CHAPTER 10
HOW THE FOOD (MOSTLY SODA) INDUSTRY CO-OPTS PUBLIC HEALTH AND DISTORTS NUTRITION SCIENCE
When Coca-Cola and Skittles were created, it may be true that the manufacturers didn’t know just how much obesity and disease their products would cause. But this is no longer the case. Big Food companies are not innocent actors caught in the wake of their unintended consequences. They are active participants in the disability, disease, and death of billions of people. Rather than changing or reinventing their products to be less harmful, Big Food has launched an intentional, thoughtful, and meticulously designed series of efforts to silence critics; manipulate science; distort the truth; and aggressively control and influence media, politicians, public health and consumer advocacy groups, and consumers. Let’s see exactly how.
In the spring of 2012, Coca-Cola was under attack.
New York City mayor Michael R. Bloomberg had just announced a controversial new plan to ban local restaurants, movie theaters, and fast-food establishments from selling large cups of sugary beverages. Chicago, Philadelphia, and other cities were debating whether to institute sugary-drink taxes to drive down their obesity rates as well. And on social media, a video called “Sugar: The Bitter Truth” was going viral, with millions of page views and more than 50,000 new viewers every month. The video showed a charismatic endocrinologist named Robert Lustig explaining in gripping detail why sugar is toxic to the liver and the body.
Americans were starting to look at their fizzy, sugar-laden beverages as the cause of their growing waistlines. Sales of full-calorie soft drinks across the United States were plummeting, reaching their lowest point in 20 years. Coca-Cola, the industry leader, was desperate to stop the bleeding. The company deployed a powerful weapon: one of its top executives, Rhona Applebaum, a tough corporate executive with a PhD in microbiology who was Coke’s chief scientist. In August 2012, Applebaum drew the battle lines. She warned the sugar executives at the International Sweetener Symposium that they needed to be more aggressive in defending their products from the public health onslaught. Applebaum put up a slide that showed a list of the food industry’s biggest detractors. On the slide were photographs of Kelly Brownell—dean of the Sanford School of Public Policy at Duke University and an obesity expert and outspoken advocate of soda taxes—along with the logo of the Center for Science in the Public Interest, a consumer watchdog group and major critic of the junk-food industry.1
Applebaum outlined how to fund “defensive and offensive science and research” to promote industry-friendly studies—a bit bizarre because science is not a weapon; it is an inquiry into truth. She warned that the industry was under attack from “detractor activism.” She complained about Lustig’s viral video on sugar, calling him a crusading “tube star” and pointing out that he and other public health critics were resonating with the public. These critics of the industry “basically go unchallenged,” she told the crowd, lamenting that even Coke had sometimes been too complacent in the face of criticism.2 Applebaum told the executives that Big Soda and the sugar industry were facing a do-or-die moment. To drive the point home, she put up a slide with a famous quote uttered by Benjamin Franklin during the Revolutionary War. “We must all hang together, or assuredly we shall all hang separately.”
Applebaum told the executives that she had come to them with “a plea from Coca-Cola” that “we all have to work together and use science” to defeat their detractors and win over the public. She laid out a strategy that Coke had devised to “balance the debate”: cultivating relationships, collaborating on research, and communicating results. Her not-so-subtle suggestion: Forming relationships with leading public health organizations would turn junk-food foes into friends. And she said that the industry had to be proactive in communicating about the health effects of sugar while telling consumers to exercise to avoid obesity. “Address the negatives—advance the positives,” she told the audience.3
Applebaum’s resolve at the symposium was not just for show. Internal e-mails show that Applebaum courted many prominent scientists, often inviting them to Coca-Cola headquarters in Atlanta and depositing thousands of dollars into their bank accounts.4 Applebaum funneled millions of dollars in payments and funding to more than a dozen prominent scientists at universities around the country. And these scientists then published dubious research that benefited the soft drink industry and supported its energy-balance message to the public. Energy balance is a code for eat less, exercise more, that familiar myth that weight loss is all about calories and soda can be part of a “balanced” diet.
A thousand calories of Coke versus a thousand calories of broccoli. Are they the same when you eat them in their effects on your body and metabolism? The science is clear.5 Absolutely not.
