Is All Sugar Created Equal?

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You’ve probably heard it countless times, especially in low-carb circles: sugar is sugar is sugar. This is true in principle – the glucose, fructose, and sucrose found in table sugar or high fructose corn syrup (HFCS) are the same molecules as the glucose, fructose, and sucrose in honey, fruit, and starchy vegetables.

But when it comes to the way your body uses these sugars, these foods are hardly comparable. In this article, I’ll show you why all sugar is not created equal, and why you should care.

Does sugar from fruit and starchy vegetables have the same impact on your health as a candy bar?

Fructose and High Fructose Corn Syrup Are Not The Same Thing

In my previous post in this series, I compared HFCS with white sugar and concluded that these two sweeteners are more or less metabolically equivalent. In the comments section, a few people brought up research showing that fructose is metabolized very differently from glucose; in fact, it’s metabolized more like alcohol.

I’ll address that research in a second, but first, understand this: high fructose corn syrup is not the same thing as fructose. Fructose is a simple sugar molecule with a specific chemical structure, while HFCS is a mixture of fructose and glucose in a roughly 1:1 ratio.

Now, there are certainly some scary studies about the metabolic effects of pure fructose. In animal models, fructose administration can cause dyslipidemia, non-alcoholic fatty liver disease, insulin resistance, and even type 2 diabetes. (1)

But these harmful effects result from animals being fed large amounts of pure, isolated fructose. In this form, fructose does act much like a toxin in the body, and it would be a terrible idea to start sweetening your food with pure fructose. But because fructose isn’t found in isolation in nature or even in our food supply, these studies are largely irrelevant to practical nutrition.

Already, we’re beginning to see that all sugar is not created equal, and that form and “packaging” makes a huge difference in metabolic effect. In this case, pure fructose does not affect the body the same way as fructose in sugar or HFCS. Now, what about fructose in fruit?

Fruit: More Than Just a Hit of Sugar

Although conventional wisdom holds that fruit is unquestionably a health food, the push to avoid sugar and excess carbohydrates has in many cases left people hesitant, even afraid to eat fruit. While it’s typically acknowledged that eating an apple is better than eating a bag of candy, fruit is still often seen as a source of sugar that should be consumed in strict moderation, and the phrase “sugar is sugar” is a common refrain, especially in Paleo or low-carb communities. The problem with this viewpoint is that added sweeteners and fruit have completely different metabolic effects.

First of all, the fiber and water found in whole fruit increase satiety, which makes it less likely that you’ll go into caloric excess. Studies going back more than forty years have shown that naturally occurring sugars in fruits are beneficial to health and do not promote weight gain, and we can see these effects in traditional cultures such as the Kuna, who obtain a significant percentage of their calories from fruit while remaining lean. (2, 3)

And despite some claims to the contrary, there’s no evidence that we should avoid whole fruit simply because it contains fructose. (4) Far from being a health hazard, like pure fructose or added sweeteners, studies overall suggest that eating whole, fresh fruit may actually decrease the risk of obesity and diabetes. (5) Additionally, randomized controlled trials have shown that eating fruit reduces oxidative stress markers and blood glucose in diabetics. (6) Further, limiting fruit intake has no effect on blood sugar, weight loss, or waist circumference. (7)

For most people, 3-5 servings of fruit per day is perfectly fine, although certain people with insulin resistance, diabetes, or metabolic syndrome may see improvements by restricting fruit intake to one to two servings a day, and by choosing fruits that are lower in sugar. Additionally, some benefits of fruit restriction for digestive issues come more from avoiding high FODMAP fruits as opposed to fruits altogether.

Solid Sugar vs. Liquid Sugar

Another angle to consider is the issue of sweeteners in beverages versus sweeteners in solid foods. Countless studies have demonstrated that drinking your sugar has uniquely harmful effects, primarily because most people fail to reduce their caloric intake to compensate for the extra calories they’re consuming in sweetened drinks. (8)

For example, a study of 323 adults found that subjects who increased the number of calories they obtained from sugar-sweetened beverages didn’t decrease their caloric consumption from other sources. (9)

Another study showed that total calorie intake among sixteen patients was greater on the days that sugar-sweetened beverages were given at lunch than on the days they weren’t. So even when the sweetener used is the same (usually sugar or HFCS), consuming it in a beverage will have different health effects than consuming it in a food.

Real Honey vs. Fake Honey

I’ve already written about the unique metabolic effects of honey, and there have been studies comparing the effects of honey and “artificial honey” on blood lipids, insulin response, and blood sugar. Although artificial honey is a mixture of glucose and fructose in the same ratio as was found in natural honey, its metabolic effects are completely different.

