Chapter 2

The Sugar Papers

Abstract

The Sugar Research Foundation (SRF) approved a literature review on carbohydrates and cholesterol in July 1965, paid its two Harvard authors $6,500, and was not named when the review appeared in the New England Journal of Medicine in 1967. Kearns, Schmidt and Glantz document this from the SRF’s correspondence and state that there is no direct evidence the industry wrote or changed the manuscript. The same Harvard author, D. Mark Hegsted, was consultant to the 1977 Senate Dietary Goals, which recommended cutting sugar and drew a written objection from the SRF’s successor. The record also holds a 2015 paper on tooth decay, a 2003 episode over a WHO report, documented in news accounts, and Coca-Cola’s 2015 funding of a research network. Studies of funding and conclusions in nutrition research find favorable results more often under industry sponsorship, with a wide range of estimates, one of them not statistically significant. The evidence on saturated fat has authors and data outside the SRF, and none of the cited sources reports a finding that sugar or any other single ingredient causes a disease.

2.1 Project 226, 1965

Finding AGR-2.1Peer-reviewed

On 13 July 1965 the Sugar Research Foundation’s executive committee approved Project 226, a literature review of carbohydrates and cholesterol metabolism, and the foundation paid the Harvard authors D. Mark Hegsted and Robert McGandy $6,500 for it.

Evidence: Exhibit 584

§2.1.1

Kearns, Schmidt and Glantz published their analysis in JAMA Internal Medicine on 12 September 2016. They read 319 documents from the Roger Adams papers at the University of Illinois and 27 documents from the D. Mark Hegsted papers at the Harvard Medical Library. The documents concern the Sugar Research Foundation (SRF), founded in 1943 and succeeded in 1968 by the International Sugar Research Foundation (ISRF). The source is the NIH author manuscript (PMC5099084).

§2.1.2

The authors trace the SRF’s interest in heart-disease research through its own records. In 1954 its president, Henry Hass, gave a speech identifying a lower-fat diet as a way to raise sugar’s share of the market. In November 1962 its Scientific Advisory Board resolved to watch research on coronary heart disease. In December 1964 research director John Hickson told an SRF subcommittee about work by John Yudkin and others “of greater or lesser repute” and proposed a major program. On 11 July 1965 the New York Herald Tribune reported Annals of Internal Medicine papers linking sucrose to coronary heart disease. The executive committee approved Project 226 two days later.

§2.1.3

Project 226 was a review by Hegsted and Robert McGandy, working under Fredrick Stare, chair of the Department of Nutrition at the Harvard School of Public Health. The SRF first offered $500 to Hegsted and $1,000 to McGandy. It paid them $6,500 in total, which the authors convert to $48,900 in 2016 dollars.

Exhibit 584 · Research article

Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents

There is no direct evidence that the sugar industry wrote or changed the NEJM review manuscript; the evidence that the industry shaped the review’s conclusions is circumstantial.

Historical analysis of Sugar Research Foundation correspondence (319 documents from the Roger Adams papers, University of Illinois; 27 documents from the D. Mark Hegsted papers, Harvard Medical Library). Reports that the SRF's executive committee approved Project 226 on 13 July 1965, offered $500 to Hegsted and $1,000 to McGandy, and eventually paid $6,500 ($48,900 in 2016 dollars); that the resulting two-part review in the New England Journal of Medicine (1967) disclosed other funding of the authors but not the SRF's funding or participation; and that Hickson (SRF) told Hegsted on 30 July 1965 he would be disappointed if the sucrose aspect were 'drowned out' and on 2 November 1966 that the draft was 'quite what we had in mind'. States limitations: one trade association's papers, no interviews, no direct evidence of authorship or edits. An erratum is listed at JAMA Intern Med 2016;176(11):1729.

Source: Kearns CE, Schmidt LA, Glantz SA; JAMA Internal Medicine 176(11):1680-1685
Date: 12 September 2016 (online); 1 November 2016 (print)
Quoted from: Discussion, 'Study Limitations' (NIH author manuscript, PMC5099084)
Grade: Peer-reviewed
Document: https://doi.org/10.1001/jamainternmed.2016.5394
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

2.2 The 1967 review and its disclosure

Finding AGR-2.2Peer-reviewed

According to Kearns et al. (2016), the 1967 New England Journal of Medicine review by McGandy, Hegsted and Stare disclosed other funding of the authors' experimental research and did not mention the Sugar Research Foundation's funding or participation.

According to Kearns et al., the 1967 New England Journal of Medicine review by McGandy, Hegsted and Stare disclosed other funding of the authors’ experimental research and did not disclose the Sugar Research Foundation’s funding or participation.

Evidence: Exhibit 584, Exhibit 585, Exhibit 586

Mechanism: The filtered record

§2.2.1

The review appeared in two parts in the New England Journal of Medicine (277:186-192 on 27 July 1967 and 277:242-247 on 3 August 1967). Kearns et al. report that it disclosed other industry and nonindustry funding of the authors’ experimental research and did not mention the SRF.

§2.2.2

The authors note that the journal has required conflict-of-interest disclosure since 1984. They also state that the review overstated the consistency of the evidence from trials of fat interventions.

Exhibit 585 · Research article

Dietary fats, carbohydrates and atherosclerotic vascular disease (Part 1)

First part of the two-part literature review that Project 226 produced (N Engl J Med 277(4):186-192; PubMed 5339697). Kearns et al. (2016) describe its funding disclosure.

