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REASSESSING THE ROLE OF SUGAR IN THE ETIOLOGY OF HEART DISEASE

The roles of animal fat and sweeteners (mono-and disaccharides) in acute myo-cardial infarction and other ischemic heart disease are examined through multi-country statistical associations between the dietary components and the heart disease mortality rates for 1986 for males and females aged 35-74 in 33 countries. For both acute myocardial infarction and other ischemic heart disease, it is found that dietary animal fat is the primary dietary macronutrient risk factor for mortality among males, with some contribution from sweeteners, while sweeteners are found to be the primary dietary macronutrient risk factor for females. Similar results are found for time-variations of coronary heart disease in Spain, 1965-1990. The likely mechanism linking sweeteners to heart disease is that it raises serum triglycerides and, hence, very low density lipoprotein levels. Similar results were reported in the 1960s, but only for males. While these results appear to be robust, others may want to reexamine these findings through other approaches. Objectives It is widely accepted that consumption of animal fat is a risk factor for coronary heart disease (CHD). 1-4 A perusal of the 1960s literature indicates that there is also a link between dietary sugars and heart disease, although this fact is overlooked in the more recent literature. Yudkin 5 seems to have made the first multi-country link between sugar and coronary heart disease, but could not exclude animal fat from also having a role. In the 1960s, he strengthened the case for sugar. 6,7 Osancová et al. 8 showed that sugar consumption correlated better than fat consumption with cardiovascular disease mortality in Czechoslovakia. Others 9-11 showed that dietary sucrose increased total serum cholesterol levels, while complex carbohydrates could lower serum cholesterol. 10 Sucrose was shown to be associated with increased serum cholesterol or lipoprotein compared with vegetables and legumes (0.1 for a 0.10-0.14 exchange of calories) 12 or purified wheat (up to 0.14 for a 0.15 exchange of calories). 13 In addition, Macdonald 14 showed that women aged 54-68 years had an average 30 mg higher serum cholesterol after being fed diets containing 7.5 g/kg of body weight of sucrose compared to purified wheat starch for 25 days. Keys 15 strongly attacked Yudkin' s claim that dietary sucrose was a major factor in the development of coronary heart disease, pointing out that some countries with high sugar consumption and low CHD incidence were omitted, that dietary fat and sugar are highly correlated, and that …