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The Effects of High Fructose Syrup
Suzen M. Moeller, PhD, Sandra Adamson Fryhofer, MD, MACP, Albert J. Osbahr III, MD, Carolyn B. Robinowitz, MD, for the Council on Science and Public Health, American Medical Association In their capacity as authors of this report, the authors represent the American Medical Association’s Council on Science and Public Health, not their individual institutions Key words: high fructose corn syrup, sugar, fructose, sweeteners, obesity
High fructose corn syrup (HFCS) has become an increasingly common food ingredient in the last 40 years. However, there is concern that HFCS consumption increases the risk for obesity and other adverse health outcomes compared to other caloric sweeteners. The most commonly used types of HFCS (HFCS-42 and HFCS-55) are similar in composition to sucrose (table sugar), consisting of roughly equal amounts of fructose and glucose. The primary difference is that these monosaccharides exist free in solution in HFCS, but in disaccharide form in sucrose. The disaccharide sucrose is easily cleaved in the small intestine, so free fructose and glucose are absorbed from both sucrose and HFCS. The advantage to food manufacturers is that the free monosaccharides in HFCS provide better flavor enhancement, stability, freshness, texture, color, pourability, and consistency in foods in comparison to sucrose. Because the composition of HFCS and sucrose is so similar, particularly on absorption by the body, it appears unlikely that HFCS contributes more to obesity or other conditions than sucrose does. Nevertheless, few studies have evaluated the potentially differential effect of various sweeteners, particularly as they relate to health conditions such as obesity, which develop over relatively long periods of time. Improved nutrient databases are needed to analyze food consumption in epidemiologic studies, as are more strongly designed experimental studies, including those on the mechanism of action and relationship between fructose dose and response. At the present time, there is insufficient evidence to ban or otherwise restrict use of HFCS or other fructose-containing sweeteners in the food supply or to require the use of warning labels on products containing HFCS. Nevertheless, dietary advice to limit consumption of all added caloric sweeteners, including HFCS, is warranted.
Key teaching points:
N The most common forms of high fructose corn syrup (HFCS) have a similar composition to sucrose (table sugar), consisting of roughly equal amounts of fructose and glucose. N Compared to sucrose, HFCS provides foods with better flavor enhancement, stability, freshness, texture, color, pourability, and consistency. N Fructose has been directly associated with adverse health outcomes; however, most caloric sweeteners contain fructose, and there is little evidence, at present, that HFCS contributes more to obesity or other conditions than sucrose does. N The literature on HFCS is limited. Improved nutrient databases are needed to facilitate more independent research (including epidemiologic studies) on the health effects of HFCS and other sweeteners. Further evaluation is also necessary of the mechanism of action and relationship between fructose dose and response. N While there is currently insufficient evidence to ban or otherwise restrict use of HFCS by food manufacturers, the Dietary Guidelines for Americans recommend limiting intake of all added caloric sweeteners, including HFCS.
