Effect Of Fructose On Glycemic Control In Diabetes
OBJECTIVE The effect of fructose on cardiometabolic risk in humans is controversial. We conducted a systematic review and meta-analysis of controlled feeding trials to clarify the effect of fructose on glycemic control in individuals with diabetes. RESEARCH DESIGN AND METHODS We searched MEDLINE, EMBASE, and the Cochrane Library (through 22 March 2012) for relevant trials lasting ≥7 days. Data were aggregated by the generic inverse variance method (random-effects models) and expressed as mean difference (MD) for fasting glucose and insulin and standardized MD (SMD) with 95% CI for glycated hemoglobin (HbA1c) and glycated albumin. Heterogeneity was assessed by the Cochran Q statistic and quantified by the I2 statistic. Trial quality was assessed by the Heyland methodological quality score (MQS). RESULTS Eighteen trials (n = 209) met the eligibility criteria. Isocaloric exchange of fructose for carbohydrate reduced glycated blood proteins (SMD −0.25 [95% CI −0.46 to −0.04]; P = 0.02) with significant intertrial heterogeneity (I2 = 63%; P = 0.001). This reduction is equivalent to a ∼0.53% reduction in HbA1c. Fructose consumption did not significantly affect fasting glucose or insulin. A priori subgroup analyses showed no evidence of effect modification on any end point. CONCLUSIONS Isocaloric exchange of fructose for other carbohydrate improves long-term glycemic control, as assessed by glycated blood proteins, without affecting insulin in people with diabetes. Generalizability may be limited because most of the trials were <12 weeks and had relatively low MQS (<8). To confirm these findings, larger and longer fructose feeding trials assessing both possible glycemic benefit and adverse metabolic effects are required. The number of people with type 2 diabetes is l Continue reading >>
The Role Of Fructose, Sucrose, And High-fructose Corn Syrup In Diabetes
The Role of Fructose, Sucrose, and High-fructose Corn Syrup in Diabetes European Endocrinology 2014;10(1):5160 DOI: Concerns are growing regarding the role of dietary sugars in the development of obesity and cardiometabolic diseases, including diabetes. Highfructose corn syrup (HFCS) and sucrose are the most important dietary sweeteners. Both HFCS and sucrose have overlapping metabolic actions with adverse effects attributed to their fructose moiety. Ecologic studies have linked the rise in fructose availability with the increases in obesity and diabetes worldwide. This link has been largely underpinned by animal models and select human trials of fructose overfeeding at high levels of exposure. Although prospective cohort studies have shown significant associations comparing the highest with the lowest levels of intake sugarsweetened beverages, these associations are small, do not hold at moderate levels of intake, and are subject to collinearity effects from related dietary and lifestyle factors. Most systematic reviews and meta-analyses from controlled feeding trials have shown that fructose-containing sugars in isocaloric exchange for other carbohydrates do not show evidence of harm and, in the case of fructose, may even have advantages for glycemic control, especially at small doses. Nevertheless, trials in which fructose-containing sugars supplement diets with excess energy have shown adverse effects, effects that appear more attributable to the excess energy than the sugar. There is no unequivocal evidence that fructose intake at moderate doses is directly related with adverse metabolic effects, although there is potentially cause for concern where fructose is provided at high doses or contributes excess energy to diets. Further investigation is warranted due to Continue reading >>
Switching From Sucrose To Fructose Lowers Insulin And Blood Glucose In The Obese And Diabetics
Switching from sucrose to fructose lowers insulin and blood glucose in the obese and diabetics Blood glucose and insulin levels were lower after consuming food or drink that contained fructose, compared to those with sucrose or glucose. By Gary Scattergood Swapping table sugar for fruit-derived sugar helpsreduce blood glucose, especially in people who are overweight or have diabetes, a new review has reported. Researchers from theUniversity of Canberra'sHealth Research Institute examined the short-term and long-term effects of swapping sucrose or glucose, for fructose, the sugar found in many fruits, vegetables and honey. The research, which has been published in the American Journal of Clinical Nutrition,found blood glucose and insulin levels were lower after consuming food or drink that contained fructose, compared to those with sucrose or glucose. The authors wrote: "We searched the Cochrane Library, MEDLINE, EMBASE, the WHO International Clinical Trials Registry Platform Search Portal, and clinicaltrials.gov. We included randomised controlled trials measuring peak postprandial glycemia after isoenergetic replacement of glucose, sucrose, or both with fructose in healthy adults or children with or without diabetes. The main outcomes analyzed were peak postprandial blood glucose, insulin, and triglyceride concentrations." University of Canberra adjunct professional associate and senior author of the report Dr Kerry Mills said that in the short-term study, the reduction in blood glucose was far greater in people who were overweight or had diabetes than in those with normal blood glucose levels. The sharp rise in blood glucose after eating glucose and sucrose is a risk factor for diabetes. Fructose, on the other hand, has to be converted by the liver before it can affec Continue reading >>
