Those extra calories may not start out as fat, but they do get stored as fat.

I have been counseling women on the underlying effects of sugar for about twenty years now. This began during a time when fat was thought to be the enemy, and eating lots of low-fat carbs and non-fat carbs were believed to promote heart health. At the time, people didn’t stop to consider that these foods, including white pasta, white potatoes, and white rice, are high-glycemic foods and therefore, easily converted to sugar in the body, depending on how they’re prepared. Starchy carbs, especially when highly refined, spike your blood sugar, which gives you a burst of energy, but leaves you with a hunger later that’s sometimes insatiable. You eat more than you need, and guess what? Those extra calories may not start out as fat, but they do get stored as fat. Now researchers in two different, large studies have determined that diets high in starchy carbs and sugar are detrimental to the heart, especially in women.

An Italian study of nearly 48,000 men and women, about one-third men and two-thirds women, was conducted for almost eight years to evaluate the effect that diets high in refined carbohydrates had on the heart. As part of the study, researchers determined the participants’ total carbohydrate intake as well as the average glycemic load (sugar load) of the foods they consumed. At the end of the study, which was published in the April 12, 2010 issue of the Archives of Internal Medicine, Sieri¹ scientists determined that eating a diet high in high-glycemic carbohydrates significantly increased the risk of cardiovascular disease in women. This was particularly true for one-fourth of the cohort—women who consumed carbs with the highest glycemic loads—whose risk was twice that of the bottom fourth—women whose carb intake consisted of foods with a low-glycemic load, such as fruits and vegetables. Heart health for the men studied was not affected, regardless of the quantity or quality of the carbs they ate, even when they consumed mostly high-glycemic carbs.

Another study published a week later in the Journal of the American Medical Association Welsh² also looked at how added dietary sugar impacts the heart in over 6,000 people (from the 1999 to 2006 National Health and Nutrition Examination Survey [NHANES]). Instead of looking at high-glycemic foods, they studied the impact of added sugars in the diet. These are defined as “caloric sweeteners used by the food industry and consumers as ingredients in processed or prepared foods to increase the desirability of these foods.” This included common sugars like cane sugar and corn syrup, but excluded natural sugars found in fruit. They found a direct correlation between a diet high in added sweeteners and a change in the markers for heart disease. Triglyceride levels, LDL (bad) cholesterol, and HDL (good) cholesterol levels were all negatively impacted. Co-author Miriam Vos, M.D., reported, “Just like eating a high-fat diet can increase your levels of triglycerides and cholesterol, eating sugar can also affect those same lipids.”

This dietary information has vast implications for women versus men as well. So often, women have been thought of as smaller versions of men. But our bodies operate differently. For years, the medical establishment assumed that symptoms of heart disease, including signs for heart attack, were the same in men and women. They’re not. Typically, when a man has a heart attack he will have chest pain that begins under the breastbone and spreads to the jaw and left arm, whereas a woman may not have chest pain at all. Instead, she will experience primarily jaw pain and indigestion, or there may just be congestive heart failure with little evidence preceding it. Although we aren’t sure, this may be attributed to the fact that women’s blood vessels are smaller than men’s. When you eat high-glycemic foods, your body releases insulin to process the sugar. This results in inflammation, and a little inflammation in a woman’s arterial walls can cause damage and spasm. High blood sugar causes a kind of caramelizing and hardening of tissue. This excess blood sugar is also converted to triglycerides and LDL cholesterol by the liver, which can cause atherosclerotic plaques to start to form.

When I was doing the research for the newly revised Women’s Bodies, Women’s Wisdom and for my PBS show (with the same name), I discovered that a large percentage of Americans consume on an average of 46 teaspoons of sugar a day. The study with Dr. Vos confirmed this. I also learned that added sugars are the culprit. And this huge increase in sugar consumption in the United States parallels the rise in obesity and diabetes—both of which are risk factors for heart disease.

All carbs aren’t created equal! A carrot and a donut are going to impact your heart’s health quite differently even though both contain sugar. The difference between them is known as the glycemic index—the rate at which a given food’s sugar is released into the blood stream. The glycemic index is a number calculated by measuring the blood sugar of individuals at precise intervals following the consumption of a given food. Store bought white bread such as Wonder Bread has a glycemic index of 100, which is very high while unrefined fruits and vegetables are in the 20’s and 30’s. In general, you can consume carbohydrates that have a low to moderate glycemic index without incurring health problems. However, there is a wide range of sugar tolerance among different individuals. Hence, some individuals will do better by keeping even moderate glycemic index foods (such as skim milk) to a minimum. For more information on the glycemic index and a list of foods with their glycemic values, go to http://www.glycemicindex.com/.

Whether or not they realize it, many women are eating foods on a regular basis that contain a lot of sugar—all the while thinking that they’re eating healthfully. A perfect example is yogurt. Some brands contain more sugar than you need for the entire day. To keep track of your daily sugar intake I recommend reading labels. I also recommend you get familiar with the glycemic index of common foods so that when you do consume sugar, it’s a low to moderate glycemic sugar. I suggest that you read The Belly Fat Cure by Jorge Cruise and Healthy for Life by Ray Strand, M.D.

One thing to note is that Jorge Cruise lumps all sugars together and recommends no more than 15 grams total per day—regardless of the glycemic index. This makes choices much easier, and the approach is healthy. However, Ray Strand, M.D., and others, use the glycemic index of a food as a guide to how healthy it is. I recommend that you experiment with both of these concepts (low-sugar versus low-glycemic) and see which approach works best for you. Either way, you have nothing to lose but a little belly fat!

Learn More — Additional Resources

• The Belly Fat Cure by Jorge Cruise
• Healthy For Life by Ray Strand, M.D.

References

1. Sieri S, Krogh V, Berrino F, et al. Dietary glycemic load and index and risk of coronary heart disease in a large Italian cohort. The EPICOR study. Arch Intern Med 2010; 170:640-647.
2. Welsh, J.A., et al, 2010. Caloric Sweetener Consumption and Dyslipidemia Among US Adults, JAMA, 303:15