Sugar versus Fat: which is worse for your heart?

This is Joseph.

Obviously this report in JAMA Internal Medicine is alarming.  The full abstract is:

Early warning signals of the coronary heart disease (CHD) risk of sugar (sucrose) emerged in the 1950s. We examined Sugar Research Foundation (SRF) internal documents, historical reports, and statements relevant to early debates about the dietary causes of CHD and assembled findings chronologically into a narrative case study. The SRF sponsored its first CHD research project in 1965, a literature review published in the New England Journal of Medicine, which singled out fat and cholesterol as the dietary causes of CHD and downplayed evidence that sucrose consumption was also a risk factor. The SRF set the review’s objective, contributed articles for inclusion, and received drafts. The SRF’s funding and role was not disclosed. Together with other recent analyses of sugar industry documents, our findings suggest the industry sponsored a research program in the 1960s and 1970s that successfully cast doubt about the hazards of sucrose while promoting fat as the dietary culprit in CHD. Policymaking committees should consider giving less weight to food industry–funded studies and include mechanistic and animal studies as well as studies appraising the effect of added sugars on multiple CHD biomarkers and disease development.

I think that this brings up two issues, related but different.  One, is whether the role of sugar in heart disease is important and I think that the evidence for this is pretty good.  Recent recommendations from the American Heart Association allow for 150 calories of added sugar for men and 100 calories of added sugar for women.  That's a pretty strong indictment of added sugar given that a 500 ml coke probably has > 50 grams  of added sugar (that's 200 calories).  So it is good that attention is being paid to this issue.

What I am less comfortable about is giving less weight to industry funded studies.  It's not immediately clear to me that the median industry study isn't really interested in learning about food and there are a lot of studies where you need industry partnership for (absent a staggering amount of government inspection and interaction).  What I prefer to do is to focus on transparency and replication.  Nobody wants to have a mistake published and the researchers I work with are fanatical about doing their best.  Do biases enter?  Absolutely.  But this is why we disclose interests, a trend that I have been reassured to see being more and more standard in the academic publishing world.

In physics, long ago, it used to be a good thing to partner with industry to create a new process, invention, or to learn more about a standard tool (I once worked with concrete).  I think there can be a lot of benefit from these interactions and they allow both sides to leverage strengths.

So instead of removing weight from these studies, I see this as a cautionary tale about how we can do better and should do better.