The Startling Link Between Sugar and Alzheimer’s

Olga Khazan wrote . . . . . . . . .

In recent years, Alzheimer’s disease has occasionally been referred to as “type 3” diabetes, though that moniker doesn’t make much sense. After all, though they share a problem with insulin, type 1 diabetes is an autoimmune disease, and type 2 diabetes is a chronic disease caused by diet. Instead of another type of diabetes, it’s increasingly looking like Alzheimer’s is another potential side effect of a sugary, Western-style diet.

In some cases, the path from sugar to Alzheimer’s leads through type 2 diabetes, but as a new study and others show, that’s not always the case.

A longitudinal study, published Thursday in the journal Diabetologia, followed 5,189 people over 10 years and found that people with high blood sugar had a faster rate of cognitive decline than those with normal blood sugar—whether or not their blood-sugar level technically made them diabetic. In other words, the higher the blood sugar, the faster the cognitive decline.

“Dementia is one of the most prevalent psychiatric conditions strongly associated with poor quality of later life,” said the lead author, Wuxiang Xie at Imperial College London, via email. “Currently, dementia is not curable, which makes it very important to study risk factors.”

Melissa Schilling, a professor at New York University, performed her own review of studies connecting diabetes to Alzheimer’s in 2016. She sought to reconcile two confusing trends. People who have type 2 diabetes are about twice as likely to get Alzheimer’s, and people who have diabetes and are treated with insulin are also more likely to get Alzheimer’s, suggesting elevated insulin plays a role in Alzheimer’s. In fact, many studies have found that elevated insulin, or “hyperinsulinemia,” significantly increases your risk of Alzheimer’s. On the other hand, people with type 1 diabetes, who don’t make insulin at all, are also thought to have a higher risk of Alzheimer’s. How could these both be true?

Schilling posits this happens because of the insulin-degrading enzyme, a product of insulin that breaks down both insulin and amyloid proteins in the brain—the same proteins that clump up and lead to Alzheimer’s disease. People who don’t have enough insulin, like those whose bodies’ ability to produce insulin has been tapped out by diabetes, aren’t going to make enough of this enzyme to break up those brain clumps. Meanwhile, in people who use insulin to treat their diabetes and end up with a surplus of insulin, most of this enzyme gets used up breaking that insulin down, leaving not enough enzyme to address those amyloid brain clumps.

According to Schilling, this can happen even in people who don’t have diabetes yet—who are in a state known as “prediabetes.” It simply means your blood sugar is higher than normal, and it’s something that affects roughly 86 million Americans.

Schilling is not primarily a medical researcher; she’s just interested in the topic. But Rosebud Roberts, a professor of epidemiology and neurology at the Mayo Clinic, agreed with her interpretation.

In a 2012 study, Roberts broke nearly 1,000 people down into four groups based on how much of their diet came from carbohydrates. The group that ate the most carbs had an 80 percent higher chance of developing mild cognitive impairment—a pit stop on the way to dementia—than those who ate the smallest amount of carbs. People with mild cognitive impairment, or MCI, can dress and feed themselves, but they have trouble with more complex tasks. Intervening in MCI can help prevent dementia.

Rebecca Gottesman, a professor of neurology at Johns Hopkins, cautions that the findings on carbs aren’t as well-established as those on diabetes. “It’s hard to be sure at this stage, what an ‘ideal’ diet would look like,” she said. “There’s a suggestion that a Mediterranean diet, for example, may be good for brain health.”

But she says there are several theories out there to explain the connection between high blood sugar and dementia. Diabetes can also weaken the blood vessels, which increases the likelihood that you’ll have ministrokes in the brain, causing various forms of dementia. A high intake of simple sugars can make cells, including those in the brain, insulin resistant, which could cause the brain cells to die. Meanwhile, eating too much in general can cause obesity. The extra fat in obese people releases cytokines, or inflammatory proteins that can also contribute to cognitive deterioration, Roberts said. In one study by Gottesman, obesity doubled a person’s risk of having elevated amyloid proteins in their brains later in life.

Roberts said that people with type 1 diabetes are mainly only at risk if their insulin is so poorly controlled that they have hypoglycemic episodes. But even people who don’t have any kind of diabetes should watch their sugar intake, she said.

