The Satiety Index … a calorie is NOT a calorie

It is with great pride ODB presents the next level of using the GI Index from the SUGIRS team at Sydney University. This article is written by Prof. Jennie Brand-Miller and PHD candidate:  Rebecca Reynolds …. James.

Prof. Brand-Miller

Rebecca Reynolds
 

 

 

 

 

 

 

 

Why do some foods give us the munchies? We just can’t stop at one bite … or two … or three … think chocolate chip cookies, potato crisps, jelly beans … No wonder we call them “more-ish”. Compare this to “old-fashioned” foods (think porridge and beans) that positively stick to the ribs. How hard is it to get more than one bowl of steaming oats down our gullets?

Many experts lay the blame for the current epidemic of obesity right at the food industry’s door. Do they have a secret ingredient that makes us eat more, so we can hold up our arms in resignation and say it’s “dietary trickery”? There may be some merit to this idea. Researchers have conjured up a way to rate foods according to how full they make us feel.

The reasons we start and stop eating are complex. Meal size is partly determined by how quickly you “feel full” during eating, and to what extent. This is called “satiation“. Similarly, the time between meals is determined by how long you feel full for. This is called “satiety“. Psychological factors are of course paramount concerning both, with learned habits, social cues and emotional states having the capacity to override the “basics” underlying eating. However, if one feels full quickly during a meal and for a long time subsequently, psychological factors lessen in significance.

How easy, and enticing, is it to gorge on fruit after a bad day at work? Any takers for eating ten apples in 10 minutes? Conversely, anyone for a warm, moist croissant? Both ten apples and a croissant provide similar amounts of energy, but differ in all other aspects, namely macronutrients, such as fat, protein and carbohydrate, and water, all of which contribute to how full you feel.

Fullness” is a new buzz word in the world of diet today, and was quantified over a decade ago by Jennie Brand-Miller, Sue Holt and others at Sydney University’s Nutrition Department. Brand-Miller’s team invented a new “scientific” measure of fullness, the “satiety index” (SI). The SI refers to the short-term satiating capacity of a food, i.e. how full one “feels” after ingestion. It was ascertained via a subjective (personal rating) satiety questionnaire, filled out every 15 minutes by healthy human subjects, after a 1000 kilojoule (kJ) portion of a test food was served for breakfast, for a period of two hours.

The higher a subject’s rating of fullness over the two hours, the higher the SI of the food, as compared to a reference food, white bread (which was assigned a SI value of 100). Subjective feelings of satiety were validated by a direct correlation with prospective ad libitum, eat as much as desired, food intake at a buffet lunch after the two-hour test period (i.e. when a subject reported high satiety after breakfast, he or she ate less at lunch). Thirty-eight common foods were tested in this way, each in 12 subjects, with some interesting results.

Croissants had the lowest SI (47) and potatoes the highest (323). In other words, croissants were only half as filling as the same energy load of white bread, while potatoes were over three times more filling. The most satiating foods weighed more and had the highest protein, fibre and water content, less fat content and lower palatability (“tastefulness”). Modern foods, ideally illustrated by the bakery and snacks/confectionery groups, scored low on the SI. Donuts and Mars Bars made subjects feel hungrier and inclined to eat more at lunch. “Wholesome” foods, high in protein and carbohydrate, on the other hand scored highly, with foods like fish and pasta making subjects feel fuller for longer.

The level of distention of the stomach and small intestine is likely to be the main factor eliciting high levels of satiety in the study, reflected by the strong correlation between the weight or water content of the food and SI, i.e. foods with the highest water content, and hence “bulk” were associated with increased feelings of fullness, potatoes being the best example.

This forms the basis of work conducted Dr Barbara Rolls, a US nutritionist, who recommends the use of food volume in weight loss, based on the higher SI of bulky, “watery” food. However, it should be noted that mechanical distention of the gut wall (via mechano-receptors) is only one contributing factor to feelings of fullness. Less obvious characteristics of bulky foods are also important. These include a low glycemic index (GIs), low fat content (and hence low energy density) and high fibre level.

