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Supporting Research

Harvard Public Health:  What should I eat?

A diet rich in vegetables and fruits can lower blood pressure, reduce the risk of heart disease and stroke, prevent some types of cancer, lower risk of eye and digestive problems, and have a positive effect upon blood sugar, which can help keep appetite in check.

National Institute of Health - Paradoxical Effects of Fruit on Obesity

 

National Institute of Health - Fruit and Vegetable Intake: Benefits and Progress of Nutrition Education

 “Fruits and vegetables (F&V) are considered in dietary guidance because of their high concentrations of dietary fiber, vitamins, minerals, especially electrolytes; and more recently phytochemicals, especially antioxidants”

 

 
ARTICLES

Center For Nutritional Studies

Is Sugary Fruit Healthy?

By Conor Kerley, PhD

January 23, 2018

We all know that fruit contains valuable nutrients (e.g. vitamin C), but most of the calories in fruit come from carbohydrates—specifically sugar. While most fruit contains a mixture of different sugars, a major sugar in fruit is fructose. You may have heard of fructose in soda and other processed foods(e.g. high fructose corn syrup), which can be detrimental to human health. So for those interested in health, should we eat fruit, be cautious, or avoid it?

The simple answer is eat fruit!

Although fructose is naturally found in fruits, it can also be created artificially to be used as a sweetener in processed foods like soda, candy etc. The sugar in processed foods is harmful, while eating sugar in the form of whole fruits is beneficial. For example, research has reported that artificially made fructose is associated with liver and blood pressure problems while fruit is not[1]and may even be beneficial.

The reasons for this are complicated, but fruits can be thought of as one of the most nutrient dense foods on the planet. Most are naturally low in overall calories while containing many micronutrients, including vitamins, minerals, and a variety of phytochemicals such as beta carotene, polyphenols, and other antioxidants. This is the exact opposite of fructose containing processed foods!

Can fruit cause type 2 diabetes?

There has been concern about the sugar content of fruit with regards to those with diabetes or at high risk for developing diabetes, and many healthcare professionals recommend limiting fruit consumption for those individuals. However, increased fruit consumption has been associated with lower diabetes risk.[2][3] Further, a 2011 study specifically among diabetics compared medical nutrition therapy with a restriction of the amount of fruit eaten to a group who had to eat at least two pieces of fruit daily. The group limiting fruit consumption had no benefit compared to those eating lots of fruit! Considering the many benefits of fruit consumption, the authors wrote that “the intake of fruit should not be restricted in patients with type 2 diabetes.”[4] A more recent study even reported that higher fresh fruit consumption was associated lower risk of diabetic complications and death among those who already had diabetes.[3] Those with blood sugar issues should follow individualised advice from their healthcare professional, but consuming fruit with other foods—for example, chopped banana on oatmeal—can help keep blood sugar more stable in those experiencing difficulty.

Can fruit cause weight problems?

Some are afraid that because fruits contain sugar that they contribute to weight problems. One study from researchers at Harvard reported that 0.22 portions of fruit daily (e.g. one fifth of an apple) was associated with a reduced risk of obesity by up to 14%.[5] A separate study from five European countries reported that a 100g increase in whole fruit intake per day was associated with a small loss of weight.[6] In a 2011 study, researchers asked one group of volunteers to decrease consumption of all sugars, including fruits while another group were asked to decrease added sugars only. The group who ate less fruit and sugar lost weight (6.5lbs) but the group consuming fruit but less added sugar lost even more weight (9lbs).[7] In fact, a major review article published in 2016 in the journal Nutrients summarised existing scientific evidence which consistently reports that fruit is associated with less obesity and even with weight loss.[8]

There are several proposed mechanisms by which fruit seems to help control weight, including high nutrient content but perhaps more importantly modulating the gut microbiome and providing prolonged satiety (feeling fuller for longer) leading to decreased overall calorie intake.[8] A fascinating 2009 trial from Pennsylvania State University compared the effect of apple, apple sauce, apple juice or apple juice with added fiber on energy energy intake. The whole apple led to increased fullness and decreased energy intake, even compared to apple juice + fiber.[9] This trial agrees with Professor Campbell’s stance of wholism versus reductionism. In other words the benefits of a piece of fruit can not be replicated by isolating individual components e.g. vitamins, minerals, fiber.

