The Metabolic Advantage of Fructose

Is fructose making us fat?  Apparently the answer is no if you get your fructose in the form of candy!

Thanks to MM for sending me this paper.

Candy consumption was not associated with body weight measures, risk factors for cardiovascular disease, or metabolic syndrome in US adults: NHANES 1999-2004

For the purposes of this study, candies were defined as follows:

Sugar candy consists of sugar in crystalline form or semisolid (amorphous) forms with other ingredients including flavors and colors; examples include peppermint, lollipops, licorice, and gum drops. Chocolate candy is a mixture of processed cacao, cocoa butter, and sugar and often contains other ingredients, including milk, fruit, nuts, and caramels.
 This group analyzed 3 sets of NHANES data to look at candy consumption defined as:

Candy consumers were defined as those participants consuming any amounts of candy/confection except gum and were placed in 1of 3 overlapping consumption groups: (a) any candy (including chocolate candy and sugar candy), (b) chocolate candy only, and (c) sugar candy only

Consumers were then compared to non-consumers.  I'm somewhat surprised that with "any" being the distinguishing cut-off that only a little more than 20% eat candy.  Of course this could be because the rest of us eat candy with a different label (can you say Nutrigrain bars? LOL).  They also broke the data down by gender and ethnicity.   Here's that breakdown {as always, click to enlarge}, though I'll not discuss this aspect further.  

Here's the intake data:

and MetS parameter data: 

(I'll include the lengthy definitions at the end of this post)

Now, the first thing that jumped out at me was the intake calories.  Lookie at that one folks.  We're often told that Americans consume roughly 300 cal/day more now than we used to.  So 20% of us get roughly 200 of those extra calories from our candy or because eating candy makes our blood glucose spike, sending out the insulin police, trapping the fat, yada yada so we eat more of everything else.   Mystery solved!  We eat more because we're eating too much sugar.  Dr. Lustig would be proud of me for uncovering this!  Sound the alarm!!  THIS is why we're fat and the sugar-shunning Japanese are so slim.  (Well, that and their notorious brown rice consumption that must contain a special non-insulinogenic starch ... but I digress ... ) .  Don't look down the aisle!

But weight ... I mean, wait!  Check out that weight and BMI data!  The candy consumers weigh a bit less and have slightly lower BMI across the board.   

Thinking ...

Thinking ...

Isn't there a term for this phenomenon?  Where folks can eat a bit more and not gain weight?  It's right on the tip of my tongue ...  Yeah!  That's it.  A Metabolic Advantage!!!

And the advantage goes to? ..........
So let's see ... that extra insidious combination of insulin spiking glucose and liver poisoning fructose, one of the most refined of all carbos ... DOESN'T MAKE US FAT.

Somebody should write a book on this stuff!

OK, but surely it makes us sick?  Umm ... again, it appears no.  
In conclusion, these cross-sectional data show an increase in energy, AS, and SFA associated with candy consumption but did not show an increase in weight/adiposity status, BP, cardiovascular risk factors, or risk of MetS. Candy consumers actually had a lower body weight and lower adiposity status than nonconsumers, even after adjusting for implausible intakes; CRP was also significantly reduced with consumption of candy. Consumption of chocolate candy was also associated with higher HDL-C and lower triglycerides.  Candy consumers had a lower risk of elevated diastolic BP than nonconsumers, whereas chocolate consumers had a decreased risk of lower HDL-C and MetS. Total candy consumption was not associated with a lower HEI. Overall, current level of candy consumption was not associated with adverse health effects.

