Is the sugar industry lying to us?    

photo from ThinkStock via Tri County Health Dept

(NOTE: podcast by Donna P Feldman MS RDN)

This has been a bad year for the sugar industry. Last September, the New York Times released an article blaming the the Sugar Association for paying off researchers in the 1960’s to direct attention away from the damaging effects of sugar and establish a link between fat and cardiovascular disease. Dr. Cristen Kearns, the dentist who uncovered this alleged deception, has received national attention, publishing three journal articles that have been picked up by hundreds of news outlets.

Dr. Kearns’ story goes something like this: she claims the sugar industry produced some shoddy science, using their money and power to sway Harvard researchers to publish journal articles that favored sugar. Dr. Kearns suggested the researchers knew all along that sugar, not fat, was to blame for America’s epidemic heart disease but chose to cover it up for a $50,000 bribe.

When Dr. Kearns combed through The Sugar Association’s documents, she found links between researchers and Sugar Association stakeholders, pay-offs, deception and lots of bad science. In a published research article, Kearns and her co-authors clam the following:

  • In the ‘70s, the National Institute of Dental Research focused on pushing fluoride instead of reducing sugar intake to prevent dental carries. This, Kearns claims, “failed to significantly reduce the burden of dental carries” and remains a widespread, yet misguided, solution to cavities
  • With endorsement from President Nixon, the National Carries Program (NCP) promoted “solutions” to dental carries, such as vaccines, directing blame for this major public health issue away from sugar
  • The Sugar Association acted much like the tobacco industry, minimizing what research clearly showed to be a dangerous substance, and passing the blame for public health problems in order to sell their product   

For Kearns, the journey to damn sugar is personal. She quit her high-level job as a dental care program manager when she saw the government-published information her peers were distributing to their patients. The handouts recommended reducing salt, fat and calories to prevent cavities but never once mentioned reducing sugar as a way to improve dental health. Dr. Kearns thought the sugar industry was using dental care providers to influence the public’s perception that sugar is not to blame for our nation’s poor oral health.

She may be right. The American Dental Association fact sheet about diabetes, diet and dental care says nothing about sugar. It recommends frequent dental checkups and ADA approved toothpaste, but does not mention the connection between sugar and cavities, or sugar and diabetes, or sugar and mouth bacteria—connections that are well-known and backed up with credible science7. An Oral Health Factsheet published by the Washington School of Dentistry recommends ‘monitoring’ diabetic patients’ diets but does not recommend restricting carbohydrates, sugar being a major player and one that irrefutably affects diabetic patients. “Educate on proper oral hygiene and nutrition,” it declares, without mentioning what proper nutrition means, what to recommend, or which nutrients to talk about. The Academy of General Dentistry fact sheet on diabetes mentions blood sugar three times, ironically recommending that diabetic patients monitor their blood sugar regularly and making a clear connection between diabetes and poor dental health but, again, recommending frequent tooth brushing as the only prevention tactic. Reducing sugar intake is not mentioned as a way to prevent mouth bacteria or even as a way to control blood sugar.

There is an undeniable connection between sugar and poor mouth health. Most children are told at some point that sugar gives them cavities—something our parents drilled into us, threatening us with a mouthful of fake teeth if we overdo it on Halloween candy.  “A dynamic relation exists between sugar and oral health,” the American Society for Clinical Nutrition reports. “Sugars…provide substrate for the actions of oral bacteria.”

Are the sugar and dental industries ignoring this connection and putting our health at risk just to push their products? Of course, it is easy to get bogged down in the controversy and quickly ascribe to the anti-sugar agenda that the media is pushing, but a better approach is to examine the science and investigate the nutritional claims The Sugar Association is making. Is their pro-sugar stance firmly rooted in evidence-based study, or merely a marketing scheme?

Sugar is a carbohydrate but not all carbohydrates are sugars. The terms “sugar” and “carb” are often used interchangeably, which causes tremendous confusion and allows for easy manipulation of nutrition recommendations and scientific truths. The Sugar Association mistakenly refers to sugar as a nutrient. Carbohydrates are a nutrient, one of the three major nutrients we need to survive (carbs, fat and protein). Carbohydrates are broken down upon consumption, yielding glucose which fuels our brain and cells, or is stored for later energy needs. Table sugar—made from sugar cane or beets, the stuff the Sugar Association is promoting—is primarily sucrose, a pure carbohydrate that is rapidly absorbed into the bloodstream and can cause spikes in blood sugar. A search of peer-reviewed research turned up dozens of articles connecting high-sugar diets to fatty liver disease, triglyceride (fatty acid) accumulation, metabolic syndrome and obesity. Study after study show the dangerous effects of sugar. Some even suggest it is an addictive substance that feeds the same pleasure centers in our brains as narcotic drugs. Rats fed a sugar solution exhibited withdrawal symptoms like those of drug addicts.

If these articles speak truth, why are their facts seemingly hidden? Why are some trying so desperately to shift the blame away from sugar? Consumers should not have to dig for this information—a diet-health connection this profound should be readily offered to the public.

