Coronary Heart Disease (CHD) is responsible for one in every four deaths in the United States, making it the number one killer of Americans every year . We know that people who are diabetic, who are overweight or obese, who eat an unhealthy diet, don’t exercise and consume excessive amounts of alcohol are at a greater risk for developing CHD , but is there a culprit that stands out among the rest?
For years, most experts believed that consuming a diet high in fat, particularly saturated fat, was the main dietary risk factor for a coronary attack, but Dr. W Gifford Jones (a.k.a. Dr. Ken Walker), is one of a growing list of medical professionals who believe that this is incorrect. What’s the real culprit? According to Jones, it’s sugar .
“Added sugar has become a part of so many products that North Americans are unaware of the amount of sugar they’re consuming. And according to Robert Lustig and other nutritional experts, it has addictive qualities like alcohol and tobacco.” 
So just how much sugar are we eating exactly? The average American consumes seventeen teaspoons of sugar every day, which adds up to 57 pounds of added sugar per year . This is a thirty percent increase over the last three decades .
The rise in sugar consumption does appear to be congruent with the rise in CHD, so that begs the question- is sugar, not fat, responsible for heart disease? While causation doesn’t always equal correlation, there is something going on here.
Sugar and Coronary Heart Disease
Needless to say, that is alarmingly high. A major study conducted over the course of 15 years and published in 2014 found that participants whose diets were 25 percent sugar were more than twice as likely to die from CHD than those who ate ten percent or less. These findings rang true regardless of the participant’s age, sex, physical activity level, or body mass index .
Added fructose, which you will most often find in the form of sucrose, or table sugar, and high-fructose corn syrup (HFCS), appear to be particularly harmful. These added sugars are found in processed foods and beverages, and lead to leptin resistance. Leptin is an important hormone in the maintenance of healthy body weight, and being resistant to it increases your risk for obesity, and subsequently CHD .
Excess fructose also increases your risk for non-fatty liver disease, a very strong risk factor for CHD and the most common form of liver disease in the United States, as well as diabetes, another prominent risk factor .
“Excess sugar’s impact on obesity and diabetes is well documented, but one area that may surprise many men is how their taste for sugar can have a serious impact on their heart health,” says Dr. Frank Hu, professor of nutrition at the Harvard T.H. Chan School of Public Health .
Fat and Coronary Heart Disease
Fat was named the main culprit behind CHD in the 1970s and remained that way until 2014 . What was the thought process behind this, and is there still some truth to it?
Since fats are not all created equal, this is not a simple yes-or-no question. It is important to understand the difference between the types of fats and how they affect your health to find the answer.
Unsaturated fats are known as “good” fats. There are two types, monounsaturated and polyunsaturated, and both of them lower your risk for disease. Olive oil and other minimally processed vegetable oils, nuts, seeds, and fish are all good sources of these types of fat .
Trans fats are found in processed foods that contain partially hydrogenated oil. They may be present in fried foods, margarine, baked goods, and even microwaved popcorn. This type of fat has been shown to increase your disease risk even when eaten in small quantities. Thankfully, they have been widely removed from products because of their damaging health effects .
Saturated fats are where things get confusing. Scientists originally thought they should be avoided because they raised cholesterol levels, but they failed to make the distinction between LDL (Low-Density Lipoprotein) and HDL (High-Density Lipoprotein) cholesterol. They later learned that LDL was linked to an increased risk of disease, while HDL actually lowered your risk .
Despite the fact that saturated fat raised your levels of both “good” and “bad” cholesterol, scientists were still wary of its health effects. New research, however, has made things even more complicated.
Researchers have found that not all LDL cholesterol is bad, because there are subtypes – small and large. Small lipoproteins are capable of easily penetrating the arterial wall, so having high levels of these could lead to heart disease . Large lipoproteins are too big to penetrate the arterial walls, so do not contribute to an increased risk of heart disease. People who have predominantly small LDL particles have a three-times increased risk of heart disease .
Furthermore, the length of the fatty acid chain also appears to change the impact it has on your heart. For example, palmitic acid, which has 16 carbons, raises LDL levels a small amount, while stearic acid, which has 18 carbons, does not .
All of this is to say that saturated fat may not be as problematic as we once thought. That does not mean, however, that fat is not important. Studies have found that while simply reducing your saturated fat intake does not inherently lower your risk of heart disease, replacing it with a healthier fat will .
So Where Did This Confusion Come From?
In the 1960s and 70s, most of the research that was conducted surrounding fat, sugar, and CHD was done through observational studies. The problem with that is that humans don’t eat just fat or just sugar, they eat food. Often, foods that are high in saturated fat are also high in sugar, and vice-versa, and people who eat lots of one most likely eat lots of the other, as well .
Researchers from the Albert Einstein College of Medicine have concluded, however, that sugar is a greater contributor to CHD than fat.
“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 an increased understanding of how nutrition impacts the body and specifically coronary heart disease.” 
Take Action Against CHD
It is incredibly important that you take charge of your own health and lifestyle to prevent developing Coronary Heart Disease. Here are some guidelines for how you can keep your heart healthy:
- Reduce sugar intake. Given all of the research, this is one of the most important steps to reducing your risk. You should attempt to reduce your sugar intake so that it makes up no more than five percent of your diet. You can do this by limiting the number of candies and sugar-sweetened beverages you consume, including soft drinks, fruit or vegetable juices (yes, even some veggie juices are high), and sports drinks .
- Consume a variety of fats. Saturated fat is no longer the villain it used to be, but it is still important that you consume them in moderation, to give you room in your diet to include other beneficial fats, like mono and polyunsaturated fats, and omega-3s. Foods like fish, olive oil, nuts and seeds, and avocados are excellent sources of these types of fats. Trans fats should be less than one percent of your total daily intake . Small amounts of naturally occurring trans fats from things like dairy products are fine. In fact, the evidence seems to indicate that naturally occurring trans fats do not pose the same risk artificial ones do when it comes to CHD.
- Stay active. Physical activity lowers your risk of CHD, and you should try to include at least thirty minutes of moderate-intensity physical activity five days per week .
- Reduce stress. The association between stress and heart disease is still being studied, but it is true that high stress levels can lead to other unhealthy behaviors, like overeating, drinking, smoking, and physical inactivity, which could all contribute to CHD .
The Results Are In
So who’s at fault – sugar or fat? It is hard to ignore the research that seems to be pointing at sugar as enemy number one, but the truth is, there are multiple variables to consider when protecting your heart and your health.
This research is not giving permission to eat all the saturated fat you want, but rather directing your attention to an area that you may have been more or less ignoring. If your goal is to achieve optimal health and prevent coronary heart disease, it is important that you evaluate all areas of your diet- and your life- to ensure that you are on the right track.
Reducing sugar intake, eating a variety of fats, getting plenty of exercise and reducing stress will keep your heart healthy.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.