www.sciencemag.org/content/359/6377/747/suppl/DC1

Supplementary Material for

Was there ever really a “sugar conspiracy”?

David Merritt Johns* and Gerald M. Oppenheimer

*Corresponding author. Email: dmj2119@columbia.edu

Published 16 February 2018, Science 359, 747 (2017)

DOI: 10.1126/science.aaq1618

This PDF file includes:

Supplementary Text

References

1

SUPPLEMENTARY MATERIAL

D. M. Johns, G. M. Oppenheimer, Was there ever really a “sugar conspiracy”?

Science 359, 747-750 (2018).

In this supplementary material we extract passages from the main article text, indicating

the page number on which the quoted sections appeared, and provide additional context

and documentary evidence used in shaping our historical narrative and conclusions. This

supplementary material also includes all of the references cited in the main text.

p. 747 “meddled in science”: Prominent works in this literature include:

• R. N. Proctor, Cancer Wars: How Politics Shapes What We Know and Don't

Know About Cancer (Basic Books, New York, NY, 1995).

• S. A. Glantz, L. A. Bero, J. Slade, P. Hanauer, D. E. Barnes, Eds., The Cigarette

Papers (University of California Press, Berkeley, CA, 1998).

• G. Markowitz, D. Rosner, Deceit and Denial: The Deadly Politics of Industrial

Pollution (University of California Press, Berkeley, CA, 2002).

• D. Michaels, Doubt is Their Product: How Industry's Assault on Science

Threatens Your Health (Oxford University Press, New York, NY, 2008).

• N. Oreskes, E. M. Conway, Merchants of Doubt: How a handful of scientists

obscured the truth on issues from tobacco smoke to global warming (Bloomsbury

Press, New York, NY, 2010).

p. 747 “obscure genuine uncertainty that surrounds aspects of research”: Marion Nestle

has stated that she still is not convinced by those who argue “sugar is poison” (Bailey

2016). In 2016, the prominent science journalist Gary Taubes, author of The Case

Against Sugar, acknowledged that, “it cannot be established definitively, with the science

as it now stands, that sugar is uniquely harmful—a toxin that does its damage over

decades.” He underscored that the evidence is “not as clear with sugar as it is with

tobacco” (Taubes 2016).

Claims that the activities of the sugar industry should be compared to those of the

tobacco industry have tended to look past this important difference. See also recent

debates over the evidence relating sugar and health (and assertions that the food industry

is distorting the science), as well as discussions of the contested evidence base on dietary

approaches to weight loss (Freedhoff and Hall 2016).

• M. Bailey, STAT, 12 September 2016; www.statnews.com/2016/09/12/sugar-

industry-harvard-research/

• G. Taubes, The Case Against Sugar (Alfred A. Knopf, New York, NY, 2016), p.

23.

• J. Erickson, B. Sadeghirad, L. Lytvyn, J. Slavin, B. C. Johnston, The scientific

basis of guideline recommendations on sugar intake: a systematic review. Ann.

Intern. Med. 166, 257-267 (2017).

2

• D. Schillinger, C. Kearns, Guidelines to limit added sugar intake: junk science or

junk food? Ann. Intern. Med. 166, 305-306 (2017).

• N. Teicholz, The Atlantic, 17 January 2017;

www.theatlantic.com/health/archive/2017/01/the-limits-of-sugar-

guidelines/512045/

• Y. Freedhoff, K. D. Hall, Weight loss diet studies: we need help not hype. Lancet

388, 849-851 (2016).

p. 747 “rise of obesity … intended ends”:

• M. O’Neill, The New York Times, 8 February 1995;

www.nytimes.com/1995/02/08/us/so-it-may-be-true-after-all-eating-pasta-makes-

you-fat.html

• M. B. Katan, S. M. Grundy, W. C. Willett, Should a low-fat, high-carbohydrate

diet be recommended for everyone? Beyond low-fat diets. N. Engl. J. Med. 337,

563-567 (1997).

• G. Taubes, As Obesity Rates Rise, Experts Struggle to Explain Why. Science 280,

1367-1368 (1998).

• U.S. Department of Health and Human Services, “The Surgeon General’s call to

action to prevent and decrease overweight and obesity” (U.S. G.P.O.,

Washington, D.C., 2001).

p. 747 “healthy fats … added sugars”:

• J. E. Brody, The New York Times, 25 May 1999;

http://www.nytimes.com/1999/05/25/health/weight-loss-report-new-look-at-

dieting-fat-can-be-a-friend.html

• G.M. Reaven, Syndrome X: Overcoming the Silent Killer That Can Give You

a Heart Attack (Simon & Schuster, New York, NY, 2000).

• F. B. Hu, J. E. Manson, W. C. Willett, Types of dietary fat and risk of

coronary heart disease: a critical review. J. Am. Coll. Nutr. 20, 5-19 (2001).

• W. C. Willett, Eat, Drink, and Be Healthy: The Harvard Medical School

Guide to Healthy Eating (Simon & Schuster, New York, NY, 2001).

• D. S. Ludwig, K. E. Peterson, S. L. Gortmaker, Relation between

consumption of sugar-sweetened drinks and childhood obesity: a prospective,

observational analysis. Lancet 357, 505-508 (2001).

• B. V. Howard, J. Wylie-Rosett, Sugar and cardiovascular disease: A statement

for healthcare professionals from the Committee on Nutrition of the Council

on Nutrition, Physical Activity, and Metabolism of the American Heart

Association. Circulation 106, 523-527 (2002).

• S. P. Murphy, R. K. Johnson, The scientific basis of recent US guidance on

sugars intake. Am. J. Clin. Nutr. 78 (suppl.) 827S-833S (2003).

p. 747 “critical new accounts”: See, for example:

• G. Taubes, The soft science of dietary fat. Science 291, 2536-2545 (2001).

3

• G. Taubes, The New York Times Magazine, 7 July 2002;

http://www.nytimes.com/2002/07/07/magazine/what-if-it-s-all-been-a-big-fat-

lie.html

• G. Taubes, Good Calories, Bad Calories: Challenging the Conventional Wisdom

on Diet, Weight Control, and Disease (Alfred A. Knopf, New York, NY, 2007).

• H. Levenstein, “Lipophobia” in Fear of Food: A History of Why We Worry About

What We Eat (University of Chicago Press, Chicago, IL, 2012), pp. 125-159.

• N. Teicholz, The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a

Healthy Diet (Simon & Schuster, New York, NY, 2014).

• R. Smith, Are some diets “mass murder”? BMJ 349 g7654 (2014).

• N. Teicholz, The New York Times, 20 February 2015;

www.nytimes.com/2015/02/21/opinion/when-the-government-tells-you-what-to-

eat.html

• S. E. Nissen, US Dietary Guidelines: an evidence-free zone. Ann. Intern. Med.

164, 558-559 (2016).

• D. S. Ludwig, Lowering the bar on the low-fat diet. JAMA 316, 2087-2088

(2016).

p. 747 “preached in the wilderness”:

• R. H. Lustig, “Prophecy and Propaganda: Introduction to the 2012 edition” in

Pure, White, and Deadly: How Sugar is Killing Us and What We Can Do to Stop

It, J. Yudkin (Penguin, New York, NY, 2013), p. 12.

p. 747 “sugar conspiracy”:

• I. Leslie, The Guardian, 7 April 2016;

www.theguardian.com/society/2016/apr/07/the-sugar-conspiracy-robert-lustig-

john-yudkin

p. 747 “builds upon this revisionist foundation”: Pacific Standard magazine published a

detailed account of the origins of this new historical research on the sugar industry (Diep

2016). See also the documentary, Sugar Coated.