On this note, let us talk about potatoes and GI. Scientists think glucose is a key player in the hunger and satiety tug-of-war via stimulation and inhibiton of “appetite centres” in the brain’s hypothalamus. Potatoes are well known for their high GI and high GI foods are often associated with less fullness (satiation). A blood sugar spike followed by a rapid fall in blood glucose levels can stimulate feelings of hunger. Yet potatoes were the most filling food despite their high GI. Why? Well, one reason may be the fact that the subjects did not rate their hunger beyond two hours. Perhaps potatoes are one of those foods that make us feel only temporarily full. But more important, when we compare high and low GI foods, it is necessary to compare like with like (bread with bread, breakfast cereal with breakfast cereal). With any luck, the potato breeders will come up with a low GI, even more filling potato in the near future.

Previous work has ranked fat as the least, and protein the most, satiating macronutrient, findings supported by the SI, but has often omitted detail on type of carbohydrate and satiety, which was highlighted in Brand-Miller’s study. For example, food with a mix of slowly digestible and indigestible carbohydrate (fibre), such as porridge, scored high on the satiety scale. Oats have high levels of soluble fibre, which forms a gel in the stomach, slowing gastric emptying and hence delivery and absorption of nutrients to and from the gut. Such a viscous mix also “sticks” to the walls of the stomach and upper small intestine, activating mechano- and chemo-receptors and enteroendocrine cells which relay information to the brain via gut-brain signals (such as glucagon-like peptide-1).

These hormones signal the presence of food still in the gut, reminding us that it can take only so much food. In addition, the carbohydrate “inside” a porridge oat is generally harder for the body to process than, for example, white bread. The physical fibrous barrier encasing the oat makes it harder for digestive enzymes to access the interior. White bread in comparison contains starch that is readily available, as all the “tough” outer layers of the original wheat grain have been removed during processing. Indigestible fibre that reaches the lower climes of the small intestine has further effects of stimulating the release of a wider array of gut hormones that signal satiety (for example, peptide YY from the ileum). Similarly, anti-nutrients found in some protein-rich foods, such as baked beans (for example, trypsin inhibitors), may result in some undigested protein reaching these areas and increasing fullness.

Palatability is an important factor to consider, as individual preferences will always influence a subject’s perceived fullness. Measures to control for this were taken by serving 27 of the 38 foods under an opaque plastic hood, to minimise influences of sight and smell, as well as preconceived ideas of the level of fullness a certain food “should” elicit (11 of the foods contained liquid; for example, breakfast cereal with milk, and hence could not be served in small pieces via a hole in the hood).

It makes sense that the more palatable a food, the lower the SI, which is generally the case with high fat foods, as humans have an innate liking of the “rich” mouth feel and taste of fat. This has been hypothesised to maximise the intake of energy-rich fuel (fat is the most energy-dense nutrient) during periods of food abundance in our evolutionary past, in preparation for inevitable times of scarcity. However, today’s times are of abundance, and it is easy to passively over-consume energy via fatty foods, such as cake and french fries. High-fat foods seem to be less capable of proclaiming, “I’m here and I’ve got lots of yummy energy for you” loud or fast enough for our bodies to hear.

In conclusion, the SI ideally illustrates the fact that a calorie is NOT a calorie, i.e. not all kJs are equal. Eat 1000kJ of a fat-laden food and feel less full than after an isocaloric (equal energy) portion of a protein-rich food. In addition, different foods promote varying levels of dietary-induced thermogenesis (DIT, heat production) and fat storage. So, both sides of the energy balance equation have the potential to be manipulated; eat more filling foods to decrease food intake and foods that promote DIT and decrease fat storage to maximise energy output.

The SI is an important concept that has thus far been under-utilised and has huge potential as an anti-obesity tool. So, after reading this article, I’m afraid to say any excess fat “IS your fault”, as now you are equipped with the knowledge of how to identify those foods which try to “go behind your back” and trick your body into letting more of them in. Revert to a more traditional diet, full of foods that score high on the SI, such as porridge, fruit and fish, and stop such “dietary trickery” now.

Professor Jennie Brand-Miller is in the School of Molecular and Microbial Biosciences at the University of Sydney and Rebecca Reynolds is a PhD student, Human Nutrotion, in the School of Molecular and Microbial Biosciences. Many people consider Prof. Brand-Miller to be the ‘Godmather of GI’! Want more like this?

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From the Diabetic Desk…

Diabetes Alert Day …. And pre-Diabetes!

In the US, today is Diabetes Alert Day.
 

