Know Your Value</s>(CNN) Scientists began to uncover a link between sugar and heart disease about 60 years ago, and now, the general consensus among experts is that sugar intake is associated with heart disease risk.

But why did it take so long for researchers to inspect this link?

A group then called the Sugar Research Foundation funded some of the early research on fat as the primary risk factor for heart disease, a "sophisticated" tactic to overshadow other research that placed blame on sweets as a risk factor, according to researchers.

The foundation, now called the Sugar Association , questioned the new paper's findings in a response to CNN, saying it's "challenging for us to comment on events that allegedly occurred 60 years ago, and on documents we have never seen." The organization was founded in 1943 by members of the American sugar industry and was dedicated to the scientific study of sugar's role in food, as well as communicating that role to the public.

Researchers said the early heart disease research has implications for Americans' health today.

"If we could rewind the script back to 1965 and we had said, 'You know what, we're not just going to worry about fat and heart disease, we're also going to look at carbohydrates and in particular sugar, because that's a concentrated form of carbohydrate,' things might be really different," said Laura Schmidt, a professor of health policy in the University of California, San Francisco's School of Medicine and a co-author of the new analysis.

"If we had not dismissed the idea that carbohydrates played a significant role in heart disease, we would be potentially in a different place today in terms of our obesity and heart disease rates."

Whatever happened to Yudkin's theory? Researchers suggest that when the sugar industry "manipulated" the scientific debate on heart disease, his theory -- along with other sugar consumption research -- was swept under the rug.

The new paper was led by Cristin Kearns, a postdoctoral researcher at the UCSF School of Dentistry, who collected letters dating from 1959 to 1971 between executives at the Sugar Research Foundation and various scientists.

In one instance, according to the new analysis, foundation Vice President John Hickson received drafts of a review by Hegsted and replied, "Let me assure you this is quite what we had in mind and we look forward to its appearance in print."

"It isn't unusual for faculty who die, for their documents and materials to be stored or given as a gift to the university where they worked," Schmidt said.

"It just so happened that Roger Adams had a long history of working with the sugar organization, and his materials happened to contain documents by industry executives and are one window into how the industry manipulated science."

Kearns, Schmidt and their colleague Stan Glantz, a professor of medicine at UCSF, analyzed the letters and other heart disease research-related public documents -- from symposium proceedings to annual reports -- from the 1950s and 60s.

"It's all the same tricks. ... There was a pretty clear case emerging that eating sugar increased triglycerides, which increased heart disease risk. I think if the science had been left to its own devices, within a few years, there would have been a consensus that there was a causal link, which then should have influenced regulatory policy."

Sugar warnings, then and now

"Experts are still debating what the role of sugar and heart disease is, even though there was evidence going back to the '50s and '60s that a segment of the population with high triglyceride levels should potentially be concerned about their sugar consumption," Kearns said. "Had we come to this conclusion much earlier, people who had this triglyceride level would have been counseled much differently."

The paper suggests that a diet high in added sugars can cause a three-fold increase in the risk of death due to heart disease.

A representative for the Sugar Association emailed a statement from the association to CNN, questioning the new paper's findings about the history of heart disease research and the sugar industry.

"We acknowledge that the Sugar Research Foundation should have exercised greater transparency in all of its research activities, however, when the studies in question were published funding disclosures and transparency standards were not the norm they are today. Beyond this, it is challenging for us to comment on events that allegedly occurred 60 years ago, and on documents we have never seen," the statement said.

"Generally speaking, it is not only unfortunate but a disservice that industry-funded research is branded as tainted. What is often missing from the dialogue is that industry-funded research has been informative in addressing key issues," the Sugar Association statement said. "Most concerning is the growing use of headline-baiting articles to trump quality scientific research -- we're disappointed to see a journal of JAMA's stature being drawn into this trend."

Additionally, rates of obesity -- which puts people at a higher risk of heart disease -- have skyrocketed among both children and adults since the 1970s, according to the Centers for Disease Control and Prevention.

Schmidt, Kearns and Glantz have done the science community "a great public service" by resurfacing the history of funded heart disease research, said Marion Nestle, a professor of nutrition, food studies and public health at New York University, in an editorial accompanying the new paper in JAMA Internal Medicine.

"As George Santayana famously said in 'Reason of Common Sense' (1905), 'Those who cannot remember the past are condemned to repeat it,' " she wrote.