• F. Diep, Pacific Standard, 18 January 2016; www.psmag.com/social-justice/the-

former-dentist-uncovering-sugars-rotten-secrets

• Sugar Coated. 2015. Directed by Michèle Hozer, The Cutting Factory.

p. 747 “downplaying the evidence linking sugar and coronary heart disease”:

• C. E. Kearns, L. A. Schmidt, S. A. Glantz, Sugar industry and coronary heart

disease research: a historical analysis of internal industry documents. JAMA

Intern. Med. 176, 1680-1685 (2016).

p. 747 “By the 1960s, two prominent physiologists…”: Works cited for this historical

framing are:

4

• G. Taubes, Good Calories, Bad Calories: Challenging the Conventional Wisdom

on Diet, Weight Control, and Disease (Alfred A. Knopf, New York, NY, 2007).

• N. Teicholz, The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a

Healthy Diet (Simon & Schuster, New York, NY, 2014).

p. 747 “paid off”:

• V. Colliver, San Francisco Chronicle, 12 September 2016;

http://www.sfgate.com/business/article/UCSF-led-study-details-sugar-industry-s-

attempt-9218509.php

p. 747 “derail”:

• S. A. Glantz, M. Nestle, Podcast interview, JAMA Internal Medicine, 12

September 2016; http://jamanetwork.com/learning/audio-player/13460555

• A. O’Connor, New York Times, 12 September 2016;

www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry-shifted-blame-to-

fat.html

p. 747 “smoking gun,” “knew what the funder expected, and produced it”:

• M. Nestle, Food industry funding of nutrition research: the relevance of history

for current debates. JAMA Intern. Med. 176, 1685-1686 (2016).

p. 747 “bribe”:

• K. Doyle, Reuters 12 September 2016; www.reuters.com/article/us-health-heart-

sugar-risks/sugar-industry-downplayed-heart-risks-of-sugar-promoted-risks-of-

fat-study-idUSKCN11I1QH

p. 747 “largely shaped by the sugar industry”:

• A. O’Connor, New York Times, 12 September 2016;

www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry-shifted-blame-to-

fat.html

p. 747 “suppressed”:

• E. Fernandez, UCSF News Center, 21 November 2017;

www.ucsf.edu/news/2017/11/409116/sugar-industry-suppressed-evidence-health-

risks-sucrose

p. 747 “There was no sugar conspiracy”: Our use of the phrase “sugar conspiracy” as

noted refers to recent high-profile narratives arguing that actors in the sugar industry and

in nutrition science caused dietary research and policy to become “derailed” in the 1960s.

5

p. 748 “economic productivity and military fitness”:

• H. A. Levenstein, Paradox of Plenty: A Social History of Eating in Modern

America (University of California Press, Berkeley, CA, 2003), pp. 64-65.

p. 748 “gave $100,000 … to Harvard”:

• A. C. Waterhouse, Food & Prosperity: Balancing Technology and Community in

Agriculture (The Rockefeller Foundation, New York, NY, 2013), pp. 83-87.

https://assets.rockefellerfoundation.org/app/uploads/20131001185301/Food-

Prosperity.pdf

p. 748 “15 food firms … the Nutrition Foundation”:

• G. A. Mooney, New York Times, 28 December 1941;

http://query.nytimes.com/gst/abstract.html?res=9B05E4D9103BEF3ABC4051DF

B467838A659EDE&legacy=true

• C. G. King, A Good Idea: The History of the Nutrition Foundation (The Nutrition

Foundation, Inc., New York, NY, 1976).

p. 748 “at the center of both was Frederick J. Stare”: It is worth noting that Stare’s father

was a prominent vegetable canner in Wisconsin. Stare had worked in one of his father’s

pea-canning plants as a young man. His father’s personal relationships with food industry

executives later provided an avenue for departmental fundraising.

• F. J. Stare, Nutrition research from respiration and vitamins to cholesterol and

atherosclerosis. Annu. Rev. Nutr. 11, 1-21 (1991).

• F. J. Stare, Adventures in Nutrition (The Christopher Publishing House, Hanover,

MA, 1991), pp. 1-34, 153-174.

p. 748 “seemed to be aligned … distribution and consumption”: As Marion Nestle has

written, when the U.S. Department of Agriculture (USDA) was established in 1862 it was

given two roles—ensuring an adequate food supply and providing the public with useful

information on subjects related to agriculture—that were then seen as “complementary”:

“Increased consumption of U.S. agricultural products also was expected to improve the

health of the public” (Nestle 1993). When USDA nutritionists were developing the

“Basic Four” food guide in the early 1950s, they sought the review of producers and

found them generally supportive: “As long as the USDA was encouraging consumers to

purchase more foods from a variety of groups, agricultural producers raised no serious

objections” (Nestle 1992). In Food Politics, Nestle emphasizes the increasing conflicts

that arose between producers and policymakers as expert dietary advice underwent a

broad shift from “eat more” to “eat less” in the face of the public health challenges of

chronic disease (such as heart disease) (Nestle 2002). Of course, even before the chronic

disease era food companies pursued their own interests and sought to exploit public

awareness of vitamins and new scientific findings for advertising purposes.

6

But in general the focus on nutritional adequacy and the deficiency diseases—the

rationale for the creation of Harvard’s new nutrition unit in 1942—contributed to a sense

that productive collaboration between academic and industry scientists was not only

possible but also important for public health. The nation was just emerging from the

Second World War, during which government and industry had worked by necessity in

close coordination, and the generous federal N.I.H. grant system did not yet exist. (Before

1945, industry and private foundations were the major sponsors of U.S. health sciences

research.) Nutrition research was centered in departments of home economics and

especially in agricultural schools, which often had close ties with the food industry.

• M. Nestle, D. V. Porter, Evolution of federal dietary guidance policy: from food

adequacy to chronic disease prevention. Caduceus 6, 43-67 (1990).

• M. Nestle, Dietary advice for the 1990s: the political history of the food guide

pyramid. Caduceus 9, 137-153 (1992).

• M. Nestle, Food lobbies, the food pyramid, and U.S. nutrition policy. Int. J.

Health Serv. 23, 483-496 (1993).

• M. Nestle, Food Politics: How the Food Industry Influences Nutrition & Health

(University of California Press, Berkeley, CA, 2002), pp. 31-50.

• S. M. Horrocks, “The Business of Vitamins: Nutrition Science and the Food

Industry in Inter-war Britain” in The Science and Culture of Nutrition, 1840-1940,

H. Kamminga, A. Cunningham, Eds. (Rodopi, Amsterdam, The Netherlands,

1995), pp. 235-258.

• R. D. Apple, “Science Gendered: Nutrition in the United States, 1840-1940” in

The Science and Culture of Nutrition, 1840-1940, H. Kamminga, A. Cunningham,

Eds. (Rodopi, Amsterdam, The Netherlands, 1995), pp. 129-154.

• H. A. Levenstein, Paradox of Plenty: A Social History of Eating in Modern

America (University of California Press, Berkeley, CA, 2003), pp. 64-79.

• Institute of Medicine, Funding Health Sciences Research: A Strategy to Restore

Balance, F. E. Bloom, M. A. Randolph, Eds. (National Academy Press,

Washington, D.C., 1990).

p. 748 “war-related research”: Much of this research involved the development of fat

emulsions that could be fed intravenously to the sick or wounded. According to Stare’s

autobiography, the U.S. Army withdrew support from this research line one year after the

end of the war despite the department’s status as an “early leader” in the field. Support

for continued research on fat emulsions was later obtained from the American Cancer

Society and the Upjohn Company, but these firms ultimately discontinued support and

the fat emulsion work ended by the early 1960s.

• F. J. Stare, Adventures in Nutrition (The Christopher Publishing House, Hanover,

MA, 1991), pp. 47-48, 154-155.

• J. M. McKibbin, R. M. Ferry, F. J. Stare, Parenteral nutrition. II. The utilization of

emulsified fat given intravenously. J. Clin. Invest. 25, 679-686 (1946).

p. 748 “roughly 40% of US deaths”:

7

• H. M. Marks, The Progress of Experiment: Science and Therapeutic Reform in

the United States, 1900-1990 (Cambridge University Press, Cambridge, UK,

1997), p. 164.