In total, Coke provided more than $120 million to US universities, health organizations, and research institutions between 2010 and 2015. From 2008 to 2016 Coke funded 389 articles in 169 journals concluding that physical activity was more important than diet and that soft drinks and sugar are essentially harmless.7 You have to walk 4 miles to burn off just one 20-ounce Coke. You can’t exercise your way out of a bad diet, but these companies continue to publish data that minimizes the effect of food and inaccurately pushes exercise as the solution to our obesity and disease epidemic.8
Furthermore, Applebaum and Coke’s influence on researchers extended beyond money. One of the top scientists they courted was Jim Hill, a professor of medicine at the University of Colorado. Hill served on NIH and CDC obesity panels. He cofounded the National Weight Control Registry, the most prominent, long-running weight-loss study in America. He was also a former president of the American Society for Nutrition (ASN), which once called him “a leader in the fight against the global obesity epidemic.” It’s no surprise that ASN is heavily funded by the food industry.
Beginning in about 2011, with cities and states increasingly proposing taxes on soda and other junk foods, Hill grew cozy with Coke. He published studies paid for by Coke and the American Beverage Association (formerly known as the American Soda Pop Association), and he traveled the country giving speeches and attending conferences on Coke’s dime. Some of his research findings were so counterintuitive that they were practically unbelievable. In one study published in the high-profile journal Obesity, Hill reported that obese people who drank diet soda lost more weight than obese people who drank only water.9 Independent research consistently shows that diet drinks increase weight gain and type 2 diabetes.10 In e-mails (obtained through the Freedom of Information Act, FOIA), Applebaum had been urging Hill to publish the study, saying Coke was eager to fend off negative press about the dangers of aspartame. In one e-mail Applebaum alerted Hill that The Dr. Oz Show was planning to run a negative segment about artificial sweeteners. Applebaum told Hill that Coke was desperate for him to publish his paper. When he finally did, in May 2014, nutrition experts were incredulous.
“How coincidental that right as diet soda sales take a significant tumble, the soda industry’s main lobbying group helps fund a study that tries to claim diet sodas are superior to water,” one skeptical nutritionist told a reporter at the time.11
Hill’s deeds did not go unrewarded. Coke paid him $550,000 for “honoraria, travel, education activities, and research on weight management.” The company paid for his travel to conferences and meetings in England, Mexico, and Grenada. It also picked up the tab for Hill and his wife to fly to Australia and New Zealand.12 In 2014, the company gave Hill’s university a check for $1 million to help him start an anti-obesity advocacy group called the Global Energy Balance Network (GEBN), which was Applebaum’s brainchild. She not only conceived of the organization, but also helped to recruit its 120 members, many of whom Coke had financially supported. Behind the scenes, e-mails show, Applebaum orchestrated the group’s message, designed its website, and edited its mission statement.13 Hill, with Applebaum’s blessing, became the group’s president.
In one internal memo that the nonprofit advocacy group US Right to Know obtained, Applebaum characterized the GEBN as a “political campaign” and said the goal was to “develop, deploy and evolve a powerful and multi-faceted strategy to counter radical organizations and their proponents.” As Applebaum saw it, Big Food was at war with the public health community and science, and the GEBN would serve as the industry’s war room.
“There is a growing war between the public health community and private industry over how to reduce obesity. Sides are being chosen and battle lines are being drawn. The most extreme public health experts have gained traction with the media, with many policy makers, and with an increasing proportion of the general public.”15
Unfortunately for Applebaum, the GEBN blew up in Coca-Cola’s face. In 2015, the New York Times and other news outlets exposed the organization as an industry-funded front group. When the news broke, Coke announced that Applebaum was suddenly “retiring” from the company and cut its financial ties to GEBN, which promptly announced it was ceasing operations because of “resource limitations.”16 Resource limitations? Really? Their “sponsor’s” annual revenue in 2018 was more than $31 billion for selling sugar water.
THE BIG FOOD PLAYBOOK
Coca-Cola’s involvement in spreading disinformation is not unique. Its tactics exemplify a multipronged strategy that Big Food has been using to deceive the public for decades.
