How the sugar industry uses its financial power to manipulate the American diet.

Dr. Robert Lustig wasn’t invited to speak at the 2016 International Sweetener Colloquium in Miami, but he went anyway.

As a pediatric endocrinologist at the University of California, San Francisco, Lustig’s research and subsequent presentations have made him an outspoken, passionate critic of sugar’s toxicity and negative impact on metabolism and disease.

To Lustig, sugar is a poison. He went to Florida earlier this year to hear the latest talking points about sweeteners in the United States’ food supply.

One presentation in particular — “Is Sugar Under Siege?” — caught his attention.

The presenters were Jeanne Blankenship, vice president of policy initiatives at the Academy of Nutrition and Dietetics, and dietician Lisa Katic, president of K Consulting.

The seminar addressed the U.S. Food and Drug Administration (FDA) recommendations to list added sugars on nutrition labels and other trends that could reduce sweetener consumption.

The messaging, Lustig said, was “pro-industry and anti-science” with a steady undercurrent that humans need sugar to live, which, he says, isn’t true at all. He describes the experience as the “most exhausting three hours of my life.”

“This is a registered dietician and every single statement she made was wrong. Absolutely flat wrong. So this is what the sugar industry is hearing from its own consultants,” he said. “The industry doesn’t want to know because they just don’t care. So we have a problem if our food industry is so tone deaf that they can't hear the strains of people’s hearts stopping.”

Big Tobacco’s playbook

Whether speaking at a convention or testifying at a public hearing, Katic is a voice for the soda or food industries. As a paid consultant, she isn’t always forthcoming with these relationships when attempting to sway public opinion, according to her record in public debates. Katic did not respond to multiple requests from Healthline for comment for this article.

Critics say that’s how Big Sugar conducts its business. They restructure the conversation around health and choice, including establishing front organizations to steer conversations in their favor.

This month, researchers at the University of California, San Francisco, released a report that they said showed the sugar industry worked closely with nutrition scientists in the 1960s to make fat and cholesterol the lead culprits in coronary heart disease. They sought to downplay evidence that sucrose consumption was a risk factor, the researchers said.

A year ago, the New York Times published a report showing how the nonprofit Global Energy Balance Network (GEBN) stated that a lack of exercise — not junk food and sugary drinks — were the cause of the nation’s obesity crisis. Emails showed, however, Coca-Cola paid $1.5 million to start the group, including registering GEBN’s website. By the end of November, the nonprofit disbanded. James Hill, director of the GEBN, stepped down from his position as executive director of the University of Colorado’s Anschutz Health and Wellness Center in March.

That is one of many examples that critics say illustrate how powerful industries and lobbies influence policy and research to cloud the effects of chronically consuming a product, much like tobacco has done. Kelly Brownell, a professor of public policy, and Kenneth E. Warner, a tobacco researcher, wrote an article in The Milbank Quarterly comparing the tactics of tobacco and food industries.

They found many similarities: paying scientists to produce pro-industry science, intense marketing to youth, rolling out “safer” products, denying the addictive nature of their products, heavy lobbying in the face of regulation, and dismissing “junk science” that links their products to disease.

During the 1960s, the sugar industry steered public policy away from recommending reduced sugar consumption for children because it caused cavities. Like the tobacco industry, it was able to protect itself from damaging research. It achieved this by adopting “a strategy to deflect attention to public health interventions that would reduce the harms of sugar consumption rather than restricting intake,” according to an investigation using internal documents.

Dr. Robert Lustig Quote

It’s doing the same thing now with obesity, critics say. While groups like the Sugar Association assert “sugar is not the cause of obesity,” it actively works to shift focus away from its own product, saying energy balance is key.

Now that the public health threat from obesity is on par with smoking, the comparison seems fitting.

 “The food companies resemble the tobacco companies. Metabolically, sugar is the alcohol of the 21st century,” Lustig said. “People know about tobacco. No one knows about sugar.”

Industry opposition not always forthcoming

Last year, the San Francisco Board of Supervisors debated requiring soda advertisements to bear the following message: “Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay.” When the measure was open to public comment, Katic authored letters to the editors of the Contra Costa Times and the San Francisco Chronicle. The Chronicle identified her role as a paid consultant after a reader commented on her role in the issue.