• D. L. Hoyert, “75 years of mortality in the United States, 1935–2010” (NCHS

data brief, no 88., National Center for Health Statistics, 2012).

p. 748 “two conditions commonly linked with the ‘rich’ American diet”:

• F. J. Stare, Adventures in Nutrition (The Christopher Publishing House, Hanover,

MA, 1991), pp. 48-49.

p. 748 “27 funders”: A brochure published by the Harvard Department of Nutrition in

1951 noted that, in addition to the initial five-year grant from the Rockefeller Foundation

and ongoing budgetary assistance from Harvard University, the department had received

financial support from: Nutrition Foundation, Office of Scientific Research and

Development, American Meat Institute, John and Mary R. Markle Foundation, Williams

and Waterman Fund of the Research Corporation, Swift and Company, National Dairy

Council, U.S. Public Health Service, U.S. Army—Office of the Surgeon General,

Milbank Memorial Fund, The Upjohn Company, Children’s Bureau, New York State

Food Commission, General Education Board, Life Insurance Medical Research Fund,

National Vitamin Foundation, American Cancer Society, Great Atlantic and Pacific Tea

Company, General Mills, Armour and Company, Eli Lilly Company, Beechnut Packing

Company, Junket Brand Foods, Abbott Laboratories, Sugar Research Foundation,

National Biscuit Company, and the McCallum Foundation.

Stare’s autobiography includes an appendix with a more extensive list of sources of

support for the Harvard Department of Nutrition between 1942 and 1990.

• Harvard School of Public Health, Department of Nutrition, Nutrition Research in

the Field of Medicine and Public Health (Harvard University, Boston, MA,

1951), p. 8.

• F. J. Stare, Adventures in Nutrition (The Christopher Publishing House, Hanover,

MA, 1991), pp. 385-388.

p. 748 “It never entered my mind!”:

• D. M. Johns, Interview of B. Lown, Chestnut Hill, MA, 12 December 2016;

www.mailman.columbia.edu/sites/default/files/pdf/lown.pdf

p. 748 “believe heart attack prevention … diet low in fat”:

• L. N. Katz, A. Keys, J. W. Gofman, E. V. Allen, Atherosclerosis: a symposium.

Circulation 5, 98-100 (1952).

p. 748 “sound American diet … meat, milk, and eggs”:

8

• Harvard School of Public Health, Department of Nutrition, Nutrition Research in

the Field of Medicine and Public Health (Harvard University, Boston, MA,

1951), p. 2-3.

p. 748 “new causal paradigm”:

• H. M. Marks, The Progress of Experiment: Science and Therapeutic Reform in

the United States, 1900-1990 (Cambridge University Press, Cambridge, UK,

1997), pp. 169-172.

p. 748 “high serum cholesterol levels”:

• J. W. Gofman, F. Lindgren, H. Elliott, W. Mantz, J. Hewitt, B. Strisower, V.

Herring, T. P. Lyon, The role of lipids and lipoproteins in atherosclerosis. Science

111, 166-171 (1950).

• M. M. Gertler, S. M. Garn, P. D. White, Diet, serum cholesterol and coronary

artery disease. Circulation 2, 696-704 (1950).

• A. Steiner, F. E. Kendall, J.A.L. Mathers, The abnormal serum lipid pattern in

patients with coronary arteriosclerosis. Circulation 5, 605-608 (1952).

p. 748 “arterial disease in animals … foods such as eggs”: In this article we do not detail

the evolution of diet-heart theories from a focus on dietary cholesterol (present in eggs) to

more of an emphasis on dietary fat (especially saturated fats from foods such as butter,

whole milk, and meat). The experimental production of atherosclerosis in rabbits via

cholesterol feeding in the early 20th century was an important driver of subsequent diet-

heart research. Researchers later succeeded in producing atherosclerosis by feeding

cholesterol in some species (e.g., chicks) but struggled to do so in others (e.g., dogs).

Harvard nutrition scientists were the first to produce atherosclerosis experimentally in a

primate species (the Cebus monkey). By the late 1950s, prominent diet-heart researchers

would come to believe that the available animal-experimental evidence supported the

hypothesis that, “high-fat, high-cholesterol intake is the decisive nutritional aberration in

the causation of hypercholesterolemia and atherogenesis” (Katz et al. 1958).

• G. V. Mann, S. B. Andrus, A. McNally, F. J. Stare, Experimental atherosclerosis

in Cebus monkeys. J. Exp. Med. 98, 195-218 (1953).

• L. N. Katz, J. Stamler, R. Pick, Nutrition and Atherosclerosis (Lea & Febiger,

Philadelphia, PA, 1958), pp. 61-75.

• A. Keys, Human atherosclerosis and the diet. Circulation 5, 115-118 (1952).

p. 748 “Wartime data…”:

• H. E. Schornagel, The connection between nutrition and mortality from coronary

sclerosis during and after World War II. Doc. Med. Geogr. Trop. 5, 173-183

(1953).

9

• G. Biörck, “Wartime Lessons on Arteriosclerotic Heart Disease from Northern

Europe” in World Trends in Cardiology I: Cardiovascular Epidemiology, A.

Keys, P. D. White, Eds. (Hoeber-Harper, New York, NY, 1956), pp. 8-21.

p. 748 “supported by the U.S. dairy industry”: Ancel Keys, a physiologist at the

University of Minnesota who is often regarded as the central figure in the development of

the dietary fat hypothesis, reported that both his first trip to Italy with his wife Margaret

to test the serum cholesterol levels of men in Naples who were said to consume diets low

in fat and to exhibit low rates of heart disease, and his subsequent return trip to Italy with

the eminent cardiologist Paul Dudley White and a large group of international scientific

collaborators, were supported by the National Dairy Council. Some have emphasized that

Keys had a “conflict of interest” because his lab had received early funding from the

Sugar Research Foundation, and that this “might have naturally led him to perceive

something other than sugar as the problem” (Taubes 2016). But the fact that the dairy

industry supported the key studies that permitted the dietary fat theory to be elevated on

the international scientific stage raises questions about the claimed influence of the sugar

industry on Keys’s research and on the low-fat concept in general.

Early work in Keys’s laboratory was supported by: the War Department, U.S. Army

Quartermaster Corp—Office of the Quartermaster General, National Research Council,

Undersea Warfare Commission, U.S. Army Office of the Surgeon General, Office of

Scientific Research and Development, Home Mission’s Board of the Unitarian Society,

Mayo Foundation, John and Mary R. Markle Foundation, University of Minnesota

Department of Physical Education and Athletics, Graduate School Research Fund of the

University of Minnesota, National Dairy Council, Works Project Administration, Merck

& Company, Nutrition Foundation Inc., Corn Industries Foundation, Swift & Company,

National Confectioner’s Association, National Cane Sugar Refiner’s Association,

Williams-Waterman Fund, Sugar Research Foundation, Brethren Service Committee of

the Church of the Brethren, the Service Committee of the American Society of Friends,

and the Mennonites Central Committee. Without a comprehensive analysis of the

finances of Keys’s laboratory, there is little basis for concluding that any particular

funder should be singled out as having particularly influenced Keys’s scientific work.

(The above list of Keys’s early sources of funding is not claimed to be comprehensive; it

is drawn from Buskirk 1992 and Keys et al. 1950.)

For more information on influential dairy industry-backed studies:

• A. Keys, The Cholesterol Problem. Voeding 13, 539-555 (1952).

• A. Keys, “Field Studies in Italy, 1954” in World Trends in Cardiology I:

Cardiovascular Epidemiology, A. Keys, P. D. White, Eds. (Hoeber-Harper, New

York, NY, 1956), pp. 50-61.

• A. Keys, F. Fidanza, V. Scardi, G. Bergami, M. H. Keys, F. Di Lorenzo, Studies

on serum cholesterol and other characteristics of clinically healthy men in Naples.

AMA Arch. Intern. Med. 93, 328-336 (1954).

