thanks to xkcd.com for this

There’s a test we do, the Fructose 6 Phosphate level, that often reports in those words.

It could mean one of two things of course - that fructose + sucrose intake is too high, or that metabolic capacity is reduced for some reason. It’s usually the first reason, of course, but there is a chicken-and-egg aspect, in that fructose contributes to causing fatty liver, which can impair that metabolic capacity.

Sugars are in the news right now due to an article in the journal Nature proposing that dietary sugar should be regulated the same as tobacco, and for the same reason - they’re bad for us.

[Lustig RH, Schmidt LA, Brindis CD (2012) The toxic truth about sugar. Nature 482:27-29.]

There’s a good 12-minute video featuring Dr Lustig on Youtube, link here;  The Skinny about Obesity

We also did an Orthomolecular Medicine News Service release about it, here;  Toxic Sugar

People often ask about fruit in this regard; it obviously contains fructose, but also lots of good stuff like vitamins. Avoid or what?

Below is some of what I posted about this before, but I also re-ordered the fruits list in descending order of fructose content per unit of weight. It’s in milligrams per 100grams, so Honey at the top is 40% (High Fructose Corn Syrup, HFCS, the really bad stuff, is 50-55% fructose).

You can see that the top 3 fruits contain more than 10 times as much fructose as the bottom 3. I don’t need to tell you what to do with this info.

Here’s part of what I said about fructose previously (you can find the full post under June 2010, way down the left hand sidebar);

Two doctors in Japan have written a truly brilliant e-book on this subject. It’s free to download, and they have given permission for that both by posting it at the link below and to me directly.

Get it and read it;

http://cpms.chiba-u.jp/enquete/consent.php

It is very good at making plain sense of the whole story. I think we shall use it as a textbook.

There are some major changes happening here that we need to tell you about.

From 6th July 2011 all nutritional supplements for Dr Downing’s and Dr Meldrum’s patients will be supplied from The Dispensary Bureau Ltd, no longer from our York office. This will enable us to focus on our core job; looking after our patients.

The Dispensary Bureau is an established business which already stocks and supplies supplements for other independent medical practices. We believe that your experience of dealing with them will be happy and smooth-running. They are based in Poole, Dorset, which has surprisingly good transport links with the whole of the UK.

Your contact person there will normally be Wendy Dennis, who you will find very helpful and efficient. They are in contact with us the whole time, and there should be no fundamental changes to your service. You will still be able to obtain all the same products; they will still be selected and sourced by Dr Downing. Dispensary Bureau is the only outlet who will supply them on behalf of Dr Downing, Dr Meldrum and Nutrition Associates Ltd.

All our prices are remaining the same under the new system. The York team are still here if you have any queries, and if you are speaking to us we can send electronic instructions directly to the new team on your behalf.

To contact the new product supply team;

Dr Downing’s Order Line (dedicated number); 01202 714161

Email; orders@dispensarybureau.co.uk

To contact the patient care team in York;

Telephone;  01904 691591 or 0207 099 6003

Email; enq@naltd.co.uk

The staff line-up in our York office has also changed considerably;

Jim Duncan, our office manager for some years, has retired; we all wish him a very happy retirement.

Bernard Beckett, our nurse, has also retired, although he is doing relief work for us when needed.

Lizanne Guyll, administrator and most recently receptionist, has also moved on, with our best wishes.

Michelle Cotter has rejoined the team in a reception and patient care role

Anne Pemberton is our new nurse, and a qualified nutritional therapist. She will be helping patients with advice on diet and will support Dr Downing by answering some queries about treatment.

Debbie Twissell (accounts) and Shirley Simeson (secretary) are still with us in their same roles.

We will post photos and mini-biogs of the new team members very soon.

Dr Downing continues to practice in London as part of the New Medicine Group at 144 Harley St.   www.newmedicinegroup.com

Clinics are now on Monday and Thursday. All appointments and queries through the patient care team as above.

Clinics in York are on Tuesday and Wednesday, as before.

The office will now be closed on Fridays.

