The cardboard box looked unassuming, but as soon as Cristin Kearns opened it, she knew she was onto something juicy. Inside were documents donated to Colorado State University’s library by a corporation that didn’t exist anymore, one whose local beet sugar factories had shut down by the 1980s.
Decades after those closures, in 2009, Kearns flipped open the top manila folder. The first sheet of paper was a 1975 tip sheet from a sugar trade group to sugar company executives, marked “CONFIDENTIAL.” It gave instructions on how to talk to the press about a pro-sugar series of scientific studies — research funded by the trade group, a fact that had not been disclosed at the time.
The memo was just one of many gems uncovered in the course of a sprawling investigation into the sugar industry. For decades, Kearns and a cadre of researchers have discovered, Big Sugar sought to influence journalists, scientists, and regulators with the effect of delaying research into its product’s potentially harmful health effects.
As a former dentist, Kearns had seen some of those harms firsthand. But to drill down to what seemed to be the root cause — how the sugar industry grew so powerful and ubiquitous in the first place — she hung up her dental coat to become a unique blend of investigative journalist, historian, and health researcher. She now crosses the country in search of libraries with formerly confidential archives from now-defunct sugar manufacturers, trade groups, scientists, consultants, and executives. By combing through thousands of pages of internal documents, Kearns and her team have gained unprecedented clarity into the machinations of the sugar industry during the mid-20th century.
They’ve found, for example, that a trade group knew as early as the 1950s that sugar caused tooth decay. But when the group went on to work closely with the federal government on a program about strategies to fight decay, it downplayed the most obvious, cutting out sugar. Another time, the group funded research that inadvertently linked sugar with bladder cancer, then killed the research. Then there was a 1967 paper — secretly funded by that same trade group — that blamed fat and cholesterol for causing heart disease, but minimized data showing sugar’s risks.
More revelations are in the pipeline. Kearns is an assistant professor at UC San Francisco, which houses millions of internal documents from the tobacco, drug, and chemical industries. As of last month, it has also amassed some 30,000 documents from the food industry, including Kearns’ hauls from the basements of Big Sugar.
“I think she’s a true original in her approach to research,” Marion Nestle, an emeritus professor of nutrition, food studies, and public health at New York University, told Angle News by email. “Getting this information out is a major public service.”
Some critics of Kearns’ research have questioned how successful some of the sugar industry’s efforts to manipulate scientists actually were. But even they praise her for scrutinizing how food companies have tried to twist research and laws to their favor — a practice still very much in vogue.
Kearns’ revelations are feeding a broader backlash against sugar. Consumption of the sweet stuff, now present in all kinds of packaged foods and drinks, has tripled worldwide in the last 50 years. An emerging body of research links it to increasingly common maladies like obesity, diabetes, hypertension, and heart disease. And cities around the country, including Berkeley and Seattle, have started to tax sugary drinks.
The industry is fighting back, most recently by backing ballot measures and state laws that block future sugar taxes. In 2015, Coca-Cola funded a now-defunct network of scientists with the goal of blaming obesity on lack of exercise, not bad diet. Outside the US, manufacturers of sugary foods are funding nutrition research in developing countries where they are seeking to ramp up sales. Corporate funding doesn’t inherently corrupt, but on balance, studies bankrolled by the food industry do tend to favor the interests of their sponsors.
For its part, the Sugar Association, the industry’s US trade group, says that Kearns’ research is speculative and biased. “We acknowledge that Dr. Kearns has devoted significant time to the task of reviewing thousands of documents from over 50 years ago; however, we question her motives and certainly the accuracy of her conclusions,” President and CEO Courtney Gaine said in a statement. “The Sugar Association is proud of our long research history and believe that sugar is best enjoyed in moderation, a fact that is supported by decades of scientific research.”
But Kearns remains undeterred, and believes more secrets are waiting to be ferreted out. “We’ve just barely scratched the surface on what the industry has done to try and influence our profession.”
At a dental conference in 2007, Kearns couldn’t help but notice that some things weren’t adding up. According to one handout she received, dentists should tell patients to improve their blood sugar, blood pressure, and cholesterol by “increasing fiber and limiting saturated fats and salt.” What about sugar? she wondered.
A pamphlet given out during another talk said that sweetened Lipton Brisk tea was as healthy as nonfat milk and coffee. Bewildered, Kearns cornered the speaker afterward.
“He said, ‘There is no evidence linking sugar to chronic disease,’ and I had no comeback, because I was so shocked that he said that,” Kearns recalled.
“That was the ‘aha’ moment for me,” she said, “that I needed to dig deeper.”
Years before that, she had been the dental director of a public health clinic in Denver that served low-income patients. But there was an endless number of rotten teeth to be filled and pulled, and she soon burned out.
“It’s very obvious that diet was a major factor in this huge burden of disease in this population,” said Kearns, 47. “It’s always been on my mind, and it just wasn’t something I could have much of an impact on.”
So she switched gears, getting an MBA and taking a job as an operations manager at the dentistry arm of an insurance company.