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Questions And Answers About Fructose
What is fructose? Fructose is a monosaccharide, or single sugar, that has the same chemical formula as glucose but a different molecular structure. Sometimes called fruit sugar, fructose is found in fruit, some vegetables, honey, and other plants. Fructose and other sugars are carbohydrates, an important source of energy for the body. What other types of sugars are there? The food supply contains a variety of sugars called monosaccharides (single sugar units like fructose and glucose) and disaccharides (two monosaccharides linked together). Glucose is the main source of energy for the body because most complex sugars and carbohydrates break down into glucose during digestion. Starches contain many single sugar units linked together. The various sugars perform different functions in the body, but they all can provide energy. Sucrose is a disaccharide that contains equal parts of glucose and fructose. Known as table or white sugar, sucrose is found naturally in sugar cane and sugar beets. Other sugars in foods and beverages include: Lactose Disaccharide containing glucose and galactose Naturally occurring in milk Maltose Disaccharide containing two glucoses Crystallized from starch Dextrose Another name for glucose Crystallized from sugar cane, sugar beets and starches Corn Syrup Primarily single glucose units Produced from corn starch High Fructose Corn Syrup Primarily a mixture of glucose and fructose single units Produced from corn starch Is fructose safe? High fructose corn syrup and all other sugars are “generally recognized as safe” by the Food and Drug Administration (FDA). The Surgeon General's Report on Nutrition and Health, the National Academy of Sciences report Diet and Health, and Healthy People 2000: National Health Promotion and Disease Prevention Objec Continue reading >>
How Safe Is Fructose For Persons With Or Without Diabetes?
How safe is fructose for persons with or without diabetes? From the Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL Search for other works by this author on: From the Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL Search for other works by this author on: From the Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL Search for other works by this author on: From the Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL Address reprint requests and correspondence to RJ Johnson, Division of Nephrology, Hypertension and Transplantation, University of Florida, PO Box 100224, Gainesville, FL 32610. E-mail: [email protected] . Search for other works by this author on: The American Journal of Clinical Nutrition, Volume 88, Issue 5, 1 November 2008, Pages 11891190, Laura Gabriela Snchez-Lozada, MyPhuong Le, Mark Segal, Richard J Johnson; How safe is fructose for persons with or without diabetes?, The American Journal of Clinical Nutrition, Volume 88, Issue 5, 1 November 2008, Pages 11891190, In this issue of the journal, Livesey and Taylor ( 1 ) present a meta-analysis of clinical trials evaluating the effects of fructose intake. They concluded that fructose is safe at doses of <90 g/d and that it may have the added benefit of lowering concentrations of glycated hemoglobin (HbA1c). This meta-analysis is difficult to interpret, because it involves randomized and nonrandomized studies of differing designs, mixed populations (diabetic and nondiabetic, lean and obese), different control diets (including some sucrose-based diets that contained fructose), different study durations, and limited Continue reading >>
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Expert Discusses The Role Of Salt And Fructose In Diabetes
Expert discusses the role of salt and fructose in diabetes LOS ANGELES Sugar consumption has been implicated as a risk factor for the development of diabetes since at least the 1920s, but high salt intake may also increase the risk for obesity and prediabetes by stimulating fructose production in the liver. We think about high-salt diets as being associated with hypertension, but if you put people on a high-salt diet, you can induce insulin resistance within 5 or 10 days, Richard J. Johnson, MD , said at the World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease. There is a fair amount of published data suggesting that a high salt intake, defined as greater than 150 mmol per day, is associated with hypertension, insulin resistance, obesity, and metabolic syndrome. In fact, its been reported that obese people are slightly hyperosmolar and tend to have elevated vasopressin levels. Interestingly, sugar stimulates vasopressin production. In an unpublished mouse study, Dr. Johnson and his associates added 1% salt to drinking water and found that it stimulates fructose production in the liver. It takes months, but when you put them on a high-salt diet, they become fat and develop features of metabolic syndrome, he said. The high-salt diet induced increased energy intake, and we could show that this was due to leptin resistance by doing leptin-injection experiments. Furthermore, the mice on high-salt diets became insulin resistant. Their fasting glucose went up, their fasting insulin went up, and they developed marked fatty liver, obesity, abdominal fat, and hypertension, Dr. Johnson added. The discovery supports the notion that osmolality is the mechanism by which salt drives blood pressure, not volume expansion. And I think thats going to turn out to be imp Continue reading >>
