When this news first came out it was mind blowing, but at the same time I don't entirely get it.
So the money quote seems to be:
> The literature review heavily criticized studies linking sucrose to heart disease, while ignoring limitations of studies investigating dietary fats.
They paid a total of 2 people $50,000 (edit: in 2016 dollars).
That doesn't seem like enough to entirely shape worldwide discourse around nutrition and sugar. And the research was out there! Does everybody only read this single Harvard literature review? Does nobody read journals, or other meta studies, or anything? Did the researchers from other institutions whose research was criticized not make any fuss?
I guess the thing that I most don't get is it's now been 10 years since then, and I haven't seen any news about the link between sugar and CVD.
> There is now a considerable body of evidence linking added sugars to hypertension and cardiovascular disease
Okay, where is it? What are the conclusions? Is sugar actually contributing more than fat for CVD in most patients? Edit: Or, is the truth that fat really is the most significant, and sugar plays some role but it's strictly less?
You’re exactly right: This one incident did not shape the entire body of scientific research.
There is a common trick used in contrarian argumentation where a single flaw is used to “debunk” an entire side of the debate. The next step, often implied rather than explicit, is to push the reader into assuming that the opposite position must therefore be the correct one. They don’t want you to apply the same level of rigor and introspection to the opposite side, though.
In the sugar versus saturated fat debate, this incident is used as the lure to get people to blame sugar as the root cause. There is a push to make saturated fat viewed as not only neutral, but healthy and good for you. Yet if you apply the same standards of rigor and inspection of the evidence, excess sugar and excess saturated fat are both not good for you.
There is another fallacy in play where people pushing these debates want you to think that there is only one single cause of CVD or health issues: Either sugar, carbs, fat, or something else. The game they play is to point the finger at one thing and imply that it gets the other thing off the hook. Don’t fall for this game.
I think common sense here can be a guide though. You don't need sugar at all, excluding high levels of anaerobic exercise. Your liver can produce the glucose your body actually needs from other sources (gluconeogenesis) and a lot of your tissues that use glucose also can use fatty acids or ketones. Fructose isn't needed at all. ("low blood sugar" isn't a symptom of not consuming enough sugar, it's a symptom of a disregulated metabolism -- ie insulin resistance or other conditions)
Saturated fats have all sorts of uses biologically.
That has nothing to do with whether excesses of those nutrients cause cardiovascular disease, though. The general consensus is that the healthiest diet is one with 5-10% of total calories from saturated fat. For most people, it's necessary to restrict saturated fat to land in that range. We also need to distinguish between sugar and carbohydrates. Again, the general consensus is that intake of sugar and refined carbohydrates should be minimized, while 50-75% of total calories should come from sources of complex carbohydrates like vegetables, beans, and whole grains.
Carbohydrates are sugars (from the first sentence on wikipedia): "A carbohydrate (/ˌkɑːrboʊˈhaɪdreɪt/) is a sugar (saccharide) or a sugar derivative." Saying you need "50-75% of your energy from [sugar]" illustrates why that is a somewhat odd statement. Yes, glucose is much better than fructose, but eating a ton of glucose will still lead to high insulin spikes and inflammatory diseases. Complex carbohydrates are better in that they take longer to digest, not because they're magically different. Vegetables are good for nutrients not because you need their carbs.
GP was talking specifically about calories, not other nutrients. My impression is when a vegetable provides significant calorie content it tends to be in the form of carbohydrates.
You have to get your calories (ie raw energy) from somewhere. If you limit saturated fat to 10% then what's left for the other 90% is (roughly speaking) unsaturated fat, simple sugars, carbohydrates (ie complex sugars), and protein. In terms of long term habits converting protein to calories is probably not a great choice for your health. If you decide to go for complex carbohydrates over various oils then vegetables that provide those are a good option.
People are on ketogenic diets for years and even decades with no adverse affects. There's nothing wrong with getting energy from other sources, your body can manage it fine.
Ketogenic diets are high fat. I suggested that a diet where the bulk of your calories comes from protein (not lipids, carbohydrates, or simple sugars) was probably not great for your health.
Your body can certainly "manage" on a high protein low fat low carb diet but I don't understand it to be good for you.
Funny you should say that after today's FDA announcement. (Not taking any side here just interested in how we determine what is a consensus these days)
It's hard, because when an issue becomes politicized everyone has their own preferred "consensus". I would say it should come from the scientific community, not government agencies. Sometimes government agencies agree with the scientific consensus, but not always.
My go-to source for nutrition information is Understanding Nutrition by Whitney and Rolfes.
There is a third option: looking at the diets of your closest ancestors with the best longevity.
There may be a misconception that there is one single best diet for everyone, when in reality we people (over generations) evolve with our diets, and your best diet and my best diet may be completely different.
The problem with using science as a guide is that there are just too many variables and not enough time, data and money to isolate them all sufficiently.
However that is distinct from the idea that too much of something like refined sugar might be unhealthy for just about everyone. So science does have an important role to play, I just don't think it's advanced far enough to fully answer the question for everyone.
I would caution that just because your body can make something doesn't mean it will have optimal performance when doing so. People in ketosis do have worse peak performance in sports than those that eat more carbs/sugar.
This is true, but I don't think our understanding of nutrition is good enough to really pick and choose what we want to optimize for. Eg we still don't have a recommendation on whether we should costume external vitamin K2 or not. The same goes for many amino acids. Some of the non-essential ones can have interesting effects when taken alone, eg glutamine - seems to help the gut lining. (We also don't know whether that's perfectly safe due to cancer risks, because some cancers eat glutamine.)
Your mind and health are impacted by your physical body. If eating a certain way impacts your physical performance then it might also have effects on your health (and mind) in unexpected ways.
I'm not saying that ketosis has this kind of an effect, but rather that eating or not eating some other things might. Eg vitamin K2. The body is be able to make vitamin K2, but we might have stronger bones and teeth, and a healthier cardiovascular system, if we get extra K2 from an external source.
Looks like it's true that low-carb adapted athletes rely more on fat oxidation during exercise but performance suffers nonetheless because of increased oxygen demands that basically cannot be met.
Your entire argument here applies in the other direction as well. You do not need dietary saturated fats, and sugar has all sorts of uses biologically.
That is only partly true: you don't need dietary saturated fats, but you do need essential fats (omega-3 and omega-6), which are polyunsaturated. However, sugar does not have all sorts of uses biologically; it has only one: as one (but not the only one) source of energy.
