The Utilization of High Fructose Corn Syrup in Food and Beverages on Rising Rates of United States Obesity

By: Pollyanne E. Rystrom

A Senior Project submitted In Partial fulfillment of the requirements for the degree of Bachelor of Science in Nutrition

Food Science and Nutrition Department California Polytechnic State University San Luis Obispo, CA

December 2013

Abstract The potential relationship between high fructose corn syrup and obesity has been a controversial topic many years. In the last 40 years, high fructose corn syrup accounts for about 40% of the nations sweeteners (Shaheen E Lakhan, Annette Kirchgessner, 2013) while childhood obesity has quadrupled in the same amount of time. Through gathering information from many review and primary articles certain conclusions can be made on the subject. Both sides have been considered in this paper as both present valid arguments. While the composition of high fructose corn syrup is slightly different from normal table sugar, it is recognized similarly in the body. High fructose corn syrup has gotten a bad reputation, and though it does have some negative effects, it is very similar to sucrose. Both sugars do add empty calories and can lead to weight gain if eaten in excess. Since America has expanded the processed food quantity and availability more sugar, in all forms have been added to the food supply. Though high fructose corn syrup may not have serious consequences, it is recommended to keep the quantity eaten to a minimum as added sugar in any form significantly increases energy intake and therefore weight gain. There is still much in this area to be studied.

Introduction On almost every sweetened beverage, high fructose corn syrup has made it into the ingredients list. In the last few years, there has been a great increase in the utilization of high fructose corn syrup as a sweetener. One of the main reasons for the rise in use is that high fructose corn syrup is a way to produce the same sweetness effects as sucrose at a lower price. High fructose corn syrup is also a way to improve stability and functionality in different food and drinks (John S White, 2008). Though other sweeteners are also used, such as sucrose, glucose and fructose, high fructose corn syrup makes up about 40% of sweeteners (Shaheen E Lakhan, Annette Kirchgessner, 2013). The use of high fructose corn syrup has greatly increased in the last decade in both food and beverage products. In the same decade, the levels of obesity have skyrocketed with more than 60% of adults worldwide who are obese (Shaheen E Lakhan, Annette Kirchgessner, 2013). Is there a relationship? If so, is high fructose corn syrup metabolized differently than other sweeteners? In this paper, the potential correlation between high fructose corn syrup and obesity will be explored. Many studies have been done to examine this relationship yet there are outcomes supporting both sides; either that high fructose corn syrup is metabolized no differently than other sugars in the body or that high fructose corn syrup is metabolized differently and therefore has a factor contributing to obesity. There is a lot of controversy over this topic and both sides are clearly represented. Therefore, the purpose of this paper is to address of question of whether or not there is a relationship between high fructose corn syrup and rising obesity rates.

High Fructose Corn Syrup: Introduction to high fructose corn syrup High fructose corn syrup has become one of the most popular sweeteners used in the American diet, and accounts for about 40% of the nations sweeteners (Shaheen E Lakhan, Annette Kirchgessner, 2013). High fructose corn syrup was conservatively estimated to be 7% of daily caloric consumption in the United States (Bray et al, 2004). High fructose corn syrup was introduced into the American food supply in the late 1960s but was relatively uncommon and unheard of for a few years (White, Foreyt, Melanson, Angelopoulos, 2010). At this point, the amount of fructose in the syrup was only 15% but after several modifications the content grew to 55% fructose (Lakhan and Kirchgessner, 2013). Studies have now identified that over 10% of daily calories are from High fructose corn syrup. High fructose corn syrup also contributes to 10% of daily calories coming from fructose, where 75% in adults and 82% in children are directly from added sweeteners as opposed to naturally occurring fructose (Vos et al., 2008). Over the last 40 years, high fructose corn syrup has gained increasing popularity as a common food ingredient. Food and beverages such as soft drinks, baking products, and ice creams include about 80% of their added sugars from high fructose corn syrup (Lakhan and Kirchgessner, 2013). High fructose corn syrup has become a popular additive in America because it has a cheap sweetener that creates a sweeter taste with a smaller quantity, compared with other forms of sweeteners. Though high fructose corn syrup has been skyrocketing in the US, in Europe the use of it is under restriction because it is under a production quota. Corn is more readily grown than sugar cane, making sugar from corn

much less expensive. Another advantage of high fructose corn syrup is that can be used in a liquid form unlike that of cane sugar that is in a powder form, which makes it easier in production. In the table below, we can see the relative sweetness of the different sugar components in comparison to sucrose (Hanover 1993).

