Does sugar raise cholesterol?

Yes, a little, and more so the more sugar there is. A meta-analysis of 37 randomized trials found that higher sugar intake raised LDL cholesterol by 4.6 mg/dL (95% CI 1.9 to 7.3; metric: 0.12 mmol/L, 0.05 to 0.19) and total cholesterol by 6.2 mg/dL (0.16 mmol/L) against lower intake, with moderate to high variation between the trials. The 2022 Cochrane review of generally healthy adults found a smaller total cholesterol gap of 4.3 mg/dL (0.11 mmol/L) and no effect on LDL, on low certainty evidence.

Established. Eating more sugar raises blood fats by a small amount. Across 37 randomized trials of at least two weeks, triglycerides rose 9.7 mg/dL (0.11 mmol/L) and LDL 4.6 mg/dL (0.12 mmol/L) with higher sugar intake. The effect was strongest in trials where calories were held steady, so weight gain does not appear to explain it.

Unsettled. Whether sugar raises LDL when it only replaces other carbohydrate at the same calories is not settled. A meta-analysis of 28 such studies in 510 volunteers found rises in LDL and triglycerides, with heterogeneity between studies and signs of publication bias. The Cochrane review found no evidence of an effect on LDL.

What the trials found

The clearest single result comes from swapping sugar for starch. A network meta-analysis of 38 randomized trials in 1,383 people found that replacing sucrose with starch at equal calories lowered LDL by 8.9 mg/dL (95% CI -15 to -2.7; metric: 0.23 mmol/L, -0.38 to -0.07). Replacing fructose with starch lowered it by 0.22 mmol/L. The reviewers rated the certainty of these comparisons very low to moderate.

Fructose itself looks no worse than other sugars at the same calories. In 11 trials with 277 people, replacing glucose or sucrose with the same calories of fructose had no effect on blood lipids. Those trials ran 2 to 10 weeks.

Dose shows up clearly in one study. In a 2 week trial of 85 young adults, drinks sweetened with high-fructose corn syrup raised LDL by 7.4 mg/dL at 10 percent of energy and by 15.9 mg/dL at 25 per cent. The design was not randomized, and the doses were far above usual intake. Apolipoprotein B and non-HDL cholesterol also rose at the two higher doses.

Cutting sugar modestly has shown less. In a 12 week randomized trial of 105 Latino teenagers with obesity, free sugar fell from 11.5 to 7.3 percent of energy and no blood lipid changed, in a secondary analysis of a trial that achieved only a modest reduction. In a 10 week trial of 32 overweight adults, sugary drinks at 25 percent of energy lowered lipoprotein(a) by about 13 percent. That trial had no low-sugar comparison group, the study gives no absolute value, and LDL rose in the same people, so the drop does not offset the rise.

What population studies add

Observational data point the same way and cannot show cause. In the Framingham cohorts of 6,730 adults, those who regularly drank more than one sugary drink a day had a 52 percent higher risk of developing high triglycerides than rare drinkers (hazard ratio 1.52, 95% CI 1.03 to 2.25). The study does not give absolute rates, so how many extra people that means cannot be said from it. Across two US cohorts of about 29,000 adults, more sugary drinks went with higher LDL and apolipoprotein B and lower HDL, from a single diet questionnaire, with confounding possible.

Who should be careful

Not for everyone. The rise in LDL grows with the amount of sugar, from 7.4 mg/dL at 10 percent of energy to 15.9 mg/dL at 25 percent in the drinks trial, which was short, not randomized and used very high doses. People who get a large share of their calories from sugary drinks are the ones the trials describe.

The limits public bodies set give a practical ceiling. WHO recommends keeping free sugars below 10 percent of daily energy for adults and children, and suggests below 5 percent. Free sugars include honey, syrups and fruit juice and exclude whole fruit, and the WHO limit rests on body weight and tooth decay rather than on cholesterol. The American Heart Association in 2009 set a prudent upper limit of about 100 calories a day of added sugar for most women and 150 for most men. We have no card on sugar and cholesterol in pregnancy, in people on cholesterol-lowering drugs or in people with inherited high cholesterol, and that gap is not a reassurance.

