In the 1960s, fructose has been shown to have positive effects (with an exception like bad for tooth) in diabetes as fructose does not spike insulin directly. But today with increasing numbers of researches, the view on fructose has changed dramatically. (1) In an article published in The New York Times, they wrote about How the Sugar Industry Shifted the blame to fat in past decades. (2) We may have minutes of pleasure when we eat sugar by do you really know what happens to your body with more fructose sugar consumption? In today even food companies like Nestlé had given a statement like “We are making huge efforts to reformulate our global product portfolio to reduce ingredients like sugar, salt, and fat”.(3) We will go through here what happens to your body when you consume more fructose sugar and why it is important to make a decision.
What happens to your body with more fructose sugar consumption?
What is fructose?
Fructose is the sugar derived from fruits. When fructose is extracted from fruits it misses the natural nutritional package. It also misses the important fiber part that the whole fruit contains.
How the body uses fructose or fruit sugar?
While almost every cell of your body uses glucose, mainly liver cells have the ability to use fructose. Therefore when you eat a large amount of fructose, it almost entirely discharges at your liver. Apart from the liver, the intestine can metabolize fructose to some extent. (4) The liver converts fructose into glucose, enters into another process called De novo lipogenesis (DNL), lactic acids and a small percentage to triglycerides. (5, 6, 7) When the body needs more energy, certain enzymes break down glycogen into glucose for energy. Humans have limited storage for energy source glycogen. When the glycogen storage of the liver becomes full, the extra glucose converts to fat for storage through a process called De novo lipogenesis (DNL).
You will be wondered how another sugar glucose from simple carbohydrates can kill your health.
Fructose and de novo lipogenesis(DNL)
Research suggests fructose or a diet rich in simple sugar, promotes DNL and that further contributes to high triglycerides and liver fat accumulation. Fructose is metabolized at a faster rate than glucose, providing precursors, such as acetyl coenzyme A, for DNL. In a study on healthy lean people, within 6 hr of fructose consumption, DNL increased 20-fold, and 25% of blood triglycerides derived from DNL. Researchers found healthy people consuming high fructose diet, had a significantly higher rate of DNL and also higher liver fat accumulation than people with a low fructose diet within just 8 days of the diet. On the other hand, studies showed fructose restriction resulted in a reduction of fasting glucose as well as insulin level, lowered bad cholesterol and decreased liver fat. (8,9,10)
In another study, researchers observed that participants who consumed 150 g of fructose daily for just 4 weeks, showed a huge mean elevation of 350 mg/L of blood triglycerides levels. They also reported decreased insulin sensitivity with fructose consumption. (11)
Fructose and Non-Alcoholic Fatty Liver
We know fructose is primarily metabolized in the liver, not in a body cell, which means your cells in muscles don’t use fructose. (12) We have also learned that the liver converts fructose into glucose, lactic acid, and a small percentage of triglycerides. And a major portion of the fructose converts to glucose. A larger fraction of diet-derived fructose than to glucose is available for conversion to fat in the liver via DNL in animals as well as humans. And additionally, fructose increases the rate of DNL to a much higher degree. (4, 13, 14) Apart from that other factors like the inability to fatty acid for use as energy also contributes to fatty deposits. (4)
And various studies documented consumption of more sugar i.e. fructose as a major mediator of non-alcoholic fatty liver disease leading digestive disorders and other health-related problems due to improper liver function. (13, 14, 15, 16, 17)
Fructose contributes to abnormal cholesterol levels and negatively affect cardiovascular health
High fructose intakes showed to increase in LDL cholesterol and total cholesterol. (18) A major portion of fructose is converted to glucose in the liver and then to fatty acids via DNL. In several studies, fructose has the potential to increase blood triglycerides and LDLs to a greater extent than glucose. With more negative side, researchers also found that fructose increased the small dense LDLs, the type of small sticky LDLs that may have a link to heart disease. And on the other hand, fructose appeared as no such effect on good cholesterol HDLs. (11, 6)
More importantly, added sugar increases reactive free radicals that further increases oxidative stress. And oxidation of cholesterol promotes fatty deposits inside the blood vessels that further leads to narrowing blood vessels leading to the heart or cardiovascular disease. (53)
Sugar speeds up your aging process
Advanced glycation end products or AGEs form when proteins or fats are exposed to sugar in a process called glycation. (19,20)
AGEs can cause inflammation and damage adjacent proteins, harm the body’s cells. AGEs affect nearly every type of cell of our body and one of the factors of aging and age-related chronic disease and degenerative diseases such as diabetes, atherosclerosis, chronic kidney disease, and Alzheimer’s disease. (21,22) And excessive sugar consumption produces too much Advanced Glycation End Products (AGEs). Your body can handle a certain amount of AGEs but too many AGEs can increase inflammation as well as oxidative stress, and damage tissues. (23,24)
In external AGEs can contribute to your skin wrinkled, sagging, dark circle under eyes, etc. (25)
You are eating healthy but your cooking materials can cause inflammation and lead to disease. Know more about this.