Source: McGandy RB, Hegsted DM, Stare FJ; New England Journal of Medicine 277(4):186-192
Date: 27 July 1967
Grade: Peer-reviewed
Document: https://doi.org/10.1056/NEJM196707272770405
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

Exhibit 586 · Research article

Dietary fats, carbohydrates and atherosclerotic vascular disease (Part 2)

Concluding part of the review (N Engl J Med 277(5):242-247). Kearns et al. (2016) quote its statement (p. 246) that there was 'no doubt' the only dietary intervention required to prevent coronary heart disease was reducing dietary cholesterol and substituting polyunsaturated for saturated fat.

Source: McGandy RB, Hegsted DM, Stare FJ; New England Journal of Medicine 277(5):242-247
Date: 3 August 1967
Grade: Peer-reviewed
Document: https://doi.org/10.1056/NEJM196708032770505
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

2.3 What the sponsor wrote

Finding AGR-2.3Peer-reviewed

The Sugar Research Foundation’s research director, John Hickson, told Hegsted on 30 July 1965 that he would be disappointed if the sucrose aspect were “drowned out in a cascade of review and general interpretation,” and on 2 November 1966 that the draft was “quite what we had in mind.”

Evidence: Exhibit 584

Mechanism: The filtered record

§2.3.1

The authors quote Hickson’s letter of 30 July 1965 and his letter of 2 November 1966, both to Hegsted. The quotations are as Kearns et al. give them. The first letter was written 17 days after the executive committee approved the project. The second concerns the draft that became the 1967 review.

§2.3.2

Kearns et al. also quote Hegsted in April 1966: “Every time the Iowa group publishes a paper we have to rework a section in rebuttal.” Rich, who defends the review’s authors (section 2.4), quotes another Hegsted sentence to the SRF, “We are well aware of your particular interest in carbohydrate,” and calls it “bland.” Her article describes the correspondence as “relatively innocuous.”

§2.3.3

The 27 Hegsted documents are his own correspondence. Rich states that the record contains no correspondence between McGandy or Stare and the SRF. Kearns et al. write: “It is not clear whether the SRF commented on or edited drafts of the review.”

Exhibit 607 · Opinion

Sugar review: Rewriting history to expose a non-existent conspiracy

Dr Kearns presents no evidence that McGandy, Stare and Hegsted did anything dishonest.

Opinion piece by the chief executive of an industry association whose members include grocery suppliers and one sugar refinery (her own disclosure in the piece). Argues that the SRF correspondence was 'relatively innocuous', that a single literature review could not have derailed the debate, that McGandy and Stare had no correspondence with the SRF, and that Keys and the American Heart Association dominated the field. Quotes Walter Willett on Hegsted.

Source: Katherine Rich, FoodNavigator
Date: 19 September 2016
Quoted from: Section beginning 'Communications from the academics to the foundation's research director'
Grade: Reported
Document: https://www.foodnavigator.com/Article/2016/09/19/Sugar-review-Rewriting-history-to-expose-a-non-existent-conspiracy/
Accessed: 2026-11-09
Cited by: Findings citing this exhibit
Note: Reported opinion. The strongest rebuttal found; no peer-reviewed rebuttal by 'Erickson et al. 2017' was located. Willett quote (second hand): 'I very much doubt that he changed what he believed or would conclude based on industry funding.'

2.4 What the authors state they did not find

Finding AGR-2.4Peer-reviewed

Kearns, Schmidt and Glantz state that there is no direct evidence that the sugar industry wrote or changed the manuscript of the 1967 review and that the evidence the industry shaped its conclusions is circumstantial.

Evidence: Exhibit 584, Exhibit 607

§2.4.1

The authors list their other limits. They had one trade association’s papers, which may not be representative. They conducted no interviews because key actors had died. They did not analyze the role of other organizations that advocated saturated fat as the main dietary cause of heart disease.

§2.4.2

Rich, who states that she runs an industry association with a sugar-refinery member, wrote in FoodNavigator on 19 September 2016 that “Dr Kearns presents no evidence that McGandy, Stare and Hegsted did anything dishonest.” She argues that a single literature review could not have decided the debate between Ancel Keys and Yudkin. Her article is an opinion piece and is graded reported.

§2.4.3

Rich also quotes Walter Willett as saying Hegsted “was a very hard-nosed, data-driven person ... I very much doubt that he changed what he believed or would conclude based on industry funding.” Glantz told STAT that the reviews “helped shift the emphasis of the discussion away from sugar onto fat.” The statement is his own account and is not a finding of the paper.

2.5 The Sugar Association’s 2016 response

Finding AGR-2.5Reported

In September 2016 the Sugar Association acknowledged that the Sugar Research Foundation “should have exercised greater transparency in all of its research activities” and said funding-disclosure standards were not then the norm they are today.

Evidence: Exhibit 587, Exhibit 588

§2.5.1

STAT and NPR quote the Sugar Association’s statement of 12 September 2016. It adds that “when the studies in question were published funding disclosures and transparency standards were not the norm they are today,” and that it is “challenging for us to comment on events that allegedly occurred 60 years ago, and on documents we have never seen.” It also states: “Sugar does not have a unique role in heart disease.” It objected to “headline-baiting articles to trump quality scientific research.”

§2.5.2

The wording above is as quoted by STAT and NPR.

Exhibit 587 · Journalism

Sugar industry secretly paid for favorable Harvard research

We acknowledge that the Sugar Research Foundation should have exercised greater transparency in all of its research activities

Reports the Kearns paper and the Sugar Association's statement in response, which acknowledged that the SRF 'should have exercised greater transparency' and said it was 'challenging for us to comment on events that allegedly occurred 60 years ago, and on documents we have never seen'. Also quotes Glantz that the reviews 'helped shift the emphasis of the discussion away from sugar onto fat' and Nestle calling the findings a 'smoking gun'.

