Last month I threw together an infographic on the 12 Ways Fructose Destroys Your Body.  It’s a good summary, but the lawyer in my loves footnotes.  So here is the detail behind the claims that picture makes.  Well it’s the detail behind the last five of them.  You can read the detail behind the first seven here.

1.      Fructose destroys erectile function

Around 1 in 5 US men now suffer from erectile dysfunction.  But one of the more recent studies tells us that one in two men with Type II diabetes will suffer the problem.

We know exactly what causes most of it.  It is a lack of nitric oxide, the same beastie that prevents high blood pressure (see next point).  When its production is suppressed erectile function becomes seriously impaired.  Viagra, Levitra and Cialis work by temporarily encouraging the production of nitric oxide.

We know that the opposite of Viagra is uric acid.  It dramatically reacts with our home grown nitric oxide thereby effectively deactivating it.  If we have large amounts of uric acid in our bloodstream, we can expect our nitric oxide to be rendered ineffective.  No effective nitric oxide means no erectile function.

Nitric oxide is a muscle relaxant which allows all the relevant sphincter muscles to loosen their grip enough to encourage inbound arterial blood flow long enough to be useful (so to speak).

It should also then come as no particular surprise that erectile dysfunction is so closely aligned with the other symptoms of overindulging in fructose, namely heart disease, obesity and type II diabetes and that the number of men needing assistance is also increasing as rapidly as the incidence of those diseases.

Perhaps if sugar were renamed anti-Viagra people might think twice about consuming it?

2.      Fructose creates high blood pressure

Trial after trial conducted between 1972 and 2005 has shown that we’re twice as likely to suffer from hypertension (high blood pressure) if we have high uric acid levels. Because uric acid deactivates nitric oxide, the smooth muscle cells of our arterial walls are less relaxed and therefore more constricted.

This means that the diameter of our arteries is smaller than it might otherwise be, and our blood pressure is higher (as any plumber will tell you, a thinner pipe means higher pressure). Recent human studies have conclusively demonstrated that all you need to do to give healthy volunteers hypertension is feed them fructose.

The reason for all the interest is that there are drugs (drug companies have much deeper pockets for this kind of research) that can be used to lower uric acid levels. Recent human trials have shown that those drugs do indeed lower blood pressure, but the evidence is clear that there’s a much simpler preventative measure for all the conditions related to uric acid – kidney disease, gout and hypertension. Don’t eat or drink sugar.

3.      Fructose takes out your Heart

Throughout this section I refer to Heart Disease.  What I mean when I say that is all the diseases that are caused by Atherosclerosis (the blocking of arteries).  This group includes myocardial infarction (what most people call a heart attack), ischemic stroke and arterial thrombosis (the blocking of arteries in the limbs).  It affects all arteries but is most common in the big ones transporting the highest volume of blood, such as the ones near the heart and brain.

Some of the fat generated by fructose in the liver stays there (and causes the problems I set out in the last post), but the rest is exported into the bloodstream.  Because fat is not soluble in a water based solution like blood, it is transported by specialised proteins called lipoproteins (‘lipo’ is Greek for fat).

Lipoproteins come in a variety of sizes according to how much fat they can carry.  And scientists are now certain that having lots of large lipoproteins puts us in the lowest risk category for heart disease.  People like that are called ‘Pattern A.’  People who have lots of very small lipoproteins are called Pattern B and those people are the ones who are most likely to suffer from heart disease.

We use lipoproteins to transport the fat we eat as well as the fat we make from fructose. We know now that a diet high in saturated fat will produce Pattern A lipoproteins.  In other words, eating saturated fat lowers your risk of heart disease.  If you’re thinking this is the opposite of what we’ve been told for the last 50 years, you’re right.

We also now know that the most efficient way to convert someone from Pattern A (safe) to Pattern B (at risk) is to feed them fructose or put them on a low fat diet or, as many now do, both.  When we are fed fructose, the fat made from that fructose is exported from our liver in small dense lipoproteins.  Having more small dense lipoproteins converts you to Pattern B and sets you up for heart disease and stroke.

