How Industry Misled the World on Fat and Sugar

Prologue: The File That Shouldn’t Exist

The air within the basement archives was stale, tinged with the musty scent of growing older paper and timeworn glue. Overhead, fluorescent lights flickered with a faint hum, casting uneven shadows throughout rows of metal shelving

Cristin Kearns, a former dentist turned public well being detective, crouched beside a stack of unmarked packing containers. She was deep within the Countway Library at Harvard Medical College, immersed within the archived papers of Dr. Mark Hegsted—a Harvard nutritionist whose work within the Nineteen Sixties had grow to be quietly influential.

She was on a mission to uncover what she suspected was a buried story—one she hoped to convey into the sunshine. The silence was dense, damaged solely by the mushy rustle of her latex-gloved fingers flipping via brittle folders.

She was drained. Her legs ached from hours of looking out. Up to now, most of what she’d uncovered had been mundane—assembly agendas, outdated dietary reviews, dead-end correspondence. Nonetheless, she pressed on. The sugar trade had secrets and techniques. And she or he had come to search out them.

Then she noticed it.

A plain manila folder nestled between finances reviews and scientific abstracts. Faint graphite letters etched throughout its high: “Undertaking 226.”

She hesitated. Her breath caught.

Sliding the folder onto her lap, she gently pried it open. The scent intensified—outdated tobacco, copier ink, one thing virtually metallic. Inside: memos typed on crisp letterhead, margin notes in fountain pen, a ledger entry that learn merely: “$6,500 to Harvard College.”

She learn. Then reread.

The names jumped out at her like ghosts—Mark Hegsted. Fred Stare. The New England Journal of Drugs.

One memo outlined edits to a manuscript earlier than submission. One other inspired emphasizing dietary fats over sugar within the conclusions.

Cristin’s coronary heart pounded. Her mouth went dry.

This wasn’t a tutorial change. This was choreography—a deliberate rewriting of science.

She wasn’t simply holding analysis. She held the pivot level of a public well being story we thought we understood.

What it contained wasn’t only a path of memos and funds. It was a quiet however plain signal that the story of coronary heart illness in America had been nudged, not by new discoveries, however by deliberate affect. It raised a query that also echoes immediately: What occurs when the proof we belief has been curated for us?

Chapter 1: Buried within the Basement

The folder had cracked open a secret. However to grasp its which means, now we have to rewind—practically sixty years again in time—to a second when the science of diet teetered between two futures.

By the mid-Nineteen Sixties, the American public had grown anxious. Coronary heart assaults had been claiming fathers, uncles, and neighbors. An invisible menace was eroding the sense of management that postwar prosperity had promised.

Docs had information, ldl cholesterol measurements, post-mortem reviews, and rising epidemiological maps. However causation remained elusive, and the seek for a unifying principle created a vacuum. And in that vacuum, sure personalities rose.

Ancel Keys didn’t simply fill the void. He dominated it. A towering determine in each mind and can, Keys had the uncommon means to show information into dogma. At conferences, he challenged anybody who dared recommend an alternate rationalization. He was combative, sure—but additionally compelling. His Seven International locations Research provided what many craved: order. A graph right here, a mortality curve there, and all of a sudden all of it made sense: the extra saturated fats a nation ate, the extra coronary heart illness it suffered.

However not everybody purchased it. Behind the headlines and public declarations, the scientific group was removed from unified.

Biochemists had been elevating questions on carbohydrate metabolism. Early metabolic ward research had been starting to indicate that sugar—not fats—might spike triglycerides. Lipidologists debated the position of VLDL and remnant particles. A number of pathologists famous that fatty streaks in arteries didn’t all the time correlate with dietary ldl cholesterol.

After which there was Dr. Pete Ahrens at Rockefeller College, a lipid pioneer who urged warning. “It’s not nearly ldl cholesterol,” he warned. “The physique’s response to totally different macronutrients is complicated, and reductionism could betray us.”