Source: STAT (Melissa Bailey)
Date: 12 September 2016
Quoted from: Paragraph quoting the trade group (statement of 12 September 2016)
Grade: Reported
Document: https://www.statnews.com/2016/09/12/sugar-industry-harvard-research/
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

Exhibit 588 · Journalism

50 Years Ago, Sugar Industry Quietly Paid Scientists To Point Blame At Fat

when the studies in question were published funding disclosures and transparency standards were not the norm they are today

Carries a longer version of the Sugar Association statement, including that when the studies in question were published, funding disclosures and transparency standards were not the norm they are today.

Source: NPR The Two-Way
Date: 13 September 2016
Quoted from: Section headed 'Sugar lobby: Transparency standards were not the norm'
Grade: Reported
Document: https://www.npr.org/sections/thetwo-way/2016/09/13/493739074/50-years-ago-sugar-industry-quietly-paid-scientists-to-point-blame-at-fat
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

2.6 Dietary Goals, 1977

Finding AGR-2.6Primary record

In the first edition of Dietary Goals (February 1977), prepared with D. Mark Hegsted as a consultant, the Senate Select Committee on Nutrition and Human Needs recommended cutting sugar consumption by about 40 percent to about 15 percent of energy. The second edition (late 1977) kept a sugar goal and set it at refined and processed sugars, down about 45 percent to about 10 percent of energy.

Evidence: Exhibit 589, Exhibit 590, Exhibit 534

§2.6.1

Sections 2.6 and 2.7 own the sugar goal and the industry brief; section 4.2 of Chapter 4 owns the rest of the Dietary Goals record, including the Select Committee’s hearings and the second edition’s other changes. Hegsted, who had received the SRF payment, served as a consultant to the Select Committee on Nutrition and Human Needs, chaired by George McGovern. The first edition thanks him for working “very closely and patiently” with its staff. The print records no statement by Hegsted on the SRF payment.

The sugar goal in the two editions of Dietary Goals for the United States, 1977
Edition	Goal as printed	Location
First (February 1977)	“Reduce sugar consumption by about 40 percent to account for about 15 percent of total energy intake.”	Goal 5, p. 12; explanation p. 43
Second (late 1977)	“Reduce the consumption of refined and processed sugars by about 45 percent to account for about 10 percent of total energy intake.”	Goal 3; change explained at pp. xxxv-xxxvi

§2.6.2

Hegsted’s statement at the 14 January 1977 press conference calls the diet of Americans rich in “meat, other sources of saturated fat and cholesterol, and in sugar” and describes the diseases involved as having “a complex etiology.” It lists sugar among the foods to eat less of: “less meat, less fat, less saturated fat, less cholesterol, less sugar, less salt.”

§2.6.3

The second edition divides the 24 percent of calories from sugars into 6 percent occurring naturally and 18 percent refined and processed. It explains the revised goal as a clarification after the Committee reviewed “responses pertaining to the sugar recommendation.” The changes the same print made on meat and eggs are in section 4.2 of Chapter 4.

Exhibit 589 · Committee print

Dietary Goals for the United States (first edition, Committee Print)

5. Reduce sugar consumption by about 40 percent to account for about 15 percent of total energy intake.

First edition of the Select Committee's Dietary Goals (chair: George McGovern). Lists six goals, the fifth being a reduction in sugar consumption. Contains the statements of Hegsted, Winikoff and Lee from the 14 January 1977 press conference; Hegsted is thanked in the text for working 'very closely and patiently' with the staff.

Source: U.S. Senate Select Committee on Nutrition and Human Needs
Date: February 1977
Quoted from: U.S. Dietary Goals, item 5, p. 12 (explanation at p. 43)
Grade: Primary record
Document: https://archive.org/details/CAT10527234
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

Exhibit 590 · Congressional statement

Statement of Dr. D. M. Hegsted, Professor of Nutrition, Harvard School of Public Health (press conference, 14 January 1977)

The question to be asked, therefore, is not why should we change our diet but why not?

Hegsted's published statement on the diet of Americans, rich in 'meat, other sources of saturated fat and cholesterol, and in sugar'. Describes the diseases as having 'a complex etiology'. Contains the 'why not' passage on changing the diet, listing less saturated fat, less cholesterol and less sugar.

Source: D. Mark Hegsted, in Dietary Goals for the United States (first edition)
Date: 14 January 1977
Quoted from: Statement of Dr. D. M. Hegsted, p. 3
Grade: Primary record
Document: https://archive.org/details/CAT10527234
Accessed: 2026-11-09
Cited by: Findings citing this exhibit
Note: Same physical document as senate-1977-dietary-goals-first-edition; registered separately because it is Hegsted's own statement.

Exhibit 534 · Committee print

Dietary Goals for the United States, Second Edition (committee print)

decrease consumption of animal fat, and choose meats, poultry and fish which will reduce saturated fat intake.

Staff print, 95th Cong., 1st sess., Stock No. 052-070-04376-8. Records that meat and egg producers requested additional hearings (24 March and 26 July 1977) and that the National Live Stock and Meat Board submitted 24 experts (p. xxx). Replaces the first edition's 'decrease consumption of meat and increase consumption of poultry and fish' with the animal-fat wording (p. xl). Keeps a 300 mg cholesterol goal but suggests 'easing the cholesterol recommendation in order to increase egg consumption' for young children, pre-menopausal women and the elderly (p. xxxix; Suggestion 6). Supplemental forewords: Percy, Schweiker and Zorinsky list reservations about the cholesterol goal and the evidence (pp. vii-ix); Dole writes 'I am pleased that the second edition deletes language from the first edition recommending "eat less meat"' (p. xi). McGovern signs the Foreword as chairman (p. v).

