Letters Sugar and the heart

The sugar hypothesis of heart disease never gathered supportive data

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f811 (Published 13 February 2013) Cite this as: BMJ 2013;346:f811
  1. A Stewart Truswell, emeritus professor1
  1. 1Human Nutrition Unit, University of Sydney, NSW 2006, Australia
  1. stewart.truswell{at}sydney.edu.au

Although “sugar causes heart disease” might become a little more fashionable after Pure, White and Deadly is reissued, the scientific data and constructs will not change. Evidence for the fat hypothesis is massive and has increased since Yudkin’s book went out of print.

I think Watts conveys two wrong impressions about Yudkin’s disappointment that the sugar hypothesis was not confirmed.1 I was there. I followed Yudkin as head of nutrition at Queen Elizabeth College, London, in 1971. Yudkin was a conviction nutritionist. After 12 meetings, most scientists on a government panel on diet and heart disease managed to reach a compromise set of conclusions and recommendations. But the 1974 Department of Health and Social Security report on prevention of coronary heart disease2 has an unusual note of reservation from Yudkin, providing his belief that the report exaggerated the possible role of dietary fat in causing ischaemic heart disease and minimised that of dietary sucrose.

The conservatism of this report is thought to explain why coronary heart disease mortality (age standardised) stayed the same in England and Wales until 1978, whereas it fell substantially from 1964 in the US, Finland, Australia, and New Zealand.3

The official UK advice was brought in line with growing scientific evidence by the Royal College of Physicians/British Cardiac Society working party in 1976.4

The sugar hypothesis did not lose its force because of protests by the sugar industry. The more powerful meat and dairy industries were happy with it at the time. The sugar hypothesis simply never gathered supportive data—sucrose does not ordinarily raise plasma cholesterol and was not an independent risk factor for coronary heart disease in prospective studies. Leading nutritionists in the US and Europe never took up the sugar and coronary heart disease theory. In the UK, Yudkin’s peers were concerned and sometimes embarrassed.


Cite this as: BMJ 2013;346:f811


  • Competing interests: None declared.


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