Month: November 2025

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Sugar Industry Paid to Shift Blame for Heart Disease to Fat

 

Introduction

Today I was reminded about a post that I wrote almost eight years ago (March 12, 2018), about an article that had been published in the Journal of the American Medical Association in September 2016 [1]. The article revealed that the sugar industry had funded three renowned Harvard researchers to write a series of articles that downplayed or ignored known research that demonstrated sugar was a contributor to heart disease and instead put the blame solely on fat — especially saturated fat. I was shocked by its significance,  and it made me wonder how much of what I learned in my training needed to be revisited in this light. 

The three Harvard researchers were the late Dr. Fredrick Stare, Chair of Harvard’s School of Public Health Nutrition Department, the late Dr. Robert McGandy, Assistant Professor of Nutrition at the Harvard School of Public Health, and the late Dr. D. Mark Hegsted, a Professor in the same department. 

Dr. Hegsted went on to be directly involved in the development of the 1977 US Dietary Goals, which served as the basis for the 1980 Dietary Guidelines for Americans. These were the first Guidelines that called for Americans to decrease consumption of meat and saturated fat with the belief that it would lower the risk of heart disease.

Following suit, in 1977, Canada’s Food Guide went through a major revision with a shift to increased carbohydrates in the diet and decreased fat. Following a report submitted to Health Canada in 1977 by the Committee on Diet and Cardiovascular Disease, which advised the government to take action to prevent diet-related chronic diseases such as heart disease and high blood pressure, the revised 1982 Canada’s Food Guide shifted towards even lower-fat products.

I wondered today how many people know that decades of “low fat” messaging in both the US and Canada began by the sugar industry paying three prominent Harvard researchers to blame fat as the cause of heart disease, while discounting the role of sugar. I decided it was time to write another article. 

Sugar Industry Funding Helped Shift Blame to Fat — Especially Saturated Fat

In the mid-1960s, the Sugar Research Foundation (SRF), predecessor to the Sugar Association, aimed to counter research which suggested that sugar, not fat, might be a bigger contributor to atherosclerosis. The committee invited Dr. Frederick Stare of Harvard’s School of Public Health Nutrition Department to join its scientific advisory board and approved $6,500 ($65,750–$66,850 in 2025 dollars) “to support a review article that would respond to the research showing the danger of sucrose [1]”.

From the 2016 Kearns et al. article [1]:

“On July 13, 1965, the Sugar Research Foundation (SRF)’s executive committee approved Project 226, a literature review on Carbohydrates and Cholesterol Metabolism by Hegsted and Robert McGandy, overseen by Stare.”

 

Letters were exchanged between the Sugar Research Foundation tasked the three Harvard researchers with preparing “a review article of the several papers which find some special metabolic peril in sucrose [sugar] and, in particular, fructose”[1].

In a letter written to Dr. D.M. Hegsted, the Sugar Research Foundation made its agenda clear:

“Our particular interest had to do with that part of nutrition in which there are claims that carbohydrates in the form of sucrose make an inordinate contribution to the metabolic condition, hitherto ascribed to aberrations called fat metabolism. I will be disappointed if this aspect is drowned out in a cascade of review and general interpretation.” [2]

Hegsted replied on behalf of the Harvard team, saying:

“We are well aware of your particular interest in carbohydrate and will cover this as well as we can” [1].

Project 226, sponsored by the Sugar Research Foundation, resulted in a two-part review by McGandy, Hegsted and Stare that was published in the New England Journal of Medicine in 1967 titled “Dietary Fats, Carbohydrates and Atherosclerotic Disease” [3]. There was no mention of the Sugar Research Federation sponsorship of the research [1].  

Article in JAMA - Dietary Fats, Carbohydrates and Atherosclerotic Disease - part 1 and 2
Dietary Fats, Carbohydrates and Atherosclerotic Disease

The first part of the two-part review article written by Drs. Stare, Hegsted and McGandy stated;

“Since diets low in fat and high in sugar are rarely taken, we conclude that the practical significance of differences in dietary carbohydrate is minimal in comparison to those related to dietary fat and cholesterol.” 

