In
Praise of SUGAR
No
one would be caught writing, In Praise of SALT, then why is an Endocrinologist
who is socially committed to prevent Type 2 Diabetes and improve its care using
Psychosocial and Advanced Technological methods singing songs of Praise?
You
cannot go into a supermarket, and be offered an array of Salt Substitutes.
Potassium Chloride had been promoted but since a huge proportion of USA
population has some form of kidney dysfunction, this recommendation was
withdrawn and or to be suggested with caution. A commonly used medication used
for Hypertension also reacts with Potassium, so caution is warranted.
When
we were students, the Chinese restaurant syndrome or the familiar question by
Chinese Chefs: with lead or without Lead? Was in the popular imagination. MSG
was the culprit and it got a fair share of blame and was shunned perhaps
without scientific proof by a large proportion of Americans.
The
recommended amount of 1500 mg of sodium is exceeded twice by the national Salt
intake.
New
guidelines have been issued for the classification of High Blood Pressure and
the new measures lower what is to be considered normal Blood Pressure and that
means a greater attention to be paid to DASH diet and Salt restriction, rather
than rushing into taking medications if you are classified Hypertensive by the
new standards.
So
it was a welcome read this morning,
Juraschek SP, Miller ER 3rd, Weaver CM, et al. Effects of
Sodium Reduction and the DASH Diet in Relation to Baseline Blood
Pressure. J Am Coll Cardiol. 2017 Dec 12;70(23):2841-2848. doi:
10.1016/j.jacc.2017.10.011. Epub 2017 Nov 12. (Original) PMID: 29141784
CONCLUSIONS: The combination of
reduced sodium intake and the DASH diet lowered SBP throughout the range of
pre- and stage 1 hypertension, with progressively greater reductions at higher
levels of baseline SBP. SBP reductions in adults with the highest levels
of SBP (=150 mm Hg) were striking and reinforce the importance of
both sodium reduction and the DASH diet in this high-risk group.
This is a serious public health problem, not only
in western countries but also westernizing countries. I saw young people in
Cambodia and Colombia paralyzed on one side because of a stroke, usually due to
Hypertension. They are led to believe that medical interventions would help but
do not have the money for consultation or medications. This is in the realm of
Health Education and the above study shows that a DASH diet along with Salt
Restriction would decrease SBP in most people. The medications are utilized
when these measures fail, as there are recalcitrant elevations in BP in all
populations.
Coming back to Sugar, currently the polemic has
turned to Sugar, while the past twenty years was focused on Low Fat, which now
has been shown to be dangerous, and not beneficial. Now we are in the Age of
Aquarius, and the villain is Sugar.
Remember, Indians from India have been consuming
sugar for centuries if not millennia but their Diabetes Epidemic is of recent
origin, and the high disease states they suffer when they migrate may have
cultural components and not to mention the Microbiome which they have inherited
for the millennia of their existence in that sub continent.
Excellent work is coming out of the Lab at
Weitzman Institute of Science in Israel, under the direction of Drs. Eran
Elinav and Eran Segal. Information and their recent articles are available on
the net, YouTube and the other usual resources.
When I woke up this morning, Megan Lobus, District
Clinical Manager for Medtronic Systems, had sent welcome information to me.
She wanted me to be aware of the work of Dr.
Sabysachi Sen at George Washington University who had done research on
Artificial Sweeteners.
Ordinary nutritionists talk about Quantitative
aspects of Nutrition. The scientific community to which Dr. Sen belongs to
delves into the qualitative aspects and Investigators such as Drs. Elinav and
Segal go further into the system of Microbiome and prove their connection.
I am in the process of familiarizing myself in
depth about the work of Drs. Elinav and Segal. I have a good friend, Dr. MW in Miami;
we have friendly banter about what is happening in Medical Research, which has
an immediate bearing on the society.
I asked the question:
(From Drs. Elinav and Segal)
Which is more likely to raise your blood sugar levels: Sushi or Ice cream?
We both have acquired Talmudic way of thinking,
and his answer is typical of this.
The natural guess is ice cream with all the
sugar but sushi can contain a lot of rice, which can be broken down quickly.
I wrote back to him with the summary of the
article published CELL by Drs. Elinav and Segal
Which is more likely to
raise your blood sugar levels: Sushi or Ice cream?
According to a Weizmann Institute study reported in the journal
Cell, the answer varies from one person to another. The study, which
continuously monitored blood sugar levels in 800 people and approximately
46,000 meals, revealed that the bodily response to all foods was highly
individual.
The study, called the Personalized Nutrition Project (www.personalnutrition.org),
was conducted by the groups of Dr. Eran Elinav, laureate of the Rappaport 2015
Bio medical young researcher of the Immunology Department and Prof. Eran Segal
of the Computer Science and Applied Mathematics Department in the Weizmann
Institute. The scientists found that different people responded very
differently to both simple and to complex meals. For example, a large number of
the participants’ blood sugar levels rose sharply after they consumed a
standardized glucose meal, but in many others, blood glucose levels rose
sharply after they ate white bread, but not after glucose. Elinav: “Our aim in
this study was to find factors that underlie personalized blood glucose
responses to food. We used that information to develop personal dietary
recommendations that can help prevent and treat obesity and diabetes, which are
among the most severe epidemics in human history.”
The scientists generated an algorithm for predicting
individualized response to food based on the person’s lifestyle, medical
background, and the composition and function of his or her Microbiome. In a
follow-up study of another 100 volunteers, the algorithm successfully predicted
the rise in blood sugar in response to different foods, demonstrating that it
could be applied to new participants. The scientists were able to show that
lifestyle also mattered. The same food affected blood sugar levels differently
in the same person, depending, for example, on whether its consumption had been
preceded by exercise or sleep.
