As a type-1 diabetic who avoids all sugar (and most carbs) like the plague, but frustratedly watches as credible organizations continue to recommend diets that are still very high in carbs, this was extremely relevant to interests, and incredibly frustrating to read, effectively confirming nearly any suspicion you've ever had about nutrition science when you kind of skeptically look at the fluctuating, contradictory, and sometimes nonsensical recommendations (a diabetic really needs 150g of carbs a day? really?). Some of the anecdotes in here about personal attacks by respected scientists are incredibly troubling, and really make the whole field look like a sham.
It's a longread, so I'll just post some of the more interesting passages:
It's a longread, so I'll just post some of the more interesting passages:
Robert Lustig is a paediatric endocrinologist at the University of California who specialises in the treatment of childhood obesity. A 90-minute talk he gave in 2009, titled Sugar: The Bitter Truth, has now been viewed more than six million times on YouTube. In it, Lustig argues forcefully that fructose, a form of sugar ubiquitous in modern diets, is a poison culpable for Americas obesity epidemic.
A year or so before the video was posted, Lustig gave a similar talk to a conference of biochemists in Adelaide, Australia. Afterwards, a scientist in the audience approached him. Surely, the man said, youve read Yudkin. Lustig shook his head. John Yudkin, said the scientist, was a British professor of nutrition who had sounded the alarm on sugar back in 1972, in a book called Pure, White, and Deadly.
If only a small fraction of what we know about the effects of sugar were to be revealed in relation to any other material used as a food additive, wrote Yudkin, that material would promptly be banned. The book did well, but Yudkin paid a high price for it. Prominent nutritionists combined with the food industry to destroy his reputation, and his career never recovered. He died, in 1995, a disappointed, largely forgotten man.
Perhaps the Australian scientist intended a friendly warning. Lustig was certainly putting his academic reputation at risk when he embarked on a high-profile campaign against sugar. But, unlike Yudkin, Lustig is backed by a prevailing wind. We read almost every week of new research into the deleterious effects of sugar on our bodies. In the US, the latest edition of the governments official dietary guidelines includes a cap on sugar consumption. In the UK, the chancellor George Osborne has announced a new tax on sugary drinks. Sugar has become dietary enemy number one.
This represents a dramatic shift in priority. For at least the last three decades, the dietary arch-villain has been saturated fat. When Yudkin was conducting his research into the effects of sugar, in the 1960s, a new nutritional orthodoxy was in the process of asserting itself. Its central tenet was that a healthy diet is a low-fat diet. Yudkin led a diminishing band of dissenters who believed that sugar, not fat, was the more likely cause of maladies such as obesity, heart disease and diabetes. But by the time he wrote his book, the commanding heights of the field had been seized by proponents of the fat hypothesis. Yudkin found himself fighting a rearguard action, and he was defeated.
In 1980, after long consultation with some of Americas most senior nutrition scientists, the US government issued its first Dietary Guidelines. The guidelines shaped the diets of hundreds of millions of people. Doctors base their advice on them, food companies develop products to comply with them. Their influence extends beyond the US. In 1983, the UK government issued advice that closely followed the American example.
The most prominent recommendation of both governments was to cut back on saturated fats and cholesterol (this was the first time that the public had been advised to eat less of something, rather than enough of everything). Consumers dutifully obeyed. We replaced steak and sausages with pasta and rice, butter with margarine and vegetable oils, eggs with muesli, and milk with low-fat milk or orange juice. But instead of becoming healthier, we grew fatter and sicker.
Look at a graph of postwar obesity rates and it becomes clear that something changed after 1980. In the US, the line rises very gradually until, in the early 1980s, it takes off like an aeroplane. Just 12% of Americans were obese in 1950, 15% in 1980, 35% by 2000. In the UK, the line is flat for decades until the mid-1980s, at which point it also turns towards the sky. Only 6% of Britons were obese in 1980. In the next 20 years that figure more than trebled. Today, two thirds of Britons are either obese or overweight, making this the fattest country in the EU. Type 2 diabetes, closely related to obesity, has risen in tandem in both countries.
At best, we can conclude that the official guidelines did not achieve their objective; at worst, they led to a decades-long health catastrophe. Naturally, then, a search for culprits has ensued. Scientists are conventionally apolitical figures, but these days, nutrition researchers write editorials and books that resemble liberal activist tracts, fizzing with righteous denunciations of big sugar and fast food. Nobody could have predicted, it is said, how the food manufacturers would respond to the injunction against fat selling us low-fat yoghurts bulked up with sugar, and cakes infused with liver-corroding transfats.
Nutrition scientists are angry with the press for distorting their findings, politicians for failing to heed them, and the rest of us for overeating and under-exercising. In short, everyone business, media, politicians, consumers is to blame. Everyone, that is, except scientists.