The purpose of these changes is to improve the care that we provide. We know that we have not always achieved the standard that we aim for; this is our opportunity to do better. Will you help us please? Now that the York  team is focussed on patient care, we would value hearing from you - with any problems, queries, criticisms or suggestions, or just to catch up.

Thank you.

]]> http://naltd.co.uk/things-change-for-the-better/feed/ http://naltd.co.uk/the-vitamin-cure-for-allergies/ http://naltd.co.uk/the-vitamin-cure-for-allergies/#comments Thu, 27 Jan 2011 19:48:37 +0000 Webmaster http://naltd.co.uk/?p=471

Well, my new book is out - at least in the USA. The Vitamin Cure for Allergies is part of a long series of “The Vitamin Cure for…” books published by Basic health Publications, intended to be on display near the check-out in health stores.

Since writing it I’ve found myself quoting it quite a lot, so I’m obtaining some copies to make available to you direct.

The US cover price is $14.95, which works out at about £9.50. We’ll get a discount on that, but there will be shipping costs, so let’s assume that will be the cost, and if there’s a serious saving we’ll pass it on to you. You can get it for less on Amazon, but there will be shipping to add (who has second-hand books to sell when it’s only just been released, for heaven’s sake?)

Now, although all the Basic Health series books carry several very sound disclaimers, I think that the UK regulators would expect me to make things even clearer, so here goes;

Despite the title, nothing in this book is intended to make a claim of ability to cure allergies. The information it contains is intended to enable you to work with your doctors, not to replace them. As Chapter 2. Allergies that kill makes plain, allergies can be dangerous, and you must not ignore medical advice.

Here is the chapter list, to give you some idea of the content;

What is an Allergy?

Allergies that kill

Avoiding Inhalants

Avoiding Foods & Chemicals

Genes, Pollution & Diet

Nutrition for Allergies

Exercise and lifestyle changes

Desensitisation and Other Options

Resources

I’m going right off The Independent. Their health editor, Jeremy Laurance, has never been particularly “independent” in his reporting, but on 8th December just gone he excelled himself.

In a piece entitled;

Vitamin D, the cure-all supplement that could be bad for your health

he wrote;

But vitamin D, it turns out, has been oversold. After reviewing more than 1,000 research papers, the authoritative Institute of Medicine in the US has concluded that the high levels often recommended are unnecessary and could even be harmful.

If he was accurately reported in this piece, Oliver Gillie, who wrote a book on the subject called Sunlight Robbery (the title will ring bells with some of you), was pretty feeble in his comments, saying only that;

“American adults are already getting about 300 international units from sun and fortified milk and orange juice, whereas in the UK we get an average of only 150 IUs per day from all sources. So this means we need to take 450 IUs per day to fall in line with the IoM recommendation,”

Which ignores the extensive evidence that we actually need much more vitamin D, and that it is not toxic at all at the doses we recommend.

In anything concerning vitamin D, you should turn immediately to The Vitamin D Council website run by the excellent John Cannell, a psychiatrist in California. Here is some of what he said;

http://www.vitamindcouncil.org/vdc-statement-fnb-vitamin-d-report.shtml

After 13 years of silence, the quasi governmental agency, the Institute of Medicine’s (IOM) Food and Nutrition Board (FNB), today recommended that a three-pound premature infant take virtually the same amount of vitamin D as a 300 pound pregnant woman. While that 400 IU/day dose is close to adequate for infants, 600 IU/day in pregnant women will do nothing to help the three childhood epidemics most closely associated with gestational and early childhood vitamin D deficiencies: asthma, auto-immune disorders, and, as recently reported in the largest pediatric journal in the world, autism.

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Various media have recently declared that detox treatments are a waste of time, because all you need is a liver and kidney. Well, yes and no. Yes, it’s clear that there are all sorts of products sold over-the-counter that are worthless, and that most detox diets amount simply to stopping taking toxins in for a while, not to actually removing them. But no, we do all have liver and kidneys, but they are not all the same because of variations (“polymorphisms”) in the genes, and thus in the enzymes. The detox system is amazing, but not perfect. Nowadays we are all exposed to far more toxins than the system developed to handle, and it is possible to overload our detox capacity - particularly if we have genetic polymorphisms.

