Is high fructose corn syrup (HFCS) worse than sugar for health?

High Fructose Corn Syrup vs. Sugar: Health Effects

High fructose corn syrup (HFCS) is not significantly worse than regular sugar (sucrose) for health outcomes related to mortality and morbidity, as both have similar metabolic effects and comparable fructose-to-glucose ratios. 1

Composition and Metabolism

• HFCS and sucrose (table sugar) have nearly identical compositions:
  • HFCS-42 and HFCS-55 (most common forms) contain approximately equal amounts of fructose and glucose
  • Sucrose is a disaccharide of 50% fructose and 50% glucose 2
  • The primary difference is that in HFCS, the monosaccharides exist free in solution, while in sucrose they exist as a disaccharide 2
  • Sucrose is rapidly cleaved in the small intestine, resulting in free fructose and glucose being absorbed from both sweeteners 1, 2

Metabolic Effects

• Both HFCS and sucrose produce similar metabolic responses:

  • Similar effects on blood glucose and insulin levels
  • Comparable impacts on lipid metabolism
  • Equal effects on inflammatory markers 3

• A clinical trial comparing honey, sucrose, and HFCS-55 found that daily intake of 50g of carbohydrate from any of these sweeteners for 14 days resulted in similar effects on:

  • Glycemic measures
  • Lipid metabolism
  • Inflammatory responses 3

Health Concerns with Both Sweeteners

Both HFCS and sucrose can contribute to health problems when consumed in excess:

1. Cardiometabolic Effects:

   • Both can increase triglyceride levels 3
   • Both may contribute to cardiovascular disease risk factors 4
   • Both can promote hepatic de novo lipogenesis (fat creation in the liver) 1

2. Advanced Glycation End Products (AGEs):

   • Fructose (in both HFCS and sucrose) is a potent reducing sugar that promotes formation of AGEs 5
   • AGEs are implicated in aging processes and development of vascular complications 1

3. Metabolic Disturbances:

   • High doses of rapidly digested glucose and fructose (from either source) are harmful through overlapping pathways 1
   • Both can contribute to obesity, diabetes, and non-alcoholic fatty liver disease when consumed excessively 5, 4

Guidelines for Consumption

The American Diabetes Association and other authorities recommend:

• Limiting all added sugars, including both HFCS and sucrose 1, 6
• Avoiding sugar-sweetened beverages from any caloric sweetener to reduce risk of weight gain and worsening cardiometabolic risk 1, 6
• Focusing on overall carbohydrate quality rather than targeting specific types of sweeteners 1

Common Pitfalls in Sugar Consumption

• Assuming "natural" sugars like sucrose are healthier than HFCS 6
• Focusing on the type of sweetener while ignoring total carbohydrate content 6
• Consuming beverages with high fructose:glucose ratios (including both HFCS-sweetened beverages and some fruit juices), which may promote intestinal formation of pro-inflammatory advanced glycation end products 1

Bottom Line

The evidence does not support singling out HFCS as worse than sucrose for health outcomes. The total amount of added sugars in the diet, regardless of the source, is the more important consideration for health. Both sweeteners should be consumed in limited quantities to reduce risk of obesity, diabetes, cardiovascular disease, and other health problems.