Categories:

Serotonin, Fatigue, Training, and Performance

Also See:
Carbohydrate Lowers Serotonin from Exercise
Health Benefits of Glycine
Gelatin > Whey
Tryptophan, Sleep, and Depression
Thyroid peroxidase activity is inhibited by amino acids
Whey, Tryptophan, & Serotonin
Protective Glycine
Running on Empty
Thyroid peroxidase activity is inhibited by amino acids
Gelatin, Glycine, and Metabolism
Gelatin, stress, longevity
The anticatabolic effect of glycine
Enzyme to Know: Tryptophan Hydroxylase
Whey, Tryptophan, & Serotonin
Omega -3 “Deficiency” Decreases Serotonin Producing Enzyme
Hypothyroidism and Serotonin
Estrogen Increases Serotonin
Role of Serotonin in Preeclampsia
Maternal Ingestion of Tryptophan and Cancer in Female Offspring
Tryptophan Metabolism: Effects of Progesterone, Estrogen, and PUFA
Anti-Serotonin, Pro-Libido

The fatigue produced by “over-training” is probably produced by a tryptophan and serotonin overload, resulting from catabolism of muscle proteins and stress-induced increases in serotonin. -Ray Peat, PhD

Am J Clin Nutr. 2000 Aug;72(2 Suppl):573S-8S.
Serotonin and central nervous system fatigue: nutritional considerations.
Davis JM, Alderson NL, Welsh RS.
Fatigue from voluntary muscular effort is a complex phenomenon involving the central nervous system (CNS) and muscle. An understanding of the mechanisms within muscle that cause fatigue has led to the development of nutritional strategies to enhance performance. Until recently, little was known about CNS mechanisms of fatigue, even though the inability or unwillingness to generate and maintain central activation of muscle is the most likely explanation of fatigue for most people during normal daily activities. A possible role of nutrition in central fatigue is receiving more attention with the development of theories that provide a clue to its biological mechanisms. The focus is on the neurotransmitter serotonin [5-hydroxytryptamine (5-HT)] because of its role in depression, sensory perception, sleepiness, and mood. Nutritional strategies have been designed to alter the metabolism of brain 5-HT by affecting the availability of its amino acid precursor. Increases in brain 5-HT concentration and overall activity have been associated with increased physical and perhaps mental fatigue during endurance exercise. Carbohydrate (CHO) or branched-chain amino acid (BCAA) feedings may attenuate increases in 5-HT and improve performance. However, it is difficult to distinguish between the effects of CHO on the brain and those on the muscles themselves, and most studies involving BCAA show no performance benefits. It appears that important relations exist between brain 5-HT and central fatigue. Good theoretical rationale and data exist to support a beneficial role of CHO and BCAA on brain 5-HT and central fatigue, but the strength of evidence is presently weak.

Med Sci Sports Exerc. 1997 Jan;29(1):45-57.
Possible mechanisms of central nervous system fatigue during exercise.
Davis JM, Bailey SP.
Fatigue of voluntary muscular effort is a complex phenomenon. To date, relatively little attention has been placed on the role of the central nervous system (CNS) in fatigue during exercise despite the fact that the unwillingness to generate and maintain adequate CNS drive to the working muscle is the most likely explanation of fatigue for most people during normal activities. Several biological mechanisms have been proposed to explain CNS fatigue. Hypotheses have been developed for several neurotransmitters including serotonin (5-HT; 5-hydroxytryptamine), dopamine, and acetylcholine. The most prominent one involves an increase in 5-HT activity in various brain regions. Good evidence suggests that increases and decreases in brain 5-HT activity during prolonged exercise hasten and delay fatigue, respectively, and nutritional manipulations designed to attenuate brain 5-HT synthesis during prolonged exercise improve endurance performance. Other neuromodulators that may influence fatigue during exercise include cytokines and ammonia. Increases in several cytokines have been associated with reduced exercise tolerance associated with acute viral or bacterial infection. Accumulation of ammonia in the blood and brain during exercise could also negatively effect the CNS function and fatigue. Clearly fatigue during prolonged exercise is influenced by multiple CNS and peripheral factors. Further elucidation of how CNS influences affect fatigue is relevant for achieving optimal muscular performance in athletics as well as everyday life.

Amino Acids. 2001;20(1):25-34.
Amino acids and central fatigue.
Blomstrand E.
There is an increasing interest in the mechanisms behind central fatigue, particularly in relation to changes in brain monoamine metabolism and the influence of specific amino acids on fatigue. Several studies in experimental animals have shown that physical exercise increases the synthesis and metabolism of brain 5-hydroxytryptamine (5-HT). Support for the involvement of 5-HT in fatigue can be found in studies where the brain concentration of 5-HT has been altered by means of pharmacological agents. When the 5-HT level was elevated in this way the performance was impaired in both rats and human subjects, and in accordance with this a decrease in the 5-HT level caused an improvement in running performance in rats. The precursor of 5-HT is the amino acid tryptophan and the synthesis of 5-HT in the brain is thought to be regulated by the blood supply of free tryptophan in relation to other large neutral amino acids (including the branched-chain amino acids, BCAA) since these compete with tryptophan for transport into the brain. Studies in human subjects have shown that the plasma ratio of free tryptophan/BCAA increases during and, particularly, after sustained exercise. This would favour the transport of tryptophan into the brain and also the synthesis and release of 5-HT which may lead to central fatigue. Attempts have been made to influence the 5-HT level by giving BCAA to human subjects during different types of sustained heavy exercise. The results indicate that ingestion of BCAA reduces the perceived exertion and mental fatigue during exercise and improves cognitive performance after the exercise. In addition, in some situations ingestion of BCAA might also improve physical performance; during exercise in the heat or in a competitive race when the central component of fatigue is assumed to be more pronounced than in a laboratory experiment. However, more experiments are needed to further clarify the effect of BCAA and also of tryptophan ingestion on physical performance and mental fatigue.

Adv Exp Med Biol. 1995;384:315-20.
Tryptophan, 5-hydroxytryptamine and a possible explanation for central fatigue.
Newsholme EA, Blomstrand E.
In prolonged exercise the plasma level of branched-chain amino acids (BCAA) may fall and that of fatty acid increases: the latter increases the free tryptophan level, so that the plasma concentration ratio, free tryptophan/BCAA may increase leading to higher levels of tryptophan and therefore of 5-hydroxytryptamine (5-HT) in brain. The latter increases the activity of some 5-HT neurons in the brain which can cause sleep and which could, therefore, increase the mental effort necessary to maintain athletic activity. Drinks containing branched-chain amino acids should restore vigor to athletes whose performance is depressed by an excess of cerebral 5-HT. Recent work suggests that intake of branched-chain amino acids may improve performance in slower runners in the marathon and decrease perceived physical and mental exertion in laboratory experiments. This suggestion is supported by pharmacological manipulations that result in either increased or decreased physical performance.

Brain Res Bull. 1997;43(1):43-6.
Changes in the albumin binding of tryptophan during postoperative recovery: a possible link with central fatigue?
Yamamoto T, Castell LM, Botella J, Powell H, Hall GM, Young A, Newsholme EA.
Erratum in
Brain Res Bull 1997;44(6):735.
Tryptophan is the precursor of the neurotransmitter 5-hydroxytryptamine (5-HT), known to be involved in sleep and fatigue. In the blood, tryptophan binds to albumin, and that which does not, free tryptophan, competes with branched chain amino acids (BCAA) for entry into the brain. The plasma concentrations of albumin, free tryptophan, total tryptophan, and BCAA were measured before and after major surgery in nine elderly and nine coronary artery bypass graft (CABG) patients. In both the elderly and the CABG patients plasma free tryptophan concentrations were increased after surgery, compared with baseline levels; the plasma free tryptophan/BCAA concentration ratio was also increased significantly after surgery. Plasma albumin concentrations were decreased significantly after surgery in both the elderly and the CABG patients. Plasma BCAA concentrations were not affected by surgery in either group. The effect of exercising to exhaustion on 5-HT and tryptophan were investigated in Nagase analbuminemic rats (NAR). The intrasynaptosomal concentration of tryptophan, 5-hydroxy-tryptophan, and 5-HT was increased by fatigue after exercise. In addition, running time to exhaustion was shortened in NAR. These data suggest that free tryptophan uptake and 5-HT synthesis were enhanced in the nerve terminal. A decrease in plasma albumin may account for the increase in plasma-free tryptophan levels. An increase in plasma free tryptophan, resulting in an enhanced plasma concentration ratio of free tryptophan/BCAA, may lead to a higher 5-HT concentration in some parts of the brain and, consequently, to central fatigue. It is suggested that provision of BCAA as a dietary supplement may counteract the increase in plasma free tryptophan and thus improve the status of some patients after major surgery.

Adv Exp Med Biol. 1999;467:697-704.
The role of tryptophan in fatigue in different conditions of stress.
Castell LM, Yamamoto T, Phoenix J, Newsholme EA.
Tryptophan is the precursor for the neurotransmitter 5-hydroxytryptamine (5-HT), which is involved in fatigue and sleep. It is present in bound and free from in the blood, where the concentration is controlled by albumin binding to tryptophan. An increase in plasma free tryptophan leads to an increased rate of entry of tryptophan into the brain. This should lead to a higher level of 5-HT which may cause central fatigue. Central fatigue is implicated in clinical conditions such as chronic fatigue syndrome and post-operative fatigue. Increased plasma free tryptophan leads to an increase in the plasma concentration ratio of free tryptophan to the branched chain amino acids (BCAA) which compete with tryptophan for entry into the brain across the blood-brain barrier. The plasma concentrations of these amino acids were measured in chronic fatigue syndrome patients (CFS) before and after exercise (Castell et al., 1998), and in patients undergoing major surgery (Yamamoto et al., 1997). In the CFS patients, the pre-exercise concentration of plasma free tryptophan was higher than in controls (p < 0.05) but did not change during or after exercise. This might indicate an abnormally high level of brain 5-HT in CFS patients leading to persistent fatigue. In the control group, plasma free tryptophan was increased after maximal exercise (p < 0.001), returning towards baseline levels 60 min later. The apparent failure of the CFS patients to change the plasma free tryptophan concentration or the free tryptophan/BCAA ratio during exercise may indicate increased sensitivity of brain 5-HT receptors, as has been demonstrated in other studies (Cleare et al., 1995). In post-operative recovery after major surgery plasma free tryptophan concentrations were markedly increased compared with baseline levels; the plasma free tryptophan/BCAA concentration ratio was also increased after surgery. Plasma albumin concentrations were decreased after surgery: this may account for the increase in plasma free tryptophan levels. Provision of BCAA has improved mental performance in athletes after endurance exercise (Blomstrand et al., 1995, 1997). It is suggested that BCAA supplementation may help to counteract the effects of an increase in plasma free tryptophan, and may thus improve the status of patients during or after some clinically stressful conditions.

Int J Sport Nutr Exerc Metab. 2007 Aug;17 Suppl:S37-46.
Amino acids and the brain: do they play a role in “central fatigue”?
Meeusen R, Watson P.
It is clear that the cause of fatigue is complex, influenced by both events occurring in the periphery and the central nervous system (CNS). It has been suggested that exercise-induced changes in serotonin (5-HT), dopamine (DA), and noradrenaline (NA) concentrations contribute to the onset of fatigue during prolonged exercise. Serotonin has been linked to fatigue because of its documented role in sleep, feelings of lethargy and drowsiness, and loss of motivation, whereas increased DA and NA neurotransmission favors feelings of motivation, arousal, and reward. 5-HT has been shown to increase during acute exercise in running rats and to remain high at the point of fatigue. DA release is also elevated during exercise but appears to fall at exhaustion, a response that may be important in the fatigue process. The rates of 5-HT and DA/NA synthesis largely depend on the peripheral availability of the amino acids tryptophan (TRP) and tyrosine (TYR), with increased brain delivery increasing serotonergic and DA/NA activity, respectively. TRP, TYR, and the branched-chained amino acids (BCAAs) use the same transporter to pass through the blood-brain barrier, meaning that the plasma concentration ratio of these amino acids is thought to be a very important marker of neurotransmitter synthesis. Pharmacological manipulation of these neurotransmitter systems has provided support for an important role of the CNS in the development of fatigue. Work conducted over the last 20 y has focused on the possibility that manipulation of neurotransmitter precursors may delay the onset of fatigue. Although there is evidence that BCAA (to limit 5-HT synthesis) and TYR (to elevate brain DA/NA) ingestion can influence perceived exertion and some measures of mental performance, the results of several apparently well-controlled laboratory studies have yet to demonstrate a clear positive effect on exercise capacity or performance. There is good evidence that brain neurotransmitters can play a role in the development of fatigue during prolonged exercise, but nutritional manipulation of these systems through the provision of amino acids has proven largely unsuccessful.

J Sports Sci. 1995 Summer;13 Spec No:S49-53.
Central and peripheral factors in fatigue.
Davis JM.
The causes of fatigue during muscular exercise include factors that reside in the brain (central mechanisms) as well as the muscles themselves (peripheral mechanisms). Central fatigue is largely unexplored, but there is increasing evidence that increased brain serotonin (5-HT) can lead to central (mental) fatigue, thereby causing a deterioration in sport and exercise performance. Although there are also strong theoretical grounds for a beneficial role of nutrition in delaying central fatigue, the data are much more tenuous. Dietary supplementation with branched-chain amino acids (BCAA) in low doses produces small and probably inconsequential effects on peripheral markers of brain 5-HT synthesis (plasma free tryptophan/BCAA), whereas larger doses are likely to be unpalatable, reduce the absorption of water in the gut, and may increase potentially toxic ammonia concentrations in the plasma. Alternatively, carbohydrate supplementation results in large reductions in plasma free tryptophan/BCAA and exercise time to fatigue is significantly longer, but it is difficult to distinguish between the effects of carbohydrate feedings on central fatigue mechanisms and the well-established beneficial effects of carbohydrate supplements on the contracting muscle. These data support the exciting possibility that relationships exist among nutrition, brain neurochemistry and sport performance. However, while the evidence is intriguing and makes good intuitive sense, our knowledge in this area is rudimentary at best.

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Vitamin C and Iron Absorption

Also See:
Coffee Inhibits Iron Absorption
Iron’s Dangers

Int J Vitam Nutr Res Suppl. 1989;30:103-8.
The role of vitamin C in iron absorption.
Hallberg L, Brune M, Rossander L.
Iron requirements remain the same despite the current lower energy requirement. This means that more iron must be absorbed per unit energy. A higher bioavailability of the dietary iron can be achieved by increasing the content of food components enhancing iron absorption (ascorbic acid, meat/fish) or by decreasing the content of inhibitors (e.g., phytates, tannins). The latter is not feasible considering the recent and reasonable trend toward increasing the intake of dietary fibre. The key role of ascorbic acid for the absorption of dietary nonheme iron is generally accepted. The reasons for its action are twofold: (1) the prevention of the formation of insoluble and unabsorbable iron compounds and (2) the reduction of ferric to ferrous iron, which seems to be a requirement for the uptake of iron into the mucosal cells.

Fed Proc. 1983 Apr;42(6):1716-20.
An overview of current information on bioavailability of dietary iron to humans.
Morris ER.
Bioavailability factors can greatly modify the absorption of dietary iron consumed in different meals by an individual. A greater percentage is generally absorbed of heme iron from animal tissues than of nonheme iron of either animal or plant food. The amount of meat in a meal is the only bioavailability factor known to influence absorption of heme iron. Absorption of iron from the exchangeable nonheme iron pool of a meal is influenced by both enhancing and inhibiting substances or factors. Ascorbic acid, meat, fish, and poultry enhance absorption of nonheme iron, and meals may be classified according to relative bioavailability depending on the content of meat, fish, poultry, and/or ascorbic acid. Some low-molecular-weight organic acids may also increase the bioavailability of nonheme iron. Synthetic metal-chelating agents added to foods and the beverages tea and coffee will inhibit absorption of nonheme iron in a concentration-dependent manner. Wheat bran, soy products, cow’s milk, and egg tend to decrease bioavailability of nonheme iron when included in a meal. However, the effect of compounds thought to be responsible for the inhibition in purified form (phytate, fiber, phosphoproteins) is dependent on chemical form and concentration. In some foods there may be as yet unidentified inhibitors or interaction between compounds to inhibit absorption of nonheme iron. Currently available information permits estimation of relative bioavailable iron in a meal.

Ann N Y Acad Sci. 1980;355:32-44.
Interaction of vitamin C and iron.
Lynch SR, Cook JD.
Food iron is absorbed by the intestinal mucosa from two separate pools of heme and nonheme iron. Heme iron, derived from hemoglobin and myoglobin, is well absorbed and relatively little affected by other foods eaten in the same meal. On the other hand, the absorption of nonheme iron, the major dietary pool, is greatly influenced by meal composition. Ascorbic acid is a powerful enhancer of nonheme iron absorption and can reverse the inhibiting effect of such substances as tea and calcium/phosphate. Its influence may be less pronounced in meals of high iron availability–those containing meat, fish, or poultry. The enhancement of iron absorption from vegetable meals is directly proportional to the quantity of ascorbic acid present. The absorption of soluble inorganic iron added to a meal increases in parallel with the absorption of nonheme iron, but ascorbic acid has a much smaller effect on insoluble iron compounds, such as ferric oxide or ferric hydroxide, which are common food contaminants. Ascorbic acid facilitates iron absorption by forming a chelate with ferric iron at acid pH that remains soluble at the alkaline pH of the duodenum. High cost and instability during food storage are the major obstacles to using ascorbic acid in programs designed to combat nutritional iron deficiency anemia.

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Thyroid Status and Oxidized LDL

Also see:
Thyroid Status and Cardiovascular Disease
High Cholesterol and Metabolism
The Truth about Low Cholesterol
Inflammatory TSH
“Normal” TSH: Marker for Increased Risk of Fatal Coronary Heart Disease
The Cholesterol and Thyroid Connection
High Blood Pressure and Hypothyroidism
A Cure for Heart Disease
Hypothyroidism and A Shift in Death Patterns
Low Blood Cholesterol Compromises Immune Function

J Clin Endocrinol Metab. 1997 Oct;82(10):3421-4.
Both hypothyroidism and hyperthyroidism enhance low density lipoprotein oxidation.
Sundaram V, Hanna AN, Koneru L, Newman HA, Falko JM.
Hypothyroidism is frequently associated with hypercholesterolemia and an increased risk for atherosclerosis, whereas hyperthyroidism is known to precipitate angina or myocardial infarction in patients with underlying coronary heart disease. We have shown previously that L-T4 functions as an antioxidant in vitro and inhibits low density lipoprotein (LDL) oxidation in a dose-dependent fashion. The present study was designed to evaluate the changes in LDL oxidation in subjects with hypothyroidism and hyperthyroidism. Fasting blood samples for LDL oxidation analyses, lipoprotein determinations, and thyroid function tests were collected at baseline and after the patients were rendered euthyroid. The lag phase (mean +/- SEM hours) of the Cu+2-catalyzed LDL oxidation in the hypothyroid state and the subsequent euthyroid states were 4 +/- 0.0.65 and 14 +/- 0.68 h, respectively (P < 0.05). The lag phase during the hyperthyroid phase was 6 +/- 0.55 h, and that during the euthyroid phase was 12 +/- 0.66 h (P < 0.05). The total and LDL cholesterol levels were higher in hypothyroidism than in euthyroidism and were lower in hyperthyroidism than in the euthyroid state. We conclude that LDL has more susceptibility to oxidation in both the hypothyroid and hyperthyroid states. Thus, the enhanced LDL oxidation may play a role in the cardiac disease process in both hypothyroidism and hyperthyroidism.