Diabetes Day
 
 

 

 

 

 

 

Diabetes Alert Day is held every year on the fourth Tuesday of March to call attention to diabetes and to encourage everyone to find out if they are at risk. While diabetes is often a hereditary condition, it is still possible to develop diabetes even if you have no known history of it in your family. In addition, type 2 diabetes is often preventable through regular medical checkups and a healthy lifestyle.

The focus this year is on prevention and a condition called Pre-Diabetes. You can find out if you are at risk by taking the Type 2 Risk Assessment and then read more below about what you can do to prevent or manage type 2 diabetes.


Prediabetes: Prevention And Treatment

The recommended treatment for prediabetes is similar to the prevention strategies for type 2 diabetes. In many cases, the progression of prediabetes can be halted, and even reversed, by making healthy eating and fitness habits a daily routine.

The Diabetes Prevention Program (DPP), a large-scale study of diabetes prevention strategies in those at high risk for type 2 diabetes (including those with impaired glucose tolerance), found that even moderate lifestyle changes can make a big difference in preventing diabetes and reversing prediabetes in some people. DPP participants who engaged in 30 minutes of physical activity daily and lost 5 to 7% of their body weight cut their risk of getting type 2 diabetes by 58%.

If you have prediabetes, losing excess pounds through proper diet and exercise can improve the body’s ability to use insulin and to process glucose more efficiently. A dietitian or a certified diabetes educator [CDE} can help you develop a food plan that works for you. Our choice is a low-GI diet. Always check with your physician before starting a new fitness program, especially if you have a chronic illness or other health problems.

The DPP also found that the type 2 diabetes drug metformin was beneficial to some individuals with prediabetes/impaired glucose tolerance. Those study subjects that were treated with metformin reduced their risk of getting type 2 diabetes by 31%.

Take the test – as we used to say in parachute school: ‘Knowledge Dispels Fear”!

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The First Step …. Buy the best Diabetic Cookbook!

One of the first steps new diabetics take is to seek out a good diabetic cookbook. The problem many find, however, is that there are hundreds out there. Each one states that it is the top and sells itself as the best thing since high-fibre, low-GI, sliced bread. It is important for a new diabetic, or pre-diabetic, seeking a good resource for cooking to learn their body’s reaction to certain foods and ingredients so adjustments can be made as needed.

Unless you like doing math in your head; it is equally important to make sure it’s an Australian book with our metric weights and measures and available products. With a base of 300M people, they have many more diabetic products sitting on supermarket shelves!

Low GI Eating Made Easy

[see that GI label!]

One of the first lessons everyone learns early on in the disease is that they may not react to all foods the same as other diabetics. Some diabetics can eat high fibre, low sugar foods and have no rise in blood sugar levels. Some people have no response to sugar alcohols (such as maltitol, sorbitol, or xylitol.) Part of this response has to do with the current level of pancreatic function, while medications also affect the body’s ability to handle some substances. No single diabetic cook book can take all of the variables into account but good ones allow for substitutions and adjustments for people with varying levels of carbohydrate tolerance.

When looking for a diabetic cook book, it is important to find one that explains the recipes in detail and also supplies alternative ingredients for those that may cause problems for people. Some recipes may call for the use of sugar and the recipe should offer alternatives (and proper conversion amounts) such as Equal, alternative sweeteners (sucralose, etc.), and sugar alcohol products. Some recipes even give combination alternatives such as adding cinnamon and Equal to replace sugar. A recipe that calls for flour should offer alternative suggestions for those people who react adversely to processed flour.

Offering alternatives in the diabetic cook book is important, but it is also essential to offer conversion amounts. For example Equal (and some other sugar alternatives) are much sweeter than sugar itself. Knowing this, recipes that call for a certain amount of sugar may need less Equal, however the bulk needs to be made up for with other ingredients. Some flour alternatives can only be substituted for a portion of the whole flour amount. Heavy cream can be used in place of milk but must be mixed with water, and therefore amounts need to be adjusted. A good diabetic cook book must take these adjustments into consideration.

Lastly, a good diabetic cook book must have recipes for foods that an individual would enjoy making and eating. Any nutritional plan is doomed to failure from the start if the meals selected are forced or do not offer variety. A person who ate a lot of sweet and Hi-GI food before being diagnosed with diabetes may find it difficult to adjust to a bland diet. In this case, a diabetic cookbook with recipes for low-GI, sweet snacks will be beneficial. Flip through the pages of a diabetic cook book that you are interested in and see if it holds recipes that you are interested in, and if those recipes offer alternative ingredients and adjustments it may be the right fit for you.

