Restaurant eating: A fructose landmine

13. January 2011 William Davis (25)
There is no remaining question that fructose is among the worst possible things humans can consume.

Followers of the Heart Scan Blog already know this, from conversations like The LDL-Fructose Disconnect, Where do you find fructose?, and Goodbye, fructose.

But fructose, usually as either high-fructose corn syrup (44%, 55%, occasionally higher percentage fructose) or sucrose (50% fructose), is ubiquitous. I've seen it in the most improbable places, including cole slaw, mustard, and dill pickles.

It's reasonably straightforward to avoid or minimize fructose exposure while eating at home, provided you check labels and focus on foods that don't require labels (like green peppers, salmon, and olive oil, i.e., unprocessed foods). But when you choose to eat at a restaurant, then all hell can break loose and fructose exposure can explode.

So what are some common and unsuspected fructose sources when eating at a restaurant?

Salad dressings--Dressings in all stripes and flavors are now made with high-fructose corn syrup and/or sucrose. This is especially true of low-fat, non-fat, or "lite" dressings, meaning oils have been replaced by high-fructose corn syrup. It can also be true of traditional non-low-fat dressings, too, since high-fructose corn syrup is just plain cheap.

Olive oil and vinegar are still your safest bets. I will often use salsa as a dressing, which works well.

Sauces and gravies--Not only can sauces be thickened with cornstarch, many pre-mixed sauces are also made with high-fructose corn syrup or sweetened with sucrose. Barbecue sauce is a particular landmine, since it is now a rare barbecue sauce not made with high-fructose corn syrup as the first or second ingredient. Sauces for dipping are nearly always high-fructose corn syrup-based.

Ketchup--Yup. Good old ketchup even is now made with high-fructose corn syrup. In fact, you should be suspicious of any condiment.

Highball, Bloody Mary, Margarita, Daiquiri, beer--Even the before-dinner or dinner drink can have plenty of fructose, particularly if a mix is used to make it. While Blood Marys seem the most benign of all, adorned with celery, pickle, and olive, just take a look at the ingredient label on the mix used: high-fructose corn syrup.

Fructose is a stealth poison: It doesn't immediately increase blood sugar; it doesn't trigger any perceptible effect like increased energy or sleepiness. But it is responsible for an incredible amount of the health struggles in the U.S., from obesity, to diabetes, to hyperlipidemias and heart disease, to arthritis, to cataracts.
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Comments (25) -

  • Chuck

    1/13/2011 3:41:14 PM |

    I can't believe that there is so much high fructose corn syrup in all these foods. Thanks for the information!

  • JohnR

    1/13/2011 3:48:51 PM |

    I question the importance here. If you've already eliminated the major offenders like sweet drinks and desserts, is the amount of fructose you're likely to consume from sources like restaurant salad dressings really likely to do any more damage than, say, the ethanol in the glass of wine you drink with dinner 4 or 5 times a week?

    Also, Heinz now makes a non-HFCS ketchup ("Simply Heinz"), not that subbing sucrose for HFCS really buys you much from a health perspective.

  • Ed Terry

    1/13/2011 4:03:34 PM |

    Proponents of HFCS state that it's no worse than sucrose.  However, the physical properties of HFCS allow it to be used in a lot more foods than sugar.

  • Tom H.

    1/13/2011 6:16:21 PM |

    I'm thinking about eating an apple a day. How would this affect my glucose levels, and lipid levels. Is my plan good, bad, or neutral? Thanks for any answers.

  • Thrasymachus

    1/13/2011 6:24:44 PM |

    I could go on about the amazing, appalling corruption of our ssystem of government but the fact the government promotes and subsidizes bad food for the benefit of a tiny portion of the population has to be one of the worst examples.

  • Might-o'chondri-AL

    1/13/2011 11:32:06 PM |

    Apple harvest, before refrigeration, was consumed as cider. The more alcoholic it got the less residual fructose it had.

    "An apple a day keeps the doctor away" is a relatively new rhyme. Old heirloom tree stock yields pretty sour apples; we've bred them to be sweeter.

  • Dr. William Davis

    1/14/2011 12:11:52 AM |

    Fructose is far worse than previously suspected. It is, in my view, a large part of the reason so many Americans are obese, diabetic, with all the complications of these conditions.

    A few milligrams per day from fructose is likely of little to no consequence. But a little here, a little there and it all adds up. Ketchup, salad dressing, a couple of pieces of fruit, some "organic agave nectar" on your dessert, an you've had a substantial exposure.

    Let the belt out a notch or two.

  • Darrin

    1/14/2011 1:53:10 AM |

    It's definitely a drag that so much of the food you get in a restaurant now is doused in sugar to match most peoples' tastes, to say nothing of the fact that everything is also cooked in refined vegetable oils!