"We have to ask ourselves how many lives and dollars could have been saved, and how different today's health picture would be, if the industry were not manipulating science in this way," he said in the statement. "Only 50 years later are we waking up to the true harm from sugar."</s>A 1967 literature review in The New England Journal of Medicine pointed to fat and cholesterol as the dietary culprits of heart disease, glossing over evidence from the 1950s that sugar was also linked to heart disease. According to the new report, the NEJM review was sponsored by the Sugar Research Foundation (SRF), which is today the Sugar Association, although its role was not disclosed at the time.

In the report, Laura A. Schmidt of the University of California, San Francisco and colleagues point out that Harvard professor of nutrition Dr. Mark Hegsted co-directed the SRF’s first heart disease research project from 1965 to 1966. Schmidt and colleagues say communications between the SRF, Hegsted and another professor, Roger Adams, uncovered from the University of Illinois archives and the Harvard Medical Library reveal that the foundation set the objective for the literature review, funded it and reviewed drafts of the manuscript.

“I thought I had seen everything but this one floored me,” said Marion Nestle of New York University, who wrote an editorial on the new findings. “It was so blatant. And the ‘bribe’ was so big.”

“Funding research is ethical,” Nestle told Reuters Health by email. “Bribing researchers to produce the evidence you want is not.”

The researchers also reviewed symposium proceedings and historical reports. In 1954, they say, foundation president Henry Haas gave a speech highlighting the potential of reducing American fat intake and recapturing those calories as carbohydrates that would increase the per capita consumption of sugar more than a third.

In 1962, an American Medical Association nutrition report indicated that low-fat high-sugar diets may actually encourage the development of cholesterol. Two years later, according to the new report, SRF vice president John Hickson proposed that the SRF embark on a major program to counter “negative attitudes toward sugar.”

Increasingly, epidemiological reports suggested that blood sugar, rather than blood cholesterol or high blood pressure, was a better predictor of atherosclerosis. Two days after The New York Herald Tribune ran a full page story on the link to sugar in July 1965, the SRF approved “Project 226,” a literature review on cholesterol metabolism to be led by Hegsted and, among others, Fredrick Stare, another Harvard nutritionist with industry financial ties.

Nine months later, Schmidt and colleagues write, Hegsted explained that the project was delayed to continually rewrite rebuttals to new evidence linking sugar to heart disease that had been published in the interim.

By September of 1966, according to the report, Hickson was requesting additional drafts of the literature review from the Harvard researchers, though there is no direct evidence that the Foundation commented on or edited the drafts. By November 2, Hickson had approved the latest draft as “quite what we had in mind.” The two-part review, concluding that the only change necessary to prevent heart disease was to reduce dietary fat intake, was published in the NEJM the following year, with no mention of the SRF’s participation.

The journal did not require conflict of interest disclosure until 1984.

“The sugar association paid very prestigious Harvard scientists to publish a review focusing on saturated fat and cholesterol as the main causes of heart disease at the time when studies were starting to accumulate indicating that sugar is a risk factor for heart disease,” Schmidt told Reuters Health by phone. “That has an impact on the whole research community and where it’s going to go.”

“For example a lot of the messaging during this period around how to prevent heart disease focused on, why don’t you use margarine rather than butter, which has less saturated fat,” Schmidt said. Now we know that margarine is full of trans fat, which causes heart disease and has been nearly eradicated from the U.S. food supply.

“When manufacturers took out fat they added sugar,” she said. “We’ve really lost a lot of time in evaluating how sugar impacts coronary heart disease,” but the actual impact on public health over the last five decades is impossible to measure.

Large amounts of sugar and saturated fats are both detrimental to health and their effects are hard to separate, Nestle said, but it seems reasonable to keep sugar intake to about 10 percent of daily calories.

Today, industry money still funds plenty of scientific research, but increasingly journals and scientists disclose these funding sources, Schmidt said.

“We acknowledge that the Sugar Research Foundation should have exercised greater transparency in all of its research activities, however, when the studies in question were published funding disclosures and transparency standards were not the norm they are today,” the Sugar Association told Reuters Health in a statement. “Beyond this, it is challenging for us to comment on events that allegedly occurred 60 years ago, and on documents we have never seen.”

“The Sugar Association is always seeking to further understand the role of sugar and health, but we rely on quality science and facts to drive our assertions,” the statement said.</s>Influential research that downplayed the role of sugar in heart disease in the 1960s was paid for by the sugar industry, according to a report released on Monday.

With backing from a sugar lobby, scientists promoted dietary fat as the cause of coronary heart disease instead of sugar, according to a historical document review published in JAMA Internal Medicine.

Though the review is nearly 50 years old, it also showcases a decades-long battle by the sugar industry to counter the product’s negative health effects.

The findings come from documents recently found by a researcher at the University of San Francisco, which show that scientists at the Sugar Research Foundation (SRF), known today as the Sugar Association, paid scientists to do a 1967 literature review that overlooked the role of sugar in heart disease.

