Attack is the best defence

Extracted from Pure, White and Deadly, by John Yudkin, Penguin, 1988.

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Attack is the best defence

One way in which the sugar industry responds to attack is to try to put pressure on the other food industries that seem to be drawing attention to the harmful effects of sugar. An example is a talk I once gave that was sponsored by one of the large international food manufacturers. It was published in a book, together with several other talks on nutrition by other research workers. In my talk, I again had occasion to refer to research on the undesirable qualities of sugar. Soon after the book was produced, the chairman of the food company that had organized the talks and was distributing the book was approached by the chairman of a sugar refining company, and asked to stop the distribution of the book because it was not seemly for one food manufacturer to 'knock' the product of another. After some argument, the book's distributor agreed to do this; the sugar man was not to know that only two out of the several thousand copies had not yet been sent out.

An obvious way to respond to attack is simply to deny its basis; an even more subtle way is to claim that exactly the opposite is true. If most people say that sugar causes dental decay, you must keep on publishing advertisements or short articles in which you stress that sugar is not important; what is important is constitutional proneness to dental decay, or whether one uses the toothbrush often enough. And when most people say that sugar makes you fat, you mount a campaign in which you claim that in fact sugar makes you slim. We saw some examples of this earlier. The most intensive publicity activity of the sugar industry has been its attack on cyclamate. This campaign was pursued even though, as I showed, sugar interests like to claim immunity from attack by other food producers. On the other hand, the sugar industry has supported very little research as to what sugar does in the body. It did, it is true, for several years support research on sugar and dental caries, but even some of this support has been withdrawn. I myself have several times invited the International Sugar Research Foundation to support the work we were doing in my laboratory, on the grounds that the sugar people themselves ought to be the first to know whether their product does in fact produce ill effects. Two or three times it really appeared that they were going to help us financially in our research, but each time the suggestion fell through.

The International Sugar Research Foundation has, on very rare occasions, supported experimental work directly relating to the possible involvement of sugar in producing disease. For example, a research report appeared in the middle of 1971 from Wake Forest University in North Carolina. A dozen miniature pigs were fed on diets with sugar and compared with a dozen fed without sugar. Six pigs in each group were killed at the end of one year; the remaining six in each group were killed at the end of two years. The International Sugar Research Foundation has triumphantly claimed that the results prove that sugar does nothing either to the cholesterol level or to the development of atherosclerosis. A careful look at the results, however, shows that the cholesterol in the sugar group was, as it happened, somewhat lower than that of the control group at the beginning of the experiment; thereafter it was almost continuously higher. Moreover, there was in fact more atherosclerosis in the sugar-fed pigs than in the control pigs.

Can you wonder that one sometimes becomes quite despondent about whether it is worth while trying to do scientific research in matters of health? The results may be of great importance in helping people to avoid disease, but you then find that they are being misled by propaganda designed to promote commercial interests in a way that you thought only existed in bad B films.

Some of my best friends...

Every so often people are told that they should eat, or should not eat, a particular food because of its effect on their health. The publicity may or may not be well founded; what is important to the producer or manufacturer of the food is whether it is believed and acted on. If people really believe that they are less likely to suffer a heart attack if they eat margarine rather than butter, the margarine manufacturer will rejoice and the butter producers will be saddened. And, understandably, both will take steps to advance or protect their commercial interests.

It is then not unreasonable when the producers and the refiners of sugar, and the manufacturers of sugar-rich products, react vigorously to publicity suggesting that sugar is harmful to health and its consumption should be curtailed. What may be considered less reasonable are some of the particular ways these organizations react. A few of these have come my way, and in this chapter I give some examples that may be interesting to those who wonder whether there is justification for the concern expressed from time to time about the power that is in the hands of the 'multi-nationals'.

The World Sugar Research Organisation, or, What's in a name?

In the year or two after the UK publication of Pure, White and Deadly, the book was translated into Finnish, German, Hungarian, Italian, Japanese and Swedish. By 1979 it clearly needed updating, since there had been quite a number of new discoveries about the effects of sugar. Although the publishers were pressing me to produce a new edition, I was then too occupied with other activities to have the time for what would have to be a fairly extensively re-written book. So the English edition went out of print.

This fact was not overlooked by the sugar industry. The Quarterly Bulletin of the World Sugar Research Organisation (WRS0), published from the London headquarters, is a sort of newsletter containing mostly summaries of research that bring good tidings to the industry. On the whole, these are from articles that either comment favourably on the use of sugar, its production or marketing, or that draw attention to some unfavourable aspect of the use of sugar and are then criticized in the Bulletin.

In 1979 it published the following under the headline, 'For your dustbin':

'Pure, White and Deadly'. J. Yudkin. Davis-Poynter Ltd, London 1972.

Readers of science fiction will no doubt be distressed to learn that according to the publishers the above work is out of print and no longer obtainable.

Like any serious research worker, I do not mind people disagreeing with whatever conclusions I draw from research - my own or that of other serious research workers. But to say that my work is 'science fiction' is to say that what I had published as representing the results of my research and that of my departmental colleagues, as well as the research by other scientists I had quoted, was invented and imaginary.

