There will always be a market for conspiracy theories, but conspiracy theories are sometimes facts.
It's a secret conversation that's been in the dust for 50 years.
"We value your opinion very much, and we will do our best to accommodate it." （We are well aware of your particular interest, and will cover this as well as we can.）
"I'm pretty sure that's what we want and look forward to getting it delivered for print as soon as possible." （Let me assure you this is quite what we had in mind, and we look forward to its appearance in print.）
The first sentence came from Dr. Hegsted, a famous nutrition professor at Harvard University at the time, and the second sentence came from John Hickson, an executive in the sugar industry.
Apparently, Harvard scholars wrote a "soft article" that sugar executives wanted.
And this "soft article" was published in the top medical journal NEJM, so much so that the dietary recommendations for the prevention and treatment of cardiovascular disease have been deflected for decades. The scandal was not revealed until 2016 by JAMA Internal Medicine magazine[1].
JAMA Internal Medicine Disclosures Internal Documents Related to Sugar and Cardiovascular Disease Research[1]
But the potential health damage caused by the scandal is incalculable.
How did all this happen? Let's go back to 50 years ago, when the beginning of the article began.
How to "whitewash" the crisis with money
The United States has the least healthy diet of all developed countries.
High in sugar, fat and calories is a characteristic of its diet. This has also led to a high incidence of obesity, coronary heart disease and diabetes. Since the middle of the last century, the focus on health and the popularization of related medical knowledge have greatly affected the sales of such products.
However, by the 80s, few scientists believed that sugar addition was a major cause of coronary heart disease.
In the first edition of the "1980 American Dietary Guidelines" introduced by the US government, reducing the intake of whole fat, saturated fat and dietary cholesterol to prevent cardiovascular diseases, but did not mention sugar addition as a cause of coronary heart disease.
So, what has happened in these decades?
In order to maintain the market sales of the huge sugar industry empire, since the 60s of the last century, the sugar association organized by the major sugar giants has used its "money" influence to continuously infiltrate the entire nutrition expert. The most direct and effective way is to let top nutrition experts publish the idea that "sugar is harmless" in top journals.
They found several professors at Harvard Medical School, each of whom received a commercial bribe equivalent to $50,000 (about 344,200 yuan) today, for which they cheered for the sugar industry for decades to come.
One of those scientists was Dr. Mark Hegsted, who later became head of the USDA's nutrition division and helped draft the first edition of the federal government's dietary guidelines in 1977. The other is Fredrick J. Stare, dean of the Harvard School of Nutrition.
So in the decades that followed, neither academic articles nor official dietary guidelines pointed out the dangers of sugar. People believe that eating sugar the most is to cause tooth decay, and fat is the root cause of diseases such as coronary heart disease.
Until 2007, at the US FDA (Food and Drug Administration) hearing, there were no warnings related to sugar and heart disease and diabetes. In fact, according to the latest research, in addition to being a risk factor for coronary heart disease, sugar is also closely related to obesity, diabetes, hypertension, gout and other diseases.
In 50 years, I don't know how many people have suffered from diseases from sugar. In 2012 alone, there were 702,308 cardiovascular and metabolic disease-related deaths in the United States, of which 10.8% of coronary heart disease deaths and 14.8% of diabetes deaths were attributed to sugar-sweetened beverages.
The professors have passed away, but the truth was only discovered in 2010 and revealed in 2016.
They were also forever nailed to the academic pillar of shame.
What are the dangers of sugar?
Studies have shown that in addition to being a risk factor for coronary heart disease, sugar is also closely related to obesity, diabetes, hypertension, gout and other diseases.
Clinical studies have found that when saturated fatty acids in the diet are replaced with sugars of the same energy (sucrose or fructose syrup; Commonly used additives in sugar-sweetened beverages), elevated LDL, triglycerides, and decreased HDL are associated with an increased risk of coronary heart disease [2].
Evidence on the association of saturated fatty acids and sugars with coronary heart disease[2]
In other words, the intake of sugars of the same energy has a greater effect on blood lipids than saturated fatty acids.