But it was not impossible to foresee that the vilification of fat might be an error. Energy from food comes to us in three forms: fat, carbohydrate, and protein. Since the proportion of energy we get from protein tends to stay stable, whatever our diet, a low-fat diet effectively means a high-carbohydrate diet. The most versatile and palatable carbohydrate is sugar, which John Yudkin had already circled in red. In 1974, the UK medical journal, the Lancet, sounded a warning about the possible consequences of recommending reductions in dietary fat: The cure should not be worse than the disease.
Still, it would be reasonable to assume that Yudkin lost this argument simply because, by 1980, more evidence had accumulated against fat than against sugar.
After all, thats how science works, isnt it?
These sharp fluctuations in Yudkins stock have had little to do with the scientific method, and a lot to do with the unscientific way in which the field of nutrition has conducted itself over the years. This story, which has begun to emerge in the past decade, has been brought to public attention largely by sceptical outsiders rather than eminent nutritionists. In her painstakingly researched book, The Big Fat Surprise, the journalist Nina Teicholz traces the history of the proposition that saturated fats cause heart disease, and reveals the remarkable extent to which its progress from controversial theory to accepted truth was driven, not by new evidence, but by the influence of a few powerful personalities, one in particular.
Teicholzs book also describes how an establishment of senior nutrition scientists, at once insecure about its medical authority and vigilant for threats to it, consistently exaggerated the case for low-fat diets, while turning its guns on those who offered evidence or argument to the contrary. John Yudkin was only its first and most eminent victim.
Today, as nutritionists struggle to comprehend a health disaster they did not predict and may have precipitated, the field is undergoing a painful period of re-evaluation. It is edging away from prohibitions on cholesterol and fat, and hardening its warnings on sugar, without going so far as to perform a reverse turn. But its senior members still retain a collective instinct to malign those who challenge its tattered conventional wisdom too loudly, as Teicholz is now discovering.
In a series of densely argued articles and books, including Why We Get Fat (2010), the science writer Gary Taubes has assembled a critique of contemporary nutrition science, powerful enough to compel the field to listen. One of his contributions has been to uncover a body of research conducted by German and Austrian scientists before the second world war, which had been overlooked by the Americans who reinvented the field in the 1950s. The Europeans were practising physicians and experts in the metabolic system. The Americans were more likely to be epidemiologists, labouring in relative ignorance of biochemistry and endocrinology (the study of hormones). This led to some of the foundational mistakes of modern nutrition.
The rise and slow fall of cholesterols infamy is a case in point. After it was discovered inside the arteries of men who had suffered heart attacks, public health officials, advised by scientists, put eggs, whose yolks are rich in cholesterol, on the danger list. But it is a biological error to confuse what a person puts in their mouth with what it becomes after it is swallowed. The human body, far from being a passive vessel for whatever we choose to fill it with, is a busy chemical plant, transforming and redistributing the energy it receives. Its governing principle is homeostasis, or the maintenance of energy equilibrium (when exercise heats us up, sweat cools us down). Cholesterol, present in all of our cells, is created by the liver. Biochemists had long known that the more cholesterol you eat, the less your liver produces.
Unsurprisingly, then, repeated attempts to prove a correlation between dietary cholesterol and blood cholesterol failed. For the vast majority of people, eating two or three, or 25 eggs a day, does not significantly raise cholesterol levels. One of the most nutrient-dense, versatile and delicious foods we have was needlessly stigmatised. The health authorities have spent the last few years slowly backing away from this mistake, presumably in the hope that if no sudden movements are made, nobody will notice. In a sense, they have succeeded: a survey carried out in 2014 by Credit Suisse found that 54% of US doctors believe that dietary cholesterol raises blood cholesterol.
To his credit, Ancel Keys realised early on that dietary cholesterol was not a problem. But in order to sustain his assertion that cholesterol causes heart attacks, he needed to identify an agent that raises its levels in the blood he landed on saturated fats. In the 30 years after Eisenhowers heart attack, trial after trial failed to conclusively bear out the association he claimed to have identified in the Seven Countries study.
The nutritional establishment wasnt greatly discomfited by the absence of definitive proof, but by 1993 it found that it couldnt evade another criticism: while a low-fat diet had been recommended to women, it had never been tested on them (a fact that is astonishing only if you are not a nutrition scientist). The National Heart, Lung and Blood Institute decided to go all in, commissioning the largest controlled trial of diets ever undertaken. As well as addressing the other half of the population, the Womens Health Initiative was expected to obliterate any lingering doubts about the ill-effects of fat.