 

The report continued: 

”the major evidence today suggests only one avenue by which diet may affect the development and progression of atherosclerosis. This is by influencing the levels of serum lipids [fats], especially serum cholesterol.“

”…there can be no doubt that levels of serum cholesterol can be substantially modified by manipulation of the fat and cholesterol of the diet.“

”on the basis of epidemiological, experimental and clinical evidence, that a lowering of the proportion of dietary saturated fatty acids, increasing the proportion of polyunsaturated acids and reducing the level of dietary cholesterol are the dietary changes most likely to be of benefit.“

Dr. Marion Nestle, Professor of Nutrition, Food Studies and Public Health at New York University, wrote an editorial that appeared in the same issue of the Journal of the American Medical Association as Kearns’ article [1]. In it, she said that the documents provided “compelling evidence” that the sugar industry initiated Project 226 to exonerate sugar as a major risk factor for coronary heart disease [4].

Hegsted and the 1977 US Dietary Goals

Dietary Goals for the United States, Select Committee on Nutrition and Human Needs, United States Senate. Washington : U.S. Govt. Print. Off., 1977. http://hdl.handle.net/2027/uiug.30112023368936, title page
Dietary Goals for the United States, 1977

Dr. Hegsted went on to play a significant role in advising the Select Committee on Nutrition and Human Needs that oversaw the development of the 1977 Dietary Goals for the United States — and oversaw the writing of the first Dietary Guidelines for Americans that called for a reduction in saturated fat consumption to lower the risk of coronary heart disease [5], [6]. 

Below is a quote about Dr. Hegsted’s role in the Select Committee on Nutrition and Human Needs that oversaw the 1977 Dietary Goals for the United States.

“Dr. Hegsted has worked very closely and patiently with the committee staff on this report, devoting many hours to review and counselling. He feels very strongly about the need for public education in nutrition and the need to alert the public to the consequences of our dietary trends. He will discuss these trends and their connection with our most killing diseases. [5]”

There were 8 hearings of the Committee titled “Diet Related to Killer Diseases” that were held from July 1976 until October 1977 [6], which provided an opportunity for US senators to hear from leading scientists, government officials, and business representatives about the risks of diet on heart disease, cancer, and other chronic diseases.

“Of those who gave testimony at the first hearings, perhaps the two most important were assistant secretary for health and former director of the National Heart and Lung Institute, Theodore Cooper, and Professor Hegsted” [6].

Interestingly, Dr. Hegsted admitted that the primary evidence for “killer diseases” was epidemiologic, the weakest form of scientific data, and not clinical data [8]. Despite this admission, Hegsted stated that there was ”a clear linkage between plasma serum lipids, atherosclerosis and coronary disease” and that it was ”clear that diet controls cholesterol levels“[8].

Hegsted’s statement that there was “a clear linkage” between plasma fat and heart disease was based on only 8 randomized clinical trials that were available at the time, and which had only 2,467 male subjects, and no female subjects [9].

Furthermore, there was no clinical evidence that reducing total fat or saturated fat lowered death from all causes or cardiovascular disease [9].

Several researchers pleaded with the Committee to wait for more research.

The director of the National Heart, Lung and Blood Institute, Dr. Robert Levy, said “no one knew if eating less fat would prevent heart attacks“. 

Dr. Robert Olson of St. Louis University said, “I plead in my report and will plead again orally here for more research on the problem before we make announcements to the American public.” 

Dr. Peter Ahrens said, “advising Americans to eat less fat on the strength of such marginal evidence was equivalent to conducting a nutritional experiment with the American public as subjects“.

Committee Chairman Senator McGovern responded:

“Senators don’t have the luxury that the research scientist does of waiting until every last shred of evidence is in.”

 

Hegsted believed there could be “no risk” to recommending that the American public eat less meat, less fat, particularly saturated fat, and less cholesterol.[8].

Long-Term Outcomes and Modern Evidence

Hegsted relied heavily on Ancel Keys’ yet-unpublished Seven Countries Study [9], which compared men aged 40–59 in the USA, Finland, the Netherlands, Yugoslavia, Greece, and Japan.