The Sugar Association vehemently denies any association with sugar and poor health. Labeling sugar as a nutrient and declaring it a “simple, irrefutable fact” that sugar is part of a healthy diet, they cite the FDA’s statement that sugar consumption has no effect on heart disease and obesity risk. An info sheet published by the Sugar Association claims, “Nutrition experts consistently recommend increasing carbohydrates to achieve a healthful diet.” In reality, most nutrition experts (registered dietitians) recognize the dangers of high carbohydrate and added sugar intake and recommend decreasing consumption of these low-nutrient foods. In the USDA school breakfast guidelines, solid fats, sugars, refined starches (carbohydrates) and sodium are considered unhealthy and these products are limited in school food service. According to the USDA, our children don’t consume enough nutrient-dense foods and are filling up on low-nutrient, processed foods that contain added sugar, salt and fat. Schools are required to serve fruits and vegetables without added sugars and limit the “discretionary calories” that come from sweet and salty snacks. The USDA certainly does not consider sugar an important, healthful nutrient. While the jury may still be out on the sugar-heart disease debate, we do have proof that sugar is unhealthful in many other ways, most troubling its link to obesity, diabetes and cavities in children.

The Sugar Association, Dr. Kearns believes, impacted nutrition policy and legislation for decades. In the ‘60s and ‘70s, the National Institute of Craniofacial Research, allegedly funded by the sugar and sweets industries, poured hundreds of thousands of dollars into research initiatives to prevent cavities, such as vaccines and testing the carcinogenic potential of foods. Sugar was not investigated as a primary cause of tooth decay, and for years was left out of the discussion in FDA and USDA policy-making. Today, documents published by dental associations reflect this bias. The FDA has only recently changed its pro-sugar stance. Last year, they suggested Nutrition Facts labels report how many grams of added sugars a product contains. The Sugar Association opposed their suggestion, declaring we did not have enough scientific proof to warrant the legislation. But, this summer, the FDA passed new regulations requiring added sugars to be listed on all food labels (which has since been postponed). The FDA cited studies, reporting, “scientific data shows that it is difficult to meet nutrient needs while staying within calorie limits if you consume more than 10 percent of your total daily calories from added sugar.” The Sugar Association’s website brazenly remarks, “Of note, current intakes of added sugars in the U.S. are only ~13% of calories.”

At the 2016 Academy of Nutrition and Dietetics national convention, The Sugar Association distributed materials to registered dietitians claiming sugar does not cause disease and is part of a healthy diet.  A picture workbook for kids referred to sugar as “fun” and promoted the benefits of this “nutrient.” At the conference, the Academy announced its partnership with The Sugar Association in funding a grant that will study the impact of egg yolk consumption on cholesterol levels. The beaming Sugar Association CEO presented the research grant alongside an Academy of Nutrition and Dietetics research chair. The group Dietitians for Professional Integrity is up in arms about this, suggesting it undermines the profession. Half a century after the Sugar Association’s alleged payoffs and deception, the industry giant continues to fund research to condemn fat.  

In her paper, Dr. Kearns warned that the sugar industry worked tirelessly (and successfully) in the ‘60s and ‘70s to steer the debate away from sugar and toward fat, blaming dietary fat for epidemic heart disease. In recent years, the Association’s influence on research and diet recommendations seems to have slowed, but now they are back on the national stage, embracing the image of their industry as a pioneer of scientific research. Should industry giants be allowed to fund nutrition-related grants? According to Dr. Kearns, these are the same shameful practices that caused nutrition’s most deplorable sellout.

The controversial New York Times article and others like it are catchy, provocative and scandalous. Many of us find it easy to believe the industry is lying to us and influencing science for gain. However, there are always two sides to the story. The Sugar Association is trying to protect its reputation and attempting to re-create a positive image of sugar after a disastrous public relations fallout. The people feel cheated, scammed and misled. Dietitians question the integrity of their professional association.

When examining the facts, it is important to distinguish between published, non-biased studies and statistics that are used as a marketing scheme to support a positive image of a product. Studies that prove the dangers of sugar have been available for decades but are only now being brought to the public’s attention. The statement offered by The Sugar Industry, claiming we do not have the science to prove sugar is dangerous, is wrong. We have studies, however questionably funded they may be, showing sugar is safe. We also have mounds of published journal articles showing an undeniable link between refined sugar consumption and high triglycerides, high blood sugar, weight gain, liver disease and poor oral health. Governing bodies such as the FDA and USDA are now making changes to dietary recommendations based on this science—recommendations that attempt to reduce added sugar consumption and improve our health.

After Kearns’ article was released and the media grabbed ahold of an anti-sugar stance, the Sugar Association released the following statement:

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.

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.

Certainly, industry-funded research is the norm for many food products. Still, Kearns alleges the sugar industry went too far, even if it occurred in a time of our nation’s history when the lines between research and bias may have been blurred, or nonexistent. If the documents Kearns uncovered had been written today, the public outcry would have probably been much worse. It is easy to ignore events that occurred 50 years ago, tucked away in documents that take a professional researcher to uncover. But, events like this shaped our public health and nutrition policy for decades. It is important to be aware of the politics that occurred to create our nation’s food system and the bias that undoubtedly occurs when large entities publish documents to educate healthcare professionals promoting their product—especially when that product has been shown to have nutrition and public health concerns.   

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