*From Deltoid archives for 2004, a [repost](http://scienceblogs.com/deltoid/2004/09/zywicki.php)*

In my previous post I mentioned Daniel Davies’ demolition of yet another dodgy Steve Milloy article. Milloy attacked a recent JAMA study that found:

Higher consumption of sugar-sweetened beverages is associated with a greater magnitude of weight gain and an increased risk for development of type 2 diabetes in women, possibly by providing excessive calories and large amounts of rapidly absorbable sugars.

Todd Zywicki, who endorsed Milloy’s piece as a “devastating critique” has mounted a defence of Milloy. Unfortunately it is clear that Zywicki has not read the article (subscription required) or even the abstract describing the study.

Zywicki dismisses concerns about Milloy’s character raised by Davies and John Quiggin as not relevant to the question of whether the JAMA study is a good one or not. It isn’t, but Zywicki hasn’t read the JAMA study. Instead he is relying on Milloy to accurately describe it. Milloy’s character suggests that his description of the study might be misleading; and in fact it is misleading and as we will see below, Zywicki has been mislead.

Zywicki writes:

Milloy says that the once the researchers “statistically adjusted their results for bodyweight (a risk factor for diabetes) and for caloric intake (a proxy measure of consumption of sweetened foods other than soda), the 83 percent increase [in type 2 diabetes prevalence] dropped to an even more statistically dubious (and soft-pedaled) 32 percent increase.” Now it seems to me that Milloy is obviously correct here—bodyweight and non-soda caloric intake seem to me to obviously relevant to trying to isolate the marginal effect of the increased soda consumption. So the 83 percent figure is really an irrelevant number

Milloy has mislead Zywicki into thinking that the 83% increase in diabetes was partly caused by confounds—that the women who drank more sugary drinks also happened to be heavier and eat more and that these factors are what caused most of the increase. But right in the abstract they clearly state (my emphasis):

After adjustment for potential confounders, women consuming 1 or more sugar-sweetened soft drinks per day had a relative risk [RR] of type 2 diabetes of 1.83 (95% confidence interval [CI], 1.42-2.36; P<.001 for trend) compared with those who consumed less than 1 of these beverages per month.

So what is the 32% figure that Milloy tried to pass off as the “real” increase? Well, they found that increased soda consumption was associated with weight gain and weight gain is known to be a risk factor for diabetes. The 32% increase is the extra risk factor for soda consumption on top of the increase from the weight gain from drinking more soda. It would only be the real risk if sugar-sweetened drinks did not cause weight gain, but they do.

This is not the only matter that Milloy has misled Zywicki about. Zywicki writes:

Milloy similarly notes that the study does not control for genetics or lifestyle issues

But the study did control for genetics and lifestyle issues (my emphasis):

We evaluated whether the association between sugar-sweetened soft drink consumption and risk of diabetes was modified by BMI, physical activity, and a family history of diabetes using analyses stratified by these variables and by modelling interaction terms.

Milloy even accuses the authors of “scientific misconduct” for not mentioning another study that Milloy alleges contradicts their results. But that other study was not about soft drink consumption but about overall sugar consumption. The new study suggests that consuming sugar in a drink where it is more rapidly absorbed may increase the risk of diabetes. This is hardly contradicted by results that suggest that sugar intake including that in solid food is not a risk factor. Zywicki endorses the serious charges that Milloy makes without checking whether they are accurate.

Update: The Washington Times has also published Milloy’s misleading article and Reason‘s Nick Gillespie was also taken in. Matthew Yglesias reckons that libertarians should just argue that they have a right to unhealthy food instead of trying to debunk the science that shows them to be unhealthy.

Update 2: Nick Gillespie links here (thanks!) and to a Tech Central Station article by Jon Robison that criticizes the JAMA study. Robison, like Milloy, tries to pass of the 32% increase in diabetes, which is the extra risk after accounting for the effect of weight gain, as the total increase in risk. Robison also asserts that “Epidemiologists generally agree that relative risks less than 2 should be ignored or at least viewed with extreme skepticism”. In fact, epidemiologists do not “generally agree” with this. I explain why in this post.