In one study, supplementation with real honey decreased triglycerides and LDL cholesterol, increased HDL cholesterol, and even decreased plasma homocysteine. (10) On the contrary, the artificial “honey” raised triglycerides and LDL cholesterol. Other similar studies have found that natural honey results in more stable postprandial blood sugar and insulin response when compared with artificial honey. (11, 12)

There are further examples that I won’t get into, but I hope I’ve demonstrated that the phrase “sugar is sugar” is simply not accurate when it comes to nutrition and “real” food. The source of sugar does make a difference, and we as a community need to be careful about generalizing study results where they may not apply, and demonizing foods that don’t deserve to be demonized.

If you missed any of the previous articles in this series on sweeteners, be sure to check them out below, and stay tuned for the final post where I’ll tie everything up and give you some practical tips on where sweeteners should fit in a healthy diet.

Now, I’d like to hear from you. Did you believe that all sugar is created equal? Do you now? Share your thoughts in the comments!

Previous articles in this series:

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Comments Join the Conversation

  1. Groentjes says

    I have a question about a certain type of sugar, crystalized sugar. Apparently called rock candy in English according to wikipedia. Where I come from it is used in certain types of cookies and I love the taste of it.
    I have read that this type of sugar is regarded as part of traditional chinese medicine. Does it have therapeutic properties ?
    I am just really curious, but cannot find anything about it

  2. Mike says

    If anyone here has done any research they would know that the reason diabetes is so prevalent is due to the mitochondria and pancreas destroying polyunsaturated fats and not sugar. Otherwise my blood sugar of 95 with 500+g of fruit sugar a day would not be possible.

    Have a nice day.

  3. Suzanne Anderssen says

    I am grateful to the scientists out there who are continually researching and investigating what’s in our food and providing us with informed options on what we then choose to eat. However, it feels like we have put too much faith in the scientists to prove once and for all what is healthy for our bodies.
    What if we relied less on research, and more on what our bodies are telling us what is good for us and what supports us? Our bodies tell us at every opportunity whether it ‘likes’ that food we just ate or not. What we eat needs to be about what feels good in our body immediately and long after we’ve eaten the food, not about what tastes good. And you can have both!
    Our body can and does tell us (when we choose to listen and be totally honest with ourselves) how much sugar we need and from what source. One day we might need an apple, another day it might be blueberries. It won’t ever tell us we need to eat a candy bar though!
    Just listen, feel what’s going on, and we can then use our scientists to confirm what we already feel.

    • Roberta says

      I try to keep my carbs down. I feel better when I do but I have noticed something interesting. When I have cane sugar I feel a crash and always regret it but when I eat coconut sugar I don’t get the big crash. Coconut sugar must break down completely different in my body.

  4. Travis Jensen says

    Unfortunately, knowing whether HFCS is more like sucrose or more like fructose is not possible. While the industry states it is 55-45 fructose-sucrose, independent testing has shown it to have a large variability, up to 65% fructose[1]

    If Richard Johnson’s hypothesis is right, and the fructose->uric acid pathway is a causal pathway to metabolic syndrome, diabetes, and obesity[2], then that extra amount is not just an unimportant mis-statement, but rather, a dangerous lie. Given the high fructose content in many of the “natural” sweeteners like honey and maple syrup, it would also recommend seriously limiting the use of those.

    1. http://onlinelibrary.wiley.com/doi/10.1038/oby.2010.255/full

    2. https://www.youtube.com/watch?v=blzZKUFN4x0

    • Suzanne Anderssen says

      Beth, try eating coconut sugar and see/feel how that is in your body. Do you feel stimulated, racy, confused, bloated, headachy, dull, sad, flat, tired after eating it? Your body will tell you if you’re prepared to listen. Science is awesome, but your body is even more amazing and Always truthful – the body cannot lie.

    • Lisa B says

      Coconut Sugar has a significant sucrose and fructose content. It should affect blood sugar levels the same.
      From my readings of ALL the sweetener articles Chris Kresser wrote, my choice is Erythritol, Honey, Xylitol, and Stevia. That is, after detoxing from all sweet things for a couple weeks in order to rid the body and brain from the addiction to sweet things, so that when I choose to have something sweet, I can eat those sweeteners in moderate amounts.

