effort resulted in the 1967 publication of a two-part review article in the New England Journal of Medicine, titled “Dietary fats, carbohydrates, and atherosclerotic vascular disease.” The review was written by Frederick Stare (the chairman of the Harvard Department of Nutrition) and two professors of nutrition at Harvard. The authors did not disclose that the Sugar Research Foundation had paid them $6,500 (equivalent to $48,900 in 2016 dollars) to write the review.
A letter that had been sent by the director of research at the Sugar Research Foundation to one of the authors made it clear that the Foundation’s “particular interest” in funding the review article was to deal with the bad press that sugar had been receiving. The author replied that he was well aware of the Sugar Research Foundation’s interest, and that the authors would cover that topic as well as they could. The published review article discounted research showing that sucrose consumption increased triglyceride levels. The basis for rejecting that evidence was the claim that serum cholesterol is the only legitimate biomarker for CHD risk. The article also discounted a study showing that substituting sucrose with vegetables or with additional fat markedly improved serum cholesterol levels. The reason for ignoring that evidence was that these dietary interventions are supposedly not feasible. Observational studies linking higher sugar intake with a higher risk of CHD were also downplayed on the grounds that epidemiological evidence cannot prove causation.
In contrast to its harsh criticism of the sucrose research, the review article ignored many of the flaws in the research that purported to implicate dietary fat and cholesterol. Moreover, despite having previously argued that observational studies cannot prove causation, the article cited observational studies to support the contention that CHD is caused by dietary fat and cholesterol. The two-part article concluded that there is strong evidence that dietary saturated fat and cholesterol play a role in the causation of CHD, whereas evidence implicating sugar is minimal and of little practical significance.
The Harvard Nutrition Department’s pro-sugar bias was not lost on some of the avant garde nutritionists of the day. Noted author and Prevention Magazine columnist Carlton Fredericks often referred to Frederick Stare as the “Candy King of Cambridge,” and once remarked that Stare’s impending retirement promised to be his greatest contribution to the field of nutrition. Nevertheless, the review article that was secretly bought and paid for by the sugar industry helped solidify the consensus view that saturated fat and cholesterol, not sugar, was the cause of CHD.
Fast-forward a half-century. Now there is a growing consensus that the importance of saturated fat and cholesterol in the diet has been greatly overestimated. And while it is not yet generally accepted that refined sugar is a key factor in the causation of CHD, a significant body of evidence points in that direction. Of course, the sugar industry continues to deny that there is any connection at all between sugar consumption and heart disease.
I predict that sometime in the future there will be sufficient evidence to convince most doctors and scientists that sugar plays an important role in the causation of CHD. And while the sugar industry might eventually face product-liability lawsuits for having misrepresented the dangers of its product, the industry will at least be able to take comfort in the fact that having egg on your face is not as bad as having sugar in your veins.
- Szanto S, Yudkin J. The effect of dietary sucrose on blood lipids, serum insulin, platelet adhesiveness and body weight in human volunteers. Postgrad Med J. 1969;45:602-607.
- Israel KD, et al. Serum uric acid, inorganic phosphorus, and glutamic-oxalacetic transaminase and blood pressure in carbohydrate-sensitive adults consuming three different levels of sucrose. Ann Nutr Metab. 1983;27:425-435.
- Murakami M. Dietary sugar in the management of arteriosclerosis and hypertension. Jpn J Med. 1968;7:114-115.
- Nakai T. Experimental studies on the pathogenesis of arteriosclerosis. The effect of high-carbohydrate and high-fat diets on the development of vascular lesions. Jpn Circ J. 1971;35:419-423.
- Murakami M. Effect of sugar on atherosclerosis in nonhuman primates. Jpn Circ J. 1973;37:1033-1038.
- Kearns CE, et al. Sugar industry and coronary heart disease research: a historical analysis of internal industry documents. JAMA Intern Med. 2016;176:1680-1685.
- McGandy RB, et al. Dietary fats, carbohydrates and atherosclerotic vascular disease. N Engl J Med. 1967;277:186-192.
- McGandy RB, Hegsted DM, Stare FJ. Dietary fats, carbohydrates and atherosclerotic vascular disease. N Engl J Med. 1967;277:245-247.
Reprinted with permission from the Townsend Letter.