Should I eat dietary sugar & added sugars?

Our experts suggest that while humans consuming fruit and honey is evolutionarily sensible, pure fructose in high amounts can disrupt the microbiome and cause pathology.

The combination of excess fructose, high carbohydrate loads, and polyunsaturated seed oils is seen as a 'perfect storm' driving modern disease.

However, fructose in a full food matrix like orange juice, honey, or oranges is generally not considered a concern, and some literature is beginning to question the negative impact of sucrose.

• 01Paul Saladino claims that glucose intake, unlike fructose or orange juice, induced oxidative stress and an inflammatory response in a study.
• 02Peter Attia states that fructose ingestion can lead to weight gain by increasing energy intake and decreasing energy expenditure.
• 03Paul Saladino suggests that the combination of excess fructose, high carbohydrate loads that convert glucose to fructose, and polyunsaturated seed oils creates a 'perfect storm' driving modern disease.
• 04Paul Saladino notes that fructose in a full food matrix like orange juice, honey, or oranges is not a concern.
• 05Paul Saladino points out that low-fat processed foods marketed in the 1980s and 1990s were often high in fructose and processed sugar.
• 06Paul Saladino claims that pure fructose in high amounts can disrupt the microbiome and cause pathology.
• 07Peter Attia observes that animals fed a high-sugar diet developed diabetes and fatty liver, unlike those fed starch.
• 08Paul Saladino states that excessive consumption of sucrose, HFCS, hybridized fruit, and high carbohydrates with seed oils creates a pro-inflammatory state.
• 09Peter Attia mentions that combining glucose and fructose can increase carbohydrate oxidation rate during high-intensity exercise to approximately 1.3-1.4 grams per minute for elite athletes.
• 10Bryan Johnson asserts that consuming 17 teaspoons of added sugar daily is not an evolved human behavior.
• 11Peter Attia explains that high fructose corn syrup is formed by mixing fructose and glucose.
• 12Paul Saladino believes that humans consuming fruit and honey is evolutionarily sensible.
• 13Paul Saladino suggests that fructose, as found in sucrose, may be a problem for humans.
• 14Peter Attia states that a large quantity of fructose is detrimental to health.

Our experts disagree on the overall harm of fructose, with Paul Saladino stating he no longer believes fructose is inherently bad for humans, and that conflating all fructose sources as bad is dangerous. He also notes that rodent studies showing fructose is harmful should not be directly extrapolated to humans. Peter Attia suggests that replacing glucose with fructose in equal amounts does not demonstrably worsen health outcomes if total energy intake is preserved, and that high fructose corn syrup is not inherently fattening independent of calories and primarily leads to overconsumption. Paul Saladino also points out that correlations between high fructose corn syrup consumption and diabetes prevalence are weaker than commonly believed, and that the literature is beginning to question the negative impact of sucrose. The exact dose threshold of fructose that might lead to statistically significant differences in metabolic parameters is not yet known, and the available evidence is not sufficiently robust to conclude that fructose, high fructose corn syrup, or sucrose consumption affects NAFLD.

The verdict would change if more robust evidence emerged definitively linking fructose in whole food matrices to negative health outcomes, or if further research clarified the specific dose thresholds at which fructose becomes detrimental to human health, independent of caloric intake and food matrix.