My view of the statement published in the Bulletin was shared by all those colleagues who saw it. My solicitor, who had had great experience in libel cases, was of the same opinion, but wisely sought the opinion of two separate barristers, both specialists in libel law. They also took the view that it is libellous to suggest that a scientist whose work has been published in British and foreign scientific journals of repute has in fact been presenting fictitious research findings.

We initiated an action for libel, which began a four-year exchange of letters between lawyers. In the end, the sugar organization and its editors agreed to publish a retraction, and to pay my legal costs, which up to that time had not reached too high a level. We therefore settled with the organization and abandoned the suit. Here is the statement that was published in the Bulletin in March 1984:

In the Quarterly Bulletin of September 1979 we commented on the fact that the book, 'Pure, White and Deadly' by Professor John Yudkin had gone out of print. We also made other comments relating to the contents and value of the book. We are sorry that the publication of those comments has been taken by Professor Yudkin to impugn his integrity or reputation as a scientist.

Professor Yudkin is internationally known for his work on nutrition, having written a large number of research papers that have been published in a wide range of scientific and medical journals of the highest repute. He is also the author of several widely read books on nutrition, a subject with which his studies have been principally concerned. He has over the years acted as a consultant to a number of companies concerned with the manufacture of food or ingredients relating to food, including Ranks Hovis McDougall, Unilever and the National Dairy Council. Based on a series of experiments which he has been carrying out since the late 1950's he has formed views for which he is well known to the effect that sugar is not a safe commodity for human consumption. We accept that he holds these views and no imputation is cast upon his sincerity or the good faith of his research. Professor Yudkin recognizes that we do not agree with these views and accepts that we are entitled to express our disagreement.

An ironical aspect of this affair was that the then Editor of the Bulletin was at the time a member of the Council, that is, the governing body, of Queen Elizabeth College, where I had been Professor of Nutrition for many years. He had been appointed Honorary Treasurer, and had been a member of the College Council in 1976, when, five years after I had formally retired, it had elected me a Fellow of the College - an honour that had otherwise been given only to retired administrative members of the College. He must therefore have voted for, or at least acquiesced in, my election as Fellow, which took place 'in recognition of [my] contribution to the reputation of the College in helping to establish and build a flourishing and highly respected Department of Nutrition'. During the prolonged period when the lawyers were exchanging letters about my 'work of fiction', I attended an informal party at the College, where I was buttonholed by the Principal. He took me aside and told me that he had heard I was seeking to sue the Treasurer of the College Council. Just as I was about to thank him for sympathizing with me for being maligned by the Treasurer, he made clear his view that it was I that was at fault for attacking an officer of the Council of my own College. I thought that it would have been more appropriate if he had suggested that the Treasurer should resign from the Council for his unwarranted attack on an Emeritus Professor of the University and a Fellow of the College.

Freedom of choice depends on freedom of information

By itself, the affair I have just described would be of little public concern. But it is only one small example of the activities of the various organizations that comprise the multinational sugar industry.

Take smoking. When there is talk of helping to prevent lung cancer or chronic bronchitis caused by smoking by controlling advertising or by increasing taxes on tobacco, there is considerable protest, mostly from the tobacco industry, that such actions curtail freedom of choice. We are told that society has no right to interfere if a person is prepared to take the risk of dying of cancer, or of being unemployable because of severe bronchitis. But freedom of choice exists only if there is freedom of information. The sugar industry has constantly attempted to prevent the public from being informed about the harmful effects of sugar. To substantiate this accusation, let me cite some of my own experiences during the past 20 years or so.

Early in 1964 I received an invitation to read a paper on the research we had been carrying out on food habits. The invitation came from the secretary of an organization in Paris called La Fondation Internationale pour le Progres de l'Alimentation (FIPAL). I was told that the organization was supported by the food industry, but that its work was uninfluenced by commercial considerations. In July of that year, I published in the Lancet some of our findings, including evidence suggesting that sugar was a cause of coronary heart disease. Shortly afterwards I received an agitated letter from the secretary of FIPAL, asking whether there was any truth in the reports of this research that had appeared in French newspapers. The reason for this letter, the writer said, was that, as well as being secretary of FIPAL, he was also secretary to the French body concerned with promoting sugar. My reply to this was that the reports of our work were correct, and I suggested that in the circumstances it might be better if I withdrew from the conference. This elicited a strong denial that his letter implied any suggestion that my presence at the proposed meeting was not welcome. The secretary repeated the statement in his first letter that FIPAL's sole objective was to promote work and discussion on nutritional problems.

The meeting took place in September that year, and papers were read by some dozen research workers. One of my colleagues accompanied me to Paris, and he and I were asked to stay for two or three days after the meeting in order to edit the contributions for publication. Some months later I was sent the proofs of my own paper, with a request from the secretary: since I had mentioned that there was now evidence that the recent considerable increase in sugar consumption was a possible cause of the increase in some diseases, would I please withdraw this statement or put in a footnote that this was a personal opinion that was not universally agreed? I wrote to say that this request was not compatible with his early assurances of the impartiality of FIPAL; I suggested that if they did not wish to publish my paper as I had read it, I would rather they did not publish it at all.

