Download FRUCTOSE

Fructose & Cardiovascular Disease:
A not so sweet connection
Presented by:
Cindy Brinn MPH, RD, CDE, BC-ADM
PeaceHealth St. Joseph Medical Center
Nutrition & Diabetes Clinic
[email protected]
SUGAR
Empty calories . . . associated with
dental carries. Obesity is really just an
excess calorie problem . . source of
calories doesn’t really matter.
FDA, ADA, ADA
. . . .Sugar is fine in “moderation”
Dietary Sugars Intake and Cardiovascular Health:
A Scientific Statement from the American Heart Association
Circulation 2009;120;1011-1020; originally published online Aug 24, 2009;
Dietary Sugars Intake and Cardiovascular Health:
A Scientific Statement from the American Heart Association
Women: 100 calories a day of added sugar = 6tsp/day
Men:
150 calories a day of added sugar = 9tsp/day
Circulation 2009;120;1011-1020; originally published online Aug 24, 2009;
• Sugar associated with:
–
–
–
–
Hypertension
Altered lipids
Inflammation
Obesity
Circulation 2009;120;1011-1020; originally published online Aug 24, 2009;
Sucrose, High Fructose Corn Syrup
& Cardiovascular Disease
•What’s the evidence that sugar and high fructose
corn syrup is associated with CVD?
•What exactly is high fructose corn syrup and
what happens when we eat it?
•How much sugar are we really eating?
•What should I tell my patients?
Who will win the Sweetener Race?
• Artificial Sweeteners
–
–
–
–
Saccharine
Nutrasweet
Acesulfame K
Splenda
Who will win the Sweetener Race?
• Natural Sweeteners
–
–
–
–
–
–
Sucrose
High fructose corn syrup
Agave syrup
Honey & Maple syrup
Sugar alcohols
Stevia
How Much Sugar do we really eat?
80
Sugar Intake UK & USA kg/person
years 1700-2000
Johnson R. AJCN 2007;86:899-906
60
40
20
0
1700
1750
1800
1850
1900
1950
2000
Measurement of Sweetener Consumption:
Added Sugar
• Added Sugar Availability –Disappearance data
– Over estimates
• Up 19% between 1970-2005
• 148g/day to 176 g/day = 37t./day to 44t./day
• Added Sugar intake ((NHANES) self reported
consumption)
– Under estimates
• Up 25% between 1977-1999
• 64 g/day to 82 g/day = 16 t./day to 20 t./day
• 256 calories/day to 328 calories/day
Average added sugar:
Increased about 4 tsp/day/past 25
years
80
60
Sugar Intake UK & USA kg/person
years 1700-2000
Johnson R. AJCN 2007;86:899-906
40
20
0
1700
1750
1800
1850
1900
1950
2000
80
Sugar Intake UK & USA kg/person
years 1700-2000
Johnson R. AJCN 2007;86:899-906
60
40
20
Problem:
Chronic 50 year
exposure to high and
increasing intakes of
sugar . . .
0
1700
1750
1800
1850
1900
1950
2000
**
How Much Sugar is OK to eat?
WHO/FAO Expert Consultation:
Diet, Nutrition and the Prevention of Chronic Diseases
• “Free sugars” (added sugars) <10% of total
caloric intake
– 1600 calorie diet = 10 tsp sugar
World Health Organization
USDA Food Guide or DASH
• 1600 calorie diet
– 3 tsp. added sugar per day
• 2000 calorie diet
– 8 tsp added sugar per day
Dietary Sugars Intake and Cardiovascular Health:
A Scientific Statement from the American Heart
Association
“100 calories a day of added sugar = 6tsp/day”
Circulation 2009;120;1011-1020; originally published online Aug 24, 2009;
Institute of Medicine (IOM)
U.S. Dietary Reference Intakes
(DRIs)
• <25% of energy from added sugar
• Lack of clear and consistent relationship
between total or added sugar intake and
obesity
• Insufficient evidence to recommend upper
limit for dietary sugars
http://books.nap.edu/openbook.php?isbn=0309085373
25%/day of calories
from added SUGAR
25% calories for 2000 calorie diet =
500 sugar calories =
33tsp sugar =
2/3cup sugar per day
How many people eat more than 25% of
calories from added sugars?
