People who are at high risk for suffering a heart attack because they have a genetic factor that causes high LDL (bad) cholesterol should be treated with severe restriction of added sugars and all refined carbohydrates (BMJ Evidence-Based Medicine, June 2020). The same advice should be given to people who are at increased risk for heart attacks for any reason.

For more than 70 years, doctors have recommended that people who have high cholesterol levels severely restrict dietary saturated fats and dietary cholesterol to lower high blood cholesterol levels and help to prevent heart disease. However, research has failed to prove that restricting eggs, butter, cream, fat milk and all animal fats protects people from heart attacks (J Am Heart Assoc, Dec, 2014;3(6):e001236), although a recent study suggests that eating eggs raises blood cholesterol in obese people (Nutrition, Metabolism & Cardiovascular Diseases, July 7, 2020).

The recommendations to avoid dietary fats and dietary cholesterol without also restricting sugar and refined carbohydrates may well have increased the incidence of heart attacks as well as diabetes, obesity, and certain cancers (Br J Sports Med, 2017;51:133–9). When people restrict dietary saturated fats and dietary cholesterol, they often replace these foods with sugars and refined carbohydrates that can raise the bad LDL cholesterol levels even higher, as well as lowering the good HDL cholesterol (Curr Atheroscler Rep, Nov 2010;12(6):384–390).

Why High Blood Sugar Increases Heart Attack Risk
• All carbohydrates are single sugars or sugars in chains.
• You cannot absorb any carbohydrates until they are broken down into single sugars.
• After sugar is absorbed into the bloodstream, it must be used immediately for energy or it can be stored only in your liver and muscles.
• Once your liver and muscles are full of the meager amounts of sugar they can store, sugar remains in your bloodstream and the excess is converted to a fat called triglycerides.
• Then your liver combines triglyceride molecules and a lesser number of cholesterol molecules to make the bad LDL cholesterol.
• High levels of small dense LDL cholesterol turn on your immune system to cause inflammation that can lead to clots, plaques and heart attacks.
High blood levels of another genetic component of high cholesterol, Lp(a), can also cause insulin resistance, clots, heart attacks and premature death. Severe restriction of sugar and refined carbohydrates can help to lower Lp(a) (Nutr Metab, 2006;3:19).

My Recommendations
If you have high LDL (bad) cholesterol, you are also at high risk for having high blood sugar, insulin resistance, obesity, diabetes, high blood pressure, clotting problems and inflammation. Treatment is to severely restrict foods that cause a high rise in blood sugar: all foods with added sugar, all drinks with sugar in them including fruit juices, and all sources of refined carbohydrates (wheat, rice, corn and other grains that are ground into flour to make bakery products, most cold breakfast cereals, pastas, chips, crackers, cookies and so forth). Refined carbohydrates are also found in many other processed foods; check the list of ingredients.