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Diabetes Update: Fructose

Number 28; January 4, 2002

By David Mendosa

This newsletter keeps you up-to-date with new articles, columns, and Web pages that I have written. I list and link most of these on my Diabetes Directory at

From time to time Diabetes Update may also include links to other Web pages of special interest.

My most recent contributions are:

    on January 4, 2002
  • Hispanicsalud
    My current "About the Internet" column for the American Diabetes Association's Web site focuses on the prevalence of diabetes among Hispanics. I look at the only Web site that deals specifically with the issue of Hispanic health, particularly diabetes. The URL is

    on December 24, 2001

  • Diabetes Resources
    In October Abbott Laboratories Inc. MediSense Products published my short list of recommended Web sites and books in the Welcome Edition of the PrecisionTM TakeCharge News, but only on Christmas Eve did they send me a copy. For books they asked me to pick one each for people with type 1 and type 2 diabetes. The decision for type 2 was easy: a great new book by Gretchen Becker (a subscriber to this newsletter), but for type 1 it was more difficult. See if you agree. The article is on-line at

Updates include:

  • Fructose
    Sugar is in and fructose is out. The American Diabetes Association's new statement on "Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications" actually represents a very small change in position. The most important change, it seems to me, is its recommendation that we avoid the use of fructose to sweeten our foods.

    Actually, sugar in moderate amounts has been acceptable for the past seven or eight years. In May 1994 the ADA stopped recommending that people with diabetes avoid sugar. Since then, the organization has focused on the total amount of carbohydrates in the diet, regardless of their source.

    The organization's new statement, which is in the January 2002 issue of Diabetes Care and available on-line at no charge at, for the first time, however, says that we should avoid fructose other than that which occurs naturally in fruit. This is in spite of the fact that fructose causes less of a rise in blood glucose than sugar. Specifically, its glycemic index is 32 (where white bread = 100), while table sugar (sucrose) has a GI of 92.

    Then, why avoid fructose? Because "fructose may adversely effect plasma lipids," the ADA says.

    This is a shift from the ADA's Position Statement on "Nutrition Recommendations and Principles for People With Diabetes Mellitus" issued a year ago and on-line at At that time the organization said that moderate consumption of fructose-sweetened food was okay.

    While the new statement didn't cite sources for the effect of fructose on lipids, they are easily found. One person who has campaigned vigorously against fructose for years is Nancy Appleton, the author of Lick the Sugar Habit (Garden City Park, N.Y.: Avery Publishing Group, 1996). Ms. Appleton writes on page 90 of her book:

    Dr. J. Hallfrisch studied cholesterol and triglyceride levels and found that fructose, unfortunately, caused a general increase in both the total serum cholesterol level and the low-density lipoprotein fraction of cholesterol in most subjects. The triglyceride levels also rose significantly, especially in those persons whose blood sugar levels rise higher than normal when they eat sugar. It was concluded that high levels of dietary fructose can produce undesirable changes in blood lipid levels, which are associated with heart disease.
    The complete citation is J. Hallfrisch, S. Reiser, and E.S. Prather, "Blood lipid distribution of hyperinsulinemic men consuming three levels of fructose," American Journal of Clinical Nutrition, Vol. 37, May 1983, pp. 740-748, abstract online at

    Subsequent studies support these findings. John P. Bantle et al., "Effects of dietary fructose on plasma lipids in healthy subjects," American Journal of Clinical Nutrition Vol. 72, November 2000, pp. 1128-1134, on-line at found that a diet high in fructose produced high fasting, postprandial, and daylong plasma triglyceride levels among men, but strangely not among women.

    S. Reiser et al., "Blood lipids, lipoproteins, apoproteins, and uric acid in men fed diets containing fructose or high-amylose cornstarch," American Journal of Clinical Nutrition Vol. 49, May 1989, pp. 832-839 found "that in a diet high in saturated fatty acids and cholesterol, fructose increases the levels of risk factors associated with heart disease, especially in hyperinsulinemic men."

    Back in 1995, Jack Challem, a well-known medical journalist, wrote an excellent article about the dangers of fructose for The Nutrition Reporter. The article is online at


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