The Wrong White Crystals: Some Insights into Salt and Sugar

The Bad News on Bread?


Writing about the American Diet is maddening. Not a day goes by that a remarkable insight, announced one day, is refuted the next. These are not ignorant armies warring by night, but well-funded industry groups, philosophically invested academics and journalists, and people who consider food a religion, fighting it out for your attention. These activists drown out more informed souls (see previous newsletter about drug companies “crowding out” other research); the public has a hard time finding more accurate and balanced views of diet and health (think Walter Willets at The Harvard School of Public Health).


When I was in medical school, caloric restriction was the solution to weight loss. “Calories-in-calories-out” was the dictum.  There was an evolving position that a “low-fat” diet was the way to health. What we have come to understand is that no one thing – calories or fat, or exercise, or supplements, or hormones – will create long term weight loss.  Diets that focus on one thing fail 95% of the time.


So it is refreshing to have a review that considers the relationship between 2 major nutrients – salt and sugar- to hypertension. The conclusion of the authors is that sugar is more damaging than salt.  This would explain several key observations. Salt consumption is relatively constant across many populations, though the incidence of blood pressure varies significantly. In populations where salt has been restricted, proportionate improvements in hypertension and reduction in heart disease have not taken place. The linkage between carbohydrate consumption and increased heart disease, even in the absence of a diagnosis of diabetes, grows stronger year-by-year.  At Age Management Boston, we monitor everybody’s insulin on a yearly basis, and motivate patients to take anti-diabetic measures even before sugar rises.


The authors of “White Crystals” are saying that sugars increase blood pressure, heart rate, and myocardial oxygen demand. They contribute to inflammation throughout the vascular tree. Sugar and salt are both bad for blood pressure; sugar, however, is the greater evil.


Where Does That Leave Bread?


Joy of Cooking recipes for bread are basically one part salt, two parts sugar/honey, and four parts flour (which is as glycemic as sugar) with eggs/milk/yeast added. Bread is the largest source of salt in the American diet (Centers for Disease Control) – not potato chips, pizza, or pretzels. The list:


1 – Bread and rolls, 7.4%

2 -Cold cuts/cured meats, 5.1%

3 – Pizza, 4.9%

4 -Fresh and processed poultry, 4.5%

5 -Soups, 4.3%

6 -Sandwiches like cheeseburgers, 4%

7 -Cheese, 3.8%

8  -Pasta dishes like spaghetti with meat sauce, 3.3%

9 -Meat dishes like meatloaf with tomato sauce, 3.2%

10- Snacks, including chips, pretzels, popcorn and puffs, 3.1%


The CDC does not have a list of foods with high combined sugar and salt (it would be a complicated computation), however, the majority of dishes on the high-salt list are also high in sugars (carbohydrates). Is it any wonder there is an epidemic of hypertension (1/3 of adults) and Type II diabetes (1/10 adults)?


If you are not hypertensive or diabetic, reducing bread consumption might reduce future risk in a very marginal way. Some Type II diabetics who give up bread (and don’t substitute another carbohydrate!) experience improved blood sugar control in weeks (and hypertension improves later).


Understanding that many will find it hard to give up bread, I will offer advice about consuming bread.  First, try to limit your intake. At a restaurant, put bread on the bread plates and send the extra back to the kitchen. Balance your meal – don’t get the baked potato; get some vegetables.  Dunk your bread in olive oil, rather than use butter. Olive oil will reduce the glycemic impact of the bread by slowing absorption.



The wrong white crystals: not salt but sugar as etiological in hypertension and cardiometabolic disease

                        James J DiNicolantonio1 and Sean C Lucan2


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