That is precisely what happened. The book appeared with my name in the list of those who had contributed to the meeting, but you will find no record of what I said there.

Sugar and artificial sweeteners

You would expect the sugar industry to keep up a steady campaign against the use of artificial sweeteners like saccharin and cyclamate, and some of the newer products like aspartame. This campaign is now much less active than it used to be, since the sugar refiners are themselves in the process of developing new artificial sweeteners. Nevertheless it is still interesting to look at some of their earlier activities in this field. Take the cyclamate affair. The sugar industry spent a great deal of money on research and publicity on the possibly harmful effects of cyclamate. They announced this repeatedly in their information reports right up to 1969, when cyclamate was banned in the USA, the UK, and some other countries. Here is a quotation from an American sugar agency as early as 1954, explaining why sugar was spending so much money on publicity:

'These substitutes might never command a really damaging share of the market in terms of bottles, cans, and cases, but their share of market in terms of human prejudice might be very damaging indeed. This obviously calls for a broad programme of information about sugar among consumers. It is the only real insurance the industry can have.'

By 1964 the sugar industry had come to the conclusion that artificial sweeteners really were a serious challenge. The President of Sugar Information Incorporated, addressing the Sugar Club, then said, 'Every man in this room is affected directly in the pocket-book, by the challenge of the synthetic sweeteners. I want to discuss with you the nature of this challenge, its dimensions and its impact. I want to tell you what we are doing to meet it.' He then went on to describe an advertising campaign 'questioning the value of synthetic sweetened soft drinks'. Some of the experiments with cyclamate that the sugar people sponsored were really not very well carried out. For example, in one experiment rats were fed with a diet containing per cent of cyclamate, which is equivalent in sweetening power to sugar amounting to one and a half times as much as the total amount of food normally eaten! Nobody will therefore be surprised that the rats did not thrive on this diet, and did not grow as well as did rats without cyclamate.

But the great scientific discovery about what 5 per cent of cyclamate in the diet does to the growth of rats was very widely publicized, not only in articles in many magazines, but in an information brochure sent to, amongst others, every Member of Parliament in Britain.

The chief irony of the cyclamate story is that the eventual banning of this sweetener in the United States was the result of research sponsored by Abbott Laboratories, the world's largest manufacturer of cyclamate. In this research, carried out by the Food and Drug Research Laboratories in New York, rats were given enormous doses of cyclamate with saccharin, equivalent in sweetening power to 11 pounds of sugar a day. At the end of two years, a very long time in the life of a rat, a few animals showed the beginnings of cancer of the bladder. Ordinarily, one would now get a group of experts together to try and evaluate the relevance of these studies to the human consumption of something like one fiftieth of the equivalent dose - about the maximum amount of cyclamate anyone would take. Indeed, it is now widely accepted that the occurrence of cancer in that experiment had nothing to do with cyclamate or saccharin.

Nevertheless the decision to ban cyclamate was inevitable because of the Delaney Clause in the American food and drug legislation. This, as you recall, says that any material that, in any dose, over however long a time, causes cancer in any animal, must not be used in human food. So cyclamate was banned in the USA, and then in several other countries, thereby presumably inviting everybody to go on eating all the sugar they wanted. Now, however, most countries, having reconsidered the position, have removed the ban.

There is also a personal twist to these experiments and results. When I he reported some of the experiments that my colleagues and I have done, sometimes with as much as 15 ounces of sugar a day in young men, but often with a lot less, I am told that these are abnormally large amounts and that our results are not valid. In fact they are nowhere near the equivalent of the astronomical amounts of cyclamate that had to be used in order to show how 'dangerous' this material is.

The British Nutrition Foundation

The British Nutrition Foundation was born in 1967, 26 years after the birth of the Nutrition Foundation of the United States. The latter is funded almost entirely by the American food industry and has a large Council, comprising not only members of the industry but also research workers in nutrition and food sciences and distinguished members of the public. It produces a regular monthly journal, Nutrition Reviews, which discusses and comments on recendy published research in the wide field of nutrition. The Nutrition Foundation also publishes occasional volumes that summarize what research has discovered in the major areas of nutrition. On the whole, it can be said that the American Nutrition Foundation is not influenced by the fact that it is funded by the food industry, although it has to be admitted that it rarely criticizes aspects of the industry that a completely uncommitted group might consider deserve at least some degree of criticism.

Thus, when it was set up in 1967, the British Nutrition Foundation (B N F) had the American organization as a model, and it too was funded by the food industry. Its first and major sponsors were the sugar refiners Tate & Lyle, and the flour millers then known as Rank. This combination occurred, it seems, chiefly because of the personal friendship between, on the one hand, the families of Tate and Lyle, and on the other hand the Rank family. There was also a business friendship between the two groups, since Rank was to a sizeable extent a user of sugar - for example, in the manufacture of cakes and biscuits - especially after it had amalgamated with two other large firms in the flour milling and baking industry to form Rank Hovis McDougall.

