Does Sugar Cause Heart Disease?
What is Heart Disease?
What do we mean by heart disease? There are various health problems that can be included in this description. Congenital defects can lead to increased volume in circulating blood. An incompetent valve can cause blood to ‘leak back’. This again could be caused by a congenital problem or it could be caused by rheumatism or syphilis. There can be problems of increased resistance to the blood flow, so that blood pressure must rise for the circulation to be maintained. There can be decreased force, due to a disease affecting the heart muscle, perhaps due to rheumatic heart disease; and there can be disturbances in the rhythm of the heart, from a variety of causes: malnutrition, emotional disturbances or over exertion.
But the main disease of the heart is created artificially by man and is the principle cause of death in affluent societies. It is man-made. It is caused by arteriosclerosis, and this results in 90% of the failures of the heart to do its job as a pump. Thus failure is known in medical terminology as myocardial infarction or, in layman’s terms, coronary thrombosis. The main form of arteriosclerosis is known as atheroma or atherosclerosis. It means a thickening and hardening of the artery wall, with roughening of the interior surface of the wall. To this surface adheres a fatty streak of ‘plaque’ which builds up, in the same way as a water pipe collects a limey substance over the years in an area of calcareous water supply.
This fatty streak of arterial plaque grows over a certain length of time; but, unlike a furring-up water pipe, it grows in patches. At these spots, where there is atherosclerosis, there is a gradual obstruction to the flow of blood. This may continue for years without any symptoms. Some people may die of other causes and their arteriosclerotic may never have caused them any trouble. But for many, there occurs a startling event: coronary thrombosis.
A blood clot has formed in an artery leading to the heart and it frequently forms on or near one of those patches of atheroma. Sometimes a patch will detach itself from the artery or blood vessel wall and is carried down until it completely occludes (i.e. blocks) the artery.
Sometimes a haemorrhage develops beneath the plaque and pushes it out to obstruct the lumen or passageway of the artery. Sometimes there is only the narrowing of the artery, without complete obstruction, but preventing sufficient blood getting through to the heart.
These atherosclerotic patches are accumulations of fats, cholesterol and calcium, and scar tissue induced, perhaps, by these substances, or by the deterioration of the artery wall, since the plaque extends deep into this wall.
These arterial plaques can begin to develop at an early age. During the Korean War, autopsies performed on U.S. soldiers revealed that 20% of these men in their early twenties had significant amounts of atheroma. A nation-wide education plan began, including jogging, heart health education and watching of cholesterol in the diet. Autopsies carried out in the Vietnam War showed very little evidence0f atherosclerosis. A significant drop in coronary artery disease had begun to take place in the U.S.A. but not in Britain!
Role of Cholesterol
High levels of cholesterol are usually associated with heart disease. But the simplistic view: high blood cholesterol = atheroma = heart disease is now considered not only unproven, but probably untrue. There is apparently an electro-chemical attraction of cholesterol to the deteriorating artery wall, but this does not make cholesterol the cause of heart disease or atheroma. It has also been found incidentally that high density lipoprotein, which transports cholesterol back to the liver for excretion, has some protective function.
Other factors besides cholesterol are often involved: smoking, obesity, over-eating, a diet too rich in saturated fats and high in calories, thyroid deficiency, high blood pressure, constant emotional stress, and above everything, lack of exercise, have all been linked to heart disease. Diabetes mellitus greatly increases the risk of it but there is epidemiological and experimental evidence that sugar may be more a cause of heart disease than fats in the diet.
Role of Sugar
First of all, let us deal with refined sugar. We know that it is not only short of vitamins and minerals, it actually consumes them. Yet it is present in 90% of retail processed foods. Vitamin B6 and chromium are two nutrients that are consumed by sugar and these nutrients are essential to a healthy heart. Besides, in the cycle when glucose is burned in the cell (known as Kreb’s Cycle), it requires at least ten nutrients: B2, B3, B6, C, E, manganese, magnesium, chromium, calcium, and zinc. If any of these are missing – and, as we have seen, B6 and chromium are certainly at risk – then a toxic, incompletely burned compound can be deposited in the cell, the cell can start to deteriorate, and this may well be the start of atheroma in the walls of blood vessels.