What expert bodies say

EFSA, the European food safety agency, concluded in 2022 that randomized trials show a positive and causal relationship between added and free sugars and dyslipidemia, at a moderate level of certainty. It could not set a safe upper level and advises keeping intake as low as possible in a nutritionally adequate diet. When WHO set its sugar limits in 2015, it listed the link between free sugars and blood lipids as a question still needing systematic reviews. That guideline predates the 2017 to 2022 reviews above and the EFSA opinion.

How we searched

What would change this answer

• Randomized trials longer than six months at the sugar intakes people actually eat, 5 to 15 per cent of energy, with LDL or apolipoprotein B as the main outcome. Most trials above ran weeks, and the clearest dose results come from very high intakes.
• An updated Cochrane review. The 2022 review rated its evidence low certainty and found no trial that measured heart attacks or deaths.
• Any trial with cardiovascular events as the outcome, which does not yet exist.

More on sugar, from teeth to blood pressure, is on the sugar page.

Sources

1. ev-sgch-01 · Meta-analysis or systematic review · systematic review and meta-analysis of randomized controlled trials, PROSPERO-registered · n = 37 trials
   Higher compared with lower sugar intakes significantly raised triglyceride concentrations [mean difference (MD): 0.11 mmol/L; 95% CI: 0.07, 0.15 mmol/L; P < 0.0001], total cholesterol (MD: 0.16 mmol/L; 95% CI: 0.10, 0.24 mmol/L; P < 0.0001), low-density lipoprotein cholesterol (0.12 mmol/L; 95% CI: 0.05, 0.19 mmol/L; P = 0.0001), and high-density lipoprotein cholesterol (MD: 0.02 mmol/L; 95% CI: 0.00, 0.03 mmol/L; P = 0.03).
   
   Who: adults and children in randomized trials of at least 2 weeks that changed free sugar intake
   Effect: total cholesterol MD +6.2 mg/dL (95% CI 3.9 to 9.3; metric: 0.16 mmol/L, 0.10 to 0.24); LDL +4.6 mg/dL (1.9 to 7.3; metric: 0.12 mmol/L, 0.05 to 0.19); triglycerides +9.7 mg/dL (6.2 to 13; metric: 0.11 mmol/L, 0.07 to 0.15); HDL +0.77 mg/dL (0 to 1.2; metric: 0.02 mmol/L, 0.00 to 0.03)
   Certainty: Heterogeneity I2 36 to 75%; effect strongest where energy balance was kept, so not explained by weight gain.
   Am J Clin Nutr, 2014 · checked 2026-10-07 · we read the abstract
2. ev-sgch-02 · Meta-analysis or systematic review · systematic review and meta-analysis of isoenergetic intervention trials · n = 510
   There were significant increases in HDL cholesterol, LDL cholesterol, and triacylglycerols, although for LDL cholesterol and triacylglycerols there was significant heterogeneity between studies and evidence of publication bias.
   
   Who: volunteers in isoenergetic trials comparing free sugars with complex carbohydrates
   Effect: significant rises in HDL, LDL and triacylglycerols; heterogeneity and publication bias for LDL and triacylglycerols
   Certainty: Short to moderate trials; heterogeneity and publication bias for LDL and triglycerides.
   Am J Clin Nutr, 2017 · checked 2026-10-07 · we read the abstract
3. ev-sgch-03 · Meta-analysis or systematic review · systematic review and network meta-analysis of randomized controlled trials · n = 1,383
   A reduction in LDL-cholesterol concentrations was shown for the exchange of sucrose with starch (MD: -0.23 mmol/L; 95% CI: -0.38, -0.07 mmol/L) or fructose with starch (MD: -0.22 mmol/L; 95% CI: -0.39, -0.05 mmol/L; SUCRAstarch: 98%).
   
