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Medicine Biotech

A Popular Sugar Additive May Have Fueled the Spread of Two Superbugs (latimes.com) 125

Zorro (Slashdot reader #15,797) quotes the Los Angeles Times: Two bacterial strains that have plagued hospitals around the country may have been at least partly fueled by a sugar additive in our food products, scientists say. Trehalose, a sugar that is added to a wide range of food products, could have allowed certain strains of Clostridium difficile to become far more virulent than they were before, a new study finds. The results, described in the journal Nature, highlight the unintended consequences of introducing otherwise harmless additives to the food supply.
Nearly half a million people were sickened by C. difficile in 2011, when it was directly linked to 15,000 deaths. "The misuse and overuse of antibiotics has long been thought to be responsible for the rise of many kinds of antibiotic-resistant 'superbug'," notes the article, before citing a researcher who now believes "the circumstantial and experimental evidence points to trehalose as an unexpected culprit."

A Popular Sugar Additive May Have Fueled the Spread of Two Superbugs

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  • highlight (Score:1, Insightful)

    ...highlight the unintended consequences of introducing otherwise harmless additives to the food supply.

    It seems like this 'highlights' one unique and unproven possibility, and nothing more. Getting ahead of ourselves....

    • by tomhath ( 637240 )
      What they've found is that certain strains of C.diff can convert trehalose into glucose; so the bacteria are using the sugar that's available to them. The important thing to keep in mind is that millions of people consume trehalose every day. It takes more than a bit of this sugar in one's food to cause the problem.
      • The Actual Process (Score:5, Informative)

        by LeftCoastThinker ( 4697521 ) on Sunday January 07, 2018 @02:30PM (#55881205)

        Yes and no. What they propose is happening is that Cdiff, which something like 30% of the world's population carries in their GI, has become an infectious problem (Cdiff infection, or CDI) in the last 15 years because of the following process: First, a patient takes life saving antibiotics for a medical problem. Without antibiotics something like 60% of infections are fatal (the bad old days before penicillin was discovered). Those antibiotics wipe out the infection, but also the good GI bacteria, but Cdiff is able to make an impervious spore form that is immune to all known antibiotics except for Metronidazole and Vancomycin (which are both not normally given for infections, Vancomycin especially has some very nasty side effects). Once the patient is better and they discontinue antibiotics, the Cdiff can flourish in the absence of other bacteria. It produces some very nasty toxins, one that destroys cells as well as a systemic poison that can kill you (toxin A and B).

        The new discovery is that it is not just the absence of healthy bacteria in the GI that triggers CDI, but the presence of this food additive Trehalose that was previously thought to be safe, because the body doesn't absorb it very well (though it does get absorbed): "Trehalose is nutritionally equivalent to glucose, because it is rapidly broken down into glucose by the enzyme trehalase, which is present in the brush border of the intestinal mucosa of omnivores (including humans) and herbivores." https://en.wikipedia.org/wiki/... [wikipedia.org]

        The bottom line is now that we know that Trehalose is a aggravating risk factor for CDI, any foods that contain it should be required to carry a large warning label on the front of the package (like cigarettes) describing the danger, if it is not banned altogether as a food additive. At the same time, the companies that are profiting from the manufacture and sale of Trehalose are looking at a serious lawsuit, since about 50,000 people in the US alone have died from Cdiff in the last 10 years.

        There will be no human trials, other than to ban Trehalose for patients during and for a month after treatment with antibiotics (typical incidence time frame for CDI). If the cases of Cdiff drop precipitously, especially in high risk patients, that will be all the confirmation required.

        • by tomhath ( 637240 )

          except for Metronidazole and Vancomycin (which are both not normally given for infections, Vancomycin especially has some very nasty side effects)

          Nonsense. Vancomycin is one of the more commonly prescribed antibiotics in hospitals.

          The new discovery is that it is not just the absence of healthy bacteria in the GI that triggers CDI, but the presence of this food additive

          That's not how I read it. There are a couple of strains of C.diff that can metabolize Trehalose, making it equivalent to glucose - as you state in your second paragraph. So hospitals should treat it with the same caution as they do other sugars when a patient might be at risk of a C.diff infection. Otherwise it doesn't pose any particular threat.

          • 1. Oral Vancomycin is only marginally absorbed, in IV form it can damage multiple organs and patients must be monitored closely. Orally it can damage your intestinal lining for the same reason, it is less damaging than the CDI though, considering CDI can kill you. Metronidazole can damage nerve endings, causing peripheral neuropathy and other bad things.