  • yoyo

    1/14/2011 2:18:23 AM |

    Beer does not contain (more than trace) fructose. It does contain significant dextrose and starch in excess of what is found in wine/whiskey.

  • Anonymous

    1/14/2011 3:14:47 AM |

    How much fructose did a caveman on average consume? Does anyone know?

  • revelo

    1/14/2011 3:58:30 AM |

    Some of the cooked vegetables at restaurants (especially tomato sauce and diced tomatoes) also typically come from cans with BPA linings.

    MSG is also pretty common with restaurant food. I once saw a guy at a Chinese place carrying a 50 lb sack of MSG into the back door. Yes, it comes in bulk. Most horrifying food-related sight I have ever seen, and trust me, Chinatown has some pretty horrifying food-related sights. But it's not just Chinese food. MSG is everywhere.

  • revelo

    1/14/2011 5:25:49 AM |

    Re: fructose and average cavemen. "Average" is meaningless. But during berry season, I wouldn't be surprised if 60% of the calories were from berries, so 30% of calories each from fructose and glucose, with dried meat or fish making up the other 40%. Have you ever been in the mountains of Washington during August? Incredible numbers of wild blueberries, slightly smaller than the ones in stores but just as tasty. The Indians of that area preserved blueberries in salmon oil, so they would be available year-round.

    Humans are clearly designed to process fructose as 30% or more of daily calories, just like our ape ancestors. Whether this amount of fructose contributes to longevity or not is another story. Evolution needs us to bear and raise healthy offspring, which requires living to age 40 or so. After that, we are no longer needed, and evolution might even want us to get out of the way after age 40.

  • Ruth

    1/14/2011 9:16:38 AM |

    As often the solution is simple: eat real food. Don't eat anything that is advertised. Stay away from anything that has been processed. Learn how to cook.

  • Might-o'chondri-AL

    1/14/2011 6:13:14 PM |

    Just wondering about "cave men" and their kin .... It seems their epoch's realtors
    pitch about cave sites being all about location, location, location determined who got the best pickings.

    I don't think the hunting was all so easy for them. Cavemen had to share any game brought down; a fellow needed to feed his gun bearer and give his trucker some.

    For them it was probably hieracrchial portion of the kill and seasonal wild pickings. Mostly allaying hunger with rationed dried meat and what they dug up or stripped from plants.

    When the cave far from water it might mean progressive dehydration spells. Many may very well have been experiencing protracted disassociation brain chemistry states.

  • Davide Palmer

    1/14/2011 6:42:31 PM |

    Dr. Davis,

    Yet, in my opinion, I still think there is a substantial difference between consuming natural fructose and HFCS.

    For example, an apple contains polyphenols, flavanols, fiber, and other various anti-inflammatory substances that work synergistically together to buffer the some of negative effects high blood glucose.

    Pure HFCS, on the other hand is highly processed from genetically modified corn, void of any buffering nutrients and very high in reactive aldehydes and ketones(which cause serious oxidative stress and inflammation).

    --Big difference, here

    A high consumption of HFCS has, through numerous studies, been clearly implicated in numerous conditions such visceral fat, insulin resistance, fatty liver and obesity, etc. A high consumption of natural fruit has not.

    A just think this distinction should be made more clearly. Just my opinion.

  • Davide Palmer

    1/14/2011 6:42:53 PM |

    Dr. Davis,

    Yet, in my opinion, I still think there is a substantial difference between consuming natural fructose and HFCS.

    For example, an apple contains polyphenols, flavanols, fiber, and other various anti-inflammatory substances that work synergistically together to buffer the some of negative effects high blood glucose.

    Pure HFCS, on the other hand is highly processed from genetically modified corn, void of any buffering nutrients and very high in reactive aldehydes and ketones(which cause serious oxidative stress and inflammation).

    --Big difference, here

    A high consumption of HFCS has, through numerous studies, been clearly implicated in numerous conditions such visceral fat, insulin resistance, fatty liver and obesity, etc. A high consumption of natural fruit has not.

    A just think this distinction should be made more clearly. Just my opinion.

  • Might-o'chondri-AL

    1/14/2011 11:37:37 PM |

    Hi Davide Palmer,

    Would you please elaborate on ketones? I am assuming it's about the context wherein they occur.

    I was taught ketones are the heart's preferred fuel.
    One Doctor who uses cocconut oil for Alzheimers says we fortuitously convert it into ketones.

  • Davide Palmer

    1/15/2011 12:26:55 AM |

    oops...meant to say reactive carbonyls. Reactive ketones are produced in response to reactive carbonyls.

  • Anonymous

    1/15/2011 12:53:55 AM |

    your correct about the problems of BBQ sauce. i have eliminated most of the HFCS from my diet...except for BBQ sauces. the best tasting one in my opinion is Sweet Baby Rays but its loaded with HFCS, and lots of sodium. KC Masterpiece is marginally healthier and less appetizing. Any recommendations for a readymade sauce?

