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The link between sugar and research funding

Sugar: at the heart of the obesity crisis The prevalence of obesity (body mass index >30) in the UK has increased from 6% of males and 8% of females in 1980 to 24% of males and 25% of females in 2012.

Sugar Several articles published in the BMJ over the past couple of years have implicated sugar at the heart of this obesity crisis. An article reviewing the up-to-date science and theories on what makes us fat described the two currently accepted mechanisms; the “energy balance hypothesis” which simply states that excess energy consumption (or insufficient energy expenditure) causes obesity, and the “metabolic hypothesis” which attempts to answer why the satiety feedback mechanism fails, resulting in people over-eating. It recognises that insulin levels are effectively driven by the carbohydrate content of the diet, so that refined, high glycaemic index sugars (particularly sucrose and fructose corn syrup), are absorbed quickly, causing an increase in post-prandial blood glucose, so an insulin spike is elicited from the pancreas, which causes more fat to be stored around the body. This is thought to set in motion the pathway to obesity.

A systematic review and meta-analysis of randomised controlled trials and prospective studies in 2012 concluded that (freely consumed) sugar sweetened drinks increased the likelihood of children being overweight after 1 year follow-up. Sugar in this liquid form does not induce satiety to the same extent as sugar in solid form, making overconsumption easier.

It has been recognised for years that sugar has adverse effects on health, namely obesity, diabetes, heart disease and dental caries. Indeed the British physiologist John Yudkin wrote the book, “Pure, White and Deadly” in the 1970s, linking sugar with heart disease. However, the link between sugar and poor health has been controversial, partly because the research data is weak and partly because of the huge economic interests invested in sugar-based products by governments and the food industry.

The “no candy man” from the United States (Professor Robert Lustig of paediatric endocrinology in the University of California) voiced his opinion to the BMJ. He firmly believes insulin resistance, triggered by eating refined, high glycaemic index sugars, is the mechanism for our obesity crisis. Sugar is weakly addictive and shares the same reward pathways in the brain as nicotine and cocaine. He says that most of the opposition to the research he has undertaken has come from the sugar industry that he believes use similar techniques to the tobacco industry 50 years ago. He likens sugar and metabolic syndrome to tobacco and lung cancer.

Research and funding The tangled web of the sugar industry, sugar research and the UK government advisory bodies was exposed in the BMJ article called “Sugar: spinning a web of influence“. An investigation by the BMJ uncovered evidence that demonstrates the extent to which key public health experts are linked with the sugar industry and related companies (such as Nestle, Coca-Cola and Mars) through funding.

The Medical Research Council (MRC) and their associated Human Nutrition Research (HNR) unit, stressed that the income from the sugar industry did not benefit researchers personally but went into the unit’s central budget. However, a spokesperson said that researchers were encouraged to work closely with the drug and food industry. The Scientific Committee on Nutrition (SACN) also received funding from industries with a vested interest in the outcome of their research. Further, the decline in UK universities core public funding for research, adds to the problem.

The article concluded that the SACN and the MRC are one small group of public health specialists in a relatively small market, but if this conflict of interests-type funding is perceived across all global areas, the scale of this “magnetic field of influence” tactic, can start to be appreciated.

How can this tangled web be untangled? In May 2014, in California State a bill was passed, seeking to label drinks containing more than 75 calories with a warning stating that sugary drinks contribute to obesity, diabetes and tooth decay.

Of note, there is a legal form that companies need to submit for the benefit of their investors, which lists any risks the company are aware of that could affect sales. Two risks identified by such companies include, the threat of health driven regulation and taxes and also research into the health effects of their products. PepsiCo’s submission said, “Studies are underway by third parties, to assess the health implications of consumption of certain ingredients or substances present in certain of our products, including…sugar.”

On a practical basis, GPs can utilise their strong web of influence in the community and advise the replacement of sugary drinks with water and milk and replacement of sucrose with complex carbohydrates (for energy) or with honey or fructose in fruits (for sweetness/ quick energy source).   http://www.bmj.com/content/349/bmj.g6608

article written by Dr Maria Ray (reproduced with permission of Doctors.net.uk)

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