What’s the public health effect of a health claim for fructose?

Industry has welcomed​ the recent publication of a health claim for fructose, which backs the sweetener’s beneficial effect on blood sugar levels, when compared to regular sugar (sucrose) or glucose.

Specifically, companies can claim: “Consumption of foods containing fructose leads to a lower blood glucose rise compared to foods containing sucrose or glucose”.​

However, there have been numerous studies linking fructose with negative health impacts, and the European Food Safety Authority (EFSA) acknowledged these in its scientific opinion too, warning that “high intakes of fructose may lead to metabolic complications such as dyslipidaemia, insulin resistance and increased visceral adiposity”.​

Health claim seduction…​

The European Heart Network is among those who are sceptical that there could be any public health benefit from the fructose health claim.

“In the case of fructose, there is a risk that a “positive” claim may have negative health effects if it leads to increased energy intake because people are seduced by the claim,”​ EHN director Susanne Logstrup told FoodNavigator. “High intake of fructose may lead to metabolic complications, including dyslipidaemia and insulin resistance. Whether this will be the outcome, remains to be seen, of course.”​

She added: “EHN’s view is that claims should only be allowed if they have a public health benefit. If they do not, we do not see the value of them – even if there is no obvious negative public health impact.”​

So how did the positive end up outweighing the negative?​

EFSA says its role is to provide information to European risk managers at the Commission, Parliament and Member States – but it is not involved in the regulatory process that takes place based on its opinions.

“So, the authorisation for the use of health claims (including the final conditions of use and any restriction of use) is ultimately under the remit of the European Commission and the Member States,”​ an EFSA spokesperson said.

As for the European Commission, it says the decision to approve the claim was conditional on replacing other sugars with fructose, and according to EFSA’s opinion, the panel assumed that the target population was individuals who wished to reduce their post-prandial glycaemic responses.

A spokesperson for the Commission said: “Therefore, it does not encourage the intake of fructose in the general population as such but instead it targets people who are already consumers of sugars."​

For the time being, the Commission says the effects of the claim will be closely followed on the request of some Member States, who asked that the Commission pay attention to the evolution of fructose intakes following authorisation of the claim.

If necessary, it will consider whether EFSA needs to provide more scientific advice in relation to the claim, depending on evolving scientific knowledge and whether there is a dramatic rise in fructose consumption. 

Excessive intakes​

The Commission spokesperson added: “Any of the possible adverse effects that have been reported could be caused only at consumption levels that would largely exceed the reference intakes of sugars.”​

Indeed, the research cited by EFSA in its opinion involves very high levels of fructose consumption. While the UK’s Department of Health recommends that no more than 10% of a person’s daily energy should come from added sugars of any kind, in one cited study​, mice were fed a diet with fructose meeting 25% of their energy needs.

All of the studies cited involve consumption of fructose at levels that far exceed recommendations for all added sugars.

Nevertheless, Europeans tend to consume more added sugars than the recommended maximum and the EFSA report cites plenty of research suggesting that excessive consumption of fructose may be more harmful in some ways than other kinds of sugar – although, within limits, it is less harmful when it comes to causing blood glucose spikes.