>25% of calories from
SUGAR
Males
13% 4-8 yrs
20% 9-18yrs
15% 19-50yrs
Females
13%
4-8yrs
21%
9-13yrs
31%
14-18yrs
21%
19-50yrs
National Academy of Sciences, IOM, Dietary Reference Intakes 2002
US Sources of Added Sugar Intake
Soda
33%
Sugar & Candy
16%
Fruit Drinks
10%
(fruitades & fruit punch)
Dairy desserts & milk products
9%
Other grains (honey nut waffles, cinnamon
toast, etc.)
6%
Are some eating < 10% of calories from
added sugars?
<10% of calories from
SUGAR
25%
21%
30%
45%
4-8 yrs
9-18yrs
19-50yrs
50+yrs
National Academy of Sciences, IOM, Dietary Reference Intakes 2002
• >50% of your patients eat more
than 10tsp/sugar/day
• >70% of your patients <50 years eat
more than 10tsp/added sugar/day
• Likely most of your patients
consume more than 6tsp/added
sugar/day
Sugar Chemistry:
Sucrose: The “Gold” Standard
Natural Sugar Sources
• Glucose*
• Fructose*
• Galactose*
• Sucrose** (glucose-fructose) (Table
Sugar)
• Lactose** (glucose-galactose) (Milk
Sugar)
*Mono-saccharide
**Di-saccharide
Sugar Sources
• Glucose*-– Sucrose (50%), High Fructose Corn Syrup
(50%), Maple Syrup & Starches (100%) &
Fruits, Juices & Milk (50%)
• Fructose*-– Sucrose (50%), High-Fructose Corn Syrup
(50%), Honey (40%), Maple Syrup, Fruits (520%) & Juices
• Galactose*-– Milk/Dairy
Sugar Sources
Absorption/Metabolism
Intestinal enzymes
•
•
•
•
•
Glucose*
Fructose*
Galactose*
Sucrose** (glucose
Lactose** (glucose
fructose)
galactose)
Glucose & Fructose Metabolism
• Galactose →
– Liver quickly converts majority to
glucose
• Glucose →
– Used as an immediate energy source
by all cells
– OR stored as glycogen by all cells
– OR converted into TG by the liver and
stored in cells
• Fructose →
– NO cells use fructose as an energy
source!
– Goes immediately to the liver where it
is rapidly converted to fatty acids and
transported as free fatty acids or
triglycerides and ultimately stored
Excellent article on
Carbohydrate Chemistry &
Metabolism
http://www.medbio.info
/Horn/PDF%20files/
carbohydrate_metabolism_Mar
ch_2007b.pdf
What’s the problem with added
sugars?
USDA Food Guide:
Why “Moderate” intake of sugar?
• Excess Energy & fewer nutrients
• Adverse health effects of sugar
– Dental carries
Murphy S. AJCN 2003; 78(suppl):827s-33s
American Diabetes Association & FDA
• “No adverse health effects w/
increased sucrose consumption in
individuals with diabetes or with
normal glucose.”
• Based mostly on acute blood
glucose effects
American Heart Association
• Excess sugar linked to metabolic
abnormalities & adverse health
conditions
• Reduces essential nutrient intake
• Limited trial data . . Observational
studies indicates soft drinks is
associated with excess energy
intake, higher body weight & lower
intake of essential nutrients.
Chronic Diseases & Sugar
• Heart Disease
–  TG, LDL, HDL,  insulin sensitivity
• No conclusive studies
• Cancer
–  lung cancer risk --Case-control study
in Uruguay-- risk with  sugar intake
– Breast—inconsistent
–  colorectal cancer & polyps
Mardes A. Fam Econ Nutr Rev 2001;13(1):87-91
Burly EurJCancerPrev 1997;6:422-34
Limitations of
Nutrition Science Research
• Nutrition Research isn’t easy to do!