That sugar however is produced by the body itself.
Technically speaking, dietary requirement for sugar is 0. This doesn't mean it isn't useful to have some, but it definitely shouldn't be the basis of the food pyramid.
> There is another fallacy in play where people pushing these debates want you to think that there is only one single cause of CVD or health issues: Either sugar, carbs, fat, or something else. The game they play is to point the finger at one thing and imply that it gets the other thing off the hook. Don’t fall for this game.
Okay but right now we're talking about science getting corrupted by money. Which did happen in this instance, so that companies could hide the damage that sugar does to people.
Sugar does damage and scientists were paid to downplay that fact. It is not the first time. This is concerning when we talk about principles and public trust.
Where I'd suggest you go too far is implying that saturated fat and sugar are similarly bad. Technically you do hedge the claim with "excess", which is effectively a tautology, so the claim isn't outright false. You also don't qualify whether you mean excess in absolute terms (i.e. caloric intake) or as a proportion of macronutrients.
In practical terms, I don't consider it useful guidance based on the available evidence. As far as I can tell, there's little to no evidence that saturated fat is unhealthy (but lots of bad studies that don't prove what they claim to prove). Meanwhile, the population-wide trial of reducing saturated fat consumption over the past half-century has empirically been an abject failure. Far from improving health outcomes, the McGovern committee may well have triggered the obesity epidemic.
I think the benefits of "low fat" may have been dulled by how literally people took that message, and what companies replaced the fat with.
Most available "low fat" products compensated by adding sugar. Lots of sugar. That way it still tastes nice, but its healthy right?
Just like fruit juice with "no added sugar" (concentration via evaporation doesn't count) is a healthy alternative to soda right?
In truth your body is perfectly happy converting sugar to weight, with the bonus that it messes up the insulin cycle.
At a fundamental level consuming more calories than you burn makes you gain weight. Reducing refined sugar is the simplest way to reduce calories (and solves other health issues.) Reducing carbohydrates is next (since carbs are just sugar, but take a bit longer to digest). The more unprocessed the carb the better.
Reducing fat (for some, by a lot) is next (although reduce not eliminate. )
Both sides want to blame the other. But the current pendulum is very much on the "too much sugar/ carbs" side of things.
Agreed, this is a big part of the problem. The average person doesn't have anything resembling a coherent mental model of nutrition, and vague conflicting nutritional advice only adds to the confusion. The average person doesn't even know what a carb is, much less understand the biochemistry of how their body processes one.
Does "reduce fat consumption" mean a proportional reduction (i.e. increase carb/protein consumption) or an absolute reduction (i.e. decrease overall caloric intake)? In either case, what macros and level of caloric intake relative to TDEE are the assumed starting point? Who knows, but the net effect has been multiple generations hooked on absurd concentrations of sugar and UPFs.
> The next step, often implied rather than explicit, is to push the reader
This is the key part of this. It isn't even about the post or person that is being replied to, it's about the far wider audience who doesn't post but who who reads these interactions.
The big problem is that "truth tellers" very often leverage media platforms to sell their unscientific and unsupported or lightly supported opinions.
It's relatively simple to ultimately buy airtime to sell a product and have the one air host fawn over it as if what's been sold is the greatest truth of our lifetime. Some of the court documents against infowars placed the price for that sort of airtime at something like $20,000.
The problem comes in that the actual experts have very little want or desire to do the same. We're lucky if we see a few "science communicators" that step up to the plate, but they very rarely end up with the funds to sell the truth.
This a big part of how the "vaccines cause autism" garbage spread. Long before it caught on like it did, Wakefield was going around to conferences and selling his books and doing public speaking events on the dangers.
That pattern is pretty apparent if you look at major fad diets over the years. Selling that "you just have to eat meat" or "You just have to eat raw" or "You just have to eat liver" can make you some big money and may even land you on opera where you can further sell your magic green coffee beans.
Medical reality is generally a lot more boring. Like you point out, CVD is likely influenced by multiple factors. Diet, alcohol intake, exercise (or lack thereof) all contributing factors.
I disagree. Demand is the big problem, not supply.
The general public possesses domain-independent expertise on social pressures, institutional and financial incentives, and other non-epistemological factors that in some cases can support a rational rejection of scientific consensus.
Inadequate gatekeeping—premature or belated consensus or revision—is a failure of a given field of inquiry, not a failure of the general public.
> The next step, often implied rather than explicit, is to push the reader into assuming that the opposite position must therefore be the correct one.
See this in the constant "the MSM is imperfect, that's why I trust Joe Rogan or some random `citizen-journalist' on Twitter" nonsense. It's how everything has gotten very stupid very quickly. People note that medical science has changed course on something, therefore they should listen to some wellness influencer / grifter.
> excess sugar and excess saturated fat are both not good for you
The submitter of this entry is clearly a keto guy, and it's a bit weird because who is claiming sugar is good or even neutral for you? Like, we all know sugar is bad. It has rightly been a reasonably vilified food for decades. Positively no one is saying to replace saturated fats with sugar. In the 1980s there was a foolish period where the world went low fat, largely simply because fat is more calorically dense and people were getting fat, ergo less fat = less calories. Which of course is foolish logic and people just ate two boxes of snackwells or whatever instead, but sugar was still not considered ideal.
Someone elsewhere mentioned MAHA, and that's an interesting note because in vilifying HFCS, MAHA is strangely healthwashing sucrose among the "get my info from wellness influencers" crowd. Suddenly that softdrink is "healthy" because of the "all natural sugar".
The 80’s anti fat diet was mostly clogged arteries before we had all these anti cholesterol drugs and research showing how little impact dietary cholesterol has.
US obesity simply wasn’t as common (15% in 1985 vs 40% today) and at the time most research is on even healthier populations because it takes place even earlier. Further many people that recently became obese didn’t have enough time for the health impact to hit and the increase of 2% between 1965 and 1985 just didn’t seem that important. Thus calories alone were less vilified.
Put another way when 15% of the population is obese a large fraction of them recently became obese (last 10 years), where at 40% the obese population tends to be both heavier and have been obese for much longer. Heath impacts of obesity depend both on levels of obesity and how long people were obese.
The government and medical groups were advocating lower fat diets for CVD reasons, but among the mainstream it took hold overwhelmingly because it was seen as a mechanism for weight reduction or management. A gram of fat has twice the calories of a gram of protein or carbs, and this was widely repeated (yes, I was alive then). Similarly, if being fat was bad (and yes, it was viewed as very bad), then fat as a component of food must similarly be bad.