What are the benefits?

There is also consistent evidence that eating fruit is associated with lower risk of multiple cancers and cardiovascular diseases, including stroke.[10] Increasing fruit consumption has even been associated with decreased risk of dying from Alzheimer’s disease[11] and COPD.[12]

As long ago as 1985, it was suggested that fruit and vegetables may protect against early death.[13]Multiple subsequent studies also observed decreased risk of early death with higher fruit consumption. Indeed a 2017 review of 95 studies published in the International Journal of Epidemiology noted that increased fruit consumption was associated with less cardiovascular disease, including stroke, less cancer and less premature death.[10] Some studies reported that those eating the most fruit compared to the least fruit had a 40-50% decreased risk of premature death.[14][15] Another study reported that compared to those who didn’t eat fruit, consuming a single portion of fruit each day was associated with a 19 month longer life.[16] Imagine what five portions of fruit daily might do!

Low fruit consumption is considered to be the fourth leading contributor to the global disease burden[17] and it has even been estimated that 7.8 million premature deaths worldwide may be caused to a low fruit and vegetable intake.[10]

What type of fruit?

It should come as no surprise that fresh fruits are consistently regarded as the best type of fruit. Frozen fruit is a close second and can make a cheaper, convenient source, especially when certain fruit is not in season. Dried fruits generally contain similar nutrients as fresh or frozen but are more concentrated. However, the sugar content will also be more concentrated.

Juice made from fruit, even freshly squeezed fruit, will have most of the fiber and lots of nutrients stripped away. There is consistent evidence that fruit juice consumption increases the risk of weight gain, particularly in children.[8] Fruit juice consumption has been associated with a higher risk of type 2 diabetes.[2] One interesting study compared whole apple, clear apple juice, and cloudy apple juice. The whole apple would be the highest in fiber while the clear juice would contain virtually no fiber. The people who ate whole apples had a drop in total and LDL cholesterol, while the people who consumed the clear apple juice actually had an increase in cholesterol. Those who consumed cloudy apple juice had a drop in cholesterol but not as much as the whole apple group. This suggests that fiber is very important for the health benefits of fruit.[18]Additionally, caution is required with canned or tinned fruit, which often contains added sugar or syrup. One study even reported that tinned fruit was associated with increased risk of death.[19]Therefore, try to stick to fresh or frozen fruit. Occasional dried fruit is fine for most too. Increase your consumption of fresh fruit by snacking on various fruits, preparing fruit based desserts, and blending fruits to make tasty smoothies!

So there you have it: eating more fruit helps decrease risk of obesity, disease, and death. Perhaps an apple a day does keep the doctor away… if accompanied by other whole plant foods!

