Alcohol is Anti-Inflammatory, but …

I was trying to be good as I celebrated a friend’s birthday last night.  Didn’t touch the French bread, didn’t succumb to the pasta, and steadfastly resisted the cake, but everybody knows that dry red wines are healthy … and I was feeling very healthy as they began to pour the second bottle.

The truth is that alcohol is anti-inflammatory and the relationship between alcohol consumption and the tendency to have an elevated C-reactive protein number (a measure of inflammation) is a mildly U-shaped curve.  Those that abstain completely from alcohol tend to have a higher CRP than those who drink lightly or moderately.  It is only when one drinks excessive quantities of alcohol that CRP begins to rise.  This anti-inflammatory effect is believed to be the reason that light to moderate alcohol consumption has been shown statistically to be somewhat cardio-protective.  So, drink up, right?

Hate to spoil the party, folks, but there is another side to alcohol.  Alcohol is a hepatotoxin that messes with our livers.  Like fructose, ethyl alcohol raises triglycerides, contributes to fatty liver, worsens insulin resistance, and promotes obesity in a dose dependant fashion.  There is probably some threshold below which the liver can safely detoxify it, but for people who are overweight or suffer diabetes or some other metabolic disorder, this threshold may be very low.  As fructose and alcohol have an additive effect, the amount of alcohol one can safely consume is diminished by the consumption of sweet foods which contain fructose.

So, what is the optimal amount of alcohol to consume?  It takes very little alcohol to get the anti-inflammatory effect.  Three to four fluid ounces (90-120 mL) of dry wine or a shot of distilled spirits is probably all it takes.  Most people can probably safely detoxify this much alcohol without hurting their livers.  Anything beyond this will not significantly improve inflammation but will have the aforementioned ill effects on your liver and your metabolism.

I love fine wines and really hate to be a killjoy, but I believe that the health recommendation should be to drink lightly, that is, one small serving of alcohol per day.  What most of us think of as moderate drinking may be too much for somebody with a metabolic disorder like obesity or diabetes.

In my own case, I try to limit my combined daily consumption of fructose and alcohol to less than 20 grams a day.  A four ounce glass of wine has about  15 grams of alcohol, a medium apple has about 9 grams of fructose, a 12 oz. can of Coke has 22 grams of fructose, and a piece of birthday cake has about 12 grams of fructose.  I get about 6 grams a day of fructose from the vegetables I eat.  So, if I have a glass of wine, it has to be a small one to meet my goal and I cannot eat any fruit or sweets.

I am not as disciplined as this blog might suggest.  On some occasions, I choose hedonistic pleasures over health, but let’s at least be honest about how much drinking is healthy.

Xylitol: Healthy Like Sugar Isn’t

Xylitol is a sugar alcohol that is naturally occurring in the human body and is found in many plants.  It was originally made for birch but is mostly extracted from corn today.  Its taste, color and cooking properties are very similar to cane sugar … but that’s where the comparison ends.  In terms of health, xylitol is almost exactly the opposite of sugar and other fructose sources.

Xylitol is a prebiotic that is fermented in the gut creating short chain fatty acids (SCFA) which encourage the growth of good micro-organisms … but sugar and other fructose sources encourage the growth of harmful bacteria and yeasts seriously disturbing gut ecology.

Xylitol is anti-inflammatory … but sugar and other fructose sources are strongly pro-inflammatory.

Xylitol, in some studies, was shown to improve fasting blood glucose levels and post prandial blood glucose levels … but sugar and other fructose sources induce insulin resistance and worsen blood glucose levels.

As little as 7.5 grams of xylitol induced a satiety effect measured at about a 5-8% reduction in calories consumed in one study  … but sugar and other fructose sources impair leptin hormonal signaling resulting in increased hunger and weight gain.

Xylitol improves lipid profile resulting in lower triglycerides, higher HDL and lower LDL … but sugar and other fructose sources are turned directly into triglycerides in the liver and worsen the lipid profile.

Xylitol chewing gum is known to prevent tooth decay … but sugar and other fructose sources cause cavities.

Xylitol’s prebiotic function will improve immune function in general and xylitol gum is also known to prevent ear infections … but sugar and other fructose sources can impair immune function.

Xylitol prevents yeast infections … but sugar and other fructose sources encourage the overgrowth of Candida yeast in the intestine, urinary tract and vagina.

Xylitol helps heal an inflamed intestinal lining … but sugar and other fructose sources can destroy the delicate hair-like villi that line the intestine and contribute to a leaky gut.

