The Sugar - Fat Seesaw

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Posted: 28/09/2016 Print

The Sugar - Fat Seesaw

The History Between Sugar and Fat

Throughout the years, both sugar and fat have been demonised with a seesaw between them for which one is the deadliest to our health.

Usually when our total energy intake from fat decreases, our intake of energy from sugar ends up increasing.

It appears that it is difficult for us as a population to comply with the guidelines that are provided for us to reduce both sugar and fat intake.

The Sugar - Fat Seesaw

Research has shown that sugar and fat intake have an inverse relationship, (a diet high in fat will more likely to be one that is lower in sugar) which is why it is known as the sugar - fat seesaw (Gibney et al., 1995, and Sadler et al., 2015).

In 1972 John Yudkin’s published a book called Pure White and Deadly, which discussed the impact of sugar on weight gain and therefore increased risk of coronary thrombosis, diabetes, liver disease, other chronic diseases and tooth decay.


Around the same time Ancel Keys was conducting the famous study, known as the ‘Seven Countries Study’ (Yugoslavia, Finland, Netherlands, Japan, Italy, Greece, and United States), which found a correlation between saturated fat, high cholesterol and coronary heart disease. Carbohydrates were promoted to be helpful with weight control and the consumption of fat would lead to an increase risk of cardiovascular disease and mortality.

Keys did not agree with Yudkin’s belief that sugar was linked to heart disease and thought it was a “mountain of nonsense” and that it was fat that we needed to be aware of (Teicholz, 2015).

Ultimately, Keys’ results for cutting out fat to prevent heart disease was successful and Yudkin’s theory was pushed aside. Could this be because Keys’ research was backed by the food industry, including the sugar industry and also, in part, due to the vast number of subjects from the Seven Countries Study?

The Seven Countries Study

There were some limitations with the Seven Countries Study where it was discussed that they had ‘cherry-picked’ countries, excluding France and Germany who both consume high levels of saturated fat but low rates of heart disease.

One of the other issues was that due to being an ‘observational study’ the results were ‘correlation’ - if you have every studied psychology I’m sure you know the phrase or something similar “correlation no causation”. Basically, this means just because there seems to be a relationship, doesn’t mean that saturated fats cause heart disease. There may be other factors that are causing heart disease.

The Demise of Fat

The acceptance of this study, lead to the demise of fat and the promotion of carbohydrates and low-fat food products which were filled with sugar to enhance taste.

However, over the years, even with the culprit saturated fat being identified for causing weight gain and heart disease, rates of obesity in the UK have risen - between 1993-2014 from 14.9% of adults over the ages of 16 being obese, to 25.6% in 2014.

In 2014 it was found that 61.7% of the adult population was overweight or obese (Public Health England, 2014).

Obesity is linked to an increase in risk of developing non-communicable diseases including, cardiovascular disease, cancer, and Type 2 diabetes.

Unlike Type 1 diabetes which is not related to lifestyle, Type 2 diabetes can be triggered if an individual is overweight or obese and is usually seen in adults over 40 years. However, recently in the UK, it was found that there is now 533 children and young people living with Type 2 diabetes (Diabetes UK, 2016).

This demonstrates that even though we had been told to cut down our consumption of fat, something else may be linked to obesity and the non-communicable diseases……….

The saturated fat in spreads and margarines, was replaced by artificial trans fats and though many supermarkets and fast food chains have voluntarily agreed to now no longer use trans fats within spreads, there is still no ban in the UK.

Trans Fats and High Fructose Corn Syrup

Artificial trans fats are created through partial hydrogenation of vegetable oils (a chemical process) whereby the structure of the fatty acid is altered through the addition of hydrogen atoms, enabling the vegetable oils to become solid at room temperature.

These trans fats can still be found in some biscuits and pastries. Trans fats have been linked to an increased risk of heart disease. A systematic review and meta-analysis of observational studies found that trans fats are associated with coronary heart disease, whereas saturated fats were not found to be linked to coronary heart disease (de Souza et al., 2015).

We have, also, moved now to looking at specific carbohydrates which may also be linked to obesity and disease.


High fructose corn syrup has also been implicated in the obesity crisis. There was found to be a strong association between the consumption of the high fructose corn syrups (which is added to foods and beverages) and weight gain in the US.

Fructose is digested and metabolised differently to that of glucose and does not stimulate the secretion of insulin (which controls blood sugar levels) and leptin (a hormone which communicates with the body that we are satiated).

When we consume sugary drinks and foods high in high fructose corn syrup, it leads to an increase in energy intake and therefore weight-gain due to it being calorie dense but nutrient poor (Bray et al., 2004).

Where Are We Now?

In 2012, Yudkin’s book was republished, with an additional introduction by Robert Lustig.

Lustig emphasised the importance of looking at sugar and high-fructose corn syrup in a 2009 video, called “Sugar: The Bitter Truth” and its impact on obesity and diabetes.