Obesity was obviously far less common, but concern about weight -- and note that weight standards were much, much tighter (see the women in virtually any 1980s movie, which today would be consider anorexic) -- was endemic culturally. Snackwells weren't being sold to middle age men, they were being sold overwhelmingly to younger office women paranoid about their weight, and it wasn't because they were concerned about their arteries. Low fat products overwhelmingly targeted weight loss, including such ad campaigns as the "special k pinch".
"Thus calories alone were less vilified."
I'm sorry, but this is simply ahistorical. Calories were *EVERYTHING* among a large portion of the population. What is your knowledge on the 1980s from, because it certainly isn't based upon observable reality.
In the 1980s, being slightly overweight made you the joke (like literally the joke, as seen from Chunk in the Goonies, and many parallels in other programs). As calories became cheaper and people's waists started bulging, it was an easy paranoia to exploit.
Sure, that’s a reasonable take, but satiety research was also far less developed.
The general understanding at the time was basically a full stomach tells people they have eaten enough. We didn’t understand the multiple systems the body uses to adjust the hunger drive and how much a high carb low fat diet messes with them.
> I'm sorry, but this is simply nonsensical. Calories were EVERYTHING among a large portion of the population. What is your knowledge on the 1980s from, because it certainly isn't based upon observable reality.
Less vilified is on a relative scale, I was alive back then and there was plenty of nonsensical low calorie diets being promoted. However you also saw crap like the Fruitarian Diet where unlimited fruit meant people could actually gain weight on a diet that also gave them multiple nutritional deficiencies.
Low fat dieting is in part from that same mindset as fruitarian diet where it’s not the calories that are the issue but the types of food you were eating. Digging just a little deeper these ideas made more sense before global supply chains and highly processed foods showed up. Culture can be a lot slower to adapt than technology or economics, diet advice from your grandparents could be wildly out of date. Cutting X means something very different when you have 20 available foods vs 20,000.
The US FDA requires that schools not serve whole milk or any products containing normal and natural saturated fats, and instead serve “low fat” versions which literally remove the fats and replace them with sugar.
You say nobody is doing this, but all the subsidized meals for my kids do this.
Taking the cream out is (by some diet theories) bad. The fat in whole milk slows down the absorption of lactose, leading to a slower rise in blood glucose compared to skim milk. Whole milk is more satiating as well, because of the fat.
If you are trying to have some reasonable balance of fat, protein, and carbs in your diet, pushing kids from whole to skim milk is going to move the diet towards consuming more sugar/carbs, even if you have a seperate rule trying to tighten sugar consumption.
When you take a high satiety, high fat item, and replace it with a non-fat, low satiety item, you are in effect replacing fat with sugar, because you will eat/drink more of it to get same number of calories, and same amount of fullness.
Drink a glass of whole milk, then drink a cup of skim milk and tell me there is no difference. Try the same with full fat yogurt and non-fat yogurt. Big difference in satiety, but more importantly blood sugar response. Roughly the same amount of fat in a glass of whole milk as 1/4 pound burger.
>Big difference in satiety, but more importantly blood sugar response.
There is a negligible difference in glycemic index / glycemic load between the variations of M.F. milk products. Some analysis has skim milk as having a lower GI.
Unflavoured Milk is not relevant to the GI conversation.
I don't think anyone ( at least around me ) is drinking milk based drink twice as much just because they feel like they get less energy per drink from skimmed milk.
You are making an argument that people do so, do you have any evidence for this ?
Skim milk is not "low fat". It is fat free. In the US milk labeled as low fat is 1% or 2% milk fat (usually 2%). Whole milk is around 4%. Skim milk rounds to 0%.
Is it added deliberately or just concentrated as a side-effect? Say fat comprised, let me guess, 5% of whole milk volume. If you take away this 5% v/v component, now everything else in one liter of skim milk is 5% concentrated by comparison, unless they add water.
It's saying it's you give all your change away and then replace it with new money then you increase your bill value.
The meal does not get smaller. The meal has a calorie target, and the milkfat gets replaced with new food. And almost never will that new food be a chunk of lard, so it will increase the carb ratio.
>which literally remove the fats and replace them with sugar.
This is not accurate.
No they didn't "replace" the fats with sugar. There is a chocolate milk option, just as there was before, but all options need to be 1% or low M.F., which nutrition and medical science overwhelmingly supports.
Is chocolate milk not ideal? Of course. We all know that. They shouldn't serve it either.
Starch is the preferred carbohydrate, since digestion depolymerizes it to pure glucose which can be used directly by cells.
Cane sugar, a disaccharide, is split by digestion into its constituent glucose and fructose molecules, and the latter must be further processed by the liver. It is 50% fructose.
High fructose corn syrup is 55% fructose.
A variety of other sugars, such as maltose and lactose occur naturally in a variety of foods. However, they are in low enough concentrations to not be a health problem.
HFCS is from 42% - 55% fructose (the glucose obviously filling the remainder). Many uses are on the lower end.
A lot of people think the "high fructose" part of the name is relative to sucrose's 50:50. In reality it's relative to corn syrup which is almost entirely glucose, but some of the glucose can be processed to fructose to more closely match the sucrose that people are accustomed to. They go a little higher on the fructose because it is perceived as sweeter, so with a 55% ratio they can use less for the same sweetness.
While what you say is true, starch is still nutritionally unnecessary. And wheat in particular has a lot of unhealthy or even outright toxic substances in it, especially if you are talking about the whole wheat.
But there is also the fallacy where some people want you to believe basically everything will cause CVD and there is no single thing you could do to change it, so therefore just keep doing whatever you’re doing.
I call this the "Everything in Moderation" fallacy. From what I've heard people who say it, they emphasize the everything part of it. In other words almost everything is bad for you so just eat a little bit of everything and you won't get too much of the bad stuff. It's maddening.
The way I understand it (and my understanding is certainly poor, so I welcome well-supported pushback on it), is that few, if any, components in the food that we in developed countries eat today are actively harmful in themselves (with the caveat outlined below)
The main issue is overconsumption leading to overweight and obesity. Food that’s high in refined sugars and/or saturated fats tend to contribute to this, because it’s palatable and calorie-dense
So in that sense, yes - I believe that as long as your diet is varied enough that you get sufficient intake of all, or at least most, of the essential nutrients, and you don’t eat too much (i.e. in moderation), the ratio of macronutrients doesn’t make a big difference to your health outcome
The crux is that moderation is hard when the food is jam-packed with calories, and it’s so delicious you just want to keep stuffing your face
By volume most of the food in modern western grocery stores is unnaturally sugary or otherwise calorie dense.
