The Heart of the Matter
By Lisa Andrews Med RD LD


It’s February and Valentine’s Day is right around the corner. But before you surprise your sweetheart with a sweetheart filled with beautiful chocolates, let’s take a look at the latest in diet and heart disease. For chocolate’s sake, why not start with sugar?

For years, scientists blamed dietary fat on the risk for heart disease, but perhaps it’s what’s combined with fat that may be at the heart of the problem. A recent study published in JAMA Internal Medicine found that a diet filled with sugar may raise your risk for heart disease, regardless of weight gain. 1

The US Dietary Guidelines advise us to consume no more than 10% of calories from added sugar. In a typical 2000 calorie diet, that’s 200 calories or roughly 50 grams of added sugar. For most people, that equates to one, 12 oz. regular soda with the remaining sugar likely coming from hidden sources such as ketchup or breakfast cereal. 2

In a 15-year study done by Quanhe Yang and associates, participants that consumed more than 25% of total calories from sugar were over twice as likely to die from heart disease than those who consumed 10% or less. Regardless of other risk factors such as advanced age, sex, weight, exercise and gender, sugar intake was a better predictor of heart disease risk. American’s sugar consumption comes from a variety of sources including sugar-sweetened beverages such as soda and sports drinks, desserts like pies, cake, doughnuts and other pastries, candy, ice cream and ready to eat cereal. 1

The American Heart Association gives more specific suggestions for sugar intake based on gender- advising no more than 6 teaspoons per day for women and 9 teaspoons per day for men. 3 Eating too much sugar has been found to raise blood pressure, blood sugar, and triglycerides in addition to prompting the liver to deliver more harmful fats to the bloodstream that lead to inflammation. Excessive sugar intake is also linked with unwanted weight gain and cavities. 3

In addition to sugar, saturated and trans-fat intake remain a risk factor for heart disease. Both types of fat raise LDL (“lousy” cholesterol) and also increase the risk of stroke and developing diabetes. Little was known about trans-fat before 1990 until research started connecting trans-fat with deleterious health effects. It is estimated that for every 2% of calories consumed from trans-fat, the risk for heart disease increases by 23%. In 2013, the USDA pulled trans-fat off the GRAS (Generally Recognized as Safe) list but prior to that several fast food restaurants ditched trans-fat from their menus including Taco Bell, Burger King and KCF in 2006, Dunkin Doughnuts in 2007 and Wendy’s and McDonald’s in 2008. However, trans fat may still be lurking in foods such as microwave popcorn, commercial crackers and cookies, coffee creamer, cookie dough, croissants, granola bars and other foods. 4 Advise consumers to read the Nutrition Facts label and avoid foods containing hydrogenated or partially hydrogenated oils.

Saturated fat found primarily in higher fat animal foods (beef, bacon, butter, full fat dairy products) is also still a culprit when it comes to risk for heart disease, though recent studies challenged this notion. 5 Saturated fat is known to increase blood cholesterol and lower HDL (“healthy” cholesterol), but what you substitute it for makes a difference. If it is replaced with processed carbohydrates or trans-fat, the risk for heart disease is not reduced. Using polyunsaturated fats, monounsaturated fats or adding whole grains in place of saturated fats helps reduce heart disease risk. 5 Dietitians should advise reducing saturated and trans-fat from hydrogenated oils, butter and lard and encourage the use of corn, safflower, sunflower and other vegetables oils in addition to canola, olive and peanut oil.

A plant-based diet is never going to go out of style when it comes to reducing the risk of heart disease. Years and years of scholarly research continue to advise us to eat more vegetables, fruit, whole grains, legumes, nuts and seeds. A recent study published in the Journal of Family Practice advised 198 participants to follow a plant-based/vegan diet. In nearly 90% of subjects that adhered to the diet, 81% improved symptoms and had less complications from heart disease. 6 Fruits and vegetables contain polyphenols and phytochemicals that have been proven to be protective against heart disease as they prevent the oxidation of LDL. In addition, a plant-based diet is low in fat, cholesterol, sugar and sodium as long as unhealthy, processed foods are not included (such as candy, processed crackers, cookies, chips and other snack foods). 6

As heart disease remains the number one killer in the US, it is prudent for RDs to advise a heart-healthy diet that is low in saturated and trans-fat, processed sugar and excess sodium. Including more plant-based meals that include a variety of produce (fruits/vegetables), whole grains, legumes, nuts, seeds and healthy oils from mono and polyunsaturated fats, will aid in the reduction of heart disease as well as other chronic diseases such as cancer, diabetes and obesity. Remind your patients to eat “more plants and less cow” and stay physically active.


  1. Quanhe Yang, PhD1; Zefeng Zhang, MD, PhD1; Edward W. Gregg, PhD2; et al Dana Flanders, MD, ScD3; Robert Merritt, MA1; Frank B. Hu, MD, PhD4,5

Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults. JAMA Intern Med. 2014;174(4):516-524. doi:10.1001/jamainternmed.2013.13563

  1. US Dietary guidelines https://health.gov/dietaryguidelines/2015/

  2. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugars

  3. Joyce A. Nettleton,a,*Ingeborg A. Brouwer,b Johanna M. Geleijnse,c and Gerard Hornstrad Saturated Fat Consumption and Risk of Coronary Heart Disease and Ischemic Stroke: A Science Update. Ann Nutr Metab. 2017 Apr; 70(1): 26–33.

  4. Clifton PM1, Keogh JB2. A systematic review of the effect of dietary saturated and polyunsaturated fat on heart disease. Nutr Metab Cardiovasc Dis.2017 Dec;27(12):1060-1080

  5. Esselstyn CB Jr., Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract. 2014;63:356-364b.