So in conclusion, eating more saturated fat makes you eat more but weigh less.  >:-)  

Elevated systolic BP was defined as ≥130 mm Hg.
Elevated diastolic BP was defined as ≥85 mm Hg.
Elevated BP was defined as ≥130/85 mm Hg.
Lower HDL-C was defined as b40 mg/dL for men and b50 mg/dL for women.
Elevated fasting triglycerides were defined as ≥150 mg/dL.
Elevated fasting glucose was defined as ≥110 mg/dL.
Increased WC was defined as N102 cm for men and N88 cm for women.
Meets 3 or more of MetS risk components.
Elevated LDL-C was defined as ≥100 mg/dL.


kds said…
In conclusion, I think one should take retrospective studies funded by "Nutrition Impact, LLC" ( and published in no-name journals with a grain of salt. Let's see what NI, LLC's website says in its About section- surely it will include something about funding good science to find the best models to approximate reality oh wait nm:

"Nutrition Impact is a small consulting firm that specializes in helping food & beverage companies develop and communicate aggressive, science-based claims about their products and services."
MM said…
Are you sure you want to thank me for this study? I'm having trouble getting my head around the results. So... do you think that maybe since this is a self-selected group, the "candy eaters" are people who can eat candy and get away with it? That is they already have "high metabolism". So, what we're seeing is a group of those really annoying people that can eat whatever they want and not gain? Or is the take-away message that I should be including more candy in my diet? LOL, Maybe I should try it.
CarbSane said…
@kds: Are you accusing O'Neil, Fulgoni & Niklas of professional malfeasance?

Either the data are what they are, or they're not. If this study had been funded by CSPI or PETS (People for the Ethical Treatment of Sugarcane) or the Atkins foundation or ...

I'm posting the MA angle somewhat tongue in cheek in case you haven't figured out my sense of humor just yet.

FWIW, from the Acknowledgement: "This work is a publication of the United States Department of Agriculture (USDA/ARS) Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Tex. The contents of this publication do not necessarily reflect the views or policies of the USDA nor does mention of trade names, commercial products, or organizations imply endorsement from the US government. This research project was supported by the National Confectioners Association and USDA–Agricultural Research Service through specific cooperative agreement 58-6250-6-003. Partial support was received from the USDA Hatch Project LAB 93951. "

Not seeing NI,LLC funding this study. Seems you jumped the gun there a bit. What's wrong with helping a company make science-based claims? Sure better than the alternative, no?
CarbSane said…
@Razwell: I'll be sure to let durianrider know!
CarbSane said…
@MM: Chuckle ;) I'm not going on a Matt Stone-styled Great Sucrose Adventure anytime soon.
kds said…
@cs: Professional malfeasance? 2nd author Fulgoni is Senior VP at Nutrition Impact, LLC (check the footnote: Lol, I'd consider it professional malfeasance if the study the National Confectioners Association paid NI, LLC to do 'didn't' show that candy is good for you.

It's pretty clear your MA bit is tongue-in-cheek, but unfortunately the legitimate rhetorical points you're trying to make about fructose and insulin seem pretty silly too in light of the source material.
CarbSane said…
So Jeff Volek is guilty of professional malfeasance because Atkins Foundation funded some of his work? Are you accusing them of rigging their statistics? Seems so. What evidence do you have that they did?

I'm not a big believer in HFCS and all the subsidies and crap that resulted in this product infiltrating our food supply. Yet the manufacturers have had to expend quite a bit of money to defend non-science based assaults on the "evil" of their product. How is that different than the dairy councils and beef alliances funding studies that show their products aren't killing us?

Double standard?
kds said…
I can't tell if you're being serious or just facetiously playing devil's advocate at this point, but in case it's the've only come up with Volek as a double standard because you've created a false equivalency. The fact that the NCA or Atkins or Corn Growers' Association or Pfizer or Merck funds studies is troubling, but it's clearly inexcusable that the 2nd author of the paper you quoted makes his living by doing Big Brother-esque "candy is good for you, 'science' says so" consulting for corporations whose business it is to peddle sugar. Fulgoni's entire livelihood depends on food and supplement corporations asking him to help them support their health claims with science. IOW, he is directly getting paid by folks who have a vested interested in his science showing positive results for them. AFAIK, Volek has no such conflicts of interests.

