Sugar, Heart Disease and Cancer: An unsavory story of wealth versus health

In 1965, the Sugar Research Foundation (SRF) secretly funded a study by three Harvard scientists. It was published in the New England Journal of Medicine (NEJM), one of the most prestigious medical journals in the world. The review discounted a growing body of evidence linking sugar consumption to blood lipid levels that cause coronary heart disease. At the time, the cause of heart disease was vigorously debated. Sugar or fat? The study concluded that dietary fats were to blame.

The authors suspected that gut bacteria had something to do with their findings. And so in 1968, another group began a research project to compare the nutritional effects of bacteria in the intestinal tract of rats fed either sucrose or starch. It was funded by the sugar industry and called Project 259.

The research yielded a treasure trove of findings.

In one of the earliest demonstrations of the microbiome’s impact they found a significant decrease in triglycerides in germ-free rats fed a high sugar diet compared to a conventional diet. This suggested that gut bacteria play a causal role in sugar-induced elevation of blood lipids.

In addition, the investigators observed an unexpected connection between sugar consumption and elevated levels of beta-glucuronidase, an enzyme associated with bladder cancer in humans.

The principal investigator reported these results to SRF (by this time it had become the International Sugar Research Foundation) and asked to for a three-month extension to conclude the work.

His request was denied.

These remarkable findings resulted in the termination of Project 259. The data was not published. For nearly 50 years essential evidence on how sugar increases the risk for cardiovascular disease and cancer, the two leading causes of death, was withheld.

The original NEJM review however did not disappear. It played a significant role in identifying dietary fat rather than sugar as a cause of heart disease. One scientist who received funding from the sugar industry, D. Mark Hegsted, was appointed head of nutrition at the United States Department of Agriculture. In 1977 he oversaw the drafting of the first federal government dietary guidelines.

Many in the research community believe that the policy of encouraging Americans to reduce dietary fat resulted in a flood of low-fat, high-sugar “health foods” that fueled the obesity epidemic.

Cristin E. Kearns, a professor of dentistry and health policy at UCSF, unearthed this story sifting through piles of documents archived at Harvard and other university libraries. There she found correspondence between sugar industry executives and scientists explicitly directing attention away from sugar and focusing on fat as a cause of heart disease. Her work was instrumental in creating the UCSF Food Industry Documents Archive , a collection containing over 32,000 documents related to industry’s influence on food and beverage policy.

Dr. Hegsted, an author of the NEJM review wrote, “We are well aware of your particular interest and will cover this as well as we can.” Preliminary drafts went back and forth. A sugar industry director expressed his satisfaction with the work, “Let me assure you this is quite what we had in mind, and we look forward to its appearance in print.”

Research has continued to document the damaging effects of dietary sugar on our health. No aspect of our biology escapes its toxicity.

· Sugar accelerates aging process. Cell telomere length provides a measure of how fast an individual is aging. In a study of 5,309 individuals, those who drink sugary drinks on a regular basis are shown to have much shorter telomere lengths than individuals who do not drink sugary drinks.

· Sugar increases the risk of cavities by acidifying the oral environment allowing bacteria to demineralize the teeth surfaces.

· Glucose is known to amplify cortisol secretion during a psychological stress event. Unlike protein and fat, glucose has been shown to increase the cortisol level 4 fold under stressful conditions. (Hormones and Behavior)

· Multiple studies have shown that those who consume 1 to 2 servings of sugary beverages per day have a 26% increased risk of developing type 2 diabetes. (American Diabetes Association)

· People with type 2 diabetes (high sugar diet is a leading risk factor) run a higher-than-normal risk of developing liver, pancreatic, colon, bladder and breast cancer.

· Research suggests that it is sugar’s relationship to higher insulin levels and related growth factors that may influence cancer cell growth the most.

· High-carb diets can increase an individual’s risk of developing dementia by 84% compared to low-carb diets. People with high blood sugar have a much faster rate of cognitive decline than individuals with blood sugar in the normal range. Type 2 diabetes doubles the risk of developing Alzheimer’s disease compared to non-diabetics.

· Research has demonstrated the overlap of neural circuitry and commonalities between drug abuse and sugar addiction in humans. “Hyperpalatable” (sugar-infused) foods highjack the brain’s reward centers impairing the decision-making process in the same manner as is seen with drugs of abuse.