“Just because you don’t have type 2 diabetes doesn’t mean you can eat whatever carbs you want,” she said. “Especially if you’re not active.” What we eat, she added, is “a big factor in maintaining control of our destiny.” Roberts said this new study by Xie is interesting because it also shows an association between prediabetes and cognitive decline.

That’s an important point that often gets forgotten in discussions of Alzheimer’s. It’s such a horrible disease that it can be tempting to dismiss it as inevitable. And, of course, there are genetic and other, non-nutritional factors that contribute to its progression. But, as these and other researchers point out, decisions we make about food are one risk factor we can control. And it’s starting to look like decisions we make while we’re still relatively young can affect our future cognitive health.

“Alzheimer’s is like a slow-burning fire that you don’t see when it starts,” Schilling said. It takes time for clumps to form and for cognition to begin to deteriorate. “By the time you see the signs, it’s way too late to put out the fire.”

Source: The Atlantic

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WHO Says Baby Food Has Too Much Sugar And Is Marketed Wrongly

Sarah Boseley wrote . . . . . . . . .

Commercial baby foods contain too much sugar – even when they are labelled as savoury meals, says the World Health Organization, which is seeking a ban on added sugars in foods for children under 36 months old.

WHO Europe is calling for a crackdown on the high levels of sugar in the diet of babies fed on commercially available foods, warning that their first teeth may suffer and they are at risk of developing a preference for sweet foods, which may lead to overweight and obesity-related disease in adulthood.

It also says sugar-laden baby foods are being inappropriately marketed for babies under the age of six months, even though the WHO recommends exclusive breastfeeding up to that age.

An analysis from WHO Europe of what was for sale in the UK, Denmark and Spain in 2016-17 showed that commercially available baby foods generally complied with guidance on salt, protein, fat and carbohydrate, but many products were high in sugar.

Sugars accounted for 70% of the food calories in fruit purees, but the purees were also added to savoury meals. “Many savoury type meals sold in the United Kingdom and Denmark derived over 15% energy from total sugars, with fruit purée providing much of the sugar content even in ostensibly savoury products,” said the WHO report.

These can be considered free sugars, just as they are in fruit juice, and if eaten frequently “may pose a threat to the very young as first teeth erupt”. The sweetness may also influence the child’s food preferences as they grow up, said the report.

The report, described as a discussion paper, sets out WHO Europe’s recommendations for a “nutrient profile model” for baby foods.

The WHO says all added sugars, including fruit juice concentrate, should be banned from all commercial baby foods. No foods should contain more than 5% of pureed fruit by total weight, particularly in savoury foods. Dry savoury snack foods, such as biscuits, should not have more than 15% of calories supplied by sugar.

Fruit drinks and juices, sweetened cows’ milk and milk alternatives, confectionery and sweet snacks should not be marketed as suitable for infants and young children up to 36 months.

The WHO says the labelling of sugar in baby foods needs improvement. Many baby foods in the UK have misleading labels, it says. Cow & Gate’s butternut squash, chicken and pasta for babies from seven months does not name the largest vegetable component, while chicken is only 9.5%. It suggests it should be renamed “Tomato pasta with butternut squash and chicken”. Heinz strawberry, raspberry and banana puree sold for babies from four months does not have the main ingredient in the name. It should be called concentrated apple puree (79%) with banana (8%) and raspberry (5%), it suggests.

The lead author, Dr João Breda, head of the WHO European office for prevention and control of noncommunicable diseases, said they were very concerned about the high levels of sugar in baby foods and the labelling of products.

“In these commercial products we found a very significant amount have added sugar,” he said. “There is way too much sugar. Added sugar in many products should be eliminated, in our view. The total amount of sugar is also too high in many products. And we have issues with marketing. A lot of products are marketed as suitable at four months and under six months, totally against the WHO guidelines.”

Although babies like the sweetness of breast milk, it was important to let them explore different tastes after six months, he said. “We are talking about diversification of the diet at six months. It is really crucial you have products that are not only sweet products. If babies are exposed to different tastes from the beginning, they will be more willing to try other things.”

He said there was already a move to reformulate these products in the food industry, which he hoped governments would encourage.

A second report finds widespread inappropriate promotion of commercial baby foods in four countries – Austria, Bulgaria, Hungary and Israel, all of which are in the WHO’s Europe region – even though guidance on the claims that can be made was agreed in 2016.