Source: U.S. Senate Select Committee on Nutrition and Human Needs
Date: December 1977
Quoted from: Food Selection Suggestion No. 3, p. xl (replacing the first edition's "decrease consumption of meat and increase consumption of poultry and fish")
Grade: Primary record
Document: https://archive.org/details/CAT79715358
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

2.7 The industry brief to the Select Committee

Finding AGR-2.7Primary record

In 1977 the International Sugar Research Foundation, successor to the Sugar Research Foundation, submitted a brief to the Select Committee stating that the first edition of Dietary Goals was “misleading” and “not based on scientific evidence.”

Evidence: Exhibit 591

Mechanism: Lobbying and purchased policy

§2.7.1

The brief fills pages 685 to 696 of the Supplemental Views, a Select Committee print of November 1977. It states that the ISRF was incorporated in 1968 as successor to the SRF (founded 1943), has members in nine countries and spends about $100,000 a year on research. Its general paragraph states that the first edition “is misleading and will compound the confusion it intends to dispel.” The brief also states that the report did not reflect the hearing testimony and was “not based on scientific evidence.”

§2.7.2

The submitter is the ISRF. No Sugar Association document appears in the Supplemental Views. The Committee issued its second edition after reviewing responses on sugar, and the edition kept a sugar cut.

§2.7.3

Sections 2.1 to 2.7 therefore document two things from the same organization’s records. In the 1960s the SRF commissioned and paid for a literature review. In 1977 its successor objected in writing to a Senate print that recommended a sugar cut, whose consultant had been a paid author of that review. The diet-heart literature has other authors and other data (section 2.14), and none of these documents shows the sugar industry shaping it or the Dietary Goals.

Exhibit 591 · Industry submission printed in a Senate committee print

Sucrose and Health: A Brief Submitted by the International Sugar Research Foundation to the Select Committee on Nutrition and Human Needs

"The Report" is misleading and will compound the confusion it intends to dispel

Industry brief, pp. 685-696 of the Supplemental Views (committee print, November 1977), objecting to the sucrose portions of the first edition. States that the ISRF was incorporated in 1968 as successor to the Sugar Research Foundation (founded 1943), with members in nine countries, and that it spends about $100,000 a year on research.

Source: International Sugar Research Foundation, in Dietary Goals for the United States: Supplemental Views
Date: 1977
Quoted from: 'General' paragraph, brief p. 685
Grade: Primary record
Document: https://archive.org/details/CAT78698154
Accessed: 2026-11-09
Cited by: Findings citing this exhibit
Note: The submitter is the ISRF, not the Sugar Association.

2.8 The National Caries Program

Finding AGR-2.8Peer-reviewed

Kearns, Glantz and Schmidt reported in 2015 that 78 percent of the sugar industry’s submission was incorporated into the National Institute of Dental Research’s call for research applications for the National Caries Program, a program on tooth decay.

Evidence: Exhibit 596

Mechanism: Lobbying and purchased policy

§2.8.1

This is the 2015 paper in PLoS Medicine, published 10 March 2015. It concerns tooth decay and does not concern heart disease. The authors analyzed cane and beet sugar industry documents from 1959 to 1971. The National Institute of Dental Research (NIDR) launched the National Caries Program in 1971.

§2.8.2

The authors state that they had one source of industry documents and conducted no interviews.

Exhibit 596 · Research article

Sugar industry influence on the scientific agenda of the National Institute of Dental Research's 1971 National Caries Program: a historical analysis of internal documents

Seventy-eight percent of the sugar industry submission was incorporated into the NIDR's call for research applications.

Historical analysis of cane and beet sugar industry documents, 1959-1971, on the NIDR's National Caries Program. This is the 2015 PLoS Medicine paper; it concerns tooth decay, not coronary heart disease.

Source: Kearns CE, Glantz SA, Schmidt LA; PLoS Medicine 12(3):e1001798
Date: 10 March 2015
Quoted from: Abstract, Methods and Findings
Grade: Peer-reviewed
Document: https://doi.org/10.1371/journal.pmed.1001798
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

2.9 The WHO report, 2003

Finding AGR-2.9Reported

The 2003 WHO/FAO report on diet and chronic disease set a population goal of under 10 percent of energy from free sugars and described that goal as controversial. In March and April 2003, according to AP, CSPI and the Guardian, the Sugar Association's president wrote to WHO that the association would ask Congress to challenge U.S. funding, a food-industry coalition asked HHS Secretary Tommy Thompson to intervene on 20 March, and Senators Larry Craig (R-ID) and John Breaux (D-LA) made a further request to Thompson on 28 March. AP also reports that the senators wrote Agriculture Secretary Ann Veneman.

The 2003 WHO/FAO report on diet and chronic disease set a population goal of under 10 percent of energy from free sugars and described that goal as controversial. In March and April 2003, according to AP, CSPI and the Guardian, the Sugar Association’s president wrote to WHO that the association would ask Congress to challenge U.S. funding, a food-industry coalition asked HHS Secretary Tommy Thompson to intervene, and Senators Larry Craig (R-ID) and John Breaux (D-LA) wrote to two cabinet secretaries.

Evidence: Exhibit 592, Exhibit 593, Exhibit 594, Exhibit 595

Mechanism: Lobbying and purchased policy

§2.9.1

The WHO/FAO expert consultation met in Geneva from 28 January to 1 February 2002, and the report was published in 2003 as Technical Report Series 916. Table 6 sets the free-sugars goal. The text states that “a population goal for free sugars of less than 10% of total energy is controversial” and defends it by pointing to limitations in studies that found no effect on weight.

