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Stop Focusing on Salt. Sugar Is A Far Greater Cause of Killer Diseases

Cut down on your fat. Reduce your salt intake. Lower your consumption of refined sugar. How many times have you heard these statements? But only one of these recommendations is more important that the other two. If you're interested in lowering blood sugar, resetting your metabolism, preventing weight gain, reducing high blood pressure, stroke and heart disease, only a reduction in sugar will tackle all of the above.

Prevailing thinking about obesity and related diseases holds that quantifying calories should be a principal concern and target for intervention.

Part of this thinking is that consumed calories -- regardless of their sources -- are equivalent; i.e. ‘a calorie is a calorie’. There needs to be a greater qualitative focus on the sources of calories consumed (i.e. a greater focus on types of foods) and on the metabolic changes that result from consuming foods of different types.

Calorie-focused thinking is inherently biased against high-fat foods, many of which may be protective against obesity and related diseases, and supportive of starchy and sugary replacements, which are likely detrimental.

Fructose A Greater Health Threat Than Salt

The intake of dietary fructose has increased significantly from 1970 to 2000. There has been a 25% increase in available "added sugars" during this period. The average person has a daily added sugar intake of 79 g (equivalent to 15% of energy intake), approximately half of which was fructose.

A segment of populations in most developed nations appear to be genetically predisposed to high blood insulin and triglyceride levels when consuming diets high in carbohydrate causing abnormal glucose tolerance. Reports indicate that maternal fructose intake may affect a child's endocrinology and glucose tolerance.

In the fight to curb the prevalence of heart disease, experts warn the dangers, particularly linked to fructose, must be highlighted.

Heart disease is the number one cause of premature death in the developed world.

And high blood pressure is its most important risk factor, accounting for almost 350,000 deaths in the US in 2009 and costing more than $50 billion each year.

Dietary advice to help lower high blood pressure has historically focused on cutting salt intake. But this approach is very flawed.

A study by lead researcher Dr. Niels Graudal, of Copenhagen University Hospital in Denmark, adds to a growing body of research questioning the long-term benefits of a low-salt diet. A review of seven previous studies published in the journal the Cochrane Library found that a moderate reduction in salt intake did not reduce a person's risk of dying or having heart disease.

In a systematic review published by The Cochrane Library, British scientists found that cutting salt consumption did not translate into lower death or heart disease risk.

A paper published in the American Journal of Hypertension warns that once average daily consumption dips to below 6.25g, the risk of heart attacks and strokes starts to increase once more. Restricting salt consumption increases levels of cholesterol and triglycerides -- both of them harmful fats which cause heart disease -- and also leads to insulin resistance (the early stages of type-2 diabetes). Diets low in salt also increase the levels of fat and hormones in the blood that are known to increase the risk of heart disease.

The problem is not salt, it's the type of salt we use. It takes just half an hour for one meal high in table salt to significantly impair the arteries’ ability to pump blood around the body, alarming research has shown. Blood flow becomes temporarily more restricted between 30 minutes and an hour after the food has been consumed. Most scientific studies use processed table salt as a source of sodium which the body has a hard time physiologically to process unlike its natural counterpart sea salt.

Most salt in a person's diet comes from processed foods, which also happen to be a rich source of added sugars, the scientists argue.

Sugar may be much more meaningfully related to blood pressure than sodium, as suggested by a greater magnitude of effect with dietary manipulation.

Previous studies such as a two-year dietary study published in the journal Diabetologia showed that food with a lot of fat and few carbohydrates has a better effect on blood sugar levels and blood lipids. Despite the increased fat intake with a larger portion of saturated fatty acids, their lipoproteins did not get worse. Quite the contrary -- the HDL, or ‘good’ cholesterol, content increased on the high fat diet.

Compelling evidence from basic science, population studies, and clinical trials implicates sugars, and particularly the monosaccharide fructose, as playing a major role in the development of hypertension (high blood pressure).

When Culture Becomes A Disease Risk

Sugar is so heavily entrenched in the food culture in the United States and other countries that getting people to kick the habit will require much more than simple education and awareness campaigns, the UCSF scientists have said.

In journal Nature, Robert Lustig MD, Laura Schmidt PhD, MSW, MPH, and Claire Brindis, DPH, colleagues at the University of California, San Francisco (UCSF), argue that sugar's potential for abuse, coupled with its toxicity and pervasiveness in the Western diet make it a primary culprit of this worldwide health crisis.

Sugar, they argue, is far from just "empty calories" that make people fat. At the levels consumed by most Americans, sugar changes metabolism, raises blood pressure, critically alters the signaling of hormones and causes significant damage to the liver -- the least understood of sugar's damages. These health hazards largely mirror the effects of drinking too much alcohol, which they point out in their commentary is the distillation of sugar.

Worldwide consumption of sugar has tripled during the past 50 years and is viewed as a key cause of the obesity epidemic. But obesity, Lustig, Schmidt and Brindis argue, may just be a marker for the damage caused by the toxic effects of too much sugar. This would help explain why 40 percent of people with metabolic syndrome -- the key metabolic changes that lead to diabetes, heart disease and cancer -- are not clinically obese.

Americans eat and drink roughly 22 teaspoons of sugar every day - triple what they consumed three decades ago - and most people aren't even aware of the various ways sugars sneak into their diets, often via breads and cereals and processed foods. Terms that identify sugars on labels include sucrose, glucose, fructose, maltose, hydrolysed starch and invert sugar, corn syrup and honey.

