By Paul Goldfinger, MD, FACC, Fellow on the Clinical Council–American Heart Association.

In the 1980’s I started getting interested in nutrition and prevention in relation to atherosclerotic cardiovascular diseases. The focus on lowering cholesterol, especially with drugs, was supported by scientific research, and Lipitor (atorvastatin) became the most widely used medication in history. Low fat diets were embraced as the most healthy way to eat. It was also in the 1980’s that the obesity epidemic was first noted.

In the 1990’s, some of my patients went on the Atkins diet, on their own, which emphasized eliminating dietary carbohydrates. I was impressed with their weight loss, although the increased dietary fat that Atkins suggested did not seem like a good idea. My advice to them was to continue their usual heart-healthy eating, but cut down on carbs to get the weight loss advantage.

Now there is evolving information about the role of sugar in promoting a variety of chronic diseases.

Here is a 2012 basic understanding regarding sugar:

1. Sugar is needed by the human body. It’s OK to have some sugar, but we eat much more than we need. Excess sugar intake, obesity and high caloric intake are new developments in the evolution of man.

2. Sugar comes in a variety of forms including processed table sugars made from cane and beets, corn sugars, honey, and natural sources from food. Carbohydrates are converted to sugar in the body, so we can include carbs as part of the sugar problem.

3. In recent years, Americans have increased their intake of sugars to about 130 pounds per person per year, contributing to the “obesity epidemic.” Being overweight or obese are risk factors for chronic health problems including heart disease, diabetes, high blood pressure, sleep apnea and metabolic syndrome*. The risk of some cancers also increases with obesity.

4. Of the 600,000 food items sold in this country, over 80% contain added sugar. Look for hidden sugars in processed foods — read the labels. Excess sugar in the body is converted into fat which accumulates in a variety of places — especially around our bellies and abdominal organs, but also inside our liver and our arteries.

Sugar induces disturbances in our metabolism, such as increased insulin release which in turn results in weight gain.

Sugar also stimulates pleasure centers in the brain which release dopamine and cause increased desire for more sugar. In this regard, it is similar to addictive substances such as cocaine and alcohol.

5. Half of our sugar intake is derived from corn in the form of cheap high fructose corn syrup. This HFCS is much less expensive than regular sugar and it is sweeter. It is often added to foods such as hamburger rolls, baked goods, salad dressing, ketchup (Heinz “original”), frozen foods, fruit flavored yogurt, ice cream and sodas. It also keeps breads soft and prevents freezer burn. The other half of our sugar intake is from sucrose, i.e. table sugar. The ingredient in these sugars that is most damaging to the body is fructose, which is about half the content of table sugar.

Some carbohydrates are considered to be much less harmful than pure sugar. These include complex carbohydrates found in fiber, whole grains, fruits and vegetables. But any excess eating that results in more sugar in your body may cause harm by promoting obesity.

6. Sugar is sugar, whether it is from sugar cane/beets or from corn. The corn industry says that the name HFCS is misleading the public, and they want a new name for their product: “corn sugar.” A law suit has resulted over this.

7. Read labels: One gram of sugar contains 5 calories. One teaspoon of sugar contains 5 grams, i.e. 25 calories. A 16-ounce soda has 60 grams of sugar — 300 calories (i.e. 12 teaspoons of sugar).

Total added dietary sugar should be about 30 grams per day which is 6 tsp. or 150 calories. This doesn’t include carbs that you eat in fruits, vegetables and dairy products.

When you read labels, look for “sugar” and “carbohydrate.”

8. “Metabolic syndrome:*” includes truncal obesity (around the middle), hypertension, type II (“adult onset’) diabetes, and high blood fats (LDL “bad” cholesterol and triglycerides.) This syndrome is associated with the development of cardiovascular disease.

REFERENCES: Drs. Marian Nestle and Malden Nesheim: “Why Calories Count — From Science to Politics.” Also: Michael Pollan, “The Omnivore’s Dilemma.” And Dr. Robert Lustig, “The Real Truth About Sugar.”

“Prevention Does Work — A Guide to a Healthy Heart” by Paul Goldfinger MD and Eileen Goldfinger, BA.

Blogfinger article: Fat people–Why?

Blogfinger article: “Looking for food in all the wrong places”

Also — the quotes of the day, from Marion Nestle, PhD: “Don’t eat anything artificial.”

And, from Michael Pollan: “Don’t eat anything your grandmother wouldn’t recognize as food.”