  5. Marcia says

    Chris,

    This is good information, but your examples don’t seem to speak specifically to the impact of the ‘sugar’ being ingested. When you say that the benefit to consuming sugar via fruit is better than consuming sugar via an articial means, your commentary focuses on how eating the fruit lowers your overall calorie intake, not to how the sugar from the fruit impacts your health ( or doesn’t).

    I remain confused about the impact of sugar in fruit vs the impact of sugar consumed artificially. I think a couple of notable ‘fruititarinas’-Steve Jobs and Horst Redenbacher (Aveda) both had significant liver damage that has NOT been directly tied to their diet but is certainly suspect given your reference to the non-alcohol fatty liver disease that has been a proven result of excessive intake of artificial sugars.

    Thanks for the attempts to simplify a nuanced problem but I’m not sure I have the answer yet.

  6. Nate says

    Well as a Type 1 diabetic, I can tell you no diabetic should eat 1 or 2 fruit servings per day if they want normal blood sugars. I’ve had diabetes for 50 years and I believe I’m a live and not blind today because I started eating a low carb high fat diet 10 years ago. Dr. Bernstein’s Diabetes Solution explains that even an average blood sugar of 120 mg/dl can cause disease.

    To me bread and bagels are not much more than baked blood sugar. Anyone with diabetes and even metabolic syndrome should know that eating something that their body cannot properly handle will do damage.

  7. Wilmark says

    When you say “drinking your sugar” will this apply to making smoothies only of pure fruit, with NO added sugar? Ive been trying to investigate the pros and cons of fruit smoothes, some claim that the fine liquid helps digestion of the nutrients, others claim that there will be greater sugar absorption and ‘destruction of the fiber’. What does the science say about this?

    • arto says

      For extreme poor digestion cases, juicing is used to easily digest nutrients. In most cases, the main benefit is to quickly obtain nutrients, or in the case of vegetables, to be able to obtain a much larger quantity of nutrients without the time to eat them.

      The digestion of solids usually takes over 3 hours to enter the bloodstream. Anything juiced passes the digestive system and enters the bloodstream in less than 1/2 an hour. All nutrients… and all sugars.

      The fast increase of blood sugar from juicing fruits, not to mention fructose, starts the insulin-fatty acid chain reaction that happens with any sugar.

      Best to eat fruits, juice vegetables, and not too many of those that have a lot of sugar like carrots and beets.

  8. says

    I agree that the paleo crowd is not correct in considering fruit as the same as all other sugars. When I was a fairly strict raw foodist in San Diego, I knew lots of people that ate large amounts of fruit, none of whom had metabolic syndrome or blood sugar problems.
    This is an interesting website /book I just came across: http://www.healingdiabeteswithfruit.com/
    which discusses diabetic cases that have been healed largely by eating fruit. Dr. Gabriel Cousins also heals diabetes but does restrict fruits I believe while getting blood sugar under control. His documentary movie – “Simply Raw: Reversing Diabetes in 30 Days” is worth a watch too, though they ate mostly nuts, seeds and veggies

  9. Carol Willis says

    More info on the ample fruit diets e.g. raw vegan, high raw etc, and their effects on fatty liver please. Do age and weight play a large role in those cases? Or what factors might modify a fatty liver response to an ample fruit diet?

  10. says

    Interesting article, what I find in my practice is that some people seem to abuse honey and agave etc, because it is not table sugar they think they can use it liberally. I suppose there are people that eat too much fruit but that is not an issue I have encountered in my practice.

    • helene says

      I read Suzanne Somers books and she states her husband used to eat 20 pieces of fruit a day. But he thot it was ok. It was fruit! Many adults feel the same…and about juice. Hey, its fruit; can’t be bad! Children will also do this if allowed, eat huge amts of fruit. They’re just subbing fruit for another junk food. Same dental caries, sugar imbalances, hyperactivity, diabesity as eating junk food.
      Adults who eat grains, esp wheat, will be eating way too many grains too so they can limit the fruit. If they go off the grains, boom! Fruit is the next food to abuse. Greens and fat are limited when not limiting grains and fruit, even when junkfood is cut out. When you have a client eating too many greens or other fibrous veggies, let me know. It’ll never happen with no limits on fruit.

    • Boundless says

      > … abuse honey and agave etc, because it is
      > not table sugar they think they can use it liberally.

      I opined on honey earlier. On agave, you might tell them that so-called “agave nectar” should actually be called “extra high fructose agave root syrup”. It is usually made the same way as HFCS, and can be up to 90% free fructose.

      Making it also destroys the plant. Your tequila and mezcal drinking clients might be horrified about that.