§2.9.2

AP and CSPI report that Sugar Association president Andrew Briscoe wrote to WHO about the report, and CSPI states that the association said it would ask Congress to challenge future funding, giving the U.S. contribution as $406 million. CSPI states that the association’s letter attached one from two senators. The Guardian’s reported account is that the association and six other food-industry groups asked the HHS Secretary to use his influence to get the report withdrawn.

§2.9.3

AP reports that Thompson was asked to intervene in two requests, one on 20 March 2003 from a coalition of food-industry groups and another on 28 March from Senators Breaux and Craig, co-chairs of the Senate Sweetener Caucus. AP also reports that the senators wrote Agriculture Secretary Ann Veneman. Breaux is a Democrat and Craig a Republican. The Sugar Association told AP: “There are 192 members of the World Health Organization - 165 of those produce sugar.”

§2.9.4

AP reported on 23 April 2003 that Thompson had not responded and that an HHS spokesman said the department was reviewing the report and had not yet concluded whether the sugar standards were appropriate. USDA had no response to the senators’ letter. AP’s article of 23 April 2003 covers the report’s launch. None of the cited sources reports a change to the report’s text or to U.S. funding.

§2.9.5

None of the letters is online. CSPI’s release offers copies. BMJ 328:185 describes a leaked January 2004 HHS letter to WHO.

Exhibit 592 · International report

Diet, Nutrition and the Prevention of Chronic Diseases (WHO Technical Report Series 916)

The Consultation recognized that a population goal for free sugars of less than 10% of total energy is controversial.

Joint expert consultation report (Geneva, 28 January-1 February 2002; published 2003). Table 6 sets a population goal for free sugars of under 10 percent of total energy. The text on free sugars says the goal is controversial and defends it by citing limits in studies that found no effect on weight.

Source: World Health Organization and Food and Agriculture Organization of the United Nations
Date: 2003
Quoted from: Chapter 5, 'Free sugars', p. 56 (Table 6, p. 55)
Grade: Primary record
Document: https://www.who.int/publications/i/item/924120916X
Accessed: 2026-11-09
Cited by: Findings citing this exhibit
Note: Page numbers taken from the PDF text layer; confirm against the printed edition.

Exhibit 593 · Journalism

Sugar Lobbyists Sour On Study

One request was March 20 from a coalition of food industry groups, another March 28 from two U.S. senators, John Breaux, D-La., Larry Craig, R-Idaho.

Reports that Sugar Association president Andrew Briscoe wrote the WHO director general attacking the report; that HHS Secretary Tommy Thompson was asked to intervene, in one request on 20 March 2003 from a coalition of food industry groups and another on 28 March from Senators John Breaux (D-LA) and Larry Craig (R-ID), co-chairs of the Senate Sweetener Caucus; that the senators also wrote Agriculture Secretary Ann Veneman; and that Thompson did not respond before the 23 April release.

Source: Associated Press, via CBS News
Date: 23 April 2003
Quoted from: AP via CBS News, 23 Apr. 2003, paragraph beginning 'Many governments, including the United States'
Grade: Reported
Document: https://www.cbsnews.com/news/sugar-lobbyists-sour-on-study
Accessed: 2026-11-09
Cited by: Findings citing this exhibit
Note: CBS News hosts the AP wire text, not AP's own site. The Briscoe letter, the coalition letter and the Craig-Breaux letter are not online.

Exhibit 594 · Press release

Big sugar's "thuggish" tactics come under fire

Sugar Association president Andrew C. Briscoe III wrote that the association would ask “Congressional appropriators to challenge future funding of the U.S.’s $406 million contributions” to the WHO.

Advocacy-group release that quotes the Sugar Association's letter to WHO Director-General Brundtland: the association would ask Congress to challenge future funding of the U.S. contribution of $406 million, and attached a letter from Senators Larry Craig (R-ID) and John Breaux (D-LA) to two cabinet secretaries. Says copies of the letters were available from CSPI.

Source: Center for Science in the Public Interest
Date: 21 April 2003
Quoted from: CSPI press release, updated 21 Apr. 2003, paragraph 3
Grade: Reported
Document: https://www.cspinet.org/new/200304211.html
Accessed: 2026-11-09
Cited by: Findings citing this exhibit
Note: Reported, advocacy source. Ask CSPI for the letters (contact named in the release) to replace this exhibit.

Exhibit 595 · Journalism (reprint)

Political context of the World Health Organization: sugar industry threatens to scupper the WHO

Abstract (read): the Sugar Association demanded that Congress end funding of the WHO unless the guidelines were withdrawn, and the association and six other food industry groups asked the HHS Secretary to use his influence to get the report withdrawn.

Source: Sarah Boseley (reprint of Guardian report of 21 April 2003), International Journal of Health Services 33(4):831-833
Date: 2003
Grade: Reported
Document: https://doi.org/10.2190/U0MW-WM82-N5BH-E20C
Accessed: 2026-11-09
Cited by: Findings citing this exhibit
Note: Reported; abstract only.

2.10 Coca-Cola and the Global Energy Balance Network

Finding AGR-2.10Reported

The New York Times reported in August 2015 that two universities disclosed a $1.5 million Coca-Cola donation to start the Global Energy Balance Network; the University of Colorado School of Medicine returned its $1 million gift in November 2015, and the network announced on 30 November 2015 that it was discontinuing operations.

Evidence: Exhibit 597, Exhibit 598, Exhibit 599

Mechanism: Managing the narrative

§2.10.1

The New York Times reported on 9 August 2015 that the website gebn.org was registered to Coca-Cola headquarters and that Coke had given close to $4 million since 2008 to two of the network’s founders. Coca-Cola told the Times that it matters to the company that the researchers it works with “share their own views and scientific findings, regardless of the outcome, and are transparent and open about our funding.” Network president James Hill said: “They’re not running the show ... We’re running the show.” He said Coke registered the site because members did not know how.

