September 2, 2014

Dr. Virender Sodhi and Dr. Anup Mulakaluri

Introduction

The Vedic philosophy teaches us the idea of “Anna Brahma”, which means “Food as God”. This description is a symbolic statement made by the poetic ancestors of India. It symbolizes the importance of food to life – suggesting it is as essential as God is to life. For this reason, traditional Ayurvedic cooking methods were carefully developed to prepare the best quality and most non-toxic foods. When I see patients in the clinic, ninety-nine percent of them are cooking foods in a way that is toxic for them. If they are not cooking, they are eating processed foods that have a fair share of toxins as well. This pattern is not the fault of the individual; rather it is caused by misunderstanding and miseducation that persists culturally. Some examples are:

  1. Heat is associated with food safety for its function of killing microbes in raw food, especially meats – Food is often cooked at excessively high heat or it is cooked for a long time with the intention to kill microbes.
  2. Frying food is considered a delicacy – oils also heat to a very high temperature, which promotes oxidation of food.
  3. Use of preservatives and excessive processing of food is used to store food for a prolonged period – this process exposes us to unusual chemicals; as well as old, rancid food. 

All of these have one common effect on the food we eat – these result in the formation of Advanced Glycation End products (AGE’s) on the food or within the body.[1] With heat, this process occurs very quickly; but without heat, formation of AGE’s take days to weeks; the results are a brownish/black end product. AGE’s are created when reducing sugars react with amino acids of protein, lipids or DNA.[2] The attachment of glucose to these molecules (protein, lipid, or DNA) is called Glycation – the new sugar-bound substance is called Advanced Glycation End products (AGE’s). Formation of AGE’s can permanently alter or stop the activity of proteins; they can bind surfaces of cells to modify cellular function; and they may modify regions of DNA blocking normal expression.

Glycation of food naturally occurs based on the method of cooking and preservation. Glycation also occurs inside the body in the presence of excessive sugars in the bloodstream, called endogenous glycation. This type of endogenous glycation is more damaging to the health of the individual. Eating foods that are high in AGE’s contribute to endogenous glycation process.

The effect of Glycation:

Glycation is extremely disruptive to a wide range of functions in the body. AGE’s can be created in the food before eating or they can be created in the body after eating. After entering the body, AGE’s seem to act through two main mechanisms[2]:

  1. Advanced Glycation End-products (AGE’s) bind to a specific receptor on the surface of cells, called Receptor for Advanced Glycation End-products (RAGE). Binding indicates to the cells to begin producing NF-KappaB molecules. The NF-KappaB takes the signal to the DNA, which promotes the productions of other signaling molecules. These include inflammatory signals like cytokines, Tumor necrosis factor-ɑlpha (TNF-ɑ); as well as vascular adhesive factors called vascular cell adhesion molecule 1 (VCAM-1). AGE-RAGE binding results in the following:
    Cytokines, TNF-ɑ, and others These molecules signal to the immune cells of the body to become activated and generate inflammatory activity in the body. This can lead to excessive systemic inflammation in the body.
    VCAM-1 This protein signals to the cells of the blood vessel wall to become more permeable – helping inflammatory cells leave the bloodstream and spread inflammation into the organs.
  2. AGE’s also activate an enzyme called NADP(H) oxidase. This is one of the most abundant enzymes in the body designed for a specific purpose in energy production pathway. Over-activation of this enzyme results in excessive oxidation in the body – which promotes oxidative damage to cells and DNA. Altogether, this contributes to the burden of inflammation and oxidation that is created by the first effect of AGE-RAGE binding.