The first Director of the British Nutrition Foundation was the late Professor Alastair Frazer, a biochemist who had taken a special interest in the biochemistry of drugs and had just retired from the Chair of Pharmacology at Birmingham University. His major research had been on how the body digests and absorbs fat from food. To this extent, then, he was concerned with nutrition, although in a fairly narrow field. At first he was kept busy approaching other firms in the food industry, most of whom were, it seems, less than enthusiastic about promising financial support to the organization; for this reason the B N F had a precarious first few years. However, one approach to the food industry seemed more successful than most: Professor Frazer's claim that, in a climate of growing consumer concern about processes and additives used by the food industry, the BNF would stand as a sort of protective fence between the industry and the public. In spite of these time-consuming efforts to produce funds for the Foundation, the Director-General nevertheless found time to supervise and support a film telling of the virtues of sugar as a food.

From what I have said, you might ask whether the BNF at that time tended to be somewhat on the side of sugar, and if so whether it has remained so. I shall let you make up your own mind when you have finished reading this chapter.

The Director-General objects

In the late 1960s Rank Hovis McDougall (RHM) to begin research into the possibility of producing an inexpensive high-protein food: an attempt that, some twenty years and tens of millions of pounds later, has recently resulted in an excellent savoury pie appearing on the market. At the very beginning of the project I was asked by the then Director of Research of RHM to act as an adviser on the project.

At the same time he told me that his friends from Ranks Hovis McDougall and from Tate & Lyle, both of which continued to be major sponsors of the BNF, had said that it was not appropriate for me to advise RH M; nevertheless he himself wanted me to do so. A short while after the project got under way, he told me that the Director-General of the BNF was pressing him to tell me to desist from saying that sugar was harmful. I said that it would be more sensible if we had a meeting with Professor Frazer at which I would describe the results of our recent research and explain the reasonableness of my views.

We met at BNF headquarters: Professor Frazer, the Research Director of RHM, two or three members of BNF, and I. We had an interesting discussion, from which it was clear that Professor Frazer was not very up to date on research into the causes of coronary heart disease, or research into some of the effects of sugar on the body. He strongly rejected the suggestion that sugar had, or could have, anything to do with coronary disease. He insisted that there was no relationship between the increase in sugar consumption and any increase in coronary disease; in fact, he said, there had not been an increase in the disease. I said that this was contradicted by the general recognition of cigarette smoking as an important cause of the disease; as there had been a tremendous increase in smoking, it followed there must also have been an increase in the prevalence of heart disease. 'That only shows,' said Professor Frazer, 'that smoking too has nothing to do with the disease' - a view that would have been supported by very few other scientists or doctors.

As we left the room after lunch, the Director-General was overheard to say, 'You can take it that Yudkin won't be getting any research grants from the B N F'; this prophecy was certainly fulfilled.

The BNF doesn't want nutritionists from QEC

Throughout my time as Head of the Department of Nutrition at Queen Elizabeth College, neither I nor any of my colleagues had any association with the BNF. I should point out here that my Department, instituted in 1953, was the first in any European university to be devoted to undergraduate and postgraduate teaching of nutrition, and was carrying out research that was probably at least as extensive as that of any other nutrition department in the country.

In terms of the alms of the BNF, its most important committee must be its Science Committee. The chairmen of this committee have always been distinguished scientists; none has been a professional nutritionist but they have all had some contact, if sometimes rather remote, with the subject of nutrition. As I write, there have been five chairmen of this committee since the Foundation began; these have included the late Sir Charles Dodds, one of the outstanding biochemists of the time, and the late Sir Ernst Chain, who shared the Nobel Prize for the discovery of penicillin with Florey and Fleming. Both Dodds and Chain approached me while Chairman and asked why I was not on the BNF Science Committee, or indeed on any of its other committees. When I said that I had not been invited, they asked if they might suggest that I should be appointed. To this I agreed, although I guessed what the reply would be. And so it proved. Both chairmen had been told in due course that there was no question of having me in any way associated with the BNF. What I had not guessed was that the member of the BNF Board from Tate & Lyle, which had remained one of the major sponsors of the Foundation, had said that if I were appointed he would resign from the Board, and would see that his firm - and others - withdrew their sponsorship.

After it was founded in 1953, the Nutrition Department of Queen Elizabeth College rapidly became a thriving centre of nutrition research, and was soon responsible for having trained several of the graduates doing nutrition research in other laboratories in this country and abroad. We were clearly interested, therefore, when in 1970 it was announced that a joint committee of the Agricultural Research Council and the Medical Research Council (ARC-MRC Committee) was being set up to examine the current state of nutrition research in the UK, and what important problems most needed investigating. To our surprise, neither I nor any of my staff were appointed to the ARC-MRC committee.

After the report had been published I happened to be writing to the Chairman of the Committee, who was a long-standing friend. In the course of my letter I said that it would interest me to know why no one from my department had been invited to join his committee, in view of our position as an important nutrition research centre. He replied that, since he himself was not a nutritionist, he had taken advice from people in the field. He had consulted the British Nutrition Foundation, and it was they who had told him that I was not an appropriate person to be on the Nutrition Research Committee.