Comments

  1. #1 J
    July 8, 2010

    Very nice work, Tim. Thanks.

  2. #2 Harald Korneliussen
    July 8, 2010

    Sure, it’s a good post, but why the rerun?

  3. #3 Eli Rabett
    July 8, 2010

    Posting this on Pepsi Blogs may be a no no

  4. #4 Tim Lambert
    July 8, 2010

    The Pepsi sponsored blog just [got pulled](http://scienceblogs.com/seed/2010/07/food_frontiers.php).

  5. #5 Stu
    July 8, 2010

    All of a sudden I really want some Coca-Cola.

  6. #6 Brian Angliss
    July 8, 2010

    I ran across Milloy in 2007, when I ran into his Demand Debate “poll.” I dove in and found that he’s attacked organic milk labels, critics of aspartame, and the link between IGF-1 and breast cancer in women, all on “junk science” grounds. I ran a three-part series on the guy in 2007, the first part of which is here.

    And while it doesn’t directly affect anyone outside the US, his uber-libertarian legal and investment project was part of a) the Citizens United SCOTUS review that overturned the ban on direct corporate funding of political candidates and b) the recent SCOTUS decision partly overturning the Sarbanes-Oxley accounting law. FEAFund is controlled by Milloy and Tom Borelli, both of whom were involved in the secondhand smoke PR push and investigations.

  7. #7 Mark Shapiro
    July 8, 2010

    Steven Milloy is a liar and a fraud.

    How I would love for one of his attackees to let folks know that!

  8. #8 Pinko Punko
    July 8, 2010

    Well done, T. Well done.

    Raising the specter of what shill-for-blog really means in the long run (Tech Central Station) is a nice reminder for how awful even a supposed transparent contribution from industry would be.

  9. #9 Trim&Fit
    July 8, 2010

    Stu

    If you must, stick to diet coke

  10. #10 Trim&Fit
    July 8, 2010

    Stu

    If you must, stick to diet coke

  11. #11 Trim&Fit
    July 8, 2010

    Stu

    If you must, stick to diet coke

  12. #12 Trim&Fit
    July 8, 2010

    Stu

    If you must, stick to diet coke

  13. #13 Trim&Fit
    July 8, 2010

    Stu

    If you must, stick to diet coke

  14. #14 Trim&Fit
    July 8, 2010

    Stu

    If you must, stick to diet coke

  15. #15 Trim&Fit
    July 8, 2010

    Stu

    If you must, stick to diet coke

  16. #16 Trim&Fit
    July 8, 2010

    Stu

    If you must, stick to diet coke

  17. #17 Trim&Fit
    July 8, 2010

    Stu

    If you must, stick to diet coke

  18. #18 Trim&Fit
    July 8, 2010

    Stu

    If you must, stick to diet coke

  19. #19 Trim&Fit
    July 8, 2010

    Stu

    If you must, stick to diet coke

  20. #20 ben
    July 8, 2010

    Does anyone not know that sugary drinks are bad for you? Kinda like smoking? Seems like the money spent on this study could have gone toward something more important.

    Diet coke, eh? The artificial sweetener probably causes cancer. No thanks.

  21. #21 Stu
    July 8, 2010

    I do drink diet coke over normal coke.

    Ben, I know – although I’m led to believe aspartame can cause a whole host of problems other than cancer. I just don’t want to get fat. Actually scratch that, I just think diet coke tastes better.

    If I could break the hold this fizzy demon holds over me, I expect I’d be healtier. But, from what I’ve read, the same does not hold for the beer or black coffee I drink. Seems I’m in what’s considered a beneficial range of consumption there! No such thing exists for cola. So hooray for beer and coffee!

  22. #22 Harald Korneliussen
    July 9, 2010

    Separating the hype from the whitewashing when it comes to sweeteners might have been something. I can’t say I have been able to do that for sure, but I’m confident the risk from sugars are underappreciated compared to sweeteners.
    So sugarfree cola it is for me. It’s a habit I picked up when I was a bit down in my life, and I’ve just sort of kept it. The best variety isn’t Cola Zero or Pepsi Max. It’s the one from the dispenser in the IKEA restaurant. Seriously.

