a recent JAMA
paper on how the brain responds to fructose and glucose has made something of a splash in the popular press, frequently leading to claims along the lines of "proof that high-fructose sweeteners make you fat!" or some such rot. the paper doesn't actually prove that. i'm not entirely sure what it does prove -- i think it's mostly interesting to specialists in the field -- but i thought i'd try to clear the air a bit.
a little background: both glucose and fructose are simple sugars (monosaccharides) that the body can run on directly. there are some important differences between them:
* the body can run on glucose directly, but fructose is first metabolized by the liver into other compounds which the body runs on.
* the brain runs
only on glucose, and takes it directly out of the bloodstream.
* ...and as a consequence, if we don't get enough glucose in our diets, the body makes some to keep the brain going.
* other tissues also run on glucose, but their ability to take it up is controlled by insulin.
from these alone, i would have expected that the body responds differently to glucose and fructose. in fact, the obvious result -- which silly reporters seem to have gotten all excited about -- is that if you take in a lot of glucose all at once, you'll get a much larger insulin spike than if you take in the same amount of energy in fructose.
the paper provides a bunch of details on the differences. most of the paper is about different brain responses, which i can't say much about. that's beyond my training (i'm a biochemist, dammit, not a doctor!). however, it does make perfect sense to me: since the brain needs glucose specifically, i'd expect it to react different to getting some than not. i'm actually curious now how the brain reacts to getting the same amount of energy as fats and proteins (vs the two different sugars)... i did say i'm a biochemist. :)
the researchers also looked at other responses, including both objective and subjective measures of how satiated the sugars make people feel. the former were made by looking a bunch of peptides that regulate hunger and satiety:
Baseline levels of plasma glucose, fructose, insulin, GLP-1, PYY, leptin, ghrelin, and lactate were not different between the glucose and fructose conditions (TABLE2). Glucose ingestion caused significantly greater elevations in plasma glucose..., insulin..., (Figure 1B and C), and GLP-1... concentrations compared with fructose ingestion, whereas plasma fructose, lactate, and PYY levels were greater after fructose ingestion compared with glucose ingestion (Table 2). Levels of leptin and ghrelin were not significantly different following ingestion of fructose compared with ingestion of glucose.
(statistical details elided)so, the things we'd expect to respond directly to the two different sugars did the expected things, which is a good positive control. of the others, only peptide YY -- which is involved in the regulation of appetite -- responded differently. if the peptide YY results were taken in complete isolation, they'd say that fructose is better at suppressing appetite than glucose. (but i wouldn't do that, especially given the lack of difference in leptin and ghrelin concentrations.)
subjective effects were made by ye olde tenn pointe scale survey, a method the researchers provide citations for being valid. i didn't check the cited papers because:
There was no significant difference between glucose vs fructose ingestion on predrink-postdrink changes in hunger..., fullness..., or satiety[.] Glucose ingestion resulted in a significant difference in predrink-postdrink changes in fullness... and satiety..., whereas fructose ingestion did not have a significant effecton predrink-postdrink changes in fullness... or satiety[.]
(statistical details elided; my emphasis)so there's not much to see in terms of how "filling" the two sugars are. i can't quite explain the differences in their pre- vs post- effects in isolation, except to say that the sample population was pretty small (20 people), so it may just be a fluke. more research is clearly required; send more sweet drinks. ;)
so, given the absence of real differences here (unless you're a peptide YY fan), why did the press get all excited? i'd say it was because the authors shot their collective mouths off in their first sentence in an attempt to seem "relevant":
Importance Increases in fructose consumption have paralleled the increasing prevalence of obesity, and high-fructose diets are thought to promote weight gain and insulin resistance. [...]
Of course, they might just as well have said that increases in fructose consumption have paralleled increasing standards of living worldwide, increasing global temperatures, increasing number of exoplanets known, or any number of other silly things which are the reason sensible people say that correlation doesn't prove causation. bad researchers, no credibility.
i'm generally suspicious of simple explanations for large problems. my bias specifically in this case is for falling exercise and increasing food availability as people have gotten wealthier. i don't see that this paper has done much to say one way or the other.