Having praised during the eighties the merit of this 'natural sugar', the scientific community is now unanimous; consuming fructose constitutes the worst dietary advice that one could give to diabetics, who without further ado, should throw their fructose jars in the nearest available bin.

For example, it is known today that an over consumption of fructose promotes hypertension, renal dysfunction, raised uric acid levels, visceral and/or abdominal fat accumulation (including fatty liver), diabetes (well I never!) and the fearsome metabolic syndrome.

The latter represents an undisputed modern day plague, combining physical signs (obesity or simply abdominal fat (midriff tyre)), raised blood pressure, and biological abnormalities (raised insulin and triglycerides, lowered 'good' HDL cholesterol, raised hepatic enzymes SGPT) – an explosive cocktail that acts as direct precursors to degenerative diseases: diabetes, cardiovascular events, Alzheimer etc...

But how much is "too much fructose" and are all forms of fructose equal in this apocalyptic scenario? The answer is no; the fructose from fruits and vegetables is not as dangerous as that which is used as sweetener, a crystallised form, derived from the corn waste process (HFCS or High Fructose Corn Syrup). Its price is attractive and its sweetening power superior to classic sugar (sucrose), making it an ideal choice for the food industry, even more so because it doesn't make one feel satiated in the same way as classic sugar and fat would.

As a guide, one can fix the maximum limit for fructose intake at 30 grams per day, but this figure should be reduced for those who present with a slightly or abnormally raised level of uric acid. In the case of hyperuricemia, fructose intake should be reduced below 15 grams a day!

To help you, you can find a "fructose list" on my website: www.gmouton.com (PDF file to download free of charge). This list gives you the fructose contents of fruits, vegetables, dried fruits and various drinks. You can also access all the scientific references on the topic via the fructose conference (conferences/Nutrition & Function) in English.

Final warning: do not believe the slogan "without added sugar" on food packaging. All this means is no added sucrose - but it can still be full of fructose. Rather, the actual amount of sugars can be found on the 'Nutritional Information' box printed on the product, under the heading "Carbohydrates of which sugars". The trick comes from playing on the s of sugars: Fructose is not a sugar but one of the sugars!

Congratulations Dr Kellogg! This is the American Physician who invented Cornflakes in 1894.

Dr Kellogg you have managed to make millions of people believe that to benefit from a decent breakfast they should buy, not a natural product, but instead one that has been processed and packaged in a factory.

We can see the results:

• grains are often the cause of allergies: wheat, with its integral gluten protein, and corn, represent two major causes of food allergies, in Europe and in America respectively.
• sugar is found in great quantities to make them palatable.

It must be recognised that this ‘coup de bluff’ should have earned Dr Kellogg the first Nobel prize in Medicine (or perhaps Marketing), more than a century ago. Unfortunately, the very first Nobel Prize was only awarded in 1901.

Who could have imagined that so many people, in ever increasing numbers it seems, would feel compelled to swallow a processed product 'to remain in good health'.

A further problem arises when milk is added to produce this ‘cereal-soup’. Milk that comes from the animal kingdom could provoke harmful reactions:

-IgE or IgG allergies to casein and to beta-lactoglobulin, two major milk proteins - and lactose intolerance.

Or milk from vegetable sources, which are very poor sources of protein: such as rice milk; or from other cereals whose hydrolysis releases great quantities of fast-sugars - as stated on the labels.

Protein, here it is the ‘grand word’. Indeed, the fact is that nearly six billion individuals eat protein with their breakfast! And you? Are you one of those few hundreds of millions of weirdos- that live in North America and in some Western European countries - that have decided to ignore the fundamental rules of physiology, namely the need to stabilise blood sugar levels after the overnight fast?

Here are examples of the proteins eaten at breakfast round the world:

Smoked fish in Scandinavia; black-pudding in Wales; haggis in Scotland; bacon and eggs in England; Feijoada - black beans baked with various kind of meat and sausages in Brazil; small ravioli stuffed with meat or fish in Ecuador.

Then, when discussing this matter with those unaccustomed to eating protein at breakfast, we realised that there was a problem…

If the person remained sceptical regarding the need for protein at breakfast and claimed - in the face of contradictory evidence - that they were healthy and happy with their croissant and marmalade or toast and jam, I would tell them about the people of Asia. You would not find, across this continent, anyone eating a traditional breakfast without protein in it. And I would add: “there are four billion inhabitants; they must have some reason to do so, surely?”

