The non-absorbed fructose can be rapidly propelled into the colon, where its contact with the anaerobic flora causes fermentation, bloating and diarrhea. It is remarkable that this action of dietary fructose on intestinal microbes can generate byproducts that influence systemic physiology and brain. Fructose entering the enterocyte cytosol may be phosphorylated by Ketohexokinase enzyme resulting in rapid depletion of ATP and accumulation of pyruvate and acetyl-CoA. Although these events help maintain the downhill fructose gradient into the cytosol, they also reduce intestinal Ca2+ and inorganic phosphate transport that compromises absorption of certain minerals essential for bone health. Under normal conditions, systemic fructose concentration is relatively low in healthy humans and tissues such that liver and kidneys are sensitive to small changes in circulating fructose. Excessive fructose intake also stimulates endogenous glucose production and lipid synthesis in the liver, events associated with the spectrum of MetS, such as obesity and systemic inflammation. Regarding fructose metabolism in intestine, the enteroendocrine cells after detecting fructose in the gut, activate a cascade of endocrine events. In particular, luminal fructose stimulates secretion of human PYY, cholecystokinin, neurotensin, and serotonin by secretory intestinal cells. A large body of literature indicates that most fructose is metabolized in the liver after being absorbed by the intestine to the bloodstream . The liver is the primary organ for processing lipids and proteins, which are exported to brain and other tissues and organs. Lipids are essential for brain function and behavior, being part of plasma membranes,stackable planters working as molecular transport systems, neuronal signaling systems, etc.. The brain contains the second highest concentration of lipids in the human body. The metabolism of brain lipids is tightly regulated through a liver-brain interaction in which the autonomic nervous system plays a crucial role.
Liver dysfunction can be aggravated by consumption of fructose as fructose is mainly metabolized in the liver where is converted into fatty acids that can reach the brain and expand the inflammatory reaction started in the periphery. Fructose is metabolized in liver via fructolysis, and the primary metabolites and by-products include glucose, lactate, triglyceride, free fatty acid, uric acid and methylglyoxal. GLUT5 is widely expressed in adipose tissue, kidney, muscle skeletal tissue, testis and brain that could also participate in fructose metabolism. It can be noted that fructose metabolism differs from that of glucose since hepatic fructose is converted rapidly to triose-phosphate independently of insulin control and without a citrate feedback. A large portion of fructose is converted into glucose which can be released into the bloodstream or stored as glycogen. Another portion of fructose is converted into fatty acids, which under exacerbation can contribute to the formation of hypertriglyceridemia and fatty liver disease. Furthermore, experimental long-term fructose consumption decreases mitochondrial enzymes that catalyze β-oxidation in the liver. Excessive lipid accumulation elicited by fructose in hepatocytes can also disrupt mitochondrial function and elevate levels of oxidative stress and inflammation. When compared with glucose, fructose over consumption exerts divergent effects on hepatic mitochondrial function. Quantitative electron microscopy revealed that fructose but not glucose increases the number of mitochondria in the liver, and increases fission and/or decreases fusion. These experimental data indicate that fructose-induced mitochondrial dysfunction may contribute to the development of fatty liver disease. Fructose consumption also induces pancreatic β-cells hyper-responsivity to glucosestimulated insulin secretion which can affect peripheral metabolism given the extreme sensitivity of adipose and other tissues to the action of insulin. The enzyme fructokinase C that rapidly phosphorylates fructose in the liver, reduces ATP, activates purine nucleotide turnover that culminates in the formation of uric acid as well as Reactive Oxygen Species and mitochondrial dysfunction.