4.      Fructose makes you depressed (and anxious)

We can become depressed because things aren’t going well. If having your cat run over doesn’t alter your mood (one way or the other depending on how you feel about cats I guess) then you were probably built by aliens. But the science suggests how long we stay depressed has more to do with biochemistry than the state of Fluffy’s road-safety skills.

Food makes us happy (shocking, I know). Even seeing food improves our mood. This is because the anticipation of a feed, fires up the hormones responsible for how we feel. The sight (or smell) of food gives us a squirt of the pleasure hormone, dopamine. Dopamine focuses our attention, makes us think more clearly and helps us move faster and more effectively. It’s an important signal to our body that we are in for something good and we need to pay attention. And that was probably pretty handy in times gone by.  If you have to chase your food, being sharper was definitely an advantage.

Once we actually start eating, another hormone, serotonin kicks in. Serotonin is the ying to dopamine’s yang.  It’s our chill-out-all-is-good hormone. The serotonin makes us feel happier and less stressed. We relax, our mood improves (Fluffy will still be road kill, but we’ll feel better about it) and our minds can turn to less important things than eating.  Sex, another thing important for keeping humans around has exactly the same effect.  Anticipation produces dopamine and ‘achievement’ produces serotonin.

Researchers have known for a long time that severe depression is strongly associated with an inability to properly absorb serotonin in the brain. No (or low) serotonin absorption makes it much harder for us to come back from unhappiness. And this can translate into anxiety and depression if it’s sustained for long enough. The primary anti-depressant drugs available in Australia (Cipramil, Luvox, Prozac, Lovan, Aropax and Zoloft) all work by targeting the serotonin system. They give the brain more time to absorb the serotonin. Some other drugs (Ecstasy, Amphetamines and LSD) work by enhancing the amount of serotonin we produce (but you might find it tricky to get a prescription for them).

If all is well with our hormone system then severe depression should be an extremely rare disease. But it’s not. Depression is a major chronic health problem and it is getting much worse at a very rapid rate. Something is messing with our serotonin system and the evidence is starting to mount that the something is fructose. Fructose is the only carbohydrate which produces a significant spike in our cortisol levels. Cortisol is our stress hormone. It’s terribly handy for confrontations with unexpected bears (for example) because it ramps up dopamine (to focus the mind and sharpen the movements). It also rapidly increases the amount of dopamine we can absorb. But it does so at the expense of our ability to absorb serotonin.

We like dopamine. It is our reward drug. It tells us we are about to get good stuff (like food and sex). Frequent hits of fructose mean frequent hits of dopamine. This leads inevitably to fructose addiction and that is exactly the mechanism used by other man-made opiod drugs (like nicotine and cocaine). The trouble is that it seems the upregulating of dopamine at the expense of serotonin can become hard-wired if we allow it to go on for long enough. And once we’re addicted, we can’t help but let it go on for long enough.

We don’t run into that many bears on a daily basis (well, I don’t). Fructose was once about as common as a bear encounter, but is now embedded in almost every processed food we buy. And it has an addictive quality as powerful as nicotine.  We are now on a constant drip of fructose. That means we are on a constant cortisol (and therefore dopamine) high. This in turn continuously impairs our ability to absorb serotonin, the one substance that can turn our mood around. Fluffy will still become a bumper sticker if he chooses an inopportune moment to cross the freeway and that will probably be a downer. But the science is suggesting that how quickly (or if) we bounce back from that may depend on how much fructose we are eating.

5.      Fructose destroys your Brain

As well as destroying the brain with an acute event like stroke (see the previous section), fructose can destroy our brains more slowly by causing dementia.

For a long time, researchers have known there is a strong relationship between diabetes and dementia. Estimates have varied, but you are approximately two to four times as likely to have dementia if you also have diabetes or a history of insulin resistance (the precursor to Type II Diabetes discussed above). Now a bunch of Swedish twins are starting to put some real meat on the bones of the diabetes link.

