Nutrition in the News: Commentary on Two Major Announcements This Week

The date was July 27, 1967. A very significant paper was published in the New England Journal of Medicine that shaped a lot of what we now see as interesting post hoc controversy. The article was entitled Dietary Fats, Carbohydrates and Atherosclerotic Vascular Disease. And it was authored by Robert Megandy, Mark Higstead and Frederick Stairs from the Departments of Public Health and Nutrition at Harvard. Some of you probably know Dr. Ster was the founder of the Department of Nutrition at Harvard and was an extraordinary key opinion leader globally in establishing nutrition policy. And this article really is a kind of a ground setting article in the context of our now present 2016 perspective and the decisions that are made within societies as to what is the healthy food supply, what should we be eating, how do we nutritionally support people and how does that influence the food industry all the way down to the delivery of prepackaged foods through Meals on Wheels or through school lunch programs? Big issues, right, that tie to articles in a major top tier journal. And what did these articles that were really a two part series of articles, one in July 27 issue and the other in the August 3 issue of the New England Journal of Medicine, what did they really say? What they said is that the debate that had been going on for some period of time, actually starting in the early 60s, as it relates to fat versus carbohydrate in the diet and where the major problems lay, was it in dietary sugar consumption or was it in excess fat consumption? So, as you probably recognize, the literature is replete as I go through just a summary of the review papers on fat versus sugar over those years, from the 50s right on up until today, it's literally thousands of papers that have been written in the professional nutrition and medical journals. So you had Ancel Keys from the University of Minnesota, who was the proponent of the dietary fat hypothesis as it related to vascular disease. And then you had John Yudkin, as you know, who is an equally prominent medical doctor, nutritional biochemist in England, who was the proponent of the fact that sugar excesses were really cause of the problem. And then we get to these landmark papers in the New England Journal of medicine in 67 that say, well, you know, carbohydrate as sugar is small in its contribution to atherosclerotic disease, but the real problem is dietary fat. So we jump on the Ancel Keys bandwagon and away we go and we leave behind the Yudkin dietary sugar hypothesis. Now, sadly, as we roll forward in history to today, John Yudkin eventually now is deceased. He was kind of professionally defrocked. He lost the battle. He lost his professional station. Even though he had extraordinary research and communication tools. His message was blotted out by the dietary fat hypothesis. Individuals and Ancel keys won the battle of the day. There are a couple of interesting quotes if we look in this New England Journal of Medicine article. These two page two set articles that I think are very important because they really define in the summary what the review of all of the present world literature that these investigators felt defined the difference between carbohydrate and fat in the diet. And they say the following in the July 27 issue. They say in summary, the controlled studies that they reviewed in this paper have all used carbohydrate variations within practical and palatable ranges of intake and have included ordinary available foodstuffs and have demonstrated slight reductions in blood lipids when dietary sugar are replaced by complex carbohydrates. So that's slight reductions. However, and this is the important sentence, how are these changes are of such a small order as compared with those obtained by changes in fats that our opinion is that they have no practical importance. So basically, sugar restriction is not a major issue and we're not worried about too much sugar. It's really the fats are the problem. In the follow up paper in the August 3 issue of the New England Journal of Medicine, this theme is kind of further amplified in the summary of this issue. And they say in quote, these effects are somewhat more pronounced. These are the effects that are seen with sugar when the diets are very low in fat. If you put a lot of sugar into a low fat diet, they say that's where you get a more profound effect. But since these diets that are low in fat and high in sugar are rarely consumed, we conclude that the practical significance of differences in dietary sugars is minimal in comparison to those related to dietary fat and cholesterol. And those two articles and those statements within set the tone from that point on to establish what later became the low fat high sugar dietary principles that were found in processed foods and prepackaged foods of the 1980s and even into the 1990s, which then was associated with some of the most rapid rise in obesity, diabetes and insulin resistance problems that we have ever witnessed in the world. Now it's globally being exported to other developing countries. So how did this all happen? If this was based upon, you know, sound information, were the scientists and the nutritionist that far off. And of course now we recognize has come to light just this last Week in the JAMA Internal Medicine was an extraordinary meta analysis research paper principally authored by Kristen Kims, who is a postdoctoral student at the University of California San Francisco, who actually is a dentist as well as an MBA who's going on in public health. And he and his colleagues Laura Schmidt and Stanton Glintz, author, co authored this paper entitled Sugar Industry and Coronary Heart Disease A Historical Analysis of Internal Industry Documents. They went back to the original source documents that were in the libraries of various places where Stair, Frederick Steyer and Megandy and Hickstadt had been writing to other people. And lo and behold they found that there was very strong