Choose right carbohydrates and right fats (RCRF) - keys to optimal health

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1 Editoril on Nutrition Choose right crbohydrtes nd right fts (RCRF) - keys to optiml helth Stig Bengmrk Division of Surgery & Interventionl Science, University College London, London, UK Correspondence to: Stig Bengmrk. 185 Brrier Point Rod, Pontoon Dock, London E16 2SE, UK. Emil: stig@bengmrk.se. Provennce: This is n invited Editoril commissioned by Editor-in-Chief Yilei Mo (Deprtment of Liver Surgery, Peking Union Medicl College Hospitl, Chinese Acdemy of Medicl Sciences, Beijing, Chin). Comment on: Dehghn M, Mente A, Zhng X, et l. Associtions of fts nd crbohydrte intke with crdiovsculr disese nd mortlity in 18 countries from five continents (PURE): prospective cohort study. Lncet 217;39:-62. Submitted Nov 16, 217. Accepted for publiction Dec 13, 217. doi: /hbsn View this rticle t: Industril processes destroys helth-promoting foods Rw plnt foods - not fts - should be lterntive to refined crbohydrtes These re my reflections fter reding rticle from Dehghn et l. (1). It is incresing well documented tht it is Industril processing: frctiontion, seprtion, condenstion, drying, freezing, irrdition, burning, rosting, curing, microvwing, emulsifying, tosting, supplementing food dditives but lso plnt breeding etc. which significntly destroys the nutritionl nd helth-promoting effects of plnt foods (Figure 1). Foods which hve undergone such processes hve to lrge extent lost their nutritionl nd helth-promoting bilities. Such foods re for exmple Often - uncceptbly - rich in clories prticulrly sugr nd sugr-like foods (bred, pst, pizz, cooked tubers, polished rice etc.) but lso, which is often neglected, rich in long-chin triglycerides (LCT) contributed by met, diry products but lso in incresing mounts of edible/ cooking oils. It is lso well documented tht processed refined crbohydrte products such s sugr nd other sugrlike foods re quickly bsorbed by the smll intestine, nd trnsported by the portl vein to the liver, where they re fst metbolized. Lrger consumption of such molecules crete much incresed burden to ll internl orgns, often referred to s postprndil inflmmtion, stte regulrly lsting bout 2 3 hours fter ech mel. The scientific world seems often to tke for grnted tht the only vilble replcement for sugr-rich foods is incresed intke of fts especilly so clled sturted fts - n opinion tht I hve gret difficulties to ccept (2,3). The sme group of uthors choose in nother recent study (4) to insted replce refined crbohydrtes with to lrge enxtent rw fruits, vegetbles, nd legumes nd found tht it significntly reduced mjor crdiovsculr diseses, myocrdil infrction, crdiovsculr mortlity, non-crdiovsculr mortlity, nd totl mortlity. Fruit intke ws ssocited with lower risk of crdiovsculr, non-crdiovsculr, nd totl mortlity, nd legume intke with reduced noncrdiovsculr deth nd reduced totl mortlity. Of specil interest is their observtion tht rw vegetble intke ws ssocited with strong effects on helth prmeters nd ssocited with very lower risk, much in contrst to intke of vegetbles, which fter cooking demonstrted much more modest helth benefits. Another study, published lredy in 27 (5) compred helth prmeters of rw food eters nd with those of Stndrd Western (Americn) food eters nd reported drmtic differences in vrious helth prmeters [systolic blood pressure 124 vs. 132, distolic blood pressure 62 vs. 79, fsting glucose 85 vs. 95, fsting insulin 2.8 vs. 5.9, Hom-IR.59 vs. 1.36, CRP.52 vs nd crotid