Fructose And Diabetes
Sarah Davis has worked in nutrition in the clinical setting and currently works as a licensed Realtor in California. Davis began writing about nutrition in 2006 and had two chapters published in "The Grocery Store Diet" book in 2009. She enjoys writing about nutrition and real estate and managing her website, RealtorSD.com. She earned her bachelor's degree in nutrition from San Diego State University. The fructose found in fruit may actually increase the risk of diabetes.Photo Credit: Stockbyte/Stockbyte/Getty Images Diabetes is a chronic disease in which a persons body cannot produce insulin or cannot use insulin to move sugar from the bloodstream to the cells. The dietary intake of sugar is generally limited for diabetics because eating sugars can raise their blood sugar levels to dangerously high levels. Diabetics have several types of sugar to look out for in the foods they eat, and some are worse than others in terms of their effect on blood sugar. Fructose is a type of sugar which, according to the Weston A. Price Foundation, has been recommended for diabetics as opposed to other types of sugar. Fructose is the type of sugar naturally found in fruits and honey, but it is also crystallized and used in the making of many candies and commercialized food products. The Price foundation says fructose does not raise blood sugar levels as quickly as other types of sugar, such as sucrose. Even though fructose has been promoted as one of the better sweeteners for diabetics to use, an article from 2009 says it may not be a good idea for non-diabetics to use too much fructose. According to Reuters Health, consumption of fructose may lead to a greater risk of diabetes in individuals who are not already diabetic. They says the intake of a particular type of sugar made from fru Continue reading >>
Fructose And Diabetes
As part of the overall diabetes discussion, there lurks the misconception that somehow fructose does not contribute to diabetes. This is a major misunderstanding. Fructose is directly associated with diabetes, especially high-fructose corn syrup. When one is cellularly addicted to glucose, sucrose, and/or fructose, they become stuck in sugar metabolism for making energy. For years, limited and conventional “wisdom” has held that fructose does not affect your blood sugar. This is accurate on a superficial level but unscientific in its assumption that because fructose does not raise blood sugar, it does not affect insulin resistance and cause many metabolic disease problems from the metabolic abnormalities associated with metabolizing an excess amount of fructose. It is therefore falsely deemed a safer sugar than glucose. None of this has been proven to be true. A primary difference is that fructose is metabolized differently than glucose. Fructose is metabolized much more rapidly than any other sugar into fat via the liver. It is also primarily metabolized in the liver. Because of this it has also been associated with a high level of nonalcoholic fatty liver disease (NAFLD) and a rapid accumulation of a particular kind of fat (triglycerides) that is stored in both the liver and general fat tissue. This is related not only to NAFLD but also to heart disease and hypertension. Glucose, when combined with fructose (as in sucrose and high-fructose corn syrup), accelerates fructose absorption. These metabolic differences are further enhanced in light of recent research reported in the March 2011 Diabetes, Obesity and Metabolism, which found that cortical areas around hypothalamus in the brain responded differently to fructose than to glucose. They found that in brain scans Continue reading >>
The Trouble With Fructose For Diabetes
Now that our doctors and scientists have begun to realize how big a danger that fructose is for us we can hope that the twin epidemics of diabetes and obesity can finally be halted. But for each of us individually the more important message is that we can still save our health if we avoid added fructose. The phrase “added fructose” means the fructose that we add to what we eat. The sugar in fruit is of course fructose, but essentially all experts agree that it isn’t a problem because we get that fructose along with fiber, antioxidants, and the other good stuff in whole foods. But added fructose includes what we simply call sugar, table sugar, or sucrose. These three terms all mean the same thing — sugar that is half fructose and half glucose. Added fructose also includes high fructose corn syrup (HFCS), the sweetener that we usually get in soft drinks. In HFCS, fructose is nearly 50 percent of its weight, while the fructose in a fresh peach, for example, is only about 1 percent of its weight. The new review also suggests that 100 percent fruit juice, although it technically is not a sugar-sweetened drink, has such high concentrations of fructose that it also provides fuel for the diabetes and obesity epidemics. Reducing how much fructose you eat without compromising your fruit intake may be the best way to start managing your diabetes if your blood sugar levels are higher than you would like them to be. These are the main messages of a special article written by a cardiovascular research scientist at Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, and by two M.D. co-authors in a mainstream professional diabetes journal. The results of the study take direct aim at the lax standards of the American Diabetes Association and the 2010 Dietary Gui Continue reading >>