Across all four countries, 28% to 60% of baby foods were marketed as suitable for under six months, in violation of the WHO’s code. The agency recommends exclusive breastfeeding up to six months. Between a third and three-quarters of products made health claims, which are also not allowed under the guidelines, and 16% to 53% had cartoon characters on the labelling, which is not recommended because it encourages “pester power” in children. Sweet flavours predominated in the products.

Source: The Guardian

Why Fad Diets Are Wrong about Sugar in Fruit

Carrie Dennett wrote . . . . . . . . .

In recent months, my dietitian colleagues and I have been encountering more and more people making claims like “fruit is bad for you” or “fruit is toxic”. “What is going ON?” one of them posted on a dietitian internet mailing list. What’s going on is that the current crop of fad diets – such as paleo, keto, carnivore and pegan – have persuaded a lot of people that fruit is a dietary no-no.

There was a time when we didn’t question whether fruit was good for us, when we more or less took “eat your fruits and veggies” to heart. Today, many people are worried that fruit is too high in carbs, sugar and calories.

One of my patients wouldn’t eat any fruit other than blueberries because she had bought into the myth – again, promoted by fad diets – that blueberries are the only “safe” fruit to eat because they are “low glycemic” (in other words, they don’t cause your blood sugar to spike). Here’s the kicker: she didn’t even like blueberries.

Berries are the only fruit allowed on the pegan diet, a mash-up of paleo and vegan diets – the subtext being that other fruit is a ticket to high blood sugar. This, believe it or not, is a fairly liberal stance compared to other trending diets. For example, many followers of the keto diet and the carnivore diet (aka the “zero carb” diet) call fruit toxic because of its sugar. Now that’s what I consider disordered eating.

It’s true that whole fruit contains sugar, but it is natural sugar. The sugar we would be wise to limit is added sugar, found in regular soda and many highly processed foods. When you eat an apple, a pear, a peach or some berries, their sugar comes wrapped in a fibre-, water- and nutrient-rich package. Fibre slows the release of fruit’s natural sugar into your bloodstream, preventing a sugar spike, especially if you eat your fruit as part of a meal or snack that contains protein and healthy fats.

Ditching fruit may mean missing out on some key nutrients. Many fruits are rich in not just vitamins and minerals but also phytochemicals, which are natural plant-based compounds that appear to have a variety of health benefits, including helping to prevent cancer and promote cardiovascular health. Pigment-rich berries and cherries are especially good sources of phytochemicals, but apples, oranges and other fruits contain phytochemicals, too.

Some of my older patients have adopted the blueberries-only rule because of preliminary research on the Mind diet – a hybrid of the Mediterranean diet and the Dash diet. This research found an association between eating blueberries and a lower risk of Alzheimer’s disease – likely because blueberries are rich in a type of phytochemical called anthocyanins. Other fruit was found to be “neutral”, meaning it appeared to neither increase nor decrease risk of Alzheimer’s – but somehow, the information has been twisted to make patients think they should avoid all fruit except berries.

This is unfortunate because even if clinical research confirms that non-berry fruit doesn’t help prevent Alzheimer’s, such fruit may still help prevent other chronic diseases we would all like to avoid. A study published in the March issue of the Journal of the Academy of Nutrition and Dietetics, for example, found that moderate fruit intake was associated with a lower risk of heart disease, stroke, Type 2 diabetes, several cancers and other chronic health conditions.

The bottom line is that fruit – especially when in season – adds pleasure, nutrition and variety to our meals

What about juice? Juice has been vilified (likened to soda but with more nutrients) or glorified (consumed freely because of those nutrients). While drinking juice every time we’re thirsty isn’t a good idea, 100 per cent fruit juice in moderation – an eight-ounce (237ml) glass per day – adds nutritional value to the diet without adding excessive sugar. Orange juice, in particular, does not appear to affect blood sugar, possibly because of the soluble fibre and pectin that makes it into the glass, as well as the phytochemical hesperidin.

Fears about pesticide residues on fruit have also made some people wary about eating non-organic fruit – even though organic agriculture does use approved pesticides, and traces of non-approved pesticides are regularly found on organic produce.

Fears about pesticides tend to get stirred up each year when the Environmental Working Group, a Washington-based non-profit activist organisation, releases its “Dirty Dozen” list of “most contaminated” fruits and vegetables. But the EWG’s methods have come under fire, and it is important to remember that even if a specific type of produce has “more” pesticide residue than another type, that residue could be well within levels determined to be safe.