A very quick introduction to genomics

Remember that we each have, in every cell, 2 copies of each of the 23,000+ genes that determine our heredity, one from each parent. The old genetics was about being able to say, for example, “Your child has a 25% chance of having Down’s Syndrome”; the new genomics enables us to say “Untreated, you have 3 times the population-average risk of developing Alzheimer’s, but there are things you can do about it”. We can do this because since the Human Genome Project we have been learning to identify the SNiPs ( Single Nucleotide Polymorphisms) on our genes. These small changes in our DNA can have large effects on our chemistry.

You can have both copies of the gene normal, both copies abnormal (with the SNiP) or one of each. Having both the same is termed homozygous, having one of each heterozygous.

For instance, if you receive a report that you have a variation/polymorphism called MTHFR (C677T) this means that in the MTHFR gene (which codes for Methyl-Tetra-Hydro-Folate Reductase, the key enzyme that activates folic acid), at position 677 counting from the start of the chromosome, the base Cytosine is replaced with Thymine. That one-base alteration will reduce the activity of the enzyme that is produced, especially if you are homozygous for the change. In real life that change is associated with an increased risk of autism, and of heart disease because of a molecule called homocysteine.

A quick guide to hepatic detox

Detoxification is one of the most-studied areas in genomics; while the whole subject is complicated, with at least 30  main enzymes (not counting the variations possible in each of them), sometimes a clear pattern emerges from the report.The detox process splits into two successive phases.

Phase 1 Detox

All the Phase 1 enzymes are members of a large family called Cytochrome P450 (which is why the genes for these enzymes are all called CYP-something, and we now tend to use that abbreviation for the enzyme as well as for the gene).

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New genomic study further explains thyroid treatment problems

I am very grateful to the patient who alerted me to the paper by Panicker et al  (J Clin Endocrinol Metab 94: 1623–1629, 2009) that shows one reason why some people do better on T4 plus T3 than they do on T4 alone. Their introduction says;

…a significant number of patients report persistent symptoms despite titration of T4 replacement to adequate serum levels of thyroid hormone and normalization of TSH levels.

They identified a gene, DIO2, which is one of three very similar genes; DIO1and DIO2 code for the enzyme deiodinase that converts T4 (thyroxine) into the much more active hormone T3 (tri-iodothyronine). But DIO1 is not present inside the brain, and DIO3 produces a deactivating enzyme, so inside the central nervous system only DIO2 activates the hormone.

A tiny alteration in the DIO2 gene, known as a polymorphism (in fact a Single Nucleotide Polymorphism, or SNiP), can mean that while the rest of the body gets plenty of T3, and the blood tests look accordingly normal and healthy, inside the brain there is less T3. This is a good illustration of what we are finding genomics can do. Remember that we all have two copies of every gene, every chromosome; one from your mother, one from your father. So you can have both copies normal, both copies abnormal (with the SNiP) or one of each.

What these researchers found is firstly that, when on treatment with T4 alone, those with one of each gene felt worse than those with two normal genes, and those with two SNiP’d genes felt even worse. The difference wasn’t very big though - about 10-15% in the scores - but in a symptom score questionnaire this could mean a lot or hardly anything.

When it came to treatment, those with two normal copies did the same on both regimes; those with one of each type did somewhat better on T4 and T3, and those with two SNiP’d copies did even better, which brought them up to the level of wellness that the ones with “normal” genes achieved on T4 alone.

Interestingly, although the chemical difference seems to be inside the brain, the difference in scores showed on items like the General Health Questionnaire (GHQ), and not on the scales for anxiety and depression (HAD).

Although only about 2 in 12 of us has two SNiP’d genes, 5 out of 12 have one, so only 5 out of 12 have two normal genes. In other words, more than half of us are “abnormal” in this way - no, correct that, more than half of the study population, who all had a diagnosis of underactive thyroid, and were on thyroxine  treatment already.  So if you have a thyroid problem and are on T4, there is at least an even chance that you would be better off on T3 as well.

