Family Practice -- eLetters for Halsted, 0 (2008) 581-58

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Article:
Charles H Halsted
Perspectives on obesity and sweeteners, folic acid fortification and vitamin D requirements
Fam. Pract. 2008; 0: cmn058v1-58 [Abstract] [Full text] [PDF]

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HFCS: a controversy that never should have been: John S White (12 February 2009)

Response to John White: Charles H Halsted (12 February 2009)

HFCS: a controversy that never should have been 12 February 2009

John S White,
Nutritional Biochemist
White Technical Research, Argenta, IL 62501
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Re: HFCS: a controversy that never should have been

Author Halsted (1) is certainly justified in selecting high-fructose corn syrup (HFCS) as one of the most controversial nutritional issues during his watch as editor in chief of the American Journal of Clinical Nutrition (AJCN). One could make the argument, however, that AJCN ignited and then fueled the issue by giving it so much print space and so little expert peer review in the final years of Halsted’s tenure.
The HFCS issue is shocking for the hubris and ignorance exhibited by academics writing about industrial products and processes, and nutritionists writing about food science, all of who should have studied their subject more thoroughly. Papers in AJCN by Bray et al (2) and those that followed (3- 10) contained errors of fact, omission or hyperbole that proper peer review should have detected and eliminated. These papers led directly to the wholesale confusion and misunderstanding about HFCS that exists today, and created a mythology that demonized an otherwise innocuous ingredient:
• Statistical correlation (HFCS and obesity) was broadly interpreted as evidence of causation;
• Regular, glucose-based corn syrup was confused with HFCS;
• Fructose was confused with HFCS;
• HFCS was incorrectly assumed to be nearly all fructose;
• Differences were presumed in composition, metabolism and sweetness of HFCS and sucrose, though they are nearly identical in all respects (11, 12);
• Experiments with pure fructose were extrapolated to HFCS, though they are compositionally different;
• Experiments with rodents were extrapolated to humans, though there are obvious and significant differences;
• Metabolic upsets induced by supraphysiological doses of pure fructose (up to 6-fold excess) were attributed to HFCS at typical intake levels;
• Supraphysiological fructose experimentation has blinded scientific bodies to potential benefits of fructose at low-to-moderate intakes (13, 14).
These and other errors could easily have been avoided had authors and referees armed themselves with basic background information about HFCS (15).
The 2004 hypothesis of Bray et al (2) stated that increased use of HFCS was an important cause of obesity. Between publication, purported validation and reporting, the hypothesis morphed to accepted fact that was embraced by a generation of scientists, physicians, nutritionists, dietitians and journalists who consider AJCN the undisputed source of nutrition information.
Despite growing consensus that sucrose and HFCS are metabolically equivalent (16), it is apparent that Halsted still supports the Bray hypothesis by the off-handed manner he acknowledges the opposing view of Forshee et al (17) at the hind end of his paper. It is indeed ironic that this paper was rejected by Halsted’s AJCN prior to its eventual publication in another journal.
References
1. Halsted C. Perspectives on obesity and sweeteners, folic acid fortification and vitamin D requirements. Fam Pract 2008.
2. Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 2004;79:537-43.
3. Gross LS, Li L, Ford ES, Liu S. Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment. Am J Clin Nutr 2004;79:774-9.
4. Wu T, Giovannucci E, Pischon T, et al. Fructose, glycemic load, and quantity and quality of carbohydrate in relation to plasma C-peptide concentrations in US women. Am J Clin Nutr 2004;80:1043-9.
5. Le KA, Faeh D, Stettler R, et al. A 4-wk high-fructose diet alters lipid metabolism without affecting insulin sensitivity or ectopic lipids in healthy humans. Am J Clin Nutr 2006;84:1374-9.
6. Aeberli I, Zimmermann MB, Molinari L, et al. Fructose intake is a predictor of LDL particle size in overweight schoolchildren. Am J Clin Nutr 2007;86:1174-1178.
7. Bray GA. How bad is fructose? Am J Clin Nutr 2007;86:895-896.
8. Johnson RJ, Segal MS, Sautin Y, et al. Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. Am J Clin Nutr 2007;86:899- 906.
9. Sanchez-Lozada LG, Le M, Segal M, Johnson RJ. How safe is fructose for persons with or without diabetes? Am J Clin Nutr 2008;88:1189-90.
10. Teff KL, Elliott SS, Tschop M, et al. Dietary fructose reduces circulating insulin and leptin, attenuates postprandial suppression of ghrelin, and increases triglycerides in women. J Clin Endocrinol Metab 2004;89:2963-72.
11. Hanover LM, White JS. Manufacturing, composition, and applications of fructose. Am J Clin Nutr 1993;58:724S-732S.
12. Melanson KJ, Zukley L, Lowndes J, Nguyen V, Angelopoulos TJ, Rippe JM. Effects of high-fructose corn syrup and sucrose consumption on circulating glucose, insulin, leptin, and ghrelin and on appetite in normal-weight women. Nutrition 2007;23:103-12.
13. Bantle JP, Wylie-Rosett J, Albright AL, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2008;31 Suppl 1:S61-78.
14. Livesey G, Taylor R. Fructose consumption and consequences for glycation, plasma triacylglycerol, and body weight: meta-analyses and meta - regression models of intervention studies. Am J Clin Nutr 2008;88:1419-37.
15. White JS. Straight talk about high-fructose corn syrup: what it is and what it ain't. Am J Clin Nutr 2008;88:1716S-1721S.
16. Fulgoni V, 3rd. High-fructose corn syrup: everything you wanted to know, but were afraid to ask. Am J Clin Nutr 2008;88:1715S.
17. 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 Sci Nutr 2007;47:561-82.
Conflict of Interest:
The author is a consultant to the food and beverage industry in the area of nutritive sweeteners. His clients include individual companies, research institutes, food industry councils and trade organizations.

Response to John White 12 February 2009

Charles H Halsted,
Professor
University of California Davis 95616
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Re: Response to John White

The author thanks Mr White for his contributions to the controversy. The goal of my article was to present controversial areas that had been explored during my tenure as Editor of the American Journal of Clinical Nutrition. Regarding the controversy on obesity and high fructose corn syrup, my report cited an article (reference 14) that "holds that there is no convincing epidemiological or metabolic relationship between consumption of HCFS and wight gain." Further, my article clearly states that "more definitive prospective studies on the metabolic consequences of HCFS in human subjects will be required to settle this controversy."
Conflict of Interest:
None declared