Ask Chris: Is Fructose Really That Bad? | Chris Kresser
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Ask Chris: Is Fructose Really That Bad?

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Paul from Facebook asks:

What are your thoughts on fructose? Is it really as bad as Paleo is making it out to be?

Dr. Robert Lustig has worked hard in recent years to demonize fructose, and his efforts have paid off. His YouTube video “Sugar: The Bitter Truth” has over 2.5 million views as of this writing. Lustig et al. claim that fructose is a uniquely fattening poison (when compared to glucose) that is as toxic to the liver as alcohol.

But is this true? Does the current evidence support this position? I’ve changed my views on this over time as I’ve become better acquainted with the literature, so I’d like to share my current understanding with you.

When it comes to fructose, calories matter

There’s no doubt that refined sugar – including fructose – can be problematic. But studies suggest that this is only true when calories are in excess.

This may be the most dangerous aspect of refined sugar: it leads to unintentional overeating. In a recent post on fructose, obesity researcher Stephan Guyenet points out that most people in these studies aren’t deliberately overfeeding. They are inadvertently overfeeding because they aren’t spontaneously compensating for the calories added to the diet via a large fructose- or glucose-sweetened beverage.

This doesn’t happen with fruit or other whole foods that contain glucose or fructose.

When people add fruit to their diet, they reduce their calorie intake elsewhere to compensate. Not so with liquid-sweetened beverages like soft drinks.

When people add a soda or two a day to their diet, they tend not to reduce consumption of other foods, and thus their calorie intake increases.

This is where fructose does appear to be more harmful than glucose. Although people don’t compensate for calories added via glucose or fructose, the fructose-sweetened beverages have more serious metabolic effects.

Is fructose uniquely fattening?

Dr. Lustig argues that, when compared to glucose, fructose is uniquely fattening. He claims that fructose is the most efficient substrate for de novo lipogenesis (DNL), which is the process by which the liver converts carbohydrates to fat.

However, Dr. Lustig relies on animal evidence that doesn’t apply to humans. There’s a big difference between mouse carbohydrate metabolism and human carbohydrate metabolism. When mice are on a high-carbohydrate diet that doesn’t provide excess calories, it’s common to see DNL rates of 50 percent and up. In other words, they are efficient at converting carbohydrates into fat, even when they’re not overeating. (1)

But in humans on an isocaloric diet (without excess calories), de novo lipogenesis falls into the range of 10 to 20 percent. The conversion of carbohydrate is less efficient in humans than it is in mice.

The research in this area is robust and uncontroversial. Nearly 50 controlled feeding studies have been performed on various aspects of cardiometabolic control. Most investigators working in this field believe that DNL in humans is negligible in response to fructose, and doesn’t comprise a significant source of dietary calories.

There’s another problem with extrapolating the animal evidence to humans in this case. The mice in the studies Lustig cites are eating huge amounts of fructose: up to 60 percent of total calories. You’d have to drink more than four 44 ounce Super Big Gulps a day to get that much fructose. Ain’t gonna happen.

According to researcher Dr. Sievenpiper in an interview with science writer David Despain at Evolving Health, the 50th percentile intake for people in the U.S. is 49 grams per day, which works out to 10 percent of total calories. Even the 95th percentile intake of 87 grams per day doesn’t exceed 20 percent of calories. That’s a lot of fructose, but it’s nowhere near the 60 percent of calories fed to mice.

Is fructose an evil toxin?

Dr. Lustig refers to fructose is a “poison” that is nearly as toxic to the liver as alcohol. But again, human evidence doesn’t support this claim.

In a recent paper, Dr. Luc Tappy and colleagues labeled acetate, fructose and different metabolites with stable isotope tracers so they could see how fructose is metabolized in the human body. (2) They found that 50 percent ends up as glucose, 25 percent goes to lactate and greater than 15 percent goes to glycogen. The remainder is oxidized directly (to CO2 through the TCA cycle) and a small portion – as low as 2-3% – is converted to fat via de novo lipogenesis.

