New study: does sugar cause heart disease?

Harmful soda

Bad soda

Are today’s high rates of overconsumption of sodas and other sugar sources a direct cause of heart disease? It’s possible, more and more people think so, and a new study gives this idea further support.

Of course, today’s study only shows statistical associations. In this study, people who consumed large amounts of sugar, for example sodas, got heart disease more often. Correlation doesn’t prove causation, so this doesn’t mean that this study has proven what is cause and effect. However, this study did demonstrate a linear association: the more sugar the greater the risk.

This study is just another piece of the puzzle, and more and more people are starting to see a clear picture, and taking the health hazards stemming from excessive sugar consumption seriously.

Prof. Laura Schmidt at University of California San Francisco writes in a commentary in JAMA:

We are in the midst of a paradigm shift in research on the health effects of sugar, one fueled by extremely high rates of added sugar overconsumption in the American public.

Past concerns revolved around obesity and dental caries as the main health hazards. Overconsumption of added sugars has long been associated with an increased risk of cardiovascular disease (CVD). However, under the old paradigm, it was assumed to be a marker for unhealthy diet or obesity. The new paradigm views sugar overconsumption as an independent risk factor in CVD as well as many other chronic diseases, including diabetes mellitus, liver cirrhosis, and dementia—all linked to metabolic perturbations involving dyslipidemia, hypertension, and insulin resistance. The new paradigm hypothesizes that sugar has adverse health effects above any purported role as “empty calories” promoting obesity. Too much sugar does not just make us fat; it can also make us sick.

The fight against cigarettes has almost been won in the West. Now the fight against sugar is starting to get serious. The health benefits may be at least as great.


Toxic Sugar: Fantastic Video on the Obesity Epidemic!

Doctors Warn: “Sugar Is the New Tobacco”

“Sugar is addictive and the most dangerous drug of the times”

The Real Cause of Heart Disease

Sugar: Sweet with a Bitter Aftertaste


  1. Daniel Ferreira
    "Man Lands on Moon"
    Reply: #2
  2. FrankG
    It may be old news to many of us Daniel but there are still to this day, those who deny the Moon Landings ever took place :-)
  3. Boundless
    > Now the fight against sugar is starting to get serious.
    > The health benefits may be at least as great.

    Not until it's understood that:
    a. many carbs are just as glycemic as sugar (e.g. wheat, oats), and
    b. It's really all about the full-time glycemic diet

    Sugar needs to be gone, but it's just the visible portion of the glycberg.

    Reply: #5
  4. Francois
    And further to what FrankG and Boundless stated, there is still a long ways to go for the general population AND for physicians, who for most of them have no clue. It is so much easier to follow guidelines (dictated by BigPharma and BigFood) and read only abstracts than read articles critically and make your own mind. When I presented the LCHF treatment of diabetes to a group of physicians, I got bewildered looks for most of them: Mind you, these "new" concepts were around at the beginning of the XXth century and doc Eenfeldt has put on his web site a hyperlink to an electronic version of a cookbook with exactly these principles. The only people who did not seem surprised were very old p[hysicians over 70 years old, to whom this whole concept was familiar. We can thank Ancel keys for killing this idea by Yudkin in the early XXth century, because it contradicted his own obsession that fat was bad.

    it will take many more studies - unfortunately - before we can get the attention of young physicians. Teaching a little epidemiology and biostats in medical schools may also be another good idea, as the average physician has no clue (and no interest) on how to read and decipher a medical article.

  5. murray
    "Glycberg" -- splendid neologism.

    I would spell it "glyceberg" (to make clear the c is a sibiliant, as in "ice"), but perhaps dropping the "e" was just a typo.

    Yes, sucrose is the tip of the glyceberg.

  6. charles grashow
    The study is talking about ADDED sugar not naturally occurring sugar such as fresh/frozen fruit for example.

    "Major sources of added sugar in Americans' diets are sugar-sweetened beverages, grain-based desserts, fruit drinks, dairy desserts and candy. A can of regular soda contains about 35g of sugar (about 140 calories).