It did nothing of the sort. At the end of the trial, it was found that women on the low-fat diet were no less likely than the control group to contract cancer or heart disease. This caused much consternation. The studys principal researcher, unwilling to accept the implications of his own findings, remarked: We are scratching our heads over some of these results. A consensus quickly formed that the study meticulously planned, lavishly funded, overseen by impressively credentialed researchers must have been so flawed as to be meaningless. The field moved on, or rather did not.
In 2008, researchers from Oxford University undertook a Europe-wide study of the causes of heart disease. Its data shows an inverse correlation between saturated fat and heart disease, across the continent. France, the country with the highest intake of saturated fat, has the lowest rate of heart disease; Ukraine, the country with the lowest intake of saturated fat, has the highest. When the British obesity researcher Zoë Harcombe performed an analysis of the data on cholesterol levels for 192 countries around the world, she found that lower cholesterol correlated with higher rates of death from heart disease.
In the last 10 years, a theory that had somehow held up unsupported for nearly half a century has been rejected by several comprehensive evidence reviews, even as it staggers on, zombie-like, in our dietary guidelines and medical advice.
The congressional review has come about partly because of Nina Teicholz. Since her book was published, in 2014, Teicholz has become an advocate for better dietary guidelines. She is on the board of the Nutrition Coalition, a body funded by the philanthropists John and Laura Arnold, the stated purpose of which is to help ensure that nutrition policy is grounded in good science.
In September last year she wrote an article for the BMJ (formerly the British Medical Journal), which makes the case for the inadequacy of the scientific advice that underpins the Dietary Guidelines. The response of the nutrition establishment was ferocious: 173 scientists some of whom were on the advisory panel, and many of whose work had been critiqued in Teicholzs book signed a letter to the BMJ, demanding it retract the piece.
Publishing a rejoinder to an article is one thing; requesting its erasure is another, conventionally reserved for cases involving fraudulent data. As a consultant oncologist for the NHS, Santhanam Sundar, pointed out in a response to the letter on the BMJ website: Scientific discussion helps to advance science. Calls for retraction, particularly from those in eminent positions, are unscientific and frankly disturbing.
The letter lists 11 errors, which on close reading turn out to range from the trivial to the entirely specious. I spoke to several of the scientists who signed the letter. They were happy to condemn the article in general terms, but when I asked them to name just one of the supposed errors in it, not one of them was able to. One admitted he had not read it. Another told me she had signed the letter because the BMJ should not have published an article that was not peer reviewed (it was peer reviewed). Meir Stampfer, a Harvard epidemiologist, asserted that Teicholzs work is riddled with errors, while declining to discuss them with me.
Reticent as they were to discuss the substance of the piece, the scientists were noticeably keener to comment on its author. I was frequently and insistently reminded that Teicholz is a journalist, and not a scientist, and that she had a book to sell, as if this settled the argument. David Katz, of Yale, one of the members of the advisory panel, and an indefatigable defender of the orthodoxies, told me that Teicholzs work reeks of conflict of interest without specifying what those conflicts were. (Dr Katz is the author of four diet books.)
Dr Katz does not pretend that his field has been right on everything he admitted to changing his own mind, for example, on dietary cholesterol. But he returned again and again to the subject of Teicholzs character. Nina is shockingly unprofessional I have been in rooms filled with the whos who of nutrition and I have never seen such unanimous revulsion as when Miss Teicholzs name comes up. She is an animal unlike anything Ive ever seen before. Despite requests, he cited no examples of her unprofessional behaviour. (The vitriol poured over Teicholz is rarely dispensed to Gary Taubes, though they make fundamentally similar arguments.)
In March this year, Teicholz was invited to participate in a panel discussion on nutrition science at the National Food Policy conference, in Washington DC, only to be promptly disinvited, after her fellow panelists made it clear that they would not share a platform with her. The organisers replaced her with the CEO of the Alliance for Potato Research and Education.
http://www.theguardian.com/society/2016/apr/07/the-sugar-conspiracy-robert-lustig-john-yudkinThe nutritional establishment has proved itself, over the years, skilled at ad hominem takedowns, but it is harder for them to do to Robert Lustig or Nina Teicholz what they once did to John Yudkin. Harder, too, to deflect or smother the charge that the promotion of low-fat diets was a 40-year fad, with disastrous outcomes, conceived of, authorised, and policed by nutritionists.
Professor John Yudkin retired from his post at Queen Elizabeth College in 1971, to write Pure, White and Deadly. The college reneged on a promise to allow him to continue to use its research facilities. It had hired a fully committed supporter of the fat hypothesis to replace him, and it was no longer deemed politic to have a prominent opponent of it on the premises. The man who had built the colleges nutrition department from scratch was forced to ask a solicitor to intervene. Eventually, a small room in a separate building was found for Yudkin.
When I asked Lustig why he was the first researcher in years to focus on the dangers of sugar, he answered: John Yudkin. They took him down so severely so severely that nobody wanted to attempt it on their own.
