Diabetic Hypertension, Browning of the Arteries

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I decorated a flan with a drizzle of honey, and my torch produced a toasted spiral.  That was just fructose plus proteins, with a little heat, to produce advanced glycation end products (AGE) that are brown.  If you prefer, you can do the same reaction with egg whites and sugar in meringues, or by grilling brined pork chops basted with honey and anchovy paste.  Fructose is 10X better than other sugars at producing glycation, AGE and browning.

AGE and Arteries

Why do we care about the Maillard reaction and advanced glycation end products (AGEs)?  Of course, understanding the biochemistry of cooking is inherently satisfying and it helps to explain why Dr. House used vinegar to stop meatballs from browning too fast in his cooking class, but it also explains what’s cooking in atherosclerosis, cardiovascular disease.  It turns out that AGEs are highly inflammatory and inflammation of arteries leads to plaque formation.  [LDL is less important, because it only aggravates the primary event, inflammation, and that is why fish oil is more helpful for cardiovascular disease than statins.]  So increasing blood sugar is a problem, because it increases the rate of the Maillard reaction in binding blood sugar to the amino acids of proteins, such as hemoglobin to produce HgA1C, and causing vessel inflammation.  AGE in small capillaries also kills the capillaries and causes a rise in blood pressure by making harder for the heart to force blood from arteries to veins.  AGE causes hypertension and that is why salt consumption is not as important.   High blood sugar also increases the level of another powerful glycation agent, methylglyoxal, the active antibacterial agent in Manuka honey.  Honey is effective as a wound dressing, because it AGEs microbes to death!

The Trouble with AGE-ing is Inflammation

Cells detect the presence of AGEs with a surface Receptor for AGE (RAGE).  Binding of AGE to RAGE turns on the inflammation transcription factor, NFkB, with the release of inflammatory cytokines and the symptoms of inflammation.  One of my students did some computational protein modeling of the RAGE, because I was interested to see if RAGE would also bind Metformin.  Sure enough, our hunch was confirmed, indicating that Metformin might also reduce some forms of inflammation and be a treatment for diabetic high blood pressure.

Fructose vs. Inulin; AGE vs. Soluble Fiber

Fructose and the storage polymer of fructose, inulin, are similar to glucose and the storage polymer of glucose, starch.  The polysaccharides, inulin and starch can be converted to the sugars, fructose or glucose by industrial heating or enzymes.  Thus, agave inulin is converted into nectar, and corn starch is converted into syrup.  The polysaccharides are not sweet, but the sugars are.  The polysaccharides don't form AGEs with amino acids (unless they are broken up by high heat into sugars first) and fructose is 10X more chemically aggressive in forming AGEs than glucose.  Agave nectar (fructose) is a better browner than honey or high fructose corn syrup (corn syrup treated with a commercial enzyme to convert some of the glucose into sweeter fructose.)  Both inulin and some forms of starch (resistant starch), reach the colon and are digested by gut flora, i.e. they are soluble (fermentable) fiber.  The gut flora convert the resistant starch into short chain fatty acids that are anti-inflammatory.  Typical starch, e.g. corn starch or wheat flour, is digested by gut enzymes and goes directly into the blood as glucose, it is high glycemic and never reaches the gut flora.

AGE in Food

Should we fear browned foods as inflammatory.  I don't think that AGE in foods is any more of a hazard than all of the toxic phytochemicals that are touted as plant antioxidants.  I think that the gut and liver provide protection.  I brown the sugar on my flans and sear my steaks, even as I relish eating my veggies.  The body can detox these natural products in the gut better than it can handle the AGE made by high blood sugars.

Take Home Messages:

• Sugars in baked goods or blood, react with amino acids or proteins to make inflammatory AGEs.
• Blood sugar tests only measure glucose and ignore fructose, which is even more unhealthy.  So, foods laced with fructose can be low glycemic, but very unhealthy.
• The major AGE in blood is HgA1C.
• Diabetics have more stable, lower blood sugar on low carb diets, e.g. my Anti-Inflammatory Diet.  The liver produces needed blood sugar from protein.
• Diabetic use of fructose or agave nectar or honey encourages AGE, inflammation and diseases of diabetes.
• Starch (not RS) is the only polysaccharide digested by gut enzymes and is high glycemic.
• AGE is inflammatory leading to artery plaque and hypertension.
• AGE as browned foods are probably tolerated by the body.

Low Carbs Lower Triglycerides

Blood Triglycerides Depend on Diet Carbs, not Fats

I don’t know why the medical community keeps pushing the low fat diets to modify blood lipids. The medical literature shows that a low fat, high carbohydrate diet (more than 50 grams of starch/sugar in a meal) produces high triglycerides, and a low carb diet ( less than 50 grams per meal), regardless of saturated fats and meat, produces lower triglycerides.

In seems reasonable that fats in the diet should mean fats, triglycerides, in the blood, but that ain’t so. It’s the rise in blood insulin in response to a rise in blood sugar due to high glycemic index foods in a meal, that yields high blood triglycerides.

The low carb, low triglycerides facts of life were brought to may attention by my wife’s blood chemistry. She knows better, but refuses to follow my preacherly suggestions about an anti-inflammatory diet. She follows most of the use of supplements and prohibitions about vegetable oils, but loves carbs. She eats two thick slices of bread in a sandwich and I cut a thinner slice and eat mine open-faced. I can’t eat her pancakes or French toast. Ok, I eat lots of dark chocolate, but I don’t have flavored syrup in my lattes.

She was stressed by a high triglycerides (292 mg/dl) in her blood work and her doctor wanted to start her on meds. I was sympathetic. Not really. I actually said, “carbs, carbs, carbs,” until she threatened me. I nagged heavily to just junk the junk and wait on the meds. She started counting grams of carbs with each meal. Actually she tried to average over the whole day, I nagged, she finally relented and stuck to the plan. No more than 50 grams of carbs in any meal. (I think 30 grams, would actually be better.)

One month later, her blood work showed triglycerides down 57% to 127 mg/dl. Individual results may vary, but this is pretty straightforward. Carbs are important -- avoid them. The food pyramid is for chumps. The highest glycemic food you will encounter is a French baguette (95), compared to pastas in the 30s or table sugar at 70.

The facts are:

• Saturated fats in meat are no big deal, and much better than...
• Vegetable oils (most are rich in omega-6 oils, except olive oil) are inflammatory.
• Fish oil (omega-3 DHA/EPA) is anti-inflammatory (unless there is also too much vegetable oil.)
• Starch and sugar increase blood triglycerides and are only needed to gain or keep body fat. Losing weight is much easier without starch/sugar.
• Most people are deficient in vitamin D and C (even with plenty of solar exposure).
• High fructose corn syrup is ten times more damaging than starch/sugar, and is especially bad for diabetics. It doesn’t raise blood sugar as much as starch, it just causes damage, e.g. glycation, at an extraordinarily high rate. It also ages skin by accelerating cross-linking of collagen. Very bad stuff even in fruit juices.
• Eating plant anti-oxidants protects unsaturated fats as they pass through the oxidizing environment of the stomach, so nuts are better unroasted and eaten with veggies.