Breakfast will set the pace for the whole day ahead. It should correct the low levels of blood sugar that followsfrom twelve hours of fasting. However, it could make a ‘good’ or a ‘bad’ job of it. It would be a ‘good’ job if the blood glucose curve rises smoothly and holds until the next meal, without suddenly causing premature hunger. It would be a ‘bad’ job if the blood glucose curve starts to oscillate; the peak provoked by the toxic breakfast inevitably leading to a sudden drop in blood-sugar levels.

Such a crash in blood sugar is caused by the excess of glucose consumed, which triggers the secretion of large amounts of insulin, a fat-storage hormone that rapidly clears sugar from the bloodstream. Then we find the curve lower than at its starting point. This state of low blood sugar (hypoglycaemia) promotes the uncontrollable sugar cravings that will reactivate the infernal machine once again.

Instead of stability, the toxic breakfast generates fluctuations in blood sugar levels that give rise to the impulse to eat more sugars, thus perpetuating the phenomenon until bedtime and, sometimes, this can even lead to waking up during the night.

To avoid the increase of blood sugar,straight after breakfast, one must, of course, stay away from fast sugars. However, it is not only carbohydrates containing fast-sugars that are the problem. A layer of fat on the toast won’t change anything; protein is needed to slow down carbohydrate digestion, and to smooth the peak of blood sugar that will certainly occur if eating only starchy foods.

This principle remains valid for all meals and snacks. It must be recognisedby all those who have a great capacity for metabolising carbohydrates very efficiently; among whom we can find the vast majority of those who see their abdominal fat rapidly accumulating more and more; let alone the obese and those with type II diabetes (“fat” diabetes).

You have probably heard of coeliac disease already; the genetic and auto-immune affliction affecting about 1% of the population of Western Europe. It is a severe allergy to gluten with devastating health consequences. Gluten containing proteins are present in four cereals: wheat, rye, barley and oats (spelt and kamut are old grains of the wheat family but with much less gluten, while the cereal teff doesn’t have any).

Coeliac disease can be detected with a specific blood test but the diagnosis must be confirmed by a biopsy of the duodenal/jejunal mucosa, which is performed by endoscopy. This disease has major health consequences and only the strict and complete avoidance of gluten will avoid the associated health risks, which include: multiple nutrient deficiencies, osteoporosis, anemia, auto-immune pathologies, and digestive lymphomas, to name only several of the most common risks.

This disease involves an immune response based on Immunoglobulins IgA. Other allergies to gluten via IgE (immediate or anaphylactic reactions) or IgG (delayed reactions) can also occur but are not part of coeliac disease. In this latter situation, clinical reactions vary enormously from one patient to another and they do not necessarily involve the digestive tract. Strict adherence to a gluten-free diet is not mandatory as is the case with coeliac disease, but gluten avoidance still plays an important therapeutic role.

In addition to true allergies, which involve the development of specific anti-bodies by the immune system, there are also other intolerances/sensitivities to gluten, which don’t involve the immune system (as is the case for lactose intolerance, which is entirely different to an allergy against animal milks).

One specific gluten protein is gliadin, consumption of which stimulates the secretion of zonulin by the intestinal mucosa. This human protein discovered by Alessio Fasano in 2000 is responsible for the opening of the tight junctions between the enterocytes leading to a leaky gut or intestinal permeability.

This phenomenon can happen to everyone, independently of an allergy to gluten. Any intestinal permeability increases the passage of non-digested macromolecules (‘invaders’) which are at the origin of a trigger of the immune system. In predisposed individuals, this can lead to auto-immunity or atopy (allergic respiratory or cutaneous allergies towards usually well tolerated allergens like pollen, animal hair or mites). Nowadays, these two pathologies are encountered more and more frequently.

The other form of intolerance to gluten comes from a small protein with deleterious effects. It is the WGA or Wheat Germ Agglutinin polypeptide, the inflammatory activity of which is responsible for many unpleasant symptoms after ingestion of gluten, including abdominal bloating.