Almost 14,000 twins participated in a recently published study. The twins were part of the Swedish twin registry and were all over the age of 65. Because they had provided health data to the registry throughout their lives, the researchers had excellent information about their health over a very long period.

Twins are great for this kind of work because when one becomes ill but the other doesn’t; large tracts of potentially irrelevant causes are eliminated. Clearly the twins share the same gene pool and (usually) have been raised in an identical environment. When dementia sets in early, as it increasingly is (15,000 Australians under the age of 65 now have dementia), the number of possible causes is narrowed further. The study proved beyond any doubt that diabetes is associated with dementia (at least in Swedish twins). Even more interestingly, they concluded that the longer you have had diabetes (or insulin resistance), the more likely you are to develop dementia. In a somewhat depressing footnote, the researchers suggest their estimate (that you are 125% more likely to become demented if you are diabetic) is probably a bit light on because so many diabetics die before they are old enough to notice they are losing their grip.

Research published a month after the twin study took the issue further and established a direct link between consuming sugar and ‘impaired cognitive function’. Almost 3,000 people suffering from Type II Diabetes, aged 55 years and older took part in that study. They were subjected to a battery of tests (part of a standardised set used for detecting early signs of dementia) designed to measure things such as how fast they performed calculations, how well they multi-tasked and the accuracy of their memory.

The researchers then compared the results of the tests to measures of each person’s average blood glucose reading over time. They found that there was a significant correlation between a person’s score on the tests and their blood sugar level. The higher the blood sugar level, the lower their score on all the tests. Just to put icing on the cake, the researchers noted that a one per cent rise in blood sugar takes you two whole years closer to dementia.

Persistently high blood sugar is caused by insulin resistance, which in turn is caused by over consumption of fructose.  And the research is clearly suggesting the next step in that deadly cascade is dementia.  Perhaps we should rename Alzheimer’s disease, Type III diabetes.

Last month I threw together an infographic on the 12 Ways Fructose Destroys Your Body.  It’s a good summary, but the lawyer in me loves footnotes.  So here is the detail behind the claims that picture makes.  Well, it’s the detail behind seven of them.  The rest will come in the next post on this topic.

1.    Fructose rots your teeth

The first part of your body that fructose touches is your teeth and they are usually the first to go in its path of destruction.

The statistics are clear. Populations exposed to sugar for the first time go from ‘background’ levels of decay (of around 4 cavities per 100 teeth) to ‘modern’ levels of around 24 cavities per 100 teeth. The mechanism is known and the science is uncontroversial. Not even Coca-Cola dares deny that sugar and tooth decay go together like peas and carrots.

Tooth decay is caused by bacteria called S. Mutans (Streptococcus Mutans). S. Mutans loves a good feed of sugar. And after it gets some, it produces lactic acid as a waste product. It’s that lactic acid that can do the damage to our teeth. But if the only sugar in our diet is glucose or carbohydrates that are converted to glucose, our saliva quickly neutralizes the acid and we regenerate any damaged enamel.  This means t0oth decay is kept to the minimum.

But, if there is some fructose available as well as glucose then through a quirk of evolutionary biology, S. Mutans can build itself a saliva proof home.  

We call this little anti-saliva shield, plaque. Plaque binds S. Mutans to each other and to the tooth enamel. It traps the lactic acid against the tooth surface, protects it against the waves of saliva and gives it time to eat through the enamel.

2.    Fructose inflames your gut

Our small intestine can become inflamed when toxic molecules normally attached to bacteria (endotoxins) escape through our intestinal walls and into our bloodstream.  Our immune system has an inflammation reaction to endotoxins.

Binge drinking alcohol will produce exactly that effect.  Unfortunately so will overconsumption of fructose.  If you drink alcohol all day every day then fructose will not be noticeably adding to the problem, but if you are like most people and your daily poison choice is sugar, then it is probably responsible for your inflamed gut.

