They Say Fructose Is Safe - But it's Unknowingly Destroying Your Liver

As you already know, we are in the middle of an obesity epidemic with nearly 70 percent of the population overweight. It's not surprising that we would have complications of obesity. This is why so many children are developing "nonalcoholic liver disease" (also known as "nonalcoholic fatty liver disease" or NAFLD), since obesity is characterized not only by excess fat near the surface of your body, but also excess fat in and around your internal organs.

Sometimes excess fat accumulates in the liver and can lead to inflammation and scarring, which is a serious condition called nonalcoholic steatohepatitis (NASH). When your liver is scarred, it can no longer function normally. In its most severe form, this can progress to cirrhosis and liver failure. This condition used to be extremely rare, if not virtually unseen, in children. Unfortunately, this is not the case today.

Liver cirrhosis is a terrible disease you would never want your child to have.

Symptoms include:

• Fluid retention
• Muscle wasting
• Bleeding from the intestines
• Weight loss

NASH is a "silent" liver disease—most people are not aware they have a liver problem. NASH is only diagnosable by liver biopsy. There are currently no blood tests or scans that can reliably tell you whether you have simple NAFLD, or whether it has progressed to NASH, which is much more serious.

Both NASH and NAFLD are becoming more common as American waistlines are growing, and the segment of our population most at risk is our youth. If your child develops NAFLD, his risk for developing NASH and cirrhosis is much higher. NASH is usually progressive and virtually untreatable. Therefore, the time to intervene is BEFORE permanent liver damage has a chance to occur. Preventing obesity is key, as it is the excess liver fat that serves as the substrate for more serious disease to develop over time.

Nonalcoholic Fatty Liver Disease in Children

According to Manco et al, the longer you have NAFLD, the more likely it is to progress into more serious disease like liver fibrosis (accumulation of abnormal fibrous tissue), cirrhosis (accumulation of scar tissue), and NASH. Therefore, it's very concerning that children are developing this so early in their lives.

The following facts about pediatric NAFLD are disturbing:

• Cases of pediatric NAFLD have been reported in children down to 3 years old.
• A marker of NAFLD (elevated ALT) is present in eight percent of adolescents tested in the U.S.
• Among obese children and adolescents, NAFLD has been identified in 20 percent of American children and adolescents, 44 percent of Italian, and 74 percent of Chinese.
• NAFLD is strongly associated with insulin resistance and other classic symptoms of metabolic syndrome, and is far more common than many physicians realize.
• Children with high abdominal fat have the highest risk for NAFLD progressing to NASH.

Everyone agrees that the only preventative strategy to battle NAFLD is by paying careful attention to diet and exercise. If your child is obese, the objective should be gradual weight loss, since rapid weight loss has been shown to result in increased stress on the liver and faster progression into NASH.

In terms of diet, the pandemic of pediatric NAFLD has directly paralleled our children's skyrocketing obesity rates. And obesity rates have followed Western dietary trends: overconsumption of processed foods and sodas made up of simple carbohydrates and loads of sugar—especially fructose.

When it Comes to Sugar, Fructose is the Worst of the Worst

Fructose is a cheap form of sugar used in thousands of food products and soft drinks, which can damage your, or your child's, metabolism. More than any other form of sugar, heavy fructose consumption can cause dangerous growths of fat cells around vital organs and can trigger the early stages of diabetes, heart and liver disease.

Fructose, usually derived from corn, is fueling the obesity crisis in a big way due to its heavy use by the food and beverage industry in the form of high-fructose corn syrup (HFCS) and crystalline fructose. If you or your child are consuming excess fructose daily, it can result in damage to your liver.

Since the 1970s, the consumption of HFCS in the United States has skyrocketed. Soda and other sweetened beverages are easily some of the largest contributors, in which HFCS is the primary sweetener.

But HFCS is also in the vast majority of processed foods—even those you wouldn't think of as sweet, such as ketchup, soup, salad dressing, bread and crackers. Even "natural" foods often contain fructose as a sweetener. So even if you don't drink soda, if you eat processed or packaged foods at all, you're likely consuming fructose—and a lot of it. Fructose accounts for 10 percent of the calories in the average American diet.  Metabolically, it's the worst of the worst.

How Consuming Fructose Can Damage Your Liver

Fructose is very hard on your liver, in much the same way as drinking alcohol.

