The Truth About Fructose Dangers

Pure crystalline fructose is an alternative natural sweetener that has long been used in the natural products industry as a common sugar substitute. Its major claim to fame is that in the short term fructose raises blood sugar far less than sucrose, the primary sugar found in white sugar that is made from sugar cane or sugar beets. Crystalline fructose should not be confused with the synthesized liquid sweetener called high fructose corn syrup (HFCS), which is made by a different process and is a mixture of roughly half fructose and half glucose (dextrose) that is widely used in the beverage and processed food industries. Unlike HFCS, fructose is a naturally occurring sugar made by plant photosynthesis that is a primary sugar in many healthy fruits. Being about 50% sweeter than sucrose, fructose can also be used more sparingly in recipes to cut their caloric intake by about 1/3.

Because of the unique challenges of formulating natural products without the use of artificial sweeteners or flavorings, sometimes a small amount of fructose is the best match for the flavorings in a product. For example, liquid vitamin B-12 has a distinct flavor profile and other sweeteners do not mask it quite as well as fructose can. Often a mixture of sweeteners may be used to create a “mouth feel” that is acceptable to consumers, who often use white sugar as their sensory standard for sweeteners. While some people may intellectually prefer other sweeteners or even white sugar, in sensory tests the fructose mixture often gets higher marks from consumers, and this leads to high compliance with recommended label uses.

I appreciate the concerns over the use of fructose. It has certainly been abused in the Western diet, especially in the form of HFCS. Americans' fructose consumption on average has tripled over the past century. But increased consumption of fruit juice and sucrose itself also are implicated in our national health decline; certainly not fructose alone, nor fructose in low doses.

According to Dr. Lustig*, an authority on fructose metabolism, human studies have not consistently shown the effect of fructose to induce insulin resistance; a negative effect reported in some animal and preliminary human studies related to altered liver metabolism. Dr. Lustig also admits that not all human studies show a negative effect of fructose on liver health or metabolic syndrome. There appear to be certain individual factors involved that make such effects somewhat idiosyncratic. Many of the studies cited are cell studies, animal studies giving high doses of fructose to mutant mice, or human studies where consumption of a lot of soft drinks were involved that provided a large number of calories comprising an unhealthy proportion (25% or more) of total daily caloric intake (about 500 calories as fructose every day). Contrast this with a healthy nutritional product that provides only a few calories, a very low percent versus those unhealthy diets!

Dr. Lustig notes that "In the hypocaloric (eg, starvation) state, fructose is as beneficial as glucose"; while also noting it has ill effects in the "hypercaloric state". He also discusses how a small amount of ethanol, a substance with similar liver effects to high fructose diets, is actually health-promoting while large amounts have the opposite effect. This reinforces that the ability of substances to elicit ill effects on the liver are typically dose dependent and require larger-than-normal amounts. In effect, 'the dose makes the poison;' as has been noted for many substances throughout history.

Dr. Lustig specifically cites three what he calls "antidotes" to the negative hepatic (liver) effects of fructose:

1. reduce the amount consumed

2. exercise

3. increase fiber intake.

So, upon reviewing these facts, the consumption of a small amount of fructose is unlikely to be harmful to the general public. Additionally, consumption of reasonable amounts may also be quite harmless if the person gets enough fiber and/or exercise. And the accepted fact that fructose does not directly raise blood glucose still gives it some short term advantages over certain other sweeteners for many people, if consumed at appropriate levels. Faster acting sugars that are higher on the Glycemic Index like glucose (which represents close to half of the sugar content of HFCS) would more immediately impact one's blood sugar, with chronic overuse eventually leading to insufficient/reduced insulin sensitivity (increased insulin resistance) that is associated with a loss of blood sugar control. Higher Glycemic sugars would affect this blood glucose control system much faster than an equivalent amount of pure fructose. And a lack of insulin sensitivity also indicates a problem in properly absorbing and recycling vitamin C in many of our body's cells; especially immune, muscle, and bone cells.

There are a variety of natural sweeteners to fit into most individuals' personalized dietary regime; but I do not promote the indiscriminate use of any sweetener, especially refined or synthetic ones. People like to have choices and will select sweeteners according to their own taste and health issues. For example, some avoid barley malt because of gluten sensitivity or certain other sweeteners because of corn allergies. People on limited diets need to scrutinize the available sweeteners and select what seems right for their own situation. But it's clear that a small amount of almost any natural sweetener, say to sweeten a cup of tea, does not seem to have any demonstrable health risk. For overly large amounts, the potential risks do increase. But a demonstrated risk level typically represents consumption of several hundred calories a day of refined sugars, including fructose, and it obviously is unwise to take in most of our daily carbohydrates in the form of refined sugars of any kind.