Unfortunately both alcohol and fructose also appear to increase the populations of bacteria which produce endotoxins in our intestines (something charmingly termed bacterial overgrowth). So we get the double whammy of more endotoxins in our gut and doors left ajar (gut permeability) to let them into our bloodstream.

3.    Fructose destroys your liver

After absorbed fructose hits your bloodstream, next stop is the liver.  We are adapted to a diet where most carbohydrates are glucose or glucose based.  So we have exquisitely finely tuned feedback loops which tell us we are full when we’ve taken on enough glucose.

Those loops don’t fire for fructose, so our liver will merrily convert any that it finds straight into fat.  That fat is stored in the liver and exported into our bloodstream.   Because we all have such a high fructose diet more than a third of Adults now have (NAFLD) Non Alcoholic Fatty Liver Disease as a result. NAFLD can then progress through various disease stages and ultimately end in cirrhosis requiring a liver transplant.

By the way there is interesting speculation that the trigger for converting mere fatty liver into cirrhosis is an immune response to endotoxins leaking from the gut.

4.    Fructose takes out your pancreas (and your eyes and limbs)

Our bodies convert most carbohydrates to glucose. In healthy people that glucose is pumped out to the cells that need energy via our bloodstream. Cells that need energy, signal their desires by moving glucose receptors to the cell surface (kinda like hanging out the “this room needs servicing” sign in a hotel).

But when fructose-fat accumulates in the liver and bloodstream, it affects something called insulin sensitivity.  The receptors never get to the cell surface (or if they do, it’s in smaller numbers). The result is that the glucose goes sailing by. The maid doesn’t know the room needs her and our bodies starve in a sea of food.

Because the glucose doesn’t get used by the cells (or not as many of them), it stays in the bloodstream longer and the result is a longer than normal high blood sugar concentration.  This is called insulin resistance or pre-diabetes.

Our body usually responds to insulin resistance by pumping up the insulin levels until the glucose is cleared.  If we ask our body to run on overdrive like that for years, for most of us, our pancreas (the insulin maker) will pack it in and we will need to get daily insulin injections to live.  Along the way, the persistent high blood glucose will result in blindness and limb amputations for many sufferers.

5.    Fructose makes us fat

Our appetite control hormones are exquisitely balanced to ensure we have just the right amount of energy on hand.

But when that balance is disrupted, our fuel management system can veer wildly out of control. A disrupted appetite control system can store too little or too much fuel. Too little looks like anorexia, too much looks like, well, most of us. Obesity is a symptom of a failure of the balance of hormones controlling how much food we take in.

When the pancreas attempts to cope with elevated blood glucose (caused by fructose derived fat) by ramping up insulin, it is only fixing the immediate problem. All that extra insulin doesn’t make the damaged cells any less insulin resistant, it just means that undamaged cells use the insulin to make fat.  In other words the blood glucose is cleared from the bloodstream by making us fatter.

Just for good measure, fructose also interferes directly with leptin signalling.  Leptin is our long term energy storage hormone, the one that tells us not to eat between meals.  Fructose makes us less sensitive to that hormone and as a result we eat more of everything.

This double dose of hormone dysfunction causes us to store too much fat in our cells, but the body is not aware the fat is there and keeps demanding food. Our appetite control system thinks we are starving even while we have more than enough fat being packed away (usually in very unsightly places).

When an obese person restricts the amount of food they eat, they are not changing the underlying error in the appetite control system. The body thought it was starving before the diet, now it’s really starving. It will not use the fat store to satisfy its need for food because the hormonal disruption means it doesn’t even know it’s there.

The hormones will force the body to sacrifice muscle and even organs to make up for the missing calories. And the whole time, the dieter will feel like they are starving to death.