The Dark Nasty Truth About Fructose And Type 2 Diabetes
If you have type 2 diabetes, there's one food you want to avoid at all costs – fructose. Consumption of fructose has been linked to increased weight gain, higher triglyceride levels (cholesterol), high blood pressure, insulin resistance, higher small dense LDL cholesterol and fatty liver, not to mention, it is a form of sugar so may send your blood sugar soaring also. Is that enough to raise your curiosity? Read on to discover the dark and nasty truth about this common food ingredient. What is Fructose? Fructose is a simple sugar that is naturally found in fruits. It is easy to remember this, because the word “fructose” actually sounds similar to the word “fruit.” Different fruits contain different levels of fructose and some vegetables also contain small amounts of it. If you’ve ever turned over a can of soda and looked at the label, you've probably noticed a different kind of fructose listed on it, called high fructose corn syrup (HFCS). This is a processed form of fructose that is used as a sweetener to replace sugar. On labels it can be labelled as HFCS or it may simply be labelled as fructose—either way, it's the same thing. The bad news is, you will find fructose in most processed foods from pizza sauce to crackers to breakfast cereal, just to name a few. And soon you'll find out that fructose is the worst of the worst when it comes to healthy eating… we'll get to that in just a moment. Fructose Nutrition Facts As mentioned earlier, the amount of fructose in fruits and vegetables varies greatly. Here are several examples of food that contain various amounts of natural fructose: 1 medium-sized apple w/skin = 13g of fructose 10 cherries = 4g of fructose 1 medium sized banana = 7g of fructose 1 sweet potato = 0.7g of fructose 5 medium strawberries = 5 Continue reading >>
Fructose Not So Bad For Diabetes When Consumed In Moderation: Study
New research suggests fructose may not be so bad after all for diabetics — rather, it’s having too much of it that may wreak havoc. St. Michael’s Hospital researchers in Canada found that people with Type 1 and Type 2 diabetes actually experienced blood sugar control benefits when they consumed fructose, as well as a decrease in blood pressure, cholesterol, body weight and uric acid. These health benefits were similar to those that would be seen on medications, researchers noted. The Diabetes Care review included an analysis of 18 different studies that, in total, surveyed 209 people with diabetes with age groups ranging from teens to the elderly. While amounts and method of fructose intake ranged per study (whether it was just sprinkled onto their food, or incorporated in another way), all of the trials involved consuming fructose for anywhere from seven days to 12 weeks. “We’re seeing that there may be benefit if fructose wasn’t being consumed in such large amounts,” study researcher Adrian Cozma, a research assistant at St. Michael’s Hospital, said in a statement. “All negative attention on fructose-related harm draws further away from the issue of eating too many calories.” Fructose naturally occurs in honey, fruit and vegetables. Together with glucose, it makes table sugar (sucrose), researchers said. It’s also in high-fructose corn syrup. However, the results of this study refer only to pure fructose. It does not imply that our bodies react the same to fructose-containing table sugar and high-fructose corn syrup. In fact, a 2010 Princeton University study published in Pharmacology, Biochemistry and Behavior study showed that high-fructose corn syrup is associated with increased weight gain in mice compared with table sugar. And the Mayo Clini Continue reading >>
Fructose For All? - Diabetes Self-management
For people with diabetes, fructose is perhaps the most controversial of the three main forms of dietary sugar (the others are glucose and galactose, which joins with glucose to form lactose in milk products). While the risks of glucose are clear it raises blood glucose levels and lactose seems to be fine unless a person is lactose-intolerant, there has often been conflicting evidence regarding the health effects of fructose. On the one hand, it tends to have only a modest effect on blood glucose levels because it must be broken down gradually by an enzyme in the liver, which converts it to glucose that the body can use for energy. On the other hand, fructose has been implicated in raising triglyceride levels in the blood as well as blood pressure . Is there any way to weigh its risks and benefits? That is what scientists recently tried to do in an analysis of 18 clinical trials that studied fructose consumption, published in the journal Diabetes Care. These trials were selected on the basis that their participants had Type 1 or Type 2 diabetes, they lasted at least seven days, and they measured the effects of dietary fructose on fasting blood glucose and insulin levels as well as HbA1c . These were all randomized controlled trials in which a standard meal plan was compared with one containing more fructose but the same number of calories. According to an ANI (India) article on the analysis , the researchers found that fructose had an overall beneficial effect on blood glucose control, as measured by HbA1c. This effect was accomplished without any detected adverse effects on body weight, blood pressure, or blood cholesterol, and no change in insulin levels. Meanwhile, the average reduction in HbA1c from fructose substitution was 0.53%, representing a major impact on blo Continue reading >>