Table 1 (Hanover 1993) Composition of high fructose corn syrup High fructose corn syrup is comprised of syrup from corn that has gone through enzymatic processing in order to convert some of its glucose into fructose. The reason it is called high fructose corn syrup is not because it has an extremely high amount of fructose (other than that of 90% HFCS), but because that corn syrup on its own does not contain any

fructose, but rather, only glucose. When the glucose in the corn syrup is converted to fructose the corn syrup is now of a higher glucose concentration becoming high fructose corn syrup. To begin the process of producing high fructose corn syrup, the starch from corn must go through hydrolysis in order to extract the dextrose (Hanover 1993). Once the dextrose has been isolated, it is converted to fructose through the use of glucose isomerases, including microbiological sources such as Actinoplanes missouriensis, Bacillus coagulans, Flavobacterium arborescens, and streptomyces (Hanover 1993). The figure below shows the steps that starch from corn plants go through in order to become either 42% HFCS, 90% HFCS, or a blended 55% HFCS.

Figure 1 (Hanover 1993)

High fructose corn syrup is a disaccharide made up of both fructose and glucose. There are a few different forms of high fructose corn syrup, but the most common of these is HFCS-55 and HFCS-42. This form of sweetener is very similar in composition to the disaccharide sucrose (Moeller, Fryhofer, Osbahr, Robinowitz, 2009). Although the name implies that high fructose corn syrup is made up of mostly fructose, the composition of HFCS-55 is only about 55% fructose, 42% glucose and 3% higher saccharides and HFCS-42 is 42% fructose and 53% glucose (Collino, 2011). Comparatively, sucrose is made up of 50% fructose to 50% glucose. In the figure below it shows the composition of the two most common forms of high fructose corn syrup; HFCS 42%, HFCS 55%. Then, in the following figure we are able to see how glucose and fructose bond to form the disaccharide sucrose.

Figure 2

Figure3 Though these disaccharides are very similar in the composition of their monosaccharides, the primary difference is that the monosaccharides in high fructose corn syrup exist free in solution, while the components in sucrose remain as disaccharides in solution. (Moeller, Fryhofer, Osbahr, Robinowitz, 2009). The free monosaccharides in high fructose corn syrup allow food manufacturers an advantage by providing a better and sweeter flavor while using less of the sweetener. It also allows for a more stable product. The free monosaccharides also enhance freshness, texture, color, pourability and

consistency in the foods they are added to when compared to sucrose. Though as a sweetener in food manufacturing, high fructose corn syrup can act differently than its comparable sucrose, in the body, some suggest that both are absorbed similarly. The disaccharide forms of sucrose are broken down in the body once they enter the small intestine into fructose and glucose and there are absorbed as free fructose and glucose, similar to that of high fructose corn syrup. Other research has shown that high fructose corn syrup and sucrose are digested and absorbed differently because of the different levels of fructose and glucose in each and the way that each of the monosaccharides are digested and absorbed (Moeller, Fryhofer, Osbahr, Robinowitz, 2009). We will explore further about how the different sweeteners may be handled by the gastrointestinal tract differently from on e another. Glucose Metabolism: Glucose is essential to the body in activating hormones to regulate the blood sugar levels in the blood and organs in the body. There are many different transporters that bind to glucose and allow entry into the cells, although sodium-dependent glucose transporter 1, or SGLT-1, is the main route of intake into the small intestine. Like the name implies, SGLT1 requires not only Na+, but it also requires an ATP molecule. Although galactose metabolism will not be covered in this paper, it uses this same method of entry into the enterocytes. The figure below is able to show us how the simple sugars enter into the enterocyte, cell in the small intestine, and how these cells absorb the sugar and export it for further processing.

Figure 4 When the body consumes glucose, the pancreas senses an elevated amount of glucose in the blood and beta cells of the pancreas will release the hormone insulin. This release of insulin will facilitate entry of glucose into cells in order to start the breakdown of these monosaccharides to produce energy for the body, also known as the process of glycolysis. Insulin will also assist in the steps of glycolysis by activating an enzyme known as phospofructose kinase 1(PFK-1) to convert fructose 6 phosphate to fructose 1,6 bisphosphate; an essential energy dependent unidirectional step in glycolysis. When glucose is absorbed into a cell in the body, it can either be used in the process of glycolysis to create energy for that part of the body, or it can exit into the blood using the GLUT-2 transporter (Crane 1975). Glucose can also be made into glycogen (a storage form of glucose) if there is no need for extra energy and that glycogen will be stored in the tissues for use at another time. Fructose Metabolism:

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Though each simple sugar monosaccharides has the same chemical equation C12O6H12, they have different taste properties, shapes, and recognition by transporters and enzymes. While glucose and galactose are hexagons, fructose structured as a pentagon as seen below.

