Fructose metabolism as a common evolutionary pathway of survival associated with climate change, food shortage and droughts

R. J. Johnson, P. Stenvinkel, P. Andrews, L. G. Sánchez-Lozada, T. Nakagawa, E. Gaucher, A. Andres-Hernando, B. Rodriguez-Iturbe, C. R. Jimenez, G. Garcia, D. H. Kang, D. R. Tolan, M. A. Lanaspa

Research output: Contribution to journalReview articlepeer-review

71 Scopus citations


Mass extinctions occur frequently in natural history. While studies of animals that became extinct can be informative, it is the survivors that provide clues for mechanisms of adaptation when conditions are adverse. Here, we describe a survival pathway used by many species as a means for providing adequate fuel and water, while also providing protection from a decrease in oxygen availability. Fructose, whether supplied in the diet (primarily fruits and honey), or endogenously (via activation of the polyol pathway), preferentially shifts the organism towards the storing of fuel (fat, glycogen) that can be used to provide energy and water at a later date. Fructose causes sodium retention and raises blood pressure and likely helped survival in the setting of dehydration or salt deprivation. By shifting energy production from the mitochondria to glycolysis, fructose reduced oxygen demands to aid survival in situations where oxygen availability is low. The actions of fructose are driven in part by vasopressin and the generation of uric acid. Twice in history, mutations occurred during periods of mass extinction that enhanced the activity of fructose to generate fat, with the first being a mutation in vitamin C metabolism during the Cretaceous–Paleogene extinction (65 million years ago) and the second being a mutation in uricase that occurred during the Middle Miocene disruption (12–14 million years ago). Today, the excessive intake of fructose due to the availability of refined sugar and high-fructose corn syrup is driving ‘burden of life style’ diseases, including obesity, diabetes and high blood pressure.

Original languageEnglish
Pages (from-to)252-262
Number of pages11
JournalJournal of Internal Medicine
Issue number3
StatePublished - 1 Mar 2020

Bibliographical note

Publisher Copyright:
© 2019 The Association for the Publication of the Journal of Internal Medicine


  • fructose
  • metabolic syndrome
  • metabolic water
  • uric acid
  • vasopressin


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