Sugar Industry’s Covert Influence on Heart Disease Research: A Decade‑Long Campaign to Shift Focus from Carbohydrates to Fats

In 2016, a comprehensive UCSF analysis of more than 340 internal documents—over 1,500 pages—brought to light a deliberate campaign by the sugar industry in the 1960s to pivot public and scientific attention from carbohydrates to fats and cholesterol as the key dietary culprits behind coronary heart disease. The archives, made available through public registries, show that the Sugar Research Foundation (an industry trade group comprising 30 members worldwide) had, as early as 1954, recognized that a nationwide shift toward low‑fat diets would push per‑capita sucrose consumption higher by more than one third. The industry’s strategic maneuver began in earnest after a 1965 surge of media coverage linking sucrose to heart disease. Facing mounting evidence that excess sugar raises blood lipids—triglycerides and cholesterol—researchers at an independent university began documenting the emerging scientific link between sugar and atherosclerosis. In response, the Sugar Research Foundation commissioned “Project 226,” a literature review orchestrated by Harvard University’s School of Public Health Nutrition Department. The resulting 1967 New England Journal of Medicine paper, authored without financial disclosure, asserted that the only dietary intervention needed to curb heart disease was to curb cholesterol intake and replace saturated fats with polyunsaturated fats. Project 226, funded at approximately $50,000 in 2016 dollars, was crafted under the sugar industry’s guidance. The industry set the review’s objectives, selected the articles to include, and received multiple drafts before publication. Yet its influence remained hidden from the final manuscript, a fact the UCSF researchers could not overlook. The review was selective, condemning studies that linked sucrose to cardiovascular risk while dismissing limitations in research on dietary fats. By focusing exclusively on blood cholesterol as the sole significant lipid marker, the industry’s narrative effectively minimized the cardiometabolic dangers of a high‑sugar diet. The effect was profound: both the general public and the scientific community adopted this perspective, influencing dietary guidelines and public health messaging for decades. "The literature review helped shape not only public opinion on what causes heart problems but also the scientific community’s view of how to evaluate dietary risk factors for heart disease," explained lead author Cristin Kearns, DDS, MBA, one of the researchers who unearthed the documents. The UCSF study’s findings, published on Sept. 12, 2016 in JAMA Internal Medicine, underscore the essential role of unbiased scientific reviews and transparent financial disclosures in nutrition research. Stanton A. Glantz, PhD, senior author and UCSF center director, warned: "He who pays the piper calls the tune," highlighting how subtle manipulation remains a pervasive threat in industry‑funded studies. Moreover, co‑author Laura Schmidt, PhD, a principal investigator in the UCSF SugarScience initiative, noted that the science of the past several decades has firmly placed added sugar, not just saturated fat, as a driver of hypertension and cardiovascular disease. Yet policy documents and dietary guidelines frequently lag behind, still echoing the legacy narrative that places cholesterol, rather than sugar, at the center of heart disease prevention. The UCSF investigation was supported by the Philip R. Lee Institute for Health Policy Studies, the Hellmann Family Fund, UCSF’s School of Dentistry, and grants from the NIH’s National Institute of Dental and Craniofacial Research, National Cancer Institute, and others. UCSF remains at the forefront of translational research and global health leadership, encompassing world‑class medical, dental, nursing, and pharmacy programs, alongside top‑ranked hospitals and comprehensive community outreach in the Bay Area. Its commitment to evidence‑based practice continues to shape health policy worldwide. These revelations call for a renewed insistence on methodological integrity, full disclosure of funding sources, and a re‑evaluation of the policy legacy that favors saturated fat over sugar as the primary dietary determinant of heart disease.