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What has sugar got to do with stress
by Dr C.S. Foo

A SNIPER'S bullet that tears through the chest, and a massive heart attack, have two things in common - searing pain and the possibility of death. If that is overly dramatic, let us review today what is slowly cooking us to death.

The three assassins that are stealthily killing us day by day are sugar, oxygen, and inflammation, like a sweet on fire! Arguably, this column is not meant for serious scientists, but I am very passionate about science, as the insight of our insides opens the gate to so many possibilities in the prevention of chronic ailments.

The path of preventive medicine has always fascinated me as we are gatekeepers, ushering a person on a journey that may change destiny. A practitioner is also a map maker drawing up directions, but alas, the directions are often too confusing, difficult to follow, and worse, downright misleading. It had never occurred to me that a simple mind made complex (by too many textbooks) can regain wisdom from simplicity, and that was when my lenses changed from microscopic to wide angled, as the deceptive trio was unmasked.

The mere mention of the word stress conjures up less than friendly images of the tyranny within. It is no secret that our favourite foods are generally high glycaemic, shooting up our blood sugar rapidly, and crashing down rapidly like a roller coaster, with the unused sugar turning into fat around the belly.

Glycaemic (sugar) stress is the chronic effects of feeding the body with too much sugar. In its simplest form, glucose is paramount for energy production, without which there would be no life. Yet it is a highly toxic molecule when in excess. The reason for this dilemma is obvious - we eat too much!

"But I don't take sugar" is a common defence. Bear in mind that all carhohydrates turn to sugar, albeit at different rates. It is no secret that our favourite foods are generally high glycaemic, shooting up our blood sugar rapidly, and crashing down rapidly like a roller coaster, with the unused sugar turning into fat around the belly.

A protruding waistline is an incubator for many diseases. The Metabolic Syndrome harbours the sinister ambitions of diabetes, hypertension, heart disease, stroke and obesity.

Oxidative stress (free radical burden) is the pressure on our bodies caused by excessive errant oxygen molecules known as free radicals, which literally steal our health and youth by the seconds. The demands of modern society, bludgeoning influx of toxic foods, environmental poisoning, compounded by unhealthy lifestyle habits, add up the load of free radicals, thereby inducing a significant oxidative stress. This state is not ameliorated by the imbalanced nutrition stemming from poor food choices.

Acute inflammation

Some fertile areas of the body that do not get too much sun are like a damp, tropical rainforest, perfect for mushrooming fungi of all sorts. A yeast infection at the underarm can be an incessant nuisance, resulting in uncontrollable scratching due to itchy skin inflammation.

Among the foliage, bacteria finds the abode an ideal breeding ground and causes trouble when it invades the skin. A boil in the armpit is more than just a painful embarrassment.

The marvellous story of the body's ministry of defence goes something like this. Under the skin are stationed sentries (macrophages), which are roused by the intrusion of a foreign invader. They quickly send out SOS signals (cytokines) that open up the blood vessels and mobilise an army of specialised white blood soldier cells (neutrophils) that creep along the engorged arteries.

Fluid and cells pour onto the site of infection, the latter gobbling up the bacteria like hungry wolves or delivering knockout punches to everything in their path. In the indiscriminate search and destroy mission, the white blood cells spray round after round of ammunition that annihilate not only the intruders but innocent bystanders as well.

The collateral tissue damage leads to painful pus formation, which either "ripens" and discharges to the exterior or is ultimately released by the doctor's knife.

Fortunately, once the threat is neutralised, the inflammation mode is turned off and the cinders finally extinguish, leading to resolution.

The preceding sequence of events was first described by Aulus Cornelius Celsus, a Roman medical writer from the 1st century AD, who described the stages of dolor (pain), calor (heat), rubor (redness) and tumour (swelling).

Next time, when a "bag" of pus appears, refrain from complaints and be appreciative that our protectors have done a good job. Imagine the devastating peril should the inflammation spread beyond the boundaries (septicaemia) to infect the entire host.