support, financial support by the sugar research industry for much of this information that then sent the opinions of these individuals through a lens that ultimately led sugar to sound okay and fat to sound as the culprit. So we've laid on top of 40 years of American culture and world food policy a lot of data analysis from minimum studies, small study sizes and then interpretation with a lens to to sieve that conclusion to go towards a specific pre ordained hypothesis, the dietary fat hypothesis of Ancel Keys. I think it's extraordinary if you get a chance to read the JAMA Internal Medicine article the Sugar Industry and Coronary Heart Disease Research in its entirety because it really does a fantastic job of detailing how this information can be misinterpreted, misused in such a way as it directs global nutrition policy for so many years. That man in fact created huge adverse outcome in terms of health for literally millions of people. Now I don't want to jump to too much of an abstraction here, but I'd like to tie this to one other thing that's happening simultaneously in terms of an aha in our culture. You probably know that it was just announced that a potential merger acquisition has just been suggested between Bayer Chemical and between Monsanto. And you probably recognize that there is a very significant trend now moving towards the seed producing companies and the AG chemical companies to join forces. This is a little bit like what's happening in the healthcare system. When we see pharmaceutical companies interfacing themselves in kinds of consanguity with hospitals and with insurance companies, we start to see a kind of an interesting lack of separation of different sectors within the system in which there then is kind of cooperativism towards a specific philosophy. And if you look at the Bayer connection into Monsanto, knowing that Monsanto has a very significant GMO portfolio of different seeds that then require in some cases their own types of herbicides to be used in order to manage the crops because of the nature of the genetic modifications that have occurred in these plants. Now we start to see that we have really started to intervene. Almost like producing a medicine for an illness to create then an iatrogenic condition that requires another medicine to treat the illness that we just tried to eradicate. So I think that there is again a lack of transparency, a lack of total understanding of how the system works, A lack of going back to fundamental principles and really examining in a systems wide nature these changes that are occurring that ultimately favor a few, but may be at the expense of many. And I think that what's happening in, you probably know, even in farming, the cost of seeds for an average corn farmer now have gone from something like $300 up to $1,000 so that it actually produces then a lack of profitability for the amount of corn that they're producing on their fields because they're actually not able to charge enough to recoup the cost of the, of the production method. So now we have an overabundance of product and we have lower prices which make the farmer less successful financially. We have the support then of the ag chemical business and we have a control of seeds, all of which then are now moving towards genetic manipulation to require certain ag chemicals. So I think that this construct that we, that science knows best and that we have answers to these problems and that we implement technology to solve world problems sounds really great and I'm a supporter for the use of good science and good technology. But then how does that information get sieved through decision making processes that ultimately end up in industrial application and in quarterly earnings reports and in driving promotions and corporate benefits and, and CEO bonuses. I think that that's where we're really starting to see some breakdown in the system. It's not the fault of technology, it's not the fault of science. It's not even the fault of confusing information. It's the fault of how this ultimately gets designed not for the public good, but for the profit of the individual corporation or the individual activity area. So I believe that we're going to have to step back and really take a hard look at how we incentivize, how we incentivize in the health care system, the health of the individual as being centric to the whole economics of the system. How we incentivize in the food production system, the quality of food and how it ultimately gets prepared and processed and consumed as part of the health of the individual. The individual should be at the center of all of this system from which then the economics are built around that as the primacy for how the system is going to be incentivized. I think that is what I've learned really from going all the way back and I think in my own life of having debates with these representatives, the Mark Henksteads and the Frederick Stairs, back in the early 70s, on the sugar issue. And we were told that we didn't have the facts, they had the facts. We were misinterpreting it. We were the outliers, they were the insiders. They knew the answers. And now we only find later that they had answers, but the answers were not the answers that were built on really the truth of the evidence. And the evidence was not fully understood nor properly described to those who were ultimately pulled along through this whole process into what in the food system became 40 years of the dietary fat hypothesis, of which then sugar consumption went up and up and up, and we got into high fructose corn syrup sweeteners and into more and more problems until we did this uncontrolled experiment called diabetology and obesity that was produced out of a hypothesis that favored some at the expense of many. So that would be my kind of interpretation as to the nature of where we find ourselves today. It's a great opportunity area for change, but the rules of the road have to change in terms of the decision making if we're going to really move the health of the individual forward effectively.