In this video from MedCram, Dr. Seheult discusses the low-carb fruit fallacy. What does this fallacy state? It simply states that the amount of fructose in one item is equivalent to fructose in another item. For example, 39 grams of sugar in soda is the same as 39 grams of sugar in a whole fruit product. There is a belief that sugar is sugar regardless of where it is coming from and it doesn’t matter how it is packaged.
Natural vs extracted substances
What has normally happened in the industry, especially the pharmaceutical industry, is that there will be found some type of substance in nature that has a known benefit on the human body. This substance effect can be seen and have a measured effect in the human body, but because it is in nature, it is surrounded by other substances. However, due to technology we have the ability to take this substance and isolate it, extract it from the surrounding substances, and then concentrate, package, and sell it and assume it will have the same effect as it did when it was in its natural package. There are financial incentives for this because if you can isolate a compound that is beneficial to humans it can be made into a medication and it can be sold. This however falls on the belief that the substance is just the sum of its parts; however, we know that not to be true. Dr. Seheult uses another term that probably describes this situation better and it is gestalt. The dictionary defines this as something that is made of many parts and yet is somehow more than or different from the combination of its parts. When we look at the original substance in its native form, we are not taking into account the interaction that substance has with other substrates that are surrounding it. From a dietary perspective, we have the gut lining itself and there are many ways that the substance and other substrates in a food product will interact with that. For example these other substrates may hold onto the original substance so that it takes longer for that substance to be absorbed by the body or it could be absorbed with it and it could affect how it interacts with the bacteria that line the gut also known as the gut microbiome. So even if you have the same amount of weight in a substance that is in its natural state versus one where it has been extracted individually, there is a potential that the substances will behave differently depending on what other substrates are around them or not around them.
Beta-carotene and vitamin E
One example of where this actually happened involves beta-carotene. It is found in colorful vegetables and fruits. It was thought to prevent cancer. This paper from the 1980’s suggested beta-carotene based on human prospective and retrospective studies that could protect against lung cancer and probably against stomach cancer. They felt that the protective factor was probably beta-carotene itself rather than the total vitamin A. So beta-carotene was isolated and then used in a randomized controlled trial in 1994 from the NEJM in male smokers. The trial found, unexpectedly, a higher incidence of lung cancer among the men who received beta-carotene supplementation than among those who did not. There was an 18% increase and this was statistically significant. The study concluded they found no reduction in the incidence of lung cancer among males after 5-8 years of dietary supplementation with alpha-tocopherol (vitamin E) or beta-carotene. The trial instead raised the possibility that these supplements may actually have harmful effects. Later in 2015, another trial suggested that vitamin E supplement intake and the lung cancer risk among female nonsmokers was associated with an increased lung cancer risk after 12 years of follow up. In contrast, the study found that total dietary tocopherol was inversely associated with lung cancer risk. This study showed that vitamin E in nature has a completely different effect than vitamin E given by itself. Another study showed the importance of getting nutrients from foods rather than supplements.
Is fructose always the same?
So the question today is again regarding the low carb fruit fallacy. Does fructose as a dissolved solvent in a solution have the same effect as fructose that is complexed with fiber in whole fruit?
MedCram has discussed fructose before in its Update 83 and showed that high usage of high fructose corn syrup in food was very high in the U.S. and correlated with oxidative stress levels. Fructose in an isolated state or as an added sugar is not good for your health. It can also interfere with vitamin D conversion to the active form. However, does fructose or sugar that is complexed naturally have the same effect as the high fructose sweetener that is added to processed foods?
If you look carefully at the whole fruit you will see that there are compartments that are set aside and act like smaller quantities of package sugars that can be released over time. The pockets are made up of fiber. Dr. Steven T. Devor states, “The physical form and structure of the carbohydrates are what matters. A whole natural fruit is composed of unbroken cell walls that intertwine and bind the natural sugar to the natural fiber. When those cell walls are not broken down in processing, it requires a greatly increased amount of time for your own digestive system to break them down and for the natural sugar to enter your bloodstream. This results in a much slower rise in your blood glucose. The intact cell wall structure is the key difference between a whole natural fruit and a smoothie or fruit juice.”
Is an ingredient list enough?
You can’t just look at the ingredient list because there is a difference when the substance is by itself or with other substrates when it is packaged.