            2. The problem with Trehalose is that it is not as quickly/easily absorbed by the body. The net effect is that this sugar makes it all the way through

        • Great post!

        • That in case of infecctions 60% of the involved die is nonsense,
          Not even lung pneumona has such a high death rate.

          • In 2011, the CDC pegged almost 500,000 cases of CDI with 29,000 deaths. It is deadly shit (sorry for the pun), especially for the elderly. The only reason pneumonia is not as deadly is because of antibiotics. It used to kill a much higher percentage of those infected.

            http://www.cidrap.umn.edu/news... [umn.edu]

            • What has that to do with the claimed death rate of the parent?

              If infections had a 60% death rate I would be probably dead 20 times now ... or do you think I'm superhuman that
              I survived 30 infections? Have to tell my siblings that we are from a superhuman family. Perhaps all germany is like this? Are we all .... oh my god ... Zomnies?

              • ummm... RTFA I said "50,000 people in the US alone have died from Cdiff in the last 10 years." In my more recent post, I point out that in 2011 alone, there were 500,000 cases of CDI, so in 10 years, that would be 5,000,000 cases of CDI. So my ballpark number of 50,000 deaths was a fatality rate of about 1%. Put down your crack pipe and step away from the keyboard... http://www.cidrap.umn.edu/news... [umn.edu]

                Furthermore, I know that in 1999 there were very few CDI, but the cases and fatalities rose dramatically

                • First of all, it was not clear that you talk about CDIF.
                  Then again, it makes no sense to talk about it in the context of antibiotics as the article is about the fact that cdif is resistent to antibiotics.

                  Furthermore, you might want to educate yourself a bit instead of talking out of your ass about things which you are clearly ignorant "If infections had a 60% death rate I would be probably dead 20 times now." NO RTFA, PRE ANTIBOITCS MOST SERIOUS INFECTIONS WERE FATAL...

                  And I pointed out that this is nonsen

        • If true, certainly ban it.

          I had a similar problem. Had oral surgery, doctor prescribed an antibiotic I've never taken before (I've had penicillin and amoxicillin plenty before without issue). I forget what it was called but I remember him warning me not to ever drink alcohol on it as I would end up vomiting explosively apparently. At any rate it absolutely nuked all the flora and fauna in my gut apparently, and the about the following weekend I got Cdiff (just before Hockey Pool no less). Had it for 3 excru

          • I don't think banning honey will go down very well.

          • who prescribed another antibiotic which cleared it up almost immediately (like the next day thankfully), and hilariously ginger-ale as apparently even after only a couple of days I was severely dehydrated

            The ginger ale isn't in the least bit amusing. It - and variants - are SOP for dealing with significant dehydration where the patient is otherwise not suspected to have gut damage and is unlikely to lose consciousness unattended. Clearly, you want to get fluids into the patient ASAP.

            Now, the next bit is g

    • by mikael ( 484 )

      There are petri dish experiments where you can take strains of bacteria which cannot digest particular sugars, place them in a large petri dish tray with nutrients and an "undigestable sugar", then watch as the mutations gradually build up until they are capable of digesting that particular sugar.

      • I saw a horrifying experiment where they had bacteria on agar blocks. The first one had no antibiotic, the next one had 1x, the one after that 10x , 100x, 1000x, and so on.

        So the bacteria spread all through the antibiotic free block. Then some mutant strain appears which is able to colonise the one with 1x antibiotic concentration. After a while another mutant strain appears and that colonises the one with 10x antibiotic concentration. Given enough time, the bacteria eventually colonise the block with 1000x

        • by mikael ( 484 )

          This is the video:

          https://www.youtube.com/watch?... [youtube.com]

          https://www.wired.com/story/ba... [wired.com]

          • Another wonderfully devious mechanism is transcription errors in HIV. HIV is a retrovirus - it stores its genetic material as RNA and uses an enzyme called reverse transcriptase to copy RNA to DNA. Normally all copying goes the other way - DNA is copied to RNA which is then used as instructions to build proteins.

            So reverse transcriptase is in a sense going the wrong way - it's the biological equivalent of disassembling a binary to produce an assembler file. And the interesting thing it has a high transcript

        • by rtb61 ( 674572 )

          Which is why composite anti-biotics should become the norm. More than one kind in the medication, larger overall dose but the combination should ensure similar side affects are compounded. This to push the bacteria beyond the point where it's DNA can incorporate all the required selective resistances. It can resist any one or two at a time but not multiples of three or more.

