HFCS: Health Risk
or Hype?
Marilyn Schorin, PhD, RD, FADA
Tox Forum
July 19, 2004
What is HFCS?
Sweetener designed to mimic profile
of sucrose
HFCS is formed by enzymatic
isomerization of glucose in corn syrup
to fructose, then blended back with
glucose to get desired glucose-
fructose blend
Name “high fructose corn syrup”
distinguishes it from other corn syrups
HFCS and sucrose are very similar in
composition and components
Formation of High Fructose Corn Syrup
Confusion of Terminology
HFCS ≠ corn syrup
Corn syrup – essentially all glucose,
less sweet
HFCS – 42-55% fructose. Sweetness
profile ~sucrose
HFCS ≠ fructose
GRAS Approval
Initial FDA approval in 1983
“The agency has concluded that high
fructose corn syrup is as safe for use
in food as sucrose, corn sugar, corn
syrup and invert sugar”
GRAS status reaffirmed in 1996
(21CFR 184.1866)
Trend in Usage
HFCS-42 created in 1970
Technological developments in
late 1970’s permitted formation
of HFCS-55
Commercial use increased after
1980
Coca Cola contains 50/50
solution with sucrose
1982 -Pepsi Cola has a 50/50
solution
WHY IS HFCS SO
POPULAR?
Retains moisture and prevents drying out
Controls crystallization
Helps control microbiological growth
(osmotic pressure HFCS > Sucrose or MIS)
Blends easily with sweeteners, acids, and
flavorings
Provides controllable substrate for browning
and Maillard reaction.
Sweetness equivalent to invert liquid sugar
Low viscosity
Lower cost than sucrose (USA)
Metabolism of HFCS and Sucrose
Sucrase splits
sucrose into
monosaccharides
Sucrase is not rate-
limiting
At the site of
absorption, there is
no difference
between sucrose
and HFCS
Confusion about HFCS composition due
to its name is one cause for the
suggestion that HFCS plays a
significant role in obesity and diet-
related chronic diseases.
Some say HFCS causes obesity….
The Obesity Epidemic
Obesity is rapidly increasing
Worldwide, one in four people is
overweight
In US
64% of adult Americans overweight,
30% obese
About 1 in 6 children is overweight
Obesity --- HFCS Link
Caloric contribution
±4 kcal per gram, like other carbohydrates,
protein
Fats have ±9 kcal per gram
Ethanol has ±7 kcal per gram
Caloric intake in children remained constant
1970 to 88/94
Caloric density of HFCS is relatively low. HFCS could cause
obesity if massive amounts consumed
or substituted for lower calorie foods.
Obesity, HFCS and Fructose
Bray et al. 2004
Obesity Trends in Selected Countries
Obesity increasing in areas with
no HFCS usage
Obesity Causes
Lifestyle Habits
Sedentary behavior
Automobiles
Stress
Food consumption
Etc.
Caloric Imbalance
Lifestyle Habits
Macronutrient Composition
Refined Carbohydrates
Habits
Sugars
Habits
HFCS
Habits
HFCS has a very small role in the burgeoning
obesity crisis
How could HFCS contribute to
obesity?
HFCS cited as stimulating appetite for other
foods
Replaces less energy-dense foods
Reduces motivation to exercise
…There is no evidence for a direct,
causal effect of HFCS on obesity
Is there indirect evidence for a
link between HFCS and
obesity?
Indirect evidence
Soft drink consumption
Soft drinks are major source of sweeteners in US diet
Principal sweetener in caloric soft drinks is HFCS
Planet Health Study (2001)
548 11-year olds in Boston area
Observation, not intervention
Each serving of soft drink above baseline increased
risk of obesity by 60%
Cornell study (2003)
30 children 6-13 years old observed for 4 to 8 weeks
Children consuming >12 oz per day sweetened
beverages did not reduce caloric consumption and
gained more weight
Indirect Evidence -II
Virginia Tech (2003)
Analysis of CSFII (1994-1996) showed no link between
Body Mass Index and consumption of regular soft drinks
NAS Dietary Reference Intakes for Macronutrients
Most studies show an inverse relationship between
carbohydrate (and sugar) intake and BMI
Sugars (total sugar intake) should not exceed 25% of
calories, due to risk of inadequate vitamin/mineral intake
HFCS consumed as soft drinks
shows no consistent effect on body
weight or BMI
If HFCS is causing obesity, will we
reduce obesity by eliminating it?