1. Liver burden number one: After eating fructose, 100 percent of the metabolic burden rests on your liver—ONLY your liver can break it down. This is much different than consuming glucose, in which your liver has to break down only 20 percent, and the remaining 80 percent is immediately metabolized and used by the rest of the cells in your body.
2. Liver burden number two: Fructose is converted into fat that get stored in your liver and other tissues as body fat. Part of what makes fructose so bad for your health is that it is metabolized to fat in your body far more rapidly than any other sugar. For example, if you eat 120 calories of fructose, 40 calories are stored as fat. But if you eat the same amount of glucose, less than one calorie gets stored as fat. Consuming fructose is essentially consuming fat!

Fructose metabolism is very similar to the way alcohol is metabolized, which has a multitude of toxic metabolites that, if consumed in excess, can lead to NAFLD. Metabolically, consuming fructose is very similar to consuming alcohol. The byproducts are similar, which is why the effects on the liver are similar. For a complete discussion of fructose metabolism, see my comprehensive article about this.

Ironically, the very products that most people rely on to lose weight—low-fat diet foods—are often those that contain the most fructose. Studies confirm that consuming large amounts of HFCS may contribute to the development of NAFLD. And most kids today are consuming massive amounts!  It is my belief that fructose is the largest dietary factor behind the rising rates of fatty liver disease among today's youth.

Fructose is the Leading Dietary Culprit in Childhood Obesity

Although the American Beverage Association claims there is "no association between high fructose corn syrup and obesity," a long lineup of scientific studies suggest otherwise. For example:

• Dr. David Ludwig of Boston Children’s Hospital did a recent study of the effects of sugar-sweetened drinks on obesity in children. He found that for each additional serving of a sugar-sweetened drink, both body mass index and odds of obesity increased.
• The Fizzy Drink Study in Christchurch, England explored the effects on obesity when soda machines were removed from schools for one year. In the schools where the machines were removed, obesity stayed constant. In the schools where soda machines remained, obesity rates continued to rise.
• In a 2009 study, 16 volunteers were fed a controlled diet including high levels of fructose. Ten weeks later, the volunteers had produced new fat cells around their hearts, livers and other digestive organs. They also showed signs of food-processing abnormalities linked to diabetes and heart disease. A second group of volunteers who were fed a similar diet, but with glucose replacing fructose, did not have these problems.

Please understand that while there are many contributing factors, I am convinced that excessive FRUCTOSE consumption is the primary cause of the obesity epidemic in both children and adults. Sweetened beverages and processed foods are the main sources of fructose.

For an in-depth understanding of just how fructose can destroy your health and the health of your children, please watch this excellent video lecture in its entirety (part 1, and part 2). Dr. Lustig's presentation on this subject really opened my eyes to this issue, and then Dr. Johnson, who is the chairman of medicine at the University of Colorado, reinforced it with his book, The Sugar Fix: The High-Fructose Fallout That Is Making You Fat and Sick.

If you disagree with my assessment, then please review the resources above and see if you still hold the same position. The evidence is beyond compelling.

What Else Does Science Say about the Health Impact of Fructose?

 Select the hyperlinks to review how fructose may harm your health:

Raise your blood pressure, and cause nocturnal hypertension	Insulin resistance / Type 2 Diabetes	Non-alcoholic fatty liver disease (NAFLD)
Raise your uric acid levels, which can result in gout and/or metabolic syndrome	Accelerate the progression of chronic kidney disease	Intracranial atherosclerosis (narrowing and hardening of the arteries in your skull)
Exacerbate cardiac abnormalities if you're deficient in copper	Have a genotoxic effect on the colon	Promote metastasis in breast cancer patients
Cause tubulointerstitial injury (injury to the tubules and interstitial tissue of your kidney)	Promotes obesity and related health problems and diseases	Promotes pancreatic cancer growth
Raises triglycerides, which can increase your risk for heart disease	Interfere with leptin and insulin signaling, which help control hunger and fat storage	Accelerate the aging process

If you visit GreenMedInfo's fructose page, you'll see there are 21 different research studies linking excessive dietary fructose with fatty liver disease. This relationship is now well established.  So don't be tempted to fall for the food and beverage industry's propaganda, claiming HFCS is no worse for you than sugar. If this were true, we wouldn't be seeing our children's livers looking like the livers of "seasoned alcoholics."

Common Sense Guidelines for Preventing Liver Disease

By modifying your child's lifestyle in the following ways, you can help him reach or maintain his ideal weight:

• Keep fructose from all sources less than 25 grams per day. Fructose is one of the primary sources of calories in the U.S., and your child may need to dramatically reduce foods that are high in fructose, such as sodas and fruit juices. Fruits need to be carefully measured as well to make certain that no more 15 grams of fructose are consumed. See the table below to get an idea of how much fructose is in your child’s favorite fruits.
  