    • helene says

      Some ppl feel stevia white powders or glycerite is too processed. They use the green powders or the stevia leaves themselves. For me even if it was as bad as hfcs or agave etc (which it’s nowhere near) I don’t have a problem becuz you need an infestimally small amt. And I also just trained my sweet tooth to need very little sweetness in my diet. Water with lemon or pure cranberry juice, whole fruit only, no caffeine drinks needing sweetening, most meals with no sweet taste at all. So when I have the rare almond flour muffin it can have stevia in it or the few drops in my greens smoothie.

      • marcie says

        Thank I am a sweet drinker I consume most of my calories from drinks so to switch to liquid stevia is going to be a huge change that I plan to achieve.. thanks for all the great input .

        • Hélène says

          The thing is your body is hooked on the SUGAR not just the sweet taste. So when you switch to stevia, your body is not going to be happy. You’ll want more and more and more. Maybe even sugary/starchy foods.
          At least for a few days to a few weeks (I’ve seen it take a few WEEKS, yes). Then your body will adjust to low sugar intake. But be ready for a battle.
          And there are products out there that propose to make this transition easier/shorter. They don’t really– that I’ve ever seen.
          It’s a matter of simply being in agony for awhile.
          Knowing that tho may give you the fortitude to pull through it.
          There IS relief at the end of tunnel! Just keep slogging through the withdrawal and readjusting of your diet. It’s WORTH IT.

    • John Es says

      You might want to avoid products like Truvia.

      Many products promote the fact that they use stevia, but, you’ll find erythritol in the ingredients. For some reason, they don’t mention that (I wonder why).

      The last time I bought stevia, it was a liquid, in a little dropper bottle from my health food store – the store brand, IIRC. I rarely use sweeteners, myself, just eat my share of fruit to get plenty of sweetness and sugar carbs.

      If I was eating something that required sweetening, I would use stevia, based on the information I have, to date. I can handle pure cranberry juice just fine, so, I seem to have lost my sweet tooth.

      http://en.wikipedia.org/wiki/Truvia

  11. says

    re: “natural honey”

    We can argue about the metabolic effects of this sugar, but anyone planning to consume it needs be aware of the rampant dilution, adulteration and outright fraud in the honey market. The chances that’s it’s largely HFCS are surprisingly high.

    I’ve previously summarized this on the Wheat Free Forum under topic “Honey”, linked from my user name here.

    I don’t eat honey. My personal policy on fructose is:
    – zero refined fructose from any source
    – fructose in whole foods only as whole fresh (not dried) fruits, and subject to my net carb targets (and fruits vary wildly in sugar content : blueberries do not equal papaya).

    Either blood sugar (BG and HbA1c) matter, or they don’t. If they do, the glucometer or HbA1c kit overrules the Nutrition Facts the fruits would have if they had an NF panel, which they don’t, so you’re on your own here.

  12. marcus volke says

    Chris, you stated “studies overall suggest that eating whole, fresh fruit may actually decrease the risk of obesity and diabetes. (5)”
    But when I followed the link what the study actually said was “Separately, quantity of vegetable intake (0.76 [0.60-0.97]), but NOT fruit, was inversely associated with T2D in adjusted analysis”

  13. Trish says

    All I know is that I’m sick of people refusing to eat a freaking banana because it’s going to make them fat – sheesh.

    Thanks for the article Chris – very edifying!

  14. James says

    What’s the verdict on agave, then? I hear it is a way lower GI sweetener and yet it’s a refined product made up largely of fructose.

    And what about the sugars in say, kefir? Does the fat and protein blunt the blood sugar response? Ditto for fruit when consumed with fat or protein?

    And does low blood sugar raise cortisol, which in turn draws upon glycogen stores and raises blood sugar? Could eating too little therefore also impair metabolism?

    Sugar is confusing.

  15. says

    Hi – which would be better base for a sport drink powder, fructose or glucose?
    There is a lot of contravesy, as an athelete we need these beverages but which is the better option?
    Thanks so much
    Diane

    • marcus volke says

      Hi DIanne, dr. jaminet addresses that question here -http://perfecthealthdiet.com/2012/01/is-it-good-to-eat-sugar/

      He concludes that a 70% glucose, 30% fructose/galactose mix is best.