   Who: participants in RCTs of isocaloric swaps between fructose, glucose, sucrose and starch
   Effect: LDL MD -8.9 mg/dL (95% CI -15 to -2.7; metric: -0.23 mmol/L, -0.38 to -0.07) sucrose to starch; -8.5 mg/dL (-15 to -1.9; metric: -0.22 mmol/L, -0.39 to -0.05) fructose to starch; no effect on triglycerides
   Certainty: Certainty of evidence very low to moderate (CINeMA).
   Am J Clin Nutr, 2020 · checked 2026-10-07 · we read the abstract
4. ev-sgch-04 · Meta-analysis or systematic review · Cochrane systematic review and meta-analysis of randomized controlled trials · n = 763
   There was minimal effect of low intake of added sugar on total cholesterol levels (MD 0.11, 95% CI 0.01 to 0.21; I² = 0%; 16 studies; 763 participants; low certainty of evidence) and triglycerides (MD 0.10, 95% CI 0.03 to 0.17; I² = 3%; 14 studies; 725 participants) but no evidence of effect on LDL-cholesterol and HDL-cholesterol.
   
   Who: generally healthy adults aged 22 to 57 in RCTs comparing levels of added sugar, mean 14 weeks
   Effect: total cholesterol MD 4.3 mg/dL (95% CI 0.39 to 8.1; metric: 0.11 mmol/L, 0.01 to 0.21), 16 studies, low certainty; triglycerides MD 0.10 (0.03 to 0.17); no evidence of effect on LDL or HDL
   Certainty: Low certainty (GRADE); risk of bias mostly unclear; no trial measured heart attacks or deaths.
   Cochrane Database Syst Rev, 2022 · checked 2026-10-07 · we read the abstract
5. ev-sgch-05 · Meta-analysis or systematic review · systematic review and meta-analysis of randomized controlled trials · n = 277
   There was no effect on fasting blood insulin or blood lipids.
   
   Who: adults and children with or without diabetes; 40 to 150 g/day fructose for 2 to 10 weeks
   Effect: no effect on blood lipids or insulin; triglycerides -7.1 mg/dL (95% CI -12 to -1.8; metric: -0.08 mmol/L, -0.14 to -0.02)
   Certainty: Short trials; shows that the type of sugar matters less than the amount.
   Am J Clin Nutr, 2017 · checked 2026-10-07 · we read the abstract
6. ev-sgch-06 · Observational data · parallel-arm nonrandomised double-blind intervention study · n = 85
   Consuming beverages containing 10%, 17.5%, or 25% Ereq from HFCS produced dose-dependent increases in circulating lipid/lipoprotein risk factors for CVD and uric acid within 2 wk.
   
   Who: adults aged 18 to 40, BMI 18 to 35; HFCS drinks at 0%, 10%, 17.5% or 25% of energy needs
   Effect: fasting LDL change: 0% -1.0, 10% +7.4, 17.5% +8.2, 25% +15.9 mg/dL (P < 0.0001 for dose); apoB and non-HDL also raised at the two higher doses
   Certainty: Not randomized; 2 weeks; very high doses compared with usual intake.
   Am J Clin Nutr, 2015 · checked 2026-10-07 · we read the abstract
7. ev-sgch-07 · Randomized controlled trial(s) · double-blind parallel-arm randomized trial · n = 32
   In conclusion, in older, overweight/obese adults, consuming sugar-sweetened beverages reduced Lp(a) levels by ∼13% independently of apo(a) size variability and the type of sugar consumed.
   
   Who: overweight or obese adults, mean age 54; glucose- or fructose-sweetened drinks at 25% of energy needs
   Effect: Lp(a) -13.2% overall; LDL-C and triglycerides increased
   Certainty: Small; no low-sugar control arm; Lp(a) fall does not offset LDL rise.
   J Lipid Res, 2024 · checked 2026-10-07 · we read the abstract
8. ev-sgch-08 · Randomized controlled trial(s) · randomized controlled trial, secondary analysis · n = 105
   Free sugar intake decreased in the intervention group compared to the control group [11.5% to 7.3% vs. 13.9% to 10.7% (% Energy), respectively, p = 0.02], but there were no effects on any outcome of interest (pall > 0.07).
   
