Posted by Richard Proudfoot

The research paper selected for this week is titled: “Fructose: Metabolic, Hedonic, and Societal Parallels with Ethanol”

This research paper is a review study from the Department of Pediatrics and Institute for Health Policy Studies, University of California, San Francisco, CA 94143, This single authored thorough review article is by Robert H. Lustig, M.D., M.S.L., Professor emeritus of Pediatrics, Division of Endocrinology at the University of California, San Francisco (UCSF). The article is published in the September 2010 Journal of the AMERICAN DIETETIC ASSOCIATION. The author reviews the biochemical, addictive, and cultural similarities of ethanol and fructose in comparison to glucose. 

This study is important because while general knowledge and cultural norms acknowledge the ill effects of over consumption of ethanol, the over consumption of fructose (sugar) ill effects are not recognized by the public or the scientific community.

The key findings from this study are that ethanol and fructose both have parallels in the liver as substrates for de novo lipogenesis, hepatic insulin resistance, dyslipidemia, and hepatic steatosis. The fructosylation of proteins with resultant superoxide formation can result in hepatic inflammation like acetaldehyde, an intermediary metabolite of ethanol.  Lastly by stimulating the “hedonic pathway” of the brain both directly and indirectly, fructose creates habituation, and possibly dependence; also paralleling ethanol.

Clinical implication from of this study is a reminder that the over consumption of fructose (sugar) and /or ethanol can lead to alcoholic steatohepatitis and non-alcoholic steatohepatitis and cirrhosis; cardiomyopathy or myocardial infarction; hypertension; dyslipidemia; pancreatitis, malnutrition; obesity and addiction or habituation. That both ethanol and fructose are liver toxins that should be avoided, particularly with any hint of liver disease. That sugar is a gateway drug to all addictions.1  

1. Lustig RH. Fructose: metabolic, hedonic, and societal parallels with ethanol. J Am Diet Assoc. 2010;110(9):1307-1321. doi:10.1016/j.jada.2010.06.008

Posted by Richard Proudfoot

 

 

 

A key finding of this study was that vitamin D deficiency increased as the amount of packs smoked per year increased and that Vitamin D deficiency seemed to amplify the negative effects that smoking has on pulmonary function. This relates to nutritional science because Vitamin D deficiency is also related to type 2 diabetes and the onset of metabolic syndrome so when you have a patient or client that is a smoker, recommending foods that are high in vitamin D, and/or vitamin D supplementation, could potentially make a difference with respect to both insulin sensitivity and lung function.

 

Clinically, this study highlights potential of Vitamin D supplementation and that it could be used as part of a therapy for people with COPD that have a more severe deficiency and could potentially have beneficial and protective effects for smokers before they develop COPD with simultaneous synergistic effects at modulating MetS.

This study looks further into a common treatment for smoking cessation, Varenicline. This study’s purpose is to determine if this treatment can have an impact for individuals who are dealing with heavy drinking and smoking. They defined heavy drinking as four or more drinks for women and five or more drinks for men at least twice a week, they defined smoking for their inclusion criteria for an individual who smokes two or more times a week. Included were 131 participants split into two groups; a placebo group and treatment group who received 1 mg of varenicline twice a day for 16 weeks. The results showed that there was a decrease in heavy drinking within the men in the treatment group compared to the placebo group. Overall, the varenincline decreased smoking within the entire treatment group, which is expected since it is a known treatment for smoking cessation. This could be important for nutritional sciences because of the differences in results between genders, this could show that the treatment used could be metabolized differently between the two genders. 

 

 

References

 

1. O’Malley, Zweben, A., Fucito, L. M., Wu, R., Piepmeier, M. E., Ockert, D. M., Bold, K. W., Petrakis, I., Muvvala, S., Jatlow, P., & Gueorguieva, R. (2017). Effect of Varenicline Combined With Medical Management on Alcohol Use Disorder With Comorbid Cigarette Smoking: A Randomized Clinical Trial. JAMA Psychiatry (Chicago, Ill.), 75(2), 129–138. https://doi.org/10.1001/jamapsychiatry.2017.3544

 

 

 

 

Hartmann-Boyce, J., Livingstone-Banks, J., Ordóñez-Mena, J. M., Fanshawe, T. R., Lindson, N., Freeman, S. C., Sutton, A. J., Theodoulou, A., & Aveyard, P. (2021). Behavioural interventions for smoking cessation: an overview and network meta-analysis. The Cochrane database of systematic reviews, 1, CD013229. https://doi.org/10.1002/14651858.CD013229.pub2

 
-Stephen Mayer 

One key finding of this study was that, in males, smoking showed a higher risk in most/all of the metabolic criteria. They especially reached significantly low levels of HDL’s, high triglyceride counts, and an increased waist circumference. They also found, in regard to males, that healthy nutrition behavior reduced the risk of an increase in blood pressure. Looking into the male workers and alcohol use, alcohol use heavily increased weight circumference, but decreased the risk of low HDL levels. From this data, it was found that exercising helped decrease the risk of an increased waist circumference. For women, alcohol did not show any significant interactions between nutrition, exercise, and MetS (possibly due to the small sample size of females in this cohort). 

This study is important to nutritional sciences because it helps us understand the link between different lifestyle factors (nutrition, exercise, smoking, and drinking) and the development or side effects of MetS. Lifestyle factors can greatly contribute (although are not the only contributor) to the development of different chronic diseases, such as MetS. One downfall of this study is that it focused more on males than females, due to a higher number of significant interactions within the males. Their sample size also had a relatively small number of female smokers, so they were unable to use that for data purposes. 

