In a new clinical trial with 145 subjects, subjects were gi…

Subjects were given beverages to drink three times per day, containing:

Aspartame, control
Glucose, 25% daily energy requirements
Fructose, 17.5%
Fructose, 25%
High-fructose corn syrup, 17.5%
HFCS, 25%
Sucrose, 25%

Patients were told to refrain from drinking any other sugar-sweetened beverages.

Riboflavin was added to the drinks as a biomarker for adherence and tested in the urine.

Urinary riboflavin was low at the beginning, rose throughout the study, and did not rise differently between participants in each group over the course of the study, indicating that the biomarker worked and adherence was similar between groups.

The trial was double-blinded and on an outpatient basis.

Subjects were not randomized but groups were matched for sex, BMI, and concentrations of fasting triglyceride (TG), cholesterol, HDL-C, and insulin at baseline.

Correspondingly, the groups were roughly matched for the means of these parameters. This is important because differing baseline metabolic characteristics could skew results between groups, so matching them minimizes this bias.

There were minimal dropouts in each group. Minimal dropouts means that something from the intervention did not cause people to drop out and the results to be artificially biased.

There was no significant increase in bodyweight over the course of the study, meaning that the results found could not be caused by a change in bodyweight.

A before-after comparison was used, with aspartame as a control.

All fructose-containing drinks increased:
24-hour triglycerides
24-hour uric acid
Fasting LDL cholesterol
Fasting apoB

The increases in each category were:

24h triglycerides: Fructose > HFCS & glucose
Fasting LCL-C: F25 & HFCS25 > F17.5 & HFCS17.5
Fasting apoB: F25 & HFCS25 > F17.5 & HFCS17.5
24h uric acid: F25 > HFCS25 & F17.5 > HFCS17.5 > G25

FRUCTOSE-SWEETENED BEVERAGES BAD

The graph is as follows. All bars with different subscripts are significantly different from each other.

FRUCTOSE-SWEETENED BEVERAGES BAD

Even though the groups being tested have only a relatively small number of subjects (about 20-30), the dose-response relationship for some of the parameters increases our confidence that the effects are real.

FRUCTOSE-SWEETENED BEVERAGES BAD

As you can see, glucose only increased uric acid, triglycerides, and apoCIII (present on the major energy-containing lipoproteins in the blood), not lipoproteins.

However, HFCS, containing both fructose and glucose, often had a more potent effect than fructose alone.

This is interesting, because it suggests that glucose and fructose interact to worsen metabolic parameters.

The investigators measured this interaction in post-hoc analyses and found that the interaction between glucose and fructose accounted for a substantial proportion of the effect not accounted by glucose or fructose alone.

In other words:

Fructose by itself is bad.
Glucose is either not bad or not very bad.
But fructose plus glucose are horrible.

This is important because fructose plus glucose is the main form of dietary sweetener in the Western diet. In other words, horrible.

The study authors account for this in the following hypothetical model, supported by other research.

In this model (to simplify somewhat), fructose increases secretion of energy-containing TG-rich lipoproteins (TRLs), which then become LDL after the energy in the TRLs is used. Glucose blocks the uptake of LDL by the liver and encourages oxidation in the blood.

This is just a hypothetical model, so please do not bandy it about for the next 10 years on Twitter as if it is the truth (as many of you are prone to do, ugh), or I will personally kill you.

(This is a joke. I will not kill anyone @TwitterSupport.)

Takeaways

1. Consumption of fructose-containing beverages increases factors that contribute to heart disease, dementia, etc., in a dose-response manner. This means soft drinks, sweetened teas, etc.

Two bottles of Coca-Cola would get many people to a similar dose as this study.

Even if you maintain a healthy weight, you will still increase these risk factors if you consume sugar-sweetened beverages.

In other words, sugar-sweetened beverages and saturated fat have very similar effects on lipoproteins involved in heart disease risk: bad.