In the final stage of the study, the scientists designed a
dietary intervention based on their algorithm; this was a test of their ability
to prescribe personal dietary recommendations for lowering blood glucose level
responses to food. Volunteers were assigned a personalized “good” diet for one
week, and a “bad” diet – also personalized – for another. Both good and bad
diets were designed to have the same number of calories, but they differed
between participants. Thus, certain foods in one person’s “good” diet were part
of another’s “bad” diet. The “good” diets indeed helped to keep blood sugar at
steadily healthy levels, whereas the “bad” diets often induced spikes in
glucose levels —all within just one week of intervention. Moreover, as a result
of the “good” diets, the volunteers experienced consistent changes in the
composition of their gut microbes, suggesting that the Microbiome may be
influenced by the personalized diets while also playing a role in participants’
blood sugar responses.
Dr. MW reminded me that in some of the conferences he had attended
on Microbiome (he is an avid attender at innovative conferences), that
artificial sweetener and its responses (bad) have been associated with changes
they produce in the Microbiome.
A nice way to connect Dr. Sen’s work from GWU in USA to the
brilliant work of the Israeli scientists.
Endocrine Society, the professional society for serious minded
Endocrinologists in the world, had sent a note when Dr. Sen presented his work
at the annual meeting.
- Low-calorie, artificial sweeteners appear to play
havoc with the body’s metabolism, and large consumption of these sugar
substitutes could promote fat accumulation, especially in people who are
already obese, preliminary research suggests. The study results will be
presented Monday at ENDO 2017, the Endocrine Society’s 99th annual meeting in
Orlando, Fla.
“Many health-conscious individuals like to consume
low-calorie sweeteners as an alternative to sugar. However, there is increasing
scientific evidence that these sweeteners promote metabolic dysfunction,” said
Sabyasachi Sen, M.D., an Associate Professor of Medicine and Endocrinology at
George Washington University in Washington, D.C., and the study’s principal
investigator.
Sen and his colleagues tested sucralose, a popular
low-calorie sweetener, on stem cells—cells that could change into mature fat,
muscle, cartilage or bone cells—taken from human fat tissue. They placed these
cells in Petri dishes for 12 days in media that promotes fat production. At a
0.2-millimolar sucralose dose similar to the concentration found in the blood
of people with high consumption of low-calorie sweeteners—equal to four cans of
diet soda per day—the researchers said they observed increased expression of
genes that are markers of fat production and inflammation. There also was
increased accumulation of fat droplets in cells, particularly at a larger dose
(1 millimolar), Sen reported.
With this evidence, the investigators then
conducted a separate experiment. They analyzed biopsy samples of abdominal fat
obtained from eight subjects who said they consumed low-calorie sweeteners
(mainly sucralose and a trace of aspartame, and/or acesulfame potassium). Four
of the subjects were healthy weight, and four were obese. According to Sen,
they saw evidence of increased glucose (sugar) transport into cells and
overexpression of known fat-producing genes, compared with fat biopsy samples
from subjects who did not consume low-calorie sweeteners.
Additionally, he noted that subjects who consumed
low-calorie sweeteners, which are several-fold sweeter than sugar, showed an
overexpression of sweet taste receptors in their fat tissue; this
overexpression was up to 2.5-fold higher than in subjects without history of
consumption of these sweeteners. Overexpression of sweet taste receptors in the
abdominal fat, he said, may play a role in allowing glucose to enter cells,
from which the body absorbs it into the bloodstream.
All these findings are signs of metabolic
dysregulation in which the cellular mechanisms are changing to make more fat,
he explained. Of concern, Sen said, these effects were most apparent in the
obese individuals who consumed low-calorie sweeteners, rather than individuals
of normal weight. He added that the observed increased uptake of glucose into
the cells is also concerning for consumers who have diabetes and prediabetes,
“who already have more sugar in their blood,” compared to their counterparts
who do not have diabetes.
More studies are necessary in larger numbers of
people with diabetes and obesity to confirm these findings, he stressed.
“However, from our study,” Sen stated, “we believe
that low-calorie sweeteners promote additional fat formation by allowing more
glucose to enter the cells, and promotes inflammation, which may be more
detrimental in obese individuals.”
MICROBIOME
is turning out to be an important actor in the health and disease prevention of
human being and as Dr. Elinav said: we might be able to help millions of people
around the world.
In
my recent visits to Malaysia and Qatar I was astonished at the level of obesity
in both countries! Certainly like they
used to say: The Natives are restless, in this case their MICROBIOME, for
feeding these ancient Asiatic and Desert bodies with KFC, McDo, Krispy Kreme
and plastic food. Time to tell them gently that the best food for their bodies
is their own foods which they have been consuming for centuries, long before
they became rich with Petrodollars or Cutting Palm trees in Borneo.
I
am an Anthropologist, a wandering one at that, but also practice Endocrinology
mostly among native populations in this planet.
My
own patients, in their innocence ask me occasionally:
Hey
Brown Sugar Doctor, making a pun of my appearance, why do you eat sugar?
My
body knows how to digest brown sugar, molasses that come from sugar cane but it
does not know what to do with Splenda, Aspartame, Acesulfame, Dextrose,
Dextrose with Stevia, marketed by Wal-Mart as being Natural
And
also, as we say in Cuba: Life is too short to drink bad coffee!
Thanks
ML for sending me the clip from Endo Society of which I am a proud member and
MW for continuing Talmudic discussions on Nutrition for Human beings.
