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  Sugar vs salt debate
(Updated: 21/10/2016)
A recent article from the British Medical Journal lends much needed insight into the sugar vs. salt debate. I often tell my patients that sugar is their enemy (and other foods that quickly turn to glucose). We know that heart disease is the leading cause of premature mortality in the developed world and hypertension is one of the biggest risk factors. This information shifts the conversation. To avoid hypertension and heart disease, we should be focusing on the sugar in our diets.

Hypertension is a primary or contributing factor in almost 350,000 deaths and costs $50 billion annually (2009 data). Based on this study, dietary guidelines should target sugar-high fructose corn syrup in particular.

High fructose corn syrup is the most common sweetener used in processed food and drinks such as sugary fruit juice and soda. A diet consisting of daily added sugar intake that adds up to a quarter of total daily calories can triple a person's heart disease risk compared to people who consume less than 10 percent. Consuming more than 74 grams of fructose a day can also lead to a 77 percent higher risk of blood pressure above 160/110 mm Hg.

Processed foods are a major source of both sodium and sugar (in the form of refined carbohydrates). These refined carbohydrates (starches) are quickly converted in the body to glucose, raising blood glucose and insulin levels, contributing to insulin resistance and causing weight gain.

Sugars, especially monosaccharide fructose, are now being more closely associated with development of hypertension and increased cardiovascular risk through a variety of mechanisms. Lowering fat in our diets by increasing sugars (i.e. fat-free ice cream) is likely doing even more damage due to increased intake of simple carbohydrates and sugar. It seems that the drive to lowering sodium may actually be increasing hypertension and heart disease.

So what is the best diet to avoid cardiovascular disease? Vegetarian, vegan, paleo, Mediterranean, low fat, high fat? I have nothing against those who choose a vegan or vegetarian diet for themselves. However, be aware of the simple carbohydrates (breads, pasta, and white rice) which will lead to higher risk of hypertension and heart disease.

Low fat likely isn't the answer in the presence of simple carbohydrates. Atkins has been shown to be difficult to sustain and I am not convinced in its true form it is a healthy long-term diet. I tend to recommend a Mediterranean type diet-one rich in vegetables, moderate fruit intake, healthy proteins, monounsaturated fats, and low in simple carbohydrates (garlic bread and pizza are NOT found in the Mediterranean diet plan).

The CDC estimates that 16 percent of total caloric intake for children and adolescents currently comes from added sugars. More than 40 percent of calories from added sugar come from sugar-laden beverages, like soda. We should remember that the naturally occurring sugar found in fruit and vegetables have not been found to have harmful effects on our health. When it comes to adding sugar, don't. As a society, we need to address this now to prevent our children from having a lifetime of ill health.
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