Quite often, questions come from our BFT readers that convince us we have an extraordinarily inquisitive and bright readership, something for which we are very grateful. It convinces us our many uncompensated hours of research and writing and staying up past our bedtime are worth the effort.
In this case, the question stems from a post written by Dr. Lance Setterfield, a globally recognized guru in the field of microneedling and a personal friend of Drjohn and Drgeorge. It has to do with concerns that microneedling in “patients with glycation” might not be a great idea. After giving you a chance to read Dr. Setterfield’s post immediately below, we’ll provide some additional information about the phenomenon of glycation and answer our reader’s question about topical products.
HIGHLY RECOMMENDED FOR PHYSICIANS AND NURSES WHO PERFORM DERMAL NEEDLING
This book is the most recent (3rd edition) update of what BFT considers the “bible” of dermal needling. There is no more complete resource available. Purchase at: https://www.needlingguide.com
From Dr. Setterfield’s online post:
Is Microneedling Contraindicated in Patients with Glycation?
Wrinkles may worsen with microneedling in patients prone to glycation, but this is not an absolute contraindication to treatment. Glycation is due to abnormal cross-linking of collagen. Therefore, the greater the amount of new collagen that is produced via needling, (be that cosmetic or medical), the more cross-linking and worse the appearance, if it was truly due to glycation.
Glycation looks like ‘cobblestone’ which is quite different to loss of structural integrity due to sun damage. In the latter, we typically also see hyperpigmentation. Other things to consider that may ‘appear’ similar to glycation, or complicate the appearance of glycation, would be scarring (due to electrolysis or chemical peels, done repeatedly over a lengthy time), or sebaceous hyperplasia. Solar elastosis may also have a similar appearance.
http://www.dermnetnz.org/dermal-infiltrative/solar-elastosis.html
Glycation is more pronounced in diabetics and influenced by diet, so any positive changes associated with needling may also be due to dietary advice given at the time of consultation. Products that contain ingredients that combat glycation, such as L-Carnosine, or Supplamine, should always be used in conjunction with microneedling. These can be applied topically or taken as a supplement. I would recommend both oral and topical in severe cases.
Remember that a normal fasting blood sugar and HgbA1c does not rule out glycation. In the early stages of metabolic disorders, the body may compensate to maintain normal readings, so the pathological process is occurring without evidence of the endpoint (abnormal blood test). In other words, the body is “working” much harder to be “normal”. Another point to consider is that readings may be set high at the lab for the benchmark for pathology so as not to have too many of the population labeled as diabetics. If one believes in prevention rather than cure, we should not be waiting for full-blown endpoint pathology, such as nerve and skin damage via glycation, to establish itself.
GLYCATION: THE SECOND MAJOR CAUSE OF SKIN DAMAGE
Everyone is aware of the damaging effect of sun exposure on the skin. Fewer are aware that the second most damaging process is glycation, which while obvious and visible in the skin, actually occurs throughout the body.
Excessive sugar, in all its forms whether natural or processed, promotes inflammation, depresses the immune system and is damaging to the skin and all internal tissues and organs. This is the result of a chemical reaction called glycation. Most people have an excess sugar intake and excess sugars initiate glycation at an increased rate.
WHAT IS GLYCATION?
In essence, glycation is the same chemical reaction, the Maillard reaction, that occurs between amino acids and sugars that gives browned foods their distinctive color and flavor. Seared steaks, pan-fried dumplings, cookies and other kinds of biscuits, breads, toasted marshmallows, and many other foods undergo this reaction – and so does our skin, albeit at a much slower rate and at much lower temperature.
The reaction is named after French chemist Louis-Camille Maillard, who first described it 
in 1912 while attempting to reproduce biological protein synthesis. It is a form of non-enzymatic browning which typically proceeds rapidly from around 140 to 165 °C (280 to 330 °F). The reactive carbonyl group of the sugar reacts with the nucleophilic amino group of the amino acid, forming a complex mixture of poorly characterized molecules responsible for a range of aromas and flavors. This process is accelerated in an alkaline environment. (Now, you know why a lye solution is painted onto dough to produce dark brown pretzels and pretzel bread!!)