Not only that, but the sugar releases hormones from adrenal glands and the pancreas. Eventually, after continual sugar intake, the adrenals and pancreas stop producing hormones and a whole series of ills beset us: exhaustion, after all that ‘energy’ from sugar, diabetes, allergies, depression – and heart disease? Well, that could be at the end of the line. For if stress, a known factor in heart disease – or rather our ability to deal with stress – is affected by eating refined sugar, then sugar can be considered a contributory factor in heart disease for this reason alone.
But there are many factors that point a finger at sugar. Dr Richard Ahrens (University of Maryland) has stated that ‘the most carefully designed studies have consistently shown that heart disease victims do consume more sugar. It is relevant to observe that the pandemic of heart disease continues to increase on a world wide scale ‘in rough proportion to the increase in sugar consumption but not in proportion with saturated fat intake’ (1).
Perhaps the main adversary of sugar in this country has been Prof. John Yudkin, during his time at the Department of Nutrition, Queen Elizabeth College. His view of heart disease is somewhat different to the simplistic cholesterol picture outlined above. He says that coronary disease ‘starts with much more extensive disturbances than just a rise of cholesterol in the blood.’ For one thing, there is a rise in other fatty components of the blood, especially the triglycerides, sometimes called neutral fats; many people believe that this rise occurs far more frequently than does the rise in cholesterol.
Secondly, other biochemical changes take place, including disturbance of the metabolism of glucose or blood sugar in the same direction as that found in diabetes. There is often a rise in the level of insulin and other hormones in the blood, and sometimes a rise in uric acid. There are alterations in the activity of several enzymes and the behaviour of blood platelets is changed (2).
He places some importance in blood platelet stickiness and adhesion to the walls of blood vessels, as do other research workers. The platelets of sugar-fed rats, he found, clumped together (aggregate) more easily than the platelets of rats fed without sugar. He also found that sugar-fed rats develop enlarged adrenal glands and Prof. A.M. Cohen of Jerusalem found that sugar-fed rats developed abnormalities in the way that their pancreases produced insulin. These sorts of experiments lead one to the conclusion that hormone production is thrown into ‘Red Alert’, as Patrick Holford has described it, by sugar, with consequent adverse effects which we have mentioned.
Yudkin found in his experiments that a quarter to a third of his subjects, (this time young men), showed a special sensitivity to sugar, while the remainder did not. This sensitivity of some individuals to a particular food is very important in diet, nutrition, and disease, but makes hard and fast ‘scientific’ evidence difficult to produce, since individual tolerance and susceptibility throw the near patterns of cause and effect out of order.
He found that, in all the young men, a sugar-rich diet produced an increase in blood triglycerides after two weeks. In addition, six of them showed other changes: they put on five pounds in weight, the level of insulin in the blood rose, and there was an increase in the stickiness of the blood platelets. All these changes disappeared entirely, or almost entirely, two weeks after the men went back to their usual diet. So, in the ‘sugar sensitive men’, insulin level rose and blood platelet stickiness and increased obesity were all noticed; these are all factors which are prevalent in heart disease.
Yudkin had some difficulty in producing atheroma in his experimental rats; but Dr L. Chevillard of Paris and his co-workers reported atheroma in the aorta of rats when sugar was included in their diet.
Yudkin has traced a heart disease epidemic among Western nations that has followed a sevenfold increase in the consumption of sugar. The wealthiest of nations with the highest incidence of heart disease consume the most sugar. He observed that the sugar consumption of heart disease victims was higher prior to their first heart attack than the sugar consumption of carefully matched control subjects, free of heart disease (3).
Yudkin’s theories were not popular with Ancel Keys, an American nutritionist, who maintained that fats, and in particular animal fats, were the cause of heart disease and related ills. But Yudkin found that the relationship between fat consumption and coronary mortality was not as good as the relationship between sugar consumption and coronary mortality.
He was supported in this view by Dr A.M. Cohen of Jerusalem, who found that recently arrived immigrants from the Yemen had little coronary disease, though the disease was common among Yemenites who had immigrated twenty or so years earlier. The diet in the Yemen had been quite high in animal fat and butter but low in sugar; when they arrived in Israel they adopted the usual high sugar diet of that country.
With diabetes, another factor in heart disease, Yudkin found that there was a high correlation between those dying of diabetes and sugar consumption, and no correlation between these deaths and fat consumption. Again, Prof. Cohen confirmed that recent Yemeni immigrants into Israel had a prevalence to diabetes of only 0.06 % compared to earlier (20 years or more) Yemeni immigrants into Israel, who had a 2.9% prevalence. Other immigrants from Western Europe, America and North Africa had similar levels of diabetes, far more than the Yemenites who had recently immigrated. Again, these other immigrants’ only change in diet was increased sugar consumption when they arrived in Israel.