The long arm of the sugar industry

You may well consider that my experiences with the British Nutrition Foundation reflect a rather remote and perhaps unimportant sort of intervention of sugar interests in the affairs of academic workers carrying out research and disseminating its results. Let me then mention two rather more direct interventions. Those of you who have been to Switzerland will no doubt have seen one of the many elegant branches of the supermarket chain Migros, or will have bought petrol in one of the Migros garages. During his lifetime the founder of this large organization, Gottlieb-Duttweiler, set up a trust whose income is a percentage of the turnover of the business. Among many other activities, it organizes occasional symposia on subjects of international concern, such as ecology and nuclear energy. In 1977 the Gottlieb-Duttweiler Institute appointed Al Imfeld to organize these symposia, beginning with one that was to consider the subject of sugar - its production and distribution, its political and economic background and activities, and its role in human nutrition. Al Imfeld asked me to be one of the speakers at this symposium and invited me to read a paper on the nutritional role of sugar. Soon after I had sent him my proposed paper, and a month or two before the meeting was due to take place, Imfeld wrote to say that the meeting had been cancelled and that he had been dismissed from his job; he added that he knew that I would understand the reasons for these events.

The Gottlieb-Duttweiler Institute did hold a meeting on sugar in 1981, although this time I did not receive an invitation to attend. It was a somewhat bowdlerized meeting in that none of the speakers dealt with the international financial and political activities of the sugar companies, as had been intended at the meeting planned originally by Imfeld. Nevertheless, it was interesting to read in the report of the meeting what was said by Eugenie Hollinger, the representative for consumer affairs of the Migros organization: 'I well remember the appearance of the German translation of John Yudkin's sugar report, SÃss aber gefÃhrlich (Pure, White and Deadly) in 1974. I had the greatest difficulty at that time in persuading any newspaper publisher that the book should be reviewed. They were all afraid of an advertising boycott by the affected food industry and distributors. Subsequently Imfeld published a book with the simple title Zucker, which strongly indicts the world-wide activities of the sugar industry and explicitly points out the role it played in bringing about the abandonment of the Institute's original meeting and the loss of his job.

My second example occurred three or four years later. A new artificial sweetener, aspartame, was about to be given government approval in the UK, U S A and several other countries. Aspartame is produced by the American pharmaceutical company G. D. Searle, which has a large operation in England. I was approached by the English company to organize a conference dealing generally with carbohydrates in nutrition, although there would be in addition one speaker from Searle who would give a paper about the new and still little-known aspartame. I spent a great deal of time corresponding with possible speakers, from the UK and from other countries, and discussing the particular areas that they would be asked to cover. Bookings were made for the travel and accommodation of the participants, as well as arrangements for the conference itself at a large hotel in Stratford-upon-Avon. Two weeks or so before the meeting was to take place, it was cancelled. At this late stage I was left with the unpleasant task of informing the speakers with whom I had been carrying on prolonged and detailed correspondence, and who by now had prepared the papers they had intended to give at the conference. More difficult still, I had to try as tactfully as I could to avoid telling them what I understood to be the real reason for the cancellation. The person from Searle who for months had been making the manifold technical arrangements for the conference told me the news about the cancellation; he was understandably very upset and angry. It was therefore not surprising that he could not restrain himself sufficiently to maintain the secrecy that the company presumably intended concerning the reason for the abandonment of the conference. According to him, it was the Coca-Cola Company that had pressed Searle to cancel the meeting. Coca-Cola are the world's largest single users of sugar. In 1977, I am told, they used one million tons of sugar in the U S A, so they had a considerable interest in what the public were told about sugar. Meanwhile they were also producing Diet-Cola for people wanting low-calorie soft drinks; although making up only a small proportion of total soft-drink consumption, this was nevertheless a large and thriving market. Thus, in the early 1980s, Coca-Cola was negotiating with Searle about using aspartame in these drinks instead of only saccharin - an enormous potential market for the new sweetener. This fact gave Coca-Cola the opportunity to suggest that their decision could depend on whether Searle proceeded with the conference, which would undoubtedly have publicized new research on the ill-effects produced by the consumption of sugar. And Searle abandoned the conference.

Telling the truth about tooth decay

The most impressive campaign to inform people of the ill-effects of sugar consumption was, I believe, the one begun in 1977 by the North-Rhine Dental Insurance Association (the Kassen-Zahnartzlichen Vereinigung Nordrhein, or KZV). This was done mostly through the enthusiastic and energetic activities of its chairman, Dr Edvard Knellecken. With more than Li million a year that they put aside for anti-sugar propaganda, KZV advertised in newspapers and magazines, wrote letters to doctors, scientists and politicians, and campaigned for a range of legislative measures to combat the promotional activities of the sugar industry. They suggested that packets of chocolates and confectionery should have printed on them some symbol such as a toothbrush to indicate the potential damage to the teeth from the consumption of these products. They asked that no suggestion should be allowed in advertising that sugar promoted health or fitness, or performance at sports. They asked for a tax to be put on sugar itself, and on all sugar-rich food and as there is on tobacco an alcohol.

The KZV called a widely publicized conference at which the media were well represented and where speaker after speaker described the ill-effects of sugar consumption and the research that had been done to demonstrate this. I gladly accepted their invitation to this conference and was the only non-German present. I spoke of our research on sugar in relation especially to heart disease and diabetes.