High levels of glucose or a high carb diet worsens the problem of glycation (glucose-binding) by a large degree. Simply put, more sugar or carbs in the diet allows for greater frequency of glycation (see more discussion under “diabetes” section). The effect of AGE’s extends to a fundamental level of the body physiology; therefore, it has been observed to contribute to a wide variety of diseases. Here are some major examples:

  1. Cardiovascular disease: AGE’s create excessive cross-linking among the collagen proteins of the blood vessel wall.[3] Abnormal cross-linking leads to stiffness of the blood vessels. Additionally, the AGE-RAGE binding promotes increased permeability of the blood vessel walls. This results in deposits of cholesterol in the blood vessel walls. Associated with inflammatory activity, these deposits become plaque in the blood vessels.[4] Such vascular dysfunction can make the heart very vulnerable. AGE’s can also create cross-links within the tissue of the heart itself; thus, weakening heart’s functional capacity progressively overtime.[5]
  2. Diabetes: Among diabetic individuals, the glycation products from food are as much a problem as the high blood sugar. Prolonged high blood sugar results a continuous process of glycation in the blood vessels. Effects of glycation on the blood vessel walls result in breakdown of small blood vessels called capillaries. Because capillaries are at the end, blood vessels that reach all the organs and skin surface, breakdown allows invasion of AGE’s into various organs of the body. Organs like the kidneys, heart, nervous system, eyes, etc. can undergo severe dysfunction as a result.[6]
  3. Renal disease: While damage to blood vessel seen with diabetes contributes; glycation that directly enters the filtration system of the kidneys can play a big role in renal failure. Glycation, independent of diabetes, can also have a significant detrimental effect on the kidneys.[7]
  4. Neurodegenerative disease: the combined effect of oxidation and inflammation related with aging and AGE’s are thought to primary risk factors for Alzheimer’s disease.[8] AGE-RAGE binding in brain tissue can contribute to problems like dementia and cerebral ischemia.[9]
  5. Others: presence of AGE’s also contributes to diseases like osteoporosis[10], arthritis[11], eye disease[12], and many more.

Strategies for prevention:

Cooking Procedure:

Cooking is what makes your food nectar or poison. Here are some essentials for cooking. 

If you are reading this article, discard all of your non-stick pans. Lots of animal data shows that these are cancer causing. Use of an iron pot is acceptable as long as you do not have excessive iron in your body; too much iron is also extremely toxic. Excessive iron promotes cancer like wild fire. Ceramic coated pots are your best choice.

Grilling and use of a barbecue are also toxic cooking methods. You notice food browning with grilling and barbecue, that means more glycation and oxidation. My favorite phrase is , “You do not find frying pans on the tree.” We basically are animals and we do not process fried and burnt foods very well. In simple language, all the toxins get trapped in your liver. Whenever I order an ultrasound of the liver, the majority of people show fatty degeneration on the superior surface of liver. It has become so common that it is “the norm” and no physician pays any attention to the fact that almost all the individuals have this fatty degeneration condition. In addition, our love for red wine, beer or martini shots make it worse. Physicians only start to take notice when your liver enzymes start to elevate. By this time, more than 50% of your liver is already compromised. This disease is called Non-alcoholic fatty liver disease (NAFLD).

Lots of my East Indian population patients are vegetarian. But actually they are consuming lots of grains like rice and wheat; as someone said that they are, “Grainarians”. That grain-rich diet was perfect for the farming community, as a majority of them were farmers. They need a long-standing energy source to work hard in the fields – lifting, ploughing, carrying or climbing on the trees. But as they become software engineers, doctors, teachers and scientists, most of them sit in front of their computers burning very few carbohydrates, having abdominal obesity, hypertension, heart disease, diabetes and even cancer. Their consumption of vegetable and beans is minimal as compared to their carbohydrate intake.

Vegetables are cooked to their max with a special addition of sautéed onions, ginger, garlic, tomatos and spices. The so-called TADKA, a wonderful combination of spices that is rendered useless due to frying in oil. Oil has an average boiling temperature of 450 degrees Fahrenheit as compared to water’s boiling point of 212 degrees Fahrenheit. You are cooking your food at twice the temperature, making it rancid. All the browning of those nice herbs is making it worthless rather than nutritious.  Ayurvedic cooking did not recommend cooking the way we are cooking food these days, it is more gourmet cooking. The right way of cooking is to put the cut onions, ginger, garlic, tomatoes in a ceramic coated pan, put the lid on; now the temperature will not exceed 212 degrees Fahrenheit. Let them soften, add spices and oils or ghee in the end. You will have an amazing aroma and food will taste much better without destroying the nutritious spices and herbs.

