Ask Dr. H: How high fructose corn sweetener, sugar differ

Question: Do you think high fructose corn sweetener is bad?

Answer: Despite the widespread use of high fructose corn sweetener, blamed by some for the obesity epidemic seen in adults and children, there have not been any studies showing that fructose is different from sucrose (table sugar). While we're probably consuming too much sugar overall, the teaching to date has been that sugar is sugar. That paradigm might shift a bit with a new study that seems to show a difference between the two.

Researchers at the University of Florida evaluated the effect of 24 ounces of high fructose corn syrup (HFCS) vs. sucrose-sweetened soft drinks on 40 men and women, and found a difference between how the two affect the body. The makeup of the sugars resulted in how much fructose was absorbed by the body.

Sucrose is 50 percent fructose and 50 percent glucose bonded together as a complex carbohydrate, while HFCS is a mixture of 55 percent free fructose and 45 percent free glucose.

The researchers showed that HFCS soft drinks result in significantly higher fructose blood levels than sucrose-sweetened soft drinks. The HFCS soft drinks resulted in a higher uric acid level and a 3 mm greater rise in the systolic blood pressure.

High uric acid levels not only are a risk factor for gout, but also are associated with a higher risk of hypertension, heart disease, and kidney disease. The researchers did not address whether there are any differences in long-term health effects.

I would not view HFCS as evil, but I think it's a good idea to put healthy limits on the consumption of all sugar-sweetened beverages and foods, with the goals of a balanced diet that avoids putting on excess weight and includes adequate exercise. Obesity has more to do with inadequate exercise/activity than sugar.

Cause of chronic hives can be elusive, but antihistamines can help

Q: I've had hives with itching and facial swelling for the last 10 months. I've been to four MDs and have had many, many blood tests to see what I may be allergic to. All tests show nothing and I've decided to now seek help from a homeopathic specialist. The itching is driving me crazy. Can you help?

A: Chronic hives are pretty tough to figure out. They're most often from an allergic reaction to a food, food additive/preservative, drug, or insect sting. One in five people will have them at some point in life. They generally don't last for more than a day or so, and usually respond nicely to an antihistamine.

Most of the time, we can figure out the cause - like a new soap or perfume, or a new medication - but sometimes the cause isn't obvious, and the hives persist for months or years.

I've alluded to using antihistamines to treat hives. Histamines are substances released from cells or tissue in response to a particular trigger. They cause the raised areas of hives. They're also responsible for allergy symptoms like itchy eyes, sneezing fits, and runny nose.

It's all an exaggerated response by your immune system to some allergic trigger. You're likely familiar with over-the-counter antihistamines like Benadryl, Claritin/Alavert, Zyrtec, or Allegra.

If they don't help, we usually add a second antihistamine like Zantac or Pepcid. Even though they help with heartburn and ulcers, they're also a type of antihistamine. Using a traditional antihistamine along with an ulcer medication like Zantac or Pepcid has been shown effective in more than half of those with hives.

Here's where it gets complicated: There are many causes for chronic hives - food; medication; physical factors like exercise, cold weather, or skin pressure; autoimmune disorders such as lupus or rheumatoid arthritis; aspirin; and an underlying cancer such as lymphoma or colon cancer. An overactive thyroid, hepatitis, or emotional stress won't cause hives by themselves, but they can cause hives in someone predisposed to them or make an existing case that much worse.

In more than half the cases of chronic hives, we're at a loss to pinpoint the cause. Nonetheless, it's still important to gather a detailed history of events. Keeping a diary to record outbreaks, new foods eaten (pay close attention to food additives/preservatives), medications taken, perfumes/soaps used, and pertinent activities can be very helpful.

I'd keep pursuing a possible cause, but use an antihistamine combo to keep symptoms at bay. Sometimes one antihistamine works better than another. A short course of prednisone may be very helpful as well. There is hope: A fair number of folks with chronic hives will have spontaneous clearing of the hives in as mysterious a fashion as when they first appeared.


Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: "Ask Dr. H.," Box 767787, Atlanta, Ga. 30076. Due to the large volume of mail received, personal replies are not possible.