Three years ago (March 12, 2018) I wrote about an article that appeared in the Journal of the American Medical Association in September 2016  that revealed that the sugar industry had funded three renowned Harvard researchers to write a series of articles that downplayed, discredited or ignored known research that demonstrated sugar was a contributor to heart disease — and instead put the blame on fat, especially saturated fat.
When I read it, I was stunned at its significance — and it made me wonder how much of what I learned in my training needed to be revisited in a current light.
As written about in my initial post, two of the three Harvard researchers paid by the sugar industry were the late Dr. Fredrick Stare, chair of Harvard’s School of Public Health Nutrition Department and the late Dr. D. Mark Hegsted, a professor in the same department . I only found out after I had posted the article in March 2018 that one of the 3 Harvard researchers, Dr. D. Mark Hegsted was directly involved in the development of the 1977 US Dietary Goals  —which was by Hegsted and his staff at the newly-created Office of Nutrition of the Department of Agriculture as the basis for the 1980 Dietary Guidelines for Americans. These were the first Guidelines that called for Americans to decrease consumption of meat and saturated fat with the belief that it would lower the risk of heart disease.
I planned to go back at some point and write an updated post that included the historic paper trail, but never did. Today when I was posting on social media about the ~300 articles I have written the last 5 years (under the Food For Thought tab), I realized I inadvertently omitted three articles — with one of them being the one about the sugar industry’s sponsorship of the Harvard researchers. That article was too important to leave off — and it still needed to be updated.
Today, instead of taking the stat holiday off, I rewrote the earlier article with inclusion of documentation of Hegsted’s role — both in writing the sugar industry sponsored papers in 1967, and his role in advising the Select Committee on Nutrition and Human Needs on the 1977 Dietary Goals.
This is the resulting article.
In the mid-1960’s, the Sugar Research Foundation (SRF), the predecessor to the Sugar Association wanted to counter research that had been published at the time which suggested that sugar was a more significant contributor of atherosclerosis, than dietary fat. The Sugar Research Foundation invited Dr. Stare of Harvard’s School of Public Health Nutrition Department to join its scientific advisory board, and then approved $6,500 in funds ($50,000 in 2016 dollars) “to support a review article that would respond to the research showing the danger of sucrose”.
From the 2016 Kearn’s et al article ,
“On July 13, 1965, the Sugar Research Foundation (SRF)’s executive committee approved Project 226, a literature review on Carbohydrates and Cholesterol Metabolism by Hegsted and Robert McGandy, overseen by Stare.”
According to the article, letters were exchanged between the Sugar Research Foundation and the three Harvard researchers that tasked them preparing “a review article of the several papers which find some special metabolic peril in sucrose [sugar] and, in particular, fructose ”.
In a letter written to Dr. DM Hegsted, the Sugar Research Foundation made its agenda clear ;
“Our particular interest had to do with that part of nutrition in which there are claims that carbohydrates in the form of sucrose make an inordinate contribution to the metabolic condition, hitherto ascribed to aberrations called fat metabolism. I will be disappointed if this aspect is drowned out in a cascade of review and general interpretation.”
Hegsted replied to the Sugar Research Federation on behalf of the three Harvard researchers, saying;
“We are well aware of your particular interest in carbohydrate and will cover this as well as we can .”
Project 226, sponsored by the Sugar Research Foundation resulted in a 2-part literature review by McGandy, Hegsted and Stare that was published in the New England Journal of Medicine in 1967 titled “Dietary Fats, Carbohydrates and Atherosclerotic Disease”. There was no mention of the Sugar Research Federation sponsorship of the research .
The first part of the two-part review article written by Drs. Stare, Hegsted and McGandy stated;
“Since diets low in fat and high in sugar are rarely taken, we conclude that the practical significance of differences in dietary carbohydrate is minimal in comparison to those related to dietary fat and cholesterol.”
The report concluded;
“the major evidence today suggests only one avenue by which diet may affect the development and progression of atherosclerosis. This is by influencing the levels of serum lipids[fats], especially serum cholesterol.”
The Harvard researchers continued;
“there can be no doubt that levels of serum cholesterol can be substantially modified by manipulation of the fat and cholesterol of the diet”
“on the basis of epidemiological, experimental and clinical evidence, that a lowering of the proportion of dietary saturated fatty acids, increasing the proportion of polyunsaturated acids and reducing the level of dietary cholesterol are the dietary changes most likely to be of benefit.”
Stare, Hegsted and McGandy did not disclose that they were paid by the Sugar Research Foundation for the two-part review that vindicated sugar and blamed fat — most notably dietary saturated fat.