Over 50 years, the consumption of sugar has tripled worldwide (Lustig et al., 2012). Lustig continues to discuss how our ancestors were only able to access sugary fruits a few months out of the year, or from the honey that bees guarded. Now sugar has been added to an abundant amount of our food. “Nature made sugar hard to get; man made it easy,” (Lustig et al., 2012).

High sugar consumption has been linked to metabolic syndrome including hypertensions, high triglycerides and insulin resistance and there is an argument that fructose exerts toxic effects similar to alcohol (Lustig et al., 2012). So, if all of this information is being published now, why was Yudkin’s ridiculed when he first published his concerns over sugar?

On the 12th September 2016 an article was published in the Journal of the American Medical Association (JAMA), which looked at the role the Sugar Research Foundation (now the Sugar Association) had in the role of finding dietary causes of coronary heart disease.

The Sugar Research Foundation

In 1965, the Sugar Research Foundation sponsored a literature review linking fat and cholesterol to coronary heart disease and softening the risk that sucrose may have (Kearns et al., 2016).

The Sugar Association and the industry still deny the link between added sugar and coronary heart disease.

This research discusses how the industry pursued influencing the debate over causes of coronary heart disease in the 1950’s and 60’s (Keys vs Yudkin). In 1954, The Sugar Research Industry spent $5.3million (in 2016 dollars) to teach people that sugar keeps humans alive to provide us with the energy to “face our daily problems” (Kearns et al., 2016).

In 1967 a literature review was published in the New England Journal of Medicine, by three researchers: McGandy, Hegsted, and Stare, which found that the only intervention needed to prevent coronary heart disease was reducing dietary cholesterol, swapping saturated fat for polyunsaturated fat in the diet.

An interesting point to note here is that this research and the researchers were funded by the Sugar Research Foundation, with selective research included – all of which was unknown to the rest of the world, including the sugar industry’s part in its creation (Kearns et al., 2016).

From 1967, the article goes on to mention other evidence has surfaced that the sugar industry may have been influencing policies and regulations created for quite some time. It is not uncommon for industries to fund research, to allow assessment of benefits and risks of their products, however it is the secretiveness that is shrouded around the sugar industry research that is the issue (Kearns et al., 2016).

It is not possible to cut private sectors from funding research as well. Due to the sparse amount of funding available, researchers are dependent on funding. However, it is important that the researchers and the publishing of articles are transparent and any conflicts of interest are included.

It does make you wonder though, how often policies and regulations are influenced by the private sector funding within that area!


In the UK, we are advised to consume no more than 5% of our total dietary energy from free sugars (these are sugars added to food and those in honey, syrups and unsweetened fruit juices) for those 2 years and above (SACN, 2015).

This means:

Sugar cubes

  • For those aged 11+ no more than 30g/day (this equates to 7 sugar cubes)
  • Children between 7-10 no more than 24g/day (6 sugar cubes) and
  • Children aged 4-6 need no more than 19g/day (5 sugar cubes)

To put this into perspective, a 330ml full-sugar can of drink, can have 35g of sugar in one serving - this is more than the recommended amount for those ages 11+. Also bear in mind that this is only one drink and excludes any other sugary foods and drinks you may also have.

Total sugar intake (including naturally occurring sugars) should be no more than 90g/day for an adult (Public Health England, 2015).

The Importance of Keeping Active

It is important to stay active and keep moving.

Han walking

A sedentary lifestyle is linked to obesity and cardiovascular disease and exercising has a host of beneficial effects including both psychological and physiological.

The phrase ‘everything in moderation’ comes to mind when giving advice in regards to what we should and shouldn’t eat.

Although there’s little beneficial effect of consuming added sugar, it doesn’t mean that you can’t eat it, you just need to be aware of what you are eating and make sure that you don’t consume in excess.

Check Labels

Checking labels

We’re always advising readers to look at labels and what is in the foods we’re eating and bread is no exception.

You may already be aware that bread can be high in salt. Another thing to be aware of is that when purchasing brown bread and believing you are making the right choice over white bread, you should check the ingredients list........

Brown bread can sometimes be wholemeal bread, or other times it can be white flour that is coloured with caramel. Although sugar naturally occurs in bread, some companies are actually adding sugar to their bread, even wholemeal bread. Added sugar is not required in the process of making bread and adds nothing to the flavour so it is not necessary to be included.

What Should We Be Doing?

Up our dietary fibre

Instead of sugary meals try and swap for meals rich in dietary fibre. This has been associated with lower incidences of cardiovascular disease, stroke, hypertension, colon cancer and Type 2 diabetes (SACN, 2015).

Dietary fibre recommendation are 30g/day for adults. Sources of it include:

  • wholemeal bread
  • oats
  • bananas
  • beans and pulses
  • nuts
  • vegetables and
  • root vegetables, to name a few.

Do your research

If reading articles, try and find the research they are based on.


