fructose… victim or villain?

  • Fructose (a.k.a “fruit sugar”) is used to sweeten many modern processed foods due to its sweetness and low cost.
  • On the plus side, fructose has a lower glycemic index value than glucose and does not require as much insulin to metabolise.
  • On the downside, fructose is processed directly by the liver, does not trigger appetite signaling hormones such as leptin, and in excess can lead to increased triglycerides and LDL, and can lead to fatty liver.
  • If we focus on nutrient dense foods that don’t spike blood glucose levels will mean that we largely avoid empty calories, including foods high in fructose.

it all started when…

Not so long ago people with diabetes were advised to use fructose rather than glucose as the sweetener of choice.[1]  

More recently though the reputation of fructose has become tarnished.

Let’s look at what happened and what it means for us now.[2]

the good

At first glance, fructose appears to have a number of positive qualities.

  1. With a Glycemic Index (GI) value of 19, fructose raises blood glucose less than other sweeteners such as sucrose (table sugar) (GI = 66) or pure glucose (GI = 100).[3] [4]
  2. Fructose requires less insulin to metabolise than other carbohydrates. [5]
  3. High fructose corn syrup is cheaper than other sweeteners (though this is largely due to government subsidies).[6]
  4. Calorie for calorie, fructose is sweeter than sucrose so you don’t need to use as much to get the same effect.[7]

the bad

These days the list of negatives attributed to fructose is increasing.

  1. Excess fructose increases triglycerides and LDL cholesterol more than glucose.[8]
  2. Excess fructose can lead to fatty liver, insulin resistance and type 2 diabetes.[9] [10]
  3. Fructose does not trigger appetite the signalling system hormones insulin and leptin so it is easy to overeat foods sweetened with fructose.[11]
  4. Fructose over consumption may be at the heart of metabolic syndrome which has also been linked to a wide range of cancers.[12]

foods highest in fructose

The foods highest in fructose are listed below.  With soft drinks at the top of the list, it is also interesting to note that a range of naturally occurring foods are not far behind.

food % calories from fructose
cola 58%
agave 52%
Sprite 51%
apple sauce 50%
apple juice 50%
honey 50%
salad dressing (fat-free) 48%
apples 45%
pears 43%
grapes 42%
ginger ale 42%
mango nectar 42%
dates 41%
Powerade 40%
pineapple 40%
lemonade 40%
watermelon 40%
raisins 36%

For our ancestors, high fructose, low satiety fruits would have been an effective way to store some extra fat in preparation for winter.

In our modern environment though, foods high in fructose are available all year round and can easily lead to excess consumption of “empty calories”.

Fruits do contain vitamins, however most fruits are typically not as nutrient dense as vegetables.  Avocados and olives are the only fruits that routinely make it into the lists of nutrient dense foods.

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High Fructose Corn Syrup (HFCS) was developed in the 1950s and was incorporated into our diet in processed foods between 1975 and 1985.[13]  HFCS now represents more than 40% of the caloric sweeteners added to foods and beverages and is the sole source of sweetener in soft drinks in the USA.[14]

The low nutritional value of soft drinks combined with the fact that they are easily over consumed makes for an ominous combination.

02-cola-kraut-big

fructose, glucose, sucrose, starch…  does it really matter?

There has been a lot of discussion about the perils of added sugar (e.g. That Sugar Film and I Quit Sugar) as well as dire warnings about high fructose corn syrup.  However in the end I’m not sure there is a big difference.

Fructose is processed directly by the liver and converted to triglycerides and LDL, largely without insulin.

Glucose that isn’t burned immediately raises blood sugar and is mopped up by insulin and stored as body fat and triglycerides in the blood.

So in the end, excess carbohydrate, whether it comes from fructose or glucose, ends up as stored body fat or fat in your blood stream (i.e. cholesterol).

The table below shows a comparison of the types of sugars contained in a number of foods along with their nutrient density score (note: a ND score of zero corresponds to the average of the foods in the USDA foods database, less than zero means that it’s less nutrient dense than average).

food % calories from carbs % starch % maltose % glucose % fructose Nutrient Density / cal
cola 100% 0% 0% 42% 58% -0.43
apple juice 95% 0% 15% 22% 49% -0.37
sweet potato 84% 31% 17% 3% 2% -0.11
white bread 79% 61% 3% 3% 3% -0.03

In his Perfect Health Diet Paul Jaminet says:

“A nourishing, balanced diet that provides all the required nutrients in the right proportions is the key to eliminating hunger and minimising appetite and eliminating hunger at minimal caloric intake.” 