For discussions of early sources of funding for Keys’s laboratory:

10

• E. R. Buskirk, 1: From Harvard to Minnesota: Keys to Our History. Exerc. Sport

Sci. Rev. 20, 1-26 (1992).

• A. Keys, J. Brozek, A. Henschel, O. Mickelson, H. L. Taylor, The Biology of

Human Starvation, Volume I (University of Minnesota Press, Minneapolis, MN,

1950), pp. xxvii-xxviii.

• G. Taubes, The Case Against Sugar (Alfred A. Knopf, New York, NY, 2016), p.

150.

p. 748 “a study involving four research centers”:

• J. W. Gofman, M. Hanig, H. B. Jones, M. A. Lauffer, E. Y. Lawry, L. A. Lewis,

G. V. Mann, F. E. Moore, F. Olmsted, J. F. Yeager, E. C. Andrus, J. H. Barach, J.

W. Beams, J. W. Fertig, I. H. Page, J. A. Shannon, F. J. Stare, P. D. White,

Evaluation of serum lipoprotein and cholesterol measurements as predictors of

clinical complications of atherosclerosis: report of a cooperative study of

lipoproteins and atherosclerosis. Circulation 14, 691-742 (1956).

p. 748 “international studies”:

• G. V. Mann, J. A. Muñoz, N. S. Scrimshaw, The serum lipoprotein and

cholesterol concentrations of Central and North Americans with different dietary

habits. Am. J. Med. 19, 25-32 (1955).

• G. V. Mann, B. M. Nicol, F. J. Stare, Beta-Lipoprotein and Cholesterol

Concentrations in Sera of Nigerians. Br. Med. J. 2, 1008-1010 (1955).

• N. S. Scrimshaw, M. Trulson, C. Tejada, D. M. Hegsted, F. J. Stare, Serum

lipoprotein and cholesterol concentrations: Comparison of rural Costa Rican,

Guatemalan, and United States populations. Circulation 15, 805-813 (1957).

• C. Tejada, I. Gore, J. P. Strong, H. C. Mcgill, Comparative severity of

atherosclerosis in Costa Rica, Guatemala, and New Orleans. Circulation 18, 92-

97 (1958).

p. 748 “ambitious cohort studies”:

• G. M. Oppenheimer, Becoming the Framingham study 1947–1950. Am. J. Public

Health 95, 602-610 (2005).

• T. R. Dawber, F. E. Moore, G. V. Mann, II. Coronary Heart Disease in the

Framingham Study. Am. J. Public Health Nations Health 47, 4-24 (1957).

• J. T. Doyle, A. S. Heslin, H. E. Hilleboe, P. F. Formel, R. F. Korns, III. A

Prospective Study of Degenerative Cardiovascular Disease in Albany: Report of

Three Years' Experience—1. Ischemic Heart Disease. Am. J. Public Health

Nations Health 47, 25-32 (1957).

• J. M. Chapman, L. S. Goerke, W. Dixon, D. B. Loveland, E. Phillips, IV. The

Clinical Status of a Population Group in Los Angeles Under Observation for Two

to Three Years. Am. J. Public Health Nations Health 47, 33-42 (1957).

11

p. 748 “more evidence was needed”:

• K. Garrety, “Dietary Policy, Controversy, and Proof: Doing Something versus

Waiting for the Definitive Evidence” in Silent Victories: The History and Practice

of Public Health in Twentieth-Century America, J. W. Ward, C. Warren, Eds.

(Oxford University Press, New York, NY, 2007), pp. 405-406.

p. 748 “scientifically plausible”:

• K. Garrety, Social worlds, actor-networks and controversy: The case of

cholesterol, dietary fat and heart disease. Soc. Stud. Sci. 27, 727-773 (1997).

p. 748 “tentatively backed the low-fat diet”:

• F. Burns, Boston Globe, 26 September 26, 1955.

• B. Clark, Reader’s Digest, November 1955.

• A.P. New York Times, 8 November 1955;

http://www.nytimes.com/1955/11/08/archives/transcript-of-the-news-conference-

with-dr-white-on-condition-of-the.html

p. 748 “1956 magazine column”: Stare and others from his department had given similar

tentative dietary advice for those at risk of heart disease in the scholarly literature.

• F. J. Stare, P. D. White, McCall’s, March 1956.

• F. J. Stare, T. B. Van Itallie, M. B. McCann, and O. W. Portman, Nutritional

studies relating to serum lipids and atherosclerosis: therapeutic implications.

JAMA 164, 1920-1925 (1957).

p. 748 “dominant paradigm”: The 1961 edition of the Cecil-Loeb Textbook of Medicine

contained an entry on atherosclerotic heart disease asserting that enough research

evidence had been gathered to suggest that the cholesterol concept of atherogenesis

satisfied Koch’s postulates for determining whether an agent caused a disease (Greene

2007). The entry was based on a 1959 article by Robert Olson (who would later become

an important critic of U.S. federal dietary guidelines) that argued: “It has been

convincingly demonstrated that decreases in the [cholesterol-containing] β-lipoproteins

can be obtained by reduction of the percent of dietary calories from fat or the substitution

of polyunsaturated fat for saturated fat in the diet” (Olson 1959). (The β-lipoproteins are

today generally referred to as LDL. At the time the research community was divided on

whether measures of serum total cholesterol or the β-lipoproteins provided a better

predictor of heart disease risk. Serum total cholesterol tests remained dominant through

much of the 1970s (Gordon 1988).) In January 1961, Ancel Keys appeared on the cover

of Time magazine for an article titled “The Fat of the Land.”

• J. A. Greene, Prescribing By Numbers: Drugs and the Definition of Disease

(Johns Hopkins University Press, Baltimore, MD, 2007) pp. 152-157.

12

• R. E. Olson, I. Cardiovascular Disease—With Particular Attention to

Atherosclerosis. Am. J. Public Health Nations Health 49, 1120-1128 (1959).

• T. Gordon, The diet-heart idea: outline of a history. Am. J. Epidemiol. 127, 220-

225 (1988).

• Anonymous, Time, 13 January 1961;

http://content.time.com/time/subscriber/printout/0,8816,828721,00.html

p. 748 “a new statement from the American Heart Association (AHA)”:

• I. H. Page, E. V. Allen, F. L. Chamberlain, A. Keys, J. Stamler, F. J. Stare,

Dietary fat and its relation to heart attacks and strokes. Circulation 23, 133-136

(1961).

p. 748 “pilot study for a large ‘definitive’ trial”:

• H. M. Marks, The Progress of Experiment: Science and Therapeutic Reform in

the United States, 1900-1990 (Cambridge University Press, Cambridge, UK,

1997), pp. 181-196.

p. 748 “an uphill battle”:

• J. Yudkin, Times of London, 12 September 1961.

p. 748 “had taught nutrition at London University since 1946”:

• J. Yudkin, Degrees in nutrition at London University. Nutr. Bull. 15, 191-195

(1990).

p. 748 “unable to obtain funding from the government’s Medical Research Council”

• D. F. Smith, “Nutrition in Britain in the Twentieth Century,” thesis, University of

Edinburgh, 1986, p. 453, FN183.

p. 748 “turned to industry for support”: As the historian Sally Horrocks has written of

nutrition science in Britain, “Industry grew in relative importance as a source of finance

for nutrition research as the lavish funding provided by the Medical Research Council in

the interwar years dried up at the same time as nutrition was gaining acceptance as an

independent academic subject at the undergraduate level. The pioneer in this was John

Yudkin at Queen Elizabeth College (now part of King's College), whose department

produced the first nutrition graduates in the mid 1950s” (Horrocks 1995). Based on

archival research at King’s College, Horrocks reported that Yudkin received funding

“from at least 18 different firms and 3 food producing organisations between 1947 and

1973.” Some of Yudkin’s publications disclose funding sources; others do not.