• Most study one nutrient at a time—
(“deeply flawed”)
Marion Nestle
New York University Nutritionist
Nutrition Research Challenges
• Theory: Sugar causes heart disease
• Study: Low Sugar diet
– Diet is now higher in foods not containing
sugar—what are these foods . . What is their
impact on health?
• Second variable introduced
• Maybe it is not the reduced sugar that is
working, but the increased mono fat or
non-sugar containing food . . . . . . how do
we know??
“Gold Standard”
Clinical Investigation
• Costly
• Many variables to control—
smoking, medications, stress,
exercise and food
49,000 women followed for 8 years, 2 groups . . .
“dietary intervention that reduced total fat intake and
increased intakes of vegetables, fruits and grains
did not significantly reduce the risk of CHD, stroke
or CVD . . .
JAMA Feb. 8, 2006
•Women’s Health Initiative Trial
•160,000 women
•45 clinics
•$625 million
Low Sugar Diet
Dietary Sugars Intake and Cardiovascular Health:
A Scientific Statement from the American Heart
Association
“100 calories a day of added sugar = 6tsp/day”
Circulation 2009;120;1011-1020; originally published online Aug 24, 2009;
FRUCTOSE
Fructose
• Controversy & Confusion around
high fructose corn syrup (HFCS)
• Unique digestion, absorption &
metabolism of fructose
– Association with elevated lipids &
insulin resistance
Trends in obesity and Fructose Intake
Bray G. AJCN 2004;79:537-43
Total Fructose
HFCS
Obesity
Overweight
HFCS
Free Fructose
Seattle Grocery Chain Stops Selling Foods
Made With High Fructose Corn Syrup
June 30, 2008 Seattle-area food
cooperative PCC Natural Markets has
removed all products containing highfructose corn syrup from its shelves, and
has announced that it will no longer carry
any product sweetened with the
controversial ingredient.
High Fructose Corn Syrup (HFCS) & Fructose
**
AMA
Press
Release
“ There is no scientific research that HFCS
deserves the blame for obesity more than
sugar or other caloric sweeteners.”
Comparison of Caloric Sweetener
Compositions
HFCS-42
HFCS-55
Sucrose
Honey
Fructose
42%
55%
50%
45%
Glucose
53%
42%
50%
43%
Other
Sugars
5%
3%
0
5%
Sugar consumption
(# per yr per person)
1970-2007
USDA
Sugars&
Sweeteners
Yearbook.
2007
Powerpnt.lnk
What is the difference between
Sucrose & High Fructose Corn
Syrup?
• Sucrose = “Bound” fructose &
glucose
• HFCS = “Free” fructose & glucose
Fructose = “Fruit Sugar”
Fructose found in Sucrose & HFCS,
Agave syrup & Honey & Fruit
50% fructose
5-20% fructose
Honey: 40% fructose
HFCS: 50% fructose
**
Changes in Fructose Consumption
Average added sugar:
Increase of 4 tsp/day/past 25 years
Average Fructose Consumption:
30g/day → 40g/day over 25 years
7 1/2 tsp/day → 10 tsp/day
(increase of 2½ tsp/day)
Bantle JP. AmJClinNutr 2000; 72:1128-34
**
Are some consuming a lot of added
fructose?