While cola and apple juice may have the highest percentage of calories from fructose they also have the lowest nutrient density values.  So if you’re not worried about the carbs it’s going to be better to have the sweet potato or the bread from a nutrient density point of view.

Although at the same time you’ll notice that the sweet potato and bread both have less nutrients per calorie than the average of all the foods analysed.  There are a going to be better food options if you’re interested in nutrient density and / or blood glucose control.

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the bitter truth

While Robert Lustig has drawn a parallel between the toxic effects of alcohol and fructose on the liver,[15] it is not entirely clear whether the overall effect of fructose is actually worse than any other form of carbohydrate, particularly if not eaten in excess.[16]

If you are insulin sensitive and have excellent blood glucose control should you avoid all apples and grapes just because they contain fructose?  I’m not sure.

Perhaps naturally occurring fructose with the fibre packaging it came in is not going to be such a big deal.  A quick check with a blood glucose meter will tell your whether your body can tolerate that banana or orange.

What we do know is that substituting carbohydrates with fat, particularly omega 3 (fish) and oleic acid (olive oil),  will provide positive outcomes in terms blood markers such as HDL and LDL (see the Good Fats, Bad Fats).

Even the gurus though are divided on the topic of fructose.  Dr Richard Feinman says:

“Dietary carbohydrate restriction remains the best strategy for obesity, diabetes and metabolic syndrome.  The specific contribution of removal of fructose or sucrose to this effect remains unknown.”[17]

fructose and the food insulin index

If you have read much of my blog you’ll know that I’m interested in using the food insulin index data to refine our understanding of our insulin response to food.  So what does the fact that fructose requires less insulin than glucose mean for predicting our insulin response to food?

As shown in the plots below, our insulin response to food is loosely related to carbohydrate content and the glycemic load of our diet.[18]   When we look a little closer though we see that high protein foods require insulin while fibre containing foods require less insulin than we might have expected.

image005.png

Once we account for the effects of fibre and protein we are better able to predict our blood glucose and insulin response to food.  However even after we account for fibre and protein the outliers that require less insulin than we might have anticipated seem to be foods higher in fructose (e.g. Coke, corn, raisins, bananas, and oranges).

image011.png

We know that fructose requires less insulin than other carbohydrates.  Once we account for this fact the correlation improves even further.  The high fructose foods move back towards the trend line.  The best correlation is achieved when we assume that 72.5% of fructose does not require insulin.  This aligns with the observation that fructose has a lower GI and our understanding that fructose can be converted to glucose via gluconeogenesis.

image015.png

useful for diabetes or just a ‘fun fact’?

For people with type 1 diabetes this additional understanding of the way fructose affects insulin demand could be used to more accurately calculate insulin doses.  Rather than simply assuming that all carbohydrates require insulin we can better predict the insulin demand by considering protein, fibre and fructose.

However, in practice this is probably a little over the top.  The simplest approach for people trying to manage insulin and blood glucose levels is to simply avoid or limit non-fibre carbohydrates, including fructose containing foods.

what does this it all mean?

But what does this mean for the rest of the population who do not routinely pay attention to their blood glucose levels?

12540702_591220951035726_6583204407992788954_n

I think the take home of all this is that if we focus on nutrient density and maximising nutrient dense foods the foods that are highest in simple carbohydrates (like fructose, glucose and sucrose) will fall off our shopping list.

Fructose, glucose, sucrose, maltose or starch?  Which one is worse?  Personally, I’m not sure, but I think  if you focus on nutrient dense foods that normalise your blood glucose the question largely becomes irrelevant.