Glucose and glycogen are easily processed by the body, and 2-3% conversion to fat is not significant. And while some have claimed that lactate may be problematic, a paper published more than a decade ago contradicts this. (Hat tip to Evelyn from CarbSane.) According to the authors:

The bulk of the evidence suggests that lactate is an important intermediary in numerous metabolic processes, a particularly mobile fuel for aerobic metabolism, and perhaps a mediator of redox state among various compartments both within and between cells… Lactate can no longer be considered the usual suspect for metabolic ‘crimes’, but is instead a central player in cellular, regional and whole body metabolism.

Translation: lactate from fructose isn’t a problem.

What does this mean for you and fructose?

Fructose-sweetened beverages like soft drinks and juice cause metabolic problems when calories are in excess, and studies have shown that people are not likely to compensate for the additional calories they get from such beverages.

This is why soft drinks and other beverages sweetened with fructose aren’t a good idea. That said, an occasional glass of fruit juice within the context of an isocaloric diet is unlikely to cause problems – unless you have a pre-existing blood sugar issue.

I don’t think there’s any basis for avoiding whole fruit simply because it contains fructose. As I’ve shown in this article, there’s nothing uniquely fattening or toxic about fructose when it isn’t consumed in excess. And since whole fruit contains fiber and other nutrients, it’s difficult to eat a lot of fruit without simultaneously reducing intake of other foods.

Fruit has been part of the human diet for longer than we’ve been, er, human. We’re well-adapted to eating it, and capable of processing the fructose it contains. (Unless you are FODMAP intolerant – but that’s a different issue entirely.)

315 Comments

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  1. I have been living in Germany for 2.5 years now. I am married to a German with children. My experience here in Germany is: The fruit aisles in all the grocery stores are very small. There are no big displays of fruit of any kind. Nothing like Whole Foods. The people of Germany eat a lot of fat, mostly pork and of course cheese along with bread. They eat this for breakfast and dinner. They traditionally do not eat a lot of fresh or cooked vegetables, these are only eaten at the mid day meal, covered in a cream or cheese sauce. They do drink a lot of alcohol along with drinking coffee and indulging in chocolate. They do exercise “every day”. A large majority of both men and woman would be classified as underweight in the US – they look absolutely fabulous well into their 70’s along with being fit – like fit enough to be mountain biking – I have seen it with my own eyes. We live near “Bike the Rock” competition. I am 5’8″ and weigh 150 and I am considered a bit overweight. The largest size in all stores is 12, above that you must go to specialty old womans store. (I barely make the cut!) Getting back to fruit. I have cut out sugar and fruit, out of my diet. One thing that is sure for me, that eating fruit excites my taste buds and then it all ends up with my splurging on something sugary. I agree we were not meant to eat fruit as we do today.

    • That’s your own lack of discipline if you splurge after fruit. When I am eating healthy, fruit included, I find it easy to resist sugar laden foods.

      And all that high fat dairy and chocolate? That’s why rates of testicular cancer are high in Germany, nothing to be proud about.

      • Dan, I find it quite distasteful that you judge people and tell them they have no idea what they are talking about, or they have no discipline, as though you are smarter than everyone else and you have it all figured out. Everyone is on their own path of self-awareness and nutrition. To have productive discussion, we certainly don’t need someone logging on and berated everyone like an internet bully.
        Didn’t you learn with every other five year old: If you can’t say something nice, don’t say anything at all.

    • That´s one good example of generalization! If this is what you have learned about Germans after 2,5 years living there…that`s really sad. That is as worse than saying that all Americans only eat Hamburgers all day, which seems to be actually more realistic than what you write about german eating habits.
      What you write is absolutely not right, I can say that, because I am German and nobody that I know behaves the way you describe;-)

    • Thanks for sharing . The reality on the streets is what counts and not lab rat junk science with bottom line horseshit.

      CHeers ! !

  2. I can only speak for myself: fructose for the span of about 4-5 years, when I was vegan and eat a lot of fruit even, destroyed my health……I was a raw food vegan, normal vegan and even was fruitarian for a few months. I had thyroid issues, gastrointestinal issues…..it was brutal. I don’t eat any fruit now, none. The only fructose I consume now is minimal in some vegetables. And my health and overall well being has completely reversed. I can’t say what I have done and do is for everyone, but I can tell you that as far as my body goes, fructose is extremely toxic, even in small amounts. I don’t care what anyone else has to tell me. Glucose and dextrose, I can eat a ton of and no side effects what so ever.

