Fructose from added sugars linked to high blood pressure

The consumption of fructose has increased significantly since the 1970s, when high fructose corn syrup (HFCS) was introduced into the United States food supply. The use of HFCS now exceeds that of sucrose (table sugar) in sweetened foods in the U.S.

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Absorption of fructose and glucose:

Sucrose is composed of one fructose molecule and one glucose molecule.   There are differences between fructose and glucose metabolism. Fructose is absorbed in the small intestine, transported to the liver through the portal vein, and then metabolized via the same process that breaks down glucose to make energy – however, fructose is only broken down in the liver, whereas glucose can be used by any cell in the body.  Ingesting glucose raises blood glucose levels, and ingesting fructose does not raise glucose as quickly or as much, but raises triglyceride levels much more.1

Fructose was once regarded as a “safe” sweetener for diabetics, because of its small effect on blood glucose levels.   However, fructose is a reducing sugar, which means that it contributes to the formation of advanced glycation end products (AGEs), which contribute to diabetes and its complications, Alzheimer’s disease, and cardiovascular disease.2 Since fructose consumption also elevates triglycerides and diabetics are already at risk for cardiovascular disease, increasing triglycerides adds to this risk. Added fructose consumption has also been associated with non-alcoholic fatty liver disease, and elevated cholesterol and retinopathy in diabetics.1

 

Fructose in natural foods vs. fructose in HFCS:

Fructose makes up half of the sucrose molecule, and HFCS contains similar proportions of fructose and glucose as sucrose does (HFCS is 55% fructose).   Fructose may be found alone (free) or complexed with glucose as sucrose. In most fruits, much of the fructose is bound to glucose. Fructose entry into blood is slowed when it is in sucrose form, because sucrose must be first split by enzymes in intestinal cells. Fructose molecules in HFCS, however, are free, and therefore absorbed more rapidly. It is thought that the enzymes in the liver responsible for breaking down fructose are overwhelmed by the large loads of fructose delivered by HFCS-sweetened beverages, allowing for large quantities of fructose to be released into the blood.1

 

Fructose and elevated blood pressure:

The current study examined data from 4528 adults, whose median fructose intake from added sugars was 74 grams per day. As a reference point, 74 grams of fructose is roughly the amount present in 2 ½ twenty-ounce soft drinks or 13 bananas.1,3 The researchers determined that fructose intake at or above the median 74 grams per day increased the risk of elevated blood pressure. 

Subjects who consumed 74 grams or more of fructose each day in added sugar increased their risk of blood pressure elevated above 135/85 by 26%, above 140/90 by 30%, and above 160/100 by 77%.4

Essentially, the average fructose intake in the U.S. is a quantity that increases chronic disease risk – and not just risk of diabetes. Elevated blood pressure contributes to risk of heart attack, stroke, heart failure, and kidney disease.

There are no “safe” sweeteners - whole fruits and root vegetables are the only sweet-tasting foods that are health-promoting.   Added sugar in any form is calorie-dense and deficient in nutrients, and therefore detrimental to health.

 

References:

1. Teff KL, Grudziak J, Townsend RR, et al. Endocrine and metabolic effects of consuming fructose- and glucose-sweetened beverages with meals in obese men and women: influence of insulin resistance on plasma triglyceride responses. J Clin Endocrinol Metab. 2009 May;94(5):1562-9.

2. Glenn JV, Stitt AW. The role of advanced glycation end products in retinal ageing and disease. Biochim Biophys Acta. 2009 Oct;1790(10):1109-16.

Loy CT, Twigg SM. Growth factors, AGEing, and the diabetes link in Alzheimer's disease. J Alzheimers Dis. 2009 Apr;16(4):823-31.

Peppa M, Uribarri J, Vlassara H. Aging and glycoxidant stress. Hormones (Athens). 2008 Apr-Jun;7(2):123-32.

Peppa M, Stavroulakis P, Raptis SA. Advanced glycoxidation products and impaired diabetic wound healing. Wound Repair Regen. 2009 Jul-Aug;17(4):461-72.

Yamagishi S. Advanced glycation end products and receptor-oxidative stress system in diabetic vascular complications. Ther Apher Dial. 2009 Dec;13(6):534-9.

Barlovic DP, Thomas MC, Jandeleit-Dahm K. Cardiovascular disease: what's all the AGE/RAGE about? Cardiovasc Hematol Disord Drug Targets. 2010 Mar;10(1):7-15.

3. Nutrition Data. http://nutritiondata.self.com/

4. Jalal DI, Smits G, Johnson RJ, Chonchol M. Increased Fructose Associates with Elevated Blood Pressure. J Am Soc Nephrol. 2010 Jul 1. [Epub ahead of print]

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Comments (7) Read through and enter the discussion with the form at the end
StephenMarkTurner - July 28, 2010 10:46 AM

I had wondered abut the fuss regarding HFCS (since the percentage of fructose is not that much higher than sugar).

Thanks for clarifying.

Regards, Steve

Patricia - July 28, 2010 8:52 PM

This is significant information to me thank you

Sami uz Zaman - July 29, 2010 1:06 AM

These days It is being propagted that extract of 'STEVIA ' is the best sweetner ( 300 times more sweeter than sugar ) It has no side effect rather better for diabetic persons. Many food products and beverage manufacturers are said to be using stevia extract.

Please confirm the claims of having no side efdfects and chemical structure.
Thanks

Deana Ferreri, Ph.D. - July 29, 2010 9:31 AM

Sami,
Stevia is made from the leaves of a shrub that grows in South America. The sweetener is a concentrated extract from the leaf (stevioside or rebaudoside), which has raised some concerns about toxicity, as reported by the Center for Science in the Public Interest: http://www.cspinet.org/stevia/

Also, in general, all low- or no-calorie sweeteners disrupts the body's natural connection between sweetness and calorie delivery, and often perpetuates cravings for sweets.

Paul - July 29, 2010 3:41 PM

In addition to the problems posed by fructose identified in Deana's article, Dr. Robert Lustig of UCSF has identified additional problems with fructose which he outlines in his video, Sugar- The Bitter Truth http://www.youtube.com/watch?v=dBnniua6-oM Dr. Lustig believes that fructose is diproportionately responsible for the obesity epidemic in America in the last 30 years in part because of its ability to: 1) facilitate de novo lipogenesis ,creating fat from carbohydrate in the liver like a beer belly, and 2) interfere with the body's homeostatic system of appetite regulation by reducing leptin sensitivity (a hormone that tells when we are full) and attenuating ghrelin suppresion after you eat a meal. In plain english, fructose can help fool your body's signals to tell you to stop eating.

Dr. David Kessler, MD, former FDA Administrator under both Bush and Clinton states in his book "The End of Overeating" that sugar (sucrose) relative to fat and other flavorings was calorie for calorie the most addicting ingredient in processed food. p.31

Nothing I've read about refined sugar to date being added to our food gives me comfort. I've replaced fruit juice for my son with water and a second serving of whole fruit.

While I think demonizing any particular ingredient generally isn't a good idea, if the shoe fits, it should be worn. Recently got rid of agave nector for the same reason, mostly fructose.

Shawn - November 29, 2010 3:52 PM

I'm still confused; it's okay to consume unlimited amounts of fruit, so it's okay to consume unlimited amounts of fructose from fruit?

Deana Ferreri, Ph.D. - November 29, 2010 4:51 PM

Shawn,
Dr. Fuhrman recommends about 3-5 fresh fruit servings per day, not unlimited fruit. Also, note that the fructose content of fruit is quite low compared to sweetened foods.

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