The Nutrition Debate #154: Salt, Sugar and Fat

Since last March, when it was published, I have resisted commenting on Michael Moss’s popular eBook, Salt Sugar Fat: How the Food Giants Hooked Us. I do not want to be perceived as negative. In other areas of my writing, my commentary has led readers to say I am just an old-style, country curmudgeon. And Mr. Moss, a New York Times investigative reporter since 2000, has made a career out of sensationalizing popular causes, even when the popular idea is a myth. Lumping together salt, sugar and fat as an unhealthy agglomeration is just one of those myths. I get curmudgeonly just thinking about it.

So, when The Lancet, a peer-reviewed medical journal, published this week a “Perspective” titled “Salt, Sugar and Fat or branding, marketing, and promotion,” by Dariush Mozaffarian, it caught my attention. As both a cardiologist and epidemiologist at the Harvard School of Public Health, his take would be “informed” and “professional,” vs. a rant such as I might have written. Turns out, it is. Dr. Mozaffa’s “perspective” is well-reasoned, balanced and, to my surprise and delight, in the end, negative, at least in the areas of interest to me and to anyone committed to public health and “re-education.”

According to Dr. Mozaffarian, Moss “shines” and “the text sparkles” as he “argues that the food industry manipulates and is deeply dependent on these three ingredients to create maximally alluring, addictive products that drive overconsumption, obesity and other chronic diseases. Moss “smoothly and deftly walks us through these fascinating stories, yet he seems to miss his own point.” According to Dr. Mozaffarian, “Salt Sugar Fat is, however, unconvincing when Moss attempts to link these fascinating stories and products, including their successes, failures and health effects, back to salt, sugar and fat.”

He allows that the case made by Moss for salt is “reasonable,” but that “a central tenet – that fat content in foods induces overconsumption and poor health – has been disproven by prospective studies and randomized trials.” Hallelujah, I say! “Yet this folklore is repeatedly asserted,” Mozaffarian continues, “overlooking the evidence that both the total fat content of foods and the overall fat content of the diet has little, if any, influence on major diseases, including type 2 diabetes, heart disease, or cancers” [emphasis added]. AMEN! Would that this message could be broadcast on a continuous loop over the air until is sinks in. Drumbeaters and axe grinders like me would have to find other ‘work,’ or go fishing, or take up golf.

Dr. Mozaffarian’s indictment of the 3^rd member of this cabal, sugar, starts off a bit timidly, to my taste: “All refined carbohydrates – whether white bread, white rice, most potatoes and breakfast cereals, or packaged foods containing these refined grains, cereals, and starches – have largely indistinguishable metabolic harms as sugars.” He’s not a type 2 diabetic, obviously.  “Whereas sugars in liquid form are most obesogenic, there is only limited reliable evidence to suggest that sugars in foods are any worse for health than other refined carbohydrates and starches – all are detrimental”  (emphasis mine again). “This key issue is only mentioned by Moss in the first chapter, then seems to be promptly forgotten,” he quips.

Early in his perspective, Dr. Mozaffarian’s review makes a glancing but unmistakable blow at Ancel Keys’s “Six Country Study” with this comment: “During the 1950s and 1960s, crude comparisons across nations, basic feeding studies and animal experiments began to document how our diets might influence chronic conditions, such as heart disease and cancers.” He makes a similar jibe when referring to Moss’s piece with “the described ‘science’ seems to be highly selective, relying on hand-picked subsets of rat experiments, short-term trials in volunteers, and ecological comparisons.” Ouch!

Nevertheless, “the focus on how diet affects obesity and its complications, including diabetes,” was the impetus for this eBook. “People have recognized for millennia that overeating leads to weight gain,” Mozaffa says, but then he brightens my day with this follow-up: “Yet, this was historically attributed to weakness of individual will.” Do I detect the skepticism of a scientific mind at work here? Then, Dr. Mozaffarian-the-epidemiologist emerges: “Obesity’s remarkable and rapid contemporary rise across diverse races, social classes, cultures and nations – including perhaps most influential of all, in children – has created a new awareness that external influences on dietary choices are likely powerful and widespread…”

Here is the common thread that links Moss and Mozaffarian: “external influences on dietary choices,” but here is also where they depart. Mozaffarian says, “Throughout Salt Sugar Fat Moss attempts to indict these three ingredients as principal forces behind product development and sales, Yet, time and again, the stories reveal the true drivers of the success of individual products and our modern overconsumption: the immense and pervasive power of modern advertising and promotion.” One simple example Dr. M. cites is how Coca Cola came to dominate globally with its systematic, data-driven strategy to infiltrate life’s ‘special moments’ and create early brand adopters. Global sales of Coke skyrocketed from about US$4 billion to $18 billion between 1980 and 1997 – without changes in sugar, salt or fat,” he notes.

 Dr. Mozaffarian concludes that, “Ultimately, the irony is that in trying to bring everything back to these three ingredients- whether related to food formulations, product success, or health – Salt Sugar Fat sensationalizes their true role. The real story, otherwise compellingly told, is not the allure of salt, sugar, and fat, but the remarkable power of modern branding, marketing and promotion. The real story for me is how the Harvard School of Public Health has got it right. Go Harvard!