Around that time, Kearns had been reading books by Nestle, the NYU professor, and investigative journalist Gary Taubes that were critical of the food industry’s influence on science. Wondering if something might be similarly afoot with sugar, Kearns stumbled onto the website for the Sugar Association. To her disbelief, it touted the fact that 1,000 papers had exonerated sugar of links to chronic disease.
Kearns went on to learn that the group had originally been known as the Sugar Research Foundation, formed in 1943. She began digging so deeply into the organization’s origins that by 2009, she quit her job to do research full-time.
One day, she typed “sugar” into the Denver public library’s catalog and scored one of her first big finds, learning that internal documents from the defunct Great Western Sugar Company were spread out across a bunch of libraries in Colorado. That week, she drove an hour and a half to examine one of those collections at Colorado State University in Fort Collins. In an archive reading room where Kearns wasn’t allowed to bring in anything but a pencil, the staff brought out a couple boxes to review. One of them, to her astonishment, held the confidential 1975 memo.
More googling unearthed more treasures. The University of Illinois turned out to house the papers of Roger Adams, an emeritus professor of organic chemistry who had advised the Sugar Research Foundation and a later incarnation, the International Sugar Research Foundation, from 1959 to 1971. He left behind a trail of correspondence, reports, and meeting minutes that provided a window into how the group interacted with the government and funded research intended to serve its interests, Kearns says.
As stacks of photocopies began swallowing up her kitchen table, Kearns tried to figure out what to do next. She wasn’t affiliated with a university, had no special library privileges, and lacked any historical research or journalism training. But she liked to write. Maybe she could turn all this material into a news story.
Someone who might be able to help, she thought, was Taubes, whose books, like Good Calories, Bad Calories and Why We Get Fat, questioned the evidence for the low-fat diet that was a fixture of dietary guidelines. When he didn’t reply to her emails, she chased him down at a bookstore reading.
“It’s probably a cliche to say this, but my eyes probably literally lit up,” Taubes recalled of their first meeting. “I think I even scared Cristin a little with my reaction. What she told me she had found was precisely what I suspected.”
Together, they wrote a cover story for Mother Jones in late 2012. “Research on the suspected links between sugar and chronic disease largely ground to a halt by the late 1980s, and scientists came to view such pursuits as a career dead end,” they wrote. “So effective were the Sugar Association’s efforts that, to this day, no consensus exists about sugar’s potential dangers.”
The exposé caught the eye of UCSF professor Stanton Glantz, who in the 1990s was leaked internal documents that showed how the tobacco industry covered up smoking’s harms.
He flew Kearns out to give a talk at UCSF, and was so impressed that he offered her a fellowship by voicemail before she landed back in Denver. (As Angle News has reported, Glantz recently settled a sexual harassment lawsuit lodged by a former postdoctoral fellow in his tobacco research group. UCSF also found that he violated its sexual harassment policy, a finding he is contesting, according to the university. He declined to comment on this subject, other than pointing to a statement previously posted on his website.)
Although the tobacco and sugar industries may have employed similar tactics to protect their products, their products were not equally dangerous. Tobacco executives knew that scientific evidence showed that nicotine was addictive and that smoking caused lung cancer, and worked to cover it up. But because the evidence about sugar’s toxicity has always been more ambiguous, “producers simply needed to make sure that the uncertainty lingered,” Taubes and Kearns wrote in Mother Jones.
Kearns, Glantz, and other colleagues have used the sugar archives to reconstruct how that process happened. A trio of papers they’ve published over the last three years reexamine a crucial period in nutrition research after World War II, when scientists were debating whether fats or sugars were the primary cause of coronary heart disease.
One of the UCSF team’s most discussed findings concerns a 1967 paper in the influential New England Journal of Medicine. A few years prior, the Sugar Research Foundation had become concerned about studies showing that a low-fat, high-sugar diet could spike cholesterol levels. Its research director proposed that it “could embark on a major program” to counter “negative attitudes toward sugar,” internal documents showed.
The group enlisted a few Harvard nutritionists — Mark Hegsted, Robert McGandy, and Fredrick Stare — to write an article summing up what existing scientific literature said about the dangers of table sugar, known technically as sucrose. As Kearns’ team reported, the foundation paid them nearly $49,000 in today’s money, sent over papers to include, and looked at the final draft with approval: “Let me assure you this is quite what we had in mind and we look forward to its appearance in print.”
Neither the foundation’s funding nor its role was disclosed in the finished product, which was indeed favorable to sucrose: Hegsted’s team concluded that reducing cholesterol and saturated fats, not sugar, was the way to reduce heart disease. But in her analysis of their paper many years later, Kearns came to believe that they dismissed and cherry-picked study data that raised questions about sugar, citing reasons that, in her view, were biased and inconsistent. It was a “smoking gun,” Nestle wrote in a commentary alongside Kearns’ 2016 paper.
The Sugar Association disputes those findings. While acknowledging that its predecessor “should have exercised greater transparency in all of its research activities,” it pointed out at the time of Kearns’ paper that “funding disclosures and transparency standards were not the norm they are today” and that “industry-funded research has been informative in addressing key issues.”