We were not surprised that the publicity achieved by this meeting was followed by strong reaction from the various branches of the sugar industry. One of these was of special interest to me; it was a copy of a letter received by Dr Knellecken, written by an Austrian doctor, Dr Gottinger. Here is a translation of part of the letter:

Thank you very much for kindly sending me your information about dental caries.

I am surprised that it seems to have escaped your attention that dental caries has for a long time been accepted as an infection, and vaccines against the condition are already being prepared...

Perhaps it has also escaped your attention that Professor Yudkin is not a university professor, and has no professorial chair. He is, rather, a grammar-school teacher in London, as stated in his books, and he has also never carried out any experimental work, but used only statistical arguments. I know his books and have some of them. In the opinion of many authoritative people, he is in fact not a scientist to be taken seriously.

I have wondered what motive Dr Gottinger had in making such an outrageous and unwarranted attack on a medical colleague. I wrote to him correcting his misapprehension by pointing out that I had a string of university qualifications, was holder of the Chair in Nutrition and Dietetics at London University and had published getting on for 300 research articles in many scientific and medical journals of international repute, as well as several books, which it was clear he had not read. You will perhaps not be surprised to learn that Dr Gottinger did not reply to this or to subsequent letters; I do, however, still get from him a request for a reprint each time I publish a new research paper.

Sadly, the activities of the KZV were interrupted when Dr Knellecken was accused of financial fraud in relation to the funds of the association - accusations that were instigated by the sugar industry. As a result, KZV's attempt to inform the German people of the considerable damage that sugar does to their health was brought to a sudden standstill. Some three or four years later, however, I was delighted to see that, although belatedly, Dr Knellecken's reputation had been wholly vindicated, as was made clear by a report in the German magazine Naturartz. This said that Dr Knellecken had been accused of the misappropriation during the three years of his presidency of DM 22 million of KZV funds, by spending it on the dissemination of educational material about the damage to health caused by the use of refined sugar. The verdict of the court rehabilitated Dr Knellecken completely. He had been very careful to act only after obtaining the consent of his colleagues, particularly where expenses were involved, and the court found nothing that would point to undue pressure in his suggestions of the course of action to be taken by the association. Naturarzt added the following comment:

Dr Knellecken has been subject without any justification to persistent mud-slinging because of his fight for the health and well-being of patients and against the attacks on the integrity of their dentists. Dr Knellecken, his friends and his family were publicly abused and humiliated. His position, after thirty years of professional activity, has been gravely endangered.

Meanwhile, before this judgement had totally exonerated Dr Knellecken, his successor in the KZV had been persuaded to sign an undertaking that any statements that KZV would make in its health promotion would in future be agreed with the sugar industry.

Nought out of ten for tact

Since most of our food comes to us as the product of some sort of agricultural activity, and since the food we eat has such an important influence on our health, it is surprising that there is so little discussion about the relationship between agriculture and nutrition. That is why I was pleased when, in June 1978, I heard that the Institute of Biology - of which I am a Fellow - had arranged a joint meeting with the Centre for Agricultural Strategy. The meeting was to consider the possible impact on agriculture that would occur if people were persuaded for nutritional reasons to reduce their consumption of milk or sugar, or change the quantities and kinds of fat they eat, or increase their consumption of dietary fibre from cereals, fruits and vegetables.

Each of these four subjects was to be considered initially by a small panel of experts who would meet a few times before preparing a report to be presented at the Symposium in November. I was asked to chair the panel that was to consider sugar and other sweeteners.

In the middle of October the General Secretary of the Institute of Biology received a letter from which I quote:

Dear Dr Copp,

I am writing to you in my capacity as a Fellow of the Institute rather than as Chief Executive of Tate and Lyle's Group Research and Development.

It has come as a surprise that Professor Yudkin has been chosen to speak on the general subject of 'sweeteners' at the forthcoming symposium on 'Food, Health and Farming', when in fact he has not done any definitive research on the subject; with the possible exception of his work on sucrose. It would have been, in my opinion, of greater interest and value to the symposium to have selected a speaker on this subject who could, at the very least, have been expected to be objective. Professor Yudkin, as you know, has in the past used symposia of this type for attacks on sugar irrespective of medical evidence which contradicts his views... It is indeed a pity that you have not included someone on your programme who... could have presented new data rather than the 'same old story' which we have heard from Professor Yudkin periodically.

The General Secretary of the Institute of Biology replied to this in a letter which included the following:

Thank you for your letter of 11 October. However, I think you may not have seen the programme for the conference on 'Food, Health and Farming' and so I enclose one. You will see that Professor Yudkin is presenting the report of a panel. He will therefore be putting forward views agreed by a group of responsible scientists including the Research Director of Beechams Limited.