The letters followed the continuing narrative of Big Soda: “calories are calories and sugar is sugar, whether found in food or beverage form.” More exercise, not less soda, is key, she argued.

“Singling out one food or beverage as the root cause of the problem is not the answer to our public health challenges,” Katic wrote.

Katic also testified to the board stating it was “overly simplistic and potentially misleading to single out sugar-sweetened beverages as the driving cause of type 2 diabetes and obesity.”

Supervisor Scott Wiener questioned Katic about how, as a dietician, she went against the recommendation of the California Dietetic Association, which was in favor of the warning on sugar-sweetened beverages. He also pointed out she was paid by the American Beverage Association to testify before the board.

“This is a multi-billion, aggressive industry. They hire people to say what they want to say,” Wiener told Healthline. “They rely on junk science because they’re making a product that makes people sick.”

In June, Philadelphia passed a 1.5-cent-per-ounce tax on sodas, which takes effect January 1. As part of the soda industry’s multi-billion dollar approach to stop it, Katic wrote more letters, including one to Philly.com, where she makes no mention of her ties with the soda industry.

Asked for comment regarding Katic, the American Beverage Association’s statement said, “These are the facts we bring to light in the hope that complex health issues like obesity get the serious attention they deserve based on known facts.” The research Katic and other consultants use are often from official-sounding organizations with conflicts of interest, including funding and close ties to the industry. This has many critics questioning the validity of their findings.

Much like the Global Energy Balance Network, other groups like the Calorie Control Council and the Center for Food Integrity — which have .org websites — represent corporate food interests and publish information reflecting them. 

Another group critical of the soda taxes in Berkeley and other places is the Center for Consumer Freedom, an industry-funded nonprofit “devoted to promoting personal responsibility and protecting consumer choices.” It and other groups typically weigh in when taxes or regulation attempts to reel in bad food. Their rally cries often bemoan the rise of the “Nanny State.” Other groups who engage in similar measures, such as Americans Against Food Taxes, are fronts for the industry, namely the American Beverage Association.

Big Soda = Big Lobbying

When San Francisco attempted to pass a tax on soda in 2014, Big Soda — the American Beverage Association, Coca-Cola, PepsiCo, and Dr. Pepper Snapple Group — spent $9 million to stop the measure. Advocates for the bill spent only $255,000, according to a report from the Union of Concerned Scientists. From 2009 to 2015, the soda industry paid out at least $106 million to defeat public health initiatives in local, state, and federal governments.

In 2009, a federal excise tax was being considered on sugary drinks to discourage its consumption and help fund the Affordable Care Act. Coke, Pepsi, and the American Beverage Association responded by dramatically increasing their lobbying efforts. The three spent more than $40 million on federal lobbying in 2009, compared to their normal $5 million a year. Spending dropped down to normal levels in 2011, after their lobbying efforts proved to be successful. The measure was dropped due to industry pressure.

To fight against proposed soda taxes, the American Beverage Association spent $9.2 million on the San Francisco measure, $2.6 million in nearby Richmond in 2012 and 2013, and $1.5 million in El Monte in 2012. The more than $2.4 million it spent against a Berkeley tax was in vain. Voters approved a penny-per-ounce tax on sugary beverages in November 2014.

Josh Daniels, a member of the Berkeley school board and the group Berkeley vs. Big Soda, said the tax is one way to combat soda marketing.

“You have hundreds of millions of dollars being spent on presenting sugary drinks as cool. Noticing the price change is one way to help people understand that this is having a negative impact on their health,” he told Healthline. “And the rest is up to that person. We’re not trying to take away personal choice in any way, but the impacts are real, both for individuals and for society.”

While the tax didn’t get the needed two-thirds of voters in San Francisco, the warning label addition passed the Board of Supervisors unanimously. The American Beverage Association, the California Retailers Association, and the California State Outdoor Advertising Association challenged the new law on First Amendment grounds

On May 17, the American Beverage Association’s request for injunction was denied. In his decision, United States District Judge Edward M. Chen wrote the warning was “factual and accurate,” and San Francisco’s health problem, partially related to sugar-sweetened beverages, was “a serious one.” Set to take effect July 25, a separate judge granted an injunction preventing the law from taking effect while the beverage industry appealed.

