In part 1 of this Exclusive Interview, Jamie Uribarri talks with Diabetes in Control Publisher Steve Freed during the ADA 2017 Scientific Sessions in San Diego, CA about the compounds called Advanced Glycation Endproducts (AGE) in food, and the benefits of a low AGE diet.
Jamie Uribarri, MD, is a physician and clinical investigator at The Icahn School of Medicine at Mount Sinai in New York.
Transcript of this video segment:
Freed: This is Steve Freed with Diabetes in Control. We are here at the American Diabetes Association 77th Scientific Sessions, 2017. We are here to present to you some really exciting interviews with some of the top endos from all across the world. We have with us a very special guest, who is also presenting here, Jamie Uribarri. Did I get that right?
Freed: I get 10 points for that.
Freed: We can start off by you telling our audience a little bit about yourself, ADA must appreciate what you do.
Uribarri: I got my medical degree in Chile but I have been in the United States in New York at the Mount Sinai School of Medicine for many years. For many years, we have been involved in the study of these compounds in food, Advanced Glycation Endproducts, that I call AGEs as an abbreviation and how they affect health and how they may cause diseases. That has been the main reason of my research over the past few years. I’m also a practicing physician; I am a nephrologist and I deal with kidney diseases and that’s my interaction with diabetes. As you know, about 1/3 of the diabetic patients will end up with kidney disease, and most of these will end up on dialysis, and therefore, that is my interaction with the diabetes world.
Freed: So the title of your symposium is: “Healthy Lifestyle Matters for People with Diabetes and Kidney Disease: Finding the Good and Avoiding the Bad Food Choices for Patients with Diabetes and Kidney Disease.” Is there a short title?
Uribarri: (Laughing) That’s a very long title. But “Healthy Lifestyles” I would say, and “How to Live Healthy.”
Freed: We hear a lot about AGEs in our foods that we eat. Maybe you can give us an idea into that? The way I like to put it is, the sign of a good speaker is someone who presents ideas and concepts and then when people leave, they take that knowledge and they use it in their practice the next day. If you’re a presenter and you have beautiful slides but no one remembers anything when they walk out the door, then it is a waste of time for everybody. So what do you want them to take away from your presentation?
Uribarri: Well, most physicians are very well aware of these compounds, the AGEs that I call them, in relation to hyperglycemia. We know that if you have high glucose that is going to react with the three amino groups of protein and through a series of complicated chemical reactions, is going to form these AGEs. That has been known for many decades. Many people accept that most of the complications that we observe in diabetes over the long-term, are related to these compounds. But today we are talking about the AGEs that come from the food – food contains AGEs. When you cook food with application of high levels of heat under dry conditions, you may generate large amounts of AGEs. Although only a fraction of them are absorbed, indeed, that may be important, and they clear into the body, they get together with endogenously generated AGEs, and they lead to oxidative distress and inflammation, which eventually, cause disease. So over the years, we have shown significant amount of work in trying to demonstrate that if you take a diabetic patient, for example, or somebody with chronic kidney disease and you randomize them either into high AGE diet or low AGE diet, when people follow the low AGE diet, they have a significant reduction of inflammation, less oxidative distress and we have even shown that we are able to reduce insulin resistance as assessed by the so-called HOMA Index. So this is very significant and we believe strongly that a high AGE diet is a factor-causing disease and, more importantly, going into a restricted AGE diet actually can prevent the development or the manifestation of disease.
Freed: Have we seen studies to show that result?
Uribarri: Yes, we have presented literature in 2002, many studies in important journals such as the PNAS, Diabetes, and so on and so forth. The first study that we presented was when we took a group of diabetes patients and randomized them into either a high AGE diet or a low AGE diet and the foods were prepared for them in our clinical research center. The participants came and picked them up twice a week and at the end of a period of observation of about 6 weeks, we were able then to show marked decrease in the markers of inflammation and oxidative distress. And then after that, we have repeated other people with diabetes and insulin resistance; we have been able to repeat that in patients with metabolic syndrome in which case with a study of over one year. And of course in this case, the patient prepared their own food at home and with very detailed guidance by the study dietician that kept calling them twice a week and face-to-face interviews like once a month or every two months. The findings are remarkably uniform. The low AGE diet brings down the levels of the AGEs in the circulation, but more importantly, that seems to be associated with decrease in markers of oxidative distress, inflammation, C-reactive protein (CRP), TNF alpha, and in the case of diabetic patients with insulin resistance, we bring down the HOMA Index. This has been reproduced by a couple of people in other countries such as in Mexico, Denmark, Australia, and France. So we believe that this is serious and we just want to continue in larger number of people to demonstrate that the study can be reproduced.