  16. Angela says

    I understand what you wrote and thank you. I have a question, I have taken most carbs (breads, pastas etc) out of my kids diet. Now they eat fruit all day long for a snack. I tell them it is still sugar…they get moody ( I am guessing the high and then low when the sugar wears out) and go for more food. And my youngest just seems to get tired so easily (she eats the most fruit). So is your article saying it isn’t the fruit in sugar giving the highs and lows? I am always suggesting something with protein for a snack too but they eat all day and are skinny and I run out of food ideas. Thanks

    • Hélène says

      Have raw veggies cut up and ready to go in the fridge. And also having cooked veggies ready to nuke (I know but hey I’m being realistic here) gets them to eat those too.
      Enforce the rule they have to have protein with EACH piece of fruit. We only have fruit for dessert here. Very rarely have it alone — only if I’m desperate and they’ve had alot of veggies that day and are sick of them lol
      Protein can be nuts and seeds, cheese, plain yogurt (stevia glycerite sweetened maybe), nut butter. Doesn’t have to be meat.
      You could even just say, hey 3 pieces of fruit a DAY is it. What you eat with a meal counts twds that. And then enforce it.
      Fruit can be just like junkfood, becoming a junkfood itself…cravings, filling up on it to the exclusion of dairy and veggies. NOT GOOD.

  17. Kristin says

    As somebody with insulin resistant pcos, I’ll stick to low fruit. I’ve had to increase carbs recently while treating SIBO, so I’ve added small amounts potatoes, apples, banana, mandarins, always with added fat, but still I’ve noticed difference with my appetite control and I regained small amount of weight. As much as I’ve enjoyed eating these, they’re natural, they taste good etc, I’m looking forward to removing them again. I’ve lost 40 kg, but it’s taken 3 years, and I’ve had long periods where my weight would not budge in that time. Last thing I want to do is go backwards.

      • John Es says

        The referenced study is directly linked in this article. Chris has made it very easy to do your homework.

        • BarbaraAinSC says

          I looked up the links, per your suggestion. The 2 links/articles reference “honey-comparable glucose-fructose” and “simulated honey and D-glucose using oral glucose”. I’m not sure that I would call that “fake honey” – it doesn’t really sound like honey to me. At any rate, I believe that Chris should have defined this term a little more, at least in this case. In my opinion, “honey substitute” or “honey equivalent” seems more apt than “fake honey”. I always appreciate Chris’s articles, but this mention left me confused.

        • Wenchypoo says

          You might also do a search for counterfeit foods–honey isn’t the only food sold in this country that’s been faked to make more affordable to the masses!

          We’re talking olive oil, “scallops” (that turn out to actually be circle cuts of white fish), etc.

    • Hélène says

      “Although artificial honey is a *mixture of glucose and fructose in the same ratio as was found in natural honey*, its metabolic effects are completely different.”

  18. Suzanne says

    I’ve had type one diabetes for 22 years, And I agree that I do have to limit my fruit intake. On the advice of several including Dr. Bernstein’s book, I went very low carb cutting fruit out almost entirely. I think the result of that is a very slowed metabolism, a slowdown of my thyroid, and failure to heal my hurting adrenals. I am slowly adding back berries kiwi grapefruit and occasionally more sweet fruits. I have to do more experimentation with things like honey and sweet fruits, But I have to be careful with things like bananas, As my body can read them as just plain sugar. I wish I had been more aware growing up, and was not in a situation where I have to restrict healthy foods. I will tell you that my body reads bagels and other things with Whiteflower is just plain sugar also. The insulin spike maybe slowed because of added fat, But still a metabolic nightmare

    • Hélène says

      Bananas are like white sugar to my body too! I can feel the effects even. Which sucks, becuz the flavor of smoothies with even 1/2 a banana just cant be beat, no matter how much stevia glycerite I use!
      I stick to raspberries, blackberries and occasionally blueberries when on the rare occasion I even have fruit at all in my smoothie. It’s usually greens only with stevia.
      Sometimes I get really mad at my parents for feeding me crap and teaching me to destroy my metab. But I know they were ignorant. Parents nowadays don’t have this excuse. The info is EVERYWHERE. WheatBelly is a household word!

  19. says

    Great insights Chris! My picture is that sugar bound up with fiber (as in fruit) is primarily metabolized in the gut by gut bacteria creating short chain fats which are what actually enter the body. Processed sugars mostly avoid the gut bacteria and go straight into the body, raising sugar levels in the blood. Does that story seem right to you?

    • paula says

      I hope thats is true & fruit is thus metabolized easier. I think many diabetics would disagree?
      I grew up on Omohundro Dr. in TN. I always thought it was an unusual name.

  20. says

    I had heard that “sugar is sugar no matter where it comes from”. And as usual I believed it:(
    BUT Chris, now that you have almost the final word in my dietary life, I will definitely add more honey to my diet – gladly and I will pass it on to my grandchildren as well.
    Thanks.