The Seven Country Study data have been criticized for decades for several reasons, including the fact that Keys omitted countries such as Switzerland or France, which were known to have very high saturated fat consumption, yet low rates of heart disease. 

In addition, data from Greece, Italy and Yugoslavia were thought to have not been representative of what they normally ate, since these countries were still facing poverty post WWII.

Despite the limitations, a hypothesis linking saturated fat to heart disease formed the basis for 40+ years of low-fat dietary advice in the US and Canada. These recommendations were largely epidemiology-based and assumed that reducing meat and saturated fat while increasing grains and cereals carried no risk.

The results?

Heart disease remains the leading killer — not only in the US, but according to the CDC, worldwide. Decreasing dietary saturated fat did nothing to change this. In fact, a 2020 meta-analysis in the Journal of the American College of Cardiology found no benefit in lowering saturated fat for cardiovascular disease or mortality, and suggested saturated fat may be protective against stroke [7].

Meanwhile, over the past 40+ years, obesity and type 2 diabetes rates have skyrocketed, along with carbohydrate intake — both if which are known to increase the risk of cardiovascular disease. 

Final Thoughts

It is historically significant that the sugar industry’s funding of three Harvard researchers resulted in the absolving of sugar as having a role in the development of heart disease and placed the blame solely on saturated fat.

Dr. Hegsted’s subsequent influence on the 1977 US Dietary Goals and the 1980 Dietary Guidelines highlights the adverse role that industry-sponsored research can have on people’s health.

National dietary guidelines concerning saturated fat intake based on weak epidemiologic data “was equivalent to conducting a nutritional experiment with the American public as subjects“.

As a Dietitian, making recommendations to individuals to lower dietary saturated fat intake based on lab work and family history is good clinical practice.

Establishing general population based dietary guidelines to reduce the intake of saturated fat based on weak evidence is not. 

National dietary guidance must be based on robust clinical data, as well as epidemiological studies — including the impact of different types of fats in heart disease. It also needs to factor in the role of sugar and refined dietary carbohydrates as drivers of obesity and metabolic disease, which can contribute to heart disease.

To your good health. 

Joy 

 

You can follow me on:

Twitter: https://twitter.com/jyerdile

Facebook: https://www.facebook.com/BetterByDesignNutrition/

References

  1. Kearns C, Schmidt LA, Glantz SA, et al. Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA Intern Med. 2016;176(11):1680-1685. [https://pubmed.ncbi.nlm.nih.gov/27617709/]
  2. Husten L. How Sweet: Sugar Industry Made Fat the Villain. Cardio|Brief, Sept 13, 2016. [https://www.cardiobrief.org/2016/09/13/how-sweet-sugar-industry-made-fat-the-villain/]
  3. McGandy RB, Hegsted DM, Stare FJ. Dietary fats, carbohydrates and atherosclerotic vascular disease. N Engl J Med. 1967;277(5): part 1: pg. 186-192 and part 2: pg. 242–247. 
    [part 1: https://www.nejm.org/doi/10.1056/NEJM196708032770505],
    [part 2: https://www.nejm.org/doi/abs/10.1056/NEJM196707272770405]
  4. Nestle M. Food Industry Funding of Nutrition Research: The Relevance of History for Current Debates. JAMA Intern Med. 2016;176(11):1685–1686. doi:10.1001/jamainternmed.2016.5400. [https://pubmed.ncbi.nlm.nih.gov/27618496/]
  5. Dietary Goals for the United States, Select Committee on Nutrition and Human Needs, United States Senate. Washington: U.S. Govt. Print. Off., 1977. [https://www.govinfo.gov/content/pkg/CPRT-95SPRT98364O/pdf/CPRT-95SPRT98364O.pdf]
  6. Oppenheimer GM, Benrubi ID. McGovern’s Senate Select Committee on Nutrition and Human Needs versus the meat industry on the diet-heart question (1976-1977). Am J Public Health. 2014;104(1):59–69. doi:10.2105/AJPH.2013.301464. [https://pmc.ncbi.nlm.nih.gov/articles/PMC3910043/]
  7. Astrup A, Magkos F, Bier DM, et al. Saturated Fats and Health: A Reassessment and Proposal for Food-based Recommendations. J Am Coll Cardiol. 2020;75(24):3118–3135. doi:10.1016/j.jacc.2020.05.077. [https://pubmed.ncbi.nlm.nih.gov/32562735/]
  8. United States. Congress. Senate. Select Committee on Nutrition and Human Needs. (1977). Diet related to killer diseases: hearings before the Select Committee on Nutrition and Human Needs of the United States Senate, Ninety-fifth Congress, first session. Keys A. Coronary heart disease in seven countries. Nutrition. 1997;13(3):250–252; discussion 249, 253. doi:10.1016/s0899-9007(96)00410-8. [https://babel.hathitrust.org/cgi/pt?id=uc1.a0000416073&seq=3]
  9. Harcombe Z. An examination of the randomized controlled trial and epidemiological evidence for the introduction of dietary fat recommendations in 1977 and 1983: A systematic review and meta-analysis. University of the West of Scotland, 2015. [https://pubmed.ncbi.nlm.nih.gov/25685363/]
  10. Yerushalmy J, Hilleboe HE. Fat in the diet and mortality from heart disease: a methodologic note. N Y State J Med. 1957;57(14):2343–2354. [https://pubmed.ncbi.nlm.nih.gov/13441073/]

