Dr. Sarah Stombaugh:
This is Dr. Sarah Stambaugh, and you are listening to the Conquer Your Weight Podcast.

Announcer:
Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stambaugh.

Dr. Sarah Stombaugh:
Hello, everybody, and welcome to this week’s episode of the Conquer Your Weight podcast. We are talking about something that has been all over my social media news feeds recently, which is this concept of fruit being bad for you. A lot of conversation around fructose, and we’ll talk about why that may make sense in the context of things like high fructose corn syrup. But I get asked all of the time by patients, is fruit bad for me? Do I need to cut fruit out of my diet or do I need to limit it as part of my diet? And the answer is usually not. So in today’s episode, we are going to talk about what that means, why that’s the case, how you can include fruit as a really important part of your nutrition plan, and why it’s actually rarely recommended to cut it out.

Now, of course, this is going to be general information that if you’re my patient, we could talk about in an appointment. If you are not my patient, and you’re in Virginia, Illinois, or Tennessee, where I am licensed to practice medicine, and you’re looking for a doctor to support you in this, I see patients in person in Charlottesville and then by telemedicine throughout the states of Virginia, Illinois, and Tennessee. So if you are in one of those states, I would love to see you in person or by telemedicine to talk about this a little bit more and how it applies to you. But if you are not one of those people, if you are one of my regular podcast listeners and take this question back to your own medical team, ask your obesity medicine physician or a nutritionist or someone on your medical team who can help you to understand this question and this answer in the context of your own health journey. Now, before we get started, I do want to also invite you to please reach out to me if you ever have questions. I think one of my favorite things is hearing from listeners, hearing the episodes that have really made a difference in their lives, hearing the questions that they have and answers that we’ve been able to provide. And it is so fun for me when you all reach out. And so if you have been listening to this podcast for any amount of time and thinking, oh my gosh, I wish Dr. Stombaugh would do a podcast on XYZ topic, please reach out and let us know that. The best way to reach out is you can email us anytime at info at sarastambamd.com. Again, it’s info at sarahstombaumd.com. We’ll put that in the show notes. So like I said, please feel free to reach out. We love getting suggestions from you. And even if you’re like, well, I haven’t listened to every single episode. There’s so many at this point. That’s okay. Reach out, give us an idea. If we have already done that topic, we’ll just reply and say, thanks for this idea. We addressed it here. But a lot of times we’re even doing similar topics, addressing them from a not hesitate to reach out. We are always looking for good ideas and it is my favorite thing to know that I am addressing the questions that you have.

So with that, let’s dive into this topic. What is the deal with fruit? Is it good for you? Is it bad for you? Does fruit cause weight gain? Does fruit cause weight loss? Why is there so much controversy around this and why is everybody talking about this right now? This is a question that I am seeing pop up all over my different social media feeds. And I think the reality is, is that there’s a lot of conversation around high fructose corn syrup right now, high fructose corn syrup, bringing conversation to fructose, which then is bringing conversation to things like fruit, which generally do have high fructose in them. So let’s take a step back and talk about what is fruit? What are the good things? What are the bad things? is fruit contributing to our weight journey? So this misconception about fruit exists for many different reasons. I think as we look at some of the changes in our dietary trends over the last few decades, we saw particularly in the 80s and the very early 2000s, this fear of fat. There was the low-fat diet era, and that continued until we started to see some shift really in the early 2000s where the Atkins diet became popularized. The Atkins diet had a huge emphasis in consuming fat. We saw that then sort of evolve more into the ketogenic diet. And a lot of people having conversations about high fat, low carbohydrate. What’s been really interesting is over the last couple of years, we’ve seen more shift towards conversation around protein. And people are like “protein, protein, protein, are you getting your protein?” And what’s really interesting about all of these diets is they’re taking these different pieces of our macronutrients, emphasizing them, demonizing the others, and we really lose a lot when we lean so heavily into any one food group.