Not all acute inflammation are infective in nature. Bronchitis, asthma and sinusitis invoke a different form of inflammation. An offending trigger sets off a cascade of immune reactions that congest and clog the airways.

Acute inflammation can also be brought on by injury, errors in metabolism (e.g. gout), auto-immune diseases (e.g. rheumatoid arthritis, lupus, etc, when the immune system turns on the host), and so on.

Chronic inflammation - the secret killer

Both glycaemic and oxidative stress have been dealt with in detail in past articles. The final link to chronic degenerative diseases is chronic inflammation.

Unlike the distress of acute inflammation, this is a much more sinister situation as there are no immediate symptoms. A state of inflammation that does not switch off is deemed chronic. Potent inflammatory mediators are released and the cycle is self propagating in a vicious manner.

We issue our own licence to eat rather indiscriminately. As our palate is the master of our stomach, gustatory pleasure is of prime importance, and needless to say, our high glycaemic favourites are pro-inflammatory in nature. The expanded waistline, a.k.a. visceral fat, is like a rumbling volcano spewing hot stuff (inflammatory mediators) that can trigger inflammation.

When the human cells are attacked by free radicals or external threats, be it poisoning, injury, or damage, a master switch (nuclear factor kappa beta) within the cells is thrown, like an alarm system, which then instructs the cells's DNA to send signals to manufacture pro-inflammatory proteins, which in turn propagate more inflammation.

As the bell is constantly ringing, inflammation becomes chronic and prolonged as the body is fooled into believing that the threat is persistent.

When immune cells are erroneously turned on, they revolt by attacking the host, resulting in a bizarre potpourri of conditions, collectively known as auto-immune diseases. Rheumatoid arthritis and lupus commonly cause painful joint inflammation, but the process can affect multiple organs.

Multiple sclerosis, with consequent paralysis, occurs when nerves are inflamed. Psoriasis is a disfiguring inflammatory skin disorder. Even Alzheimer's disease has underlying inflammation.

It seems almost every chronic condition is stamped by inflammation. Certainly the body's discharge pipes, namely the intestines, are not spared. Crohn's and ulcerative colitis are notorious troublemakers.

The heart is on fire

About a decade ago, there were scientific rumblings that heart disease is associated with inflammation. This was first proposed by a German pathologist, Dr Rudolph Virchow, in the mid 1800s, and as usual, his theory was sidelined into the archives.

Today, the concept is re-emerging from the closet. Being conquered by naivety and a subscriber of scepticism for a greater part of life, my eyebrows raised to my scalp line when I first heard that heart disease was due to inflammation. I thought it was just a plumbing problem, now they tell me that the heart is on fire!

For years, it was taught that having high cholesterol equates to heart disease, and yet 50% of heart attacks have normal cholesterol counts, which begs for the search of some other underlying mechanism.

In an article printed in a respected peer-reviewed journal, the Archives Of Internal Medicine (April 11, 2005), a meta-analysis (review) of 100 clinical trials involving 250,000 individuals found that a group of cholesterol busters lowered death due to heart attack by 23%, as compared to omega 3 fish oil, which outperformed drugs by a whopping 32%. This led the researchers to infer that fish oil offered cardioprotection through an alternative mechanism, likely an anti-inflammatory pathway, as fish oils do not affect cholesterol levels.

It is curious to note that the same cholesterol drugs are feverishly being studied at this very moment to determine if they have anti-inflammatory properties apart from lowering cholesterol. The one with this additional feature would beat the pack.

As the fire of inflammation burns within the artery walls, as in the case of progressive heart disease, an inflammatory substance called C-reactive protein is released and its presence has been used to gauge the extent of inflammation within the blood vessels. This test can be easily requested in a routine blood analysis.

I have never been excited in my entire professional career until now (ironically, just as I am contemplating early retirement) when finally the pieces of the jigsaw puzzle come together to become a complete picture. Many modern day diseases are man-made and are preventable. The roots are now bared and need our outmost attention.

We have spent too much time and money treating the foliage. Nurturing the roots pays long-term dividends, and if we do not start now, then when?

Dr C.S. Foo is a medical practitioner.


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