Fareed Zacharia interviewed Chief Medical Correspondent Sanjay Gupta on CNN on Sept. 10, 2014 regarding why sugar is worse than fat.
I like to explain why it is important to rethink the issues of fat, cholesterol, sugar, starchy foods, longevity, prevention of cardiovascular diseases (strokes, heart attacks) and cancer.
I have blogged about this many times before, but perhaps an overview regarding these issues would be in order.
The Framingham Heart Study indicated first that too much cholesterol in our system was a problem leading to heart attacks and strokes (Ref. 3). As more research was done, the reasons for this have become clearer.
The liver plays a major role in the metabolism of glucose. Digestion of refined starchy foods starts in the mouth where amylase from the saliva digests the surface of the pasta or white bread you eat. The stomach carries on with this process and the job is finished in the small intestine with the help of pancreatic enzymes (Ref.1). This digestive process is so efficient that within 20 to 30 minutes all of the refined carbs from pasta, donuts and bread appear as sugar in the blood stream. The portal vein system that collects the nutrients from the gut delivers all sugar straight to the liver where it is reassembled into glucagon as the storage form in the liver and skeletal muscles. This would all be good, would we have periods of fasting in between our sugar consumption. Periods of famine are no longer part of modern civilization, but consumerism is. Most of the processed food contains sugar and this leads to excess sugar uptake, which has to be processed by our liver. The end result is production of LDL cholesterol, oxidization of LDL cholesterol by sugar and in the process the production of VLDL (=very low-density lipoproteins) that leads directly to deposits in the arterial walls and clogging of arteries. Triglycerides are also produced, which leads to fat deposits (the cause of the obesity wave all around us).
2. Where does the fat that we see around us come from?
In the past we thought that it was from too much saturated fat and cholesterol in the food that would have caused the accumulation of fat and cholesterol in the body. Now we know that this was an over-simplification. In fact more cholesterol and fat comes from metabolized sugar and with a slight time delay also from starchy foods.
Sugar and starchy foods (like pasta, white rice, white bread, potatoes, grapes, honey etc.) get metabolized by your liver into LDL cholesterol, triglycerides, and fat. This does not mean that you should not pay attention to the total fat content and the quality of fats you eat.
3. The finer points about subfractions of cholesterol
You have heard many times about the good (HDL) and the bad (LDL) cholesterol. Sugar and refined starches do not only lead to the production of LDL cholesterol, but also to oxidized LDL cholesterol, which is very aggressive (VLDL=very low-density lipoproteins) leading directly to deposits in the arterial walls and to clogging of arteries. Your doctor can order a detailed lipid profile test, if you belong into a higher risk group to determine your VLDL level.
It may surprise you to read that many of the foods that were demonized in the past 2 to 3 decades like whole eggs; unprocessed grass-fed red meat, coconut oil etc. are now seen to be good for you.
But there are provisos: supplement with molecularly distilled omega-3 fatty acids, have enough vitamin D3, vitamin K2 and calcium in your diet or supplement with these. This will make sure that calcium will leave the blood stream (not lead to arteriosclerosis) and enter into the bones where it is needed for healthy bone structure. The anti-inflammatory effect of vitamin D3 and of the omega-3 fatty acids will prevent arthritis, strokes, heart attacks and cancer.
4. Four major conditions causing heart attacks and strokes
According to Ref. 2 only 4 conditions have been proven over the years to lead to serious hardening of arteries causing strokes and heart attacks: dyslipidemia (high triglycerides, high LDL cholesterol and VLDL), hypertension, cigarette smoking, and/or diabetes (Ref. 3). What has not been appreciated until recently is the fact that sugar and refined starchy foods metabolized by the liver are the culprits in causing plaque in arteries as the oxidized LDL cholesterol is aggressively invading the arterial wall and is inflammatory. A total cholesterol level greater than 5.2 mmol/L (200 mg/dL) has been shown to be associated with increased heart attacks and strokes. Ref. 2 also points out that dietary changes; days of fasting and weight loss have all been shown to stabilize and reduce plaque lesions and reduce heart attacks and strokes. It is the rupture of unstable plaques that lead to attraction of platelets and thrombus formation. It is this localized thrombosis that leads to the closure of coronary arteries or brain vessels causing heart attacks and strokes. According to Ref. 2 there are 9 factors that determine whether we get a stoke or heart attack, the four factors mentioned above (dyslipidemia, hypertension, cigarette smoking, diabetes) and abdominal obesity, lack of physical activity, low daily fruit and vegetable consumption, alcohol overconsumption, and a psychosocial risk. This latter factor includes any kind of chronic stress like interpersonal stress at work or home, depression, financial stress, major life events like marriage, death, divorce, and lack of control. Counseling is useful for support regarding psychosocial risk factors. It is significant to note that according to Ref. 2 several studies have shown that 90% of heart attacks and strokes can be prevented by paying attention to these 9 risk factors. Managing stress effectively and seeking professional help for psychosocial difficulties as well as avoiding the physical health risks will contribute to good allover health.
Where does this leave us? For decades we have been told that saturated fats and cholesterol in our diet were the culprits and we replaced them with sugar that is part of a low-fat diet. We need to pay attention to the glycemic index and cut out high glycemic foods. However, it is OK to eat some carbs from the medium glycemic food list and most of our carbs from the low glycemic food list. With regard to fat it is important to consume only the healthy fats including omega-3 fatty acids. By taking care of the 4 major causes of heart attacks and strokes and also attending to the additional minor contributors mentioned above you will be able to eliminate 90% of the cardiovascular events. As you change these things you will also prevent many cancers as you changed the body metabolism and chronic inflammation has been taken care of as well as I pointed out in several blogs before. Finally, pay attention to stress management. The body and mind work together.
I have discussed all of these items in detail in my book as well (Ref. 3).
More information on high density and low density carbs: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/carbohydrates/
1.Townsend: Sabiston Textbook of Surgery, 19th ed.,Copyright 2012 Saunders.
2.Melmed: Williams Textbook of Endocrinology, 12th ed.,Copyright 2011 Saunders.
3. Dr. R. Schilling: “A Survivor’s Guide to Successful Aging“. Paperback through Amazon.com, 2014.
Last edited Nov. 8, 2014