Address correspondence to: Suzen M. Moeller, PhD, Senior Scientist, Medicine and Public Health Division, American Medical Association, 515 North State Street, Chicago, IL 60654. E-mail: firstname.lastname@example.org Members of the Council on Science and Public Health at the time this report was written: Mary Anne McCaffree, MD (Chair), Oklahoma City, OK; Sandra Adamson Fryhofer, MD, Atlanta, GA; Stuart Gitlow, MD, MPH, MBA, New York, NY; C. Alvin Head, MD, Augusta, GA; Mohamed K. Khan, MD, PhD, Buffalo, NY; Russell W.H. Kridel, MD, Houston, TX; Ilse R. Levin, DO, MPH&TM, Springfield, MA; Lee R. Morisy, MD, Memphis, TN; Albert J. Osbahr III, MD, Hickory, NC; Carolyn B. Robinowitz, MD, Washington, DC; Amber Sabbatini, MPH, Corona, CA; Gary L. Woods, MD, Concord, NH; Barry D. Dickinson, PhD (Secretary), Chicago, IL. NOTE: In their capacity as authors of this report, the authors represent the American Medical Association’s Council on Science and Public Health, not their individual institutions. A version of this report was presented to the American Medical Association House of Delegates, June 15, 2008, as Report 3 of the Council on Science and Public Health. Authors’ personal financial interest: None
Journal of the American College of Nutrition, Vol. 28, No. 6, 619–626 (2009) Published by the American College of Nutrition 619
which manufactures more HFS than any other country . Nonnutritive sweeteners include sucralose. and hydrogenated starch hydrolysates [9. food supply increased 27%.Effects of High Fructose Syrup INTRODUCTION High fructose corn syrup (HFCS) has been increasingly added to foods since its development in the late 1960s. This report reviews the chemical properties and biological effects of HFCS in comparison to other added caloric sweeteners and evaluates the potential impact of banning or otherwise restricting the use of fructosecontaining sweeteners by food manufacturers. found in many breakfast cereals. dairy products. Since 1966.2]. condiments. Low-calorie and nonnutritive sweeteners are increasingly used in food products . However. Sugar alcohols. Only a few small. is half the price of sugar (sucrose). respectively . food supply. xylitol. food supply.6] the generally recognized as safe (GRAS) status of HFCS. Meanwhile. Likewise. erythritol. Epidemiologic studies on HFCS and health outcomes are unavailable. Department of Agriculture’s (USDA’s) Economic Research Service. DESCRIPTION OF SUBJECT HFS are sweeteners produced from starches such as corn. and provide an average of 2 kcal per gram (range: 0. rates of obesity have risen even in countries where little HFCS is consumed.S. isomalt. However. at 59 pounds per person in 2005.S. HFCS is pervasive in the U. beverages. meat and fish products. lactitol. These low-calorie sweeteners include sorbitol. as has total calories. This is apparently due to the increased use of noncaloric sweeteners. spreads. In addition. the Food and Drug Administration (FDA) has affirmed (1983) and reaffirmed (1996) [5. soups. acesulfame potassium. 28. as reflected by the increased availability of diet soft drinks and bottled water. and saccharin. frozen dinners. However. with honey and edible syrups (eg. rice. Due to their intense sweetness. desserts. 620 VOL. the availability of sucrose (from refined cane and beet sugars) decreased 33%. raising the price of soft drinks by an expected 1% . beyond ecological studies. mannitol. and fruit juice concentrates. Rising rates of obesity since the early 1980s. and other products . The availability of HFCS in the food supply grew more than 100-fold since its introduction in 1967 . making the amount of energy actually consumed even from aspartame negligible . which cost 30 cents per pound in 2005. shortly after HFCS was widely introduced into the U. The per capita availability of crystalline fructose and fruit juice as sweeteners is not tracked by the U. HFCS is the most prevalent HFS. found direct correlations between HFCS and obesity. Corn is the primary starch used to produce HFS in the United States. which account for 45% and 42%. Corn-derived glucose (dextrose) and glucose syrups comprise an additional 12% of the added sweetener market. also known as polyols. beyond those of other caloric sweeteners. Sweeteners in the Food Supply Caloric sweeteners include sugar (sucrose). Increased corn prices in response to ethanol production are expected to have little impact on the price of HFCS. HFCS. thus. canned