You have to restrict yourself to produce and a few scant other options to escape with balanced nutritional products.
They even advertise cereals as a "part of a healthy breakfast". Which is a lie under any circumstances, because it's never a healthy part if you eat it long term. (Yes it could keep you from starving to death in a famine, still not 'healthy'.) Imagine if they could only say "it will keep you from starving, and may significantly contribute to diabetes"
I don’t think “Everything in Moderation” means you won’t get too much of the bad stuff. The philosophy alludes to the fact that in the modern world, trying to have the ideal diet is exhausting and near impossible. Lack of choice, money, time, education, self control etc. all contribute to you intentionally or unintentionally eating stuff that’s going to do irreparable harm to you. You could be eating salads and somehow poisoning yourself with pesticides and high sugar/fat/sodium salad dressings. Which is why this philosophy focuses on, do everything in moderation and you’ll maybe avoid CVD and other diseases for longer. It is meant for people who cannot meet the idealistic standards of what you are supposed to do.
Is it really that exhausting though? I've been on a zero-carb diet for two months (other than thanksgiving or christmas), and it really hasn't been hard at all. If I eat at a restaurant there's some things I can't avoid (seed oils), but otherwise it's not too hard to look at a menu and see things I can eat. The only hard part is to be optimally healthy I need to cook for myself, but that's always been true.
In a lot of ways, it's actually been easier. Because my blood sugar isn't crashing every few hours, I can easily skip a meal and feel perfectly fine. Fasting is very easy for me now, which it wasn't at all on an unhealthy diet.
Yet you are unavoidably eating micro-plastics too, which have been linked to adverse CV events.
Also:
- If you are eating more fish (as opposed to eating meat), you are likely consuming more mercury.
- If you are eating more fresh veggies you are probably ingesting more pesticides.
- If you are easting dark chocolate for its health benefits, you are also ingesting cadmium and other heavy metals.
So all the above should be done in moderation. Even things that seem like unalloyed good can be dangerous. A burst of exercise beyond your conditioning can lead to a CV event. Too much water can be poisonous. Some people get constipation for too much veggies in their diet.
For example, instead to sticking to a narrow faddish supposedly healthy diet, you can enjoy a wide range of foods, which will make it more likely you are getting all the nutrients that will do you good (of course clearly unhealthy food should be avoided).
The body is more complex than we can ever know. There are some general principles for good health (including CV health) that should be followed, but to me it is clear that good health does not arise from a slavish devotion to very detailed set of rules.
Funnily I've heard that one reason why obesity is prevalent is that we have too many variations of food. Seems like our hunger controller suspends satiety when we eat a food too much, but when we eat few of lots of different foods, it's broken.
It'd be funny if lots of fad diets actually works because people are forced to eat a single type of food and that's entirely enough for it.
Your post sounds like "bad things can happen so why bother". Having a good diet isn't "slavish devotion", it's more like "don't eat something obviously terrible"
People who don’t make money, have to take care of childcare while working 2-3 jobs, probably aren’t able to cook themselves. Nor are the people who live in food deserts that only have limited options able to optimize around a specific diet that’s not restricted by availability.
I cook my own food and optimize around eating healthy. I wouldn’t be able to do it if I made less money or had a more demanding job or didn’t have great grocery stores in a 10 mile radius or had to spend time in childcare or any of the other completely valid reasons people have.
Besides, you yourself just described “do things in moderation” yourself: holidays, Christmas, restaurants etc. That’s really what the philosophy is.
What is moderation? The volume (or mass) of a single apple of alcohol is going to make you very drunk (most alcohol is mixed with water: an apple's worth of beer is very little, that much Everclear is a problem).
That is what I hate about the everything in moderation. We need to do better since some things should be in much larger amounts than others.
I think we all would agree that any amount of rat poison is a bad thing, thought perhaps this is too much of a strawman.
the greatest travesty of modern science is that fraud is not illegal.
in every other industry that i can imagine, purposely committing fraud has been made illegal. this is not the case in modern science, and in my opinion the primary driver of things like the replication crisis and the root of all the other problems plaguing academia at the moment.
It's hard to prove when it isn't investigated. How many of the debunked psychology professors took federal funding? How many have been criminally investigated?
my own institution launched an internal investigation into a professor who i know for a fact committed fraud and was "unable to prove intentional wrongdoing". academic institutions have taken the "this never happens because we are morally pure" approach which we all know is a load of baloney, they are perversely incentivized to never admit fraud.
the witness and reportee who i am friends with was directly instructed by this professor to falsify data in a more positive light in order to impress grant funders. multiple people were in attendance in this meeting but even that was not enough to see any disciplinary action.
duke also has a notorious reputation for being a fraud mill.
Note both those guys were found guilty for taking government money under false pretenses (to do with fake science, not for doing fake science, which is more supporting evidence that fake science is legal.
> That doesn't seem like enough to entirely shape worldwide discourse around nutrition and sugar.
People are often surprised when they find out how little people sell out for. The going rate for a member of congress in 2015 was a little less [0] - about $43,000.
> The going rate for a member of congress in 2015 was a little less [0] - about $43,000
If that's really the factor that swung the vote, there is more to it than that contribution. There may be a promise of a job after Congress. Or there may be an expectation of continued contributions.
Put another way, if you donate $43,000, you're not going to get a line item in a law. (Counterpoint: I've never donated more than a few thousand in my life, and I've had a hand in multiple state and now three federal laws. A lot of people don't civically engage. If you're the only person calling your elected on a bill they don't care about, and you aren't a nutter, they'll turn you into their de facto staffer on it.)
You probably only need 15% of congress. Some of the unbought ones will follow, some would vote for your side anyway, and there are often unrelated things in the bill that will bring a bunch of those who otherwise don't care about this issue with.
I'm not a medial researcher, but my impression is that many fields find it difficult to produce the robust high-level risk comparisons that you ask about. I.e. if you're looking at blood fats, even there you'll find many complicated contextual factors (age, sex, ethnicity, type of lipids i.e. LDL or lp(a) or ...?). The same might be the case for sugar. So it's not really easy/cheap to combine detailed state-of-the-art measurements of different causes into one randomized controlled trial.
