dimanche 17 décembre 2017


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promoted but since a huge proportion of USA population has some form of kidney dysfunction, this recommendation was withdrawn and or to be suggested with caution.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.