Nutritive and Non-Nutritive Sweeteners

NNNS: High Fructose Corn Syrup (HFCS) (2010)


White, John S. Misconceptions about High-Fructose Corn Syrup: Is It Uniquely Responsible for Obesity, Reactive Dicarbonyl Compounds and Advanced Glycation Endproducts? J. Nutr. 2009 139: 1,219S-1,227S.

PubMed ID: 19386820
Study Design:
Narrative Review
R - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

To bring perspective to two misconceptions about high fructose corn syrup:

  1. Common misconceptions. This will be addressed by defining the true composition and characteristics of added sugars, their metabolism and practical considerations that must be addressed whenever sweeteners are used with foods and beverages.
  2. Emerging misconception. This is whether high fructose corn syrup in carbonated soft drinks is a substantive contributor of reactive discarbonyl compounds and advanced glycation end-products in comparison to other dietary sources and endogenous physiological production levels.
Inclusion Criteria:

The author cites approximately 78 articles in support of fructose sweetened beverages do not contribute to the obesity epidemic any more than sucrose sweetened beverages.

Exclusion Criteria:

Not applicable

Description of Study Protocol:

No methodology given for obtaining studies 

Data Collection Summary:

Not applicable 

Description of Actual Data Sample:


Not applicable


Summary of Results:

Key Statements

All common nutritive sweeteners have fructose

  • Near equal amounts of fructose and glucose are found in all common nutritive sweeteners
  • Fructose and glucose are consumed together in the diet thus appear together in digestion, absorption, circulation and metabolic disposition.

Fructose: Glucose ratios in high fructose corn syrup are common in nature

  • It is important when comparing dietary contributors of fructose to analyze their total sugars as the free, hydrolyzed monosaccharides because it is this free sugars composition that reaches the bloodstream and enters metabolism
  • More than 50 fruits, vegetables and nuts fall within the fructose composition range of high fructose corn syrup, sucrose, invert sugar and honey.

Fructose: Glucose ratios in high fructose corn syrup are common in nutritive sweeteners

  • Human bodies are well adapted to handle the common sugar ratios of most fructose-containing sweeteners with ratios of fructose: Glucose ratios from 0.7 to 1.2 (range of high fructose corn syrup -42 and -55).
  • Concerns that introduction of high fructose corn syrup changed the balance of fructose and glucose in the Unites States since the 1970s is unfounded. The author points to a study that indicates this balance has not altered since the 1960s.

 High fructose corn syrup and sucrose are equally sweet

  • Only crystalline fructose in dry application has twice the sweetness of sucrose
  • High fructose corn syrup-55 was formulated to have similar sweetness intensity as sucrose.

High fructose corn syrup adds functionality beyond sweetness

High fructose corn syrup replaces undesirable food ingredients (propylene glycol for moisture retention) by providing numerous functional benefits: Flavor enhancement, colligative properties, fermentable solids, reducing sugars, appetizing flavors, resistance to crystallization and moisture retention.

High fructose corn syrup and sucrose are equally used in the United States

  • Sucrose and high fructose corn syrup are used roughly in same amounts and since the 1970s has replaced sucrose on a 1-for-1 basis
  • High fructose corn syrup lost aggregate sales volume starting in 1999 due to consumer awareness of diet and nutrition, the development of high-intensity non-caloric sweeteners, and the increasing popularity of bottled water.

Sucrose is the dominant sweetener worldwide

  • Worldwide, local sugar production is protected by formidable trade restrictions. Example:Special tax levied by Mexico on high fructose corn syrup sweetened carbonated soft drinks was very effective in protecting it's domestic sugar industry.
  • Estimated high fructose corn syrup production worldwide is only 8%.

High fructose corn syrup correlates poorly with US and global obesity

  • High fructose corn syrup availability peaked in 1999 and is now dropping, but obesity rates have remained elevated by 33% of the population for those over 20 years
  • High fructose corn syrup is widely available in South Korea since the 1980s and the obesity rates are low to moderate by global standards
  • Argentina uses a small proportion of high fructose corn syrup yet has one of the world's highest obesity rates
  • Mexico uses a smaller proportion of high fructose corn syrup than the US but has higher obesity rate.

Fructose sweeteners have not driven disproportionate energy intake

  • Energy rates from added sugars, although higher in 2005 than 1970, increased at a slower rate than total energy and energy from fats and flour/cereals
  • Americans are eating more of everything, not just specifically high fructose corn syrup.

Replacing high fructose corn syrup does not affect metabolic markers of obesity

  • When compared to sucrose, no differences in metabolic markers of obesity or measures of satiety were observed: Serum glucose and insulin, ghrelin, leptin, triglycerides and uric acid
  • Hunger, satiety, and short-term energy intake were also comparable between the two sweeteners.

Fructose-containing sweeteners use common refining methods

The FDA recently verified that high fructose corn syrup can be labeled "natural" because it contains no artificial or synthetic ingredients or color additives and its manufacturing process satisfies FDA requirements.

Reactive Dicarbonyl Compounds (RDC) and Advanced Glycation Endproducts (AGE) are formed in common foods and beverages

  • RDC's are intermediates in the Maillard Reaction
  • AGE modify and crosslink most proteins in the body (collagen and DNA).

RDC and AGE are produced from many simple sugars

  • RDC are ubiquitous in the environment
  • RDC and AGE are produced by Maillard reactions during cooking.

RDC and AGE are Continually Produced in Human Metabolism

RDC and AGE are produced endogenously from a variety of enzymatic and non-enzymatic reactions.

Carbonated soft drinks are not a unique food source of RDC and AGE

  • Considerably higher levels of methylglyoxal are found in toast, brewed coffee, soybean paste and cheeses vs. high fructose corn syrup. High fructose corn syrup-55 has lower RDC levels than honey.
  • AGE levels in soft drinks are low but this analysis is unproven
  • To produce 24-hour endogenous methylglyoxal production, the author estimates a person would need to consume 1,129 servings per day of carbonated soft drinks
  • RDC and AGE would likely bind food and gastrointestinal substrates thus gastrointestinal proteases would have limited ability to digest AGE-modified protein substrates. Thus these are poorly absorbed and only 10% of dietary AGE is absorbed from the intestines and roughly 30% of that is excreted by the kidneys.


Author Conclusion:

Replacing high fructose corn syrup in foods with other fructose-containing sweeteners will provide neither improved nutrition nor a meaningful solution to the obesity crisis.

Funding Source:
Other: International Life Sciences Institute, North American Branch
Reviewer Comments:
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? N/A
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? N/A
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? No