However moderation made for poor headlines.

Throughout the Atlantic, a quieter however no much less rigorous thoughts drew totally different conclusions. Dr. John Yudkin, a British physiologist and nutritionist, had been learning one other ingredient that flooded the postwar food regimen: sugar. He didn’t have Keys’ charisma, nor his political acumen. However he had information—and concern.

In 1972, Yudkin printed Pure, White and Lethal, a startling critique of sugar and its hidden position in illness. He pointed to laboratory research exhibiting sucrose raised triglycerides and promoted insulin resistance. He famous that the rise in sugar consumption tracked not with fats, however with rising coronary heart illness and weight problems charges.

Sugar, he argued, wasn’t simply empty energy. It was a biochemical saboteur.

He was met with a wall of silence. After which, a storm of ridicule.

The dietary debate was now not simply tutorial. It was private. Political. And worthwhile. He was ignored. Or worse, dismissed as fringe.

Behind closed doorways, others took discover—particularly the individuals who had probably the most to lose.

Chapter-2: The Quiet Assembly

The sugar trade had been watching. And when the science started to shift towards them, they didn’t panic. They deliberate.

Someplace behind the boardroom doorways of mid-century Manhattan, the sugar trade determined to not struggle the science, however to information it.

A confidential memo had circulated simply days earlier than, rattling even probably the most assured executives. Findings from college labs within the US and overseas pointed to a brand new perpetrator: sugar. Not fats. Not ldl cholesterol. However refined carbohydrates that spiked triglycerides, raised insulin, and presumably contributed on to atherosclerosis.

Momentum was constructing. On July 11, 1965, the New York Herald Tribune ran a full-page article on new sugar research printed within the Annals of the New York Academy of Sciences. It warned that rising analysis “threatened to tie the entire enterprise [of diet and heart disease] in a knot.” What had as soon as appeared speculative was gaining traction: sugar’s position in coronary heart illness was now not a fringe speculation—it was changing into credible. The trade knew it wanted to behave.

Round a smoky desk, ties loosened and pressure excessive, one government reportedly stated, “It’s only one paper.”

“For now,” got here the reply.

They knew what was at stake: billions of {dollars}, hundreds of jobs, and the rigorously cultivated picture of sugar as harmless and pure.

Then one voice reduce via the haze:
“We don’t must struggle the science. We simply must information it.”

Nobody argued.

The plan was quiet, strategic—not a press launch or an advert marketing campaign, however a scientific intervention. They’d channel their efforts into the journals. Into the very establishments that formed consensus. On the helm was John Hickson, Vice President and Director of Analysis on the Sugar Analysis Basis (SRF)—a elegant operator who understood that shaping science meant shaping perception.

An inventory of potential allies shortly converged on Harvard. On the heart was Dr. Mark Hegsted—well-published, revered, and, as they hoped, receptive. His division chair, Dr. Fred Stare, introduced institutional clout. Along with Dr. Robert McGandy, they agreed to put in writing a two-part literature evaluate for what would quantity to over $50,000 in immediately’s {dollars}.

The funding? Quiet.
The edits? Delicate.
The aim? Crystal clear.

Undertaking 226 was born—a masterstroke of public relations disguised as scholarship. The authors’ tutorial credentials gave the papers monumental weight. However the sugar trade’s position in shaping them would stay totally hidden.

On July 30, 1965, SRF government John Hickson clarified the Basis’s expectations in writing to Hegsted:

“Our explicit curiosity needed to do with that a part of diet wherein there are claims that carbohydrates within the type of sucrose make an inordinate contribution to the metabolic situation, hitherto ascribed to aberrations referred to as fats metabolism. I will probably be disillusioned if this side is drowned out in a cascade of evaluate and normal interpretation.”

Translation: “We’re involved concerning the rising claims that sugar (particularly sucrose) contributes to metabolic issues like coronary heart illness—issues that the general public at the moment blames on fats. We wish to make sure that your article pushes again on these sugar-related claims. Don’t get distracted by broader dialogue. Give attention to defending sugar.”