      • It is even simpler.
        In the real world a specimem of bacteria does not livve alone, there are other bacteria around it.
        If one of them breaks up the long sugars, all of them can feed on on it.

        • by mikael ( 484 )

          I read that they had tubes that allowed fragments of DNA/RNA to be shared between each other. They also have signalling systems to tell everyone to go easy on the food when it is in short supply. They form biofilms as a defense mechanism. Under environmental stress, they actually accelerate mutations by doubling expression of genes.

    • Re:highlight (Score:5, Informative)

      by Cinnamon Beige ( 1952554 ) on Sunday January 07, 2018 @12:31PM (#55880685)

      ...highlight the unintended consequences of introducing otherwise harmless additives to the food supply.

      It seems like this 'highlights' one unique and unproven possibility, and nothing more. Getting ahead of ourselves....

      Actually, reading the paper [nature.com] over in Nature (sorry, paywall) and good science reporting from the kinds of places that'll link you straight to Nature? They're very clear that they've not gotten to do human trials--which is understandable, you're not going to get to do them without the paper, and even then you might have a severe amount of trouble getting permission to do them given that C. diff can be fatal.

      What it highlights, really, is that the current methods used to determine if a food additive is harmless are stupid. Animal models are only good at telling us if it's safe for that species--in this specific case, some of the weaknesses the researchers behind the paper note is that we don't know if trehalose [nih.gov] makes it far enough in the human intestine to reach where C. diff gets found. (It totally does in mice.) The models they used, however, were a lot closer to human than is usual for safety testing: the mice were modified and set up to have human-like gut flora, which is what was required to catch this problem. That said, given that the enzyme required to break down trehalose is not abundant even in those people who have it? It's likely that the mouse models are close enough.

      • Yeah, designing a study to catch something like this would be extremely difficult and expensive, with the intersection with an infection followed up by antibiotic treatment. You'd have to have so many permutations for different treatment regimens and their affects on various microflora environments in the human body (and validated animal models for each!) that you're going to easily get to more than the whole industry spends on food additives in total, I'd bet.
    • Re:highlight (Score:5, Insightful)

      by interkin3tic ( 1469267 ) on Sunday January 07, 2018 @12:33PM (#55880689)
      This is not idle unproven speculation. Scientists use phrases like "suggests" rather than "proves" only because they recognize their own data can be misleading. This is published in one of the most competitive journals, speculation doesn't cut it.

      The article can be found paywalled here [nature.com] The abstract highlights that any uncertainty is in the related details, not whether or not it happened.

      Clostridium difficile disease has recently increased to become a dominant nosocomial pathogen in North America and Europe, although little is known about what has driven this emergence. Here we show that two epidemic ribotypes (RT027 and RT078) have acquired unique mechanisms to metabolize low concentrations of the disaccharide trehalose. RT027 strains contain a single point mutation in the trehalose repressor that increases the sensitivity of this ribotype to trehalose by more than 500-fold. Furthermore, dietary trehalose increases the virulence of a RT027 strain in a mouse model of infection. RT078 strains acquired a cluster of four genes involved in trehalose metabolism, including a PTS permease that is both necessary and sufficient for growth on low concentrations of trehalose. We propose that the implementation of trehalose as a food additive into the human diet, shortly before the emergence of these two epidemic lineages, helped select for their emergence and contributed to hypervirulence.

      I haven't read the paper and don't have a background in it. Reviewers do sometimes make mistakes obviously. But you'd be an idiot to say this is "just an unproven possibility." Leave spewing "meh, scientists, what do they know, just a theory" FUD to the sleazeballs hired by the relevant industry. If you have an actual critique of their methods, by all means, post it here and on pubmed commons or wherever else. Publish a response in nature even. But don't fucking parrot cigarette company lawyers, climate change deniers, and creationists, here on slashdot.

    • by dwywit ( 1109409 )

      Quick, somebody with points mod this "Insightful". I'm glad we have such experts to guide us.

      Sheesh.

  • by blind biker ( 1066130 ) on Sunday January 07, 2018 @10:55AM (#55880207) Journal

    I was pissed that I had to click on the stupid article link just to find out the name of the sugar, so there it is.

    From Wikipedia: [wikipedia.org]

    Trehalose, also known as mycose or tremalose, is a natural alpha-linked disaccharide formed by an ,-1,1-glucoside bond between two -glucose units. In 1832, H.A.L. Wiggers discovered trehalose in an ergot of rye,[3] and in 1859 Marcellin Berthelot isolated it from trehala manna, a substance made by weevils, and named it trehalose.[4] It can be synthesised by bacteria,[5] fungi, plants, and invertebrate animals. It is implicated in anhydrobiosis—the ability of plants and animals to withstand prolonged periods of desiccation. It has high water retention capabilities, and is used in food and cosmetics.

