← Metabolical The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine
Metabolical Chapter 23. The Party Line
Author: Robert H. Lustig Publisher: New York, NY: HarperCollins Publishers Publish Date: 2021-5-4 Review Date: Status:💥
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As demonstrated in the film Merchants of Doubt (2014), the tobacco industry followed a consistent playbook for several decades to keep the world smoking. Ultimately, the science caught up with the industry, and the law caught up with everyone (even though the tobacco executives themselves weren’t found to be personally culpable). However, it took forty-four years from the first report of tobacco and lung cancer to the Mississippi attorney general suing Big Tobacco for recoupment of Medicaid costs related to lung cancer. As dramatized in Dark Waters (2019), E. I. du Pont consistently stonewalled for nineteen years to avoid litigation regarding its use of perfluorooctanoic acid (PFOA or Teflon) in pots and pans. We learned the hard way that big money industries will do anything they can to turn a profit at whatever cost to lives, the environment, and society at large.
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The sugar industry is one of the most egregious villains in the bunch. Based on our current recognition of sugar’s toxicity and their responses to litigation thus far, one might assume that Big Sugar learned its tricks from Big Tobacco. But it’s actually the other way around—the Sugar Research Foundation was founded in 1943, and one of its executives, Dr. Robert Hockett, peddled his manipulation tactics to the Tobacco Industry Research Committee in 1954. In any case, the playbooks are almost identical—deny, deflect, distract, delay. The entire processed food industry has adopted this policy. Some tactics involve influencing scientists, others influence public opinion, and even more influence governments and the courts. The UCSF Industry Documents Library now hosts a food industry section open to the public, with a particular focus on sugar, which has been used by my colleagues to document the extent and magnitude of food industry subterfuge.
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Influencing Scientists
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“More doctors smoke Camels over any other cigarette …” This was just one of many advertising efforts of Big Tobacco to co-opt the public by co-opting scientists, as documented by Stanford research Robert Proctor in his book Golden Holocaust (2012). True to the corporate playbook, the processed food industry has similarly co-opted their most influential, but not necessarily knowledgeable, critics using four different strategies.
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Distracting away from the real problem. As we explored in Chapter 10, we have the data to demonstrate that processed food is a primary causative factor for diabetes, fatty liver disease, heart disease, and tooth decay; correlative for cancer, dementia, hypertension, addiction to other substances, and depression; as well as plausible for autoimmune disease and anxiety. But when the food industry addresses these issues in public, they only refer to the “obesity epidemic.” Until about 2010, they ignored the problem entirely, deflecting the issue back to the consumer and using the tobacco industry meme of “personal responsibility.” When they couldn’t deny culpability any longer, they chose to divert the public health conversation specifically toward obesity, for two reasons: because for them and the dietitians, it’s still all about calories, and the public still believes it (hopefully I’ve done a good enough job with this book to finally kill the calorie). The data for sugar and obesity is also relatively weak, or at least it has been until recently.
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One study showed that soda and desserts rank below French fries and potato chips as a cause of weight gain. You’ll notice that all are processed foods and that French fries are generally consumed with loads of sugar-sweetened tomato ketchup and most flavored potato chips have lots of sugar, even if they aren’t technically a dessert. This is the crux of the food industry’s overarching message—if sugar is only one of many causes of obesity, then why pick on it specifically? The industry regurgitates its mantra that “a calorie is a calorie”; therefore it’s about energy balance, gluttony and sloth, diet and exercise, and if you’re fat, it’s your fault. Yet, when weight and calories are factored out, the correlation between sugar consumption and diabetes becomes much stronger—in other words, the effect of other calories on weight gain dilutes out the specific effects of sugar on diabetes. In addition, there are countries where diabetes rates are astronomical while obesity rates are low—such as India, Pakistan, and China—yet their sugar consumption has increased by 15 percent in the past six years alone.
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Of course, fast food is more than just sugar. Maybe it’s the hamburgers, maybe it’s the French fries, maybe it’s the Filet-O-Fish sandwiches; it could even be the salad dressing. Roberto De Vogli at UC Davis wanted to know which component was the real culprit, so his team assembled the cash register receipts for eighteen years in all thirty-seven OECD countries (a mean feat to be sure), categorized what was consumed, and correlated each with weight gain over time. His research revealed it was the sugar-sweetened beverages that drove the weight gain over the processed animal- and plant-based products. Of course, this study was retrospective, not prospective, and it doesn’t prove causation. Nonetheless, the sugar remains a constant.