 

Copyright ©2025 BetterByDesign Nutrition Ltd.

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything you have read or heard in our content.

 

Nutrition is BetterByDesign

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The Worst Carb For Blood Sugar You’ve Probably Never Heard Of

[Update, November 17, 2025: This article was updated to include several powerful graphics from a 2025 paper about the health implications of maltodextrin as an additive in processed foods]

Introduction

A recently updated article titled Complex Carbohydrates as Long Chains of Sugar Molecules, explained that “complex carbohydrates” are really just long chains of sugar molecules, like pearls on a string, and that how quickly blood sugar rises depends on the specific types of sugars in those chains. 

Monosaccharides (made up of a single sugar molecule) are sugars such as glucose and fructose that break down very quickly and quickly impact blood glucose. 

Disaccharides (made up of two sugar molecules), such as sucrose (table sugar), are made up of glucose and fructose combined, and break down more slowly than monosaccharides like glucose and fructose. As a result, the rise in blood glucose is slightly slower than glucose. 

What if you found out that the worst carbohydrate for blood sugar is one that you’ve probably never heard of?

What if you found out that this carbohydrate is often found in sugar-free foods, but is not considered a sugar under Canadian food labeling regulations? 

That is what this article is about.

Glycemic Index (GI)

The Glycemic Index (GI) is a ranking system for carbohydrate-containing foods based on how quickly they raise blood sugar (blood glucose) levels after they are eaten.

Foods are ranked on a scale of 0 to 100, with pure glucose assigned a value of 100. 

High GI foods (ranked with a GI of 70 or more) are rapidly digested and absorbed, causing a quick and high spike in blood sugar levels.

Medium GI foods (ranked with a GI of 56-69) have a moderate effect on blood sugar levels.

Low GI foods (ranked with a GI of 55 or less) are digested and absorbed slowly, releasing glucose gradually into the bloodstream and causing a slower, smaller rise in blood sugar. 

As mentioned in the previous article, factors such as the amount of fiber in the food, as well as the amount of food processing of that food, including cooking, can affect a food’s GI value. 

The Glycemic Index of pure glucose (also called dextrose) is 100, the highest score.

The Glycemic Index of table sugar (i.e., sucrose) is rated with a GI of 65-80 (depending on the source) [4]. Sucrose is a disaccharide made of a mixture of glucose (which has a GI of 100) and fructose (which has a GI of 25). While its overall impact on blood glucose is significant, it is less than pure glucose, which is a monosaccharide, because sucrose takes longer to digest, and thus to spike blood sugar. 

The carbohydrate that you’ve probably never heard of has a Glycemic Index between 85 and 105 (depending on the source), which is higher than table sugar (sucrose) and higher than pure glucose. 