J Clin Endocrinol Metab. 1998 May;83(5):1752-5.
Increased oxidizability of low-density lipoproteins in hypothyroidism.
Diekman T, Demacker PN, Kastelein JJ, Stalenhoef AF, Wiersinga WM.
Hypothyroidism leads to an increase of plasma low-density lipoprotein (LDL) cholesterol levels. Oxidation of LDL particles changes their intrinsic properties, thereby enhancing the development of atherosclerosis. T4 has three specific binding sites on apolipoprotein B; furthermore it inhibits LDL oxidation in vitro. We therefore hypothesized that T4 deficiency not only results in elevated LDL-cholesterol levels but also in increased LDL oxidation. Ten patients with overt hypothyroidism were studied when untreated (TSH 76 +/- 13 mU/L, T4 40 +/- 6 nmol/L) and again when they were euthyroid for at least 3 months during T4 treatment (TSH 2.7 +/- 0.5 mU/L, T4 115 +/- 11 nmol/L). Plasma lipids and lipoproteins and the oxidizability and chemical composition of LDL were determined. The transition from the hypothyroid to the euthyroid state was associated with a decrease (mean +/- SE) of plasma total cholesterol (5.8 +/- 0.3 vs. 4.8 +/- 0.2 mmol/L, P < 0.005), LDL cholesterol (3.8 +/- 0.3 vs. 2.9 +/- 0.2 nmol/L, P < 0.005) and apolipoprotein B (1.2 +/- 0.1 vs. 0.9 +/- 0.1 g/L, P < 0.005); plasma high-density lipoprotein cholesterol, apolipoprotein A-1, and triglycerides did not change. The actual content of dienes in LDL particles was increased in hypothyroidism, with a decrease after T4 suppletion [median (range) = 257 (165-346) vs. 188 (138-254) nmol/mg LDL protein, P < 0.005; reference range 140-180]. The lag time, an estimate of the resistance of LDL against oxidation in vitro, was shortened when hypothyroid but normalized after T4 treatment [29 (19-90) vs. 77 (42-96) min, P < 0.005; reference range 67-87]. The density, the relative fatty acid content, and the vitamin E content of LDL particles did not change. In conclusion, the hypothyroid state is not only associated with a quantitative increase of LDL particles, but it also changes their quality by increasing LDL oxidizability.

Arterioscler Thromb Vasc Biol. 1998 May;18(5):732-7.
Effect of thyroid function on LDL oxidation.
Costantini F, Pierdomenico SD, De Cesare D, De Remigis P, Bucciarelli T, Bittolo-Bon G, Cazzolato G, Nubile G, Guagnano MT, Sensi S, Cuccurullo F, Mezzetti A.
In this study, the effect of different levels of thyroid hormone and metabolic activity on low density lipoprotein (LDL) oxidation was investigated. Thus, in 16 patients with hyperthyroidism, 16 with hypothyroidism, and 16 age- and sex-matched healthy normolipidemic control subjects, the native LDL content in lipid peroxides, vitamin E, beta-carotene, and lycopene, as well as the susceptibility of these particles to undergo lipid peroxidation, was assessed. Hyperthyroidism was associated with significantly higher lipid peroxidation, as characterized by a higher native LDL content in lipid peroxides, a lower lag phase, and a higher oxidation rate than in the other two groups. This elevated lipid peroxidation was associated with a lower LDL antioxidant concentration. Interestingly, hypothyroid patients showed an intermediate behavior. In fact, in hypothyroidism, LDL oxidation was significantly lower than in hyperthyroidism but higher than in the control group. Hypothyroidism was also characterized by the highest beta-carotene LDL content, whereas vitamin E was significantly lower than in control subjects. In hyperthyroidism but not in the other two groups, LDL oxidation was strongly influenced by free thyroxine blood content. In fact in this group, the native LDL lipid peroxide content and the lag phase were directly and indirectly, respectively, related to free thyroxine blood levels. On the contrary, in hypothyroidism LDL oxidation was strongly and significantly related to serum lipids. In conclusion, both hypothyroidism and hyperthyroidism are characterized by higher levels of LDL oxidation when compared with normolipidemic control subjects. In hyperthyroid patients, the increased lipid peroxidation was strictly related to free thyroxine levels, whereas in hypothyroidism it was strongly influenced by serum lipids.

Endocr Res. 2004 Aug;30(3):481-9.
Effect of thyroid function on LDL oxidation in hypothyroidism and hyperthyroidism.
Oge A, Sozmen E, Karaoglu AO.
Oxidized low-density lipoproteins (LDL) are highly suspected of initiating the atherosclerosis process. Hypothyroidism is frequently associated with hypercholesterolemia and carries increased risk for atherosclerosis. In contrast to hypothyroidism, hyperthyroidism is not associated with increased LDL cholesterol, but is associated with increased oxidized LDL. This study was designed to evaluate the changes in LDL oxidation in subjects with hypothyroidism or hyperthyroidism, and to reveal the effects of treatment in hypothyroidism and hyperthyroidism on LDL oxidation and lipid profiles. Thirty-two patients with hypothyroidism and 16 patients with hyperthyroidism were studied before the therapy and thereafter, when they were euthyroid with appropriate treatment. Plasma lipids and lipoproteins, and the oxidizability of LDL by determining the levels of malonaldehyde bis (dimethyacetyl) (MDA) and diene conjugation, were determined at baseline and after the patients were rendered euthyroid. The actual content of dienes in LDL particles was increased in hypothyroidism, with a decrease after T4 supplementation (p < .001). Dienes in LDL particles were increased in hyperthyroidism, with a decrease after treatment (p < .05). In hypothyroid patients, the lag phase was shorter in the pretreatment period than in the euthyroid period (p > .05). The lag phase of hyperthyroid patients was shorter in the pretreatment period than in the euthyroid period and hypothyroid state (p < .001). The Cu2+-catalyzed dienes of LDL and MDA oxidation in the hypothyroid state and the subsequent euthyroid states were decreased (p < .001). The Cu2+-catalyzed dienes of LDL (p < .01) and MDA oxidation (p < .001) in hyperthyroid patients after treatment were decreased. The enhanced LDL oxidation may play a role in the cardiac disease process in both hypothyroidism and hyperthyroidism.

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180 Nutrition Program Testimonial – Yeast Infections, Digestion, PMS

Female, 34, Southern California

What was the primary benefit of doing the Program for you?
Reoccurring vaginal yeast infections have ceased completely. Bloating and gas that was previously frequent only occurs if I eat the wrong foods.

How long did you spend in calendar time on the Program?
4 months

What were your body temperature and pulse changes during the Program?
Starting temperature was in the low 96s. Currently, I have consistent temperatures in the high 97s and low 98s depending upon where I am in my menstrual cycle.

Summarize your experience with the program as a testimonial to be used with your permission.
I’ve come a long way. Being very frustrated about the direction of my health for nine months was extremely taxing for me both physically and emotionally. My health had always been good and this was the first time that I had a long stretch of time where I couldn’t correct my problems quickly.

For nine months, I had reoccurring vaginal yeast infections, which were accompanied by thinning of my hair, and frequent gas and bloating. I also noticed flare ups seemed to be worst during certain parts of my menstrual cycle. Doctors did little to help or explain why this was occurring and maybe in this case actually put me going in the wrong direction. Nothing I did dietary seemed to be beneficial despite being strict with an “anti-yeast” diet, which varies depending upon what website you go to. That created some confusion on my part.

A girlfriend of mine told me about some of the information that FPS was putting out on their blog and Facebook page. I contacted Rob to see if he felt some of his recommendations would be of any benefit. He didn’t make any promises but was confident we could make some positive changes after he reviewed my assessment documentation.

Well, within two months my symptoms drastically lessened and by the end of four months I no longer had any symptoms. At the current time, I’ve been healthy for a period of eight months now. I didn’t want to write my testimonial too soon for fear that I would jinx myself or something, but Rob’s recommendations were definitely the key to my health reversal. Most of his coaching was the exact opposite of what I was doing previously including eating sugars from ripe fruits, orange juice, milk and consuming saturated fats which I thought weren’t healthy for me. I know better now though.

Rob was able to explain to me the big picture of how these symptoms can come about and then created a step by step program to that was initially a big change but with each day it became much easier for me to put into action. I had to increase my metabolism, eat digestible foods to improve my gut health, and balance my blood sugar if I was going to getting better. The foods were tasty and most were easy to find at my local grocery store. I know what to look for on labels to tell real from imposter health foods. My perspective on food has changed completely and for the better. I cannot believe how good healthy eating tastes! All of my girlfriends are asking me for my recipes.

Another added benefit is that my PMS is virtually gone. The only time I have menstrual issues is when I have a period of time when my diet isn’t the way it should be. I have the knowledge of what to eat and why to balance my hormones.

I hope this testimonial can help someone else that is in my shoes, b/c I was getting so frustrated and didn’t know where else to turn. I am glad that I found this information and hope others can approach this information with an open mind because it really works. You’ll have to be a little patient as health correction doesn’t happen overnight, but the results are worth the wait. Thanks FPS!

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The “chemical imbalance” myth

by Chris Kresser L.Ac

June 30, 2008 in DepressionMyths & Truths

serotonin illustration

“A theory that is wrong is considered preferable to admitting our ignorance.” – Elliot Vallenstein, Ph.D.

The idea that depression and other mental health conditions are caused by an imbalance of chemicals in the brain is so deeply ingrained in our psyche that it seems almost sacrilegious to question it.

Direct-to-consumer-advertising (DCTA) campaigns, which have expanded the size of the antidepressant market (Donohue et al., 2004), revolve around the claim that SSRIs (the most popular class of antidepressants) alleviate depression by correcting a deficiency of serotonin in the brain.

For example, Pfizer’s television advertisement for Zoloft states that “depression is a serious medical condition that may be due to a chemical imbalance”, and that “Zoloft works to correct this imbalance.”

Other SSRI advertising campaigns make similar claims. The Effexor website even has a slick video explaining that “research suggests an important link between depression and an imbalance in some of the brain’s chemical messengers. Two neurotransmitters believed to be involved in depression are serotonin and norepinephrine.” The video goes on to explain that Effexor works by increasing serotonin levels in the synapse, which is “believed to relieve symptoms of depression over time.”

These days serotonin is widely promoted as the way to achieve just about every personality trait that is desirable, including self-confidence, creativity, emotional resilience, success, achievement, sociability and high energy. And the converse is also true. Low serotonin levels have been implicated in almost every undesirable mental state and behavioral pattern, such as depression, aggressiveness, suicide, stress, lack of self-confidence, failure, low impulse control, binge eating and other forms of substance abuse.

In fact, the idea that low levels of serotonin cause depression has become so widespread that it’s not uncommon to hear people speak of the need to “boost their serotonin levels” through exercise, herbal supplements or even sexual activity. The “chemical imbalance” theory is so well established that it is now part of the popular lexicon.

It is, after all, a neat theory. It takes a complex and heterogeneous condition (depression) and boils it down to a simple imbalance of two to three neurotransmitters (out of more than 100 that have been identified), which, as it happens, can be “corrected” by long-term drug treatment. This clear and easy-to-follow theory is the driving force behind the $12 billion worth of antidepressant drugs sold each year.

However, there is one (rather large) problem with this theory: there is absolutely no evidence to support it. Recent reviews of the research have demonstrated no link between depression, or any other mental disorder, and an imbalance of chemicals in the brain (Lacasse & Leo, 2005; (Valenstein, 1998).

The ineffectiveness of antidepressant drugs when compared to placebo cast even more doubt on the “chemical imbalance” theory. (See my recent articles Placebos as effective as antidepressants and A closer look at the evidence for more on this.)

Folks, at this point you might want to grab a cup of tea. It’s going to take a while to explain the history of this theory, why it is flawed, and how continues to persist in light of the complete lack of evidence to support it. I will try to be as concise as possible, but there’s a lot of material to cover and a lot of propaganda I need to disabuse you of.

Ready? Let’s start with a bit of history.

The history of the “chemical imbalance” theory

The first antidepressant, iproniazid, was discovered by accident in 1952 after it was observed that some tubercular patients became euphoric when treated with this drug. A bacteriologist named Albert Zeller found that iproniazid was effective in inhibiting the enzyme monoamine oxydase. As its name implies, monoamine oxydase plays an essential role in inactivating monoamines such as epinephrine and norepinephrine. Thus, iproniazid raised levels of epinephrine and norepinephrine which in turn led to stimulation of the sympathetic nervous system – an effect thought to be responsible for the antidepressant action of the drug.

At around the same time, an extract from the plant Rauwolfia serpentina was introduced into western psychiatry. This extract had been used medicinally in India for more than a thousand years and was thought to have a calming effect useful to quite babies, treat insomnia, high blood pressure, insanity and much more. In 1953 chemists at Ciba, a pharmaceutical company, isolated the active compound from this herb and called it reserpine.

In 1955 researchers at the National Institutes of Health reported that reserpine reduces the levels of serotonin in the brains of animals. It was later established that all three of the major biogenic amines in the brain, norepinephrine, serotonin, and dopamine, were all decreased by reserpine (again, in animals).

In animal studies conducted at around the same time, it was found that animals administered reserpine showed a short period of increased excitement and motor activity, followed by a prolonged period of inactivity. The animals often had a hunched posture and an immobility that was thought to resemble catatonia (Valenstein, 1998). Since reserpine lowered levels of serotonin, norepinephrine and dopamine, and caused the effects observed in animals, it was concluded that depression was a result of low levels of biogenic amines. Hence, the “chemical imbalance” theory is born.

However, it was later found that reserpine only rarely produces a true clinical depression. Despite high doses and many months of treatment with reserpine, only 6 percent of the patients developed symptoms even suggestive of depression. In addition, an examination of these 6 percent of patients revealed that all of them had a previous history of depression. (Mendels & Frazer, 1974) There were even reports from a few studies that reserpine could have anantidepressant effect (in spite of reducing levels of serotonin, norepinephrine and dopanmine).

As it turns out, that is only the tip of the iceberg when it comes to revealing the inadequacies of the “chemical imbalance” theory.

The fatal flaws of “chemical imbalance” theory

As Elliot Valenstein Ph.D., Professor Emeritus of psychology and neuroscience at Michigan University, points out in his seminal book Blaming the Brain, “Contrary to what is often claimed, no biochemical, anatomical or functional signs have been found that reliably distinguish the brains of mental patients.” (p. 125)

In his book, Valenstein clearly and systematically dismantles the chemical imbalance theory:

  1. Reducing levels of norepinephrine, serotonin and dopamine does not actually produce depression in humans, even though it appeared to do so in animals.
  2. The theory cannot explain why there are drugs that alleviate depression despite the fact that they have little or no effect on either serotonin or norepinephrine.
  3. Drugs that raise serotonin and norepinephrine levels, such as amphetamine and cocaine, do not alleviate depression.
  4. No one has explained why it takes a relatively long time before antidepressant drugs produce any elevation of mood. Antidepressants produce their maximum elevation of serotonin and norepinephrine in only a day or two, but it often takes several weeks before any improvement in mood occurs.
  5. Although some depressed patients have low levels of serotonin and norepinephrine, the majority do not. Estimates vary, but a reasonable average from several studies indicates that only about 25 percent of depressed patients actually have low levels of these metabolites.
  6. Some depressed patients actually have abnormally high levels of serotonin and norepinephrine, and some patients with no history of depression at all have low levels of these amines.
  7. Although there have been claims that depression may be caused by excessive levels of monoamine oxydase (the enzyme that breaks down serotonin and norepinephrine), this is only true in some depressed patients and not in others.
  8. Antidepressants produce a number of different effects other than increasing norepinephrine and serotonin activity that have not been accounted for when considering their activity on depression.

Another problem is that it is not now possible to measure serotonin and norepinephrine in the brains of patients. Estimates of brain neurotransmitters can only be inferred by measuring the biogenic amine breakdown products (metabolites) in the urine and cerebrospinal fluid. The assumption underlying this measurement is that the level of biogenic amine metabolites in the urine and cerebrospinal fluid reflects the amount of neurotransmitters in the brain. However, less than one-half of the serotonin and norepinephrine metabolites in the urine or cerebrospinal fluid come from the brain. The other half come from various organs in the body. Thus, there are serious problems with what is actually being measured.

Finally, there is not a single peer-reviewed article that can be accurately cited to support claims of serotonin deficiency in any mental disorder, while there are many articles that present counterevidence. Furthermore, theDiagnostic and Statistical Manual of Mental Disorders (DSM) does not list serotonin as the cause of any mental disorder. The American Psychiatric Press Textbook of Clinical Psychiatry addresses serotonin deficiency as an unconfirmed hypothesis, stating “Additional experience has not confirmed the monoamine depletion hypothesis” (Lacasse & Leo, 2005).

When all of this evidence is taken in full, it should be abundantly clear that depression is not caused by a chemical imbalance.

But, as Valenstein shrewdly observes, “there are few rewards waiting for the person who claims that “the emperor is really nude” or who claims that we really do not know what causes depression or why an antidepressant sometimes helps to relieve this condition.”

How have we been fooled?

There are several reasons the idea that mental disorders are caused by a chemical imbalance has become so widespread (and none of them have anything to do with the actual scientific evidence, as we have seen).

It is known that people suffering from mental disorders and especially their families prefer a diagnosis of “physical disease” because it does not convey the stigma and blame commonly associated with “psychological problems”. A “physical disease” may suggest a more optimistic prognosis, and mental patients are often more amenable to drug treatment when they are told they have a physical disease.

Patients are highly susceptible to Direct-to-Consumer-Advertising (DCTA). It has been reported that patients are now presenting to their doctors with a self-described “chemical imbalance” (Kramer, 2002). This is important because studies show that patients who are convinced they are suffering from a neurotransmitter defect are likely to request a prescription for antidepressants, and may be skeptical of physicians who suggest other interventions such as cognitive behavioral therapy (DeRubeis et al., 2005). It has also been shown that anxious and depressed patients “are probably more susceptible to the controlling influence of advertisements (Hollon MF, 2004).

The benefit of the chemical imbalance theory for insurance companies and the pharmaceutical industry is primarily economic. Medical insurers are primarily concerned with cost, and they want to discourage treatments (such as psychotherapy) that may involve many contact hours and considerable expense. Their control over payment schedules enables insurance companies to shift treatment toward drugs and away from psychotherapy.