Figure 5 The entrance of fructose into the enterocytes of the small intestines requires a different transporter than that of the other monosaccharides such as glucose and galactose. Fructose uses an energy-dependent transporter called GLUT-5 to enter into the cell in contrast to both glucose and galactose that enter through a sodium dependent transporter called SGLT-1(Reeves, 2013). Once fructose enters a cell it can enter into later steps of glycolysis or it can be excreted into the blood through the GLUT-2 transporter. While an excess of both glucose and galactose in the cell can be made into glycogen in the cell to store energy for another time, fructose entry in certain cases into the cell bypasses the unidirectional step in the process and cannot convert to the compound that becomes glycogen (Crane, 1975). This bypass of the compound fructose 6-phosphate that is able to

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convert into glycogen stores, is not possible for fructose in the major route in the liver cells, though it is possible when fructose enters into muscles and kidneys (Reeves, 2013). Fructose does not stimulate the release and excretion of insulin into the body unlike the intake of glucose. When insulin is released in the body it stimulates the breakdown of glucose removing excess glucose in the blood allowing glucose to be absorbed and to be used as energy. Without the signaling of insulin, blood glucose levels may reach dangerous levels in the blood, not allowing the breakdown of simple sugars. Since fructose does not set off insulin into the blood, sugars cannot be broken down in glycolysis. A study done by Teff showed results where meals high in fructose have shown a reduction in circulating insulin and leptin levels in women (Teff et al.,2004). Fructose also does not enhance leptin production. Leptin is an adipose-derived hormone that binds to leptin binding sites to signal satiety and induce metabolism. Without the production of leptin, cells may not signal that they have had enough energy, which can leave the body longing for an increased intake (Bray, Nielsen, Popkin, 2004). Though for the most part all monosaccharides including fructose, glucose and galactose undergo glycolysis to provide energy for cells, there are definitely certain differences in uptake and signaling that fructose undergoes. Since High fructose corn syrup is the main intake of fructose, concerns have been raised by certain studies. With the discoveries found about fructose metabolism, intake high fructose corn syrup would presumably produce a lesser degree of insulin or leptininduced satiety when compared with that of a meal of sucrose and thus fuel overeating. Even still, fructose is a naturally occurring sugar found in fruits and honeys, and is

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sometime recommended since it doesnt raise the blood sugar as often and has a lower glycemic index. With that being said, the difference between the fructose found in nature and that of high fructose corn syrup is the enzymatic process to convert some of the glucose in sucrose into fructose to create high fructose corn syrup. That makes sugar in the form of high fructose corn syrup always have to be an added sugar in foods in beverages as opposed to just a sugar that occurs naturally. High Fructose Corn syrup metabolism: Since high fructose corn syrup is made up of both glucose and fructose, both routes of entry are possible. When high fructose corn syrup is in solution, both monosaccharides are free, unlike that of sucrose where in solution it remains a disaccharide. Some research argues that this difference may play a role on how it is metabolism different from sucrose. High fructose corn syrup does make up much of the American intake of fructose and some studies have shown that even the slight higher amounts of fructose result in a different metabolism (White, 2009). With that being said, high fructose corn syrup does not only have a slightly higher amount of fructose, but it also contains an altered form of fructose. Since corn syrup is made up of mostly glucose, there are enzymatic changes that occur to convert the glucose in corn to fructose. This alteration of fructose instead of the natural form can also affect the way the body uses the sweetener. Although studies have predicted different routes of metabolism between sucrose and high fructose corn syrup, more studies and research need to be conducted. Obesity: Introduction of Obesity:
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The rates of obesity have been skyrocketing in the last several years not only in America but all parts of the world, with over 60% of American and European adults becoming obese. Obesity is classified as a body mass index, or BMI, greater than or equal to 30 kg/m^2. This means that a persons weight is heavier than what is considered healthy for his/her own height. It is different than just being overweight; obesity is having the weight come from too much body fat. Obesity is not only affecting adults of the world, but childhood obesity has become one of the greatest health issues worldwide, increasing in both developed and developing countries. In the U.S. alone, it is estimated that 18% of children and adolescents are clinically obese (Lakhan and Kirchgessner, 2013). Causes of obesity: There is no single contributor to obesity but there are many things that play into the development of the disease. Overall, the main fact is that a person is eating more calories than are required for energy expenditure. Each person puts out a different amount of calories per day depending on genetic makeup, basal metabolic rate in each person, as well as exercise levels. If there are more calories going in than calories being used, weight gain occurs. In extreme amounts, this weight gain can lead to obesity. Some of the factors that have played into the drastic levels of obesity worldwide in the last few decades include, a sedentary lifestyle, high consumption of processed food, increase in intake of sugar sweetened beverages, excessive energy intake, and an increased portion size, high fat intake (P.H. Wilding, 2001). Since food that are highly processed and have high caloric levels are also available at very low prices, obesity can become more prevalent in those with low economic status. High-density, high-energy foods have become the cheap and