Dietary Sugars Intake and Cardiovascular Health:
A Scientific Statement from the American Heart Association
“100 calories a day of added sugar = 6tsp/day”
. . . . . 50% fructose . . 3tsp/day fructose . . =
Recommendation of 12g/day fructose
Circulation 2009;120;1011-1020; originally published online Aug 24, 2009;
>25% of calories from SUGAR
20% Adults average more than
Males
Females
60grams/day added fructose
13% 4-8 yrs
13% 4-8 yrs
15tsp/day21%
= 1/39-13yrs
cup
20% =9-18yrs
15% 19-50yrs 31% 14-18yrs
21% 19-50yrs
25% Children averaging more than
Males
Females
75 grams/day added fructose
13% 4-8 yrs
13% 4-8 yrs
19tsp/day21%
= 1/29-13yrs
cup
20% =9-18yrs
15% 19-50yrs 31% 14-18yrs
21% 19-50yrs
**
Fructose (grams)
Fructose in Foods
12 oz. coke
20 grams
½ c. pudding
9 grams
¾ cup raisin bran
5 grams
1 apple
6 grams
1 banana
5 grams
1 c. apple juice
14 grams
1 peach
2 grams
1 apricot
1 gram
Added
Fructose
Natural
Fructose
**
Fructose (grams)
Fructose in Foods
12 oz. coke
20 grams
½ c. pudding
9 grams
¾ cup raisin bran
5 grams
1 apple
6 grams
1 banana
5 grams
1 c. apple juice
14 grams
1 peach
2 grams
1 apricot
1 gram
Added
Fructose
Natural
Fructose
How is high fructose corn syrup
made?
•
•
•
•
Corn →
Corn starch →
Corn syrup (100% glucose) →
Use enzymes to invert glucose to
fructose →
• Blend glucose and fructose to
make HFCS-42 or HFCS-55
• HFCS-55 is used in most beverages
What are researchers/organizations saying
about fructose?
American Diabetes Association &
Fructose
“In individuals with diabetes, fructose
produces a lower postprandial glucose
response when it replaces sucrose or
starch in the diet; however, this benefit is
tempered by concern that fructose may
adversely affect plasma lipids.
Therefore, the use of added fructose as
a sweetening agent in the diabetic diet
is not recommended. There is, however,
no reason to recommend that people with
American Diabetes Association & Sucrose
“Substantial evidence from clinical studies
demonstrates that dietary sucrose does
not increase glycemia more than
isocaloric amounts of starch. Thus, intake
of sucrose and sucrose-containing foods
by people with diabetes does not need
to be restricted because of concern
about aggravating hyperglycemia.
Sucrose can be substituted for other
carbohydrate sources in the meal plan
High Fructose Corn Syrup
CUT BACK
•
•
•
•
Not toxic, but large amounts may be unsafe
or promote bad nutrition.
HFCS not more harmful than sucrose
Consume too much of both
Large amounts increase TG’s-- increase risk of
heart disease
Large amounts may affect hormones insulin,
“
leptin, ghrelin—hormones
that regulate appetite,
increasing risk of wt. gain & obesity
Dietary Sugars Intake and Cardiovascular Health:
A Scientific Statement from the American Heart Association
“100 calories a day of added sugar = 6tsp/day”
Circulation 2009;120;1011-1020; originally published online Aug 24, 2009;
What’s really the problem with
fructose?
(from sucrose or HFCS)
Experimental Animal Studies w/Fructose
•
•
•
•
•
•
•
•
•
•
•
•
Fructose induces Metabolic Syndrome
Insulin Resistance
Elevated TG’s
Abdominal obesity
Elevated BP
Inflammation
Oxidative stress
Endothelial dysfunction
Microvascular disease
Hyperuricemia (Gout)
Glomerular hypertension (Renal disease)
Fatty liver
Metabolic Changes
NOT SEEN WITH GLUCOSE
Sanchez-Lozada L. AmJClinNutr 2008;88:1189-90
Rat Study: High Fructose Diet (30% calories)
• X 2 wks
– Insulin resistance (esp. in muscle—related to
accumulation of TG lipids in muscle)
– IGT
–  Body fat
–  Blood pressure
–  Triglycerides—esp. VLDL TG
–  Non-alcoholic fatty liver disease
Le KA. CurrOpClinNutr&MetabCare 2006;9:469-475
Experimental Animal Studies w/Fructose
•
•
•
•
•
•
•
•
•
•
•
•
Fructose induces Metabolic Syndrome
Insulin Resistance
Elevated TG’s
Abdominal obesity
Elevated BP
Inflammation
Oxidative stress
Endothelial dysfunction
Microvascular disease
Hyperuricemia (Gout)
Glomerular hypertension (Renal disease)
Fatty liver
Human studies?