Excess low satiety empty calories are a disaster regardless of their source.

references

[1] http://www.ncbi.nlm.nih.gov/pubmed/8116561

[2] http://www.sustainabletable.org/704/high-fructose-corn-syrup-if-this-doesn-t-convince-you-nothing-wil

[3] http://www.glycemicindex.com/

[4] http://nutritiondata.self.com/topics/glycemic-index

[5] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682989/

[6] http://www.sustainabletable.org/704/high-fructose-corn-syrup-if-this-doesn-t-convince-you-nothing-wil

[7] https://en.wikipedia.org/wiki/Sweetness

[8] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682989/

[9] https://intensivedietarymanagement.com/fructose-causes-insulin-resistance-hormonal-obesity-xxxii/

[10] http://www.ncbi.nlm.nih.gov/pubmed/6986758

[11] http://jama.jamanetwork.com/article.aspx?articleid=1555133

[12] http://www.nature.com/articles/502181a.epdf?referrer_access_token=CRP9U8WXl4mJNfqo4orP8dRgN0jAjWel9jnR3ZoTv0NtMj8L_3KRZVWZabicm7rvejgBPA4AV527Qu8-lWRGqIxVOFzXZjTnCCLiGH3Cd8fpHyZSBlGYrIgA04OTQQIrjy1agpIy5_6ESWux-NHg0zKa2ClJnOIUZqNbtXoJFFr2HdBa6iyAUWVKStjD0NjDMX0FQip1TKgHUWBGgBLjUdNMDyU4sogyzodhJ_UmvDA%3D&tracking_referrer=www.theguardian.com

[13] http://www.sustainabletable.org/704/high-fructose-corn-syrup-if-this-doesn-t-convince-you-nothing-wil

[14] http://ajcn.nutrition.org/content/79/4/537.full

[15] https://www.youtube.com/watch?v=dBnniua6-oM

[16] http://superhumanradio.com/blog/meta-analysis-of-59-trials-shows-no-detrimental-effects-of-fructose-on-blood-lipids.html

[17] http://www.amazon.com/The-World-Turned-Upside-Down/dp/0979201829

[18] http://ses.library.usyd.edu.au/handle/2123/11945

[19] http://www.thebloodcode.com/calculators/

[20] http://www.amazon.com/Cholesterol-Clarity-What-Wrong-Numbers/dp/1936608383

[21] http://www.amazon.com/Cholesterol-Clarity-What-Wrong-Numbers/dp/1936608383

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13 thoughts on “fructose… victim or villain?”

  1. Excellent post. I’ve read a good bit of Ray Peat’s works, and you did a wonderful job explaining and comparing the various effects of fructose vs glucose or rather, starch. I’m still wrestling with all of this, and wonder about the role of resistant starch in achieving weight loss and ideal blood glucose levels. I find it more difficult, though, to exercise self control with starch compared to fruit. And then what about all of the cultures who enjoyed robust health consuming starch, many times fermented. I’m referring to the scots and those in the America’s who ate masa harina, which was corn soaked in lime. Maybe these methods of grain preparation increased the resistant starch, reduced anti-nutrients, and left one with a nutrient dense easily digested food high in RS. Bottom line, I generally pick one carb per meal. Sometimes it’s apples turned into a semi-high fat apple crisp, other times it’s a banana or potatoes. But I always consume these carbs with fat and most always protein too. I’m still overweight, but I don’t have diabetes. Aha, maybe I could gleam more tips by reading more of your informative posts!

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    1. I think it’s going to be important to get a range of fibre. It seems just focussing on resistant starch can cause an overgrowth. See https://optimisingnutrition.com/2015/10/05/ketogenic-fibre/

      Lots of people can deal with carbs but unfortunately many of us have been eating so much processed carbs for so long we need to back off the processed carbs.

      Hopefully when you read more of the blog you will find that main themes are to normalise blood glucose (through managing the insulin load of your food) and then to maximise nutrient density.

      Best of luck on the journey.

      Like

  2. Fructose is supposed to be good for endurance athletes (according to Dr. Lagakos of Calories Proper)–beyond that, I know of no situation where fructose is beneficial. Personally, it blows me up like a cow (we’re talking 1 avocado here).

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      1. That’s why I avoid the fruit and just use the oil when I want that avocado taste–no fructose in the oil.

        For everything else, I let my meter be my guide.

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  3. Pingback: What's Up Doc?
  4. Lustig’s main points seem to be:
    Fructose in excess contributes to fatty liver. This in turn contributes to insulin resistance.

    Other carbs in excess contribute to fat elsewhere in the body, but not specifically in the liver, so not the same contribution to insulin resistance.

    He also lumps Fructose with Trans fats, Branched Chain Amino Acids, and Alcohol in the unique way they are dealt with in the liver.

    Of course the best way to deal with this is to avoid / minimize sugars in general.

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