  I recommend limiting your child's daily fructose intake from fruit to 15 grams, because it would be very unusual for his not getting additional fructose from other foods, since it's added to just about ALL processed foods and beverages. For example, there are about 40 grams of HFCS per can of soda.
  
  So please, carefully add your fruits based on the table below to keep the total fructose from fruit below 15 grams per day.

Fruit	Serving Size	Grams of Fructose
Limes	1 medium	0
Lemons	1 medium	0.6
Cranberries	1 cup	0.7
Passion fruit	1 medium	0.9
Prune	1 medium	1.2
Apricot	1 medium	1.3
Guava	2 medium	2.2
Date (Deglet Noor style)	1 medium	2.6
Cantaloupe	1/8 of med. melon	2.8
Raspberries	1 cup	3.0
Clementine	1 medium	3.4
Kiwifruit	1 medium	3.4
Blackberries	1 cup	3.5
Star fruit	1 medium	3.6
Cherries, sweet	10	3.8
Strawberries	1 cup	3.8
Cherries, sour	1 cup	4.0
Pineapple	1 slice (3.5" x .75")	4.0
Grapefruit, pink or red	1/2 medium	4.3

Fruit	Serving Size	Grams of Fructose
Boysenberries	1 cup	4.6
Tangerine/mandarin orange	1 medium	4.8
Nectarine	1 medium	5.4
Peach	1 medium	5.9
Orange (navel)	1 medium	6.1
Papaya	1/2 medium	6.3
Honeydew	1/8 of med. melon	6.7
Banana	1 medium	7.1
Blueberries	1 cup	7.4
Date (Medjool)	1 medium	7.7
Apple (composite)	1 medium	9.5
Persimmon	1 medium	10.6
Watermelon	1/16 med. melon	11.3
Pear	1 medium	11.8
Raisins	1/4 cup	12.3
Grapes, seedless (green or red)	1 cup	12.4
Mango	1/2 medium	16.2
Apricots, dried	1 cup	16.4
Figs, dried	1 cup	23.0

• Follow my nutrition plan so that you can tailor your child’s diet to his needs . Be sure to introduce your child to whole foods, steering away from processed foods. Gardens are a wonderful classroom for children—gardening teaches them that REAL food comes from the ground, not from grocery store aisles!
• Replace sweet, sugary juices and sodas with pure, clean water.
• Help your child exercise. Children need to exercise daily, just as adults do. Exercise will not only help your child achieve or maintain his optimal weight, but it can lift his mood, help him to sleep better, boost his grades, reduce hyperactivity, stimulate growth hormone, improve his immunity, and help correct metabolic imbalances related to other hormones, like insulin and leptin. Exercise can even override “fat genes.” Exercise WITH your children—it will benefit the entire family.
• Set limits on your child’s TV/computer time.
• Help your child to let go of his emotional blocks. Tools like the Emotional Freedom Technique (EFT) are very helpful when it comes to losing weight, as well as decreasing stress and negative emotions. EFT is a technique that is easy to learn, even for children, and can be helpful to your child in a variety of circumstances.

Natural Agents That Can Help Restore Your Child's Metabolic Health

There are some scientific studies showing that the effects of fructose toxicity can be ameliorated with several natural nutritional substances, which is important since there are NO medications proven effective for children. Natural agents showing promise include the following:

• The number one and single most important step is to limit or even eliminate the use of sugar, especially fructose until you are healthy, and then only have less than 25 grams per day.  This will have a dramatic and remarkable improvement in your child’s health and should be done before considering any supplements.
• Chlorella and spirulina have been found to improve fructose toxicity. Chlorella was shown to improve insulin sensitivity, and spirulina has been found to improve hyperlipidemia.
• Ginger was shown to have a beneficial effect on fructose induced insulin resistance and hyperlipidemia in rat studies.
• Green tea was also shown to reduce insulin resistance in rats fed fructose.
• The antioxidant resveratrol was found to prevent cardiovascular changes in fructose-fed rats.
• Holy basil prevented insulin resistance in fructose fed rats.

Although science is beginning to identify natural treatments that can help undo the damaging effects of fructose, it is important to remember that the best way to prevent liver damage is prevent your child from becoming obese in the first place, by teaching him how to make good lifestyle choices. Use yourself as a model. Remember, children learn new habits best from their parents—good AND bad!

Additional References:

• Dig Dis May 2010
• J Hepatol July 2011
• National Digestive Diseases Information Clearinghouse (NDDIC)
• J Am Coll Nutr December 2008
• CBS News Healthwatch February 11, 2009
• J Clin Invest May 2009