2 43 Bengmrk. Choose RCRF keys to optiml helth Figure 1 Summry of fctors often ssocited with negtive effects on helth. The two illustrtions in the upper corners re from United Sttes Deprtment of Agriculture - USDA: Economic Reserch Service using USDA Agriculturl Sttistic Service nd proprietry dt intim-medi thickness (IMT).56 vs..74] (Figure 2). Long-chin ftty cids induces endotoxemi nd postprndil inflmmtion The body hs no possibility to tke up long-chin ftty cids directly through the portl vein in order to quickly metbolize these fts. This pthwy is restricted to ftty cids with chin length shorter thn twelve crbon toms (3). Long-chined ftty cids, which to bout 8% consist in niml ft need to be trnsported through the thorcic duct. Most of these will remin in the generl circultion during 2 3 hours nd will be exposed to the endothelium of ll blood vessels the body including the crotids nd the brin vessels. Such exposure induces short-term inflmmtion - postprndil inflmmtion nd long-term intiml clcifictions constitutiong strong risk fctors for hert disese but lso other chronic diseses including Alzheimer s nd type 2 dibetes. Among the negtive consequences ssocited with elevted postprndil glucose nd insulin re: Incresed content of endotoxin in blood (sid to be equivlent to smoking three cigrettes) (3,4); Cscdes of inflmmtory nd oxidtive stress (5); Relese of tumour necrosis fctor-α, key proinflmmtory cytokine (4); Incresed numbers of ctivted leukocytes (6); Incresed inflmmtory rection, significntly potentited by simultneous intke of sugr (5) (Figure 3). Medium-chin ftty cids inhibits postprndil inflmmtion Medium-chin triglycerides, or MCTs, re sturted fts contining 8 to 12 crbons. The three MCTs - cpric cid, cprylic cid nd luric cid - re nturlly found in vriety of niml nd vegetble fts, but, regretbly, few sources contin significnt mounts. Coconut oil nd plm kernel oil re the top sources of MCTs. Both hve bout 11 grms of sturted ft in 1 tblespoon of oil. Out of the totl sturted ft, you ll get 7.4 grms of MCTs from tblespoon of plm kernel oil nd 7.9 grms from coconut oil. MCTs re known to possess severl importnt helth effects - including generl nti-inflmmtory bilities. It is importnt to know tht MCTs re very low in energy nd quickly metbolized in the body - leving no residuls. These properties hve mde MCT fvorite tools in control f weight - prticulrly controlling bdominl obesity. A recent prospective double-blind rndomized dietry

3 HeptoBiliry Surgery nd Nutrition, Vol 6, No 6 December Figure 2 Advntges on rw food vegn diet (5). Reprinted with permission from Rejuvention Reserch Volume 1, Issue 2, 26, rej , published by Mry Ann Liebert, Inc., New Rochelle, NY. POSTPRANDIAL INFLAMMATION - ASSOCIATION TO SUGAR & FAT INTAKE A 18 B 16 Men IG Men IG ±2SD Cp. BG Minutes fter mel Glucose concentrtion (mg/dl) Brekfst Lunch Dinner Frequency (counts) AM 8 AM 1 AM 12 PM 2 PM 4 PM 6 PM 8 PM 1 PM 12 AM 2 AM 4 AM 6 AM Time Plsm endotoxin (pg/ml) Freckmn G et l. J Dibetes Sci Technol. 27;1: Erridge C et l. Am J Clin Nutr 27;86: Figure 3 Postprndil inflmmtion ssocited with intke of three mel dy (7) nd the height nd length of the ssocited endoxemi (8).

4 432 Bengmrk. Choose RCRF keys to optiml helth A LONG-CHAIN & MEDIUM CHAIN FATTY ACIDS & INFLAMMATION Yu S et l. Microbiol Biotechnol 217;27: B 3 1 min 2 min 3 min COX-2/GAPDH mrna (rbitrry unit) 2 15 b 1 b 5 No oil CAN OLV MCDG inos/gapdh mrna (rbitrry unit) 2 b b 15 b 1 5 No oil CAN OLV Figure 4 Comprison of inflmmtion inducing effects of rw (A) (15) nd heted (B) medium- nd long-chined ftty cids. (B) Men ± SEM concentrtions of toxic ldehydic lipid oxidtion products [mmol./mol. ftty cid (FA)] generted in culinry oils when heted ccording to lbortory-simulted shllow frying episodes t 18 : trns-2-lkenls. Different letters indicte significnt differences between groups within the pnel (P<.5). Colour codes: sunflower oil (yellow); corn oil (blue); extr virgin olive oil (green); coconut oil (red). MCDG trns-2-alkenls (mmol./mol. FA) intervention study (9) reports tht MCT-rich diet lters the plsm lipidome nd nd seems to benefit crdic function nd fsting insulin levels in humns with type 2 dibetes - effects not obtined by long-chin ftty cids - LCT. Diets rich in MCTs, but not in LCTs, decrese severl plsm sphingolipids, cermide, nd cylcrnitines, which re implicted in dibetic crdiomyopthy, nd decreses in these sphingolipids correlte well with improved fsting insulins (1,11). Coconut nd plm oils which were the mjor sources of dietry fts for centuries in most of Africn, Asin, nd South Americn countries nd remin so in rurl res while it to lrge extent hve been replced by edible oils such s olive oil, cnol oil nd sunflower oil, prticulrly in North Americ nd Europe. As MCTs re ll sturted, they were, without ny support of studies brnded s unhelthy highly sturted fts nd it is only in recent yers tht the MCTs re receiving its recognition for ll its helth-promoting properties. The 18 countries nd five continents study is focusing on food consumed minly in rurl res to lrge extenmt in Asi nd South Americ. It is unfortunte tht the study do not report which fts re dominting in the foods eten in the vrious rurl res of the countries studies - nd lso tht the pttern of ftty cids hve been nlysed in this study. Intke of of ft nd mounts type of fts consumed vries to lrge extent between countries nd continents. It is regretble tht the food hbits re not reported in n importnt study like this. I hve been in contct with one the uthors who informs tht this is plnned to be be the next step in this series of most interesting studies. Western diet rich in cytotoxic nd genotoxic lipid oxidtion products (LOPs) A very high percentge of humns continuously consume cytotoxic nd genotoxic LOPs present in fried foods vilble in Western diets, nd the possibility tht the regulr ingestion of such toxins my contribute to chronic, non-communicble humn diseses hs recently ttrcted considerble level of public helth reserch interest (12,13). Notbly, polyunsturted ftty cids (PUFAs) present in edible oils oxidtively degrde when exposed to high temperture frying prctices, nd generte very high levels of such helth-thretening LOPs: PUFAs re much more redily peroxidised t stndrd frying tempertures thn monounsturted ftty cids (MUFAs), wheres sturted ftty cids (SFAs) re very highly resistnt to this process (14) (Figure 4 A,B). A recent study supports observtions tht long-chin ftty cids - not only those in cow och pig ft - but lso those in vrious edible oils, incresing consumed prticulrly in the Western world hve, compred to medium-chin ftty cids strong bility to induce inflmmtion nd disese (15) nd

