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 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 plaque buildup in the arteries. 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. Project 226 authors eventually received $6500, or $48,900 in
2016 dollars, from SRF, the report said.
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 or funding.
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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.
In the U.S., about 610,000 people die of heart disease every year,
according to the Centers for Disease Control and Prevention in
Atlanta, making heart disease the leading cause of death for both
men and women. Risk factors include being overweight or obesity as
well as diabetes - all of which are worsened by excess sugar intake.
“When manufacturers took out fat they added sugar,” Schmidt 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.
SOURCE: http://bit.ly/IZGqPC JAMA Internal Medicine, online
September 12, 2016.
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