Mito
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Sugars have emerged as the dominant nutrient of concern. Attention has focused squarely on the fructose moiety as the main bad actor in sugars due to its unique set of biochemical, metabolic, and endocrine responses. Fructose is increasingly being regarded as the principal driver of obesity, diabetes, and their downstream cardiometabolic complications (1, 2), a point of view now widely propagated in popular books (3–6) and documentary movies (7, 8). This special concern about fructose was not always the case.
The findings of Evans et al. (25, 26) justify the early interest in fructose as an alternative sweetener. In pooling the totality of the highest quality evidence from randomized controlled trials, they confirm that fructose in substitution for glucose or sucrose over a wide dose range has the ability to reduce postprandial glycemic responses and improve longer term glycemic control without incurring any adverse effects. These data dispute the notion that there would be any advantage to the popular strategy (5, 6) of replacing fructose with glucose-containing sugars free of fructose (including glucose, maltose, and their many proxies such as brown rice syrup and barley malt syrup), as a means of mitigating the purported adverse effects of fructose. This strategy would only serve to increase the GI or relative postprandial glycemic response to foods while leaving the calories unchanged or even higher given that glucose is less sweet than fructose and so takes more to achieve the same level of sweetness. On the other hand, the replacement of glucose containing sugars with fructose [which is currently used as an added sweetener in only ;2% of retail products (48)] may have important advantages in safely lowering the GI or relative postprandial glycemic response to foods and thereby decreasing the glycemic impact of diets in people with diabetes or at risk of diabetes.
The story of fructose reflects the cyclic nature of much in nutrition. The present pair of systematic reviews and meta-analyses by Evans et al. (25, 26) has brought the evidence full circle. Where once fructose was endorsed and then later renounced as an alternative sweetener, it is now in a position to be endorsed again on the basis of the accumulated evidence. Sources of uncertainty, however, remain with the inconsistency and imprecision in the estimates for chronic fructose intake. There is a need for more long-term (.6 mo) randomized trials to clarify the benefits of the replacement of glucose-containing sugars and starches with fruc- tose with the use of “real world” food applications in people with diabetes or at risk of diabetes. In the meantime, the current signal for net benefit means that one can have confidence that fructose is at least no worse than the glucose-containing sugars that it would replace.
http://ajcn.nutrition.org/content/early/2017/07/19/ajcn.117.161539.full.pdf
The findings of Evans et al. (25, 26) justify the early interest in fructose as an alternative sweetener. In pooling the totality of the highest quality evidence from randomized controlled trials, they confirm that fructose in substitution for glucose or sucrose over a wide dose range has the ability to reduce postprandial glycemic responses and improve longer term glycemic control without incurring any adverse effects. These data dispute the notion that there would be any advantage to the popular strategy (5, 6) of replacing fructose with glucose-containing sugars free of fructose (including glucose, maltose, and their many proxies such as brown rice syrup and barley malt syrup), as a means of mitigating the purported adverse effects of fructose. This strategy would only serve to increase the GI or relative postprandial glycemic response to foods while leaving the calories unchanged or even higher given that glucose is less sweet than fructose and so takes more to achieve the same level of sweetness. On the other hand, the replacement of glucose containing sugars with fructose [which is currently used as an added sweetener in only ;2% of retail products (48)] may have important advantages in safely lowering the GI or relative postprandial glycemic response to foods and thereby decreasing the glycemic impact of diets in people with diabetes or at risk of diabetes.
The story of fructose reflects the cyclic nature of much in nutrition. The present pair of systematic reviews and meta-analyses by Evans et al. (25, 26) has brought the evidence full circle. Where once fructose was endorsed and then later renounced as an alternative sweetener, it is now in a position to be endorsed again on the basis of the accumulated evidence. Sources of uncertainty, however, remain with the inconsistency and imprecision in the estimates for chronic fructose intake. There is a need for more long-term (.6 mo) randomized trials to clarify the benefits of the replacement of glucose-containing sugars and starches with fruc- tose with the use of “real world” food applications in people with diabetes or at risk of diabetes. In the meantime, the current signal for net benefit means that one can have confidence that fructose is at least no worse than the glucose-containing sugars that it would replace.
http://ajcn.nutrition.org/content/early/2017/07/19/ajcn.117.161539.full.pdf