    Quanhe Yang, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues used national health survey data to examine added sugar consumption as a percentage of daily calories and to estimate association between consumption and CVD.

    Study results indicate that the average percentage of daily calories from added sugar increased from 15.7 percent in 1988-1994 to 16.8 percent in 1999 to 2004 and decreased to 14.9 percent in 2005-2010.

    In 2005-2010, most adults (71.4 percent) consumed 10 percent of more of their calories from added sugar and about 10 percent of adults consumed 25 percent or more of their calories from added sugar.

    The authors note the risk of death from CVD increased with a higher percentage of calories from added sugar. Regular consumption of sugar-sweetened beverages (seven servings or more per week) was associated with increased risk of dying from CVD.

    Once again the good doctor Andreas Eenfeldt links to a study where the ENTIRE study is not available for use to read and study and doesn't make the distinction between ADDED sugar and natural sugar

    Reply: #9
  7. bill
    Is it correct to say that carbohydrates are made of
    strings of sugar molecules stuck together?

    I believe the answer is yes.

  8. Craig
    I think it is going to take along time for the true message that all carbs act the same in the body and that cutting down on them drastically is key to good health and preventing disease. However, I think unless you are diabetic we need to get the 'Eat Real Food' message out there first and foremost as it is a major step in the right direction.

    The reason I believe this is that people who are clinically obese will not stop eating the processed crap that our society has been used to eating. They will not do this of their own accord because this is their lifestyle; one they have been born into. Until we stop the food industry giving us so called foods that are laden with sugar and chemicals the temptation for many is just too great.

    We need to get real on this whole issue, not everyone will stop eating 'frankenfoods' of their own accord and we need to heavily subsidise real food; veg, fruit, eggs, meat etc. Processed food needs to be banned and we need purity laws.

    Just telling people about this is not good enough.

    My goodness, I sound like a fascist.

  9. Paul the rat
    "...distinction between ADDED sugar and natural sugar."

    Dear charles grashow please take a pencil and a paper and draw for us the difference in molecular structure between, as you say ".. ADDED sugar and natural sugar". Than scan it and post it for all of us to see, please. We are all dying from curiosity to see the difference !! - we really do !!!

    Reply: #11
  10. charles grashow

    SO - are you saying a banana is as dangerous as a bottle of soda??

    Replies: #12, #14
  11. murray
    My understanding is that this was an observational study based on self-reporting. Correlation does not imply causation, however, we have a good understanding of the metabolic pathways, so an inference of causation is well-supported, if not definitive. That said, we don't have an accurate assessment of the relative contributions of added sugar versus other sources of sugar. We do know from Weston Price's work that acellular sugar and starch has growth-distorting effects (in jaw, nasal and face structure) and inhibits tooth regeneration, and generally negatively affects health. Other work suggests acellular starch and sugar causes a toxic gut flora in the small bowel, which may account for many of the observed effects, either directly or by affecting the metabolism of the sugar or starch.

    What struck me was the study's author commenting about the "exponential" increase in cardiovascular disease with consumption. Not linear. Exponential!

    What appears to be happening is that intra-cellular sugar and starch in fruit and vegetables is more slowly unlocked from cells, buffering the rate at which the glucose and fructose is absorbed and allowing good bacteria to consume much of the sugar, saving the body from a toxic rate of ingestion. Biology is all about rates. So it may be from a metabolic perspective that 1 teaspoon in soda has the metabolic impact of 3 teaspoons in fruit or 5 teaspoons in vegetable. So yes, fruit would have the same metabolic effect, but you would need more sugar in fruit than sugar in soda or fruit juice to have the same impact. It follows that a large consumption of sugary fruit specially bred to be sweet (easily extracted from cells) would be close to added sugar. Further, the larger the baseline of fruit sugar, the greater (exponentially!!!!) the effect of any added sugar. So, for example, it might be that a few, highly fibrous fruit (not mangoes or bananas) release sugar slowly enough for bacteria to eat much of the sugar, but once that threshold is exceeded the absorption rate lurches up, being a phase transition that results in "exponential" (nonlinear, really) impact from the next level of sugar dose.

