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Added fructose is key driver of type 2 diabetes, warn experts

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By Nathan Gray+

30-Jan-2015
Last updated on 30-Jan-2015 at 15:30 GMT2015-01-30T15:30:23Z

Added sugar, and in particular added fructose, is a primary driver of type 2 diabetes, say researchers - who suggest industry should be incentivised to slash levels in foods and drinks.
Added sugar, and in particular added fructose, is a primary driver of type 2 diabetes, say researchers - who suggest industry should be incentivised to slash levels in foods and drinks.

Added sugars, particularly those containing fructose, are a principal driver of diabetes and pre-diabetes and should be ‘drastically’ reduced, according to leading researchers.

Reporting in Mayo Clinic Proceedings, the experts challenge current dietary guidelines and propose sweeping reductions in the amount of added sugar, and especially added fructose, that people consume.

Citing previous recent research, the team state that there is strong evidence to show that added sugars, particularly those containing fructose, are a principal driver of diabetes and pre-diabetes, even more so than other carbohydrates. 

“At current levels, added-sugar consumption, and added-fructose consumption in particular, are fuelling a worsening epidemic of type 2 diabetes,” said lead author Dr James DiNicolantonio, from Saint Luke’s Mid America Heart Institute.

“What we found, in general, was that with iso-caloric exchange of sugar for starch or glucose or lactose, there was significant metabolic detriments in regards to insulin resistance and type 2 diabetes,” said DiNicolantonio – who noted that carbohydrate intake in general has long been associated with diabetes incidence, but that for many years it has been unclear which type of carbohydrate was driving diabetes and pre-diabetes. 

“It is clear from our review that this is being driven by sugar, not other forms of carbohydrate,” he said.“What we have found is that the trials that are using refined sugars, those actually are much more potent than what are found in fruits and vegetables – which are also buffered with fibre and phytonutrients.”

“So, it’s not fructose from fruits and vegetables that we need to worry about, it’s fructose coming from added sugars." 

DiNicolantonio and his team urged for ‘drastic reductions’ in the consumption of foods and beverages containing added fructose, suggesting that there should be incentives for industry to add less sugar, especially fructose-containing varieties, to food and beverage products.

Whole food guidelines 

While fructose is found naturally in some whole foods like fruits and vegetables, consuming these foods poses no problem for human health, the team noted – adding that eating fruits and vegetables is likely protective against diabetes and broader cardiometabolic dysfunctions.

As a result, the team propose that dietary guidelines should be modified to encourage individuals to replace processed foods, ‘laden with added sugars and fructose’, with whole foods like fruits and vegetables. 

“Most existing guidelines fall short of this mark at the potential cost of worsening rates of diabetes and related cardiovascular and other consequences,” they argue.

Source: Mayo Clinic Proceedings
Published online ahead of print, doi: 10.1016/j.mayocp.2014.12.019
"Added Fructose: A Principal Driver of Type 2 Diabetes Mellitus and Its Consequences"
Authors: James J. DiNicolantonio, et al

1 comment (Comments are now closed)

All calories matter, as does fitness

As this is an overview of the literature, and not a study, there are many other factors to consider in the diet and lifestyle that may lead to the development of metabolic syndrome or diabetes. The amount of fructose in "high fructose" sweeteners, is no more than the amount in table sugar or honey - about 50% fructose and 50% glucose. As the authors point out: "Nonetheless, all these dietary-replacement trials likely have low applicability to the real world, where isocaloric exchanges are unlikely and sugar may be consumed in addition to, rather than in place of, starch and other dietary constituents."
Obesity and body fat impact metabolism as well as dietary composition. Sugar does not cause diabetes - poor eating habits and a lack of physical activity increase its risk. While reducing sugars and sweets in the diet is good advice, we should focus more on the nutrient-rich, fiber-rich foods that are missing, and encourage people to eat more vegetables and healthy grains, and smaller portions.

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Posted by Rosanne Rust, MS, RDN, LDN
10 February 2015 | 21h422015-02-10T21:42:42Z

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