Consumption of small amounts of pure crystalline fructose simply doesn’t have a measureable effect on health and doesn’t need to be avoided. It’s the fructose consumed in large quantities in processed foods and beverages, where it comprises perhaps the major source of carbohydrates in the modern diet, that is the real health concern.

* Lustig RH. Fructose: metabolic, hedonic, and societal parallels with ethanol. J Am Diet Assoc. 2010 Sep;110(9):1307-21. PubMed PMID: 20800122.

Excerpts from an iterview with me about natural sweeteners

A whole leaf, full spectrum extraction of stevia preserves the many phytonutrients naturally present in the plant. One study reported over 100 natural stevia phytonutrients; the majority being polyphenols and other plant antioxidants. By contrast, there are about 9 steviosides. But the new “Reb A” fraction products being sold as food sweeteners (PureVia™, Truvia™) represent only a single chemical isolated from the stevia plant, though these two sweeteners are actually sold with added sugar alcohol (Erythritol, see below) and “natural flavors”.


Some artificial sweeteners cannot be used in cooking; for example, aspartame. By contrast, natural sweeteners typically do not lose their sweetness when cooked. And studies have indicated that artificial sweeteners may backfire by shutting down the satiety signals that tell us when we’re full…in those studies the groups fed artificial sweeteners ate up to 3 times the calories as control groups.

Sugar alcohols don’t raise blood sugar as rapidly as sugar does, yet they’re as bulky as sugar so they can be used “spoon - for - spoon” to replace sugar. But their level of sweetness may vary, with xylitol being the closest to sugar. Sugar alcohols have a range of sweetness and absorption; the amount that is absorbed from the GI tract affects the possibility of it being somewhat laxative at high levels, which can vary from person to person. Sorbitol may be laxative at moderate levels of 10 grams or more, mannitol at over 20 grams; xylitol at over 30 grams. Erythritol is virtually free of a laxative side affect even at higher levels, but is expensive. Also, sugar alcohols tend to have a cooling effect in the mouth and actually taste better when combined with a different type of sweetener.

Sugar alcohols also boast an FDA-approved health claim: “Frequent between-meal consumption of foods high in sugars and starches promotes tooth decay. The sugar alcohols in [name of food] do not promote tooth decay.”

I think that organic maple syrup, agave and xylitol are doing quite well as natural sweeteners, with erythritol a more recent option that is catching up. The recent crossover of a certain isolated fraction of stevia (Reb A) as a mass market sweetener has some drawbacks: it doesn’t taste like whole leaf extract, and is combined with both erythritol and natural flavors. And there are certified organic full spectrum extractions without the typical bitter aftertaste or added flavoring agents.

Many stevia products are still only legal to sell as herbal dietary supplements, not as sweeteners. Some companies may think that all stevia products are now approved for use in foods, but that is not true. Retailers should take their cues from the packaging, and only carry reputable brands that strictly follow labeling laws. It is primarily the isolated “Reb A” fraction of stevia that can be used in foods. Most other stevias have not been approved for food use, with some exceptions.

Excerpts from my interview about nutrition and diabetes

Fasting blood sugar tests are how doctors have long checked patients for blood sugar issues. A person’s options are greatest when they first discover that their blood sugar has gone out of balance. If they wait until after they’re on insulin or other medications, any natural means for improvement in blood sugar control could cause a dose of medicine to become an overdose. It is very important that your physician knows if you are going to try to control your blood sugar naturally, and that you test your blood sugar levels every time before taking medication in order to avoid dangerous interactions.

It normally takes several years to progress to full diabetes, and many people make diet and lifestyle changes that can control their blood sugar and prevent the development of diabetes without the use of drugs. But prolonged pre-diabetes weakens the system, being inflammatory and unsustainable over the long term. Of course, progression to full-blown diabetes is the biggest risk; meaning medications for the rest of your life, circulatory problems that can lead to blindness, neuropathy and amputations, more risks from infections, inflammatory problems, and even premature death. Adjustments to medications are needed and there is the possibility of insulin shock or diabetic comas. Frequent urination, high blood pressure, even the elevated risk of heart attack and stroke are other serious issues that diabetics face.