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easy way to go in families who are trying to eat on a budget, yet unfortunately, this is having increasing dangerous effects. Since high fructose corn syrup is in many processed foods that are at a low price and highly available, it is possible that the increase usage and consumption of high fructose corn syrup in the food industry is also causing obesity (P.H. Wilding, 2001). In the next few sections we will further discuss the potential relationship between high fructose corn syrup and the growing obesity epidemic. Effects of obesity: The onset of obesity is not independent of other variables. When a person is diagnosed with obesity, there are many other complications that come along with it. One strong association is with type 2 diabetes making obesity a major risk factor for also developing type-2 diabetes. Other complications that have an increased risked when associated with obesity are high blood pressure, hypertension, strokes, certain cancers, arthritis and cardiovascular disease (P.H. Wilding, 2001). Having a weight that is too heavy for the height of a person poses many strains to the body. On of the greatest effects this has is on the heart. Treatment: In order to prevent the negative effects that come along with obesity a person must take action to reduce body weight. The loss of even 5-10% body weight can put off or prevent these side effects completely (Medline plus, 2013). The most effective treatment for someone who is obese is to start being physically active and decreasing energy intake. Even getting started with 10 minutes of low impact physical activity a day can really help metabolism and weight management. Eating nutrient dense foods is important but at the
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beginning stages it is important to just eat less. In order to lose weight, energy intake going in must be less than energy intake being expended. After these initial steps, it is important to limit foods and beverages with high fat and cholesterol that can lead to many diseases especially associated with the heart. It is also important to limit sugar intake, and possible the intake of high fructose corn syrup. The direct relationship between the two components are controversial and will furthered be talked about by looking at specific experiments. High Fructose Corn Syrup and Obesity Since high fructose corn syrup was not commonly used up until 40 years ago, people could not help but notice that with the insertion of elevated levels of high fructose corn syrup into the food supply, obesity rates also skyrocketed (Lakhan and Kirchgessner, 2013). Now, high fructose corn syrup makes up about 40% of added sweeteners and there is now about 35% of Americans who are obese (Wright, 2012).The graph below shows the rising rates of both obesity (in a blue bar graph) and high fructose corn syrup (in a blue line graph) within the last forty years.

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Figure 6 Though there may or may not be a relationship between the two, it definitely has made people begin to question the potential effects of high fructose corn syrup and the risk it may instill in the American population. Stemming from a curiosity in a relationship between high fructose corn syrup and obesity, may studies broke out to explore the matter further. In this section we will explore the different study methods and techniques that scientists have executed in order to come to a conclusion on high fructose corn syrup and the potential effects it plays on the human body. Studies with both positive and negative

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results regarding the hypothesis were preformed showing both sides of high fructose corn syrup. A study by Stanhope shows twenty-four-hour endocrine and metabolic profiles following consumption of high-fructose corn syrup-, sucrose-, fructose-, and glucosesweetened beverages with meals (Stanhope, 2008). In this study, the compared the metabolic and endocrine effects of High Fructose corn syrup as well as a comparison of pure fructose and glucose. The objectives of the study were to compare the metabolic and endocrine effects of consuming high fructose corn syrup and sucrose-sweetened beverages and evaluate if sex and adiposity affected the outcome. Their final objective was to compare high fructose corn syrup and sucrose-sweetened beverages effects with the consumption of fructose or glucose sweetened beverages. The study is a clinical trial that tested sucrose against high fructose corn syrup sweeteners. In order to carry this out, the study used 34 subjects, 18 male and 16 female participants. The subjects were also considered for age, body weight, percent body fat, and body mass index. The 34 subjects were broken up into five groups, eight females with a percent body fat over 32, eight females with a percent body fat under 32, nine men with a percent body fat under 22, and nine men with a percent body fat over 22. They also had eight male subjects in a subset that consumed 100% fructose sweetened beverages or 100% glucose sweetened beverages along with the isocaloric meal, that were studied with an additional two days. These subjects were measured over a 24-hour period on two separate days in which they consumed three isocaloric meals of mixed nutrients along with a high fructose corn syrup sweetened beverage or a sucrose-sweetened beverage.

