"Fructose -- New Elite Sweet."
"Fructose allows you to maintain a constant blood sugar level, which satisfies your sweet tooth, eliminates food cravings and supplies you with plenty of energy." Dust jacket of "Dr. Cooper's Fabulous Fructose Diet"
"Replaces ordinary sugar with fructose . . . suitable for diabetic diets." Ad for Sweet Lite
"The first NATURAL replacement for saccharin and ordinary sugar (sucrose). Ad for Batter Lite Cakes and Cookies
"Now diabetics, hypoglycemics, calirie watchers and health-concious people can ALL enjoy pure, natural honey flavor . . ." Ad for Sweet Lite
"Shasta now replaces ordinary refined sugar with simple sweetners like fructose, a kind found in fresh fruit." Ad for Shasta
IF ALL OF the above statements are true, does that mean a diabetic can safely consume fructose-sweetened soft drinks and avoid those which contain saccharin or ordinary sugar?
That the magic diet has finally appeared; that you can eat all you want and lose weight?
That fructose is the answer to overconsumption of refined white sugar (sucrose)?
Or that fructose is any better or worse than any of the sweetners it has been designed to replace?
The truth is, none of the answers tells the entire story and some of the claims confuse the issue. To complicate matters further, the fructose in Shasta is not the same as the fructose which is referred to in the other statements.
Fructose, or fruit sugar, occurs anturally in fruits, vegetables and honey. It is somewhat sweeter than sucrose, ordinary table sugar, but has the same number of calories. Sucrose is half fructose and half glucose. But the fructose in Shasta is not pure fructose. According to the company, itis high fructose corn sweetener, which is 55 percent fructose, 42 percent glucose.
And the kind of fructose used in processed foods may be any one of several combinations of fructose and glucose or just pure fructose. Fructose sells for about $4 a pound, over 15 times the cost of sucrose. High fructose corn sweetener is less expensive than sucrose. Americans consumed almost 12 pounds per capita of the corn sweetener last year in processed foods.
Many people do not realize the high fructose corn sweetner like that used in Shasta is not pure and this worries the American Diabetic Association (Ada) and physicians who treat diabetics. While the value of pure fructose in the diabetic diet is the subject of debate, the value of high fructose corn sweetner is not; it is no different from sucrose.
Barbara El-Beheri, nutrition program coodinator for ADA, says the Shasta ad and ads like it are "deceptive. Patients have to be cautioned about reading those ad. It could be a serious problem, particularly if they start adding fructose-containing foods to their diet."
Within the professional community a debate over the usefulness of fructose for diabetics has been raging for years. The body does not metabolize fructose the way it metabolizes glucose. In order for the body to utilize blood glucose, insulin, the hormone that regulates blood sugar, is needed. Fructose goes directly to the liver without insulin. Theoretically, because there is no dramatic fluctuation in blood sugar, it is easier for diabetics to handle fructose. In addition, there is some evidence that fructose raises triglyceride (fat) levels in the blood.
Dr. John Davidson, professor of medicine at Emory University and director of the diabetes unit at Grady Hospital in Atlanta is strongly opposed to the use of fructose by diabetics. He told the ADA that "there is no justification for the conclusion that nutritive sweeteners [fructose] may provide some advantage in dietary management."
Davidson said in a telephone interview that "fructose cannot be excluded from restrictions that apply to all nuitritive sweetners" for diabetics. "I would challenge anyone that there is evidence in hand which indicates the rules of the game should be changed. There are acute experiments that still haven't been done and there are no long-term feeding studies." By long-term, Davidson means "at least 10 years."
Despite lack of long-term studies a lrecent press release from Hoffman-LaRoche, manufacturers of pure fructose, said: "Many people on sucrose restricted diets such as diabetics . . . are able to use fructose safely under adequate medical supervision as part of a calorie controlled diet."
Davidson challenged "the fructose pushers to come up with contrary facts that should make us change those rules. If they've got them I haven't seen them," he said.
Myron Brin, director of clinical research at the Roche division of Hoffman LaRoche, took exception to Davidson's statement. "If he's [Davidson] calling us fructose pushers, I'm not going to get into that." Brin suggested that Davidson might not be up on all the literature.
Davidson was particularly critical of companies that use high fructose corn sweetners but do not make clear the difference between them and pure fructose. "The vested interests are very effective in bamboozling the public. What they are trying to do is systematically mislead obese patients and patients with diabetes in order to get them to use this product."
Cecil Lowry, executive vice president of science and technology for Shasta admitted "the ad certainly is highlighting fructose without commenting on any other sweetner." But he said, "Shasta is not practicing medicine. I do know that some doctors are allowing some diabetics to use fructose." Lowry said he couldn't say "why fructose is better than sucrose."