Uric acid is a waste product from the breakdown of purines in the liver that once released to the circulation can reach the brain. Fructose catabolism in liver induces rapidly ATP depletion and release of uric acid to the systemic circulation resulting in hyperuricemia. In situations of high fructose consumption, oxidative stress promoted by accumulation of uric acid triggers an inflammatory response in liver and extrahepatic tissues, causing inflammation and lipid accumulation. Uric acid can harm the brain as seen in patients with Alzheimer’s and Parkinson’s disease in which uric acid acts as a risk factor for disease progression and a possible marker of cognitive dysfunction. The uric acid-mediated oxidative stress-induced lipid peroxidation causes DNA damage and activates inflammatory factors that lead to cell damage. The gut is the largest microbial, endocrine, and immune organ in humans and mice. The bacterial composition of the gut has emerged as profound regulator of whole-body metabolism and contributing to host immune homeostasis, and influencing brain function and disease. Gut microbiota plays an important role in brain-gut interaction and behavior by producing metabolites, hormones and immune factors that can influence the brain. Fructose affects microbiota composition and abundance that associate with metabolic dysregulation and select pro-inflammatory phenotypes in hypothalamus, liver and adipose tissue. Proinflammatory microbiota and its byproducts such as LPS recruit macrophages that bind toll-like receptors leading to the release of cytokines causing inflammation of the intestinal mucosa. As a consequence, there is a decrease in tight junction proteins resulting in a greater permeability of the intestinal barrier increasing the penetration of pathogens into the bloodstream. The hypothalamus is the master center for regulation of brain and body metabolism and control of appetite and feeding behavior, and works with the hippocampus to regulate cognitive function. The hypothalamus controls all body organs via the pituitary endocrine axis and the autonomic nervous system.
Fructose affects food intake by stimulating release of glucocorticoid hormones which feedback on the hypothalamus. Fructose over consumption , reduces total protein kinase B , Ser473-phosphorylated Akt , and insulin receptor phosphorylation in the hypothalamus. Insulin inhibits the expression of neuropeptide Y and agouti-related protein , which are orexigenic neuropeptides that stimulate food intake in the hypothalamus. Therefore, excess of circulating insulin secondary to fructose-induced insulin resistance dysregulates energy homeostasis leading to AgRP/NPY over expression, in association with an increase in appetite and body weight. Fructose affects appetite hormones like ghrelin, leptin and peptide YY , which are secreted in the periphery and travel via circulation to the hypothalamus. Fructose stimulates release of leptin from adipocytes and promotes leptin resistance together with an enhancement of satiety signals in the hypothalamu. Leptin resistance involves Janus Kinase -mediated phosphorylation, activation of transcription 3 functions, and impairment of leptin transport through the BBB. The leptin resistance elicited by high fructose , can occur on the absence of body weight gain or circulating leptin levels; therefore, it is possible that leptin resistance is an early feature in the chronic process of development of a fructose-induced metabolic disorder. On the other hand, a short period of fructose consumption in humans has been shown to result in lower levels of circulating insulin and leptin, and fails to suppress post-meal ghrelin levels. Therefore, it seems that the length and concentration of fructose intake are crucial determinants for the type of physiological response. It is notable the strong interaction between pathways that regulate food reward and metabolism in the brain, and that they become dysfunctional in metabolic disorders such as obesity. The hypothalamus harbors neurons that express the endocannabinoid receptor 1. The endocannabinoid system seems to play a regulatory role on the rewarding aspect of the consumption of palatable foods,stacking pots and particularly high fructose. Endocannabinoids levels are increased in response to fasting and are suppressed postprandially. In addition, a single intravenous injection of leptin, which regulates energy balance and eliminates hunger, reduces endocannabinoid release from the hypothalamus. Experimental evidence indicates that short-term consumption of fructose but not glucose increases mRNA levels of CB1 receptor and affects enzymes involved in the synthesis/degradation of endocannabinoids. The hypothalamus plays a crucial role on the control of brain and body homeostasis. Fructose has several metabolic effects in the hypothalamus such as depletion of ATP, increase in activation of AMP kinase, inactivation of acetyl-CoA carboxylase, reduction of malonyl-CoA, together with stimulation of food intake. Furthermore, fructose-induced hypothalamic AMPK activation increases hepatic gluconeogenesis by the elevation of circulating corticosterone level, further contributing to systemic insulin resistance. Fructose but not glucose has been shown to reduce hypothalamic cerebral blood flow in healthy volunteers . Ancillary, fructose is metabolized faster than glucose in the brain, pointing out another difference between fructose and glucose.
