Commenting on Geoff Watts, 2013;346: e7800

23 January 2013

Ideas about diet and disease coexist in two worlds, the world of popular culture and myth, and the world of science. Though “sugar causes heart disease” might become a little more fashionable after “Pure, White and Deadly”is reissued, the scientific data and constructs will not change. Evidence for the fat hypothesis is massive and has increased since Yudkin’s book went out of print.

I think Geoff Watts conveys two wrong impressions about John Yudkin’s disappointment that the sugar hypothesis did not get confirmed. I was there. I followed him as head of Nutrition at Queen Elizabeth College, London, in 1971. Yudkin WAS a conviction nutritionist. Most scientists on a government panel on diet and heart disease, after 12 meetings, manage to reach a compromise set of conclusions and recommendations. But the DHSS 1974 Report on Prevention of Coronary Heart Disease [1], which had 13+7 members, has an unusual Note of Reservation by Professor J Yudkin, providing his belief that the Report exaggerated the possible role of dietary fat in causing IHD, and minimized the possible role of dietary sucrose.

The conservatism of this report has been thought to explain why coronary heart disease [CHD] mortality [age standardized] stayed the same in England and Wales until 1978, while it fell substantially from 1964 in USA, Finland, Australia and New Zealand. [2]

The official UK advice was brought in line with growing scientific evidence by the Royal College of Physicians/ British Cardiac Society Working party in 1976. [3]

The sugar hypothesis did not lose its force because of protests by the sugar industry. The more powerful meat and dairy industries were happy with it at the time. The sugar hypothesis simply never gathered supportive data, starting with the fact that sucrose does not ordinarily raise plasma cholesterol and has not been found an independent risk factor for CHD in prospective studies. Leading nutritionists in USA and Europe never took up sugar and CHD. In the UK Yudkin’s peers were concerned and sometimes embarrassed.

By the time the BMJ’s best selling “ABC of Nutrition” was first published in 1986, sugar does not appear in the 4 page chapter, on CHD written for general practitioners .

I think it would have been more useful if Penguin had reissued a different Yudkin classic, “This Slimming Business”[1958]. It’s beautifully written and the messages are [in general] still needed.

A Stewart Truswell
University of Sydney
Email:stewart.truswell@sydney.edu.au

[1] Department of Health and Social Security. Diet and Coronary Heart Disease. Report of the Advisory Panel of the Committee On Medical Aspects of Food Policy [Nutrition] on Diet in relation to Cardiovascular and Cerebrovascular Disease. HM Stationary Office, London.
[2] Mirzaei M, Truswell A S, Taylor R and Leeder S R. Coronary heart disease epidemics: not all the same. Heart 2009;95:740-746.
[3] Report of a Joint Working Party of the Royal College of Physicians of London and the British Cardiac Society. Prevention of Coronary Heart Disease. J Roy Coll Physicians London 1976; 10:213-275.
[4] Truswell A S. ABC of Nutrition. BMJ Books, London, 1986, 1992, 1999, 2003.

Competing interests: None declared

Stewart Truswell, s.truswell@mmb.usyd.edu.au

University of Sydney, Molecular Building G08, University Of Sydney

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