I spent some time in eastern Africa as an environmental officer, my home was in Nairobi. On an assignment to Uganda, I ran across an old Brit MD and we discussed heart and vascular disease. He commented that the local diet was high in fat but that the prevalence of heart disease was low but had increased following the establishment of sugar plantations and refineries.

The fat may impact the ability of the endothelial cell to generate NO and the sugar generate ROS, thus pro inflammatory transcription factors, hence upregulation of ICAM-1

See, for example: Mitochondrial Reactive Oxygen Species Mediate Lysophosphadylcholine-induced Endothelial Cell Activation, by Xinyuan Li, et al.

Dr Edo McGowan

I spent some time in eastern Africa as an environmental officer, my home was in Nairobi. On an assignment to Uganda, I ran across an old Brit MD and we discussed heart and vascular disease. He commented that the local diet was high in fat but that the prevalence of heart disease was low but had increased following the establishment of sugar plantations and refineries.

The fat may impact the ability of the endothelial cell to generate NO and the sugar generate ROS, thus pro inflammatory transcription factors, hence upregulation of ICAM-1

See, for example: Mitochondrial Reactive Oxygen Species Mediate Lysophosphadylcholine-induced Endothelial Cell Activation, by Xinyuan Li, et al.

Dr Edo McGowan

Dear Dr. Edo,

Thanks so much for the answer. From your experience, you can see that there is a misconception somewhere and that has resulted to the increase in metabolic diseases.

Ok now you see NO is good because it helps lower blood pressure. While a significant increase in ROS causes cellular damage.

Beyond the "science" there are basic policy issues. There is also a need to start looking at antibiotic resistant organisms and xenobiotics, as found in discharged sewage, the wastewater's conversion into "reclaimed" water, and the use of these sewage byproducts in irrigated agriculture. Davide Bulgarelli, in THE SCIENTIST discusses the relationship of microbes and the microbiome surrounding and internalized within plants. This may be influenced by what is found in wastewater----plants can bioaccumulate toxins/xenobiotics and these can impact the ROS affecting the mitochondria. The typical water quality tests (coliform) as suggested by either US EPA or WHO are not capable of reflecting the reality of these potential risks.

As Africa continues to dry down, especially under accelerating population pressures, the need for water reuse will increase. This will be affected by the ability, and thus need to remove the undesirable constituents found in wastewater. Thus, there is a need for a comprehensive over-view of factors impinging on human metabolic processes, as found in wastewater, that, in addition to diet, affect the gut biome, thus the metabolism of nutrition, hence health. Since this can include impacts to mitochondria, this will also have the potential to impact neuron-degenerative diseases, hence the cognitive capacities of citizens and their ability to function in an increasingly technical world.

Dr Edo McGowan

Dear Dr. Edo, I agree with you.

In my opinion, I think there is a need to review the basic health policies and begin cutting down the excesses of the so called coca cola companies and cohorts.

Let me give you an example of the true situation of things where I am in Nigeria. There is an increase cases of death resulting from high blood pressure popularly known as high b.p. You don't need to carryout a study in this case to confirm. Simply visit an hospital, the first thing Doctors check now is high blood pressure. Infact you will hardly find a family without the cases of high bp. Every family is now encouraged to have a high bp monitoring device. Also, I noticed a special type of death called slumping. For instance the person is healthy, no signs of ill health, he or she slumps. Everyone says is high bp. I also noticed that every nook and cranny I have been in Nigeria says that high cholesterol is the cause of high blood pressure even now. Now people are avoiding oily foods. They are encouraged to eat vegetables and fruits- That's great.

Also, the so called coca cola companies are busy rebranding and packaging the 'poison' in different formats while the WHO and other responsible agencies are now spectators clapping. For instance, they increased from 35 cl bottle to 50 cl which when compared in relation to the the price differences, one will prefer the 50 cl killer bottle. You see the trick? Let me not go to the contents of coca cola.

Ok same person who took this 50 cl of sugar for instance in the day time goes happily in the evening to refresh with a bottle of alcohol (ethanol) maybe sometimes more. Maybe the happiness hormone has been stimulated. The propaganda is that alcohol is good for health but not too much of it-That's great.

I think there is a need to go back to the drawing board. The health and policy making institutions has been infiltrated and are not living up to expectations. Or probably the whole thing is too complex for them to handle. What do you think?

For most diabetes Fructose has been implicated in a lot of studies.

So is fructose most deadly than alcohol?

Interesting and scholarly discussions. I'm following

It's a nice question indeed. Thank you@Egbuna. The issue should be clarified properly. I think some researches on sugar are not coming into the light due to it's tremendous application in foods and drinks. However, the existing studies are also not sufficient to clarify the complex mechanisms of the diseases. It could be a good topic to summarize in a systematic review...Thank you

Dear Dr. Mostafizur,

Thanks for your kind remarks. I agree with you. There is a need for proper clarification through systematic reviews. Translating it into different languages will also do a lot good. Existing books for medical students needs to be revised. They should be able to advice patients properly.

