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I haven’t posted an industry-funded study for a while, but here’s a good one.  This is a systematic review published in the Annals of Internal Medicine attacking dietary advice to eat less sugar on the grounds that such advice is not scientifically justified.

This one doesn’t pass the laugh test.

What are dietary guidelines supposed to do?  Tell people to eat more sugar?

This review is particularly peculiar:

• It was funded by the International Life Sciences Institute (ILSI), a food-industry front group.
• Two of the four authors consult for ILSI, and one of the two is on the scientific advisory board of Tate & Lyle, the British sugar company.
• The authors admit that “given our funding source, our study team has a financial conflict of interest and readers should consider our results carefully.”  No kidding.
• It was published by a prestigious medical journal.  Why?
• It is accompanied by an editorial that thoroughly demolishes every single one of the authors’ arguments.

I can understand why ILSI wanted this review.  Many of its funders make sugary foods and drinks.  They would like to:

• Cast doubt on the vast amounts of research linking excessive sugar intake to poor health.
• Discredit dietary guidelines aimed at reducing sugar consumption.
• Head off regulatory attempts to tax or label added sugars.

In funding this study, ILSI is following the tobacco industry playbook to the letter.  Strategy #1 is to cast doubt on the science.

When the 2015 Dietary Guidelines came out with a recommendation to restrict sugar intake to 10% of calories or less, the Sugar Association called it“agenda-based, not science-based.”  The Annals review says international sugar guidelines do not “meet criteria for trustworthy recommendations and are based on low-quality evidence.”

I detect a theme here.

But I ask again: what are dietary guidelines supposed to do?  We cannot lock up large numbers of people and feed them controlled amounts of sugar for decades and see what happens.  Short of that, we have to do the best we can with observational and intervention studies, none of which can ever meet rigorous standards for proof.  So this review is stating the obvious.

Take a look at the accompanying editorial.  After destroying each of the flawed premises of this review, it concludes:

Industry documents show that the F&B [Food & Beverage] industry has manipulated research on sugars for public relations purposes….Accordingly, high quality journals could refrain from publishing studies on health effects of added sugars funded by entities with commercial interests in the outcome. In summary, our concerns about the funding source and methods of the current review preclude us from accepting its conclusion that recommendations to limit added sugar consumption to less than 10% of calories are not trustworthy. Policymakers, when confronted with claims that sugar guidelines are based on “junk science,” should consider whether “junk food” was the source.

I don’t ever remember seeing a paper accompanied by an invited editorial that trashes it, as this one did, but this incident suggests a useful caution.

Whenever you hear that something isn’t “science-based,” look carefully to see who is paying for it.

The press coverage

• The New York Times: A Food Industry Study Tries to Discredit Advice About Sugar (I’m quoted)
• NPR: How Much Is Too Much? New Study Casts Doubts On Sugar Guidelines (I’m quoted)
• EurekAlert: Dietary sugar guidelines are based on low quality evidence
• WTKR:The debate continues on how much sugar is OK
• Time: Should You Trust the New Research About Sugar?
• CSPI: Industry-funded Study Designed to Cast Doubt on Sugar Advice
• Daily Mail (Reuters): So we CAN eat more sugar? Controversy as top journal publishes Coca Cola-funded study claiming sweets are NOT as bad as feds claim (I’m quoted)

Marcus Strom of the Sydney Morning Herald in Australia did a follow up to my post, “I’ve been WikiLeaked!”

Recall that a Coca-Cola representative took notes at a talk I gave in Australia and passed them up the chain of command where they got hacked as collateral damage from the ones obtained from Hillary Clinton’s campaign manager, John Podesta.

The notes advised ongoing monitoring of my activities in Australia but also of research conducted by Dr. Lisa Bero, in whose group I was working for a couple of months early this year.

The article begins: 

Coca-Cola has been exposed having a secret plan to monitor research at Sydney University that examines how private companies influence public health outcomes in areas such as obesity.