Our own assuredly less than comprehensive review of Yudkin’s publications, trade

magazines, press accounts, interviews, and archival documents from King’s College

13

suggests that his department received funding or maintained consulting arrangements

with: Agricultural Research Council, Medical Research Council, London Research

Foundation, Leverhulme Trust, National Dairy Council, International Dairy Federation,

National Milk Publicity Council, the Nestlé Company, General Foods Corporation, the

Energen Foods Company, Genatosan Ltd., Unilever, H.J. Heinz Company Ltd., Marks &

Spencer, the Butter Information Council, the British Egg Marketing Board, the National

Commission on Egg Nutrition, Flour Advisory Bureau Ltd., Potato Marketing Board,

Cadbury Bros., Bayer Products, Bovril, Beecham Ltd., Rank-Hovis-McDougall Ltd.,

McVitie & Price Ltd., Geest Industries Ltd., Fisons Pharmaceuticals Ltd., Howards of

Ilford Ltd., British Drug Houses Ltd., Allen and Hanbury Ltd., Kylon Ltd., H.W. Carter

and Co., and the British Empire Cancer Campaign.

• S. M. Horrocks, “Nutrition Science and the Food Industry in Britain, 1920-1990”

in Food Technology, Science and Marketing: European Diet in the Twentieth

Century, A. P. den Hartog, Ed. (Tuckwell Press, East Linton, UK, 1995), pp. 14,

17 FN22.

• King’s College London Archives, Queen Elizabeth College collection, Reference

QAS/GPF3, Box 1, Folder “Grants for Professor John Yudkin and the Department

of Nutrition 1947 Jul – 1973 Jan.”

p. 748 “I’ve always been a consultant to the food industry,” “highly illogical”:

• D. F. Smith, Interview of J. Yudkin, November 1979. Transcript is with the

Wellcome Unit for the History of Medicine, Glasgow University.

p. 748 “entry in the diet-heart debates”:

• J. Yudkin, Diet and coronary thrombosis: hypothesis and fact. Lancet 270, 155-

162 (1957).

p. 748 “rich in meat and cheese … not a recipe for cardiac arrest”:

• J. Yudkin, This Slimming Business (MacGibbon & Kee, London, UK, 1958), p.

150.

p. 748 “actually endorsed saturated fat restriction”:

• Yudkin, John, Etiology of cardiac infarction. AMA Arch. Intern. Med. 104, 681-

683 (1959).

p. 748 “elevated rates of heart disease among some immigrants”:

• A. M. Cohen, S. Bavly, R. Poznanski, Change of diet of Yemenite Jews in

relation to diabetes and ischaemic heart-disease. Lancet 278, 1399-1401 (1961).

p. 748 “new claims suggesting a sugar-sensitive constituent of the blood”:

14

• M. J. Albrink, Triglycerides, lipoproteins, and coronary artery disease. Arch.

Intern. Med. 109, 345-359 (1962).

p. 748 “people who take a lot of sugar … than those who take little”:

• J. Yudkin, J. Roddy, Levels of dietary sucrose in patients with occlusive

atherosclerotic disease. Lancet 284, 6-8 (1964).

p. 748 “20 letters to the editor”: Yudkin had actually published two articles on sugar in

the same July 1964 issue of the Lancet; his second article argued that dietary fat and

dietary sugar consumption appeared to be correlated to a considerable degree at the

national level. Some of the responsive letters were linked by title with one of the articles

and some with the other, but most focused on his questionnaire-based study or on his

sugar hypothesis in general. See, for example:

• R. W. Howell, Dietary fat and dietary sugar. Lancet 284, 312 (1964).

• H. E. S. Pearson, Dietary fat and dietary sugar. Lancet 284, 256-257 (1964).

• J. W. Marr, J. A. Heady, Levels of dietary sucrose in patients with occlusive

atherosclerotic disease. Lancet 284, 146 (1964).

• H. Keen, G. Rose. Dietary fat and dietary sugar. Lancet 284, 362 (1964).

• T. L. Cleave, Dietary fat and dietary sugar. Lancet 284, 206-207 (1964).

• J. A. S. Dickson, Dietary fat and dietary sugar. Lancet 284, 361 (1964).

p. 748 “wide press attention”:

• Anonymous. New York Times, 3 July 1964;

http://query.nytimes.com/gst/abstract.html?res=9A06E6D7103BE13ABC4B53DF

B166838F679EDE&legacy=true

p. 748 “new offers from book publishers”: In April 1964, Yudkin’s British publisher sent

an updated version of his slimming book to a New York literary agent, but the firm felt it

would not be successful in the American market. After Yudkin’s sugar work appeared in

the press in July, however, the New York publisher Bernard Geis wrote to Yudkin

suggesting instead a book on “your important new sugar-free approach to diet.”

• B. Geis to J. Yudkin, 29 July 1964. Box 117, Folder “Yudkin, John,” Watkins

Loomis Records, Rare Book and Manuscript Library, Columbia University.

p. 748 “a controlled feeding study at Danvers State Hospital”:

• D. M. Hegsted to P. B. Hagopian, 13 December 1961. Box 9, Folder 21

“Hagopian, Dr. Peter B., 1961-1967.” D. Mark Hegsted Papers, 1952-1999

(inclusive), 1960-1978 (bulk). H MS c54. Harvard Medical Library, Francis A.

Countway Library of Medicine, Boston, Mass. Hereafter, Hegsted Papers.

15

• D. M. Hegsted to F. H. Mattson, 26 March 1962. Box 10, Folder 27 “F.H.

Mattson, Proctor and Gamble Co.” Hegsted Papers.

p. 748 “a new dairy industry fund”: The experimental phase of the Danvers study was

launched in June 1962, apparently drawing upon existing departmental funds, with the

expectation that Hegsted would be able to secure an N.I.H. grant to fund the study on an

ongoing basis. Some four months into the work Hegsted reported to his Proctor &

Gamble (P&G) collaborator: “I am considerably provoked since I just heard via the

grapevine that our application to N.I.H. for support of this project was turned down. Just

how long we can keep going, or what we will do isn’t clear.” Then in January 1963, he

told his P&G contact: “Unfortunately, the boss insists we don’t have enough funds to

keep this in operation and we may have to change the nature of the program.” Then there

was a hiatus in work at Danvers. Then in September 1963 Hegsted wrote to his P&G

contact: “I have just been informed that the National Dairy Council is prepared to give us

some support for the coming year.”

In Danvers publications, Hegsted and colleagues thank the following funders: John A.

Hartford Memorial Fund, U.S. Public Health Service/N.I.H., Nutrition Foundation, Fund

for Research and Teaching, Department of Nutrition, Harvard School of Public Health,

the Special Dairy Industry Board. We believe that all of these sources except for the dairy

industry funds were monies the department already had on hand and/or regular donors to

the department. (P&G supplied oils for the project, but there is no indication they funded

the research. The Hood Milk Company supplied milk and ice cream.)

The Special Dairy Industry Board was a research fund created by the U.S. dairy industry

in early 1962 to pay for studies on the biological activity of dairy lipids and their role in

the disease process. The establishment of this special fund reflected a new level of

concern among milk producers about the dietary fat hypothesis and its apparent threat to

what had long been seen as “nature’s most nearly perfect food.”

For correspondence related to Danvers and the department’s struggles to fund it:

• D. M. Hegsted to F. H. Mattson, 1 June 1962. Box 10, Folder 27 “F.H. Mattson,

Proctor and Gamble Co.” Hegsted Papers.

• D. M. Hegsted to F. H. Mattson, 10 October 1962. Box 10, Folder 27 “F.H.

Mattson, Proctor and Gamble Co.” Hegsted Papers.

• D. M. Hegsted to F. H. Mattson, 17 January 1963. Box 10, Folder 27 “F.H.

Mattson, Proctor and Gamble Co.” Hegsted Papers.

• D. M. Hegsted to F. H. Mattson, 25 September 1963. Box 10, Folder 27 “F.H.