Yes . . But not all.
Absolutely with  TG and Leptin
Havel P. Nutr Rev 2005;63(5):133-157
Daly M. AJCN 2003; 78(4):865s-872s
Bloomgarden Z. Diabetes Care 2004; 27(2):602-09
Insulin
Grehlin
Leptin
Fructose
Metabolism
**
What is unique about fructose (vs.
glucose)?
• Does not stimulate insulin release.
– Does not stimulate leptin release (a
hormone that signals satiety).
– Does not suppress grehlin release (an
appetite-stimulating hormone).
– Does not activate adipose tissue
lipoprotein lipase
What else is unique about fructose
(vs. glucose)?
These hormones are
very involved with
• Does not stimulate insulin release.
carbohydrate & lipid
metabolism and
• Does not stimulate leptin release (a
appetite regulation.
hormone that signals satiety).
• Does not suppress grehlin release
(an appetite-stimulating hormone).
**
Fructose
Metabolism
No controlled regulation of fatty
acid synthesis from fructose—
occurs rapidly & unchecked
 Adipose lipoprotein lipase . . So
reduced clearance of TG’s
Effects of Fructose or Sucrose
Consumption on Circulating
Lipids
• 18 small studies reviewed (n=5-15)
• Healthy or hyperinsulimic &/or
obese ♀♂
• Fed fructose or sucrose or
glucose—5-40% of energy x1-12
wks
• Results: dose dependent rise in TG
**
only
w/fructose or sucrose diet
Havel P. Nutr Rev
2005;63(5):133-157
2004 Teff Study: Fructose &
Leptin
Fructose
• 12 normal weight women—30%
kcals as fructose or glucose (45
AUC
insulin
leptin
grehlin
grams
glycemiaat each meal)—followed
hormone, etc. levels x 24hrs
 55%
 49%
 24%
 30%
Teff K. JClinEndo&Metab 2004; 89(6):2963-72
TG
 35%
2009 Teff Study
Fructose & TG’s in Insulin Resistant Adults
• 17 obese adults
• 30% kcals added fructose or glucose
leptin
grehlin
TG
xAUC
24hrs
glycemia a variety of hormones
• Measured
Fructose
 50 %
 30%
No
 200%
difference
Teff K. JClinEndoMetab 2009; doi:10.1210jc.2008-2192
Processing fructose
exhausts liver ATP
“A typical fructose meal can also
reduce ATP levels in vascular
endothelial cells . . . this actually
acts like a type of ischemia and can
cause transient arrest of protein
synthesis and increase production
of inflammatory proteins,
endothelial dysfunction and
Cirillo P. oxidative
Nephrol Dial Transplant
stress.”2009 24:1384-87
Fructose Stimulates Uric Acid Production
Johnson, RJ etal 2009: Endocrine Rev 30(1):96-116
Elevated Uric Acid: Beyond Gout
An independent predictor of:
• Hypertension
• Obesity
• Hyperinsulinemia, Insulin
resistance—(blocks the action of insulin),
Type 2 diabetes
• Renal disease
• Metabolic Syndrome
• Cardiovascular Disease (reduced
endothelial
nitric
oxide)
Johnson R. 2007
AmJClinNutr
86:899-906
Cirillo R. Nephrol Dial Transplant 2009: 24:1384-87
Association of Fructose to Metabolic Syndrome & Type 2 Diabetes
Johnson RJ. Endocrine Rev 2009; 30(1):96-116
Sugar Intake UK & USA kg/person
80 years 1700-2000
Johnson R. AJCN 2007;86:899-906
60
40
20
0
1700
1750
1800
1850
1900
1950
2000
Sugar Intake UK & USA kg/person
80 years 1700-2000
Johnson R. AJCN 2007;86:899-906
Problem:
Chronic 50 year
exposure to high and
increasing intakes of
sugar . . .
60
40
20
0
1700
1750
1800
1850
1900
1950
2000
What could be the problem with
“chronic” exposure to fructose?