This carbohydrate is maltodextrin. 

Glycemic Index and Glycemic Load of Maltodextrin - from https://glycemic-index.net/maltodextrin/
Glycemic Index and Glycemic Load of Maltodextrin – from https://glycemic-index.net/maltodextrin/

Maltodextrin plays a functional role in food manufacturing, primarily serving as a bulking agent, thickening agent, and stabilizer. Products known to contain some of the highest maltodextrin content include sports and energy drinks.

Maltodextrin is also often found in sugar-free foods, but it is not considered a sugar under Canadian food labeling regulations; rather is classified as a “complex carbohydrate”, a polysaccharide food additive.

Note: The reliability of the Glycemic Index in predicting blood sugar responses in individuals was called into question in research conducted in 2016 and 2019, as outlined in this earlier article. However, it is still used, and for comparative purposes, it is used in this article.

What Is Maltodextrin and What Does It Do to Blood Sugar?

Maltodextrin is a refined carbohydrate made from starch — usually from corn, rice, potato, or wheat. Food manufacturers use it as a thickener, filler,  or stabilizer in a wide range of foods and drinks.

Although maltodextrin doesn’t taste very sweet, the body digests it similarly to pure glucose, so it can raise blood sugar very quickly.

Maltodextrin is created when starch is treated with enzymes to break it down into shorter chains of glucose molecules. Because it’s already partially digested, the body absorbs it quickly, giving it a Glycemic Index (GI) between 85 and 105 (depending on the source), which is significantly higher than regular table sugar (sucrose), which has a GI ≈ of 65 and can even be higher than pure glucose (dextrose). 

While maltodextrin has practical applications in the manufacturing of sports drinks or medical nutrition products where quick energy is needed, it is also found in a wide range of foods, including infant formula, protein supplements, and even sugar-free foods. 

Its presence in sugar-free foods is concerning because it can result in a very significant spike in blood sugar in those who are deliberately trying to avoid sugar.

Splenda® brand sucralose packet
Splenda® brand sucralose packet

Sucralose, used in the sugar-free sweetener Splenda®. It is made from sucrose (table sugar), where three hydroxyl groups (-OH) are replaced by chlorine. It is approximately 600 times as sweet as table sugar, so most of a packet of Splenda® is maltodextrin, used as a filler.  A 2008 research study found Splenda® to be 1.1% sucralose, 1.1 % glucose, 4.23% moisture, and >93.59% maltodextrin.

While Splenda® is “sugar-free”, the maltodextrin in it can cause blood glucose to spike significantly higher than table sugar. 

Below is a graph comparing the glucose spike from maltodextrin, glucose, and sucrose (table sugar). Table sugar (sucrose) spiked blood glucose to ~145 mg/dl (8.0 mmol/L) at 30 minutes, and maltodextrin spiked blood glucose to ~165 mg/dl (9.0 mmol/l) at 40 minutes.

Comparison sample blood glucose response to maltodextrin, glucose and sucrose (table sugar) - from [6]
Comparison sample blood glucose response to maltodextrin, glucose, and sucrose (table sugar) – from [6]

Below is a bar chart illustrating the percentage of products containing maltodextrin.

Some of the highest maltodextrins are found in sports and energy drinks (84%); however, protein supplements have the same percentage of maltodextrin (84%), and infant formula has an even higher percentage (89%).

Product Categories with the Highest Maltodextrin Inclusion - from [6] Yarley EJ, Unveiling Hidden Sugars: A Critical Analysis of Maltodextrin as a Polysaccharide Additive in Processed Foods and Its Health Implications
Product Categories with the Highest Maltodextrin Inclusion – from [6]

Maltodextrin is also present in a wide range of foods that are marketed as “healthy options”, including protein powders and meal replacement bars. As is the case with sugar-free foods containing maltodextrin, consumers rely on labels on these products to make informed dietary choices, unaware of the impact that maltodextrin can have on their blood sugar.

