BSEM – Sugar.... the Brain, the Microbiome and Cancer – October 2015

Some notes on the presentations

Please click on the links for the individual presentations.


Introduction Dr Shideh Pouria
Sugar related neurocognitive impairment and alteration of the gut microbiota Professor Henry Butt
Healing the glutoxic brain – and sugar and cancer Dr Heinz Reinwald
The ketogenic diet Dr Damien Downing
Fructose and sucrose intake: measurable biochemical parameters including new findings and clinical correlates John McLaren Howard
Is sugar toxic beyond its calories? Dr Robert Lustig


An introduction to sugar consumption in the 21st century

Dr Shiden Pouria

We are currently experiencing an epidemic of disease and poor health including:

  • Obesity
  • Cardiovascular and brain disease
  • Metabolic problems (diabetes)
  • Digestive issues
  • Cancers
  • Drop in fertility
  • Psychiatric and behavioural problems - but...

• While the genetic pool has not changed, lifestyle factors have.
After 2.6 million years of a minimal carbohydrate, high fat diet we have now changed to a high carbohydrate low fat diet.

• Sugar was virtually unknown until 16th century.
Discovery of the New World (cane sugar) and then sugar extraction techniques from beet, finally followed by high fructose corn syrup in 1960s has now boosted average sugar intake per day in the UK to 90 grams.

• Most the the sugar consumed is in the form of hidden sugar – of the 600,000 items in the American food supply, 80% have added sugar. Figures the same for the UK.

• Sugar and addiction. Sugar and drugs have identical effect on neuronal pathways.

• Sugar and cardiovascular disease. Those who consume 21% or more of their daily calories as sugar are twice as likely to die of heart disease compared to those who take 7% or less.

• Sugar and hormones. Grains, sugar and fructose reduce levels of 7 of our 12 most important hormones, trigger stress hormones and hormones that signal fat deposition.

• Fructose. Far more destructive metabolic effect than other naturally occurring sugars; same narcotic effect as alcohol; same metabolic effect on liver as alcohol.

WHO recommendations likely to be set at a maximum of 5% of total calorie intake from sugar.



Sugar related neurocognitive impairment and alteration of the gut microbiota

Professor Henry Butt, Senior Fellow (Hon) and Adjunct Associated Professor at Victoria University, Australia

Recent evidence suggests a strong link between the intestinal microbiota and the central nervous system, and that healthy intestinal microbiota modulate brain development and stress related behaviours.

The effects of a sugar-heavy diet on the gut microbiota can contribute or possibly even cause diseases such as neuro cognitive impairment, depression, chronic fatigue syndrome, fibromylagia, IBS and autism.

• In chronic fatigue syndrome there are significant changes in the gut microbiota, namely a far higher population of fecal streptococci in proportion of the E.coli bacteria. (A 'normal' population would be 95% E coli to less than 5% Streptococci/Enterococci; in CFS patients this can almost be reversed.)

• Streptococci does not appear in newborns until after the introduction of sugar.

• Bacteria 'fed' on a substrate of glucose produce lactic acid but while E coli produce L Lactic acid, Streptococci produce D lactic acid. Humans have the enzyme to break down and metabolise L Lactic acid, they are very poor at breaking down and converting D Lactic acid. High levels of D Lactic acid significantly alters the PH of the colon.

• So there is a direct relationship between fecal streptococcus and the acidity of the bowel.

• Moreover, in both autism and PANDAS, streptococcus in the large bowel (coming from the oral cavity and therefore from food) is pathologically high e.g. 44% versus 8% in controls.

• High levels of both enterococci and streptococci in the bowel correlate significantly and positively with neurological dysfunctions, gastrointestinal disturbance and poor sleep.

In summary: persistent intake of dietary sugar (glucose) may affect microbial metabolism changing the internal ecosystem resulting in acidosis. This is turn may affect neurocognitive functions, sleep patterns and may promote the pathophysiology of the gastrointestinal tract.

E. coli

Chronic Fatigue patients who often suffer from cognitive malfunctions, constipation and food sensitivities, normally have very low populations of E.coli.

What do E.coli do?

They produce Chorismic acid which is a precursor of folic acid. Folic acid then needs ubiquinol in order to make the conversion into tyrosine phenylalanine, trypotophan and then dopamine all of which are essential for mood control.

CFS patients are often very low in folic acid. But while gut micro organisms will produce plenty of folic acid, ubiquinol is important for the conversion process.

If E.coli is low that may suggest that the bowel is stuck. Live E.coli have been used very successfully to treat long term constipation.


Healing the glutoxic brain – and sugar and cancer

Dr Heinz Reinwold

Dr Reinwald runs an alternative medicine practice in Bayreuth with a particular focus on clinical nutrition and detoxification. In his presentation he focused first on what he calls the glucotoxic diet (a diet which draws energy from carbohydrate and sugar rather than fats) and then on the connection between sugar and cancer.