The motivation of the pharmaceutical companies should be fairly obvious. As mentioned previously, the market for antidepressant drugs is now $12 billion. All publicly traded for-profit companies are required by law to increase the value of their investor’s stock. Perhaps it goes without saying, but it is a simple fact that pharmaceutical companies will do anything they legally (and sometimes illegally) can to maximize revenues.

Studies have shown that the advertisements placed by drug companies in professional journals or distributed directly to physicians are often exaggerated or misleading and do not accurately reflect scientific evidence (Lacasse & Leo, 2005). While physicians deny they are being influenced, it has been shown repeatedly that their prescription preferences are heavily affected by promotional material from drug companies (Moynihan, 2003). Research also suggests that doctors exposed to company reps are more likely to favor drugs over non-drug therapy, and more likely to prescribe expensive medications when equally effective but less costly ones are available (Lexchin, 1989). Some studies have even shown an association between the dose and response: in other words, the more contact between doctors and sales reps the more doctors latch on to the “commercial” messages as opposed to the “scientific” view of a product’s value (Wazana, 2000).

The motivation of psychiatrists to accept the chemical imbalance theory is somewhat more subtle. Starting around 1930, psychiatrists became increasingly aware of growing competition from nonmedical therapists such as psychologists, social workers and counselors. Because of this, psychiatrists have been attracted to physical treatments like drugs and electroshock therapy that differentiate them from nonmedical practitioners. Psychiatry may be the least respected medical specialty (U.S. General Accounting Office report). Many Americans rejected Fruedian talk therapy as quackery, and the whole field of psychiatry lacks the quality of research (randomized, placebo-controlled, double-blind experiments) that serves as the gold-standard in other branches of medicine.

Dr. Colin Ross, a psychiatrist, describes it this way:

“I also saw how badly biological psychiatrists want to be regarded as doctors and accepted by the rest of the medical profession. In their desire to be accepted as real clinical scientists, these psychiatrists were building far too dogmatic an edifice… pushing their certainty far beyond what the data could support.”

Of course there are also many “benefits” to going along with the conventional “chemical imbalance” theory, such as free dinners, symphony tickets, and trips to the Caribbean; consultancy fees, honoraria and stock options from the pharmaceutical companies; and a much larger, growing private practice as the $20 billion spent by drug companies on advertising brings patients to the office. Psychiatrists are just human, like the rest of us, and not many of them can resist all of these benefits.

In sum, the idea that depression is caused by a chemical imbalance is a myth. Pharmaceutical ads for antidepressants assert that depression is a physical diseases because that serves as a natural and easy segue to promoting drug treatment. There may well be biological factors which predispose some individuals toward depression, but predisposition is not a cause. The theory that mental disorders are physical diseases ignores the relevance of psychosocial factors and implies by omission that such factors are of little importance.

Stay tuned for future articles on the psychosocial factors of depression, the loss of sadness as a normal response to life, and the branding of new psychological conditions as a means of increasing drug sales.

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Making a Killing: The Untold Story of Psychotropic Drugging

https://www.youtube.com/watch?v=UDlH9sV0lHU

This video provides the facts about psychotropic drugs and the huge profits they create for the pharmaceutical industry. These drugs are not safe and have not been on the market long enough to provide sufficient long term studies regarding their effects. These drugs do cause addiction, however most “doctors” would call this dependence because you do not have to take an increasing dose over time. They are completely fine with you being addicted to the same amount of any given drug on a daily basis. Over half of the people that commit suicide in the United States are prescribed to psychotropic drugs. (Ex: Paxil (Paroxetine), Zoloft (Sertraline), Prozac, Wellbutrin (Bupropion), Effexor, Seroquil, Ultram (Tramadol), etc.)

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180 Nutrition Program Testimonial – Digestion, Sleep, Energy, Libido

Male, 30 years old, Southern California

What was the primary benefit of doing the Program for you?
The knowledge of how the human body really works, and what it takes to truly nourish your body so it can heal.

Did you experience changes in energy, appetite, emotional balance and mental sharpness?
Yes, I experienced an increase in all 4.

Did you have identified problems upon entering the Program, and were they changed?
I had digestion and evacuation issues, and also sleep problems. They all greatly improved on the program, and fairly quickly.

What is your next major plan for improving your health now, after the Program, if you have
one?

The program has become a way of life for me, so I will be continuing to implement what I have learned in the program in the future.

What were your body temperature changes during the Program?
My average waking temp is now between 97.8-98.0 an increase from 97. During the day my temp is now up to 98.6.

What is your normal pulse rate now? Did this change?
Pulse is also up to an average of 75 bpm. Up from around 60 bpm.

Would you recommend the Program to others?
l would highly recommend this program.

Summarize your experience with the program.
Before I began the program I had a lot of health concerns. I wasn’t digesting well, sleeping well, and I had lost my energy and libido as well. All this at the age of only 29! I was seen by many doctors and had lots of tests done, but they could find nothing. So I began surfing the web hoping to find a solution to my problems. I started trying just about everything out there, from a vegetarian diet to even a raw food diet, but nothing seemed to work. ln fact, it seemed to make things worse.

Then I came across the work of Ray Peat. As I read through a lot of his work a lot of things really made sense to me. The problem was that there was also a good portion of his work that I didn’t understand as well. As I kept researching his work and surfing the web some more trying to piece it all together so that I can implement his findings into my daily life I came across the Functional Performance Systems web page. lt was full of information on the findings of Ray Peats work. As I looked through the site, I saw that they offered a program that would help piece it all together for me so I could finally really put his work to the test.

That was when I decided to give FPS a call and give the program a try. That ended up being the best choice I made in my search to better health. That was when I met Rob Turner of FPS. Rob was the best teacher on the work of Ray Peat that I could have hoped for! He was with me every step of the program and really helped me understand how the human body really works and how to really heal your body by fixing your metabolism. Each week Rob went through each step of the program at my pace and really made it very easy to understand.

That was when things really started to change in the right direction for me. I was finally giving my body the fuel it needed to begin to heal. ln just a few weeks I started digesting better, sleeping better and my energy was coming back as well. Rob showed me how I can track my progress through my body temperature and pulses. As my temps and pulses began to rise my problems were getting better. I was finally healing my broken metabolism. I couldn’t believe that it could be done by just eating the way the body was designed to be feed. Even when there were bumps in the road Rob was always there to walk me through the problem and get me through it. I learned so much in this program and would highly recommend it to anyone who was looking to truly better their health!

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Thumbs Up: Fructose

Also see:
Theurapeutic Honey – Cancer and Wound Healing
Carbohydrates and Bone Health
Sugar (Sucrose) Restrains the Stress Response
HFCS – More to it than we thought
Protection from Endotoxin
Lactose Intolerance: Starch, Fructose, Sucrose, & Thyroid Status
Commentary on Type 2 Diabetes
Are Happy Gut Bacteria Key to Weight Loss?
Soybean oil causes more obesity than coconut oil and fructose
The common oil that science now shows is worse than sugar

“The animal studies that are used to make the argument provided the animals an excessive amount of polyunsaturated fat, which are antagonistic to the oxidation of sugar and tend to reduce the rate of metabolism, and usually also excessive calories. The special value of fructose is that it can be oxidized even by diabetics, lacking insulin, and that it increases the metabolic rate, causing calories to be burned at a higher rate. The journals are publishing propaganda and calling it science. They are doing this to preserve the myth that cholesterol and triglycerides are the cause of heart disease, that was invented in the 1950’s and 1960s to sell vegetable oils.” -Ray Peat, PhD

Diabetes Care. 2007 Jun;30(6):1406-11. Epub 2007 Mar 23.
Orange juice or fructose intake does not induce oxidative and inflammatory response.
Ghanim H, Mohanty P, Pathak R, Chaudhuri A, Sia CL, Dandona P.
OBJECTIVE:
We have previously shown that 300 kcal from glucose intake induces a significant increase in reactive oxygen species (ROS) generation and nuclear factor-kappaB (NF-kappaB) binding in the circulating mononuclear cells in healthy normal subjects. We hypothesized that the intake of 300 calories as orange juice or fructose, the other major carbohydrate in orange juice, would induce a significantly smaller response than that of glucose.
RESEARCH DESIGN AND METHODS:
Four groups (eight subjects each) of normal-weight subjects were given a 300-cal drink of glucose (75 g), fructose (75 g), or orange juice or water sweetened with saccharin (control group) to drink, and then blood samples were collected.
RESULTS:
There was a significant increase in ROS generation by mononuclear cells (by 130 +/- 18%, P < 0.001), polymorph nuclear cells (by 95 +/- 22%, P < 0.01), and in NF-kappaB binding in mononuclear cells by 82 +/- 16% (P < 0.01) over the baseline after 2 h of glucose intake. These changes were absent following fructose, orange juice, or water intake. There was significantly lower ROS generation and NF-kappaB binding following orange juice, fructose, and water compared with glucose (P < 0.001 for all). Furthermore, incubation of mononuclear cells in vitro with 50 mmol/l of the flavonoids hesperetin or naringenin reduced ROS generation by 52 +/- 7% and 77 +/- 8% (P < 0.01), respectively, while fructose or ascorbic acid did not cause any change. CONCLUSIONS: Caloric intake in the form of orange juice or fructose does not induce either oxidative or inflammatory stress, possibly due to its flavonoids content and might, therefore, represent a potentially safe energy source.

Am J Hypertens. 2008 Jun;21(6):708-14. Epub 2008 Apr 10.
Hepatic effects of a fructose diet in the stroke-prone spontaneously hypertensive rat.
Brosnan MJ, Carkner RD.
BACKGROUND:
Feeding stroke-prone spontaneously hypertensive rats (SHRSP) a diet rich in fructose results in a profound glucose intolerance not observed in the normotensive Wistar Kyoto (WKY) strain. The aim of this study was to investigate the role of the liver in the underlying mechanisms in the SHRSP.
METHODS:
SHRSP and WKY rats were fed either 60% fructose or regular chow for 2 weeks with blood pressure being measured using tail-cuff plethysmography and radiotelemetry. Intraperitoneal glucose tolerance tests were performed and livers harvested for analysis of expression of inflammatory mediators and antioxidant proteins by western blotting and quantitative reverse transcriptase-PCR. The serum triglyceride content and fatty acid profiles were also measured.
RESULTS:
Feeding SHRSP and WKY on 60% fructose for 2 weeks resulted in glucose intolerance with no increases in levels of blood pressure. Serum triglycerides were increased in both strains of fructose-fed rats with the highest levels being observed in the SHRSP. The serum fatty acid profiles were changed with large increases in the amounts of oleic acid (18.1) and reductions in linoleic acid (18.2). Levels of expression of c-jun N-terminal kinase/stress activated protein kinase (JNK/SAPK), and nuclear factor kappaB (NF-kappaB) were shown to be unchanged between the livers of the chow and fructose-fed groups. In contrast, protein levels of the three isoforms of superoxide dismutase (SOD) were upregulated in liver of SHRSP fed on fructose while only manganese SOD (MnSOD) was upregulated in fructose-fed WKY rats.
CONCLUSIONS:
These results demonstrate that the major contribution of the liver in the early pathogenesis of metabolic syndrome may be an increased secretion of triglyceride containing altered proportions of fatty acid pools. Feeding rats a diet rich in fructose does not affect hepatic expression of inflammatory pathways and the increased hepatic SOD expression may constitute an early protective mechanism.

Am J Clin Nutr. 1989 Jun;49(6):1290-4.
Dietary fructose or starch: effects on copper, zinc, iron, manganese, calcium, and magnesium balances in humans.
Holbrook JT, Smith JC Jr, Reiser S.
A balance study was conducted to assess the effects of consuming low-copper diets, high in fructose or cornstarch. The study involved 19 apparently healthy males, aged 21-57 y. The two experimental diets averaged 0.35 mg Cu/1000 kcal and provided 20% of the calories from fructose or cornstarch. Cu, zinc, calcium, magnesium, and iron balances were determined 1 wk before the study (pretest) when the subjects consumed self-selected diets and after consuming the experimental diets for 6 wk. No major differences in mineral balances were evident between the two groups during the pretest study when the subjects ate self-selected diets. In contrast, when fed the test diets, the group consuming the low-Cu fructose diet had significantly more positive balances for all minerals studied than the group fed the low-Cu cornstarch diet. The results indicate that dietary fructose enhances mineral balance.

Anaesthesist. 1995 Nov;44(11):770-81.
[Fructose vs. glucose in total parenteral nutrition in critically ill patients].
[Article in German]
Adolph M, Eckart A, Eckart J.
Parenteral nutrition required following surgery or injury should not only meet post-aggression caloric requirements but also match the specific metabolic needs so as not to worsen the metabolic disruptions already present in this situation. The primary objective of parenteral nutrition is body protein maintenance or restoration by reduction of protein catabolism or promotion of protein synthesis or both. Whether all parenteral energy donors, ie., glucose, fructose, other polyols, and lipid emulsions, are equally capable of achieving this objective continues to be a controversial issue. The objective of the present study was to answer the following questions: (1) Do glucose and fructose differ in their effects on the metabolic changes seen following surgery or injury, the changes in glucose metabolism in particular? (2) Can the observation of poorer glucose utilization in the presence of lipids be confirmed in ICU patients?
PATIENTS, MATERIALS AND METHODS:
A prospective, randomized clinical trial has been conducted in 20 aseptic surgical ICU patients to generate an objective database along these lines by performing a detailed analysis of the metabolic responses to different parenteral nutrition protocols. The effects of a glucose solution+lipid emulsion regimen vs fructose solution+lipid emulsion regimen on a number of carbohydrate and lipid metabolism variables were evaluated for an isocaloric (carbohydrates: 0.25 g/kg body weight/h; lipids: 0.166g/kg body weight/h) and isonitrogenous (amino acids: 0.0625 g/kg body weight/h) total nutrient supply over a 10-h study period.
RESULTS:
A significantly smaller rise in blood glucose concentrations (increase from baseline: glucose+lipids P<0.001 vs fructose+lipids n.s.) suggested that fructose had a small effect, if any at all, on glucose metabolism. Serum insulin activity showed significant differences as a function of carbohydrate regimen, i.e. infusion of fructose instead of glucose produced a less pronounced increase in insulin activity (increase from baseline: glucose+lipids P<0.001 vs fructose+lipids P<0.01). Impairment of glucose utilization by concomitant administration of lipids was observed neither in patients who first received glucose nor in those who first received fructose.
CONCLUSIONS:
As demonstrated, parenteral fructose, unlike parenteral glucose, has a significantly less adverse impact than glucose on the glucose balance, which is disrupted initially in the post-aggression state. In addition, the less pronounced increase in insulin activity during fructose infusion than during glucose infusion can be assumed to facilitate mobilization of endogenous lipid stores and lipid oxidation. Earlier workers pointed out that any rise in free fatty acid and ketone body concentrations in the serum produces inhibition of muscular glucose uptake and oxidation, and of glycolysis. These findings were recorded in a rat model and could not be confirmed in our post-aggression state patients receiving lipid doses commensurate with the usual clinical infusion rates. The serious complications that can result from hereditary fructose intolerance are completely avoidable if a careful patient history is taken before the first parenteral use of fructose. If the patient or family members and close friends, are simply asked whether he/she can tolerate fruit and sweet dishes, hereditary fructose intolerance can be ruled out beyond all reasonable doubt. Only in the extremely rare situations in which it is not possible to question either the patient or any significant other, a test dose will have to be administered to exclude fructose intolerance. The benefits of fructose-specific metabolic effects reported in the literature and corroborated by the results of our own study suggest that fructose is an important nutrient that contributes to metabolic stabilization, especially in the post-aggression phase and in septic patients.

Bone. 2008 May;42(5):960-8. Epub 2008 Feb 15.
The effect of feeding different sugar-sweetened beverages to growing female Sprague-Dawley rats on bone mass and strength.
Tsanzi E, Light HR, Tou JC.
Consumption of sugar beverages has increased among adolescents. Additionally, the replacement of sucrose with high fructose corn syrup (HFCS) as the predominant sweetener has resulted in higher fructose intake. Few studies have investigated the effect of drinking different sugar-sweetened beverages on bone, despite suggestions that sugar consumption negatively impacts mineral balance. The objective of this study was to determine the effect of drinking different sugar-sweetened beverages on bone mass and strength. Adolescent (age 35d) female Sprague-Dawley rats were randomly assigned (n=8-9/group) to consume deionized distilled water (ddH2O, control) or ddH2O containing 13% w/v glucose, sucrose, fructose or high fructose corn syrup (HFCS-55) for 8weeks. Tibia and femur measurements included bone morphometry, bone turnover markers, determination of bone mineral density (BMD) and bone mineral content (BMC) by dual energy X-ray absorptiometry (DXA) and bone strength by three-point bending test. The effect of sugar-sweetened beverage consumption on mineral balance, urinary and fecal calcium (Ca) and phosphorus (P) was measured by inductively coupled plasma optical emission spectrometry. The results showed no difference in the bone mass or strength of rats drinking the glucose-sweetened beverage despite their having the lowest food intake, but the highest beverage and caloric consumption. Only in comparisons among the rats provided sugar-sweetened beverage were femur and tibia BMD lower in rats drinking the glucose-sweetened beverage. Differences in bone and mineral measurements appeared most pronounced between rats drinking glucose versus fructose-sweetened beverages. Rats provided the glucose-sweetened beverage had reduced femur and tibia total P, reduced P and Ca intake and increased urinary Ca excretion compared to the rats provided the fructose-sweetened beverage. The results suggested that glucose rather than fructose exerted more deleterious effects on mineral balance and bone.

Ann Nutr Aliment. 1975;29(4):305-12.
[Effects of administering diets with starch or sucrose basis on certain parameters of calcium metabolism in the young, growing rat].
[Article in French]
Artus M.
The important role of many carbohydrates on calcium metabolism has been demonstrated by FOURNIER and DUPUIS. Starch, however, neither influences the absorption nor the retention of calcium. Less is known about the effects of sucrose. In this study the influence of starch on calcium metabolsim has been compared with that of sucrose. Male weanling Wistar rats were divided into three groups according to their diets. The first group received a refined and well-balanced diet (except for the absence of vitamin D), containing 68 p. 100 of starch. The second group received the same diet except sucrose was substituted for the starch. The third group received the same diet as Group 1, with the addition of vitamin D. Plasma calcium citrate and urinary citrate and calcium were determined. At the age of 2 months after one night of fasting, each group of rats was injected intraperitoneally with a 1 ml, aqueous solution containing 1 mg calcium and 0, 6 mu Ci45Ca. Twenty-four hours later the animals were sacrificed and the calcium femur percentage, radioactivity p. 1,000 of the injected dose of 45Ca, and specific radioactivity were determined. When performance data from Group 3 were compared to Group 1 and Group 2, the following results were obtained: —Group 1 (starch diet without vitamin D) had very low plasma calcium levels; urinary calcium, plasma citrate and urinary citrate levels were lowered, and the calcium femur percentage was smaller. Bone avidity for calcium was found. –Group 2 (sucrose diet without vitamin D) had normal plasma calcium levels. Urinary calcium and citrate and plasma citrate did not show significant differences from those of animals receiving vitamin D. No significant differences were found in the specific radioactivity and radioactivity p. 1,000 of the administered dose. Contrary to starch, sucrose maintained calcium homeostasis, and apparently, normal ossification, although the femur was lighter than those of animals receiving vitamin D. Further work is necessary to determine whether the fructose component of the sucrose molecule is responsible for the increased calcium utilization and, if so, what levels of ingestion are necessary for this activity.