Junk-food companies routinely recruit nutrition experts to do work for them, paying them enormous sums to promote unhealthy products and to criticize studies that the industry doesn’t like. The food industry spends more than $12 billion a year funding nutrition studies (while the NIH spends only $1 billion), polluting and diluting independent research, and confusing policy makers, the public, and even most doctors and nutritionists. Studies funded by the food industry are eight to fifty times more likely to find a positive outcome for their products. The food industry forms deep financial partnerships with policy makers, public health groups, and academic societies.
During medical school, I believed science was an honest field. But I’ve discovered how much the food industry manipulates nutrition studies. And they are frequently tainted. Their results depend on the design of the study, who is doing the analysis, and who is paying for it. The sad reality is that Big Food is furiously promoting false science.
Just looking at Coca-Cola, researchers, through FOIA, obtained 87,013 pages of documents including five agreements between Coke and public institutions in the United States and Canada.17 The “research” contracts allow Coca-Cola to review research prior to publication and maintain control over study data, whether the study gets published, and any acknowledgment of Coca-Cola’s funding of the study. If they don’t like the results, Coke gets to bury the findings. And they support front groups that pose as independent organizations to mislead consumers. How is that real science?
So much for the purity of science and independent researchers! Big Food’s ironclad plan to fool you with junk science and bogus claims is once again reminiscent of the tobacco industry’s efforts to subvert the truth in past decades. The many ways in which Big Food is borrowing the tactics of Big Tobacco were documented in a landmark 2008 paper written by Kelly Brownell, which was titled The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?18 As Brownell noted, “Disputing science has been a key strategy of many industries, including tobacco. Beginning with denials that smoking causes lung cancer and progressing to attacks on studies of secondhand smoke, the industry instilled doubt. Likewise, groups and scientists funded by the food industry have disputed whether the prevalence figures for obesity are correct, whether obesity causes disease, and whether foods like soft drinks cause harm.” Unbelievably, the food industry front group the Center for Consumer Freedom claims that the obesity epidemic is a hoax.19 Guess they have never been to Disneyland, or taken a walk down Main Street America.
This coordinated industry-wide strategy aims to influence science, public health organizations, and professional societies and corrupt government policy and lawmakers. When the food industry has contributed as much as $300,000 to the PAC of the congressman who introduces the Cheeseburger Bill,20 which will prohibit lawsuits against food companies for any injury caused by their food—and most of Congress votes for it—you don’t have to wonder who is pulling the strings.
TAINTED SCIENCE
As consumers, we depend on unbiased studies to shed light on the foods we should eat and the ones we should avoid. While some food companies do carry out legitimate and informative research, many fund their own studies for self-serving purposes. Why? One reason is marketing. Food companies use studies to make dubious health claims about their products so they can increase sales. The other reason is so they can manufacture doubt. When independent studies point to the dangers of their products, food companies respond with their own questionable studies that say otherwise—just as tobacco companies funded studies that cast doubt on the link between smoking and lung cancer. As we already saw with Coke, the soft drink industry seems to have mastered this practice better than anyone.
In February 2001, The Lancet published a large independent study (“independent” being the key word) that was among the first to demonstrate that:
Sugar-sweetened beverages increase obesity rates in kids.
A child’s likelihood of being overweight increased in direct proportion to the number of soft drinks he or she consumed.
For every can of soda a child drank each day, their odds of becoming obese rose by 60 percent.21
The study was a bombshell. It garnered international headlines, and more than 1,000 other scientific articles would go on to cite it. In the days and weeks that followed the study’s publication, Coke’s stock plummeted. Its share price declined 20 percent relative to the Dow Jones Industrial Average, a downswing that persisted for months. In total the drop represented a loss of $20 billion in the company’s valuation.
How did Coke and other soft drink makers respond? In the decade that followed, they funded a slew of studies that claimed that sugary drinks were innocent. Coke, Pepsi, the American Beverage Association, Tate & Lyle (a corn syrup producer), and other sugar and soda industry groups sponsored (“sponsored” being the key word) a half dozen systematic reviews that examined whether sugary drink consumption was linked to weight gain. Every single one of these studies found zero association between sugary drinks and obesity.