Pick of the Australian Diabetic Cookbooks

There are several available from the GI Team – make sure you are looking at the Australian section – including Low GI Eating - Made Easy … a beauty for new comers to the field…. The Low GI Diet – Cookbook with offerings even from the great Margaret Fulton. These have the obvious advantage of having all the GI ratings built into the recipes. Diabetes & Pre-diabetes handbook

The Low GI Diet Cookbook

Even their handbooks – this is the brand new one: Diabetes & Pre-Diabetes handbook- include good recipes and food hints – such as feeding diabetic toddlers!

From Australian Women’s Weekly and endorsed by Diabetes Australia comes The Diabetes Cookbook. It stresses menus for people with diabetes and their families! “Every delicious recipe has been selected by an expert nutritionist and is endorsed by Diabetes Australia so ALL the ingredients are on the ‘allowed’ list.”
It is a good staple and can usually be found for under $13 making it good value for money.

Women's Weekly Cookbook

A little harder to track down but worth the effort is an Australian treasure called: The Ultimate Diabetes Cookbook by Virginia Hill and Lorna Garden. Now it is important to check the author’s name as there is an American book with exactly the same name but not the same Aussie recipes! A bit of history: the first version was published as ‘Simply Delicious’ in 1996 and ‘Sweet Sensations’ in 1999 …. Just in case you spot one at the school fete.

The Ultimate Diabetes Cookbook

Remember, it may be better to eat several small meals during the day instead of one or two big meals.

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Type 2 – a Personal Approach to Diabetes Control

I am now 65 – was diagnosed over a dozen years ago and have maintained a pretty constant HbA1c below 7.0.  This contrasts pretty much with my very busy lifestyle and home life; starting new businesses and raising an 8 year old daughter. The majority of my business associates don’t know that I am a diabetic.

My regimen is based on simple and easy to follow rules in my diet, my exercise and my medication.   This works for me; it doesn’t necessarily work for you … I have been lucky to work with some of the best GP’s and endocrinologists below the equator.  So the first step in my program is – talk to your doctor, see him or her every three months. This is not one to do on your own!

DIET

If this is not your first visit to the ODB, you will know we are great supporters of the Glycemic Index.
Not all carbohydrates are evil is the motto of the low GI diet. As a measurement of how quickly a particular carbohydrate is used by the body, the Glycemic Index is already found on nutritional labels in Europe and Australia, but has yet to be endorsed any American organization.

Manufacturers have prepared low-GI foods and I make great use of their products.
Bread is a staple in my house and I make sure it’s a low-GI product.
That’s what’s so different about the GI, it’s not low carbohydrate, it’s more selective carbohydrate.

Foods with low GI are metabolized slower, meaning they sit in your digestive track longer and are gradually absorbed by the body. This leads to a more gradual blood glucose increase, keeping your hunger satiated longer. You feel ‘fuller’! More on feeling full later in the week.

How do I fit this into my lifestyle – in my wallet is a go/no-go list … last week I gave you my list of go foods …. now for my list of no-go

No-Go No. 1  Spuds   I have learned to swap white potatoes with sweet potatoes and yams; not to eat them when I am out.  If you must occasionally scratch your potato itch, cook them the day before in a salad and put them in the fridge overnight … it slows down the rate of digestion of the starch.

No-Go No. 2  Breakfast Cereals  I obviously don’t chow down on Coco Pops; but you may be surprised at the others in the hi-GI list; they include Cornflakes, Bran Flakes, Total, Rice Bubbles, Sultana Bran, Cheerio’s, Weet-Bix is borderline.

No-Go No. 3  Staples  Poor old potatoes, they get a pasting again [no fries and no mash] along with short grain white rice and tapioca.

No-Go No. 4  Snacks   Not what you think: the drop-em list includes pretzels, water crackers, rice cakes, the ubiquitous scone and as you would expect: maple syrup and donuts.

No-Go No.5   Fruits    The two traps for the unwary are watermelon and dates.

No-Go No. 6  Vegetables  There are two here too: parsnips and pumpkin.

No-Go No. 7  Bread   The usual culprits: white [unless modified and proudly wearing its low-GI label], bagels and French baguettes.