Soda taxes do appear to be gaining favor with the public.In the November 2016 election, San Francisco and the two nearby cities of Oakland and Albany easily passed measures that added a penny-per-ounce surcharge to sodas and other sugar-sweetened beverages. A tax on the distributors of soda and other sugar-sweetened beverages was also approved by voters in Boulder, Colorado.

Food industry-funded research

Besides touting her expertise as a dietician, Katic often cites her credentials as a member of the American Dietetic Association, another organization that’s been scrutinized for its close ties to the sugar and soda industries. She backs up her claims with research from the American Journal of Clinical Nutrition, which has a history of publishing research from people with direct ties to the sweetener industry.

For five years, Maureen Storey, Ph.D., and Richard A. Forshee, Ph.D., published articles on a variety of aspects of sugar-sweetened beverages, including health effects and trends of consumption. Together, they were part of the Center for Food, Nutrition, and Agriculture Policy (CFNAP), “an independent, affiliated center” at the University of Maryland at College Park. Requests for more information from the university were not granted.

Among their research, the CFNAP published a study that found insufficient evidence that high-fructose corn syrup doesn’t contribute to obesity differently than other energy sources. Another study found there wasn’t enough evidence to suggest high-fructose corn syrup contributes to weight gain. One study even suggested that removing soda machines in schools won’t help reduce childhood obesity.

The CFNAP received funding by the Coca-Cola Company and PepsiCo, according to their disclosure statements, and their findings were used in pro high-fructose corn syrup marketing.

One of their most widely cited studies found zero connection between sugar-sweetened beverages (SB) and body mass index (BMI). This finding contradicted non-industry funded research at the time.

Before that study was published in 2008, Storey — a former Kellogg’s executive — would go on to become the senior vice president for science policy at the American Beverage Association. She is now the president and chief executive officer of the Alliance for Potato Research and Education, and was on a panel in April about food policy at the National Food Policy Conference in Washington, D.C., an annual meeting sponsored primarily by major food producers and retailers.

Forshee is currently with the FDA as the associate director for research in the Office of Biostatistics and Epidemiology in the Center for Biologics Evaluation and Research. Neither Storey nor Forshee responded to requests from Healthline for comment.

Their research at the CFNAP was included in a retrospective analysis examining the outcomes of studies related to sugar-sweetened beverages and weight gain when research was funded by Coke, Pepsi, the American Beverage Association, or others in the sweetener industry.

Published in the journal PLOS Medicine, the study found 83 percent of their studies concluded there wasn’t enough scientific evidence to support that drinking sugary drinks made you fat. The exact same percentage of studies without conflict of interests concluded that sugar-sweetened beverages could be a potential risk factor for weight gain. Overall, the conflict of interest translated to a five-fold likelihood the study would conclude no connection between sugary drinks and weight gain.

While the data isn’t 100 percent definitive on sugar’s impact on obesity, there’s causative data that excess sugar leads to type 2 diabetes, heart disease, fatty liver disease, and tooth decay. While experts like Lustig, who don’t take industry money, warn of excess sugar’s detrimental health effects on the global population, Katic says it’s wrong to imply soft drinks contribute to obesity or diabetes “in any unique way.”

“They really don’t,” she said in a video for the American Beverage Association. “They are a refreshing beverage.”

Conflicts of interest

Besides messaging, sugar and soda manufacturers have heavily invested in research, which creates potential conflict of interest and questions the validity of nutrition science. Marion Nestle, Ph.D., M.P.H., is a professor of nutrition, food studies, and public health at New York University and an outspoken critic of the food industry. She writes at FoodPolitics.com and is also a member of the American Society of Nutrition (ASN), which has given her doubts as to their conflicts of interest in the face of corporate sponsorship.

The ASN came out harshly against the FDA’s recommendation of including added sugar on the nutrition label. In a letter to the FDA, the ASN said “this topic is controversial and a lack of consensus remains in the scientific evidence on the health effects of added sugars alone versus sugars as a whole.” The letters share the same talking points as many companies who submitted identical letters, saying the FDA “did not consider the totality of scientific evidence.”

“There is nothing unique about sugar-sweetened beverages when it comes to obesity or any other adverse health outcome,” letters from Swire Coca-Cola and the Dr. Pepper Snapple Group say.

