Internal US sugar industry documents recently revealed the part that the industry, in conspiracy with scientists, and by lobbying public institutions, played in the 1960s and 1970s in determining that public health policy to reduce mortality from coronary heart disease should focus on saturated fats as the main cause of such disease whilst ignoring the impact of sugar consumption. This influence lasted for decades, compromising the efficiency of public policies to deal with the main cause of death in many countries, including the USA and Mexico.

A recent report published in JAMA Internal Medicine entitled “Sugar industry and coronary heart disease research. A historical analysis of internal industry documents” contains information on the strategy developed by the sugar industry in the USA, through its Sugar Research Foundation (SRF), to deny the link between sugar consumption and heart disease and remove sugar from the public health policy spotlight.

Towards the end of the 1950s, significant concern arose about the increase in mortality from coronary heart disease in the USA, and scientific studies focused on emphasising that the causes were fat and cholesterol on one hand and sucrose (sugar) on the other.

By funding scientific studies and influencing government organisations, the SRF singled out saturated fat and cholesterol as the sole cause of heart disease, avoiding any public policy to reduce sugar consumption. In fact, the sugar industry saw a low-fat diet as an opportunity to increase the presence of sugar in the diet. In 1954, the SRF president, Henry Hass, declared that, “…this change would mean an increase in the per capita consumption of sugar more than a third [sic] with tremendous improvement in general health”.

The SRF itself was aware of the existence of studies that singled out sugar as the main cause of heart disease which “indicated that, in low fat diets, the kind of carbohydrate ingested may have an influence on the formation of serum cholesterol” and that, “from a number of laboratories of greater or lesser repute, there are flowing reports that sugar is a less desirable dietary source of calories than other carbohydrates”. From the end of the 1950s, John Yudkin suggested that other factors increased the risk of cardiovascular disease, such as sugar, which was at least equally important as saturated fat.

In 1965, the SRF invited Dr Fredrick Stare, the chair of the Harvard University School of Public Health Nutrition Department, to become a member of the foundation. In July that year, the SRF contacted Dr Mark Hegsted, a member of the faculty headed by Stare who had published two articles reporting results from an epidemiological study suggesting that blood glucose levels were a better predictor of atherosclerosis than serum cholesterol level or hypertension; that is, a clearer link between sugar and heart disease than between fat and heart disease. In a third study, he asserted that “perhaps fructose, a constituent of sugar but not of starch, [was] the agent mainly responsible”.

The results attracted the attention of the media, which began to publicise the link between sugar and heart disease. The SRF funded a literature review, entitled “Carbohydrates and cholesterol metabolism”, by the same Harvard researchers (Hegsted and McGandy) led by Stare. Internal documents demonstrate that the object of the review was to condemn the studies linking sugar to heart disease.

The study was published in the New England Journal of Medicine in 1967 and no mention was made of SRF funding. The review concluded that the only recommended measure to prevent heart disease was to reduce dietary cholesterol and substitute polyunsaturated fat for saturated fat, and denied all evidence of harm caused by sugar.

The investigation of internal documents demonstrates how the industry also put pressure on the National Caries Program of the Institute of Dental Research to play down sugar consumption as the main cause of tooth decay. The industry influenced the writing of the report entitled “Sugar in the diet of man”, which protected its interests in the 1976 US Food and Drug Administration evaluation of the safety of sugar.

There is consensus that the recommendations to reduce the consumption of saturated fat should be maintained as an objective to protect cardiovascular health, but the exclusion of sugar as an ingredient related to heart disease and, consequently, the increase in sugar consumption because of these industry strategies have had untold health consequences, including obesity, diabetes and heart disease.

After the Second World War, and whilst science and public health policy were in the clutches of the sugar industry, multinational companies marketing sugary food and drinks began to expand in food markets on all the continents.

Sugar, and in particular high fructose corn syrup, with the huge corn production subsidies in the USA from the 1980s onwards, became an ingredient present in the majority of products, from cereal and yoghurt to soft drinks and dressings. Sugar, be it from cane or corn syrup, became an omnipresent ingredient in ultra-processed food and drinks.

The practice of buying science and determining public policy has been continued to the present day by the sugar industry, but particularly by the soft drinks industry, which is responsible for the greatest amount of sugar consumed by the population.

In 2015, internal documents were made public demonstrating that Coca Cola had funded a group of academics from the University of Carolina to found the Global Energy Balance Network, an initiative that appeared to be independent and called itself “the voice of science”, focusing on emphasising that the obesity epidemic, diabetes and heart disease had nothing to do with what people ate and drank but were caused by a lack of exercise.