Mattson, Proctor and Gamble Co.” Hegsted Papers.

For background on the Special Dairy Industry Board:

• H. E. O. Heineman, “Importance of the Symposium to the Dairy Industry” in

Symposium: Dairy Lipids and Lipid Metabolism, M. F. Brink, D. Kritchevsky,

Eds. (The Avi Publishing Company, Inc., Westport, CT, 1968), pp. 1-3.

16

• M. F. Brink, D. Kritchevsky, “Preface” in Symposium: Dairy Lipids and Lipid

Metabolism, M. F. Brink, D. Kritchevsky, Eds. (The Avi Publishing Company,

Inc., Westport, CT, 1968), p. vii-viii.

p. 749 “quantify their impact on blood cholesterol levels”: A paper by Hegsted and

colleagues that was published in the proceedings of a September 28-29, 1967 symposium

sponsored by the Special Dairy Industry Board reviews the results of the various studies

that had emerged from the Danvers investigation. According to Hegsted’s letters, the

Danvers series on sugar and starch began in August or September 1964.

• D. M. Hegsted, R. B. McGandy, M. L. Myers, F. J. Stare, “Effects of Specific

Fatty Acids on Serum Cholesterol in Man: Studies with Semisynthetic Materials”

in Symposium: Dairy Lipids and Lipid Metabolism, M. F. Brink, D. Kritchevsky,

Eds. (The Avi Publishing Company, Inc., Westport, CT, 1968), p. 161-175.

• D. M. Hegsted to F. H. Mattson, 6 August 1964. Box 10, Folder 27 “F.H.

Mattson, Proctor and Gamble Co.” Hegsted Papers.

• D. M. Hegsted to F. H. Mattson, 25 September 1964. Box 10, Folder 27 “F.H.

Mattson, Proctor and Gamble Co.” Hegsted Papers.

p. 749 “Hegsted had earned a reputation as a data-driven scientist”: Bernard Lown, a

cardiologist who joined Harvard’s Department of Nutrition in 1958 and knew Hegsted

well, said the following in a December 2016 interview: “Hegsted was of unimpeachable

integrity. He was interested in nutritional policy. He was interested in diet and health. He

was a very straightforward, scientific, where-is-the-data type of person.” Gary Taubes, a

science journalist and author of three detailed books on history of 20th century dietary

science and policy who has said he has interviewed over 600 clinicians, investigators, and

administrators involved in nutrition, commented on Hegsted’s reputation in a 2017

podcast interview: “Hegsted was sort of a weirdly if not bizarrely honest man. And I’m

not the only person who thinks this.”

• D. M. Johns, Interview of B. Lown, Chestnut Hill, MA, 12 December 2016;

www.mailman.columbia.edu/sites/default/files/pdf/lown.pdf

• G. Taubes. The Livin’ La Vida Low-Carb Show (February 2017);

www.thelivinlowcarbshow.com/shownotes/15780/1223-gary-taubes-shares-an-

update-on-the-future-of-the-nutrition-science-initiative-nusi/

p. 749 “an analysis of adult protein requirements”:

• D. M. Hegsted, A. G. Tsongas, D. B. Abbott, F. J. Stare, Protein requirements of

adults. J. Lab. Clin. Med. 31, 261-284 (1946).

p. 749 “provoked the ire of the beef industry”:

• W. J. Broad, Nutrition research: end of an empire. Science 213, 518-520 (1981).

p. 749 “a talk on 6 May 1965, at a meeting of the Nutrition Foundation”:

17

• The Nutrition Foundation, Inc. “Food Industry Advisory Committee: 1965

Meeting. Skytop, Pennsylvania, May 5-7, 1965. [Agenda].” Box 11, Folder 14

“Nutrition Foundation, Inc. Food Industries Advisory Comm. Skytop, Penn. May

5-7, 1965.” Hegsted Papers.

p. 749 “worth considering,” “without controlled laboratory data,” “rather minimal,”

“abundant evidence implicating dietary fat”:

• D. M. Hegsted, “Carbohydrates and Lipid Metabolism (In Relation to Ischemic

Heart Disease and Serum Cholesterol).” Box 11, Folder 14 “Nutrition Foundation,

Inc. Food Industries Advisory Comm. Skytop, Penn. May 5-7, 1965.” Hegsted

Papers.

p. 749 “Hegsted equation”:

• D. M. Hegsted, R. B. McGandy, M. L. Myers, and F. J. Stare, Quantitative effects

of dietary fat on serum cholesterol in man. Am. J. Clin. Nutr. 17, 281-295 (1965).

p. 749 “helped nudge the AHA to extend its warning”:

• J. T. Dwyer, L. Ausman, E. Kennedy, D. Mark Hegsted, Ph.D. J. Nutr. 140, 1402-

1403 (2010).

p. 749 “one attended Hegsted’s talk”: Kenneth R. Hanson, Director of Research and

Development, American Sugar Company, was in attendance, according to a conference

guest list. At least by 1968, Hanson was a member of the Board of Directors of the

International Sugar Research Foundation. (The Sugar Research Foundation became the

International Sugar Research Foundation on 1 July 1968.)

• Nutrition Foundation, Inc. “Food Industries Advisory Committee Meeting, May

5-7, 1965, Skytop Lodge, Skytop, Pennsylvania: Committee members and guests

in attendance.” Box 11, Folder 14 “Nutrition Foundation, Inc. Food Industries

Advisory Comm. Skytop, Penn. May 5-7, 1965.” Hegsted Papers.

• International Sugar Research Foundation, Inc., “What’s At Stake In Sugar

Research?” [1968 brochure]. Box 9, Folder 41 “International Sugar Research

Foundation, Inc., Dr. Philip Ross.” Hegsted Papers.

p. 749 “an SRF executive reached him by phone”: John Hickson, the SRF’s Vice

President and Director of Research, spoke with Hegsted by phone on 14 June 1965 and

sent him a letter two days later. In the letter he confirmed plans to visit Harvard on 1 July.

• J. L. Hickson to D. M. Hegsted, 16 June 1965. Box 12, Folder 6 “Sugar Research

Foundation, Dr. John Hickson, 1965-1966.” Hegsted Papers.

18

p. 749 “to discuss his research”: The day after Hickson’s visit Hegsted wrote a letter to

Charles O’Boyle, Director of the Sucro-Chemical Division of the Colonials Sugar

Company, that said: “I was talking to John Hickson yesterday and mentioned that we

were interested in incorporating fatty acids into the diet in combinations that we cannot

readily achieve with natural oils. He suggested that some of the sugar esters might offer

possibilities. Our studies on cholesterol metabolism suggest that myristic and palmitic

acid are primarily responsible for the elevation in serum cholesterol caused by relatively

saturated oils.” Hegsted and colleagues subsequently undertook a new study series at

Danvers that sought to “test some oils in which specific fatty acids … would be fed in

combinations that just could not be found in natural oils” (Hegsted et al. 1968). Thus it is

clear that Hegsted and Hickson discussed the Danvers study on 1 July 1965.

• D. M. Hegsted to C. O’Boyle, 2 July 1965. Hegsted Papers. Box 12, Folder 6

“Sugar Research Foundation, Dr. John Hickson, 1965-1966.” Hegsted Papers.