fruits. using per capita estimates of HFCS consumption. These nonnutritive sweeteners do not contain any calories. which has 4 kcal per gram. and most involved some form of industry support. use of HFCS appears to have leveled off. from 113 pounds per person per year to 143 pounds per person per year in 2005 . the amount of added caloric sweeteners in the U. Tagatose and trehalose are sugars that are similar to the sugar alcohols in function and provide 2 kcal and 4 kcal per gram.0 kcal/g) [9. including the use of warning labels on foods containing high fructose syrups (HFS). human and animal studies have found direct associations between fructose and adverse health outcomes. aspartame.10]. and declines in consumption of regular soft drinks . Increased consumption of soft drinks and fruit drinks contributed to more than half of this increase in added sugar intake . because nutrient databases do not contain information on the HFCS content of foods and have only limited data on added sugars in general. 6 . have fueled concerns about its potential adverse health effects. at a cost of 14 cents per pound.S. snack foods. although the per capita use of these sweeteners is not available from the Economic Research Service. Most caloric sweeteners contain fructose and all provide 4 kcal per gram. There is no limitation on its use beyond good manufacturing process . of added caloric sweeteners in the U. are not fully absorbed from the gastrointestinal tract. short-term experimental studies have compared the effects of HFCS to those of sucrose. very small quantities are needed. after peaking in 1999 at 64 pounds per person. Consumption of added caloric sweeteners in general has increased over the last 30 years. breads. The most commonly used sweeteners are refined sugars and HFCS. maple syrup. NO. Concern about the health effects of HFCS developed after ecological studies. tapioca. molasses) comprising the remaining 1% .2–3. crystalline fructose. the adverse health effects of HFCS. sauces. most of which contain fructose. maltitol.10].S. HFCS. food supply . except for aspartame. honey. and cassava [1. molasses. wheat. potato. neotame. salad dressings. are not well established.S. respectively. The adverse metabolic effects of fructose have likewise raised concerns about excessive amounts of fructose in the American diet (estimated at 10% of daily calories ).
For example. ice cream. HFCS-90 is used to produce HFCS-55. Estimated Molecular Composition of Common Caloric Sweeteners (%) [3. condiments. The monosaccharide content of HFCS-42 and HFCS-55 is similar to that of sucrose (table sugar).13]. The properties of free fructose are particularly significant in enhancing the versatility of HFCS. the covalent bond between the fructose and glucose molecules breaks down in low acid environments. which affects the amount of fluid secreted in the stomach [17. as the standard. which is a disaccharide composed of 50% fructose and 50% glucose . Crystalline fructose. However. HFCS-90 was developed (90% fructose) and combined with HFCS-42 to create HFCS-55 (55% fructose) . Insulin is believed to directly and indirectly JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 621 .15]. fructose intake does not stimulate insulin secretion. this provides better browning of baked goods and better retention of red colors . where only a small amount is needed due to its more intense sweetness. which contains 42% fructose.20]. Even if sucrose is not hydrolyzed before consumption. such as during storage in hot climates [1. respectively). regardless of whether they originated as part of HFCS or sucrose. dairy products. HFCS-42 is used in baked goods. In addition. 53% glucose. The different types of HFCS have distinct uses in food production.Effects of High Fructose Syrup Table 1. which does not contain any fructose. In the 1970s. contains 98–100% fructose [1.18].13–15] Fructose HFCS-42 HFCS-55 HFCS-90 Sucrose Honey Molasses Apple juice Orange juice Crystalline fructose 42 55 90 50 49 50 59 51 100 Glucose 53 42 9 50 43 48 31 49 0 Higher saccharides 5 3 1 0 8 3 10 0 0 Chemical Properties of HFCS Compared with Sugar The term ‘‘high fructose corn syrup’’ implies that the syrup is primarily comprised of fructose. such as those found in soft drinks. with a sweetness of 173 relative to crystalline sucrose. which depend on the concentration of the solute.21]. as well as at high temperatures. which is the least refined form of sugar (Table 