Adding more vegetables in your diet:

Vegetables are a great source of bioflavonoids, polyphenols, and a variety of vitamins and minerals. All of these contribute to the antioxidant activity of the body that helps to balance the effects of AGE’s.[13] Eating large amounts of vegetables provides a two-fold protective benefit: 1) It provides you with important antioxidant micronutrients. 2) Vegetables are low in simple carbs, therefore they have a very low AGE’s burden. These vegetables also provide fiber that helps eliminate toxins by promoting normal bowel activity.

I recommend everyone adding 7-8 servings of vegetables. Try to eat vegetables and fruits which are available in season, most of them are available at a farmers market. I grow my own vegetables at the clinic and at home. Whenever you come in for your next visit to our clinic, try to stop by my kitchen garden. A lot of times, people ask me, “Dr. Sodhi, how can I add that many vegetables to my diet.” Here are some solutions:

For breakfast options: A couple of times per week you can eat boiled cucumbers, tomatoes, steamed spinach, zucchini or other greens.  If you are used to an Indian style of cooking you can prepare your wheat or other grain dough with greens like spinach, fenugreek greens, kale, chard, mustard. Use your imagination. This comes out so good that you will never go back to the “sugary donut” diet.

Add a big serving of kale, chard, mustard greens, Bok Choy, tomatoes, cucumbers, zucchini, carrots, beets or other seasonal vegetables for Lunch.

  • Use 2-3 servings of cooked vegetable per day. You have now completed your goal of 7-8 servings of vegetables per day.
  • Add 2 servings of seasonal fruits to your diet.
  • Add 1-2 servings for non-vegetarians and at least 3 servings for vegetarians of nuts and seeds. These should be raw, unroasted and unsalted. Another way is to make a milk concoction with these nuts and seeds. For making the milk, soak one handful of these nuts and seeds in one glass of water overnight, then add 1-2 teaspoons of honey, ¼ teaspoon of turmeric powder, ¼ teaspoon of ginger and blend. You will have a wonderful nut milk, without any chemicals or preservatives, and with all the enzymes and nutrients intact.

You can also add a few strands of saffron, cardamom and cinnamon in the solution. For ease, you can soak these overnight in the blend itself. To clean the blender, add water and spin for 30 seconds and rinse.

Using herbs and spices in your cooking can promote healthy digestion of nutrients from food. Healthy Digestion is another essential basis for general health. Digestive function can be promoted at all levels of the process; from intestines to cellular digestion. Spices like ginger, cumin, coriander, black pepper, turmeric, etc. have demonstrated significant, positive effects on overall metabolic function.[14] Efficient digestion aids in proper breakdown of large molecules prior to absorption; it also helps the body to differentiate nutrition from toxic substances.

Turmeric: This household spice contains the compound curcumin. Curcumin has been studied in hundreds of studies over the years to demonstrate effective anti-inflammatory and antioxidant activity in the body.[15] For this powerful effect, curcumin has been shown to be a useful tool against cancer, atherosclerosis, diabetes, auto-immune disease and much more. Specific to AGE’s, curcumin has been shown to block the AGE-RAGE binding in the body.[16] This helps to block the downstream cellular effect of the toxin. Thus, curcumin helps prevent inflammatory cascade and DNA remodeling that is a part of AGE-toxicity.  