    • Well, there’s your problem, you had to concept of balance, of course you have no idea what you are talking about, you clearly didn’t in the first place. Fruit is one of the healthiest foods on planet earth. Take your agenda else where. Hilarious that you still take in dextrose, notorious for helping bad bacteria grow in the gut.

    • I am 66 years old and almost 5 years on a whole food plantbased diet of Dr.Esselstyn for coronay hearth desease .
      I eat an average of 5 servings of fruit per day sometimes up to 10.mostly Apple’s, banana , orange, blue and blackberries…
      I have moderate excercise 1 hour per day.(walk, bike)
      I have Total cholesterol of 100mg/dl LDL 70 and Triglycerides 80
      I felt never better since.
      The arteriosclerosis is partially reversing.
      Jean

      • Did you eat a lot of processed foods prior? Plant based foods get all the credit when in fact the actual reason one feels better is because they ceased eating processed foods and hormone/antibiotic laden meats. I ate raw vegan for a number of years and initially felt better but then the health issues started mounting. I went back to eating meat but hormone, antibiotic and grain free only, from animals that lived their lives as if in the wild. I eat 80/20 sometimes 90/10 I’m in my 60’s and my blood works are now looking great. I also look and feel great. I will never go back to a plant based diet again.

        • Read the China study (dr.Campbell) about the disastrous consequences of consuming animal proteins .
          It’s not only about arteriosclerosis, but also cancer, autoimmune diseases ( diabetes, multiple sclerosis ,chrons disease etc,)osteoporosis …
          I am upset that as a pharmacist, these important findings where intentionally kept out of my advised scientific literature ( by corporate money )
          I will never consume a milligram of animal ingredients for the rest of my life.
          Jean.

    • Friends: When ” science investigators” say fat, fructose,protein, carbohidrates, vitamins, probiotics and many other food components, you have to be alert, precautious,intelligent and smart when looking at the ” details ” of their super investigations. I agree with Dean that vegans with high intake of fruits, vegetables and whole foods have many ” side effects “. Fructose in fruits is amazingly beneficial, except for too sweet fruits for diabetics, but even so all fruits are exceptionally beneficial for humans. We are designed to be animal protein, animal fat and carbohydrates eaters. Any diet that excludes one of them or suggest a low intake of one of them is just going to fail.
      Vegans are defficients in many minerals and nutrients that are found only in animals, supplements barely fullfil the defficiency. Isolated vitamins and nutrients even in multi supplements are worthless and even become counter productive in mnay cases. Food must come in its original package. Fruits must be avoided in juices because of their high fructose/glucose content and also the fiber, and many other highly nutricious components bonded to the fiber are lost when juicing. Fructose indeed is very high and eventually something to take care of.
      We also know that vegans have the highest levels of UA among meat eaters, and vegetarians, they also have the lowest concentration of calcium, Omega 3, and vit b12. Lets get away from vegans a litle bit.
      Sciencetists are dangerous because proteins are from animals and plants, fats from animal and plant sources, and can be saturated, unsaturated and a mixture of both, carbohydrates are fruits and vegetables, grains and seeds, any vitamin or supplement can be natural and synthetic. if we look back, the real sickness of all times are the industrialization of agriculture and food processing. Industrial agriculture means GMOs,highly toxic chemicals in the food chain, soil depletion of nutrients and the inmense damage to the food natural and healthy intake patterns of humans. Animal proteins are highly toxic due to vaccines, hormones, antibiotics, supplements and genetic mutations. Animal fats are not mostly saturated anymore, they contain saturated and unsaturated fats. Refined grains and seeds, GMOs, highly toxic in agrochemicals and during processing and rhe human endless desire for money are producing the most damaging, toxic and poison conteining products…..REFINED GRAIN/SEED OILS. Grains and seeds are to be eliminated from the human,diet. They are not only genetically changed but they they contain many antinutrients. To say the least are lectins such as glutten and other proteins. Uric acid is a residue of animal and plant proteins,and specially a residue of industrial highly concentrated corn fructose and refined table sugar. Uric acid is NOT produced by fructose in fruits and vegetables because if eaten whole, the high amounts of minerals, vitamins, fiber and antioxidants make Uric acid rather a beneficial, necessary nutrients that acts as a powerful antioxidant in the body. Vegans consume a vast amount of legumes very high in purines. 3/4 of a cup of beans is the recommended daily intake of proteins frm beans. I never seen a vegan eating less than 1 1/2 cups of beans on a daily basis not to mention other sources of protein. I am actually recovering from arthritis that started as gout. I am also vegan, and when I was told a habe gout almost had a heart attack,but I was pro active, googled and investigated about nutrition for more than 2 years and became my own doctor and it is working. I like beans, but I had to cut my intake to 1/4 of what Imusually ate. I also like breads, cookies and pasta, got rit of them, and beer was my weekend all time friend, I still do not know what to do with my dear friend.
      Vegans have high uric acid because we think that veganism is the answer, but far from the truth, we have to learn the basics in nutrion. Vegans produce more uric acid but develop less gout and have trouble with excreting it because:
      -b12 defficiency
      -calcium defficiency since oxalates binds to them. This mineral is a must to make fluids more alkaline in the kidneys and urine in order to neutralize the acidity of urate and urinate the uric acid.
      -excess high corn syrup always present in 90 per cent of the food vegans like like sodas, artficial fruit juices and also added refined sugar in alll breads, cookies,pastas,desserts and many, many others.
      -iodine defficiency, very common in all people. Hypothyroidism.
      -excess unsaturated oils disrupting hormone function, since hormones are made from cholesterol which uses saturated fats only as cofactor. All people are loaded with unsaturated plant oils,our metabolism is slow to excrete uric acids which, because of the delay are reabsorved into the body.
      -vit c defficiency High fructose corn syrup is compleately empty of any nutrient.
      this vitamin es essencial to protect the uric acid from vegetable fats to slow the excretion of uric acid.
      -not enough water to quickly flash uric acid through the kidneys to the urine.
      -acidic ph