Top 10 Processed Foods with the Highest Maltodextrin Content in mg/serving - from [6] Yarley EJ, Unveiling Hidden Sugars: A Critical Analysis of Maltodextrin as a Polysaccharide Additive in Processed Foods and Its Health Implications
Top 10 Processed Foods with the Highest Maltodextrin Content in mg/serving [6]

Why Blood Sugar Spikes Matter

Since maltodextrin digests and absorbs rapidly, it can cause rapid spikes in blood glucose and insulin levels.

Over time, repeated spikes can lead to:

    • Energy crashes or fatigue after meals

    • Increased hunger and sugar cravings

    • Blood sugar instability in people with diabetes, PCOS, or insulin resistance

    • Possible gut microbiome disruption when consumed in large amounts 

Final Thoughts…

Maltodextrin is a common hidden carbohydrate used in processed foods.

While maltodextrin may serve a useful role in the manufacturing of specialized products for athletes or in medical nutrition products, people relying on a  “healthy” protein shake or a meal replacement bar are usually unaware of the effect it can have on their blood sugar.  How much more do those with prediabetes or diabetes (type 1 or type 2) need to know which products, including sugar-free products, contain maltodextrin?

For those needing to control their blood sugar, it is recommended to read labels closely and limit foods containing maltodextrin. Choosing whole-food carbohydrate sources in amounts that can be monitored (“carb counting”) makes controlling blood sugar possible.

To your good health. 

Joy 

 

You can follow me on:

Twitter: https://twitter.com/jyerdile 
Facebook: https://www.facebook.com/BetterByDesignNutrition/

 

 

References

    1. Brand‑Miller JC, Foster‑Powell K, Atkinson F. The International Tables of Glycemic Index and Glycemic Load Values. Am J Clin Nutr. 2002;76(1):5–56. 2008: DOI 10.2337/dc08-1239) [https://pubmed.ncbi.nlm.nih.gov/18835944/]
    2. U.S. Department of Agriculture (USDA). FoodData Central: Maltodextrin – Ingredient Profile and Energy Content. Washington, DC: USDA; Accessed 2024. URL: https://fdc.nal.usda.gov
    3. U.S. Food and Drug Administration (FDA). Code of Federal Regulations Title 21 – Maltodextrin (21 CFR 184.1444). Silver Spring, MD: FDA. URL: https://www.ecfr.gov/current/title-21/chapter-I/subchapter-B/part-184#p-184.1444
    4. Health Canada. List of Permitted Food Additives with Other Accepted Uses. Ottawa, ON: Health Canada; Updated 2023. URL: https://www.canada.ca/en/health-canada/services/food-nutrition/food-additives/permitted-use-additives.html
    5. Hofman, D. L., van Buul, V. J., & Brouns, F. J. P. H. (2015). Nutrition, Health, and Regulatory Aspects of Digestible Maltodextrins. Critical Reviews in Food Science and Nutrition, 56(12), 2091–2100. https://doi.org/10.1080/10408398.2014.940415
    6. Yarley EJ, Unveiling Hidden Sugars: A Critical Analysis of Maltodextrin as a Polysaccharide Additive in Processed Foods and Its Health Implications, International Journal of Medical Science and Clinical Invention 12(04): 7602-7621, 2025DOI:10.18535/ijmsci/v12i.04.02 https://valleyinternational.net/index.php/ijmsci
    7. Magnuson BA, Roberts A, Nestmann ER, Critical review of the current literature on the safety of sucralose, Food and Chemical Toxicology,
      Volume 106, Part A, 2017, Pages 324-355, https://doi.org/10.1016/j.fct.2017.05.047.
    8. Abou-Donia MB, El-Masry EM, Abdel-Rahman AA, McLendon RE, Schiffman SS. Splenda alters gut microflora and increases intestinal p-glycoprotein and cytochrome p-450 in male rats. J Toxicol Environ Health A. 2008;71(21):1415-29. [http://www.ncbi.nlm.nih.gov/pubmed/18800291]

 

Copyright ©2025 BetterByDesign Nutrition Ltd.

LEGAL NOTICE: The contents of this blog, including text, images, and cited statistics, as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis, and/or treatment, and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything you have read or heard in our content.

 

Nutrition is BetterByDesign