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There may be some negative
effects from too high levels of fructose. At least in rats, a high level
of fructose is sometimes used to cause hypertension. Neither glucose nor
sucrose seems to do this. High levels of fructose may also be associated
with too high levels of blood fat (serum triglycerides), which may already
be too high in HIV. On this basis, high levels of fructose in our diet
might be considered (more) undesirable (than either glucose or sucrose).
An issue that may be important
here for people in whom we are seeing (sometimes strange changes in body
composition -"Crix belly" or "protease paunch", "Buffalo hump", a more
general term "lipodystrophy", or whatever other names get used here) is
that insulin insensitivity, which is a characteristic of NIDDM seems to
accompany this change in body composition. Thus the body tries to make
more insulin to compensate for its lower activity, that is insensitivity
(just means the insulin doesn't do its job as well as it should). It's
too early yet to decide on "cause and effect", but there are a bunch of
things that may be problems. From some other studies of non-HIV related
cases of NIDDM, it MIGHT be that high levels of fructose are not desirable.
But there is also some evidence that HIGH levels of sucrose and glucose
may also be undesirable. From this, then one might suggest that HIGH levels
of either fructose, glucose or sucrose are undesirable. Keep in mind here,
that I'm referring to HIGH levels. It is unrealistic to try to avoid all
dietary sugars. But we can easily keep low those added sugars, and foods
which have simple sugars as their main form of carbohydrate.
Some more information
on the carbohydrates is in a monograph about Liquid Food Supplements, and
is available at the CATIE web site, by
looking under the sections for monographs, and then find my name. But this
information was written before the issues came up with lipodystrophy. I'll
be doing a more lengthy article on this, likely to be published in a newsletter
in the Fall. For now, we can speculate a lot, but with little information
as to what is really going on. There were some good reviews by Dr Donald
Kotler from the recent Geneva International AIDS conference - hopefully
you were able to access these - I got them from the web site, but I suspect
there are other community-based sites that also have these available.
One issue that I've not
addressed here, is that the different enzymes to do with metabolism of
fructose and glucose may have different dependence's on certain minerals.
In general, magnesium is important for many enzymes that deal with the
glucose. It runs in my mind that manganese may be involved in an enzyme
to do with fructose, but I need to look this up. Generally, chromium, zinc,
magnesium, and manganese are all involved. Of these, zinc and magnesium
have been commonly observed to be low in HIV/AIDS in the absence of supplementation.
Both should be monitored, although it is difficult to interpret serum zinc
levels. Serum magnesium should be monitored every 3-6 months. Mixed nuts
and some tofus are good dietary sources. Bananas, leafy greens, avocado
are some other reasonable sources. A 250 mg magnesium citrate supplement
is used by many. I'm not aware of chromium having been observed to be low
in HIV/AIDS, but there are studies of NIDDM where 500-1000 MICROgrams were
found to help make the insulin more active (that is the insulin INsensitivity
was lowered).
I hope this is of help
for you. It may be possible to provide more information if you have more
specific issues that you're dealing with. But to be frank, it will not
be easy to provide much more definitive information, but the subject (as
you can tell from my answer) is quite complex, and there is not always
agreement by experts. I hate the expression, but it is true, "we need more
research".
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