As for the effects of sugar, I think there's some evidence that's not too hard to find, e.g. some meta analyses showing something around 10% increase in dose-dependent risk (RR ~ 1.10) [1,2]. A lot of the literature seems to be focused on beverages, e.g. this comparative cross-national study [3].
If you have a randomized controlled trial, the sugar dose is varied and other confounding variables are controlled by randomization. So you measure the causal impact of sugar only. There are studies showing that.
With observational studies, if you have a dose-dependent effect, then that's good evidence (although not completely conclusive) of a causal relationship. This is what many studies do.
If you have a meta analysis covering many primary studies, and if those vary a lot of context (i.e. countries, year, composition of the population), and you still get a consistent effect, then that's another piece of support for a causal relationship.
The few studies that I've looked at seem to show a pretty robust picture of sugar being a cause, but there might be selection bias - i.e. we'd need an umbrella / meta meta study (which ideally accounts for publication bias) to get the best estimate possible.
Observational studies, and meta analyses relying on them, don't resolve the fundamental problem of causal inference. The best you can do without an experiment is a really clean natural experiment, but those are rare. It's hard to credibly establish a causal relationship without a robust experiment.
What are "the habits surrounding consumption of the beverage?" It's been my observation that soda drinkers drink soda all day, no matter what they are doing.
I don't know why this was re-posted today (kind of suspicious that this floats again after 10 year just by chance) anyway, there is a full citation-heavy book by Gary Taubes about this, and one of his points was that the sugar industry paid 2 million in 1970's dollars to create the nutrition department of Harvard, which was the first nutrition department in the world. (This was to say that nutrition science itself has been corrupt since its birth).
To be true to Taubes, my memory was too approximate. The actual claim was that in 1976 Fred Stare, the director and founder (in 1942) of the Department of Nutrition of the Harvard School of Public Health was exposed by Michael Jacobson having received around 200.000 dollars in the course of the preceding 3 years from Kellogg's, Nabisco e and their foundations, after he had testified before the Congress about the virtues of cereal as a breakfast food. Apparently this discredited Stare as a scientist.
Wikipedia also states that "Kellogg's funded $2 million to set up the Nutrition Foundation at Harvard. The foundation was independent of the university and published a journal Nutrition Reviews that Stare edited for 25 years." But I cannot find this is Taubes's book.
"The UCSF researchers analyzed more than 340 documents, totaling 1,582 pages of text, between the sugar industry and two individuals...."
That is, this research (into industry influence) focused on the available and reviewed correspondence between the industry group and two specific researchers. There's nothing about this article or the referenced analysis which precludes additional other researchers being similarly influenced.
> They paid a total of 2 people $50,000 (edit: in 2016 dollars). That doesn't seem like enough to entirely shape worldwide discourse around nutrition and sugar.
You would be astonished at how little it takes to bribe, I mean donate, to a politician for example. For as little as $10-20k USD you can get a literal seat at a table with a sitting senator or congresscritter for several hours at a "charity" dinner, with results as expected.
Good comment. Industry influencing research is nothing new (Global Warming, Oxycodone), and the dollar amount is small but it really doesn't take a lot of money to influence anyone. This case was interesting because they diverted attention to another contributor and influenced public policy against savory snacks; I remember the public health campaign against habitual daily consumption chips/crisps, without equally addressing chocolate bars: https://www.thetimes.com/travel/destinations/uk-travel/a-pac...
And I'd also comment the ludicrous abstract comparison of drinking oil in a year. I wouldn't want to eat a football field of raw potato either.
I do wonder how/why the Savory Snack industry didn't fire back, and why don't we have anything better than: are they both equally bad or is fat or salt worse.
Did you know the average bribe accepted for a politician is something like 5K (This was from a few years back so probably higher now). So yeah this is totally within bribe limits.
As a unrelated note it really is depressing to think about how easy it is to buy off politicians and how much money the bribers have vs an average person.
Average home price in the late 60s was 25k so even if it is equivalent to $50k in 2016 dollars, 25k could still get you further than today in some specific areas.
Some clarification as the actual numbers and the random 25k number keep getting compared to the wrong contexts in this chain (it originally arose as a misunderstanding that the 50k was already in terms of 2016 dollars instead of the original 1960s payment https://news.ycombinator.com/user?id=CodeWriter23):
~$6,000-$7,000 is the amount the researchers were paid off with in the mid 60s. This is roughly equivalent to ~$50,000 in 2016 when using CPI-U figures.
$25,000 in the mid 60s would be equivalent to ~$193,000 by the same measure, and does not relate to $50,000 in 2016 in any way.
But your core point that the items in the CPI-U basket do not adjust equally, which is why it's a basket in the first place. Median housing price in 2016 was ~$300,000, so ~$193,000 is a bit of variance... but not nearly as much as mixing the numbers from the different comparisons made it sound.
$25,000 in 1969 has the same buying power as approximately $220,000 to $226,000 today
In terms of 2016, from gemini:
> In 2016, $25,000 from 1969 was worth approximately $163,490.
> Based on the Consumer Price Index (CPI), $1 in 1969 had the same purchasing power as $6.54 in 2016. This represents a total inflation increase of roughly 554% over that 47-year period
People are just downvoting you rather than discussing for some reason. It drives me bonkers when I see that happen here... :).
rendaw was pointing out the $50k in the article & parent comment was in terms of 2016 dollars, not that the mid 60s $25k in CodeWrite23's comment converts to $50k in 2016.
I.e. that the researchers would not be getting anything close to a house + charger + spare change for just half the $50k amount. They got more like $6k-$7k at time of payment in the mid 60s. Which is still a good chunk of change for the time... just not the amounts it was made to sound.
I doubt that the 50k was given to the research as personal pay. It was likely a “research grant” that was used to fund the research and/or get swallowed up as “overhead” by the university
It's not just a currency issue; inflation is by definition a reduction in the purchasing power of a fixed wage, and the issue we're facing is that the purchasing power of people's wages is less. If their wages were denominated in a unit of account that wasn't continuously losing value, they wouldn't be continuously losing purchasing power.
The reason you may not know it's an issue is because inflation in our current system isn't just a loss of purchasing power, it's a transfer of purchasing power to those who first receive/spend the newly created money: the banking/financial system. So of course the system invested a lot of money, time and effort in convincing you that it's a good thing to continuously donate a fraction of your purchasing power to the finance industry every year.
