I find it curious why people don't want to know or talk about their numbers ... blood sugar, blood pressure, blood fats.  My brain tells me it's a form of denial, but choosing not to see it won't make it go away.  I know it's not easy quitting smoking or starting an exercise program, but at least you're alive.
That's all, don't mean to sound bleak  

You forgot agave syrup, which a lot of people are using as an "all natural" low-glycemic replacement for HFCS. In fact, it contains more fructose than HFCS.

One manufacturer's products include “low glycemic monosacharide.” Gosh, I wonder what that is.

It would be a service, if you (or someone) posted a "fructose" content list which includes all the common fruits and berries. I eat a lot of berries and have wondered if that is such a good idea. A list would help us define "good calories" regarding these possible fructose bombs.

Thanks for the visuals and labels on fructose...I am very aware of fructose contents and fruit -- especially since I have experience with fruit and gout attacks that may or may not be supported in literature.  I will only add that every time you purchase a product DO NOT ASSUME CONTENTS ARE THE SAME as when you last purchased.  For example, Classico pasta sauces which I used as base for soups and stews (all LC) has started adding sugar.  CostCo Kirkland brand marinated artichoke hearts (again LC) started out using olive oil, now uses cannola oil. My experience as label-reading shopper is food producers are now adding sugars including fructose to just about everything because the buying public perceives sugar to be tastier...even the rotisserie chickens most grocery delis have now...be careful if you very LC to whether the spice rub has sugar in it.

What don't you find it in?

Finding it hard to believe that an apple wouldn't have some other redeeming value that counteracts or balances the fructose content: soluble fiber, fiber, vitamins, minerals, etc.  Hopefully this is not an indictment of all fresh fruits?

It's all very well to measure fructose content, but it is meaningless unless we know what intake levels have to be before they become problematic.

In my own case, when I went "paleo" a couple of years ago, I swore off sugar, grain, and processed foods.  I lost 15 lbs over six months without trying.  Now this was before I heard about the fructose issue, and I was eating fruit like I never had before in my life, 3 to 4 pieces a day, and the sweet ones, too:  apples, bananas, grapes, dates, etc.  Surely I was ingesting more fructose than I had been before with a blob of ketchup here, steak sauce there...

Not to put too fine a point on it, but what you show as A.1. Steak Sauce is actually their marinade. Real A.1. Steak Sauce (at least my bottle) contains no HFCS, but does have 2g sugar per serving. Thank you for spending the time you do on this blog; you, along with some others, have given me the intellectual and scientific basis I needed to change my diet. The improvements, physical and mental, have been astounding.

The fructose info is interesting, but I agree with GK. We really need to know what is considered a safe level before condemning all fructose sources.

Fruits do have certain health benefits, some more than others, especially berries. There is also the possibility that by becoming super fructose-phobic and avoiding all fruits/berries,  that one could decrease their chances of heart disease, just to succumb to cancer instead.

Perkdoug, I have found that the web site "nutrition data" has a breakdown of sugars for things. Go to nutritiondata.com and type in the food you are interested in. Choose the right food and quantity and then go down to the section on carbohydrate and click the see more details. When I did that for dates, 1 medjool has about 7.6 grams of fructose (eek!). Like many folks I am cutting down on my fructose consumption so use this table a lot.

How about the king of HFCS--Soft drinks and candy.

As someone else asked, "what don't you find it in?"

Fructose can be found in many vegetables too.  One sweet onion has 6.69 grams, a half head of cabbage has 6.58 grams, a head of lettuce has 5 grams, a cup of chopped red peppers has 3.37 grams, a medium sized cucumber has 2.62 grams.  In fact nutritiondata.com lists 138 vegetables which have some amount of fructose in them (albeit many having very small amounts.)

So, if one's goal is to avoid all sources of fructose and still maintain any semblance of good health, well good luck.

@Nameless: Well put!

I think tossing fruit is a bit of the baby out with the bathwater.Fruit has the most wonderful spectrum of bright tastes and flavors of any food we have on the planet. "Healthy" vegetables encompassed the bitter, the flat, and the algae like part of the flavor spectrum. Me, is meet and nice in small to medium quantities but when eaten in low-carb volumes, it just becomes something you shovel in to make hunger go way.

Fruit is a wonderful gift. Adding a little sugar and heating some berries produces this wonderful sauce you can pour over pancakes or creps (if my diabetes let me have crepes). Some fat, flour, and salt makes a wonderful crust that you wrap around sliced and spiced fruit. Cold cherries crunch between your teeth dribble juice around your tongue while you roll the stone around your mouth cleaning off the last of the fruit meat. Peaches with ginger, peach blackberry, blueberry pie. Sliced and cored apples cooked in red-hot cinnamon sauce on the stove and then chilled before serving on Christmas Eve. On a hot August day, wandering through an orchard and dodging Yellowjackets when picking a beautifully ripe peach off the tree.  Pulling a crisp apple out of winter store in November and tasting what will become cider.

