CardioExchange Archive

Too much negative attention has been focused on salt and not enough on sugar, write two authors in Open Heart. Reviewing the extensive literature on salt and sugar, they write that the adverse effects of salt are less than the adverse effects of sugar. The evidence supporting efforts to reduce salt in the diet is not convincing and we would be far better off reducing sugar instead of salt in the modern diet.

“Future dietary guidelines should advocate substituting highly refined processed foods (ie, those coming from industrial manufacturing plants) for natural whole foods (ie, those coming from living botanical plants) and be more explicitly restrictive in their allowances for added sugars,” write James DiNicolantonio and Sean Lucan. “The evidence is clear that even moderate doses of added sugar for short durations may cause substantial harm.”

Salt prevention is often the cornerstone of dietary therapy for people with hypertension or at risk for developing hypertension. Less appreciated is that sugar can raise blood pressure in addition to its other well known adverse metabolic effects. Hypertensives are also much more likely than nonhypertensives to have insulin resistance — and it is well established that high sugar in the diet can exacerbate this problem and lead to diabetes.

“Sugar may be much more meaningfully related to blood pressure than sodium, as suggested by a greater magnitude of effect with dietary manipulation,” they state.

Lowering salt in processed foods may cause people to compensate and ultimately consume more processed food, the authors write. The end result is consumption of the same amount of salt but even more sugar, since these foods also often contain high amounts of added sugars.

The authors cite a wide variety of studies showing the ill effects of sugar. For instance, people who get a quarter or more of their calories from added sugar have a nearly threefold increased risk of cardiovascular death.

One particular villain is high fructose corn syrup, which is most often used in sugar sweetened beverages. “Worldwide, sugar sweetened beverage consumption has been implicated in 180,000 deaths a year,” they write.

One piece of good news: sugars, including fructose, are not harmful and may be even beneficial when they are consumed “in their naturally occurring biological contexts”– in other words, as whole fruits.