References

  1. Petta S, Marchesini G, Caracausi L, Macaluso FS, Cammà C, Ciminnisi S, Cabibi D, Porcasi R, Craxì A, Di Marco V. Industrial, not fruit fructose intake is associated with the severity of liver fibrosis in genotype 1 chronic hepatitis C patients. J Hepatol. 2013 Dec;59(6):1169-76.
  2. Muraki I, Imamura F, Manson JE, Hu FB, Willett WC, van Dam RM, Sun Q. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ. 2013 Aug 28;347:f5001
  3. Du H, Li L, Bennett D, Guo Y, Turnbull I, Yang L, Bragg F, Bian Z, Chen Y, Chen J, Millwood IY, Sansome S, Ma L, Huang Y, Zhang N, Zheng X, Sun Q, Key TJ, Collins R, Peto R, Chen Z; China Kadoorie Biobank study. Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults. PLoS Med. 2017 Apr 11;14(4):e1002279.
  4. Christensen AS, Viggers L, Hasselström K, Gregersen S. Effect of fruit restriction on glycemic control in patients with type 2 diabetes–a randomized trial. Nutr J. 2013 Mar 5;12:29.
  5. He, K.; Hu, F.B.; Colditz, G.A.; Manson, J.E.; Willett, W.C.; Liu, S. Changes in intake of fruits and vegetables in relation to risk of obesity and weight gain among middle-aged women. Int. J. Obes. Relat. Metab. Disord. 2004, 28, 1569–1574.
  6. Buijsse, B.; Feskens, E.J.; Schulze, M.B.; Forouhi, N.G.; Wareham, N.J.; Sharp, S.; Palli, D.; Tognon, G.; Halkjaer, J.; Tjønneland, A.; et al. Fruit and vegetable intakes and subsequent changes in body weight in European populations: Results from the project on Diet, Obesity, and Genes (DiOGenes). Am. J. Clin. Nutr. 2009, 90, 202–209.
  7. Madero M, Arriaga JC, Jalal D, Rivard C, McFann K, Pérez-Méndez O, Vázquez A, Ruiz A, Lanaspa MA, Jimenez CR, Johnson RJ, Lozada LG. The effect of two energy-restricted diets, a low-fructose diet versus a moderate natural fructose diet, on weight loss and metabolic syndrome parameters: a randomized controlled trial. Metabolism. 2011 Nov;60(11):1551-9.
  8. Sharma SP, Chung HJ, Kim HJ, Hong ST. Paradoxical Effects of Fruit on Obesity. Nutrients. 2016 Oct 14;8(10). pii: E633.
  9. Flood-Obbagy JE1, Rolls BJ. The effect of fruit in different forms on energy intake and satiety at a meal. Appetite. 2009 Apr;52(2):416-22.
  10. Aune D, Giovannucci E, Boffetta P, Fadnes LT, Keum N, Norat T, Greenwood DC, Riboli E, Vatten LJ, Tonstad S. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol. 2017 Jun 1;46(3):1029-1056.
  11. Williams PT. Lower risk of Alzheimer’s disease mortality with exercise, statin, and fruit intake. J Alzheimers Dis. 2015;44(4):1121-9.
  12. Du H, Li L, Bennett D, Yang L, Guo Y, Key TJ, Bian Z, Chen Y, Walters RG, Millwood IY, Chen J, Wang J, Zhou X, Fang L, Li Y, Li X, Collins R, Peto R, Chen Z; China Kadoorie Biobank study. Fresh fruit consumption and all-cause and cause-specific mortality: findings from the China Kadoorie Biobank. Int J Epidemiol. 2017 Apr 24.
  13. Verlangieri AJ, Kapeghian JC, el-Dean S, Bush M. Fruit and vegetable consumption and cardiovascular mortality. Med Hypotheses. 1985 Jan;16(1):7-15.
  14. Hertog MG, Bueno-de-Mesquita HB, Fehily AM, Sweetnam PM, Elwood PC, Kromhout D. Fruit and vegetable consumption and cancer mortality in the Caerphilly Study. Cancer Epidemiol Biomarkers Prev. 1996 Sep;5(9):673-7.
  15. Tian X, Du H, Li L, Bennett D, Gao R, Li S, Wang S, Guo Y, Bian Z, Yang L, Chen Y, Chen J, Gao Y, Weng M, Pang Z, Jiang B, Chen Z; China Kadoorie Biobank study. Fruit consumption and physical activity in relation to all-cause and cardiovascular mortality among 70,000 Chinese adults with pre-existing vascular disease. PLoS One. 2017 Apr 12;12(4):e0173054.
  16. Bellavia A, Larsson SC, Bottai M, Wolk A, Orsini N. Fruit and vegetable consumption and all-cause mortality: a dose-response analysis. Am J Clin Nutr. 2013 Aug;98(2):454-9.
  17. Lim, S.S.; Vos, T. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors 
and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease 
Study 2010. Lancet 2012, 380, 2224–2260.
  18. Ravn-Haren G, Dragsted LO, Buch-Andersen T, Jensen EN, Jensen RI, Németh-Balogh M, Paulovicsová B, Bergström A, Wilcks A, Licht TR, Markowski J, Bügel S. Intake of whole apples or clear apple juice has contrasting effects on plasma lipids in healthy volunteers. Eur J Nutr. 2013 Dec;52(8):1875-89.]Aasheim ET, Sharp SJ, Appleby PN, Shipley MJ, Lentjes MA, Khaw KT, Brunner E, Key TJ, Wareham NJ. Tinned fruit consumption and mortality in three prospective cohorts. PLoS One. 2015 Feb 25;10(2):e0117796.
  19. Aasheim ET, Sharp SJ, Appleby PN, Shipley MJ, Lentjes MA, Khaw KT, Brunner E, Key TJ, Wareham NJ. Tinned fruit consumption and mortality in three prospective cohorts. PLoS One. 2015 Feb 25;10(2):e0117796.