Xylitol has 40% less calories than sugar and a much lower Glycemic Index.

Xylitol has a clean sweet taste … but sugar and other fructose sources have a sticky sickening sweet taste.

Is xylitol the perfect sugar substitute?  Well, maybe not perfect, but I believe it to be the best.  Xylitol’s main shortcoming is that some people develop diarrhea and flatulence when they eat too much.  Examined closely, this apparent shortcoming is revealing.  People who suffer ill effects from xylitol probably have unbalanced gut flora which are not able to digest it.  As people who have problems with xylitol gradually increase consumption, the community of micro-organisms in their gut adapts to be able to digest it.  In doing this, one’s gut flora greatly improves in other health promoting ways.

The great majority of people who are new to xylitol can eat up to 25 grams (1 ounce) with no ill effects.  In one study, participants were given a very large dose of 400 grams a day (almost a pound) of xylitol and more than half of the participants reported no ill effects.  The main ill effect reported was flatulence and a smaller number reported diarrhea.

While xylitol has been shown to be absolutely safe and generally healthy for both adults and children, the same cannot be said for all animals.  Xylitol is toxic to dogs.  This may be serious problem for people who share food with their pets.  You cannot give pets any food containing xylitol.

I do not have a dog in my 15^th floor apartment, but even if I did, I would not feed it my food.  And, like the majority of people, I have no GI issues with xylitol.  I have always loved the fresh, natural taste of xylitol compared to some of the odd tasting artificial sweeteners, but I only recently came to understand the prebiotic effects of xylitol.  So, for me and most people, maybe xylitol really is the perfect sweetener.
          
Where I live in China, xylitol is the most common sugar substitute and is used by almost all diabetics.  It costs about $4.00/lb.  I note that in the US, it can be purchased online at Swanson Health Products for about $5-9.00/lb.


If you have not tried it, I encourage you to experiment to see if it is for you.

Grow the Garden

Gut flora sounds so much nicer than intestinal bacteria, don't you think? So many people think of the intestine as a sewer system when in fact it is an amazing garden of diverse micro-organisms and the center of a healthy life.

Like growing a garden, cultivating healthy gut flora can be a slow process. And, yet, bad diet, illness or medicines of mass destruction can destroy it as quickly as the aerial spraying of Agent Orange can wipe out an ancient forest.

Most depictions of the small intestine and the large instestine look like coiled sausages and support the misconception that it is just a bunch of yucky looking plumbing full of waste. Let's take a look inside this much misunderstood miracle.

The lining of the intestine is carpeted in a growth of finger-like protusions called villi. Think a luxuriant and diverse habitat as rich as an Amazonian rain forest ... or, if you want to dive deeper into a metaphor, maybe a vibrant tropical coral reef teaming with life. This is the prime residential real estate in the gut ... garden view ... and where all the bacteria prefer to live. When the bad bacteria or thug bugs take over the neighborhood, things get out of balance and often a confused immune system will destroy the delicate villi in a failed effort to attack the source of the problem. Autoimmune inflammatory bowel diseases are a case of the forest being slashed and burned in a failed action to bring balance to a serious messed up gut environment.

Let's back up and look at what's in the gut besides the villi. People who think the intestine is just full of ... well, you know ... probably are full of it. In a person cultivating good gut health, maybe 75% of the contents of the gut are diverse micro-organisms. In an unhealthy person, maybe only 25%. The human gut contains 10-100 trillion micro-organisms which is a lot more than the total number of human cells in the body. In the words of microbiologist Dr. Jeffrey Gordon, "We are more microbe than man." Hundreds of species, thousands of sub-species, far weightier than the human mind ... we have only just begun to understand the microbial complexity of the human gut.

So, when the doctor prescribes broad spectrum antibiotics to kill the bad bugs and suggests you eat yogurt to minimize the effect of Antibiotic Associated Diarrhea (AAD), here's a good question to ask -- Doesn't most yogurt just have two kinds of bacteria? What about the other 998 species of bacteria we will be killing?

Let's speak in generalities -- good and bad bugs. Your state of health is clearly reflected in the microbial composition of your gut, your gut ecology. Obese people have very different bugs than thin people, and people who suffer chronic disease with the associated chronic inflammation have very different gut flora than healthy people. Allow me to tell a simple tale of good and bad.

