Arterial hypertension due to fructose ingestion: model based on intermittent osmotic fluid trapping in the small bowel

Table 1 The proposed interplay between osmotic loads in the upper digestive tube and sodium and fluid sparing actions imposed on kidneys and large bowel by increased ADH and aldosterone secretion due to a transitory decline in the circulatory volume

Beverage	Content & overall osmolarity	Fluid cycle				Secretion
(V = 0.5L)	(O)	Theoretic values		Fluid absorption in hours		Aldosterone	ADH
		Initial trapped volume V_d= V*O/300-V	Total volume for absorption V_>a= V_d+V	< 2 h with	< = 4 h
Salty commercial soup	1.3% NaCl, 400 mosm/L	~ 0.16 L	~ 0.66 L	~ 0.66 L	none	blocked by sodium absorption	increased by reduction in circulatory volume
Sucrose soft drink	13.3% sucrose, 400 mosm/L	~ 0.16 L	~ 0.66 L	~ 0.33 L with glucose	~ 0.33 L with fructose	weak and transitory increase in secretion due to small initially trapped volume
HFCS soft drink	glucose 360, fructose 440, overall 800 mosm/L	~ 0.83 L	~ 1.33 L	~ 0.6 L with glucose	~ 0.73 L with fructose	increased secretion due to slow fructose absorption results in sodium & volume sparing in kidneys and large bowel
WHO peroral rehydrattation solution	glucose 75, salt 170, overall 245 mosm/L	none	0.5 L	near 0.5L	almost none	rehydration without fluid trapping, hormone secretion is reduced

Soft drinks with high fructose corn sirup (HFCS) are so hyperosmolar that they trap large volumes of intestinal fluid until their sugars are absorbed (Fig. 1.). Absorption takes longer for fructose [13–15]. Other liquids are moderately hypertonic and their influences on fluid and sodium homeostasis are much weaker. The WHO recomended solution for rehydratiopn is hypotonic so no fluid is being trapped in the small bowell.

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