 


HEALTHLINE.COM 

Is Fruit Good or Bad for Your Health? The Sweet Truth

Written by Kris Gunnars, BSc on May 31, 2018

"Eat more fruits and vegetables."

This is probably the world’s most common health recommendation.

Everyone knows that fruits are healthy — they are real, whole foods.

Most of them are also very convenient. Some people call them "nature's fast food" because they are so easy to carry and prepare.

However, fruits are relatively high in sugar compared to other whole foods.

For this reason, you might wonder whether they are truly healthy after all. This article sheds some light on the subject.

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Excessive Sugar Is Bad, But Its Effects Depend on the Context

A lot of evidence has shown that excessive intake of added sugar is harmful (123).

This includes table sugar (sucrose) and high-fructose corn syrup, both of which are about half glucose, half fructose.

One reason that excessive added sugar intake is harmful is the negative metabolic effects of fructose when consumed in large amounts.

Many people now believe that because added sugars are bad, the same must apply to fruits, which also contain fructose.

However, this is a misconception. Fructose is only harmful in large amounts, and it’s almost impossible to overeat fructose by eating fruit.

SUMMARY

Evidence suggests that fructose can cause harm when consumed in excess. However, there is not enough fructose in fruit to cause concern.

Fruit Also Contains Fiber, Water and Significant Chewing Resistance

Eating whole fruit, it is almost impossible to consume enough fructose to cause harm.

Fruits are loaded with fiber, water and have significant chewing resistance.

For this reason, most fruits (like apples) take a while to eat and digest, meaning that the fructose hits the liver slowly.

Plus, fruit is incredibly filling. Most people will feel satisfied after eating one large apple, which contains 23 grams of sugar, 13 of which are fructose (4).

Compare that to a 16-ounce bottle of Coke, which contains 52 grams of sugar, 30 of which are fructose, and has no nutritional value (5).

A single apple would make you feel quite full and less inclined to eat more food. Conversely, a bottle of soda has remarkably poor satiety and people don't compensate for the sugar by eating less food (6).

When fructose hits your liver fast and in large amounts, as is the case when you drink soda, it can have adverse health effects over time.

However, when it hits your liver slowly and in small amounts, as is the case when you eat an apple, your body is well adapted to easily metabolize the fructose.

While eating large amounts of added sugar is harmful to most people, the same does not apply to fruit.

SUMMARY

Whole fruits take time to chew and digest. Because of this, you feel fuller and your body can easily tolerate the small amounts of fructose.

Fruits Contain Lots of Fiber, Vitamins, Minerals and Antioxidants

Of course, fruits are more than just watery bags of fructose.

There are lots of nutrients in them that are important for health. This includes fiber, vitamins and minerals, as well as a plethora of antioxidants and other plant compounds.

Fiber, especially soluble fiber, has many benefits, including reduced cholesterol levels, slowed absorption of carbs and increased satiety. Plus, studies have shown that soluble fiber can help you lose weight (78910).

What’s more, fruits tend to be high in several vitamins and minerals that many people don't get enough of, including vitamin C, potassium and folate.

Of course, "fruit" is an entire food group. There are thousands of different edible fruits found in nature, and their nutrient compositions can vary greatly.

So, if you want to maximize fruits’ health effects, focus on ones that are rich in nutrients. Try fruits with more skin.

The skin of fruits is usually very rich in antioxidants and fiber. This is the reason that berries, which have greater amounts of skin, gram for gram, are often considered healthier than larger fruits.

It is also a good idea to switch things up and eat a variety of fruits because different fruits contain different nutrients.

SUMMARY

Fruits contain large amounts of important nutrients, including fiber, vitamins, minerals and various antioxidants and plant compounds.

Most Studies Show Health Benefits

Multiple observational studies have shown that people who eat more fruits and vegetableshave a lower risk of various diseases.

Many of the studies pool together fruits and vegetables, while some only look at fruits.

One review of nine studies found that each daily portion of fruit consumed reduced the risk of heart disease by 7% (11).

Also, a study including 9,665 US adults found that a high fruit and vegetable intake was associated with a 46% lower risk of diabetes in women, but there was no difference in men (12).