Dietary Fructose And Metabolic Syndrome And Diabetes1–3
Go to: Introduction When ingested by humans, fructose is absorbed by an active transport system but at a slower rate than is glucose (1). Coingestion of glucose increases intestinal absorptive capacity for fructose. In the absence of glucose, human intestinal capacity to absorb fructose appears to be quite variable with some people unable to completely absorb 30- to 40-g quantities (1). Those individuals unable to completely absorb ingested fructose are at risk for diarrhea and other gastrointestinal side effects. The first several steps in fructose and glucose metabolism differ significantly. Fructose stimulates only modest insulin secretion and does not require the presence of insulin to enter cells (2). Avidly taken up by hepatic cells, fructose is rapidly converted to fructose-1-phosphate and bypasses the early, rate-limiting steps of glucose metabolism. Fructose-1-phosphate is mainly converted to lactate, glucose, and glycogen (3). Gluconeogenesis from fructose is increased by starvation and poorly controlled diabetes. Fructose may also form acetyl-CoA, which is used in fatty acid synthesis. Enhanced activity of lipogenic enzymes with chronic fructose feeding may promote hepatic triglyceride production and output of VLDL particles. If energy intake is excessive, the potential for fructose to stimulate lipogenesis is presumably increased substantially. Fructose is the sweetest-tasting naturally occurring carbohydrate. Advances in technology in the 1960s made possible the production of inexpensive high-fructose syrups from corn starch (4). The taste and sweetness of 55% high-fructose corn syrup are equivalent to those of sucrose. Because of sweetness and low cost, high-fructose syrups found commercial application. In the mid-1980s, 55% high-fructose syrup was adopted Continue reading >>
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The Fructose Wars - Diabetes Self-management
Reading the blogs of other people with Type 2 diabetes has led me in some interesting directions. One of the side trips I took came when I read that fructose has less impact on insulin than other forms of sugar. Did that mean it was a good choice as a sweetener for people who have diabetes? The desire to answer that question led me straight into the war over HFCS, or high-fructose corn syrup, which is made up of glucose and fructose. On both sides of the debate the passions are high. For those who think that HFCS is the culprit behind an epidemic of Type 2 diabetes and obesity, this is an all-out, no-holds-barred battle. On the other side are the makers of HFCS who say there is nothing wrong with their product, that sugar is sugar. In the middle are the scientists who use blind and double-blind studies that often lead to more questions than answers. It is extremely difficult to prove one or the other of the opposing arguments absolutely right. You can imagine the problems researchers come up against when trying to measure diets to prove anything in the laboratory. We are not good lab rats. Eating habits and body types and human nature add so many variables that neither side is going to win this argument by the scientific method any time soon. Two things come up consistently in studies I have read. One is that fructose does not cause insulin to be released as quickly as glucose does. The problem with this is that if insulin does not go up, leptin does not go up either. Leptin is your fullness hormone. It signals that you are no longer hungry. So a person drinks a sugary soda which is almost sure to have lots of fructose in the form of HFCS gets a lot of calories, but still feels hungry. Doctors who deal with obese children see this as a big part of the obesity epidemic Continue reading >>
Fructose Boosts Insulin Production By Beta Cells
Fructose Boosts Insulin Production by Beta Cells Sweet Taste Receptor Signaling in -Cells Mediates Fructose-Induced Potentiation of Glucose-Stimulated Insulin Secretion, by George A. Kyriazis and colleagues. Proceedings of the National Academy of Sciences of the United State of America 109:E524E532, 2012 What is the problem and what is known about it so far? After eating, glucose from the food enters the blood and triggers the beta cells in the pancreas to release insulin. But thats not the whole story. Other nutrients, for example fats, can also spur insulin production. In recent decades, fructose has become ubiquitous in the human diet and is found in many foods and beverages in the form of high fructose corn syrup. Its not clear how all this fructose is affecting the body, though some research has suggested links to health problems like type 2 diabetes. Why did the researchers do this particular study? The researchers wanted to determine whether fructose can activate the release of insulin from beta cells. The mice were given fructose by injection, while their insulin and blood glucose levels were monitored. The researchers observed a rapid increase in insulin production by the mice after the injection of fructose. Fructose only affected insulin levels in the presence of glucose, suggesting fructose plays a supporting role in insulin production. The studies were done in mice, so its unclear whether these results will be true in people. The authors report that fructose appears to fine-tune insulin production and that more research is needed to determine whether this new finding may factor into the possible link between high fructose corn syrup and type 2 diabetes. Continue reading >>
