Intended for healthcare professionals

Letters Saturated fat is not the major issue

Sugar, not fat, is the culprit

BMJ 2013; 347 doi: (Published 19 November 2013) Cite this as: BMJ 2013;347:f6846
  1. Danny C G Lim, cardiology and medical registrar1
  1. 1Healthcare Locums, North East England, Durham, UK
  1. dcglim{at}

For decades, a diet high in fat (particularly, saturated fat) has been cited as the cause of cardiovascular disease.1 But not everything stacks up. Epidemiological studies of populations such as the Inuit, who traditionally survive almost entirely on animal food sources (and consume large amounts of saturated fat) have a very low incidence of cardiovascular disease. By demonising fat for decades, we have been side tracked from targeting the real culprit, refined carbohydrates, particularly sugar.

Numerous randomised controlled trials have shown that a low carbohydrate diet (versus a low fat diet) results in higher concentrations of high density lipoprotein (protective against heart disease) and lower triglyceride concentrations.2 3 4 A prospective cohort study of 75 521 women followed for 10 years found that a diet high in refined carbohydrate is an independent risk factor for cardiovascular disease.5

Despite this, the official NHS guidance on sugar is inadequate and contradictory. It recommends us to cut down on the amount of sugar we consume yet encourages us to consume five portions of fruit and vegetables a day. Under this guidance, juices, smoothies, canned, and dried fruit—all high in sugar—count as part of the “five a day” ( Adherence to this advice can easily lead to excessive sugar consumption. To illustrate, a 150 mL glass of orange juice, a 250 mL smoothie, a 30 g portion of raisins, and 80 g of canned peaches amounts to 69 g of sugar or about 16 teaspoons of sugar. There is no maximum amount of sugar recommended but clearly 16 teaspoons of sugar a day is far from healthy. We have lost sight of the real culprit, and our public health message really needs to focus on sugar.


Cite this as: BMJ 2013;347:f6846


  • Competing interests: None declared.


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