Food writer Michele Simon, J.D., M.P.H., a public health lawyer and ASN member, said the ASN’s stance wasn’t surprising considering they were sponsored by the Sugar Association.

Similarly, the Academy of Nutrition and Dietetics (AND) has a history of potential conflicts of interest, including accepting funding and editorial control from major food industry powerhouses such as Coke, Wendy’s, the American Egg Board, the Distilled Spirits Council, and more.

With limited public money available for research, scientists often take these research grants to do their work. Some grants come with restrictions, others do not.

“Researchers want research money,” Nestle told Healthline. “[The] ASN and other institutions are working on policies to manage such conflicts.  The Academy of Nutrition and Dietetics just came out with one. These may help.”

To combat these potential conflicts, groups like the Dieticians for Professional Integrity urge groups like the AND to “prioritize public health instead of enabling and empowering multinational food companies.”

The battle for transparency

Last year, Coca-Cola released its records on who received $120 million of its grants since 2010. Larger grants went to places like the American Academy of Family Physicians, American Academy of Pediatrics, and the American College of Cardiology. Other non-health related groups included the Boys and Girls Club, the National Park Association, and the Girl Scouts. The biggest beneficiary of Coke money was Pennington Biomedical Research Center — a nutrition and obesity research facility — and its foundation with more than $7.5 million.

One Coke-funded study by Pennington concluded that lifestyle factors like a lack of exercise, not enough sleep, and too much television contributed to the obesity epidemic. It didn’t examine diet. That research was published a year ago in the journal Obesity, a publication of the Obesity Society.

Nikhil Dhurandhar, who was president of the Obesity Society at the time and researched obesity for 10 years at Pennington, recently published an analysis of a study in JAMA regarding sugar intake and cardiovascular disease. His recommendation, along with Diana Thomas, a mathematician who studies obesity at Montclair State University and the Obesity Society, concluded there isn’t enough evidence to support health policy limiting sugar intake. Their research was used in a press release for the American Beverage Association.

“It’s a very controversial issue. We have the weakest of evidence, observational studies,” Thomas told Healthline. “People’s diets are complex. They don’t just consume sugar.”

In response, Natalia Linos, Sc.D., and Mary T. Bassett, M.D., M.P.H., with the New York City Department of Health and Mental Hygiene disagreed.

“Excessive consumption of added sugar is not about a small group of individuals making poor dietary choices. It’s a systemic problem,” they wrote in JAMA. “Ambitious public health policies can improve the food environment and make it easier for everyone to live healthier.”

The Obesity Society, along with other health groups, have been supportive of including added sugar on food labels. A commentary Thomas co-wrote in Obesity suggests that the move will help consumers who want to consume less sugar in their diets. But the Obesity Society’s relationship with major food and soda producers has some, like Nestle, calling their objectivity into question. The Obesity Society took in $59,750 from Coca-Cola, which the group says it used to pay for student travel expenses to its annual meeting, Obesity Week.

Natalie Linos Quote

The Obesity Society also has a Food Industry Engagement Council, chaired by Richard Black, vice president for global research and development of nutrition sciences at PepsiCo, and attended by representatives of the Dr. Pepper Snapple Group, Dannon, Nestlé foods, Mars, Monsanto, and the Center for Food Integrity, the industry front group. According to meeting minutes, the council addressed the issue of transparency with corporate partners, opting to disclose meeting minutes and their funding sources online.

Dhurandhar says the food industry has a lot to offer, including expertise from its food scientists.

“Whoever comes up with a solution, we want to work with them,” he said. “It doesn’t mean they are making decisions. We want to be inclusive and not exclusive.”

In its official position, the Obesity Society says that dismissing or discrediting scientists and their research because of their funding shouldn’t be practiced. Instead, they urge for transparency.

“In order to avoid this, we have to put policies in place. No matter who is in charge, they have to follow these policies,” Dhurandhar said. “Instead of focusing on funding, I would prefer the study itself is scrutinized.”

If the science is valid, he says, it shouldn’t matter who funded the research.

“It’s not about following their selfish agenda,” Dhurandhar said. If more public research money was available, “we wouldn’t bother with another funding source.”