Thank you.

In case of diabetes fructose is most deadly than alcohol

I agree with Md. Mostafizur Rahman

I would say that fructose and alcohol are two different things. Not better, nor worse, but different. How deadly they are depends on each individual, how they are consumed and quantitites one has in determined period of time..

Vilemar Magalhães

Dear Dr. Vilemar,

Thanks for the answer. I agree with you, fructose and alcohol are quite different and the consumption rate will determine how deadly they are.

In my opinion, I think fructose is more deadly. For instance, if a large percentage of the population do not see anything wrong in regulating their fructose intake because it taste real good. What happens? Fructose intake excels causing more problems. The reverse is the case with alcohol at least people know about the dangers or if they don't, I am sure they will probably get intoxicated which sends some signals. This makes fructose a silent killer or what do you think?

Thanks.

Egbuna, C.

High, Egbuna,,, high sugar intake is probably much detrimental than high fat intake. Recently trial has shown that diatery fat intake may not be very important in pathogenesis of coronary artery disease. Majority of bad cholesterol in the blood are formed in the body, dietary source having least contribution. Chronic exposure to high sugar can lead to development of diabetes and also derangement of serum lipids.. Thanks

Dear Dr. Biswajit,

I agree with you. The rate of consumption of sugar (refined or unrefined) is on the increase which correlates with increasing cases of metabolic diseases. However, there should be a clear definition of the sugar we talk about. Glucose is healthy for the body which enables the body derive its energy for the day to day function. Fructose is the key element here which should be regulated.

Thank you.

Regards,

Egbuna, C.

Dear Mr. Egbuna, dear All, who left here your comments, I'm not a scientist, professor and thus not an expert in this field at all. However, I would like to share my observations, which are very limited and thus cannot be of scientific weight and importance. Yet, I feel that these observations can be a good illustration of the fact that the reality of life can vary from even the best theory. Judging by the photographs, my mother was a gracile girl in her childhood (1930-1940) and in her youth. She is now known to be adipose, suffers from hypertension, gout, peripheral arterial disease, and mild type 2 diabetes. The same changes from a tiny girl into adipose granny underwent my granny, who died in 1984. According to old photos, which she kept stored in large photo albums, her body transformations occurred after the 1950s, when ended war and post-war famine in the Soviet Union. At that time there wasn't Coca-Cola, event not Pepsi available. O.K., I would not deny that there were own sweetened beverages in the Soviet Union and simple sugar in abundance. I understand that these are only 2 anecdotal cases. And, yes, what about 6 month old overweight babies? There are no 6 month old overweight babies in my story, but it took only a bit more than couple of weeks for my mom to ruin our labrador-retriever, when we left it in her care during our trip abroad. Believe me, our labrador does not drink sweetened lemonade and since the puppy's age is ready to eat all the food that she may found. But, she was in a good shape, until we left her with my mom alone. It was enough to shift the balance "in the good old law of Conservation of energy" or as Mr. Robert H. Lustig it presented "energy-in against energy-out", by giving a food in abundance and not doing dog-walks, and our labrador-retriever went overweight. This is my story about observation and analysis of just two cases (+ dog), but I'm quite confident that the same story you may find out in millions of families in Asia and Africa, which succeeded from a poverty into more or less wealthy situation.

With all due respect to the creators of science,

Janis Ansbergs, former medical doctor (not practicing medicine anymore)

Dear Dr. Janis,

Thanks so much for your comments. I got some point from it. But I will like to take you back to history. First, the emergence of diabetes was dated back as far as the 1st century (2000 years ago +). At that time (yet minimal), there was no effective treatment for diabetes. It was in 1920 that effective treatment was uncovered by the Canadian scientists, Frederick Banting and Charles Herbert Best when they isolated and purified insulin.

Similarly, obesity and heart disease was also dated back long ago. For instance, Sushruta, an Indian surgeon par Excellence related obesity to diabetes and heart disorders in the 6th century.

So this subject matter is not a new one. The body metabolic activities is influenced by so many factors including lifestyle, nutrition, genetic factors, environmental factors etc.

In the early time, diabetes was dreadful and a killer disease. Solutions were sought by researchers, just by everyone.

In the 1900, a belief emanated from an experiment when extremely high amounts of dietary cholesterol fed to rabbit was found to increase blood cholesterol by twenty-fold and a soft plaque like substance formed on the coronary arteries. This is when the chant for the regulation of dietary fat intake began. Since then, health institutions and policy makers has depended on it- That's fine! In the reality, fat is part of the cause of diabetes.

Today what is happening?

