The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease

How long before your doctor talks to you about sugar vs. salt? Do not make any medical decisions with this until you talk to your doctor.
http://www.nacion.com/vivir/medicina/azucar-enfermedades_del_corazon-nutricion_LNCFIL20141209_0002.pdf
James J DiNicolantonio,1 Sean C Lucan2
To cite: DiNicolantonio JJ,
Lucan SC. The wrong white
crystals: not salt but sugar as
aetiological in hypertension
and cardiometabolic disease.
Open Heart 2014;1:e000167.
doi:10.1136/openhrt-2014-
000167
Received 28 June 2014
Revised 28 August 2014
Accepted 1 October 2014
1Department of Preventive
Cardiology, Saint Luke's Mid
America Heart Institute,
Kansas City, Missouri, USA
2Department of Family and
Social Medicine, Albert
Einstein College of Medicine,
Montefiore Medical Center,
Bronx, USA
Correspondence to
Dr James J DiNicolantonio;
jjdinicol@gmail.com
ABSTRACT
Cardiovascular disease is the leading cause of
premature mortality in the developed world, and
hypertension is its most important risk factor.
Controlling hypertension is a major focus of public
health initiatives, and dietary approaches have
historically focused on sodium. While the potential
benefits of sodium-reduction strategies are debatable,
one fact about which there is little debate is that the
predominant sources of sodium in the diet are
industrially processed foods. Processed foods also
happen to be generally high in added sugars, the
consumption of which might be more strongly and
directly associated with hypertension and
cardiometabolic risk. Evidence from epidemiological
studies and experimental trials in animals and humans
suggests that added sugars, particularly fructose, may
increase blood pressure and blood pressure variability,
increase heart rate and myocardial oxygen demand,
and contribute to inflammation, insulin resistance and
broader metabolic dysfunction. Thus, while there is no
argument that recommendations to reduce
consumption of processed foods are highly appropriate
and advisable, the arguments in this review are that the
benefits of such recommendations might have less to
do with sodium—minimally related to blood pressure
and perhaps even inversely related to cardiovascular
risk—and more to do with highly-refined
carbohydrates. It is time for guideline committees to
shift focus away from salt and focus greater attention
to the likely more-consequential food additive: sugar.
A reduction in the intake of added sugars, particularly
fructose, and specifically in the quantities and context
of industrially-manufactured consumables, would help
not only curb hypertension rates, but might also help
address broader problems related to cardiometabolic
disease.

KEY MESSAGES
What is already known on this subject?
▸ Cardiovascular disease is the leading cause of
premature mortality in the developed world, and
hypertension is its most important risk factor.
▸ Controlling hypertension is a major focus of
public health initiatives, and dietary approaches
have historically focused on sodium.
What might this study add?
▸ The predominant sources of sodium in the diet,
processed foods, are also generally high in
added sugars, the consumption of which might
be more strongly and directly associated with
hypertension and cardiometabolic risk.
How might this impact on clinical practice?
▸ Clinicians should shift focus away from salt and
focus greater attention to the likely more-consequential
food additive: sugar.
▸ A reduction in the intake of added sugars, particularly
fructose, and specifically in the quantities
and context of industrially-manufactured
consumables, would help not only curb hypertension
rates, but might also help address
broader problems related to cardiometabolic
disease.