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EXECUTIVE SUMMARY
Since the 1970s, the use of high-fructose corn syrup (HFCS) in the U.S. food supply has increased dramatically typically as a replacement for sucrose (table sugar) in soft drinks and many food products. The prevalence of obesity has also increased substantially between the 1970s and the early 2000s. Because of this coincidental timing, HFCS has been erroneously demonized as a unique cause of the obesity epidemic in the United States. Sucrose and HFCS have essentially the same composition, and thus it would be highly unlikely for them to have different effects on body weight or metabolism. Experimental evidence, as well as analyses of epidemiologic data, indicate that sucrose and HFCS have equivalent effects on food intake and therefore on body weight. Scientific evidence does not support the notion that HFCS is uniquely responsible for the American obesity epidemic.
CONTENTS
Introduction ................... 3 HFCS: What is it? .......... 4 HFCS: Where is it? ........ 7 Health Concerns ........... 8 Conclusions .................... 11
INTRODUCTION
a great deal of information from the ingredients list on food packages, and many use this information to decide which foods to purchase or avoid. In some cases it makes perfect sense to base food purchase decisions on the ingredient list for example, to avoid ingredients to which one is allergic. Sometimes, however, shoppers can be influenced by media hype about the supposed health-promoting or health-damaging effects of one or another food ingredient, such as high-fructose corn syrup (HFCS). Over the last eight years, the media have bombarded us with unsubstantiated hypotheses about the deleterious effects of HFCS; it has been blamed for uniquely fueling the obesity epidemic, for causing diabetes and even for causing a condition known as metabolic syndrome. How did this happen, and what does the scientific evidence tell us about HFCS? In 2004, Dr. George Bray, a well-respected obesity researcher, presented a talk at a professional meeting in which he noted that the widespread use of HFCS in American foods and beverages in the 1970s coincided with the start of the obesity epidemic. He and his colleagues expanded on this idea in the American Journal of Clinical Nutrition. In general, their hypothesis stated that the consumption of the fructose in HFCS gave rise to metabolic abnormalities that helped fuel the gain of body fat. One implication of this theory was that consuming
HFCS affects health adversely to a greater extent than does consumption of table sugar (sucrose). Further, these authors suggested that consuming HFCS in beverages, particularly soft drinks, was more problematic than consuming it in solid foods, because people are less likely to compensate for consuming extra liquid calories by consuming fewer calories later. Although this reasoning was hypothetical, it was often presented as fact in the lay press, and it has affected the behavior of some consumers. Indeed, as recently as May 2011, a consumer survey found that 44 percent of consumers say they try to limit their consumption of HFCS, and 4 percent of those in a second survey said they actively avoid it. While the scientific literature includes numerous studies that do not support the hypotheses suggested by Bray and colleagues, much of this information is ignored by the media, and thus is unavailable to the public. The purposes of the current report, therefore, are to clarify the composition and utility of HFCS, and to compare these qualities and the health effects of HFCS to those of the most similar caloric sweetener sucrose.
ABSORPTION
Sucrose and HFCS are both absorbed in the first part of the small intestine the duodenum. Before absorption can occur, sucrose must be split into its component monosaccharides, glucose and fructose. This is accomplished by the action of the enzyme sucrase in the lining of the small intestine. When present in some preparations, such as somewhat acidic beverages, the sucrose may be partially split before it is consumed. Since the glucose and fructose in HFCS are already single molecules when consumed, they can be absorbed without enzyme action. Importantly, no matter whether the glucose and fructose come from HFCS or from sucrose, each is absorbed in the same way. From the small intestine, the glucose and fructose travel in the bloodstream to the liver where they may be metabolized for energy, used to form other molecules, stored as various products, or they may enter the systemic circulation and travel to other organs.
SWEETENER Sucrose Fructose High-fructose corn syrup (55% fructose) High-fructose corn syrup (42% fructose) Glucose
100 117 99 92 67
Much attention has been focused on the fact that use of HFCS has increased greatly since its introduction in the 1970s. Indeed, one might think that sucrose is no longer used at all. In fact, as shown in Table 2, sucrose is still used more than HFCS, and as a percent of total calories from caloric sweeteners HFCS has actually decreased slightly in the last decade.