Dr. P. J. Palumbo, associate professor of medicine at the Mayo Medical School and Mayo Clinic said: "There is no advantage to using fructose over sucrose. You can use any of these carbohydrates provided you stay within calorie levels. This is true of insulin dependent diabetics [usually diabetes which begins in childhood and is often called juvenile diabetes] and adult onset diabetics [whose diabetes symptoms in 90 percent of the cases are due to obesity]. Fructose has no advantage over any other sweetener."
But Palumbo agreed that "there is a difference of opinion and confusion for the practicing physician." Some physicians, particularly in Europe, are permitting diabetics to use fructose. But Dr. John Brunzell associate professor of medicine at the University of Washington, feels "a diabetic patient is fooling himself by thinking he can eat fructose-containing foods because they don't have glucose in them. He still has to consider that fructose has calories, the same as glucose."
On the other side is Dr. Nancy Bohannon, a diabetes specialist at the University of Calfornia Medical Center. In September Bohannon presented the results of an experiments which showed that "blood sugar levels did not rise to the same extent after a fructose-containing meal as after a sucrose-containing meal." Funding for Dr. Bohannon's work was supplied by the Swiss company, Xyrofin Ltd., in which Hoffman-LaRoche has a financial interest. Hoffman-LaRoche is acting as Xyrofin's agent for selling fructose in this country.
As part of a panel sponsored by Hoffman-LaRoche, Bohannon told an audience last month that diabetics can substitute frucose for complex carbohydrates in the 20 percent range of total carbohydrate calories."
Palumbo and Davidson take exception to that recommendation.Davidson was incredulous. "I don't believe she [Bohannon] made that recommendation." The ADA, which is preparing recommendations regarding fructose that are expected to fall between Davidson and Bahannon's positions, expressed astonishment at the Latter's remarks.
According to Barbara El-Beheri, ADA "would never say substitute simple carbohydrages [fruits, vegetables and grains]. There's potential for danger there," she said.
According to El-Beheri, fructose is the caloric equivalent but not the nutritional equivalent of a complex carboyhydrate.
"A certain amount can be allowed in some [diabetic] diets," El-Beheri said. "But on 1,200 to 1,500 calories a day the individual needs all those calories to get the nutrients. There is no way to have a nutritive sweetener in that diet.
"We don't know what the long-term ramifications are of eating fructose," El-Beheri said.
Which is what the Food and Drug Administration seems to have decided. A report prepared for the agency by the Federation of American Societies for Experimental Biology (FASEB) concludes that "there are insufficient data to determine if fructose, or any other carbohydrate, has beneficial properties for the long-term dietary management of diabetes"
The report, released in May 1978, says "leading authorities on the dietary management of diabetes mellitus affirm that the main emphasis in obese patients should be on control of caloric intake to achieve and maintain ideal body weight. Most authorities now recommend that dietary fat and sugar be reduced and that the proportion of calories as starch be increased in both of the main types of diabetes [obese, insulin-independent and lean, insulin-dependent]."
The other major concern about fructose is its effect on triglyceride levels.
A number of experiments have also been conducted to determine whether fructose elevates triglyceride levels more than other sweeteners. There is some evidence that fructose converts more quickly to fat than other sugars. There is also some evidence that adult onset diabetics have high triglyceride levels. And some scientists believe an elevated triglyceride level is a risk factor in heart disease.
Studies comparing the effects on triglyceride levels after ingestion of sucrose, glucose or fructose are contradictory. Some indicate fructose does not raise triglyceride levels as much as the other two sweeteners; some studies indicate exactly the opposite.
But most researchers seem to agree on one point: Even if there are differences between the effects on triglyceride levels of fructose and other sweeteners, no one known their significance now because no long-term feeding studies have been done. Says Brunzell, "We don't know what the long-term effects are."
Studies done by Palumbo, suggest that fructose "is the bad guy" and raises triglyceride levels more than glucose does. His data also suggest that "if you raise triglyceride levels you increase the body's production of cholesterol and raise uric acid levels.
Other studies have shown the opposite.
Where does that leave normal individuals?Equally in limbo. While fructose is sweeter than sucrose, which could mean that one might use less fructose, hence fewer calories, questions remain about the ability of fructose to raise trigylyceride levels. In addition, the sweetness of fructose is related to the medium in which it is used. And, of course, the cost of pure fructose is very high.
In soft drinks, such as the Shasta beverages, the difference in calories is insignificant, approximately 20 per 12 ounce can. Shasta says in its ads that it is introducing an alternative to soft drinks sweetened with refined sugar, "an alternative," the ad says, "you can feel good about."
In light of the available information about fructose, it is not clear exactly what there is to feel good about.