An investigation revealed Big Sugar worked to shift the blame onto dietary fat and cholesterol. This may be one reason we don't associate the sweet stuff with cardiovascular risk factors, according to the authors of the report.

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When people think about the health risks of eating too many sweets, they tend to think of weight gain, diabetes, and cavities—not, necessarily, heart disease. And when asked about dietary risk factors of heart disease, the leading cause of death worldwide, chances are your go-to response would be high-fat foods like burgers or steaks.

But in fact, sugar and heart disease may be more linked than many of us realize, according to a report published this week in JAMA Internal Medicine—and there’s a very disturbing reason why we haven’t made the connection.

For years, the sugar industry anonymously funded nutritional research on heart disease, according to archival documents uncovered by researchers at the University of California San Francisco (UCSF). And while there’s no direct evidence that sugar executives wrote or changed actual published conclusions, it is clear that they influenced research methods in order to promote dietary fat as the main cause of heart disease while downplaying the role of sugar.

Cristin Kearns, DDS, a researcher in the UCSF School of Dentistry, first began wondering about Big Sugar’s role in government health recommendations back in 2007 while attending dental conferences on gum disease and diabetes.

“I wasn’t hearing anything about sugar consumption as a risk factor, so I started wondering if the sugar institute had influenced federal policy,” she says. She uncovered documents in public libraries and co-wrote an article published in 2012 that detailed the industry’s role in a 1976 FDA report.

Once Dr. Kearns began working at UCSF, she teamed up with researchers in the school’s Center for Tobacco Control Research and Education who had made similar discoveries about the cigarette industry. “Our first paper was on how the sugar industry influenced tooth decay research, and for the next project I wanted to look further back, to the sugar industry’s heart-disease program.”

What they found was equally incriminating. Internal documents from the Sugar Research Foundation (SRF) revealed correspondences with a Harvard University professor who was paid by the SRF to conduct research in the 1960s that focused on fat and cholesterol as the dietary causes of coronary heart disease.

The SRF, which later became the Sugar Association, dictated what the research would be about, contributed articles to be included in a literature review, and received drafts of the research before its publication. When the review was published in the New England Journal of Medicine in 1967, the SRF’s funding or role was not disclosed. (The journal did not require authors to disclose such details until 1984.)

Although these documents provided only a small view into the activities of one industry trade group, the authors say that they do demonstrate “the importance of having reviews written by people without conflicts of interest and the need for financial disclosure.”

It also provides an important message to the general public. “The industry has worked to keep the average American from making the connection between sugar consumption and heart disease,” says Dr. Kearns. Knowing the truth is important, she adds, especially for people who are concerned about heart disease or are at higher-than-average risk—like, for example, anyone with high triglycerides.

“We knew back in the 60s that sugar consumption could impact triglycerides, and I think that subgroup of people really should have been counseled much earlier on the importance of restricting their sugar consumption,” she says.

In response to the report, the Sugar Association issued a statement saying that the industry “should have exercised greater transparency in all of its research activities.” However, it also questioned the researchers’ “continued attempts to reframe historical occurrences to conveniently align with the currently trending anti-sugar narrative,” and claimed that decades of research have concluded “that sugar does not have a unique role in heart disease.”

Sugar’s exact role may still be unclear, says Dr. Kearns, but scientists are playing catch-up from many years of biased science. “I’d like to see policymakers looking at the risk of sugar," she says, "and to really scrutinize that evidence of cardiovascular disease that’s previously been left out of the equation.”

She’d also like to see more regulation around the funding of scientific studies. “We have much more stringent policy now that we ever did before, but we are still debating in the public health community whether the food industry should be funding nutrition studies,” she says. “Our research is an important part of that debate, because it’s evidence of what can happen when they do.”