Good News about AGEs

The news about AGEs isn’t all bad. We are not helpless against increasing levels of advanced glycation end products (AGEs) in our blood.

My recent blog entry here reviews Joe Anderson’s site that recommends a daunting diet of low-AGE foods. In my “Diabetes Update” newsletter I earlier reviewed Dr. Helen Vlassara’s research that found foods cooked at high temperatures dramatically increased the production of AGEs and that they produce inflammation-causing proteins.

Changing how we cook is clearly the first strategy to minimize AGEs in our bodies. This means cutting back, if not eliminating, fried, barbecued, broiled, or baked foods. But there is more that we can do.
The influential professional journal Diabetes Care has just published its first review about diabetes and AGEs. The lead author, Dr. Amy Huebschmann of University of Colorado Denver and Health Sciences Center, kindly sent me a PDF of the review a couple of days before official publication. An extract of the article is online.

Two people who are passionate about controlling AGEs have discussed the review with me. Karen LaVine, a registered nurse and Certified Diabetes Educator, says, “Think of the huge positive potential we can have on the future health of this country, if all health care providers know these facts and instruct their patients about them.”

To Karen the key statement in the review is that “while diabetic animals fed standard diets developed expected vascular or renal tissue injury, age-matched diabetic cohorts fed a low-AGE diet remained largely free of pathology despite untreated chronic hyperglycemia.”

After thinking hard about that statement, I agree with Karen. For years, at least since the U.K. Prospective Diabetes Study and the Diabetes Control and Complications Trial were completed more than 10 years ago, the received wisdom of diabetes professionals has been “that keeping blood glucose levels as close to normal as possible slows the onset and progression of eye, kidney, and nerve diseases caused by diabetes.” While low A1C levels must be awfully important, a low-AGE diet seems to be even more important.

Joe Anderson, whose site I reviewed here earlier, agrees that the new review is an excellent paper. To him dietary AGEs reduction is “what has been shown to work, and that is what all diabetics in a more perfect world would be doing now. The other problem is that most real world people don’t have a clue about what a low AGEs diet would be.”

Joe goes on to point out that the new review nevertheless concentrates mostly on drug cures for a high-AGEs diet. Most of these are experimental and many haven’t even been tested yet in humans. But two of the most common drugs for diabetes, metformin (Glucophage) and pioglitazone (Actos), each seem to reduce AGEs in preliminary studies.

Karen points out that benfotiamine and pyridoxamine are the only two therapeutic agents available without a prescription that the review lists. Three years ago I wrote about benfotiamine – a synthetic form of Vitamin B1 – in my “Diabetes Update” newsletter as a promising way to prevent diabetic retinopathy.

At that time I discussed benfotiamine with Dr. Paul Chous, an optometrist whose book Diabetic Eye Disease I reviewed in my “Diabetes Update” newsletter. I wrote then that you can, however, take too much benfotiamine, so taking it without a prescription is a bad idea. Dr. Chous pointed out that benfotiamine is fat soluble, which we cannot easily eliminate if we take too much.

Because benfotiamine seems so important in counteracting AGEs, I just now asked him about it again. He says that while he is concerned about potential toxicity from fat soluble nutriceuticals in general, he knows of no reports of it with benfotiamine. He goes on however, to say that one consideration is that benfotiamine might promote pre-existing tumor growth – not cause tumors, but promote their growth.

Dr. Chous says that he takes 150mg of benfotiamine three times a day. He know of two companies that claim to produce pharmaceutical-grade benfotiamine: Benfotiamine.net and Brentwood Health International. I wasn’t able to contact the Brentwood website.

Karen says, “As far as I can tell, benfo, even though it is readily available, remains basically unknown and unused because no major pharmaceutical company can make money off of it. Let’s face it, practically no one talks to their patients about avoiding ingested AGEs (yet!), so they don’t understand the potentials of benfo and pyridoxamine.”

And pyridoxamine is even harder to find. While benfotiamine has been studied quite a bit in humans, pyridoxamine as an anti-AGEs therapy has only been studied in animals.

Dr. Huebschmann cautions that benfotiamine and pyridoxamine are supplements, which the Food and Drug Administration doesn’t regulate. “That compromises the ability to rely on these as a therapy.”

I was surprised that her review emphasizes some common things that can make it harder to deal with AGEs. They are green tea and vitamins C and E.

So I asked Dr. Huebschmann about them. “In subjects with type 2 diabetes mellitus, I would not encourage green tea,” she replied. “Vitamin C and E in the form of a multivitamin would pose no concern to me at this time, but I would not encourage extra vitamin C or E consumption for subjects with type 2 diabetes mellitus. Other studies have shown that vitamin E consumption over 400 IU per day may be hazardous, and this is not recommended for any population at this time.”

And until now we have had yet another problem with AGEs. It is complicated to measure tissue AGEs, because existing methods are expensive, time consuming, lack specificity, are poorly reproducible, and/or are invasive.

However, DiagnOptics B.V. in Groningen, The Netherlands, has developed the AGE Reader. The company recently got approval to sell it in Europe.

“We are currently in the process of obtaining FDA approval to be able to offer the AGE Reader to hospitals in the U.S.,” Managing Director Bart van den Berg just wrote me. “The AGE Reader measures autofluorescence of the skin to estimate the quantity of advanced glycation end products in the patient’s tissue. We did a large clinical trial in type 2 diabetes patients and found a strong correlation between the AGE Reader measurements and the cardiovascular risk.”

The essence of the news about AGEs is that it people are becoming more aware. This is just the beginning, but awareness is the first step toward eventual control. That’s good news.

This article is based on an earlier version of my article published by HealthCentral.