  • by Wrath0fb0b ( 302444 ) on Sunday January 07, 2018 @11:08AM (#55880253)

    And shame on both the LA Times and /. for not ensuring that there was a link to the original article [nature.com] or at least a DOI [wikipedia.org].

    • Oh, I'd go on about the Slashdot 'editors' but then, they're Slashdot editors.

      I'd be surprised if even a tiny fraction of the LA Times readership knew what a DOI was. And anyone who did could do exactly what you did.

      Lighten up, Frances.

    • by Anonymous Coward

      Not to mention the actual history.

      The sugar tax was part of the early Cuba boycott from the 1960s.
      It set off the boom in corn syrup production, and obesity, which continues.

      They can't remove the sugar tax without hurting the weight loss industry.

  • by skam240 ( 789197 ) on Sunday January 07, 2018 @11:16AM (#55880291)

    I've never trusted artificial sweateners. Call it irrational if you want but they just seem like getting something for nothing and I don't trust that. In this case we just discovered Trehalose's hidden "price".

    I have a close friend who has been diagnosed c.diff free for almost three months now. It took him years of discomfort and our last line drug for the disease (which apperently is new enough insurance companies arent covering it yet) to get to this point.

    To improve my own diet I just ate less and less sweet stuff over time. After a while you don't crave it any more.

    • by skam240 ( 789197 )

      Sorry, correction.

      "In this case we may have just discovered Trehalose's hidden "price".

    • by billyswong ( 1858858 ) on Sunday January 07, 2018 @11:47AM (#55880425)
      The article is confusing but Trehalose is a real sugar, providing energy similar to table sugar, and exists in nature too. The article should elaborate more on why food industries use this rare form of sugar now when they could have used table sugar instead.
      • by Anonymous Coward

        Because they can claim 'no sugar added' on the package.

        • So an addictive drug that change its chemical formula slightly from the standard form will suddenly gain legal status? Wow. If a food company can claim 'no sugar added' for a chemical that tastes like sugar and gives energy to body like sugar (trehalose is readily digested into glucose in human bodies), then it's not totally the food industries' fault. The regulation authority need to take responsibility too.
          • You can blame the food industry while blaming the regulation authority, especially since there's a very high chance that we've got enough regulatory capture that treating them as separate entities doesn't make sense.
        • Because they can claim 'no sugar added' on the package.

          I'm skeptical of that - trehalose doesn't appear to be like aspartame or sucralose. Do you have a citation?

      • Except that it really is artificial in terms of 'not normally seen in this concentration in anything but highly processed foods'. Which are, for reasonable definitions of the term, artificial.

        But, yes, you point out that it can provide energy to bugs. So it's a real fuel source. If you're a bug.

        • It's also readily digested into glucose in the human digestive tract so, well, it can provide energy to humans as well.
      • Re: (Score:2, Insightful)

        Because too many people have a rabid fear of sugar after listening to the anti-sugar nazis for decades?
      • But one of the pathways this bacteria used was breaking down trehalose into glucose, which it could then use. If that's the case, then table sugar would likely have the same problem, unless I'm missing something.
        • More competition for glucose.

        • by HiThere ( 15173 )

          IIUC (not at all sure) Trehalose is digested further down the digestive tract than is sucrose. They also seem to imply that only some people have the enzymes needed to digest it.

      • The article should elaborate more on why food industries use this rare form of sugar now when they could have used table sugar instead.

        Since it can be extracted from starch, I'm going to guess cost.

    • Recurrent C diff is most effectively treated by stool transplants. Been known for at least 6 years.

      • by skam240 ( 789197 )

        Was tried. Failed.

        • No, actually does work. Sometimes. I can't recall correctly and I'm too lazy to lookIIRC it's about 50% with current 'technology'. People are working madly to figure it out. Something in there is helpful. And that's no shit.

    • To improve my own diet I just ate less and less sweet stuff over time. After a while you don't crave it any more.

      The same thing happens with salt.

      • by skam240 ( 789197 )

        Deffinitly. When i dip salted tortilla chips in store bought salsa it's far too salty for me nowadays.

        I generally buy unsalted tortilla chips and make my own salsa with little to no salt depending on the quality of the ingredients and the type I'm making.

