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Dear Dr. Roach: There was some controversy recently in a medical journal about the risk of sugar intake for heart disease. What is your take?

M.P.

Dear M.P.: There was a recent article in the Annals of Internal Medicine that evaluated recommended limits on added sugar in food. The guidelines came from the World Health Organization, Public Health England and the U.S. Department of Health and Human Services. Although their guidelines were different, all recommended limiting added sugar intake.

The paper, which was funded by a trade group, concluded that the guidelines were based on low-quality evidence and “do not meet criteria for trustworthy recommendations.” That’s the controversy.

I did an extensive search of recent articles on the health effects of high-sugar diets. I found two fairly well-done trials that show a modest increase in risk of chronic diseases (diabetes, heart disease, breast cancer and gallbladder disease) in people who have higher-glycemic-index diets.

I also reviewed a companion piece in the Annals, which found evidence that studies supported by manufacturers of sugar-sweetened beverages were much more likely to find that sugar is NOT a good cause of chronic disease than studies that were independently funded.

This suggests that the sugar industry may be trying, as did the tobacco industry, to discredit work on diet. I must unfortunately conclude that the Annals review paper has a potential for conflicts of interest.

Nearly all authorities agree that excess dietary sugar is a significant risk factor, not only for the development of diabetes, but also for other serious medical conditions. I continue to recommend against excess sugar intake. However, I can’t say exactly how much is safe, so I think using a guideline, such as the U.S. Health and Human Services recommendation to limit to less than 10 percent of daily calories, is rational.

Dear Dr. Roach: It seems a lot of people have high total cholesterol and take drugs for it.

But what do you think of an elderly person having a total cholesterol of 138 without taking any drugs? It seems to me this is an unhealthy situation, and somehow this person needs to do something to increase his cholesterol. How would a person do this? The stats are triglycerides 99, HDL 45 and LDL 74.

R.I.

Dear R.I.: Unfortunately, I can’t answer the question, because a low cholesterol level can be either a healthy or an unhealthy finding, depending on the circumstance.

For a healthy, active elderly person of normal weight, the numbers you told me about would represent a low risk of heart disease. However, low cholesterol levels, particularly in the elderly, often go along with poor nutritional status and chronic disease. It wouldn’t surprise if you told me the person you are referring to has a serious chronic illness (of almost any type).

If the person does have chronic illness, the cholesterol is a marker for a problem, not a problem in itself. Therefore, the treatment isn’t increasing the cholesterol (especially with unhealthy foods); rather, the treatment should be directed at the underlying disease. If a disease is unknown but suspected, then a careful history and physical exam, with a judicious laboratory evaluation, is warranted.

Email questions to ToYourGoodHealth@med.cornell.edu.

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