1) . free fructose and glucose in HFCS are ‘‘reducing sugars. Thus. and other products [3. In products sweetened with sucrose. although the exact composition varies by type. HFCS-55 was formulated to have the same level of sweetness as sucrose and is used primarily in carbonated soft drinks. the covalent bond between the fructose and glucose molecules in sucrose is easily cleaved by the enzyme sucrase in the brush-border cells of the small intestine [11. Fructose and Glucose in the Body Since the hydrolysis of sucrose under low pH or high temperatures results in free fructose and glucose. The only difference is the greater osmotic pressure generated by the smaller monosaccharides compared with the disaccharide sucrose. the smaller monosaccharides generate higher osmotic pressures and lower freezing points than the disaccharide sucrose. the monosaccharides fructose and glucose exist free in solution in HFCS. Other caloric sweeteners (with the exception of pure glucose) contain similar or even higher amounts of fructose. HFCS-42 and HFCS-55 have significantly higher moisture contents than sucrose (29% and 23% versus 5%. Likewise. Unlike glucose. concerns about the role of fructose in appetite and metabolism. Crystalline fructose is the sweetest monosaccharide. has a reference value of 100 (glucose has a relative sweetness score of 74) . HFCS maintains its structural stability over a range of temperatures and acidic conditions . HFCS-42 has less fructose than sucrose and is therefore slightly less sweet. resulting in HFCS-42 . other sweetened beverages. In contrast to sucrose. while apple juice has about twice as much fructose as glucose (Table 1) [3. Many of the concerns about HFCS are. in fact.’’ while sucrose is nonreducing. the body is absorbing free fructose and glucose molecules. orange and grape juices have equal amounts of fructose and glucose. not on their identity . Regular corn syrup is mainly used as a nonsweet thickener and consists of pure glucose and glucose polymers. which.5. Honey has a molecular composition similar to that of sucrose and HFCS . canned fruits. such as its greater ability to adsorb and retain moisture compared with sucrose . and frozen desserts . which can be made from HFCS as well as from sucrose.17]. HFCS was developed in 1967 through the partial enzymatic isomerization of glucose to fructose.16]. as well as in ‘‘light’’ foods. which is likely due to the lack of fructose transporters (Glut-5) in the b cells of the pancreas [11. In contrast.5]. Many of the advantages of HFCS (Table 2) are due to the colligative properties of the free fructose and glucose molecules. A recent study reported that the sucrose content of a cola beverage decreased from 36% of total sugars to only 10% of sugars 3 months after manufacture. This creates variability in the taste profile of the product. as found in HFCS. the types of HFCS used in most food products are high only in fructose as compared with regular corn syrup. and 5% higher saccharides (Table 1) . beverages containing either sweetener should be absorbed similarly by the body. Fructose is more quickly emptied from the stomach compared with other sugars and is absorbed in the intestines more slowly and less completely than glucose [19. as does molasses. For example.13. and the free fructose content increased from 32% to 44% of total sugars . Fruit juices also contain similar amounts of fructose.
longitudinal. has significantly increased rates of lipogenesis . although the adverse effects seem limited to high intakes and not to the small amount of naturally occurring fructose in fruits and vegetables (approximately 15 g/d. 28. N Maintains its structural stability over a range of temperatures and acidity levels. were strongly and consistently associated with higher total calorie consumption in cross-sectional. HFCS and sucrose did not affect the balance of iron. A recent review and meta-analysis found that soft drinks. In most animal models. magnesium.21]. diets high in fructose increase total energy intake. and HFCS. They have been associated with overconsumption of calories and with weight gain in animals and humans . as it is usually found in citrus juices. N Maintains the pourability of frozen products due to its lower freezing point.27. NO. both in experimental studies  and in long-term prospective studies [32. when fructose is consumed with glucose. a 12-oz serving of a soft drink may contain 25 g of fructose . although