Carbohydr Res. 2009 Sep 8;344(13):1676-81. Epub 2009 Jun 3.
Protective role of fructose in the metabolism of astroglial C6 cells exposed to hydrogen peroxide.
Spasojević I, Bajić A, Jovanović K, Spasić M, Andjus P.
Astroglial cells represent the main line of defence against oxidative damage related to neurodegeneration. Therefore, protection of astroglia from an excess of reactive oxygen species could represent an important target of the treatment of such conditions. The aim of our study was to compare the abilities of glucose and fructose, the two monosaccharides used in diet and infusion, to protect C6 cells from hydrogen peroxide (H(2)O(2))-mediated oxidative stress. It was observed using confocal microscopy with fluorescent labels and the MTT test that fructose prevents changes of oxidative status of the cells exposed to H(2)O(2) and preserves their viability. Even more pronounced protective effects were observed for fructose 1,6-bis(phosphate). We propose that fructose and its intracellular forms prevent H(2)O(2) from participating in the Fenton reaction via iron sequestration. As fructose and fructose 1,6-bis(phosphate) are able to pass the blood-brain barrier, they could provide antioxidative protection of nervous tissue in vivo. So, in contrast to the well-known negative effects of frequent consumption of fructose under physiological conditions, acute infusion or ingestion of fructose or fructose 1,6-bis(phosphate) could be of benefit in the cytoprotective therapy of neurodegenerative disorders related to oxidative stress.

Brundin, et al. (1993) compared the effects of glucose and fructose in healthy people, and saw a greater oxygen consumption with fructose, and also an increase in the temperature of the blood, and a greater increase in carbon dioxide production. -Ray Peat, PhD

AJP – Endo April 1993 vol. 264 no. 4 E504-E513
Whole body and splanchnic oxygen consumption and blood flow after oral ingestion of fructose or glucose
T. Brundin and J. Wahren
The contribution of the splanchnic tissues to the initial 2-h rise in whole body energy expenditure after ingestion of glucose or fructose was examined in healthy subjects. Indirect calorimetry and catheter techniques were employed to determine pulmonary gas exchange, cardiac output, splanchnic blood flow, splanchnic oxygen uptake, and blood temperatures before and for 2 h after ingestion of 75 g of either fructose or glucose in water solution or of water only. Fructose ingestion was found to increase total oxygen uptake by an average of 9.5% above basal levels; the corresponding increase for glucose was 8.8% and for water only 2.5%. The respiratory exchange ratio increased from 0.84 in the basal state to 0.97 at 45 min after fructose ingestion and rose gradually after glucose to 0.86 after 120 min. The average 2-h thermic effect, expressed as percent of ingested energy, was 5.0% for fructose and 3.7% for glucose (not significant). Splanchnic oxygen consumption did not increase measurably after ingestion of either fructose or glucose. The arterial concentration of lactate rose, arterial pH fell, and PCO2 remained essentially unchanged after fructose ingestion. Glucose, but not fructose, elicited increases in cardiac output (28%) and splanchnic blood flow (56%). Fructose, but not glucose, increased arterial blood temperature significantly. It is concluded that both fructose and glucose-induced thermogenesis occurs exclusively in extrasplanchnic tissues. Compared with glucose, fructose ingestion is accompanied by a more marked rise in CO2 production, possibly reflecting an increased extrasplanchnic oxidation of lactate and an accumulation of heat in the body.

Am J Clin Nutr. 1993 Nov;58(5 Suppl):766S-770S.
Fructose and dietary thermogenesis.
Tappy L, Jéquier E.
Ingestion of nutrients increases energy expenditure above basal metabolic rate. Thermogenesis of carbohydrate comprises two distinct components: an obligatory component, which corresponds to the energy cost of carbohydrate absorption, processing, and storage; and a facultative component, which appears to be related with a carbohydrate-induced stimulation of the sympathetic nervous system, and can be inhibited by beta-adrenergic antagonists. Fructose ingestion induces a greater thermogenesis than does glucose. This can be explained by the hydrolysis of 3.5-4.5 mol ATP/mol fructose stored as glycogen, vs 2.5 mol ATP/mol glucose stored. Therefore the large thermogenesis of fructose corresponds essentially to an increase in obligatory thermogenesis. Obese individuals and obese patients with non-insulin-dependent diabetes mellitus commonly have a decrease in glucose-induced thermogenesis. These individuals in contrast display a normal thermogenesis after ingestion of fructose. This may be explained by the fact that the initial hepatic fructose metabolism is independent of insulin. This observation indicates that insulin resistance is likely to play an important role in the decreased glucose-induced thermogenesis of these individuals.

Diabetes Metab. 2005 Apr;31(2):178-88.
Consumption of carbohydrate solutions enhances energy intake without increased body weight and impaired insulin action in rat skeletal muscles.
Ruzzin J, Lai YC, Jensen J.
OBJECTIVES:
In the present study, we investigated whether replacement of tap water by fructose or sucrose solutions affect rat body weight and insulin action in skeletal muscles.
METHODS:
Rats were fed standard rodent chow ad libitum with water, or water containing fructose (10.5% or 35%) or sucrose (10.5% or 35%) for 11 weeks. Body weight and energy intake from chow and drinking solutions were measured. Urinary catecholamines secretion was determined after 50-60 days. At the end of the feeding period, soleus and epitrochlearis were removed for in vitro measurements of glucose uptake (with tracer amount of 2-[3H]-deoxy-D-glucose) and PKB Ser473 phosphorylation (assessed by Western Blot) with or without insulin.
RESULTS:
Fructose and sucrose solutions enhanced daily energy intake by about 15% without increasing rat body weight. Secretion of urinary noradrenaline was higher in rats drinking a 35% sucrose solution than in rats drinking water. In the other groups, urinary noradrenaline secretion was similar to rats consuming water. Urinary adrenaline secretion was similar in all groups. Insulin-stimulated glucose uptake and insulin-stimulated PKB phosphorylation were not reduced by intake of fructose or sucrose solution.
CONCLUSIONS:
Fructose and sucrose solutions enhanced energy intake but did not increase body weight. Although noradrenaline may regulate body weight in rats drinking 35% sucrose solution, body weight seems to be regulated by other mechanisms. Intake of fructose or sucrose solution did not impair insulin-stimulated glucose uptake or signaling in skeletal muscles.

Minerva Endocrinol. 1990 Oct-Dec;15(4):273-7.
[Postprandial thermogenesis and obesity: effects of glucose and fructose].
[Article in Italian]
Macor C, De Palo C, Vettor R, Sicolo N, De Palo E, Federspil G.
In order to check whether reduced postprandial thermogenesis, as found in obese subjects depends on insulin resistance, the study tested whether the thermogenetic response to glucose in a group of obese subjects and a group of normal weight subjects differed from that obtained using an insulin-independent monosaccharide such as fructose. Nine obese subjects and 6 control subjects were included in the study. An oral glucose tolerance and fructose tolerance test (75 g) was performed in all subjects on different days. Energy expenditure was calculated both in basal conditions and during the test (resting metabolic rate: RMR) using indirect calorimetry expressed per kg of lean weight, as assessed using bioimpedance measurement techniques. Blood samples were collected to assay glycemia and insulinemia. Results show that increased RMR induced by glucose was significantly reduced in the group of obese subjects compared to controls. In the same group of obese subjects, RMR was found to be significantly higher following fructose in comparison to the glucose response but did not differ from that in controls. Data confirm the existence of reduced thermogenesis in obese subjects induced by glucose. The fact that this phenomenon was not recorded in the same subjects following the fructose tolerance test, whose metabolism is insulin-independent, supports the hypothesis that reduced glucose-induced thermogenesis in obese subjects may depend on insulin resistance.

Many studies have found that sucrose is less fattening than starch or glucose, that is, that more calories can be consumed without gaining weight. During exercise, the addition of fructose to glucose increases the oxidation of carbohydrate by about 50% (Jentjens and Jeukendrup, 2005). -Ray Peat, PhD

Br J Nutr. 2005 Apr;93(4):485-92.
High rates of exogenous carbohydrate oxidation from a mixture of glucose and fructose ingested during prolonged cycling exercise.
Jentjens RL, Jeukendrup AE.
A recent study from our laboratory has shown that a mixture of glucose and fructose ingested at a rate of 1.8 g/min leads to peak oxidation rates of approximately 1.3 g/min and results in approximately 55% higher exogenous carbohydrate (CHO) oxidation rates compared with the ingestion of an isocaloric amount of glucose. The aim of the present study was to investigate whether a mixture of glucose and fructose when ingested at a high rate (2.4 g/min) would lead to even higher exogenous CHO oxidation rates (>1.3 g/min). Eight trained male cyclists (VO2max: 68+/-1 ml/kg per min) cycled on three different occasions for 150 min at 50% of maximal power output (60+/-1% VO2max) and consumed either water (WAT) or a CHO solution providing 1.2 g/min glucose (GLU) or 1.2 g/min glucose+1.2 g/min fructose (GLU+FRUC). Peak exogenous CHO oxidation rates were higher (P<0.01) in the GLU+FRUC trial compared with the GLU trial (1.75 (SE 0.11) and 1.06 (SE 0.05) g/min, respectively). Furthermore, exogenous CHO oxidation rates during the last 90 min of exercise were approximately 50% higher (P<0.05) in GLU+FRUC compared with GLU (1.49 (SE 0.08) and 0.99 (SE 0.06) g/min, respectively). The results demonstrate that when a mixture of glucose and fructose is ingested at high rates (2.4 g/min) during 150 min of cycling exercise, exogenous CHO oxidation rates reach peak values of approximately 1.75 g/min.

Am J Physiol. 1987 Sep;253(3 Pt 1):G390-6.
Fructose prevents hypoxic cell death in liver.
Anundi I, King J, Owen DA, Schneider H, Lemasters JJ, Thurman RG.
Perfusion of livers from fasted rats with nitrogen-saturated buffer caused hepatocellular damage within 30 min. Lactate dehydrogenase (LDH) was released at maximal rates of approximately 300 U . g-1 . h-1 under these conditions, and virtually all cells in periportal and pericentral regions of the liver lobule were stained with trypan blue. Infusion of glucose, xylitol, sorbitol, or mannitol (20 mM) did not appreciably change the time course or extent of damage due to perfusion with nitrogen-saturated perfusate. However, fructose (20 mM) completely prevented damage assessed by LDH release, trypan blue uptake, and ultrastructural changes for at least 2 h of perfusion. Neither glucose, xylitol, sorbitol, nor mannitol (20 mM) increased lactate formation above basal levels during hypoxia. On the other hand, fructose (0.4-20 mM) caused a concentration-dependent increase in lactate formation that reached maximal rates of approximately 180 mumol . g-1 . h-1. The dose-dependent increase in glycolytic lactate production from fructose correlated well with cellular protection reflected by decreases in LDH release. ATP:ADP ratios were also increased from 0.4 to 1.8 in a dose-dependent manner by fructose. The results indicate that fructose protects the liver against hypoxic cell death by the glycolytic production of ATP in the absence of oxygen.

Biochem J. 1967 January; 102(1): 177–180.
The influence of fructose and its metabolites on ethanol metabolism in vitro
H. I. D. Thieden and F. Lundquist
1. Fructose caused an increase in the rate of ethanol oxidation by rat-liver slices, and d-glyceraldehyde was found to have a similar effect. 2. Addition of glycerol lowered the rate of ethanol oxidation if the incubation medium contained fructose and ethanol, but no such effect was found if it contained glucose and ethanol. 3. The formation of glycerol by the slices during incubation and the concentration of α-glycerophosphate in the slices were highest in medium containing fructose and ethanol. 4. In experiments without ethanol in the incubation medium, fructose strongly increased the pyruvate concentration, which resulted in a decrease of the lactate/pyruvate concentration ratio. Addition of ethanol to the medium resulted in a marked decrease in pyruvate concentration. 5. Oxygen consumption is greater in slices incubated in medium containing fructose and ethanol than in slices incubated in medium containing glucose and ethanol.

Am J Physiol Endocrinol Metab. 2005 Jun;288(6):E1160-7. Epub 2005 Jan 25.
Inclusion of low amounts of fructose with an intraportal glucose load increases net hepatic glucose uptake in the presence of relative insulin deficiency in dog.
Shiota M, Galassetti P, Igawa K, Neal DW, Cherrington AD.
The effect of small amounts of fructose on net hepatic glucose uptake (NHGU) during hyperglycemia was examined in the presence of insulinopenia in conscious 42-h fasted dogs. During the study, somatostatin (0.8 microg.kg(-1).min(-1)) was given along with basal insulin (1.8 pmol.kg(-1).min(-1)) and glucagon (0.5 ng.kg(-1).min(-1)). After a control period, glucose (36.1 micromol.kg(-1).min(-1)) was continuously given intraportally for 4 h with (2.2 micromol.kg(-1).min(-1)) or without fructose. In the fructose group, the sinusoidal blood fructose level (nmol/ml) rose from <16 to 176 +/- 11. The infusion of glucose alone (the control group) elevated arterial blood glucose (micromol/ml) from 4.3 +/- 0.3 to 11.2 +/- 0.6 during the first 2 h after which it remained at 11.6 +/- 0.8. In the presence of fructose, glucose infusion elevated arterial blood glucose (micromol/ml) from 4.3 +/- 0.2 to 7.4 +/- 0.6 during the first 1 h after which it decreased to 6.1 +/- 0.4 by 180 min. With glucose infusion, net hepatic glucose balance (micromol.kg(-1).min(-1)) switched from output (8.9 +/- 1.7 and 13.3 +/- 2.8) to uptake (12.2 +/- 4.4 and 29.4 +/- 6.7) in the control and fructose groups, respectively. Average NHGU (micromol.kg(-1).min(-1)) and fractional glucose extraction (%) during last 3 h of the test period were higher in the fructose group (30.6 +/- 3.3 and 14.5 +/- 1.4) than in the control group (15.0 +/- 4.4 and 5.9 +/- 1.8). Glucose 6-phosphate and glycogen content (micromol glucose/g) in the liver and glucose incorporation into hepatic glycogen (micromol glucose/g) were higher in the fructose (218 +/- 2, 283 +/- 25, and 109 +/- 26, respectively) than in the control group (80 +/- 8, 220 +/- 31, and 41 +/- 5, respectively). In conclusion, small amounts of fructose can markedly reduce hyperglycemia during intraportal glucose infusion by increasing NHGU even when insulin secretion is compromised.

J Clin Endocrinol Metab. 2000 Dec;85(12):4515-9.
Acute fructose administration decreases the glycemic response to an oral glucose tolerance test in normal adults.
Moore MC, Cherrington AD, Mann SL, Davis SN.
In animal models, a small (catalytic) dose of fructose administered with glucose decreases the glycemic response to the glucose load. Therefore, we examined the effect of fructose on glucose tolerance in 11 healthy human volunteers (5 men and 6 women). Each subject underwent an oral glucose tolerance test (OGTT) on 2 separate occasions, at least 1 week apart. Each OGTT consisted of 75 g glucose with or without 7.5 g fructose (OGTT+F or OGTT-F), in random order. Arterialized blood samples were obtained from a heated dorsal hand vein twice before ingestion of the carbohydrate and every 15 min for 2 h afterward. The area under the curve (AUC) of the change in plasma glucose was 19% less in OGTT+F vs. OGTT-F (P: < 0.05). Glucose tolerance was improved by fructose in 9 subjects and worsened in 2. All 6 subjects with the largest glucose AUC during OGTT-F had a decreased response during OGTT+F (31 +/- 5% decrease). The insulin AUC did not differ between the 2 studies. Of the 9 subjects with improved glucose tolerance during the OGTT+F, 5 had smaller insulin AUC during the OGTT+F than the OGTT-F. Plasma glucagon concentrations declined similarly during OGTT-F and OGTT+F. The blood lactate response was about 50% greater during the OGTT+F (P: < 0.05). Neither nonesterified fatty acid nor triglyceride concentrations differed between the two OGTT. In conclusion, low dose fructose improves the glycemic response to an oral glucose load in normal adults without significantly enhancing the insulin or triglyceride response. Fructose appears most effective in those normal individuals who have the poorest glucose tolerance.

Diabetes Care. 2001 Nov;24(11):1882-7.
Acute fructose administration improves oral glucose tolerance in adults with type 2 diabetes.
Moore MC, Davis SN, Mann SL, Cherrington AD.
OBJECTIVE:
In normal adults, a small (catalytic) dose of fructose administered with glucose decreases the glycemic response to a glucose load, especially in those with the poorest glucose tolerance. We hypothesized that an acute catalytic dose of fructose would also improve glucose tolerance in individuals with type 2 diabetes.
RESEARCH DESIGN AND METHODS:
Five adults with type 2 diabetes underwent an oral glucose tolerance test (OGTT) on two separate occasions, at least 1 week apart. Each OGTT consisted of 75 g glucose with or without the addition of 7.5 g fructose (OGTT + F or OGTT – F), in random order. Arterialized blood samples were collected from a heated dorsal hand vein twice before ingestion of the carbohydrate and every 15 min for 3 h afterward.
RESULTS:
The area under the curve (AUC) of the plasma glucose response was reduced by fructose administration in all subjects; the mean AUC during the OGTT + F was 14% less than that during the OGTT – F (P < 0.05). The insulin AUC was decreased 21% with fructose administration (P = 0.2). Plasma glucagon concentrations declined similarly during OGTT - F and OGTT + F. The incremental AUC of the blood lactate response during the OGTT - F was approximately 50% of that observed during the OGTT + F (P < 0.05). Neither nonesterified fatty acid nor triglyceride concentrations differed between the two OGTTs. CONCLUSIONS: Low-dose fructose improves the glycemic response to an oral glucose load in adults with type 2 diabetes, and this effect is not a result of stimulation of insulin secretion.