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To date, the food industry refuses to engage in a rational discussion about the role of added sugar in chronic metabolic diseases exclusive of its effects on obesity, because the message of obesity works for them. Or at least it worked for them until 2019, when the reason for this paradox was unraveled. It turns out that sugar has two effects on weight gain. One is an immediate function, where year by year consumption predicts year by year weight gain; the second function is what your mother ate before you were even born. As explored earlier, mother’s consumption of sugar reaches across the placenta, goes to the liver to turn sugar into liver fat, and to the pancreas to make extra insulin, which drives fetal fat cell development. This is why obesity rates keep going up in the US, even though sugar consumption has dropped slightly in the last decade—the current generation is still paying for the previous generation’s SpaghettiOs. That Coke wasn’t just the “real thing” for you, but for your unborn kids, too.
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Following the money. The sugar industry has a long history of co-opting scientists. My UCSF colleagues Cristin Kearns, Laura Schmidt, and Stanton Glantz have discovered the paper trail of influence by the Sugar Research Foundation. The foundation engaged in a coordinated disinformation effort to exonerate sugar and divert attention toward saturated fat as a cause of cardiovascular disease in 1967, and away from sugar as a cause of dental caries in 1971. Since then, sugar, high-fructose corn syrup, beverage, and processed food industry concerns have paid scientists to be complicit in marketing sugar as healthy, or at least benign. More recently, an analysis of Web of Science citations from 2008 to 2016 identified 779 articles with Coca-Cola conflicts of interest regarding funding. A subsequent comparison with Coca-Cola’s own transparency website (established in 2016 after the New York Times exposé on the Global Energy Balance Network) identified 128 articles and 471 authors who weren’t disclosed by Coca-Cola, as well 19 academic investigators who had direct email contact with the company. The question is whether academia and industry should be allowed to work together, especially if academia can be so easily co-opted by money.
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Espousing the alternate view, Dr. John Sievenpiper of St. Michael’s Hospital in Toronto, in the documentary Sugar Coated (2015), stated, “Academics, as much as people believe they are biased, they want to do good research, and if they can’t get the money to answer important questions as they see them, in their labs and clinics, from the government, they’ll look to other sources.” But what if those sources have their own agendas?
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Obfuscating scientific research. One would expect the totality of evidence on the detrimental effects of sugar to be reflected in systematic reviews or meta-analyses; however, many of these publications yield inconsistent results. It’s a classic rewrite of the tobacco playbook. One problem is that many of these studies are funded by the food industry, with the intention of diluting the available data, specifically to paper over any significant effects. However, these inconsistencies are exposed completely when food industry sponsorship is taken into account. We shouldn’t be surprised to find that studies funded by industry are 7.4 times more likely to show a favorable conclusion, and in cases when the data didn’t fit the industry’s narrative, they just deep-sixed it. The industry’s influence in distorting public health messages even extends to institutions and organizations that have a responsibility to scientific integrity, such as the University of Sydney protecting scientists who used a faulty dataset in order to exonerate sugar as a cause of obesity.
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Co-opting public health experts. For years as part of their public relations machinery, soft drink companies would push lack of physical activity as a cause of obesity. However, the evidence reveals that the impact of physical activity on chronic disease is minimal. You just can’t outrun a bad diet. The beverage companies have sponsored a total of ninety-six public health efforts, with the proviso that they don’t address soft drinks. For example, Dr. Brenda Fitzgerald, the recently disgraced director of the U.S. Centers for Disease Control, wouldn’t divest her portfolio from tobacco stocks and had also taken money from Coca-Cola. Coca-Cola also bankrolled the now-defunct Global Energy Balance Network, a consortium of three academics “on the take” to promulgate lack of exercise as the cause of obesity. In their own words, “an energy balance framework is the only framework that makes sense in addressing obesity.” Even Michelle Obama caved to food industry pressure in the president’s second term, shifting her focus away from the importance of a healthy diet exclusively toward promoting physical activity. Even the Academy of Nutrition and Dietetics (AND), British Dietetic Association (BDA), and the Dieticians Association of Australia (DAA) all receive annual contributions from food industry concerns. After all, you shouldn’t bite the hand that feeds you.
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Influencing Public Opinion—the Meme of “Personal Responsibility”
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Influencing Government and the Courts
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In the 1960s Ralph Nader and Unsafe at Any Speed (1965) spearheaded the American consumer movement. Environmentalism was gaining speed. Regulatory agencies like OSHA and the EPA were founded. Distrust of Big Business was at its peak. But then in the 1970s something happened. Big Industry, of which Big Food is a major player, started to wage a propaganda war in the halls of Congress and the Supreme Court to take back what they viewed was rightfully theirs. How did they do it?
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Disinformation campaigns and legislation.