• D. M. Hegsted, R. B. McGandy, M. L. Myers, F. J. Stare, “Effects of Specific

Fatty Acids on Serum Cholesterol in Man: Studies with Semisynthetic Materials”

in Symposium: Dairy Lipids and Lipid Metabolism, M. F. Brink, D. Kritchevsky,

Eds. (The Avi Publishing Company, Inc., Westport, CT, 1968), p. 161-175.

p. 749 “special metabolic peril in sucrose”:

• J. L. Hickson to D. M. Hegsted, 15 July 1965. Box 12, Folder 6 “Sugar Research

Foundation, Dr. John Hickson, 1965-1966.” Hegsted Papers.

p. 749 “sufficiently broad to make it worth doing”:

• D. M. Hegsted to J. L. Hickson, 10 August 1965. Box 12, Folder 6 “Sugar

Research Foundation, Dr. John Hickson, 1965-1966.” Hegsted Papers.

p. 749 “a draft of which he shared with SRF”: Responding to a letter from Hickson

asking about a lecture he had given, Hegsted noted in a letter that the lecture had

“included the paper which has just been published in the American Journal of Clinical

Nutrition [the ‘Hegsted equation’ paper] and also the work on carbohydrate that has just

been submitted [based on his Nutrition Foundation talk and the Danvers carbohydrate

series]. I am enclosing a copy of the latter manuscript. This includes everything we have

done on carbohydrates. We have about completed our literature review and hope to get

something on paper for the carbohydrate review fairly soon.”

In referring to “the work on carbohydrate” with no additional explanation, this Hegsted

letter provides further evidence that the Danvers carbohydrate series was familiar to

Hickson; it also indicates that Hegsted and colleagues had written up and submitted the

paper on the results of the Danvers carbohydrate series—and shared it with SRF—prior

to starting the process of drafting the sponsored sugar review.

• D. M. Hegsted to J. L. Hickson, 26 November 1965. Box 12, Folder 6 “Sugar

Research Foundation, Dr. John Hickson, 1965-1966.” Hegsted Papers.

19

p. 749 “potent role,” “amply demonstrated,” “not yet been shown.”

• R. B. McGandy, D. M. Hegsted, M. L. Myers, F. J. Stare, Dietary carbohydrate

and serum cholesterol levels in man. Am. J. Clin. Nutr. 18, 237-242 (1966).

p. 749 “SRF-sponsored review”: The review was published in two parts.

• R. B. McGandy, D. M. Hegsted, F. J. Stare, Dietary fats, carbohydrates and

atherosclerotic vascular disease. N. Engl. J. Med. 277, 186-192 (1967).

• R. B. McGandy, D. M. Hegsted, F. J. Stare, Dietary fats, carbohydrates and

atherosclerotic vascular disease. N. Engl. J. Med. 277, 245-247 (1967).

p. 749 “national patterns in diet and disease”:

• J. Yudkin, Patterns and trends in carbohydrate consumption and their relation to

disease. Proc. Nutr. Soc. 23, 149-162 (1964).

p. 749 “refining his questionnaire-based study”:

• J. Yudkin, J. Morland, Sugar intake and myocardial infarction. Am. J. Clin. Nutr.

20, 503-506 (1967).

p. 749 “effect of elevated sugar intake on insulin and platelet adhesiveness”:

• S. Szanto, J. Yudkin, The effect of dietary sucrose on blood lipids, serum insulin,

platelet adhesiveness and body weight in human volunteers. Postgrad. Med. J. 45,

602-607 (1969).

p. 749 “~£25,000 per year (~$530,000 in 2018)”

• C. Driver, The Guardian, 20 April 1966.

p. 749 “high-protein breakfast promotion”:

• S. Baker, The Guardian, 14 April 1966.

p. 749 “seventeen day milk diet”:

• Anonymous, The Guardian, 25 May 1966.

p. 749 “value of taking milk before alcoholic drinks”:

• D. S. Miller, J. L. Stirling, J. Yudkin, Effect of ingestion of milk on

concentrations of blood alcohol. Nature 212, 1051 (1966).

20

p. 749 “Drive Safely on Milk”:

• H. Velten, Milk: A Global History (Reaktion Books, London, UK, 2010), p. 96.

p. 749 “dairy consultant … ‘Sense and Nonsense about Dairy Foods’”:

• Anonymous, Dairy Industries, March 1969, p. 145.

• Anonymous, Dairy Industries, May 1969, p. 311.

• Anonymous, The Medical Officer, 13 June 1969, p. 326.

p. 749 “diversion tactics,” “prove beneficial by freeing butterfat from any ‘guilt’.”

• International Dairy Federation, Annual Memento (International Dairy Federation,

Brussels, Belgium, 1973), p. 112.

p. 749 “deterrent to good nutrition policy”:

• D. M. Hegsted to M. Winitz, 7 August 1969. Box 7, Folder 15 “Vivonex and

Company.” Hegsted Papers.

p. 749 “a possible ‘anti-Yudkin’ effort ... he does have the interest of the press”:

Members of the panel were: Edward H. “Pete” Ahrens Jr. of Rockefeller University; Alan

N. Howard of Cambridge; Robert McGandy of the Harvard Department of Nutrition (a

coauthor on the Danvers study and the SRF-sponsored review); Gardner C. McMillan of

the National Heart Institute of the N.I.H.; Rodolfo Paoletti of the University of Milan;

Daniel Steinberg of the University of California, San Diego.

• International Sugar Research Foundation, Inc., “Summary of the Discussion and

Recommendations of the Atherosclerotic Vascular Disease Panel, November 6,

1969.” Box 49, Folder “ISRF Scientific Advisory Board, 1968-69.” Roger Adams

Papers, University of Illinois Archives.

p. 749 “Multiple government research teams”:

• R. W. Howell, D. G. Wilson, Dietary sugar and ischaemic heart disease. Br. Med.

J. 3, 145-148 (1969).

• C. J. Burns-Cox, R. Doll, K. P. Ball, Sugar intake and myocardial infarction. Br

Heart J. 31, 485-490 (1969).

• L. Platt, K. P. Ball, W. W. Brigden, R. Doll, M. F. Oliver, D. D. Reid, J. P.

Shillingford, A. M. Thomson, and T. B. Begg, Dietary sugar intake in men with

myocardial infarction: report to the Medical Research Council by its working-

party on the relationship between dietary sugar intake and arterial disease. Lancet

296, 1265-1271 (1970).

p. 749 “other forceful critiques”:

21

• A. Keys, Sucrose in the diet and coronary heart disease. Atherosclerosis 14, 193-

202 (1971).

• A. R. P. Walker, Sugar intake and coronary heart disease. Atherosclerosis 14,

137-152 (1971).

p. 749 “he retired and began summarizing his case against sugar”:

• N. Marsh, The History of Queen Elizabeth College: One Hundred Years of

University Education in Kensington (King’s College London, London, UK,

1969), pp. 248, 271-274.

• J. Yudkin, Sweet and Dangerous: The New Facts About the Sugar You Eat as a

Cause of Heart Disease, Diabetes, and Other Killers (Wyden, New York, NY,

1972).

p. 749 “NIH declined to fund the “definitive” trial”:

• H. M. Marks, The Progress of Experiment: Science and Therapeutic Reform in

the United States, 1900-1990 (Cambridge University Press, Cambridge, UK,

1997), pp. 191-196.

p. 749-750 “persistent exhortations”:

• United States White House. White House Conference on Food, Nutrition, and

Health: Final Report. Report of Panel II-3: Adults in an Affluent Society (U.S.

G.P.O., Washington, D.C., 1970), pp. 52-53.

• Atherosclerosis Study Group (J. Stamler, R. R. Beard, W. E. Connor, V. G.

deWolfe, J. Stokes III, P. W. Willis III) and Epidemiology Study Group (A. M.

Lilienfeld, T. R. Dawber, J. T. Doyle, F. H. Epstein, L. H. Kuller, W.

