Fructose, Sucrose, and High Fructose Corn Syrup: Modern Scientific Findings and Health Implications12

Added sugars have increased in diets in the United States and many other industrialized countries over the past 30 y. Controversies have arisen, because some investigators have suggested that sugars, in general, and sugar-sweetened beverages, in particular, may be associated with increased risk of obesity, metabolic syndrome, heart disease, and other serious health conditions. Many of these arguments have been based on epidemiologic studies, randomized clinical trials, and theoretical constructs. Results of randomized clinical trials have been inconsistent. The Dietary Guidelines for Americans and the AHA have published similar recommendations for added sugars. The debate among the public is complicated by confusion over the terms “fructose,” “high fructose corn syrup (HFCS),” and “sucrose,” with many people believing that there are metabolic differences between HFCS and sucrose. This confusion persists despite the fact that both the American Medical Association and the Academy of Nutrition and Dietetics have issued statements reporting that both of these sugars are essentially equivalent. Furthermore, there is a broad scientific consensus on the metabolic equivalence of HFCS and sucrose. With this as a backdrop, 5 leading experts in the metabolism and health effects of fructose, HFCS, and sucrose gathered for this symposium to present data and discuss and debate relevant scientific findings related to the metabolism and health effects of these sugars. The symposium’s first speaker was JohnWhite, a sugar biochemist and Founder and President of White Technical Research. Dr. White provided detailed evidence concerning the metabolic equivalence of HFCS and sucrose. He reminded the audience that fructose is rarely consumed by itself in the human diet. It is virtually always consumed in combination with glucose, whether it is in carbonated soft drinks, fruit juices, or many fruits and vegetables. Dr. White presented a detailed discussion concerning the biochemistry andmetabolism of sucrose and HFCS and contrasted this with studies done on pure fructose compared with glucose, often delivered in dosages above normal population consumption levels. Dr. White provided data demonstrating that the amount of glucose in the human diet from all sources far exceeds the amount of fructose from all sources. He concluded that fructose is not increasing in the human diet and that good cause and effect evidence does not exist that uniquely links the metabolism of fructose from normally consumed sugars at typical dosages to a variety of adverse health conditions. The second speaker, Dr. George Bray, Chief of the Division of Clinical Obesity and Metabolism at the Pennington Biomedical Research Center, presented data documenting that sugar consumption has risen dramatically in the United States in the last 100 y and particularly in the last 30 y. He raised a special concern about soft drink consumption, which has also risen dramatically during this period and is the leading source of fructose in the American diet delivered either through sucrose or HFCS used to sweeten beverages. Dr. Bray provided a summary of epidemiologic evidence showing an association with soft drink intake and obesity, metabolic syndrome, gout, and fatty liver disease. He then reviewed recent studies that suggest that soft drink calories are less satiating than calories from solid foods. Dr. Bray concluded by reviewing 3 randomized controlled trials of sugar-sweetened beverages. One 10-wk trial demonstrated weight gain in the group consuming sucrose-sweetened beverages compared with Aspartame-sweetened beverages. The second study demonstrated weight gain and increased blood pressure in sucrose-sweetened beverages compared with Aspartame-sweetened beverages. Dr. Bray noted that trials comparing fructose to glucose showed increases in both 1 This article is a summary of the symposium “Fructose Sucrose and High Fructose Corn Syrup. Modern Scientific Findings and Health Implications” held April 22, 2012 at the ASN Scientific Sessions and Annual Meeting at Experimental Biology 2012 in San Diego, CA. The symposium was sponsored by the ASN Medical Nutrition Council and supported in part by an educational grant from the Corn Refiners Association. The organizer has indicated that related reviews of this symposium will be submitted for publication in an upcoming issue of Advances in Nutrition. 2 Author disclosures: Dr. Rippe’s research laboratory has received unrestricted grants and Dr. Rippe has received consulting fees from ConAgra Foods, Kraft Foods, PepsiCo International, the Corn Refiners Association and Weight Watchers International. P. M. Kris-Etherton serves on the McDonald’s Global Advisory Board. * To whom correspondence should be addressed. E-mail: [email protected].