We have encountered many forms of unfavorable reactions to gluten, auto-immune or otherwise, the pathophysiological complexity of which is only matched by the multitude of clinical manifestation. The most surprising aspect of this diagnostic labyrinth resides in the frequent absence of digestive symptoms with allergic patients (they may have, for example, cutaneous or neurologic symptoms), while the simple sensitivity to WGA can produce pronounced digestive discomfort. Ultimately, we should not be surprised by the elevated percentage of people who claim to have better digestion, or simply feel better, without gluten.

On a practical point, gluten-free substitutes must be examined carefully. Their lack of palatability often gives rise to the immoderate addition of sugar, whilst the lack of binding often requires the use of egg whites. The high glycemic index of gluten-free products, and their typically prohibitive cost, should also be noted.

Moving beyond the gluten free cereals, let’s mention tubers, roots, legumes and the other pseudo-grains (quinoa, amaranth, buckwheat), which offer good alternatives. You can download this information, and much more in this field, from my website www.gmouton.com: see tab lists and also the detailed conference on celiac disease (tab conferences, heading nutrition and function).

I can remember when I was a medical student, the launch of these “miraculous” drugs destined to heal gastric and duodenal ulcers. At that time we only had relatively inefficient anti-acids and here was a breakthrough; a one month treatment with omeprazole, maybe two in more severe cases, was often enough to heal the ulcer.

Unsurprisingly, this application was extended to treat inflammation of the oesophagus (heartburn), as well as the deleterious symptoms of gastro-oesophagial acid reflux. However, no definitive cure was seen during several months of treatment, rather a very temporary relief that would quickly disappear as soon as treatment was halted.

Currently there are a multitude of patients taking proton pump inhibitors (PPI) long term – sometimes “for life” we are told - because they are not willing to stop and risk the return of the burning symptoms and pain.

Here we are again, facing the trap of the symptomatic treatment destined to improve one complaint, in this case acid reflux, without worrying about the real causes that could explain the problem.

Often, acid reflux originates from a mechanical fault affecting the closing of the valve that protects the oesophagus from leaks of hydrochloric acid secreted by the stomach. In medical terms, this is called a hiatus hernia.

However since many patients who have a certain degree of hiatus hernia do not have – or no longer have – pain, suggests that other factors contribute to the oesophageal soreness.

It is acknowledged that once balance has been restored to the intestinal ecosystem (with a change of diet, with pre and/or probiotics, natural or medical antimicrobial treatments, digestive enzymes etc… – in effect a whole therapeutic strategy individualized to the patient) the symptoms will disappear and allow many patients to reduce and then eventually stop taking the PPI.

The side-effect profile of long term PPI use is far from reassuring. They result as a logical consequence of artificial suppression of hydrochloride acid (HCl) and with it, the loss of its multitude of physiological roles.

The change of pH (acidity) in the stomach can have a number of deleterious effects. It can lead to a proliferation of bacteria in the small intestine (SIBO or small intestinal bacterial overgrowth), due to the survival of pathogens that would normally be destroyed by HCl (and can also include fungal infections, or infection by cosmopolitan amoeba and other protozoans). Increases in infectious pathologies targeting the intestines such as Clostridium Difficile diarrhoea and bacterial gastro-enteritis, have all been cited in medical scientific journals.

The change of pH can also disrupt the physiological mechanisms of the digestive tract to absorb nutrients. This perturbation can manifest itself through many deficiencies identified in patients taking long term PPIs. For example; iron and vitamin B12 deficiencies can induce anaemia, calcium and magnesium deficiencies facilitate osteoporosis and also hypomagnesaemia.

As far as digestive cancers are concerned, the situation is more serious. If PPIs protect against oesophagus adenocarcinoma, they actually increase the risk of gastric cancer (a consequence of the lack of HCl) and gastric carcinoids (the consequence of hypergastrinemia). PPIs also increase the prevalence of gastric polyps. Taken as whole, these are very serious side-effects...

Ultimately, the question is whether chronic PPI use is justified? This is clearly a question of growing concern, especially as we do not yet have sufficient hindsight to be able to judge the long term consequences. Surely we cannot casually disregard the important physiological mechanism, the production of hydrochloric acid by the stomach, which came about long ago as part of the process of human evolution?

The most severe cases of cardial incompetence (cardia : entry to the stomach) can benefit from a surgical procedure, while in less severe cases it is definitely better to nurture the intestinal ecosystem to restore the physiological equilibrium.