On a more practical level, I also need to make the decision on how much fruit versus how much bulk  laxative? If I eat one piece every days, I'm looking 8+ tablespoons of Metamucil.  bleck.  I'd rather starve myself in  other areas to make room for the delightful sweetness of fruit.

Who said throw fruit out?

I believe you are reading things that aren't there.

I disagree.  without giving a threshold of "bad", your presentation implies that all fructose at any level is bad.  I read some comments as expressing fear or doubt that they were eating too much fruit.  others like me what to know the threshold of bad.

just between you and me, I'd give up living before I gave up fruit.  no joke.  the flavours of fruit are that important to me.  I've already lost enough food ground with diabetes, I'm not giving up any more.

According to Dr. Richard Bernstein, fruit does not have to be a part of a healthy diet. Here is what he says in his book, Diabetes Solution:

"Although eliminating fruit and fruit juices from the diet can initially be a big sacrifice for many of my patients, they usually get use to this rapidly, and they appreciate the effect upon blood sugar control. I haven't eaten fruit in almost forty years and I haven't suffered in any respect. Some people fear that they will lose important nutrients by eliminating fruit, but that shouldn't be a worry. Nutrients found in fruits are also present in the vegetables you can safely eat."

Dr. Bernstein has had T1DM for about 50 years and advocates a very low carb diet to help normalize blood sugars. http://www.diabetes-book.com/

Because of blood sugar problems I have eliminated all sources of HFCS and have greatly limited my fruits. I find I can eat a few berries or a bite or two of other fruits without raising my blood glucose, but I mostly stick with colorful low carb veges.

Dr: Davis -- "Who said throw fruit out? I believe you are reading things that aren't there."

Yet you start this post with a photo of an apple. Although perhaps it wasn't  your intention, it certainly implies that fruit is bad.

National estimates of dietary fructose intake increased from 1977 to 2004 in the United States.
high-fructose corn syrup percentage of sweeteners increased from 16% in 1978 to 42% in 1998
Since 1978, mean daily intakes of added and total fructose increased in all gender and age groups, whereas naturally occurring fructose intake decreased or remained constant.
If you can't get the full text at least read the abstract. The full text has some interesting charts presenting the data more clearly.
It isn't eating naturally sourced fructose from whole fruit driving increased obesity. Increases in fruit consumption are dwarfed by greater increases in total daily energy and carbohydrate intakes.

RE: Comment by Nameless (“Yet you start this post with a photo of an apple. Although perhaps it wasn't your intention, it certainly implies that fruit is bad”)
-------------------------------------------------------------------------------------------

The good doctor is merely demonstrating in effective graphic terms that
too much of a good thing is not good. The numbers (ie gms of fructose)
are important guidelines. There’s no point in getting your nuts in wringer over it!

Bernstein developed Diabetes at age 12. He was born in 1934, so at age 75, he has been diabetic for 63 years. No diabetic complications. Normal blood sugar for all!!

I think its more helpful to express sugar content (and fructose if known) as a percentage rather than an amount per (varying) serve.  It makes it easier to compare apples to apples (scuse pun).  I've prepared a few listings of various food groups (several hundred items in each) on this basis at www.howmuchsugar.com if you are interested.

Some people suffer from fructose malabsorption. One source states that it is found in approximately 30-40% of the population of Central Europe. If one has that condition, then it would be prudent to avoid all fructose, even the fructose found in fruit. I love the taste of fruit, but it is destroying my health due to malabsorption issues. Fortunately, we know that some cultures lived very healthy lives without eating fruit (e.g. Eskimos).

I don't get it. What am I not seeing?

How much high fructose corn syrup is in a serving of the BBQ sauce? How much in a serving of the steak marinade?

You state such figures for a serving of apple (1 medium), and for a serving of honey (2 Tablespoons).

I had to give up fruit to prevent further beta cell damage (above 140 apparently for pre-diabetics, and maybe everyone, I don't know). Fruit and many veggies are toxic to people with glucose intolerance. I had to give up veggies for now, until I can find one that I can tolerate. Cabbage was too hard on my blood sugar. I am slowly trying to figure out what I can eat and how to minimize the glycemic impact. Unfortunately, I might have to damage my beta cells to find out what works. The system told me I was fine, even though I told them I had sugar problems. I gave up on doctors 10 years ago, since they were useless. I finally bought a meter and started testing, and the truth is painful.

In addition, since I have been involved with cardiac CT for now nearly 24 years, the PLC also affords me an opportunity to develop a CT coronary angiography training program for cardiologists and radiologists (www.cardiaccta.us). Together, these new efforts are merely an extension of my interests in prevention, patient care, and teaching.

The question I have - what happens if you eliminate wheat, add the fish oil, and niacin, normalize vitamin D and still don't hit the TYP target of 60-60-60? What's the thought process for deciding to take a statin???

Dr. Davis,

Have you checked this out yet. It looks like something worth considering. I've heard some very interesting things lately about new microbes being found in association with diseases not considered infectious until now. The association of enterovirus with Type 1 and Type 2 diabetes also points to the inflammation potentially being nonautoimmune in nature and raises the question of whether Vitamin D is downregulated as part of the body's attempt to fight invasion.