  23. #23 toby
    July 9, 2010

    The amazing thing is that some thinks Milloy has a charcter to defend. the guy is a bigger fraud than Monckton.

  24. #24 Wow
    July 9, 2010

    “but I’m confident the risk from sugars are underappreciated compared to sweeteners.”

    Hmmm. Nope.

    Sugar is something your body has had to adapt to (and it has adapted to biochemistry) for ages. The only way you can have bad effects from sugar is by using too much. OK, for the USians, that means you can’t avoid but over use it (sugar in EVERYTHING?!?!?!?!). Sweeteners are meant to subvert your biochemistry to make you think it’s sweet. Your body is being faked by chemicals in a concoction it hadn’t seen before (else it isn’t patentable).

    But (rather like vegetarians wanting tofu beef slices) if you want it sweet, why not use sugar? If you don’t want sugar, don’t have it sweet. You’re not SUPPOSED to have sugary bread to put your corned beef in, and it’s superfluous for a sandwich with jam/jelly in.

  25. #25 Wow
    July 9, 2010

    “I just don’t want to get fat. Actually scratch that, I just think diet coke tastes better.”

    If you don’t like the taste, you’ll drink less and won’t get fat!

    See if you can get your drink with cane sugar instead of HFCS. Arizona has that generally available, imported from Mexico.

  26. #26 Robert
    July 9, 2010

    “Does anyone not know that sugary drinks are bad for you? Kinda like smoking?”

    A lot of work has gone into understanding exactly how and why smoking is bad for you. This is important in treating smokers, encouraging cessation, and guiding public policy (is smoking in bars safe for others? Etc.) I can see similar benefits in understanding sugary drinks.

    Broadly speaking, we have a very primitive understanding of the physiology of metabolism, including obesity. There are about 50 hormones and neurotransmitters in the mix (so far) and in most cases we have only the vaguest idea of what they do.

    “I’m led to believe aspartame can cause a whole host of problems other than cancer.”

    Yes. The cancer risk, if it exists, is likely very small, or it would be really apparent by this time. The larger problem seems to be that artificial sweeteners ramp up your appetite for sweet things — like an addictive drug, you get more and you want more (maybe — we’re not sure!) The sweetener is safe, but the additional calories you consume chasing the White Crystal Devil are not.

    About 95% of people who lose weight on a diet gain all or most of it back within a few years. The issue in a macro sense is that billions of years of evolution on this planet has left us with really really good solutions to problems that have been with us a long time — like stopping bleeding, fighting off infection, or running away from predators — but as regards the problems we have created for ourselves in the last few thousand years, evolution is a moron. It’s just too slow.

    Our metabolisms are evolved for calorie scarcity, which was the way of things for billions of years, and is the reason we love sugar and fat and salt. Calorie abundance we have few evolutionary defenses for, and it doesn’t help that we have clever capitalists (who are only doing their job — selling stuff) designing “food” and marketing it in a way that targets our genetic vulnerability.

    This is why obesity is so hard to tackle. A tax on sugary drinks might help, might not. An easy (some sarcasm there) first step would be to stop subsidizing the production of sugar and corn(syrup), and agriculture products generally.

  27. #27 Marion Delgado
    July 9, 2010

    Tim:

    We need to get the concept of confounders across to the publics of our countries. Whenever I talk about vaccine stuff and bring that up, no one understands it.

  28. #28 Brian Angliss
    July 9, 2010

    I’ve personally found that standard US Coke (made with high fructose corn syrup) leaves me craving more, especially if I choose to drink one “because I’m thirsty.” Mexican coke (made with real sugar) leaves me quenched so I don’t drink more than one. The same is true of Mountain Dew (HFCS) vs. Mountain Dew Throwback (sugar).