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The study then measured circulating glucose, insulin, leptin, ghrelin, triacylglycerol, and free fatty acid concentrations. These labs were measured after consuming three doses of either sucrose beverages or beverages sweetened with high fructose corn syrup. There were two experimental trials per subject that were randomly assigned and were spaced a month apart from each other. The subjects would consume identical meals, based on calculated calorie requirements with either a high fructose corn syrup sweetened beverage or one with sucrose. When the researches looked at the data, they saw that the results from leptin, TG, insulin, 24-hour glucose, grehlin were similar between sucrose and high fructose corn syrup. This studys main focus was on the effects that the sweeteners had on the endocrine and metabolic systems in the body. Through the study then concluded that sucrose and high fructose corn syrup do not have large short-term effects though there were different findings in regards to TG responsible. Below the figure shows the baseline body weight and fasting plasma concentrations of glucose, hormones, and lipids on each study day.

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Table 2 (Stanhope, 2008 page 1197) The study on the subset of seven men that were measured two extra days consuming the same isocaloric meals accompanied by beverages sweetened with either 100% fructose or 100% glucose was able to examine the effects of each sweetener on different measures. The results shown below give baseline body weight and plasma concentrations of glucose, hormones, and lipids on each study day in seven men. The results reveal that there is no significant difference in baseline characteristics or body weight among the different sweeteners (Stanhope, 2008).

Table 3 (Stanhope, 2008 page 1200.) The study not only looked at the comparison between the sweeteners but it also looked at other factors such as the effects on either males or females. The study considered

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many different lab results that may have been altered including body weight, glucose, insulin, leptin, ghrelin, TG, FFA, cholesterol, LDL, HDL, and ApoB. Another strength was that the subjects were assessed by a complete blood count and a serum biochemistry panel to assess eligibility. There were many exclusion factors so that the subjects met criteria. UC Davis Institutional Review Board approved the experimental design and registered dietitians made the meal plans for the randomly assignment subject. Though there is much strength to this study, there are also many limitations. The study also did not allow for other co variable or cofounders to be considered. These may have included physical activity, diet history, certain risk factors and other variables that may have played an influence on how metabolism or the endocrine system could have been affected. Another study done by Bocarsly et al gave an opposing result from that of Stanhope. It examined how high-fructose corn syrup effected characteristics of obesity in rats and the results of increased body weight, body fat and triglyceride levels. (Bocarsly, 2010). This study examines the effects of high fructose corn syrup on rats by performing clinical trials to evaluate if there is signs of obesity that show up in the rats. This study is a clinical trail that uses two different experiments to measure both short-term and long-term effects of high fructose corn syrup against other sweeteners in rats. The first experiment was male rats with short-term, two months, high fructose corn syrup access. The second experiment was male and female rats with long-term (six-seven months) access to high fructose corn syrup. The short-term experiment uses four different test groups that contained 10 weight-matched male rats each and were each assigned a

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different diet for eight weeks. One of the groups was a control group to have a standard to measure against the test groups. The first group was assignment 12h/day of 8% high fructose corn syrup, the second, 12 h/day 10% sucrose, third, 24 h/day high fructose corn syrup, all with ad libitum rodent chow and the forth group was the control that was assigned ad libitum chow alone. Results showed that the rats with 12-h high fructose corn syrup access gained significantly more weight compared to rats on 12-h sucrose in eight weeks. This was still the case even though the group was consuming fewer calories from high fructose corn syrup than the sucrose group was consuming from sucrose. The second experiment was six to seven months where the researchers looked at body weight, obesogenic parameters and gender differences to explore if high fructose corn syrup had an effect on the rats. The experiment had three groups for the males, each with 8 male rats, and had them consume their diet for six months. The first group was assigned 24-h high fructose corn syrup and ad libitum chow, the second, 12-h high fructose corn syrup and ad libitum chow and third, ad libitum chow alone. Male rats with ad libitum and high fructose corn syrup had increased body weight in six months as well as abdominal fat and triglyceride levels when compared with the control male rats. The females were studied for seven months and had an extra test group of 12-h sucrose, since sucrose only showed effects on body weight in females in the first experiment. Female rats 24-h of high fructose corn syrup gained more body weight than both the control and those assigned sucrose. Not only did female fats on seven months of high fructose corn syrup access have significantly higher body weight, but they also had increased abdominal fat and elevated triglyceride levels when compared to the chow and sucrose fed control female rats. Results showed that both male and female rats that