  • reikime

    1/15/2011 2:13:35 AM |

    As one of many out there who suffers from Fructose Malabsorption, I can tell you it is a very hard substance to avoid!  Garlic, onions, apples, pears are very high in fructose and everyone has their own personal threshhold for tolerance.

    I wonder how this factors into overall health issues such as cardiovascular disease, IDDM etc.?

  • d

    1/15/2011 2:55:36 PM |

    I read some studies (sorry, I don't have immediate links) where men eating HFCS had their lipid profiles somewhat return to baseline after eating the HFCS diet beyond 3 months?  

    Has anyone else read this?

  • ultrasonic liposuction guide

    1/18/2011 6:43:44 AM |

    I can't believe that there is so much high fructose corn syrup in all these foods. I just want to say that eat real food. Don't eat anything that is advertised.
    Thanks for the information! Please keep sharing!

  • Anonymous

    1/21/2011 2:57:10 AM |

    I thought I once read that a caveman ate only 12 to 15 tablespoons of sugar per year based on the scarcity of fruit and the type of fruit that existed but I have not been able to verify. Just wondering if anyone had data.

  • John Fernandes

    2/11/2011 3:47:17 AM |

    Research just released by University of Auckland shows that fructose consumption can harm unborn babies

    http://www.stuff.co.nz/life-style/wellbeing/4647075/Fructose-can-harm-babies-study

  • Anonymous

    2/23/2011 1:26:28 PM |

    So Dr. Davis are you suggesting we don't eat fruit at ALL. Or just have a few servings per day?

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What tests are MORE important than cholesterol?

What tests are MORE important than cholesterol?

12. May 2013 William Davis (8)
In the conventional practice of early heart disease prevention, cholesterol testing takes center stage. Rarely does it go any further, aside from questions about family history and obvious sources of modifiable risk such as smoking and sedentary lifestyle.

So standard practice is to usually look at your LDL cholesterol, the value that is calculated, not measured, then--almost without fail--prescribe a statin drug. While there are indeed useful values in the standard cholesterol panel--HDL cholesterol and triglycerides--they are typically ignored or prompt no specific action.

But a genuine effort at heart disease prevention should go farther than an assessment of calculated LDL cholesterol, as there are many ways that humans develop coronary atherosclerosis. Among the tests to consider in order to craft a truly effect heart disease prevention program are:

--Lipoprotein testing--Rather than using the amount of cholesterol in the various fractions of blood as a crude surrogate for lipoproteins in the bloodstream, why not measure lipoproteins themselves? These techniques have been around for over 20 years, but are simply not part of standard practice.

Lipoprotein testing especially allows you to understand what proportion of LDL particles are the truly unhealthy small LDL particles (that are oxidation- and glycation-prone). It also identifies whether or not you have lipoprotein(a), the heritable factor that confers superior survival capacity in a wild environment ("The Perfect Carnivore"), but makes the holder of this genetic pattern the least tolerant to the modern diet dominated by grains and sugars, devoid of fat and organ meats.

--25-hydroxy vitamin D--The data documenting the health power of vitamin D restoration continue to grow, with benefits on blood sugar and insulin, blood pressure, bone density, protection from winter "blues" (seasonal affective disorder), decrease in falls and fractures, decrease in cancer, decrease in cardiovascular events. I aim to keep 25-hydroxy vitamin D at a level of 60 to 70 ng/ml. This generally requires 4000-8000 units per day in gelcap form, at least for the first 3 or so years, after which there is a decrease in need. Daily supplementation is better than weekly, monthly, or other less-frequent regimens. The D3 (cholecalciferol) form is superior to the non-human D2 (ergocalciferol) form.

--Hemoglobin A1c (HbA1c)--HbA1c represents glycated hemoglobin, i.e., hemoglobin molecules within red blood cells that are irreversibly modified by glucose, or blood sugar. It therefore provides an index of endogenous glycation of all proteins of the body: proteins in the lenses of the eyes that lead to cataracts; proteins in the cartilage of the knees and hips that lead to brittle cartilage and arthritis; proteins in kidney tissue leading to kidney dysfunction.

HbA1c provides an incredibly clear snapshot of health: It reflects the amount of glycation you have been exposed to over the past 90 or so days. We therefore aim for an ideal level: 5.0% or less, the amount of "ambient" glycation that occurs just with living life. We reject the notion that a HbA1c level of 6.0% is acceptable just because you don't "need" diabetes medication, the thinking that drives conventional medical practice.

