Presented by:

Fructose & Cardiovascular Disease:A not so sweet connection

Cindy Brinn MPH, RD, CDE, BC-ADMPeaceHealth St. Joseph Medical

Center Nutrition & Diabetes ClinicCBrinn@PeaceHealth.org

SUGAREmpty 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;

Circulation 2009;120;1011-1020; originally published online Aug 24, 2009;

• Sugar associated with:– Hypertension– Altered lipids– Inflammation– Obesity

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?

• 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

Who will win the Sweetener Race?

How Much Sugar do we really eat?

1700 1750 1800 1850 1900 1950 2000

80

60

40

20

0

Sugar Intake UK & USA kg/person

years 1700-2000Johnson R. AJCN 2007;86:899-906

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

1700 1750 1800 1850 1900 1950 2000

80

60

40

20

0

Sugar Intake UK & USA kg/person years 1700-2000Johnson R. AJCN 2007;86:899-906

1700 1750 1800 1850 1900 1950 2000

80

60

40

20

0

Sugar Intake UK & USA kg/person

years 1700-2000Johnson R. AJCN 2007;86:899-906

Problem: Chronic 50 year exposure to high and increasing intakes of sugar . . .

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

National Academy of Sciences, IOM, Dietary Reference Intakes 2002

Females

13% 4-8yrs

21% 9-13yrs

31% 14-18yrs

21% 19-50yrs

US Sources of Added Sugar Intake

Soda 33%

Sugar & Candy 16%

Fruit Drinks (fruitades & fruit punch) 10%

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% 4-8 yrs

21% 9-18yrs

30% 19-50yrs

45% 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 (5-20%) & Juices

• Galactose*--– Milk/Dairy

Sugar Sources Absorption/Metabolism

• Glucose*• Fructose*• Galactose*• Sucrose** (glucose fructose)• Lactose** (glucose galactose)

Intestinal enzymes

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_March_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

• Controversy & Confusion around high fructose corn syrup (HFCS)

• Unique digestion, absorption & metabolism of fructose– Association with elevated lipids & insulin

resistance

Fructose

HFCS

Total Fructose

Free FructoseObesity

Bray G. AJCN 2004;79:537-43

HFCSOverweight

Trends in obesity and Fructose Intake

June 30, 2008 Seattle-area food cooperative PCC Natural Markets has removed all products containing high-

fructose corn syrup from its shelves, and has announced that it will no longer carry

any product sweetened with the controversial ingredient.

                                     

        

Seattle Grocery Chain Stops Selling Foods Made With High Fructose Corn

Syrup

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.”

**

HFCS-42 HFCS-55 Sucrose Honey

Fructose 42% 55% 50% 45%

Glucose 53% 42% 50% 43%

Other Sugars

5% 3% 0 5%

Comparison of Caloric Sweetener Compositions

USDA Sugars& Sweeteners Yearbook. 2007

Powerpnt.lnk

Sugar consumption (# per yr per person)

1970-2007

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

**

5-20% fructose 50% fructose

Honey: 40% fructose

HFCS: 50% fructose

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)

Changes in Fructose Consumption

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

Males

13% 4-8 yrs

20% 9-18yrs

15% 19-50yrs

Females

13% 4-8 yrs

21% 9-13yrs

31% 14-18yrs

21% 19-50yrs

20% Adults average more than 60grams/day added fructose

= 15tsp/day = 1/3 cup

Males

13% 4-8 yrs

20% 9-18yrs

15% 19-50yrs

Females

13% 4-8 yrs

21% 9-13yrs

31% 14-18yrs

21% 19-50yrs

25% Children averaging more than 75 grams/day added fructose

= 19tsp/day = 1/2 cup

Fructose in FoodsFructose (grams)

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 in FoodsFructose (grams)

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 diabetes avoid naturally occurring fructose in fruits, vegetables, and other foods.”

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 or, if added to the meal plan, adequately covered with insulin or another glucose-lowering medication.”

“

Not toxic, but large amounts may be unsafe or promote bad nutrition.