Similar reports from Czechoslovakia (4) and from South Africa (5), showed that sugar intakes were highest in those groups having the highest incidence of heart disease. Dr Gigon of Germany showed that sugar added to animals’ diet caused them to malnourish themselves to the point of death. Dr Ahrens (1974) showed how sugar increases blood pressure, and J.I.Mann et al (6) showed how sugar elevates blood levels of triglycerides. Animal studies by Macdonald and G. Thomas (7) and other subsequent work by Durand (1968) Dalderup and Vissar (1969) conclude that replacing starch calories with sugar shortens the average lifespan of the animal.
Sugar and Stress
We have pointed out above the susceptibility to stress as a factor in heart disease, and Dr Cheraskin (U.S.S.R.) confirms this by saying: “By far the biggest culprit in the inability to deal with stress is refined sugar.”
With regard to angina, (a severe pain in the heart muscle) Dr B.P. Sandler (8) has produced evidence that eating foods rich in sugar can bring on angina pains and even cause heart attacks, because the sugary meal results in the over-production of insulin and a sharp fall in blood sugar levels. It is possible, indeed, it is probable that there is a link between hypoglycaemia (low blood sugar) and heart disease. Certainly, patients given a low blood sugar diet for hypoglycaemia experience fewer angina attacks (9).
Types of Sugar
We mentioned at the start of this enquiry into sugar and heart disease that we would first deal with refined sugar. Many nutritionists, like Yudkin, Ross Hume Hall, and Dr Abram Hoffer, consider all sugar to be equally dangerous to health, whether it is brown, unrefined or in any other form. Sugar, they consider, is a useless food of which we would be well rid, since we obtain enough sugar in far less dangerous forms, such as fructose from fruits and from the breakdown of carbohydrates in the body.
But it is only fair to mention that there is a theory by one of Russia’s most famous researchers, Prof. H. Brekhman of the Far East Scientific Centre of USSR Academy of Sciences, which he elaborates in ‘Brown Sugar and Health’. He maintains that certain foods have a particular quality of energy, which results from the way certain nutrients are combined in individual foods, which Brekhman calls ‘structural information’, and which makes the food ‘biologically active’. In other words, full of vital energy, or ‘life-force- stimulating’.
He states that raw sugar appear to increase resistance to illness, heighten energy levels, and improve an organism’s ability to deal with stress, the very reverse of white, refined and coloured sugars. For sugar to be unrefined, it must contain the tin film of molasses surrounding the sucrose crystal. This contains some 200 organic nutrient which are useful in themselves and which are essential for the breakdown of the sucrose in the body. This sugar can be found coming from Barbados, Guyana or Mauritius. And it could be said that it is to unrefined sugars what honey, with its multitude of nutrients, is to ordinary sugar.
This idea of unrefined sugar being a high quality food is by no means new. Before the First World War, Dr. Forbes Ross drew attention to the value of Molasses in connection with cancer (8). Molasses is rich in potassium salts, calcium, magnesium and iron. One also hears, or used to hear, that the poor workers on sugar plantations in India and elsewhere have remained healthy on a diet of sugar cane exclusively.
Dangers of Sugar
Whatever may be the benefits of unrefined sugar and molasses as health-giving, complete foods, we think that, due to the likelihood of ‘sugar sensitiveness’ and the sedentary habits of the majority of people in the U.K. today, it might be unwise to consume much of these foods if one has a tendency to heart problems. Indeed, Cyril Scott, the writer of Crude Black Molasses, specifically warns sufferers from diabetes that molasses is not suitable for them. We have already seen how diabetes can be increased by sugar in the diet. So, for heart disease patients, any large amount of sugar, refined, unrefined, molasses, syrups and even honey are not to be recommended.
Low Sugar Diets
Let us now look around the world to get a general picture of peoples who have a diet low in sugar. Two such groups are the tribes in East Africa known as Masai and Sumburu. They consume meat and milk, and so they have a very high consumption of animal fat. According to the theories of the ‘high fat = high blood cholesterol = heart attack’ school, these tribes should have a high mortality due to this disease. Yet they have very little heart disease. True, they take a great deal of exercise, walking perhaps twelve miles per day. They may also have some efficient way of dealing with blood cholesterol: it may be that they have become efficient at metabolising fats because they have been coping with large quantities all their lives. Or it may be a genetic characteristic, enabling them to deal with this factor in ways that other races conspicuously fail to achieve. But one thing is quite certain: these tribes eat virtually no sugar.