HEALTH CONCERNS
OBESITY
The most prominent claim about the deleterious effects of HFCS on health is that it is uniquely or largely responsible for the epidemic of obesity. Not only does evidence supporting this hypothesis remain elusive, there are multiple reasons why it cannot be true. For example, the substantial increase in obesity documented in the last several decades is not confined to the United States. World-wide statistics show that overweight and obesity and its co-morbidities, such as type 2 diabetes, are common in other Western countries Great Britain and Canada as well as in developing countries such as Egypt and India. These increases have occurred despite the limited or complete absence of HFCS-sweetened beverages in these nations, and thus the increased obesity seen around the world cannot be simply attributed to HFCS. Also, if the increased obesity prevalence in the United States were uniquely due to the change from sucrose to HFCS, there must be some material difference between the two sweeteners to account for this effect. As explained above, however, sucrose and HFCS are essentially the same once they have been digested both contribute essentially equal proportions of fructose and glucose, and the body absorbs both in the same manner. Another route by which some argue that HFCS leads to weight gain is through increased caloric intake. Theoretically, this occurs because consumption of sweetened beverages is not accompanied by a decrease in the amount of food consumed at a meal (satiety), nor does it decrease the size of subsequent meals (satiation) in the same way that solid foods do. And since in the United States, beverages are typically sweetened with HFCS, it follows (according to this hypothesis) that this sweetener is responsible for the increased energy intake that has been occurring over the past several decades (Table 2). Indeed, this idea has been a focus of nutrition research for some time. This theory fails to take into account the growing consumption of low or non-calorie beverages in the United States. Indeed, USDA data indicate that as a percentage of total calories, consumption of added sugars has been declining. TABLE 2 Thus, the data do not support the conclusion that HFCS-sweetened beverage consumption leads to more calorie consumption than does that of sugarsweetened beverages. Researchers have compared the effects of different sweeteners on food consumption. In one study of young men and women, participants drank cola beverages sweetened with sucrose, HFCS-42, or HFCS-55. The effects of these beverages on consumption of a meal a couple of hours later were compared with the effects of drinking a diet cola, 1 percent milk or no beverage. All beverages except the diet soda contained 215 calories. Participants rated their feelings of hunger, fullness and desire to eat both
HEALTH CONCERNS
YEAR 1970 1980 1990 2000 2009
SUGAR CALORIES
(Cane/Sugar Beets)
HFCS CALORIES
TABLE 2. Per capita average daily caloric intake from sucrose and HFCS: average and percent of total calories. *
*From U.S. food availability, adjusted for spoilage and other waste. Source: Buzby J, Wells HF. Loss-adjusted food availability data: calories. USDAEconomic Research Service, 2007. Internet: www.ers.usda.gov/Data/FoodConsumption/ spreadsheets/foodloss/Calories.xls). Updated 2011. (Accessed 15 Oct. 2011)
before drinking the beverages and at intervals thereafter. Whether sweetened with sucrose or either of the HFCS varieties, hunger, fullness and desire to eat were similar in all three study groups. Further, the number of calories consumed at lunch was similar for all the sweetened colas and not significantly different than that consumed in the diet soda or no beverage conditions. Another group of researchers also compared the effects of a preload of sucrose or HFCS-sweetened beverages on energy intake at a subsequent meal compared to an isocaloric (having the same number of calories) drink of milk or of a diet beverage. In addition to energy intake, which did not differ between the sweetened beverages, the study included measurement of
insulin and other hormones that affect food intake. Food consumption approximately one hour after drinking the test beverages was lower after the energy-containing beverages than after the diet beverage. Again, there was no difference in satiety or energy intake effects between drinks sweetened with sucrose or with HFCS. In addition, these drinks did not differ in their effects on appetite-controlling hormones. A review of relevant studies also concluded that beverages sweetened with sucrose or HFCS do not differ in their effects on short-term food intake and hormonal responses. Further, the data did not support a unique contribution by HFCS to weight gain or obesity.
HEALTH CONCERNS
Using data from national surveys, Drs Sun and Empie examined the relationship between obesity risk and sweetened beverage consumptionprimarily HFCSsweetened beverages. After controlling for a variety of factors known to be associated with obesity risk, such as smoking, education, physical activity, and TV/ screen-watching hours, they found that populations who frequently consumed sugar/HFCS-sweetened beverages did not have a higher rate of obesity or increased obesity risk than did those who consumed such drinks infrequently. Finally, Drs Drewnowski and Bellisle made two important points about the supposed connection between body weight and sweetened beverages. First, the epidemiologic data on these links come from cross-sectional data or temporal trends, neither of which allow us to conclude that the beverages caused changes in body weight. Second, the evidence that compares the satiating power of various liquids and solids has not been confirmed. They also point out that some liquids, such as those prepared for individuals who cant eat solid foods (meal replacements) cause, rather than suppress satiety. Indeed, some of these products are effective in helping people lose weight. Given that liquid meal replacements also contain HFCS, these researchers suggested that metabolism and physiology were not the only answer and that more attention must be paid to food-related behavior. For example, HFCS-sweetened meal replacements may have been effective because they were consumed in place of a meal and in the context of weight management. Thus, there are insufficient data to support the hypothesis proposed by Bray and colleagues that HFCS is uniquely, causally related to the epidemic of obesity in the United States.
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CONCLUSION
purported unique health effects of HFCS are unwarranted. Consumption of HFCS or sucrose in excess, like the excess consumption of any energy-containing nutrient, can lead to weight gain, overweight, and obesity along with its co-morbidities. But the data, experimental as well as epidemiologic, do not support any distinction between beverages or foods sweetened with sucrose and those sweetened with HFCS. It is unfortunate that misunderstanding of a hypothesis about HFCS led to its repetition as though it had been a proven fact. Repetition can lead to belief, whether or not there is any scientific underpinning for that belief. This is what has happened with HFCS.
This is not to say that the increased prevalence of overweight and obesity in the United States is not a serious issue, one that must be addressed with care and based on solid scientific evidence. But no single food or ingredient can be held responsible for what is actually a result, in most cases, of an unhealthy lifestyle too many calories consumed and too few used.
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REFERENCES
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