  21. amy says

    I think the SCD diet is onto something. Eating fresh fruit doesn’t result in an overgrowth of bacteria in the small intestine, it’s mostly metabolized in the stomach when eaten on it’s own. Same with raw honey. Manufactured sugars and grains negatively effect gut flora. I don’t get that lightheaded sugar high from a big bowl of fresh fruit that I get from even half a muffin. I suspect it’s related to gut flora. Every organism is unique, and we need to keep reminding ourselves of this. Different genes, different diets in infancy, different probiotic profile from the birth canal…. We can only correct so much, and then we have to do what allows us to feel the best we can, and live our lives.

  22. says

    “For most people, 3-5 servings of fruit per day is perfectly fine, although certain people with insulin resistance, diabetes, or metabolic syndrome may see improvements by restricting fruit intake to one to two servings a day, and by choosing fruits that are lower in sugar” This is from your blog post BUT the problem is…..most of society is not in a place where they can eat 3 to 5 servings of fruit per day. Being a nutrition coach, if my clients need to lose weight, especially more than 30 pounds “which a good majority do” I limit their fruit intake to 1 to 2 servings per day or their weight loss stops. From my experience “which is 30 years in the industry” when on a weight loss journey fruit is not your best friend and in fact can be a hindrance. A better option is to go to cruciferous and high leafy green veggies for the vitamins, mineral, antioxidants and fiber you need and leave the fruit to a minimum.

  23. says

    I love how you tackle topics like this with reviewing the science, putting it in perspective and getting into enough detail without being too scientific. Just a thanks for all you do. Sharing this on social media and will include links to it in future writing.

  24. Jane Goodman says

    I have glucose intolerance and find that even low-glycemic fruits can give me sugar spikes in the 140-180 range. Including things like Blackberries, blueberries… If fruits are metabolized via the liver rather than via insulin why should this be?

    • Chris Kresser says

      Fruits contain both glucose and fructose. Some fruits contain more glucose than fructose, others vice versa.

    • John Es says

      According to http://nutritiondata.self.com

      Blackberries and blueberries contain almost as much glucose as fructose. The ratio is practically 1:1, like table sugar or HFCS.

      You don’t mention how much you’re eating, or what other macronutients you are having with your berries, so, maybe it’s worth mentioning to keep the portion small, and add fats like cream, coconut milk, etc. to slow down the burn.

    • Catherine says

      A glucose spike can also come from glucose production in your body via cortisol. So even though the food didn’t have a lot of glucose, you see the huge spike because something in the food caused a stress response, and increased cortisol. The cortisol then increased blood glucose. I’ve heard of this happening to people with wheat intolerance when they eat wheat.

    • Wenchypoo says

      Let’s not forget that the varieties we have access to today have been bred and hybridized to within an inch of their lives to amp up the sweetness and shelf life. This is NOT the same fruit Grok ate.

  25. Karl says

    You said, “For most people, 3-5 servings of fruit per day is perfectly fine, although certain people with insulin resistance, diabetes, or metabolic syndrome may see improvements by restricting fruit intake to one to two servings a day”.

    I’ve read most Americans are insulin resistant. Thoughts?

    • Brandon Gresham says

      BINGO!

      It’s obvious, too, that we have metabolic disorders when you simply look at our waistlines and activity levels. Lots of Americans are fairly active (not formal exercise, but not just sitting all day either), yet so many of us have that broken metabolism belly look.

      We should be careful to clarify the CONTEXT of a recommendation. Fruits are healthy? Yes, but only provided you are already healthy.

    • amy says

      “people with insulin resistance, diabetes, or metabolic syndrome” – I’d say this covers a very large percentage of the population!

    • Chris Kresser says

      Current research suggests about 1/3 of Americans have impaired glucose tolerance and/or insulin resistance. Diabetes and metabolic syndrome are less common.

      In my audience, and my patient population, both are less common than the numbers above. There’s no reason for lean, metabolically healthy people to significantly restrict fruit consumption, but of course if someone has a blood sugar issue they will need to exercise caution.

      • Hélène says

        I have not read such a low percentage in a long time. Everything I read is double that. Depending on the age population it’s can be even higher.
        I think it’s epidemic and it’s only that the inclusion of young ppl are skewing it so it doesn’t appear as bad as it is for anyone over 30, maybe even 25. There are so many FAT young ppl now tho, in another decade that’ll be gone lol
        I fear a diabesity invasion in westernized countries.