Even if you don’t understand the bulk of what the research is talking about, go down to the bottom of the research and check out their acknowledgements and whether they have any conflicts of interest.

This can allow you to make an informed decision on how much you trust the research and what it found. The conflict of interest should include if any of the researchers work for certain companies, which may benefit from the results or whether they were funded by companies of interest.

Eat less sugar

If you are ever unsure of the amount of sugar in products, there is a great app you can use from Change4Life called Sugar Smart. With this you scan the barcode on your food and it will show you the amount of sugar in the product.

It is important to be aware of the ingredients that are included in your meals and, in this case, the amount of sugar per portion that is in the food you are eating.

The app above allows you to see per portion how many grams and amount of sugar cubes it contains - sometimes the results can be very surprising and even more sugar found in things that you wouldn’t expect to have it!

It’s great to cut down your sugar intake and I realise this isn’t always easy. My advice would be to choose foods that are as natural and sugar free as possible and if you are going to sweeten a meal or a drink, it is at least better to do it yourself. This way, you are in control of how much you add.

Further, there’s a great website called Action on Sugar which has up-to-date news on sugar and the concerns associated with a high sugar diet.

Further Reading

If you’d like to read more into this, the article by Kearns, Schmidt, and Glantz provides a more in-depth read on the role that the sugar industry had in the sway between the sugar fat debate and how fat was demonised and sugar was kept out of the limelight for its potential implication on health. 

The problem with all this conflicting information provided for us is that we lose trust with what we are told by those who are meant to be looking out for us.

The best advice that I can give is to always make sure you read up around the area, so that you can make an informed decision.

It’s great to keep an open mind about new information out there but it’s even better to critically look at what you read or are told. Hey, even critically look at this article and investigate further.

Like I said, life is about keeping a balance and have everything in moderation (except vegetables, have lots of those!).

There isn’t any nutritional benefit to consuming free sugars but if you do, just slowly try to ween yourself off - if you like having a sugary drink, try swapping it for water infused with fruit, or sparkling water for some fizz.

Always check the label before you buy something and that app I’ve mentioned above is really helpful.

Nutrition is a complex area and new research regarding information on what may be harmful or beneficial for us is always changing and being updated. It’s best to try and stay informed to help make decisions, or talk to a health professional.

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Bray, G. A. Neilsen, S. J. and Popkin, B. M. (2004). Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. American Society for Clinical Nutrition, 79 (4), pp- 537-543.

de Souza, R. J., Mente, A., Maroleanu, A., Cozma, A. L., Ha, V., Kishibe, T., Uleryk, E., Budylowski, P., Schünemann, H., Beyene, J., and Anand, S. S. (2015). Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. The British Medical Journal, [online] Available here.

Diabetes UK. (2016). More than 500 children and young people have Type 2 diabetes. Available here.

Gibney, M. Sigman-Grant, M. Stanton, J. L. and Keast D. R. (1995). Consumption of sugars. The American Society for Clincal Nutrition, 62(1), pp. 178S-193S.

Kearns, C. E. Schmidt, L. A. and Glantz, S. A. (2016). Sugar industry and coronary heart disease research: a historical analysis of internal industry documents. Journal of the American Medical Association, [online] Available here

or if you would prefer there is an article by The New York Times

Lustig, R. H. Schmidt, L. A. Brindis, C. D. (2012). Public health: the toxic truth about sugar. Nature, 482 (7383), pp, 27-29.

Public Health England. (2014). UK and Ireland prevalence and trends. Available here.

Public Health England. (2015). Why 5%. Available here.

Sadler, M.J. McNulty, H. and Gibson, S. (2015). Sugar-fat seesaw: a systematic review of the evidence. Critical Reviews in Food Science and Nutrition, 55, pp. 338-356.

Scientific Advisory Committee on Nutrition. (2015). Carbohydrates and health. Available here:

Teicholz, N. (2015). The big fat surprise. Scribe Publications. (Great read if you are interested in)

About Lucy Bee Limited

Lucy Bee is concerned with Fair Trade, ethical and sustainable living, recycling and eating close to nature with additive free products for health.

Members of the Lucy Bee team are not medically trained and can only offer their best advice. Any information provided by us is not intended to diagnose, treat, cure or prevent disease.

Please note you should always refer your health queries to a qualified medical practitioner.

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About Daisy Buckingham

Portrait of Daisy Buckingham

Daisy is a Registered Associate Nutritionist with a Master's Degree in Public Health Nutrition, which is Association for Nutrition (AFN) accredited. She, also, has a BSc degree in Psychology and Cognitive Neuroscience; and has completed an AFN accredited Diet Specialist Nutrition course and is currently studying for a PgDip in Eating Disorders and Clinical Nutrition.

Daisy has worked for an NHS funded project, the Diabetes Prevention Programme; and shadowed a nutritionist in Harley Street. 

Daisy is Lucy's sister and is the Lucy Bee voice on all aspects of nutrition and its effect on the body. 

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