   Who: Latino youth with obesity, mean age 14.8; sugar reduction (goal 10% of energy or less) vs standard advice
   Effect: free sugar fell from 11.5% to 7.3% of energy; no effect on lipid profile (all P > 0.07)
   Certainty: Modest reduction achieved; 12 weeks; secondary analysis.
   Nutrients, 2023 · checked 2026-10-07 · we read the abstract
9. ev-sgch-09 · Observational data · prospective cohort study · n = 6,730
   Long-term regular SSB consumers also had a higher incidence of high triglyceride (hazard ratio, 1.52; 95% CI, 1.03-2.25) compared with low consumers.
   
   Who: Framingham Offspring (n 3,146) and Generation Three (n 3,584) adults
   Effect: HDL -1.6 mg/dL; triglycerides +4.4 mg/dL over 4 years; incident high triglycerides HR 1.52 (95% CI 1.03 to 2.25)
   Certainty: Observational; food frequency questionnaires; residual confounding possible.
   J Am Heart Assoc, 2020 · checked 2026-10-07 · we read the abstract
10. ev-sgch-10 · Observational data · cross-sectional analyses within prospective cohorts · n = 29,265
    SSB consumption was positively associated with LDL cholesterol, apoB, TG, RLP-TG, RLP-C, and non-HDL cholesterol concentrations and total cholesterol:HDL cholesterol and apoB:apoA1 ratios; and negatively associated with HDL cholesterol and apoA1 concentrations (P-trend range: <0.0001 to 0.008).
    
    Who: Framingham Offspring Study (n 3,047) and Women's Health Study (n 26,218) adults
    Effect: positive association with LDL-C, apoB, triglycerides, non-HDL-C; negative with HDL-C and apoA1 (P-trend <0.0001 to 0.008)
    Certainty: Observational, single diet measurement; confounding possible.
    J Nutr, 2022 · checked 2026-10-07 · we read the abstract
11. ev-sgch-11 · Position of an expert body · EFSA scientific opinion based on a systematic review · n = —
    There is evidence from RCTs for a positive and causal relationship between the intake of added and free sugars and risk of dyslipidaemia (moderate level of certainty).
    
    Who: adults in randomized trials of added and free sugars
    Effect: positive causal relationship with dyslipidemia, moderate certainty (>50 to 75% probability)
    Certainty: EFSA could not set a safe upper level; advises intake as low as possible in a nutritionally adequate diet.
    EFSA Journal, 2022, Tolerable upper intake level for dietary sugars (EFSA NDA Panel) · checked 2026-10-07 · we read the fulltext
12. ev-sgch-12 · Position of an expert body · WHO guideline · n = —
    In both adults and children, WHO recommends reducing the intake of free sugars to less than 10% of total energy intake2 (strong recommendation). WHO suggests a further reduction of the intake of free sugars to below 5% of total energy intake (conditional recommendation3).
    
    Who: adults and children
    Effect: free sugars <10% of energy (strong), <5% (conditional)
    Certainty: Limit rests on body weight and tooth decay; free sugars include honey, syrups and fruit juice, not whole fruit.
    WHO, 2015, Guideline: sugars intake for adults and children · checked 2026-10-07 · we read the section
13. ev-sgch-13 · Position of an expert body · WHO guideline · n = —
    Need for systematic reviews and meta-analyses relating free sugars intake to blood lipid levels, blood pressure and diabetes-related outcomes
    
    Who: adults and children
    Effect: research need named: free sugars and blood lipid levels
    Certainty: WHO 2015 predates the 2017 to 2022 reviews and EFSA 2022.
    WHO, 2015, Guideline: sugars intake for adults and children · checked 2026-10-07 · we read the section
14. ev-sgch-14 · Position of an expert body · scientific statement · n = —
    A prudent upper limit of intake is half of the discretionary calorie allowance, which for most American women is no more than 100 calories per day and for most American men is no more than 150 calories per day from added sugars.
    
    Who: American women and men
    Effect: added sugars upper limit about 100 calories/d (women), 150 calories/d (men)
    Certainty: 2009 statement; based mainly on energy and nutrient quality rather than lipid trials.
    Circulation, 2009 · checked 2026-10-07 · we read the abstract