A meta-analysis of 173753 populations explored the association between sugar-sweetened beverages and coronary heart disease. Studies have found that consuming 1 more sugar-sweetened beverage per day (1 serving = 330 mL, the sugar content of a drink) is associated with a 16% increased risk of coronary heart disease, and the more you drink, the higher the risk [3].
Conversely, limiting saturated fatty acid intake does not reduce all-cause and cardiovascular mortality, nor does it reduce the risk of coronary heart disease.
Another study published in ATVB included healthy volunteers, with an average age of 31 years, who were each given a 600 mL bottle of sugar-sweetened drink (72g sugar, energy 1200 KJ).
Using purified water as a control, it was found that after drinking 600 mL of sugar-sweetened beverage, the microvascular function and macrovascular endothelial function of volunteers were significantly impaired, and the internal mechanism may be related to oxidative stress caused by increased blood glucose [4].
Sugar-sweetened beverages cause significant impairment of vascular endothelial function[4]
This means that even a 600 mL bottle of sugary drink can cause damage.
Limit the intake of "bad sugars"
While a bottle of sugary drink is lethal, we shouldn't keep all sugar out. Carbohydrates are one of the three major nutrients in the human body and should be consumed in a balanced manner.
What really needs to be restricted is "added sugar", that is, sugar that is not contained in the food itself.
The World Health Organization's 2020 updated nutrition guidelines [5] recommend that adults' daily added sugar intake should be controlled below 5% of total energy, that is, about 25~30 grams per day.
WHO 2020 updated nutrition guidelines[5]
These added "bad sugars" mainly come from sugary drinks, snacks and white sugar, sucrose or fructose syrup added during cooking, not glucose, let alone starch, cellulose and other polysaccharides.
If you pay attention to the packaging of beverages, most sugary drinks are added with white sugar, and more than 95% of white sugar is sucrose; A small part is added to fructose syrup, which is decomposed to produce fructose.
A large number of studies have found that compared with glucose or starch, sucrose and fructose can induce elevated blood lipids, insulin resistance, platelet dysfunction, and eventually lead to obesity, coronary heart disease, and diabetes. By limiting the intake of sucrose and fructose, the above abnormalities can be significantly reversed.
In addition, the sugar content of various beverages varies greatly. For sugary drinks, in addition to the most famous "cola", there are many "sheep's clothing" members, including but not limited to fruit juice drinks, sports drinks, energy vitamin drinks, iced tea, yogurt, herbal tea, sour plum soup.
With the standard of WHO added sugar within 25 g per day, any 1 bottle may exceed the standard.
But there are also healthier drinks, sodas, and a variety of sugar-free teas. Among the common drinks in China, the healthiest is boiled water.
Curated by: gyouza|Image source: Visual China
The author of this article: Mai Jingting, deputy chief physician of the Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
Bibliography:
1.Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents.JAMA Internal Medicine,2016,176 (11):1680
2.The Evidence for Saturated Fat and for Sugar Related to Coronary Heart Disease.Prog Cardiovasc Dis. 2016 ; 58(5): 464–472. doi:10.1016/j.pcad.2015.11.006.
3.Consumption and risk of coronary heart disease: a meta-analysis of prospective studies. Atherosclerosis. 2014;234:11–16. doi: 10.1016/j. atherosclerosis.2014.01.037.
4.Effects of Sugar-Sweetened Beverage Consumption on Microvascular and Macrovascular Function in a Healthy Population. Arteriosclerosis, Thrombosis, and Vascular BiologyVol. 37, No. 6
5.https://www.who.int/news-room/fact-sheets/detail/healthy-diet
6.Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in the United States.JAMA. 2017;317(9):912-924.
7. Fructose and cardiometabolic health: what the evidence
from sugar-sweetened beverages tells us. J Am Coll Cardiol.2015;66:1615–1624. doi: 10.1016/j.jacc.2015.08.025.
8.Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. American Journal of Clinical Nutrition, 2010 , 91 (3) :535
9.Dietary intake of saturated fat is not associated with risk of coronary events or mortality in patients with established coronary artery disease. J Nutr. 2015; 145:299–305. [PubMed: 25644351]
10.Sucrose-sweetened beverages increase fat storage in the liver, muscle,
and visceral fat depot: a 6-mo randomized intervention study. Am J Clin Nutr 2012;95:283–9.