Tuesday, May 10, 2011

Fructose - Something To Worry About?

There was this middle-aged man who was so frustrated with having many episodes of gout attacks. He told me that he's already cut down everything imaginable - no red meat, no kacang, no seafood and no alcohol at all. Still, he will be needing painkillers and gout medication almost every other week. When I pressed further, I discovered that he has quite an active lifestyle. Eventually we traced the problem down to his consumption of 100-plus. He drinks two 1.5L bottles everyday...for as long as he can remember. I read sometime back that there's a link between sweetened/sugary drinks and gout and suggested he stop the 100-plus. He did. The incidence of gout attacks totally reduced and he's bought  painkillers just once in the past year.

The keen business mind might point out that I just killed off a source of repeating income and that gives me a lot of food for thought. More importantly there's all this buzz going on about sugar and fructose in particular. Check out the video by Prof Lustig from UCSF, it's a full length lecture but a very compelling case against fructose.

Unfortunately fructose is very common in our modern diet and it mostly comes from High Fructose Corn Syrup (55% Fructose - 45% Glucose) and table sugar / sucrose /gula (50% Fructose - 50% Glucose) used as sweeteners in many beverages and foodstuffs. Recently due to the bad rap against HCFS, they've changed the name to corn syrup (sirap pepejal jagung), but its the same thing. So how exactly does fructose increase uric acid?
Eh? Whadaya mean bollocks?

It does far more damage than just increasing the uric acid concentrations in the blood. There are links between high fructose intake and blood pressure, increased triglycerides, diabetes and quite possibly cancer. But before we go overboard with an ascetic lifestyle and totally swear off sugar, I'd like to say a few things in defense of fructose.

i) It is present in a lot of fruits. Dates, raisins, prunes, grapes, pears and apples are a few with high concentrations of fructose.
ii) Our bodies are made to handle fructose.

So what's the fuss about? Looking at a typical Malaysian diet -

Breakfast: Tausa pau, Dim Sum (dipped in ketchup), Coffee (with condensed milk)
Morning Snack : Apple and Kiwi
Lunch: Sweet and Sour Pork Rice, Soya Cincau
Afternoon Snack: Yogurt Drink, Tiger Biscuits
Dinner: Baked Beans and Tuna (with mayo) with lettuce in tortilla wrap, Mixed fruit juice
Dessert: Cheesecake
Supper: Roti Telur and Teh Ais

Do you see the problem here? And this is on a relatively healthy day, not yet including soft drinks, various types of snacks (chocolate/ice cream) or fast food meals. We mostly focus on eating healthy 'main meals' but we tend to forget the hidden sugars present in the small titbits and condiments that accompany it. The obvious ones are the drinks (including the fruit juices with no added sugar printed on it - not so healthy after all). Another thing we can see is that almost all processed foods contain sugar.

I'd like to state that there's nothing wrong with having sugar in our food, the problem happens only when there's chronic overconsumption and this is where Prof Lustig hits the spot. We're eating too much of it because we didn't know that its everywhere. And we're wondering why the metabolic syndrome and cancer rates are going through the roof. 

It is also not just about 'oh, I'll go do more exercise and burn off the calories from sugar'. If you have 120kcal from a piece of white bread and 120kcal from a bottle of coke, the white bread contains mostly glucose and that can be utilized by every cell in the body. Coke on the other hand, has 45% glucose only and the 55% of the fructose have to be broken down by the liver thereby placing an extra burden on it, not to mention the by-products of fructose metabolism (uric acid, triglycerides). It is like telling an alcoholic to do more cardio exercises to burn off the calories from the bottle of whiskey he's just polished off, it doesn't work that way.

A few years back, I would have probably said 'Life is short! Control your food for what oh? Eat what you like!' but I don't subscribe to that view anymore. Earlier this year one of my in-laws passed away due to complications with cancer (quite ignorant of lifestyle modification advice by the doctors I heard). Another family friend has just spent RM300,000 in 3 months for cancer treatments and I am hearing firsthand the suffering and difficulties they are going through. Tragic isn't it? You've retired and are supposed to enjoy life in the golden years, but what little you have left of your entire life of hard work goes to keeping you alive. Instead of traveling the world with your loved ones, you're contributing to your doctor's vacation fund instead. Or traveling around looking for a cure.

I'm probably not going to stop eating sweet stuff like cakes and ice cream but I'm definitely going to do it in moderation. No one can say for sure now how much is too much, but one thing's for sure, we will benefit from eating less sugar.