At the same time, independent researchers continued to conduct their own studies, publishing eleven extensive reviews that examined whether sugary-drink consumption was a strong determinant of weight gain and obesity. Out of these eleven studies, nine of them found that the answer was a resounding yes. Many of the studies even noted that public health authorities had enough evidence to discourage people from drinking soda.
The scope of this problem is enormous. An analysis published in JAMA in 2017 found that compared to independent research, industry-sponsored food studies of all kinds have a 30 percent greater likelihood of reporting conclusions favorable to their sponsors. The researchers found that this level of bias was on par with studies funded by Big Pharma, which are notorious for portraying risky drugs in a favorable light.
SCIENCE OR PROPAGANDA?
In a report entitled Nutrition Scientists on the Take from Big Food, Michele Simon details how the food industry has corrupted the nutrition science community. In a review of 206 studies, researchers found that not a single industry study published showed a negative outcome. Another investigation found that industry-funded studies were nearly eight times more likely than independent studies to show a positive outcome.22 Another review of 133 studies on sugar-sweetened beverages found that 82 percent of independently funded studies show harm from sugar-sweetened beverages, while 93 percent of industry-funded studies found that soda and sugar-sweetened beverages were not associated with any health problems.23
Yet another recent study found that industry-sponsored studies showed no harm from artificial sweeteners, but independently funded studies found significant harm.24 Coca-Cola and PepsiCo would have us believe that they are being good corporate actors by reducing calories in their drinks. Don’t believe them.
For consumers, this means that you have to be hyperaware. When you see a company touting the health benefits of their products on food labels, in an advertisement, or on a website or television show, there’s a good chance that the claim came from a dubious study that was wholly bought and paid for by industry.25 Or when you see studies casting doubt on the harmful effects of their products, don’t believe those either. Take a look at the ridiculous studies that the food industry is feeding you…
Sweet Deception
In 2011 a study in the journal Food & Nutrition Research looked at data on more than 7,000 kids and concluded that those who ate candy were up to 26 percent less likely to be overweight or obese than kids who didn’t eat candy. The candy eaters did not have increased blood pressure, cholesterol, or other metabolic risk factors. In fact, they had lower inflammation than the non-candy eaters.26 The findings were almost too good to be true. “This study suggests that candy consumption did not adversely affect health risk markers in children and adolescents,” the authors wrote. Who knew candy was a health food! Shocking, right? Well, not if you know who funded the research.
The authors of this study received thousands of dollars from the National Confectioners Association, a trade group that represents the makers of Skittles, Hershey’s, and Butterfingers. The candy group not only paid for the study but was also involved in analyzing the data and writing the manuscript. E-mails show one of the authors, Victor Fulgoni, a former Kellogg’s executive, acknowledging to his coauthors about incorporating the candy industry’s feedback in their study manuscript. “You’ll note I took most but not (all) their comments.”
As absurd as it was, the study nonetheless generated plenty of positive media—precisely what the candy industry was looking for. “Does Candy Keep Kids from Getting Fat?” one CBS News headline declared.27 No, it doesn’t. But that hasn’t stopped the candy industry from funding other studies that claim that candy consumption has no link to heart disease, obesity, or metabolic syndrome.28
If you think that top peer-reviewed scientific journals publish objective research, think again. One of the most respected medical journals, the Annals of Internal Medicine, published a study in 2017 entitled “The Scientific Basis of Guideline Recommendations on Sugar Intake: A Systematic Review.”29 At first read I was taken aback. The conclusions contradicted almost all the science I had studied on sugar for 20 years. “Guidelines [to reduce] dietary sugar do not meet criteria for trustworthy recommendations and are based on low-quality evidence.” Turns out the “study” was funded by the International Life Sciences Institute (ILSI), the food and agriculture industry front group founded by a Coca-Cola executive and whose sponsors include, along with Coca-Cola, Bayer, Dow AgroSciences, DuPont, ExxonMobil, General Mills, Hershey Foods, Kellogg’s, Kraft, McDonald’s, Merck & Co., Monsanto, Nestlé, Novartis, PepsiCo, Pfizer, and Procter & Gamble. And the lead author was on the board of Tate & Lyle, one of the largest makers of high-fructose corn syrup.