Probiotics (the good bugs) are sticky. They love living in the luxuriant villi that line the wall of the intestine and literally stick around this area of the gut. When they establish residence here, there is little available space in the neighborhood for bad bugs like E. coli, Salmonella, Clostridium, Candida yeast, etc. Probiotic organisms also produce substances that create an unfavorable environment for bad bugs and encourage the growth of more good bugs. Finally, the good bugs ferment soluble fiber into the short chain fatty acid (SCFA) butyrate which has many beneficial effects in the gut. It signals the immune system that peace and harmony reigns in the gut and prevents any autoimmune attacks that may lead to chronic inflammation.

The prebiotic fibers that I previously wrote of are like fine dining in the gut environment that only encourage the best of bugs to take up residence. Think of fructose and other simple carbohydrates as the equivalent of crystal meth being distributed in the neighborhood. An evil substance that supports the thug bugs and makes things quickly deteriorate. Probiotics are the outstanding bacteria that you want to daily invite into your body knowing they will bring out the best in your gut's microbial community.

Obviously, the above is a gross simplification, but I hope it gets you thinking about what you need to be doing to grow your garden and be healthy.

Tale of Two Rats – How Fiber Can Make You Beautiful and Healthy

Not an epic novel, my story concerns two rats – a fat rat and a thin rat. Some bored scientists analyze their fecal content and discover they are distinctly different. The gut flora in the fat rat has more of a bacteria called firmicutes (think F for fat) and the thin rat has more bacteriodes (think B for beautiful). Said scientists decide to amuse themselves by performing a fecal transplant. The unsuspecting thin rat gets the fecal content of the fat rat. It’s a tragic story. With no change in diet, the thin rat whose gut flora is now dominated by firmicutes gets fat.

Another two rats, another story. Two thin rats and each has more bacteriodes in the gut flora. The sadistic scientists put one of the healthy rats on a high fructose diet. Predictably, thin rat develops a new gut ecology with dominant firmicutes … and gets fat.

Final story. Some kind hearted scientists observe that bacteriodes are able to produce a short-chain fatty acid called butyric acid which seems to improve the gut ecology with many benefits. Being better scientists than cooks, rather than feed the rats some tasty food naturally high in fiber, they add 5% sodium butyrate to their laboratory rat chow. The rats that are supplemented with sodium butyrate do not get fat like their buddies on the same highly fattening diet. Check out the graph below:

Actually, the last story has a really happy ending. Not only do these rats not get fat, their post prandial blood glucose levels are much better with the butyrate and their insulin resistance improves as measured by HOMA-IR.

Moral of the story? Nope, I am not recommending fecal transplants for all my chubby T2 friends and I am not suggesting you use sodium butyrate as a condiment in all your favorite foods. Let me tell you how the same healthy gut environment can be achieved in the human species.

The way bacteriodes are supposed to work in people is that they ferment fiber to produce butyrate. Nope, I am not talking about your raisin bran cereal. The sugar in it will feed the evil firmicutes and hasten your demise while the insoluble fiber from the wheat bran going through your gut like sawdust will likely providing more irritation than health. But isn’t fiber supposed to help diabetics? As it turns it, only soluble fiber is the diabetic’s friend.

Soluble fibers from rich sources like low carb veggies, flax meal, chia seeds and supplements like pectin, beta-glucan, FOS, inulin, etc. are the healthy nutrients that the good bacteria love. The bacteriodes will thrive on this stuff and you will look and feel great.

While you are are savoring your broccoli and enjoying a flax meal muffin, don’t forget the bad guys. Do not feed the firmicutes! NO FRUCTOSE! If you dare consume any unhealthy quantities of sugar, HFCS or fruit juices (and any quantity is unhealthy) please contact me immediately to learn how you can schedule that fecal transplant.

OK, most of my readers already know that I am no doctor or scientist … and certainly not a pillar of virture. Seems I succumbed to temptation only this morning when my wife offered me a piece of nice dark chocolate. Should perfection elude you, too, please refer to my earlier posting and eat lots of low carb, probiotic yogurt daily. Having more probiotic bacteria in the neighborhood will help keep out the bad guys.

Breaking News -- According to an article in ScienceNews, my Venti-sized Americano coffee may have as much as 2 grams of that soluble fiber that is so beloved by bacteroides. Discussion continues at the Da Mu Zhi Guangchang Starbucks.

Limiting AGEs, Limiting Complications

Imagine a juicy piece of barbecued meat, marinated in a sweet BBQ sauce and grilled over flaming charcoal until it is a nice brown color with crispy pieces on the outside. Sounds good? Imagine your internal organs processed in the same way and you have a picture of the formation of advanced glycation end-products (AGEs), one of the most harmful processes associated with chronic inflammation. AGEs are the products of sugars and proteins binding together and, in the human cells, it is damage that cannot be undone. While all human tissue is subject to damage by AGEs, the lining of blood vessels in diabetics is especially sensitive leading to heart disease, long-lived nerve cells rapidly accumulate damage resulting in neuropathy, microvascular destruction leads to retinopathy and nephropathy, and AGEs are implicated in the destruction of beta cells in the pancreas. Where do these AGEs come from?

