Challenging the Fructose Hypothesis: New Perspectives on Fructose Consumption and Metabolism


In considering the volume of contemporary literature on fructose, One conclusion stands clear: fructose is safe at typical intake levels but can produce adverse metabolic effects when abused—as is true of most nutrients.

It turns out that the largest abusers of fructose are not American consumers, but research scientists. For the adult population as a whole, dietary fructose exposure ranges from very low to <18% E. Over this range, recent meta- and NHANES analyses demonstrate no differential effects of fructose compared with other sugars on weight gain, blood pressure, uric acid, blood lipids, and hyperlipidemia;

Evidence is presented in this review that fructose has not disproportionately increased in the human diet (in fact, it has increased very little in the past 90 y) and that cause-and-effect evidence of adverse effects is lacking at typical human exposure levels and patterns. The fructose hypothesis must be continually challenged for human relevance.


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6 thoughts on “Challenging the Fructose Hypothesis: New Perspectives on Fructose Consumption and Metabolism

  1. I guess then my experience is the opposite. The more fructose, hugh fructose corn syrup, fermented fructose one eats at one sitting throws off metabolic balance and increases met Syndrome. This is evident in body habitus as well as many markers of fructose metabolism such as Uric Acid and ferritin. Do your own N=1 experiment with low and high fructose and see what happens.

    Realize that Population based studies are not always helpful when treating individuals.

    • Dr. Horvitz
      This is not really a population study but a review of broad swath of fructose literature, from food composition to medical longitudinal to animal models. You are correct about benefits of low simple sugar diet, but the purpose of the literature review was not to promote a high sugar diet nor dismissing the negative effects of excess sugar in one’s diet. It was to expose the myth that sugars with same basic nutritional/metabolic impact as fructose pose same deleterious effects of excessive amounts in our diets. This review exposes just the tip of the iceberg of just how inaccurate and mislead the nutritional literature really is. So, it matters not whether my four cokes per day are sweetened with HFCS or cane sugar. Fructose is no more the culprit sucrose was or honey or molasses was before that. The slow replacement of healthy fat and quality protein with energy dense high carb food in abundance and cheap was the beginning of the metabolic derangement we now see, in my opinion.

    • We can agree to disagree as fructose is metabolised differently than sucrose and thus can have different metabolic effects.
      Fructose rate-limiting metabolic step is in the liver. Liver can only handle so much at one time.
      Sucrose or Glucose can be handled anywhere, thus less metabolic issues.
      I will see if I can dig up more info on this and send to you.

      Best part of healthcare is that there are always multiple opinions and no one treatment is right for everyone.

  2. You state that glucose and sucrose can be handled anywhere but that fructose has limitations in liver. But sucrose is simply one molecule of glucose and one molecule of fructose! And fructose is metabolized to glucose in liver. So we are back to same point because sucrose is 50% glucose. The Glucose to Fructose ratio in typical diet, as a source of sweetened foods or naturally sweetened, is about 5:1 you must overload liver severely to overwhelm adolase B. In range of 50 grams (5 apples or 16 0unces of pure fruit juices. Fructose will otherwise be changed to glucose, stored at glycogen or used as building blocks for triglycerides just as pure glucose can. No one is suggesting increasing fructose artificially is good, but point being that it would be just as deleterious, or nearly so, to push sucrose or pure glucose to high levels of consumption. Again, one of the main points of the review of these data is that it is not reasonable to single out fructose alone for an effect caused by similar metabolized monosaccharides given the fact that the content of fructose related to glucose in our diets is and has been fairly consistent. This is largely because sucrose, which was replaced by HFCS, also contains fructose. And finally HFCS is mixture of pure fructose and sucrose to begin with. So we were using always utilizing fructose and didn’t realize it. It is indeed total burden of excess sugars measured by total absolute car load and as percentage of total calories that we should be focused on.

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