Avoidance of Fructose Could do Double Duty Preventing Type 2 Diabetes and Alzheimer’s
Dr. Pham H. Liem
Insulin Resistance Found in Brains of Alzheimer’s Victims
The U.S. is facing an epidemic of obesity, diabetes and Alzheimer’s. But the magic bullet for these devastating illnesses may not be a new miracle drug, but lifestyle changes such as more exercise and strict avoidance of too much fructose.
Pham H. Liem, MD, associate chief of staff for geriatric medicine, Central Arkansas Veterans Healthcare System, spoke recently at an Alzheimer’s conference in Fayetteville about evidence suggesting that over consumption of fructose may lead to inappropriate accumulation of fat which can trigger inflammation and insulin resistance resulting in type 2 diabetes. Insulin resistance in the brain is also implicated in Alzheimer’s disease.
“Insulin resistance is the cause of type 2 diabetes, and insulin resistance was recently found in the brains of Alzheimer’s patients, also,” said Liem, who holds the Jackson T. Stephens Professor of Geriatrics at the University of Arkansas for Medical Sciences. “In recent years, large amounts of fructose have been added to the diet of Americans. Data from the Centers for Disease Control and Prevention links increased consumption of fructose with higher rates of obesity. Higher rates of obesity and type 2 diabetes are a consequence of the fat cell dysfunction that causes inflammation. It also causes high blood pressure and high lipid cholesterol.
“We call this metabolic syndrome. It appears this series of risk factors may also be related to the type of Alzheimer’s we have seen of late. We believe Alzheimer’s is a type of insulin resistance just like insulin resistance outside of the brain.”
Fructose, also known as high-fructose corn syrup (HFCS), is found in large amounts not just in obvious places like juice and soft drinks, but also in many other products such as bread, soups, crackers, catsup, cereal, salad dressings and fast foods.”
The average American consumes 41.5 pounds of HFCS per year. The problem is the liver can only handle a limited amount of fructose—25 grams maximum per day—about the amount contained in one 12-ounce soft drink.
“The body takes in glucose and makes the energy necessary to live,” Liem said. “Fructose doesn’t go into that pathway and becomes a free fatty acid. Some, like triglycerides, go into the blood stream. Either it builds up fat in the belly, or it goes into other areas where it doesn’t belong like muscles and other tissues. It becomes a problem because the body tries to react against it. It creates an inflammation reaction. These inflammation reactions are very bad for tissues including the insulin receptors.”
Liem said by reducing the risk of vascular disease by controlling blood pressure and cholesterol, you can also lower the incidence of type 2 diabetes and Alzheimer’s.
“Furthermore, the medical community has been so wrong treating type 2 diabetes the same as type 1 diabetes, which is a concentrated effort into controlling blood sugar,” Liem said. “In 2008 there was a major type 2 diabetic study from the National Institutes of Health called the ACCORD study. It clearly shows that if you give too much insulin to type 2 diabetes patients to try to control blood sugar, you actually kill these people, surprisingly, not from low blood sugar, but because of the high incidence of strokes and heart attacks. Giving too much insulin to people who are resistant to insulin is like putting kerosene on the fire.”
Liem is concerned that many health professionals don’t know this. All healthcare professionals should be aware of the ACCORD study on type 2 diabetes.
“The right way to treat type 2 diabetes is with a high protein, low fat, low calorie diet with exercise,” Liem said. “People need to be educated about the toxicity of fructose and limit its consumption. If you eat fruit, berries that have fructose, it is good for you and can never consume more than 25 grams a day.”
HFCS can be disguised under other names like fructan, which is being done because of the bad publicity for HFCS. Producers of that HFCS have asked the FDA to allow them to change the name to corn sugar.
Regular sugar is not innocent, either. Cane sugar, for example, is half glucose and half fructose.
“We got smarter about fat, and now it is time to get smarter on carbohydrates,” Liem said.
There is an urgent need to find ways to prevent Alzheimer’s due to the fact that it strikes half of Americans who reach age 85. Two risk factors for Alzheimer’s are age and heredity. While there isn’t anything you can do about heredity at present, there are is a vaccine for Alzheimer’s that shows promise for enhancing the body’s immune system to prevent the disease.
“We hope that it can go through the FDA to be approved for people with genetic Alzheimer’s,” he said. “Until then, the environmental approach is all you can do.”
Kristin M. Bosc, MD, a neuropsychologist with Schmieding Center for Senior Health and Education in Springdale, said current treatments for Alzheimer’s don’t tackle the disease process. The drugs help maintain functioning longer, but don’t stop the disease.
Bosc said by the time doctors see people with obvious memory loss, there is too much damage for disease modifying drugs to be effective.
“The big push in research now is to find biomarkers in the blood or spinal fluid, or in MRIs, to show who is going to get Alzheimer’s,” Bosc said. “We need to detect this when people are in their 40s so we can prevent it. Top researchers think several drugs have failed in phase three trials because we are testing drugs too late in the disease process.”
Immunotherapy is one area of greatest promise. Unfortunately, a phase 2 vaccine trial was stopped because about six percent of those receiving the vaccine developed encephalitis.
“Now they are looking at people in the trial who passed away, and their brains are showing there was a lot of plague clearance,” Bosc said. “That is promising. Now we are looking at passive ways to immunize with synthetic substances. We want something that won’t trigger t-cell responses, anti-inflammatory drugs that will bind to plaque and clear it out of the brain. There are a couple of sites in Arkansas that are doing those trials. I have quite a few patients enrolled in phase three trials for one of those drugs. It is too soon to tell, but the preliminary results are promising, especially for those who don’t have the risk factor gene (the ApoE4 gene). People who do have that risk factor are more susceptible to side effects, so they are getting a lower dose.”
Bosc advises doctors to screen all patients over 65 for memory loss. Talk with family members and if there is any concern about memory loss, consider neuropsychological testing. Current medicines work better the earlier you start them.
“Patients should be encouraged to exercise regularly, which is a huge protective factor, and the Mediterranean diet has also been found to be really protective,” Bosc said. “Overall, what is good for your heart is good for your brain.”