And we can tell which genes you have.  I emailed my colleagues at the laboratory in Luxembourg where we send much of our genomics, and they have been at work setting up the test. We’ve started sending samples already. The cost for testing this one gene will be no more than £50.

If I know one thing about laboratory testing, it’s that you can’t always get what you want. Some people will be disappointed to find that they have the good version of the gene, for instance. But it seems to me to be an open and shut case for others; if you are on T4 but disapponted with progress, and you have the SNiP’d gene, you deserve at least a trial of T4 plus T3. And the ordinary thyroid function tests won’t help you sort this out.

We used to think that fructose, fruit sugar, was a useful substitute for sucrose, “table sugar”; sadly we now know better.

Fructose intolerance happens when fructose is not absorbed well; fruits and fruit juices with higher levels of fructose can then cause gas, bloating, abdominal cramps and diarrhoea.

But in the long-term it is this is probably better than what happens if you do absorb it; the metabolic effects of fructose include as much weight gain as from sucrose, plus worse insulin resistance and damage to fat metabolism. Fructose leads to oxidative stress, and so increases LDL (‘bad’ cholesterol) and leads to high blood pressure and damage to arteries.

It has now been shown that fructose also increases uric acid (which can cause gout, arthritis and kidney stones) at the same time as depleting ATP, the cell’s main energy currency. Anybody with a high uric acid on blood testing is strongly advised to cut out fructose from their diet. With further laboratory tests we can now even detect a build-up of fructose products in the cell - and do so with worrying frequency.

Definitions

Fructose is a naturally occurring simple sugar found in fruit, vegetables, and honey.

Sucrose (table sugar) consists of one molecule of glucose and one of fructose. This form of fructose is absorbed more slowly than pure fructose, but will still be as harmful to metabolism in the end.

High Fructose Corn Syrup (HFCS) is a sweetener in many processed foods and soft drinks. It is made up of almost half glucose and half fructose. An average 600 ml can of soft drink contains 32.6 grams (over 6 teaspoons) of fructose. HFCS is also used to sweeten baked goods, canned fruits, dairy products, ketchup and jams.

Sorbitol is a sugar alcohol used as an artificial sweetener and found naturally in fruits and fruit juices.  It can also be found in many “diet foods” such as diet soft drinks, sugarless gum, sugar-free jelly/jam, and liquid medications.  Sorbitol often creates similar symptoms to fructose – especially when fructose and sorbitol are ingested together.

The best way to take fruit is as the whole, fresh fruit; even freshly squeezed fruit juice will give you more fructose. But anything labelled as squash or fruit drink may well have even more fructose in the form of HFCS.

Dietary Sources of Fructose

(mg of Fructose per 100 grams):

• Honey 40,900

Fruit:

• Bananas 4,850
• Grapes 8,130
• Apples 5,900
• Figs 22,900
• Cherries 6,000
• Pears 6,230
• Strawberry 2,500
• Blackberry 2,400
• Orange 2,250
• Blueberry 4,970
• Grapefruit 2,500
• Raisins 29,700
• Dates 32,000
• Prunes 12,500
• Persimmon 5,560
• Kiwi Fruit 4,350
• Watermelon 3,360
• Plums 3,070
• Raspberry 2,350
• Honeydew Melon 2,960
• Pineapple 2,050
• Cantaloupe 1,870
• Peach 1,530
• Nectarine 1,370

Herbs:

• Paprika 6,710
• Chilli powder 4,290
• Ginger 1,780
• Molasses: 12,800

Vegetables:

• Tomato 1,370
• Cabbage 1,650

These Substances may Counteract the Toxic Effects of Fructose

N-Acetyl-Cysteine (NAC) may inhibit the ability of Fructose to increase Blood Pressure and cause Insulin Resistance.

Lipoic Acid may inhibit the ability of Fructose to cause Cross-Linking of Proteins.

Cinnamon may inhibit the ability of Fructose to cause Insulin Resistance.

Green Tea may inhibit the ability of Fructose to cause Insulin Resistance and to increase Triglyceride levels.

