Sugary drinks, fruit, and increased risk of goutBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39479.667731.80 (Published 07 February 2008) Cite this as: BMJ 2008;336:285
All rapid responses
Author Underwood has badly missed the mark in warning “…it would be
advised for the EU to allow increased use of isoglucose [high fructose
syrup, HFCS] until its safety has been confirmed.” And his comment that
“Perhaps liberalization of the sugar trade will remove the demand for high
fructose corn syrup; this would improve the health of consumers…of
countries that produce cane sugar” displays a fundamental lack of
understanding of the composition and metabolism of HFCS and sucrose
The safety of high fructose corn syrup was affirmed when it was first
granted Generally Recognized as Safe (GRAS) status by the US Food and Drug
Administration (FDA) in 1983, and again when GRAS status was reaffirmed in
1996 (1). Numerous expert scientific panels have evaluated the safety of
HFCS, fructose and sucrose in the past three decades and found that the
sweeteners pose no risk to human health at common levels of consumption
other than dental caries.
Expert scientific panels at two recent symposia have unanimously
there is no difference in the way HFCS and sucrose are metabolized (2,3).
And rightly so, as HFCS and sucrose are indistinguishable by the body in
terms of composition (half glucose and half fructose) and metabolic
disposition once in the bloodstream.
It is unfortunate that so many scientists confuse HFCS and pure
HFCS is not pure fructose, but rather 42% or 55% fructose with the
glucose or glucose oligomers (HFCS-90 at 90% fructose is a specialty
and not used in appreciable quantity). Pure fructose is used by the food
industry as a specialty sweetener for specific functional reasons that add
substantive value. It is important to note that the human diet—almost
without exception—finds fructose and glucose together; in fact the
fructose:glucose ratio is typically 0.7 (4).
It is also unfortunate that so many scientists attribute results of
experimentation with pure fructose to HFCS. Contrary to author
claim, there is no evidence that HFCS has an adverse effect on
and gout. The scientific literature is replete with experiments
metabolic perturbations from pure fructose at exaggerated concentrations.
But data from such experimentation are unreliable, since no one eats a
pure fructose and certainly not at such extraordinary levels. Neither are
experiments an indictment of foods and beverages sweetened with pure
fructose: used and consumed at common levels, pure fructose adds
functionality to formulations and poses no health threat.
Given the close compositional similarities and metabolic processing
sucrose and HFCS, it is of no health consequence whether the sugar trade
liberalized or not—the human body simply cannot distinguish them. And
absent data to the contrary, sucrose, HFCS and fructose are safe for
consumers in a balanced and moderate diet.
1. 61 Fed. Reg. 43447 (August 23, 1996), 21 C.F.R. 184.1866. Direct food
substances affirmed as Generally Recognized as Safe; High Fructose Corn
Syrup - Final Rule.
2. American Society for Nutrition Symposium. Everything you always
wanted to know about HFCS but were afraid to ask. Experimental Biology.
Washington, DC. April 2007.
3. ILSI-USDA Workshop: State of the science on dietary sweeteners
containing fructose. Beltsville, MD. March 18-19, 2008.
4. Forshee RA, Storey ML, Allison DB, et al. A critical examination of the
evidence relating high fructose corn syrup and weight gain. Crit Rev Food
The author is a consultant to
the food and beverage industry
in the area of nutritive
sweeteners. His clients include
research institutes, food
industry councils, trade
organizations and individual
Competing interests: No competing interests
The most popular sugary drinks are the colas. All cola drinks are very
addictive, regardless of whether they are sweetened with sugar or artificial
sweeteners. It's tragic that so many people are addicted to cola drinks and
believe the misleading advertising of the cola industry. How ironic that such a
harmful beverage is associated with vitality and enjoyment. The beverage
industry is a rogues' gallery of toxic, addictive substances: cola, soda, coffee,
tea, and alcohol. These insidious beverages are responsible for a lot of sickness
Competing interests: No competing interests