Sugar, Not Salt, at Heart of Cardiometabolic Disease

A new study contends that dietary guidelines for treating hypertension and cardiovascular disease (CVD) should focus on reducing the amount of added sugars, primarily fructose, and not salt.

Researchers at Montefiore Medical Center (New York, NY, USA) and St. Luke's Mid America Heart Institute (Kansas City, MO, USA) conducted a review of epidemiological studies and experimental trials in animals and humans and concluded that the evidence suggests that added sugars, particularly fructose from corn syrup, may increase blood pressure (BP) and BP variability, increase heart rate and myocardial oxygen demand, and contribute to inflammation, insulin resistance, and broader metabolic dysfunction.

They also suggest that while recommendations to reduce consumption of processed foods are highly appropriate and advisable, the benefits of such recommendations might have less to do with sodium—which is minimally related to BP and perhaps even inversely related to CVD risk—and more to do with highly-refined carbohydrates. They conclude that reduction in the intake of added sugars, particularly fructose, and specifically in the quantities and context of industrially-manufactured consumables, would help not only curb hypertension rates, but might also help address broader problems related to cardiometabolic disease. The review was published on December 10, 2014, in BMJ Open Heart.

“Recent data encompassing over 100,000 patients indicates that sodium intake between 3 and 6 gram per day is associated with a lower risk of death and cardiovascular events compared to either a higher or lower level of intake,” concluded study authors James Di Nicolantonio, MD, of Saint Luke's, and Sean Lucan, MD, of Montefiore Medical Center. “In fact, there is some evidence suggesting that reducing sodium intake could lead to worse health outcomes, such as increased cardiovascular and all-cause mortality in patients with diabetes, and increased hospitalizations and mortality in patients with congestive heart failure.”

“Just as most dietary sodium does not come from the salt shaker, most dietary sugar does not come from the sugar bowl; reducing consumption of added sugars by limiting processed foods containing it, made by corporations, would be a good place to start,” added the study authors. “The evidence is clear that even moderate doses of added sugar for short durations may cause substantial harm.”

Related Links:
St. Luke's Mid America Heart Institute
Montefiore Medical Center
Link to Hospimedica item on Salt study