§2.10.2

The Times’s $1.5 million figure covers two universities. The $1 million gift went to the University of Colorado. In November 2015 the Colorado School of Medicine returned its gift, saying that “the funding source has distracted attention from its worthwhile goal.” Coca-Cola said it would give the sum to the Boys and Girls Clubs of America. Food Dive reports that the American Academy of Pediatrics and the Academy of Nutrition and Dietetics ended their relationships with Coca-Cola after the company’s disclosure.

§2.10.3

The network posted on 30 November 2015 that it was “discontinuing operations due to resource limitations.” AP reported emails showing that Coke helped select the group’s leaders, edited its mission statement and suggested website content. Coke accepted the retirement of Rhona Applebaum, its chief health and science officer. Hill and Steven Blair, the network’s vice president, did not respond to AP.

§2.10.4

The exhibits are news reports.

Exhibit 597 · Journalism

Coca-Cola Funds Scientists Who Shift Blame for Obesity Away From Bad Diets

two universities that employ leaders of the Global Energy Balance Network disclosed that Coke had donated $1.5 million last year to start the organization

Reports that Coca-Cola provided financial and logistical support to the Global Energy Balance Network; that two universities disclosed, under open-records laws, a Coke donation of $1.5 million to start it; that Coke had given close to $4 million since 2008 to two of its founders; that gebn.org was registered to Coca-Cola headquarters; and Hill's statement that 'They're not running the show. We're running the show.' Includes Coca-Cola's statement on researcher independence.

Source: The New York Times (Anahad O'Connor)
Date: 9 August 2015
Quoted from: Paragraph beginning 'Coke has made a substantial investment in the new nonprofit' (read in the Dallas Morning News syndicated copy)
Grade: Reported
Document: https://well.blogs.nytimes.com/2015/08/09/coca-cola-funds-scientists-who-shift-blame-for-obesity-away-from-bad-diets/
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

Exhibit 598 · Journalism

University giving back $1M grant to Coca-Cola

the funding source has distracted attention from its worthwhile goal

Reports that the University of Colorado School of Medicine returned the $1 million Coca-Cola gift that funded the Global Energy Balance Network, that Coca-Cola said it would give the sum to the Boys & Girls Clubs of America, and that the American Academy of Pediatrics and the Academy of Nutrition and Dietetics, which had accepted $3 million and $1.7 million from Coca-Cola since 2010, ended their relationships after Coca-Cola's disclosure.

Source: Food Dive
Date: 9 November 2015
Quoted from: Statement of the University of Colorado School of Medicine, as quoted
Grade: Reported
Document: https://www.fooddive.com/news/return-to-sender-university-giving-back-1m-grant-to-coca-cola/408831/
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

Exhibit 599 · Journalism

Anti-obesity group funded by Coke disbanding

discontinuing operations due to resource limitations.

Reports that the Global Energy Balance Network said on its website on Monday night (30 November 2015) that it was discontinuing operations; that AP had reported emails showing Coke helped select the group's leaders, edited its mission statement and suggested website content; that Coke accepted the retirement of Rhona Applebaum, its chief health and science officer; and that Hill and Blair did not respond to requests for comment.

Source: CBS News / Associated Press
Date: 1 December 2015
Quoted from: Second paragraph (statement posted by the network, 30 November 2015)
Grade: Reported
Document: https://www.cbsnews.com/amp/news/anti-obesity-group-funded-by-coke-global-energy-balance-network-disbanding
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

2.11 The Coca-Cola emails

Finding AGR-2.11Peer-reviewed

A peer-reviewed analysis of 18,036 pages of Coca-Cola emails with university researchers concluded that Coca-Cola sought to obscure its relationship with the researchers, minimize the public perception of its role and use the researchers to promote industry-friendly messaging.

Evidence: Exhibit 600

Mechanism: Managing the narrative

§2.11.1

Serodio and colleagues published the analysis in Public Health Nutrition on 3 August 2020. The emails were exchanged with academics at West Virginia University and the University of Colorado, and U.S. Right to Know obtained them through state open-records requests in 2015 and 2016. One co-author, Ruskin, works for that group.

§2.11.2

The authors coded the emails against a set of political-influence strategies. The abstract’s conclusion concerns Coca-Cola’s conduct toward the researchers.

Exhibit 600 · Research article

Evaluating Coca-Cola's attempts to influence public health 'in their own words': analysis of Coca-Cola emails with public health academics leading the Global Energy Balance Network

Coca-Cola sought to obscure its relationship with researchers, minimise the public perception of its role and use these researchers to promote industry-friendly messaging.

Thematic content analysis of 18,036 pages of Coca-Cola emails with academics at West Virginia University and the University of Colorado, obtained through state open-records requests by U.S. Right to Know in 2015-2016. Co-author Ruskin works for the group that obtained the emails.

Source: Serodio P, Ruskin G, McKee M, Stuckler D; Public Health Nutrition 23(14):2647-2653
Date: 3 August 2020 (online)
Quoted from: Abstract, Conclusions
Grade: Peer-reviewed
Document: https://doi.org/10.1017/S1368980020002098
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

2.12 Funding source and conclusions

Finding AGR-2.12Peer-reviewed

Three analyses of nutrition research compared funding source with conclusions and found industry-sponsored work more often favorable to industry. A meta-analysis of 12 reports found a risk ratio of 1.31 that the authors call not significant. An analysis of 17 reviews of sugar-sweetened beverages and weight gain found a risk ratio of 5.0 for reviews with a disclosed industry conflict. A study of 206 articles on soft drinks, juice and milk found that 0 percent of all-industry-funded interventional studies had unfavorable conclusions against 37 percent of studies with no industry funding.

