Hypothesis: Could Excessive Fructose Intake and Uric Acid Cause Type 2 Diabetes?

ByCrossFitJanuary 16, 2019

In this review, Richard Johnson et al. argue fructose—which makes up half of table sugar and high-fructose corn syrup—has a unique metabolic impact that might directly lead to diabetes, particularly when consumed in excess of 50 grams per day.

It is the lipogenic characteristics of fructose, in association with its ability to induce ATP depletion and uric acid generation, that are largely responsible for its ability to induce metabolic syndrome. Furthermore, it is fructose’s unfortunate ability to induce increasing sensitivity with increasing exposure that makes it increasingly relevant in a society that is rapidly increasing its total fructose intake.

Fructose, unlike other sugars, is directly metabolized in the liver, where it increases liver fat, raises triglyceride levels and increases uric acid when consumed chronically. Over time, this can lead to insulin resistance; hypertension; damage to the liver, kidneys and blood vessels; metabolic syndrome; and diabetes. Human, animal and epidemiological studies are reviewed supporting both the correlation between increased sugar intake and metabolic disease on a population level and the various mechanisms by which fructose can lead to metabolic damage.

They conclude that the current evidence suggests sugar is detrimental in more ways than merely being “empty calories,” and that if additional research supports the hypothesis that fructose (and so sugars) promotes metabolic disease, it would suggest removing fructose from the diet can prevent obesity and metabolic syndrome, as well as the conditions that follow from them.

From Hypothesis: Could Excessive Fructose Intake and Uric Acid Cause Type 2 Diabetes?: Figure 2—Effect of fructose on various organ systems. Table sugar, HFCS, and natural sources provide fructose, which in excess has numerous effects on the brain, liver, vasculature, kidney, and adipocyte. The net effects induce all features of the metabolic syndrome and ultimately Type 2 diabetes.

Comments on Hypothesis: Could Excessive Fructose Intake and Uric Acid Cause Type 2 Diabetes?


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Matthieu Dubreucq
November 3rd, 2019 at 1:28 pm
Commented on: Hypothesis: Could Excessive Fructose Intake and Uric Acid Cause Type 2 Diabetes?

All the propaganda from big soda can make it hard to know what is true and what is dangerous. But the no 1 way to fight back is to educate ourself and pass on that information to a maximum of people. Thanks for posting!

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Dale Saran
January 17th, 2019 at 5:23 pm
Commented on: Hypothesis: Could Excessive Fructose Intake and Uric Acid Cause Type 2 Diabetes?

Bingo. Unfortunately, the industries that profit from this condition - both in the cause and treatment - are massive, accounting for (conservatively) 30-40% of GDP in the US alone. Probably more. Think food companies, big pharma, big agra, and healthcare, all of whom get rich by: (1) Manufacturing - ConAgra et al actually get government subsidies for corn, which becomes HFCS; (2) Food - these folks sell products that contain HFCS, which is in virtually every food product in the aisles of your grocery store, which causes the problem; (3) Pharma - a massive industry that creates medications that treat symptoms, but not the underlying cause of the problem; (4) Healthcare - companies like DaVita (dialysis) are fast-growing and make HUGE profits off of diabetes.

Is it a coincidence that Warren Buffet/Berkshire Hathaway is (a) the largest single shareholder of Coca-Cola and its liquid HFCS, (b) an agricultural subsidy guy (the "Wizard of Omaha"!), (c) owner of Dairy Queen (100%), and (d) DaVita - dialysis centers - BH owns 17% of it and the likely successor to Buffet is the CEO of DaVita? Good ol' Warren gets your tax dollars to keep the price of liquid HFCS cheap, puts HFCS in everything you eat, sells you DQ and Coke, and gets your money on dialysis when you're kidneys are failing and dying. Beloved of Progressives and Conservatives alike, too, because he says all the right things and pays all the right people in DC. That's one of the richest people in the world.

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Dale Saran
January 17th, 2019 at 5:24 pm

And one more point, ask yourself why the science is all over the place and look at what all of those industries have to do with publishing garbage "science" and "nutrition" that continues to confuse and obfuscate the issue. These people make Big Tobacco look like the Boy Scouts of America.

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Clarke Read
January 17th, 2019 at 8:44 pm

It is somewhat telling that one of the major tactics used by the sugar industry (broadly defined to include companies like Coke) mimics a core Big Tobacco tactic - seizing scientific ambiguities to shut down further discussion.

As many on these pages know, Big Tobacco could push back on anti-smoking legislation for years using two arguments that seemed to stand up to objective analysis - first, that smokers were only harming themselves (so invoking personal responsibility) and second, that there was no causal link between smoking and lung cancer (which, as discussed in previous articles, is a simplistic interpretation of the fact that the link was largely based in observational studies, but one that can seem reasonable at first glance). It's been a while since I reviewed the lit on this "case", but I don't think it's coincidental that the hammer really started to fall once secondhand smoking began to knock down that first pillar.

The sugar industry has been able to push back for years on the basis of similar arguments: (1) If sugar is harmful, a person ought to be allowed to harm themselves; (2) Beyond this (they argue), sugar is just "empty calories", and so there is no reason to single out sugar specifically. If sugar is associated with metabolic disease (again, so advocates argue), it is purely a consequence of the calories sugar contains, and so the problem really is that we need to get people to eat less or move more in general. (See as evidence, Coke's widespread exercise promotion campaigns, previously in the U.S. and now in China)

Argument (1) may be seeing some pressure as cost and accessibility constraints in healthcare turn local problems into systemic problems. Diabetes costs us billions of dollars each year (see link below), and when you total the set of diseases sugar may exacerbate - heart disease, diabetes, liver disease, Alzheimer’s, many cancers - you are likely talking in the trillions. Even if the direct impact is individual, the indirect impact affects us all.

And articles like this one (as well as the work of Rob Lustig and some researchers within the diabetes and liver disease fields in particular) are beginning to undermine (2). Sugar, they argue, is not just empty calories, but a uniquely harmful substance, at least when consumed in the amounts Americans consume it today. That point is key because it’s very challenging to argue sugar consumption should be specifically deterred (whether through taxation, marketing, other regulations, etc.) or incriminated unless we can show either that a calorie of sugar is more harmful than a calorie of other foods or that sugar-containing foods are, for reasons directly tied to their sugar content, more harmful than other foods. We’re a LOT closer to answering that question than we used to be.

This is a topic we’ll see come up many times on Crossfit’s pages, I’m sure. And it should be, as sugar could be one of the most important preventable causes of metabolic disease and some of the lowest-hanging fruit to drive widespread improvements in healthcare.


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