Podcast: What's The Difference Between High Fructose Corn Syrup And Cane Sugar

Dr. Jonathan Waitman: Patients think if they avoid high-fructose corn syrup, that they’re avoiding all sugar. Getting a lot of cane sugar in your diet is also unhealthy.

Gabrielle Gambino: Yeah, I agree. I think they’re generally the same type of bad.

Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Courtney Allison.

Most Americans consume 2 to 3 times the recommended amount of added sugar every day. With news of popular soda brands switching to using cane sugar instead of high-fructose corn syrup, we wondered: is this really a healthier option?  

To learn more about the different types of sugar and how they impact our health, I spoke with Gabrielle Gambino, a clinical dietitian at NewYork-Presbyterian/Weill Cornell Medical Center, and Dr. Jonathan Waitman, and obesity specialist at NewYork-Presbyterian and Weill Cornell Medicine. 

They explain what high-fructose corn syrup is made of, how it’s different from cane sugar, and offer helpful tips on how to make healthier choices around all types of sweeteners.

Courtney: Gabrielle. Dr. Waitman, thank you so much for joining us today.

Dr. Jonathan Waitman: My pleasure

Gabrielle Gambino: Thank you for having us.

Courtney: So we are here today to talk about an ingredient that’s been in the news a lot: high-fructose corn syrup. Gabrielle, can you give us a definition of high-fructose corn syrup? What is it, how is it different from sugar on a chemical level? 

Gabrielle Gambino: So high-fructose corn syrup is a compound made chemically between glucose and fructose, which are two simple sugars. It is modified in the chemical realm to be free-flowing simple sugars, and a lot of products are using these today because high-fructose corn syrup is actually much cheaper than the cane sugar product.

Courtney: And what did we start to see across the population when high-fructose corn syrup became such a widespread ingredient,

Gabrielle Gambino: So there isn’t a straight causality to this, but we did see a lot of our overweight and obesity numbers soar, from the 1970s onward, we saw that number go up and up. And this could be due to a lot of things, but there was a lot of consumption of the products that use high-fructose corn syrup in them. So all of the overproduced products and the sugary sweetened beverages. That consumption increased dramatically over this time.

Dr. Jonathan Waitman: And with increased consumption of highly processed foods, we see increased calorie intake. So we can say that these highly processed foods make us feel less full and certainly contribute to obesity.

Gabrielle Gambino: I agree with Dr. Waitman. If you look at the ingredients on the high processed foods list, they’re all very low in fiber and micronutrients, and these types of nutrients help our bodies regulate our hunger. So naturally, you’re going to be eating more of these foods. Not even that, the sugar itself is addicting, and so our bodies are just going to be asking for more of the processed foods versus whole foods.

Courtney: Are there any key differences you can elaborate on between the way we process high fructose corn syrup versus other sources of sugar?

Gabrielle Gambino: So if we’re comparing high-fructose corn syrup to cane sugar, which is also called sucrose, they’re both made up of the same simple sugars. They’re both made up of glucose and they’re both made up of fructose. High-fructose corn syrup has slightly more fructose compared to glucose. In terms of percentages, that’s about 55% for high-fructose corn syrup versus 50% for table sugar or sucrose. So in terms of metabolism, fructose is not cleaved by any enzymes, and typically goes straight to the liver for processing.

Glucose uses enzymes. This is a step process that is regulated by our hormones and satiety hormones, and because fructose doesn’t have that step, theoretically our bodies are not feeling satiated after eating a lot of fructose.

So a lot of people postulate that high-fructose consumption does not satiate our bodies leading to over consumption of this sugar, and that can lead to various deleterious effects such as triglyceride overload, fatty deposits in the liver, uric acid, which causes gout and inflammation.

Courtney: And now for the big question. I think there’s a lot of confusion recently around the health effects of corn syrup versus cane sugar. Is high-fructose corn syrup worse for your health than cane sugar?

Gabrielle Gambino: So essentially high-fructose corn syrup and sucrose generally give the same deleterious effects on our bodies. And although there is some research about a little bit of an elevation in inflammation with high-fructose intake, in general, when you’re looking at the way our bodies metabolize both of these compounds, they cleave that glucose and fructose pretty quickly. So you’re ending up with the same simple sugars either way and generally the same amounts. So literature pretty much to this date shows that there’s no difference between sugar and high-fructose corn syrup, but they’re both pretty bad for us in excess.