I have recently posted on my internet site www.gmouton.com a scientific article on this subject, written in English and well referenced (20 publications in major medical journals). You can find them in the tab “articles” preceding the identifier “5c”.

Now it is time to bring some enlightenment to the multiple negative reactions humans can have towards animal milk products. It is an important subject about which we constantly hear many confusing statements, with people swiftly mistaking the three main components of milk products: sugars, proteins, and fats.

It is mainly sugars, in particular lactose, that gives rise to intolerances; proteins such as casein, alpha-lactalbumin and beta-lactoglobulin that can generate allergies of different types; and fats rich in saturated fatty acids (mainly stearic acid and pentadecylic acid) and in trans fatty acids (cis-linoleic acid for example) along with cholesterol.

Let’s start with the fats. The excess of LDL cholesterol (but you need some to stay in good health regardless of what they tell you) and pentadecylic acid are considered as atherogenic, at least indirectly. But in contrast, the stearic acid doesn’t appear to be harmful and the conjugated linoleic acid (CLA) can even be useful for our health even though it is a trans fatty acid. This is in stark contrast to the trans fatty acids created artificially by the overheating and hydrogenation of vegetable oils, with are extremely toxic for humans.

Mammal milk contains a complex mixture of various proteins, and consequently multiple antigens (at least one hundred can be counted!) which can be at the origin of allergies, being either of the immediate reaction type (IgE antibodies), or delayed reaction type (IgG antibodies). The caseins of animal milks differs significantly from human milk, hence their allergenicity, while the beta-lactoglobulin doesn’t even exist in maternal milk as this gene doesn’t belong to the human genome.

Indeed, cow’s milk has more protein than human milk, the latter being a lot sweeter due to its richness not in lactose but in oligosaccharides which are small complex sugars that promote the growth of the bifidobacteria of the newborn intestinal flora (bifidogenic factor). Goat’s milk and ewes milk are intermediaries, with more whey than cow’s milk and therefore closer to human milk, which of all the mammal milks contains the most whey (a mixture of proteins, often beneficial) including alpha-lactalbumin.

This explains the excess allergenicity of cow’s milk, less so of goat’s milk, and even less for ewe’s milk even when we find considerable individual variations. The allergenicity is reduced if we hydrolyse these proteins, hence some hydrolysed hypoallergenic baby formulas for new-born infants.

The explanation as to why frequent allergy to the proteins of cow’s milk is seen is because they are introduced too early in the baby’s diet. In contrast, in the last century, breast feeding was prolonged and they also had wet-nurses. In the 6 to 12 months of early life the intestinal mucosa remains abnormally permeable to allow the protective antibodies of maternal milk (antibody IgA, absent from cow’s milk) to come to the rescue of the immature immune system of the new born, which is yet incapable of synthesizing them. Everything is sorted out later, but too late for many babies that are allergic to cow’s milk ….and pureed banana!

Cow’s milk is abundant in lactose, a disaccharide (glucose + galactose) that can only be digested by the action of lactase, an enzyme (disaccharidase) secreted exclusively in the mucosa of the small intestine. When this is disrupted, for example by an episode of diarrhoea, we encounter difficulties in tolerating lactose for a few days, until such time that the brush border has recuperated.

Lactose intolerance simply reflects the lack of the enzyme lactase, only temporary in the case detailed above, but permanent for many Caucasians and for the immense majority of other populations of the globe for which it constitutes the rule and not the exception. It is not an allergy, there are no antibodies and no intervention of the immune system: it is indeed what can be properly termed an ‘intolerance’.

This is why all of those people who buy lactose free milks in order to escape the devastating effects of milk protein allergy make a huge mistake! One must admit that the marketing of these products is perverse because it addresses itself to all those people who do not digest milk, without any distinction….

One can find skimmed milk (with no fats) and lactose free milk (with no sugars) but no milk without proteins. One should consider whether a milk without fats, sugars and proteins is no more than plain water!

To replace the animal milk for people with allergies, vegetable milks are a good option but you need to be careful of the high sugar content. Read the labels! It is better to use them in rotation and it is recommended not to abuse soya milk. You will find a complete list of current types of vegetable milk on my website www.gmouton.com.