And that’s true whether we’re talking about carbohydrates, whether we’re talking about fats, whether we’re talking about proteins. Each of those three macronutrients, those are the three macronutrients that make up all of the foods that we eat, and each of them is very important in different roles in our body. Now, there is also a fourth macronutrient, which is alcohol. Alcohol is a macronutrient that your body does not need, but does process in a separate or different way. And so I do like to point that out because alcohol is often part of what they are consuming. It’s something they would desire to consume. And we will decide if it makes sense for someone to incorporate that in a very intentional way into their nutrition plan. But for the purpose of today’s conversation, we’re talking about carbohydrates, we’re talking about fat, and we’re talking about protein. So carbohydrates, fat, protein, those are the three different macronutrients. And every single one of those three is important in its own right. The biggest challenge that comes up is we’ve seen different shifts in which macronutrients are good for us, which macronutrients are bad for us.

We’ve seen that carbohydrates are this huge umbrella and underneath carbohydrates, we have all of our fruits. We have all of our vegetables. We have all of our grains in our whole form. We have all of our legumes. We have nuts falling into that category. We have seeds falling into that category. Even those, those do of course have fat and protein in them as well. These all fall into the carbohydrate category. You then also include carbohydrates like sugary and sweetened beverages, things like juices, things like sodas, things like sweetened coffee drinks or sweetened tea drinks. We also see added sugars going into things like sauces, into salad dressings, into yogurts. We see carbohydrates, including things like our processed snack foods, things like chips, things like crackers, things like cookies, and all of these different foods are in that category of carbohydrate. And so when people are saying carbohydrates are bad for you, it’s really hard for me to reconcile that when you look at someone who’s eating a very whole food plant-based diet, someone’s whose diet includes a lot of things like lentils and quinoa and beans, and they’ve got kale and sweet potatoes and mushrooms and all different types of fruits and there’s nuts and there’s seeds. And you’re looking at that type of diet. And that is a diet that is predominantly a carbohydrate diet. And yet, I don’t think there are any, some people will argue anything, but I think most people would look at a diet like that and say, oh, this is a very healthy diet.

This is a diet that looks like, you know, you would feel really good if you consume these type of foods. They would really energize you. They would really fill you up. People might look at that and think, oh gosh, I wish I could eat like that. But I imagine it would take a lot of time to prepare that type of food or whatever it looks like. But we’re looking at a diet that’s like all fruits, all vegetables, all whole grains and beans. and nuts and seeds, and that is really carbohydrate forward. And yet people who are saying things like low carbohydrate, how do you reconcile that? Which is where when we demonize entire food groups like carbohydrates, there is a world of difference between eating a bag of Skittles and eating a sweet potato. What happens when you eat those two things are incredibly different. And you’re going to say, okay, duh, Dr. Stombaugh, you’re comparing a candy to a vegetable. But even if we take it to what is the difference between eating an apple versus eating a glass of apple juice?

Let’s talk about that because that’s really comparing apples to apples as opposed to comparing things that are very different from one another. So what is true is that if we had an apple and we had a glass of apple juice, nutritionally, those things would be very similar in terms of vitamins. Fruit often provides really great vitamins for us, things like vitamin C, certain B vitamins, especially folate. We may have certain electrolytes like potassium. There’s going to be other minerals, antioxidants, phytonutrients, and fruit does a really good job of providing that nutrition. Now, when we look at a whole piece of fruit, it’s going to have a lot of fiber in it. What fiber does is it helps to create volume. So there’s bulk that can be helpful for filling us up. So literally helping to create that feeling of satiety. It can help to slow down digestion which is important both in the setting of, you know, we’re absorbing the same amount of sugar here, but we’ve got fiber to help slow down that digestion, help it last a little bit longer in our system, helps to provide bulk for our stools. So it can be really good for healthy bowel movements, having regular bowel movements. And so fiber is one of the main differences if we look at that apple versus a glass of apple juice. Now, what’s really interesting is if we think about how many apples it would take to get a cup of apple juice let’s say you’re trying to make eight ounces of apple juice you’re likely going to have to take three or four apples and use a juicer to create the juice for eight ounces of apple juice versus if you had just a single apple that would you know volume wise be a little bit heavier and fill you up where a glass of apple juice is not going to do that so the fiber helps create that feeling of satiety a glass of apple juice you would likely have alongside the rest of a regular meal, it would likely be something that didn’t create much fullness. You know, our body perceives it very similarly to water in terms of texture, in terms of how quickly we absorb it. The sugar that’s in that apple juice is going to be absorbed really pretty quickly, especially depending on if you’re comparing that to what’s happening with an apple or depending on if and how much other types of foods you’re eating alongside of it. And so these are very different things when we have an apple in its whole form. Now, we compare that even more to like processed type things or high fructose corn syrup, which we’ll get into in just a minute. But we can see that there’s a very different thing happening.

