Results herein show that the practice of adding more fructose to HFCS, than is generally-recognized-as-safe,[51] has a compounding effect on excess-free-fructose dosages. It is evident that by the early 1980’s, daily average per capita excess-free-fructose contributions, from HFCS, exceeded dosages associated with pediatric fructose malabsorption (~ 5g)[15–16] and its broader health consequences.[4–50] For individuals consuming HFCS at average or above average consumption levels, that contained higher than generally-recognized-as-safe fructose-to-glucose ratios,[51] this milestone was reached between 1980–1982, a period coincident with the advent of the unexplained US asthma epidemic,[64–68] and that is before considering contributions from apple juice.
The ability to absorb free fructose is saturable and ranges widely from ~ 5 g to ~ 50 g.[4–16] Fructose malabsorption is often unaccompanied by gas and bloating.[14] Hence, the practice of adding more fructose to HFCS,[1–2] than is generally-recognized-as-safe,[51] is a problem, particularly for unwitting fructose malabsorbers. The capacity to absorb free fructose is lower in children (~ 5 g)[15–16] than adults (~ 10 g),[4–13] and limited research shows that African Americans have higher fructose malabsorption prevalence than Hispanics at comparable excess-free-fructose intakes.[69] Notably, both groups (children and African Americans) have been disproportionately affected by the unexplained US asthma epidemic.[64–68]
Importantly, very few natural foods contain more fructose than glucose. Apples (~ 4.3 g excess-free-fructose (EFF)/medium-sized apple)[3], pears (~ 5.9 g EFF/medium-sized pear)[3], mangoes (~ 4.4 g EFF/mango)[3], and watermelon (~ 2.8 g EFF (1 diced 8-oz cup)[3] are popular exceptions, and when eaten as whole fruits, in moderation, excess-free-fructose dosages are less likely to trigger malabsorption. There are no known genetic mutations associated with fructose malabsorption[70] which would not be a problem if not for the advent and widespread use of sweeteners with high fructose-to-glucose ratios (HFCS,[1–2] crystalline fructose (100% fructose), agave syrup (70%-90% fructose)[71–72] and apple powder[3]). Excess-free-fructose average per capita intake estimates herein are therefore understated, as these additional sources of excess-free-fructose have not been accounted for in this analysis.
Notably, the excess-free-fructose content in a 12 oz. can of cola with 39 grams of HFCS is 3.9 g (21.45–17.55 = 3.9 g) when the fructose/glucose percentages are 55/45, i.e. the 1.2:1 ratio. The dosage increases to 7.8 g (23.4–15.6 = 7.8 g) when the HFCS variant is 60/40 (i.e. the 1.5:1 ratio), and jumps to11.6 g, when the HFCS variant is 65/35 (~ 25.3 g – 13.7 g = 11.6 g), i.e. the 1.9:1 ratio. From a national nutrition and health policy perspective, recommendations to reduce sugar sweetened beverage (SSB) intake are inadequate to address unwitting exposures, as high fructose-to-glucose sweeteners (HFCS,[1–2] crystalline fructose, apple powder,[3] apple juice,[3] and agave syrup[71–72]) are ubiquitous in the US food supply. The practice of adding more fructose to HFCS, than is generally-recognized-as-safe, as reported by the University of Southern California’s Keck School of Medicine,[1–2] is likely not limited to beverages.
Nutrition labels should provide details of total fructose content and of the excess-free-fructose content in foods and beverages. This is consistent with recommendations by researchers at the Keck School of Medicine.[1–2] Warnings are warranted when foods contain excess-free-fructose. Not only do nutrition labels not provide information of the fructose-to-glucose ratio in added sweeteners, even if they did, independent oversight is needed to ensure compliance with safety standards. It is noteworthy that 100% crystalline fructose is promoted as a low glycemic alternative to table sugar, and is available for purchase in US grocery stores, but is void of malabsorption warnings.[73] It is worth noting that prior to an undisclosed settlement agreement, between the US Sugar Association and US corn refiners, HFCS was heavily promoted as “just like sugar.”[74–75] This messaging likely slowed research of excess-free-fructose induced consequences of fructose malabsorption beyond gas, bloating and interference with nutrient absorption - research which continues to lack momentum. Fructose in the gut causes dysbiosis – a condition linked to rheumatoid arthritis, diabetes, eczema, asthma, inflammatory bowel disease (IBD) and syndrome (IBS), cardiovascular disease (CVD), non-alcohol associated fatty liver diseae (NAFLD), chronic kidney disease (CKD) and mental health disorders.[22]