High Sugar Diets
Another study was made of the inhabitants of St Helena. These people do not eat a lot of fat, less than the Americans and British in fact. They do take a lot of exercise, because St Helena is extremely hilly and there is very little mechanical transport. They do not smoke a lot: cigarette consumption is much lower than it is in most Western countries. And yet the people of St Helena have quite a lot of coronary disease. What is the explanation? There can only be one cause for the prevalence of this disease: the average sugar consumption in St Helena is around 100 pounds per person a year.
Further Yudkin Trials
Professor Yudkin looked at all these facts and decided to test his ideas out on a group of patients. He chose 20 men with coronary disease, 25 with peripheral vascular disease and 25 matched control patients with other ailments. The patients with coronaries were in hospital with their first known attack, had up to that time no hint that they had heart disease and had not consciously changed their diets. They were questioned about the diets they had had before their heart attacks.
It was found that patients with coronaries and peripheral heart disease had all consumed substantially higher amounts of sugar than the controls. The median values were: 113 grams a day for coronary patients, 128 grams a day for the patients with vascular disease and 58 grams a day for the control patients. In another subsequent trial, the results were: coronary patients 147 grams, control groups 67 and 74 grams.
No one, not even Dr Ancel Keys, has been able to show any difference in fat consumption people with and people without coronary disease. So the results of the sugar trials are, to say the least, interesting.
Sugar and Cholesterol
Dr Ian MacDonald of Guys Hospital, London, that in young men, sugar raised the cholesterol in the blood and particularly the level of triglycerides. For some reason, it does not happen with young women, but it does happen with older women after the menopause. This may explain why heart disease is more common with men up to a certain age but women then ‘catch them up’ at a later stage.
Causes of Heart Disease
We have now covered all the ingredients that go towards the result in heart disease. They include hereditary tendencies, including psychological make-up, and special susceptibility or sensitivity to the various factors which are known to be associated with heart disease. These are, to repeat them again: smoking, high blood pressure, over-eating, obesity, prolonged emotional traumas, stress, diabetes and lack of exercise. But patients with heart disease will ask the nutritionist: what then can I eat? Is my trouble exacerbated by fat or is it sugar than is the trouble?
Fat or Sugar
A large amount of fat will certainly cause problems, if it is not balanced by a reasonable amount of exercise. It can also cause obesity. Obesity will cause heart strain. But as we have seen in this study, a large amount of sugar, or even a moderate amount of sugar in those who are ‘sugar sensitive’, can cause untold harm and lead to atheroma and thus to heart disease.
The using up of chromium and pyridoxine (Vit. B6); the tendency to affect the pancreas and adrenals; the tendency to produce high levels of triglycerides; the stripping of other essential vitamins and minerals; the problems of hypoglycaemia; the tendency towards diabetes and obesity; all these are the results of a substance that, at any rate in its refined state, adds no nutrients to our diet. It is a substance which gives us a boost of ‘energy’ from which we may have to pay the penalty, sooner or later, in atheroma, heart disease and perhaps sudden death from coronary thrombosis.
Does sugar cause heart disease? Well, it’s one of many factors, but who can tell if it isn’t the most invidious, and perhaps the most lethal, of all?
1. Yudkin J. American Journal of Clinical Nutrition 1974
2. Yudkin J. Pure, White and Deadly 1972 p.83
3. Keys A. Proceedings of the Nutritional Society 1964
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5. Walker A.R.P. Journal of South African Medicine 1968
6. Mann J.I. et al Clinical Science 1971
7. MacDonald, & Thomas G.A. Clinical Sciences 1956
8. Sandler B.P. Internal Medicine News 1974
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10. Ross, Forbes Cancer. Its Cause & Cure
John Yudkin: Pure, White, and Deadly
Richard Passwater: Super Nutrition for Healthy Hearts
Patrick Holford: the Whole Health Manual
Robert A Miller M.D.: How to live with Heart Attack
Dr Ian Anderson: Heart Attack
Leslie Kenton: Ultra Health
Curtis Shears: Nutrition Science and Health Education
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The Penguin Medical Encyclopaedia
This article is for information only and is not to be regarded as forming any kind of individual medical advice on health.