The scandal resulted in the organisation being closed down and the company was compelled to publish information on its funding of scientists, institutions, associations of health professionals, patients’ associations, ethnic minority associations, etc. Such funding sought to neutralise possible criticism and garner support for its version of the energy balance.

Months later, Mexico’s International Life Science Institute, an institution funded by the food and drinks industry, organised an event in Mexico with US researchers to deny the impact of soft drinks on health and criticise the tax on such drinks that had been introduced in Mexico. The group of guest experts was headed by Dr James Rippe, who had received 10 million dollars from the US Corn Refiners Association to establish that the consumption of sugar had no impact on cardiovascular health. It is worth bearing in mind that this event took place in 2015, 50 years after the sugar industry launched its strategy to shift attention away from the link between sugar and heart disease. Subsequent to a decision taken by ILSI International, the ILSI office in Mexico, headed by a Coca Cola official, was closed down for seeking to intervene in public policy.

The researchers who recently published the analysis of internal sugar industry documents state that “This historical account of industry efforts demonstrates the importance of having reviews written by people without conflicts of interest and the need for financial disclosure”.

As explained by the US Center for Science in the Public Interest, the sugar industry strategy was exposed by the soft drinks industry, which had the same objectives: “Since the late 1970s, the Dietary Guidelines for Americans have advised the public to consume less added sugar. Unfortunately, that advice was drowned out by multi-million dollar ad campaigns for soda and other sugary drinks and foods”.

The ILSI case in Mexico is clear about the fact that the soft drinks companies have taken over from the sugar industry to draw attention away from the harm caused by this ingredient, especially when added to drinks. ILSI, which is headed by a Coca Cola official and brought a scientist paid by the producers of high fructose corn syrup to Mexico, illustrates how the baton is passed from one industry to another with the sole aim of denying the scientific evidence. The relay will no longer blame saturated fat; in this case, the drinks industry is pointing the finger at physical activity, reducing everything to a dogma of consuming and burning calories. One need only return to the 1960s to realise that the studies that demonstrated the harmfulness of sugar never focused on obesity; they focused on the metabolic harm caused by this ingredient.

Industry funding, in this case by the soft drinks companies, has focused on denying the evidence of the harmfulness of sugar in these drinks and funding studies to deny that public policies recommended to reduce consumption are effective. This is what is happening in Mexico, where soft drinks companies have funded studies to deny the effects of the tax to reduce consumption and try to avoid this tax measure being applied as originally recommended to further reduce consumption:  a 20% tax; that is, 2 pesos per litre.

Just as the sugar industry did from the 1960s onwards to focus the attention of public health policies on saturated fat and shift it away from the harm caused by sugar, the soft drinks industry subsequently focused attention on physical activity to shift it away from soft drinks as the main cause of obesity epidemics, diabetes and heart disease. These companies make the largest global investments in advertising and, in many cases, collaborate with the health authorities in several countries.

The health authorities defend their collaboration with these companies and carry out campaigns that appear to be promoting public health when in fact they are shifting attention away from the harm caused by soft drinks and focusing on the fact that the problem is all about energy balance, promoting physical activity.

25 years on, the authorities are still being deceived or want to be seen as being deceived, whilst the harmful effects spread and health systems collapse.

About the author

Alejandro Calvillo received his Bachelor’s degree in Sociology, carried out doctoral studies in Philosophy at the Universidad de Barcelona, and is a graduate of the Higher Learning Program on the Environment and Sustainable Development at El Colegio de México. For 25 years, he has been developing public awareness-raising and advocacy campaigns with civil society organizations. In 2006, he founded the consumer rights organisation El Poder del Consumidor in 2006, which has been carrying out policy advocacy campaigns for a decade to transform the obesogenic environment in Mexico, by promoting a national tax on sugar-sweetened beverages, healthy school food policy, the prohibition of child targeted marketing of unhealthy food and beverages and the adoption of effective front of pack labeling. He has served on advisory panels to the Pan American Health Organization, Consumers International and Mexico’s national consumer protection agency (PROFECO). For over 20 years, he has also written and been a columnist for different national media.

This blog "Secuestran por 50 años la salud pública" first appearded on the Mexican online newspaper "SinEmbargo.mx". NCD Alliance thanks Sin Embargo for permitting us to translate and publish it in English.