    So any "fruit is great" / "added sugar is evil" distinction I expect is folly. Happy statins. On the other hand, I expect there is some difference. Modest seasonal consumption of heritage (low sweetness, high fiber) breeds of fruits are likely perfectly okay, unless someone is already metabolically damaged from chronically high carbohydrate consumption.

  12. Paul the rat
    @ charles

    SO - are you saying that, say, my enterocytes can distinguish between glucose derived from:

    a) rough, uncut oates
    b) rye bread with tahini
    c) whole-grain pasta and some green trown in
    d) coca-cola
    e) apple
    f) banana
    g) spoon of table sugar derived from sugar cane (which goes into the bottle of soda)

    which of these sources my enterocytes will sense as added sugar and which as natural sugar ?

  13. murray
    Another reason the effect of sugar consumption would appear to be exponential (again, nonlinear), is that as there appear to be rate-dependent thresholds in the liver and other cells. Liver could buffer much of the glucose onslaught at rate-1 by making glycogen to the extent the glycogen capacity is not already used up. If the rate of glucose ingestion exceeds rate-1, then other cells, especially muscle, would have to take up blood sugar, say at rate-2. Someone who exercises regularly, or say walks after a meal (as the ancient Romans and Chinese figured out, without tier one RCT studies) then rate-2 increases and, additionally, the muscles have more capacity to take in sugar, as a function of the muscle sugar burn rate and the extent to which the muscle's glycogen buffer is already used up. Once glycogen buffers are filled, then rate 1 and rate 2 would drop nonlinearly. So influx rate might slightly exceed rate 1 + rate 2, but increasing influx might overwhelm glycogen buffers, resulting in non-linear increase in the influx rate. Glucose influx beyond rate 1 + rate 2 would force the liver to start making triglycerides (liponeogenesis). The rate of this, rate 3, is always non-zero, but Phinney and Volek's book shows graphs from studies showing as carbs go up (from any source), the rate of liponeogenesis at some point veers up nonlinearly. I expect this is when rate of glucose influx exceeds rate 1 + rate 2, or those rates drop suddenly due to glycogen buffers getting full or, of course, insulin resistance. What struck me was the wide variation, with some people getting the nonlinear rise at just 20% calories from carbs, whereas others went up to 60% before the nonlinear rise. Fructose influx, of course, does not have the benefit of glycogen buffers or muscle burn rates, the liver essential makes triglycerides from fructose, which uses up much of the rate-3 capacity of the liver. Eating fructose thus lowers the rate 1+rate 2+rate 3 capacity available to handle glucose influx, lowering the point at which there is a nonlinear increase in production of triglycerides and VLDL particles (which become small dense LDL down the line). Once the rate 3 capacity is overwhelmed, then I expect the rate of fatty liver accumulation starts to go up non-linearly.

    So there are a lot of rate variables to play with in terms of how you ingest the sugar (acellular, intra-cellular, amount in one serving, how well-encased in fibre, amount of fructose, and such) and how well you buffer the sugar (glyogen capacity, insulin sensitivity, postprandial muscle burn rate). The ingestion of any source of sugar will affect the rates and the various nonlinear bifurcation points. However, not all forms of sugar (including starch) will have the same effect that way, as they have different rates of ingestion, etc.But even at a low rate of ingestion, a large quantity of low rate matches a lesser quantity of high rate ingestion.

    Bottom line, never binge on sugar or starch, from any source.

  14. Paul the rat
    @ charles

    let us play hypothetical.

    A) tomorrow morning I will consume 1.0 L of Coca-cola for breakfast and 1 hour later I will investigaste how my body responded to that glucose in coca cola

    B) day after tomorrow I will consume 2 apples and 2 bananas for breakfast (as many people do). One hour later I will investigate my body response to glucose in these fruits.