Furthermore, one study that looked at fruits and vegetables separately found that vegetables were associated with a reduced risk of breast cancer, but this didn’t apply to fruit (13).

Many other studies have shown that eating fruits and vegetables is associated with a lower risk of heart attack and stroke — the two leading causes of death in Western countries (1415).

One study looked at how different types of fruit affect the risk of type 2 diabetes. Those who consumed the most grapes, apples and blueberries had the lowest risk, with blueberrieshaving the strongest effect (16).

However, one problem with observational studies is that they cannot prove that the associations they detect are direct causal relationships.

People who eat the most fruit tend to be more health conscious, less likely to smoke and more likely to exercise.

That said, a few randomized controlled trials (real human experiments) have shown that increased fruit intake can lower blood pressure, reduce oxidative stress and improve glycemic control in diabetics (1718).

Overall, it seems clear from the data that fruits have significant health benefits.

SUMMARY

Plenty of evidence shows that a high fruit intake is associated with a lower risk of serious diseases like heart disease, stroke and type 2 diabetes.

Eating Fruit Can Help You Lose Weight

It’s often forgotten that fruits are incredibly filling.

Because of their fiber and water contents and the extensive chewing involved in eating them, fruits are very satiating.

The satiety index is a measure of how much different foods contribute to feelings of fullness.

Fruits like apples and oranges are among the highest scoring foods tested, even more filling than beef and eggs (19).

This means that if you increase your intake of apples or oranges, you will likely feel so full that you will automatically eat less of other foods.

There is also one interesting study that demonstrates how fruits can contribute to weight loss (20).

In this six-month study, nine men ate a diet consisting only of fruits (82% of calories) and nuts (18% of calories).

Not surprisingly, these men lost significant amounts of weight. Those who were overweight lost even more than those who were at a healthy weight.

Overall, given the strong effects that fruits can have on satiety, it seems beneficial to replace other foods, especially junk foods, with fruit to help you lose weight over the long term.

SUMMARY

Fruits like apples and oranges are among the most filling foods you can eat. Eating more of them should lead to an automatic reduction in calorie intake and ultimately, weight loss.

When to Avoid Fruit

Even though fruit is healthy for most people, there are some reasons why others may need to avoid it.

One is intolerance. For example, eating fruit can cause digestive symptoms in people with and intolerance to FODMAPs.

The other reason is being on a very low-carb or ketogenic diet. The main goal of these diets is to reduce carb intake sufficiently for the brain to start using mostly ketone bodies for fuel instead of glucose.

For this to happen, it’s necessary to restrict carbs to under 50 grams per day, sometimes all the way down to 20–30 grams.

Given that just a single piece of fruit can contain more than 20 grams of carbs, it’s obvious that fruits are inappropriate for such a diet. Even just one piece of fruit per day could easily knock you out of ketosis.

SUMMARY

The main reasons to avoid fruit include a relevant intolerance or being on a very low-carb or ketogenic diet.

Fruit Juices and Dried Fruits Are Always a Bad Idea

Even though whole fruits are very healthy for most people, the same cannot be said for fruit juices and dried fruit.

Many of the fruit juices on the market aren't even "real" fruit juices. They consist of water mixed with some sort of concentrate and a whole bunch of added sugar.

But even if you get 100% real fruit juice, it is still a bad idea.

There is a lot of sugar in fruit juice, about as much as a sugar-sweetened beverage.

However, there is no fiber and chewing resistance to slow down consumption, making it very easy to take in a large amount of sugar in a short period of time.

Similarly, dried fruits are very high in sugar, and it’s easy to eat large amounts of them.

Smoothies are somewhere in the middle. If you put the whole fruit in the blender, it's much better than drinking fruit juice. Still, eating the whole fruit is best.

SUMMARY

Although eating whole fruits is very healthy, the same isn’t necessarily true for fruit juice and dried fruit. Both are high in sugar and easy to overeat.

The Bottom Line

Fruit is healthy for most people.

While excessive sugar intake can be harmful, this doesn’t apply to whole fruits. Rather, they are “real” food, high in nutrients and satisfyingly filling.

If you can tolerate fruit and you're not on a low-carb or ketogenic diet, by all means, eat fruit.

Try eating more whole fruits as part of a healthy, real-foods-based diet to enjoy their health benefits.