Is Sugar Now Public Enemy #1?

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It seems medical journals are publishing more and more anti-sugar articles of late. Sugar is increasingly replacing added salt, saturated fat, and cholesterol as what MDs should be concerned about their patients overconsuming. Indeed, even socio-economic journals are focusing on America’s sweet tooth. []. Certainly, no one could argue that a diet high in refined sugar is heart healthy. And a quick look around the world certainly makes it clear that sugar intake is positively correlated with improving economic conditions. But for the past 15 years or so per capita sugar intake has been declining in the USA and yet obesity and type 2 DM continue to rise. And since the stock market bottomed in early 2009, it has returned to all-time highs, but sugar intake has continued to decline (albeit to levels that are still way too high).

But one could probably find a better correlation between meat intake and economic good times than sugar intake. It is pretty obvious that economic well-being leads people all over the world to increase their intake of meat and dairy products and also increase their intake of refined sugars. The concerning part about the Dr. Stanton Glantz’s opinion piece in the recent JAMA is that it feds the questionable narrative of Atkins and Paleo-Diet advocates that sugar is what really promotes heart disease rather than foods high in added salt, saturated fat and cholesterol. []. Was Dr. Mark Hegsted at Harvard wrong that foods higher in saturated fat and cholesterol increase serum cholesterol levels and higher serum cholesterol levels promote heart disease? Clearly citing Dr. Hegsted's as an example of having been biased for profit seems a stretch. What about the far more questionable conclusions of researchers like Dr. DiNicolantonio (a pharmacist at St. Luke's in Kansas) proclaiming in medical journals that sugar is the white crystal more responsible than salt for causing hypertension (HTN). []. Is Dr. Nicolantonio not a paid consultant to the Salt Institute? Is it any wonder that America's MDs and the general public are so confused about diet and disease?

Here's what I see happening. Since statins have come along, the impact of cholesterol-raising foods high in saturated fat and cholesterol on coronary artery disease (CAD) has certainly been muted. Before statins came along, MDs were told that a normal serum cholesterol level was about 180 to about 330mg/dl. Since statins came along, the NCEP has told MDs and the general public a "desirable" cholesterol level is <200mg/dl. And even lower levels are being promoted now for those deemed at high risk of CVD. We saw the same thing happen with blood pressure (BP) in the 1960s & 1970s after diuretics came along. Up until the early 1970s, most MDs were taught that a normal systolic BP was 100 + age. Ever since then, BP goals have been declining and now with the data from SPRINT, the medical community — with prodding from the pharmaceutical industry — is being increasingly told that more BP meds in higher doses should be prescribed to push BP down to 120/80mmHg. Now no one can argue that a cholesterol level of 310mg/dl is healthy or physiologically normal nor that a BP goal of 135/85mmHg represents optimal BP control. However, since we now know that a diet high in added salt, saturated fat, and cholesterol were largely the cause of most people developing HTN and also an "undesirably" high serum cholesterol level that led them to develop atherosclerosis and ultimately heart attacks, stroke, and heart failure why did drugs become the answer to diet-caused disease? Could it have been the political-economic efforts of the medical establishment with prodding from big pharma to convert diet-caused ills into "medical" ills best treated by MDs and not RDs?

So why has the medical establishment become so willing of late to focus blame on refined sugars for promoting not only weight gain but also the accompanying insulin resistance, metabolic syndrome, and type 2 DM? One cannot argue that refined sugar, especially added to beverages, is playing a major role in promoting excessive calorie intake. And excessive calorie intake clearly plays a major role in a host of metabolic abnormalities called the "metabolic syndrome" that includes elevated BP, dyslipidemia, and type 2 DM. However, big pharma has not come up with a drug or drugs that can largely negate the adverse metabolic effects of weight gain, and insulin resistance is being driven largely from consuming too much refined sugar. While deaths from coronary heart disease are down markedly in the past 40-50y and part of this is clearly due to drugs used to lower elevated BP and serum cholesterol levels, the medical establishment has largely failed to stem the obesity and type 2 DM pandemics. Yes, bariatric surgery is one of the fastest growing medical interventions in the USA, but its costs, risks, and complications make it unlikely to ever be viewed by the public as an acceptable general solution to the growing epidemic of obesity and type 2 DM. For some with type 2 DM, bariatric surgery certainly has less risk that staying obese. However, the FDA and big pharma have a rather sordid history of approving and marketing weight control drugs that failed to actually reduce either weight (for long) and/or total mortality. The failure of big pharma to produce a relatively safe and effective weight loss drug is contrasted by the relative success of BP meds and cholesterol-controlling meds that have at least been proven to reduce CVD and total mortality, especially in higher-risk individuals. Perhaps the history of failure of the medical establishment to come up with a fairly effective drug to treat or prevent obesity and its associated mortality compels it to focus its ire on the sugar industry as the new public enemy #1?

Bottom Line: One cannot argue that most Americans ought to be consuming less refined sugar. No doubt too much refined sugar is playing some role in promoting weight gain and contributing to insulin resistance, dyslipidemia, higher BP, fatty livers, and type 2 DM. No doubt added sugar also plays some role in promoting atherosclerosis and CAD, but it is not more important for raising BP than added salt nor is it more important than dietary saturated fat and cholesterol for raising serum cholesterol levels and promoting CAD. Singling out sugar as now being more responsible for raising BP and cholesterol levels than added salt and fat & cholesterol-rich animal products is clearly a gross distortion of what the best quality scientific data tells us is most likely true. Creating the impression among MDs and the general public that it is refined sugar rather than added salt and foods high saturated fat and/or cholesterol that is really most responsible for causing CVD makes no sense scientifically. However, it appears to make sense politically/economically to the medical establishment and that is something that should concern all nutrition-oriented health professionals.

By James J. Kenney, PhD, FACN

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