When comparing a whole apple to applesauce and apple juice, you will find that for the applesauce and whole apple that their insulin spike is similar because the cells in the apple have not been broken and then glucose will be absorbed slowly. In contrast, apple juice has a high insulin spike, as it is liquid and cells have been broken and it allows a large bolus of sugar to be presented. When there is fiber surrounding the fructose, as in the whole fruit or applesauce, it allows it to get absorbed more slowly. It will have a different effect as compared to apple juice. In this study, in 2008, they looked at 71,000 nurses who were followed from 1984, and none of them started with diabetes or cardiovascular disease. At the end of the study, they diagnosed 4529 cases of diabetes with an incidence of 7.4 percent. They found that consumption of green leafy vegetables and fruit was associated with a lower hazard of diabetes whereas consumption of fruit juices may be associated with an increased hazard among women.
Another study that was a randomized crossover clinical trial looked at plasma glucose and insulin responses after consumption of breakfasts with different sources of soluble fiber in type 2 diabetes patients. It looked at an isocaloric diet with the same makeup of carbs, proteins and fats between both arms. They used a high fiber diet (9.7 g), high fiber supplementation diet (9.1 g) and usual fiber (2.4 g) diet. They again used similar amounts of protein , fats and carbohydrates in the diets. The diet with the highest fiber had a statistically significant lower amount of glucose in the area under the curve and had the lowest amount of insulin and this was directly related to fiber. Fiber is extremely important directly for the bacteria in the gut microbiome. Things that your body may not be able to break down, can be broken down and absorbed by the bacteria in your gut.
One final study Dr. Seheult reviews is a prospective observational study for 7 years on approximately 0.5 million Chinese adults looking at fresh fruit consumption in relation to the incidence of diabetes and diabetic vascular complications. They found that among those who were without diabetes at baseline, higher fruit consumption was associated with a lower risk of developing diabetes and among those with baseline diabetes, higher fruit consumption was associated with a lower risk of all-cause mortality and lower microvascular and macrovascular complications.
So what is the take home message? There is nothing wrong with low carb diets. The issue lies in that simply using ingredient lists to make our decisions may not be taking into account everything. We need to realize that depending on how the sugar is packaged i.e. whole fruit, makes a huge significance on the delivery of that sugar and its effect on the body.
LINKS / REFERENCES:
Does beta-carotene prevent cancer? A critical appraisal (Nutrition Research) | https://www.sciencedirect.com/science…
The Effect of Vitamin E and Beta Carotene on the Incidence of Lung Cancer and Other Cancers in Male Smokers (NEJM) | https://www.nejm.org/doi/full/10.1056…
Vitamin E intake and the lung cancer risk among female nonsmokers: a report from the Shanghai Women’s Health Study (International journal of cancer) | https://pubmed.ncbi.nlm.nih.gov/24916…
Study: Vitamin E from Food, Not Supplements, May Lower Women’s Lung Cancer Risk (American Institute of Cancer Research) | https://www.aicr.org/resources/blog/s…
Coronavirus Pandemic Update 83: High Fructose, Vitamin D, & Oxidative Stress in COVID-19 (MedCram) | • Coronavirus Pande…
Cellular water transport process in apple tissue (Scientific Reports) | https://www.researchgate.net/figure/C…
Variation in Cell Wall Metabolism and Flesh Firmness of Four Apple Cultivars during Fruit Development (MDPI) | https://www.mdpi.com/2304-8158/11/21/…
Sugar in Fruit versus Added Sugar (Fleet Feet) | https://www.fleetfeet.com/s/columbus/…
Whole Fruits and Fruit Fiber Emerging Health Effects (Nutrients) | https://www.ncbi.nlm.nih.gov/pmc/arti…
Intake of Fruit, Vegetables, and Fruit Juices and Risk of Diabetes in Women (Diabetes care) | https://www.ncbi.nlm.nih.gov/pmc/arti…
Plasma glucose and insulin responses after consumption of breakfasts with different sources of soluble fiber in type 2 diabetes patients: a randomized crossover clinical trial (American Journal of Clinical Nutrition) | https://www.sciencedirect.com/science…
Addition of dietary fiber sources to shakes reduces postprandial glycemia and alters food intake (Nutricion hospitalaria) | https://pubmed.ncbi.nlm.nih.gov/25561…
Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults (PLoS medicine) | https://www.ncbi.nlm.nih.gov/pmc/arti…
Fruit and Diabetes (Diabetes UK) | https://www.diabetes.org.uk/guide-to-…
Optimal Health & Immunity Explained Clearly (MedCram) | https://www.medcram.com/courses/wellness