And, that’s not that hard to remember! Here is a full list online … David Mendosa is a diabetic treasure!

Patented Pills

EXERCISE

This is a no-brainer!

You can prove the effect of exercise to yourself simply by checking your BGL before and after a half hour brisk walk. I sometimes even risk a hypo.

New research shows that moderate exercise, such as walking, cycling, or jogging, can significantly reduce the risk of death for people with Type 2 diabetes. This study followed over 3,300 people and correlated their level of physical exercise with mortality to find that moderate exercise reduced the chance of cardiovascular death by 9%, and more vigorous exercise reduced the total chance of death by 33%.

To people with diabetes, this probably isn’t new news. We have long been advised to pursue physical exercise, especially cardiovascular exercise, in order to improve their overall health and reduce their chance of death. This study simply adds support to the notion that physical exercise is the number one way to enhance your health and avoid the downward health spiral associated with diabetes.

Now, don’t rush off and join a gym. Healthy exercise can be as little as three thirty minute workouts a week with time beforehand to warm up and a cool down time afterwards.

I do some stretching exercises and speed walking for twenty minutes.

A couple of do’s and don’t’s: drink plenty of water and take it easy –this is meant to be moderate.   Don’t hold your breath when you feel the strain, breathe out; don’t stand still after your twenty odd minutes of speed walking, walk around slowly as part of your cool down.

You want to get into this deeply –try Professor Bob Montgomery’s book: Your Good Health –it also contains a good section on giving up smoking as well. My last puff was over 25 years ago! Bob was a pioneer in so many areas of good health.

Now that I am over 60, I make that five mornings a week rather than the minimum three whenever I can. It makes me feel good!

Starving ChinaMEDICATION

Keep in mind that drugs are not magic. If you are taking a drug for diabetes control, it is still essential that you follow a good diet and get regular exercise. These two elements of diabetes control are the pillar on which all other diabetes treatment rests.

I have a cocktail of three prescription medicines:
Metformin:  It works by helping the insulin that your body is still making work better. It also has a side effect which is very beneficial for most people with Type 2 diabetes—it makes you lose a little bit of weight by decreasing appetite. Another good side effect for some people is that it tends to lower triglycerides (certain fats in the blood), which is great if you tend to have high triglycerides.
Glibencalmide: It works by making your body produce more insulin. As you probably know, when you have type 2 diabetes, your body is able to make some insulin, but not quite enough to overcome the insulin resistance that your body has. When you take these drugs, your body is able to make a little more insulin.
Thiazolidinediones: I use a brand name called Avandia. These drugs work by helping the insulin that your body is already making work better, but they work on different parts of your body than metformin does.

Each performs a slightly different function.

I cannot stress too much that this works for me and you need to discuss dosages and oral mixes with your own doctor.

As I said, I was diagnosed as a T2 nearly fifteen years ago now, I have a heavy family diabetic history, so I guess it was inevitable …but, touch wood, the above regime has kept my HbA1c below 7.0 for the last five years. It’s not meant for you, it is meant to make you think!

Note: the cartoons are from a cool diabetic information site and the clever wit of Mike Adams and with help from Dan Berger.

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The Glycemic Index for Dummies – The Wrap Up for the Week

If you’re like me, a T2 with little time to monitor all this stuff … I mean I do drink Diet Coke, what more do you want?… here it is all on one page along with my patented [sort of] go/no-go list.  And, there is nothing to buy!

In my defence, the above is not quite accurate … I was diagnosed a T2 over a dozen years ago, was on the original panel for Avandia in New Zealand and the PRC and with a combo of tablets, limited exercise and diet, have returned an HbA1c under 7.0 for years now. 

However, one person has made the management of my diabetes so much easier…. Professor Jennie Brand-Miller, who holds a PersonalJennie-Brand Miller
Chair in Human Nutrition in the School of Microbial
Biosciences at the University of Sydney. Her research interests
focus on all aspects of carbohydrates—diet and diabetes, the
glycemic index of foods, insulin resistance, lactose intolerance
and oligosaccharides* in infant nutrition. She holds a special
interest in evolutionary nutrition and the diet of Australian
Aboriginies.

That is the official resume: I know a little of her personal struggle
to get the GI recognised – the dismissal by colleagues overseas.
The academic world is small –even smaller for diabetics.
She defied an army of critics and now the Sydney University
Glycemic Index Research Service
[SUGIRS –cute?]  is
respected around the world. Jennie not only persevered, her
books have sold over 2M copies around the world -her nickname around Sydney Uni is ‘GI Jennie’!