SRF set an objective for the review, funded it and reviewed drafts before it was published in the New England Journal of Medicine, which did not require conflict of interest disclosure until 1984. The three Harvard scientists who wrote the review made what would be $50,000 in today’s dollars from the review.

Marion Nestle, a nutrition, food studies and public health professor at New York University, said the food industry continues to influence nutrition science, in an editorial published alongside the JAMA report.

“Today, it is almost impossible to keep up with the range of food companies sponsoring research – from makers of the most highly processed foods, drinks, and supplements to producers of dairy foods, meats, fruits, and nuts – typically yielding results favorable to the sponsor’s interests,” Nestle said. “Food company sponsorship, whether or not intentionally manipulative, undermines public trust in nutrition science, contributes to public confusion about what to eat, and compromises Dietary Guidelines in ways that are not in the best interest of public health.”

The cushy relationship between food companies and researcher has been captured in recent investigations by the Associated Press and New York Times. The AP revealed in June that candy trade groups were funding research into sweets. And in 2015, the New York Times showed how Coca-Cola has funded millions in research to downplay the link between sugary beverages and obesity.

The Sugar Association said in a statement that SRF “should have exercised greater transparency” in its research, but also accused the study authors of having an “anti-sugar narrative”.

“We question this author’s continued attempts to reframe historical occurrences to conveniently align with the currently trending anti-sugar narrative, particularly when the last several decades of research have concluded that sugar does not have a unique role in heart disease,” the Sugar Association said. “Most concerning is the growing use of headline-baiting articles to trump quality scientific research – we’re disappointed to see a journal of JAMA’s stature being drawn into this trend.”

The findings were based on documents found by Cristin Kearns, a postdoctoral fellow at UCSF, in library archives.

The scientists and executives involved are no longer alive.

In recent years, the link between fat and heart disease has become a more contentious topic – a 2010 review of scientific studies of fat in the American Journal of Clinical Nutrition found that “there is no convincing evidence that saturated fat causes heart disease”. The role of sugar in heart disease is still being debated.</s>The sugar industry began funding research that cast doubt on sugar's role in heart disease -- in part by pointing the finger at fat -- as early as the 1960s, according to an analysis of newly uncovered documents.



In 1964, the group now known as the Sugar Association internally discussed a campaign to address "negative attitudes toward sugar" after studies began emerging linking sugar with heart disease, according to documents dug up from public archives.



In an editorial published Monday that accompanied the sugar industry analysis, New York University professor of nutrition Marion Nestle noted that for decades following the study, scientists and health officials focused on reducing saturated fat, not sugar, to prevent heart disease.



The American Heart Association cites a study published in 2014 in saying that too much added sugar can increase risk of heart disease, though the authors of that study says the biological reasons for the link are not completely understood.



The findings published Monday are part of an ongoing project by a former dentist, Cristin Kearns, to reveal the sugar industry's decades-long efforts to counter science linking sugar with negative health effects, including diabetes.</s>NEW YORK (AP) — The sugar industry began funding research that cast doubt on sugar's role in heart disease — in part by pointing the finger at fat — as early as the 1960s, according to an analysis of newly uncovered documents.

The analysis published Monday is based on correspondence between a sugar trade group and researchers at Harvard University, and is the latest example showing how food and beverage makers attempt to shape public understanding of nutrition.

In 1964, the group now known as the Sugar Association internally discussed a campaign to address "negative attitudes toward sugar" after studies began emerging linking sugar with heart disease, according to documents dug up from public archives. The following year the group approved "Project 226," which entailed paying Harvard researchers today's equivalent of $48,900 for an article reviewing the scientific literature, supplying materials they wanted reviewed, and receiving drafts of the article.

The resulting article published in 1967 concluded there was "no doubt" that reducing cholesterol and saturated fat was the only dietary intervention needed to prevent heart disease. The researchers overstated the consistency of the literature on fat and cholesterol, while downplaying studies on sugar, according to the analysis.

"Let me assure you this is quite what we had in mind and we look forward to its appearance in print," wrote an employee of the sugar industry group to one of the authors.

The sugar industry's funding and role were not disclosed when the article was published by the New England Journal of Medicine. The journal, which did not require such disclosures at the time, began requesting author disclosures in 1984.

In an editorial published Monday that accompanied the sugar industry analysis, New York University professor of nutrition Marion Nestle noted that for decades following the study, scientists and health officials focused on reducing saturated fat, not sugar, to prevent heart disease.

While scientists are still working to understand links between diet and heart disease, concern has shifted in recent years to sugar and carbohydrates, and away from fat, Nestle said.