EFFECTS OF THE MAILLARD REACTION ON HUMAN PHYSIOLOGY
The Maillard reaction is involved in diseases in the human body including diabetic complications, pulmonary fibrosis, neurodegeneration, eye diseases, and atherosclerosis (“hardening” of the arteries.) The eyes are particularly susceptible to injury from AGEs. In the cornea, the accumulation of AGEs is associated with thickened corneal stroma, corneal edema, and morphological changes. In the lens, Maillard chemistry has been studied extensively in the context of cataract formation. Glycation may lead to destabilization of the vitreous gel structure within the eye via unnecessary cross-linking between collagen fibrils. This process is more strongly observed within diabetic patients. Within the retina, the accumulation of AGEs has also been observed at a higher level among patients with age-related macular degeneration (AMD).
With these examples of the negative effects of glucose chemically reacting with proteins and lipids in the delicate tissues of the eye, it is easy to understand that the same chemical reaction can cause damage in other tissues, including the collagen and elastin within the skin.
THE DOWNSIDE OF OXYGEN AND SUGAR – “CAN’T LIVE WITH ‘EM, CAN’T LIVE WITHOUT ‘EM”
The human body depends on fuel and oxygen to provide the energy that powers our physiology. Mitochondria powers up every cell in our body using glucose, fatty acids, and oxygen. But it comes with a price. Sugar is the most damaging compound to mitochondria
As glycation progresses, this leads to mitochondrial energy production that slows down, along with increased oxidative stress. Eventually, damaged mitochondria can stop functioning, accelerating the aging process both inside and outside the body.
Glycation takes its toll slowly. It “gums up” proteins, deactivates enzymes, triggers unhealthy, cellular signaling and damages DNA = AGEing you.
The two tissues in our skin that make our skin look youthful and springy are elastin and collagen. These are the proteins in the skin most affected by glycation, creating discolored, weak and hardened tissues leading to wrinkles, sagging skin and a loss of radiance. Glycation is a natural process in the human body. Because most everything that we eat converts to glucose in order to utilized as mitochondrial “fuel”, diet modification is important in the management of the rate and scale of glycation. Foods with high concentrations of sugar contribute to the rate of glycation. This is even more of a concern when it comes to fructose, which contributes to glycation at a rate 10 times as fast as glucose. Avoiding foods with fructose (think how ubiquitous corn derived fructose is in processed foods) should be a priority. Food with high concentrations of sugar should be a small part of one’s diet.
STATEGIES TO REDUCE GLYCATION
Avoid Excess Carbohydrate Intake. Such as whole wheat bread, white potatoes, white rice, pasta, and all grains. Excess healthy carbs are also a contributor to glycation.
Avoid High Temperature Cooking (think crispy, blackened foods). Steaming, stewing and poaching are the cooking methods rather than frying, direct-fire grilling and high-temperature roasting.
Add Antioxidant Rich Foods: Make every plate and anti-inflammatory meal. Choose all veggies, nuts, seeds, low-sugar fruits such as raspberries, blackberries, kiwi, healthy fats such as avocados, macadamia nut oil, and healthy proteins such as whole pastured eggs,
DIET, TARGETED SUPPLEMENTS, AND SKINCARE INGREDIENTS TO COPE WITH GLYCATION
Carnosine. Carnosine helps prevent cellular glycation. This nutrient is a potent free-radical scavenger and anti-glycating agent that inhibits AGEs formation and its cross-linked proteins. Take carnosine with fat for bio-availability.
Benfotiamine. This nutrient (a lipid-soluble form of thiamine, vitamin B1) can boost your body’s cellular levels of vitamin B1, which is an essential component in clearing the dangerous debris left behind due to glycation.
Curcumin. Curcumin is the active component in the spice turmeric. Curcumin is an antioxidant, powerful anti-inflammatory, antimicrobial, anticancer, memory-enhancing, life-extending, and Curcumin uniquely protects against AGE-induced diabetic complications.
Tomato Paste. Research shows that simple tomato paste strongly inhibited the formation of AGEs in the glycation process.
Resveratrol. Resveratrol has the ability to reduce oxidative stress along with its highly protective cellular effect.
Rosemary. The use of the herb rosemary will help reduce the formation of AGEs.
Alpha Lipoic Acid. Alpha Lipoic Acid possesses unique properties that specifically slow mitochondrial dysfunction and reversing mitochondrial damage by preventing the release of damaging oxidants.
SELECTED REFERENCES
Advanced glycation end products (AGE) in human chronic skin wounds. Histol Histopathol. 2014 Feb;29(2):251-8.