In a leaked internal email, a paid consultant to Coca-Cola South Pacific writes that a “key action” for the global soft-drinks manufacturer is to “monitor research project outcomes through CPC [Charles Perkins Centre] linked to Lisa Bero’s projects”.

Future monitoring should include planned research on “treatment and prevention of obesity, diabetes and cardiovascular disease”, the email says.
Professor Bero, who works at the university’s Charles Perkins Centre, studies the integrity of industry-sponsored research and how it is used to influence public policy. While in the US, she worked to expose the influence of tobacco companies on health debates. Those methods are now being used to examine how companies like Coke seek to influence public health outcomes.

The reaction: See letters printed in response (you have to scroll way down to find them)

Roberto Mercadé, President of Coca-Cola South Pacific, wrote to object that Coke is not secretly monitoring academics; its monitoring is entirely public:

Readers of the article “Revealed: Coke’s plan to monitor academic” (Herald, October 22-23) may have been left with the impression that Coca-Cola South Pacific somehow engages in the “secret” monitoring of academics at the University of Sydney. Put simply, we don’t. We make no secret of the fact that we keep abreast of research in the health and wellbeing sector, as you would expect of any food or beverage company. The important work being done by the university on the integrity of industry-sponsored research is among the many fields important to us. Finally, in the article the word “monitor” was also used out of context and distorted to mean something other than what it is – our ongoing engagement with academics and experts in health and wellbeing.

Steve Harrison, Balmain

It’s no great surprise that Coca Cola is panicked by research into the cause of diabetes. The consumption of sugar and processed foods looks more and more like a major reason for diabetes, many cancers and other serious diseases. In turn, the company, the food industry and drug companies will all be in big financial trouble when the penny drops that a diet of fresh food is the basis for good health.

If a fraction of the money spent on seeking cures was used to educate people to cut processed food and sugar from their diet we would be a much healthier society. We went through a very similar process with Big Tobacco some years ago, although that was on a smaller scale.

In the words of Hippocrates: “Let food be thy medicine and medicine be thy food.”

Ivan Head, Camperdown

The score? Coke, Zero: Professor Bero, one.

The World Health Organization took two actions yesterday to encourage people to cut down on consumption of sugar-sweetened beverages.

It issued a report urging national governments to consider taxes: “Taxes on sugary drinks: Why do it?  

Governments can take a number of actions to improve availability and access to healthy foods and have a positive influence on the food people choose to consume. A major action for comprehensive programmes aimed at reducing consumption of sugars is taxation of sugary drinks. Just as taxing tobacco helps to reduce tobacco use, taxing sugary drinks can help reduce consumption of sugars.

It defines sugar drinks as products that contain added sugar, corn or fruit-juice concentrates and include carbonates, fruit drinks, sports drinks, energy and vitamin water drinks, sweetened iced tea, and lemonade.

It also took immediate action to remove sugary drinks from its Geneva headquarters

The agency explained this action:

The move signifies how seriously WHO is taking its leadership role in implementing policies to improve public health…By implementing this policy WHO is setting a positive example for Member States, other organizations and visitors…WHO vending machines, restaurants and coffee shops will continue to sell water, fizzy water, and unflavoured milks with different fat contents, teas and coffees, and beverages with non-sugar sweeteners (such as diet and zero calorie drinks). Sugar packets for use with tea and coffee will continue to be served.

These actions are getting plenty of attention.

The Guardian pointed out that:

Battle lines are being drawn in Colombia, where a consumer movement is pressing the case for a sugary drinks tax and the industry is fighting back…Last month, the Asociación Educar Consumidores – the consumer organisation which, like its Mexican equivalent, has backing from Bloomberg Philanthropies in the US – produced an educational video to be broadcast on television, warning that drinking too many sugary drinks can lead to diabetes and other diseases.

But after a complaint from Postobón, the Colombian beverage giant, the government’s regulatory agency charged with consumer protection banned any showing of the video on TV, saying it was inaccurate and could confuse the public.

Michael Bloomberg, now a global ambassador for WHO issued a statement.