This problem is global. In Australasia, Nestlé partnered with nutrition societies and funded dubious studies to promote its sugary powdered drink, called Milo, to millions of parents and children. Milo is a malted sugar beverage like Ovaltine with the same glycemic index as Coca-Cola. With the backing of local nutrition experts, the company marketed the ultraprocessed concoction as a nutritious breakfast meal, running ads featuring cartoons, energized schoolchildren, and famous kid-friendly pop stars. They also promoted it as a health and sports drink targeted at kids who have an “energy gap,” which they claimed four out of five kids suffer from. I must have missed the class in medical school where we learned about the dreaded energy gap that must be cured with a sugary drink. Nestlé enlisted Dr. Tee Siong to “prove” that Milo was a health drink.30 He served as science director for more than 20 years for ILSI Southeast Asia. Is it any surprise that Malaysia is Asia’s fattest country?
Dr. David Ludwig, professor of nutrition at Harvard Medical School, reviewed Siong’s study and found that its design was flawed. The dietary analysis used was not validated and the Milo drinkers were more active and had far less screen time, which the analysis didn’t account for. Oh, and Nestlé reviewed the manuscript.
Sugarcoated Research
While these examples are from recent years, the sugar industry has been duping Americans with deceptive research for more than a half century. Sugar executives acknowledged a link between sugar consumption and chronic disease back in the 1950s and ’60s. An industry trade group called the Sugar Research Foundation funded animal research as far back as the 1960s that looked at the relationship between sugar and heart disease. But documents show that when the research suggested that sugar might cause both heart problems and cancer—a result they found terrifying—the industry buried the data and never published their results. Around the same time, the sugar trade group paid Harvard scientists the equivalent of $50,000 in today’s dollars to publish an influential review in the New England Journal of Medicine dismissing the idea that sugar caused heart disease. The real culprit, they claimed, was saturated fat.31
In fact, the two authors of that review, Fred Stare and Mark Hegsted, were the most prominent nutrition scientists at the time. Dr. Stare started the nutrition department at Harvard, the first in the country. He and the school received $29 million over his career from the food industry, including sugar industry funding for thirty studies from 1952 to 1956.32 In 1975 he wrote a book called Sugar in the Diet of Man. We need say no more. His colleague, Mark Hegsted, went on to help develop the first US Dietary Guidelines under Senator George McGovern, advising us to cut the fat and not worry about sugar and carbs, setting the stage for the greatest health crisis in the history of our species. There were no conflict-of-interest disclosure requirements for researchers in the 1960s.
Today a small handful of influential researchers are still deeply involved with the sugar and corn syrup industries. One of them is James Rippe, a scientist who runs an institute that specializes in churning out studies for the food industry. The lobbying group for the high-fructose corn syrup industry, the Corn Refiners Association, paid Rippe $10 million over a four-year period for his research and even kept him on a $41,000-a-month retainer to write editorials defending corn syrup from critics.33 And Rippe then produced a series of studies that reported the following:
Guidelines on reducing added sugar intake are unwarranted.
Eating added sugar doesn’t promote insulin resistance (pre-diabetes or diabetes).
Consuming even five times the upper limit of sugar recommended by the American Heart Association (AHA) doesn’t increase blood pressure or screw up your cholesterol.34
With almost ten times as much of this “junk” research on junk food as of true independent science, the public, the media, and the policy makers stay confused.
Whole Grains: Not the Whole Truth
If you believe the federal government, whole grains are practically a superfood. But in reality, their health benefits are dubious at best because we typically refine and process them until they are barely recognizable.
Of course, the AHA gets money from cereal makers to put their seal of approval on the packages and receives hundreds of thousands of dollars for each “endorsement.” Twix is a health food according to the AHA, in case you weren’t aware—and so are Froot Loops, Cocoa Puffs, and French Toast Crunch, right along with the 7 teaspoons of sugar per serving. It shouldn’t be called breakfast; it should be called dessert.
When you grind it into flour, whole wheat or not, it is worse than sugar. The glycemic index of sugar is 65 and that of whole wheat bread is 75, which means that the bread raises your blood sugar more than table sugar. Below the neck, there is no difference between a bowl of sugar and whole wheat bread. Well, actually, the bread is worse.