• Body adapts to chronic exposure
– Increasing fructose transporters (GLUT
5)
– Increasing fructokinase (enzyme
responsible for converting to fatty
acids)
– As a result: even small amounts of
fructose will cause metabolic
abnormalities ( TG,  Uric Acid, 
insulin resistance, etc.)
Cindy’s thoughts:
South Beach Diet . . . Atkins Diet
...
When you eliminate the “enemy” .
. the army of transporters and
enzymes is no longer needed
Long Term Intake of Fructose
• Elevated fasting uric acid levels
(after only 2 weeks of high
fructose/sucrose intake)
• Dose-dependent relationship
Fructose up-regulates ins
transporter
(Glut 5) and fructokinase
• Fructose up-regulates its
transporter
(Glut 5) and fructokinase
• As a consequence . . .subjects
administered a high fructose diet
show an enhanced rise in uric acid
in response to a standard fructose
load
• Subjects w/Met Sx &/or fatty liver
**
NEW RESEARCH
“Consuming fructose-sweetened, not
glucose-sweetened, beverages
increases visceral adiposity and
lipids and decreases insulin
sensitivity in overweight/obese
humans.”
Stanhope KL. Etal. April 20, 2009. J.
**
NEW RESEARCH: Study
Design
• Double blind parallel arm study with
matched controls and 3 well
controlled phases==10 weeks total
• n=39, 40-72 yr old participants,
BMI=25-35
• 8 week intervention period—25%
daily energy from either glucose or
fructose sweetened beverage,
**
Results: % ChangesGlucose
from
Baseline
Body Weight
+1.8%
Fructose
+1.4%
Total body fat (kg)
+3.2%
+2.8%
Waist circumference
+1.7%
+1.9%
Total abdominal fat
+4.8%
+8.6%
Extraabdominal fat
+4.6%
+7.3%
Intraabdominal fat
+3.2%
+14%
**
Results: % ChangesGlucose
from
Baseline
Body Weight
+1.8%
Fructose
+1.4%
Total body fat (kg)
+3.2%
+2.8%
Waist circumference
+1.7%
+1.9%
Total abdominal fat
+4.8%
+8.6%
Extraabdominal fat
+4.6%
+7.3%
Intraabdominal fat
+3.2%
+14%
**
Results: % Changes from
Baseline
Glucose
Fructos
e
Fasting TG
+9.7%
+3.9%
TG area under curve
-32%
+99.2%
%
Glucose Results: TG Changes over 24 hrs
**
Glucose Results: TG Changes over 24 hrs
**
Fructose Results: TG Changes over 24 hrs
**
**
Results: Lipid Changes from
Baseline
Fasting TG
TG area under curve
Fasting LDL Cholesterol
Fasting sdLDL
Cholesterol
Fasting oxLDL
Cholesterol
Glucose
Fructos
e
+9.7%
-32%
+ 3.6%
+13.3%
+3.9%
+99.2%
+13.9%
+44.0%
+.7%
+12.8%
**
Changes from baseline:
Glucose, insulin, insulin sensitivity
Glucose
Fructos
e
-1.4%%
+2.9%
+5.3%
+10.2%
Glucose 3-h AUC OGTT +31.4%
%
+60.2%
Insulin Sensitivity index
-17.3%
Fasting Glucose
Fasting Insulin
+1.1%
**
Study Conclusions:
• In 10 weeks a 25% Fructose diet:
•  Abdominal visceral fat
•  small dense LDL & oxidized LDL
Chol
•  Total postprandial TG
•  Insulin levels
•  Insulin sensitivity
Stanhope KL. 2009. J. Clin. Invest. doi:10:1172JCI37385
More Fructose Thoughts
“ . . . urgent need for public awareness of the
risks associated with high fructose consumption
and greater efforts should be made to curb the
supplementation of packaged foods with high
fructose additives (including sucrose!).”
“ . . recent findings raise serious concern
regarding the deleterious effects of fructose and
its potential role in metabolic disorders .”