    I don’t do artificial sweeteners because I’ve had bad experiences with all of them except saccharine (and try finding any soda sweetened with that these days), and I try not to dump more chemicals into my body than I have to. YMMV, however.

  29. #29 Paul UK
    July 10, 2010

    The word is ‘REPOSTE’ my dear man (with the tone of Peter in Family Guy trying to sound posh).

  30. #30 jodyaberdein
    July 10, 2010

    My post is still in moderation over at the pepsi blog tho:

    Just so I’m clear:

    We want to empower top scientists working in industry to lead science-minded positive change within their organizations.

    Specifically we want to help top scientists research, discuss, think about subjects like: the potential effects of selling, targeted at the young, sugary highly calorific drinks to an increasingly fat and diabetic population.

    I can see the scientific difficulty here. Definitely worth the discussion I should say.

    Alternatively Pepsi scientists could take note of their CEO’s rather interesting views on the cause of obesity and get a proper job researching obesity in a proper metabolic medicine unit.

    http://blogs.wsj.com/health/2010/04/28/pepsico-ceo-blames-obesity-on-lack-of-exercise-really/

    J

  31. #31 Harald Korneliussen
    July 10, 2010

    Wow: If aspartame was as bad as they say, we’d know it by now, since it’s been used for such a long time. It’d have showed up in epidemiological studies. As far as I know, it doesn’t (unless you forget to correct for the confounding factor that diabetics use a lot more sweeteners than everyone else!)

    Sugar use _does_ show up in epidemiological studies, like the one Tim discussed six years ago.

    So theoretical considerations about why artificial sweeteners bad, are hardly worth speculating about. They aren’t bad, at least not bad enough that it can be observed. Sugar, on the other hand, is.

  32. #32 Wow
    July 10, 2010

    Harald, your first assertion is merely a theoretical construct.

    Overeating shows up in health studies, this doesn’t make eating dangerous.

  33. #33 truth machine
    July 12, 2010

    Pet peeve: has mislead, has been mislead

  34. #34 truth machine
    July 12, 2010

    I do drink diet coke over normal coke.

    Why drink any of this junk?

    I just don’t want to get fat.

    Eat well and exercise.

  35. #35 truth machine
    July 12, 2010

    Calorie abundance we have few evolutionary defenses for

    Ever see a fat farmer? It isn’t just that calories are abundant, but that we can obtain them with so little effort. It makes sense, then, to expend that effort in other ways. There are few obese people in my town, where hiking, swimming, running, cycling, and dancing are popular.

  36. #36 Sam-Hec
    July 13, 2010

    Looking to make the take-home message here.

    So HFCS laden foods are badder than other foods with identical (or more) calories because the former are addictive? or to paraphrase someone here ‘it leave’s you craving more’?

  37. #37 Wow
    July 13, 2010

    @25: or just eat less.

  38. #38 davep
    July 13, 2010

    Wow@15: “See if you can get your drink with cane sugar instead of HFCS. Arizona has that generally available, imported from Mexico.”

    The HFCS used in soda is 55% fructose and 45% glucose. Cane sugar (sucrose) is 50% fructose and 50% glucose. Honey is not much different than HFCS55 either. And fruit juice is sugar water.

    That is, cane sugar is no better or worse for you!

    The health issues with sugar (of nearly any kind) is the quantity in the diet.

  39. #39 Wow
    July 13, 2010

    davep, from what I remember of the biochemistry is that the corn stuff gets broken first and the sucrose gets stored for later because you’re overloaded. But your body wants to burn new calories, not extract them from fats laid down, so your body wants more sugar despite having laid down the calories from HFCS sucrose content.

    Rather similarly, alcohol burns easier and so your drinking means your eating is laid down as a beer gut (not made of beer!) and you burn the short-lived alcohol calories.

    Then you’re hungry.

    But as I said re 25, eat less. We’re more sedentary, we don’t NEED the calories. So eat less.

  40. #40 davep
    July 13, 2010

    wow@29 “davep, from what I remember of the biochemistry is that the corn stuff gets broken first and the sucrose gets stored for later because you’re overloaded.”