Abstract
The matricellular protein galectin-3 (Gal-3) is upregulated in excisional skin repair in rats where it has been shown to modulate the inflammatory phase of repair. Recent research into kidney pathology has implicated Gal-3 as a receptor for advanced glycation end products (AGE), resulting in the binding and clearance of these molecules. AGEs are thought to contribute to defective skin repair in diabetic patients as well as a result of the normal aging process. However, the distribution and localization of Gal-3 and AGEs has never been performed in human chronic skin wound tissue. Using immunohistochemistry, the localization of Gal-3 and AGEs in tissue isolated from chronic wounds and non-involved skin from the same patient was investigated. Of the 16 patients from which tissue was isolated, 13 had type II diabetes, one had type I diabetes and 2 patients without diabetes were also examined. In non-involved dermis, Gal-3 was detected strongly in the epidermis and in the vasculature. However, at the wound edge and in the wound bed, the level of Gal-3 labelling was greatly reduced in both the epidermis and vasculature. Labelling of serial sections for Gal-3 and AGE demonstrated that where Gal-3 immunoreactivity is reduced in the epidermis and vasculature, there is a concomitant increase in the level of AGE staining. Interestingly, similar labelling patterns were evident in diabetic and non-diabetic patients. The results from our study demonstrate an inverse correlation between Gal-3 and AGEs localization, suggesting that Gal-3 may protect against accumulation of AGEs in wound healing.
Effect of advanced glycation end products on gene expression profiles of human dermal fibroblasts. Biogerontology. 2008 Jun;9(3):177.
Abstract
The Maillard reaction and its end products, AGE-s (Advanced Glycation End products) are rightly considered as one of the important mechanisms of post-translational tissue modifications with aging. We studied the effect of two AGE-products prepared by the glycation of lysozyme and of BSA, on the expression profile of a large number of genes potentially involved in the above-mentioned effects of AGE-s. The two AGE-products were added to human skin fibroblasts and gene expression profiles investigated using microarrays. Among the large number of genes monitored the expression of 16 genes was modified by each AGE-preparations, half of them only by both of them. Out of these 16 genes, 12 were more strongly affected, again not all the same for both preparations. Both of them upregulated MMP and serpin-expression and downregulated some of the collagen-chain coding genes, as well as the cadherin- and fibronectin genes. The BSA-AGE preparation downregulated 10 of the 12 genes strongly affected, only the serpin-1 and MMP-9 genes were upregulated. The lysozyme-AGE preparation upregulated selectively the genes coding for acid phosphatase (ACP), integrin chain alpha5 (ITGA5) and thrombospondin (THBS) which were unaffected by the BSA-AGE preparation. It was shown previously that the lysozyme-AGE strongly increased the rate of proliferation and also cell death, much more than the BSA-AGE preparation. These differences between these two AGE-preparations tested suggest the possibility of different receptor-mediated transmission pathways activated by these two preparations. Most of the gene-expression modifications are in agreement with biological effects of Maillard products, especially interference with normal tissue structure and increased tissue destruction.
Evaluation of tissue accumulation levels of advanced glycation end products by skin autofluorescence: A novel marker of vascular complications in high-risk patients for cardiovascular disease. Int J Cardiol. 2015 Apr 15;185:263-8.
Abstract
A non-enzymatic reaction between reducing sugars and the amino groups of proteins, lipids and nucleic acids is known as the “Maillard reaction”. The reactions have progressed in a normal aging process and at an accelerated rate under hyperglycemic, inflammatory, and/or oxidative stress conditions, thus leading to the formation and accumulation of advanced glycation end products (AGEs). Cross-linking modification of organic matrix proteins such as collagen by AGEs not only leads to an increase in vascular and myocardial stiffness, but also deteriorates structural integrity and physiological function of multiple organ systems. Furthermore, there is a growing body of evidence that interaction of AGEs with a cell surface receptor RAGE elicits oxidative stress generation and subsequently evokes inflammatory, thrombogenic and fibrotic reactions, thereby being involved in the development and progression of various age- or diabetes-related disorders, including cardiovascular disease (CVD), Alzheimer’s disease, osteoporosis, cancer growth and metastasis. Skin AGE levels measured in biopsy specimens are associated with the development and progression of diabetic microangiopathy. Recently, accumulation levels of AGEs in the skin can be measured non-invasively by autofluorescence. Accumulating evidence has suggested that skin autofluorescence (SAF) is correlated with the presence and severity of vascular complications of diabetes and could predict future cardiovascular events and death in patients with diabetes. This review summarizes the pathophysiological role of tissue accumulation levels of AGEs in vascular damage in high-risk patients, especially focusing on the association between SAF and cardiorenal disorder.
