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Big Sugar's Sweet Little Lies

How the industry kept scientists from asking: Does sugar kill?

Working to the industry's recruiting advantage was the rising notion that cholesterol and dietary fat—especially saturated fat—were the likely causes of heart disease. (Tatem even suggested, in a letter to the Times Magazine, that some "sugar critics" were motivated merely by wanting "to keep the heat off saturated fats.") This was the brainchild of nutritionist Ancel Keys, whose University of Minnesota laboratory had received financial support from the sugar industry as early as 1944. From the 1950s through the 1980s, Keys remained the most outspoken proponent of the fat hypothesis, often clashing publicly with Yudkin, the most vocal supporter of the sugar hypothesis—the two men "shared a good deal of loathing," recalled one of Yudkin's colleagues.

On federal panels, industry-funded scientists cited industry-funded studies to dismiss sugar as a culprit.

So when the Sugar Association needed a heart disease expert for its Food & Nutrition Advisory Council, it approached Francisco Grande, one of Keys' closest colleagues. Another panelist was University of Oregon nutritionist William Connor, the leading purveyor of the notion that it is dietary cholesterol that causes heart disease. As its top diabetes expert, the industry recruited Edwin Bierman of the University of Washington, who believed that diabetics need not pay strict attention to their sugar intake so long as they maintained a healthy weight by burning off the calories they consumed. Bierman also professed an apparently unconditional faith that it was dietary fat (and being fat) that caused heart disease, with sugar having no meaningful effect.

It is hard to overestimate Bierman's role in shifting the diabetes conversation away from sugar. It was primarily Bierman who convinced the American Diabetes Association to liberalize the amount of carbohydrates (including sugar) it recommended in the diets of diabetics, and focus more on urging diabetics to lower their fat intake, since diabetics are particularly likely to die from heart disease. Bierman also presented industry-funded studies when he coauthored a section on potential causes for a National Commission on Diabetes report in 1976; the document influences the federal diabetes research agenda to this day. Some researchers, he acknowledged, had "argued eloquently" that consumption of refined carbohydrates (such as sugar) is a precipitating factor in diabetes. But then Bierman cited five studies—two of them bankrolled by the ISRF—that were "inconsistent" with that hypothesis. "A review of all available laboratory and epidemiologic evidence," he concluded, "suggests that the most important dietary factor in increasing the risk of diabetes is total calorie intake, irrespective of source."

Big Sugar found a reliable advocate in Frederick Stare, whose department at Harvard was bankrolled by the likes of Kellogg, Kraft, and Coca-Cola.

The point man on the industry's food and nutrition panel was Frederick Stare, founder and chairman of the department of nutrition at the Harvard School of Public Health. Stare and his department had a long history of ties to Big Sugar. An ISRF internal research review credited the sugar industry with funding some 30 papers in his department from 1952 through 1956 alone. In 1960, the department broke ground on a new $5 million building funded largely by private donations, including a $1 million gift from General Foods, the maker of Kool-Aid and Tang.

By the early 1970s, Stare ranked among the industry's most reliable advocates, testifying in Congress about the wholesomeness of sugar even as his department kept raking in funding from sugar producers and food and beverage giants such as Carnation, Coca-Cola, Gerber, Kellogg, and Oscar Mayer. His name also appears in tobacco documents, which show that he procured industry funding for a study aimed at exonerating cigarettes as a cause of heart disease.

The first act of the Food & Nutrition Advisory Council was to compile "Sugar in the Diet of Man," an 88-page white paper edited by Stare and published in 1975 to "organize existing scientific facts concerning sugar." It was a compilation of historical evidence and arguments that sugar companies could use to counter the claims of Yudkin, Stare's Harvard colleague Jean Mayer, and other researchers whom Tatem called "enemies of sugar." The document was sent to reporters—the Sugar Association circulated 25,000 copies—along with a press release headlined "Scientists dispel sugar fears." The report neglected to mention that it was funded by the sugar industry, but internal documents confirm that it was.

Leading the panel that evaluated sugar for the FDA: George Irving, a former chair of the scientific advisory board for the International Sugar Research Foundation, an industry group.

The Sugar Association also relied on Stare to take its message to the people: "Place Dr. Stare on the AM America Show" and "Do a 3 ½ minute interview with Dr. Stare for 200 radio stations," note the association's meeting minutes. Using Stare as a proxy, internal documents explained, would help the association "make friends with the networks" and "keep the sugar industry in the background." By the time Stare's copious conflicts of interest were finally revealed—in "Professors on the Take," a 1976 exposé by the Center for Science in the Public Interest—Big Sugar no longer needed his assistance. The industry could turn to an FDA document to continue where he'd left off.

While Stare and his colleagues had been drafting "Sugar in the Diet of Man," the FDA was launching its first review of whether sugar was, in the official jargon, generally recognized as safe (GRAS), part of a series of food-additive reviews the Nixon administration had requested of the agency. The FDA subcontracted the task to the Federation of American Societies of Experimental Biology, which created an 11-member committee to vet hundreds of food additives from acacia to zinc sulfate. While the mission of the GRAS committee was to conduct unbiased reviews of the existing science for each additive, it was led by biochemist George W. Irving Jr., who had previously served two years as chairman of the scientific advisory board of the International Sugar Research Foundation. Industry documents show that another committee member, Samuel Fomon, had received sugar-industry funding for three of the five years prior to the sugar review.