Using Spices to meet your constitutional needs:

Dosha– Constitutional humor Spices
Vata: If you experience irregular appetite, indigestion, gas and bloating, abdominal pain – This may indicate that you have a Vata constitution OR you are experiencing Vata imbalance. Ginger, Galangal, Turmeric, Black pepper, Long Pepper, Oregano, Tarragon, Thyme, Rosemary, Sage
Pitta: If you experience a strong appetite, heartburn, inflammatory flares, ulcerative diseases, gastritis, colitis, irritability, aggression, etc. This may indicate that you have a Pitta constitution OR you are experiencing Pitta imbalance. Coriander, Cumin, Fennel, Licorice, Sweet neem (curry leaves), Cinnamon, Parsley, Star Anise, Dill seeds, Basil (thai), Mint
Kapha: If you experience indigestion, water retention, lethargy, excessive sleep, dulness, heaviness, attachment, etc. This may indicate that you have a Kapha constitution OR you are experiencing Kapha imbalance. Ginger, Galangal, Black pepper, Long pepper, Garlic, Rosemary, Paprika, Tarragon, Turmeric, Mustard seeds, Sage

References

  • [1] Uribarri J, et al. Advanced Glycation End Products in Foods and a Practical Guide to Their Reduction in the Diet. J Am Diet Assoc. 2010 June ; Vol. 110(6), Pg. 911–16.
  • [2] Luevano-Contreras, C * and Chapman-Novakofski, K. Dietary Advanced Glycation End Products and Aging. Nutrients 2010, Vol. 2, Pg. 1247-1265.
  • [3] Sims, T.J.; Rasmussen, L.M.; Oxlund, H.; Bailey, A.J. The role of glycation cross-links in diabetic vascular stiffening. Diabetologia 1996, 39, 946-951.
  • [4] Zieman, S.; Kass, D. Advanced glycation end product cross-linking: Pathophysiologic role and therapeutic target in cardiovascular disease. Congest. Heart Fail. 2004, 10, 144-149.
  • [5] Hartog JWL, et al. Advanced glycation end-products (AGEs) and heart failure: Pathophysiology and clinical implications. European Journal of Heart Failure, 2007; 9, 1146–1155.
  • [6] Nass N and Simm A. Advanced glycation end products (AGEs) in diabetes. Endokrinologie IV, Sept. 2009; Published online www.saw-leipzig.de/forschung/projekte/zeitstrukturen-endokriner-systeme/endokrinologieiv/nass.pdf
  • [7] Goh S-Y and Cooper ME. The Role of Advanced Glycation End Products in Progression and Complications of Diabetes. J Clin Endocrinol Metab 2008; 93, 1143–1152.
  • [8] Cruz-Sanchez FF, et al. Oxidative stress in Alzheimer’s disease hippocampus: A topographical study. J. Neurol. Sci. 2010, 299, 163-167.
  • [9] Liu L-F, et al. Receptor for Advanced Glycation End Products: Its Role in Alzheimer's Disease and Other Neurological Diseases. Future Neurology. 2009; Vol. 4(2):167-177.
  • [10] Hein GE, et al. Glycation endproducts in osteoporosis — Is there a pathophysiologic importance? Clinica Chimica Acta, 2006; Vol. 371, 32–36.
  • [11] Pullerits R, et al. Decreased levels of soluble receptor for advanced glycation end products in patients with rheumatoid arthritis indicating deficient inflammatory control. Arthritis Research & Therapy 2005, 7, R817-R824.
  • [12] Stitt AW. Advanced glycation: an important pathological event in diabetic and age related ocular disease. Br J Ophthalmol 2001; 85, 746–753.
  • [13] Vlassopoulos A, et al.  Oxidative stress, protein glycation and nutrition – interactions relevant to health and disease throughout the lifecycle.  Proceedings of the Nutrition Society, 2014. ISSN 0029-6651
  • [14] Westerterp-Plantenga M, et al. Metabolic effects of spices, teas, and caffeine. Physiology & Behavior, 2006; Vol.  89,  85–91.
  • [15] Menon VP and Sudheer AR. Antioxidant and Antiinflammatory properties of Curcumin. Adv Exp Med Biol. 2007; Vol. 595, Pg. 105-25.
  • [16] Lin J, et al. Curcumin eliminates the inhibitory effect of advanced glycation end-products (AGEs) on gene expression of AGE receptor-1 in hepatic stellate cells in vitro. Lab Invest. 2012 June; Vol. 92(6), Pg. 827–841.