Noninvasive measurement of advanced glycation end-products in the facial skin: New data for skin aging studies. J Cosmet Sci. 2017 May/Jun;68(3):195-204.
Abstract
Using skin autofluorescence (SAF) as a marker of advanced glycation end-products (AGEs) has been extensively studied in the last decade since the introduction of the noninvasive in vivo measurement technique. Data have shown the level of skin AGEs increases with chronological age in healthy human beings, and this increase is substantially higher in age-matched diabetic patients. In skin research, glycation with the accompanying accumulation of skin AGEs has been regarded as one of the primary skin aging mechanisms that contribute to skin wrinkling and the loss of skin elasticity. To date, the totality of SAF data reported in literature has been obtained from measurements on the arm, and noninvasive measurement of facial skin AGE accumulation would add great value to skin aging research. In this study, we report the levels of facial and forearm skin AGEs in 239 men and women of 21-65 year of age. Significantly lower levels of AGEs were detected in the facial skin than in the forearm skin from the young Caucasian groups, and the difference was much larger for men than for women. The rate of change in skin AGE level over age was found to be about 50% higher in men than in women, which further highlights the gender difference. A statistically significant correlation between the levels of skin AGE and facial wrinkling was also observed. The facial skinAGE data may provide new insight into skin aging research.
Skin autofluorescence predicts cardio-renal outcome in type 1 diabetes: a longitudinal study. Cardiovasc Diabetol. 2016 Sep 1;15(1):127.
Abstract
BACKGROUND: We aimed to analyze the relationships between skin autofluorescence (SAF) and incident macrovascular events and renal impairment after 4 years of follow-up in patients with type 1 diabetes (T1D).
METHODS: Two hundred and forty-three patients (51.2 ± 16.7 years old) with T1D participated. SAF was measured by AGE-Reader-TM at inclusion. Macrovascular events (MVE), estimated glomerular filtration rate (eGFR) and urinary albumin excretion rate (AER) were recorded then and 4 years later. Multivariate logistic regression was used to analyze the relationships between SAF and incident MVE and renal profile 4 years later.
RESULTS: Patients with incident MVE had a higher SAF (p = 0.003). SAF predicted incident MVE after adjustment for age, sex, body mass index, tobacco, diabetes duration, hypertension, HbA1c, AER, eGFR (OR 4.84 [95 % CI 1.31-17.89], p = 0.018). However, this relation was no longer significant after adjustment for history of MVE. An inverse relation was found between SAF and incident eGFR (p = 0.0001). Patients with incident eGFR <60 ml/min/1.73 m(2) had a SAF higher than patients with normal eGFR. After adjustment for the previous criteria, SAF remained associated with the risk of impaired incident eGFR (OR 7.42 [95 % CI 1.59-34.65], p = 0.018). No relation was found between SAF and increased AER 4 years later.
CONCLUSIONS: SAF predicts MVE in patients with T1D, adjusted for cardiovascular risk factors but the most powerful predictive factor remains history of MVE. SAF also predicts eGFR impairment, adjusted for initial AER and renal function. SAF could be a useful non-invasive tool for estimating risk of cardiovascular or renal impairment in patients with T1D.
Accumulation of Advanced Glycation Endproducts and Subclinical Inflammation in Deep Tissues of Adult Patients With and Without Diabetes. Can J Diabetes. 2018 Jan 10
Abstract
OBJECTIVES: Advanced glycation endproducts (AGEs) play a key role in the development of foot complications in people with diabetes. Skin autofluorescence (AF) might noninvasively determine tissue accumulation of AGEs. This study evaluated the association between skin AF and AGE contents in the deep tissues of those with diabetes and the further consequences of such contents.
METHODS: Between September 2014 and September 2015, we studied 33 patients, with and without diabetes, who had received lower-limb amputations. Skin AF was measured. Artery, nerve and skin were harvested during surgery. AGE contents were quantified using high-performance liquid chromatography mass spectrometry and were located by immunohistochemistry staining. Inflammatory cells were also located by immunohistochemistry, immunofluorescence and scanning electron microscopy.
RESULTS: Values of skin AF and AGE contents in artery, nerve and skin in patients with diabetes were higher than those in healthy patients. Skin AF was strongly affected by AGE contents in these tissues. AGE contents in various tissues were strongly correlated with each other. Differing AGEs were deposited in similar manners in the same tissues and were accompanied by inflammatory cells.