Now, what’s really challenging is that most Americans, honestly, most people in our world, and certainly most Americans are not getting enough fiber. So you have advice like fruit isn’t good for you. limit the amount of fruit might be contributing to your weight gain and then similarly being told that you need to get more fiber in your diet and those types of pieces of advice are at odds with one another so what absolutely is true is that most people need more fiber in the diet getting you know 25 to 30 grams or more per day is recommended and most people are not doing that fiber is going to come from things like fruits from vegetables from whole grains from nuts and beans and seeds and all of those type of things. And those are super, super, super important because fiber plays a really important role in our gut microbiome, in our digestive health, in our regular bowel movements. And so fruit has a lot of fiber. It does also have sugar. Let’s talk about when I say sugar, that is also an umbrella term. And this is where I think the fructose has gotten such a bad reputation, especially as of late.

So when we think about table sugar, that is sucrose. That is a disaccharide, meaning that that is fructose and that is glucose combined together or bonded together to make. So two monosaccharides, fructose and glucose bonded together to make a disaccharide. Our body can break that down and utilize the glucose and utilize the fructose. Now, what’s interesting is that for many reasons, which are beyond the scope of this podcast, but in America, we had a surplus of corn. The corn was subsidized. How do we use all that corn? We started utilizing high fructose corn syrup. High fructose corn syrup is named that way because it has a much higher fructose content compared to corn itself, which is predominantly starch actually, but when broken down is predominantly glucose. So what’s really interesting is that high fructose corn syrup on average, now there’s different variations out there, but on average, most high fructose corn syrup is about 55% fructose and 45% glucose. So really not that different compared to table sugar and people who were getting really up in arms about high fructose corn syrup. The reality is if we, you know, people are really into like, let’s talk about Coca-Cola, for example, and you think about having a Coca-Cola manufactured in America, what’s made with high fructose corn syrup. And then in the States, especially, I feel like a lot of people are obsessed with Mexican Coke. And if you read the label, it’s made with cane sugar. And they’re like, it tastes different, which it does. Of course it does. It’s made with a different ingredient, but they’re like, oh, and it’s better for you. It’s not. The reality is, is that cane sugar and high fructose corn syrup, they are different ingredients. The flavor profile of those is going to be slightly different from one another. So certainly people who say they can taste the difference, of course you can. They’re different ingredients. That makes sense.

But when you look at it from a nutritional standpoint. You’re talking about cane sugar, which is 50-50 glucose and fructose. And you’re talking about high fructose corn syrup, which is 55-45 fructose to glucose. So they’re really not that different from one another. And what’s true on both of those things is that there is an obscene amount of added sugar. And when I say sugar, cane sugar, high fructose corn syrup, there is an insane amount of added sugar. often on the order of like 50 grams in a serving. As a reminder, we’ve talked about this before, but there are four grams in a teaspoon of sugar. So if you are talking about 50 grams of sugar, you’re talking about 12 teaspoons. Can you imagine like getting a teaspoon out of your drawer, going to the sugar cup and measuring out 12 of those? It doesn’t matter whether we’re talking about cane sugar. It doesn’t matter whether we’re sugar. When you compare that to the amount of sugar that is in a piece of fruit, it is a fraction of that. And, and this is where the really big and comes in, it is packaged alongside fiber. It is packaged alongside water to give it this very large volume that helps to fill you up, that slows your digestion. And they are almost entirely different foods in the body.

