AGEs: How to guide your patients

The important role of diet in chronic disease is well known. As registered dietitian nutritionists (RDNs), we regularly focus on the benefits of certain foods and nutrients, whether it be helping our patients reduce their intake of fat or add more fiber to their diet.

Going beyond food and nutrients alone, researchers have also found a connection between a substance called advanced glycation end products or AGEs and disease development and progression. This substance is linked with certain foods, dietary patterns such as the Western diet, and certain methods of food preparation. Taking a closer look at each can not only further our nutrition knowledge but also improve the recommendations we give to our patients.

What are AGEs?

Advanced glycation end products or AGEs are a result of the commonly known Maillard reaction. Within this process, these substances are produced when a reducing sugar carbonyl group combines with a protein, aminophospholipid or nucleic acid free amino group. Adding to the complexity, it can take place at two separate times.

First, it might occur within the body’s tissues and fluids as part of metabolism, and dietary components such as simple sugars tend to drive this response. Alternatively, production of AGEs through the Maillard reaction can be stimulated by certain types of foods and the method used for cooking. Foods cooked at higher temperatures over a longer time, such as fried or roasted foods, are associated with higher AGE production.

The western diet

The Western diet is associated with not only obesity and its many comorbidities, but also with a higher incidence of AGE formation. Foods commonly consumed as part of this dietary pattern are more extensively processed, marketed as cheaper than a healthier alternative, and may have a longer shelf life.

Along with these choices may also come certain nutrients such as simple sugars (think fructose as one!) or refined grains and a higher content of saturated fat. As processing of certain foods in the Western diet occurs, especially with methods using longer exposure to higher temperatures, formation of undesired AGEs is more common.

AGEs and health implications

So, what does this mean in terms of the impact of dietary AGEs and health? While some accumulation is anticipated with the body’s metabolism, additional absorption from diet, especially in excess, can have negative consequences. While the body can prevent some accumulation with normal antioxidant function, increased levels of dietary AGEs create oxidative stress and inflammation.

In terms of chronic disease, AGEs are most frequently associated with diabetes and obesity but can also influence cardiovascular health, damage blood vessels leading to chronic kidney disease, limit function of the nervous system, and may impact neurological disorders such as Alzheimer’s dementia. More attention to dietary AGEs and the benefits of reducing these harmful substances should be considered by the RDN with patient care.

Practical application to reduce dietary AGEs

Different preparation or cooking methods can influence the presence of AGEs in the foods being consumed. Paying attention to simple techniques to reduce AGEs and maintaining a healthy diet can go a long way for your patients. Consider the following tips to lower dietary AGEs and make an impact on the individual with chronic disease.

• Plan ahead and marinate. While this method may be a little more time consuming, marinating foods, particularly meats, can reduce the dietary AGEs being consumed in these selections. Certain marinades such as vinegar or lemon juice not only help tenderize meat but also create a more acidic environment, reducing the presence of dietary AGEs.
• Temperature makes a difference. Timing and heat intensity can make a difference in the number of AGEs that are formed during the cooking process. Cooking at a lower temperature lessens the presence of AGEs as the item is cooked.
• Mix it up with cooking methods. As part of patient education, we often highlight healthier cooking methods and this can also be true when thinking about reducing dietary AGEs. Regularly frying and roasting should be discouraged and instead methods with moist heat such as boiling or slow cooking should be recommended.
• Increase plant-based foods. Foods from plant-based sources offer many health benefits and can also be lower in dietary AGEs in comparison to meat or other animal-based choices. Many plant-based foods can be eaten raw, avoiding the need for cooking and the opportunity for AGEs to develop. Also, these foods may be naturally high in antioxidants helping to prevent AGE formation.
• Start from scratch with homemade meals. Homemade meals are generally a healthier option, and this includes a reduction in dietary AGEs as well. AGEs are more likely to be found in foods that are processed. Encourage your patients to try different recipes at home that include whole, fresh foods as ingredients.

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References:

Cepas V, Collino M, Mayo J, Sainz R. Redox signaling and advanced glycation endproducts (AGEs) in diet-related disease. Antioxidants. 2020:9(2):142.

Food and Nutrition. 7 Tips for Reducing AGEs in Your Food. https://foodandnutrition.org/november-december-2015/7-tips-reducing-ages-food/. Accessed October 5, 2022.

Ribeiro P, Tavares J, Costa M, Mattar J, Alfenas R. Effect of reducing dietary advanced glycation end products on obesity-associated complications: a systematic review. Nutrition Reviews. 2019:77(10):725-734.

Sergi D, Boulestin H, Campbell F, Williams L. The role of dietary advanced glycation end products in metabolic dysfunction. Mol Nutr Food Res. 2020:65(1):1900934.