Sugar and CV Mortality: What Does the Research Say?

Transcription

1 Sugar and CV Mortality: What Does the Research Say? Kim Allan Williams, Sr., M.D., MACC, FAHA, MASNC Past President, American College of Cardiology James B. Herrick Professor and Chief, Division of Cardiology Rush University Medical Center, Chicago, IL No Disclosures

2 Burden of CV Disease Cardiovascular disease accounts for nearly 801,000 deaths in the US. That s about 1 of every 3 deaths in the US. About 2,200 Americans die of cardiovascular disease each day, an average of 1 death every 40 seconds. About 92.1 million American adults are living with some form of CVD or the after-effects of stroke. Costs of CVD/stroke are estimated to total more than $316 billion in health expenditures and lost productivity. Nearly half of all black adults have some form of cardiovascular disease, 47.7 % of women and 46% percent of men.

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7 Obesity Epidemic

8 Obesity Epidemic Increased availability of a variety of palatable and affordable foods Decreased physical demands of many jobs Increased "screen time" television, computers and smart phones Nutritional programming -- overweight and obese mothers who may be increasing their unborn child s risk of obesity Changes in sleep patterns and stress Changes in the bacteria in the digestive track Temperature of our houses and workplaces

9 Obesity Epidemic Nearly 78 million US adults and 13 million children Obese individuals have less ability to resist food cues Healthy dining is difficult Dining out is a challenge: American style big meals, refined grains, red meat, unhealthy fats and sugary drinks American s are eating fewer fruits, vegetables, whole grains and nuts (Harvard School of Public Health)

10 Seven approaches to staying heart healthy: Be active (exercise regularly/daily) Keep a healthy weight (BMI < 25) Cholesterol control Don t smoke or use smokeless tobacco Eat a heart-healthy diet Keep blood pressure healthy (<120 systolic) Learn about your blood sugar and diabetes (A1c < 5.7%) 3%

11 Global CVD CVDs are the number 1 cause of death globally 17.5 million people died from CVDs in 2012, representing 31% of all global deaths 7.4 million coronary heart disease 6.7 million stroke Over three quarters of CVD deaths take place in low- and middle-income countries. 11

12 Sugar Not as sweet as it tastes! 12

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21 Sugar can be unfavorable on lipid profiles: TC increases HDL decrease Triglyceride increase High sugar diets are associated with: impaired glucose tolerance (diabetes) insulin resistance elevated uric acid level altered platelet function These can be reversed when lowering sugar in the diet 22

22 Sugar-related hyperglycemia is associated with proinflammatory and prothrombotic glycated LDL Sugar-related hyperinsulinemia is associated with: smooth muscle cell proliferation lipogenesis dyslipidemia inflammation oxidative stress increased platelet adhesiveness Fructose, and fructose-containing sweeteners (e.g. sucrose or high-fructose corn syrup) may present greater risk of CHD than glucose (alone or as starch) 23

23 Fructose, as compared to glucose, increases oxidized low-density lipoprotein (oxldl) which likely leads to: endothelial cell dysfunction/apoptosis foam cell formation abnormal vascular tone and decreased blood flow, inflammation increased cell adhesion molecule expression pro-clotting increased intracellular oxidative stress 24

24 Fructose increases the levels of advanced glycation end products which, may lead to dysfunctional macrophages entering the arterial wall and contribute to atherosclerosis. Oxidative stress, reactive oxygen species forming in the heart and aorta, and lipid peroxidation may also play a role in fructose-induced adverse cardiac effects. Feeding sucrose causes the development of atheroma, the degree to which depends on the amount of sucrose (not fat) in the diet. 25

25 Humans that develop ischemic heart disease have been found to eat more sugar Sugar seems to act as both a predisposing factor for heart disease (e.g. through inflammatory, thrombotic, oxidative, and hormonal pathways), and a precipitating factor (e.g. through an increase in myocardial oxygen demand, cardiac sympathetic nerve activity, and platelet adhesiveness). Replacing saturated fats with sugars increases the risk of heart attacks. A diet high in added sugars has been found to cause a 3-fold increased risk of death due to cardiovascular 26

26 Dietary guidelines should shift focus away from reducing saturated fat, and from replacing saturated fat with carbohydrates, especially when these carbohydrates are refined. To reduce the burden of CHD, guidelines should focus particularly on reducing intake of concentrated sugars, specifically the fructose-containing sugars added by industry like sucrose and high-fructose corn syrup. P R O G R E S S I N C A R D I O V A S C U L A R D I S E A S E S 5 8 ( )

27 Treatment? Elevated cholesterol Vascular damage Inflammation Heart attack Stroke Death

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35 Cumulative Incidence of the Primary End Point and the Key Secondary Cardiovascular End Point. Ridker PM et al. N Engl J Med DOI: /NEJMoa

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37 PORFOLIO DIET Participants were randomly assigned to undergo 1 of 3 interventions on an outpatient basis for 1 month: a diet very low in saturated fat, based on milled whole-wheat cereals and low-fat dairy foods (n = 16; control); the same diet plus lovastatin, 20 mg/d (n = 14); or a diet high in plant sterols (1.0 g/1000 kcal), soy protein (21.4 g/1000 kcal), viscous fibers (9.8 g/1000 kcal), and almonds (14 g/1000 kcal) (n = 16; dietary portfolio).