CONCLUSIONS: AGE contents were strongly correlated with each other and were accompanied by inflammatory cells. Skin AF measurement could provide information about the systemic accumulation of AGEs.
Advanced Glycation End-products are associated with Physical Activity and Physical Functioning in the older population. J Gerontol A Biol Sci Med Sci. 2018 Apr 28.
Abstract
BACKGROUND: Decline in physical activity and functioning is commonly observed in the older population and might be associated with biomarkers such as Advanced Glycation End-products (AGEs). AGEs contribute to age-related decline in the function of cells and tissues in normal aging and have been found to be associated with motor function decline. The aim of this study is to investigate the association between the levels of AGEs, as assessed by skin autofluorescence, and the amount of physical activity and loss of physical functioning in older participants.
METHODS: Cross-sectional data of 5,624 participants aged 65 years and older from the Lifelines cohort study was used. Linear regression analyses were utilized to study associations between skin autofluorescence/AGE-levels (AGE reader), the number of physically active days (SQUASH), and physical functioning (RAND-36), respectively. A logistic regression analysis was used to study associations between AGE-levels and the compliance with the Dutch physical activity guidelines (SQUASH).
CONCLUSIONS: This study indicates that high AGE levels may be a contributing factor as well as a biomarker for lower levels of physical activity and functioning in the older population.
Accumulation of advanced glycation end products is associated with macrovascular events and glycemic control with microvascular complications in Type 2 diabetes mellitus. Diabet Med. 2018 Apr 23.
Abstract
AIM: The United Kingdom Prospective Diabetes Study (UKPDS) study showed that glycemic control (HbA1c ) can predict vascular complications in Type 2 diabetes mellitus. The Diabetes Control and Complications Trial (DCCT) study showed that accumulation of advanced glycation end products (AGEs) from skin biopsies predicts vascular complications in Type 1 diabetes. Previously, we showed that tissue AGEs can be measured non-invasively using skin autofluorescence (SAF). The aim of this study was to compare the predictive value of HbA1c and SAF for new macrovascular events and microvascular complications in people with Type 2 diabetes.
METHODS: A prospective cohort study of 563 participants, median age 64 years [interquartile range (IQR) 57-72], diabetes duration of 13 years, from five Dutch hospitals was performed.
RESULTS: After a median follow-up of 5.1 (IQR 4.3-5.9) years, 79 (15%) participants had died and 49 (9%) were lost to follow-up. Some 133 (26%) developed a microvascular complication and 189 (37%) a macrovascular event. Tertiles of HbA1c were significantly associated with development of microvascular complications (log rank P = 0.022), but not with macrovascular events. Tertiles of SAF were significantly associated with macrovascular events (log rank P = 0.003). Cox regression analysis showed SAF was associated with macrovascular events: crude hazard ratio (HR) 1.53 (P < 0.001) per unit increase, HR 1.28 (P = 0.03) after correction for UKPDS score. HbA1c was predictive for microvascular complications: crude HR 1.20 (P = 0.004), HR 1.20 (P = 0.004) after correction for UKPDS score.
CONCLUSION: This study shows that tissue accumulation of AGEs, assessed by SAF, is associated with development of macrovascular events in people with Type 2 diabetes, whereas HbA1c is associated with the development of microvascular complications.
Thank you for this in-depth article on AGEs and the recommendations for tackling it. Two questions…
What are your thoughts on cinnamon as a possible AGE prevention? I’ve read that it works as a blood sugar regulator (in many cases) and have been taking it for this purpose for years. Does that mean it can also suppress glycation?
I was also taking curcumin (prophylactically in an attempt to discourage melanoma development) but stopped last year when I read about a review in the Journal of Medicinal Chemistry that claimed curcumin essentially had no medicinal value! So, I’m heartened to see that you’ve listed it above as a targeted supplement to help offset glycation and plan to start taking it again. But, I’m wondering, are you familiar with the review in question (“The Essential Medicinal Chemistry of Curcumin“) and if so, what are your thoughts on their opinions? Here’s the abstract: https://www.ncbi.nlm.nih.gov/pubmed/28074653
Thanks again for a terrific article.
Marianne
Thank you, Marianne, for your thoughtful question. Reading medical literature can be frustrating, especially when contradictory findings and conclusions are found. The issue then is which results should one believe. The methodology of the study must be examined closely and sometimes it starts as a numbers game.