The first paragraph is doing a tricky little sleight of hand. Yeah inflation reduces the power of a fixed wage. Nobody has that kind of fixed wage. The issues with wages and prices we face are not caused by inflation, which is really easy to compensate for.
The second part is just confusing. Inflation benefits the first to "receive/spend" new money? Receiving and spending are opposites, and inflation benefits anyone that's spending whether they got that money first or fiftieth.
The US had 0-1% inflation a year until the federal reserve. I blame the FED and currency, yes. Look up the "what happened in 1970" charts, and its we got off the gold standard.
It's a confluence of various factors. Explosive population growth, for example. The modern economy (of which fiat currency plays a pivotal role) relies on that of course, as the lending system is a bet on future growth. If that fails the whole thing can enter a state of catastrophic failure. But population growth has more precedence. Fiat currency, bureaucratization, etc. were adopted as reactions to increasingly explosive populations and unchecked rationalism developing the absolutely ridiculous modern state system.
If you want demons to point a finger at, you're going to have to look further back in time than the 20th century. Then and now we're just doing a frantic tap dance to keep what we inherited from catching on fire.
Huh, what? Population increased a lot in the 19th century, and many countries did not have fiat currencies back then; and the price level most went down slowly as the population grew.
(Modern day 2%-ish stable inflation is mostly fine for the economy, even if it technically erodes the value of money in the long term. The classic pre-WW1 gold standard was also fine-ish. The Frankenstein gold standard-ish they until the 1970s was bad. And so was the rampant inflation that followed for a while.)
I specifically mentioned that population growth precedes fiat currency. Where's your confusion? I'm explicitly telling you to broaden your perspective and look at overarching political currents across the centuries succeeding the renaissance. For instance many countries also were not so extensively bureaucratized, particularly in how they interfaced with the public, until the late 19th century and early 20th century.
Political evolution is spread over many years and is structurally anisotropic. Metallism's death was inevitable by the 18th century at best, but don't misunderstand that to mean it was going to happen immediately. It's also just a symptom. The enlightenment's political revolution is a manifold spread across centuries. Don't just look at the symptoms, you won't understand anything and it will lead you to half-baked conclusions.
No, fiat currency has allowed our money supply to track closer to our GDP, preventing currency shortages and price manipulation by foreign adversaries, giving us the most stable economy the world has ever experienced over the last 50 years. Yes, it can be abused (and some Asian countries have taken this to dangerous extremes), but it’s better than all the alternatives so far.
Or maybe the combination is the problem. I couldn’t consume much sugar on its own nor much cream but put the two together in ice cream and I could eat it all day long.
That is what I came to believe as well. If sugar alone was the problem, vegans would be fat. If fat alone was the problem, ketogenic and carnivore diets wouldn't help people lose weight.
It seems to be the combination of two at the same time that causes the issues.
>That is what I came to believe as well. If sugar alone was the problem, vegans would be fat. If fat alone was the problem, ketogenic and carnivore diets wouldn't help people lose weight.
This logic is faulty because both vegans and keto/carnivore people are selected for adherence to diets. If you can stick to either dietary restrictions, you can probably also not pig out on pop tarts or whatever.
That is incorrect, actually. I find it relatively easy to adhere to keto diet. But the moment I try to introduce more "diverse" foods, I gain weight.
Because processed food diet is IMPOSSIBLE to adhere to without gaining weight. Caloric restriction simply doesn't work - your body wants nutrients, not just calories. Which is to say, your willpower will fail sooner or later, unless you find a way of satisfying nutritional needs without excess caloric intake.
>That is incorrect, actually. I find it relatively easy to adhere to keto diet. But the moment I try to introduce more "diverse" foods, I gain weight.
Keto diets might be easier to stick to than calorie counting or whatever, but the fact that you bothered with a diet at all means you're selecting for people who care about their health.
There is also a high chance you selected for people who were not eating well before. Or you selected for people that for genetic reasons are more likely to get fat.
Either way you cannot be sure your selection applies to other people.
GP didn’t say processed foods, but I can see why you went there because it’s a good point. That said, there are also those of us who can’t function without carbs (e.g. if I don’t eat them I will be too weak to work out or run, get light-headed, etc.).
That doesn’t mean they have to be processed, though, or that it requires gaining weight along with them. I personally survive primarily off of clean meats and homemade sourdough bread (which has literally 4 ingredients). If I cut out the bread I get hypoglycemic after runs and pass out. And with it, my weight stays around the same (though I’ve lost maybe 30lb in the last year or so due to just running more and lifting less).
Edit: and when I say “clean meats” I do not mean “lean” meats. Plenty of saturated fats. My bloodwork and other vitals are probably the best my doctor sees all year.
Well, yeah, I have no problem with carbs from fruit so long as they aren't causing issues (which to me they do, but that is a me problem, not a general indication).
Nobody cares about fat, except as it influences how well they look. They care about good health. There are many people who would be happy to sit in a wheelchair all day (they probably don't know how uncomfortable that is and would demand extra comfort, but the idea). People don't want to exercise (in general). They want to eat good tasting food. They want to drink, smoke, and do other drugs. They want whatever their religion says is good.
Because these are often in conflict they must compromise something. If you find a way to be fat while: looking good, living a long life, and being able to do the other things in life you want through life people would be happy.
Of course being fat correlates strongly with things people don't like about living a long healthy life and so we try to lose weight, but that is only a proxy.
"Okay, where is it? What are the conclusions? Is sugar actually contributing more than fat for CVD in most patients?"
Depends on the type of fat, I think. From what I have found out myself, it is trans fats > sugars / simple carbohydrates > polyunsaturated fats > complex carbohydrates > monounsaturated fats > saturated fats.
But of course, you also have to consider nature of food. In nature, you would consume either carbohydrates or fats - either plants or meat. But processed foods include a lot of fats and a lot of carbs in a single package. And that is the actual killer. Fats aren't an issue, carbs aren't that much of an issue, isssue is the nature of fats and carbs consumed, and issue is the way we consume them.
You'll find many people claiming almost the exact opposite, just as confidently. Plant fats are generally seen as much healthier, especially olive oil and similar fats. This idea that the combination of macronutrients that a food contains also seems highly suspect - generally people tend to think that macronutrients work independently of each other.
The reality is, of course, that we just don't know. Nutrition "science" is almost entirely bogus (the only real part of it is the discovery of the nature and functioning of the various vitamins, and thus the elimination of scurvy and similar diseases - plus a few other extremes). Even the existence and importance of dietary fiber in many foods was a very recent discovery (resistant starch and oligosaccharides were only identified as dietary fiber in the 2000s, for example) - meaning that even the base caloric contents of many foods were wrongly measured as late as the 2000s (and who knows what else we're missing here).