6 & 7. Fructose messes up your kidneys (and gives you gout)

When fructose is converted to fat by our liver, a significant amount of a waste product called uric acid is produced.  Our kidneys are our built in pool filter for removing waste products like uric acid.  But they can be overwhelmed by the quantities that will be produced by the amount of fructose in the modern diet.  When that happens our kidneys start to fail.  And this is likely to be why excess uric acid has been associated with significant increases in kidney disease in a long line of rat studies and more recently in human trials.

Kidney disease is massively debilitating. The only effective ‘treatment’ is getting hooked up to a dialysis machine three times a week. Meanwhile the number of people needing that treatment is growing at the rate of 6 per cent every year. The only ‘cure’ is replacing the kidneys (if you’re lucky enough to get to the head of the transplant queue (currently the wait is about four years) before you die.

A side effect of that failure to remove uric acid is that it accumulates in the joints of the feet and ankles, causing a form of acute arthritis called gout.  If you suffer from gout, then it might be time to get your kidney function tested.

And that’s the first 7 ways fructose wrecks your body and health.  I’ll detail more in the next post, but if you want a preview check out my infographic – 12 Ways Fructose Destroys Your body.

In the early 1800s the average person ate about 1.3 teaspoons of sugar a day.  Now the average person eats somewhere between 35 and 45 teaspoons of sugar a day. But the irony is that the modern adult probably thinks they barely eat any at all.  Our food supply has been so completely and totally polluted with sugar, that it is almost impossible to buy packaged food that doesn’t contain it.

One half of that sugar tsunami is a substance called fructose. It doesn’t matter whether the sugar is made from corn (called High Fructose Corn Syrup), beets (called Beet Sugar) or cane (called Cane Sugar or often just Sugar), it is all half glucose and half fructose.  And because we have never before in our evolutionary history as a species been exposed to significant quantities of fructose, our bodies are incredibly poorly adapted to dealing with it.

Consume serious quantities (like that contained in 35-45 teaspoons of sugar a day) and the chronic diseases caused by the maladaptation start to pile up.  The picture above shows the 12 biggest disease states that science has currently linked to fructose consumption.

One in every 250 Australians suffer from a severely debilitating disease but no-one (especially those who have it) dare to speak its name. The annual rate of new diagnoses has at least tripled since 1990 and hospitilisations caused by it have doubled in the last decade alone. This is a disease which is clearly out of control but the worst news is that it is likely to be just the proverbial canary in the coal-mine for much worse epidemics lurking in the background.

IBD (Inflammatory Bowel Disease) is chronic inflammation of the bowel and lumps together two main diseases, Ulcerative Colitis and Crohn’s Disease. IBD is a life-long condition that is generally first diagnosed between the ages of 15 and 40. The chronic inflammation results in recurrent bouts of abdominal pain, diarrhoea, vomiting, fever, weight loss and rectal bleeding.

Doctors are careful to distinguish IBD from IBS (irritable bowel syndrome). IBS is characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits but no bowel abnormalities are detectable using routine clinical testing. Evidence is however beginning to emerge that suggests that IBS may in fact be a low-level pre-cursor to IBD.

Needless to say, IBD has a significant impact on a sufferer’s emotional well-being and it’s something they generally like to keep very much to themselves. Most will suffer enormous discomfort for most of their lives and just try to soldier on. But a person experiencing a ‘flare’ of the symptoms requires near-continuous care. And hospitilisation and surgery is often required. In 2010, over 27,000 hospilitizations occurred for IBD treatment in Australia. A decade earlier there had been just 13,000.

IBD is caused by the body’s immune system attacking the bowel. The standard treatment is to prescribe anti-inflammatory (immune suppressing) drugs. Beyond that, the official position is that IBD is idiopathic (meaning we don’t know what causes it or therefore how to cure it other than by chopping out bits of inflamed bowel).