Three analyses of nutrition research compared funding source with conclusions and found industry-sponsored work more often favorable to industry, with estimates from a relative risk of 1.31 (not significant, 12 reports) to 5.0 (17 reviews of sugar-sweetened beverages and weight gain).

Evidence: Exhibit 601, Exhibit 602, Exhibit 603

Mechanism: The filtered record

Studies comparing funding source with conclusions in nutrition research
Study	Material	Result	Stated limits
Lesser et al., PLoS Medicine, 2007	206 articles on soft drinks, juice and milk	Odds of a favorable conclusion 7.61 times higher for all-industry-funded than non-industry-funded interventional studies (95% CI 1.27-45.73)	Wide confidence interval
Bes-Rastrollo et al., PLoS Medicine, 2013	17 systematic reviews of sugar-sweetened beverages and weight gain	Reviews with a food-industry conflict were five times more likely to conclude there was no positive association (RR 5.0, 95% CI 1.3-19.3)	Six conflicted reviews; publication bias not excluded
Chartres et al., JAMA Internal Medicine, 2016	12 reports on nutrition studies	Industry-sponsored studies more likely to reach favorable conclusions (RR 1.31, 95% CI 0.99-1.72); the authors call the difference not significant	Findings “suggest but do not establish” an association

§2.12.1

The three studies cover different material and measure the association differently. The weakest estimate, Chartres et al., is not statistically significant. The strongest rests on six conflicted reviews. None of the studies shows what any sponsor did to a particular result. They bear on how often funded work and favorable conclusions occur together.

Exhibit 602 · Research article

Relationship between funding source and conclusion among nutrition-related scientific articles

Funding source was significantly related to conclusions when considering all article types (p = 0.037).

Reviews 206 articles on soft drinks, juice and milk (1999-2003). Among interventional studies, 0 percent of all-industry-funded studies had unfavorable conclusions versus 37 percent of studies with no industry funding.

Source: Lesser LI, Ebbeling CB, Goozner M, Wypij D, Ludwig DS; PLoS Medicine 4(1):e5
Date: 9 January 2007
Quoted from: Abstract, Methods and Findings
Grade: Peer-reviewed
Document: https://doi.org/10.1371/journal.pmed.0040005
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

Exhibit 601 · Research article

Financial conflicts of interest and reporting bias regarding the association between sugar-sweetened beverages and weight gain: a systematic review of systematic reviews

Those reviews with conflicts of interest were five times more likely to present a conclusion of no positive association than those without them (relative risk: 5.0, 95% CI: 1.3–19.3).

Seventeen systematic reviews (18 conclusions). Six disclosed a food-industry financial conflict. Of 12 conclusions from reviews without a disclosed conflict, 10 (83.3 percent) found a potential risk for weight gain; of 6 conclusions from reviews with a disclosed conflict, 5 (83.3 percent) found the evidence insufficient. The authors state they cannot rule out publication bias among reviews declaring no conflict.

Source: Bes-Rastrollo M, Schulze MB, Ruiz-Canela M, Martinez-Gonzalez MA; PLoS Medicine 10(12):e1001578
Date: 31 December 2013
Quoted from: Abstract, Methods and Findings
Grade: Peer-reviewed
Document: https://doi.org/10.1371/journal.pmed.1001578
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

Exhibit 603 · Research article

Association of Industry Sponsorship With Outcomes of Nutrition Studies: A Systematic Review and Meta-analysis

Although industry-sponsored studies were more likely to have conclusions favorable to industry than non-industry-sponsored studies, the difference was not significant.

Meta-analysis of 12 reports. Industry-sponsored nutrition studies were more likely to have favorable conclusions (risk ratio 1.31, 95% CI 0.99-1.72), a difference the authors call not significant. The authors say the findings suggest but do not establish an association.

Source: Chartres N, Fabbri A, Bero LA; JAMA Internal Medicine 176(12):1769-1777
Date: December 2016
Quoted from: Abstract, Conclusions and Relevance
Grade: Peer-reviewed
Document: https://doi.org/10.1001/jamainternmed.2016.6721
Accessed: 2026-11-09
Cited by: Findings citing this exhibit
Note: Included in this register as the closest counterweight to the sponsorship-bias findings.

2.13 The Seven Countries Study

Finding AGR-2.13Peer-reviewed

The Seven Countries Study followed 12,763 men in 16 cohorts in seven countries, and its authors’ 1986 report on 15 years of follow-up relates cohort death rates to dietary saturated fat while stating that causal relationships are not claimed.

Evidence: Exhibit 606

§2.13.1

Ancel Keys of the University of Minnesota led the study. The 1986 report states: “Causal relationships are not claimed but consideration of characteristics of populations as well as of individuals within populations is urged in evaluating risks.” No document in the record connects the study to the SRF or to Project 226.

Exhibit 606 · Cohort study

The diet and 15-year death rate in the seven countries study

Causal relationships are not claimed but consideration of characteristics of populations as well as of individuals within populations is urged in evaluating risks.

Fifteen cohorts, 11,579 men aged 40-59 at entry, 2,288 deaths in 15 years. Cohort death rates related positively to average saturated-fat share of energy and negatively to monounsaturated fat; unrelated to carbohydrate share. Cross-population comparison, 'causal relationships are not claimed'.