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41 From: Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults JAMA Intern Med. 2014;174(4): doi: /jamainternmed Figure Legend: Adjusted Hazard Ratio (HR) of the Usual Percentage of Calories From Added Sugar for Cardiovascular Disease Mortality Among US Adults 20 Years or Older: National Health and Nutrition Examination Survey Linked Mortality Files, Histogram of the distribution of usual percentage of calories from added sugar in the population. Lines show the adjusted HRs from Cox models. Midvalue of quintile 1 (7.4%) was the reference standard. The model was adjusted for age, sex, race/ethnicity, educational attainment, smoking status, alcohol consumption, Copyright physical activity 2014 American level, family Medical history of cardiovascular disease, antihypertensive Date medication of download: use, Healthy 9/4/2014 Eating Index score, body Association. mass index, All systolic rights reserved. blood pressure, total serum cholesterol, and total calories. Solid line indicates point estimates; dashed lines indicate 95% CIs.

42 From: Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults JAMA Intern Med. 2014;174(4): doi: /jamainternmed Figure Legend: Adjusted Hazard Ratio (HR) of Cardiovascular Disease Mortality Comparing Quintile 5 With Quintile 1 of Usual Percentage of Calories From Added Sugar by Selected Characteristics Among US Adults 20 Years or Older: National Health and Nutrition Examination Survey Linked Mortality Files, For the Healthy Eating Index score, the top 50% or higher included the participants with a score of 63.5 or more; high physical activity included the participants who had moderate intensity to vigorous activities 5 or more times per week. Limit lines indicate Copyright 95% 2014 CI. Body American mass Medical index is calculated as weight in kilograms divided by Date height of in download: meters squared. 9/4/2014 Association. All rights reserved.

43 Daily intake of >2 servings of sweetened beverages (consumed by 6% of participants) was associated with increased risk of LADA (OR: 1.99, 95% CI: ), and for each 200 ml daily serving, OR was 1.15 (95% CI: ). Findings were similar for sugarsweetened (OR: 1.18, 95% CI: ) and artificially sweetened beverages (OR: 1.12, 95% CI: ). Similarly, each daily serving increment in total sweetened beverage conferred 20% higher type 2 diabetes risk (95% CI: ). 44

44 Australian researchers used a cohort of 27 healthy people and found that those who were given artificial sweeteners for two weeks had higher levels of blood glucose, glucose absorption, gut peptides and insulin, increasing their risk of developing type 2 diabetes, compared with the placebo group. 45

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46 Some Interrelation among Sugar Consumption, Percentage of Daily Calories from Saturated Fat and Mortality from Coronary Heart Disease McGandy RB et al. N Engl J Med 1967;277:

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54 From: Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in the United States JAMA. 2017;317(9): doi: /jama Figure Legend: Absolute and Proportional Cardiometabolic Disease Mortality Associated With Suboptimal Dietary Habits Among US Men and Women in 2012The bars represent the estimated absolute number (top panel) and percentage (bottom panel) of cardiometabolic deaths related to 10 dietary factors compared with optimal intakes. The dietary factors are listed in rank order of total mortality in men and women combined. Error bars indicate 95% uncertainty intervals. CHD indicates coronary heart disease; CVD, cardiovascular disease; PUFA, polyunsaturated Copyright fat American Medical Date of download: 3/8/2017 Association. All rights reserved.

55 triglycerides... rise when simple sugars exceed 20% of energy per day 56

56 Interpretation. High carbohydrate intake was associated risk ofreplacement total mortality, Isocaloric with (5% higher of energy) of whereas total with fat and individual types fat carbohydrate polyunsaturated acidsofwas were related with to lower Total of fat associated an total 11%mortality. lower risk and types (HR of fat0 89 were[95% not CI associated with mortality ]), cardiovascular disease, myocardial infarction, whereas replacement of carbohydrate withor cardiovascular disease mortality, whereas saturated fatty acids, monounsaturated acids, saturated had not an inverse association with or proteinfatwas significantly associated stroke. guidelines should be with riskglobal of totaldietary mortality. reconsidered in light of these findings. 57