Key references

Tappy L, Leˆ K-A. Metabolic Effects of Fructose and the Worldwide Increase in Obesity. Physiol Rev 90: 23– 46, 2010; doi:10.1152/physrev.00019.2009.

While virtually absent in our diet a few hundred years ago, fructose has now become a major constituent of our modern diet. Our main sources of fructose are sucrose from beet or cane, high fructose corn syrup, fruits, and honey. Fructose has the same chemical formula as glucose (C6H12O6), but its metabolism differs markedly from that of glucose due to its almost complete hepatic extraction and rapid hepatic conversion into glucose, glycogen, lactate, and fat. Fructose was initially thought to be advisable for patients with diabetes due to its low glycemic index. However, chronically high consumption of fructose in rodents leads to hepatic and extrahepatic insulin resistance, obesity, type 2 diabetes mellitus, and high blood pressure. The evidence is less compelling in humans, but high fructose intake has indeed been shown to cause dyslipidemia and to impair hepatic insulin sensitivity. Hepatic de novo lipogenesis and lipotoxicity, oxidative stress, and hyperuricemia have all been proposed as mechanisms responsible for these adverse metabolic effects of fructose. Although there is compelling evidence that very high fructose intake can have deleterious metabolic effects in humans as in rodents, the role of fructose in the development of the current epidemic of metabolic disorders remains controversial. Epidemiological studies show growing evidence that consumption of sweetened beverages (containing either sucrose or a mixture of glucose and fructose) is associated with a high energy intake, increased body weight, and the occurrence of metabolic and cardiovascular disorders. There is, however, no unequivocal evidence that fructose intake at moderate doses is directly related with adverse metabolic effects. There has also been much concern that consumption of free fructose, as provided in high fructose corn syrup, may cause more adverse effects than consumption of fructose consumed with sucrose. There is, however, no direct evidence for more serious metabolic consequences of high fructose corn syrup versus sucrose consumption.

Choi, Y. K., et al.  Fructose intolerance: an under-recognized problem.  Am J Gastroenterol. 98(6):1348-1353, 2003.

Although the role of lactose intolerance in the pathogenesis of abdominal symptoms is well known, the role of fructose intolerance is unclear.  The aims were 1) to examine the prevalence of fructose intolerance in patients with unexplained abdominal symptoms, and 2) to explore whether fructose concentration influences fructose breath test.  Over 2 yr, patients with unexplained symptoms answered questionnaires and underwent fructose breath tests.  Patients received 50 g fructose in 150 ml water (33% solution).  Breath samples were collected for hydrogen and methane.  In a second study, breath test was performed after giving either 10%, 20%, or 33% fructose solution. Data were analyzed retrospectively.  A total of 183 patients (50 male, 133 female) had breath tests, of whom 134 (73%) were positive.  Among these, 119 (89%) had elevated H(2), and 15 (11%) had elevated CH(4) or both gases.  Questionnaires showed that flatus (83%), pain (80%), bloating (78%), belching (70%), and altered bowel habit (65%) were the most common symptoms.  Breath test reproduced symptoms in 101 patients (75%). In the second study, 14/36 (39%) tested positive with a 10% solution, 23/33 (70%) with a 20% solution, and 16/20 (80%) with a 33% solution (10% versus 20% or 33%, p < 0.01).  Fructose intolerance may cause unexplained GI symptoms.  The higher yield of positive tests in our initial study may be due to referral bias or testing conditions; lower test dose produced a lower yield.  Nonetheless, recognition and treatment of fructose intolerance may help many patients.

Ledochowski, M., et al.  Fructose- and sorbitol-reduced diet improves mood and gastrointestinal disturbances in fructose malabsorbers.  Scand J Gastroenterol. 35(10):1048-1052, 2000.