        • Catherine says

          Not everyone overweight is insulin resistant though. Most overweight people don’t develop diabetes from what I’ve read, because you need the genes for it.

    • Hélène says

      I think 2-3 fruits a day is plenty for anyone, including normal metabolisms. For everyone else (the other, oh, 65-80% of Americans) 1-2 LOW glycemic fruits daily is more than plenty. You still want to be able to eat some healthy starchy vegs too so I’d say one fruit a day, max. Unless you’re a young person who has not killed their metab yet. AND you are active so you are not in the process of killing ur metab LOL
      Keto diets rly allow no fruit or starchy vegs. They work to regain some metabolic function in sick ppl. Once you’ve stablized you can add in some fruit and starchy vegs, as you can tolerate it. Remember MOST Americans are sick. Their metabolisms are screwed. Recovery is not complete healing, it’s making it *better* for most ppl.
      If you have good genes and this doesnt affect you, thank your lucky stars. But it DOES affect most adults.
      It’s too bad we poison our kids’ metabolisms. I wish parents understood this instead of thinking theyre loving their kids by feeding them CRAP and/or too much of any healthy thing they mite happen to accidentally give them :(

  26. Gretchen says

    The problem with understanding high fructose corn syrup is understanding the meaning of “high fructose.”

    Regular corn syrup is almost 100% glucose. So if you converted only 10% of the glucose to fructose, the fructose level would be high in relation to regular corn syrup and would be HFCS, even though it contained less fructose than table sugar (sucrose), which has 50% fructose .

    But most people think “high fructose” means a lot of fructose, a lot more than table sugar.

    Ironically, a lot of people who are afraid of “high fructose” corn syrup with 55% fructose are substituing agave syrup, which is almost 90% fructose because it’s marketed as all natural and low-glycemic.

    • jlocicero says

      Thanks for writing this! I was confused when the article stated “HFCS is a mixture of fructose and glucose in a roughly 1:1 ratio.” That makes it about a third fructose – how could it be higher fructose than sucrose? Now I understand it is not higher in fructose than sucrose – just higher in fructose than ordinary corn syrup. I always assumed HFCS had more fructose than glucose. Thanks for clearing this up!

      • Catherine says

        Wouldn’t a 1:1 ratio mean 50% glucose and 50% fructose, not 1/3?

        Sucrose is also 50% glucose and 50% fructose, since sucrose is just fructose bound to glucose. Therefore, the amount of fructose in HFCS and plain sugar is about the same: 50%.

        (HFCS is usually stated as being 55% fructose, but that’s why Chris said the ratio is “roughly” 1:1. Incidentally, this means HFCS does have more fructose than glucose, but not by a lot.)

  27. James says

    Chris,
    Thanks for the nice summary. Will you be addressing the issue of others equating complex carbohydrates with sugar digestion. Or did you do this elsewhere? for instance recently i saw someone on twitter talking about bagels being equal to 14 spoons of sugar. I can’t believe the rate of digestion (GL) is the same, the same point has been made about wholemeal bread
    Cheers
    James

    • Brandon says

      James, the bagel/sugar discussion you’ve seen was talked about a lot in the book Wheat Belly (a great read, incidentally).

      While the total effect of eating a bagel vs straight up sugar is certainly not the same, the book’s authors explained that it is indeed the same from an insulin-load perspective. That is, eating either caused a similar response in blood glucose levels.

      Not surprisingly, eating whole wheat bread causes a similar response as eating a candy bar.

      While this does not mean the entire impact on the body is identical between these foods, it does show a relationship that leads to at least some of the most serious modern ills (diabetes, obesity, hormone signaling, etc)

      While I agree that sources of natural whole foods sugars are not the same as processed forms, it’s worth remembering: grain based foods are not unprocessed whole foods (can you find bread in the wild?)

      And while I agree with Chris’s general point here, I also think context is important. Someone with a broken metabolism (that is, someone who has abused sugar to the point where their insulin sensitivity is wonky) already has a problem dealing with large amounts of sugar. While fruit is indeed better than table sugar, it seems to me the lifetime abuse of sugar in the past necessitates a reduction of all sugar in order to return to balance. That is, unless there is a study showing that fruit does not trigger an insulin response (which of course you will never find).

      • Eric says

        I don’t think it’s that useful to compare plain bread and bagels to sugar when normally these are consumed with varying amount of butter and cheese or dipped in olive oil which can have a huge effect on the overall GI of the meal/snack. Likewise a pack of greasy peanut butter cups has a much lower GI than a bag of skittles. I don’t recommend eating these things, just food for thought.

