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Fructose: Dangerous at any level?
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Lurking in your food is an ingredient that can wreak more havoc than ever thought previously. It’s not saturated fat, it’s not ice cream, it’s not salt.

Lurking in your food is an ingredient that can wreak more havoc than ever thought previously.

It’s not saturated fat, it’s not ice cream, it’s not salt. It’s fructose - a sugar found in many foods,
both naturally and added by food manufacturers. It is a unique sugar with distinct
physiologic properties that set it apart from other sugars.

Nutritional trends over the past 40 years have caused fructose to explode as an additive in your food. While fructose once occupied only a modest place as simple table sugar (sucrose)─one that we all recognized back in 1950 as something that made us fat and diabetic if overconsumed - it has worked its way into our diets through all manner of foods, from ketchup to bread to salad dressings. Much of the addition of fructose has been conducted in the name of low-fat nutrition, but has ended up (as much 20th century nutritional advice) accomplishing more harm than good. Add fructose to the growing list of 20th century nutritional blunders.

Let’s discuss why fructose is so destructive and why avoiding it is important to your coronary plaque control program.

The battle over high-fructose corn syrup

You’ve likely witnessed the media battle being waged over high-fructose corn syrup. Some say it is bad for health, while others (like the Corn Refiners Association) say it’s natural and no different from other sweeteners.

What is so bad about high-fructose corn syrup?

Well, a better way to phrase this question would be: Why is fructose so bad? High-fructose corn syrup is just a more concentrated form of fructose. It is also found in other sweeteners and foods.

Fructose can be found as part of:

Sucrose (table sugar): Fructose comprises one-half of sucrose, a disaccharide (di = two), the other half occupied by glucose. Sucrose was the traditional means through which Americans overconsumed fructose.

High-fructose corn syrup (HFCS): Since 1967, HFCS has been increasingly used to replace sucrose in processed foods. HFCS comes in three varieties: HFCS-42 (used in baking and soft drinks), HFCS-55, and HFCS-90 (rarely used), the numbers referring to the percentage of fructose (42%, 55%, and 90%). HFCS-42 and HFCS-55 are approximately the same in composition as sucrose. All three forms of HFCS are calorically equal to sucrose, with 4 calories per gram (as are all carbohydrates) and 16 calories per teaspoon. HFCS use by food manufacturers has increased 10-fold since 1970 and now constitutes 40% of all sweeteners in the U.S. food supply (Bray GA et al 2004).

Some critics of high-fructose corn syrup advocate a return to sucrose, which is, in reality, much the same in composition. Unfortunately, this has caused a firestorm of controversy and misunderstanding, prompting arguments that HFCS should be eliminated from the food supply, to arguments that it is as “good” for Americans as sucrose.


The Corn Refiners Association today applauded a decision by the American Medical Association (AMA) that concluded “high fructose syrup does not appear to contribute to obesity more than other caloric sweeteners.” “This science-based decision by the nation’s leading medical body reaffirms that no single food or ingredient is the sole cause of obesity. Rather, too many calories and too little exercise is a primary cause,” said Audrae Erickson, president, Corn Refiners Association." Press Release, June 17, 2008
Corn Refiners Association

(Note that corn syrup not designated as “high-fructose” does not contain fructose, but is pure glucose.)

Honey: Honey is 48% fructose, 52% glucose, similar in composition to both sucrose and high-fructose corn syrup. While honey contains minute quantities of additional healthy ingredients, it is essentially nothing more than liquid sucrose.


Fructose research really got underway in the 1970s when it was believed to be a healthy, low-glycemic index (glycemic index of 20, compared to 100 for glucose, 55 for sucrose) sugar for diabetics. Indeed, fructose does not increase one-hour blood sugar like most other sugars and can decrease HbA1c, the long-term measure of blood glucose control. But metabolic consequences of fructose began to be recognized, especially increased triglycerides. The enthusiasm for fructose as a safe diabetic sugar-substitute therefore waned.

Like many food additives, HFCS was a product whose undesirable health effects weren’t recognized until years after its widespread dissemination into the U.S. food supply. In fact, over the past decade, it has come to dominate processed food labels, often occupying number one, two, or three position on labels of main ingredients. 60% of the calories in apple juice, for example, come from the high-fructose corn syrup; apple juice is widely used to sweeten fruit juices and other beverages, such as protein shakes, energy drinks, and “health” juices like V8 Fusion®.

Americans now obtain an average of nearly 60 grams fructose per day, or 10.2% of total calories from fructose, a role previously largely occupied by sucrose. In the most recent National Health and Nutrition Examination Survey (NHANES), the largest source of fructose was sugar-sweetened beverages (30%), followed by grains (22%) and fruit or fruit juice (19%), the remainder from sweets, vegetables, and dairy products (Vos MB et al 2008). The introduction of HFCS has not only replaced sucrose, but it has also yielded a net increase in fructose exposure for Americans (Gaby AR 2005).

Clinical studies suggest that fructose consumption is associated with:

  • Non-alcoholic fatty liver: So-called “fatty liver” is induced by fructose consumption in both animals and humans; ingestion of 91 grams fructose per day was sufficient to generate non-alcoholic fatty liver (Ouyang X et al 2008).
  • Failure to suppress appetite: Insulin normally triggers leptin secretion from fat cells which, in turn, suppresses appetite. Fructose does not stimulate insulin nor leptin, and appetite is therefore not suppressed (Teff K et al 2002). Some authorities believe HFCS used in place of sucrose in soft drinks fails to suppress appetite to a greater degree than a similar quantity of fructose calories consumed as solid food (e.g., jelly beans) (Bray GA 2004).
  • Obesity: Animals and people given fructose as sucrose, HFCS, or directly as fructose gain weight, with weight concentrated in the abdominal region, specifically visceral (Bray GA et al 2004).
  • Insulin resistance: High quantities of fructose have been shown to block insulin responses (Beck-Nielsen H et al 1980).
  • Increased uric acid: While meats have traditionally been blamed for increased uric acid (the underlying cause of gout and possibly a coronary risk factor), fructose has emerged as the “modern” trigger for increased uric acid, accounting for the increase in uric acid blood levels and gout over the past 40 years despite declining U.S. meat consumption (Reiser S et al 1989).
  • Increased LDL cholesterol and apoprotein B: Compared to glucose, fructose increases LDL cholesterol (3.6% vs. 13.9%) and apoprotein B (similar to LDL particle number; 3.0% vs. 27.2%). Fructose also increases small LDL to a greater degree than glucose (13.3% vs. 44.9%) (Stanhope KL et al 2009).
  • Numerous studies have demonstrated that fructose increases fasting triglycerides in a dose-dependent manner (Bantle JP et al 2000). Triglyceride increases vary, but typically range from 50-100 mg/dl, depending on quantity of intake and individual sensitivity. More recent data have shown that, if triglycerides are tracked over an extended period (i.e., postprandial triglycerides), there is a doubling of net triglyceride levels (Stanhope KL et al 2009).

 

In short, increasing intakes of fructose are associated with a constellation of metabolic disturbances. Effects are dose-dependent, with effects beginning with exposures as little as 30 grams per day and increasing in magnitude with greater quantities.
 

How much is too much?


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