Since the studies I've found show raising Vitamin D does NOT have a positive impact on diabetes, though Vitamin D is low in diabetes, this is a serious concern.

If we are eliminating inflammation but not organisms causing inflammation, long term the results may not be so good.

A total cholesterol of 132 can be quite unhealthy considering that all cause mortality in the lowest quartile of total cholesterol is twice the death rate in the upper quartile of total cholesterol.  A paleo diet would produce more optimum cholesterol numbers (no grains, etc, as recommend here) but that diet varies by latitude with more carbs the closer to the equator one lives with total cholesterol varying accordingly.

Additionally, dig a little deeper and Sam likely has a much better LP(a) value than John.  He's probably sick fewer times during the year, and he's risk of getting cancer is half that of John's.

Oh, and Sam probably has less bodyfat as a nice healthy side effect of wheat reduction.

My HDL was suck at 38 since 2002. I went to 40mgs crestor mid 2008. I put myself on 2 grms of niacin, this fixed the perpetually high trigs, and the 40gms crestor crushed the LDL

Then I found this blog and went on vitamin D.  I already had followed fish oil but not consistently so I fixed that.  After 4 months on Vitamin D, my HDL was up to 50
oh...and my LDL dropped too.

My Dr. told me I was a poster child for Crestor treatment but she allow the change back to 20mgs anyhow.  I did take a month off from crestor to get rid of the muscle/bone aches and pains and have now restarted 20mgs with no problems.

I am going to spend a few months on 20mg and check the lipid profile, if good, next step is statin free for me.

I eliminated wheat - and all grains - from my diet nearly three years ago (I eat low carb Paleo). My fish oils give me a total of 1680 mg EPA and DHA per day, and my vitamin D levels since last year have varied between 50 ng/ml and 80 ng/ml. However, my lipid profile is not like either John's or Sam's:

LDL cholesterol 154 mg/dl
HDL cholesterol 93 mg/dl
Triglycerides 36 mg/dl
Total cholesterol 255 mg/dl

My cardiologist and endocrinologist are happy with my profile because they say the ratios are good, no one is asking me to take a statin. My calcium score is 0.

I have read too that too low a cholesterol level is just as bad and, maybe worse, than too high !

Anne

Hi, Jenny--

Excellent point. Perhaps a topic for a future discussion.

However, we do witness positive effects on various phenomena associated with diabetes when vitamin D is normalized: reduction in CRP, dramatic increase in HDL, modest reduction in triglycerides and small LDL, and reduction in blood sugar if insulin resistance is present.

Will vitamin D replacement impact on cardiovascular mortality in diabetics? Uncertain, though I predict it does to a substantial degree.

Plus John will likely experience some nasty side effects from the statin that Sam will not!

Jenny, love your blog, your spirit,and your free questing mind.

My take on Vitamin D and Diabetes:

In general, Vitamin D does better at preventing disease than ameliorating it once it exists.  There is soom good Finnish epidemiological evidence that supplementing Vitamin D to levels in the 50's can decrease the incidence of Type 1 diabetes in children.
Proposed mechanism has to do with the leaky gut hypothesis.  D deficiency leads to impaired intercellular signalling through degredation of tight junctions between cells.  Adjacent intestinal lining cells can't effectively talk to each other. Bacteria, viruses etc "leak" through, The immune system gets overwhelmed, then the immune system notices that pancreatic islet cells look a whole lot like a portion of a proteus or klebsiella bacteria and whammo, you have type 1 diabetes, rheumatoid arthritis, etc.  

Type 2 diabetes seems to be another story.  Since Vitamin D is often sequestered in fat, lowering serum 25-OH Vitamin D levels, and type 2 diabetics tend to be obese, therein may be part of the association.  

But no one essentially dies of a Hgb A1c of, say, 6.7.  As you know, it's the sequelae -  the heart attacks, strokes, CHF.  I do recall one recent study on MI, diabetes, and Vitamin D levels.  It may be that D can help prevent the adverse sequelae of type 2 dm with no direct effect on A1c.

Dr. Davis,

I just saw your reply to my earlier question.  The one decent study I've found suggests that dramatically raising Vitamin D has no significant effect on blood sugar.

My concern is this: when we lower inflammation by raising Vitamin D are we putting out the fire or turning off the smoke alarm.

Though inflammation clearly raises heart attack risk and lowering it does prevent heart attack, there are many other forms of inflammation that are important because it's a sign we are fighting off invaders that need to be fought off. So if we turn down inflammation we may be promoting microbe-stimulated cancers five years later.

And if as some evidence suggests, cardiac inflammation stems from bacteria originally associated with gum disease, raising the Vitamin D might lower the inflammation but not bacterial infestation which over time cannot be good for us.

Is there any evidence that Vitamin D does more than improve the markers like CRP (the smoke alarm) and actually eliminates the disease state?

So far I am not seeing that in Diabetes.