And so eating an apple versus drinking a Coca-Cola, those are totally different things in terms of what happens. Now, the conversation has been, well, fructose is bad because it can only be metabolized by your liver, where glucose can be used in every single cell of the body. That is true, sort of. Glucose is very well utilized throughout the body. Almost every cell in the human body can utilize glucose. When we look at the metabolism of fructose, it is primarily metabolized in the liver. It can actually be metabolized in other parts of the body as well in much smaller quantities. And when the liver is overloaded with fructose, it can create and contribute to things, maybe not create, but contribute to things like metabolic disease. So the risk of insulin resistance, the risk of prediabetes, of diabetes, of heart disease, of polycystic ovarian syndrome, of conditions that are related to underlying insulin and resistance, having too much fructose, especially by itself, or, you know, in these really processed beverages, really processed foods that is going to contribute to too much sugar that needs to be predominantly processed by the liver. And of course that’s a problem. And fruit is not the reason that that is happening. It is incredibly hard to overeat fruit. I do have patients for whom they have had binging episodes where they’ve been I have a patient who binged on three pounds of peaches or five pounds of peaches, for example. That is a lot of peaches to consume in one setting.

I made a video that went viral on TikTok last year about overeating watermelon. It is absolutely possible. Watermelon is so refreshing and you can sit there and eat and eat and eat. And if you’re losing or trying to lose weight, it may not be in line with your health goals to eat half of a watermelon in one setting. But what is absolutely true is that we do need, we don’t need fruit, but fruit can be a really important part of a well-balanced diet. And then especially when you look at, well, how am I consuming it? What is the role that it plays for me? Fruit is a carbohydrate. When eaten on its own, even though it does have a lot of fiber on it, the digestion of it is going to be quicker compared to, let’s say you ate a chicken breast that is going to be predominantly protein, maybe a partner it as part of a meal that includes protein, maybe includes a little bit of fat, is that as even going to better support the digestion of those foods? Now we’ve got some fiber, we’ve got some protein, we’ve got some fats, and those can be digested together in a way that has this very well-rounded glucose response curve, such that the meal sticks with you for a longer period of time. It creates that initial satiety because you’ve got some good volume from fiber. It creates that lasting satiety because you’ve got protein and you’ve got fats, which are the predominant signals of satiety or fullness in the body.

And so when we can take fruit and partner it with proteins and fats, that’s where the magic is. We get our fiber, we get our protein, we get the things that our body needs in a way that feels really good in the body, supports all of our different health goals, and is not going to create problems. What is a problem is when we’re eating fruits that are really highly processed. So that can look like having smoothies all the time or having fruit beverages, like fruit, even fruit juice by itself, for example. Honestly, we don’t need fruit juice by itself. If you are having fruit juice, I would just swap it out for a whole piece of the same fruit. Glass of grapefruit juice in the morning, have a grapefruit, have a half a grapefruit. Glass of apple juice in the morning, have an apple. Glass of orange juice in the morning, have an orange. There really no purpose for someone having a glass of fruit juice. You can absolutely substitute that for a whole piece of fruit. That would be more in line with weight loss goals, for example, helpful to get that fiber in, helpful to support your bowel health. And so if you’re having fruit juice, a lot of people are having smoothies. You have to be really careful with smoothies. I do think, especially on a GLP journey, like early on, you may not feel like eating huge volumes of food and smoothies can be a great way to help if you’re feeling a little bit nauseated, don’t feel like eating a lot, you can get in some really good nutrients with a smoothie. They are sort of pre-digested. And so if you think about when we eat food, if you were to put food in your mouth, you chew it and then you swallow it, and then it starts breaking down further in the stomach. What is happening with a smoothie is that the blender is doing really all of the work of chewing. So you don’t have to do that. So it is absorbed a little bit more rapidly compared to if you were eating all of those same ingredients.