    C) then for the next 10 years I will eat 2 apples and 2 bananas for breakfas every day (and have whole -multi grain pasta with some greens thrown in for dinner)

    D) after 10 years I will repeat A and B

    Knowing my very low tolerance to glucose, after 10 years I'll probably be pre-diabetic or fully blown type 2 despite the fact that I consumed only healthy natural sugars.

  15. charles grashow

    "I don’t think there’s any basis for avoiding whole fruit simply because it contains fructose. As I’ve shown in this article, there’s nothing uniquely fattening or toxic about fructose when it isn’t consumed in excess. And since whole fruit contains fiber and other nutrients, it’s difficult to eat a lot of fruit without simultaneously reducing intake of other foods.

    Fruit has been part of the human diet for longer than we’ve been, er, human. We’re well-adapted to eating it, and capable of processing the fructose it contains."

    Reply: #16
  16. Paul the rat
    "...Fruit has been part of the human diet for longer than we’ve been, er, human..."
    how do you know this ?
  17. murray
    "there’s nothing uniquely fattening or toxic about fructose when it isn’t consumed in excess"

    That begs the question. What is "excess"? That is what needs to be determined. My point is that "excess" varies with the form the sugar is consumed and the state of the person consuming. All sugars are toxic in excess in similar ways. Eating a ton of fruit will get you to the same outcome as a lot of soda.

  18. charles grashow
    @Paul the rat

    "Which paleo diet should we eat? The one from twelve thousand years ago? A hundred thousand years ago? Forty million years ago? If you want to return to your ancestral diet, the one our ancestors ate when most of the features of our guts were evolving, you might reasonably eat what our ancestors spent the most time eating during the largest periods of the evolution of our guts, fruits, nuts, and vegetables—especially fungus-covered tropical leaves."

    "As for me, I’ll choose to eat the fruits and nuts like my early ancestors, not because they are the perfect paleodiet but instead because I like these foods and modern studies suggest that consuming them offers benefits. I’ll supplement them with some of the great beans of agriculture, too much coffee, maybe a glass of wine and some chocolate. These supplements are not paleo by any definition, but I like them. What should you eat? The truth is that many different diets consumed by our ancestors–al insect diet, mastodon diets or whatever you please–would be, although some perfect panacea, better than the average modern diet, one so bad that any point in the past can come to seem like the good ole days, unless you go too far back to a point when our ancestors lived more like rats and probably ate everything, including their own feces. Sometimes what happens in paleo should really stay in paleo."


    How much fruit do you eat?

    Replies: #19, #20
  19. murray
    Plenty of avocados and olives; one or the other daily. About 6-10 cranberries (fresh or frozen) and a tablespoon or two of wild blueberries most days. Other berries from time to time, especially blackberries and Saskatoon berries. For me, tomato and bell peppers are fruit (they are quite sweet for me and tomatoes from the field in season have massive umami); I have about 1/2 of one or the other per day, more tomato when in season. I eat apple peel, frequently, or an entire apple on days I do more than a couple hours of endurance exercise. I use lemons and limes a fair amount in cooking. I have almost any fruits as flavour-enhancing condiments--in about the same proportion one might use mustard or relish as a condiment, but not daily. You don't need a lot of strawberry coulis, for example, to have a big flavour impact. On the weekend I made finely diced strawberry (1/8th to 1/16th-inch dice) with a little grand marnier added, I let it sit for a couple of hours to draw out the strawberry flavour and develop a sauce texture, then had some on unsweetened creme fraiche. The others had the coulis with the lemon-ricotta-almond souffle I made, using xylitol and almond meal in place of sugar and flour. (Too sweet for me.)

    Fruit for me are flavourful anti-oxidant vitamin pills; I eat them for anti-oxidants and flavour, not for calories. Frankly, I enjoy a slice of fennel bulb more than a piece of fruit. I eat a lot more vegetables than fruit.

