[Rhonda]: But when you're saying fructose, what about fructose found in fruits or...?
Is that as much of a problem?
[Ron]: Well, fructose is, of course, a fruit sugar, that's how it gets its name.
But when it's, again, in the context of a food, like a, let's say, even an orange or
an apple, you are not getting either the dose of fructose or the packaging of fructose that
you get when you add sugar to a Coke and then drinking it in a concentrated form that's
absorbed more rapidly, and there's much more of it.
You have to eat an awful lot of fruit to get the amount of fructose that you get from a
single can of Coke, for example.
But also importantly, it's the fiber and it's the overall packaging of the sugar that can
sort of buffer its metabolic effects in fruits that, I think, make it much less of a problem,
from a dietary standpoint.
[Rhonda]: So just that people understand, you know, your research and others have shown
that it's more of the foods that have a high glycemic index maybe.
Foods that are more refined, had added sugars, added fructose?
[Ron]: Well, I kinda carefully avoid that issue because I think there's still a lot
of uncertainty on that score.
I think that the effects of fructose, the metabolic effects of fructose are unquestionable.
I don't think there's any doubt that this fructose makes fat, makes the liver, when
it encounters fructose, makes fat, and that starts this whole process in motion.
Starches, again, coming in various packages, ranging from more easily processed and more
rapidly broken down starches that makes glucose, because that's a big-time product of starch,
they are considered high glycemic index, ranging in starches that are less processed and consumed
in the context of high fiber, which are less rapidly broken down, have lower glycemic index.
That's all, no question about the differences in those characteristics of those starches.
However, it's been difficult to show that glycemic index itself is an important influence
on lipoprotein metabolism or, for that matter, heart disease risk.
We sort of vilify processed foods, which I think there's a good reason to do, and that
spills over into vilifying processed starches, and I don't have any reason to recommend to...
I know, I see patients, I certainly tell them to stay away from that stuff because it just
adds calories and doesn't have all the nutrients that are contained in a fiber-rich whole grain
form.
But whether the glycemic index itself or the glycemic load, which is the total amount of
those carbohydrates that are consumed that raise blood sugar levels, whether those are
really harmful or not, I've tried to stay out of that argument because I don't think
there's really been a compelling amount of evidence either way.
In fact, a study was just reported by a colleague of mine from Harvard in which they failed
to show a relationship between glycemic index and LDL levels or lipid levels.
So I'd say that's an open question.
I think focusing on sugars and added sugars is a way that we can all come together.
People who would have been focused on fat as a culprit, for the most part, are also
acknowledging that added sugars is a big problem.
So we've come together on this issue.
Beyond that, I think we still have a lot to learn.