Nav: Home

The evidence for saturated fat and sugar related to coronary heart disease

January 13, 2016

KANSAS CITY, Mo. (December. 23, 2015) -- Atherosclerotic Coronary Heart Disease (CHD) is responsible for one in every six deaths in the United States as well as being the leading cause of death throughout the developed world. Healthcare professionals have for many years sought to limit and control CHD by focusing on prevention and, from a dietary perspective, on limiting saturated fats.

In an article published in the journal Progress in Cardiovascular Diseases, Saint Luke's Mid America Heart Institute cardiovascular research scientist and James J. DiNicolantonio, PharmD, and James H. O'Keefe, MD, examined the question of whether that focus may be misplaced and ask does sugar have a greater impact on coronary heart disease than saturated fat?

The theory of dietary saturated fats as the principal promoter of elevated serum cholesterol and heart disease stems from research beginning in the 1950's by an American scientist Ancel Keys. It was this theory which was embraced by the American Heart Association and the US federal government in the 1960s and 70s. However, at the same time of Keys research, a British physiologist John Yudkin argued that sugar intake was more closely related to incidence of and mortality from CHD.

Both Yudkin and Keys were able to support their theories through observational studies in large part because people eat foods, not isolated food constituents. Dietary sources of saturated fat are also often dietary sources of sugar and people who eat lots of sugar often also eat lots of saturated fat.

Along with co-author, Sean C. Lucan, MD, MPH, MS, from the Albert Einstein College of Medicine, DiNicolantonio and O'Keefe evaluated the evidence to date linking saturated fats and sugars to CHD, considering basic science, epidemiology, and clinical trial data related to CHD risk, CHD events, and CHD mortality. The authors concluded that sugar consumption, particularly in the form of refined added sugars, are a greater contributor to CHD than saturated fats.

"While the original studies upon which the longstanding guidelines were based were largely observational," said DiNicolantonio, "We now have more than a half century of data as well as increased understanding of how nutrition impacts the body and specifically coronary heart disease."

The metabolic aspects of saturated fatty acids (SFAs) are complex but existing research suggests that certain SFAs may actually confer measurable benefits for lipid profiles and CHD risk. For instance, some SFAs increase high-density lipoprotein cholesterol (HDL), which is often referred to as the "good cholesterol" as this lipoprotein is associated with a reduced risk of CHD

Replacing saturated fats, or any other component, from one's diet almost inevitably means replacing it with something else. When carbohydrates, particularly refined carbohydrates like sugar, replace saturated fats, which can have a negative impact on lipid profiles (HDL tends to fall and triglycerides tend to rise).

As stated earlier, people don't eat isolated fatty acids - they eat foods that are a mix of various fatty acids and other food constituents. While high intakes from processed meats may increase risk of CHD, higher intakes from dairy sources of saturated fat may not only pose no risk but actually decrease risk.

Consuming a diet high in sugar for just a few weeks has been shown to cause numerous abnormalities found in patients with CHD, such as high total cholesterol, triglycerides, LDL, oxidized LDL, uric acid, insulin resistance and abnormal glucose tolerance, low HDL, and altered platelet function. The overall effect of consuming a diet high in sugar on these numerous health markers is likely more detrimental to overall health compared to increased consumption of saturated fat, which can increase LDL but at the same time raise HDL.

Added fructose - generally in the form of sucrose (table sugar) or high fructose corn syrup (HFCS) in processed foods and beverages seems especially potent for producing harm. Consuming these sugars can lead to resistance in leptin, which is a key hormone in the maintenance of normal body weight. The overconsumption of added fructose undoubtedly increases the risk for obesity, which is also a risk factor for CHD.

Excess fructose also markedly increases the risk for non-alcoholic fatty liver disease (NAFLD) - the most common liver disease in the US and a strong independent risk factor for CHD. The association between NAFLD and CHD is stronger than the link between CHD and smoking, hypertension, diabetes, male gender, high cholesterol or metabolic syndrome.

Sugars occurring naturally in fruits and vegetables pose no increased risk for CHD. The problem is refined sugars - with ultraprocessed foods being of greatest concern. Products with added sugars represent 75% of all packaged foods and beverages in the US and most commonly contain sucrose or HFCS, which seem to raise CHD risk even more than other sugars such as glucose.

A diet high in sugar has also been found to promote prediabetes and diabetes. And patients with both of these conditions have a much greater risk for CHD compared to normal healthy patients, particularly a severe narrowing of the left main coronary artery.

Ultra-processed foods also tend to be sources of saturated fats but the harms associated with eating these products may have nothing to do with the fat and everything to do with processed foods themselves. Therefore, best advice is to avoid processed foods rather than to simply avoid SFAs as avoiding SFAs might direct people away from foods that are not only completely benign but actually beneficial (such as dairy foods) but also steer people towards foods that may be harmful - i.e. low-fat, ultra-processed, with huge amounts of hidden added sugars.