It’s a positive development that more people address health conditions when they first have indications of a growing problem. This may be partly because of high health care costs, but many people are motivated to improve their health for its own sake.

Metabolic Syndrome is a pre-diabetes condition defined as a combination of three or more of these symptoms: waist circumference over 40” for men and over 38” for women, high blood sugar (defined as a fasting blood glucose level over 100 mg/dL), high triglycerides (over 150 mg/dL), low high-density lipoprotein (HDL, the "good" cholesterol, levels below 40 mm Hg for men and under 50 for women), and hypertension (high blood pressure; the top number (systolic) over 130 and/or the bottom number (diastolic) over 85). Medical treatment for one or more of these symptoms is also considered a risk factor. Metabolic Syndrome increases belly fat and is a step on the path towards developing adult-onset diabetes. Low blood sugar (hypoglycemia) may be a symptom of yo-yo blood sugar regulation, a loss of control that could develop into pre-diabetes and diabetes.

There are a number of factors, but lifestyle choices are controllable, whereas a genetic predisposition is not. Most gene expression, the way that genetics actually plays out in real life, responds to environmental factors. For the gene itself, nutrients are part of its environment that trigger or suppress specific genetic responses.

Dr. Thomas A. Barringer of Carolinas Medical Center in Charlotte, North Carolina reports that his studies show that multiple vitamins benefit our diabetic population. He states that “any population at risk of having marginally inadequate nutrition, such as the elderly in general, might also benefit." Dr Barringer adds: “all obese people might benefit." He pointed out that supplements are safe and relatively inexpensive, so taking a daily multivitamin is "a reasonable option" for people who are overweight, who have any type of diabetes, who may not receive adequate nutrition or whose immune system is weak. (March 4th 2003 Annals of Internal Medicine)

Take a good multiple vitamin with a fat-containing meal in order to absorb the fat soluble nutrients. If you take green foods or other nutritionally dense dietary supplements, take them with a meal to help increase the total nutritional value of that meal.

Alpha Lipoic Acid (ALA) is a potent antioxidant that reduces insulin resistance. Insulin resistance occurs from swings in blood sugar from poor diets high in refined carbohydrates (white flour, white sugar, high fructose corn syrup) that eventually lead to the hormone Insulin becoming ineffective at moving carbohydrates out of the bloodstream into the cells. ALA has the additional benefit of protecting cells from oxidative damage, including liver cells.

Chromium is available in several forms. While much of the current evidence is on the form called chromium picolinate, other forms may be gentler and more active in controlling cholesterol, such as chromium nicotinate that’s bonded to niacin (Vitamin B-3). This mineral helps us to properly manage blood sugar and is a component of Glucose Tolerance Factor. Chromium may also help maintain lean body mass (muscle) during calorie-restricted dieting.

Citrin® helps to limit the liver's production of fat from carbohydrate.

GlucoFit® is a source of corosolic acid for proper insulin sensitivity to allow sugars to be moved from the bloodstream into cells.

Gymnema sylvestre improves uptake of glucose into cells, may block ability to taste “sweet” and may be useful for maintaining healthy cholesterol and triglyceride levels

HCA (-Hydroxycitric acid) is an extract from the fruit rind of Garcinia cambogia may reduce the body’s ability to convert carbohydrates into stored fats.

Stevia extract is a natural herbal product that is non-caloric, may support pancreatic function and promote insulin sensitivity.

Agave Nectar Dangers; facts and myths

The people claiming that fructose is worse than sucrose are ignorant and plain wrong. HFCS is typically 42% fructose, mostly glucose; some is 55% fructose.

Is blood sugar no longer an important issue? Diabetes statistics would seem to insist that it is still relevant. In that regard alone, fructose (with a Glycemic Index rating of 20, versus 100 for 100% sucrose white sugar) is far better than sucrose in terms of not provoking high blood sugar and the resulting insulin reactions.

And the repetition that agave nectar production is analogous to HFCS production is mind numbingly simplistic and misleading. In terms of agave production, taking inulin that's made of chains of fructose, adding non-GMO "plant enzymes" to free the fructose, then heating and filtering is not really that unnatural a process; in fact, in some ways quite similar to human digestion. HFCS production involves converting 100% sucrose corn syrup into fructose and then adding pure corn syrup to achieve the 42% or 55% fructose syrup (the rest of the 100% in each form is pure corn syrup as sucrose). There is no corn used to make agave nectar, and sugars are not converted into other forms or blended.