      • Chris Kresser says

        I don’t buy the argument that eating a bagel has the same effect as eating 14 spoons of sugar. Of course I don’t advocate eating either bagels or 14 spoons of sugar, but I’d be willing to wager a lot that if we did post-meal blood sugar and insulin testing on a group of people eating those foods, we’d see *very* different responses.

        • Hélène says

          That’s exactly the point the book’s making. It DOES affect bld levels, spiking insulin, with both those foods.
          My own sugar testing bears this out.

          • Wenchypoo says

            And as far as “sugar is sugar” is concerned, IT IS when you’re talking to a diabetic or a potential diabetic.

          • Emerson says

            Back in the 1920s a scientist decided to put people on a high sugar diet.

            The results? Improved insulin sensitivity, meaning that the insulin was more effective at getting sugar into the cells on a high sugar diet compared to the baseline diet.

            It’s counter-intuitive, but it’s true.

            • Emerson says

              Janket SJ, Manson JE, Sesso H, Buring JE, Liu S. A prospective study of sugar intake and risk of type 2 diabetes in women. Diabetes Care. 2003 Apr;26(4):1008-15.

              Smith U. Carbohydrates, fat, and insulin action. Am J Clin Nutr. 1994 Mar;59(3 Suppl):686S-689S.

        • beaker says

          Chris is especially right in regards to sourdough based breads. Maybe this warrants an article “not all breads are created equal”. I looooong ferment sourdough all my breads. I ferment them for 3-4 days sometimes.

          “With the sourdough, the subjects’ blood sugar levels were lower for a similar rise in blood insulin,” says Graham, whose findings are to be published in the British Journal of Nutrition.
          He continues, “What was even more interesting was that this positive effect remained during their second meal and lasted even hours after. This shows that what you have for breakfast influences how your body will respond to lunch.”

          5 Benefits to Sourdough Preparation

          1- Increases beneficial lactic acid
          The longer rise time needed for sourdough increases the lactic acid and creates an ideal pH for the enzyme phytase. This enzyme breaks down phytates (read more about the dangers of phytic acid here) more effectively than in yeast breads. Sourdough rye has the least amount of phytates (somehow the Swiss culture mentioned above must have known this) making it a healthier bread.
          2- Predigestion of starches
          The bacteria and yeast in the sourdough culture work to predigest the starches in the grains, thus making it more easily digestible to the consumer.
          3- Breakdown of gluten
          Here again, the longer soaking and rising times in the preparation of sourdough breaks the protein gluten into amino acids, making it more digestible.
          4- Preservative
          The acetic acid which is produced along with lactic acid, helps preserve the bread by inhibiting the growth of mold.
          5- Better blood glucose regulation
          There has been some research suggesting that sourdough bread — sourdough white bread — showed positive physiological responses. The subjects’ blood glucose levels were lower after eating sourdough white bread compared to whole wheat, whole wheat with barley and plain white bread. Interestingly, the subjects tested after eating whole wheat bread fared the worse — with spiking blood glucose levels.
          Additionally, the researchers found that the positive response lasted through the next meal and for several hours after that. They concluded that what you have for breakfast will influence how the body responds to the next meal.
          This is all well and good, but the most pressing reason is the TASTE! That tangy, slightly sour taste is awesome! If you eat grains, make sourdough your primary source of grains.
          – See more at: http://realfoodforager.com/5-reasons-to-make-sourdough-your-only-bread/#sthash.rnaaqEpV.dpuf

          • Alec says

            Great feedback on sourdough bread- I’ve started eating sourdough bread about once per month now with good raw cheese, pate, and smoked wild salmon. I started doing after this after influences from WAPF and Michael Pollan (Cooked and Omnivore’s Dilemna). This is one place where food traditions are very important- a good quality sourdough bread is so much different nutritionally than a cheap mass produced white bread.

      • marcus volke says

        the biggest distinction between sugar and bread is that atarch breaks down to 100% glucose, while sugar is 50% fructose. The GI or insulin spikes following ingestion are irrelevant, sugar has a lower GI because fructose doesnt spike insulin, but fructose is still more insulinogenic.

      • Christy says

        Hello Chris- I was curious about your thoughts on agave necter as compared to other sugars or sweeteners. I like using it in replace of refined sugar because I thought it was better.
        Also- I have begun using beet sugar in my baking. Thoughts on this as well?
        Thanks!
        Christy

        • Rob says

          Don’t use beet sugar. Sugar beets are all genetically modified. I’m curious to hear Chris’s thoughts on palm sugar.

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