March Madness: The Last Fourth of Nutrition

Final Four Exit: “Cane Sugar > HFCS”

Voices close to MAHA generally support reducing added sugar, but they often promote cane sugar as a better choice because it is seen as less “chemical” and less likely to show up in ultra-processed foods. It’s also the origin of the whole “Mexican coke is better” story—the same soda, but sweetened with sucrose instead of HFCS, so it must be healthier…right?

This claim does not hold up.

Chemically, sugar (sucrose) is a 50/50 split of glucose and fructose bound together. HFCS – commonly HFCS-55 (the version used in soft drinks, making up about 50-70% of HFCS usage) – is about 55% fructose and 45% glucose, just unlimited. Your body breaks down sucrose into the same two molecules anyway, so metabolically they are very similar.

So why is HFCS treated like a villain?

Something historical. Some early animal studies suggested that high fructose intake could lead to worsening metabolic effects, increasing the risk of stroke. But chickens process food differently than humans, and when tested in well-controlled human trials, these differences disappear.

A powerful example is a hard, double blind 2021 clinical trial funded by the NIH in which healthy adults consume beverages sweetened with HFCS or sucrose. Both groups experienced similar negative changes compared to a control (such as increased liver fat, decreased insulin sensitivity, and impaired blood lipids), but there was no difference between HFCS and sucrose. This study is one of the most comprehensive head-to-head comparisons we have.

Concerns about adding large amounts of fructose-containing sugars are entirely valid, given the context. Obesity and type 2 diabetes. But the idea that HFCS is particularly harmful while cane sugar is somewhat benign doesn’t hold up in controlled human data.

Final Verdict: Same game, different jersey.

And just like that the “cane sugar > HFCS” bracket ends.

Final Four Exit: “Less ingredients = healthier.”

A favorite MAHA talking point is that we should eat “real food” and avoid ultra-processed stuff. i agree! But, no one can agree on anything Precisely what ultra-processed foods mean.

One way to define this is the number of components. If a food has less than _____ (fill in the number) ingredients, it is considered a staple food. Otherwise, it is ultra-processed. However, this is a piece of cake.

Let’s use a sandwich as an example. Sandwiches are made up of many parts. They can be as simple as two ingredients (bread and cheese) or as complex as a grand creation with lots of vegetables, meats, cheeses, spices and bread varieties. Any slightly “complex” sandwich may have more than a few ingredients, and I’d say that’s a good thing. A sandwich with less than five ingredients is a sad sandwich, indeed.
Of course, true enthusiasts might argue that each portion of a sandwich should contain less than ____ ingredients. And down the rabbit hole we go. So, let’s examine just one ingredient: an apple. An apple looks simple, but it contains many natural chemical compounds (eg, catechin, epicatechin, quercetin, malic acid, cyanide, etc.). If we were to list them all, an apple would look highly processed by this definition.

Additionally, “few ingredients” assumes that all items are good with just a few ingredients. However, arsenic, lead, and hemlock are all “single ingredients.” Cyanide is a “natural” substance and is present in the chemical apple mentioned earlier.

While fewer ingredients seem like a good compliment to ultra-processed foods, the argument quickly falls apart upon closer inspection.

Thus, the team “Less ingredients = better” makes its final 4 exits.

Runner-up: Protein Mixing

The typical American gets too much protein; There is no evidence that protein deficiency is a common problem in the United States. Of course, there is always the discussion about the special needs of people: athletes, people on GLP-1s, etc.

“Concern about not getting enough protein occurs when you’re eating less or taking weight-loss drugs. People who are on a restricted diet, diagnosed with an eating disorder, or taking weight-loss drugs stop eating. This starts to have a lot of side effects, including not getting enough protein and losing a lot of muscle mass, which is not the way you want to lose weight.”

—Christie Wimpen, RDN, LD, Mayo Clinic Health System

While the marketing of protein has been rife with truly outlandish offerings (protein cold foam coffee!), every time a new food fad or recycled comes back into fashion, companies will seize marketing opportunities. While the average person probably gets enough protein in their diet, the real question is whether you really need to pay more just because it’s marketed as having protein. The answer is probably not. That said, there are worse fad diets, and as long as you eat a balanced diet with lots of fruits, vegetables, and protein options, this fad is relatively harmless.

A strong showing – but not enough to win it all. Protein Maxxing finished as the runner-up.

Champion: Fiber Mixing

Basically, “fiber mixing” is simply deliberately increasing our intake of dietary fiber—the parts of plant foods that we can’t digest but that our gut microbes love. Think oils, beans, lentils, fruits, vegetables, nuts, seeds, and whole grains. Unlike other candidates, this one isn’t hype—it’s based on science.

The average American’s fiber intake is about 15-18 grams per day, while the recommendations are about 25 grams/day for women and 38 grams for men. This gap is because fiber is officially considered a nutrient of public health concern.

The fiber bracket wins because it quietly lifts the heaviest:

• Gut Health: Nourishes beneficial microbes, supports a healthy microbiome
• Metabolic Health: Helps regulate blood sugar and improves insulin sensitivity
• Heart Health: Lowers LDL cholesterol and improves blood lipids
• Satiety: Increases fullness, which can contribute to overall energy expenditure
• Digestive function: improves regularity and reduces the risk of constipation

Mechanically, fiber’s benefits come in properties such as viscosity (forms gels that slow digestion) and fermentability (fuels gut bacteria to produce beneficial compounds such as short-chain fatty acids).

Large-scale meta-analyses consistently show that high levels of fiber are associated with heart disease, type 2 diabetes, some cancers, and even all-cause mortality.

One in particular A comprehensive review of umbrellas, 33 meta-analyses and covering about 17 million people, found convincing evidence for reduced cardiovascular mortality, strong links to reduced risk of heart disease and type 2 diabetes, and suggestive reductions in many cancers and strokes.

As always, there is a caveat, because fiber is not perfect in any case. Some people with conditions like irritable bowel syndrome or inflammatory bowel disease may need to adjust the types or amounts of fiber, especially during bloating. And suddenly switching from very low to very high consumption can cause swelling or discomfort.

But it’s the exceptions that require correction—not the evidence to eliminate fiber altogether.

The final verdict: Not just a trend—a rare case where tech and science are on the same team.

And this year’s champion, Net Reduction: Fiber Mixing.