The FDA's instructions were clear: To label a substance as a potential health hazard, there had to be "credible evidence of, or reasonable grounds to suspect, adverse biological effects"—which certainly existed for sugar at the time. But the GRAS committee's review would depend heavily on "Sugar in the Diet of Man" and other work by its authors. In the section on heart disease, committee members cited 14 studies whose results were "conflicting," but 6 of those bore industry fingerprints, including Francisco Grande's chapter from "Sugar in the Diet of Man" and 5 others that came from Grande's lab or were otherwise funded by the sugar industry.

The sugar review panel cited five reports to contradict the notion that sugar consumption leads to diabetes—all had industry ties.

The diabetes chapter of the review acknowledged studies suggesting that "long term consumption of sucrose can result in a functional change in the capacity to metabolize carbohydrates and thus lead to diabetes mellitus," but it went on to cite five reports contradicting that notion. All had industry ties, and three were authored by Ed Bierman, including his chapter in "Sugar in the Diet of Man."

In January 1976, the GRAS committee published its preliminary conclusions, noting that while sugar probably contributed to tooth decay, it was not a "hazard to the public." The draft review dismissed the diabetes link as "circumstantial" and called the connection to cardiovascular disease "less than clear," with fat playing a greater role. The only cautionary note, besides cavities, was that all bets were off if sugar consumption were to increase significantly. The committee then thanked the Sugar Association for contributing "information and data." (Tatem would later remark that while he was "proud of the credit line...we would probably be better off without it.")

The committee's perspective was shared by many researchers, but certainly not all. For a public hearing on the draft review, scientists from the USDA's Carbohydrate Nutrition Laboratory submitted what they considered "abundant evidence that sucrose is one of the dietary factors responsible for obesity, diabetes, and heart disease." As they later explained in the American Journal of Clinical Nutrition, some portion of the public—perhaps 15 million Americans at that time—clearly could not tolerate a diet rich in sugar and other carbohydrates. Sugar consumption, they said, should come down by "a minimum of 60 percent," and the government should launch a national campaign "to inform the populace of the hazards of excessive sugar consumption." But the committee stood by its conclusions in the final version of its report presented to the FDA in October 1976.

"The next time you hear a promoter attacking sugar, beware the ripoff," warned a sugar industry ad. "Remember he can't substantiate his charges."

For the sugar industry, the report was gospel. The findings "should be memorized" by the staff of every company associated with the sugar industry, Tatem told his membership. "In the long run," he said, the document "cannot be sidetracked, and you may be sure we will push its exposure to all corners of the country."

The association promptly produced an ad for newspapers and magazines exclaiming "Sugar is Safe!" It "does not cause death-dealing diseases," the ad declared, and "there is no substantiated scientific evidence indicating that sugar causes diabetes, heart disease or any other malady...The next time you hear a promoter attacking sugar, beware the ripoff. Remember he can't substantiate his charges. Ask yourself what he's promoting or what he is seeking to cover up. If you get a chance, ask him about the GRAS Review Report. Odds are you won't get an answer. Nothing stings a nutritional liar like scientific facts."
 

The Sugar Association would soon get its chance to put the committee's sugar review to the test. In 1977, McGovern's select committee—the one that had held the 1973 hearings on sugar and diabetes—blindsided the industry with a report titled "Dietary Goals for the United States," recommending that Americans lower their sugar intake by 40 percent (PDF). The association "hammered away" at the McGovern report using the GRAS review "as our scientific Bible," Tatem told sugar executives.

McGovern held fast, but Big Sugar would prevail in the end. In 1980, when the USDA first published its own set of dietary guidelines, it relied heavily on a review written for the American Society of Clinical Nutrition by none other than Bierman, who used the GRAS committee's findings to bolster his own. "Contrary to widespread opinion, too much sugar does not seem to cause diabetes," the USDA guidelines concluded. They went on to counsel that people should "avoid too much sugar," without bothering to explain what that meant.

In 1982, the FDA once again took up the GRAS committee's conclusion that sugar was safe, proposing to make it official. The announcement resulted in a swarm of public criticism, prompting the agency to reopen its case. Four years later, an agency task force concluded, again leaning on industry-sponsored studies, that "there is no conclusive evidence...that demonstrates a hazard to the general public when sugars are consumed at the levels that are now current." (Walter Glinsmann, the task force's lead administrator, would later become a consultant to the Corn Refiners Association, which represents producers of high-fructose corn syrup.)

By 1999, the average American would be eating more than double the amount of sugar the FDA had deemed safe in 1986.

The USDA, meanwhile, had updated its own dietary guidelines. With Fred Stare now on the advisory committee, the 1985 guidelines retained the previous edition's vague recommendation to "avoid too much" sugar but stated unambiguously that "too much sugar in your diet does not cause diabetes." At the time, the USDA's own Carbohydrate Nutrition Laboratory was still generating evidence to the contrary and supporting the notion that "even low sucrose intake" might be contributing to heart disease in 10 percent of Americans.

By the early 1990s, the USDA's research into sugar's health effects had ceased, and the FDA's take on sugar had become conventional wisdom, influencing a generation's worth of key publications on diet and health. Reports from the surgeon general and the National Academy of Sciences repeated the mantra that the evidence linking sugar to chronic disease was inconclusive, and then went on to equate "inconclusive" with "nonexistent." They also ignored a crucial caveat: The FDA reviewers had deemed added sugars—those in excess of what occurs naturally in our diets—safe at "current" 1986 consumption levels. But the FDA's consumption estimate was 43 percent lower than that of its sister agency, the USDA. By 1999, the average American would be eating more than double the amount the FDA had deemed safe­—although we have cut back by 13 percent since then.

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