another study found HFCS-sweetened beverages to adversely affect magnesium. resulting in a clearer and crisper perception of other flavors. insulin resistance. (though effects on leptin secretion) inhibit food intake . and average fructose intakes are about 97 g/d) .33]. abdominal distention. while ghrelin appears to increase hunger and appetite .24]. Thus. (Leptin generally inhibits food intake and increases energy expenditure . A smaller body of literature reports soft drink consumption to be inversely Fructose and Adverse Health Outcomes Human and animal studies have found direct associations between high intakes of fructose and adverse health outcomes. N Maintains the soft texture of baked goods by retaining moisture and resisting crystallization. 6 . N Increases fermentability. and long-term experimental studies. flatulence. fructose can be more easily incorporated into phospholipids and triacylglycerols than glucose. The body does not appear to compensate for extra calories from beverages as well as those from soups or solid foods [11. which is higher than the amount that most people consume [11. it is possible that HFCS could affect the balance of certain minerals in the body. resulting in firmer canned fruits and less freezer burn in frozen fruits. in contrast to the hormonal response after glucose ingestion . as well as with other adverse health outcomes. and zinc over 2 weeks in one study that examined this issue . suggesting that soft drinks may reduce feelings of satiety.31]. whether sweetened with HFCS or sucrose. further inhibiting the ability of fructose to provide satiety signals [11. increase hunger. In addition. calcium. In addition. The brain and central nervous system also lack Glut-5 transporters. or acclimate individuals to prefer sweeter and generally more calorie-dense foods . However. insulin resistance. with the strongest associations seen in the experimental studies .20]. which makes it more economical in producing breads.5] N Enhances other flavors because its sweetness is detected quickly and early by the taste buds. body weight. absorption of fructose is improved and malabsorption and its associated symptoms are less likely to occur [19. Individuals with diabetes and hyperinsulinemia may be particularly sensitive to these adverse effects of excessive 622 VOL. sucrose. but does not linger. weight gain. In addition. calcium. and hypertension [21. fructose intake . Calorically Sweetened Beverages and Adverse Health Outcomes Calorically sweetened beverages are a significant source of HFCS in the American diet . fructose in both sucrose and HFCS appears to be equally detrimental. soft drink consumption has been positively associated with body mass index (BMI). but not the same amount of glucose. visceral adiposity. for comparison.20]. dyslipidemia [21. but not in humans at intakes of 20% of total energy .Effects of High Fructose Syrup Table 2. as well as gout . Several studies have found higher energy intakes than could be explained by consumption of the soft drinks alone. and abdominal pain [19.27]. More immediate adverse consequences of excessive fructose intake include diarrhea. Advantages of HFCS over Sucrose in Food Manufacturing [3. and phosphorous homeostasis over 6 weeks .28] (including postprandial hypertriglyceridemia ). consumption of excess amounts of fructose. borborygmus. fructose consumption does not increase leptin or decrease ghrelin levels. More than half of healthy individuals report symptoms of gastrointestinal distress after consuming 25 g or more of crystalline (pure) fructose . In addition.) The chemical-reducing properties of free fructose allow it to form stable complexes with iron that promote both iron and zinc absorption . In humans. as fructose metabolism bypasses the key rate-limiting step in the liver that slows glucose metabolism . fructose has been associated with increased total energy intake. N Provides better browning and flavor in baked goods and better color retention in products such as ketchup and strawberry preserves. frequent consumers of fructose may have greater tolerance or threshold for these potential side effects . dyslipidemia. However. N Maintains freshness and prolongs shelf life through improved moisture control and less microbial spoilage. including obesity and the metabolic syndrome. Because HFCS contains free fructose. Fructose and sucrose both reduce the bioavailability of copper in animals at high intakes.