      Sorry for so long text

      Tito

      • I am afraid you make it to complicated.
        Eat as much as possible unprocessed foo.
        I take 2×1 spoon (15gr) of flaxseed per day.
        No animal (fish) is able to produce omega-3 by itself.
        They all get it from plants.
        We need 1mg B12 per day.most milk substitutes I use contain some b12 ,some calcium, enough to keep the levels ok.
        I can also state that the most important side effect is the enhanced sexual live.(testosterone level is 945)
        Since I was on the diet dally intercourse makes my wife and myself a happy and energetic couple.
        We would never ever want to miss this .

        Jean

  3. I agree that Lustig is wrong about fructose being toxic. The effects of fructose are part of natural survival adaptation in most species, including humans. And yes, it’s calories that make the difference. But the excess caloric intake is a result of the effects of fructose.

    Dr. Richard Johnson, an evolutionary biologist, (his lectures can be found on youtube) fed fructose to mice isocalorically and discovered no weight gain. But, they developed all the other symptoms of metabolic syndrome: insulin resistance, fatty liver, high uric acid, high cholesterol, high trig, inflammation.

    The problem is that he also found that fructose down regulates leptin and up regulates ghrelin (the appetite hormones) meaning that it makes you continue to want to eat regardless of how full you get. Yes, there is some fiber in fruit, but there is no fat for satiety. This is natures intended way to enable animals to accumulate fat in the fall to hold it over through the winter. Given the limited fruit available (berries mostly) and the limited time available (fall mostly) it’s not going to translate to huge weight gains for humans, but still some.

    OTOH, if fruit is available all year, that’s generally not consistent with nature. Also, the entire center section of every supermarket is loaded with processed foods containing high fructose corn syrup, which most modern societies consume in abundance.

    The key here is leptin and ghrelin. Regardless of how innocuous a piece of fruit or a glass of juice is, if you can’t stop consuming it, you can gain weight and begin to develop signs of metabolic syndrome, if only temporarily.

    There are some people who can eat fruit endlessly and never gain a pound. Nature suggests that these are the exception and not the rule. I even remember when I was following Macrobiotics that I was warned not to eat too much fruit as it would lead to weight gain.

    You say that high consumption of soft drinks is unlikely, but that simply isn’t consistent with real life observation. Morgan Spurlock demonstrated this in his movie “Supersize Me,” where he consumed the equivalent of 30 lbs. of sugar in a single month by drinking a juice with breakfast and a large soft drink with lunch and dinner. His doctors were amazed that he was developing liver disease. Of course, they unknowingly attributed it to a “high fat diet” because it was fast food, but if you analyze the macro composition, it was mostly carbohydrate, and of that, mostly sugar.