Hegsted replied with assurance:

“We’re nicely conscious of your explicit curiosity in carbohydrate and can cowl this in addition to we are able to.”

A easy aim: exonerate sugar. Blame fats.

And make it seem like goal science.

The draft could be despatched. The edits would comply with. And shortly, probably the most trusted medical journal in America would carry their message, with no single phrase about who had paid for it.

Chapter 3: A Journal’s Quiet Affect

This was the quiet coronary heart of the technique: to embed the sugar trade’s narrative inside the scientific canon. And there was no higher car than The New England Journal of Drugs (NEJM). Prestigious, influential, and broadly learn by physicians and policymakers alike, it provided legitimacy with a stamp of neutrality.

A two-part evaluate article titled Dietary Fat, Carbohydrates and Atherosclerotic Vascular Illness appeared in The NEJM in 1967, printed one week aside—on July 27 and August 3.

The evaluate, co-authored by Dr. Mark Hegsted, Dr. Robert McGandy, and Dr. Fred Stare, did exactly what the SRF had paid for. It wasn’t a smear marketing campaign towards rising science on sugar. That will’ve drawn consideration. As a substitute, it was a masterpiece of omission and emphasis.

Written with tutorial restraint and layered in cautious prose, each installments bore all of the markings of neutral science. There was no disclosure of funding from the SRF; on the time, such declarations weren’t required.

Research linking sugar to elevated triglycerides had been downplayed or discredited. The evaluate emphasised dietary fats and ldl cholesterol as the primary culprits in coronary coronary heart illness, casting doubt on different hypotheses with out showing overtly biased.

One of many opinions acknowledged flatly: “The foremost proof immediately suggests just one avenue by which food regimen could have an effect on the event of atherosclerosis. That is by influencing the focus and the composition of serum lipids.” It continued, “The sensible dietary modifications which might be most likely most helpful in lowering the incidence of atherosclerosis are these which scale back the consumption of saturated fats, ldl cholesterol, and complete energy.”

Carbohydrates had been talked about, however their position was dismissed: “There could be little doubt that serum levels of cholesterol could be considerably modified by the food regimen. The impact of dietary carbohydrate on serum ldl cholesterol is minimal…”

For a lot of within the diet science group, the article turned a keystone. It nudged unsure researchers towards the fats speculation and away from carbohydrate critique.

Whereas Robert McGandy was listed first on each articles—usually a marker of lead authorship—it was Hegsted who corresponded with the SRF, formed the evaluate’s framing, and later turned a central determine in US dietary coverage. The paper bore three names, however just one would grow to be its lasting image.

However the publication timeline could increase some questions. Hickson’s memo to Hegsted was despatched in July 1965, but the articles didn’t seem till mid-1967. Whereas such delays weren’t uncommon in tutorial publishing, the correspondence suggests the SRF remained engaged throughout the evaluate course of. Drafts seem to have been reviewed and mentioned with enter from the inspiration. Whether or not the delay was purely logistical or partly strategic is unclear, however the consequence was rigorously calibrated. Correspondence reveals that drafts had been reviewed and edited for tone and emphasis.

Younger scientists realized shortly: sugar didn’t get funded. Sugar didn’t get printed. Sugar didn’t get applause.

A quiet orthodoxy shaped—not declared, however enforced. At its heart was a evaluate article that by no means acknowledged its true writer.

However that evaluate didn’t simply sit on a shelf. It started to maneuver—in newspapers, boardrooms, and finally, into the bloodstream of public coverage itself.

Chapter 4: The Ripple Results

Inside weeks of its launch, wire‑service bulletins and syndicated columns echoed the Harvard authors’ conclusions. Whereas no headlines stated it outright, the message was unmistakable: fats was the perpetrator, and sugar was off the hook.

