Updated: Apr 3
PharmD. Candidate, 2022
You may have been told at some point to “stay away from fruit because there is too much sugar.” What really sparked my interest was when one of my diabetic patients in clinic told me that he read online about how diabetics should avoid fruit completely because there is “too much sugar.” Even worse, the uneducated patient thought it would be better to eat a candy bar verses an apple (he thought the sugar content was the same).
Nutrition plays such a major role in diabetes management. We know that an increased amount of carbohydrates in the diet is the main cause of increased glucose (sugar) levels and a high carbohydrate diet is the main driver of diabetes. And yes, carbohydrates are technically sugar because they turn into glucose when processed by the body. I like to tell my patients, when they are looking at a nutrition label look at the total amount of sugar and total amount of fiber. In fact, the American Diabetes Association (ADA) guidelines recommend a diet that is high in fiber-rich foods, including fruits.
Nutrition Facts labels list: breakdown of the total carbohydrate from dietary fiber, sugars and sugar alcohols
On Nutrition Facts food labels, the grams of dietary fiber are already included in the total carbohydrate count, but because fiber is a type of carbohydrate that your body cannot digest, the fiber does not increase your blood sugar levels. Therefore, you may subtract the grams of fiber from the total carbohydrate. Look at the example below. See if you can calculate the amount of carbohydrates in a Hersey’s chocolate bar versus a medium-sized apple.
Example: Hershey’s chocolate candy bar compared to a medium-sized apple
Hershey’s bar: 44g carb- 2 g fiber= 42g carbohydrates
1 medium apple: 22g carb- 5g fiber= 17g carbohydrates
(Also, note the differences in sugar content)
If you’re still confused, that’s okay. Keep reading.
In an article written by Michael Greger, MD, he notes that “most guidelines recommend eating a diet with a high intake of fiber-rich food including fruits, because they’re so healthy— antioxidants, anti-inflammatory, improve artery function and reduce cancer risk.” His article also notes how “emerging literature has shown that low-dose fructose may actually benefit blood sugar control.”
For example, “having a piece of fruit with each meal would be expected to lower, not raise, the blood sugar response. The threshold for toxicity of fructose may be around 50 grams. The problem is that’s the current average adult fructose consumption. Likewise, the levels of half of all adults are likely above the threshold for fructose toxicity, thanks to industrial sugars like table sugar and high fructose corn syrup, and adolescents currently average 75.”
Is that limit for added sugars or for all fructose? If we don’t want more than 50, and there’s about 10 in a piece of fruit, should we not eat more than five fruits a day? Quoting from the Harvard Health Letter, “The nutritional problems of fructose and sugar come when they are added to foods. Fruit, on the other hand, is beneficial in almost any amount.” What do they mean almost? Can we eat ten fruits a day? How about twenty fruits a day? It’s actually been put to the test.
“Seventeen people were made to eat twenty servings a day of fruit. Despite the extraordinarily high fructose content of this diet, presumably about 200 grams a day—8 cans of soda worth—the investigators reported no adverse effects (and possible benefit actually) for body weight, blood pressure, and insulin and lipid levels (fats in the blood) after three to six months. More recently, Jenkins and colleagues put people on about a twenty-servings-of-fruit-a-day diet for a few weeks, and no adverse effects on weight or blood pressure or triglycerides, and an astounding 38- point drop in LDL cholesterol.”
There was one side effect, though. Given the 44 servings of vegetables they had on top of all that fruit, they recorded the largest bowel movements apparently ever documented in a dietary intervention.”
Muraki, et al. published a study analyzing the fruit consumption and risk of type 2 diabetes. Their findings “suggest that a higher consumption of specific whole fruits, particularly blueberries, grapes, and apples, is significantly associated with a lower risk of type 2 diabetes, whereas greater consumption of fruit juice is associated with a higher risk.”
Fruits that are Highest in Sugar:
(OK in moderation)
Grapes: 1 cup- 23 grams of sugar
Cherries: 1 cup- 18 grams of sugar
Pears: one medium pear- 17 grams of sugar
Watermelon: one medium wedge- 17 grams of sugar
Bananas: one medium banana-14 grams sugar
Fruits with LESS Sugar:
Avocado: one whole avocado- 1.33 grams of sugar
Guava: one medium- 5 grams of sugar
Raspberries: 1 cup- 5 grams of sugar
Cantaloupe: one medium wedge – 5 grams of sugar
Strawberries: one cup - 7 grams of sugar
· The sugar found in fruit is NOT the processed the same in the body as the sugar found in candy bars and other sweets.
· Unlike candy bars and other simple sugars, fruit contains many other nutrient-dense contents that keep you feeling full longer and provide other nutrients for your body such as vitamins, antioxidants, and fiber.
· The majority of Americans receive the most sugar in their diet from industrial sugars like table sugar and high fructose corn syrup.
· It is fruit JUICE that we should avoid, not fruit.
· In the studies that were analyzed, an extremely high fruit diet created no adverse effects on weight or blood pressure or triglycerides, and an astounding 38- point drop in LDL cholesterol.
· Fruits and vegetables are also notorious to help regulate your bowel movements.
· Everything is OK in moderation, especially fruit.
· Always talk to your doctor, reach out to a nutrition coach or dietician if you have further questions about how to incorporate more fruit into your diet to yield the beneficial effects.
Li M, Fan Y, Zhang X, Hou W, Tang Z. Fruit and vegetable intake and risk of type 2 diabetes mellitus: meta-analysis of prospective cohort studies. BMJ Open. 2014;4(11):e005497. Published 2014 Nov 5. doi:10.1136/bmjopen-2014-005497
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;12:29. Published 2013 Mar 5. doi:10.1186/1475-2891-12-29
Blacker BC, Snyder SM, Eggett DL, Parker TL. Consumption of blueberries with a high-carbohydrate, low-fat breakfast decreases postprandial serum markers of oxidation. Br J Nutr. 2013;109(9):1670-1677. doi:10.1017/S0007114512003650
Muraki I, Imamura F, Manson JE, et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies [published correction appears in BMJ. 2013;347:f6935]. BMJ. 2013;347:f5001. Published 2013 Aug 28. doi:10.1136/bmj.f5001