Fructose consumption can elicit robust changes in oxidative stress in the hypothalamus. For example, high-fructose consumption for 10 weeks decreases levels of antioxidant enzymes, including cytoplasmic copper-zinc superoxide dismutase 1, mitochondrial manganese superoxide dismutase 2, glutathione peroxidase, glutathione reductase, and catalase. The actions of fructose on hypothalamic metabolism may be operational for regulation of metabolic disorders such as obesity, insulin resistance , and other disorder. Using systems nutrigenomics in a rodent model of high fructose consumption, it has been reported that fructose uses the extracellular matrix biglycan gene to alter molecular pathways related to oxidative phosphorylation, glucose metabolism and fatty acid metabolism in the hypothalamus. This prominent response of Bgn in hypothalamus elicited by fructose is crucial to understand how metabolic disorders influence brain centers. The hippocampus plays a preponderant role on learning and memory processing and works with the hypothalamus to integrate feeding behavior with higher order functions. The hippocampus is highly susceptible to the action of fructose such that high fructose consumption results in alterations in cognitive function. Experimental evidence in rodents shows that over consumption of fructose for a duration , sufficient to disrupt peripheral metabolism reduces hippo campal insulin receptor signaling, which is commensurable to poor learning and memory performance. In addition, 15% fructose by 8 weeks compromises the capacity of the hippocampus to sustain synaptic plasticity in the forms of long-term potentiation and long-term depression , followed by reduction of synaptic contact zones and neurogenesis. Even a shorter period of fructose or sucrose consumption but not glucose, reduces hippocampal neurogenesis. Fructose consumption is currently perceived as an important cause of metabolic disorders with subsequent detriment of cognitive function. In this context, several mechanisms have been suggested for the action of fructose on cognitive function such as disruption in oxidative metabolism, decreases in neurotrophic factor expression, increases in oxidative stress and inflammation. A comprehensive study showed that high fructose consumption in rodents for 6 weeks disrupts pathways associated with cell energy metabolism involving peroxisome proliferation-activated receptor gamma coactivator 1-alpha , mitochondrial transcription factor A and sirtuin 1, and synaptic plasticity modulators such as cAMP response element-binding protein . The fact that PGC-1α interacts with TFAM on mitochondrial bio-genesis and SIRT-1 affects synaptic plasticity via post transcriptional regulation of CREB suggests that fructose may disrupt the interface between cell metabolism and synaptic plasticity, making the brain susceptible to neurological disorders. Interestingly, the effects of fructose on cognition may also involve inflammatory pathways that are affected by hepatic metabolism. For example, translocation of high mobility group box 1 , a highly conserved non-histone DNA-binding protein, from nucleus to cytoplasm in response to high fructose consumption elicits an inflammatory cascade involving Toll like receptor 4 , nuclear factor-kappa B and the transcription of proinflammatory cytokines. The TLR4/NF-κB signaling pathway activation elicited by HMGB1 induces apoptosis in hippo campal cells and subsequent cognitive deficits in animal models of obesity. The over consumption of fructose-sweetened beverages is particularly relevant to young individuals. Experimental short-term fructose consumption in young rodents results in increased levels of inflammatory and oxidative damage markers in the hippocampus. These studies reinforce the idea that oxidative stress and inflammation play a central role in fructose-induced damage to the brain even in offspring. In turn, studies showing increases in cerebral protein nitration followed by cytochrome c oxidase and Citrate synthase activity in the hippocampus from adult, but not young, suggest that aging might exacerbate the oxidative condition induced by this diet and this is particularly relevant since protein nitration plays a role in the progression of neurological disease. Chronic fructose consumption disrupts various cellular processes such as inflammation and oxidative metabolism which reduces the threshold for a range of neurological and psychiatric disorders. For example, visceral fat and serum triglycerides induced by high fructose consumption have been associated with anxiety and depression-like behaviors. Furthermore, it is known that fructose modulates the serotonergic system, which has important actions on the regulation of emotions and cognition.