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Advanced Glycation End Products (AGEs) and Insulin Sensitivity

Should your patients avoid high heat cooking?… 

Advanced Glycation End Products, or AGEs, are substances that are thought to impair glucose metabolism in type 2 diabetic patients. They are formed in the body via an addition of a carbohydrate to a protein. Cooking, particularly cooking temperature, plays a major factor in the development of AGEs outside the body. High heat cooking such as baking, frying, and grilling greatly promotes AGE products. Therefore, high levels of AGEs are present in many common foods.

Previous research from animal studies suggest that a diet high in AGE products contributes to increased insulin levels, higher insulin resistance, and increased incidence of type 2 diabetes. Other studies have shown the beneficial effects of an AGE restricted diet on type 2 diabetic patients in terms of better glucose metabolism. This study focuses on how AGE products affect insulin sensitivity.

A current two factorial designed study was conducted to compare the effects of insulin sensitivity on foods prepared from cooking methods that either increased or decreased AGE formation, as well as the effects of fructose on insulin resistance. A total of 73 overweight women with ages ranging from 20-50 were studied in Copenhagen Denmark and were given a 4 week parallel dietary intervention. The dietary intervention consisted of two open labeled arms (high AGE diet versus low age diet) along with 2 double blinded arms that consisted of either fructose or glucose supplements. Both diets resembled a typical Danish diet but differed in cooking methods. The high AGE group had to fry, bake, or roast their food while the low AGE group was instructed to boil or steam their food. Each volunteer was provided with bottles containing either 20 g fructose or 22 g glucose in a double blinded manner and was instructed to consume 3 bottles daily in conjunction with their main meals. Dietary and urinary AGE concentrations were then measured to estimate AGE intake and excretion. The results of the study show that although both groups had about the same intake of energy, protein, and carbohydrates, volunteers in the low AGE group consumed 15% more protein, 10% more carbohydrates, and 22% less fat compared with the volunteers in the high AGE group. Additionally, the observed levels of insulin resistance in the low AGE group were similar to those seen in normoglycemic volunteers.

In summary, a diet consisting of low AGE products improved insulin resistance in overweight women. Also, fructose did not affect insulin resistance nor any other outcomes.

This study stresses the importance of food choice, which includes limiting processed foods, as well preparing foods in ways that lower AGE production. Foods that inherently have low AGE products should be included as well, in an effort to reduce insulin resistance and better manage type 2 diabetes. Further studies are warranted to expand this study include to more groups (males, ethnicity, etc.) of people.

Practice Pearls: 
  • Opt to have food prepared by steaming or boiling rather than fried or toasted.
  • Fructose does not affect insulin sensitivity negatively.
  • Portion size is imperative in properly managing insulin sensitivity and diabetes in general.

Alicja, Mar B. et al. "Consumption of a Diet Low in Advanced Glycation End Products for 4 Weeks Improves Insulin Sensitivity in Overweight Women." Diabetes Care 37 (2014): 88-95