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Fructose: Friend or Foe?

Long thought to be the better sugar for people with diabetes, fructose may not be so great after all.


Diabetes Fructose

By Jack Challem

Most people think of fructose as a natural fruit sugar. After all, it’s one of the main sugars (along with glucose and sucrose) in fruits. In fact, the amount of fructose in most fruits is relatively small, compared with other sources. Fruit also contains a host of great nutrients, including fiber, which slows the absorption of sugars.

The fructose found in processed foods, however, is another story. Between 1980 and 2000, Americans decreased their intake of sucrose (table sugar), but the amount of fructose consumption more than tripled. The reason for this was that food makers replaced sucrose (table sugar) with high-fructose corn syrup (HFCS) to sweeten foods and beverages.

HFCS does not come from fruit. It’s a highly processed blend of sugars (typically 55 percent fructose and 45 percent glucose) derived from corn. Because the fructose in HFCS is part of a man-made blend (as opposed to the natural compound of sugars found in fruit), the body metabolizes it very differently from other sugars.

Also, people with diabetes were told that because fructose doesn’t raise blood glucose levels, it was a good alternative to sugar. Therefore, they began using fructose-rich agave nectar under the mistaken assumption that it posed no diabetes-related risk. 

Unlike glucose, which enters the bloodstream and raises blood sugar levels, fructose is taken up directly to the liver. Sugar and honey contain about 50 percent glucose and 50 percent fructose, so regardless of which is consumed, blood glucose will rise. By contrast, agave nectar contains about 85 percent fructose, on average, so it has less of an impact on blood sugar and is considered a “low glycemic” sweetener. However, high fructose intake has been shown to worsen insulin resistance, increase the liver’s production of triglycerides, and promote abdominal fat storage—all of which jeopardize the health of those with diabetes.

Research Findings

Between 2000 and 2010, a lot of research came out linking fructose to an increased risk for health complications such as obesity, diabetes, high cholesterol, and heart disease. These research findings garnered a lot of press attention, and Americans responded by decreasing their fructose consumption. According to the U.S. Department of Agriculture (USDA), as of 2015, consumption of HFCS was the lowest it had been since 1992.

This doesn’t necessarily mean that people are healthier. On the one hand, we’re seeing a decrease in HFCS consumption; on the other, we are also seeing sugar consumption reach a thirty-year high. Current research shows negative consequences from high consumption of both types of sweeteners. In fact, a number of recent studies contradict the research from the early 2000s, and suggest that HFCS isn’t any more harmful than regular sugar when consumed at normal levels.

While more research is needed to put an end to the HFCS debate, one thing is clear. A healthy diet that minimizes processed carbohydrates and sugar-sweetened food and beverages has always been the healthy choice for most people, particularly those with type 2 diabetes.

What You Can Do

First, make a decision to get your added sweetness from whole fruit. Fruit provides a wealth of good nutrition, especially high-fiber, non-starchy fruits such as berries, nectarines, and apples. Consider adding some of these (fresh or frozen) to unsweetened, whole-milk yogurt or topping them with whipped cream.

Read the ingredients lists on bottles and packages. Pay attention to added syrups, juices, and concentrates used to sweeten; reject products containing HFCS. Make a habit of controlling your sweet tooth and limiting your intake of all added sweeteners, like HFCS, fructose, sucrose (sugar), glucose, and corn syrup to improve control of your blood sugar.

Skip soft drinks and fruit juices altogether, whenever possible. A typical twelve-ounce soft drink, sweetened with HFCS, provides the equivalent of twelve teaspoons of sugar and about 150 calories. Some brands of fruit juice are even worse. These are calories you probably don’t need, or should at least spend on something more nutritious. Try switching to water, seltzer, or other unsweetened beverages, like herbal tea. You can choose flavored varieties, or infuse them with your own fruit, such as lemon wedges, lime wedges, raspberries, or strawberry slices.

Jack Challem, The Nutrition Reporter™, is a member of the American Society for Nutrition and one of America’s most trusted nutrition and health writers. He is the bestselling author of more than twenty books, including Stop Prediabetes Now.

Sources

Christopher, L. R., J. Uribarri, and K.L. Tucker. “Intake of High-Fructose Corn Syrup Sweetened Soft Drinks, Fruit Drinks, and Apple Juice Is Associated with Prevalent Arthritis in U.S. Adults, aged Twenty to Thirty Years.” Nutrition and Diabetes. March 2016. https://www.ncbi.nlm.nih.gov/pubmed/26950480.

Khan, T. A., S. Blanco-Mejia, R. de Souza, C. W. C. Kendall, and J.L. Sievenpiper. “Relation of Total Sugars and Fructose-Containing Sugars with Risk of Cardiovascular Disease: a Systematic Review and Meta-Analysis of Prospective Cohort Studies.” The FASEB Journal. http://www.fasebj.org/content/30/1_Supplement/904.7.short.

Lowndes, J., D. Kawiecki, S. Pardo, V. Nguyen, K.J. Melanson, Z. Yu, and J.M. Rippe. “The Effects of Four Hypocaloric Diets Containing Different Levels of Sucrose or High-Fructose Corn Syrup on Weight Loss and Related Parameters.” Nutrition Journal. August 2012. https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-11-55.

Popkin, B. M., and C. Hawkes. “Sweetening of the Global Diet, Particularly Beverages: Patterns, Trends, and Policy Responses.” The Lancet. December 2015. http://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00419-2/abstract.

U. S. Department of Agriculture. “Sugar and Sweeteners Yearbook Tables.” U.S. Department of Agriculture Economic Research Service. Last Modified March 16, 2017.
https://www.ers.usda.gov/data-products/sugar-and-sweeteners-yearbook-tables.aspx.

van Buul, V. J., L. Tappy, and F.J. Brouns. “Misconceptions About Fructose-Containing Sugars and Their Role in the Obesity Epidemic.” Nutrition Research Reviews. June 2014. https://www.ncbi.nlm.nih.gov/pubmed/24666553.

White, J. S. “Challenging the Fructose Hypothesis: New Perspectives on Fructose Consumption and Metabolism.” Advances in Nutrition. 2013. http://advances.nutrition.org/content/4/2/246.full.

Updated by Julia Telfer, 3/17; Franziska Spritzler, RD, CDE, 10/17.

Fructose: Friend or Foe?
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