Fructose, insulin resistance, and diabetes
When your cells develop insulin resistance, they ignore the signal of insulin to take up glucose from the blood. As a result, your blood sugar can goes high. Animals feeding with large amounts of fructose can rapidly produce multiple features of the metabolic syndrome. That included obesity, abnormal cholesterol, fatty liver, hypertension, insulin resistance, and diabetes. (26) We have already gone through the roles of fructose in the development of the non-alcoholic fatty liver. And the non-alcoholic fatty liver is associated with metabolic syndromes like obesity, insulin resistance or further type 2 diabetes. (27, 28) It also strongly associated with both the liver and adipose tissue insulin resistance as well as reduced whole-body insulin sensitivity. Some studies documented 45–50% reductions in whole-body insulin sensitivity. (29)
However, association always doesn’t result in causation.
And there is also debate about insulin resistance or diabetes with fructose consumption. (30) We believe when there are reasonable explanations to understand the process and that is supported by high-quality studies.
The earlier clinical study observed a significant decrease in liver insulin sensitivity even with relatively small amounts of daily fructose consumption. (31) A published a prospective observational cohort study on both diabetic and non-diabetic participants recruited from the ongoing German Diabetes Study, indicates that fructose from sugar-sweetened beverage appears to have a detrimental effect on peripheral and liver insulin sensitivity, even when consumed in very moderate daily amounts. On the other hand, fruit-derived fructose didn’t have the same effect. (32) Remember, fructose from fruits has a combination with fiber, but when extracted to sugar-sweetened beverage doesn’t.
A 2016 Meta-Analysis of 29 studies including clinical studies included more than 1000 normal and overweight or obese participants. Researchers of the study concluded high fructose consumption promotes liver insulin resistance even in non-diabetic adult peoples without affecting peripheral or muscle insulin sensitivity. (33)
Mighty mineral magnesium also showed to improve insulin sensitivity and thus prevent insulin resistance. Know more about this along with Recommended Dietary Allowances as well as food sources.
The mechanisms by which high-fructose consumption causes insulin stimulation and further insulin resistance remain uncertain. Human dietary intervention studies are consistently indicating that fructose may have more significant effects on liver insulin resistance than peripheral insulin resistance. A high presence of insulin itself is insulin resistance in later stage and glucose is an insulin stimulator. We can speculate that high insulin results from fructose-induced glucose production, may subsequently lead to peripheral insulin resistance. (26)
Furthermore, fructose promotes complications in glucose metabolism, accumulation of fat in the liver, and alterations in the lipid profile, which, associated with an inflammatory response, will imply a systemic picture of insulin resistance. (34) A recent 2019 study demonstrated that increased liver fats cause the fats to overspill into several tissues, including the pancreas causing impairment in insulin production that cause type 2 diabetes. (35)
Fructose consumption and weight gain
Although not all, dietary intervention studies in humans also demonstrate that overfeeding fructose, but not glucose can increase visceral fat. Visceral fat is a type of body fat that’s stored within the abdominal cavity and close to many vital organs, such as the pancreas, liver, and intestines. Increased visceral fats lead to many health complications. (26) Excessive consumptions of fructose are consistently associated with increased weight, which may be attributed to increased caloric intake as well as effects on energy balance and nutrient partitioning. Furthermore, fructose overconsumption induced leptin resistance and reduced satisfaction, which in turn lead to consuming more results in obesity. (26, 36, 37 )
You will see children remain still hungry even after eating lots of foods with added sugar or sugar-sweetened beverages.