Diabet Med. 1989 Aug;6(6):506-11.
Dietary fructose as a natural sweetener in poorly controlled type 2 diabetes: a 12-month crossover study of effects on glucose, lipoprotein and apolipoprotein metabolism.
Osei K, Bossetti B.
The metabolic effects of fructose incorporated in the normal diets of 13 poorly controlled, Type 2 diabetic patients were studied in a 6-month, randomized, crossover study. Patients used 60 g day-1 of crystalline fructose in divided amounts as part of their isocaloric (1400-3900 kcal), weight-maintaining diet. During fructose supplementation, the distribution of carbohydrate-derived calories was 35% complex and 15% simple, the latter solely from fructose. This was compared with the patients’ values on their usual diabetic diet (carbohydrate 50% (mostly complex), fat 38%, and protein 12%). After 6 months of taking fructose, fasting serum glucose decreased from 12.6 +/- 1.1 (+/- SE) to 9.8 +/- 1.3 mmol l-1 (p less than 0.02), while it was unchanged on normal diet (11.0 +/- 0.1 vs 11.6 +/- 0.9 mmol l-1, NS). Glycosylated haemoglobin was also reduced from 11.3 +/- 0.4 to 9.9 +/- 0.5% (p less than 0.05) on fructose, but unchanged on the control diet (10.4 +/- 0.7 vs 11.2 +/- 0.7%, NS). No significant long-term deleterious changes were observed in the fasting serum lipids, lipoproteins, and apolipoproteins A-1 and B-100. Fructose was well tolerated without significant effects on body weight, or lactic acid and uric acid levels.

American Journal of Clinical Nutrition, Vol 59, 753S-757S
Fructose in the diabetic diet
MI Uusitupa
Fructose is an energy-yielding sweetener coming from different natural sources (fruit, berries, and vegetables) or is added to soft drinks, bakery products, and candies. The current content of fructose in the diabetic diet seems to be within recommendations. Because of the low glycemic index of fructose, fructose may be an alternative as a sweetener for those diabetic patients who like sweet foods but are liable to high postprandial glucose concentrations. In patients with mild non-insulin-dependent diabetes mellitus, fructose may result in lower postprandial glucose and insulin responses than will most other carbohydrate sources. In clinical studies, fructose has either improved metabolic control of diabetic patients or caused no significant changes. In patients susceptible to hypertriglyceridemia high doses of fructose should be avoided because of a potential hypertriglyceridemic effect. Long-term experiences about the use of fructose from large scale controlled studies on diabetic patients are lacking.

If fructose can by-pass the fatty acids’ inhibition of glucose metabolism, to be oxidized when glucose can’t, and if the metabolism of diabetes involves the oxidation of fatty acids instead of glucose, then we would expect there to be less than the normal amount of fructose in the serum of diabetics, although their defining trait is the presence of an increased amount of glucose. According to Osuagwu and Madumere (2008), that is the case. If a fructose deficiency exists in diabetes, then it is appropriate to supplement it in the diet. -Ray Peat, PhD

Nigerian Journal of Biochemistry and Molecular Biology 23 (1): 12 – 14, 2008. ISSN 0189-475
Depleted Blood Fructose in Diabetes
C. G. Osuagwu and H. E. O. Madumere
The whole blood and plasma concentrations of two hexoses, glucose and fructose, were estimated and compared in 61 non-diabetics (30 males and 31 females) and 61 diabetics (30 males and 31 females). For non-diabetics, the whole blood and plasma concentration of glucose (mg/dl) were 72.52 ± 8.90 and 87 .54 ± 12.26 while for diabetics they were 130.08 ± 34.27 and 141.03 ± 31.68, respectively. Blood and plasma fructose levels (mg/dl) for non -diabetics were 1.34 ± 0.54 and 1.34 ± 0.32, while for diabetics the values were 0.51 ± 0.33 and 0.51 ± 0.33, respectively. This finding indicates that diminished glucose utilization results to compensatory fructose utilization and depletion in diabetes. Fructose has the more stable, and same, concentrations over time in both blood and plasma than glucose. The glucose/fructose ratio for non-diabetic blood and plasma were 52.13 ± 3.30 and 65.12 ± 4.30 while the ratios for diabetics were 466.46 ± 388.76 and 501.38 ± 382.38. In all conditions considered, the differences in the blood and plasma concentrations of these hexoses between diabetics and non-diabetics were highly significant (p < 0.001). Diabetes is a hexose metabolism derangement syndrome, and not simple glucose metabolism disease. This fact should be borne in mind in diabetes management. A parameter combining glucose and fructose factors is a more efficient measure of diabetes than one of glucose alone; glucose/fructose ratio is such an index that can be employed in diagnosis.

Diabetes Care. 1980 Sep-Oct;3(5):575-82.
Effects of oral fructose in normal, diabetic, and impaired glucose tolerance subjects.
Crapo PA, Kolterman OG, Olefsky JM.
We studied the acute effects of oral ingestion of 50-g loads of dextrose, sucrose, and fructose on post-prandial serum glucose, insulin, and plasma glucagon responses in 9 normal subjects, 10 subjects with impaired glucose tolerance, and 17 non-insulin-dependent diabetic subjects. The response to each carbohydrate was quantified when the respective carbohydrate was given alone in a drink or when given in combination with protein and fat in a test meal. The data demonstrate that (1) fructose ingestion resulted in significantly lower serum glucose and insulin responses than did sucrose or dextrose ingestion in all study groups, either when given alone or in the test meal; (2) although fructose ingestion always led to the least glycemic response compared with the other hexoses, the serum glucose response to fructose was increased the more glucose intolerant the subject; (3) urinary glucose excretion during the 3 h after carbohydrate ingestion was greatest after dextrose and least after fructose in all groups. In conclusion, fructose ingestion results in markedly lower serum glucose and insulin responses and less glycosuria than either dextrose or sucrose, both when given alone or as a constituent in a test meal. However, as glucose tolerance worsens, an increasingly greater glycemic response to fructose is seen.

Am J Clin Nutr. 1982 Aug;36(2):256-61.
Comparison of the metabolic responses to fructose and sucrose sweetened foods.
Crapo PA, Scarlett JA, Kolterman OG.
We studied the acute effects of oral ingestion of fructose and sucrose sweetened cakes and ice creams on postprandial serum glucose and insulin responses in 10 normal subjects, six subjects with impaired glucose tolerance, and 10 noninsulin-dependent diabetic subjects. The data demonstrate that: 1) ingestion of fructose cakes and ice creams resulted in lower serum glucose and insulin responses than did the sucrose cakes and ice creams in all study groups; 2) when comparing cakes to ice creams, the serum glucose and insulin responses after ice cream ingestion were lower than responses after cake ingestion. In conclusion, when fructose is incorporated as a sweetener in a complex food product, it is associated with significantly lower serum glucose and insulin responses as compared to comparable sucrose sweetened foods.

Diabetes Care. 1982 Sep-Oct;5(5):512-7.
The effects of oral fructose, sucrose, and glucose in subjects with reactive hypoglycemia.
Crapo PA, Scarlett JA, Kolterman OG, Sanders LR, Hofeldt FD, Olefsky JM.
We have evaluated the acute effects of orally administered 100-g loads of fructose, sucrose, or glucose given as drinks and of 100-g loads of fructose and sucrose given in cakes on the postprandial serum glucose, insulin, and cortisol responses in seven subjects with reactive hypoglycemia. We defined reactive hypoglycemia as a serum glucose nadir of 65 mg/dl or less, symptoms compatible with hypoglycemia occurring at or after the serum glucose nadir, a hypoglycemic index of greater than 1.0, and a rise in serum cortisol to greater than 20 micrograms/dl after the serum glucose nadir. The data demonstrated that (1) pure fructose given as a drink resulted in relatively flat serum glucose and insulin responses and did not cause a hypoglycemic reaction in any of the subjects, compared with the glucose drink, which caused a hypoglycemic reaction in any of the subjects; (2) ingestion of pure sucrose as a drink elicited significantly flatter serum glucose and insulin responses than did the glucose drink and was associated with some episodes of chemical hypoglycemia and symptoms, but did not result in a hypoglycemic reaction by our definition in any patient; and (3) ingestion of fructose cake led to serum glucose and insulin responses that were lower than those caused by ingestion of sucrose cake, but ingestion of neither fructose nor sucrose cake led to a hypoglycemic reaction by our definition in any patient. In conclusion, the use of fructose as a sweetening agent given either alone, in a drink, or with other nutrients in a cake resulted in markedly flatter serum glucose and insulin responses in subjects with reactive hypoglycemia. Fructose may thus prove useful as a sweetening agent in the dietary treatment of selected patients with reactive hypoglycemia.

When rats were fed for 8 weeks on a diet with 18% fructose and 11% saturated fatty acids, the content of polyunsatured fats in the blood decreased, as they had in the Brown, et al., experiment, and their total antioxidant status was increased (Girard, et al., 2005). -Ray Peat, PhD

Nutrition. 2005 Feb;21(2):240-8.
Changes in lipid metabolism and antioxidant defense status in spontaneously hypertensive rats and Wistar rats fed a diet enriched with fructose and saturated fatty acids.
Girard A, Madani S, El Boustani ES, Belleville J, Prost J.
OBJECTIVE:
Larger doses of fructose and saturated fat have been associated with oxidative stress and development of hypertension. The effects of modest amounts of fructose and saturated fatty acids on oxidative stress are unknown.
METHODS:
To increase knowledge on this question, 10-wk-old spontaneously hypertensive rats and Wistar rats were fed for 8 wk with a control diet or an experimental diet enriched with fructose (18%) and saturated fatty acids (11%; FS diet). The total antioxidant status of organs and red blood cells was assayed by monitoring the rate of free radical-induced red blood cell hemolysis. Sensitivity of very low-density lipoprotein and low-density lipoprotein (VLDL-LDL) to copper-induced lipid peroxidation was determined as the production of thiobarbituric acid-reactive substances. Antioxidant enzymes and vitamins were also measured to establish the oxidative stress effect.
RESULTS:
The FS diet did not affect blood pressure in either strain, but it increased plasma insulin concentrations only in Wistar rats without affecting those of glucose of either strain. The FS diet significantly enhanced plasma and VLDL-LDL triacylglycerol concentrations without affecting concentrations of VLDL-LDL thiobarbituric acid-reactive substances. The decreased content of arachidonic acid and total polyunsaturated fatty acids in VLDL-LDL by the FS diet may have prevented lipid peroxidation in this fraction. Moreover, FS consumption by both strains was accompanied by a significant increase in total antioxidant capacity of adipose tissue, muscle, heart, and liver. This may have resulted from increased tissue ascorbic acid levels and glutathione peroxidase and glutathione reductase activities in tissues.
CONCLUSIONS:
These findings clearly indicate that the FS diet did not alter blood pressure of spontaneously hypertensive rats and Wistar rats. The FS diet resulted in hypertriglyceridemia but increased the total antioxidant status, which may prevent lipid peroxidation in these rats.

In 1963 and 1964, experiments (Carroll, 1964) showed that the effects of glucose and fructose were radically affected by the type of fat in the diet. Although 0.6% of calories as
polyunsaturated fat prevents the appearance of the Mead acid (which is considered to indicate a deficiency of essential fats) the “high fructose” diets consistently add 10% or more corn oil or other highly unsaturated fat to the diet. These large quantities of PUFA aren’t necessary to prevent a deficiency, but they are needed to obscure the beneficial effects of fructose.
-Ray Peat, PhD

J Nutr. 1963 Jan;79:93-100.
Influences of dietary carbohydrate-fat combinations on various functions associated with glycolysis and lipogenesis in rats. I. Effects of substituting sucrose for rice starch with unsaturated and with saturated fat.
CARROLL C.
ABSTRACT Weanling rats were fed diets differing only in source of carbohydrate
and fat for 2 to 4 weeks. Livers were assayed for glucose-6-phosphatase and fructose
diphosphatase activities, and for content of glycogen and lipids. Effects on enzyme
activities of substituting fructose for glucose were similar to those observed on sub
stituting sucrose for rice starch (previous report). Feeding either hydrogenated
coconut oil (HCO) or hydrogenated peanut oil (HPO) in place of corn oil (CO)
modified the enzymatic responses to dietary fructose.
Results with HPO were some what different than those with HCO. Labile phosphorus values were highest in groups
fed sucrose or fructose with CO, and lowest in those fed rice starch or glucose with
HPO. Effects of dietary carbohydrate on accumulation of lipid in liver appeared to be
a function of the type of fat fed, namely, substitution of a fructose source for a
direct glucose source resulted in the accumulation of less fat in livers of rats fed CO,
but of more fat in livers of rats fed a hydrogenated oil. Proportions of phospholipid
and cholesterol in liver lipid, and concentration of cholesterol in serum also varied with the combination of carbohydrate and fat fed.

“Sugars are probably more favorable than starches for the immune system (Harris, et al., 1999), and failure of the immune system is a common feature of cancer.” -Ray Peat, PhD

J Surg Res. 1999 Apr;82(2):339-45.
Diet-induced protection against lipopolysaccharide includes increased hepatic NO production.
Harris HW, Rockey DC, Young DM, Welch WJ.
The host response to Gram-negative infection includes the elaboration of numerous proinflammatory agents, including tumor necrosis factor alpha (TNFalpha) and nitric oxide (NO). A component of the hepatic response to infection is an elevation in serum lipids, the so-called “lipemia of sepsis,” which results from the increased production of triglyceride (TG)-rich lipoproteins by the liver. We have postulated that these lipoproteins are components of a nonadaptive, innate immune response to endotoxin [lipopolysaccharide (LPS)] and have previously demonstrated the capacity of TG-rich lipoproteins to protect against endotoxicity in rodent models of sepsis. Herein we report the capacity of a high-fructose diet to protect against LPS, most likely by inducing high circulating levels of endogenous TG-rich lipoproteins. The protective phenotype included the increased production of NO by hepatic endothelial cells. Rats, made hypertriglyceridemic by fructose feeding, experienced decreased LPS-induced mortality (P < 0.03) and systemic TNFalpha levels (P < 0.05) as compared with normolipidemic (chow-fed) controls. The increased survival was associated with elevated levels of inducible NO synthase (NOS2) mRNA levels and NO production (82 +/- 26 vs 3 +/- 3 nmol nitrite/10(6) cells, P < 0.001) by hepatic endothelial cells. Nonselective NOS inhibitors reversed the protective phenotype in vivo and readily decreased NO production by cultured endothelial cells from hypertriglyceridemic rats in vitro. This study suggests that a high-fructose diet can protect against endotoxicity in part through induction of endogenous TG-rich lipoproteins and hepatic endothelial cell NO production. This is the first report of diet-induced hyperlipoproteinemia and subsequent protection against endotoxemia.

The consumption of carbohydrate, like an increase of thyroid hormone, insulin, or progesterone, increases the retention of sodium; fructose is the most effect carbohydrate (Rebello, et al., 1983). -Ray Peat, PhD

Am J Clin Nutr. 1983 Jul;38(1):84-94.
Short-term effects of various sugars on antinatriuresis and blood pressure changes in normotensive young men.
Rebello T, Hodges RE, Smith JL.
This is a report of the effects of sugars on salt metabolism and on blood pressure. Twenty young men, none of whom had a personal or family history of hypertension, were orally hydrated after an overnight fast and required to lie recumbent for 6 h except for urinary voiding and blood pressure measurements which were performed at 1/2 h intervals. Venous blood samples were drawn at hourly intervals. The volunteers were kept constantly hydrated by giving them water to drink equivalent to the volumes of urine voided. Two hours from the start of the experiment each subject was given one of the following sugars: glucose, fructose, sucrose, galactose, lactose, or water alone. After oral hydration the subjects appeared to develop natriuresis and kaliuresis. This was quickly abolished by ingestion of either glucose, fructose, sucrose, or lactose, but not by galactose or water alone. Fructose was the most potent antinatriuretic agent. Both glucose and sucrose significantly elevated systolic blood pressure. This lasted for 2 h after glucose ingestion and 1 h after sucrose ingestion.

Ann Intern Med. 2012 Feb 21;156(4):291-304. doi: 10.1059/0003-4819-156-4-201202210-00007.
Effect of fructose on body weight in controlled feeding trials: a systematic review and meta-analysis.
Sievenpiper JL, de Souza RJ, Mirrahimi A, Yu ME, Carleton AJ, Beyene J, Chiavaroli L, Di Buono M, Jenkins AL, Leiter LA, Wolever TM, Kendall CW, Jenkins DJ.
BACKGROUND:
The contribution of fructose consumption in Western diets to overweight and obesity in populations remains uncertain.
PURPOSE:
To review the effects of fructose on body weight in controlled feeding trials.
DATA SOURCES:
MEDLINE, EMBASE, CINAHL, and the Cochrane Library (through 18 November 2011).
STUDY SELECTION:
At least 3 reviewers identified controlled feeding trials lasting 7 or more days that compared the effect on body weight of free fructose and nonfructose carbohydrate in diets providing similar calories (isocaloric trials) or of diets supplemented with free fructose to provide excess energy and usual or control diets (hypercaloric trials). Trials evaluating high-fructose corn syrup (42% to 55% free fructose) were excluded.
DATA EXTRACTION:
The reviewers independently reviewed and extracted relevant data; disagreements were reconciled by consensus. The Heyland Methodological Quality Score was used to assess study quality.
DATA SYNTHESIS:
Thirty-one isocaloric trials (637 participants) and 10 hypercaloric trials (119 participants) were included; studies tended to be small (<15 participants), short (<12 weeks), and of low quality. Fructose had no overall effect on body weight in isocaloric trials (mean difference, -0.14 kg [95% CI, -0.37 to 0.10 kg] for fructose compared with nonfructose carbohydrate). High doses of fructose in hypercaloric trials (+104 to 250 g/d, +18% to 97% of total daily energy intake) lead to significant increases in weight (mean difference, 0.53 kg [CI, 0.26 to 0.79 kg] with fructose). LIMITATIONS: Most trials had methodological limitations and were of poor quality. The weight-increasing effect of fructose in hypercaloric trials may have been attributable to excess energy rather than fructose itself.
CONCLUSION:
Fructose does not seem to cause weight gain when it is substituted for other carbohydrates in diets providing similar calories. Free fructose at high doses that provided excess calories modestly increased body weight, an effect that may be due to the extra calories rather than the fructose.

Diabetes Care. 2012 Jul;35(7):1611-20. doi: 10.2337/dc12-0073.
Effect of fructose on glycemic control in diabetes: a systematic review and meta-analysis of controlled feeding trials.
Cozma AI, Sievenpiper JL, de Souza RJ, Chiavaroli L, Ha V, Wang DD, Mirrahimi A, Yu ME, Carleton AJ, Di Buono M, Jenkins AL, Leiter LA, Wolever TM, Beyene J, Kendall CW, Jenkins DJ.
OBJECTIVE:
The effect of fructose on cardiometabolic risk in humans is controversial. We conducted a systematic review and meta-analysis of controlled feeding trials to clarify the effect of fructose on glycemic control in individuals with diabetes.
RESEARCH DESIGN AND METHODS:
We searched MEDLINE, EMBASE, and the Cochrane Library (through 22 March 2012) for relevant trials lasting ≥7 days. Data were aggregated by the generic inverse variance method (random-effects models) and expressed as mean difference (MD) for fasting glucose and insulin and standardized MD (SMD) with 95% CI for glycated hemoglobin (HbA(1c)) and glycated albumin. Heterogeneity was assessed by the Cochran Q statistic and quantified by the I(2) statistic. Trial quality was assessed by the Heyland methodological quality score (MQS).
RESULTS:
Eighteen trials (n = 209) met the eligibility criteria. Isocaloric exchange of fructose for carbohydrate reduced glycated blood proteins (SMD -0.25 [95% CI -0.46 to -0.04]; P = 0.02) with significant intertrial heterogeneity (I(2) = 63%; P = 0.001). This reduction is equivalent to a ~0.53% reduction in HbA(1c). Fructose consumption did not significantly affect fasting glucose or insulin. A priori subgroup analyses showed no evidence of effect modification on any end point.
CONCLUSIONS:
Isocaloric exchange of fructose for other carbohydrate improves long-term glycemic control, as assessed by glycated blood proteins, without affecting insulin in people with diabetes. Generalizability may be limited because most of the trials were <12 weeks and had relatively low MQS (<8). To confirm these findings, larger and longer fructose feeding trials assessing both possible glycemic benefit and adverse metabolic effects are required.

