Nearly every day, each and every one of us will consume food products that contain Advanced Glycation End products (AGEs). Yet few people have ever heard of these chemical by-products which affect almost every cell and molecule in the body and contribute to the aging process as well as having a role in diabetes complications such as kidney disease.

Advanced glycation is a biochemical process brought on by an excess of sugar – we see it in the browning of fruit and the process is also apparent in the aging of collagen, resulting in the gradual formation of wrinkles and lines on our skin as we grow older. Advanced Glycation End-products are also commonly consumed in western diets since they are made by modern processing techniques to give food taste, texture and properties such as longer shelf life.

There are essentially two ways in which the body accumulates an excess of AGEs.  People with diabetes or pre-diabetes, experience a build up of AGEs due to an excess in blood sugars circulating through the body. Glycation is a major problem in diabetes and has the capacity to do significant damage to the organs of a person with diabetes over several decades.

Essentially, AGEs speed up the aging process, and can lead to a “caramelization” of major organs such as the kidney. Kidney disease is an important risk factor for heart attack. It is estimated that as many as 70 per cent of people with diabetes die from heart attack or stroke.

But for most of us, we are exposed to AGEs through the food we consume. Foods that are processed, and contain high levels of sugar and fat, foods that are grilled and baked are known to contain excessive levels of AGEs. Typical examples include cola drinks, coffee, toasted breakfast cereal, commercially baked products and crispy, fried food such as chicken nuggets.

The processes involved in cold storage also produce AGEs so that food sold as ‘fresh’ which has been refrigerated for six months can actually be quite high in AGEs. As well as having a deleterious effect on organ function, AGEs are also known to reduce the amount of essential amino acids contained in food. This in-turn inhibits the body’s ability to absorb the nutrient content of what we eat.

The study of AGEs, their effect on the human body and contribution to the development of chronic disease is a relatively new field. AGEs first emerged in the 1980s in context of the study of aging and it was not until the nineties that we started to understand the implications for people with diabetes. However, in this short time, there are has been several important scientific studies into AGEs that compel us to re-think our approach to food.

I am personally buoyed by the momentum we are seeing in this field with the establishment of two key scientific groupings (COST & IMARS) focused on bringing together researchers from across the globe to discuss their research and develop a better understanding of how AGE’s impact human health.

There is much more to be done. The food and grocery industry has a key role to play in helping consumers identify and limit the amount of harmful chemicals they ingest through modified foods. Better labeling of processed foods is just the beginning. Consumers should be able to go into a supermarket and put together a fresh meal with ease.

In the UK, large supermarket chains such as Tesco and Marks and Spencer have been responding to calls for healthier choices by retailing products such as pre-washed and cut vegetables and fruit. They seem to be able to offer packaged ‘convenience’ food with a short shelf life that is fresh and low in preservatives. And consumers have responded very positively.  Pre-cut, bite-sized celery and carrot sticks, quartered apples and diced vegetables are anathema to Australian grocers who maintain a high entry barrier for new products coming onto the market – especially those which threaten to take market share from house labels.

Manufacturers also have a responsibility to monitor and limit the amount of dangerous chemical by—products in their offerings. Regrettably, it seems regulation is the surest way to do this because it creates a level playing field, ensuring that a manufacturer isn’t penalized by poor sales performance if they modify their products in a way that reduces the flavor, making them less attractive than saltier, more processed rivals.

Mounting an argument for regulation of AGEs is not going to be an easy task. In the first instance, we need to be able to provide irrefutable evidence about the existence of AGEs and the danger they pose to good health. The best way to do this is through large-scale, evidence-based scientific trials, similar to the ones the pharmaceutical industry sponsor when they want to solicit support for bringing a new drug to market.

At present, it is difficult to get funding for trials of more than 200 people and more often than not, nutritional studies in Australia average a dismal 30-40 participants. Contrast that with the power of the pharmaceutical industry who are able to gather evidence on cohorts of five to ten thousand people with ease (Josie: please change this to whatever you think is accurate). It seems unlikely that the Australian government would be willing to take on the might of the manufacturing industry based on the evidence gathered from 50 people.

Two changes would assist with the push for regulation. First, we need investment in large-scale studies into the impact of modified foods and their potential contribution to chronic disease. Second, regulating authorities could meet scientists half-way by reconsidering the scale and weight of what is acceptable as an evidence base. In other words, we need a shift in thinking that enables smaller studies to be seen as scientifically significant.

The task is difficult but not insurmountable. Last year, the German parliament rejected a bill that would see better labeling of AGE laden foods. But to their credit, the German institute for consumer protection and food safety (BVL) has identified six product categories associated with acrylamide risk. Acrylamide is a possible carcinogen which forms when starch-rich foods are fried or baked. It’s a close cousin of the AGEs. The BVL has announced a concerted approach to reducing acrylamide, in consultation with the food industry. The categories are: French fries; other fried potato products; pastries; Swedish style breads; coffee powder; and breakfast cereals[c1] .

But while the evidence is still emerging and in the absence of a global campaign, backed by a well funded lobby group, there are certain steps we take at an individual level to guard against the hazards of AGEs.

We can start by being more mindful of what we consume. As a general rule, it’s fairly safe to assume that any food that has been modified or processed and not in its original raw form probably contains some trace of AGEs.  It follows also that the greater the level of modification, the higher the concentration of AGEs. If food has a label, chances are, a chemist was involved in its manufacture.

So while it’s important that we improve label simplicity and provide more detail about processed foods, at the end of the day, they’re still processed and high in salt, sugar, and yes, AGEs.

The best food is always ‘fresh’ and ideally, in-season. There are very good physiological reasons why certain foods are available at particular times of the year. For example, it’s no accident that nature ripens oranges in winter – just when we need vitamin C to guard against colds.

For the average consumer, trying to navigate the choices in a supermarket is a mine field.  There is so much more that manufacturers, retailers and government can do to help them emerge with a basket of nutritious ingredients that won’t compromise their health. Declaring and minimizing the amount of AGEs in the basket would be a very good start.

Last Reviewed 03/Mar/2014

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A/Prof Forbes' work has resulted in more than 80 publications in highly ranked diabetes and related journals with excellent citation rates. Her research focuses on the biochemical process of advanced glycation and diabetes.

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