Dr. Marion Nestle, Professor of Nutrition, Food Studies and Public Health at New York University wrote an editorial which appeared in the same issue of the Journal of the American Medical Association as the Kearn’s article  where she said that the documents provided “compelling evidence” that the sugar industry initiated Project 226 research “expressly to exonerate sugar as a major risk factor for coronary heart disease”.
“The investigators knew what the funder expected, and produced it. Whether they did this deliberately, unconsciously, or because they genuinely believed saturated fat to be the greater threat is unknown .”
The story doesn’t end there.
Dr. DM Hegsted went on to play a significant role in advising the Select Committee on Nutrition and Human Needs that oversaw the development of the 1977 Dietary Goals for the United States — and ultimately oversaw the writing of the first Dietary Guidelines for Americans that called for a reduction in saturated fat consumption in order to lower the risk of coronary heart disease.
Below is front page of the Dietary Goals for the United States from the Select Committee on Nutrition and Human Needs from December 1977 , and directly below that is a page from this book that refers to Dr. D.M. Hegsted’s role in advising the Select Committee on Nutrition and Human Needs on the US Dietary Guidelines .
Here is the quote about Dr. Hegsted’s role in the Committee that oversaw the 1977 Dietary Goals for the United States;
“Dr. Hegsted has worked very closely and patiently with the committee staff on this report, devoting many hours to review and counselling. He feels very strongly about the need for public education in nutrition and the need to alert the public to the consequences of our dietary trends. He will discuss these trends and their connection with our most killing diseases. ”
There were 8 hearings of the Committee titled “Diet Related to Killer Diseases” that were held from July 1976 until October 1977  and which provided an opportunity for US senators to hear from leading scientists, government officials, and business representatives about the risks of diet on heart disease, cancer, and other chronic diseases.
“Of those who gave testimony at the first hearings, perhaps the two most important were assistant secretary for health and former director of the National Heart and Lung Institute, Theodore Cooper, and Professor Hegsted” .
Hegsted admitted to the Committee that the primary evidence for an association between diet and ‘killer diseases’ was “epidemiologic” [the weakest form of scientific data] , and not rooted in clinical studies*. He felt that there was “a clear linkage between plasma serum lipids, atherosclerosis and coronary disease” and that it was “clear that diet controls cholesterol levels”.
*[Note: April 04, 2021] – There were only 8 randomized clinical trials available at the time with only 2,467 male subjects, and no female subjects  and there was no supporting evidence from those studies that reduced total dietary fat or dietary saturated fat decreased death from all causes or death from cardiovascular disease . This is why the “primary evidence was epidemiologic”.
Several researchers pleaded with the Committee to wait for more research. The director of the National Heart, Lung and Blood Institute, Dr. Robert Levy said “no one knew if eating less fat would prevent heart attacks“. Dr. Robert Olson of St. Louis University said, “I plead in my report and will please again orally here for more research on the problem before we make announcements to the American public” and Dr. Peter Ahrens said “advising Americans to eat less fat on the strength of such marginal evidence was equivalent to conducting a nutritional experiment with the American public as subjects“.
Committee Chairman Sen. McGovern responded
“Senators don’t have the luxury that the research scientist does of waiting until every last shred of evidence is in.”
Hegsted believed there could be “no risks” to recommending that the American public eat less meat, less fat — particularly saturated fat, and less cholesterol.
“What are the risks to eating less meat … fat, particularly saturated fat … cholesterol …(and) more unsaturated fat … fruits, vegetables, and cereal products, particularly those made of whole grain cereal. There are none that can be identified and important benefits can be expected. “
[Note April 4, 2021] The epidemiological data that Hegsted relied on was from Ancel Keys’ yet-unpublished Seven Country Study  where he collected data from men aged 40-59 from the USA, Finland, the Netherlands, Yugoslavia, Greece and Japan from 1958 – 1964. The Seven Country Study data has been criticized for several reasons, including the fact that Keys did not choose countries such as Switzerland or France who were known to have very high saturated fat consumption, yet low rates of heart disease. Data from Greece, Italy and Yugoslavia were thought to have not been representative of what they normally ate, since these countries were still facing poverty post WWII.
Keys had been alleging since 1952 that there was a direct association between saturated fat and heart disease based on a graph that he drawn in a 1952 presentation at Mt. Sinai Hospital in New York, and later published in 1953, in which he plotted CVD deaths per 1000 people (y-axis) against Percent Calories from Fat (x-axis), for six countries; Japan, Italy, England and Wales, Australia, Canada, the USA. The 6 points were a subset of data from a 21 country study published by Yerushalamy and Hilleboe more than a decade earlier  – and while the 6 points that Keys’ selected showed a nice linear relationship between fat intake and heart disease, the full data from Yerushalamy and Hilleboe was not linear at all. Undeterred, Keys set out in his Seven Country Study to demonstrate a relationship between saturated fat intake and heart disease.
