David Ludwig Critiques Tee Siong’s Nestlé-Funded Sugary Drink Study


Dr. David Ludwig, MD, professor of Nutrition and professor of Pediatrics at Harvard University.

Last week we examined Malaysia’s Type 2 diabetes epidemic and how the junk food industry has captured the nation’s nutritional and public health institutions. As in China, South Africa, and the United States, the junk food industry appears to have influenced Malaysia’s government through a malignant non-profit called the International Life Sciences Institute (ILSI).

Malaysian public health official Dr. Tee Siong has also served as ILSI Southeast Asia’s science director for over 20 years. Siong has leveraged his industry and government roles for personal gain by holding joint ILSI-Malaysian Ministry of Health events and charging admission fees to his own personal consulting firm. Simultaneously, the Malaysian Ministry of Health released national dietary guidelines advising Malaysians to “eat more rice.” And Malaysia’s diabetes rate has more than doubled since 1996.

We’ve received notable feedback from two readers. First, Singaporean-based science teacher John Gaskell sent us a 2015 review of “Diabetes Care in Malaysia.” The review found, “Poor dietary adherence, high consumption of carbohydrates, and sedentary lifestyle are prevalent in patients with T2D.” This observation is consistent with CrossFit Founder Greg Glassman’s assertion that excess processed carbohydrate and sedentarism are the primary causes of chronic disease. Eating large amounts of processed carbohydrates also is exactly what Malaysia’s public health officials, such as Dr. Siong, have told Malaysians to do. Dr. Siong’s Ministry of Health even puts “healthier choice labels” on Gatorade and Nestlé sugar cereal. Millions of Malaysians have gotten deathly ill following their government’s industry-sponsored advice. And this brings us to another Russells’ blog reader.

Dr. David Ludwig, MD, is a Professor in the Department of Nutrition at Harvard’s School of Public Health, a pediatric endocrinologist at Boston Children’s Hospital and a Professor of Pediatrics at Harvard Medical School. He is also the author of the New York Times #1 best-selling book “Always Hungry.”

In response to our findings, Dr. Ludwig emailed us his own critique of Dr. Siong’s research. The largest junk food company in the world, Nestlé, funded a paper Dr. Siong published on malted breakfast beverages. As the New York Times notes, this type of drink is “dominated in Malaysia by Milo, a sugary powder drink made by Nestlé.” A regular 14-ounce container of Milo power yields 168 grams of sugar, the equivalent of more than four cans of Coca-Cola. Nestlé vetted Siong’s paper before it was published, as it does all the research it pays Dr. Siong to perform. But it’s hard to believe Nestlé had to look at it very closely, given the extremely positive findings:

“Consuming malted drinks is associated with higher micronutrient intakes and higher levels of physical activity, but not with body weight status.”

Don’t go out and buy glorified chocolate milk powder for your health just yet, though. According to Dr. Ludwig, the Nestlé-Siong study does not exactly rise to the level of pristine scientific research:

“A recent NY Times investigative article raised questions about the interpretation of this study, and possible harms to public health in developing nations from consumption of sugary beverages such as the ones examined here. However, the NY Times article did not provide a detailed critique of the scientific methods.

The authors of this study conclude, ‘These findings suggest that malted drinks are a micronutrient-rich beverage which are unlikely to promote excess energy intake and obesity risk, at the consumption pattern in the population assessed.’ I believe that this conclusion is overstated, for the following reasons:

First: The study design, a cross-sectional survey, is weak and especially susceptible to confounding.

Second: The final participation rate was only about 1/5 the total invited sample, potentially leading to major selection bias (thus, undermining intent to obtain a nationally representative sample).

Third: The validity of the method to measure diet, (e.g., 10 to 12 year olds responded on their own) was not demonstrated.

Fourth: Malt beverage consumers were more physically active and watched less screen time: thus, they likely came from families with greater health consciousness. Therefore, the associations with higher intakes of a few micronutrients may simply reflect confounding. That is, they may have gotten the extra nutrients from other components of the diet. Unfortunately, this point was not examined in the study.

Fifth: Concerningly, the statistical models were not adjusted for physical activity and screen time. Doing so could have unmasked higher body weight among the malt beverage consumers. That is, perhaps the increased PAL and less screen time counteracted the adverse effects of beverage consumption.

Indeed, the true associations between sugar-sweetened beverages and body weight shown in higher quality prospective studies Schulze MB, 2004 are often not seen in cross-sectional surveys Forshee RA, 2004 – demonstrating the weak nature of this study type.”

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