The ketogenic diet

Dr Reinwald's three ages in nutrition:

  • 2.5 million years ago until 10,000BC - a high fat, high protein diet with virtually no carbohydrates
  • 10,000BC to 1850s – the development of farming and an increase in the intake of grain carbohydrates.
  • 1850s (Industrial Revolution) to the present – food processing dramatically increased the consumption of sugar from almost zero in 1600 to over 50 kilos per head, per annum today.

In health terms the massive growth in sugar consumption has been matched by the almost universally held medical belief that fats, especially animal fats, are unhealthy. This belief also holds that the consumption of carbohydrates and/or sugar is the only way to generate energy – what Dr Reinwald calls the Glucotoxic Paradigm.

He maintains that the theory that 'the glycoliptic pathway of glucose is the sole source of metabolic energy' is wrong. Carbohydrates are not necessary for energy production.

Adults can derive energy from fat just as efficiently as breastfed infants (who consume neither carbohydrates nor sugar). But first they need to be 'weaned' off carbohydrates and sugar and the enzymes needed to utilise fat for energy production need ot be re-established in the body.

This process may take days or weeks, depending on the individual, and may produce many of the detoxification/withdrawal symptoms (confusion, dizziness, dry mouth, tremor, nausea, headache, sweating) that you would expect with any detoxification process.

However, replacing sugar in the diet with fat, the ketogenic diet, may not only have significant benefits for the general population, especially in the area of brain health, but can have dramatic benefits for those suffering from Type 2 or what is known as Type 3 diabetes (which is closely linked with Alzheimer's disease).

The ketogenic diet has also been shown to be very helpful in the treatment of epilepsy.

Sugar and cancer

As early as 1887 a connection was being made between abnormally high levels of sugar in the blood and the growth of cancerous cells. This connection is not recognised by many of the leading cancer researchers who maintain that a 'sugar-free diet would not reduce the incidence or promote the healing of cancer'.

None the less, it is recognised that cancerous cells have a great ability to uptake sugar and that 'fermentation is the bioenergetic signature of tumour cells'. In other words, sugar feeds cancer cells.

From this it can reasonably be deduced that a diet, such a the ketogenic diet in which sugar does not feature, would also very largely starve cancerous cells dependent on sugar for energy. See, for example, this study on malignant brain tumours starved of energy through the adoption of a ketogenic diet.


The Ketogenic diet

Dr Damien Downing

Humans were not built to burn carbohydrates for energy but to burn fats. Dr Downing suggested that the over use of carbohydrates (which should only be consumed as a back up for small boosts in energy) shuts down the fat burning mechanisms in the body. Hence the need for a transition period (as suggested b y Dr Reinwald) while the enzymes needed to utilise fat for energy are re-established.

Dr Downing described some ketone diets and the ketone meters that can be used for ketone testing. He also suggested some sites which could be helpful in managing a ketogenic diet, especially in connection with epilepsy:
The Charlie Foundation
Matthew's Friends


Fructose and sucrose intake: measurable biochemical parameters including new findings and clinical correlates

John McLaren Howard

This was a highly technical presentation from John McLaren Howard so we would recommend that biochemists should check in at the BSEM site where the original slides will soon be available. However, for the lay reader, here are a few of the points that he made.

• Sucrose is 50% fructose and 50% glucose. Ingested sucrose should be hydrolised to fructose and glucose but this does not always happen so some unhydrolised sucrose may be absorbed.

Nota Bene. The following observations came from single patients or small groups; they do not constitute a formal research project, merely point the way to research that needs to be done.

• Mitochondria in cells are normally replaced very fast – every 4.5 minutes. This rate slows significantly after the addition of sucrose which could suggest major mitochondrial loss.

• Cell apoptosis (the death of individual cells which is a normal part of their behaviour) changed after sucrose intake. Whereas, normally, 80% of cells would be live and active, with 8-14% in early stage apoptosis and 3-6% in late stage apoptosis, after sucrose intake there were significantly fewer live cells, fewer early apoptosis cells and many more late apoptosis cells. In a cancer patient the late apoptosis cells were up by 12.5%.

• Infrared imaging in breast cancer showed that sucrose ingestion changed both the shape of the tumour and the blood balance.

• Short change polypeptides were all affected by the ingestion of 100g of sucrose in water after a meal.

• Using a TOX-8 in-vitro toxicology assay kit it would appear that added sucrose does have an effect, especially in cancer patients, in all of the following areas:

  • the cancerous cells/tumours themselves
  • energy provision via the mitochondria
  • clot formation
  • peripheral circulation
  • allergies and sensitivities
  • short term polypeptides


Is sugar toxic beyond its calories?