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In 1972, Sugar Information, Inc., ran a public disinformation campaign to deflect criticism from its product. The U.S. Federal Trade Commission (FTC) engaged in a damaging court battle, which shuttered their efforts. However, in the late 1970s, efforts to ban junk food marketing on television led to a corporate power struggle pressuring Congress to “declaw” the FTC (take away its enforcement powers), which eventually occurred in 1980; the FTC has never been heard from again.
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The 1970s also saw the rise of the American Legislative Exchange Council (ALEC), a bill mill that writes legislation beneficial to the oil, pharma, tobacco/alcohol, and food industries. Through contributions from affiliated groups and individuals, it effectively pays off congressmen to introduce these bills in order to make sure the playing field is not kept level, that these industries are protected. This goes all the way to the top. One example was the privatization of the FDA’s Generally Recognized as Safe (GRAS) list in 1997 (see Chapter 24). Most recently, the Trump administration limited even more information on junk food labels at the bidding of Big Food.
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Trade organizations.
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Trade organizations are sponsored by many companies within an industry to lobby and further the needs and profits of the industry as a whole. In the US, there’s the American Beverage Association and National Restaurant Association. In the UK, the Food and Drink Federation performs similar functions. In Australia and New Zealand, there’s the Sugar Research Advisory Service, renamed the Sugar Nutrition Resource Centre. The claim is that this is a scientific information service for health professionals, academics, and the media that aims to provide “an evidence-based view of the role of sugars in nutrition and health.” It is fronted by academics and health professionals receiving money directly from the industry, and is blatantly pro-sugar.
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When Nonprofits Profit
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Perhaps the most egregious organization of all is the International Life Sciences Institute (ILSI). Its mission, according to its website, is “to provide science that improves human health and well-being and safeguards the environment.” This organization, though nonprofit and private, is really a corporate lobby group. They say they’re all about the science—but only the science the industry promulgates. ILSI has a $17 million budget, all funded by four hundred corporate members, including some of the biggest names in food processing (e.g., Coca-Cola, DuPont, PepsiCo, General Mills, and Danone). It pushes the benefits of food processing while ignoring any science that mentions its risks. Furthermore, under the auspices of being a scientific nonprofit, one of its true missions (if it chooses to accept it) is to infiltrate the agencies that could regulate them. Nowhere is this more clear than in China, where members of China’s FDA are on the board of directors of ILSI. What could go wrong? China’s food safety has been consistently called into question, but the conflicts of interest here are widespread.
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Astroturf groups are “citizens” or nonprofit groups that mask their sponsors to appear as though they’re grassroots organizations. The U.S. Center for Organizational Research and Education (CORE; formerly the Center for Consumer Freedom) is an organization with a name deliberately designed to divert attention away from industry connection. They claim to be “dedicated to protect consumer choices and promoting common sense.” In fact, they’re funded by the fast food, meat, alcohol, and tobacco industries.
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The group was founded in the mid-1990s, using tobacco (Philip Morris donated $600,000) and restaurant industry money to oppose smoking restrictions in restaurants. Its founder, Richard Berman, also began the American Beverage Institute, which fights restrictions on alcohol use and raising the minimum wage. In a secretly recorded interview reported by the New York Times, Berman encouraged main players to attack those that oppose industry interests with threats that they could either “win ugly or lose pretty.”
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Across the pond, the Institute of Economic Affairs (IEA) is self-pronounced as “the UK’s original free market think tank.” They claim to be independent of any political party, group, or organization. But is this true? Last year they received £1.6 million ($2 million) from Big Tobacco, Coca-Cola, and sugar manufacturer Tate & Lyle. In July 2014, the IEA released a report arguing that lack of physical activity was driving the obesity epidemic rather than excess calories, and then another report (with no science) saying that research shows that sugar isn’t the cause of diabetes. When questioned as to whether the organization takes money from the food industry, spokesman Christopher Snowdon replied that the question was “irrelevant.” On the BBC, Snowdon recently suggested that those public health bodies calling for reduction of sugar, alcohol, and tobacco are responsible for increasing misery in society. Because who could be happy without a Captain and Coke in one hand and a cigarette in the other? Simultaneously, ignoring all medical information to the contrary, he suggested that we couldn’t be healthier.
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The food industry knows what it’s doing. And I know, too, because I’ve been an expert witness in several lawsuits against the food industry. When a lawsuit goes forward, the attorneys on both sides engage in the process of discovery, which entitles each side to see the correspondence and emails of the other side. As a result, everyone knows what the defendant knew and when they knew it, as does the judge. The fact that lawsuits against the food industry aren’t immediately thrown out and live to see a payday says that the courts now find that the industry is knowledgeable and culpable. This is the second of our three immoral hazards— creating a market to profit off the misery of others. And the processed food industry has done exactly that, profiting off poisoning their customers. And now those processed chickens are coming home to roost.