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Sweet But Dangerous: The Challenge of Institutional Change

Posted on February 25, 2014 by David

John Yudkin
(1910-1995)

There was a very interesting story in the Sunday Telegraph a couple of weeks ago about John Yudkin (1910-1995), a British physiologist and nutritionist who did pioneering work on the connection between the consumption of sugar and all manner of health problems. In 1972 he wrote a book Pure, White and Deadly that outlined the link between excessive sugar consumption and heart disease and hinted at its connection to obesity, diabetes and liver disease as well as possible relationships with some kinds of cancer.

Not only was this message extremely unwelcome to the sugar industry and manufacturers of processed foods, but it went against the conventional wisdom of the times that saturated fats were the problem. The fat story had been a boon to sugar industry because food processors had responded to public concern about health by producing low-fat versions of their products and using vast amounts of sugar to conceal the fact that without fat they tasted awful. Thus what followed Yudkin’s book is a classic illustration of the challenge of institutional change. Like the tobacco industry and the makers of leaded gasoline, to name just two examples, the sugar industry and those who used sugar as a major ingredient of their products, had insinuated themselves into the fabric of the communities they depended upon. Sugar manufacturers sat on national nutrition councils and pop producers sponsored conferences. They set out to discredit Yudkin and his work in ruthless, unscrupulous ways. He found himself disinvited from conferences and vilified by fellow scientists employed to discredit his work, which was dismissed as “emotional assertions” and “science fiction”.

The Challenge of Proving Cause-and-Effect

I believe that one of the reasons that Yudkin found his conclusions so compelling was the contexts in which he made his discoveries. During World War II he served with the Royal Medical Corp in Sierra Leone. There he studied a local skin disease and found that it was due to a riboflavin deficiency and not an infection. This tied in with his findings on the social and economic components of malnutrition in the UK. He returned to the UK determined to set up an interdisciplinary study of nutrition. Fortunately the lifting of food rationing in the UK after World War II supplied a crude semi-controlled experiment of the impact of diet on health. With the return of added sugar to Britons’ diets, the incidence of obesity and related health problems soared. Yudkin argued that the correlation between sugar consumption and heart disease was much clearer than that with fat. In addition he suggested that mankind had been eating fat for millennia but added sugar was a fairly recent feature of our diets.

Although the correlations were clear, the mechanisms of cause-and-effect were not. This is not surprising as several of the hormones that would explain Yudkin’s findings had not yet been discovered and the cycles of digestion were poorly understood. We now understand that the consumption of fructose (as opposed to glucose) can be digested only by the liver, which converts it to fat. Excessive consumption can lead to resistance to insulin and all the evils that accompany that.

For a student of institutional change the absence of clear proof of cause-and-effect in the workings of complex systems seems to be one of the major barriers to changing mental frameworks or paradigms (as they are popularly called) and the practices and institutions that they justify. Not only can one not show what exactly is causing a present problem but it is difficult to demonstrate the efficacy of any proposed solution. Take the current debate over the minimum wage in the USA. One would think that a “science” like economics would speak clearly on the topic and in theory it does – raising the cost of anything will reduce the amount of it consumed. In practice, of course that’s not true and the evidence for and against raising the minimum wage is equivocal. It’s context-dependent – some jobs are lost and some incomes are raised but whose and by how much varies all over the map. As a result the evidence persuades no one and people default to their worldviews and how things ought to be rather than how they are.

The Fossil Record

This challenge of proving cause-and-effect is found even in purely scientific issues that are untouched by national politics. Alfred Wegener (1880-1930) was a German geophysicist and meterorologist who was the first to seriously propose the theory of continental drift – that the continents had once been together and had drifted apart. Ever since the mapping of the earth people had noticed that the east coast of South America fitted rather snugly with west coast of Africa but Wegener gathered fossil histories and documented geological features to produce powerful evidence that the landmasses had once been joined. In the absence of a mechanism of causation, however, the evidence persuaded few others. The American Association of Petroleum Geologist organized a conference specifically to oppose his theory; some opponents argued that the oceans’ crust was too firm for the continents “simply to plough through”! It was only with the emergence of the science of paleomagnetism in the 1960s and the development of the theory of plate tectonics that the causal mechanism became clear. With that the geological paradigm change almost overnight.

All this is rather depressing for those trying to change social and political institutions where, as the minimum wage debate demonstrates, causal mechanisms are unclear, highly variable and context-dependent. It suggests that, in the absence of clear proof of cause-and-effect, one needs working examples – prototypes – of systems that have been changed from the old way of working to the new one. Even then, there will be arguments about what the causal mechanisms are. For instance, I disagree with the proponents of conscious capitalism that the movement is a “new paradigm”. Instead I suggest that it is a stage that many organizations go through and that we need to understand the dynamics of this ecological change rather than embrace the “principles” that seem to describe this one stage. But there is no doubt that the very presence of firms like Costco and Whole Foods challenges the current economic theories of cause-and-effect far more seriously than any intellectual argument.

In the case of John Yudkin his redemption seems to be near. Robert Lustig, a professor of pediatric endocrinology had discovered the same relationships between sugar and health without being aware of Yudkin’s research. But now with a mechanism of cause-and-effect in place there seems to be a chance of addressing the soaring rates of obesity and diabetes. Pure, White and Deadly has been republished and even though the sugar industry still does not accept its findings, attributing the surge in obesity to “a range of complex factors”, the World Health Organization is set to recommend a drastic cut in our sugar intake. Britons average 12 teaspoons a day (American average over 22 – there are 10 teaspoons in a single can of regular Coke!) and there is talk of a recommended limit of 5 teaspoons a day or no more than 10% of one’s calorie intake. Sweet vindication for John Yudkin, but the work of change agents everywhere will remain dangerous!