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consumed 12-h or 24-h access to high fructose corn syrup with chow gained significantly more weight when compared to the control group. The increases in body weight also resulted in increases in adipose fat, especially in the abdominal region, and elevated circulating triglyceride levels. This study was interesting because even when the male rats in the first experiment drank less total volume and ingested few calories in the form of high fructose corn syrup than the rats with the same access to sucrose, the high fructose corn syrup rats became overweight. The result of this finding along with additional findings in lab results of rats consuming high fructose corn syrup, led the researchers to believe that the increase in body weight was accompanied by an increase in fat accrual and circulating levels of TG, shows that the increase in body weight is reflective of obesity.(Bocarsly, 2010 pg 104). The figure below shows the relationship in an increase of body weight as the weeks go on. The graph displays the higher percent gain in the group that had daily access to high fructose corn syrup in comparison to that of 12- hour high fructose corn syrup or daily access to the rat chow.

Figure 7 (Bocarsly, 2010 )

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The benefits to the study method preformed by Bocarsly are they show both shortterm and long-term effects. Both male and female subjects are taken into account and evaluated on a long-term level. Fat pads were used to assess if the weight gain was in the uteral, intestinal or abdominal areas. Many relationships could be evaluated using this design such as those between high fructose corn syrup and body weight, fat accrual, and TG, gender differences and metabolism on sugars. A later study preformed by Stanhope showed increased outcome levels from both fructose and high fructose corn syrup when compared to glucose. The main outcomes that increased in this study in both males and females were postprandial triglycerides, LDL cholesterol, and apolipoprotein-B. The objective was to compare glucose, fructose, or high fructose corn syrup consumption at 25% energy requirements on the risk of cardiovascular disease (Stanhope, 2011). To perform this study, they took 48 young adults between the ages of 18 and 40 years old with a BMI between 18-35 kg/m^2. They broke up into threes group each with 16 subjects, nine males and seven females, and each got a different treatment that supplied 25% of their energy requirements; glucose, fructose, or high fructose corn syrup sweetened beverages. The subjects in each group were matched for gender, BMI, fasting triglycerides, cholesterol, high-density lipoprotein, and insulin concentrations. The study was highly selective and excluded those who smoked, habitually ingested more than two alcoholic beverages per day, exercised more than 3.5 h/wk at a level more vigorous than walking, or used thyroid, lipid-lowering, glucose-lowering, antihypertensive, antidepressant, or weight loss medications (Stanhope 2011).

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There were three parts to this study. The first was a three and a half day inpatient period where the subjects stayed at the Clinical Research Center to have baseline testing and consume a diet with 55% of calories coming from complex carbohydrates. The second phase was a twelve-day outpatient period where they ate diets ad libitum in addition to three servings of glucose, fructose, or high fructose corn syrup-sweetened beverages per day composing 25% of calories per day. The last phase included another three and a half day inpatient intervention at the Clinical research center where they had 25% of energy come from sugar-sweetened beverages and 30% from complex carbohydrates and went through further testing. The results of the 20-day study included measurements from a 24-hour serial blood collection that were done on the third day or each inpatient period. Fasting blood samples as well as postprandial blood samples were taken throughout the study. Results showed that the consumption of both fructose and high fructose corn syrup increased the 24-hour triglycerides when compared to glucose. Also increased was fasting LDL and apoB concentrations, where again, there was no effect from glucose. In the table below, the results show how much more elevated the outcomes were in both fructose and high fructose corn syrup(Stanhope, 2011).