  20. Paul the rat

    I do not care what humans ate one year ago, one hundred years ago, one million years ago or 100 million years ago; what I do care is how human biochemistry responds to dietary macronutrients now.

    Your point that our ancestors ate tropical leaves, nuts, vegetables is speculative.
    Who is to know that ancient forests weren't so full of animals and rivers full of fish that catching them was a child's play?
    Have you ever tried a real wild fruit of some kind? - they are not all that sweet, I prefer roasted hare any time, ask true Australian Aborigines.

  21. charles grashow
    Paul the rat
    Today 23:36

    "I do not care what humans ate one year ago, one hundred years ago, one million years ago or 100 million years ago."

    SO - why would you care about the paleo diet??

    Replies: #22, #25
  22. Paul the rat
    Who said that I do follow or care about paleo diet???. who knows what Paleolithic people ate ???

    I follow very low carbohydrate, moderate protein, high fat diet for many years now based on:
    1) my understanding that it is the best diet for humans -based on accumulated evidences for the past 200 years.
    2) my personal experience, i.e. the way I feel (physiology/biochemistry) on LCHF and when I compare to when I switch to vegetarian diet
    3) experiences of many people I personally know including members of my family and close friends who follow LCHF

    you forgot to quote most important statement form my post # 20 that is that I do care very much how human biochemistry responds to dietary macronutrients now, in health and diseases - it s my job

    (never stops to amaze me how people are selective what they quote)

  23. charles grashow
    the way I feel (physiology/biochemistry) on LCHF and when I compare to when I switch to vegetarian diet

    There are many more options other than LCHG and vegetarian

    Reply: #24
  24. Paul the rat
    I have tried them all. LCHF works the best for me in all aspects of my life (as it does for many people I know and many people who visit this blog, it seems). So LCHF is my lifestyle.
  25. Francois
    Are we not getting into semantics here? Paul and Murray made very important points. Carbs are not evil as such, they can be an excellent source of energy. This being said, our tolerance to carbs varies from person to person. Some of us seem to tolerate them quite well and seem to suffer no ill-effect (though as soon as the percentage of total calories from carbs reaches 40%, the epigenome is switched to inflammation - until there, no problem. At the other extremity of the spectrum, others have such a low tolerance for carbs that the fewer they eat, the better. A good example would be pre-diabetics and diabetics. : Yoshifumi Y, Uchida J et al., A non-calorie-restricted Low-carbohydrate Diet is Effective as an alternative therapy for patients with Type 2 Diabetes. Intern Med 53: 13-19, 2014
    demonstrated that even 75 grams of carbs per day were still too many for diabetes and HbA1C started creeping up after 4 months.
    The rest of people fall somewhere between these extremes.

    It seems to be better to have "natural, "cell-encased" sugar, as the fibers it comes with do slow down the sugar's absorption rate and this combination seems to have less of a detrimental effect on health. Highly sweet fruits like mangoes and bananas are so sweet that some zoos had to stop feeding them to monkeys, as they were developing obesity and diabetes.

    All this being said, there are a great varieties of "paleo" diets, with varying percentages of macronutrients. Cordain et al proved quite well that a very high protein diet was not sustainable and that most (but not all) paleo diets were mainly animal-based, with varying amounts of foods from vegetable source.

    It is also quite clear that the more sick you are (any chronic disease, from epilepsy to Alzheimer, with diabetes, heart disease and cancer and every other chronic disease), the less carbs you should intake. If you are healthy, any carb intake less than 40% of total caloric intake is probably OK. Slow carbs being the best.

    So if you want to go for one of the many paleo diets out there, feel free to do so as long as whatever you choose fits this description. Hope this helps.