The GI Index
GI Guide
The Glycemic Index is actually just a way of saying “this food raises your blood glucose, or blood sugar, a little bit, or a lot or something in between”. So, it’s simply a scale from zero to one hundred, a bit like a thermometer scale, and the foods that have G-I values close to 100 contain carbohydrates that are able to raise your blood glucose really quickly and that affect is not a good affect, you want carbohydrates to come in slowly, from a health point of view.

Classification GI range and examples:
Low GI - 55 or less - examples include: most fruit and vegetables (but not potatoes), basmati rice, oats, All-bran, Aussie Special K …and, go prunes!
Medium GI - 56 - 69 - examples include: sucrose, Mars bar, bananas, most power bars.
High GI Book- GI 70 or more - examples include: corn flakes, potato, jasmine rice, white bread, white rice, Rice Chex, forget scones and rice cakes and Gatorade.
GI Load

The glycemic load (GL) is a ranking system for carbohydrate content in food portions based on their glycemic index (GI) and the portionGI Book French size.

The usefulness of glycemic load is based on the idea that a high glycemic index food consumed in small quantities would give the same effect as larger quantities of a low glycemic index food on blood sugar. For example, white rice is somewhat high GI, so eating 50g of white rice at one sitting would give a particular glucose curve in the blood, while 25g would give the same curve but half the height. Since the peak height is probably the most important parameter, multiplying the amount of carbohydrates in a food serving by the glycemic index gives an idea of how much effect an actual portion of food has on blood sugar level.

The GI Label GI Logo

Look for it – you will find it on previous no-go foods like: breads, breakfast cereals, yoghurts and chocolate drinks … and, you can believe them!

When you see the GI Symbol  on a food package label, you will find the GI value of that food near the nutrition information panel, along with the words ‘high’, ‘medium’ or ‘low’. The value is a reliable measure based on proper testing in people.

My Personal Go/No-Go Food List

As I said at the start of this – I have kept my HbA1c below 7 for years as a T2 diagnosed over a dozen years ago via a little exercise, tablets and diet.  During that period, I started a Cable TV network in the US, a school in China and a new department at a University in NSW.  I needed a quick and easy to remember guide and the ability to eat out often.
My
Oooooh, how I wish I had access to this lot in Beijing! 

My go food list – at any time in any place – in sensible portions….

All- Bran [Aussie is lower than US!]              

Muesli

Pasta [just about all types]                          

Sweet Potatoes & Yams

Milk  [just about all types]                           

Yoghurts [look for natural sweeten]

Beans                                                         

Nuts & Raisins

Fruits  [skip dates]                                     

Vegies  [skip pumpkin and potato]

Meat, Poultry & Fish –have no carbohydrates, so no GI – watch the fat &
frying! However, woking is a good way to go! Wait till Monday.

More on my simple, go/no-go approach on Monday!

*oligosaccharides - for those that really want to know – they are natural sugars
occurring in plants, some of which are in the Aborigine diet!

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The Glycemic Index for Dummies – The Label & Standards

Low G.I Foods will make you feel fuller for longerAustralia continues to lead on the GI front.  The GI label is checked and monitored.

In a world first, Standards Australia have developed a standard for determining the Glycemic Index (GI) of carbohydrates in foods for use by food manufacturers, accreditation bodies, governments and other regulators, educational institutes, testing laboratories, and research organizations.

The standard will play an important role in improving the accuracy and reliability of GI values, ensuring that Australian consumers can trust the GI claims made on food labels. The standard which sets out a recognized scientific method to determine the GI of foods has also been submitted to the International Organization for Standardization (ISO) for possible adoption by Muselimember countries around the world including Canada, China, France, India, Japan, Malaysia, South Africa, the UK and US.

Several cases of deceptive practice have been already been investigated by the Australian Competition and Consumer Commission (ACCC), including a brand of cous cous, which had a medium GI but was claiming to be low.

Mr John Tucker, Standards Australia CEO, said the new standard would set a recognised yardstick consumers and food producers can use to guarantee the health benefits of their products.

“Consumers looking for healthy foods need to be confident the claims made by food manufacturers on their labeling are accurate,” Mr Tucker said.
“Historically, not all GI values on food labels have been reliable, with some claims based on extrapolation or inappropriate methodology.