But, putting all that aside for a sec, let's assume for a moment that the funding and the authors of the study you quoted were both pristine. We are still left with the fact that you are using rhetoric to conjure somewhat prescriptive conclusions about nutrition from data that is observational/correlative, retrospective, and self-reported. So, could Fulgoni really have a heart of gold and be in search of the honest-to-jeebus truth about candy? Could the authors have controlled for the absolute myriad of confounding variables that affect their results? Could the study's conclusion which stated that the people who ate more calories and more candy ended up weighing less actually be valid? Yeah, sure, I suppose. I also suppose North Korean news broadcasts occasionally contain factual information as well.

The point is that I take every piece of literature with a grain of salt, but that goes doubly so for unreplicated studies/analyses backed by dubious agendas and published in no-name journals.
Galina L. said…
Interesting study, one of those that makes me puzzled.Getting strange data and commenting on it adds some drama for the blog. I don't think I would be changing what I am doing(actually, I shouldn't be counted because I avoid sugars for several reasons)or advise my son or mother differently. For me was very convincing to read that chapter in GCBC on correlation between diseases of civilization and consumption of refine carbohydrates with all that evidence collected by doctors who worked in previously non-westernized places and have a chance to witness changes in health markers in population with the change in the diet. I am sorry, I forgot the cut-of amount of annual sugar consumption. Something like 24 or 36 lb a year on person, more than that, and people started to have cavities, appendix,and so on. It took couple decades for changes to develop.Somebody raised their CRP while eating candies - good for them. Among people I know ,those who must have candies around, are all sugar addicts.Sorry for anecdotal evidence.
I agree with you that all that nutritional bars we suppose to eat as healthy snack, together with Activia and Lattes are all candies. Why we discriminate against actual candies, I don't know. Not fare.How we fill the quota of refine sugars shouldn't matter that much.
Anonymous said…
Fruit is OK, because of the fiber.
I gotta side strongly with CarbSane on this one. Regardless of who funds a scientific study it is out there for anyone else to repeat the experiment. Also, the scientists involved have their professional reputations on the line. It is not so certain that one can dismiss a study simply based on who funds it.

An industry is probably going to fund a study that supports their products. They may even discard a study that doesn't meet their expectations. But if the science is tight then they are above suspicion regardless of how "evil" the facts seem to be.

Also, I would like to reaffirm my commitment to voting for CarbSane for prez. I assure you the little positive reinforcement strategy of putting soft porn up for us menfolk has no influence on my decision. Strangely, I do want some candy...
kds said…
As for the Corn Growers'/HFCS industry, I agree that they shouldn't have to defend themselves against non-science based assaults. Cause they should have their hands full with the science-based ones

"After adjustment for potential confounders, women consuming 1 or more sugar-sweetened soft drinks per day had a relative risk [RR] of type 2 diabetes of 1.83 (95% confidence interval [CI], 1.42-2.36; P<.001 for trend) compared with those who consumed less than 1 of these beverages per month. Similarly, consumption of fruit punch was associated with increased diabetes risk (RR for > or =1 drink per day compared with <1 drink per month, 2.00; 95% CI, 1.33-3.03; P =.001)."

"Cross-sectionally, individuals consuming > or = 1 soft drink per day had a higher prevalence of metabolic syndrome (odds ratio [OR], 1.48; 95% CI, 1.30 to 1.69) than those consuming < 1 drink per day. On follow-up (mean of 4 years), new-onset metabolic syndrome developed in 717 of 4033 participants (17.8%) consuming < 1 drink/day and in 433 of 2006 persons (21.6%) [corrected] consuming > or = 1 soft drink/day"

"The incidence of physician-diagnosed type 2 diabetes was assessed by interview and validated; 2,273 participants developed diabetes during follow-up. After adjustment for potential lifestyle and dietary confounders, participants consuming > or =2 soft drinks per week had a relative risk of type 2 diabetes of 1.42 (95% confidence interval (CI): 1.25, 1.62) compared with those who rarely consumed soft drinks."
My main question about this study is "Do people who eat candy consume more fructose than people who do not eat candy?"
Helen said…
Candy doesn't tend to contribute much to overall calories, while HFCS- and sugar-sweetened drinks do. Soda consumption is clearly demonstrated to be associated with metabolic syndrome (and diet soda - colas in particular, due to phosphate content - with CVD risk). Carb Sane didn't make any claims defending sugary soft drinks.

