I was recently watching TV while visiting a friend (I actually do not have regular TV anymore, which is very time liberating. Though I am not sure I can stand it through Football Season), and saw one of those High Fructose Corn Syrup (HFCS) is the same as sugar commercials. I have to admit that I was a bit unsure of how to feel about it. Part of me was saying “are you kidding me! that stuff is horrible!” and the other part was thinking “well, sugar not much better, really”. So here is the low down and I will let you decide for yourself.
First, a little biochemistry, seriously, just a little. Basically, there are two routes for sugar(s) to be processed. The type of sugar will determine the preferred route (glucose, fructose, sucrose, lactose, etc…). One route is the blood. All sugar being processed via this route is taken up by the muscles and brain to be either used or stored as energy (stored version known as glycogen). This route will increase acute insulin response, and if insulin resistance is high that will force the sugar to be stored as fat, rather than go into the muscle (basically because the muscle is unresponsive to the insulin). The alternative route is through the liver. All sugar taken through the liver is first processed for liver glycogen, then the remainder is turned into glycerin and released into the blood where it scavenges for free form fatty acids to form triglycerides, which a re then stored as body fat. Sugars processed by the liver cause a minimal rise in acute insulin, are the most likely to be stored as body fat, contribute the most to fatty liver disease, and have the largest long term effects on insulin resistance and risk of type 2 diabetes. Okay, liver bad, blood good, got it.
So, what goes where? 80% of glucose is processed via the blood, while 20% is processed via the liver. 80% of fructose goes to the liver, while 20% to the blood. Alcohol (yes, it is a sugar also, but now in the form of alcohol, which has to be turned back into sugar) processes identical to fructose, so it should be no shocker that they cause the same health problems.
So how does HFCS differ from table sugar. Table sugar is exactly 50/50 glucose/fructose while HFCS is 45/55 glucose/fructose. Honey is 25/75 glucose/fructose and agave nectar is 5/95 glucose fructose (hence its very low Glycemic Index, it all goes to the liver!). So does that mean that table sugar is better than honey? Basically…yes. Isn’t fruit all fructose? Mostly. But fresh, raw fruit normally has quite a bit of fiber and antioxidants which offset the negative effects of fructose. However, as it sits after being picked or if it is cooked, it dramatically looses nutrient and antioxidant content. So buy it fresh and eat it quickly or even better buy it fresh frozen.
There are a few other differences between HFCS and sugar. The most notable, however, is that table sugar will cause nausea if you eat a lot of it, whereas HFCS will not. For example, the original recipes for old school sodas had 10 teaspoons of sugar per 8 oz serving. That was enough for one soda to cause you to regurgitate. Soda companies battle this problem by “cutting” the drink with phosphoric acid which offsets the urge to vomit as it has a stomach “settling” effect. Today’s sodas use HFCS rather than table sugar but the acid is retained to maintain the old flavor. Many of our older patients actually recall getting sick from eating too much candy, but no one has had that problem for at least 20 years because of the universal change to HFCS. So to the food companies benefit, and your loss, you can eat all you want now and never get sick. In addition, the effects of the increased fructose consumption over years (and sugar overall) lead to high insulin levels and problems with maintaining blood sugar levels. This causes crashes and a desire to eat more sugar, which creates a vicious downward spiral toward obesity and diabetes.
So the take home message? Stay away from sugar unless it comes in edible container also known as a fruit or vegetable. But if you absolutely have to have sugar sweetened substance, table sugar is slightly better than HFCS and honey and agave nectar are worse.