Fructose: Not Just a Sweetener
Most people think of sugar as a sweetener. Your patients may be getting a lot of mixed messages about how much sugar they can have in their diets. Information they glean from popular press or magazines often dilutes dietary advice to simplified messages such as: “Avoid sugar” or “Read labels for sugar” or “Avoid products with high fructose corn syrup”. However, these sorts of messages aren’t too helpful. Simply trying to avoid sugar will not result in a nutritionally sound diet, and attempting to avoid products that contain them does not overtly impact diet and nutrition in the bigger scheme of things. Furthermore, these messages may incorrectly imply that foods low in added sugar are also low in sugar or carbohydrates.
There is no one recommended intake for total sugars in the diet, but there are guidelines. The American Heart Association recommends limiting sugar to 100-150 calories (for women and men respectively) per day, and the World Health Organization recommends free or added sugar intake be five to ten percent of total calorie intake. Your patients need individualized dietary advice based on their health and medical history. Apart from individualizing intakes (such as in patient with diabetes, heart disease, or fructose intolerance), I recommend the middle road of about 10% or less of total calories (this would be 180 calories per 1800 calories).
These guidelines are not meant to have your patients counting grams of sugar every day, or obsessing over every food label. Instead, you’ll just want to advise them to be sensible about the primary sources of sugar and the sweets they eat.
Food Science 101
Sucrose in the form of your sugar bowl (from sugar cane or sugar beets) has been consumed in the human diet for decades, while fructose from fruit and honey has been consumed for millennia (1). To help your patients keep perspective on sugar in the diet, its important is to help them understand that sugar is not just added to foods for its sweetening properties, but also for other functional properties.
Sweeteners such as crystalline fructose or high fructose corn syrup are safe ingredients that serve other purposes besides sweetening in food processing. Like other ingredients, sugars serve a variety of roles in food processing. For instance, regardless of whether bread is purchased from a store or bakery or baked at home, most recipes call for some sugar. While many breads are not sweet tasting, the sugar helps activate the yeast so the bread can rise. Other products, such as condiments or salad dressings for example, are often unjustly called out as a source of sugar. They contain minimal sugar per serving which serves as a flavor enhancer and also helps maintain the color of the products. In other cases, sugar can help people enjoy eating foods they may not eat otherwise. Consider the examples of honey glazed steamed carrots compared with raw carrots, sweetened oatmeal versus plain oatmeal, or fruit containing yogurt versus plain yogurt. Fruits, vegetables, dairy, and whole grains are foods that are under-consumed by many Americans. If a little bit of sugar helps people eat more salads or vegetables or oatmeal, that’s a victory for the overall diet.
Crystalline fructose and high fructose corn syrup contribute many useful physical and functional attributes to food and beverage applications, including:
- Sweetness: Yes, fructose is used a sweetener, but because it is sweeter than sucrose and high fructose corn syrup, less can be used, thereby reducing calories.
- Texture enhancement: Fructose promotes cake height in baked goods. Since fructose doesn’t hydrolyze in the same way as sucrose, it provides a longer shelf life to many products.
- Moisture: Fructose binds moisture well, so it’s to retain moisture and texture in products that are looking for a soft, moist, consistent texture. Crystalline fructose, while in crystal form, once dissolved and used in food products does not recrystallize. This helps provide desired moistness to products.
- Color and flavor development: Fructose provides a nice mouth feel in products, and offers an appealing aroma and browning effect when heated. The sweet taste can also enhance the flavor profile of many foods and beverages.
- Low Glycemic quality: Fructose has a lower glycemic index than other sugars, making it appealing for carbohydrate controlled products. It is also cost effective and provides lower carbohydrate content to foods.
Rather than focusing on the type of sugar in a product, help your patients reduce the overall sugar in their diet. Evaluating a diet recall can be effective in identifying food patterns that should be discussed. Many individuals can substitute some foods and beverages and enjoy their diet changes long-term. For example, limiting beverages containing sugar (choosing water or other zero calorie beverages instead), monitoring portions of desserts and other baked goods, and choosing adequate servings fruits and vegetables daily. The DASH Diet is a sensible plan and the My Plate website also has basic guidance to put your patients on a path to healthy eating. Always refer your complex or newly diagnosed patients to a registered dietitian for an individualized diet plan.
Rosanne Rust MS, RDN, LDN is a registered, licensed dietitian-nutritionist with over 25 years’ experience. As a Nutrition Communications Consultant she delivers clear messages helping you understand the science of nutrition so you can enjoy eating for better health. Rosanne is the co-author of several books, including DASH Diet For Dummies® and the The Glycemic Index Cookbook For Dummies®. A wife, and mother of 3 boys, she practices what she preaches, enjoying regular exercise, good food and festive entertaining. Follow her on Twitter @RustNutrition.