Friendly intervention

By the early 1960s the Nutrition Department of Queen Elizabeth College had become grossly overcrowded, and the College decided that it must be extended. An appeal was launched to collect funds for this, and the then College Treasurer, who was very much connected with the food industry, wrote to his friends and acquaintances in some of the major food companies. However, unlike all the other food manufacturers that were approached, Tate & Lyle declined the invitation to make a contribution. The letter from the company said that the board had given a lot of thought to the College's appeal, and continued: 'You will readily understand our Board's reluctance to support an establishment where the Professor of Nutrition considers sugar to be an unessential item of our diet and presumably teaches this theory.' The part I like best is the last few words: I take it to mean that we might have been given support if only I were teaching my students what I did not myself believe.

During 1966 I was asked to join a small group of German doctors and dentists to meet representatives of the South German sugar industry in a round-table discussion of our differences. This was, I thought, a very welcome move; better than a continuing shouting match that clearly made no progress towards mutual understanding. We had a useful discussion; without having persuaded the representatives of the refiners or the manufacturers that sugar was certainly harmful, we did, I believe, convince them that we had some justification for our concern about the effects on health.

On my return to London I wrote a letter to the then Chairman of Tate & Lyle, describing the meeting we had had and suggesting that this should be the pattern for our future relationship. The Chairman replied and said he thought it would be a good idea if I met a representative from the company. In due course a meeting was arranged and the representative came to see me in my office at Queen Elizabeth College. I began to talk to him about our research, and how our new results, not yet published, were making us even more convinced of the dangers of sugar consumption. It soon transpired, however, that the Chairman had sent someone to see me who was not familiar with our work. He was, in fact, the General Sales Manager in charge of the Technical Sales Department of the company.

This was quite different from what I had encountered in Germany. And it was also an end to my hopes that I could establish a useful dialogue with people in the sugar industry.

A pre-emptive strike

Pure, White and Deadly was first published in Britain in June 1972, but appeared in the United States a few weeks earlier under the title Sweet and Dangerous. The American publishers had taken the view that it would be useful to give a list of the then 30 or so articles in scientific and medical journals that described the experiments we had done on the effects of sugar, and set out their results. This would allow any scientist who was interested to see whether the statements in the book were justified by the results of our experiments. The publisher of the British edition, on the other hand, thought that none of its readers would be interested in such a list, and so it had been omitted.

The earlier publication of Sweet and Dangerous forewarned the British sugar industry of the imminent appearance in the UK of Pure, White and Deadly. The then British Sugar Bureau (now the Sugar Bureau), which is the publicity arm of 'British sugar refining and manufacturing', took the opportunity of producing a 'News Bulletin' which they sent to newspapers, magazines and radio and television stations that might be reviewing Pure, White and Deadly. I quote just two or three items from this document:

In this book Dr Yudkin attributes the increase of a number of diseases mainly to the role of sugar in the modern diet.

The Bureau is concerned by . . . the irresponsible way in which the evidence is presented.

The book is considered to be not only unscientific in its approach, but to contain very little more than a number of emotional assertions based on Dr Yudkin's own theory that sugar is the main cause of many diseases and should be banned.

It may be significant that in the American version of this book, entitled Sweet and Dangerous. . . Dr Yudkin relied for support on a selected bibliography containing a number of references to scientific papers, nearly all of which were by Yudkin or Yudkin et al. In the English version of the book, however, there are no references, not even to his own published papers, to support his assertions.

I don't think it is common for a book to be publicly attacked before it is even published or reviewed.

You may think that my own few experiences illustrate a fairly restrained reaction of the sugar industry in protecting itself from what it considers unwarranted attacks on its product. If so, you will be interested to know that this is now changing; no longer will the industry respond so meekly to those who have hitherto assailed it so unjustly.

The Editor of a magazine in which I had written briefly of some of the ill-effects produced by sugar received a letter in which each of my comments was vigorously criticized. The writer of the letter making these rather technical points was the Executive Director, Marketing and Sales, of British Sugar, which is the company concerned with the production and refining of beet sugar. This recalls the qualifications of the man from Tate & Lyle who came to see me at Queen Elizabeth College nearly 20 years earlier to discuss our research. Having dealt with the biochemical and clinical matters relating to my article, the letter from British Sugar proceeds, 'The sugar industry now recognizes its mistake in not effectively offsetting over the years the barrage of misinformation and disinformation fostered by individuals with a desire to profit from the credulity of the population. This is in the process of being corrected.'

I pointed out earlier that by no means every scientist agrees with my views about sugar. And there is nothing wrong with that: much of the material about which I have written still adds up to circum¬stantial evidence rather than absolute proof. But circumstantial though it is, it has been steadily accumulating over the past 20 years from several laboratories, and there is a growing number of people who believe that the case is now pretty strong that sugar is, for example, one of the causes of coronary disease.

Scientist versus scientist

I have mentioned Dr Ancel Keys and his pioneer work in relation to diet and heart disease. In 1970 he wrote a memorandum which he sent to a large number of scientists working in this field, and which with very few changes has been published in a medical journal, Atherosclerosis. It consists entirely of a strong criticism of the work I have published from time to time on the theory that sugar is the main dietary factor involved in causing heart disease.