2. Sugar is not sugar. Glucose and fructose are metabolically different, so your bread, even if it was liquid (and it is not--more in a moment), is not the same as Coca-Cola.

Stop saying all carbs are sugar.

Link this thread to anyone who says all carbs are sugar. They aren't.

3. This isn't directly addressed by this study, but cane sugar has the same metabolic effects as high-fructose corn syrup. Don't think it is any different, because it is not.

Caveats.

This was in sugar-sweetened beverages, not in foods.

Fruit does not have the same effects as a Coca-Cola, so don't even.

And bread does not have the same effects as glucose, either. So. Do. Not. Even.

The findings of this study also need to be replicated.

For people digging into this study, just note that some of the figures in table 2 are broken. Yes, I am aware of it. not sure why, but you can figure out what the actual figures are by using the CIs. This should still probably be corrected by the journal.

This is how you tweet about studies on Twitter.

Teach, don't propagandize.

What would be nice is if Twitter had a feature that gave users ready access to the "best take" on any given study, attached as a link to any tweet of that study, so that bad actors could not readily distort everything that comes out. Smash down all echo chambers. Restore sanity.

Thanks for reading. If you like my stuff, please become my patron or send a one-time donation. Every contribution makes a big difference.

https://t.co/Hk08sIg7lK

Addendum 1

Yes most “sugar-sweetened” beverages are sweetened with high-fructose corn syrup. This is glucose + fructose.

Some are sweetened with just sucrose, aka table sugar. Sucrose is also glucose + fructose.

Almost everything that is sweetened and does not use an artificial sweetener is sweetened with glucose + fructose.

In contrast, starchy carbohydrates are broken into only glucose.

Critical distinction.

Addendum 2

Liquids are metabolized differently than solid foods because solid foods must be broken down before they are absorbed. This means they are absorbed more slowly and further down the GI tract.

So the speed of absorption changes with solid foods, which changes the body’s response to these foods.

Furthermore, because the GI tract is a hormone-secreting organ, absorption lower in the GI tract will change hormonal signaling and thus change the body’s metabolic response.

These two reasons are why we cannot confidently extrapolate from this study to solid foods containing fructose. We need separate studies to know the metabolic/lipoprotein effects of such foods. Other data indicate that solid foods do not cause these effects.

Addendum 3

This was a very similar design to a study that found very similar results

Now I feel confident with these results

Don’t drink sugary drinks kids https://t.co/1XcpDeS41o

This is a very similar study with similar results https://t.co/NQkSUwurUs pic.twitter.com/omO12ZqsgQ
— Jacob Gudiol (@JacobGudiol) January 18, 2021

Addendum 4 (don't you like how I am numbering my addenda all official-like?)

Getting this question a lot.

https://t.co/SnlCeODtge

I don't believe there is yet a clear answer, unfortunately. I have included some screenshots from a recent review.

https://t.co/nWf9sF0I8N

So would you expect a juiced fruit, in a blender or esp in a juicer, to resemble the Fructose-only groups in this study or is that also way too different?
— Tak (@LouferTak) January 18, 2021

Suffice to say that whole fruits are probably a better bet.

Yet this does not necessarily mean that blended fruits are bad. We don't know. But if you want to hedge your bets, until we have more data, it wouldn't be a bad idea to focus on whole fruits over blended or fruit juice.

In a new clinical trial with 145 subjects, subjects were given drinks sweetened with aspartame, glucose, fructose, or high-fructose corn syrup for two weeks.

Some results
HFCS group:
17% higher LDL-C
15% higher apoB
11% higher

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In a new clinical trial with 145 subjects, subjects were given drinks sweetened with aspartame, glucose, fructose, or high-fructose corn syrup for two weeks.Some resultsHFCS group:17% higher LDL-C15% higher apoB11% higher

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In a new clinical trial with 145 subjects, subjects were given drinks sweetened with aspartame, glucose, fructose, or high-fructose corn syrup for two weeks.

Some results
HFCS group:
17% higher LDL-C
15% higher apoB
11% higher