Medicosnext
Dr. Aditya Mahaseth
He is a MD Physician, with a DM in Cardiology. He is a practicing senior consultant cardiologist at Kathmandu Medical College specializing in heart diseases prevention and treatment and also trained in Interventional Cardiology for cardiovascular procedures like angiography, angioplasty, pacemaker and other minimally invasive cardiac procedures. Feel free to consult with him for any issues regarding hypertension, diabetes, high cholesterol.
Heart disease is the number one cause of death worldwide. Although there is no one particular cause for heart disease, diet is considered an important cause of heart disease. Heart disease results from the narrowing of the arteries that supply the heart with blood through a process known as atherosclerosis. Fatty deposits (or plaque) gradually build up on the inside of the artery walls, narrowing the space in which blood can flow to the heart. Atherosclerosis can start when you are young, so by the time you reach middle age, it can be quite advanced.
Plaque build-up can be considered as stable or unstable. If there is too much build-up of stable plaque, it narrows the arteries, causing pain and discomfort due to not enough blood reaching the heart – this is called angina and it needs to be treated. Unstable plaque is inflamed and has a thin cap which is prone to developing a crack, allowing the blood to come in contact with the fatty contents of the plaque. The blood will clot to try to seal the gap but in doing so, the blood clot blocks the artery. This prevents the flow of blood to the heart, cuts off its oxygen supply and damages or kills the heart cells. This is a heart attack.
Cardiovascular disease stems from a number of risk factors some of which are modifiable while others are non-modifiable. The non modifiable risk factors (which cannot be changed) are advancing age, male gender, ethnicity, family history (genetics) for heart disease and then there are some modifiable risk factors that can be changed for example elevated blood pressure (more than 120/80), elevated blood sugar (prediabetes/diabetes), high cholesterol levels, smoking, physical inactivity, social inactivity, elevated body weight, and DIET. Since it is a multifactorial disease just focusing on one aspect of it won’t prevent the disease and thus a multifaceted diet, exercise program is needed to reduce the burden of cardiovascular disease.
The American Heart Association in 2022 has revised its concept for prevention of heart disease by introducing 8 essential health behaviors (heart-healthy diet, regular physical activity, avoidance of nicotine, healthy sleep) and health factors (blood lipids, glycemia, BP, body mass index).
Among the many modifiable risk factors, diet plays a particularly complex and evolving role. While dietary fat has long been blamed for heart disease due to its role in raising cholesterol and contributing to plaque formation, emerging research suggests that added sugars—particularly in processed foods and sugary beverages—may be even more harmful. Excessive sugar intake not only contributes to obesity and diabetes, but also drives inflammation, insulin resistance, and lipid abnormalities, all of which are key contributors to atherosclerosis and heart disease. This shift in understanding urges us to move beyond the simplistic “low-fat” approach and adopt a more nuanced perspective on diet, focusing on reducing sugar consumption as a critical step in heart disease prevention.
For decades, fat has been painted as the villain when it comes to heart health. Supermarket shelves were flooded with “low-fat” labels, and many people were led to believe that avoiding butter and oils would protect them from heart disease. But is fat really the enemy—or have we been blaming the wrong nutrient?
As a cardiologist, I often meet patients confused about what’s truly heart-healthy. Let’s unravel the science behind fats and sugars—and get to the facts.
A Historical Misdirection: How Fat Was Framed
In the 1960s, research like the Seven Countries Study by Ancel Keys blamed saturated fat for heart disease. As a result, dietary guidelines shifted toward “low fat everything.”
However, a bombshell paper published in JAMA Internal Medicine (Kearns et al., 2016) exposed that the sugar industry funded research that downplayed sugar’s role in heart disease and shifted the blame to fats. This manipulation distorted public perception for decades.
Modern Science: Sugar’s Role in Heart Disease
Today’s research reveals sugar may be the bigger culprit:
A 15-year study in JAMA Internal Medicine (Yang et al., 2014) found that individuals getting over 25% of their daily calories from added sugar had more than twice the risk of dying from heart disease.
Another study in Circulation (Te Morenga et al., 2014) found that excess sugar raised blood pressure and bad cholesterol (LDL) levels—both major risk factors for heart attacks.
The Truth About Fats: Not All Are Bad
Fats aren’t the enemy. But it depends on the type:
– Unsaturated fats (found in nuts, olive oil, fish) are heart-protective. The PREDIMED trial (Estruch et al., 2013) found that people on a Mediterranean diet rich in olive oil or nuts had a 30% lower risk of heart disease.
– Saturated fats (from butter, red meat) aren’t as harmful in moderate amounts as once thought. A large review (BMJ, De Souza et al., 2015) found no strong link between moderate saturated fat intake and heart disease.
– Trans fats (found in hydrogenated oils) are dangerous. They raise bad cholesterol and lower good cholesterol—and have now been banned in many countries.
What Should You Actually Eat?
Heart health isn’t about banning all fats or sugars—it’s about eating smart:
Choose:
– Whole foods: vegetables, fruits, legumes, nuts, and fish
– Mustard oil – Anti-inflammatory, rich in MUFA, and traditional in South Asia
– Olive oil – Especially extra virgin olive oil (EVOO), is well-researched and protects heart vessels
– Coconut oil – High in saturated fats; use in moderation or avoid
– Whole grains instead of refined carbs
Avoid:
– Packaged sweets, sugary drinks
– Excess white bread and fried foods
– Artificial trans fats and too much processed meat
– Repeated deep-frying with any oil—this produces toxic oxidized compounds harmful to arteries.