    What you remember is seriously incomplete and it’s surprising you didn’t do any research to confirm what you “remember”.

    The sucrose gets split in the gut into fructose and glucose. Fructose is processed by the liver (glucose is usable by all cells). (Alcohol is also mostly processed by the liver.)

    The “corn stuff” is 55% fructose and 45% glucose. This is very, very basic biochemistry. Again, “cane sugar” is no better or worse than HFCS used in soda.

    wow@29 “But as I said re 25, eat less. We’re more sedentary, we don’t NEED the calories. So eat less.”

    Eating less is obvious advice. It also means your “sugar cane” soda “advice” is pointless.

    Anyway, the types, amounts, and “delivery methods” of those calories matters too.

  41. #41 davep
    July 13, 2010

    wow:

    Anyway, it doesn’t appear that people can distinguish by taste between HFCS and cane sugar in soda.

    Also, HFCS is sweeter, which means less of it than sucrose is necessary for a given level of sweetness.

  42. #42 davep
    July 13, 2010

    wow:

    It appears that you were only recommending “cane sugar” soda for taste (not because it’s “better for you”). (My mistake.)

    Many people (not necessarily you) do think that “HFCS is bad/cane sugar is good” when the health issues (whatever they might be) of HFCS55 (used in soda) and cane sugar are nearly identical.

  43. #43 Wow
    July 13, 2010

    It’s the mix, davep. Like beer and pie & chips.

    Lovely.

    But your beer will leave you hungry because while you were metabolising the alcohol, the calories in the pie & chips was being stored for future use.

    And you need spare calories to start the chain reaction that allows you to metabolise the fats stored.

    The BAD thing is “eating too much for you”.

    And the taste of HFCS seems to be almost universally disliked compared to cane or sugar beet.

    Add to that that the US adds HFCS to ANYTHING and you’re asking for trouble.

    But sugar is a cheap way of making food palatable (again that pesky 1,000,000 year evolution without a Super Market) so in the interests of making food on the cheap, sugar WILL be added.

    And artificial sweetener is appalling: at best it keeps you acclimatised to having sugar in everything, at worst, it’s starving while surrounded with plenty (see Famine at work in “Good Omens” by N Gaiman and T Pratchett). Treat it like a nicotine patch.

    There’s no need for “Coke zero” if you only drink a Coke once a day as a treat. It’s not necessary to have sweetener if you’re only taking ENOUGH calories, rather than too many (and HFCS makes it harder to avoid “too many”). Then you can drink your Mountain Dew: the calories are merely calories you need, not a taste you crave.

    Eat appropriately and you don’t need Designer Calories.

  44. #44 eddie
    July 14, 2010

    I think it’s better to consume less than to consume and then excercise. Think of the CO2 you’re putting out.

  45. #45 Wow
    July 14, 2010

    Eddie, where does that CO2 come from?

    I think it would be better for eddie to sit down and breathe deeply. O2 is quite important for the correct operation of the brain…

  46. #46 Wow
    July 14, 2010

    davep: “Eating less is obvious advice. It also means your “sugar cane” soda “advice” is pointless.”

    Nope. Sorry. Comprehension fail.

    If you eat less, you don’t need to swap sweetner for sugar.

    This is pointless ONLY if you think eating is a mechanical process rather than something you should enjoy.

    If you don’t have HFCS (which is thrown into everything so that plenty of corn will be used because that gives corn farmers lots of government handouts) in all your foods, then you won’t even have to eat less: your bread will have fewer calories inherently.

    If you eat less, you can have soda with sugar in.

    This is only pointless if you think sugar in soda is a waste of time. In which case, why put sweetner in?

    If you have cane or beet sugar rather than HFCS your body will go “that’s enough” at a more appropriate time. This makes it easier to stop snacking and you won’t then eat more calories.

    This is only pointless if you already know that HFCS fakes your body out and stuffs up the body chemistry.

  47. #47 MFS
    July 14, 2010

    Wow,

    Kilojoules are Kilojoules. If your energy intake exceeds your energy consumption you will put on weight. The energy content of sucrose vs HFCS is not significantly different.