"After a thorough analysis of the evidence it seems appropriate to recommend dietary guidelines shift focus away from recommendations to reduce saturated fat and towards recommendations to avoid added sugars," said Dr DiNicolantonio. "Most importantly recommendations should support the eating of whole foods whenever possible and the avoidance of ultra-processed food."
-end-
Contact information for
Dr. James J. DiNicolantonio, PharmD
Cardiovascular Research Scientist
Saint Luke's Mid America Heart Institute

Webpage: http://www.saintlukeshealthsystem.org/dinicolantonio
Research: https://www.researchgate.net/profile/James_Dinicolantonio
Twitter: https://twitter.com/jjdinicol

The original paper and corresponding commentary may be found at : http://www.sciencedirect.com/science/article/pii/S0033062015300256

Article details

"The Evidence for Saturated Fat and for Sugar Related to Coronary Heart Disease" James J. DiNicolantonio, Sean C. Lucan, James H. O'Keefe (DOI: doi:10.1016/j.pcad.2015.11.006), in press Progress in Cardiovascular Diseases, published by Elsevier.

Full text of the research paper is available to credentialed journalists upon request, contact newsroom@elsevier.com

About Saint Luke's Mid America Heart Institute

Saint Luke's Mid America Heart Institute, a member of Saint Luke's Health System and a teaching affiliate of the University of Missouri-Kansas City, is one of the preeminent cardiovascular programs in the country. Its legacy of innovation began more than 25 years ago when it opened as the nation's first heart hospital. Since then, the Heart Institute has earned a world-wide reputation for excellence in the treatment of heart disease, including interventional cardiology, cardiovascular surgery, imaging, heart failure, transplant, heart disease prevention, women's heart disease, electrophysiology, outcomes research, and health economics. With more than 50 full-time board-certified cardiovascular specialists on staff, the Heart Institute offers one of the largest heart failure/heart transplant programs in the country, has the largest experience with transcatheter aortic valve replacement in the Midwest, and is a global teaching site for the newest approaches to opening challenging blocked arteries using minimally invasive techniques.

Elsevier

Related Fatty Acids Articles:

Efficiently producing fatty acids and biofuels from glucose
Researchers have presented a new strategy for efficiently producing fatty acids and biofuels that can transform glucose and oleaginous microorganisms into microbial diesel fuel, with one-step direct fermentative production.
Omega-3 fatty acids tied to fewer childhood asthma symptoms
A six-month study of children from Baltimore City by Johns Hopkins Medicine researchers has added to evidence that having more omega-3 fatty acids in the diet results in fewer asthma symptoms triggered by indoor air pollution.
Could omega-3 fatty acids help prevent miscarriages?
A new study in mice reveals that omega-3s, a type of fat found in fish oil, reduces fetal and neonatal deaths, suggesting they could prevent some miscarriages in women.
Researchers reveal prostate tumors 'fed' by fatty acids
An international multidisciplinary study initiated by Melbourne scientists has shown a link between prostate cancer and the uptake of fatty acids by cancer cells.
A hidden route for fatty acids can make cancers resistant to therapy
Researchers from the lab of Prof. Sarah-Maria Fendt at the VIB-KU Leuven Center for Cancer Biology now demonstrate that certain tumor cells use an alternative -- previously unexplored -- pathway to produce fatty acids.
Sunscreen and cosmetics compound may harm coral by altering fatty acids
Although sunscreen is critical for preventing sunburns and skin cancer, some of its ingredients are not so beneficial to ocean-dwelling creatures.
New Parkinson's disease drug target revealed through study of fatty acids
A new study led by investigators from Brigham and Women's Hospital and Harvard Medical School has provided insights into the role of fatty acids and suggests that inhibiting a specific enzyme can protect against neurotoxicity.
Omega 3 fatty acids found in seafood linked to healthy aging
Higher blood levels of omega 3 fatty acids found in seafood are associated with a higher likelihood of healthy ageing among older adults, finds a US study published by The BMJ today.
Fatty acids can slow down an overheated immune system
The STING protein is normally an important part of our immune system, but in some autoimmune diseases it is itself the source of the disease.
International team makes rare discovery of new fatty acids
Decades after scientists discovered hundreds of different fatty acids in vegetable oils, two that had managed to elude detection have finally revealed themselves to a team led by the University of Nebraska-Lincoln and Huazhong Agricultural University in China.
More Fatty Acids News and Fatty Acids Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#541 Wayfinding
These days when we want to know where we are or how to get where we want to go, most of us will pull out a smart phone with a built-in GPS and map app. Some of us old timers might still use an old school paper map from time to time. But we didn't always used to lean so heavily on maps and technology, and in some remote places of the world some people still navigate and wayfind their way without the aid of these tools... and in some cases do better without them. This week, host Rachelle Saunders...
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.