When it comes to type 2 diabetes and sugar, there is a not-so-sweet battle going on, and the fight is over high fructose corn syrup. The findings of a new study published in Global Public Health has fueled the fury by suggesting that countries with a higher availability of high fructose corn syrup (HFCS) in foods have a higher prevalence of type 2 diabetes.
What's wrong with high fructose corn syrup?
The answer to this question depends on who answers it. (Also check out the "High Fructose Corn Syrup Studies" below.) If you ask corn producers and the Corn Refiners Association, for example, they'll say there's nothing wrong. According to Audrae Erickson, president of the Corn Refiners Association, "There is broad scientific consensus that table sugar and high fructose corn syrup are nutritionally and metabolically equivalent."
Some scientists agree with this basic idea. Marion Nestle, PhD, MPH, professor of food, nutrition studies, and public health at New York University and a well-known author, noted that the new study is "based on a questionable and highly debatable premise: that high-fructose corn syrup is significantly different in its physiological effects from sucrose, or table sugar."
It's true that both high fructose corn syrup and table sugar are a combination of two simple sugars (fructose and glucose), which suggests they should have similar effects on the body. However, the lead author of the new research, Michael I. Goran, PhD, co-director of the Diabetes and Obesity Research Institute at the Keck School of Medicine at the University of Southern California in Los Angeles, believes that it is more complicated.
The fact is, table sugar consists of about 50 percent fructose and 50 percent glucose. When it comes to high-fructose corn syrup, the mixture is a bit of a mystery since the percentages are not revealed on food labels. However, the mixture is believed to range from 42 to 55 percent--or higher--for fructose.
In fact, Goran reported that he found fructose levels in beverages sweetened with HFCS ranging up from 47 percent to 65 percent. So if the fructose percentage is higher than 50 percent, could it have a negative effect on diabetes?
That remains to be seen. Goran noted that their study finding "raises a lot of questions about fructose," even though it does not establish that HFCS causes diabetes. What does his study show?
The topic of the latest study is whether high fructose corn syrup intake is associated with an increased prevalence of type 2 diabetes. Based on consumption of HFCS in 43 countries, Goron and his team reported that the prevalence of diabetes was 20 percent higher in countries that had a higher prevalence of HFCS compared with countries that had a lower availability.
The presence of high-fructose corn syrup noted in the study ranged widely. About half the countries had little to no HFCS present in their food supply, like people in Germany who consume about 1 pound of the sugar per year. People in the United States, however, consume about 55 pounds of the sugar annually.
This difference remained true or even grew stronger even after the authors made adjustments for body mass index (obesity), population, and total sugar and calorie availability. All of these data indicated to the researchers that countries with a higher availability of high-fructose corn syrup (i.e., in foods such as soft drinks and processed foods) have a higher prevalence of type 2 diabetes, separate from obesity.
Goran argues there is a difference between fructose found in fruit, where fiber is also present (and fiber slows the absorption of sugar) and fructose found in a highly refined product such as high-fructose corn syrup (which has no fiber). He explains that "there are lots of other aspects of the way fructose is handled by the body which are different than glucose that make it metabolically dangerous for the body."
High fructose corn syrup studies
High-fructose corn syrup has not fared well in a variety of studies. For example, studies conducted in Princeton reported that high fructose corn syrup is worse than table sugar when it comes to weight gain. Intake of HFCS has also been associated with autism.
Another study, presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, noted that HFCS is associated with high blood pressure. Other research has linked HFCS with stimulation of pancreatic cells, which can lead to pancreatic cancer.
So what should people with diabetes do about high fructose corn syrup, which is found in many refined foods? First, avoiding refined foods as much as possible is a good health move for everyone, including people without type 2 diabetes.
Second, too much of anything is typically not good for the body. People with type 2 diabetes need to limit their intake of sugar in whatever form it appears, including high fructose corn syrup.