Not certain if people would substitute
lower energy density (e.g. water, fruit
and vegetables) or higher density
(certain juices and fatty snacks) food
Restriction of desirable food may fuel
desire for it (prohibition, Birch et al)
Some claim that HFCS affects
obesity via an effect on appetite…
But no studies have investigated
HFCS and appetite directly
HFCS and Appetite
Almiron-Roig and Drewnowski (2003)
Compared caloric beverages of equal
nutrient density: cola, orange juice,
low fat milk compared to water
Hunger, desire to eat, and food intake
were the same following the caloric
beverages
No unique effect of cola with HFCS
Satiety of liquids vs. solids –Is
this a specific HFCS effect?
No studies designed to address effects of
HFCS on appetite
DiMeglio and Mattes (2000)
Jelly beans compared to regular soft drink
Consume 1800 kJ (about 430 kcal) of the
test food any time during the day
Caloric intake decreased with solid, not
liquid in amount matching test food
Satiety Relationships
Sugars, but not HFCS, has been repeatedly shown to
decrease subsequent intake
Anderson and colleagues using liquid mixtures, have
shown reduced intake following sucrose, glucose,
fructose
Bray et al in 2004 AJCN commentary point to lack of
compensation for calories in regular vs diet soft drinks.
Rodents overconsume sucrose-sweetened beverages
Raben et al found no compensation for sucrose-
sweetened beverages in overweight women
The effect of HFCS on appetite has not
per se been studied.
The impact of solid vs liquid foods as
well as various sweeteners on BMI and
consumption produces an inconsistent
picture.
What is the likelihood that appetite
effects are unique to HFCS?
Fructose confused with
HFCS
HFCS is confused with fructose, due to the
terminology
High intakes of fructose have been studied
Fructose does not stimulate insulin release
Insulin increases leptin; leptin decreases food
intake
Fructose enters portal circulation; may increase
triacylglycerol
However:
HFCS is NOT fructose. It is similar to
sucrose…
and
The high levels of fructose used in these
studies are not relevant to normal
consumption patterns.
HFCS: A DIABETES
CONNECTION?
Worldwide type 2 (non-insulin-dependent)
diabetes rates increasing
Genetic predisposition
Better nutrition – diabetics bearing children
Growing incidence of obesity
Causes
Old view – excess sugar intake; inadequate
insulin production
Newer view – Hyperinsulinemia and
hyperglycemia; insulin resistance
Caloric imbalance
HFCS: A DIABETES
CONNECTION?
Direct – Do HFCS users have more diabetes than
non-users?
India 5.5%
SE Asia 7.5%
N. Amer. 7.8%
Middle East 7.5%
Indirect– through effects on obesity, insulin resistance
Compare with other macronutrients
• High fat, low carb diets ~ins. resistance
Compare with other sweeteners
• Akgun et al (85) showed similar effects of HFCS
and sucrose on p. glucose, IRI. Fructose lower p.
gluc, lower IRI
• Janket et al (2003) found no effect of glucose or
fructose on Type 2 diabetes and inverse effect of
sucrose. HFCS was not identified, but can be
inferred from data.
No evidence to link HFCS
consumption with diabetes
incidence
HFCS and Lipids
No studies have examined this relationship
Fructose-lipid relationship
very high fructose intakes (17% of kcal) led
to triglyceride elevation in humans (Bantle et
al, 2000)
No increase in lipogenesis in rats with high
fructose (Mayes et al. 1993)
High carbohydrate-low fat diet increases
serum triglycerides
Conclusions
Paucity of investigational data
showing HFCS as cause of obesity
Studies infer a causal relationship
Similarity of sucrose and HFCS make
a unique effect of HFCS on obesity
unlikely
Although more research should be
done, lack of a specific or unique
effect may stymie publication