Efforts to shift science on sugar

UCSF researchers believe they have uncovered a decades-old effort by the sugar industry to exonerate sugar as a dietary culprit for heart disease and shift the blame onto fat and cholesterol.

In a paper published in Monday’s JAMA Internal Medicine, the researchers reveal a scheme in which the sugar industry’s main trade group paid two Harvard scientists to conduct a literature review in the mid-1960s that challenged emerging evidence linking sugar consumption to risk factors for cardiovascular disease.

The Harvard scientists concluded there was “no doubt” that reducing dietary cholesterol and substituting polyunsaturated fat for saturated fat would prevent heart disease. Such recommendations helped persuade Americans to replace their butter with margarine and eat fat-free cookies and other sugar-laden treats.

“We have been indoctrinated in this belief that if we don’t eat a low-fat diet, we’ll die of the No. 1 killer disease,” said coauthor Laura Schmidt, professor of health policy at UCSF School of Medicine. “Now we’ve learned the sugar industry paid off Harvard to tell us that.”

The research was based on internal industry documents unearthed by lead author Cristin Kearns, a UCSF dentist turned researcher, who found the information in public archives. Last year, she and her UCSF co-authors published a paper in the open-source scientific journal PLOS Medicine that showed the industry deflected research that linked sugar consumption to dental cavities.

In Monday’s paper, the researchers shifted their focus to cardiovascular disease. They showed that the Sugar Research Foundation, which is now known as the Sugar Association, paid Fredrick Stare and fellow faculty member D. Mark Hegsted the equivalent of about $50,000 in 2016 dollars to write a heavily critical review of studies that linked sucrose to heart disease. Neither Stare, who was then chairman of the Nutrition Department at Harvard’s School of Public Health, nor Hegsted is still alive.

Their reviews were published in the prestigious New England Journal of Medicine in 1967, a time when scientists were not required to disclose their conflicts of interest. Stare’s financial links to the sugar industry were not questioned until the mid-1970s.

“We are well aware of your particular interest ... and will cover this as well as we can,” one of the Harvard researchers wrote to a sugar industry representative around 1965.

“Review papers are very important because they define the scientific agendas,” Schmidt said. “When they’re published by Harvard researchers in the New England Journal of Medicine, people listen to that. Scientists listen to that. The (National Institutes of Health) listens to that.”

Harvard did not immediately respond to a request for comment Monday afternoon.

The Sugar Association, in a statement in response to Monday’s article, acknowledged that “the Sugar Research Foundation should have exercised greater transparency in all of its research activities.”

“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 group said, adding that funding disclosures at that time were not “the norm they are today.”

The organization also questioned the UCSF authors’ efforts to align the events with the 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 UCSF researchers noted that the focus on the link between heart disease and a high-fat diet coincided with the low-fat craze that started in the 1970s, but at the same time obesity rates began to grow rapidly across the nation and worldwide. Americans’ per-capita consumption of sugar and other caloric sweeteners rose by 39 percent, or 43 pounds, between the 1950s and 2000, according to the U.S. Department of Agriculture.

The UCSF researchers said they plan to write many more papers about the more than 340 documents, which total 1,582 pages. The Harvard researchers’ work was described as “Project 226.”

“As the saying goes, he who pays the piper calls the tune,” senior author Stanton Glantz, UCSF professor of medicine and director of the UCSF Center for Tobacco Control Research and Education, said in a statement. “There are all kinds of ways that you can subtly manipulate the outcome of a study, which industry is very well-practiced at.”

Schmidt, also principal investigator on UCSF’s SugarScience initiative, said the industry was “caught in the cookie jar,” and the public should feel rightfully duped.

“Really, what it’s about is an episode in history that demonstrates the incredible power of corporations to meddle in science in way that really impacts whole populations and their behaviors,” she said. “On a very gut level, you’ve got to be mad about that.”

A growing number of studies now suggest a link between sugar consumption and heart disease, although there’s not a consensus among researchers.

Victoria Colliver is a San Francisco Chronicle staff writer. Email: vcolliver@sfchronicle.com Twitter: @vcolliver