For years, doctors have told patients with high blood pressure to cut back on salt. Unfortunately, not everyone with high blood pressure is “salt sensitive,” meaning their blood pressure goes down or up based on how much sodium they consume. If you have high blood pressure and aren’t salt sensitive reducing the amount of sodium in your diet may do nothing to bring your blood pressure down. Not that diet doesn’t matter – it does. Now, some health experts believe the focus on sodium is overemphasized and another dietary culprit that negatively impacts blood pressure is sugar.
No doubt, it’s hard to avoid sodium OR sugar if you eat processed or packaged foods. Scan the ingredient list and nutritional data of almost any packaged product and you’ll see an abundance of both. Determining a food’s sodium content is pretty easy as milligrams of sodium is listed under the nutritional data. Sugar grams are too, but when you read the ingredient list, sugar might be listed as one of more than 60 different “aliases,” some of which end in an -ose, but all of which have health effects similar to sugar or worse.
The sugar some health experts are most concerned about is fructose, present in high-fructose corn syrup. Your body processes fructose in a different way than other sugars. It goes directly to your liver where it fuels insulin resistance and fatty liver.
So, is sugar as unhealthy for your heart and blood vessels or more so than sodium? As Richard Krasuski, M.D. from the Cleveland Clinic quotes:
“It is a little frightening that we have been focusing on salt for so long.”
Sugar, High-Fructose Corn Syrup, and High Blood Pressure
As mentioned, high fructose corn syrup has been in the limelight recently. Many processed foods, including seemingly innocent ones like sauces and salad dressings, are sweetened with high fructose corn syrup, or HFCS, as it’s often abbreviated. It has strong appeal to manufacturers because it’s inexpensive. Everyone from soft drink makers to condiment manufacturers has embraced it despite its not so stellar reputation.
How bad is sugar and its close cousin, high-fructose corn syrup? In a large study called the National Health and Nutrition Examination Survey that involved 4,528 adults, researchers questioned participants about their dietary habits, looking for a link between sugar consumption and high blood pressure.
What they found was those who consumed 74 grams of fructose daily, the amount in about 2.5 cans of sweetened soda, daily were 30% more likely to develop hypertension. Although you can argue that foods high in sugar have sodium too, so why couldn’t it be the sodium? However, researchers carefully controlled for other dietary factors like sodium consumption as well as lifestyle habits like physical activity, smoking, and alcohol use.
Don’t forget, table sugar, also known as sucrose, is half glucose and half fructose, so you’re getting fructose with table sugar too. High-fructose corn syrup contains an even higher ratio of fructose to glucose. You can’t say this study proves fructose or sugar causes hypertension or makes it worse based on this study but research does show sugar is associated with insulin resistance and metabolic syndrome, which are linked with high blood pressure.
Another study, a meta-analysis, showed increases in blood pressure of 6.9 (systolic) and 5.6 (diastolic) in those with higher sugar intake. It seems likely that sugar isn’t doing your blood vessels, heart, or metabolic health any favors.
High Sugar Diets, Magnesium, and Insulin Resistance
You might wonder HOW sugar negatively impacts your blood pressure. Eating large quantities of sugar increases the amount of insulin in your bloodstream. This, in turn, can lead to insulin resistance, especially in people who are overweight or obese. When cells become insulin resistant, they can’t take up magnesium as easily. Instead, you excrete the magnesium your cells need into your urine.
No doubt about it – magnesium, abundant in nuts, whole grain foods, and vegetables, is important for heart health, blood vessel health and for blood pressure regulation. One of the possible ways sugar raises blood pressure is by creating a magnesium imbalance. Magnesium affects how “tight” arteries are, partially by its influence on nitric oxide, a chemical that helps arteries relax. Having enough magnesium and nitric oxide is good for your blood pressure AND your heart. A number of studies show an inverse relationship between magnesium levels and heart disease risk.
Another way a high-sugar diet may contribute to high blood pressure and heart disease is by injuring the interior walls of arteries. Sugar has the ability to attach to proteins and form damaging components called advanced glycation end products, or AGEs. If AGEs attach to the inside of blood vessels, it damages them, leading to low-grade inflammation.
Sugar Contributes to Hypertension Indirectly Too
Finally, sugar indirectly contributes to hypertension and heart disease by promoting weight gain and obesity. Fat tissue produces pro-inflammatory chemicals called cytokines that can damage the interior of blood vessels. This happens in diabetics who have a high blood sugar and partially explains why they have a higher risk for heart disease.
What makes sugar unique is it’s a dietary component with calories but no nutritional value. Even so-called “healthier” sources of sugar, like honey, have only small quantities of vitamins and minerals. Contrary to popular belief, honey is no “gentler” on your blood sugar or the health of your blood vessels than sugar.
Another indirect effect of eating sugar is consuming sugar or processed carbohydrates can lead to a rise in blood triglycerides. Just as triglycerides are stored inside fat cells where cells can use them for energy, they circulate in your bloodstream. High levels of blood triglycerides are linked with heart disease. Although high triglycerides don’t directly raise your blood pressure, it’s another factor, along with hypertension, that places you at higher risk for heart disease.
The Bottom Line
According to an article on Medscape Family Medicine, Americans consume 4 to 5 times the recommended amount of sugar, which is a maximum of 6 teaspoons of sugar daily. Much of the sugar we consume comes from processed foods and sugar-sweetened drinks. By choosing more whole, unprocessed foods, avoiding sweetened beverages, and not using added sugar or sweeteners, you can dramatically reduce the amount of sugar in your diet – and if you have hypertension or are at high risk for it, that’s a very smart move.
Family Practice News. “Too Much Dietary Sugar May Raise CV Mortality” February 15, 2014.
Curr Opin Clin Nutr Metab Care. 2013 Jul;16(4):478-84. doi: 10.1097/MCO.0b013e328361c53e.
Medscape Multispecialty. “Forget Cholesterol, but Cut Sugar: New Dietary Recommendations Make Some Changes”
Medscape Family Medicine. “Sugar, Not Salt, May Be at Fault for Hypertension”
Medscape Family Medicine. “Is Sugar the Real Culprit Behind Hypertension?”
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