Fat, Sugar, Whole Grains and Heart Disease: 50 Years of Confusion

Nutrients. 2018 Jan 4;10(1):39. doi: 10.3390/nu10010039.


During the 1970s some investigators proposed that refined carbohydrates, especially sugar and a low intake of dietary fiber, were major factors in coronary heart disease (CHD). This suggestion was eclipsed by the belief that an excess intake of saturated fatty acids (SFA) was the key dietary factor, a view that prevailed from roughly 1974 to 2014. Findings that have accumulated since 1990 inform us that the role of SFA in the causation of CHD has been much exaggerated. A switch from SFA to refined carbohydrates does not lower the ratio of total cholesterol to HDL-cholesterol in the blood and therefore does not prevent CHD. A reduced intake of SFA combined with an increased intake of polyunsaturated fatty acids lowers the ratio of total cholesterol to HDL-cholesterol; this may reduce the risk of CHD. The evidence linking carbohydrate-rich foods with CHD has been steadily strengthening. Refined carbohydrates, especially sugar-sweetened beverages, increase the risk of CHD. Conversely, whole grains and cereal fiber are protective. An extra one or 2 servings per day of these foods increases or decreases risk by approximately 10% to 20%.

Keywords: cereal fiber; coronary heart disease; saturated fat; sugar; whole grains.

Publication types

  • Historical Article
  • Review

MeSH terms

  • Coronary Disease / blood
  • Coronary Disease / epidemiology
  • Coronary Disease / history
  • Coronary Disease / prevention & control*
  • Diet, Healthy* / history
  • Diet, Healthy* / trends
  • Dietary Fats / adverse effects*
  • Dietary Fats / blood
  • Dietary Fats / history
  • Dietary Fiber* / history
  • Dietary Sugars / adverse effects*
  • Dietary Sugars / blood
  • Dietary Sugars / history
  • Evidence-Based Medicine* / history
  • Evidence-Based Medicine* / trends
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Prognosis
  • Protective Factors
  • Recommended Dietary Allowances
  • Risk Factors
  • Risk Reduction Behavior*
  • Serving Size
  • Time Factors
  • Whole Grains* / history


  • Dietary Fats
  • Dietary Fiber
  • Dietary Sugars