Dr. Jonathan Waitman: Well, I’d like to keep in mind that, Gabrielle pointed out that with increased consumption of high-fructose corn syrup over time, we saw increases in diabetes as well as obesity and other diseases. Now, if we had replaced that high-fructose corn syrup with cane sugar, would we be in the same place? And the answer is, we don’t know. 

As Gabrielle pointed out, we can’t assess causality here. We can say that there’s a correlation with increased intake of high-fructose corn syrup being associated with increasing these diseases across our population, but we can’t necessarily establish causation there.

Courtney: So Gabrielle, is it correct that the quantity of sugar in our diets is more of a concern than where it comes from?

Gabrielle Gambino: Yes, in general. Absolutely. I think that today Americans are eating about 17 grams per day of added sugar, which is way too much for us. So I think in general, looking at the amount that you’re taking in with each ingredient label that you’re reading can help you cut down a little bit more on that.

Courtney: And so I know this is in the news a bit lately, how much of a difference is there between a can of soda sweetened with high-fructose corn syrup versus a can of soda sweetened with cane sugar?

Gabrielle Gambino: Not much of a difference because they’re generally made up of the same amounts. In fact, the companies might actually have to add a little bit more of the cane sugar into their product to meet that same taste profile as the high-fructose corn syrup version. 

Courtney: So it seems like added sugar is so hard to avoid, so, what’s your advice on which ones are better – or less bad – for us?

Gabrielle Gambino: Sure. I would say in general, try to stick to the most natural sounding sugar in your products as possible. Items like honey, coconut, sugar, maple syrup, those are better than items like your sugar sweeteners that you see every single day, like sucralose, um, or aspartame as well as the high-fructose corn syrup.

Dr. Jonathan Waitman: I agree. I think our, my patients, think about the packet of sugar that they put in their coffee in the morning a little bit too much, right? They overemphasize the importance of that. How many calories is that, Gabrielle?

Gabrielle Gambino: Oh gosh. It’s like maybe 15.

Dr. Jonathan Waitman: 15, 16 calories. That’s about it. And they’re not worried about like the croissant that went along with it, or like the highly processed carbohydrate, which is really what they should be worrying about.

Courtney: I mean, it’s something we keep hearing time and time again to seek out whole foods, to try to avoid ultra processed foods. Is this a message you give to your patients?

Dr. Jonathan Waitman: Absolutely. The more you can look at a product and intuitively determine the ingredients, right, the better it is for you. It’s hard to like look at a Twinkie and know what’s in there, right? But if you’re looking at an apple or broccoli or something like that, it’s a lot easier to tell.

Gabrielle Gambino: Yeah. I always tell patients to read the label and if you can’t pronounce it, you know with confidence, that ingredient on there, it might not be the best one for you.

Courtney: But then, so many whole foods also have natural sugar in them. Can you explain how eating a piece of fruit, for example, is different from drinking a can of soda, or even a glass of fruit juice?

Gabrielle Gambino: When you’re eating fruit, you’re also getting all of the other nutrients involved in that fruit, so you’re getting micronutrients, antioxidants, fiber. And that natural sweetness that your body is able to use for cellular energy to keep you full and to help your gut microbiome. All these things are brought to you by fruit, but not by say, juice, which has no fiber, just sugar. And even the juice concentrates are even worse ’cause they have the extra sugar that they add into it. So just keeping that in mind that you’re missing a lot of those nutrients.

Dr. Jonathan Waitman: The fiber slows down the absorption of the sugar, so if you are eating an orange, yes, you’re getting some sugar out of it, but you’re also getting the fiber, which is gonna slow down the absorption of that sugar, which is a good thing. So you’re not gonna get that, uh, sharp peak and valley after having an orange, but you might get it after orange juice. In addition, it would take approximately six oranges to make a glass of orange juice. Most people are not gonna sit down and eat six oranges.

Courtney: So, Dr. Waitman, shifting gears a little bit. Something we hear about when it comes to monitoring blood sugar is the glycemic index. What is the glycemic index and how does it work?