A growing number of cities and countries – including Mexico – are showing that taxes on sugary drinks are effective at driving down consumption. The World Health Organization report released today can help these effective policies spread to more places around the world, and that will help save many lives.

The International Council of Beverages Associations (ICBA) issued a statement:

ICBA is disappointed that this technical committee’s report advocates the discriminatory taxation solely of certain beverages as a ‘solution’ to the very real and complex challenge of obesity. We strongly disagree with the committee’s recommendation to tax beverages, as it is an unproven idea that has not been shown to improve public health based on global experiences to date.

Healthy Food America says the soda industry has spent $30 million to fight soda taxes, just this year.

WHO has just given its blessing to soda taxes.  Will countries respond?  How much more is the soda industry willing to spend to stop taxes?

Stay tuned.

Other accounts:

• Time Magazine
• Reuters
• NPR
• Los Angeles Times
• Christian Science Monitor
• BBC

Let’s start with the USDA’s latest figures on SNAP participation.  Enrollment is down by a couple of million which could be good news (people have jobs that pay enough to make them ineligible) or bad news (elibility runs out).

The USDA issued a report in 2001 explaining the reasons.

As the report explains:

The large decrease in the number of food stamp participants is due to both a decrease in the number eligible for food stamps and a decrease in the rate at which eligible persons participate. The decrease in the participation rate played a slightly more important role, explaining 56 percent of the fall in the number of participants. The decrease in the number of eligible persons explains 44 percent of the fall in the number of participants.

Next, let’s look at the article in the New York Times on attempts to improve the quality of foods that can be purchased with SNAP benefits.

There have been many, many, many calls for the food stamp program to promote more healthful diets. Many states have requested waivers allowing for restrictions on what benefits can buy (some items, like alcohol, tobacco and household supplies, are already prohibited). Further restrictions have been rejected by the Department of Agriculture, which administers this welfare program.

The article is based on a study trying incentives for buying fruits and vegetables, restrictions on junk foods, and a combination of both.   The study concluded:

A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants compared with a program that does not include incentives or restrictions.

the study was accompanied by an editorial calling for a trial of mixed incentives and restrictions.

But, as Daniel Bowman Simon tells me, the law only allows the USDA to do incentives.  By law, it cannot do additional exclusions.  This is because Congress says what retailers can and cannot sell to SNAP recipients:

As written in 7 U.S. Code § 2012, section (k)

“Food” means (1) any food or food product for home consumption except alcoholic beverages, tobacco, hot foods or hot food products ready for immediate consumption….

It looks to me as though excluding soft drinks, for example, would require Congress—not the USDA—to change this definition or let states do so.

Daniel wonders why USDA doesn’t make this clear.  Me too.

I’m told that three states have requested waivers and that the USDA is considering them.  How?  I don’t know, but stay tuned.

NOTE:  Several readers filed corrections on this post and I thank them.  I have revised it accordingly.

My book, Soda Politics, came out not quite a year ago but so much has happened since then that it’s been hard to keep up with everything that’s happening in campaigns to discourage consumption of sugar-sweetened beverages.

Fortunately, Healthy Food America’s Casey Hinds puts out a daily roundup of sugar and soda news (you can sign up for it and HFA’s other materials here).

A few recent items of particular interest:

USA Today’s editorial, “soda taxes fall flat“

More effective ways already are being used to change people’s diets. The best use of government authority is to empower people with the information they need to make healthier choices.

The editorial comes with a poll, still up.  You can vote on it here.  At this moment only 183 votes have come in, 51% strongly in favor of the editorial opinion.

Jim Krieger of Healthy Food America did a counterpoint

The time has come to tax sugary drinks like we tax tobacco. The analogy is powerful: As with tobacco, rock-solid evidence shows habitual use harms health. Sugary drinks are a prime culprit in rampant health problems — diabetes, obesity, and heart, dental and liver disease – that cut lives short and drive up health care costs.  Tobacco taxes have reduced smoking, while raising money to make lives better. Taxing sugary drinks would do the same

This too has a poll on which you can still vote.  Only 92 votes have come in, and only 38% strongly agree.

