|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 2 | Page : 121-122
Fructose and the obesity epidemic
Jaikrit Bhutani1, Sukriti Bhutani2, Kanishka Sawhney3, Sanjay Kalra4
1 Intern, PGIMS, Rohtak, Haryana, India
2 Intern, MAIMRE, Agroha, UP, India
3 Medical Student, Subharti Medical College, UP, India
4 Deparment of Endocrinology, BRIDE, Karnal, Haryana, India
|Date of Web Publication||12-Jun-2014|
PGIMS, Rohtak, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhutani J, Bhutani S, Sawhney K, Kalra S. Fructose and the obesity epidemic. J Obes Metab Res 2014;1:121-2
Fructose, found in fruits, is a natural sugar that is an integral part of our diet. It is generally considered a "healthy sugar" and is sometimes preferred over sucrose and glucose for consumption in diabetes and obesity.
Fructose is also present in the disaccharide-sucrose. It forms 50% of the sugar. High-fructose corn syrup (HFCS), which contains 55% fructose, is a "modern" sweetening agent. It is now widely used in a variety of food products. These include not only "sweet" beverages such as fruit juices, but also "salty" or "neutral" tasting foodstuffs such as ketchup, buns, and biscuits. ,, The promiscuous use of HFCS is not due to its health benefits which may be perceived or real, but is because of its easy availability and economic advantage. The increasing usage of fructose-based sweeteners is fuelled both by their low cost and prevalent public misconception that this sugar is healthy. HFCS-containing items may also be important contributors to the current epidemic of obesity and metabolic disorders.  Furthermore randomized control trials of fructose and sucrose, at the doses at which these are consumed in the normal diet suggests no adverse health effects.  Therefore to clarify, this aspect further, there is a need to explore epidemiologically the long-term effects of larger amounts of the sugar consumed in HFCS.
Fructose is a simple sugar which does not need insulin for its metabolic regulation. After absorption in the intestine, it is converted to fructose-1-phosphate in the liver and enters glycolysis. This lack of regulation leads to excess extra-mitochondrial citrate production, which is metabolized by de novo lipogenesis, into free fatty acids, and then into very low density lipoproteins and triglycerides. High levels of fructose, therefore, worsen insulin resistance, hypertriglyceridemia, atherogenesis, and obesity.  It has also been concluded by David Wang et al. that this fructose excess may lead to postprandial hypertriglyceridemia,  which has been shown to be preventable by exercise.  Fructose, in high concentrations, also worsens hyperuricemia and may precipitate gout.  In rats with fructose-induced type 2 diabetes, complications such as hypertension, dyslipidemia, and ventricular remodeling by inflammatory cells are worse than other exploratory models of diabetes.  These significant findings should be pursued to their logical conclusion and whether these can be extrapolated to the clinics; these complications have already become significant public health problems. A lack of awareness, however, among health-care professionals and public, allows this potentially avoidable risk factor HFCS to continue compromising our health and nutrition. The prevalent absence of proper labeling on the packaged food/beverages, as to the source and nature of sugars confounds the situation. However, the recent Food Safety and Standards Authority of India act will hopefully bring in transparency.
Health-care professionals dealing with obesity and related diseases such as diabetes and dyslipidemia, must be made aware of the potentially hazardous effects of unchecked HFCS intake. Persons with metabolic disease such as obesity, diabetes and hypertriglyceridemia must be encouraged to limit their fructose intake. Fructose-dense fruits, which are often generalized as free foods should be segregated while suggesting individualized meal plans so as to minimize their intake. Furthermore, concerted efforts should be made to lobby regulatory authorities and advocate for a reduction in HFCS use and content. Imported HFCS items need to be restricted in view of ongoing epidemic of diabesity in South-Asia.
Such advocacy and awareness campaigns in patient interest spearheaded by the JOMR, will help improve our dietary environment and perhaps reduce the burden of obesity. 
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