  4. “Moderation in all things” would seem to be the best advice for everyone and anyone. Boy, you can sure get bogged down in all these theories!

      • Not so trite as all that. My Dad lived by this motto till 98 1/2 years of age, was never hospitalized until the last 2 days of his life, and had a clear head until the end. Mind you he was quite deaf but that was due to the excessive amount of time he spent in engine rooms of ships at sea during WW2.
        MODERATION? How about nothing to excess? Or everything in moderate quantities. Except maybe kindness ☺

  5. I have just read Dr Lustig’s book. He also clearly states that there is no problem with fructose when it is consumed in fruit, with all the fiber etc. His argument is that we are overdosed on fructose when it is used as an additive in most/many processed foods. I recently spent 6 weeks in Canada (I live in Europe) and was amazed at the amount of sugar/fructose that is added to everything from mayonnaise to pickles, from natural yogurt to bread. I was also totally shocked by the number of hugely obese people I saw. Very rare on the European continent. There must be something in it!

    • “I have just read Dr Lustig’s book. He also clearly states that there is no problem with fructose when it is consumed in fruit, with all the fiber etc. His argument is that we are overdosed on fructose when it is used as an additive in most/many processed foods.”

      Boom, there is the answer. Everyone else can quit whining now.

  6. I’m glad you posted this. A lot of Paleo bloggers recommend fruit be the smallest portion of the diet but lately Im questioning whether it’s all that important. I think oxidation plays a huge role in my disease state as I have noticed more benefit from fruits and veggies than anything I’ve given up on the elimination diet. I eat plenty of leafy greens but fruits are the only way I can get the “rainbow” on a daily basis. Clearly you’re against fructose elimination in most cases, but do you have any advice on fruit restriction? I also have high pattern b LDL which is why I’m nervous to increase carb intake though I’m sure that’s more to do with glycemic control

  7. I was interested in your thoughts on fructose in honey, maple syrup, coconut syrup, coconut sugar and rice malt syrup. Are these products ok in small proportions?

  8. Regarding FODMAP content in food and in the paleo list, Ripe Bananas are considered healthy low Fodmap foods.

    But this is illogical because usually Ripe Bananas have more sugar in them, instead immature bananas are more starchy and less fructose-rich but have been placed in the alert zone of FODMAP Foods.

    This looks nonsense, can someone explain ?

    • Hi Sanxer,

      It actually depends on the type of banana (of course, FODMAPs just HAS to be confusing).

      – Common bananas are considered low FODMAP by Monash Uni’s research team in servings of 1 medium banana in all stages of ripeness.
      – Sugar (aka Lady Finger) bananas, on the other hand, are low FODMAP when green and yellow but become high FODMAP as they over-ripen and turn brown.

      However, just because something is considered low FODMAP doesn’t mean your triggers will follow the suggestions exactly; unripe bananas cause some people digestive distress not because of FODMAPs but because they are harder to digest, or bananas in general could contain something else entirely that you are sensitive to.

      And as with everything low FODMAP, if you can tolerate it in any amount, then continue eating it (as long as it’s healthy, of course). The low FODMAP diet was never meant to be a forever diet – unless, of course, you are unable to reintroduce foods without reactions. Studies are showing that a low FODMAP diet can negatively impact gut flora, as a variety of foods is required to feed the large variety of bacteria that live there. Have you seen a dietitian for help?

      I hope that made sense. 🙂

  9. By implication you are then saying that 100% pure fruit juice is too much fructose even though there is no added fructose. This is so because there is no fiber to limit the intake. I guess diluting with more water could be helpful then.

  10. Hi I would like to use this source for my science fair project. I need to know when this article was published. Please get back to me! Thanks

  11. Is it not the case that the Fructose in Sweet drinks is in fact High Fructose Corn Syrup which does have a justifiably bad reputation.

    • No, it is unjustified. The fructose percentage in HFCS is typically 55% for the type used in soft drinks, whereas in sucrose it is 50%. There are varieties that contain 42% and 90%, with the latter being the least used. I believe people have latched onto HFCS as evil for two reasons, one it has a scary name, and two it is a manufactured product, rather than being ‘natural’.