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Table 4 from Stanhope 2011 The study concluded that a two-week consumption of beverages sweetened with high fructose corn syrup at 25% of energy, increased risk factors for cardiovascular disease similarly to fructose and at greater levels than glucose. Studies had been done previously

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that produced results of increased visceral adipose deposition and de novo lipogenesis, produced dislipidemia, and decreased glucose tolerance/insulin sensitivity in older, overweight/obese men and women who consumed 25% of their energy requirements from fructose-sweetened beverages when glucose-sweetened beverages did not (Stanhope, 2009). These studies can to conclusions about older adults, yet conclusions on younger adults had not been studies or thought to have the same impact. This study was able to display the impact that both fructose and high fructose corn syrup has on younger adults as well. Another study with results more closely related to Stanhopes first study was one done by Melanson that explored the effects of high-fructose corn syrup and sucrose consumption on circulating glucose, insulin, leptin, and ghrelin and on appetite in normalweight women (Melanson, 2007). This study looked at how beverages sweetened with high fructose corn syrup or sucrose combined with mixed meals plays an effect on hormones in the body. This study was also a clinical trial that studied the affects of high fructose corn syrup and the affects of sucrose on thirty lean women. The woman were assigned two random two-day visits where they consumed beverages sweetened with either high fructose corn syrup, or sucrose as 30% of their energy on isocaloric diets on day one and day two food was eaten ad libitum. During day one the subjects also had their blood samples taken and throughout the study the subjects rated their appetite levels. Results did not show any significant difference between the two sweeteners in terms of fasting plasma glucose, insulin, leptin and ghrelin. There was also no difference in

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energy consumption on day two as a result of day one. As for appetite, the desire to eat was increased after a day on sucrose compared to high fructose corn syrup. The research concludes that the short-term effects of fructose consumed as high fructose corn syrup were no different from sucrose in lean woman. This experiment allowed for randomization among the subjects and the days in which they were allotted the treatment. The experiment also allowed for measurements for both the exposures and the outcomes. The design had a follow up day that allowed for the rating of appetite and how it is affected by sweeteners. The study also was able to measure multiple outcomes such as circulating glucose, insulin, leptin and ghrelin. The participants were very narrow of lean and normal weigh woman, allowing a more focused study. On the other hand, the study only took 30 subjects and did lab results for one to two days. Summary: The clinical studies showed varied affects in the results high fructose corn syrup had on the body. Each experiment had limited number of participants that could have been improved by a larger test group. The two studies resulting in no affects of high fructose corn syrup compared to sucrose were both done on human subjects, while the one showing signs of differences were tested using rats. The studies done on rats can allow treatments that cannot be carried out in humans. These factors include the fact that researches can control the amount and proportions of sweeteners that rats consume and at what rates. They are also able to perform trials for longer periods of time and test the results as frequently as desired. Though this is definitely something to be considered, there were other variables that could have contributed to the opposing results. One variable was the

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length of each experiment. Both human experiments, showing no relationship to high fructose corn syrup and weight gain, where only conducted in 1-2 day trials, while the experiments showing a significant difference in rats was done in both 8 weeks and 6-7 months. There are many other factors that play into the accuracy of the results in different experiments, and they cannot just be viewed at face value. Both sides of the argument, whether or not high fructose corn syrup has an effect on obesity, has attempted to prove their side through conducting experiments with ideal end results. While they both appear to be correct, they cannot both be fully accurate at the same time. Further research is to be done in both fields and a middle side may be all that can be taken from these studies at this time. For example, there were many weaknesses in the Stanhope study. One weakness of the Stanhope study is that there were only 34 participants in this study. Since this is such a large claim it requires more subjects to have it be fully evaluated. With a greater study size there is more accuracy among claims so with such a small number of subjects, it is hard to come to conclusions, especially valid conclusions. Another weakness is that the study is only of 24 hours. The blood tests may still have information regarding the previous days diet and may not accurately have been affected at all by one certain sweetener in 24 hours. The drawbacks to a study such as that done by Bocarsly this there are a small number of subjects assigned to their experiments often leading to inaccurate data. Another thing to consider is that the experiment was carried out with animal subjects, rats, and results cannot fully translate into human subjects. Further studies would have to be