        • I think I have a Japanese gene. I love love love salt. No amount seems to be too much except drinking pure ocean water. That is a bit edgy.

    • I've never trusted artificial sweateners. Call it irrational if you want but they just seem like getting something for nothing

      That's why I don't trust flavors. Sure, they seem to make food taste good, but is it really getting something for nothing?

      • by skam240 ( 789197 )

        Of course those aren't the same thing. The term "artificial" seems to have flown right over your head.

        Don't worry though, in spite of your sniping commentary I don't mind holding your hand and walking you through basic reading comprehension.

        We're all in this together my friend. We'll get you reading like a champ in no time.

        • I think you give this "artificial" term too much value. Nothing flew over my head. I'm sorry if I haven't laid out everything in literal form for you. I'll try to do better next time and not make you have to think.
    • Are you sure he had Cdiff? For "years"? I had it for 3 agony filled days. I'm pretty sure if you've had it for any length of time if would kill you. I'm pretty sure with the amount of pain I was in for 3 days I would have killed myself long before that at any rate if it didn't. Perhaps there is a range of severity, but I know with what I had there is no way I would have lasted anywhere as near as that long.

    • by jbengt ( 874751 )

      I've never trusted artificial sweateners[sic].

      The article is not about artificial sweeteners.

  • Maybe it's time (Score:2, Insightful)

    by Grand Facade ( 35180 )

    to get rid of the sugar import tax? And for the FDA to rescind some of the crap they allow in food products.

    Very little sugar is still grown in the states so which farmers are being protected and how is the populace benefitting from this tax?

    Yes, too much sugar is bad for you but, it seems like the corn sugar and the other products that are being used as a substitute for sugar are worse for the consumer.
    I attribute this to the price of imported sugar being high, if the import tax on sugar has ANY bearing on

    • If a sugar tax can be bypassed by corn sugar or whatever both taste sweet and provide energy to bodies, then the tax legislation is flawed.
    • Re:Maybe it's time (Score:5, Interesting)

      by LeftCoastThinker ( 4697521 ) on Sunday January 07, 2018 @04:20PM (#55881687)

      A little Googling will reveal that Trehalose is about 11x more expensive than sugar, so this is not a financial play, it is used because of some unique gel behavior as it gets dehydrated, and it's stability at high temperatures. It naturally occurs in Shiitake mushrooms, among other things (15-25% by dry weight). It is also only half as sweet as table sugar, so you have to use more to achieve the same sweetness.

    • by jbengt ( 874751 )

      Very little sugar is still grown in the states so which farmers are being protected and how is the populace benefitting from this tax?

      The farmers selling corn to ADM and it's not.

  • Summary reads as though it was written by someone with a stake in the price of trehalose, calling it "otherwise harmless". A bullet can kill you if it enters your body at high speed, but they're are otherwise harmless; we still don't allow people to shoot guns randomly so long as they're not aiming at someone. I'd just like to point out that "otherwise harmless" is a weasel-word for "harmful".
    • Its more like if carrots turned out to have an amino acid that a specific opportunistic pathogen really liked to grow on. Carrots would be mostly harmless, but in a specific scenario would be at fault for some people getting sick. Interestingly, replacing the additive with another sugar may well have more or less the same effect with a different opportunistic pathogen having a competitive advantage. It is actually a pretty difficult problem to decide how to catch.
      • So the real headline is "Common bacteria able to feed on less common sugar, just like many other organisms". This really shouldn't surprise anyone in the field, nor should it alarm anyone at all -- yet the summary was worded in such a way as to cause alarm. I'll admit, I didn't read TFA; after all, this is Slashdot.

        I'm not saying the summary was written the way it was with the express intent of causing alarm, mind you; just that, for people without an understanding of the actual meaning of the findings, f
    • we still don't allow people to shoot guns randomly so long as they're not aiming at someone.

      This sounds like you know what the NRA's next gun law removal campaign is going to be. "Got a gun? Now you'll be able to walk down the street firing off as long as you don't actually aim at someone!" If I were wanting to do this, I'd protect myself by not wearing my short-sightedness glasses. Then I could prove that I couldn't see anyone I actually hit.

  • Scientist try to make bug resistant plants, jack around with DNA to stop this or that in NATURE. Oh, but it's 100% safe. Yeah, right. Granted, the over prescription of antibiotics in the 80's was a mess, but that isn't the only reason. I for one, am very fortunate...the number of times I've had to use just plain old run of the mill antibiotics you can count on one hand. My younger sister on the other hand, has to have those really jacked up price kind to do her any good.

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