ONE lump or two?

Or how about three? As long as it's a balanced part of the "total make-up" of whatever you're eating or drinking, the Australian Heart Foundation seems to be OK with sugar.

Supports it even, to the tune of awarding its Healthy Heart Tick in recent years across an increasingly wide range of sugar filled foods, including burgers, pizzas, fruit bars and cereals.

That apparent laxness has the Heart Foundation facing an identity crisis, as it struggles to balance some $2.5 million in annual food industry sponsorship against its mission to make healthy recommendations.

Critics accuse the organisation of selling its credibility, claiming its refusal to limit sugar in the Tick program has further eroded the public's trust.

A news.com.au investigation has found extensive links between the Heart Foundation and the food industry; links that involve corporate sponsorship, high-level staff moving between the two and the increasing comercialisation of the influential Healthy Heart Tick certification program.

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The foundation vigorously denies suggestions its Tick is "for sale" and states it has employed people with experience in the food industry as they bring valuable expertise to the work of the Foundation.

Opponents say it is no longer appropriate for a non-profit organisation reliant on food industry funding to take on so much responsibility for healthy food labelling.

"They actually (seem to) pick the best of a bad bunch," nutritionist Dr Rosemary Stanton told news.com.au.

"Often the Tick does not translate into healthy choices for consumers, but it does increase sales of the products receiving the tick."

A sticky situation?

The relationship between the Heart Foundation and its corporate partners is at its most contentious when it comes to sugar.

The Heart Foundation Tick used to place limits on sugar content but the foundation changed its Tick guidelines in 2001.

Since then the foundation has maintained that sugar is not an issue, arguing in a recent submission to a Federal Government inquiry into food labelling that "there is a lack of evidence linking sugar to diabetes, heart disease, high blood pressure, hyperactivity or inadequate nutrient intake".

Yet in an opinion article published this month in science journal Nature, three US health academics labelled sugar as more toxic than alcohol in its impact on public health.

"Non-infectious diseases, such as heart disease, cancer and diabetes, now pose a greater health burden worldwide than infectious diseases,” doctors Robert Lustig, Laura Schmidt and Claire Brindis wrote.

"A primary culprit behind many of the major killers is sugar."

They are not alone:

- The British Heart Foundation last year warned about the dangers to heart health from added sugar after a recent study linked the two.

- The World Health Organisation and World Heart Federation also warn about high sugar consumption as a risk factor associated with heart disease, especially in the marketing of high sugar foods to children, and calls for limits on sugars in food, and;

- The American Heart Association and even the Australian Government say to limit overall sugar intake.

Yet the Heart Foundation maintains there is "no scientific consensus" that sugar as a nutrient causes heart disease and therefore was not included in the Tick's criteria.

The foundation told news.com.au that its position was based on "sound science".

"The Heart Foundation believes that people need to look at the total make-up of a food, not just one element such as sugar, to determine if it is a healthier choice," a spokeswoman told news.com.au.

"If we were to look only at sugars in a food, it would mean foods like breakfast cereals, yoghurts and even fresh, canned and dried fruit would appear to be poor choices as they can be higher in sugars than other foods despite providing vital nutrients for good health."

The only evidence it provided when asked about this was the dietary guidelines of the National Health and Medical Research Council, saying the only issue raised in the guidelines regarding sugar was in relation to dental decay.

However, a spokesman for the NHRMC contradicted this claim, telling news.com.au that the council and the current guidelines made recommendations to reduce overall added sugar intake.

The foundation also advised that the best way to reduce the risk of cardiovascular disease is to reduce the intake of sodium, saturated fat and trans fat, increase the intake of dietary fibre and reduce overall kilojoule intake. And to be more active.

So there's good sugar and there’s bad sugar?

The three mains types of sugar are glucose (sugar in its basic form), fructose (mainly found in fruit) and galactose (in milk as part of lactose).

Common table sugar - sucrose - is mainly derived from sugar cane and made up from one part glucose and one part fructose.

But it's fructose that creates the most concern, often found in products which claim no "added sugar" like fruit juice and fruit bars and the type most commonly linked to health problems.

The Heart Foundation's Tick can be found on a range of high sugar content products including Uncle Toby’s Fruit Fix bars (71 per cent sugar) Uncle Tobys Oats Temptations (34 per cent sugar) and Nestle’s Milo Breakfast cereal (29.7 per cent sugar) and Kelloggs Just Right (31.1 per cent sugar).

But try to convince the foundation that giving its Tick to foods with high sugar content equates to condoning poor nutrition and you'll come up against a senior workforce with strong links to promoting the benefits of sugar, including:

- The NSW Heart Foundation CEO since 2003, Tony Thirlwell. Mr Thirlwell was in charge of a massive campaign on behalf of the sugar industry while working for sugar giant CSR in the 1980s. It aimed to convince Australians that sugar was "a natural part of life" and was not bad for people’s health at a time when sugar consumption was declining.