78. In fact. but because there are no individual-level data on HFCS consumption . Recent studies have not found statistically significant differences between HFCS and sucrose on total energy intake. However. Additionally. diabetes . because food databases do not contain data on the HFCS content of foods. Suggested amounts are listed in sample diets that limit discretionary calories. dyslipidemia . and directly associated with dental caries.000 calorie diet. In this recommendation. half of their carbohydrate intake comes from caloric sweeteners .24]. At least 2 of the studies (which provided details on their statistical power) were powered to detect only 120. but this difference was not statistically significant .to 150-kcal differences in response [16. these small experimental studies examined only the short-term effects of sucrose and HFCS and may have been underpowered. involved investigators who have consulted with the sweetener industry. and/or ghrelin [16. systolic and diastolic blood pressure [31. gout . and dietary fiber. metabolic syndrome. intake was 192 kcal greater at the test meal after consumption of the 50:50 solution of free glucose/free fructose compared with the sucrose solution. The increase in HFCS in the food supply has been highly correlated with the increased prevalence of obesity and type 2 diabetes. In addition. Moreover. and overall dietary quality. while women experienced less hunger after consuming sucrose-sweetened beverages . taste. The affordability and versatility of HFCS compared to sucrose may have contributed to the sweetening of the American diet. men and women may respond to the sweeteners differently. In contrast to these sample healthy diets. insufficient evidence exists that HFCS consumption has contributed to obesity more than sucrose. which is less than that in most calorically sweetened soft drinks . For example. In general. The Dietary Guidelines for Americans advise people to ‘‘choose and prepare foods and beverages with little added sugars or caloric sweeteners’’ . obesity rates are rising even in countries where trade barriers have limited the use of HFCS . fruit. but not to HFCS .17. and inflammatory markers (from sucrose in beverages plus foods) . glucose.36]. compared with 0. hunger.35. as one study found that men experienced significantly less hunger after consuming HFCS than sucrose. before the use of HFCS. glucagon-like peptide 1 (GLP-1). In one study. overall satiety. another study found increased hunger in women the day after consuming 30% of calories from sucrose as compared with HFCS . calcium. It has been hypothesized that the extra 5% fructose in HFCS-55 compared to sucrose has acclimated individuals to a sweeter diet . Among the 20% of Americans consuming the most HFCS (conservatively estimated at 11% of total calories).33]. industry-funded studies reported significantly smaller effect sizes. ‘‘free sugars’’ includes all monosaccharides JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 623 . Epidemiologic studies have yet to directly measure total HFCS intake in individuals. to no more than 32 g (8 tsp or 128 kcal) per day on a 2. Unfortunately. or decreased physical activity  has. thirst. the ratio of fructose to glucose was 0. only ecological associations are available for consideration. High Fructose Corn Syrup and Obesity At present.36]. It is possible that other aspects of diet and physical activity that occurred simultaneously with increases in HFCS consumption may play a larger role in the rising rates of obesity and diabetes seen in recent years. However. even though smaller differences in energy intake may contribute over the long term to obesity or other adverse health outcomes.Effects of High Fructose Syrup associated with consumption of milk. including those from added sugar. kidney stones. increased consumption of total calories (from any source). uric acid.79 in 2002 . Additionally. calorie intake increased by 523 kcal/d between 1970 and 2003 . with added caloric sweeteners now comprising about 16% of total calories  and HFCS comprising 7% to 10% of total calories [11. or concentrations of insulin.10% of total calories to improve overall diet quality and prevent overweight and dental caries. current average intakes (estimated at 318 kcal/d) far exceed these limits . Food use data show that between 1909 and 1997. Both beverages sweetened with HFCS and those sweetened with sucrose contribute to the overconsumption of calories at meals served 50–120 minutes later compared with a diet beverage or no beverage [16. there was an 86% increase in per capita use of added caloric sweeteners in the United States . all 4 of these recent studies received financial support from the sweetener industry or Guidelines on Caloric Sweeteners Dietary guidelines generally recommend limiting intake of added caloric sweeteners of any type. macronutrient intake. the authors expressed concern about their lack of statistical power to detect a difference between sucrose and HFCS and repeated the experiment comparing sucrose to solutions of free glucose and free fructose. In 1966. although the sweetness intensity of HFCS-55 is similar to that of sucrose [3. this second experiment was powered to detect only a 120-kcal difference in response between 20% glucose:80% fructose and 80% glucose:20% fructose solutions—not to detect differences between the more similarly composed sucrose and HFCS beverages . the replacement of some sucrose with HFCS has not altered the ratio of fructose to glucose in the food supply. However.13]. leptin. particularly those examining the relationship between soft drinks and energy intake .17]. an Expert Consultation for the World Health Organization and the Food and Agriculture Organization of the United Nations recommended limiting intake of ‘‘free sugars’’ to .