The clinical implications of this study are that, as we’ve learned throughout this week, excessive use of alcohol and smoking are lifestyle factors that can be detrimental to an individual’s health when there is no intervention. Focusing on the cessation of smoking and drinking for a patient could greatly improve their health and life outcomes. Cessation should be a primary focus in the clinical setting.

Huang, J.-H., Li, R.-H., Huang, S.-L., Sia, H.-K., Chen, Y.-L., & Tang, F.-C. (2015). Lifestyle factors and metabolic syndrome among workers: The role of interactions between smoking and alcohol to nutrition and exercise. International Journal of Environmental Research and Public Health, 12(12), 15967–15978. https://doi.org/10.3390/ijerph121215035 

Purani, H., Friedrichsen, S., & Allen, A. M. (2019). Sleep quality in cigarette smokers: Associations with smoking-related outcomes and exercise. Addictive behaviors, 90, 71–76. https://doi.org/10.1016/j.addbeh.2018.10.023

Koch, M., Fitzpatrick, A. L., Rapp, S. R., Nahin, R. L., Williamson, J. D., Lopez, O. L., DeKosky, S. T., Kuller, L. H., Mackey, R. H., Mukamal, K. J., Jensen, M. K., & Sink, K. M. (2019). Alcohol Consumption and Risk of Dementia and Cognitive Decline Among Older Adults With or Without Mild Cognitive Impairment. JAMA network open, 2(9), e1910319. https://doi.org/10.1001/jamanetworkopen.2019.10319

 

This review examined nutritional status and implications of malnutrition for individuals with alcohol and drug use disorders. For this post I am focusing on alcohol use disorder (AUD). Supporting the nutritional status of individuals with AUD is often a small part of the recovery process, despite evidence that recovery outcomes can be improved with nutrition therapy.

 

Chronic alcohol consumption has been linked with mucosal damage in the mouth, esophagus, and stomach; delayed gastric emptying, increased intestinal permeability and membrane damage, bacterial overgrowth and cancer. Individuals with AUD are often deficient in or have inadequate intake of most

nutrients, including vitamins A, B vitamins, C, D, E, K, magnesium, selenium, and zinc.

 

One key finding that I found interesting is that up to an unknown level of alcohol consumption, energy from alcohol increases BMI and fat mass; however, higher alcohol consumption (more than 12.5 kcal/kg/day, which would be about 50% of caloric needs for most people) is inversely related to BMI and fat mass. Therefore, it would be important to know the severity of AUD to individualize nutritional interventions.

 

Clinical implications from this review point to the need for better nutrition screening and prioritization of nutrition therapy for patients with AUD, especially for those with malnutrition. The most important changes would be elimination of alcohol and the consumption of a well-balanced diet containing sufficient amounts of macro and micronutrients. For malnourished patients, this would be 30-40 kcal/ kg body weight and 1-2 g protein/kg. Vitamin and mineral supplementation would also be warranted in the case of deficiencies. 

 

Jeynes, K. D., & Gibson, E. L. (2017). The importance of nutrition in aiding recovery from substance use disorders: A review. Drug and alcohol dependence, 179, 229–239.

These effects of alcohol are present due to alcohols ability to introduce apoptosis among cardiac myocytes leading to fibrosis. These structural changes along with alcohol induces intracellular membrane and receptor changes cause everlasting damage to the hearts ability to maintain function. Current treatments call for the regeneration of myocytes as well as changes to accumulation of fibrous tissue, but cessation of alcoohol is recommended. A left ventricular assist device is also adeqaute treatment as it helps the heart pump more effectively under duress, however, end stage alcohol induced cardiomyopathy requires a heart transplant for reversal but is only offered to the individuals that can refrain from any alcohol use.

Fernández-Solà J. (2020). The Effects of Ethanol on the Heart: Alcoholic Cardiomyopathy. Nutrients, 12(2), 572. https://doi.org/10.3390/nu12020572

Lewis. (2020). Alcoholism and nutrition: a review of vitamin supplementation and treatment. Current Opinion in Clinical Nutrition and Metabolic Care, 23(2), 138–144. https://doi.org/10.1097/MCO.0000000000000622

This systematic review evaluated the change in alcohol consumption and other substances during Covid-19 pandemic. The Covid-19 Pandemic is relevant in today’s society as this event has yet to conclude. The world is currently entering the third summer with the virus being present. There have been consequences on the mental health of individuals since the start of the pandemic. The pandemic led to social isolation and continued stress which research has established a relationship of psychological distress and alcohol consumption. The authors found that several studies identified an increase in the proportion of people consuming alcohol during the pandemic. A few studies linked psychological factors such as anxiety, hopelessness, and social isolation with the increase use of alcohol. These findings relate to nutritional sciences because often times nutrition consultations come from referrals by primary care providers or those who work in psychology. The systematic review was conducted to evaluate the relationship substance use had on demographic and mental health during Covid-19 which can lead to potential adjustments in the amount of treatment needed for during the pandemic.

 

Roberts, A., Rogers, J., Mason, R., Siriwardena, A. N., Hogue, T., Whitley, G. A., & Law, G. R. (2021). Alcohol and other substance use during the COVID-19 pandemic: A systematic review. Drug and alcohol dependence, 229, 109150.