- A former senior nutritionist at the Heart Foundation who was also a former CSR sugar employee from the same time as Mr Thirlwell. The nutritionist also worked for the Low GI symbol program which features on CSR sugar products, Kelloggs and Nestle and has since left the Heart Foundation to work for softdrink giant PepsiCo.

- The marketing manager of the Tick program between 2006 and 2010, who had previously worked for the sugar lobby group Sugar Australia – 75 per cent owned by CSR.

- Mackay Sugar Limited, which owns the remaining 25 per cent of Sugar Australia, is also listed as a corporate sponsor of the Heart Foundation.

Mr Thirlwell denied there was any conflict of interest in his past and present roles and said his previous work with the sugar industry had no bearing on his current role at the Heart Foundation.

A Heart Foundation spokeswoman said: "Mr Thirlwell’s employment of almost a quarter of a century ago is not relevant to his current role and responsibilities.

"He is one of Australia's most senior not for profit CEOs and anyone who knows Mr Thirlwell is aware of his commitment to making Australians healthier and how hard he works to reduce death and suffering caused by cardiovascular disease."

Despite efforts to obtain responses, neither of the two former staff mentioned above would agree to be interviewed by news.com.au.

The Heart Foundation also receives sponsorship from Nestle-owned Uncle Tobys for its campaigns. Nestle research and development works with the Heart Foundation’s research team, which cites Nestle sponsored studies on its website.

The authors of the Nature article say that as worldwide sugar consumption has increased, so too has the influence of the Sugar lobby and companies that create products high in sugar.

"We recognise that societal intervention to reduce the supply and demand for sugar faces an uphill political battle against a powerful sugar lobby, and will require active engagement from all stakeholders," the authors write.

The Heart Foundation said it was aware of the fact some staff had in the past worked for the food industry and said they brought valuable expertise.

"The Heart Foundation has employed people with experience in the food industry," a spokeswoman told news.com.au.

"These employees bring with them knowledge of how the food supply can be improved to make Australians healthier."

Health activist and author David Gillespie is a well known critic of the Heart Foundation's position on sugar and food industry links. He believes commercial arrangements have "an insidious effect" on the organisation, but there's no "grand conspiracy" in relation to who they’re hiring.

"It's just relatively easy and cheap for companies to co-opt these health organisations which are so hard up for money," he said.

The money trap

The Heart Foundation's most recent financial statements show it lost almost $30 million between the 2007 and 2010 financial years.

In the financial year ending mid-2010, the Healthy Tick program netted $2,437,170. It also receives other corporate sponsorships outside the Tick program.

Last year, the Heart Foundation caved in to pressure to abandon highly damaging endorsements of McDonalds foods along with other brands selling pizzas and pies. Ticks for McDonalds products alone were worth $300,000 a year.

Since the end of its fast food deals the Heart Foundation has begun providing large-scale endorsement to supermarket generic brands. Aldi last year announced it had received Tick approval for 100 of its own branded products, but refused to reveal how much it pays the Heart Foundation annually for the endorsement.

The Heart Foundation has attacked critics in the past for suggesting the tick is "for sale", pointing out that the licensing fees pay for monitoring and testing of Tick products to ensure compliance with the Tick guidelines.

"License fees are the only income source for the Tick," a spokeswoman told news.com.au.

"Donations from members of the public are used to fund life-saving research and to fund our community heart health programs."

Nestle receives generous approval of its products, with exactly 100 currently carrying the tick, including the controversial Fruit Fix Bars, Oats Temptations and Milo breakfast cereal.

Mr Gillespie said he wasn’t surprised the Heart Foundation found ways to negate perceptions that high sugar levels were linked to health problems.

"The reality is if they changed their mind tomorrow and started limiting the amount of sugar in the guidelines there would be very few foods that would qualify," Mr Gillespie said.

"Partnership, not sponsorship"

Nestle's media relations manager Anita Catalano said sugar was not the main issue when assessing nutritional benefits in its products and that Nestle had made no attempt to influence the Heart Foundation’s health policies or position on nutrition at any time.

"Why is there so much focus on sugar?” she asked news.com.au.

"The focus should be on total energy intake (kilojoules) and the nutrients you are getting for that energy, i.e. nutrient density.

Sugar is gradually being lowered across the board in our products but what is more important is that you are getting fibre, wholegrains, vitamins and minerals as well as a great way to enjoy the benefits of milk."

Nestle described its relationship with the Heart Foundation as a "contractual relationship" and argued that it did not "pay for the Tick", rather the company earned the approval for years of work on reformulating its products.

"This is not a sponsorship but rather a partnership between two organisations trying to improve the food supply and educate consumers about healthier eating," Ms Catalano said.