A review of 30 studies including cohort studies as well as clinical studies, in 242,352 children and adults suggests a positive association between consumption of sweetened beverage with weight gain and obesity. (38) Other studies also evidenced high fructose consumption leads to increased body weight gain, elevated blood pressure, high blood sugar, high insulin level, and increased blood triglyceride (TG) concentrations. (39)
Fructose and Gastro-Intestinal symptoms
The Gastro-Intestinal tract functions as a major contributor to your immune system. A compromised and inflamed gut may be associated with many autoimmune diseases like IBD, IBS, autoimmune thyroiditis, liver disease, arthritis, diabetes, neurodegenerative diseases and more. The gut consists of the major bacterial colony to the human body that carries around 100 trillion bacteria and all that works as an ecosystem. And you need a balance between friendly bacteria and pathogenic. (40,41,42)
In general, fructose is absorbed through the small intestine. However, in the absence of transporter-like Glut5 in the intestine, the absorption of fructose in the intestine is reduced. Moreover healthy adult has the ability to absorb free fructose ranges from less than 5 g to more than 50 g. And unabsorbed fructose may contribute to gastrointestinal symptoms. Also when excess fructose reaches the colon, bacterial fermentation can occur leading to the formation of gas and other bacterial byproducts. (26) And a high fructose diet can contribute to an imbalance of gut bacteria and the growth of harmful gut bacteria. (40,41,43)
Sugar can raise uric acid and cause chronic kidney disease
Fructose feeding contributes to uric acid production including purine synthesis that produces painful crystalline in joints called gout. Increased circulating uric acid levels also increase the risk of gout. (26, 44 , 45) High uric acid also increases the load on the kidney and the risk of kidney disease. (46,47,48)
Fructose and brain function
Fructose can give pleasure to the brain for a few minutes by stimulating feel-good hormone dopamine, but give negatives results later. Your gut is an organ that is connected to all parts of the body and directly to the brain. A study found high fructose consumption promotes a bacterial imbalance in the gut with the increase of harmful bacteria and inflammation and neuronal loss in the brain region Hippocampus. (49) UCLA life scientists have found sugar consumption can damage hundreds of brain genes which can lead to a wide range of diseases further. In opposite, they also suggest that DHA an omega 3 fatty acid abandoned in the brain seems to reverse the harmful changes produced by fructose. (50)
Fructose and hypertension
Researchers also observed an increase in blood pressure with increased consumption of sugar-sweetened beverages. A high amount of salt or sodium chlorides contributes to high blood pressure. High-fructose feeding can increase intestinal salt absorption in rodents. Some researchers have hypothesized that fructose-induced increase of uric acid may impair kidney function, contributing to hypertension. However, this field needs more rigorous studies. (26, 51)
You can also read about some best available natural calorie-free sweetener as a sugar alternative.
One more problem with eating such foods is that frequent consumption of such foods creates addiction like feeling to eat more. (52)
Hidden names of sugar
One problem is that sugar hides with different names in foods. Apart from sucrose or table sugar name ended with syrup and sugar such as High-fructose corn syrup or HFCS, agave syrup, buttered syrup, maple syrup, Carob syrup, Refiner’s syrup, Sorghum syrup, date sugar, brown sugar, Confectioner’s sugar, coconut sugar, cane sugar, and similar names. Other names of foods that may contain sugar include fruit juice concentrate, cane juice, fruit extract, cane juice, molasses, caramel, honey, and the list doesn’t end here. Therefore you need to check the ingredients list before purchasing any food.
Also, read how to check the tricky food labels.
In conclusion, although fructose once thought harmless as it doesn’t stimulate insulin directly, but it contributes to non-alcoholic fatty liver and other toxicity. We have considerable data about fructose-induced health detrimental effects. We have gone enough to what happens to our body with more fructose sugar consumption. Other factors we don’t like that fructose speed up the aging process, rise uric acid level and also contribute to tooth decay. It also doesn’t give you fullness which means even after eating lots of fructose, you can still feel hunger. Moreover, it can push you to eat more sugar. A little amount of added sugar or fructose may not cause that much harm to your health but frequent and excess consumption will definitely do. And if you have any update, you may share it with us.
Disclaimer: Information provided here are generalized information for informational and entertainment purpose only, not intended to provide one to one health consultation or replace practice of a qualified practitioner. Different people may have different health condition and may have different reaction to the same food. Hence it has been advised to consult with health care provider before application of any of above information Source and references: 1. Lambertz J, Weiskirchen S, Landert S, Weiskirchen R. Fructose: A Dietary Sugar in Crosstalk with Microbiota Contributing to the Development and Progression of Non-Alcoholic Liver Disease. Front Immunol. 2017;8:1159. Published 2017 Sep 19. doi:10.3389/fimmu.2017.01159 2.https://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry- shifted-blame-to-fat.html 3.https://www.nestle.com/ask-nestle/health-nutrition/answers/sugar-obesity- children-marketing-new-york-times 4. Sarah A. Hannou,Danielle E. Haslam,Nicola M. 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