Some outside of the industry also disagree with Kearns’ interpretation of the Harvard scientists’ motives. In an essay this spring in Science, two Columbia University researchers argued that Kearns’ team had “overextended the analogy of the tobacco industry playbook” to push “conspiratorial” narratives. They pointed out that Hegsted already had well-documented concerns about fat, which is why the sugar industry chose him to oversee the paper in the first place, so the 1967 article aligned with his previous research. He was also one of many nutrition researchers worried about fat at a time when sugar research was scant.
“It’s not surprising at all that Hegsted would write a review that supported the idea that dietary fat was harmful and sugar was not that meaningful,” David Johns, one of the Science authors and a graduate student in the history of public health, told Angle News. He also believes that fixation on the paper is misplaced because it was not widely influential: By his count, at the time of Kearns’ 2016 paper, it had been cited fewer than 100 times in scientific literature.
Even Taubes is unsure if the scientists deliberately skewed the science to please their sugar overlords, or followed their own compass down a path that just happened to match their funders’ interests. “That these Harvard researchers would then check it with the sugar industry to make sure what they were writing was to its taste is a bit troublesome, but, again, it might have been standard operating procedure in the nutrition research world at the time,” he said by email.
Kearns stands by her reading of the article, which her research indicates was just one piece of what she calls “a larger public relations strategy.”
Internal documents reveal that from 1967 to 1971, the Sugar Research Foundation sank $188,000 in today’s money into a study to compare the effects of a high-sugar diet versus a high-starch diet in rats. Led by a scientist in the UK, the project aimed to evaluate the effects of sucrose on heart health. But as Kearns’ team reported last year, the experimental data suggested that sucrose consumption actually increased levels of an enzyme associated with bladder cancer in humans. The trade group halted the study and never published the unfavorable findings; its research director described the project’s value as “nil.”
The Sugar Association said last year that the study did not end because of the findings, but because it was delayed, over budget, and caught up in an organizational restructuring. Plans to continue the study fell through for unknown reasons, it said. “Throughout its history, the Sugar Association has embraced scientific research and innovation in an attempt to learn as much as possible about sugar, diet and health,” the group said.
Around the time of the rat study, the industry was seeking to influence a new tooth-decay prevention program run by a federal agency, Kearns’ team reported in 2015. Sugar companies couldn’t deny that their product caused tooth decay. So they instead funded research about preventing dental plaque and decay, efforts that Kearns says deflected attention away from the true cause of the problem.
Today, many nutrition experts agree that excess sugar provides unnecessary calories with little to no nutritional value and, over time, snowballs into health consequences. “Added sugar in particular has been clearly indicated to be a risk factor for weight gain, for type 2 diabetes, for cardiovascular disease, and I think there’s little doubt that sugar plays a role in these conditions, in the US population in particular,” Deirdre Tobias, an assistant professor at Harvard Medical School who is not involved in Kearns’ work, told Angle News.
Although public health bodies have advised generally minimizing sugar intake, they’ve only recently suggested stricter rules. The current national dietary guidelines, published in 2015, recommended for the first time that calories from added sugars be kept below a specific limit, 10% of a daily diet. In 2016, the FDA passed a rule that required food companies to add information about added sugars to nutrition labels.
But Kearns thinks the government — and the general public — would have woken up faster to the perils of sugar if not for the industry’s meddling. “Had that evidence been taken more seriously back in the ’60s, what would the state of chronic disease look like today?” she said.
The nuances of the sugar industry documents will incite debate for decades to come, but Kearns has forged a path by hunting them down in the first place.
“Cristin is one of those people about whom heroic movies are legitimately made,” Taubes said. “And like many of these people, she has a highly developed sense of right and wrong — like the best investigative journalists. Once having decided that an injustice has been perpetrated, she wasn’t going to let it go and return to her own life and let other people handle it. She’s still at it.”
Now, her documents are being digitized and posted online for everyone — researchers, reporters, foodies, everyday citizens — to read. Next, she wants to dig into candy and beverage manufacturers and trade groups. And although her research so far has retraced the industry’s activities mostly from the 1950s to 1970s, she’s excited about new finds that will widen that scope even further. One set of documents, left over from a Canadian sugar company, could shine a light on how the industry ran publicity campaigns as late as the 1980s.
Another set of documents yet to be explored, stashed at the University of Florida, were donated by relatives of Cuban sugar company executives. They chronicle the birth of the Sugar Research Foundation, when sugar executives were discussing why they needed to form it and deciding which public relations firms to hire. Kearns hasn’t fully dug into them yet, but so far, she said, they appear to show how “they were targeting doctors and dentists and nutritionists, going back to the 1940s, in very sophisticated ways.”
All these discoveries have changed Kearns’ life in more ways than one. She gave up soda years ago. She doesn’t bring anything sugary home.
Even she, though, has trouble resisting the homemade baked goods that her coworkers bring to the office. “Sugar,” she said, “is everywhere.” ●