  12. I am not an expert except in what happens to my body in reaction to what I put in it was but I have read extensively and try to understand both sides of the coin.
    I am really concerned that that you
    1) seem to be saying that most of us who are overweight are not eating excess calories?! And therefore we can eat fructose with no detrimental effect. What planet are you living on?
    2) you opine that fruit is satiating so people tend to eat less in terms of other calories. I find fruit most unsatisfying and cannot be the only person …
    So yre you saying we can all eat as much fructose and high fructose corn syrup as we like no problem?

  13. The fundamental issue for me with Chris’ article is the assertion that fructose is harmful *only* in the context of eating too many calories. Taubes thoroughly debunked the myth of the CICO paradigm of weight in his two books. So, why does Chris implicitly endorse this idea?

  14. “there is no reaction in the body that requires (fructose) sugar, as a precursor for some physiological function” is a bon mot that sounds great but, in fact….

    The fructokinase reaction converts fructose to F-1-P. Physiologically, F-1-P is a positive allosteric effector of glycogen synthase and glucokinase and a negative effector of glycogen phosphorylase (breakdown of glycogen), that is, fructose calls for glucose uptake and enhances glycogen storage. F-1-P is converted to glycolytic intermediates just like glucose.

    These physiologic functions evolved because fructose is part of human biochemistry.

    http://www.nutritionandmetabolism.com/content/pdf/1743-7075-10-45.pdf

    Support your local biochemist.

  15. Hi folks,
    This article misses a few points, but before that, in Lustig Presentation he DID mention DNL with medical students. This was at 64m:30s. I remembered this well because he said something funny….”Normal medical students, if you can call them normal – taking in a glucose load ….then a fructose load….”

    Another thing that is misrepresented here, sorry for saying, is that while fruit may appear to have been targeted, I see no evidence in the lecture. Dr Lustig did mention that fruit has fiber and that fiber mitigates how rapidly the sugar is absorbed. And the REAL problem is fructose without the fiber, or fiber-less food and that most processed foods manufactures take out the fiber to stop it from spoiling and on top of that add in the fructose to make it taste good.

    To me the entire first 20 mins was devoted to the problem of over consumption. Most of his other interviews are testimony to this. In one interview he says how much not to cross for men and for women.

    So over consumption is the problem and was identified in the lecture, because it is unknowingly in everything.

    Finally what I find most interesting and is the most important factor that made me avoid sugar (and most processed foods) is that there is no reaction in the body that requires (fructose) sugar, as a precursor for some physiological function.

    I think people should watch the video a few times, it took me a while to figure it out, since I am not a biochemistry student.

  16. Find this post highly enlightening.
    Or, at least, it’s a very plausible hypothesis Chris presents:

    Namely; if you overeat, most easily done with lots of fats and refined carbs,
    the fructose can be very problematic. If not, you might be relatively fine.

    Just look at these guys who gluttonize in massive volumes of mangos and bananas etc,
    but still experience good health, at least for some years (hey I wouldnt recommend it)

    This vid show some examples on how much fruit you need to eat get as much fruit you
    have to eat in order to comsume as much fructose as that guy in “super-size me” did:

  17. There are minor impurities in honey which alter the taste but I would be very surprised if the liver deals with fructose from honey any different than any other source.

    Also, fructose, from any source is glycogenic. Under many conditions, more than glucose. Historically fructose was known as a glycogenic substrate.

    Finally, fructose reacts much faster than glucose but fructose is cleared while glucose is maintained at constant levels. Most glycation end products come from glucose not fructose.

    Possibly of value, our perspective on fructose:
    http://www.nutritionandmetabolism.com/content/pdf/1743-7075-10-45.pdf

  18. Excellent article Chris. So good to read well thought out and researched content.

    Just finished reading the Honey Diet, which suggests that the liver deals with fructose from honey better/faster than other sources, because of the other nutrients in it. I’m wondering if anyone has figured out what these nutrients are so we can combine them from high-fructose corn syrup to facilitate glycogenesis.

    Another reason for desiring this is because fructose is known to produce 10x the amount of glycation end products compared to glucose. Fructose can help us keep our vitality topped up, but we need to minimize glycation end products to insure flexible arteries and veins in our older ages.

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