The scientifically independent group the Cochrane Database of Systematic Reviews concluded that the favorable studies on whole grains were so weak and mired in conflicts of interest that their results “should be interpreted cautiously.”35
Actually, whole grains can be healthy, but not when sprinkled into junk food. How about Whole Grain Frosted Strawberry Pop-Tarts with 38 grams of sugar and refined flour (9.5 teaspoons of sugar) and 47 ingredients, including proven carcinogenic compounds like caramel color, anyone? Eat the actual whole grain, not an industrially processed version, which carries more harm than good with every bite.
DOES THE STUDY PASS THE SNIFF TEST?
At the end of the day much of the nutrition research that is published in major journals is legit. But the food industry is determined to dupe you with bogus studies to promote their processed junk foods. Because industry studies tend to produce sensational findings, they are often picked up by blogs and news outlets, leading to eye-catching headlines. That’s why you need to be skeptical when you see the latest nutrition science headline in the news. If it doesn’t pass the smell test, then it’s best to forget it. Don’t share it on Facebook, don’t send it to friends, and certainly don’t take it as fact.
Before you buy into a headline, ask yourself some important questions. First, ask who paid for the study. Does the story mention who funded it? If it’s a study on breakfast cereal and weight gain, for example, did the NIH fund it or did Kellogg’s pay for it? You might need to dig a little deeper. If it says it is funded by the International Life Sciences Institute, you may feel relieved. Sounds legit. But dig deeper. Google the organization. See who is behind it. Be a sleuth.
As Vani Hari says in her book Feeding You Lies, “You wouldn’t believe a study on cigarettes that was funded by Philip Morris, and you probably shouldn’t believe a study on cereal paid for by a company whose bottom line depends on Froot Loops, Apple Jacks, and Frosted Flakes.”
Don’t believe everything you read. “To separate the truth from the bull,” Hari says, “I have the following suggestions. Scrutinize the source of the information, the source’s possible agenda, and the evidence provided in the message. If possible, ask: Is the evidence science-based? Who funded the science? Does the evidence logically support the claims being made? Does it seem like relevant facts or context have been left out? Remember that commercial pressures shape the form and content of research and news—and exert massive influence.”
Most important, remember that replication is the cornerstone of good science. One study that claims that soft drinks are not linked to weight gain should not distract you from the fact that dozens of independent studies have found otherwise. Instead of being led astray by one clickbait headline, think about the larger body of research. If one sensational new study contradicts a large body of research and sounds too good to be true, then it probably is.
FOOD FIX: BIG FOOD AND SCIENCE SHOULDN’T MIX
It is fine for companies to carry out small studies looking at the potential benefits of their products. It makes sense for Pepsi to study whether the electrolytes in the Gatorade it sells can help athletes rehydrate more quickly, for example, or whether products like Quaker Oats might be more satiating than cornflakes. Food companies do research so they can use their findings to make marketing claims. Consumers should be aware that these claims are often exaggerated, but this practice pales in comparison to the problem of Coke, Pepsi, and other large junk-food companies publishing studies on public health matters like obesity and the diabetes epidemic.
Big Food is in the business of selling junk food. It should not be in the business of doing public health research. There’s just no reason for it, and more important, food corporations cannot be trusted.
As my friend Dariush Mozaffarian at the Tufts School of Nutrition Science and Policy points out, there are ample reasons not to trust Big Food with public health research. Its documented tactics include “the promotion of harmful products, misleading marketing campaigns, targeting of children and other susceptible groups, corporate lobbying, coopting of organizations and social media with financial support, and attacks against science and scientists.”36
At the same time, we must also face the reality that government funding for scientific research is already scarce and continuing to dwindle year after year. In the most recent NIH strategic plan, food was mentioned only once, in reference to the Food and Drug Administration. Academic jobs and research positions at universities are becoming more and more competitive, which is driving many scientists to work for the industry.