Morning speak reveals invited diet consultants who amplified the evaluate’s reassuring tone. The American public, already cautious of ldl cholesterol, took observe—and so did meals entrepreneurs. Cereal adverts boasted “no fats, no ldl cholesterol” whereas packing spoonfuls of sugar; sweet makers ran copy that learn: “Fast power—with out the artery‑clogging grease.”

Skilled societies adopted the shifting tide. The American Coronary heart Affiliation’s 1970 dietary suggestions, citing the rising consensus, urged Individuals to restrict complete and saturated fats. Sugar was talked about solely in passing, as an non-compulsory calorie-reducer for these involved about their weight. By 1974, an AMA Council report used the NEJM evaluate to argue there was “inadequate proof” that sucrose posed a cardiovascular menace.

The pivot reached Capitol Hill in 1977, when Senator George McGovern’s Choose Committee issued “Dietary Targets for the US.” Saturated fats targets had been entrance‑and‑heart; sugar discount was additionally suggested, however press protection framed the report virtually totally as a mandate to eat much less fats. The committee’s chief scientific adviser later admitted that the Harvard evaluate—and the status it carried—had weighed closely of their deliberations.

Three years later, the primary USDA Dietary Tips for Individuals (1980) codified the message: “Keep away from an excessive amount of fats, saturated fats, and ldl cholesterol.” Sugar merited a softer directive: “Use solely moderately.” Meals producers responded with an avalanche of “fats‑free” merchandise sweetened to the hilt. Gross sales soared whereas nationwide per‑capita sugar consumption climbed.

In impact, a single, undisclosed trade‑funded article had migrated from the pages of an elite medical journal into the grocery cart of practically each American family—and from there into federal coverage.

We’ll by no means totally know the extent to which these articles influenced particular person selections, medical recommendation, or the course of public coverage. However their impression wasn’t restricted to the US. The identical narrative quickly formed official tips and advertising campaigns in Europe, Australia, Canada, and different areas, influencing meals labeling, well being training, and medical curricula worldwide.

The metabolic penalties would take many years to measure, however the narrative was set: fats was the villain, and sugar wore a cloak of innocence.

Chapter 5: Doubt by Design

Whereas the general public was studying to concern fats and embrace “heart-healthy” low-fat meals, one voice saved calling out from the margins—softly at first, then extra urgently, till it was finally ignored.

That voice belonged to John Yudkin. By the early Nineteen Seventies, he had grow to be a vocal critic of refined sugar’s position in coronary heart illness and diabetes. However his considerations—although scientifically grounded—had been more and more dismissed as excessive. His funding disappeared. Talking invites dried up. Colleagues distanced themselves.

Yudkin was not alone. A broader scientific dialogue was unfolding round sugar’s metabolic impression. Early metabolic ward research, lipid analysis, and pathophysiological information had been beginning to problem the dominant narrative. However shifting the tide of consensus was not only a scientific matter—it was political.

The Sugar Affiliation responded with strategic readability. It didn’t must disprove each critique. It wanted to form the message.

Within the mid-Nineteen Seventies, the Affiliation launched the “Sugar within the Food regimen of Man” marketing campaign. Commercials promoted sugar as a dietary help, claiming that sweet or a mushy drink earlier than meals might really assist scale back urge for food and caloric consumption. One advert learn: “The sugar in a mushy drink now can save me lots of energy later.” One other: “Snack on some sweet about an hour earlier than lunch.”

This was greater than spin. Based on Cristin Kearns and colleagues, the marketing campaign influenced how regulatory our bodies, together with the FDA, perceived the security of sugar within the Nineteen Seventies. By emphasizing life-style and urge for food management, the marketing campaign reframed sugar as an answer, not an issue.

However messaging was just one entrance. Internally, the SRF was pursuing a extra calculated technique. Memos from government John Hickson outlined a plan to form not solely public opinion however the scientific document. He really useful commissioning opinion polls, organizing a symposium to problem critics earlier than their friends, and funding analysis on coronary coronary heart illness to copy and revise research that implicated sugar as an element. “Then we are able to publish the info,” Hickson wrote, “and refute our detractors.”

