December 10th, 2014

Focus on Getting Rid of Sugar, Not Salt, Say Authors

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.


3 Responses to “Focus on Getting Rid of Sugar, Not Salt, Say Authors”

  1. Antonio H. Reis, Ph.D says:

    This is not new. From time to time studies of this kind appear in the literature (please see below the papers 1-3).
    On the other hand, the review by Cochrane Collaboration and published in The Cochrane Library, 2011, Issue 10 concluded: “Salt restriction increased the risk of all-cause death in those with congestive heart failure (end of trial relative risk: 2.59, 95% 1.04 to 6.44, 21 deaths).
    It’s time to revisit and scrutinize the old simple beliefs.

    1. Heather Basciano, Lisa Federico and Khosrow Adeli “Fructose, insulin resistance, and metabolic dyslipidemia”, Nutrition & Metabolism 2005, 2:5.

    2. Diana I. Jalal, Gerard Smits, Richard J. Johnson, and Michel Chonchol, “Increased Fructose Associates with Elevated Blood Pressure.” J Am Soc Nephrol 21: 1543–1549, 2010

    3. Stephanie Seneff, Glyn Wainwright,Luca Mascitelli,3 “Is the metabolic syndrome caused by a high fructose, and relatively low fat, low cholesterol diet?” Arch Med Sci 1, February (2011).

  2. Milton Havron, M.D. says:

    Time is far overdue for the nutritional professional community to wake up to the many ill effects of excess intake of carbohydrates generally, and refined carbs in particular. This could help stem our current epidemic of “diabesity,” with attendant dyslipidemia and nonalcoholic steatohepatosis (NASH). The traditional recommendation of 60% of daily calorie intake as carbohydrates is far too generous for the average individual. A balanced low-carb diet is a far more natural way to go for nearly all of us. I base my opinion not only on recent literature but my observations of patients in a medical weight loss clinic I supervised from 2007-2009.

  3. Jean-Pierre Usdin, MD says:

    Soft-drinks shorten Telomers (and Life!)see “American Journal of Public Health” Volume 104, Issue 12 (December 2014)
    and Bisphenol A in cans and plastic glasses ups systolic blood pressure in a South Korean study: JWatch december 9 2014…

    Have drink?