· Consumption of high-sugar foods is associated with an increased risk of several cancers including colon, prostate, breast, lung, pancreatic and endometrial.

· The 7 leading causes of death in 2016 in the US were:

1. Heart disease

2. Cancer

3. Accidents

4. Chronic lower respiratory diseases

5. Cerebrovascular diseases (stroke)

6. Alzheimer’s disease

7. Diabetes

Although diabetes is 7th, dietary sugar increases the risk of heart disease, cancer, stroke and Alzheimer’s disease.

Given the overwhelming data on the damaging effects of sugar one might assume that the government would attempt some form of regulation. The form this has taken speaks to the priorities of our society.

Thanks to the U.S. sugar program sugar beet and sugar cane farmers have had the advantage of fixed prices, cheap loans, and tariffs to keep out competitors, all at taxpayer expense. According to MarketWatch, the US spends $4 billion a year subsidizing domestic sugar production despite the Department of Agriculture’s explicit promise that it should run at no cost to the government. This has resulted in US sugar prices averaging about twice that of world prices.

Ironically, the high domestic price of sugar motivated both the Coca-Cola Company and PepsiCo to replace sugar with high fructose corn syrup, a much less expensive but more damaging product. Fructose, one of the two carbohydrates ((fructose and glucose) in refined sugar, is primarily metabolized by the liver. Glucose is metabolized by all cells. Consuming excessive fructose strains the liver which then converts fructose to fat. This leads to insulin resistance and metabolic syndrome, the major risk factors for heart disease, diabetes and obesity.

Research also has shown that fructose causes leptin resistance producing insatiable appetite and consequent obesity.

Nearly half of American’s sugar intake comes from soda and fruit drinks. The per capita consumption of fructose rose from 0.23 kg in 1970 to 28.4kg in 1997. More than 29 billion gallons of high fructose corn syrup were consumed by Americans in 2016.

In1970, sugary drinks provided 4% of daily caloric intake. By 2008, 91% of American children (6–11) were consuming as much as 60% of their daily calories from sugar-sweetened beverages. A 15-year longitudinal studypublished in JAMA Internal Medicine found that individuals had more than twice the risk of dying from heart disease if they consumed 25% or more of their total daily calories intake from sugar.

Americans have the highest average daily sugar consumption per person in the world. This was not always true. Two hundred years ago, the average American ate 2 pounds of sugar per year. That number has climbed to more than 150 pounds today.

This remarkable government subsidized marketing bonanza/public health disaster is a familiar narrative. The tobacco industry similarly manipulated research on the dangers of smoking and profited from government subsidies while peddling an addictive substance.

The American philosopher, George Santayana, said “Those who cannot remember the past are condemned to repeat it.”

In 1985, the tobacco company R.J. Reynolds acquired Nabisco. Shortly after, the largest cigarette manufacturer in the world, Philip Morris, bought General Foods and Kraft, the two largest food manufacturers, making Philip Morris the largest food company on the planet.

The same sophisticated science that defined the ideal delivery of nicotine was used by the food industry, now run by tobacco. By manipulating the form and quantity of salt, sugar and fat, and such qualities as “mouth feel,” rate of absorption, and acidity, food products are exquisitely designed to hit what they call the “bliss point.”

This recipe maximizes craving and minimizes satiety. The ideal form for anything you want to sell. Add brilliant marketing, low price, and ubiquitous access and you’ve got everyone hooked.

The latest chapter of this story has been written by Purdue Pharma, the producer of Oxycontin. This time the manipulation of science (creating a drug more addictive than morphine), concealed data (Purdue was aware of Oxycontin’s abuse soon after it went to market), failure of regulatory agencies (Oxycontin was approved by the FDA as having a lower abuse potential than other opioids based on no clinical data) and the pursuit of profit at any cost, created an opioid epidemic.

There will always be a next chapter.

Until recently, the greatest threats to our survival were predators, weather and infections. This year marks the 100th anniversary of the influenza epidemic that spread across the world in 1918 killing an estimated 50 million people.

Our species has made remarkable progress. We now create our own epidemics.