Picture 5

Res Commun Chem Pathol Pharmacol. 1977 Feb;16(2):281-90.
Effects of fructose and other substances on ethanol and acetaldehyde metabolism in man.
Rawat AK.
The comparative effectiveness of oral administration of fructose, glucose sucrose and alanine has been investigated on the rates of blood alcohol clearance, and acetaldehyde removal in man. Oral administration of fructose was found to exert the most pronounced effect. It increased the rate of blood alcohol clearance by about 100%. Orally administered alanine was found to be least effective in increasing the rate of blood alcohol clearance after blood alcohol had reached peak levels, perhaps due that poor absorption of alanine. Fructose administration partially prevented the ethanol-mediated increase inlactate/pyruvate and beta-hydroxybutyrate/acetoacetate in the blood. Fructose exerted the most pronounced antiketogenic effect and the levels of circulating free fatty acids decreased in the 24-hour fasted patients upon administration of fructose with ethanol compared to ethanol alone. Oral administrations of fructose, glucose, sucrose or alanine did not significantly change the levels of acetaldehyde in the blood. Combined administration of fructose with ethanol resulted in an increase in the levels of blood sorbitol. The mechanism through which fructose exerts its stimulatory effect on the metabolism of ethanol in the liver has been discussed.

Am J Clin Nutr. 1975 Mar;28(3):254-7.
Increased rate of alcohol removal from blood with oral fructose and sucrose.
Soterakis J, Iber FL.
The effect of oral glucose, fructose and sucrose on the disappearance rate for intravenously administered alcohol was studied in eight abstinent alcoholic subjects. The three sugars were ingested on separate days in random sequence. alcohol levels were determined at hourly intervals. During sugar ingestion, the mean rates of alcohol disappearance were: 19 plus or minus 1.4 mg/100 ml per hour (plus or minus SE), with glucose, 23.9 or minus 1.4 mg/100 ml per hour with sucrose, and 25.4 plus or minus 1.4 mg/100 ml per hour with fructose. Compared to glucose both fructose and sucrose increased the rate of alcohol from the blood. The blood levels of fructose were similar after the oral dose of 2 g/kg of fructose or 4 g/kg of sucrose.

Eur J Clin Invest. 1976 Jan 30;6(1):93-102.
Effects of fructose and glucose on ethanol-induced metabolic changes and on the intensity of alcohol intoxication and hangover.
Ylikahri RH, Leino T, Huttunen MO, Pösö AR, Eriksson CJ, Nikkilä.
The effects of fructose and glucose on the metabolic changes induced by ethanol and on the intensity of alcohol intoxication and hangover were studied in 109 healthy male volunteers. After 10 hours of fasting, the subjects were given 1.75 g of ethanol per kg body wt during 3 hours under controlled laboratory conditions. Fructose or glucose were adminstered either simultaneously with ethanol or 12 hours later during the hangover period. The intensity of alcohol intoxication and hangover were estimated 10 times during the experimental period of 20 hours using subjective and objective rating scales. Sequential determinations of blood ethanol, acetaldehyde, glucose, lactate, free fatty acids, triglycerides, ketone bodies and capillary blood acid-base balance were also made during the experiment. Under these experimental conditions neither fructose nor glucose had any significant effect on the intensity of alcohol intoxication and hangover. The sugars also had no significant effect on the rate of ethanol elimination or on the blood acetaldehyde concentration during the course of the experiment. Blood glucose concentration was decreased and blood lactate, free fatty acid and ketone body concentrations were increased during the hangover period in the subjects who had been given only ethanol. These subjects also had a marked metabolic acidosis during hangover. Glucose and fructose significantly inhibited the metabolic alterations induced by ethanol. In this respect fructose was more effective than glucose. The results indicate that both fructose and glucose effectively inhibit the metabolic disturbances induced by ethanol but they do not affect the symptoms or signs of alcohol intoxication and hangover. The results support the view that hangover is not directly related to the metabolic effects of ethanol or to its metabolic products.

Biochem J. 1998 Apr 1;331 ( Pt 1):225-30.
Dietary carbohydrates enhance lactase/phlorizin hydrolase gene expression at a transcription level in rat jejunum.
Tanaka T, Kishi K, Igawa M, Takase S, Goda T.
We have previously shown that dietary sucrose stimulates the lactase/phlorizin hydrolase (LPH) mRNA accumulation along with a rise in lactase activity in rat jejunum [Goda, Yasutake, Suzuki, Takase and Koldovský (1995) Am. J. Physiol. 268, G1066-G1073]. To elucidate the mechanisms whereby dietary carbohydrates enhance the LPH mRNA expression, 7-week-old rats that had been fed a low-carbohydrate diet (5.5% of energy as starch) were given diets containing various monosaccharides or sucrose for 12h. Among carbohydrates examined, fructose, sucrose, galactose and glycerol elicited an increase in LPH mRNA accumulation along with a rise in lactase activity in the jejunum. By contrast, glucose and alpha-methylglucoside were unable to elicit a significant increase in LPH mRNA levels. To explore a transcriptional mechanism for the carbohydrate-induced increases in LPH mRNA levels, we employed two techniques currently available to estimate transcriptional rate, i.e. RNA protection assays of pre-mRNA using an intron probe, and nuclear run-on assays. Both assays revealed that fructose elicited an increase in transcription of the LPH gene, and that the transcription of LPH was influenced only slightly, if at all, by glucose intake. These results suggest that certain monosaccharides such as fructose or their metabolite(s) are capable of enhancing LPH mRNA levels in the small intestine, and that transcriptional control might play a major role in the carbohydrate-induced increase of LPH mRNA expression.

Adv Nutr March 2013 Adv Nutr vol. 4: 246-256, 2013
Challenging the Fructose Hypothesis: New Perspectives on Fructose Consumption and Metabolism
John S. White
The field of sugar metabolism, and fructose metabolism in particular, has experienced a resurgence of interest in the past decade. The “fructose hypothesis” alleges that the fructose component common to all major caloric sweeteners (sucrose, high-fructose corn syrup, honey, and fruit juice concentrates) plays a unique and causative role in the increasing rates of cardiovascular disease, hypertension, diabetes, cancer, and nonalcoholic fatty liver disease. This review challenges the fructose hypothesis by comparing normal U.S. levels and patterns of fructose intake with contemporary experimental models and looking for substantive cause-and-effect evidence from real-world diets. It is concluded that 1) fructose intake at normal population levels and patterns does not cause biochemical outcomes substantially different from other dietary sugars and 2) extreme experimental models that feature hyperdosing or significantly alter the usual dietary glucose-to-fructose ratio are not predictive of typical human outcomes or useful to public health policymakers. It is recommended that granting agencies and journal editors require more physiologically relevant experimental designs and clinically important outcomes for fructose research.

“Alcohol’s liver toxicity is associated with an increased reductive state, higher NADH/NAD, and its toxicity is prevented by agents such as fructose, which protectively lower the NADH/NAD ratio (Khan and O’Brien, 1995, Niknahad, et al., 1995). The reductive activation of iron is an important factor in the toxicity in this case (Khan and O’Brien, 1995). The fact that fructose can protect against cyanide toxicity (Niknahad, et al., 1994), seems likely to be another illustration of the important of the redox balance.” -Ray Peat, PhD

Biochim Biophys Acta. 1995 Nov 9;1269(2):153-61.
Modulating hypoxia-induced hepatocyte injury by affecting intracellular redox state.
Khan S, O’Brien PJ.
Hypoxia-induced hepatocyte injury results not only from ATP depletion but also from reductive stress and oxygen activation. Thus the NADH/NAD+ ratio was markedly increased in isolated hepatocytes maintained under 95% N2/5% CO2 in Krebs-Henseleit buffer well before plasma membrane disruption occurred. Glycolytic nutrients fructose, dihydroxyacetone or glyceraldehyde prevented cytotoxicity, restored the NADH/NAD+ ratio, and prevented complete ATP depletion. However, the NADH generating nutrients sorbitol, xylitol, glycerol and beta-hydroxybutyrate enhanced hypoxic cytotoxicity even though ATP depletion was not affected. On the other hand, NADH oxidising metabolic intermediates oxaloacetate or acetoacetate prevented hypoxic cytotoxicity but did not affect ATP depletion. Restoring the cellular NADH/NAD+ ratio with the artificial electron acceptors dichlorophenolindophenol and Methylene blue also prevented hypoxic injury and partly restored ATP levels. Ethanol which further increased the cellular NADH/NAD+ ratio increased by hypoxia also markedly increased toxicity whereas acetaldehyde which restored the normal cellular NADH/NAD+ ratio, prevented toxicity even though hypoxia induced ATP depletion was little affected by ethanol or acetaldehyde. The viability of hypoxic hepatocytes is therefore more dependent on the maintenance of normal redox homeostasis than ATP levels. GSH may buffer these redox changes as hypoxia caused cell injury much sooner with GSH depleted hepatocytes. Hypoxia also caused an intracellular release of free iron and cytotoxicity was prevented by desferoxamine. Furthermore, increasing the cellular NADH/NAD+ ratio markedly increased the intracellular release of iron. Hypoxia-induced hepatocyte injury was also prevented by oxypurinol, a xanthine oxidase inhibitor. Polyphenolic antioxidants or the superoxide dismutase mimic, TEMPO partly prevented cytotoxicity suggesting that reactive oxygen species contributed to the cytotoxicity. The above results suggests that hypoxia induced hepatocyte injury results from sustained reductive stress and oxygen activation.

Chem Biol Interact. 1995 Oct 20;98(1):27-44.
Hepatocyte injury resulting from the inhibition of mitochondrial respiration at low oxygen concentrations involves reductive stress and oxygen activation.
Niknahad H, Khan S, O’Brien PJ.
By correlating lactate/pyruvate ratios and ATP levels, cytotoxicity induced by the mitochondrial respiratory inhibitors or hypoxia:reoxygenation injury can be attributed not only to ATP depletion but also to reductive stress and oxygen activation. Thus hypoxia, cyanide or antimycin markedly increases reductive stress, non-heme Fe release and H2O2 formation in hepatocytes. Cytotoxicity was partly prevented with the ferric chelator desferoxamine, the xanthine oxidase inhibitor oxypurinol and the hydrogen peroxide scavenger glutathione. No lipid peroxidation could be detected and phenolic anti-oxidants had little effect. However, polyphenolic antioxidants or the superoxide dismutase mimics TEMPO or TEMPOL partly prevented cytotoxicity. Furthermore, increasing the hepatocyte NADH/NAD+ ratio with NADH generating compounds such as ethanol, glycerol, or beta-hydroxybutyrate markedly increased cytotoxicity (prevented by desferoxamine) and further increased the intracellular release of non-heme iron. Cytotoxicity could be prevented by glycolytic substrates (eg. fructose, dihydroxyacetone, glyceraldehyde) or the NADH utilising substrates acetoacetate or acetaldehyde which decreased the reductive stress and prevented intracellular iron release. These results suggest that liver injury resulting from insufficient respiration involves reductive stress which releases intracellular Fe, converts xanthine dehydrogenase to xanthine oxidase and causes mitochondrial oxygen activation. The cell’s antioxidant defences are compromised and ATP catabolism contributes to oxygen activation.

Toxicol Appl Pharmacol. 1994 Oct;128(2):271-9.
Prevention of cyanide-induced cytotoxicity by nutrients in isolated rat hepatocytes.
Niknahad H, Khan S, Sood C, O’Brien PJ.
The effects of various glycolytic substrates and keto acid metabolites on the cytotoxic effects of cyanide have been studied with isolated rat hepatocytes. The sequence of cytotoxic events with 2 mM cyanide was an immediate inhibition of respiration followed by ATP depletion. Disruption of the plasma membrane occurred when 85-90% of ATP levels had been depleted. Fructose, dihydroxyacetone, glyceraldehyde, pyruvate, and alpha-ketoglutarate prevented cyanide-induced cytotoxicity and ATP depletion. Hepatocyte respiration was also restored by all except fructose. Fructose, unlike the others, also did not prevent cytotoxicity if added 30-60 min after cyanide. Fluoride, an inhibitor of the glycolytic enzyme enolase, prevented protection by fructose but not dihydroxyacetone or glyceraldehyde, suggesting that dihydroxyacetone and glyceraldehyde are cytoprotective by trapping cyanide, thereby restoring cytochrome oxidase activity and cellular ATP levels. Fructose, on the other hand, may be cytoprotective by supplying ATP through glycolysis. Hepatocytes isolated from fasted rats were five- to sevenfold more susceptible to cyanide-induced cytotoxicity. Furthermore, all glycogenic and gluconeogenic amino acids and carbohydrates were cytoprotective against cyanide toxicity toward fasted hepatocytes, suggesting that cellular energy stores determine their resistance to cyanide.

British Journal of Nutrition / FirstView Article, pp 1-11 Published online: 23 July 2013
Dietary intake of carbohydrates and risk of type 2 diabetes: the European Prospective Investigation into Cancer-Norfolk study
Sara Ahmadi-Abharia1 c1, Robert N. Lubena1, Natasha Powella1, Amit Bhaniania1, Rajiv Chowdhurya1, Nicholas J. Warehama2, Nita G. Forouhia2 and Kay-Tee Khawa1
In the present study, we investigated the association between dietary intake of carbohydrates and the risk of type 2 diabetes. Incident cases of diabetes (n 749) were identified and compared with a randomly selected subcohort of 3496 participants aged 40–79 years. For dietary assessment, we used 7 d food diaries administered at baseline. We carried out modified Cox proportional hazards regression analyses and compared results obtained from the different methods of adjustment for total energy intake. Dietary intakes of total carbohydrates, starch, sucrose, lactose or maltose were not significantly related to diabetes risk after adjustment for confounders. However, in the residual method for energy adjustment, intakes of fructose and glucose were inversely related to diabetes risk. The multivariable-adjusted hazard ratios (HR) of diabetes comparing the extreme quintiles of intake were 0·79 (95 % CI 0·59, 1·07; P for trend = 0·03) for glucose and 0·62 (95 % CI 0·46, 0·83; P for trend = 0·01) for fructose. In the nutrient density method, only fructose was inversely related to diabetes risk (HR 0·65, 95 % CI 0·48, 0·88). The replacement of 5 % energy intake from SFA with an isoenergetic amount of fructose was associated with a 30 % lower diabetes risk (HR 0·69, 95 % CI 0·50, 0·96). Results of the standard and energy partition methods were similar to those of the residual method. These prospective findings suggest that the intakes of starch and sucrose are not associated, but that those of fructose and glucose are inversely associated with diabetes risk. Whether the inverse associations with fructose and glucose reflect the effect of substitution of these carbohydrate subtypes with other nutrients (i.e. SFA), their net higher intake or other nutrients associated with their intake remains to be established through further investigation.

Ann Intern Med. 2012 Feb 21;156(4):291-304. doi: 10.7326/0003-4819-156-4-201202210-00007.
Effect of fructose on body weight in controlled feeding trials: a systematic review and meta-analysis.
Sievenpiper JL, de Souza RJ, Mirrahimi A, Yu ME, Carleton AJ, Beyene J, Chiavaroli L, Di Buono M, Jenkins AL, Leiter LA, Wolever TM, Kendall CW, Jenkins DJ.
BACKGROUND:
The contribution of fructose consumption in Western diets to overweight and obesity in populations remains uncertain.
PURPOSE:
To review the effects of fructose on body weight in controlled feeding trials.
DATA SOURCES:
MEDLINE, EMBASE, CINAHL, and the Cochrane Library (through 18 November 2011).
STUDY SELECTION:
At least 3 reviewers identified controlled feeding trials lasting 7 or more days that compared the effect on body weight of free fructose and nonfructose carbohydrate in diets providing similar calories (isocaloric trials) or of diets supplemented with free fructose to provide excess energy and usual or control diets (hypercaloric trials). Trials evaluating high-fructose corn syrup (42% to 55% free fructose) were excluded.
DATA EXTRACTION:
The reviewers independently reviewed and extracted relevant data; disagreements were reconciled by consensus. The Heyland Methodological Quality Score was used to assess study quality.
DATA SYNTHESIS:
Thirty-one isocaloric trials (637 participants) and 10 hypercaloric trials (119 participants) were included; studies tended to be small (<15 participants), short (<12 weeks), and of low quality. Fructose had no overall effect on body weight in isocaloric trials (mean difference, -0.14 kg [95% CI, -0.37 to 0.10 kg] for fructose compared with nonfructose carbohydrate). High doses of fructose in hypercaloric trials (+104 to 250 g/d, +18% to 97% of total daily energy intake) lead to significant increases in weight (mean difference, 0.53 kg [CI, 0.26 to 0.79 kg] with fructose).
LIMITATIONS:
Most trials had methodological limitations and were of poor quality. The weight-increasing effect of fructose in hypercaloric trials may have been attributable to excess energy rather than fructose itself.
CONCLUSION:
Fructose does not seem to cause weight gain when it is substituted for other carbohydrates in diets providing similar calories. Free fructose at high doses that provided excess calories modestly increased body weight, an effect that may be due to the extra calories rather than the fructose.

“Fructose prevents toxin induced apoptosis in healthy cells but doesn’t prevent apoptosis of cancer cells.” -courtesy of Jannis Dittmer

J Exp Med. 2000 Jun 5;191(11):1975-85.
Metabolic depletion of ATP by fructose inversely controls CD95- and tumor necrosis factor receptor 1-mediated hepatic apoptosis.
Latta M, Künstle G, Leist M, Wendel A.
This study demonstrates that TNF-induced hepatocyto-toxicity is prevented in vivo and in vitro after treatment with fructose. This unexpected antiapoptotic action of the sugar was exceptionally potent, as fructose completely abolished liver damage of mice even after exposure to otherwise lethal TNF doses. A similar robustness of fructose-mediated protection was also seen in vitro, because hepatocyte apoptosis was reduced by 95% over a wide range of different TNF concentrations. The effect of the sugar was exquisitely specific for nontransformed hepatocytes, which is not the case for caspase inhibitors of similar potency (8,9). Fructose neither depleted ATP nor did it protect fromapoptosis in hepatoma cells (not shown), primary neurons (23), and lymphoid cells (16). Thus, the cell type–selective effects of the sugar may be used to differentially modulate responses of tumor cells and hepatic parenchymal cells in vivo.