Americans don’t like taxes.  Even so, either this issue doesn’t generate much interest or it’s just August and too hot to think about such things.

The beverage industry spent $10.6 million to oppose Philadelphia’s soda tax initiative

The soft drink industry does not like taxes and seems willing to put fortunes into opposing them.

The Philadelphia City Council passed the tax anyway.  I keep thinking of all the good things nearly $11 million could do for public health.

Melbourne’s The Alfred Hospital reduces sugary drink consumption

The hospital did an experiment to see if they could shift the mix of drinks purchased from sugary to less sugary.  They did this by increasing the price of sugary drinks and hiding them under counters.  Sales of sugar-sweetened beverages sales fell by 36,500 drinks in a year.

I don’t get it.  Why not just stop selling them altogether?

That’s it for this August Monday.  Stay cool.  More to come.

Addition, August 23

A reader from New Zealand writes to say that “all of its hospitals no longer sell sugary sodas and some are also beginning to remove juice and artificially sweetened beverages due to their acidic nature and detrimental impact on oral health.”

I’m in Mexico City doing talks for El Poder del Consumidor, the advocacy group in part responsible for Mexico’s soda tax.  I had some time to be a tourist yesterday afternoon and got to see the Diego Rivera murals at the Palacio Nacional.

These are enormous, and stunning.  They deal with the history of Mexico in conflict and in peace.  Look closely, and you see Rivera’s deep respect for Mexico’s traditional food culture.

Along the corridor flanking the main mural, for example, is a painting above a plaque listing what the world owes Mexico—corn, obviously—but also beans, tobacco (oops), chocolate, hemp, and tomatoes.

Other panels also deal with corn—in this one, production.

Another shows how corn is used.

The corner panel at the end of the corridor is devoted to chocolate.

Along the way, quieter panels display the harvest of fruits and vegetables.

Leave the Palacio, cross the Zócolo, and you come to the Coca-Cola bar and toy store.

A brief look at Mexico’s food culture, then and now.

When the New York Times published an article describing Coca-Cola’s financial sponsorship of university researchers who de-emphasize the role of sugary drinks in raising the risk of obesity and type 2 diabetes, it kicked up a storm.

USA Today’s editorial board said:

It isn’t that companies pay scientists to put out false research. It’s that companies fund the work of scientists who happen to be doing research that spurs consumers to look away from science that hurts corporate interests.

Soft drinks are far less dangerous than cigarettes, but GEBN’s website, tweets and videos come right out of Big Tobacco’s playbook, brought into the digital era. Its leaders have done research in the past under about $3 million in grants given to their universities.

USA Today also printed a response by a Coca-Cola spokesman:

A recent New York Times article created confusion about our support of research and non-profit organizations, stating we want people to think that only exercise matters and not diet — but nothing could be further from the truth. We have always operated under the fact that a healthy, balanced diet and regular exercise are key ingredients for a healthy lifestyle.

That said, we need to do a better job of being even more transparent about the research we fund, the non-profit organizations we support and the way we publicly share this information. And we will.

Yesterday, Senator Richard Blumenthal sent letters to the University of Colorado, West Virginia University, and the University of South Carolina urging them to  clarify the nature of the University’s relationship with projects funded by Coca-Cola and to review the academic integrity of such grant agreements.

I believe your university must determine whether this research is in effect promoting a predisposed and biased agenda, rather than reflecting the impartiality and objectively (sic) expected from a public academic institution.

Years of litigation with tobacco companies were necessary to fully expose the tragic public health consequences when companies lie about the hazards of the products they sell.  I am deeply concerned that we may force future generations to relive this history if corporate-sponsored studies devoid of scientific integrity are permitted once again to deceptively downplay and conceal the dangers of a product consumed on a mass scale.

Do not underestimate Senator Blumenthal’s ability to deal with food companies.  He, you may recall, was responsible for withdrawal in 2009 of the ill-conceived Smart Choices program during his stint as Connecticut’s attorney general.

I’m still waiting for the Global Calorie Balance Network to issue its promised statement.  Stay tuned.