57 Business, Politics & Health

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59 ... Congress and the Department of Agriculture are spending more than $1.28 billion annually to subsidize the crops that are used as additives in manufacturing cookies, candies, soda pop and other highly popular junk food that arguably are among the primary contributors to childhood obesity. The sweet, fatty and calorie-rich Hostess Twinkies alone contain 14 ingredients made with highly subsidized processed ingredients, including corn syrup, high fructose corn syrup, corn starch and vegetable shortening. 60

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61 How many calories are there in a package of Twinkies? Not sure, I just love them unlike most people, they re always sweet to me

62 How much spinach must you eat to consume 1500 calories? 1. 5 pounds pounds pounds 4. None, because I m sure to eat my package of Twinkies first

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66 ... participants in the price increase condition purchased significantly less SSBs than the control group (B =.90; 95% CI = 1.70 to.10 L per household per week). There were no significant effects on purchases in other beverage or snack food categories. This means that the higher VAT rate was effective in reducing SSB purchases and had no negative side-effects." 67

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69 ... SNAP was associated with lower estimated annual health care expenditures ( $1409; 95%CI, $2694 to $125). Sensitivity analyses were consistent with these results, also indicating." 70

70 Sugar Addiction In 2014, Berkeley, California, became the first city in the U.S. to tax sugary drinks in an attempt to address a serious problem that has gotten out of control. Americans consume more soft drinks per capita than any other country on earth, contributing to our country's overinflated obesity and diabetes rates. This makes sense when you think about the fact that sugar is addictive, and it's everywhere, as James DiNicolantonio and Sean Lucan point out in their New York Times piece. They assert that sugar, found in approximately 75 percent of packaged foods in the U.S., can be as addictive as drugs.

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72 Sugar Addiction 1. Avoid Processed Foods. sugar and processed foods are as addictive as heroin or cocaine? 2. Boost Your Serotonin. Serotonin, a.k.a. the "happiness hormone, can be raised through diet, exercise, and the right sleep schedule. 3. Satisfy Your Sweet Tooth Naturally. The all-natural sweetener Stevia has zero calories, does not raise blood sugar levels (but increases insulin levels), and is 300 times sweeter than sugar.

73 Sugar Addiction 4. Drink Plenty of Water. You may sometimes think that your body is asking for sugar, when in fact it's dehydrated and really craving water! Try our favorite delicious cravings-buster: In 8 oz. of water, add the juice of ½ lemon and 5 drops of Stevia for a Body Ecology lemonade. We also suggest a warm cup of green tea, sweetened with Stevia with your meals. This way, your sweet taste is satisfied, and you won't want a dessert. 5. Keep Your Blood Sugar Stable. Eat several small, healthy Body Ecology meals throughout your day instead of three large portions to avoid dips in blood sugar.

74 Sugar Addiction 6. Have Plenty of Greens. Loaded with nutrition, green drinks help boost your energy and reduce cravings for sugar and processed foods. 7. Eat More Sea Vegetables. Rich in vitamins and minerals, seaweed or sea vegetables make for a healthy snack! Sea vegetables have a high mineral content, while eating anything with sugar immediately depletes minerals from your body. A true Body Ecology meal would include a portion of sea vegetables somewhere in that meal to ensure that you get the minerals your adrenals need.

75 Sugar Addiction 8. Enjoy Fermented Foods and Drinks. Fermented foods and drinks are perhaps the most important way to reduce or even eliminate cravings for sugar. In fact, this one is so effective that we've heard from many of our customers that it nixes sugar cravings in about 4-5 days 9. Meditate. Meditation can help ward off cravings by helping reduce stress (neuroscientist at Harvard Medical School and Massachusetts General Hospital) 10. Try EFT. If you're looking to shift the desire for sugar, lose weight, stop a habit of binging, or eliminate any addiction, you owe it to yourself to learn about the Emotional Freedom Techniques (EFT). (mantra repetition)

76 Results: The recommended daily consumption of yacon syrup with no undesirable gastrointestinal effects is 0.14 g fructooligosaccharides/kg. Daily intake of yacon syrup produced a significant decrease in body weight, waist circumference and body mass index. Additionally, decrease in fasting serum insulin and Homeostasis Model Assessment index was observed. The consumption of yacon syrup increased defecation frequency and satiety sensation. Fasting glucose and serum lipids were not affected by syrup treatment and the only positive effect was found in serum LDLcholesterol levels."

77 Summary Or we can do the right thing change our lifestyles. Heart disease mortality is increasing in the US, again. Diet, exercise and lifestyle choices are driving an increase in obesity and type II diabetes mellitus. Sugar and other refined carbohydrates increase insulin levels (as in T2DM), promoting atherosclerosis, cholesterol worsening, with subsequent heart attack, stroke and death. These consequences can be treated with drugs.

78 Change Your Lifestyle Save you money. Save your health. Save your family. Save your friends. Save your country.

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