Professor Robert Lustig

Since the middle of the 20th century, obesity thinking, especially in public health, has focused on calories: the more calories you consume, the more weight you will gain, regardless of what foods the calories are found in.

But all calories are not the same as, depending on the food, they metabolise differently. So, for example, you will absorb fewer of the calories from an almond because its high fibre content will carry some of those calories through the bowel without them being absorbed. Similarly, converting the amino acids in protein to energy takes twice as much energy per calorie to convert into calories.

But is sugar toxic?

Toxicity can damage an organ, whether that damage is acute or gradual. However, for a substance to be recognised as toxic it must:

  • present an independent risk
  • causation must be established
  • the toxicity must be exclusive of calories
  • the toxicity must be exclusive of obesity

Looking at human data on normal consumption of sugar:

  • 75% of healthcare money goes on the treatment of chronic metabolic diseases – such as diabetes
  • 30% of the population are obese and 80% of that 30% of obese people are sick. So, if we could solve the obesity problem, would that also solve the illness problem?
  • But – 40% of the normal, non-obese population have the same illnesses as the obese people – and
  • 30% of the obese population are not sick

So, obesity cannot be the problem.

Sugar consumption

Sugar consumption in the US jumped from around 10g per day in 1820 to 150g per day in 2000.

1924 saw the first dramatic increase in rates of diabetes
1931 saw the first epidemic of heart disease
1988 saw the start of an epidemic of type 2 diabetes in adolescents

Detrimental effects of sugar

1. Fructose. Fructose leads to an excess of uric acid which increases blood pressure. The mitochondria cannot handle the excess which gets stored in the liver.

2. Sugar and heart disease.

  1. 10% added sugar increases HDL in teenage girls
  2. Added sugar increases diastolic blood pressure in children far more than excess salt.
  3. Risk of death from heart disease is increased by 50% by increasing calorie intake including added sugars.

3. Sugar and diabetes. Although there is a world wide epidemic of both obesity and diabetes, some countries have high rates of diabetes without being obese – and some countries have high rates of obesity but not of diabetes. Worldwide, obesity is increasing at 1% per year, diabetes at 4% per year.

4. Fatty liver disease. Is the cause alcohol? or sugar?

As of now, 45% of Latinos, 33% of Caucasians and 24% of African Americans have steatosis or Non-alcoholic Fatty Liver Disease (NAFLD) which could develop into death. But Type 2 diabetes and obesity are not predictors of NAFLD.
So there are healthy fat people and sick fat people – and healthy thin people and sick thin people.

So what is this liver fat and where did it come from? In 2009 Fabbrini et al assessed both liver and visceral fat for effects on insulin. It was liver fat, not visceral fat that affected insulin.

5. Fructose

Glucose is metabolised in the liver into glycogen (stored energy).
Fructose does not metabolise into glycogen but into citrate which eventually becomes fat in the liver.
In a comparison of 9 adults on either a high fructose or a high complex carbohydrate diet, 38% more fat was deposited in the liver on the high fructose diet.
Browning – the Maynard reaction – is a binding of glucose to proteins. This creates hydrogen peroxide which creates aging with metabolic and biological dysfunction. (High levels of antioxidants can counteract this effect.) But fructose binds to proteins 7 times faster than glucose.

Global sugar consumption

The US: obese – lazy – unhappy – diabetic – suffering from heart disease and drinking a lot of soft drinks and sodas. Which causes which?...

The countries around the world with the highest rates of diabetes are those where they do not drink alcohol so have the highest consumption of soft drinks: Saudi Arabia, the Gulf States and Malaysia.

Comparing statistics for the effects of food consumption on diabetes in 175 countries world wide, only sugar consumption demonstrated an effect on diabetes levels:
An extra 150 calories had virtually no effect on diabetes rates
An extra 150 calories in soft drinks increased the risk 11 fold.

The proof

New study shows that sugar, not calorific content, causes rise in blood pressure, cholesterol levels, blood glucose levels and insulin resistance. See Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome in the Journal of Obesity October 2015

43 children, all of whom had been referred to hospital for excess weight and significant health issues, were put on a diet for 9 days in which the added sugar was reduced from 28% to 10% and the fructose from 12% to 4% – but the calorie count remained the same by the addition of extra starch carbohydrates.

At the end of the 9 days, there was an average drop of 57% in the production of liver fat, while their actual liver fat had reduced by 29%. There was also a reduction of 10% in visceral fat (body fat that is stored within the abdominal cavity around internal organs such as the liver, pancreas, intestines etc) and a 75% loss in pancreatic fat which should never have been there in the first place.

For the full conference see the BSEM website.

October 2015

See here for many more conference reports on a wide range of subjects.

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