Studies showing that getting 25% of daily calories, around 500 calories, solely from fructose is related to obesity begs the question of why getting nearly all of our carbs from a single sugar, rather than from a mix of sugars along with fiber and starches, is anything other than a fast food worst case scenario. This is not relevant to those taking a little agave nectar in place of other sweeteners. Trying to frighten people who now won't even take a piece of whole fruit or a couple of calories worth of fructose in a chewable or liquid dietary supplement (this is actually happening!) is in my opinion both cynical and misleading. That is not honest nutrition. Common sense should be more common.

Risk factors in developing Type 2 (adult-onset) diabetes

Improper diet and lack of exercise are major risk factors in developing Type 2 (adult-onset) diabetes. Prolonged stress and too high proportions of carbohydrates (carbs) in the diet also contribute to blood sugar problems. The problem carbs are excess levels of sugars – especially simple sugars - and starches. Complex carbs from vegetables, whole fruits, whole grains and beans are used to fuel brain activity and other body functions without excessively elevating our blood sugar. Fiber content will also help the ability of food to make us feel full. Fiber also helps to slow the introduction of other carbohydrates into the bloodstream, reducing blood sugar “peaks” after a meal. Another bonus of whole foods is that fiber can absorb cholesterol-containing bile salts, a key way to dump excess cholesterol from the body.

Eating a diet composed largely of processed/refined foods means that the carb level is probably too high while nutrients that help us to deal with blood sugar (B vitamins, fiber, chromium, etc.) are stripped from our food supply. This leaves us defenseless against weight gain, abdominal obesity, high blood pressure, high blood sugar and elevated stress hormones.

Many of us are literally drowning in excess empty calories that affect our metabolism. But skipping meals doesn’t help, nor does eating meals that lack adequate protein. Both habits discourage calorie burning.

Spikes in blood sugar are the main enemy of dieters and those with blood sugar control issues. Elevated blood sugar triggers the release of the hormone insulin, which can cause low blood sugar (hypoglycemia), which makes us fatigued after a meal. If this happens too often it can create insulin resistance, eventually causing a loss of blood sugar control that can result in Metabolic Syndrome. This is a pre-diabetes condition defined as a combination of two or more of these symptoms: insulin resistance, glucose intolerance, abnormally high insulin levels, high triglycerides, low high-density lipoprotein (the "good" cholesterol), and hypertension (high blood pressure). Metabolic Syndrome increases belly fat and is a step towards developing adult-onset diabetes.

Your options are greatest when you first discover that your blood sugar has gone out of balance. If you wait until after you're on insulin or other medications, any natural means for improvement in blood sugar control could cause a dose of medicine to become an overdose. It is very important that your physician knows if you are going to try to control your blood sugar naturally, and that you test your blood sugar levels every time before taking medication in order to avoid dangerous interactions.

Going on a low-carbohydrate (low-carb) diet is the next step. The worst carbs are the simple sugars, found in processed foods, sweets, table sugar and soda pop. Processed grains and starchy vegetables are sometimes a problem, especially in excess. Flours (especially white flour) are more of a problem than whole cooked or sprouted grains. Even carrot juice is high in sugar!

If you tend to have weight gain and blood sugar problems in middle age, the good news is that you are genetically programmed to survive a famine. The bad news is that it's a prolonged feast which can kill you! Portion control and exercise are important for your health. Controlling stress will also help your sugar balance.

The balance of nutritional components within a meal regulates fat storage and fat burning. Try to balance each meal using the ZONE diet, where at least 30% of the calories in every meal are from protein, about 30% from healthy fats and about 40% from complex carbohydrates such as whole grains, fruits or vegetables. This balance will minimize blood sugar increases. Blood sugar spikes can lead to more fat storage and less fat burning, especially without enough protein to start the calorie burning cycle after a meal.

To improve the insulin response that moves sugar out of the blood and into cells for fuel instead of turning into fat, supplements of Omega-3 fish oil (or flax oil for vegetarians), Alpha Lipoic Acid and Chromium may be helpful. Phase 2®, from a white kidney bean extract, will block some digestion of starches to sugar and therefore effectively lower your carb and calorie intake. Antioxidants of all kinds are very protective for people having blood sugar issues.

Take a good multiple vitamin with a fat-containing meal to enhance absorption of the fat-soluble nutrients. If you take green foods or other nutritionally dense dietary supplements, also take them with a meal to help increase the total nutritional value of that meal.