Added Fructose

DiNicolantonio, James J.; O’Keefe, James H.; Lucan, Sean C.

doi:10.1016/j.mayocp.2014.12.019

Cited by 134 publications

(67 citation statements)

References 118 publications

(123 reference statements)

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“…Among the sugars, the monosaccharide, fructose, and the disaccharide, sucrose (fructose + glucose), seem to be of greater concern than the glucose alone (as a monosaccharide or as a polysaccharide in starch). The fructose-containing sugars seem to cause greater derangement when it comes to elevated insulin levels, 55, 64, 65 reduced insulin sensitivity, 66–6869, 70 increased fasting glucose concentrations, 71,72 and increased glucose and insulin responses to a sucrose load. 55, 64 Providing liquid fructose supplementation to a western-type diet in mice increases lipid burden and atherosclerosis despite identical calorie consumption.…”

Section: Sugar and Chd Risk Factorsmentioning

confidence: 99%

The Evidence for Saturated Fat and for Sugar Related to Coronary Heart Disease

DiNicolantonio

Lucan

O’Keefe

2016

Progress in Cardiovascular Diseases

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284

143

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Dietary guidelines continue to recommend restricting intake of saturated fats. This recommendation follows largely from the observation that saturated fats can raise levels of total serum cholesterol (TC), thereby putatively increasing the risk of atherosclerotic coronary heart disease (CHD). However, TC is only modestly associated with CHD, and more important than the total level of cholesterol in the blood may be the number and size of low-density lipoprotein (LDL) particles that contain it. As for saturated fats, these fats are a diverse class of compounds; different fats may have different effects on LDL and on broader CHD risk based on the specific saturated fatty acids (SFAs) they contain. Importantly, though, people eat foods, not isolated fatty acids. Some food sources of SFAs may pose no risk for CHD or possibly even be protective. Thus, advice to reduce saturated fat in the diet without regard to such nuance could actually increase people’s risk of CHD. When saturated fats are replaced with refined carbohydrates, and specifically with added sugars (like sucrose or high fructose corn syrup), the end result is not favorable for heart health. Such replacement leads to changes in LDL, high-density lipoprotein (HDL), and triglycerides that may increase the risk of CHD. Additionally, diets high in sugar may induce many other abnormalities associated with elevated CHD risk, including elevated levels of glucose, insulin, and uric acid, impaired glucose tolerance, insulin and leptin resistance, non-alcoholic fatty liver disease, and altered platelet function. A diet high in added sugars has been found to cause a 3-fold increased risk of death due to cardiovascular disease. But sugars, like saturated fats, are a diverse class of compounds. The monosaccharide, fructose, and fructose-containing sweeteners (e.g., sucrose) result in greater degrees of metabolic abnormalities than seen with glucose (either isolated as a monomer or in chains as starch) and may present greater risk for CHD. This paper reviews the evidence linking saturated fats and sugars to CHD, and concludes that the latter is more of a problem than the former. Dietary guidelines should shift focus away from reducing saturated fat, and from replacing saturated fat with carbohydrates, specifically when these carbohydrates are refined. To reduce the burden of CHD, guidelines should focus particularly on reducing intake of concentrated sugars, specifically the fructose-containing sugars like sucrose and high-fructose corn syrup in the form of ultra-processed foods and beverages.

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Section: Sugar and Chd Risk Factorsmentioning

confidence: 99%

The Evidence for Saturated Fat and for Sugar Related to Coronary Heart Disease

DiNicolantonio

Lucan

O’Keefe

2016

Progress in Cardiovascular Diseases

Self Cite

284

143

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“…The fructose moiety in particular has been implicated as a potent driver of type 2 diabetes due to its unique set of biochemical, metabolic and endocrine responses 1, 2…”

Section: Introductionmentioning

confidence: 99%

The effect of small doses of fructose and allulose on postprandial glucose metabolism in type 2 diabetes: A double‐blind, randomized, controlled, acute feeding, equivalence trial

