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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LDN stands for Low-Dose Naltrexone.

Several years ago we were asked if we would help a number of patients with MS obtain this treatment, and so we did.  It would be fair to say that some of them, over 50%, improved; nobody got lastingly worse although some had short-term side-effects. For some it just didn’t work. Of course we advised them, as we are always ethically bound to, on other treatments that might benefit them; some at least saw some benfit from these also.

Since then there has been surprising progress in the use of LDN, and it has been found to be helpful in several other circumstances. For me, it is definitely time to revisit and reconsider it.

There are two major diagnoses in which LDN has shown success — you have to bear in mind that this does not mean randomised controlled trials of the therapy, and certainly not the systematic reviews of multiple RCTs that scientists now expect; it is “anecdotal” reports, published papers that state that it appeared to work for one patient or for a small number. The two diagnoses are:

• Auto-immune disease
• Cancer

Auto-immune disease is a growth area in medicine because we are discovering that more and more diagnoses fall in this category. They include:

• Arthritis and Rheumatism
• Some Thyroid diseases (Grave’s, Hashimoto’s)
• Diabetes type I (insulin-dependent)
• Crohn’s disease, Ulcerative Colitis and Coeliac disease
• Pernicious Anaemia
• Connective Tissue diseases (scleroderma, dermatomyositis, lupus)
• Psoriasis
• Antiphospholipid syndrome (Hughes’ disease)

Cancer

There are some surprising (“anecdotal” again) reports of cancer responding to LDN. There is a long way to go before one could say that it is definitely of value, and even further before we could estimate how much value or for how many.

Because of the way that we think LDN works, plus the fact that it works in Auto-immune disease and in Cancer, one big question arises; will it work in Multiple Chemical Sensitivity?

What is it?

Naltrexone is an opiate-antagonist drug; it has been used for some time to block the effects of addictive drugs such as heroin and morphine. I can recall as a junior doctor dealing with patients who were admitted in  a coma due to these drugs; when given the antagonist they sat up and spoke.

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We at the British Society for Ecological Medicine (BSEM) have been talking to the Pernicious Anaemia Society (PAS). Martyn Hooper and his colleagues there have achieved a remarkable amount, with 3,500 members after just two years, and a questionnaire that identifies several key symptoms of B12 deficiency about which none of us knew — the “strange tiredness” and “the gulps” for instance. We are looking forward to working with them, both to help sufferers and to prove that B12 deficiency is a real problem for many people. More of that on our website.

Here I want to talk about my own experiences with B12, which I’ve been using for more than 20 years — although we have learnt more all the time since then.

The first thing to say is that B12 is extremely safe. In all that time I have seen one instance of adverse effects, and that was back when we used cyanocobalamin — the original version if you like — and in a complicated case with other problems. Since we have used methylcobalamin and hydroxocobalamin the only adverse effect I have known is one male patient who called me from his car; he was on the way to casualty because just after the injection of B12 that I gave him his urine had turned pink! I was able to reassure him that it was simply overflow of the B12 he had received.

I don’t know why so many doctors are nervous of B12, and reluctant to give more than the official dose, when so many medications have much more severe and more frequent side-effects.

In 1991, in the Journal of Nutritional and Environmental Medicine, we published a “Classic Paper” from 1956, by neurologist Prof J MacDonald Holmes, called “Cerebral Manifestations of Vitamin B12 Deficiency”. The doctor reported that many patients experienced mental or neurological symptoms either before or without blood changes. The main symptoms were;

• Pronounced slowing of mental processes      100%
• Confusion and memory defect                          100%
• Depression                                                           50%
• Delusions                                                              35%

— sound familiar at all? In fact it was not new even then; we referenced a paper in the Lancet in 1929 which linked pernicious anaemia with mental changes, which it said may precede it by “many months”. As a point of interest, vitamin B12 was first isolated in 1946.

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NA Update 1

Our newsletter is emailed to those of our patients who wish to receive it, but you can download the pdf of issue 1 here. Just click on the icon above.

First published on the Alliance for Natural Health website, June 2009

Last week Cancer Research UK released figures showing that cases of melanoma exceeded 10,000 in 2006, the last available figures.

Predictably the media took this story and messed it up, producing headlines ranging from “More then 10,000 a year get skin cancer in quest for perfect tan” (Times Online) to “Recession linked to skin cancer” (The Herald).

What Cancer Research UK actually advise people to do is mainly sensible, but it does go one step too far;

“Most melanoma skin cancers are caused by over exposure to UV rays given off by the sun and sunbeds. But, crucially, if people are careful not to redden or burn, especially if they have fair, freckly or moley skin then most cases of malignant melanoma could be prevented.

“We advise people to enjoy the sun safely by spending time in the shade in the middle of the day, covering up with appropriate cool clothing and sunglasses and applying plenty of sun cream of at least factor 15.”

So what are the facts?

Melanoma rates are rising, but you can’t explain it all by UV exposure. For a start they have been rising for too long; a study in 1970 found that, beginning with those born at the beginning of the last century, every successive cohort of people of the same birth year develops more melanoma, and developed it at an earlier age. That’s not just sunbathing or sunbeds.

