The AGE Old Question: How do we Die?

June 20, 2007

The AGE Old Question:  How do we Die? 

 Competency # 20: Cuisines of the Long-Lived                       Reference: American Journal Clinical Nutrition: May 2007, p 1236  Negrean et al. 

 Understanding AGE has been history’s mystery.  Now, they are turning out to be modern medicine’s key to understanding heart disease.  “They”?  Yes, “they” are problem molecules.  AGE stands for Advanced Glycation Endproducts.  Glycation means the addition of a sugar molecule in a haphazard way to a protein, fat, or DNA molecule.  It doesn’t happen from the result of an enzyme, which places the sugar in a precise place.  It occurs through a chemical reaction brought about by high heat.  

Cooking with high heat.  And it doesn’t happen equally to all foods.  It happens to high fat, high protein foods.  Meat and cheese.  (Sounds like pizza, hamburger, fried cheese balls, Wisconsin State Fair, back yard barbecue).   And the sugar ends up being in places where it’s not meant to be.  The result is disruption of normal function of that molecule.  It can’t be digested.  It gets absorbed and hangs around.  It activates your immune system.  

The net effect has been to show that AGEs end up being pro-inflammatory, pro-oxidizing. They make the complications of diabetes worse and seem to play a role in making coronary artery disease worse.  They are trouble. Well, half of us die of coronary artery disease.  It’s the runaway epidemic of our time.  That’s how we die!  What’s the link here?  We know that people who are overweight have more diabetes.  Folks with diabetes, or “metabolic syndrome” (AKA pre-diabetes), have vascular disease at 2-5 times the rate of folks without diabetes.  

The search for the connection has been focusing on the lining of blood vessels where the problem seems to start.  Recent research has narrowed it down to the state of blood vessels right after a meal when the food we eat has its maximal chemical impact on our body’s blood vessels.  In that period, high sugar and high fat blood levels lead to “oxidative stress” and “endothelial dysfunction”.  And those two are additive.  AGEs make that stress worse. How do you test for the connection of that with AGEs?  

Here’s what Drs. Negrean and Stirban did.  The precise same food, cooked in two different ways (one that makes lots of AGEs and one that doesn’t) and then fed to 20 folks with type two diabetes.  That’s the type of diabetes you get from being overweight and can usually control with pills.  The food was prepared with high heat and frying (high AGE), or low heat (steaming for shorter periods-low AGE).  Same calories each way.   Their hypothesis was that a SINGLE MEAL, differing only in preparation style and, therefore, the amount of AGEs would have differing impact on “endothelial dysfunction”.   

One meal had 15,000 AGE units.  The low AGE meal had 2,750 AGE units.  A five-fold difference just by preparation methods. There were significant differences.  This is a very important finding for you to understand.  They found dramatic differences in blood vessel function like “Flow Mediated Dilatation”  (35% versus 21% in high versus low).  Markers of oxidative stress similarly were significantly different between the two meals.    There were no differences in blood glucose level.  It was the same food and that part was consistent.  It’s blood glucose we’ve been measuring, thinking we were on the right track.  We haven’t been measuring the AGE products we eat, or the endothelial dysfunction they cause. 

 Here is the unproven and untested hypothesis.  The daily consumption of foods made by frying, broiling or other high heat methods used on meat and cheese consistently damages our arteries.  Bit by bit, it adds up and the eventual complications of diabetes take their toll.  Your first warning sign is a heart attack, or sudden death, a bit late.  The dots are beginning to have credible connections.  This is a watershed idea and you will certainly hear more from me about this. 

 WWW.  What will work for me?  The AGE Old Question: How to get to healthy old age.  This study shows that the same food, cooked differently shows dramatic differences in outcomes on short-term effects.  If we believe that short-term effect has long-term implications, we need to start cooking differently.  If I poach, boil or stew my food, I’ll have less trouble?  I can certainly reduce the AGE products I eat by 80% by changing my food preparation methods.   I’m eating less high fat meat anyways.  Now, I have to figure out how to make it through State Fair this summer without the barbecue, the deep fried cheese curds…  So, more whole fruits and veggies and less back yard blackened barbecue.  What a bummer with summer just getting started.  How about roasted veggies?

The column is written by Dr. John E. Whitcomb, MD, Brookfield Longevity, Brookfield, WI (262-784-5300)