Basciano H. Nutrition & Metabolism 2005; 2(5):1-14
Le KA. CurrOpinClinNutrMetabCare 2006 9:469-75
***
Fructose: Review Articles
•
Johnson, R. Hypothesis: Could Excessive Fructose
Intake and Uric Acid Cause Type 2 Diabetes. Endocrine
Rev 2009; 30(1):96-116
•
Havel, Peter. Dietary Fructose: Implications for
Dysregulation of Energy Homeostasis and
Lipid/Carbohydrate Metabolism. Nutrition Reviews May
2005;63 (5):1331-57
•
Basciano, H. etal. Fructose, insulin resistnace, and
metabolic dyslipidemia. Nutrition & Metabolism Feb.
2005; 2(5):1-14
www.nutritionandmetabolism.com/content/2/1/5
•
Elliott, S. etal. Fructose, weight gain and the insulin
resistance syndrome. Am J Clin Nutr 2002;76:911-22
10% Added Sugar??
•
•
•
•
•
1600 calorie diet =
160 calories from added sugar
÷ 4kcals/gram =
40 grams sugar/day
= 10 tsp./day
Added Sugars
• 12 oz. pepsi
40g CHO
• ¼ c. pancake syrup
40g CHO
• 2 oz. snicker bar
CHO
• 2” square cake
40g CHO
• ¾ c. frosted cheerios
12g CHO
10 tsp
10 tsp
6 tsp
24g
10 tsp
3 tsp
5% added sugar from a “dessert”
and
5% added sugar from other foods
• 5 tsp from a dessert each day = 20
grams sugar . . . .maybe 150 calorie
dessert—2 inch brownie, 2 cookies,
½ c. ice cream?
• 5 tsp from other foods (crackers,
cereal, jam, etc.)
Translated for patients
• 150 calorie sweet each day if
desired (best to be limited)
• Most other food choices should not
have a sugar source listed on the
label.
**
What about artificial sweeteners?
• 0-150 calorie sweet each day if
desired (best to be limited—can be
sweetened with an artificial or
natural sweetener)
• Most other food choices should be
made without added natural or
artificial sweeteners.
“One small treat a
day . . . . . sweetened
with whatever you
want!”
“The Perfect Storm” → Diabesity
• Modern Western Diet/Lifestyle—associated most
chronic health diseases . . .
– High in fructose—from sucrose or HFCS
– High in damaged fats—trans fats & more
– Low in healthy fats—omega 3’s & more
– High in refined carbohydrates
– Low in veges, fruits, whole grains, etc.
– Low in body use/movement or exercise
Combination
of Captopril & Allopurinol Retards
The Answer:
Fructose-Induced Metabolic Syndrome “Combo
therapy might provide a superior means to prevent
diabetes and CVD.”
Roncal C. Am J Nephrol 2009;30:399-404
A Reduced Fructose Diet Retards Fructose-
Induced Metabolic Syndrome “Diet therapy
might provide a superior means to prevent
diabetes and CVD.”
Brinn C. SJH CVD Grand Rounds 2009
Promote:
“LifeStyle Medicine”
**
Hippocrates: Father of Medicine
“Let Food be thy Medicine . . . .and Medicine be thy Food.”
350 B.C.
Promote:
Profound healing benefits of
healthy foods . . .
Summary: 70% Reduction of Secondary Coronary Events:
It’s all about the Fat!
Cardiovascular Grand Rounds Feb. 2009
• “Eat fish often and/or take a fish oil
supplement daily—1 tsp fish oil or 3
extra strength fish oil supplements.
• Use extra virgin olive oil daily—
simmer in main dishes or add to
your salads.
• Eat 10-20 nuts daily—not roasted—
almonds or walnuts are the best
Summary: Sucrose, High Fructose Corn
Syrup
& Cardiovascular Disease
• Limit foods made with all sugars—
especially high fructose corn syrup
& sucrose
• Sugars are not “just empty calories”
• Sugars are becoming associated
with as much disease as
“cholesterol & saturated fats”
• Our bodies were not designed to
process so much fructose