Evidence suggests that sugars in general, and fructose in particular, may contribute to overall cardiovascular risk through a variety of mechanisms.

High-Fructose Diets = Toxicty

Eating a high-fructose diet over the long term alters your brain’s ability to learn and remember information. While earlier research has revealed how fructose harms the body through its role in diabetes, obesity and fatty liver, other studies have uncovered how the sweetener influences the brain.

Reearchers have pointed the finger at high fructose corn syrup, which is the most frequently used sweetener in processed foods, particularly fruit-flavoured and fizzy drinks.

Worldwide, sugar sweetened beverage consumption has been implicated in 180,000 deaths a year.

The evidence suggests that people whose dietary intake of added sugars adds up to at least a quarter of their total daily calories have almost triple the cardiovascular disease risk of those who consume less than 10 per cent.

And a daily intake of more than 74g of fructose is associated with a 30 per cent greater risk of blood pressure above 140/90 mm Hg and a 77 per cent increased risk of blood pressure above 160/100 mm Hg.

A high fructose diet has also been linked to an unfavourable blood fat profile, higher fasting blood insulin levels, and a doubling in the risk of metabolic syndrome.

Results presented at the Canadian Neuroscience Meeting shows that high-fructose corn syrup (HFCS) can cause behavioural reactions similar to those produced by drugs of abuse such as cocaine.

HFCS causes insulin resistance, diabetes, hypertension, increasedweight gain, and not to mention is manufactured from genetically modified corn.

Some dietary guidelines do include recommendations about daily intake of added sugars, but are not stringent enough, nor do they make specific recommendations about fructose.

Naturally- occurring sugars found in fruit and vegetables are not harmful to health. Eating fruit and vegetables is almost certainly beneficial.

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,' say researchers at the Mid America Heart Institute in Kansas City, Missouri.

And they go on to warn: 'The evidence is clear that even moderate doses of added sugar for short durations may cause substantial harm.'

Professor of cardiovascular medicine, Francesco Cappuccio, from the University of Warwick said high-sugar diets can contribute 'substantially' to cardiovascular disease.

"There is an enormous gap between what we know from science and what we practice in reality," said Schmidt, professor of health policy at UCSF's Philip R. Lee Institute for Health Policy Studies (IHPS) and co-chair of UCSF's Clinical and Translational Science Institute's (CTSI) Community Engagement and Health Policy Program, which focuses on alcohol and addiction research.

"In order to move the health needle, this issue needs to be recognized as a fundamental concern at the global level," she said.

"There are good calories and bad calories, just as there are good fats and bad fats, good amino acids and bad amino acids, good carbohydrates and bad carbohydrates," Lustig said. "But sugar is toxic beyond its calories."

Lowering Sodium Levels Is Not Based On Science

Unlike sugar, salt is not a nutrient but a chemical added to food in recent evolutionary time. Our bodies need no more than a tenth of the salt we currently eat, but it must come from natural sources. Attempting to reducing sodium based on the natural content is foods is not based on science.

In a research review published Dec. 11 in the BMJ journal Open Heart, James J. DiNicolantonio, PharmD, of Saint Luke's Mid America Heart Institute, Kansas City, Mo., and Sean C. Lucan, MD, MPH, of Montefiore Medical Center, Bronx, New York argued that the emphasis on lowering dietary sodium in guidelines aimed at reducing hypertension is misguided and not evidence-based.

There is 'absolutely no evidence' to support the claims that lowering salt levels in processed foods could spark an increase in the consumption of starches and sugars.

Organizations advocating salt restriction today -- the USDA, the Institute of Medicine, the CDC and the NIH -- all essentially rely on the results from a 30-day trial of salt, the 2001 DASH-Sodium study. It suggested that eating significantly less salt would modestly lower blood pressure; it said nothing about whether this would reduce hypertension, prevent heart disease or lengthen life.

'This shift in attention from salt to sugar is scientifically unnecessary and unsupported, and it reminds me of a well-rehearsed tactic used by industry and pseudoscience to divert public attention.

'It is inappropriate in a scientific publication.'

Sugar receives blame for many health problems, but without it, your body would cease to function properly. Naturally occurring sugars, such as those found in fruit, honey and maple syrup come from sources that benefit your diet. However, the sugars and syrups added during food processing and preparation, called added sugars, are viewed as a detriment to a healthy diet. Maximizing sugar’s benefits requires balancing the healthier and less wholesome sources.

If you are going to eat sugar, then also eat foods rich in omega-3 fatty acids, like salmon, walnuts and flaxseeds, or take a daily DHA capsule. “Our findings suggest that consuming DHA regularly protects the brain against fructose’s harmful effects,” said Fernando Gomez-Pinillahow a professor of neurosurgery at the David Geffen School of Medicine at UCLA. His team found that omega-3 fatty acids can counteract the disruption caused by sugar.

Public health initiatives framed around both salt and calorie balance sheets targeting sugar and ‘calories in’ and/or ‘calories out’ -- that reinforce messages of overeating and inactivity as underlying causes of disease, rather than intermediate effects, of obesity are a danger to public health.

We need to work within public health sectors to support the consumption of whole foods that help protect against obesity-promoting energy imbalance and metabolic dysfunction and not continue to promote calorie-directed messages may create a skewed perception of sugar which will only exacerbate epidemics of obesity and related diseases.


Natasha Longo has a master's degree in nutrition and is a certified fitness and nutritional counselor. She has consulted on public health policy and procurement in Canada, Australia, Spain, Ireland, England and Germany.

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