41]. Improved nutrient databases are needed to analyze food consumption in epidemiologic studies. 6 . Information on HFCS should be added to the USDA food composition and nutrient databases to allow for epidemiologic research on intakes of HFCS in individuals and its relationship 624 VOL. pourability. Potential Impact of Limiting FructoseContaining Sweeteners Any ban on the use of fructose-containing sweeteners would include not just pure fructose and high fructose syrups. most of which contain fructose. thus. or those at risk of obesity due to family history or other conditions . While this does not necessarily bias the results. many of which have been industry-supported. as did total calories. beyond those of other caloric sweeteners. particularly on absorption by the body. color. This replacement would not change the calorie content of sweetened foods and beverages. food preparers. the adverse health effects of HFCS. However. with health outcomes . research is needed on the possible effects of different sweeteners in various subpopulations. which develop over relatively long periods of time. dietary advice to limit consumption of all added caloric sweeteners. including obesity. no analytical method exists for differentiating between naturally occurring sugars of any type and added sugars [13. thus. 28. as are more strongly designed experimental studies. Human and animal studies have found direct associations between fructose and adverse health outcomes. In addition. The free monosaccharides in HFCS provide better flavor enhancement. NO. and consistency to foods in comparison with sucrose. and consumers. because of concerns about the adverse effects of excess fructose in the diet. While the USDA has constructed a database containing the added sugar content of selected foods . It is important that the research be free of potential bias. will likely result in the replacement of HFS with sucrose and other caloric sweeteners in food products. more research is required on the long-term effects of high consumption of these sweeteners to confirm their similarities and to compare their effects in beverages versus solid foods. warning labels on products containing HFCS would be unwarranted. the values in the database were calculated by the USDA from the ingredients listed on product labels . syrups. ISSUES FOR FURTHER RESEARCH More information is needed to clarify the impact of HFCS and other sweeteners on health. The GRAS status of HFCS is unlikely to be revoked unless such evidence is found. CONCLUSIONS HFCS is a common food ingredient in the United States. The literature on HFCS consists mostly of ecological or small. particularly as they relate to health conditions such as obesity. Because the composition of HFCS and sucrose are so similar. including overweight and obese individuals. cane and beet sugars. texture. including HFCS. Regulation to limit the use of HFS.Effects of High Fructose Syrup and disaccharides added to foods by manufacturers. Improved databases on the amount of added sweeteners in all foods are still needed. Nevertheless. and would likely not change the ratio of fructose to glucose in the food supply. there is insufficient evidence that HFCS is more likely to contribute to adverse health outcomes than sucrose or any other caloric sweetener. it is difficult to thoroughly examine the potentially differential effect of various sweeteners. as well as research on the mechanism of action and relationship between fructose dose and response. including HFCS. The addition of added sugars to the Nutrition Facts label on foods and beverages is one possible strategy to help consumers meet these recommendations. While a few studies have examined the metabolism of HFCS compared to sucrose. Nevertheless. At the present time. The primary difference between HFCS and sucrose is that these monosaccharides exist free in solution in HFCS. consisting of roughly equal amounts of fructose and glucose. Currently. more surveillance and longitudinal research on fructose is needed . including those on the mechanism of action and relationship between fructose dose and response. but in disaccharide form in sucrose. freshness. there is insufficient evidence to ban or otherwise restrict the use of HFCS or other fructose-containing sweeteners in the food supply or to require the use of warning labels on products containing HFCS. rates of obesity have risen even in countries where little HFCS is consumed. so did the rates of obesity and diabetes. HFCS is considered GRAS by the FDA. it appears unlikely that HFCS contributes more to obesity or other conditions than sucrose does. but also naturally occurring sweeteners such as honey. and fruit juices . Likewise. Likewise. as well as sugars naturally found in honey. the bias found in the soft drink studies discussed above suggests the need for more independent research. Consumption of added caloric sweeteners in general increased over the same period. The most commonly used types of HFCS (HFCS-42 and HFCS-55) are similar in composition to sucrose. are not well established. is warranted. As use of HFCS increased over the last 30 years. stability. as most previous studies were conducted by researchers who had received funds from the sweetener industry. At the present time. and fruit juices. it does not distinguish between types of added sweeteners. not in a reduction in the use of added sugars by food manufacturers. short-term experimental studies.
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