So with the whole of this research revelations and education for the consumption of fat free diet which I am sure has gone to the nook and cranny of the world, then what is happening? Instead of reduction, there is an incessant increase in the cases of obesity, diabetes and heart diseases.

As a biochemist, there is a direct link (a pathway) in which carbohydrate taken in diet is converted to fat. For instance, the molecules (acetyl coA and glycerol) needed to build a fat by de no are products from glycolytic pathway (carbohydrate metabolism pathway). Acetyl CoA can still come from other sources as well. From here, you will notice that even if one do not consume fatty diet, that the body can make fat and one can even go on and become obesed. How?- Good.

Nawadays, we have found that there is an increased consumption of sugar (fructose) and alcohol. This correlates with the increase cases of these metabolic diseases. The sugar industry to which the coca cola companies and cohorts belongs together with the alcoholic companies are making huge profits while people are dying. I am of the opinion, that the overemphasization that the high intake of cholesterol of these metabolic diseases should cease. The major problem is Sugar (fructose) and alcohol.

Please note, glucose which is also sugar is good for the body and you wouldn't get excess because the body can convert the excess of it to glycogen unlike fructose or alcohol that is converted to fat.

Regards,

Egbuna, C.

https//:egbunac.com.

Dear Mr. Egbuna,

Thank you for coming back to my comment! I agree with you absolutely that the story of dietary fats as cause of increased level of cholesterol is overemphasized in the view on pathogenesis of metabolic disease. Especially because from my own experience I know that some of adipose persons may have absolutely normal levels of cholesterol in the blood. And I also absolutely agree that, even if the fructose is only one culprit within the whole bunch of ethio-pathogenic factors, the whole humanity would benefit from eradication of this one.

Regards

Janis Ansbergs

Only if dyslipidemia occurs consequent to the high fat/cholesterol diet.

I answer base on my pharmacological expertise, a fat diet plus cholesterol rich diet following dyslipidemia could be the cause.

As well as considering the fact that in cycle of carbohydrate in body is converted to fat as well.

Fats burn in the fire created by the carbohydrates. Deadly combination is High fat diets with High carbohydrate diets.

Dear Dr. Shiva,

Thanks for your comments. In reality, what is the percentage calories of fat or cholesterol in the daily diet will cause dyslipidemia compared to the wanton intake of sugar (fructose) and alcohol?

Based on daily consumption.

Dear Dr. Khalid,

I agree with you. A high consumption of both could be deadly. Yes it is good to moderate.

But can you explain further 'Fats burn in the fire created by the carbohydrates'.

Assuming that there is enough glucose and glycogen in the body.

Our body prefer glucose for energy and if enough stores are present then lipids are spared and are deposited; cause obesity and all related problems of Metabolic syndrome. Also, if carbohydrates are present we can synthesize fats also from acetate. Fructose can easily be converted to TGs through DHAP.

Dear Dr. Khalid,

Thanks for the clarification. I agree with you.

Regards,

Egbuna, C.

Please how does the physiology of individuals come into play in answering the question?

Much of it would depend on environment, particularly nutritional history and habits.

Dear Prof. Raginald, thanks for the question. I agree with Dr Khalid, so many factors comes to play. The body physiology differs from individuals to individuals. What works for one may not not work for the other. In genetics, there are some inherent characteristics that can confer on one a selective advantage over the other or further expose one to adverse outcome just like we see in patients with a compromised immune system, deficiency of very vital enzymes, mutation etc.

One notable example is that obesity can be caused by genetic mutation also. http://www.obesity.ulaval.ca/obesity/generalities/genetic.php

Thank you.

Regards,

Egbuna, C.

definitely high fat diet is responsible for coronary heart disease but others factors also responsible for this types of diseases like tension, alcohol, smoking, sedentary lifestyle, sugary diet etc

Yes high fat diet is the major cause of coronary heart disease because the liver converts them whole and entire to cholesterol. This in turn narrow the arteries and can block them causing serious health issues such as coronary heart disease, obesity and type 2 diabetes or high sugar.

I agree with Dr. Khalid

Atherothrombotic disease (ATD) is due to an imbalance in LDL- and HDL-cholesterol. High fat diets may contribute to the either, in the sense that they MAY raise LDL-cholesterol. Diets high in simple sugars may contribute to obesity and lower HDL-cholesterol. Neither effect is a dead cert. Hence I do not interfere with a pataient's diet unless dyslipidemia is present.

Considering the pillars of metabolic syndrome, crisis in fat metabolism and carbohydrate metabolism are linked and even protein metabolism is affected too. Injury to one pathway is injury to all pathways and the diseases mentioned are manifested.

Rightly said Dr. Prince Nkemakolam Okoroh

Thank you for your views.

Talking to a long-term British physician in Uganda back in 1993 about this, he opined that the Ugandans had typically not had cardiac problems, even though they might have had a high fat diet until the country started growing sugar and the sugar refineries came in.