Sunlight protects us from other more serious cancers — probably all of them, but certainly the big ones such as colon, prostate and breast. William Grant, formerly a climate scientist with NASA, has shown that the more sunlight there is where you live (in the USA) the less your risk of developing these cancers. He estimated that 23,000 Americans died unnecessarily each year from these cancers due to lack of sunlight.
98% of skin cancers are not melanomas, they are forms known as squamous cell and basal cell carcinomas. These are clearly linked to UV exposure, but they are rarely fatal because they can be detected so early. Back in 1936 a paper in the Lancet even suggested that we should give people these treatable kinds of cancers in order to protect them from the more deadly internal cancers. I’m not advocating this, but it would probably work.

Sunburning,when the skin goes red and perhaps sore, contributes to all skin cancers (but in a complex way) while suntanning probably protects against both skin cancers and cancers of internal organs such as bowel and breast. On balance the sun probably prevents many more cancers than it causes.

Environmental pollution is emerging as another likely cause of melanoma. After the Seveso incident in 1976, when large amounts of dioxins were released into the atmosphere in northern Italy, the local melanoma rate rose more than 10-fold.

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This item originally appeared in the March 2009 issue of Lifescape magazine

Epidemic

The developed world is in the middle of an epidemic of allergies. The rate in the UK has been rising for at least 50 years, and rising steeply for the last 20. A large study in 2007 found an increase of 27 per cent over just four years; in 2005 one person in nine in the UK had a recorded diagnosis of “any allergic disease” (who knows how many haven’t bothered to get diagnosed). Hospital admissions, not the most reliable indicator, but most liable to underestimate, for food allergy rose, in the period 1990-1 to 2003-4, 5-fold in adults and 6.5-fold in children (Chart 1). The same pattern prevails for asthma, hay fever and every form of allergy. Anaphylaxis admission rates have risen even faster — 7-fold over the same period.

Why?

Each succeeding generation or birth cohort has more allergies than the previous, and each cohort has more allergies as they get older. While we know that allergies in general do have genetic components, our genes cannot change perceptibly over 50 years, so that can’t explain it. Why then such an increase? One explanation that has become popular is the “Hygiene hypothesis”;  this suggests that exposure to lots of infections in childhood is healthy for the immune system, and that we have all cleaned up our homes too much, and we should let our kids eat a bit of dirt now and then.

Nobody has really tested this theory, and there is one big problem with it; dirt just isn’t what it used to be.

When I was a medical student, long ago, we were taught that indoor dirt was made up in large part of human skin debris, plus stray food, bits of soft furnishings etc. That’s no longer true; we think of dirt as dusty dry stuff, but the dirt inside our homes has a large enough oil component that it forms an oily film on any surface, made up of oils from us, from cooking, from exhaust pollution and so on and on. And because most of the environmental pollutants around us are fat-soluble (that’s why the first step in the body’s detoxing and excretion process is to make them water-soluble), they will absorb into that film. Every time someone touches the surface they pick up a bit of both the oil and the pollutants.

Some recent studies looked at this and in particular at the levels of PBDEs (polybrominated diphenyl ether flame retardants). You can find a good summary of all this at Rachel’s Democracy and Health News, http://www.precaution.org/ — an excellent subscribable newsletter. Flame retardants must be put in soft furnishings by law, and some of the boards in your computer may be as much as 40% flame retardant.  No surprise then that the US researchers found levels of PBDEs were 20 times higher inside the houses than outside.

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first published at www.anhcampaign.org

Measles is back! 1300 cases last year! Irrational behaviour by parents! And all because of the MMR scare, which has been categorically disproved.

Balanced reporting? Definitely not. We only hear one side in this story, so what’s the other side? Read on to find out;

• The vaccine-autism link has NOT been disproved; all the studies quoted have major flaws.
• Parents now face an impossible choice; to vaccinate and risk autism, or to refuse it and risk measles complications.
• The drop in MMR take-up is not due to the “vaccine scare” so much as to loss of trust in the government’s line on it.
• Government could solve both problems by providing single vaccines on the NHS.

Millions of parents every year face a grave dilemma; should we give our child the usual vaccines and risk autism, or refuse them and risk meningitis and other complications, plus increasing pressure to vaccinate from the authorities? How to evaluate the evidence? Who can we trust?

Government policy, in the UK and USA, is clear; all your children should have all the vaccines. If they don’t you may be prosecuted (New York), and they may be barred from school (UK). And year by year the list of vaccines just grows.

Because vaccines are the new Pharma. While most of the big-earning drugs are nearing the end of their profit cycles, vaccines are just selling more and more; over $10 billion per annum worldwide, not a profit centre any company wants to abandon.

The pharmaceutical multinationals not only have preferential access to government circles via lobbyists and other less transparent links; they are the ‘jewel in the crown’ of industry, so successful that governments dare not threaten them lest they take their jobs and taxes elsewhere.

What should you do? Should you give your child the MMR? Should your daughter have the cervical cancer jab? Should you have the flu jab yourself?

The first principle is that, in a democracy, it should be your choice. We used to be a democracy until recently, but now, in a Europe where the Lisbon Treaty is still being pushed through although whenever any country has voted on it they have rejected it, they talk about post-democracy. Post-democracy is a system where most policies and laws are made not by elected representatives voting according to the wishes of the electorate, but by regulations, establishing quangos, and presidential-style decrees that all bypass democracy. Where countries go to war despite the will of the people; where indeed the elections are not representative. And where compulsory vaccination, alongside compulsory medication of our children for their putative ADHD, is imposed against our will. And where nutrients that can provide cheap, safe and effective treatments for many problems are being outlawed on the basis of dodgy evidence.

The second is that you should be provided with the information necessary to make an informed decision.

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