digest
Short Summary
Main recommendation: If you are trying to follow a keto or low-carb diet, avoid sugary drinks like soda and apple juice, and avoid whole fruit and applesauce or restrict them to a very small amount, because Dr. Westman argues that all of these raise blood sugar and insulin too much for that approach. He reacts to a MedCram video claiming that whole fruit does not have the same effect as the same amount of sugar in soda, and argues that the packaging difference is less important than the overall blood sugar response, while noting that for people eating a high-carb diet the packaging difference may matter more.
Key Points
- The MedCram video argues the "low carb fruit fallacy": that 39 grams of sugar in soda is not the same as a similar amount of sugar in whole fruit, because fiber and cell structure change how it is absorbed.
- In the MedCram data, whole apple and applesauce produced similar, lower insulin rises than apple juice, which produced a significantly higher insulin response and later low blood sugar (down to about 45 to 50 mg/dL).
- Dr. Westman responds that the glucose rise from whole apple (70 to 90 mg/dL) and applesauce is still an elevation he wants to avoid, so the difference is less important in a low-carb context.
- A 2008 Diabetes Care study of about 71,000 nurses followed for 18 years found whole fruit associated with an 18 percent lower diabetes hazard, while fruit juice was associated with an 18 percent higher hazard; Dr. Westman notes these associations are small and clinically marginal.
- Dr. Westman states that sucrose, not just fructose, is the sugar in fruit and soda, so packaging does not change what the substance is.
Details Worth Noting
- Concrete instructions: If you are following a keto or low-carb approach, do not drink soda or apple juice. Avoid whole apples and applesauce, or limit them to a very small amount if at all. Dr. Westman's program counts total carbs (not net) and allows up to about 20 total grams per day, which would not allow even one apple or half an apple. Dr. Westman suggests that if you want to check your own response, you could use a continuous glucose monitor to compare blood sugar after apples versus soda.
- Dr. Westman says that people eating a high-carb diet may find whole fruit with fiber less harmful than fruit juice, but that this does not apply to someone trying to be keto.
- The MedCram study data showed a glucose rise from 70 to 90 mg/dL after whole apple or applesauce; Dr. Westman calls this too high for a keto approach.
- Dr. Westman says the 2008 study's hazard ratios are too small to be clinically relevant, and it is an association study, not proof of cause.
- Dr. Westman's stated approach emphasizes simple, sustainable real-food rules over apps, food journals, or ketone measuring.
Bottom Line
Even though whole fruit and fruit juice behave differently in the body, Dr. Westman's view is that for someone on a low-carb or keto plan, all of these sugars are too high to include in meaningful amounts.
