Welcome Aboard the Sweet Titanic Diabetes, Cardiovascular Disease & Cancer. Disclosures. Hide not thy poison with such sugar'd words 5/11/2015

Transcription

1 Welcome Aboard the Sweet Titanic Diabetes, Cardiovascular Disease & Cancer A. Paul Chous, MA, OD, FAAO Tacoma, WA Disclosures I have spoken for, been paid honorarium or consulted for the following: Bausch & Lomb, Optos, ZeaVision, VSP, dlife, Diabetes in Control, LifeMed Media, Regeneron, Risk Medical Solutions, Freedom Meditech, GlaxoSmithKline. Kestrel Diabetes Source These associations did not unduly influence the content of this presentation or my patient care recommendations Hide not thy poison with such sugar'd words - Henry VI Part 2 1

2 Essential Questions Does increased dietary consumption of sugar/added sugars increase human risk of diabetes, cardiovascular disease & cancer? Are some added sugars metabolically more harmful? Why should eye doctors care? Increased US Sugar Consumption INCREASED Indoor Air Temperatures Polybrominated Diethyl Esters Antidepressants Time Spent Awake Maternal Age % of Middle-aged Adults Sugar Intake Isn t the only RISING variable over the last 50 years!! 2

3 Sugar and HFCS S Is A Calorie Really Just A Calorie? What is a Calorie? The energy required to raise 1 gram of through 1 degree centigrade water HYPOTHESIS: The metabolic effects of calories from various foodstuffs are (at least) partially independent of their energy content Simple sugars (added or stored in CHO) contribute to increased production of intermediate metabolites that promote disease Glucose/Sucrose Fructose AGEs Uric Acid, dense LDL-C, IR 3

4 Sugar & Disease A Look At Some Evidence 4

5 Sugar & Cancer Statistically significant increases in colon, pancreatic and breast cancers with increased dietary sugar, per some (but not all) reports Dietary sugar definitely associated with cancer mortality and recurrence The Warburg Hypothesis: Cancer cells anaerobically ferment sugar, have more insulin receptors, & perform glycolysis 10-17X the rate of normal cells, even when O2 is present PLoS One Jun 17;9(6):e Scand J Gastroenterol May;49(5):581-8 J Natl Cancer Inst Nov 21;104(22): Nutr Hosp Jul;28 Suppl 4:

6 Mechanisms? Glucose competitively inhibits vitamin C that inhibits hypoxia inducible factor-1 (HIF-1) requisite or tumor growth Free Radic Biol Med Apr;69: Integr Cancer Ther Mar;4(1):25 31 Sugar promotes cancer by increasing -catenin signaling that renders cancer cells immortal J Mol Endocrinol Dec 19;52(1):R51-66 Cancer & Obesity/Diabetes Cancer rates are significantly higher in obese/diabetic persons Increased added sugar consumption is definitively linked with increased risk of both obesity & diabetes Hyperinsulinemia promotes insulin-like growth factor (IGF) that accelerates tumor growth Public Health Nutr Feb 23:1-10. Strategies Against Cancer Reduce added dietary sugars metformin to improve glucose metabolism by normal cells without causing hyperinsulinemia significantly reduced risk of cancer and cancer mortality in diabetes patients Starve glycolysis-dependent cancer cells of ATP by inhibiting hexokinase & GAPDH with a pyruvate analog (liver, colon, lymphoma, ALL) 3-bromopyruvate (3-BrP) Oncotarget Mar 20. 6

7 Added Sugars & Diabetes Is Increased Sugar Consumption Causally Relate to the Increased Incidence of Diabetes? 7

8 23 Myth or Fact: High Sugar Intake Causes Diabetes? Econometric analysis of 175 countries Every 150kcal/person/day sugar consumption increases population diabetes prevalence 1.1% Equivalent to 1 can of soda per day PLoS One. 2013;8(2):e

9 Differences in sugar availability statistically explain variations in diabetes prevalence rates at a population level that are not explained by physical activity, overweight or obesity National obesity rates are NOT totally synchronous with rates of diabetes Sugar Availability and Increased Diabetes 9

10 Increasing US per capita consumptio 30 10

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12 34 35 Strategies Against Diabetes Keep total daily added sugars < 4o grams/day Ideally < 25 grams/day Eat foods with fewer AGEs Prevent AGE formation with curcumin and benfotiamine Lower diabetes risk by increasing macular pigment 12

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15 Sugar & Cardiovascular Disease Meta-analysis of 39 RCCTs shows that higher dietary sugar intake significantly increases triglycerides,ldl-c & BP after all controls. Am J Clin Nutr Jul;100(1):65-79 OF DEATH 15

16 Dietary fructose increases hscrp significantly more than glucose Lipids Health Dis Dec 16;13:

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18 AGEs Once More World J Cardiol Apr 26; 4(4):

19 Avoid high fructose corn syrup Learn & Teach How Food Companies Disguise Added Sugars 19

20 Thank You! A. Paul Chous, MA, OD, FAAO 20