If 10 articles agree on one conclusion, and one article does not, what’s the truth? Both curcumin and cinnamon fit in this category. Is there benefit in incorporating these botanicals into one’s diet as supplements? With substantial evidence of benefit and little to no downside risk (except perhaps to the budget), what’s the harm? That seems a reasonable approach while additional research sorts out the facts. Some interesting abstracts are below.
RE: Cinnamon as a prevention of AGE production.
Cinnamon Bark Proanthocyanidins as Reactive Carbonyl Scavengers To Prevent the Formation of Advanced Glycation Endproducts. J Agric Food Chem. 2008 Mar 26;56(6):1907-11
Abstract
Cinnamon bark has been reported to be effective in the alleviation of diabetes through its antioxidant and insulin-potentiating activities. In this study, the inhibitory effect of cinnamon bark on the formation of advanced glycation endproducts (AGEs) was investigated in a bovine serum albumin (BSA)−glucose model. Several phenolic compounds, such as catechin, epicatechin, and procyanidin B2, and phenol polymers were identified from the subfractions of aqueous cinnamon extract. These compounds showed significant inhibitory effects on the formation of AGEs. Their antiglycation activities were not only brought about by their antioxidant activities but also related to their trapping abilities of reactive carbonyl species such as methylglyoxal (MGO), an intermediate reactive carbonyl of AGE formation. Preliminary study on the reaction between MGO and procyanidin B2 revealed that MGO−procyanidin B2 adducts are primary products which are supposed to be stereoisomers. This is the first report that proanthocyanidins can effectively scavenge reactive carbonyl species and thus inhibit the formation of AGEs. As proanthocyanidins behave in a similar fashion as aminoguanidine (AG), the first AGE inhibitor explored in clinical trials, they show great potential to be developed as agents to alleviate diabetic complications.
Effectiveness of Cinnamon for Lowering Hemoglobin A1C in Patients with Type 2 Diabetes: A Randomized, Controlled Trial. J Am Board Fam Med. 2009 Sep-Oct;22(5):507-12
Abstract
Purpose: Multiple trials in the past have shown conflicting results of whether cinnamon lowers glucose or hemoglobin A1C (HbA1C). The purpose of this study was to determine whether cinnamon lowers HbA1C in patients with type 2 diabetes. I performed a randomized, controlled trial to evaluate whether daily cinnamon plus usual care versus usual care alone lowers HbA1c.
Methods: I randomized 109 type 2 diabetics (HbA1C >7.0) from 3 primary care clinics caring for pediatric, adult, and geriatric patients at a United States military base. Participants were randomly allocated to either usual care with management changes by their primary care physician or usual care with management changes plus cinnamon capsules, 1g daily for 90 days. HbA1c was drawn at baseline and 90 days and compared with intention-to-treat analysis. This study was approved by an institutional review board.
Results: Cinnamon lowered HbA1C 0.83% (95% CI, 0.46–1.20) compared with usual care alone lowering HbA1C 0.37% (95% CI, 0.15–0.59).
Conclusions: Taking cinnamon could be useful for lowering serum HbA1C in type 2 diabetics with HbA1C >7.0 in addition to usual care.
Effects of Cinnamon Consumption on Glycemic Indicators, Advanced Glycation End Products, and Antioxidant Status in Type 2 Diabetic Patients. Nutrients. 2017 Sep; 9(9): 991.
Abstract
The aim of the current study was to determine the effect of a daily intake of three grams of cinnamon over eight weeks on glycemic indicators, advanced glycation end products, and antioxidant status in patients with type 2 diabetes. In a double-blind, randomized, placebo controlled clinical trial study, 44 patients with type 2 diabetes, aged 57 ± 8 years, were randomly assigned to take either a three g/day cinnamon supplement (n = 22) or a placebo (n = 22) for eight weeks. We measured the fasting blood glucose, insulin, hemoglobinbA1c, homeostasis model assessment for insulin resistance (HOMA-IR), carboxymethyl lysine, total antioxidant capacity, and malondialdehyde levels at the beginning and the end of the study. Thirty-nine patients (20 in the intervention group and 19 in the control group) completed the study. After an eight-week intervention, changes in the level of fasting blood glucose, insulin, hemoglobinbA1c, HOMA-IR, carboxymethyl lysine, total antioxidant capacity, and malondialdehyde were not significant in either group, nor were any significant differences between groups observed in these glycemic and inflammatory indicators at the end of the intervention. Our study revealed that cinnamon supplementation had no significant effects on glycemic and inflammatory indicators in patients with type 2 diabetes.