Exogenous AGEs come from your food and drink. Basically, any food preparation with high heat that involves browning is creating AGEs … browned meats, bread crust, caramel coloring in processed foods, and even my beloved dark roast coffee beans. Raw foods and foods cooked in the presence of water contain far less AGEs. Water prevents the proteins and sugars from binding. An example would be a raw chicken breast which contains a moderate amount of AGEs with 7686 units. If you boil it, you will increase the AGEs about 50%, microwaving increases AGEs two-fold, broiling increases AGEs eight-fold, and frying will multiply AGEs ten-fold. It’s not just about meat. Roasted nuts are one of the highest sources of AGEs. Healthy fresh butter has four times as much AGEs by weight as roasted meat. In general, processed meat and other processed foods are much higher in AGEs. See list of AGEs in common foods here.

Advocates of raw vegan diets point out that this way of eating has far less AGEs because raw fruits and vegetables have very little AGEs and cooked meat is never consumed. Makes sense in theory, but studies of long-term vegetarians have shown that they actually have similar or higher levels of plasma AGEs than people eating normal American diets. How can this be? It seems that vegans eat a relatively high carb diet with lots of fructose from fruits and zero carnisone or taurine from meat. This brings us to the other source of AGEs.

Endogenous AGEs are produced in the human body when sugars bind with proteins. Diabetics are especially susceptible to this process which is believed to be the source of most diabetic complications. The best way for diabetics to lower their plasma AGEs level is to lower their A1c which correlates highly with AGEs. As AGEs are a product of inflammation, they also correlate highly with CRP. Limiting carbohydrate in the diet is one of the best ways to minimize the production of AGEs. One sugar is especially deadly – fructose, which is far too abundant in the modern diet. According to Wikipedia:

Endogenous glycations occur mainly in the bloodstream to a small proportion of the absorbed simple sugars: glucose, fructose, and galactose. It appears that fructose and galactose have approximately ten times the glycation activity of glucose, the primary body fuel.

Meat, as I have explained, can be cooked into a high-AGEs food, but it is also a source of two substances that inhibit the production of AGEs in the human body. The amino acids carnosine and taurine are only available in animal protein. For this reason, a low carb diet with little fructose and abundant animal protein may be the best diet for diabetics trying to limit damaging AGEs. Ironic, as cooked meat is one of the highest sources of exogenous AGEs.

Besides carnosine and taurine, there are several nutritional supplements which reduce the production of AGEs. The vitamins benfotiamine (lipid soluble thiamine), alpha lipoic acid (ALA) and lycopene (found in tomatoes) are well known as beneficial in preventing diabetic complications. Some phytonutrients are helpful including quercetin, EGCG (green tea extract), curcumin (turmeric extract), resveratrol (found in red wine) and others.

How to reduce AGEs? Keep your blood sugar low, eat low-carb, enjoy fresh raw veggies, cook with water, limit browned foods, avoid fructose like the plague, restrict processed foods, get enough animal protein, and consider supplements to inhibit the production of AGEs.

Fructose – The Stealth Carb

Fructose is a very useful substance if you need lab rats with inflammation. All you do is give them a 10 percent solution of fructose in their drinking water for 32 weeks, and, like magic, you have laboratory perfect models of vascular inflammation. I wonder what happens to humans who consume Coke for 32 years? http://www.ncbi.nlm.nih.gov/pubmed/18718174

There is no doubt that high levels of carbohydrate in the diet result in tissue inflammation in humans. No carbohydrate is more insidious than the sugar fructose. Table sugar is 50% fructose, high fructose corn syrup (HFCS) used in many processed foods is 55-95% fructose, and most fruit juices are very high in fructose. Even healthy whole fruit has moderate amounts of fructose, and our favorite low carb veggies usual have small amounts of fructose. You cannot completely avoid fructose, but as it is not an essential nutrient, it is wise to consciously minimize your fructose consumption.

Fructose goes directly to your liver where it is turned into triglycerides. It does not register on your glucometer right after you eat it, so diabetics often have the false impression that high fructose foods are relatively diabetic friendly. Remember, it’s a glucometer not a fructometer and you won’t catch it with your meter. Because it is so difficult to catch, I call it the Stealth Carb.