  26. charles grashow

    Your thoughts on these
    Ma-Pi 2 Macrobiotic Diet Intervention in Adults with Type 2 Diabetes Mellitus
    Medium- and Short-Term Interventions with Ma-Pi 2 Macrobiotic Diet in Type 2 Diabetic Adults of Bauta, Havana

    Reply: #27
  27. Francois
    What do I get out of it?
    1. That a lower glycemic index and a lower glycemic load diet is better for diabetics than a high glycemic index diet.
    2. That a macrobiotic diet is a vegan non-sustainable diet lacking vitamin B12, iron and vitamin D, based on some attempt to integrate Eastern philosophy (theory of contrasts, hot and cold, ying and yang) into nutrition.
    3. That the authors do not know how to read studies (or do not know how to read, period): they state : "Low fat diets encourage weight loss, whereas high fat diets are strongly associated with obesity, glucose intolerance and increased insulin resistance.[11] and give an article by Willett, Manson and Liu as a reference. The full article is available on the American Journal of Clinical Nutrition site and I did not find that statement anywhere. Willett and coll actually compare high glycemic index foods and high glycemic loads versus the reverse and do not look at high fat diets.
    On the contrary, there is enormous evidence that high fat diets promote weight loss and improvement of biochemical parameters without putting people at risk of nutritional deficiencies.
    Because the macrobiotic diet is better than the standard American diet or than any high glycemic index and high glycemic load diet does not make it a good diet: it is simply less bad.
    Parameters did improve, clearly, but the nutritional deficiencies and non sustainability of this diet makes it a no-no, clearly.

    Hope this helps.

  28. murray
    It is interesting that reading scientific commentary on the use of ketogenic diets to treat cancer, the most common objection is concern about weight loss on a high fat diet (based on experience in the field), yet in the nutrition field "it goes without saying" (i.e., everyone "knows") that high-fat is obesigenic.

    For me, Paleo is at best a presumptive guidance or a reality check in the absence of other data, that can be over-turned by evidence. Thus, I eat cheese, especially fermented raw milk cheeses, based on the evidence I have seen. After all, I have the gene for lactose tolerance, so I have evolved to eat cheese (by Paleo logic), but more importantly, lots of research confirms health benefits, and I love the taste and texture of cheese. Paleo is thus trumped.

    As Paul observes, our knowledge of hominid diet over the past 5 million years is sketchy; nonetheless it does provide a standard for plausibility in many cases. For example, numerous adaptations indicate we evolved to eat more meat, so one would expect rather compelling evidence before concluding we are metabolically ill-adapted today to eat meat. The diet-heart hypothesis was a longshot from the start and ought not to have been imposed through the food pyramid without compelling evidence (instead of over-ruling warnings from scientists of the day).

    The Paleo logic is not determinative for me--it establishes the burden of proof in a context where one has to eat pending development of better scientific evidence. Most plants are toxic in some way (they can't run from animals, so they poison them), so avoiding new plants in the diet is a reasonable presumption. However, cultural lore over millenia have devised preparation methods to detoxify legumes, from soaking, to fermenting, to cooking etc. So legumes properly prepared seem fine, contra Paleo. So I avoid legumes unless they are prepared according to tradition, until better evidence comes along.

    I rely heavily on Weston Price's work for presumptions, including a presumption against eating acellular starch and sugar and eating liver and dairy from ruminants on fast-growing grass. All the more confidence with the growing body of science, from various fields, concerning vitamin K2 and to support the presumption against acellular starch and sugar. Nothing definitive, but strong enough to conclude I have zero need for starch and sugar and some amount much less than the current "normal" level of consumption would be "excess".

    I part from the Weston Price paradigm with respect to keto-LCHF. It is often remarked that no culture has gone long-term continuous ketogenic. Perhaps not. The evidence for ethno-traditional cuisine is also prone to inaccuracy (such as a so-called low-protein diet actually being high protein because the ethnographers did not think to ask if insects were in the diet). But today's metabolic evidence (much of it posted by Paul) is supportive and promising that keto-LCHF is highly beneficial. Add in Cynthia Kenyon's work on insulin and aging, and I have over-turned my Weston Price presumption that one should not depart from what has already been proven to be long-term sustainable in traditional cultural cuisine.

    Theory is helpful and guides inquiry, but ultimately I go with experience and metabolic science.

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