SUGAR an accomplice of Salt in hypertension.

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Cardiovascular diseases are the leading cause of premature mortality and hypertension is the most important risk factor.

Salt: Historically, dietary controls solely focused on sodium and how it play role in increasing the blood pressure, & such patients should be educated to take low sodium to no sodium diets (in strictly sodium restricted conditions). Sodium reduction may decrease the blood pressure in several patients, but average blood pressure reduction might only be as great as 4.8 mm Hg systolic and 2.5 mm Hg diastolic. It is unclear that whether such reductions in sodium intake are fully beneficial or not.

According to the authors of a new study published in Open Heart, the guidelines on dietary control for hypertension should be moved away from the salt and should now be focused on the food additives: “Sugar”.

In fact reducing sodium can lead to an increase in the cardiovascular and all cause mortality in diabetic patients and raises the chances of hospital admission in patients with chronic heart failure.

According to Dr James DiNicolantnio (author of the study), Department of Preventive Cardiology at Saint Luke’s Mid America heart Institute, Kansas, in order to fulfil the body’s physical need for salt, low sodium foods are likely to increase the amount we actually eat. 

Guidelines also suggest that restricting sodium consumption below 2-3g/day may prove harmful.

Nevertheless, we cannot deny the important roles of sodium in our body. Sodium is an important electrolyte and an essential ion in the ECF (extra cellular fluid). It plays an essential role in the enzyme operations and muscle contractions along with the osmoregulation  and fluid maintenance within the body. 

Sugar: Reducing the intake of added sugars, especially fructose can aid in controlling the high blood pressures.

Processed foods are not only rich in sodium but contain fair share of highly refined carbohydrates as well. Sweetener … high fructose corn syrup is present in huge quantities in industrially processed foods. Sucrose, a disaccharide is an another ingredient found in such edibles.

The study has shown that sugars, especially monosaccharide fructose  is also a culprit in developing hypertension.

Studies: 1. An 8 weeks trial on high sugar intake vs low sugar consumption showed that high levels of sugar markedly increased the blood pressure.

Decreased levels of sodium in the processed foods can result in the increased amounts of sugars and starches which may lead to high blood pressures and cardiometabolic diseases.

2. Another 24 hours ambulatory blood pressure studies have unveiled that diets high in sugar can increase blood pressure. A randomized controlled trial was done in 74 adult men. For 2 weeks daily they were given 200g of fructose (with or without allopurinol). Primary measures included were ambulatory blood pressure, glucose and insulin, fasting lipids, body mass index and criteria for metabolic syndrome. The results showed that high amounts of fructose do increase the blood pressure and can cause features of metabolic syndrome.

3. Another study in which one 24 ounce of soft drinks were administered showed that it can cause an average maximum increase in blood pressure of 15/g mm Hg and heart rate of 9 bpm.

4. Research has also shown that individuals who ingest 25% or more calories coming from the added sugars are at three times increased risk of death due to cardiovascular diseases.

5. Sugar sweetened beverages have been seen to be linked to 180,000 deaths a year, worldwide.

Mechanisms through which sugar raises blood pressure: It has been seen that when rats are fed with sucrose, their sympathetic nervous system gets activated and resultantly cause increased renin secretion, faster heart rate, vascular resistance, and sodium retention. All of these parameters elevates blood pressure.

Dr. DiNicolantonio reported that sugar causes an increase in the level of insulin and this in turn activates the sympathetic nervous system and leads to increased heart rate and blood pressure. It somewhat desensitizes the receptors as well that are involved in regulating the blood pressure and keeping it at safe levels. Sugar drains ATP which then through several ways cause rise in blood pressure by constricting the blood vessels.

This deduces that reducing the sugar intake may prove a more better and beneficial way of reducing blood pressure than cutting down on salt all the time and the better approach is to keep the moderate levels of sodium rather than very low amounts as too little sodium in diet is further responsible for adverse health effects.

DiNicolantonio states “the best thing people can do for their health is to eat whole food and avoid added sugars- worrying less about the salt.”

Even using moderate amounts of sugar for short period of time can cause harms.

However, the natural, biological sources of sugar i.e. whole fruits are not detrimental to health but are very advantageous.

My thoughts on the topic: Salt prevention should not only be the centre of attention for hypertensive patients and sugar should be equally placed in consideration. More broader and stronger evidence are now required and more vast research should be done to find out whether reducing the sugar sweetened drinks and foods would reduce blood pressure or not.

And it does not mean that salt all of a sudden is safe for the heart failure patients or the complete concentration should only be on reducing sugar intake while letting salt roam free in the body. Too much salt and too much sugar, both can be harmful. It should not be about which crystal is bad but should be about controlling the overall diet as these two sugar and salt are common, important and yummy components of diet. 🙂

Reference:

Open Heart, BMJ

International Journal of obesity; 34(3):454-61.

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