So, how do you know if you are consuming too much fructose? There are several tell-tale signs.

1. Triglycerides will be elevated
2. Liver will be inflamed and Non-Alcoholic Fatty Liver Disease (NAFLD) will develop
3. More visceral fat on the upper body and difficulty in losing weight
4. Inflammation of the vascular system (atherosclerosis)
5. Higher insulin resistance
6. Higher C-reactive protein number evidencing inflammation
7. Fructose produces ten times as many Advanced Glycation End-Products (AGEs) as glucose

Simply avoiding sugar, HFCS and fruit juice in all its forms may be enough for most diabetics, but if you have high CRP and/or high triglycerides, you may want to look harder at the sources of fructose in your diet. Here is a list of common foods with the amount of fructose per serving. I list a can of Coke as a reference point.

FOOD	Serving	Fructose (grams)	Calories	Fructose (grams)
All food fresh unless stated	size	per serving	per serving	per 200 calories
Coke (Canned)	12 oz. can	22.5	151	29.8
Raisins (Dried)	1 small box (43g)	12.8	129	19.9
Grapes	1 cup	12.3	104	23.6
Watermelon	1 wedge (286g)	10.5	86	24.4
Tomato Paste (canned)	1 can (6 oz.)	9.9	139	14.3
Apple	1 medium-sized apple	9.7	77	25.1
Kiwi	1 cup (abt 2 kiwis)	7.7	108	14.3
Sweet Cherries	1 cup w/pits (138g)	7.4	87	17.1
Blueberries	1 cup (148g)	7.3	84	17.4
Sweet Onions	1 onion (331g)	6.7	106	12.6
Orange Juice, fresh squeezed	1 cup	5.8	112	10.3
Bananas	1 medium-sized banana	5.7	105	10.9
Plums	1 cup, sliced (abt 2 plums)	5.1	76	13.3
Honeydew Melon	1 wedge (160g)	4.8	58	16.5
Strawberries	1 cup, sliced (166g)	4.0	53	15.2
Tomato Juice (canned)	1 cup	3.7	41	18.1
Blackberries	1 cup (144g)	3.5	62	11.2
Pineapple	1 cup, chunks (165g)	3.5	82	8.5
Sweet Red Pepper	1 cup, chpped (149g)	3.4	46	14.6
Navel Oranges	1 fruit (140g)	3.2	69	9.2
Raspberries	1 cup (123g)	2.9	64	9.0
Tomatoes	1 cup, chopped (180)	2.4	32	15.2
Balsamic Vinegar (Bottled)	1 oz. (2 Tbsp)	2.4	28	16.8
Peaches	1 medium-sized peach	2.3	59	7.8
Grapefruit	1/2 fruit (123g)	2.2	52	8.4
Onions	1 cup, chopped (160g)	2.1	64	6.5
Nectarines	1 medium-sized nectarine	2.0	62	6.3
Green Pepper	1 cup, chopped (149g)	1.7	30	11.5
Green Beans	1 cup (111g)	1.5	44	6.8
Apricots	1 cup, halves (4 apricots)	1.4	74	3.9
Asparagus	1 cup (134g)	1.4	27	10.0
Summer Squash	1 cup, sliced (113g)	1.1	18	11.9
Cucumber	1 cup (1 small cucumber)	1.0	16	12.5
Cabbage	1 cup, shredded (70g)	1.0	17	11.6
Sweet Corn	1 cup (154g)	0.8	132	1.2
Brussel Sprouts	1 cup (88g)	0.8	38	4.3
Radishes	1 cup, sliced (116g)	0.8	19	8.9
Baby Carrots	5 carrots (75g)	0.7	25	5.7
Carrots	1 cup, chopped (128g)	0.7	52	2.7
Carrots	1 cup, chopped (128g)	0.7	52	2.7
Green Peas	1 cup (145g)	0.6	117	1.0
Dill Pickles (Bottled)	1 large (4")	0.6	16	7.3
Broccoli	1 cup, chopped (91)	0.6	31	4.0
Celery	1 cup, chopped (101g)	0.5	16	6.4
Lime Juice	1 oz. (2 Tbsp)	0.2	7	4.9
Okra	1 cup, chopped (100g)	0.2	31	1.4
Green Leaf Lettuce	1 cup, shredded (36g)	0.1	5	5.7
Cider Vinegar (bottled)	1 oz. (2 Tbsp)	0.1	6	2.9
Spinach	1 cup (30g)	0.0	7	1.3