Am J Clin Nutr. 2017 Aug;106(2):506-518. doi: 10.3945/ajcn.116.145151. Epub 2017 Jun 7.
Fructose replacement of glucose or sucrose in food or beverages lowers postprandial glucose and insulin without raising triglycerides: a systematic review and meta-analysis.
Evans RA, Frese M, Romero J, Cunningham JH, Mills KE.
Background: Conflicting evidence exists on the effects of fructose consumption in people with type 1 and type 2 diabetes mellitus. No systematic review has addressed the effect of isoenergetic fructose replacement of glucose or sucrose on peak postprandial glucose, insulin, and triglyceride concentrations.
Objective: The objective of this study was to review the evidence for postprandial glycemic and insulinemic responses after isoenergetic replacement of either glucose or sucrose in foods or beverages with fructose.
Design: We searched the Cochrane Library, MEDLINE, EMBASE, the WHO International Clinical Trials Registry Platform Search Portal, and clinicaltrials.gov The date of the last search was 26 April 2016. We included randomized controlled trials measuring peak postprandial glycemia after isoenergetic replacement of glucose, sucrose, or both with fructose in healthy adults or children with or without diabetes. The main outcomes analyzed were peak postprandial blood glucose, insulin, and triglyceride concentrations.
Results: Replacement of either glucose or sucrose by fructose resulted in significantly lowered peak postprandial blood glucose, particularly in people with prediabetes and type 1 and type 2 diabetes. Similar results were obtained for insulin. Peak postprandial blood triglyceride concentrations did not significantly increase.
Conclusions: Strong evidence exists that substituting fructose for glucose or sucrose in food or beverages lowers peak postprandial blood glucose and insulin concentrations. Isoenergetic replacement does not result in a substantial increase in blood triglyceride concentrations.

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Sucrose: Infant Pain Reliever

Sucrose (and sometimes honey) is increasingly being used to reduce pain in newborns, for minor things such as injections (Guala, et al., 2001; Okan, et al., 2007; Anand, et al., 2005; Schoen and Fischell, 1991). -Ray Peat, PhD

Clin Ther. 2005 Jun;27(6):844-76.
Analgesia and local anesthesia during invasive procedures in the neonate.
Anand KJ, Johnston CC, Oberlander TF, Taddio A, Lehr VT, Walco GA.
BACKGROUND:
Preterm and full-term neonates admitted to the neonatal intensive care unit or elsewhere in the hospital are routinely subjected to invasive procedures that can cause acute pain. Despite published data on the complex behavioral, physiologic, and biochemical responses of these neonates and the detrimental short- and long-term clinical outcomes of exposure to repetitive pain, clinical use of pain-control measures in neonates undergoing invasive procedures remains sporadic and suboptimal. As part of the Newborn Drug Development Initiative, the US Food and Drug Administration and the National Institute of Child Health and Human Development invited a group of international experts to form the Neonatal Pain Control Group to review the therapeutic options for pain management associated with the most commonly performed invasive procedures in neonates and to identify research priorities in this area.
OBJECTIVE:
The goal of this article was to review and synthesize the published clinical evidence for the management of pain caused by invasive procedures in preterm and full-term neonates.
METHODS:
Clinical studies examining various therapies for procedural pain in neonates were identified by searches of MEDLINE (1980-2004), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2004), the reference lists of review articles, and personal files. The search terms included specific drug names, infant-newborn, infant-preterm, and pain, using the explode function for each key word. The English-language literature was reviewed, and case reports and small case series were discarded.
RESULTS:
The most commonly performed invasive procedures in neonates included heel lancing, venipuncture, IV or arterial cannulation, chest tube placement, tracheal intubation or suctioning, lumbar puncture, circumcision, and SC or IM injection. Various drug classes were examined critically, including opioid analgesics, sedative/hypnotic drugs, nonsteroidal anti-inflammatory drugs and acetaminophen, injectable and topical local anesthetics, and sucrose. Research considerations related to each drug category were identified, potential obstacles to the systematic study of these drugs were discussed, and current gaps in knowledge were enumerated to define future research needs. Discussions relating to the optimal design for and ethical constraints on the study of neonatal pain will be published separately. Well-designed clinical trials investigating currently available and new therapies for acute pain in neonates will provide the scientific framework for effective pain management in neonates undergoing invasive procedures.

Eur J Pediatr. 2007 Oct;166(10):1017-24. Epub 2007 Jan 4.
Analgesia in preterm newborns: the comparative effects of sucrose and glucose.
Okan F, Coban A, Ince Z, Yapici Z, Can G.
The aim of this study was to evaluate the effectiveness of different oral carbohydrate solutions for alleviation of pain in healthy preterm babies. Thirty-one preterm infants who were having blood drawn by heel prick were given 2 ml of solution A (20% sucrose), solution B (20% glucose) or solution C (placebo, sterile water) into the mouth, 2 min before lancing. Behavioural responses to this painful stimulus were measured by duration of crying and facial expressions (Neonatal Facial Coding System, NFCS) and physiological responses were measured by heart rate (HR), respiratory rate (RR), and oxygen saturation changes (SaO(2)). Infants had a mean birth weight (+/-SD) of 1,401 g (406), gestational age of 30.5 weeks (2.7); at the time of the procedure the postmenstrual age was 32.3 weeks (1.5). There was no significant difference in the time spent squeezing the heel between the three groups (P = 0.669). After the heel prick of both the sucrose and glucose groups the duration of first cry and total crying time was significantly reduced (P = 0.005 and P = 0.007). When the babies received placebo they showed a significantly higher NFCS score at 4 and 5 min after the heel prick (P = 0.009 and 0.046 respectively). Following painful stimulus HR increased significantly in the first 3 min compared with baseline, and at the first minute the mean of the HR was found to be significantly higher in the placebo group than in the sucrose and glucose groups (P = 0.007). We concluded that both sucrose and glucose administered orally before a heel prick reduce the pain response in preterm infants.

Minerva Pediatr. 2001 Aug;53(4):271-4.
Glucose or sucrose as an analgesic for newborns: a randomised controlled blind trial.
Guala A, Pastore G, Liverani ME, Giroletti G, Gulino E, Meriggi AL, Licardi G, Garipoli V.
BACKGROUND:
To evaluate the effect of different oral glucose or sucrose solutions on the pain response to heelstick in newborns.
METHODS:
DESIGN:
randomised double blind placebo controlled trial of water (control) versus one of three solutions of glucose – namely 5, 33 and 50% – or one of two solutions of sucrose (33% and 50%) or nothing.
SETTING:
postnatal ward.
PATIENTS:
seven groups of 20 healthy newborns (gestational age 38-41, weighing over 2500 g) were randomised to receive 2 ml of one of the six solutions on the tongue inmediately before heelstick procedure. Main outcome measure: heart rate before, during and three minutes after the procedure.
RESULTS:
Even if the trend of the cardiac rates did not reach statistic significance, glucose solution 33 and 50% proved to be the most effective in reducing pain response.
CONCLUSIONS:
Sweet solutions may be an easy, useful, safe and cheap analgesic for minor invasive procedures in newborns.

CLIN PEDIATR July 1991 vol. 30 no. 7 429-432
Pain in Neonatal Circumcision
Edgar J. Schoen, MD, Anne A. Fischell, MD
Because newborn circumcision is a quick and safe surgical procedure, any method to relieve pain must be almost risk-free in order to be acceptable. General anesthesia and narcotic analgesia are not appropriate. Dorsal penile nerve block (DPNB) with lidocaine hydrochloride is probably the most effective and safest form of anesthesia for newborn circumcision currently available, but it can cause significant local and systemic reactions. Only a limited number of cases of DPNB have been reported and we feel that this procedure should be used cautiously until there is more published evidence of its safety. Alternative methods of pain relief including oral acetaminophen and topical anesthesia should also be studied. Of special interest is recent evidence that a sucrose-flavored pacifier is an effective analgesic during newborn circumcision.

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Ray Peat, PhD: Quotes Relating to Exercise

Also see:
Exercise Induced Stress
Exercise and Endotoxemia
Exercise and Effect on Thyroid Hormone
Exercise Induced Menstrual Disorders
Potential Adverse Cardiovascular Effects from Excessive Endurance Exercise
Ray Peat, PhD and Concentric Exercise
Endotoxin: Poisoning from the Inside Out
Protection from Endotoxin
Bowel Toxins Accelerate Aging
Protective Cascara Sagrada and Emodin
The effect of raw carrot on serum lipids and colon function
Protective Bamboo Shoots
Lactate Paradox: High Altitude and Exercise
Can Endurance Sports Really Cause Harm? The Lipopolysaccharides of Endotoxemia and Their Effect on the Heart

Change your perspective on exercise with this informative compilation of quotes from the writings of Ray Peat, PhD. This page is updated often.

DSCN6284

‎”Incidental stresses, such as strenuous exercise combined with fasting (e.g., running or working before eating breakfast) not only directly trigger the production of lactate and ammonia, they also are likely to increase the absorption of bacterial endotoxin from the intestine. Endotoxin is a ubiquitous and chronic stressor. It increases lactate and nitric oxide, poisoning mitochondrial respiration, precipitating the secretion of the adaptive stress hormones, which don’t always fully repair the cellular damage.”

“From the 19th century until the second quarter of the 20th century, cancer was investigated mainly as a metabolic problem. This work, understanding the basic chemistry of metabolism, was culminating in the 1920s in the work of Otto Warburg and Albert Szent-Gyorgyi on respiration. Warburg demonstrated as early as 1920 that a respiratory defect, causing aerobic glycolysis, i.e., the production of lactic acid even in the presence of oxygen, was an essential feature of cancer. (The formation of lactic acid is normal and adaptive when the supply of oxygen isn’t adequate to meet energy demands, for example when running.)”

“Endotoxin (like intense physical activity) causes the estrogen concentration of the blood to rise.”

“Cytochrome oxidase in the brain can also be increased by mental stimulation, learning, and moderate exercise, but excessive exercise or the wrong kind of exercise (“eccentric”) can lower it (Aguiar, et al., 2007, 2008), probably by increasing the stress hormones and free fatty acids. Sedentary living a high altitude has beneficial effects on mitochondria similar to moderate exercise at sea level (He, at al., 2012.”

“My first suggestion for someone with PMS is to avoid thyroid suppression (darkness and endurance exercise should be avoided), and to use my carrot salad recipe: Grated carrots, vinegar, coconut oil and salt are the essentials, garlic and olive oil are optional. Acetic acid and fatty acids released from the coconut oil act at different levels, and the carrot fiber is a timed-release system which also binds toxins and stimulates the bowel; the salt spares magnesium and tends to inhibit excessive prolactin release.”

“Estrogen increases most of the mediators of inflammatiop, which are generally inhibited by
progesterone. Estrogen also shifts many processes toward excitation, and it’s often hard to distinguish the mediators of inflammation from the mediators of excitation. Free polyunsaturated fatty acids, for example, which are increased under the influence of estrogen (or exercise, diabetes, nighttime, aging, histamine, parasympathetic dominance, etc.), produce both inflammation and excitation. Associated with the processes of inflammation and excitation is the tendency of estrogen and other inflammatory mediators, such as nitric oxide and serotonin, to impair mitochondrial respiration. This effect on the cells’ energy production is probably responsible for many of the things that occur in asthma, such as edema and smooth muscle contraction. Acute or chronic interference with mitochondrial respiration can produce a tremendous variety of symptoms, depending on the location, and the degree of the energy deprivation. Exercise, probably acting through some of the same mediators, also impairs
mitochondrial respiration.”

“Since fat has a very low rate of metabolism, people who lose muscle by fasting are going to have increasing difficulty in losing weight, since they will have less active tissue to consume fat. Building up muscle and lymph tissue for optimal health – even if it initially causes a slight weight gain – will make reducing easier by increasing mass of metabolically active tissue.”

“Exertion and stress have in common the need for more fuel.”

“Many factors, including poor nutrition, climate, emotional or physical stress (even excessive running) and toxins, can cause a progesterone deficiency.”

“While jogging became popular for preventing heart disease, we were frequently told by experts how many miles a person has to run to burn off a pound of fat. However, in Russia, physiologists always remember to include the brain in their calculations, and it turns out that a walk through interesting and pleasant surroundings consumes more energy than does harder but more boring exercise. An active brain consumes a tremendous amount of fuel.”

“Histamine mimics estrogen’s effects on the uterus, and antihistamines block estrogen’s effects (Szego, 1965, Szego and Davis, 1967). Estrogen mimics the shock reaction. Stress, exercise, and toxins cause a rapid increase in estrogen. Males often have as much estrogen as females, especially when they are tired or sick. Estrogen increases the brain’s susceptibility to epileptic seizures, and recent research shows that it (and cortisol) promote the effects of the “excitotoxins,” which are increasingly implicated in degenerative brain diseases.”

“Besides causing stress, estrogen levels are increased by stress. For example, a male runner’s estrogen is often doubled after a race. Men and women who are hospitalized for serious sickness typically have greatly increased estrogen levels. Estrogen’s role in terminal illness, a vicious circle in which stress decreases the person’s ability to tolerate stress, is seldom appreciated.”

“Even in rich cultures, protein deficiency, inappropriate exercise, and emotional tension will contribute to premature aging of the individual, and damage to the offspring.”

“Stress uses progesterone and can cause menstrual periods to stop. Girls who begin regular exercise (such as dancing) before puberty have later sexual development.”

“Lactic acid and carbon dioxide have opposing effects. Intense exercise damages cells in ways that cumulatively impair metabolism. There is clear evidence that glycolysis, producing lactic acid from glucose, has toxic effects, suppressing respiration and killing cells. Within five minutes, exercise lowers the activity of enzymes that oxidize glucose. Diabetes, Alzheimer’s disease, and general aging involve increased lactic acid production and accumulated metabolic (mitochondrial) damage.”

“Since lactic acid is produced by the breakdown of glucose, a high level of lactate in the blood means that a large amount of sugar is being consumed; in response, the body mobilizes free fatty acids as an additional source of energy. An increase of free fatty acids suppresses the oxidation of glucose. (This is called the Randle effect, glucose-fatty acid cycle, substrate-competition cycle, etc.) Women, with higher estrogen and growth hormone, usually have more free fatty acids than men, and during exercise oxidize a higher proportion of fatty acids than men do. This fatty acid exposure “decreases glucose tolerance,” and undoubtedly explains women’s higher incidence of diabetes. While most fatty acids inhibit the oxidation of glucose without immediately inhibiting glycolysis, palmitic acid is unusual, in its inhibition of glycolysis and lactate production without inhibitng oxidation. I assume that this largely has to do with its important function in cardiolipin and cytochrome oxidase.”

“In the last century, Sechenov found that exercising one hand strengthens not only that hand, but also the other. Brain activity stimulates growth and alteration of tissues, such as muscles.”

“One of the major “acute phase proteins,” C-reactive protein, is defensive against bacteria and parasites, but it is suspected to contribute to tissue degeneration. When its presence is the result of exercise, estrogen, or malnutrition, then its association with asthma is likely to be casual, rather than coincidental.”

“The stressful conditions that physiologically harm mitochondria are now being seen as the probable cause for the mitochondrial genetic defects that accumulate with aging. Stressful exercise, which has been known to cause breakage of the nuclear chromosomes, is now seen to damage mitochondrial genes, too. Providing energy, while reducing stress, seems to be all it takes to reverse the accumulated mitochondrial genetic damage. Fewer mitochondrial problems will be considered to be inherited, as we develop an integral view of the ways in which mitochondrial physiology is disrupted. Palmitic acid, which is a major component of the cardiolipin which regulates the main respiratory enzyme, becomes displaced by polyunsaturated fats as aging progresses. Copper tends to be lost from this same enzyme system, and the state of the water is altered as the energetic processes change.”

“Besides fasting, or chronic protein deficiency, the common causes of hypothyroidism are excessive stress or “aerobic” (i.e. anaerobic) exercise, and diets containing beans, lentils, nuts, unsaturated fats (including carotene), and undercooked broccoli, cauliflower, cabbage, and mustard greens. Many health conscious people become hypothyroid with a synergistic program of undercooked vegetables, legumes instead of animal proteins, oils instead of butter, carotene instead of vitamin A, and breathless exercise instead of stimulating life.”

“Exercise, like aging, obesity, and diabetes, increases the levels of circulating free fatty acids and lactate. But ordinary activity of an integral sort, activates the systems in an organized way, increasing carbon dioxide and circulation and efficiency. Different types of exercise have been identified as destructive or reparative to the mitochondria; “concentric” muscular work is said to be restorative to the mitochondria. As I understand it, this means contraction with a load, and relaxation without a load. The heart’s contraction follows this principle, and this could explain the observation that heart mitochondria don’t change in the course of ordinary aging.”

“The idea of the “oxygen debt” produced by exercise or stress as being equivalent to the accumulation of lactic acid is far from accurate, but it’s true that activity increases the need for oxygen, and also increases the tendency to accumulate lactic acid, which can then be disposed of over an extended time, with the consumption of oxygen. This relationship between work and lactic acidemia and oxygen deficit led to the term “lactate paradox” to describe the lower production of lactic acid during maximal work at high altitude when people are adapted to the altitude. Carbon dioxide, retained through the Haldane effect, accounts for the lactate paradox, by inhibiting cellular excitation and sustaining oxidative metabolism to consume lactate efficiently.”

“Elite athletes are generally considered to have “good genes,” and exercise is commonly said to promote good health, so a new orientation is needed to accommodate the fact that “elite” athletes, winter or summer athletes, including participants in the Olympics, have a high incidence of asthma — roughly three times higher than the general population.

It turns out that exercise induces the signs and symptoms of asthma, not only in “asthmatics,” but in normal people too.

Anaerobic exercise (getting out of breath) increases the release of, or activity of, a large variety of inflammatory mediators, beginning with lactic acid and interleukin-6 releases from the exercised muscle itself, and including factors released from various cells in the blood, and hormones including estrogen, prolactin, and sometimes TSH.”

“Exercise increases the incidence of asthma.”

“The polyunsaturated oils interact closely with serotonin and tryptophan, and the short and medium chain saturated fatty acids have antihistamine and antiserotonin actions. Serotonin liberates free fatty acids from the tissues, especially the polyunsaturated fats, and these in turn liberate serotonin from cells such as the platelets, and liberate tryptophan from serum albumin, increasing its uptake and the formation of serotonin in the brain. Saturated fats don’t liberate serotonin, and some of them, such as capric acid found in coconut oil, relax blood vessels, while linoleic acid constricts blood vessels and promotes hypertension. Stress, exercise, and darkness, increase the release of free fatty acids, and so promote the liberation of tryptophan and formation of serotonin. Increased serum linoleic acid is specifically associated with serotonin-dependent disorders such as migraine.”

“Mental stress, exercise, estrogen, and serotonin activate both the formation and dissolution of clots.”