Winkelstein, Jr.). The Primary Prevention of the Atherosclerotic Diseases:

Position Paper for the Inter-Society Commission for Heart Disease Resources,

1970. https://profiles.nlm.nih.gov/ps/access/RMACFX.pdf

p. 750 “well-credentialed skeptics”:

• G. M. Oppenheimer, I. D. Benrubi, 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 104, 59-69 (2014).

p. 750 “mentioned Yudkin’s theory only in passing”:

• United States Senate, Select Committee on Nutrition and Human Needs, Dietary

Goals for the United States (U.S. Government Printing Office, Washington, D.C.,

1977), p. 45.

p. 750 “edited mainly by Hegsted”:

22

• D. M. Hegsted to N. Mottern, October 22, 1976. Box 7, Folder 2 “United States

Senate Select Committee on Nutrition and Human Needs, Senator George

McGovern (1 of 4).” Hegsted Papers.

p. 750 “40% reduction in sugar intake”:

• United States Senate, Select Committee on Nutrition and Human Needs, Dietary

Goals for the United States (U.S. Government Printing Office, Washington, D.C.,

1977), p. 12.

p. 750 “prevailed among a coalition of scientists”:

• K. Garrety, Social worlds, actor-networks and controversy: The case of

cholesterol, dietary fat and heart disease. Soc. Stud. Sci. 27, 727-773 (1997).

p. 750 “small number of researchers … not accepted by key authorities”: We have

focused on the work of John Yudkin because he has been the subject of historical

reappraisal in recent years, and because he was the most visible advocate of the sugar

hypothesis in the 1960s and 1970s. However, it is certainly not the case that he was the

only researcher examining the consequences of excessive sugar and/or carbohydrate

intake during this period: Margaret Albrink, Aharon Cohen, Thomas (Peter) Cleave, and

George Campbell are others who were interested in carbohydrate metabolism. (We have

cited some of them in this article.) We also do not intend to convey that Yudkin’s

industry affiliations invalidate his scientific work, or that he was not an influential

scientist simply because his ideas about sugar were not widely embraced during his

lifetime. (Yudkin died in 1995.) As Gilbert Thompson has written, Yudkin was “highly

regarded in nutrition circles.” His 1957 paper challenging prevailing interpretations of the

theory that countries consuming more fat had higher rates of coronary mortality, for

example, helped drive important advances in epidemiology and causal inference.

• G. R. Thompson, The Cholesterol Controversy (The Royal Society of Medicine

Press, London, UK, 2008), pp. 25-30.

p. 750 “Normal science is a social project…”

• T. S. Kuhn, The Structure of Scientific Revolutions: Third Edition (University of

Chicago Press, Chicago, IL, 1996).

• L. Fleck, Genesis and Development of a Scientific Fact (University of Chicago

Press, Chicago, IL, 1979).

p. 750 “It didn’t happen that way.”

• D. M. Johns, Interview of B. Lown, Chestnut Hill, MA, 12 December 2016;

www.mailman.columbia.edu/sites/default/files/pdf/lown.pdf

p. 750 “What industry does is…”

23

• G. Taubes. The Livin’ La Vida Low-Carb Show (February 2017);

www.thelivinlowcarbshow.com/shownotes/15780/1223-gary-taubes-shares-an-

update-on-the-future-of-the-nutrition-science-initiative-nusi/

p. 750 “rarely required”:

• M. Nestle, Food Politics: How the Food Industry Influences Nutrition & Health

(University of California Press, Berkeley, CA, 2002), p. 133.

p. 750 “soliciting grants from the Oscar Mayer Foundation”:

• J. K. Cataldo, L. A. Bero, R. E. Malone, “A delicate diplomatic situation”:

tobacco industry efforts to gain control of the Framingham Study. J. Clin.

Epidemiol. 63, 841-853 (2010).

p. 750 “none of which were routinely disclosed”:

• T. R. Dawber, W. B. Kannel, Current status of coronary prevention: lessons from

the Framingham study. Prev. Med. 1, 499-512 (1972).

p. 750 “most journals require disclosure of conflicts of interest”:

• A. S. Relman, Dealing with conflicts of interest.” N. Engl. J. Med. 310, 1182-

1183 (1984).

• D. Mozaffarian, Conflict of interest and the role of the food industry in nutrition

research. JAMA 317, 1755-1756 (2017).

p. 750 “compliance is inconsistent”:

• D. Mandrioli, C. E. Kearns, L. A. Bero, Relationship between research outcomes

and risk of bias, study sponsorship, and author financial conflicts of interest in

reviews of the effects of artificially sweetened beverages on weight outcomes: a

systematic review of reviews. PloS one 11, e0162198 (2016).

• A. Fabbri, N. Chartres, G. Scrinis, L. A. Bero, Study sponsorship and the nutrition

research agenda: analysis of randomized controlled trials included in systematic

reviews of nutrition interventions to address obesity. Public Health Nutr. 20,

1306-1313 (2017).

• S. Krimsky, L. S. Rothenberg, Conflict of interest policies in science and medical

journals: editorial practices and author disclosures.” Sci. Eng. Ethics 7, 205-218

(2001).

p. 750 “do not address important sources of bias”:

• J. P. A. Ioannidis, J. F. Trepanowski, Disclosures in nutrition research: why it is

different. JAMA doi:10.1001/jama.2017.18571 (2017).

24

p. 750 “various sectors have tried to influence scientists”:

• K. D. Brownell, K. E. Warner, The perils of ignoring history: Big Tobacco played

dirty and millions died. How similar is Big Food? Milbank Q. 87, 259-294 (2009).

p. 750 “fund research with an eye toward marketing”:

• M. Nestle, Corporate funding of food and nutrition research: science or

marketing? JAMA Intern. Med. 176, 13-14 (2016).

p. 750 “basic purpose of increasing the consumption of sugar”:

• The Sugar Association, Inc., “Report of the Ad Hoc Stewardship Committee on

Sugar Research, August 1958.” Box 24, Folder: “Sugar Research Foundation,

Inc., Scientific Advisory Board, 1959-60.” University of Illinois Archives, Record

Series 8/1/2 ACES Dean's Office Subject Files, p. 17.

p. 750 “the ‘fat lobby’ has not only influenced…”

• M. F. Jacobson, “Preface by Michael F. Jacobson, Ph.D., Executive Director,

Center for Science in the Public Interest” in P. Hausman, Jack Sprat’s Legacy:

The Science and Politics of Fat and Cholesterol (Richard Marek Publishers, New

York, NY, 1981), p. 16.

p. 750 “butter is back”:

• M. Bittman, New York Times, 25 March 2014;

www.nytimes.com/2014/03/26/opinion/bittman-butter-is-back.html

• L. Pimpin, J. H. Y. Wu, H. Haskelberg, L. Del Gobbo, D. Mozaffarian, Is butter

back? A systematic review and meta-analysis of butter consumption and risk of

cardiovascular disease, diabetes, and total mortality. PLoS One 11, e0158118

(2016).

p. 750 “sugar is toxic”:

• G. Taubes, New York Times Magazine, 13 April, 2011;

www.nytimes.com/2011/04/17/magazine/mag-17Sugar-t.html

• R. H. Lustig, L. A. Schmidt, C. D. Brindis, Public health: the toxic truth about

sugar. Nature 482, 27-29 (2012).

p. 750 “Big Sugar”:

• G. Taubes, C. K. Couzens, Mother Jones, November/December 2012;

www.motherjones.com/environment/2012/10/sugar-industry-lies-campaign/

25

p. 750 “diet wars”:

• Y. Freedhoff, K. D. Hall, Weight loss diet studies: we need help not hype. Lancet

388, 849-851 (2016).

p. 750 “the techniques of epidemiology and causal inference evolved”:

• M. Susser, Epidemiology in the United States after World War II: the evolution of

technique. Epidemiol. Rev. 7, 147-177 (1985).

• H. Blackburn, D. Labarthe, Stories from the evolution of guidelines for causal

inference in epidemiologic associations: 1953–1965. Am. J. Epidemiol. 176,

1071-1077 (2012).

p. 750 “not yet achieved the hegemonic ‘gold standard’ status”:

• D. S. Jones, S. H. Podolsky, The history and fate of the gold standard. Lancet 385,

1502-1503 (2015).

• Evidence-Based Medicine Working Group, Evidence-based medicine. A new

approach to teaching the practice of medicine. JAMA 268, 2420-2425 (1992).

p. 750 “Out-of-date theories…”

• T. S. Kuhn, The Structure of Scientific Revolutions: Third Edition (University of

Chicago Press, Chicago, IL, 1996), p. 2-3.