"generally people tend to think that macronutrients work independently of each other"
Well, that is obviously the wrong idea. Even basic logic speaks against it: people lose weight on keto diet, people lose weight on vegan diet... so neither protein, fat nor carbs can be causing obesity. But what do foods that we know are obesogenic have in common? 1) They are highly processed and/or 2) they combine fats and carbs into single package.
But it is true that we don't know for certain. What we do know is that this dietary experiment we have had going since 1970s at the latest has failed completely. As I tend to say: paleo diet should be the basis of any diet, and then you further adjust it based on how your body responds.
People lose weight, temporarily, on all sorts of diets, restricted or not. It is the nature of specific diets that they tend to reduce appetite, and simply following a diet tends to reduce snacking - by virtue of selection bias, mostly (that is, people who are successfully following a diet are by definition people who aren't overeating).
Very traditional diets also tended to include lots of foods that are both highly processed and contain both sugars and fats, like cheese or sweet nut cakes. Paleo diets are a modern invention, and have little in common with the concept of what our ancestors ate. They often have deeply anachronistic ideas, like favoring raw foods, when the use of fire has been a core part of our ancestors consumption since way before Homo Sapiens existed.
I haven't found any paleo dieter that promotes eating solely or even primarily raw foods. That idea seems to be more common in carnivore and vegan communities.
Traditional diets however are still diets that came after the advent of agriculture.
People lose fat on calorie restricted diet. How will you get to it, either by counting them or by improving metabolism or by changing insulin levels, is a different thing.
Vegan or keto diet can both be calorie restricted, as much as any macronutrient mixture. However, it doesn't mean its sustainable. If you are hungry all the time, you can stay on the diet for some time, but not forever. Since insulin is the primary storage hormone, reducing it will make you less fat (just look at type 1 diabetics). We now know that carbs are the highest promoters of insulin, that fat has 0 influence, and protein some. We have drugs like metformin or GLP-1 that brute force some of it and they are working.
So, we know that sugar is mostly bad and that fat and protein are not. Ofc, some fats are bad for other reasons (by promoting inflamation) but that has nothing to do with obesity.
Thing about the keto diet is that "hungry all the time" simply... doesn't happen. In fact, bigger problem for keto dieters tends to be being satiated all the time and consequently undereating.
"Hungry all the time" is actually vegan thing, but plants have so few calories and pass through so quickly that vegans end up being skinny despite eating literally all the time.
You mean leafs, not plants? Cereals, beans, fruits and some roots have plenty of calories but your true fatty friends are all sorts of seeds and nuts. You also can buy their fat extract: oil.
It is not just issue of raw calories but how much body can absorb. Fruitarians for example tend to be corpse-skinny despite fruit being full of sugar, because most of that sugar simply passes through. So effective calories are less than what sugar content would indicate.
But grains and seeds do seem to be quite obesogenic, yes.
I add the word "obesogenic" to my toolbox, love how it sounds!
I don't know Fruitarians but what you describe makes sense. However the vegans I know aren't "Hungry all the time". Some are skinny and some fatty but I wouldn't say the average are skinny, you wouldn't stare at their size if you don't know their diet. Might be a personal bias though, I don't know studies about vegans hungriness or BMI.
It is definitely not protein. I tried carnivore diet for a while (had massive issues tolerating carbs lol), and the higher my protein intake was, more hungry I felt. Reducing protein and increasing fat also increased satiety.
Turns out, it is fats that produce satiety signals, and the effect seems to be by far the strongest with saturated fats, weaker with monounsaturated fats, while polyunsaturated fats actually induce hunger as strongly or even more strongly than carbohydrates do. The idea that "protein induces satiety" is a side effect of the fact that most (though not all) protein foods tend to be quite fatty.
The big question with such foods is are they worse for you just in and of themselves, or do they tend to promote obesity through inducing people to eat more? For the most part, research seems to suggest that as far as weight gain is concerned, calorie is a calorie (whether from fat, carbs, or protein), but some foods seem to induce people to eat more in general, compared to others. (highly processed and high-sugar food seeming to be some of the worst in this regard, but it's not clear exactly what it is about highly processed food that promotes this).
From what I have gathered (through research and by using myself as a guinea pig), there are two things about highly processed food that promote overeating:
1) high carbohydrate content
2) lack of nutrients
High carbohydrate content causes sugar spikes, which leads to insulin spikes, and insulin spikes both a) cause hunger and b) promote storage of energy in the form of body fat:
https://pubmed.ncbi.nlm.nih.gov/3894001/
Second issue is as I said lack of nutrients. Your body needs nutrients, and will force you to eat until nutritional requirements had been satisfied. Since processed foods have very few nutrients, your organism compensates by increasing dietary intake... which means increasing caloric intake.
I'm skeptical that paleo diet would be healthy for long term. There are studies where they find atherosclerosis in pre-industrial hunter-gatherer remains. It's called HORUS study.
From what I've managed to find in the newest research, it apppears that diet does not appear to have any impact on atherosclerosis itself. But, as they say, more data needed.
This. The amount of faith in nutrition "science" indicates severe science illiteracy in the public.
In general there are way too many confounds, and measurement is far too poor and unreliable (self-report that is wrong in quality and quantity; you can't track enough people for the amount of time where supposed effects would manifest), there is almost zero control over what people eat (diets and available foods even considerably over a decade for whole countries, never mind within individuals), and much of the things being measured lack even face/content validity in the first place (e.g. "fat" is not a valid category, and even "saturated vs. unsaturated" is a matter of degree, and each again with different kinds in each category).
We are missing so much of the basics of what are required for a real science here I think it is far more reasonable to view almost all long-term nutritional claims as pseudoscience, unless the effect is clear and massive (e.g. consumption of large amounts of alcohol, or extremely unique / restrictive diets that have strong effects, or the rare results of natural experiments / famines), or so extremely general that it catches a sort of primary factor (too much calories is generally harmful, regardless of the source of those calories).
Maybe it'll become actual science one day, but that won't be for decades.
Oh yeah, that was another question I had. So was this the only time the sugar industry influenced things? Was there an investigation? Either there was no investigation (why) or it didn't find anything else (?)
When this came out I was expecting it to be the tip of the iceberg.
