Carbs and Sugars

Carbohydrates and Sugars 101

Carbs and Sugars

Sugar gets a bad rap, regardless of the type of sugar. What we forget is there is actually sugar that is not “bad.”

Sure, the monosaccharide glucose is the best common form of sugar.  It generally makes up the majority of starchy root vegetables carbohydrate content and is far more compatible with human physiology.  Although excess glucose from some sources can still produce high blood glucose levels and may create problems with our corresponding insulin production, this form of sugar is metabolized much more cleanly than fructose.  Fructose metabolism generates uric acid production and creates oxidative stress within our cells’ mitochondria.  Our liver has to clean up the metabolic clutter produced by fructose and this contributes to fatty liver deposits and ultimately non alcoholic fatty liver disease (NAFLD), which is now at unprecedented levels across all demographics, even young children, here in the US.  In addition, a significant number of people suffer from fructose intolerance and suffer significantly with even modest amounts of this sugar.

What is the difference between “good” vs “bad” sugars (or is that even a thing)?

The better sugars are those that are metabolized without significant harmful byproducts.  Glucose can be helpful to many organs in the body such as the thyroid gland, the brain, and our adrenals, when consumed in moderation.  These organs have higher needs for glucose and although any people can follow very low carb diets indefinitely with no observable side effects, others may see aberrations in their thyroid or adrenal function.  Glucose produces very few free radicals when it is converted to energy. In comparison, fructose generates a host of undesirable free radicals that in turn damage the mitochondrial membrane and create oxidative stress.

Carbs and Sugars

What are some sources/examples of “good sugar” and why are they on the ok list — why are they healthy (or at least not unhealthy)?

The best sources of sugar would be the starch found in most root vegetables, as well as a few grains or grain-like foods/ pseudo grains, which is almost entirely made up of glucose.  Examples would be potatoes, sweet potatoes, yams, carrots, and parsnips. Rice and buckwheat are also almost entirely glucose based with respect to their starch content.

The worst sources of sugar would be any sweetener with high fructose contents such as corn syrup, fruit juice concentrates, agave, and cane sugar (where half of the sugar will be in the form of fructose).  Fruit juice is typically very high in its fructose content and should be avoided. Even some fruits have very high fructose contents and should be eaten in limited quantities such as one piece or 1 cup per day and only when in season. Examples of these fruits are mangoes, pears, grapes/raisins, apples, bananas, and pineapple.  It is better to choose those fruits with very low fructose content most often. Examples of these better choices would be raspberries, blackberries, grapefruits, and tangerines.

~ John Bagnulo MPH, PhD.


1.  Lambertz J, Weiskirchen S, Landert S, Weiskirchen R. Fructose: A Dietary Sugar in Crosstalk with Microbiota Contributing to the Development and Progression of Non-Alcoholic Liver Disease. Frontiers in Immunology. 2017;8:1159. doi:10.3389/fimmu.2017.01159

2.  Jegatheesan P, De Bandt J-P. Fructose and NAFLD: The Multifaceted Aspects of Fructose Metabolism. Nutrients. 2017;9(3):230. doi:10.3390/nu9030230.

3.  Jensen T, Abdelmalek MF, Sullivan S, et al. Fructose and Sugar: A Major Mediator of Nonalcoholic Fatty Liver Disease. Journal of hepatology. 2018;68(5):1063-1075. doi:10.1016/j.jhep.2018.01.019.

4.  Siqueira JH et al. Sugar-Sweetened Soft Drinks and Fructose Consumption Are Associated with Hyperuricemia: Cross-Sectional Analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Nutrients. 2018 Jul 27;10(8). pii: E981. doi: 10.3390/nu10080981.

5.  Sara J White, Emma L Carran, Andrew N Reynolds, Jillian J Haszard, Bernard J Venn; The effects of apples and apple juice on acute plasma uric acid concentration: a randomized controlled trial, The American Journal of Clinical Nutrition, Volume 107, Issue 2, 1 February 2018, Pages 165–172

6.  Orlando A, Cazzaniga E, Giussani M, Palestini P, Genovesi S. Hypertension in Children: Role of Obesity, Simple Carbohydrates, and Uric Acid. Frontiers in Public Health. 2018;6:129. doi:10.3389/fpubh.2018.00129.

How Fructose Affects the Brain

How Fructose Affects the Brain and Why Fruit Shouldn’t Get a Pass When it comes to Sugar

How Fructose Affects the Brain

One of the biggest misunderstandings in the field of nutrition is the role of fruit in a healthy diet.  We have been told to eat more fruits and vegetables for so long, that the two are referred to almost synonymously.  There is definitely a problem with this association.  Vegetables are rich in fiber, minerals, and typically very low in sugar.  Fruit, on the other hand, is typically much lower in micronutrients and fiber, yet much higher in sugar.  The most notable sugar in fruit is fructose. Continue reading

Critical Qualities

Critical Qualities of Enteral Formulas for Patients with Diabetes

As a greater percentage of diabetes patients require enteral support for an additional disease or condition, the nutritional qualities of a formula are pivotal.  While most enteral formulas are comprised of heavily refined carbohydrates (ranging from fruit juice concentrates to corn syrup solids) and industrially processed seed oils (corn, soybean, sunflower, and canola), there is only one whole food, high fermentable fiber, and no added sugar option.  The qualities possessed by this type of formula are aligned with those recommended for the treatment and management of insulin resistance. Continue reading


Should Sugar Be the Second Ingredient? A comparative look at enteral formulas designed for diabetes patients and why Liquid Hope is still the best.

Many RDs and clinicians ask us if Liquid hope is suitable for those with diabetes.  Absolutely.  I think the question is asked so frequently because Liquid Hope does not state anywhere on its package or in its literature that it is designed specifically for diabetes.  In contrast, descriptions of commercial formulas such as Glucerna 1.2 and Diabetisource AC 1.2 contain language that clearly delineates them from other formulas.  They are apparently formulated specific to the condition of diabetes and contain the appropriate ingredients and nutritional qualities.  Really? Let’s take a closer look at what they are and what’s in them: Continue reading

The Epidemic

The Epidemic of Non-Alcoholic Fatty Liver Disease

If an individual is obese it is most likely that they suffer from non-alcoholic fatty liver disease or NAFLD.  There was a time when this condition was quite rare. Now it appears that more than half of Americans have it and more than a third of American children suffer from it.  The condition is generally a function of a diet rich in refined carbohydrates and the concomitant gut problems such as dysbiosis and bacterial overgrowth that feed off the sugar.  Together the inflammation and damage to the liver’s detoxification efforts create a significant amount of damage to a person’s health. Continue reading

Liquid Hope Comparison

Why Functional Formularies (Liquid Hope and Nourish) Are Not The Same As Other Blenderized Enteral Formulas

It has been brought to our attention that some RDs (Registered Dietitians) and other health professionals consider Liquid Hope and Nourish to be very similar to Real Food Blends or Kate Farms products.  They are telling patients that there is no difference between Functional Formularies products and the other products that fall into this “blenderized” bucket. When this information is passed on to you whether by an RD, Durable Medical Equipment Company or a salesperson, hopefully the following information will help you understand the differences as they are very different. We hope to make this fact clear, it is like comparing apples to oranges, or in this case garbanzo beans to orange juice. Continue reading