Noronha

Braunstein

Glenn

et al. 2018

Diabetes Obesity Metabolism

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AimTo assess and compare the effect of small doses of fructose and allulose on postprandial blood glucose regulation in type 2 diabetes.MethodsA double‐blind, multiple‐crossover, randomized, controlled, acute feeding, equivalence trial in 24 participants with type 2 diabetes was conducted. Each participant was randomly assigned six treatments separated by >1‐week washouts. Treatments consisted of fructose or allulose at 0 g (control), 5 g or 10 g added to a 75‐g glucose solution. A standard 75‐g oral glucose tolerance test protocol was followed with blood samples at −30, 0, 30, 60, 90 and 120 minutes. The primary outcome measure was plasma glucose incremental area under the curve (iAUC).ResultsAllulose significantly reduced plasma glucose iAUC by 8% at 10 g compared with 0 g (717.4 ± 38.3 vs. 777.5 ± 39.9 mmol × min/L, P = 0.015) with a linear dose response gradient between the reduction in plasma glucose iAUC and dose (P = 0.016). Allulose also significantly reduced several related secondary and exploratory outcome measures at 5 g (plasma glucose absolute mean and total AUC) and 10 g (plasma glucose absolute mean, absolute and incremental maximum concentration [Cmax], and total AUC) (P < .0125). There was no effect of fructose at any dose. Although allulose showed statistically significant reductions in plasma glucose iAUC compared with fructose at 5 g, 10 g and pooled doses, these reductions were within the pre‐specified equivalence margins of ±20%.ConclusionAllulose, but not fructose, led to modest reductions in the postprandial blood glucose response to oral glucose in individuals with type 2 diabetes. There is a need for long‐term randomized trials to confirm the sustainability of these improvements.

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“…Added sugars are among the most controversial and hotly debated topics in all of nutrition [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]. Consumption of added sugars has been associated with increased risk of obesity [23,24,25] as well as increased risk factors for cardiovascular disease (CVD) [26], including dyslipidemia [27,28], elevated blood pressure [20,29,30], diabetes [21,31,32], non-alcoholic fatty liver disease [33,34], and even cognitive decline [35] and cancer [36,37].…”

Section: Introductionmentioning

confidence: 99%

Relationship between Added Sugars Consumption and Chronic Disease Risk Factors: Current Understanding

2016

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Added sugars are a controversial and hotly debated topic. Consumption of added sugars has been implicated in increased risk of a variety of chronic diseases including obesity, cardiovascular disease, diabetes and non-alcoholic fatty liver disease (NAFLD) as well as cognitive decline and even some cancers. Support for these putative associations has been challenged, however, on a variety of fronts. The purpose of the current review is to summarize high impact evidence including systematic reviews, meta-analyses, and randomized controlled trials (RCTs), in an attempt to provide an overview of current evidence related to added sugars and health considerations. This paper is an extension of a symposium held at the Experimental Biology 2015 conference entitled “Sweeteners and Health: Current Understandings, Controversies, Recent Research Findings and Directions for Future Research”. We conclude based on high quality evidence from randomized controlled trials (RCT), systematic reviews and meta-analyses of cohort studies that singling out added sugars as unique culprits for metabolically based diseases such as obesity, diabetes and cardiovascular disease appears inconsistent with modern, high quality evidence and is very unlikely to yield health benefits. While it is prudent to consume added sugars in moderation, the reduction of these components of the diet without other reductions of caloric sources seems unlikely to achieve any meaningful benefit.

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Added Fructose

Cited by 134 publications

References 118 publications

The Evidence for Saturated Fat and for Sugar Related to Coronary Heart Disease

The Evidence for Saturated Fat and for Sugar Related to Coronary Heart Disease

The effect of small doses of fructose and allulose on postprandial glucose metabolism in type 2 diabetes: A double‐blind, randomized, controlled, acute feeding, equivalence trial

Relationship between Added Sugars Consumption and Chronic Disease Risk Factors: Current Understanding

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