Source: Keys A, Menotti A, Karvonen MJ, et al.; American Journal of Epidemiology 124(6):903-915
Date: December 1986
Quoted from: Abstract, final sentence
Grade: Peer-reviewed
Document: https://doi.org/10.1093/oxfordjournals.aje.a114480
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

2.14 Saturated-fat evidence outside the SRF record

Finding AGR-2.14Peer-reviewed

A 2020 Cochrane review of 15 randomized trials (56,675 participants) found that reducing saturated fat lowered combined cardiovascular events (RR 0.83, 95% CI 0.70-0.98) with little or no effect on all-cause or cardiovascular mortality. A 2017 American Heart Association advisory concluded that replacing saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of cardiovascular disease.

Evidence: Exhibit 604, Exhibit 605

§2.14.1

The Cochrane review reports all-cause mortality RR 0.96 (95% CI 0.90-1.03) and cardiovascular mortality RR 0.95 (0.80-1.12), and grades the evidence for the reduction in combined events as moderate quality. Its comparisons of replacing saturated fat with polyunsaturated fat or with carbohydrate showed no significant difference between subgroups.

§2.14.2

The American Heart Association advisory relies on randomized trials, cohort studies and the physiology of LDL cholesterol. Its abstract states that replacing saturated fat with mostly refined carbohydrates and sugars “did not reduce CVD in clinical trials.” Both documents were written by authors other than Hegsted, McGandy and Stare, and no document read connects either to the SRF. They are reported here as documents and are not dietary advice.

Exhibit 604 · Cochrane systematic review

Reduction in saturated fat intake for cardiovascular disease (Cochrane Review CD011737)

The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events.

Fifteen randomized trials, 56,675 participants, at least 24 months. Reducing saturated fat lowered combined cardiovascular events (risk ratio 0.83, 95% CI 0.70 to 0.98, moderate-quality evidence). Little or no effect on all-cause mortality (RR 0.96, 0.90 to 1.03) or cardiovascular mortality (RR 0.95, 0.80 to 1.12).

Source: Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS; Cochrane Database of Systematic Reviews 2020(5):CD011737
Date: 21 August 2020
Quoted from: Abstract, Authors' conclusions
Grade: Peer-reviewed
Document: https://doi.org/10.1002/14651858.CD011737.pub3
Accessed: 2026-11-09
Cited by: Findings citing this exhibit
Note: Several trials gave more than saturated-fat advice.

Exhibit 605 · Scientific advisory

Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association

replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of CVD and did not reduce CVD in clinical trials

American Heart Association advisory reviewing randomized trials and prospective cohorts. States that trials that lowered saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by about 30 percent, and that replacement with mostly refined carbohydrates and sugars is not associated with lower CVD rates.

Source: Sacks FM, Lichtenstein AH, Wu JHY, et al.; Circulation 136(3):e1-e23
Date: 15 June 2017
Quoted from: Abstract
Grade: Peer-reviewed
Document: https://doi.org/10.1161/CIR.0000000000000510
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

2.15 What the documents leave open

Finding AGR-2.15Open question

The documents do not establish whether the Sugar Research Foundation's funding changed the conclusions of the 1967 review.

The documents do not establish whether the Sugar Research Foundation’s funding changed the conclusions of the 1967 review.

Evidence: Exhibit 584, Exhibit 607

§2.15.1

Deciding the question would require the SRF’s letters and the review’s drafts, or testimony from the authors. Kearns et al. state that key actors had died and that the evidence is circumstantial. The record holds no statement by Hegsted, Stare or McGandy about the SRF payment. Sources that could settle it include the UCSF Industry Documents Library, the Roger Adams papers at the University of Illinois and the Hegsted papers at the Countway Library, Harvard Medical School.

§2.15.2

No cited source makes the claim that sugar causes disease with a controlled study or regulator finding.

Exhibit 584 · Research article

Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents

There is no direct evidence that the sugar industry wrote or changed the NEJM review manuscript; the evidence that the industry shaped the review’s conclusions is circumstantial.

Source: Kearns CE, Schmidt LA, Glantz SA; JAMA Internal Medicine 176(11):1680-1685
Date: 12 September 2016 (online); 1 November 2016 (print)
Quoted from: Discussion, 'Study Limitations' (NIH author manuscript, PMC5099084)
Grade: Peer-reviewed
Document: https://doi.org/10.1001/jamainternmed.2016.5394
Accessed: 2026-11-09
Cited by: Findings citing this exhibit

Key findings

The SRF approved and paid for Project 226, a literature review by Hegsted and McGandy, in 1965 (2.1).
The 1967 NEJM review did not disclose the SRF (2.2).
The SRF’s research director wrote to Hegsted about how the sucrose aspect should be treated (2.3).
The authors state there is no direct evidence the industry wrote or changed the manuscript (2.4).
The Sugar Association acknowledged in 2016 that the SRF should have been more transparent (2.5).
The 1977 Dietary Goals recommended cutting sugar (2.6).
The ISRF objected in writing to the first edition (2.7).
78 percent of the sugar industry’s submission was incorporated into a tooth-decay research call (2.8).
The Sugar Association and senators of both parties opposed the 2003 WHO report, according to AP, CSPI and the Guardian (2.9).
Coca-Cola’s funding of the Global Energy Balance Network became public in 2015 (2.10).
A peer-reviewed email analysis found Coca-Cola sought to obscure its role (2.11).
Industry-sponsored nutrition studies more often reach favorable conclusions, with a wide range of estimates (2.12).
The Seven Countries Study does not claim causation (2.13).
The saturated-fat evidence base has authors and data independent of the SRF (2.14).
Whether the SRF’s funding changed the review’s conclusions is open (2.15).

Version 0.1. Last updated 9 November 2026. Report an error.