Fructose malabsorption is characterized by the inability to absorb fructose efficiently.  As a consequence fructose reaches the colon where it is broken down by bacteria to short fatty acids, CO2 and H2.  Bloating, cramps, osmotic diarrhea and other symptoms of irritable bowel syndrome are the consequences and can be seen in about 50% of fructose malabsorbers.  The authors have previously shown that fructose malabsorption is associated with early signs of mental depression and low serum tryptophan concentrations.  It was therefore of interest whether a fructose-

reduced diet could not only improve gastrointestinal complaints but also depressive signs seen in fructose malabsorbers.  Fifty-three adults (12 males, 41 females), who were identified as fructose malabsorbers according to their breath-H2 concentrations, filled out a Beck’s depression inventory-questionnaire, and a questionnaire with arbitrary scales for measurement of meteorism, stool frequency and quality of life for a 4-week period before dietary intervention and 4 weeks after dietary change as for fructose- and sorbitol-reduced diet.  Depression scores were reduced by 65.2% after 4 weeks of diet (P < 0.0001), and there was a significant reduction of meteorism (P < 0.0001) and stool frequency (P < 0.01).  Improvement of signs of depression and of meteorism was more pronounced in females than in males.  Fructose- and sorbitol-reduced diet in subjects with fructose malabsorption does not only reduce gastrointestinal symptoms but also improves mood and early signs of depression.

There doesn’t seem to be any swine flu left in the country, and we are closing down this offer. There is another reason too; recently Dr John Cannell, who runs the excellent Vitamin D Council website, raised a concern that the well-demonstrated cancer-preventing effect of vitamin D may be reduced or even reversed by too much vitamin A - link here . There is a debate going on about this, as you can imagine, but as it is important to protect you and all consumers from risk, we are changing our advice.

Nobody thinks that a short course of vitamin A could be harmful - the effects being discussed would take years to happen - and the evidence that vitamin A helps to improve resistance to infections has not gone away, so this is my advice;

When exposed, or at risk of being exposed to a potentially serious infection, take vitamin A at the doses already shown in the Swine Flu page, and with the other supplements recommended there, but do not continue the vitamin A beyond a maximum period of 3 months. Do not do this more than twice yearly.

Tamiflu’s not much help and there won’t be a vaccine for months; the only hope is mouthfuls of vitamins.

The best that can be said of Tamiflu is that it will reduce the duration of flu by a day or two; the worst is that it may cause confusion, self-injury and death.

Vaccine production is a catch-up game, and it will take another four months to produce one, by which time the virus may have mutated into something else.

Nutrition serves both the vulnerable and the well; vigorous supplementation can prevent or moderate the impact of viruses. The consequence of an overdose is only expensive urine; the risk of deficiency is vulnerability to infection and other disease.

Vitamins A, C, D and B12, and Zinc all have documented benefit against infections; if you really fear Swine flu take loads of them, and don’t worry if your urine is pink or yellow due to overflow. It’s cheap, available and effective, unlike Tamiflu and flu vaccine.

We have a SPECIAL OFFER ON PREVENTION OF SWINE FLU

Link to our SPECIAL OFFER

OR read on…

WHO have just confirmed that it will be November before a vaccine is available.

It may now be true that this H1N1 strain is more virulent than it seemed when it first reached the UK; but this does not alter my advice, which is:

On Tamiflu

That on average it reduces the duration of flu symptoms by 1 to 1½ days, but at the cost of common gut side-effects (nausea, stomach-ache, vomiting) and uncommon more serious ones, from brain-fog (“I couldn’t think past a comma”, one patient told me) to the strange desire to harm yourself. This is according to the official Tamiflu website [1,2].

On vaccination

That even when it becomes available, all the evidence suggests that it won’t save many lives. A 2005 study “could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group” [3]. That’s flu vaccine in general; this one hasn’t been made yet, so we have no idea how good it will be, but there’s no reason to think it will be much better than the rest.

On nutrition, though;

Vitamin D

In 2008 a brilliant study by leading vitamin D researchers [4] proposed that one reason vaccines don’t work better was widespread vitamin D deficiency due to lack of sunlight;

Over the last 20 years, why has influenza mortality in the aged not declined with increasing vaccination rates?

Given that influenza vaccines effectively improve adaptive immunity, the most likely explanation is that the innate immunity of the aged declined over the last 20 years due to medical and governmental warnings to avoid the sun. While the young usually ignore such advice, the elderly often follow it.

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