5 HeptoBiliry Surgery nd Nutrition, Vol 6, No 6 December especilly so when heted up. Biology is more complex thn often ssumed. It is sid to exist bout, different fts in Nture. Much support tht lmost ll hve different biology nd crete different rections when exposed the the humn body. It is time to stop lumping together them in studies. This is extremely neccessry in future reserch if progress shll be mde. Acknowledgements None. Footnote Conflicts of Interest: The uthor hs no conflicts of interest to declre. References 1. Dehghn M, Mente A, Zhng X, et l. Associtions of fts nd crbohydrte intke with crdiovsculr disese nd mortlity in 18 countries from five continents (PURE): prospective cohort study. Lncet 217;39: Bengmrk S. Obesity, the dedly qurtet nd the contribution of the neglected dily orgn rest - new dimension of un-helth nd its prevention. Heptobiliry Surg Nutr 215;4: Bengmrk S. Chpter 53: Inflmmtion, Microbiot nd Gut reconditioning. In: Cvillon JM, Singer M. editors. Inflmmtion: From Moleculr nd Cellulr Mechnisms to the Clinic, 4 Volume Set. Wiley, 217: Miller V, Mente A, Dehghn M, et l. Fruit, vegetble, nd legume intke, nd crdiovsculr disese nd deths in 18 countries (PURE): prospective cohort study. Lncet 217;39: Fontn L, Meyer TE, Klein S, et l. Long-term lowclorie low-protein vegn diet nd endurnce exercise re ssocited with low crdiometbolic risk. Rejuvention Res 27;1: Wrd D, English J. Beneficil Effects on Energy, Atherosclerosis nd Aging. Avilble online: mcts/ 7. Freckmnn G, Hgenlocher S, Bumstrk A, et l. Continuous glucose profiles in helthy subjects under everydy life conditions nd fter different mels. J Dibetes Sci Technol 27;1: Erridge C, Attin T, Spickett CM, et l. A high-ft mel induces low-grde endotoxemi: evidence of novel mechnism of postprndil inflmmtion. Am J Clin Nutr 27;86: Ceriello A, Qugliro L, Piconi L, et l. Effect of postprndil hypertriglyceridemi nd hyperglycemi on circulting dhesion molecules nd oxidtive stress genertion nd the possible role of simvsttin tretment. Dibetes 24;53: Alipour A, vn Oostrom AJ, Izreljn A, et l. Leukocyte ctivtion by triglyceride-rich lipoproteins. Arterioscler Thromb Vsc Biol 28;28: Airhrt S, Cde WT, Jing H, et l. A Diet Rich in Medium-Chin Ftty Acids Improves Systolic Function nd Alters the Lipidomic Profile in Ptients With Type 2 Dibetes: A Pilot Study. J Clin Endocrinol Metb 216;11: Grootveld M, Ruiz-Roddo V, Silwood CJ. Detection, monitoring nd deleterious helth effects of lipid oxidtion products generted in culinry oils during therml stressing episodes. Inform Am Oil Chem Soc 214;: Gdirju TV, Ptel Y, Gzino JM, et l. Fried Food Consumption nd Crdiovsculr Helth: A Review of Current Evidence. Nutrients 215;7: Hywood RM, Clxson AW, Hwkes GE, et l. Detection of ldehydes nd their conjugted hydroperoxydiene precursors in thermlly-stressed culinry oils nd fts: investigtions using high resolution proton NMR spectroscopy. Free Rdic Res 1995;22: Yu S, Choi JH, Kim HJ, et l. In Vitro Evidence of Anti- Inflmmtory nd Anti-Obesity Effects of Medium- Chin Ftty Acid-Dicylglycerols. J Microbiol Biotechnol 217;27: Cite this rticle s: Bengmrk S. Choose right crbohydrtes nd right fts (RCRF) - keys to optiml helth. HeptoBiliry Surg Nutr 217;6(6): doi: /hbsn