A committee advising the federal government on dietary guidelines says the available evidence shows "no appreciable relationship" between the dietary cholesterol and heart disease, although it still recommended limiting saturated fats.

The American Heart Association cites a study published in 2014 in saying that too much added sugar can increase risk of heart disease, though the authors of that study says the biological reasons for the link are not completely understood.

The findings published Monday are part of an ongoing project by a former dentist, Cristin Kearns, to reveal the sugar industry's decades-long efforts to counter science linking sugar with negative health effects, including diabetes. The latest work, published in the journal JAMA Internal Medicine, is based primarily on 31 pages of correspondence between the sugar group and one of the Harvard researchers who authored the review.

In a statement, the Sugar Association said it "should have exercised greater transparency in all of its research activities," but that funding disclosures were not the norm when the review was published. The group also questioned Kearns' "continued attempts to reframe historical occurrences" to play into the current public sentiment against sugar.

The Sugar Association said it was a "disservice" that industry-funded research in general is considered "tainted."

Companies including Coca-Cola Co. and Kellogg Co. as well as groups for agricultural products like beef and blueberries regularly fund studies that become a part of scientific literature, are cited by other researchers, and are touted in press releases.

Companies say they adhere to scientific standards, and many researchers feel that industry funding is critical to advancing science given the growing competition for government funds. But critics say such studies are often thinly veiled marketing that undermine efforts to improve public health.

"Food company sponsorship, whether or not intentionally manipulative, undermines public trust in nutrition science, contributes to public confusion about what to eat," wrote Nestle, a longtime critic of industry funding of science.

The authors of the analysis note they were unable to interview key actors quoted in the documents because they are no longer alive. They also note there is no direct evidence the sugar industry wrote or changed the manuscript, that the documents provide a limited window into the activities of the sugar industry group and that the roles of other industries and nutrition leaders in shaping the discussion about heart disease were not studied.

Nevertheless, they say the documents underscore why policy makers should consider giving less weight to industry-funded studies. Although funding disclosures are now common practice in the scientific community, the role sponsors play behind the scenes is still not always clear.

In June, the Associated Press reported on a study funded by the candy industry's trade group that found children who eat candy tend to weigh less than those who don't. The National Confectioners Association, which touted the findings in a press release, provided feedback to the authors on a draft even though a disclosure said it had no role in the paper. The association said its suggestions didn't alter the findings.

In November, the AP also reported on emails showing Coca-Cola was instrumental in creating a nonprofit that said its mission was to fight obesity, even though the group publicly said the soda maker had "no input" into its activities. A document circulated at Coke said the group would counter the "shrill rhetoric" of "public health extremists."

Coca-Cola subsequently conceded that it had not been transparent, and the group later disbanded.</s>NEW YORK – The sugar industry began funding research that cast doubt on sugar’s role in heart disease – in part by pointing the finger at fat – as early as the 1960s, according to an analysis of newly uncovered documents.

The analysis published Monday is based on correspondence between a sugar trade group and researchers at Harvard University, and is the latest example showing how food and beverage makers attempt to shape public understanding of nutrition.

In 1964, the group now known as the Sugar Association internally discussed a campaign to address “negative attitudes toward sugar” after studies began emerging linking sugar with heart disease, according to documents dug up from public archives. The following year the group approved “Project 226,” which entailed paying Harvard researchers today’s equivalent of $48,900 for an article reviewing the scientific literature, supplying materials they wanted reviewed, and receiving drafts of the article.

The resulting article that was published in 1967 concluded there was “no doubt” that reducing cholesterol and saturated fat was the only dietary intervention needed to prevent heart disease. The researchers overstated the consistency of the literature on fat and cholesterol, while downplaying studies on sugar, according to the analysis.

“Let me assure you this is quite what we had in mind and we look forward to its appearance in print,” wrote an employee of the sugar industry group to one of the authors.

The sugar industry’s funding and role were not disclosed when the article was published by the New England Journal of Medicine. The journal did not begin requesting author disclosures until 1984.

In an editorial published Monday that accompanied the sugar industry analysis, New York University professor of nutrition Marion Nestle noted that for decades following the study, scientists and health officials focused on reducing saturated fat, not sugar, to prevent heart disease.

While scientists are still working to understand links between diet and heart disease, concern has shifted in recent years to sugars, and away from fat, Nestle said.

A committee that advised the federal government on dietary guidelines said the available evidence shows “no appreciable relationship” between the dietary cholesterol and heart disease, although it still recommended limiting saturated fats.
A researcher from the University of California, San Francisco discovers that the sugar industry may have manipulated studies about heart diseases.