“Many dietitians claim that exercise doesn’t increase the need for protein, but the Russians have found that a combination of exercise and increased protein intake can increase the muscle mass. In a woman, this process can not only improve grace and body proportions, but it also increases the body’s ability to burn up fat. Other nutrients are needed for using protein properly, and for maintaining optimum nerve functioning. However, if the exercise produces too much stress and not enough muscle action, muscle will atrophy as a result of cortisone’s shifting amino acid metabolism into glucose production. Lactic acid production (getting out of breath) is the main signal of the need to produce new glucose. Therefore, “aerobic” exercise is the most stressful. Cortisone not only causes atrophy of the skin, muscles, and immune system, but it even has been found the accelerate aging changes in the brain.”

“Estrogen promotes vascular permeability by a variety of mechanisms. Serotonin, histamine, lactic acid, and various cytokines and prostaglandins contribute to the leakage stimulated by estrogen, trauma, irradiation, poisoning, oxygen deprivation, and other factors that can induce shock. Even exercise, mental stress, and aging can increase the tendency of capillaries to leak.”

“Leakage of fluid out of the blood is one of the main features of shock, and at first it is mainly the loss of water and volume that creates a problem, by reducing the oxygenation of tissue and increasing the viscosity of the remaining blood. Blood becomes more concentrated during strenuous exercise, during the night, and in the winter, increasing the viscosity, and increasing the risk of strokes and other thrombotic problems. The absence of light causes the metabolic and hormonal changes typical of stress.”

“In the resting state, muscles consume mainly fats, so maintaining relatively large muscles is important for preventing the accumulation of fats.”

“Even on the mornings that you don’t drop dead, there is reduced adaptive capacity and functional impairment before eating breakfast. For example, men who went for a run before breakfast were found to have broken chromosomes in their blood cells, but if they ate breakfast before running, their chromosomes weren’t damaged.”

“Exercise physiologists, without mentioning functional systems, have recently discovered some principles that extend the discoveries of Meerson and Anokhin. They found that “concentric” contraction, that is, causing the muscle to contract against resistance, improves the muscle’s function, without injuring it. (Walking up a mountain causes concentric contractions to dominate in the leg muscles. Walking down the mountain injures the muscles, by stretching them, forcing them to elongate while bearing a load; they call that eccentric contraction.) Old people, who had extensively damaged mitochondrial DNA, were given a program of concentric exercise, and as their muscles adapted to the new activity, their mitochondrial DNA was found to have become normal.”

“I’m not sure who introduced the term “aerobic” to describe the state of anaerobic metabolism that develops during stressful exercise, but it has had many harmful repercussions. In experiments, T3 production is stopped very quickly by even “sub-aerobic” exercise, probably because of the combination of a decrease of blood glucose and an increase in free fatty acids. In a healthy person, rest will tend to restore the normal level of T3, but there is evidence that even very good athletes remain in a hypothyroid state even at rest. A chronic increase of lactic acid and cortisol indicates that something is wrong. The “slender muscles” of endurance runners are signs of a catabolic state, that has been demonstrated even in the heart muscle. A slow heart beat very strongly suggests hypothyroidism. Hypothyroid people, who are likely to produce lactic acid even at rest, are especially susceptible to the harmful effects of “aerobic” exercise. The good effect some people feel from exercise is probably the result of raising the body temperature; a warm bath will do the same for people with low body temperature.”

“This is where the issue of cell water comes in. Carbon dioxide, produced by oxidative cell metabolism, is associated with the high energy state of the cell. When something interferes with oxidative metabolism, lactic acid is produced instead of carbon dioxide. If the cell stays very long in this low oxygen state, it swells, taking up water. (The fatigued muscle, for example, can take up so much water in a short time that it weighs 20% more than before it began working so intensely that its energy needs far exceeded the availability of oxygen. This swelling is what causes the soreness and tightness of intense exercise. The swelling persists long after the liver has cleared the lactic acid from the blood.) This swelling from taking up water is involved in one type of “edema,” and in inflammation, or activation of the cells by hormones, as well as by simple oxygen deprivation. When the eyes have been closed for several hours, the cornea swells, because it depends on direct contact with the air for its oxygen, and the eyelid, whose circulation provides oxygen for its own cells, doesn’t provide enough for the cornea.”

“Sometimes progesterone seems to be chronically deficienct (leading to slight-though possibly prolonged-menstruation, or amenorrhea), in women who exercise hard. Since progesterone can be converted into cortisone to handle stress, this would explain why well trained athletes (who need lots of cortisone) so often miss periods. It seems to be a simple over-consumption of progesterone, which is probably a reasonable biological adaptation, preventing pregnancy during times of stress.”

“Athletic training is known to slow the pulse. Cortisone, produced by stress, inhibits the thyroid gland. (When the thyroid is low, less oxygen is needed, so this is a useful adaptation for increasing endurance.) These hormonal changes are now known to produce sterility in both men and women”

“Stress and starvation lead to a relative reliance on the fats stored in the tissues, and the mobilization of these as circulating free fatty acids contributes to a slowing of metabolism and a shift away from the use of glucose for energy. This is adaptive in the short term, since relatively little glucose is stored in the tissues (as glycogen), and the proteins making up the body would be rapidly consumed for energy, if it were not for the reduced energy demands resulting from the effects of the free fatty acids.”

“Exercise increases blood clotting, and so can increase the risk of strokes and heart attacks. Some doctors have been reporting increase incidence of flat feet, varicose veins, and prolapsed uterus among runners. Walking is a better form of exercise.”

“The brain’s role in protecting against injury by stress, when it sees a course of action, has a parallel in the differences between concentric (positive, muscle shortening) and eccentric (negative, lengthening under tension) exercise, and also with the differences between innervated and denervated muscles. In eccentric exercise and denervation, less oxygen is used and less carbon dioxide is produced, while lactic acid increases, displacing carbon dioxide, and more fat is oxidized. Prolonged stress similarly decreases carbon dioxide and increases lactate, while increasing the use of fat.”

“A few fetish ideas dominate physiology, just as the gene and virus fetishes have governed cancer research. For more than a century, most physiologists have “explained” muscle soreness as being “caused by lactic acid,” while generally ignoring the great swelling of muscles that results from intense exercise. When cells don’t have enough energy — whether from inadequate fuel, overwork, lack of oxygen, or poisoning — they take up water. Too much water tends to excite the cells, and can even stimulate cell division. The hyperactive state of a muscle cell, cramping, causes energy to be spent. What is too often overlooked is that the cell needs more energy to get back into its resting state, and that an abundance of glucose or other fuel, oxygen, and thyroid are needed for the cell to produce enough energy to be quietly relaxed.”

“The reluctance to see something as simple as the swelling of a muscle when its energy is depleted, has led into other unnecessary confusions. For example, the water that the muscle takes up comes from the blood. The blood gets thicker, and is harder to pump. The loss of water from the blood makes it seem that hormones have increased, when actually they have decreased. If the tissues could be re-energized, they would release some of their water back to the blood.”

“Exercise lowers the level of thyroid hormones, partly by accelerating their breakdown. The stress of winter appears to do the same thing, and most people (and animals) need much more thyroid in the winter than they do in the summer. Exercise lowers human (and some animals’) fertility, and winter lowers animals’ fertility. I think human fertility, as indicated by sperm count, for example, is likely to be lower in winter.”

“During stress, the heart and other working organs became resistant to the glucocorticoid hormones. When a person is given radioactive testosterone, it can be seen to reach the highest concentration in the heart. It is testosterone’s antiglucocorticoid effect which causes it to enlarge skeletal muscles, when exercise is moderate. Its parallel effects on skeletal muscle and heart muscle can be seen in highly adapted (stressed) long-distance runners, since the walls of their hearts become thinner as their skeletal muscle become slimmer.”

“During moderate exercise, adrenalin causes increased blood flow to both the heart and the skeletal muscles, while decreasing the flow of blood to other organs. The increased circulation carries extra oxygen and nutrients to the working organs, while the deprivation of oxygen and glucose pushes the other organs to a catabolic balance. This simple circulatory pattern achieves to some extent the same kind of redistribution of resources, acutely, that is achieved in more prolonged stress by the actions of the glucocorticoids and their antagonists.”

“Nerves and muscle cells should be considered together, because they respond to many things in similar ways. The membrane people don’t like to think that nerves have an contractile properties, but in fact they do twitch slightly when stimulated, showing that in the entire cytoplasm that responds to information, not the hypothetical plasma membrane. When they are overstimulated, they swell, as muscles do when they are fatigued. When a muscle is stretched while it’s trying to contract (as in running downhill; this is called “eccentric contraction”) it becomes inflamed, and the structural damage is cumulative. By exercising muscle with “concentric contractions,” allowing them to shorten against resistance, the cellular damage can be repaired.”

“Lactic acid produced by intense exercise causes calcium loss from bone (Ashizawa, et al., 1997), and sodium bicarbonate increases calcium retention by bone.”

“If a tissue is stimulated to metabolize at a high rate, especially without an adequate supply of glucose, it will consume protein as fuel, with the production of ammonia…Any exaggerated stimulation, stress, or energy deficit tends to increase the level of ammonia in tissue…The use of amino acids for fuel, which happens during stress, release ammonia. Eating isolated amino acids, exercising intensely, or have an excess of cortisol, causes tissue proteins to be broken down, with the release of ammonia.”

“There are now many people who argues that a low metabolism rate, a low body temperature and slow heart beat indicate that you live a long time: “your heart can only beat so many times.” Most of these people also advocate “conditioning exercise,” and they point out that trained runners tend to have a slow heart rate. (Incidentally, running elevates adrenaline which caused increased clumping of platelets and accelerated blood clotting. Hypothyroidism–whether preexisting or induced by running–slows the heart rate, raises the production of adrenalin, and is strongly associated with heart disease, as well as with high cholesterol.”

“Free polyunsaturated fatty acids, for examples, which are increased under the influence of estrogen (or exercise, diabetes, night time, aging, histamine, parasympathetic dominance, etc.) produce both inflammation and excitation. Associated with the process of inflammation and excitation is the tendency of estrogen and other inflammatory mediators, such as nitric oxide and serotonin to impair mitochondrial respiration.”

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“The overlapping effects of estrogen, polyunsaturated fats, exercise, serotonin, histamine, lactic acid, nighttime, and hyperventilation, tend to be cumulative and self-stimulating. Degenerative changes in tissues are accelerated by all of these stress mediators.”

“Many studies have found that sucrose is less fattening than starch or glucose, that is, that more calories can be consumed without gaining weight. During exercise, the addition of fructose to glucose increases the oxidation of carbohydrate by about 50% (Jentjens and Jeukendrup, 2005).”

“Failure to renew cells and tissues leads to loss of function and substance. Bones and muscles get weaker and smaller with aging. Diminished bone substance, osteopenia, is paralleled, at roughly the same rate, by the progressive loss of muscle mass, sarcopenia (or myopenia). The structure of aging tissue changes, with collagen tending to fill the spaces left by the disappearing cells. It’s also common for fat cells to increase, as muscle cells disappear.”

“Exercise physiologists, knowing that lactic acid is produced during exercise, and cancer biologists (especially since Warburg’s work showing that all cancers have a respiratory defect) who know that cancer tends to produce lactic acid, almost always talk about the “acidity” of the fatigued muscle or cancer cell.

While it is true that the entry of lactic acid into the blood tends to produce metabolic acidosis, the cell which is producing the lactic acid is actually more alkaline than normal cells. The simplest way to think of it is that the “acid leaving the cell makes it less acidic.””

“Fatigued cells take up water, and become heavier. They also become more permeable, and leak. When more oxygen is made available, they are less resistant to fatigue, and when the organism is made slightly hypoxic, as at high altitude, muscles have more endurance, and are stronger, and nerves conduct more quickly.”

“When a muscle cell is stimulated enough to cause a contraction, the interruption of its resting phase causes a shift in the charge concentration on the proteins, potassium ions are exchanged for sodium ions, calcium ions enter, and phosphate ions separate from ATP, and are replaced by the transfer of phosphate to ADP from creatine phosphate.”

“Looking at fatigability, muscle contraction, and nerve conduction in a variety of situations, we can test some of the traditional explanations, and see how well the newer “bioelectric” explanation fits the facts. Osmotic pressure, hydrostatic pressure, atmospheric pressure, and the degree of metabolic stimulation by thyroid hormone affect fatigue in ways that aren’t consistent with the membrane-electrical doctrine.

The production of lactic acid during lactic acid during intense muscle activity led some people to suggest that fatigue occurred when the muscle wasn’t getting enough oxygen, but experiments show that fatigue sets in while adequate oxygen is being delivered to the muscle. Underwater divers sometimes get an excess of oxygen, and that often causes muscle fatigue and soreness. At high altitudes, where there is relatively little oxygen, strength and endurance can increase.

An excess of oxygen can slow nerve conduction, while hypoxia can accelerate it. (Increasing the delivery of oxygen at higher pressure doesn’t increase the cellular use of oxygen or decrease lactic acid production in the exercising muscle [Kohzuki, et al., 2000], but it will increase lipid peroxidation.)

High hydrostatic pressure causes muscles to contract, though for many years the membrane-doctrinaires couldn’t accept that. Underwater divers experience brain excitation under very high pressure. Since vicinal water has a larger volume than ordinary water (analogous to the expansion when ice is formed, though the volume increase in cell water is slightly less, about 4%, than in ice, which is 11% more voluminous than liquid water), compression under high pressure converts vicinal cell water to the state that occurs in the excited cell, the way ice melts under pressure. The excited state exists as long as water remains in that state.”

“One of the early demonstrations that cell water undergoes a phase change during muscle contraction involved simply measuring the volume of an isolated muscle. With stimulation and contraction, the volume of the muscle decreases slightly. (The muscle was immersed in water in a sealed chamber, and the volume decrease in the whole chamber was measured.) This corresponds to the conversion of vicinal water to bulk-like (dielectric) water. (The threatening implications of those experiments with spontaneous volume change were very annoying to many biologists of my professors’ generation.)

In the stimulated state, the cell’s uptake of water from its environment coincides closely with its electrical and thermal activity, and it explusion of water coincides with its recovery. In a small nerve fiber, or near the surface of a larger fiber, these changers are very fast, and in a large muscle the uptake of water is faster than the flow of water from capillaries can match, but it will become massive if stimulation is continued for several minutes. For example, two minutes of stimulation stimulation can cause a muscle’s overall weight to increase by 6%, but its extracellular compartment loses 4%, so the muscle cells gain much more than 6% of their weight in that short time (Ward, et al., 1996). The water that is taken up by cells is taken from the blood, which becomes relatively dehydrated and thicker in the process.”

“With aging, hypothyroidism, stress, and fatigue, the amount of estrogen in the body typically rises. Estrogen is catabolic for muscle, and causes systemic edema, and nerve excitation.”

“A dangerously high level of ammonia in the blood (hyerammonemia) can be produced by exhaustive exercise, but also by hyperbaric oxygen (or a high concentration of oxygen), by high estrogen, and by hypothyroidism.”

“Szent-Gyorgyi observed that, although ATP was involved in the contractions of muscles, its post-mortem disappearance caused the contraction and hardening of muscle known as rigor mortis. When he put hardened dead muscles into a solution of ATP, they relaxed and softened. The relaxed state is a state with adequate energy reserves.”

“But when tissues contain large amounts of polyunsaturated fats, every episode of fatigue and prolonged excitation leaves a residue of oxidative damage, and the adaptive mechanisms become progressively less effective.”

“Stress increases metabolic rate in a destructive, age accelerating way, with increased inflammation, and decreased resting oxidative metabolic rate. It’s the basic metabolic rate, with fast nerve conduction, quick cellular adaptation, etc., that’s biologically valuable.”

“Excess estrogen, intense exercise, starvation, anything that increases lipid peroxidation and free radical production, such as drinking alcohol when the tissues contain polyunsaturated fats, can cause organs such as heart and liver to leak their components.”

“The amount of injury needed to increase the endotoxin in the blood can be fairly minor. Two thirds of people having a colonoscopy had a significant increase in endotoxin in their blood, and intense exercise or anxiety will increase it. Endotoxin activates the enzyme that synthesizes estrogen while it decreases the formation of androgen (Christeff, et aI., 1992), and this undoubtedly is partly responsible for the large increases in estrogen in both men and women caused by trauma, sickness or excessive fatigue.”

“Chronic constipation, and anxiety which decreases blood circulation in the intestine, can increase the liver’s exposure to endotoxin. Endotoxin (like intense physical activity) causes the estrogen concentration of the blood to rise.”

“Animals that lack the unsaturated fatty acids have a higher metabolic rate and ability to use glucose, converting it to CO2 more readily, have a greater resistance to toxins (Harris, et al., 1990; even cobra venom: Morganroth, et al., 1989), including endotoxin (Li, et al., 1990)– preventing excessive vascular leakage–and to immunological damage (Takahashi, et al., 1992), and to trauma, and their neuromuscular response is accelerated while fast twitch muscles are less easily fatigued (Ayre and Hulber, 1996).”

“There are different kinds of weight gain. When a person’s metabolic rate increases, and stress hormones decrease, for example when adding two quarts of milk to the daily diet, their muscle mass is likely to increase, even while their fat is decreasing. Since muscle burns fat faster than fat does, caloric requirements will gradually increase.”

“Some muscle-building resistance exercise might help to increase the anabolic ratio, reducing the belly fat.”

“Prolonged endurance exercise will usually slow the pulse because of adaptive inhibition of the thyroid. I have seen some people with the dark circles, fatigue, and other symptoms that stopped as soon as they stopped their daily running.”

“(Protein) For intense exercise, it’s about a gram per pound of body weight.”

“Concentric resistance training has an anabolic effect on the whole body. Sprinting is probably o.k. Endurance exercise is the worst. I don’t think martial arts are necessarily too stressful.”

“When a muscle or nerve is fatigued, it swells, retaining water. When the swelling is extreme, its ability to contract is limited. Excess water content resembles a partly excited state, in which increase amounts of sodium and calcium are free in the cytoplasm. Energy is needed to eliminate the sodium and calcium, or to bind calcium allowing the cell to extrude excess water and return to the resting state. Thyroid hormone allows cells’ mitochondria to efficiently produce energy, and it also regulates the synthesis of proteins (phospholamban and calcisequestrin) that control the binding of calcium. When the cell is energized, by the mitochondria working with thyroid, oxygen, and sugar, these proteins change their form, binding calcium and removing it from the contractile system, allowing the cell to relax, to be fully prepared for the next contraction. If the calcium isn’t fully and quickly bound, the cell retains extra water and sodium, and isn’t able to fully relax.”

“I hadn’t heard that idea about aspirin and muscle, but I don’t know of enough evidence in that direction to make me think that it’s anything but a sort of marketing slogan for someone’s product (Tylenol’s campaign against aspirin created many theories of why aspirin should be avoided). Since the inflammatory processes (including platelet activation) inhibited by aspirin are generally catabolic, and since aspirin supports insulin action and energy production, I think aspirin in most situations is likely to be anti-catabolic.”

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