    You state above “There’s no need for “Coke zero” if you only drink a Coke once a day as a treat”. I would contend that, as there are 37.5g of sugar, on average, in an Australian soda can, you could be having, for example, 4 cups of tea or coffee with 2 sugars each to make up for that level of simple sugar intake. I would also contend that if you have got yourself accustomed to drinking sweet stuff when you’re thirsty, instead of water, weaning yourself off that, and back to water would significantly reduce your daily energy intake. Significantly enough to make a difference to your body weight.

  48. #48 Nathan Hinks
    September 12, 2010

    Obesity is not hard to tackle unless there is some debilitating injury that is causing excessive stagnation in a persons exercise.Obesity can be tackled by eating smarter, self discipline, and a correct, routine exercise program. Eating less could have a bearing on Obesity but eating food stimulates your metabolism so this may be counterproductive. The “sugary drinks” alone are not going to cause Americans to go into a tail spin of Diabetes. The body needs sugar everyday to keep itself operating functionally. Post 18 is correct when he says that the coke made with high fructose corn syrup is addicting in a way that makes him always want to drink more even when he has finished a whole can or bottle. There are plenty of excuses in the overweight debate but one thing remains clear: If you are motivated to lose weight you can do it, the power to win must come from within!

  49. #49 McPherson Mouse
    September 20, 2010

    Obesity has been around for a long time and taking sugary drinks out of the equation will do nothing to stop it. Much like stated in comment 38, it is the individual who chooses to be overweight not the can or bottle that which he or she picks up. Studies have shown that obesity is rather hereditary, as is type 2 diabetes (www.endocrineweb.com/diabetes/2diabetes.html), another topic of concern when talking about sugary drinks. Although these beverages may make a contribution to these conditions, they are very far from the soul reason for them. Taking these products out of the market would do nothing but further damage an already receding economy and make those who are healthy enough to enjoy these drinks angry. After all, I am an individual who consumes a decent amount of these beverages but am very healthy because I do not have a family history of these problems and exercise frequently.

  50. #50 Stu
    September 20, 2010

    >Studies have shown that obesity is rather hereditary

    Brilliant, fat parents have fat kids. Nothing to do with all the cake they keep in the house I’m sure.

    Maybe I’m being harsh. There is undoubtedly a hereditary link to one’s preponderance to gain weight; likewise, there is also undoubtedly a trend towards populations getting fatter in recent decades, linked inexorably to populations getting lazier and eating more junk food.

    >Taking these products out of the market would do nothing but further damage an already receding economy…

    Ahhh. A soft-drinks market libertarian ;-)
    So who suggested taking these drinks out of the market? Is that a viable option that anyone’s considering?

  51. #51 jakerman
    September 21, 2010

    >*Taking these products out of the market would do nothing but further damage an already receding economy and make those who are healthy enough to enjoy these drinks angry.*

    Same argument can be used to promote the adertising of Heroin on childrens television programming.

    http://www.abc.net.au/mediawatch/transcripts/s3016871.htm

  52. #52 jakerman
    September 21, 2010

    >*it is the individual who chooses to be overweight not the can or bottle that which he or she picks up.*

    Like the [4 years olds](http://www.publichealth.gov.au/pdf/atlases/sa_education_2009/Section5_Part4_Education.pdf#page=20) who “chooses” to to be obese. I guess they chose their parents too?

  53. #53 jakerman
    September 21, 2010

    >*Obesity has been around for a long time*

    Not at [these rates](http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/) it hasn’t. Are you an industry shill?

    >*and taking sugary drinks out of the equation will do nothing to stop it.*

    Argument by assertion. Now for [some evidence](http://www.ajcn.org/cgi/content/abstract/84/2/274):

    >*The weight of epidemiologic and experimental evidence indicates that a greater consumption of SSBs is associated with weight gain and obesity. Although more research is needed, sufficient evidence exists for public health strategies to discourage consumption of sugary drinks as part of a healthy lifestyle.*