Our intestine is a glorious piece of machinery. Its job is to extract every bit of stuff we can use from whatever we shove in our gob and avoid any nasty bacteria while doing it. In order to perform this magic trick we have specialist filtering cells that extract the good stuff and drop it into our lymphatic system (fats) or our blood stream (everything else). To do this we need an enormous surface area in contact with potential food. If we uncrinkled it all, our intestine would have the surface area of a football field. With all that space to cover, our immune system naturally concentrates a lot of its resources on defending the parts of our gut responsible for absorbing stuff from the outside world.

We know that IBD is not an auto-immune disease. It is not the body attacking itself. It is our immune system reacting to a foreign body. That reaction, the inflammation response, is our body’s way of defending itself against agents of harm from the outside world.

One of the key shortcuts our immune system uses is to react viciously to something called endotoxins. An endotoxin is a key part of the cell membrane of some of the nastiest critters in the bacterial world. Cholera, Salmonella, Helicobacter (responsible for stomach ulcers and cancers), Legionella, Gonorrhea and Meningococcus are among the very long list of bacteria who carry endotoxins. So it won’t come as a surprise that our immune system goes on high alert when it spots an endotoxin in our bloodstream.

The correct number of endotoxins in our blood is zero. If the number in the blood stream is any higher than that then we know there is a problem with our gut. The gut is usually impermeable to endotoxins, but it can become ‘leaky’, that is, it can become more permeable to endotoxins and they can start to leak through into our bloodstream.

We know that three very common substances will cause our gut to become more permeable, fish oil, alcohol and fructose. Animal studies have convincingly shown fish oil to increase endotoxin leakage into the bloodstream. And animal and human studies have also shown that both acute bingeing and long term exposure to both alcohol and fructose will increase (up to 20-fold) the amount of endotoxin in our blood. Unfortunately both alcohol and fructose also appear to increase the populations of bacteria which produce endotoxins in our intestines (something charmingly termed bacterial overgrowth). So we get the double whammy of more endotoxins in our gut and doors left ajar (gut permeability) to let them into our bloodstream.

These endotoxins of course send our immune system into a killing frenzy which we experience as inflammation of the intestinal tract. We also know that just like any other inflammation response it is made worse if we are consuming too much omega-6 fats found in seed oils (vegetable oils).

Much more disturbingly, the inflammation response does not end at the intestine. First stop for portal blood after the intestine is the liver and there is convincing research which tells us that our inflammation response to endotoxins is what converts a ‘mere’ fatty liver (caused by overconsumption of fructose) to an inflamed fatty liver (steatohepatitis).  Worse than that, it is looking increasingly likely that our immune response to endotoxins is implicated in a raft of diseases associated with inflammation in other organs (such as the heart, pancreas and kidneys).

Alcoholic Fatty Liver Disease now affects 6,203 people but Non-Alcoholic Fatty Liver Disease afflicts a massive 5,538,677 Australians. Even more worryingly, up to 13% of Australian children now have this chronic liver disease. If those numbers are anything to go by, we’re bingeing an awful lot more on fructose (or fish oil) than we are on alcohol. So when we go hunting for the cause of the massive rise in IBD in Australia, I’d be looking in the breakfast cereal, health food and soft drink aisles a long time before I’d be checking out the bottle shop.

When we suffer the symptoms of IBS and quite possibly, eventually, IBD. It is our gut sending us a message. It is saying you are consuming too much fructose (or in rarer cases, alcohol or fish oil). It is the visible warning that far more scary things are going on in organs that don’t throw off symptoms (until it is way too late). So if you are getting those messages from your gut – listen.

IBD is a life sentence of debilitation. It won’t kill you but it will make every part of your life awful from your mid-teens onwards. The science suggests the fastest, bestest, way to avoid it is to not binge on fructose (or booze or fish oil). The only problem with that is that the processed food industry is lacing everything we eat with fructose and just for good measure chucking in a pile of seed oils (vegetable oils) loaded with omega-6 fats to ramp up our inflammation response. Pay attention to what you eat, or preferably construct it yourself from basic ingredients and you will be a long way towards not suffering the horror story which is IBD.

Image courtesy of Ambro / FreeDigitalPhotos.net