The publication contains a number of quite incorrect and unjustified statements; for instance: that we had never tested our method for measuring sugar intake; that no one eats the amounts of sugar that we and others have used in our experiments; that it was absurd of me in 1957 to use international statistics of 41 countries as evidence for the relationship between sugar and heart disease (exactly the same statistics that Dr Keys had previously used for only six selected countries to show the relationship between fat and heart disease).

He ends by triumphantly pointing out that both sugar and fat intakes are related to heart disease, but that the cause must be fat, not sugar, because he had found in 1970 that fat intake and sugar intake are themselves closely linked. You will remember my own discussion of this point based on the fact that, as far back as 1964, I had demonstrated this same relationship between fat intake and sugar intake.

Dr Keys has at least been consistent in his views. A rather different example of strong disagreement with our findings is provided by Professor Vincent Marks, a biochemist at Surrey University. Professor Marks and a colleague reported in the Lancet in 1977 some experiments which showed that taking gin and tonic could provoke hypoglycaemia if the tonic water contained sugar, but not if it contained saccharin. This work was vigorously criticized in a letter to the Lancet by the then Director-General of the International Sugar Research Foundation; the precursor of the WSRO. Professor Marks began his reply:

May I suggest that a clue to the reason for Mr Hugil's vitriolic comments on our work is to be found in his address? The International Sugar Research Foundation must feel threatened by the accumulating evidence that John Yudkin's description of their major product as pure, white, and deadly is not too far wide of the mark.

By 1985 Professor Marks found himself able to write, in relation to the suggestion that sugar might be a cause of coronary disease, 'one of the most groundless theories puts sugar as the villain of the piece and is nothing more than scientific fraud'. And he goes on to say that other statements by 'usually ill-informed authors suggesting that sugar is a primary or indeed even a contributory cause of coronary heart disease are not only false and misleading but frankly mischievous'. This remark appeared in 1985 in a colour supplement - inserted in the trade magazine the Grocer - written, designed and produced by the public relations firm working for the Sugar Bureau.

Three months later Professor Marks was the billed speaker at one of the 'discussion meetings' organized by 'Diet and Health' which were sponsored by the Sugar Bureau. The published summary of his talk, circularized before the meeting, begins as follows:

The Diet Scandal - or are we being conned? What has brought about the change in the public image of sugar from that of an important constituent of the diet to that of an unncessary food additive responsible to a greater or lesser extent for the host of illnesses and social miscreancies? Is it a wealth of newly produced experimental evidence?... Or is it a sensationalist bandwagon based upon nothing more than anecdotal, incorrectly interpreted data?

I should make it clear that I have no general quarrel with scientists who change their minds. Any scientist may have to do this in the light of new discoveries. These may show that previously held views were based on experiments in which faulty techniques were used, or that new observations or techniques have revealed facts hitherto unknown; in either case it will be necessary to modify the conclusions drawn from the previous observations. As far as I can see, for the period between the earlier and later opinions of Professor Marks, neither of these conditions applies. More recent experimental research carried out on the subject of sugar and disease, in several independent laboratories, has both confirmed our previous conclusions and added new observations that support them. I find it surprising, then, that Professor Marks now chooses to exculpate sugar from the accusation that it is harmful to our health. Unfortunately, such statements provide a strong and continuing source of ammunition to the sugar industry not only in defending itself but in attacking the scientists and health workers who are trying to inform the public of the need to reduce their sugar consumption.

Write what you like but only if I like it too

I suppose people mostly do not hear about efforts made to interfere with what they are doing, if these go on behind their backs. But occasionally they come to light. I was once asked to produce a slimming diet for the National Dairy Council. This project appealed to me because a sensible slimming plan must not only cut down on the total amount of food, but must do so without excessively cutting down on the essential nutrients in the food - the protein, vitamifls and mineral elements. So you aim to cut down the foods that provide little or nothing except calories and keep the foods that provide lots of nutrients in proportion to their calories. The only food that contains nothing but calories is sugar; the food with the greatest number and quantities of nutrients for its calories is milk.

This was the simple basis of the diet that I designed for the National Dairy Council. After they had published the diet, the Council was asked by one of the major sugar companies - ever so politely - to remove or at least 'de-emphasize' the need to cut out sugar. The Director of the Council told me of this request, clearly expecting me to refuse to make any change; when I did refuse, he said with a smile that he fully supported me.

Pure, white - and powerful

Let me end this personal tale by repeating that I do not accuse those scientists who express disagreement with my views of doing so for improper motives. Nevertheless, I find it remarkable that there are still so many in this category, after several years of accumulating evidence that supports the conclusions that I and a few other research workers have reached. It is especially interesting that some of those who began by leaning towards accepting these views now reject them.

It is difficult to avoid the conclusion that this is the result of the vigorous, continuing and expanding activities of the sugar interests. Their product is pure and white; it would be difficult to use these adjectives for the behaviour of the producers and distributors and their intermediaries. Nevertheless, it would not be rewarding to search for an organized dirty tricks department; it seems to be more an instinctive protective action of those in the trade to deny any cover-up of the ills produced by their product, or any wrong-doing of their fraternity. The result is such a compact nucleus of power that, like a magnet surrounded by a strong induction coil, it produces a field of influence that invisibly affects many of those not in direct contact with the centre.