The tactic wasn’t denial. It was doubt. Deliberate, disciplined, and designed.

This echoed the tobacco trade’s technique.

As one sugar government later admitted: “Doubt is our product too.”

Even American scientists like George Mann, who as soon as referred to as the dietary fats speculation “the best scientific deception of this century,” confronted obstacles. Publication turned tougher. Funding scarcer. Controversy unwelcome.

Whether or not knowingly or not, universities, journals, and foundations contributed to an expert local weather that discouraged dissent. The consequence was not outright censorship, however a form of institutional gravity that pulled inquiry in safer instructions.

In time, sugar’s critics had been marginalized not by argument, however by attrition.

Nonetheless, reality has a method of resurfacing—particularly when somebody opens the incorrect field.

Chapter 6: The File That Modified the Previous

Half a century later, within the dim basement of an archive, the proof resurfaced. And the story, lengthy buried, started to unravel.

Cristin Kearns knew what she had discovered. However she additionally knew how troublesome it will be to inform the story.

Along with UCSF colleagues Laura Schmidt and Stanton Glantz, she pieced collectively the path: inner SRF paperwork, fee receipts, correspondence with Harvard school, and editorial options that had been by no means disclosed.

In 2016, their findings had been printed in JAMA Inner Drugs. The researchers examined over 340 paperwork—spanning 1,582 pages—detailing correspondence between the sugar trade and two key figures: Roger Adams, a professor of natural chemistry who served on trade advisory boards; and D. Mark Hegsted, one of many Harvard scientists behind the pivotal 1967 literature evaluate.

It was a revelation—not simply of an outdated scandal, however of the fragility of science when cash speaks louder than proof.

“Because the saying goes, he who pays the piper calls the tune,” remarked Stanton Glantz, senior writer of the JAMA Inner Drugs paper. The paper path made one factor clear: this wasn’t passive sponsorship. It was strategic authorship, with the sugar trade choosing the music, setting the tempo, and quietly conducting from behind the scenes.

Kearns didn’t simply uncover a paper path—she revealed a fracture in the very basis of how we perceive food regimen and illness. The 1967 NEJM evaluate article, funded via Undertaking 226, not solely influenced public coverage; it additionally diverted scientific consideration away from key organic mechanisms now central to cardiometabolic well being.

Take triglycerides, for instance—blood fat lengthy identified to rise in response to excessive sugar consumption. Or hepatic de novo lipogenesis—the liver’s conversion of extra fructose into fats, which can drive non-alcoholic fatty liver illness and atherogenic dyslipidemia.

Even in the Nineteen Sixties, researchers started to piece collectively how refined carbohydrates, significantly sucrose, might disrupt lipid metabolism and contribute to the event of insulin resistance. These weren’t fringe concepts. They had been biologically believable, clinically related, and more and more inconvenient. Undertaking 226 helped suppress them, not via censorship, however via omission, emphasis, and redirection. And that redirection reshaped not solely scientific journals but additionally federal coverage and public belief.

Undertaking 226 had labored. And for 50 years, nobody had identified.

The Sugar Affiliation issued a rigorously worded assertion in response to Kearns’ JAMA publication. Whereas it acknowledged that it “ought to have exercised higher transparency in all of its analysis actions,” it emphasised that funding disclosures weren’t customary on the time. The group additionally pushed again towards the research’s implications, criticizing what it referred to as Kearns’ “continued makes an attempt to reframe historic occurrences” to align with “present public sentiment towards sugar.”

The stress mirrored a broader dilemma: how ought to we choose previous trade affect by immediately’s requirements?

The Sugar Affiliation additionally expressed concern concerning the “rising use of headline-baiting articles to trump high quality scientific analysis – we’re disillusioned to see a journal of JAMA’s stature drawn into this pattern.”

