Last week the media covered the news that the sugar industry had attempted to influence (and even dictate) early medical reviews on the impact of sugar on coronary vascular disease (CHD). As usual with most news reports, the catchy headline got our attention. (Well it did for some of us, but this week Hillary’s pneumonia and the Emmys received much more attention.) And even if the news tried to render a more detailed analysis of the report, it was not overly attention worthy. I wanted to know more of the details (and yes, I will also watch the Emmys) so I read the full JAMA article that appeared online September 12, 2016. I was astounded by the factual development of the story and want to share it with you…
The story goes back to 1943 when the Sugar Research Foundation (SRF) was founded by the Sugar Association. They obviously wanted to promote sugar and back that promotion with research. The early warning signals that sugar (sucrose) ingestion could increase the risk of coronary heart disease began in the 1950s. In 1954 the president of SRF stated in a speech to the American Society of Sugar Beet Technologists (who knew that this existed) that there was now a strategic opportunity for the sugar industry to increase its market share by getting Americans to eat a lower fat diet. “If you put a middle-aged man on a low-fat diet, it takes just five days for the blood cholesterol to go down to where it should be… If the carbohydrate industries were to recapture this 20% of the calories in the US diet (The difference between the 40% which far has and the 20% which is ought to have) and if sugar maintained its present share on the carbohydrate market, this change would mean an increase in the per capita consumption of sugar more than a third with a tremendous improvement in general health.”
In 1962, the SRF became concerned about evidence showing that a low fat diet which was high in sugar could elevate blood levels of cholesterol. They suggested that their research foundation publish reviews by sponsored notable authors in order to refute these sugar concerns. They paid $6,500 (the equivalent to $48,900 in 2016 dollars) for review articles in several journals to emphasize “special metabolic pearls in sucrose and in particular fructose”. This was called Project 226. (I see a TV worthy plot here). Project 226 resulted in a two part literature review titled “Dietary Fats, Carbohydrates and Atherosclerotic Disease” in the New England Journal of Medicine in 1967. The review concluded there was “no doubt” that the only dietary intervention required to prevent CHD was to reduce dietary cholesterol and substitute polyunsaturated fat for saturated fat in the American diet. It also attempted to dismiss studies that show that sucrose and fructose intake increase risk of CHD, stating that the studies did not show typical amounts of sugar consumed in the American diet and also focused on studies done in rats. The review discounted previous studies that have shown that substituting starch for sucrose had a positive effect on improving blood triglyceride levels. They then discounted other studies that have shown that substituting fruit or vegetables for sucrose had a large affect on improving serum cholesterol levels by arguing that this intervention was infeasible.
To continue the saga… The industry commissioned a review, “Sugar in the Diet of Man” which they felt would favorably influence the 1976 US Food and Drug Administration evaluation of the safety of sugar.
According to the American Heart Association, short term studies have shown consistent adverse effects of sugar consumption by lowering levels of HDL (the good cholesterol that acts as a rotor router to decrease plaque) and raising triglyceride levels which could accelerate atherosclerosis. Sugar consumption may worsen diabetes control and the combination of sugar with protein and fats may be especially detrimental to those with diabetes. High sugar foods, which are sweet and calorie dense, increase calorie consumption and lead to weight gain (which obviously is bad for the heart). Studies today indicate that high sugar intake should be avoided. Sugar has no nutritional value other than to provide calories.
We saw a huge brouhaha in New York City when they outlawed the sale of 16 ounce sugar drinks (I can’t even imagine drinking that much fluid at once). As of 2016, sugar control policies are being promulgated both locally and world wide. Policy should not be made surreptitiously by the food industry. And indeed, since 1984, most peer-reviewed medical journals require that authors disclose all conflicts of interest. But according to the JAMA article, “whether current conflict or interest policies are adequate to withstand the economic interests of industry remains unclear.”
This story about sugar industry intrigues and their potential impact on our recommended diet and health is anything but sweet.