Fructose in medicine. A review with particular reference to diabetes mellitus.

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Summary A review is given of the metabolism of fructose in the mammalian organism, and its significance in medicine. Emphasis is laid upon the absorption and assimilation of fructose through pathways not identical with those of glucose. The metabolism of fructose is largely insulin-independent, although the ultimate fate of fructose carbons is determined by the presence or the absence of insulin. Clinical and experimental work has suggested that fructose may exert beneficial effects as a component of the diet for patients with mild and well-balanced diabetes. Fructose is absorbed slowly from the gut, and does not induce drastic changes in blood sugar levels. Secondly, fructose is metabolized by insulin-independent pathways in the liver, intestinal wall, kidney and adipose tissue. As a consequence of the rapid and efficient utilization of fructose, it has been used widely for intravenous feeding in medicine and surgery. However, it has been shown that the rapid infusion of large amounts of fruetose may cause accumulation of lactic acid in the extracellular fluid. The possibility of lactate acidosis, with concomitant impairment of the acid-base balance, already disturbed, constitutes a relative contraindication to the use of intravenous fructose in the treatment of diabetic ketoacidosis. Fructose is known to accelerate ethanol metabolism in the liver. No well-documented reports on the use of fructose in the treatment of ethanol intoxication have been published, although it has recently been suggested that fructose might be of value in the treatment of delirium tremens. Fructose may be less cariogenic than sucrose, at least in short-term experiments. Long-term trials are lacking, and thus the potential advantages of fructose in preventive odontology have not been determined. Fructose does not seem to have any side-effects when used in reasonable amounts. However, it has been reported that the administration of fructose in large amounts induces hyperlipidemia both in man and in experimental animals. Earlier suggestions concerned with the atherogenic properties of fructose have recently been challenged. The apparent increase in the incidence of coronary disease among sucrose users seems to be a statistical artefact, caused by the increased ingestion of coffee and soft drinks by cigarette smokers.