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conducted to see if in fact these results that played out on rats would indeed also have the same effect in human beings and the way they metabolized high fructose corn syrup in relation to sucrose or a control group. The study also did not consider multiple variables including a test group that had 24-h access to sucrose and how that may have affected the body weight of the rats. Lastly, things to consider for the Melanson study are that it only took 30 subjects and did lab results for one to two days. This does not allow ample subjects or time to see the true results that the sweeteners have on the body. They also just carried out the experiment in woman, which may not translate into male subjects. The appetite variable was recorded by the participants, allowing much room for error and variability among subjects. Conclusion Though I am still not sure one way or the other of what the absolute truth of high fructose corn syrup is, I am more educated and my perception has definitely shifted. At the beginning of my research, I was sure that high fructose corn syrup had negative effects on our body. I was not fully convinced, and am still unconvinced, that it leads to obesity but I was definitely more one sided. After analyzing both review and primary resources, I have found a middle ground on which to stand; one that knows and sees both sides of the topic and comes to realize much more research will need to be done in order for anything else to be decided. There is much more research to be done in the area of high fructose corn syrup and whether or not it has played into the obesity epidemic. Some things that require further
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research is; whether or not the enzymatic process of changing corn syrups glucose into fructose has an effect on the body. It would be interesting to find out the results of a study done in which they looked at fructose taken from natural sources and compared it to how the body processes fructose from glucose found in corn syrup that have been altered by enzymes. Other recommendations of trials that would shed light to the situation at hand would be to perform a clinical trial on what effect high fructose corn syrup has in young children (ages 1-5) compared to adults (ages 30-50). This would allow people to see how the body absorbs and metabolizes different sugar sweeteners at a variety of stages in the body. As our gut changes with an increase in age, certain nutrients affect the body in differing ways. A comparative study with high fructose corn syrup, sucrose, 100% glucose and 100% fructose among a vast number of ages would demonstrate these effects. The topic of high fructose corn syrup is still vastly popular among scientist to figure out how it actually reacts in the body and whether or not it has a regular effect. Even though many studies have been done, many are still lacking. These studies include results of athletes who perform on a diet of high fructose corn syrup or other sweeteners. Since many athletes will use simple carbohydrates as energy sources in sporting events, the question arises on how someones performance may be altered by the source of simple sugars consumed. Other studies, such as satiety levels after a meal high in high fructose corn syrup compared to another sweetener, have begun to be addressed; yet more research is still needed. It is especially important that further studies in this area use human subjects, as

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apposed to animal subjects, with constant access to calories, including those with high fructose corn syrup. Since human beings metabolism can come close to that of another animal, there will always be difference, and these will need to be explored before further results can be decided. Though there is an abundance of research yet to be done in this field certain conclusions may still be made. Obesity is a large-scale problem rising not only in the United States but also throughout the world. With something so complex, a single cause cannot be identified. There has to be some sort of shift in the way we have begun to live that looks different from how it was before. Though high fructose corn syrup may play a certain role in this, many other factors are also to be included. High fructose corn syrup may add to the rise in obesity but as do may other variables that need to be considered, though they may have different weights. The advancement in technology is a shift in life as it once was and has caused major changes in our world. The ability to have machines do the work, the convenience of appliances to cook or microwave food, and the availability of transportation to be powered by cars are just the beginning of how technology has caused the generational shift in lifestyle. High fructose corn syrup has too become a result of advancement in technology. Although, as high fructose corn syrup was developed because of technology, so were the development of countless other food products and machinery that caused Americans and now humans in general to gain obscene amounts of body weight. In addition of high fructose corn syrup being an outcome in technological outcomes, so has many other additives in processed foods that can have equal blame for obesity placed on them. I am not

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saying that high fructose corn syrup does not contribute to obesity, it may, but it takes more than one variable to contribute to a massive epidemic. It is clear to see that there are controversies over whether or not high fructose corn syrup adds to obesity, yet, it is also clear that the consumption of high fructose corn syrup in no way provides health benefits. With that being said, future consumption of high fructose corn syrup in either beverages or meals, should, as many foods, be kept to moderate amounts. The overconsumption of any sweeteners, high fructose corn syrup included, will contribute to an excess of calories where energy input will exceed energy output and the body will result in weight gain. As a result of this fact, both the American Heart Association and Dietary Guidelines of Americans have placed requirements on added sugars. The American Heart Association Nutrition committee recommends a limit of added sugars to 100-150 kcals per day while the 2010 Dietary Guidelines for Americans recommends intake of less than 25% of daily kcals from added sugars (Stanhope, 2011). The consumption of high fructose corn syrup is found only in processed foods and therefore will lead to an increase in foods or drinks that have been highly processed. These processed foods, where high fructose corn syrup is commonly found, also contain high amounts of calories and fat, further adding to weight gain. Though scientists may desire to place the blame on one issue to come up with a solution, such major issues are never that simple. Though high fructose corn syrup may be one piece of the puzzle in the epidemic of obesity, there are many more pieces to be considered.

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