Chocolate has a number of health-protective qualities. It will even help protect your teeth from the acids produced by sugar, so if you have chocolate with your sugar, you may not be hurting yourself on balance.

I think Charles' question about overall fructose consumption is apt.

I also think that the form of fructose matters, and what one eats with it, like the chocolate and fruit examples. I've looked and have not found a single study that implicates fruit consumption in any adverse health outcome, and it is correlated with better health in several studies. From what I've read (don't have the references handy), crystalline or free fructose is more harmful than HFCS; HFCS, which has a 55-45% ratio of fructose to glucose, like table sugar, and also has the little bond between the two molecules, is more harmful than table sugar; and liquid calories (which are commonly sweet) are more deleterious than those in solid, chewable food. Honey, even though it is high in fructose, seems to have some protective qualities that mitigate the fructose content.
CarbSane said…
Welcome Helen!

I'm of the opinion that there is something especially insidious about liquid calories from sucrose or HFCS.

The really bad stuff for the liver generally requires large doses of fructose that would be difficult to consume (without "stuffing" yourself) even on jelly beans. But some folks think nothing of drinking 20oz bottles of soda and we humans don't seem to compensate at all for those calories. I'll have to look for the study, but I have a cache of "eating disorder" type studies that showed rodents do compensate for liquid sugar caloric intake.

Yeah, Helen & Charles, it would be interesting to see the total sugar intakes for the candy eaters vs. non. I guess here is where the author bias comes in to play, as they probably aren't interested in answering that question.

Always wonder about honey. Eaton estimated paleo humans got 2-3% of calories from honey. That's not a whole lot but the fructose:glucose ratio is more similar to HFCS than sucrose.

BTW Helen, as regards "free fructose" - it varies by fruit/melon/berry, but the actual sugar content in these foods is a mix of sucrose, fructose and glucose. See for example cantaloupe:
(expand the carb content). The carbs are almost entirely sugars: 55% sucrose, 19% glucose, 24% fructose

Goshers I hope I didn't kill my liver all those summers I lived on cantaloupe (2 melons would not be unusual!), strawberries and cottage cheese (this was not a deprivation diet for me, I love these foods and always lost weight & felt great eating them).
Helen said…
To clarify, I meant free or isolated fructose as a refined product, not in a fruit, which was used in at least one study, which I didn't save, so I'd have to hunt for it again. I am not worried about whatever form of fructose appears in fruit, which also contains fiber, vitamins, minerals, and funky phytonutrients, all of which change the picture of fructose metabolism and overall biological impact.
benn686 said…
Why is that I don't think juicing fruits and vegetables is bad?

Is there any data that supports my crazy thinking?
Sanjeev said…

large intervention studies have shown no benefits of vegetables in several contexts ... colorectal cancer, for one.
CarbSane said…
@kds: As regards Volek, he was an author of TNT diet and on The New Atkins. Now I recall hearing that Westman took nothing from TNA book sales, but how about Volek?

For the record, I don't see a problem for Volek, but were I look at his works the same way I do others. If the results support a conclusion/theory, I take it on faith that there was no professional malfeasance - e.g. fudging numbers, etc. - involved. If I read something fishy - e.g. in a recent study they presented "predicted" weight loss for all participants vs. the actual weight loss of those who completed the study - let the results chips fall where they may.

@benn: I'm not a big fruit juice fan because it's too easy to overconsume fruit sugars w/o the fiber and micronutrients in the whole fruit (e.g. skin). I'm no fan of veggie juices. Blech! Except for tomato juice <- still better blended with tequila and spices ;)