It’s unrealistic to expect that not a single scientist, health professional, academic, or institution will ever accept any funding from the food industry. And not every company is nefarious. The food industry is not a monolith. Some companies recognize the growing demand for nutritious foods and have profited by catering to the health conscious with healthy, organic, and minimally processed foods. But if the food industry is going to be involved in funding studies, there are transparent principles they must follow to ensure that their research is untainted. Any engagement with the industry requires firm oversight and strict rules, like making sure that researchers have full independence to report and publish their findings, and that the companies they partner with have commendable track records of environmental and social responsibility. Some of the guidelines that Mozaffarian and other experts developed (e.g., vetting companies that want to fund studies, increasing funding for independent studies, forming an oversight committee for all studies) can reduce the problems that stem from food companies funding nutrition research. The companies should not be involved in any way in study design, data analysis, authoring of the manuscript, or even review or comments on the manuscript.
Another radical change would be to create a firewall between industry and science. This firewall would allow the food industry to fund important studies without biasing the researchers and their results. To make this work, companies would pool their donations into a common research fund. This pool of money—it could be called the Nutrition Fund, for example—could be managed and distributed to scientists by the NIH. Companies could get incentives to make donations to the fund through tax breaks and other benefits. This fund could then be used to support basic nutrition research on food, diet, and health, as well as food science research that could help companies develop products. A committee of independent scientific advisers could oversee the fund and review and approve research proposals. Ultimately, it could begin to restore the public’s faith in industry-sponsored studies.
Such an idea would not be foolproof, of course. In fact, the USDA has actually created a fund from a levy on food companies. It is called the Checkoff Program and it is ostensibly to be used for research, but it is no more than a marketing program for Big Food. Remember the campaigns “Got Milk?” or “The Other White Meat” or “Beef. It’s What’s for Dinner”? They were all paid for by Uncle Sam to promote agricultural products, regardless of their health benefits. What’s fascinating is that Congress introduced a bill to prevent FOIA (Freedom of Information Act) requests from accessing any information about the Checkoff Program. What are they hiding? Why is the government marketing food for the food industry?
Fixing Bad Science
Putting an end to Big Food’s co-opting of scientists, academics, and health groups will only solve half the problem. The other problem is that nutrition science is in need of some big changes. Many of our dietary guidelines and health recommendations are based on what is known as nutritional epidemiology, which relies on easily manipulated observational studies. That’s why Big Soda can publish study after study claiming that children who drink soft drinks aren’t on a fast track to becoming obese and diabetic—they use observational data that can easily be molded to get the outcomes they prefer. Large observational studies also gave us the disastrous advice to eat low-fat diets and six to eleven servings of bread, rice, cereal, and pasta every day! The conventional nutrition wisdom has changed again and again over the years depending on the direction in which the winds of the latest observational studies are blowing.
To illustrate what I mean about observational studies being easily manipulated, consider these examples. If I did a study of women over fifty-five years old who had sex, I would conclude that sex never leads to pregnancy. It is 100 percent accurate, but 0 percent valid. Bruce Ames, one of the world’s leading scientists, once said that if you ask epidemiologists who did observational population studies about Miami, they would conclude that everyone is born Hispanic but dies Jewish.
So what is the purpose of observational studies? It is quite simple. To generate hypotheses for future research, and to assess whether correlations are real or just noise. They never prove cause and effect. If the effect size is big, then it can be convincing and worth acting on. For example, the increased risk of lung cancer for smokers was 20 to 1. You can take that to the bank. But when a new study, for example, showed that eggs caused a “17 percent” increased risk of heart disease and an “18 percent increased risk of death,” that sounds scary, but what it means is the increased risk is 17 and 18 percent, not 2000 percent as it was for smoking and lung cancer. If it is anything less than a 2-to-1 (or a 100 percent) increased risk, ignore it.37
Large reviews of observational studies found that less than 20 percent were later confirmed in actual experimental trials.38 Asking people what they ate once or twice in 20 years and correlating that to health outcomes or death is highly inaccurate and confounding.39 For example, some large observational studies have shown that eating meat increases the risk of heart disease, cancer, and death.40 Sounds bad. But those studies were done in a time when we were all told to eat less meat to be healthy. The people who continued to eat meat didn’t pay much attention to their health in general.
The problem with observational studies is that they are frequently subject to a phenomenon known as data dredging—scientists run repeated analyses on a data set to extract insignificant findings that might otherwise be meaningless and then amplify them. That’s why nutrition science headlines can cause whiplash, with studies telling us one week that butter, cheese, and chocolate are bad for us, and then the next week new studies telling us that these foods are the key to weight loss and a slim waistline. Nutrition epidemiologists are notorious for squeezing trivial findings out of observational data sets and then transforming them into splashy and sensational research papers that attract headlines. It’s the very opposite of the scientific method. And sadly, both the food industry and nutrition policy makers use it to their advantage.