Chapter 7: The Lengthy Echo

What occurred in 1967 didn’t keep in 1967.

Unearthing the reality in 2016—practically half a century later—could have come too late to cease the momentum. As a result of by then, the results had already rippled outward, shaping many years of dietary steerage, scientific consensus, and cultural perception.

To make sure, the sector of diet science has undergone vital evolution. We now perceive that not all fat are created equal, that triglycerides and insulin resistance matter, and that refined carbohydrates are removed from innocent. Nonetheless, early distortions, particularly when amplified by establishments, can reverberate for generations, influencing how tips are written, how medical doctors are skilled, and the way sufferers understand threat.

The evaluate printed in The NEJM in 1967 didn’t simply affect policymakers. It helped tip the scales of public notion. Fats turned the enemy. Grocery store aisles crammed with low-fat, “heart-healthy” alternate options—lots of them brimming with added sugar. Yogurts, salad dressings, and breakfast cereals had been reformulated to comply with the brand new gospel.

By the Nineteen Eighties, the unintended penalties had been changing into more and more obvious. A technology that adopted the principles—buying and selling butter for margarine, eggs for cereal—discovered itself within the crosshairs of rising weight problems, insulin resistance, and sort 2 diabetes. The pendulum had swung, however not essentially in the fitting course.

And but, to say it was all incorrect could be simply as deceptive.

There may be proof that efforts to scale back saturated fats consumption have led to vital decreases in serum ldl cholesterol in lots of populations, and will have contributed to the decline in coronary coronary heart illness mortality noticed in a number of nations starting within the Nineteen Seventies and Nineteen Eighties. Public well being interventions don’t occur in isolation, and diet is just not a zero-sum recreation. The story is extra complicated than heroes and villains.

What’s tougher to quantify is the cultural and institutional momentum that adopted. The evaluate article didn’t simply contribute to scientific debate—it helped crystallize a story that formed dietary tips, meals insurance policies, and scientific messaging for many years. College lunches. The meals pyramid. Airline meals. Medical coaching. All, not directly, bore the imprint of that foundational shift.

We could by no means know exactly how highly effective the ripple impact of the NEJM articles was. However we do know this: when trade influences the framing of science, the dangers go far past a single conclusion. They reverberate within the questions that aren’t requested, within the silence round rising proof, and within the gradual erosion of public belief.

Epilogue: Aftertaste

Wanting again from the vantage level of recent drugs, one factor is evident: Undertaking 226 wasn’t nearly sugar—it was about how scientific narratives are constructed.

Cristin Kearns didn’t merely uncover a funding relationship. She uncovered a deliberate effort to form scientific consensus at a vital juncture within the historical past of diet. Her discovery reminds us that the boundary between affect and manipulation is skinny, and that even delicate shifts in emphasis can form coverage, training, and private well being choices for generations.

To be honest, trade funding doesn’t robotically discredit scientific work. Many vital advances have resulted from public-private partnerships. However when vested pursuits dictate which questions get requested—or how inconvenient findings are framed—the integrity of science is in danger.

As a result of if medical reality is formed in quiet rooms, behind grant proposals and editorial choices, then it’s our job, not simply as physicians however as residents, to ask who’s within the room. And why.

The legacy of The Sugar Papers isn’t simply prior to now. It’s within the reminder that scientific credibility should be earned, protected, and continually re-examined.

Not only for the sake of historical past. However for the individuals who stay with its penalties.

Whereas this text is grounded in verified paperwork, printed analysis, and credible reporting, sure scenes—akin to personal conversations or atmospheres—have been creatively reconstructed to reinforce narrative stream. These dramatizations purpose to convey historic occasions to life with out compromising factual integrity.

Elements of this text had been developed with the help of ChatGPT, a big language mannequin by OpenAI. The writer guided and edited all content material to make sure historic accuracy, narrative integrity, and medical relevance.