Sweet But Dangerous: The Challenge of Institutional Change

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John Yudkin

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!

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2 Responses to Sweet But Dangerous: The Challenge of Institutional Change

  1. This is a superb case study. Some of the things which struck me particularly were:

    The depths to which vested interests will go to protect their short-term interests. I wonder how he kept going? What he and what we face is not exactly the same as being locked up in Robben Island but I’m going to dig out Mandela’s book again to see what advice he has for the period that Gandhi describe so well: “First they ignore you, then they ridicule you, then they attack you. And then you win.”

    How easy it is to buy/rent otherwise apparently credible “academics” and decision-shapers.

    How even now, with all the additional evidence, the food and beverage industry still continues to try fudge/confuse/delay/water down adaptive action. Perhaps we should be asking for some kind of Truth & Reconciliation process?

    Thinking across to the parallels with the fossil fuel / climate change debate, you can see why we are in such an almighty mess!

    Reducing sugar/switching to alternative sweetners/healthier recipes must surely be easier than converting from being a dirty energy to a clean energy company.

    The food industry has a direct retail face and there is very little public tolerance when info leaks that the sector has acted in a “dirty” or unethical/irresponsible manner (e.g. horsemeat in EU, contaminated milk in China etc.). Plus the sector has many corporations that are widely considered to be “CSR leaders” including Coca-Cola. In contrast, the fossil fuel sector has a business model which is totally based on externalizing as much cost to poor people/environment/future generations. Plus there are no major players who are responsible corporation. Yes, for statistical reasons some are “best in class” (egg BP) but with the sector’s standards are so low that the “best in class” frame is meaningless in a real world context.

    Having the right to be obese and unhealthy – and worse, having the right to spread this epidemic – hasn’t become defined as a critical part of one group’s core identity. In contrast, being aggressively skeptical about climate change has actually become a badge of honour for many: http://www.nature.com/news/why-we-are-poles-apart-on-climate-change-1.11166

    I am beginning to think that those who say that climate change is a good test for whether we should be allowed to continue as a civilization/species may be more right than I thought!

    More practically, this article highlights a major weakness of the CSR1.0/ESG1.0 industry – with some honorable exceptions, it says/does very little about corporate capture of science/politics/regulators. The topic is not new – this is from 2005 and the situation has got much worse, especially in the USA.

    In my work on “preventable surprises” I do highlight this issue: http://www.preventablesurprises.com/

    I don’t yet know of any major investment firm or even corporation that is adopting this kind of systemic assessment to risk. If I am wrong, pls do let me know.

  2. warren says:

    Yes, suggesting cause and effect through simple correlation can be
    a ‘dangerous’ assumption. But in many instances it may be a good
    starting point for further examination, bringing into account more
    variables not thought of initially. Many examples suggest this.

    With respect to raising the minimum wage, the debate continues on
    the economical impact. However, I think one thing ‘may’ be clear.
    If the minimum wage is raised from say 7 dollars per hour (American)
    to 12 dollars per hour (American)…human nature will take its course.
    Those people making 25 dollars per hour (American), will want a raise.
    The argument being, ‘I started at 7 bucks an hour 15 years ago, and worked
    my way up to 25 bucks an hour, and now someone just starting here is getting
    12 bucks an hour to start’. (explaining net present value and other financial
    considerations will not dissuade this argument as it is highly emotional)

    As such, the implication being made is that, most likely, increasing minimum
    wage will create inflation, as most people will want a raise. This argument
    is based on my intuition, and what I have seen in my business endeavours.

    Secondly, and somewhat related, is institutional funding through taxes. The
    moment a ‘government corporation’ gets word that perhaps millions of extra
    dollars are going to be allocated to their department or organisation as a
    whole, example – health care, most everyone instantly wants a raise. We have
    seen this through unions immediately wanting a raise once wind of any extra
    monies coming in is apparent.

    With the increase of housing prices in our area, sub-contractors were immediately demanding more monies for their trade, as one example, those
    hanging drywall increasing their labour charges by over 100% in a period of
    3 years on new home building. (one could also argue as the cost of housing
    and rent increases, people demand more monies, or vice versa if one plays
    the correlation ‘game’……while bringing in even more variables if one
    wants to).

    My point, is that it may be more prudent to view the economy in terms of
    of a ‘Shakespearean human nature’ viewpoint, or on a psychological basis,
    rather than purely economical indicators of supply and demand, admitting that all are related in some form.


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