Skip to main content

Sievenpiper: Fructose should not "worry" in diabetes

As the fructose debate rages on, one serious concern has been what the message should be for people who have diabetes. There's no question that the alarming media headlines, articles, and YouTube videos have confused many with prediabetes and both type 1 and type 2 diabetes.

Even health professionals and organizations like the American Diabetes Association have taken a cautious approach by recommending avoidance of fructose as a sweetening agent. That is, for fear it may raise plasma lipids. They stop short of recommending people avoid fructose from fruit.

There is also the extreme arguments of Internet marketers like Joe Mercola blasting out articles about the supposed danger of fructose including that of which comes from fruit. (I've had more questions than I can count about Mercola's unreasonably scary headlines and viral copy. He makes baseless recommendations that those with diabetes should cut fructose from all sources to amounts of less than 15g per day.)

In my prior interview with John Sievenpiper, M.D., of St. Michael's Hospital, University of Toronto,  we talked of the controversies surrounding fructose, as well as rhetoric used by scientists like Dr. Robert Lustig and others, which he said could lead people to reduce intake of fruits. "That's the danger," Dr. Sievenpiper said, "that people will say that fruit is a source of fructose and won't consume fruit because it may induce obesity, metabolic syndrome, and so on. It's not just the lay public that may take this message to heart, but health professionals."

As the lead author of three systematic reviews and meta-analyses evaluating fructose's effects in randomized controlled feeding trials, Dr. Sievenpiper offered some perspective to the metabolic fate of this simple sugar in humans (versus animals). In short, these analyses found fructose had no significant effect on body weight or blood pressure in humans (as it does in rats, for example). In fact, fructose in amounts similar to that found in fruit improved glycemic control in humans.

Now, Dr. Sievenpiper and his colleagues -- including Dr. David Jenkins (who first introduced the concept of a low-glycemic index) -- has released yet another meta-analysis and systematic review to evaluate the effect on fructose on long-term glycemic control in diabetes.

The new study, published in Diabetes Care, included 18 controlled feeding trials that included 209 individuals with type 1 and type 2 diabetes. The study's results: The isocaloric exchange of fructose improves long-term glycemic control as determined by significantly reduced glycated proteins, namely hemoglobin (HbA1c) and glycated albumin.

Moreover, the isocaloric exchange of fructose reduced HbA1c by an average of 0.53 percent, which is the equivalent to taking a hypoglycemic or anti-hyperglycemic agent like glucophage (Metformin). The fructose also didn't significantly affect fasting glucose or insulin.

When I asked Dr. Sievenpiper what people with diabetes should take away from the results of the study, what they should make of fructose's contribution to total carbohydrates, and its use as a substitute for other carbohydrates in the diet, he wrote:
In the context of a healthy, nutritionally balanced, weight-maintaining diet, people with type 2 diabetes do not need to worry about avoiding sources of fructose.  
Provided weight management goals are being met, no one dietary pattern has shown itself to be best for the nutritional management of diabetes. A number of dietary patterns have shown benefit in people with diabetes. These include a low-glycemic index, Mediterranean, or vegetarian dietary patterns, as well as those which emphasize specific foods such as dietary pulses or nuts or allow for a range of macronutrient distributions. The range of possibilities allows for the individualization of diets based on treatment goals and the values and preferences of the individual. 
Within this context, using small to moderate amounts of fructose in place of other sugars and starch may offer added benefit. This would be expected to be especially true where the sources are low-glycemic index fruits and cereal grain products, both of which have shown metabolic benefit.  
That being said, we need larger, longer, and higher quality trials to clarify the benefit of fructose in people with diabetes. We are currently planning such trials. 
Fructose, far from being "toxic," may be a uniquely beneficial carbohydrate in diabetes when given in amounts equivalent to what's found in fruits, according to the evidence. Once again, the study drives home the point further that dose matters, as it does with most nutrients and bioactive compounds, and that fructose can be healthy when eating as part of a well-balanced diet.

With the virtues of a low-glycemic diet extolled recently in the media for healthy weight loss (mainly after Dr. David Ludwig and colleagues published an impressive three-way crossover study in the Journal of American Medical Association evaluating low-fat, low-glycemic index, and very low-carb diets) it's odd that more attention hasn't been given to the value of fructose as a source of low-glycemic carbohydrate.

The most likely reason, perhaps, as addressed in my previous posts, is the continuing fears people have about high-fructose corn syrup. Despite the fact that it's chemical makeup being almost identical to plain sucrose, the ingredient is still often singled out as somehow uniquely problematic. Greater intake of all foods, especially all carbohydrate sources, is what is most likely what has led us down the road of the obesity epidemic.

Bottom line? Fruit is still healthy. Fructose is most likely good for folks in amounts equivalent to what's found in fruit. Moderation in the diet needs to be the key message as it comes to any nutrient. Plus, more focus could be put on the intake of low-glycemic carbohydrates along with balanced amounts of proteins and good fats as part of a reduced-calorie diet for weight management.

Reference


Cozma AI et al. Effect of Fructose on Glycemic Control in Diabetes: A Systematic Review and Meta-analysis of Controlled Feeding Trials. Diabetes Care 2012;35:1-10.doi: 10.2337/dc12-0073

Comments

Popular posts from this blog

Which Photographer Are You?

To apply Plato's recommendation: If you know where you fit, in the immense range of the universe of photography, you'll have simple sledding with regards to promoting your photos.

Why? Above all else, there's nobody very like you. You have a fortune of encounters: information, know-how, and interests. In addition, you are a gifted picture taker. At the point when you know your own qualities and select your business sectors as needs be, you'll see that photobuyers like to work with picture takers whose documents of stock photographs coordinate their format needs. As it were, you communicate in their language.

Know thyself. You are a significant asset to photograph editors, in the event that you get your work done and discover the photobuyers whose photograph needs coordinate the photographs you like to take.

'Administration' PHOTOGRAPHY:

Numerous newcomers to the field of stock photography at first set their objectives toward publicizing, PR, modern, design, an…

The Impact of Single Parent Families

There is a rising pattern in families the country over. The quantity of separation procedures started is mounting and it is auspicious to discuss the effect of families on the youngsters and the organization of the family itself. As a matter of course, the nonappearance of one parent in the family structure negatively affects the connection between the parent and the kid just as their individual associations with society in general. They need to manage partiality busy working or in the network. The lower financial persona that is credited to them to make them an objective of misuse and hardships which ought not be available at all in any case.

The image doesn't become more clear concerning the youngsters. A few investigations have called attention to both present moment and long haul impacts of child rearing. Kids who come up short on the supervision of a male parent for the most part are inclined to wrongdoing, illicit drug use and resistance. A little girl in the family is boun…

What Could Be

With the beginning of each new year, it seems like everyone on the planet is either talking about or embarking on some type of resolution. I will be the first one to say that this used to be me each and every year. In almost every case, I tried to commit to something health-related like getting to the gym more or eating better. However, as time has passed, I have reflected on this annual tradition and deemed it to be quite silly in the greater scheme of things. Why should it take the passing of each new year to commit to change on both a professional and personal level? As such, I have not made nor pursued any resolution in many years.

An article by Mary Ellen Tribby in the Huffington Post sums up quite nicely why New Year’s resolutions don’t work:
As a matter of fact according to a study by The University of Scranton’s Journal of Clinical Psychology, only 39% of people in their twenties achieve their resolution goals each year.
And the number keeps decreasing with age. By the time you a…