Frankly, fruit doesn’t deserve the bad reputation it’s developing; it is the healthiest sweet around. We naturally like the taste of it because we are born with an affinity for sweetness.

So, how much fruit should you eat? That depends on your age, gender and level of physical activity. Two cups (256g) per day is the US Dietary Guidelines’ recommendation for men and younger women; the recommendation drops to 1½ cups (192g) for women older than 30. If you get more than 30 minutes per day of moderate-intensity exercise, you may choose to include more.

The bottom line is that fruit – especially when in season – adds pleasure, nutrition and variety to our meals. So go beyond plopping some berries in your cereal or yogurt: have an orange with your scrambled tofu, an apple with your almonds, a juicy peach for dessert. You’ll be happier – and healthier.

Source: SCMP

Not All Sugars Are Created Equal

When it comes to sugars in food, you’re far better off having a bowl of blueberries than a granola bar, a nutritionist says.

Added sugars just aren’t the same as natural sugars, noted Kara Shifler Bowers, a registered dietitian at Penn State PRO Wellness, a health center in Hershey, Pa.

“Natural sugars in fruit are different because fruits carry fiber as well as many antioxidants and vitamins such as A and C,” she explained in a Penn State Health news release.

Cutting back on added sugars can prevent a number of health problems.

Women should consume no more than 6 teaspoons (25 grams) of added sugar each day. That’s equal to just two-thirds of a can of soda or 1.5 dessert-like yogurts. For men, the limit is 9 teaspoons, or 36 grams.

“The only danger in cutting out added sugars completely is that eventually, one may binge,” Shifler Bowers said.

Instead of suddenly eliminating added sugars, it might be a good idea to cut back gradually. Try limiting sugary sweets to special occasions.

“You crave what you eat,” Shifler Bowers said. “Your body can forget about foods, so to speak, so the longer you abstain from them, the easier it will be. You can still enjoy them at times, but you won’t need to eat the same amount.”

Watch what you eat because even seemingly healthy choices such as yogurt, fiber bars, protein bars and store-bought spaghetti sauce can have high levels of added sugars.

“In granola bars, the sugars help ingredients stick together,” Shifler Bowers said. “In spaghetti sauce, sugars are used to cut the acidity. Try snacking on fruit and nuts instead.”

Parents should wait as long as possible to introduce children to sugar, even sugar in juices.

“Their taste buds are still developing, so if they get used to sweet foods, that is what they are going to want to eat as they get older,” Shifler Bowers said.

Children aged 1 to 3 should have no more than 4 ounces of fruit juice a day.

“It’s really easy to consume a lot of sugar when drinking sweet beverages. Instead of juice, try offering children fruit such as melons or berries instead, so they get plenty of fiber,” Shifler Bowers said.

Source: HealthDay

Opinion: Canada Diverges from U.S. on Sugar Substitutes in New Food Guide

Christy Brissette wrote . . . . . . . . .

As a Canadian dietitian who works and lives in the United States, I like to keep up with health policy in both countries. So, I was quite interested to see Health Canada, the governmental agency responsible for public health, is charting a new course when it comes to dietary advice, particularly in the area of sugar substitutes. It’s a track that sharply diverges from the U.S.

In a significant departure from the past as well as from the U.S. approach, Canada’s new food and dietary guidelines, released this year, say zerocalorie or low-calorie sugar substitutes are not necessary or helpful. “Sugar substitutes do not need to be consumed to reduce the intake of free sugars,” the guidelines say, adding that because “there are no well-established health benefits associated with the intake of sweeteners, nutritious foods and beverages that are unsweetened should be promoted instead.”

In contrast, the 2015-2020 Dietary Guidelines for Americans (DGAs), issued by the U.S. Agriculture and Health and Human Services departments, suggest sugar substitutes may have a place in helping people consume fewer calories, at least in the short term, though “questions remain about their effectiveness as a long-term weight-management strategy.” The guidelines neither encourage nor discourage usage.

The differences may seem subtle, but dietary guidelines in each country are used to shape what is served at public institutions such as schools and are what many health-care professionals base their recommendations on. Language matters. But before we try to explain the difference in advice, let’s have a quick primer on sugar substitutes.