What I will often advise my patients with smoothies is, can you imagine eating all of the ingredients on their own? So if you made it into a bowl, for example, and didn’t blend it up, would that be an appropriate amount of food? Or would you look at that and say, oh my gosh, that is far too much food. If you look at your smoothie ingredients and say, oh my gosh, that is far too much food, then that smoothie is too large for you and you should be consuming a smaller smoothie. But if you look at your ingredients and you’re like, yeah, This is a handful of spinach and frozen berries and a scoop of protein powder and some almond milk. And you look at that and you’re like, yeah, I would absolutely eat that as a meal, whether it’s blended up or whether it’s separated. That is a good rule of thumb for deciding that, yes, this smoothie makes a lot of sense. Be mindful of the size of your blender. Sometimes a single size serving blenders can be a really good option too, so that you don’t over consume the really large blenders. It’s easy to make two, three, four portions. And I personally think I have never had a smoothie that has saved well for a later date. People who drink leftover smoothies, I cannot even wrap my mind around that. I think smoothies are best consumed when they’re fresh, when they’re still at the temperature they were designed to be, ideally with a little bit of frozen fruit or frozen vegetable or ice cubes or whatever it is. That texture changes pretty rapidly over the course of a couple of hours. And I certainly would not be one to eat a leftover smoothie. So be mindful of that. If you’re eating, if you have a large blender, if you’re making two portions, are you drinking one portion or are you drinking two portions? That can be really important. And so when we think about this role of fruit, my recommendation to patients is keep it in your diet. You want to be mindful of how often you’re consuming fruit. Are you also consuming vegetables as part of your diet? Are you being mindful to partner it with things like fat, partner it with things like protein to create that lasting satiety? I will occasionally talk with patients who are fueling their body almost entirely with fruit. And every one or two hours throughout the day, they’ll have a handful of cherry tomatoes, and then a peach, and then strawberries, and then some carrots, and they’re just eating fruit or more starchy carbohydrates like carrots all day long. So if that is you spacing your meals out more often, bringing in some of those other macronutrients like protein and fat will be really important.

But all in all, all foods fit, even the less healthy foods. That’s not the topic of today’s conversation, but fruits should be part of your diet. Vegetables, grains, beans, nuts, seeds, other proteins and fats, as you want to incorporate all of those things, they are absolutely important. And if anybody is telling you to cut out an entire food group, I would question that. Let me think about what is our long-term relationship with food? This needs to be a health plan that aligns with your goal. that you enjoy. When you think of, okay, this isn’t just six weeks or 12 weeks, thinking about what is something that I could implement for the long-term. Now we know that certain foods like sugar and sweetened beverages, like cakes and candies and cookies and all of that are likely not going to be foods that you can eat all day, every day and be in line with your health goals. But you want to learn if there are foods like those that you really enjoy, how do you find a really intentional way to incorporate those in I will tell you almost every single one of my patients has foods that they are nervous to eat, that they have been out of control with in the past, foods that have been likely to create a binging episode or be associated with a binging episode for them. And those foods can absolutely also through the work with a health psychologist, maybe a coach or a physician who’s trained in this area, work to be incorporated in because all foods can fit. And certainly cutting out fruit makes very little sense for most people. Fruit is a very important part of the diet. And if someone is telling you to cut it out, I would look at them sideways. I would ask them why I would ask them to help explain that answer to you so that you can make the best decision for your health and your weight goals.

As always, if you have questions or maybe this podcast episode had some questions come up for you, reach out and let us know. Or if you’re in Illinois, Virginia, or Tennessee, where I am licensed to practice medicine, I would love to see you as a patient in my practice that’s all for this week’s episode we’ll see you all next time bye.