High Fructose Corn Syrup CUT BACK

• 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

Sanchez-Lozada L. AmJClinNutr 2008;88:1189-90

• 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

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

Fructose

Metabolism

GrehlinInsulin

Leptin

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)?

• Does not stimulate insulin release.

• Does not stimulate leptin release (a hormone that

signals satiety).

• Does not suppress grehlin release (an appetite-stimulating hormone).

These hormones are very involved with

carbohydrate & lipid metabolism and

appetite regulation.

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• TG rise was 7-90% from baseline

Havel P. Nutr Rev 2005;63(5):133-157

**

2004 Teff Study: Fructose & Leptin

• 12 normal weight women—30% kcals as fructose or glucose (45 grams at each meal)—followed hormone, etc. levels x 24hrs

Teff K. JClinEndo&Metab 2004; 89(6):2963-72

AUC glycemia

insulin leptin grehlin TG

Fructose 55% 49% 24% 30% 35%

2009 Teff StudyFructose & TG’s in Insulin Resistant Adults

• 17 obese adults• 30% kcals added fructose or glucose

x 24hrs• Measured a variety of hormones

Teff K. JClinEndoMetab 2009; doi:10.1210jc.2008-2192

AUC glycemia

leptin grehlin TG

Fructose 50 % 30% No difference

200%

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 oxidative stress.”

Cirillo P. Nephrol Dial Transplant 2009 24:1384-87

Johnson, RJ etal 2009: Endocrine Rev 30(1):96-116

Fructose Stimulates Uric Acid Production

Elevated Uric Acid: Beyond GoutAn 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

Johnson RJ. Endocrine Rev 2009; 30(1):96-116

Association of Fructose to Metabolic Syndrome & Type 2 Diabetes

1700 1750 1800 1850 1900 1950 2000

80

60

40

20

0

Sugar Intake UK & USA kg/person years 1700-2000

Johnson R. AJCN 2007;86:899-906

1700 1750 1800 1850 1900 1950 2000

80

60

40

20

0

Sugar Intake UK & USA kg/person years 1700-2000Johnson R. AJCN 2007;86:899-906

Problem: Chronic 50 year exposure to high and increasing intakes of sugar . . .

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 have a higher fructose intake & higher levels of liver fructokinase

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. Clin. Invest. doi:10:1172JCI37385

**

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, along with ad lib self-selected diet

**

Results: % Changes from Baseline

Glucose Fructose

Body Weight +1.8% +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 Fructose

Body Weight +1.8% +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 Fructose

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

Glucose Fructose

Fasting TG +9.7% +3.9%

TG area under curve -32% +99.2%

Fasting LDL Cholesterol + 3.6% +13.9%

Fasting sdLDL Cholesterol

+13.3% +44.0%

Fasting oxLDL Cholesterol

+.7% +12.8%

**

Changes from baseline: Glucose, insulin, insulin sensitivity

Glucose Fructose

Fasting Glucose -1.4%% +5.3%

Fasting Insulin +2.9% +10.2%

Glucose 3-h AUC OGTT +31.4%%

+60.2%

Insulin Sensitivity index +1.1% -17.3%

**

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

**

Basciano H. Nutrition & Metabolism 2005; 2(5):1-14 Le KA. CurrOpinClinNutrMetabCare 2006 9:469-75

“ . . . 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 .”

More Fructose Thoughts

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 10 tsp 40g CHO• ¼ c. pancake syrup 10 tsp 40g CHO• 2 oz. snicker bar 6 tsp 24g CHO• 2” square cake 10 tsp 40g CHO• ¾ c. frosted cheerios 3 tsp 12g CHO• 9 wheat thins 1 tsp 4g CHO• Low fat yogurt 8 tsp 32g CHO• 1 c. tomato soup 4 tsp 16g CHO• 1 Tbsp jam 2 tsp 8g CHO

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

The Answer:

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

Combination of Captopril & Allopurinol Retards 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

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 . . .

• “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 choice.”

Summary: 70% Reduction of Secondary Coronary Events: It’s all about the Fat!Cardiovascular Grand Rounds Feb. 2009

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• “1 small sweet serving a day”