“Hegsted was urging action on the basis not of evidence of a demonstrated relationship between exposure and outcome, but a combination of limited studies, prevailing scientific opinion, and risk-benefit probabilities.” ~Dr. Marion Nestle
The significance of the sugar industry’s sponsorship of the three Harvard researchers to write review papers vindicating sugar and blaming fat —especially saturated fat for heart disease is important in and by itself. The fact that one of those researchers, Dr. DM Hegsted was a major influencer of the 1977 US Dietary Goals — and then oversaw the writing of the Dietary Guidelines for Americans that called for reducing saturated fat consumption and increasing consumption of cereal products cannot be understated. Basing national dietary guidelines on epidemiologic studies made the general public the equivalent of subjects in a huge, unplanned experiment.
For 40+ years, we’ve had low fat dietary guidelines in the US and Canada that were based largely on the hypotheses of a link between dietary saturated fat and heart disease. They were not based on clincal research, but weak epidemiological studies such as Ancel Keys’ Seven Country Study that was conducted many years before it was published in 1980. Furthermore, the dietary recommendations arrogantly assumed that decreasing meat and saturated fat consumption and increasing grains and cereals came without risk.
How have these low fat dietary guidelines turned out?
Heart disease is still the number one killer in the US, and second in Canada, obesity is through the roof, and rates of type 2 diabetes continue to rise.
There were consequences to recommending Americans reduce meat, fat and saturated fat consumption and increase consumption of grain and cereal products — and that is that the subsequent rise in carbohydrate consumption directly contributed to the current obesity epidemic and the metabolic diseases that accompany it.
A report published in June 2020 in the Journal of the American College of Cardiology based on meta-analysis of randomized control trials (the strongest data available), as well as observational studies found no beneficial effect on either cardiovascular disease (CVD) or death of lowering saturated fatty acid intake and that saturated fat intake is actually protective against stroke .
Without industry influence, it is time that the role of sugar and refined carbohydrate consumption on obesity and metabolic disease informs reevaluation of dietary guidelines.
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- Kearns C, Schmidt LA, Glantz SA, et al. Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA Intern Med. 2016 Nov 01; 176(11):1680-1685.
- Husten, L, How Sweet: Sugar Industry Made Fat the Villain, Cardio|Brief, 2016 Sept 13.
- McGandy, RB, Hegsted DM, Stare,FJ. Dietary fats, carbohydrates and atherosclerotic vascular disease. New England Journal of Medicine. 1967 Aug 03; 277(5):242–47
- Nestle M. Food Industry Funding of Nutrition Research: The Relevance of History for Current Debates. JAMA Intern Med. 2016;176(11):1685–1686. doi:10.1001/jamainternmed.2016.5400
- Dietary Goals for the United States, Select Committee on Nutrition and Human Needs, United States Senate. Washington : U.S. Govt. Print. Off., 1977. http://hdl.handle.net/2027/uiug.30112023368936
- , , , DM, et al, Saturated Fats and Health: A Reassessment and Proposal for Food-based Recommendations: JACC State-of -the-Art Review, J Am Coll Cardiol. 2020 Jun 17. Epublished DOI:10.1016/j.jacc.2020.05.077
- Oppenheimer GM, Benrubi ID. McGovern’s Senate Select Committee on Nutrition and Human Needs versus the meat industry on the diet-heart question (1976-1977). Am J Public Health. 2014 Jan;104(1):59-69. doi: 10.2105/AJPH.2013.301464. Epub 2013 Nov 14. PMID: 24228658; PMCID: PMC3910043.
- United States. Congress. Senate. Select Committee on Nutrition and Human Needs. (1977). Diet related to killer diseases: hearings before the Select Committee on Nutrition and Human Needs of the United States Senate, Ninety-fifth Congress, first session. Washington: U.S. Govt. Print. Off..
- Keys A. Coronary heart disease in seven countries. 1970. Nutrition. 1997 Mar;13(3):250-2; discussion 249, 253. doi: 10.1016/s0899-9007(96)00410-8. PMID: 9131696.
- Harcombe, Z., An examination of the randomised controlled trial and epidemiological evidence for the introduction of dietary fat recommendations in 1977 and 1983: A systematic review and meta-analysis. 2015, University of the West of Scotland.
- Yerushalmy J, Hilleboe HE, Fat in the diet and mortality from heart disease; a methodologic note. N Y State J Med, 1957. 57(14): p. 2343-54.
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