--RBC Omega-3 Index--The average American consumes very little omega-3 fatty acids, EPA and DHA, such that a typical omega-3 RBC Index, i.e., the proportion of fatty acids in the red blood cell occupied by omega-3 fatty acids, is around 2-3%, a level associated with increased potential for sudden cardiac death (death!). Levels of 6% or greater are associated with reduced potential for sudden cardiac death; 10% or greater are associated with reduced other cardiovascular events.

Evidence therefore suggests that an RBC Omega-3 Index of 10% or greater is desirable, a level generally achieved by obtaining 3000-3600 mg EPA + DHA per day (more or less, depending on the form consumed, an issue for future discussion).

--Thyroid testing (TSH, free T3, free T4)--Even subtle degrees of thyroid dysfunction can double, triple, even quadruple cardiovascular risk. TSH values, for instance, within the previously presumed "normal" range, pose increased risk for cardiovascular death; a TSH level of 4.0 mIU, for instance, is associated with more than double the relative risk of a level of 1.0.

Sad fact: the endocrinology community, not keeping abreast of the concerning issues coming from the toxicological community regarding perchlorates, polyfluorooctanoic acid and other fluorinated hydrocarbons, polybrominated diphenyl ethers (PDBEs), and other thyroid-toxic compounds, tend to ignore these issues, while the public is increasingly exposed to the increased cardiovascular risk of even modest degrees of thyroid dysfunction. Don't commit the same crime of ignorance: Thyroid dysfunction in this age of endocrine disruption can be crucial to cardiovascular and overall health.


All in all, there are a number of common blood tests that are relevant--no, crucial--for achieving heart health. Last on the list: standard cholesterol testing.
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Comments (8) -

  • stuart

    5/13/2013 12:56:55 AM |

    Great summary Dr. Davis.  You're the best!

  • Sol y Sombra

    5/13/2013 11:07:44 AM |

    Thank you for the useful information you provide, Dr. Davis. But I have a question: Does it really take 3-4 years to replenish vitamin D stores in the body?

  • Amy Crain

    5/15/2013 2:26:51 AM |

    Dr. Davis..
    My husband decided to give going gluten free a try after I read your book, and shared many things with him.  He has a number of issues.  HBP and taking meds.  Asthma, knee injuries with multiple surgeries over the years, and based on his lipid panel numbers, his dr. like you said, wanted to put him on a chol. reducer.  He went gf for a month, this past month, and just this week had his blood work done.  His LDL # went up from 146 to 164, and his HDL went from 45 to 47.   His Trig at least, dropped from 190 to 122,  So he now has in hand a scrip for atorvastatin (sp.?)..  Even though my husband would be considered a slender 48 year old, he has lost 6 pounds during this month of being wheat free.  I personally began a trek of losing weight a year ago by cutting wheat and sugar, and lost over 30 pounds, going from a size 12 to a 2.  I never had any blood work done, since I didn't have any health issues.  I was really hoping for better results for my husbands numbers so that we could provide a valid testimony to those unbelievers within our family.  I don't have your book memorized, but I've scanned through the blog posts and comments and found bits and pieces about numbers and how some people experience an increase like my husband Bill did.  Could you give me a bullet point laymen's version of the reason for the increase, if it's a concern, and if not, should he get the prescription filled like the dr. ordered so that he can then do the 3 month follow up to see if the med. worked for lowering the #'s?
    OR should I just go back and do some more reading like of the above post and reread the book?
    Thanks!
    Amy

  • Lowering cholesterol diet

    5/17/2013 3:10:25 PM |

    Hey there,

    thanks for the article. I would also like to know does Vitamin C plays any role in lowering cholesterol? I am thinking about writing a blog post about it so thank you in advance dr. Davis.

  • Geoffrey Levens, L.Ac.

    5/17/2013 8:23:48 PM |

    List makes great sense to me but one question arises: In light of recent research showing increased risks outside range of 20–36 ng/ml, do you anticipate any change in your recommendations as to Vitamin D blood level?
    J Clin Endocrinol Metab. Published online March 26, 2013. Abstract

    Thank you.

  • Difficulty in the Balancing Act - Page 2

    5/23/2013 11:59:28 AM |

    [...] between triglycerides and HDL, those improve with LCHF diet. You can start reading more here;  What tests are MORE important than cholesterol? | Track Your Plaque Blog  Lipid researcher, 98, reports on the causes of heart disease | News Bureau | University of [...]

  • Stephen in Jacksonville

    6/14/2013 9:20:30 PM |

    Tests are important, and I think that there are more people today who are interested in keeping track of their cholesterol levels. This is why I think we live in such a special time. We have access to more information than ever before, and now people can learn about high cholesterol risks without having to go to the doctor. In fact, I have found a number of sites that allow people to track their cholesterol levels online. Obviously, there are some people who may go overboard with access to this information, but I do think that there are plenty of benefits to be had.

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