Dr. Jonathan Waitman: So that compares different sources of carbohydrates, and it assesses how quickly your blood sugar will go up from a given food. So let’s say white bread would have a very high glycemic index because your body converts it very quickly into blood sugar, right? As opposed to a whole grain bread, which has more fiber and is less processed and is not gonna give you as sharp a rise in blood sugar. The less processed something is, the less it’s going to drive up your blood sugar.

Courtney: Where might foods that contain high-fructose corn syrup fall on the glycemic index?

Dr. Jonathan Waitman: Generally, those are highly processed foods that your body breaks down very easily and convert into blood sugar. So the more processed something is, the more likely it is to contain high-fructose corn syrup, the higher glycemic index it’s going to be.

Gabrielle Gambino: It’s also very surprising. I was looking in my fridge just before our interview today, and I noticed that even my barbecue sauce had high-fructose corn syrup in it, and there’s about 15 grams per tablespoon of added sugar. So be very careful with those. And it’s pretty obvious, like Dr. Waitman said, if it’s processed, um, maybe eight times outta 10, there will be some high-fructose corn syrup in there.

Courtney: Well, I think it goes back to what you said about really checking the label when you’re eating. ’cause there could be some surprises.

Dr. Jonathan Waitman: I’m gonna have to check my barbecue sauce when I get home, Gabrielle.

[Laughter]

Gabrielle Gambino: I’m sorry. I’m sorry. 

Dr. Jonathan Waitman: It’s okay.

Courtney: This is all extremely helpful to understand. I’m curious about a comparison with artificial sweeteners too. Taking this example, are low or NO sugar sodas actually better for us then?

Dr. Jonathan Waitman: The truth is we don’t really know what to do with these artificial sweeteners, what we call non-nutritive sweeteners. They don’t have any calories, but that doesn’t mean they have zero impact on your body. What we do know from clinical studies is that these non-nutritive sweeteners or artificial sweeteners elicit an endocrinologic response in the body. So they’re doing something, they’re not being treated by the body as neutral. Right. And I think they’re probably having a deleterious effect.

Gabrielle Gambino:  One hundred percent. I did a literature review on this about a year ago, and we’ve found literature showing that it impacts our gut microbiome whenever you eat a lot of these. And our gut microbiome is linked to mental health, our heart health, our, you know, endocrine function. Um, so a lot of things are linked to that gut. And when you’re eating a lot of these sucralose or other types of sweeteners and your gut microbiome is off your body starts to feel the effects.

Courtney: I knew these sweeteners were bad but I don’t think I realized just how bad they are for us. So, I know our time’s running short but before we go – are there any myths about high-fructose corn syrup or sugar that you think people should know about?

Dr. Jonathan Waitman:  I think that patients think if they avoid high-fructose corn syrup, that they’re avoiding all sugar. And as Gabrielle has described, getting a lot of cane sugar in your diet is also unhealthy.

Gabrielle Gambino: Yeah, I agree. I think the way that some messaging is out today makes it sound like these products with the high-fructose corn syrup are not as healthy as those with cane sugar, but they’re generally the same type of bad. Consumers just need to remember that it doesn’t really matter where your sugar is coming from, it’s just the amount that you’re taking in that really does affect your health. Try to look for more of your whole foods. Try to stay away from any of those sugary sweetened beverages, and you’ll be better off in the long run.

Courtney: Thank you. Dr. Waitman, anything you’d like to add?

Dr. Jonathan Waitman: I believe in moderation. There aren’t very many foods that I will say never have. Um, but I’ll say certain foods, you should have less frequently.

Courtney: Gabrielle, Dr. Waitman, thank you so much for joining us today to talk through high-fructose corn syrup and sugar and all these great things about diet. We really appreciate you being here.

Gabrielle Gambino: Thank you so much.

Dr. Jonathan Waitman: Thanks for having me, Courtney. This was fun.

Courtney:  Our many thanks to Gabrielle Gambino and Dr. Jonathan Waitman. I’m Courtney Allison. Health Matters is a production of New York Presbyterian. 

 The views shared on this podcast solely reflect the expertise and experience of our guests.

To learn more about the work Gabrielle Gambino and Dr. Waitman do with patients, check out the show notes!

New York Presbyterian is here to help you stay amazing at every stage of your life. 

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