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Saturday, March 21, 2015

Sugar Consumption and Chronic Disease: A Brief History of the CardioRenal Epidemic

One-third of adults in the US are obese. One-third of adults in the US have hypertension. A little under 10% have diabetes.

It wasn't always like this. Not till the very recent past. And I am talking about the early 1900s. What happened to you America?

Sugar may be a big part of the answer to the above question (if not the complete answer). In huge amounts. Cheap and omnipresent. To understand the effects of sugar consumption on health and kidney disease, lets take an interesting detour in to the history of sugar consumption. Once one understands  how sugar's (over)use has grown in parallel with the increasing incidences of heart and kidney disease, diabetes, etc since the eighteenth century, the link between sugar consumption and adverse health consequences becomes clearer.


When Dr Symonds published his findings about high blood pressure in New Yorkers of the early 1900s, he found that barely 5% of the population had a blood pressure over 140/90. That was also the time when the US annual per capita average sugar consumption was well under 100 pounds. It now stands over 150!

One doesn't necessarily need a randomized trial to prove that we have grown fatter over the decades. Data drawn from US Civil War veterans' health surveys shows that in 1890, the prevalence of obesity was around 3.4%. This increased to 35% by the year 2000. Closely following this increased prevalence of obesity (and hypertension, and diabetes), the prevalence of end stage kidney disease went up 4-fold between 1980 and 2002.

Image courtesy of Grant Cochrane/FreeDigitalPhotos.net

However, the fact that we developed a sweet tooth over the last century does not necessarily prove that that is in fact the cause of increasing incidences of hypertension, diabetes, kidney disease etc. But it does make us wonder if our changing dietary habits, specifically the increasing consumption of sugar might have something to do with it. And here is why I think that sugar might be a big part of the puzzle...


Sugar has been around in the Indian subcontinent for at least 3000 years. However its trade really started once the Indians figured out a way to turn sugarcane juice in to sugar crystals. Later, Alexander the Great's army would note the Indians using a "sweet salt" that they called "Sarkara". This became the root word for sugar, saccharum, and saccharin. The subcontinent would remain the major center of sugar export to the world until sugar production started in Venice in the 15th century. However, even then sugar was a niche product to be bought only be the wealthy one-percent-ers! The royal families of Europe would gift it to each other. Over the next century though sugar would change the political and health landscape of humanity for ever. The health consequences are obvious. The political upheavals I am referring to is the advent of colonialism and slavery.

For a good part of my life, I worked on the Caribbean island of Grenada. A favorite pastime was hiking trips to what used to be a sugar plantation (they also make a killer dark chocolate!) from the 17th century to the early 1900s. The trips were my first tangible view in to the history of sugar trade. Looking over that estate, I would picture the enslaved Africans who were made to toil in inhuman conditions while they churned sugarcane juice in to white sugar crystals. Crystals that were then sent up to England and France to satisfy the palates of the colonial masters.  Thanks in part to the evolving tastes of Europeans, and in part to its rarity, sugar quickly became the most important and lucrative commodity in world trade. Its importance was no less than what oil's is today!

Why am I discussing history on a health blog?! Well, I would ask you to re-read the statistics I wrote in the very first line of this article. The reason you see these overwhelming numbers is related to the easy availability of sugar. As sugar became easier to produce and cheaper to buy, its per capita consumption exploded. And so you see the average American consuming 156 lbs per year! There also is a physiologic basis for this. Sugar, specifically fructose seems to have an ability to induce an increase in uric acid. It is speculated that this might be one of the major reasons behind the link between sugar intake and chronic disease.

From colonialism, plunder, slavery, and indentured labor...to obesity, hypertension, heart disease, and kidney disease. The history of sugar is inextricably inter-wined with the history of modern chronic disease. It is ingrained deeper in our lives than most of us realize. Who would have thought!


  1. sugar can be never be avoided in a country like India.Its expensive for many to re-energize themselves with small snack other energizing drinks. A cup of coffee or tea are the most sought drinks with high sugar in it to carry out your daily routine. Good that your blog is raising awareness to avoid sugar and the culture is catching up. Diabetics are so many,the dialysis units and other wards are filled with them. Much to be done to avert this problem.Many people are going after a very clean refined white color sugar,sometimes even being treated with chemicals to get this.


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