It is fitting that the most recent study of AGEs appears in this month’s issue of a gerontology journal. "¨As we grow older we do accumulate AGEs.
But the key message of the study is that "AGEs are important for healthy people too." That’s what corresponding author Dr. Helen Vlassara, professor of medicine at the Mount Sinai School of Medicine, told me when I interviewed her on Tuesday.
And AGEs are of special importance for those of us who have diabetes. "AGEs are excreted by the kidneys, whose capacity may be easily exceeded," the new study says, "especially in the presence of renal disease, diabetes, or high AGE intake."
AGEs cause oxidative stress and inflammation, which seems to have a special connection to diabetes. A lot of the AGEs in our bodies comes from what we eat.
AGEs is shorthand for advanced glycation end products. Some people call them glycotoxins.
About five years ago in my "Diabetes Update" newsletter I started to warn people with diabetes about the dangers of AGEs. Since then I wrote about AGEs in May 2006 and June 2006. I have also posted the excellent "Low AGE Meal Plan Instructions" from the Mount Sinai School of Medicine on my website.
But I know of only a couple of diabetes professionals who seem to care.
One is Karen LaVine, a registered nurse and Certified Diabetes Educator in Albuquerque. Over the years she has provided me with insights and copies of journal articles on AGEs.
The other is Gretchen Becker, who wrote one of the two best books about diabetes, The First Year - Type 2 Diabetes. This book includes an excellent discussion of the dangers of AGEs for people with diabetes.
In my interview with Dr. Vlassara I concentrated on asking her about cooking methods.
"The content of AGEs in the food is strongly influenced by the methods of preparation, particularly, the amount and duration of exposure to heat and by the associated water loss," the study says. "Thus, methods such as frying or broiling greatly augment the AGE content of common foods, compared to boiling and steaming."
She has made it clear in this and previous journal articles what she thinks are the worst and the best ways to cook foods. But I wanted to know what she thinks about some other cooking methods and whether cooking longer at a lower temperature would be better.
I starting with asking her about the baked sunchokes I had for dinner the night before. She told me that there is "no major benefit" in cooking for a longer time at a lower temperature.
"But cooking vegetables with not too much fat is already within the very safe range," she added. "Unfortunately the concern is for those people who eat meat."
Her research shows that there is an order of magnitude difference between cooking vegetables and meat. "When cooking meat or more buttery dishes, we are then talking about big time AGEs."
Basically, she recommends that we cook meat at as low a temperature and for as short a time as we can safely do. And especially to use water.
"Make sure you have a lot of water in your mixture - make sure you are either steaming, stewing, or boiling."
What about cooking in a Crock-Pot? Fine, she replied, as long as it’s not more than an hour.
Pressure cooker? The same thing. Both maintain the water in the dish.
A rice cooker? "That’s fine too."
A microwave? "In fact, it is one of the worst we have found so far," she replied. "It concentrates the heat at the center of the food. Use it for liquids, soups, and so forth but never for cooking."
Please note that this contradicts a student of AGEs that I quoted in one of my previous articles. Karen LaVine strongly agrees with Dr. Vlassara. "I haven’t had one around for several years," she just wrote me.
Finally, I asked Dr. Vlassara about a preventative for AGEs that I take myself, benfotiamine. Aside from diet, is taking benfotiamine the best thing we can do?
" I believe that it’s good," she replied. "Whether it is going to prevent disease or ameliorate it, we do not know. Taking medications without changing our dietary habits are not very likely to work. I recommend that in your writing to say to combine the two things. That would be my best bet."
David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.