> They paid a total of 2 people $50,000 (edit: in 2016 dollars).
> That doesn't seem like enough to entirely shape worldwide discourse around nutrition and sugar.
A contradictory example where this does occur is in propaganda. Technology can be applied to maximize the reach and influence of otherwise inferior arguments at a fraction of the cost. A relatively small sequence of "shows" or "films" can disproportionately affect the world view of billions.
edit: The adoption of cigarettes across the world was affected by a significantly much smaller investment in ad placement compared to its global adoption and affects due to the reach and amplification "of technology".
> And the research was out there! Does everybody only read this single Harvard literature review? Does nobody read journals, or other meta studies, or anything? Did the researchers from other institutions whose research was criticized not make any fuss?
They did. But Ancel Keys, one of the bribed researchers, author of the infamous seven countries study that laid the groundwork against fat made it his life’s mission to discredit anyone who researched sugar. He effectively made the topic academic suicide. His primary target, that served as a warning example for others was his contemporary in the U.K. John Yudkin.
… it's $68,404 in today's dollars, according to BLS's inflation calc.
(…your figure works out to a 26% per annum inflation rate. The $50k figure is in 2016 dollars — "the sugar industry paid the Harvard scientists the equivalent of $50,000 in 2016 dollars".)
Hype or getting viral is not necessarily science so its not clear when and how and why one paper suddenly becomes very known.
We know what sugar and others do, people are probably ignorant or not but its not billions are dead directly, people struggle a little bit more, the statistics number goes up. Now talk to anyone who likes to drink and eat that stuff everyday, do you think they care? no they do not.
This is one of those where you need to be able to discern nuances in your brain as multiple things are happening.
First, identifying cause and effect of CVD is super hard, and there are lots of studies with various level of indications and in reality we're still far from understanding most of it. Even just the effects of fat and sugar on it isn't clear, and our understanding of fat itself, and all its types, and of sugars and all its types, even that's incomplete. And this makes it a perfect battle ground for grift and financial interests, because you can paint various narratives and cleverly build a case for it, since in reality so many possibilities are still on the table.
I think the conclusions that are on the stronger side are those that relate to medication and surgery. Blood pressure pills, statins, antiplatelet, coronary artery bypass, aortic valve replacement, etc.
When it comes to nutrition and other lifestyle changes, things are muddy. So instead you have "school of thoughts" and belief systems forms that often tie up with personal identity.
Second, you have financial interests meddling with research and messaging. A financial interest might want to mingle even if the research supports them, just not to take any chances. And if we found two cases of it, that's just those that were caught and proven, it's likely there's many more mingling then just that. Even if it doesn't end up proving things their way, you can assume all this mingling slows things down and makes figuring out the truth much harder and slower, which maintains the state of uncertainty for longer and that state is good for financial interests.
Lastly, it's not that we know nothing at all, and everything is just beliefs. There are a few things that have strong evidence repeatedly. We know that smoking, high blood pressure, plaque buildup, high lifetime LDL, clots, and diabetes/insulin resistance are all bad and lead to increase risks of CVD. And avoiding or lowering those, no matter how, helps reduce that risk. But it's not enough for most people that want to feel in control and believe they're living in a way that CVD won't happen to them. Which makes them vulnerable to grifters and various influencers.
I am only surprised this came out of UCSF and Robert Lustig's name is not on it, since it's often a topic in his books.
Maybe nutrition-health connection is more complex than can be shown by these early studies, and the big lobbying money only needs one study to get congressional support some putative scientific backing, the entire anti science funding arm of Congress uses one factoid about a shrimp treadmill for decades and the entire antivax movement is built on that widely discredited Wakefield paper.
https://www.reuters.com/fact-check/shrimp-treadmill-study-co...
>the entire antivax movement is built on that widely discredited Wakefield paper.
You're clearly misinformed. The antivax movement is largely a grassroots movement built on the experiences of the parents of vaccine-injured children, and people who've read the literature comparing vaccinated vs unvaccinated outcomes. E.g. the large scale unpublished study conducted by the CDC, https://www.hsgac.senate.gov/wp-content/uploads/Entered-into... , which showed vaccinated children demonstrating higher rates of developmental disorders. There's not a single large scale study conducted comparing vaccinated with unvaccinated children that shows no greater rate of developmental disorders in the vaccinated group (the above study was supposed to be that, but when the results ended up showing the opposite the CDC decided not to publish it).
Ask yourself, if you believe vaccines aren't more dangerous than any other pharmaceutical product, then why not support removing the blanket liability immunity given to vaccine makers, that no other medical product needs?
> Ask yourself, if you believe vaccines aren't more dangerous than any other pharmaceutical product, then why not support removing the blanket liability immunity given to vaccine makers, that no other medical product needs?
Because vaccines aren't all that profitable compared to other pharmaceuticals but produce disproportionate public good.
The paper couldn't make it through peer review because of methodology errors.
Specifically, the sample groups had vastly different demographics and sizes which make meaningful comparisons between them impossible due to confounding factors.
This wasn't some secret CDC plot to bury research. The CDC wasn't even involved. This was just poor research.
> That doesn't seem like enough to entirely shape worldwide discourse around nutrition and sugar.
IDK, see the "BLOTS ON A FIELD?" by Science ("A neuroscience image sleuth finds signs of fabrication in scores of Alzheimer’s articles, threatening a reigning theory of the disease") or "The 60-Year-Old Scientific Screwup That Helped COVID Kill" by Wired (regarding the anti-scientific refusal to acknowledge it as airborne) for a couple of recent examples. Once underlying assumptions stop getting questioned, I think anything is at least possible.
So the money quote seems to be:
> The literature review heavily criticized studies linking sucrose to heart disease, while ignoring limitations of studies investigating dietary fats.
They paid a total of 2 people $50,000 (edit: in 2016 dollars).
That doesn't seem like enough to entirely shape worldwide discourse around nutrition and sugar. And the research was out there! Does everybody only read this single Harvard literature review? Does nobody read journals, or other meta studies, or anything? Did the researchers from other institutions whose research was criticized not make any fuss?
I guess the thing that I most don't get is it's now been 10 years since then, and I haven't seen any news about the link between sugar and CVD.
> There is now a considerable body of evidence linking added sugars to hypertension and cardiovascular disease
Okay, where is it? What are the conclusions? Is sugar actually contributing more than fat for CVD in most patients? Edit: Or, is the truth that fat really is the most significant, and sugar plays some role but it's strictly less?