Sugar substitutes include many categories, such as high-intensity sweeteners at least 100 times as sweet as sugar. They can be “artificial,” such as aspartame and saccharin, or “natural,” such as stevia and monk fruit. They can contain a negligible number of calories or be classified as low-calorie sweeteners, such as sugar alcohols.

In much of the research and in most policy documents, sugar substitutes are often discussed as a single category rather than a heterogenous group of compounds. This makes it challenging to know whether certain types are preferable.

Most concern seems to focus on artificial sweeteners. Six are approved by the U.S. Food and Drug Administration as ingredients in foods and drinks and as table sweeteners people can add themselves. You’ll find artificial sweeteners in a range of foods and drinks, including light yogurt, diet sodas, protein bars and chewing gum, as well as baked goods and frozen desserts. Carbonated drinks are the top source of artificial sweeteners in the American diet.

Research suggests stevia and monk fruit, the natural sugar substitutes, are safe for human consumption, though it’s not clear they lead to weight loss. There has been conflicting research, however, about the safety of artificial sweeteners. Some studies have suggested artificial sweeteners could increase the risk of Type 2 diabetes, heart disease, kidney disease and cancer, and may have a negative influence on the microbiome and mental health.

For example, research based on data from 37,716 men from the Health Professional’s Follow-up study and 80,647 women from the Nurses’ Health study published in Circulation last month found consuming artificially sweetened beverages is associated with a greater risk of death as well as death from heart disease. The risk was found specifically for women consuming four or more servings of artificially sweetened beverages a day. The authors say this finding needs to be confirmed by future research, but it does raise questions about whether artificial sweeteners are necessary — or should be recommended at all. As for the U.S. contention sugar substitutes might help people cut back on calories and sugar to improve their health or lose weight — that seems doubtful. A review by the non-profit research foundation Cochrane, conducted for the World Health Organization, examined 56 studies into the effects

of sugar substitutes on health. It found there is no evidence sugar substitutes provide any benefit — and may even have some risks. An analysis of U.S. dietary intake from 2003 to 2004 shows people tend to add artificial sweeteners to their diets rather than replacing sugary foods and beverages with them.

The same seems to be true for children. This month, research published in the Pediatric Obesity journal revealed in U.S. children, drinking artificially sweetened beverages is associated with consuming more calories and sugar.

U.S. and Canadian health officials are looking at the same research and have populations with similar health issues. So, why the difference in guidelines regarding sugar substitutes?

The new Canadian approach seems to be if a food or beverage doesn’t have a demonstrated health benefit, it doesn’t belong. Their 2019 guidelines suggest people’s tastebuds will adapt to lesssweet tastes when they reduce their consumption of sweetened foods and beverages — and using high-intensity sweeteners delays that process.

This is a marked change from Canada’s last dietary guidelines, released in 2007, which advised the general population to consume sugar substitutes in moderation and to cut back on them if they noticed any digestive symptoms such as gas and bloating.

The new Canadian recommendations may seem tougher, but I see them as being clearer and something for people to aspire to. The U.S. view seems to be focused on encouraging health behaviours thought to be more achievable.

Alice H. Lichtenstein, a professor of nutrition science and policy at Tufts University and member of the 2015-2020 DGA committee, seems skeptical of an all-or-nothing approach to sugar substitutes. She expressed her stance in an editorial in Circulation, responding to the study that said consuming artificially sweetened beverages is associated with a greater risk of death. “To a certain extent, as a community, we can take the high road about beverage recommendations: drink water (or flavoured water) in place of (sugar-sweetened beverages). However, continuing this simple approach would be disingenuous because we know that it has not worked well in the past and there is little reason to expect that it will work well in the future.”

A 2018 advisory from the American Heart Association also takes a more middle-ground approach to sugar substitutes than Canada’s, stating they can play a role in helping people to reduce the amount of sugar-sweetened beverages they’re drinking. The advisory also says beverages containing low-calorie sweeteners could be especially useful for people who are used to sweetness and find water unappealing at first.

I found one hint the viewpoint in the United States might be changing. Last month, the American Diabetes Association released a nutrition consensus report that recommends water replace sugar-sweetened beverages. If sugar substitutes are used, the report says, people should receive nutrition counselling to help them avoid replacing the calories and carbohydrates with food.

The authors also note any proposed advantages to sugar substitutes haven’t been proven, and there could be potential adverse effects.

Source: Winnipeg Free Press