RE: Medicinal benefits of curcumin
The Essential Medicinal Chemistry of Curcumin. (the article reference by Marianne) Med Chem. 2017 Mar 9;60(5):1620-1637
Abstract
Curcumin is a constituent (up to ∼5%) of the traditional medicine known as turmeric. Interest in the therapeutic use of turmeric and the relative ease of isolation of curcuminoids has led to their extensive investigation. Curcumin has recently been classified as both a PAINS (pan-assay interference compounds) and an IMPS (invalid metabolic panaceas) candidate. The likely false activity of curcumin in vitro and in vivo has resulted in >120 clinical trials of curcuminoids against several diseases. No double-blinded, placebo controlled clinical trial of curcumin has been successful. This manuscript reviews the essential medicinal chemistry of curcumin and provides evidence that curcumin is an unstable, reactive, nonbioavailable compound and, therefore, a highly improbable lead. On the basis of this in-depth evaluation, potential new directions for research on curcuminoids are discussed.
Anticancer potential of curcumin: preclinical and clinical studies. Anticancer Res. 2003 Jan-Feb;23(1A):363-98.
Abstract
Curcumin (diferuloylmethane) is a polyphenol derived from the plant Curcuma longa, commonly called turmeric. Extensive research over the last 50 years has indicated this polyphenol can both prevent and treat cancer. The anticancer potential of curcumin stems from its ability to suppress proliferation of a wide variety of tumor cells, down-regulate transcription factors NF-kappa B, AP-1 and Egr-1; down-regulate the expression of COX2, LOX, NOS, MMP-9, uPA, TNF, chemokines, cell surface adhesion molecules and cyclin D1; down-regulate growth factor receptors (such as EGFR and HER2); and inhibit the activity of c-Jun N-terminal kinase, protein tyrosine kinases and protein serine/threonine kinases. In several systems, curcumin has been described as a potent antioxidant and anti-inflammatory agent. Evidence has also been presented to suggest that curcumin can suppress tumor initiation, promotion and metastasis. Pharmacologically, curcumin has been found to be safe. Human clinical trials indicated no dose-limiting toxicity when administered at doses up to 10 g/day. All of these studies suggest that curcumin has enormous potential in the prevention and therapy of cancer. The current review describes in detail the data supporting these studies.
Curcumin and curcuminoids in quest for medicinal status. Acta biochimica Polonica 59(2):201-12 · May 2012
Abstract
Curcumin, known for thousands of years as an Ayurvedic medicine, and popular as a spice in Asian cuisine, has undergone in recent times remarkable transformation into a drug candidate with prospective multipotent therapeutic applications. Characterized by high chemical reactivity, resulting from an extended conjugated double bond system prone to nucleophilic attack, curcumin has been shown to interact with a plethora of molecular targets, in numerous experimental observations based on spectral, physicochemical or biological principles. The collected preclinical pharmacological data support traditional claims concerning the medicinal potential of curcumin and its congeners but at the same time point to their suboptimal properties in the ADME (absorption, distribution, metabolism and excretion) area.
Curcumin–from molecule to biological function. Angew Chem Int Ed Engl. 2012 May 29;51(22):5308-32.
Abstract
Turmeric is traditionally used as a spice and coloring in foods. It is an important ingredient in curry and gives curry powder its characteristic yellow color. As a consequence of its intense yellow color, turmeric, or curcumin (food additive E100), is used as a food coloring (e.g. mustard). Turmeric contains the curcuminoids curcumin, demethoxycurcumin, and bisdemethoxycurcumin. Recently, the health properties (neuroprotection, chemo-, and cancer prevention) of curcuminoids have gained increasing attention. Curcuminoids induce endogenous antioxidant defense mechanisms in the organism and have anti-inflammatory activity. Curcuminoids influence gene expression as well as epigenetic mechanisms. Synthetic curcumin analogues also exhibit biological activity. This Review describes the development of curcumin from a “traditional” spice and food coloring to a “modern” biological regulator.
Is there any way to break up AGEs which have already been formed,i.e. not just disrupt the formation process triggered by sugars consumed in the past few days, but “undo” preexisting AGE’s? I made lifestyle changes last year, but binged on sugar growing up.
The best way to reduce glycation of proteins in situ (already in the tissue) can best be addressed by “controlling” the factors that cause them. These are non-enzymatic reactions, i.e. follow first order kinetics, which means the more of the reactive molecules you have present, the more AGE’s that will form. For this reason, having normal sugar levels within the body are important (diabetics and pre-diabetics have higher than normal glucose levels, hence higher rates of AGE formation.) Interestingly, fructose has a 10x propensity over glucose in creation of AGE’s and if you look at processed food labels and beverages, corn-derived fructose is EVERYWHERE – another reason to make smart food choices.
