Is sugar worse than salt for blood pressure?

Hypertension, a silent killer is responsible for 24% of all coronary heart disease and 57% of all stroke deaths in India.For decades the notion that an excessive consumption of salt (NaCl) leads to hypertension has persisted. However, this idea is based on opinion, not scientific proof. The present review article suggests that the consumption of a high-salt diet is not the cause of hypertension and that there are other factors, such as added sugars, which are causative for inducing hypertension and cardiovascular disease.

In recent years, salt has become somewhat less of a culprit in heart disease, and sugar has, at least in some researchers’ eyes, taken its place. Now, authors of a new study have found that Sugar, not salt, is the principal reason behind hypertension and cardiovascular diseases. The researchers have also emphasized that there is no definite evidence that normal salt intake causes hypertension.

The patients of hypertension are advised to stop smoking, control cholesterol and weight and reduce stress. They are also recommended against high salt intake and for increasing physical exercise. The available evidence suggests contradiction in these two recommendations as-

• Exercise or physical work done in a tropical region like India on a low-salt diet can lead to a 10-fold increased risk for heat exhaustion.


• Moreover salt intake of <2300 mg/day, as recommended by the Sodium Working Group of Canada, can cause negative sodium balance, as well as negative calcium and magnesium balance.

There is a strong correlation between diet with high sugar and serum lipids, increase of former leads to automatic increase in values of latter. Sugar, in high amounts, has many well-documented negative effects on the body, and in particular, on one’s metabolic profile. There’s an established link between sugar and metabolic syndrome, a conglomeration of cardiovascular markers that includes insulin resistance, high cholesterol, high blood pressure, high triglycerides (blood fats), and excess weight, especially in the form of belly fat.

A meta-analysis of randomised controlled trials found that compared with low-sugar diet, a diet high in sugar for few weeks increases the blood pressure of approximately 7.6/6.1 mmHg. More importantly, a meta-analysis of almost 170 studies suggest that salt restriction only lowers blood pressure by approximately 1%-3% in normotensive and 3.5%-7% in hypertensives; however, it increases aldosterone, renin, noradrenaline, and blood lipids. The cumulative evidence suggests that hypertension is not primarily caused by high salt intake, whereas added sugars appear to be the real culprit.

It was concluded that restriction on salt intake may worsen overall cardiovascular health through numerous counter-regulatory mechanisms. Physicians should advise their hypertensive patients to reduce the intake of added sugars and make dietary salt less of an issue.

References

DiNicolantonio JJ, Mehta V, O'Keefe JH. Is Salt a Culprit or an Innocent Bystander in Hypertension? A Hypothesis Challenging the Ancient Paradigm. Am J Med. 2017;130(8):893-899. doi: 10.1016/j.amjmed.2017.03.011. PMID: 28373112