The studies that I put more faith in are large randomized controlled trials, which are true experiments (although they too are subject to many limitations). In a typical randomized trial, scientists manipulate one variable—sugar intake, for example—and then assign people to different groups where they are exposed to high levels of sugar or low levels of sugar. Then researchers follow them and measure things like changes in their body weight, cardiovascular biomarkers, and appetite. This is how good science is done. A randomized controlled trial can prove cause and effect. An observational study can only suggest causality.
One great example was a study of 164 people that cost $12 million (yes, it is very expensive to do the right kind of nutrition research). It was an actual experiment where people got a low-fat, high-carb diet, then switched to a high-fat, low-carb diet. The study provided the food to participants and measured their metabolism and hormones. They found that the low-carb, high-fat group burned 300 to 500 more calories a day.41 That is definitive. And if people paid attention, it would solve our obesity epidemic overnight.
“I think that much of the reason for the failures [of nutrition advice] we’ve seen is that we have over-trusted observational data,” says John Ioannidis, the chairman of disease prevention at Stanford University. “I’m not saying that it’s not possible for observational data to tell us something useful. Actually we have learned tremendous insights from observational data. But for nutrition that is so complex, and so difficult, we really need to use our best tools, our best methods, and our best safeguards before we can really trust these observational data.”
Ioannidis and others have proposed a reasonable set of guidelines to reform nutrition science, which are badly needed. They include the following:
Focus on large randomized controlled trials. Instead of publishing a million more observational nutrition studies that give us contradictory findings, the nutrition community should do large and rigorous randomized trials that give us definitive answers. According to Ioannidis, the randomized trials needed to answer critical questions in nutrition in definitive ways would add up to less than 1 percent of the NIH’s budget.
Share raw data to increase transparency. Journals should require that researchers share their raw data. This will increase transparency and reduce the likelihood of manipulation. All researchers should be able to access and analyze one another’s data. Through Harvard, the NIH has funded some of the largest population studies, involving hundreds of thousands of people over decades. Much of our nutrition beliefs are derived from these studies, including the Nurse’s Health Study and the Physician’s Health Study. But even though taxpayers funded the studies, the researchers won’t allow others to see or analyze their raw data. How does that make sense?
Enforce strict disclosure rules. Every medical and nutrition journal should adopt strict conflict-of-interest disclosure rules, and they should impose penalties on researchers who violate the policies. First-time violations could result in a six-month to one-year suspension. Those who repeatedly violate the rules should face a lifetime ban from publishing in the journal. If all journals introduced a system of penalties for flagrant violations of disclosure rules, then researchers would take the policy more seriously. As Marion Nestle wrote in her book Unsavory Truth: How Food Companies Skew the Science of What We Eat, not everyone discloses, and many disclosures are incomplete. At the University of California, San Francisco, professor of clinical pharmacy Lisa Bero and her colleagues reported that one-third or more of authors in the studies they examined had undisclosed conflicts and that a similar percentage of published reviews omit statements of funding sources.
Media outlets should also be investigating conflicts of interest and report transparently on the food industry. They should have strict conflict-of-interest policies and disclosures for any articles published. For example, an article in Forbes that targeted me made no mention that Monsanto funnels money to the industry front group behind the article—the Genetic Literacy Project. The same author, Kavin Senapathy, declared that breastfeeding is not always the best choice because it could lead to starvation and malnutrition. Sadly, most advertising is from the food or pharmaceutical industry, making tough, critical reporting difficult for media outlets.
Now you know what’s really behind all those confusing headlines and reports. The fine print reveals who is funding a study and how the data might be manipulated for profit rather than for your health. So next time you read a nutrition headline, be wary, be thoughtful, dig a little, and ask these important questions: (1) Who funded the study and what are the conflicts of interest of the authors? (2) Is this a study that can prove cause and effect or just a correlation? If there is a correlation, is the increased risk or benefit over 100 percent? If not, move on.