The greatest cause of higher levels of circulating AGE’s in our bodies are from the food we ingest. Anything grilled, fried, roasted or “browned” contains AGE’s. The lower the cooking temperature, the lower the AGE burden in the food. AGE’s trigger systemic inflammatory responses so reduced intake helps contribute to an “anti-inflammatory” diet. A panoply of diseases of aging are linked directly to inflammation. The kidneys play an important role is removal of AGE’s from the circulation, hence people with kidney disease have higher circulating AGE content.
Some pointers on reducing the burden of AGE’s can be found at: https://pcacorp.com/renal-rite-blog/agesandkidneydisease/
Every time I take a Carnosine supplement, it causes me have low blood pressure which causes me to become dizzy, lightheaded and very tired. Is this a normal side effect? I was taking 100 mg, 3 times a day. I heard you should take low doses throughout the day, as Carnosine does not stay in the body long?
One recognized potential side effect of oral carnosine is low blood pressure, especially in people already prone to lower blood pressure naturally. If it is too low, there may be danger of syncope (fainting) which may be more likely if one arises too quickly from sitting or lying down. Reducing the dose or dividing the dose into smaller quantities may be helpful.
Can sugar compounds in skincare cause glycation and should we avoid them? E.g.s: ascorbyl glucoside, decyl glucoside, glucose, sucrose. I have seen small amounts of sucrose in Environ products, and although it is a non-reducing sugar, it still causes glycation at pH 6 and temps as low as 5 degrees celsius. Then as pH lowers or temp increases, glycation increases.
https://www.sciencedirect.com/science/article/pii/S0939641116300923#f0015
Interesting question – does topically applied sugars, when they are part of the formulation of skincare products, accelerate glycation of skin proteins, thereby accelerating skin aging?
The article you cite looked at glycation of IgG proteins in pharmaceutical formulations intended for treatment of human disease through intramuscular or intravascular administration. That is an important question since maintaining the potency of such products directly affects their therapeutic benefit. Such products typically contain sugars in their formulations. Glycation during storage and subsequent inactivation of IgG antibody proteins is therefore of concern.
As background, a summary of intravenous IgG (a class of antibodies) follows:
“IVIG is used to treat various autoimmune, infectious, and idiopathic diseases. IVIG is an approved treatment for multifocal motor neuropathy, chronic lymphocytic lymphoma, chronic inflammatory demyelinating polyneuropathy, Kawasaki disease and ITP. The beneficial effects of an intramuscular injection of immune globulin for the prophylactic treatment of patients with primary immunodeficiency syndromes are well established. The therapeutic effects of IVIG go beyond antibody replacement in those patients with antibody deficiency. The number of inflammatory and autoimmune diseases (especially when it is administered intravenously) for which IVIG is used has expanded enormously. These diverse disorders range from blistering skin diseases to transplant rejection, neurologic diseases. It is widely accepted for use in persons with multiple other diseases including, but not limited to, Guillain-Barré syndrome, multiple myeloma, myasthenia gravis, acquired factor VIII inhibitor syndrome, autoimmune neutropenia, post-transfusion purpura, and polymyositis/dermatomyositis.”
Searches of PubMed and Google Scholar just now provided abundant proof of benefit of topical antiglycation ingredients. No references, however, were returned that specifically discussed the pro-glycation effects of topically applied sugars. That fact alone tends to make one think that the glycation consequence of topically applied sugars to the skin is likely non-existent or minor. If any BFT readers know of specific references, please send them to us so we may post them for our readers.
References you may find interesting on the subject of skin glycation are:
Clin Dermatol. 2010 Jul-Aug;28(4):409-11.
Nutrition and aging skin: sugar and glycation.
Pathol Biol (Paris). 2010 Jun;58(3):226-31.
Reaction of glycation and human skin: the effects on the skin and its components, reconstructed skin as a model.
Pathol Biol (Paris). 2010 Jun;58(3):226-31.
Reaction of glycation and human skin: the effects on the skin and its components, reconstructed skin as a model.
Clin Cosmet Investig Dermatol. 2016 Jun 22;9:143-50.
Results from in vitro and ex vivo skin aging models assessing the antiglycation and anti-elastase MMP-12 potential of glycylglycine oleamide.