Thought Fructose was the Good Sugar? Think again

Dr. Harriott's Comments:  In general, a good rule of thumb is that anything real sweet is not something you want to eat a lot of.  Tone it down or turn it down... for good health. =================================== Fructose Linked to High Blood Pressure

By Todd Neale, Staff Writer, MedPage Today Published: July 01, 2010 Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner People who consume the amount of fructose found in two-and-a-half regular soft drinks a day appear to have a higher risk of hypertension, a cross-sectional study showed. Consumption of at least 74 grams per day was associated with 26% to 77% greater odds of crossing various thresholds of elevated blood pressure (P<0.05 for all), compared with lower levels of consumption, according to Diana Jalal, MD, of the University of Colorado Denver, and colleagues. "Limiting fructose intake is readily feasible, and, in light of our results, prospective studies are needed to assess whether decreased intake of fructose from added sugars will reduce the incidence of hypertension and the burden of cardiovascular disease in the U.S. adult population," they wrote online in the Journal of the American Society of Nephrology. Action Points   Explain to interested patients that this cross-sectional study could not establish a causal relationship between fructose consumption and hypertension. Point out that not all previous studies exploring the link between fructose and blood pressure have identified a significant association. There has been a recent increase in the consumption of fructose in developed nations due primarily to the addition of table sugar or high fructose corn syrup to soft drinks, bakery products, fruit drinks, dairy desserts, and candies. At the same time, the prevalence of hypertension has been rising. However, epidemiological studies have yielded conflicting results as to an association between the two trends. To explore the issue, Jalal and her colleagues used data from 4,528 adults without a history of hypertension included in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2006. The majority (61%) had a systolic blood pressure of less than 120 mm Hg. Another 30% were prehypertensive (systolic pressure of 120 to 139 mm Hg). The rest of the participants had either stage 1 or stage 2 hypertension (6% and 2%, respectively). Fructose intake was determined through a self-administered dietary questionnaire. Consumption of natural fruits was excluded to isolate intake of added sugar. Median intake was 74 grams a day. Increasing systolic blood pressure was associated with increasing fructose intake, a trend that reached borderline statistical significance (P=0.05). After adjustment for demographics, comorbidities, physical activity, smoking, total kilocalorie intake, and dietary confounders including total carbohydrate, alcohol, salt, potassium, and vitamin C intake, as well as other factors, fructose intake of 74 grams per day or higher was associated with higher odds of elevated blood pressure at the following thresholds (P<0.05 for all): 135/85 mm Hg: OR 1.26 140/90 mm Hg: OR 1.30 160/100 mm Hg: OR 1.77 Additional analyses showed that fructose intake was associated with systolic -- but not diastolic -- blood pressure. The reason this study, and not some previous studies, found an association between fructose consumption and hypertension could be because of the high level of consumption in the current study, according to Jalal and her colleagues. In addition, some previous studies looked only at soft drink consumption or included naturally occurring fructose from fruit in their analyses. There are several possible mechanisms that might explain the positive association between fructose and blood pressure, the authors wrote, "including stimulation of uric acid, inhibition of [the] endothelial nitric oxide synthase system, and stimulation of the sympathetic nervous system, or by directly increasing sodium absorption in the gut." The study was limited, they wrote, by the inability to establish a causal relationship between fructose and blood pressure using cross-sectional data, the reliance on self-reports, and the possibility of confounding by glucose in the foods assessed on the dietary questionnaire. The study was supported by grants from the National Institutes of Health. Jalal reported no conflicts of interest. One of her co-authors is listed as an inventor on several patent applications for lowering uric acid as it relates to blood pressure and metabolic syndrome. He is also author of The Sugar Fix. Primary source: Journal of the American Society of Nephrology Source reference: Jalal D, et al "Increased fructose associates with elevated blood pressure" J Am Soc Nephrol2010; DOI: 10.1681/ASN.2009111111.

Got Colic? Here's a Natural Treatment that really helps

Probiotic Reduces Crying Time in Infants With Colic
/www.Medscape.com

June 17, 2010 (Stockholm, Sweden) — One week of supplementation with the probiotic Lactobacillus reuteri Protectis reduced crying time in colicky babies by 74%, compared with 38% with placebo, according to a double-blind study presented here at the 43rd Annual Meeting of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition in Istanbul, Turkey.

"The data with L reuteri are convincing and confirm, in a placebo-controlled study, our earlier data with this probiotic [Pediatrics. 2007;119:e124-e130]. We believe these results will have an impact on the treatment of infants with colic," study presenter Francesco Savino, MD, PhD, from the Department of Paediatrics, Regina Margherita Children's Hospital, University of Turin, Italy, noted in a statement issued by Swedish biotechnology firm BioGaia AB, the developer and marketer of the probiotic.

In the study, 50 infants with confirmed infantile colic were randomly assigned to L reuteri Protectis (5 drops, 108 colony forming units/day) or placebo drops for 21 consecutive days. The primary outcome was a reduction (by day 21) in average crying time to less than 3 hours per day, which is the limit of colic, Dr. Savino noted.

With L reuteri, "we saw improvement after 1 week, and at the end of the study there really was a significant effect," he told conference attendees. In addition, 84% of the L reuteri–supplemented infants reached the primary outcome by day 21, compared with 43% of infants in the placebo group (P < .05), he reported.

At baseline, median crying time per day was 370 minutes in the probiotic group and 300 minutes in the placebo group. On day 7, crying time had been reduced to 95 minutes in the L reuteri group and to 185 minutes in the placebo group (P = .082).

At the study's end (day 21), there was a significant difference in median daily crying time between the groups; it was 35 minutes in the L reuteri group and 90 minutes in the placebo group (P < .05), Dr. Savino reported.

He also noted that on days 7, 14, and 21, the proportion of infants responding to the supplementation, defined as a 50% or greater reduction in median crying time, was significantly greater in the probiotic group than in the placebo group.

In an email to Medscape Gastroenterology, Eamonn Connolly, PhD, senior vice president of research for BioGaia, in Stockholm, Sweden, said complete data from the study are scheduled to be published in a medical journal shortly.

Mechanism of Action Not Clearly Established

The effects of L reuteri noted in the study "could be due to a change in the intestinal commensal bacteria," Flavia Indrio, MD, PhD, who has studied the gastrointestinal effects of probiotics extensively, noted in an email to Medscape Gastroenterology. Dr. Indrio is a pediatric gastroenterologist in the Department of Pediatrics at the University of Bari in Italy, and was not involved in this study.

"The crying infant who received L reuteri showed a reduction in Escherichia coli in the intestinal microflora, compared with the infant treated with placebo," said Dr. Indrio.

She added that "the target of the L reuteri action could be the intestinal motility pattern, as shown in the study published by me and my coworker in the Journal of Pediatrics in 2008. Another study is running in newborns to confirm this effect."

"Definitely, treatment with probiotics could open a new therapeutic approach in some gastrointestinal diseases," Dr. Indrio concluded.

The study was sponsored by BioGaia, which develops and markets probiotic products. Dr. Savino reports being an independent investigator with no relationship with BioGaia. Dr. Indrio has disclosed no relevant financial relationships.

43rd Annual Meeting of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Presented June 10, 2010.