Up“A national standard, prepared by an independent body like Standard Australia, provides an alternative to industry using different in-house methods to obtain the GI value of a food,” Mr Tucker said.

Look for the Glycemic Index Tested logo

Alan Barclay, Acting CEO of Glycemic Index Ltd, says the standard will not stop otherwise unhealthy foods from making claims about GI but it will ensure that the GI claims are accurate.

 “Foods with the logo have been tested using the Australian Standard, and they must also meet a range of criteria for kilojoules, total and saturated fat, fiber and sodium in line with the Dietary Guidelines for Australians.”

It’s also timely with low GI food products gaining momentum worldwide as savvy consumers understand that blood glucose management matters and that a diet rich in slowly digested, low GI carbs, along with regular exercise will reduce their risk of diabetes and heart disease.

People who are choosy about their carbohydrates find that: they feel fuller for longer and are less likely to overeat:

– they have more energy
– their insulin levels are lower and they burn more fat
– over time, combined with some regular daily exercise, they lose weight

One criticism of the GI is that it’s not the best indicator of healthy food choices.

Professor Jennie Brand-Miller:  “Is there any one factor that it is a universal signpost? Fat is certainly not. We don’t recommend jelly beans and soft drinks becausYogurte they are low fat. Indeed, the beauty of the GI is that so many healthy choices are ALSO low GI choices - legumes, nuts, low fat dairy products, pasta and noodles, most fruits and vegetables, whole kernel breads and breakfast cereals. The GI gives us another reason, a very good reason, to recommend these foods. And for the person with diabetes, there’s immediate payback (within 2 hours), not 20 years down the track.”

More from Jennie on that feeling of fullness later….   

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The Glycemic Index for Dummies – The Label

GI LogoAustralia has led the way.  Starting with a GI label a couple of years ago and just last month finally getting world wide agreement on testing standards. We truly live in the GI capital of the world! [Where did I put my boxing kangaroo?] It’s not some pie-in-the-sky target –this use-it-everyday while shopping stuff!

This is the first in a two part series – this is too important to cover in just one.

The GI Label

Up until now, people have had to rely on published lists of the Glycemic Index of foods to help them decide which carbohydrate foods to eat. By placing the Glycemic Index directly on the label of foods, consumers will be able to use the GI as one factor in food choice. The symbol helps identifies foods that provide the GI value.

Which foods have the GI symbol?
Provided a food has been properly GI tested, contains 10 grams of carbohydrate per serve, and meets the set nutritional criteria for its food group (in terms of fat, sodium, fibre etc), it will be eligible for the symbol - regardless of its GI. This is to ensure that consumers can mix and match low, medium and high GI foods to meet their varying needs. It is not a low GI label!

Why put the Glycemic Index on food labels?
Up until now, people have had to rely on published lists of the Glycemic Index of foods to help them decide which carbohydrate foods to eat. By placing the Glycemic Index directly on the label of foods, consumers will be able to use the GI as one factor in food choice. The symbol helps identifies foods that provide the GI value

Will foods with added sugars be excluded?
No. Many foods with added sugar will fit the nutritional criteria for the program. The GI of a food gives more useful information about the effect of the carbohydrate on blood glucose levels than the sugar content per se. The amount of sugar (naturally-occurring or added) is not a guide to the overall nutritional profile of a food.

Does the program cover just packaged foods?
No - unpackaged fresh foods can apply to become part of the program. In these instances, the symbol will be displayed in association with the sale of the food and marketers will also need a nutrition information panel associated with that display.

Will the GI symbol only be on foods with a low GI?
The intention of the program is that foods with a range of GI values from low to high become part of the program. The main aim is to provide information about the GI of foods regardless of GI. Overall, it is important to lower the average GI of your diet. In order to do achieve this, all foods do not need to be low GI. . Foods with high GI need not be avoided and have a useful role to play in some sports situations, for the treatment of hypoglycaemia in people with diabetes and for dietary variety.

How can the GI be relevant when people differ in their blood glucose responses to foods?
The GI reflects the relative ranking of different foods, irrespective of an individual’s unique blood glucose profile. When a food’s GI is tested, the response for each subject is compared with their response to a standard food (usually glucose, but sometimes white bread is used). Their blood glucose response to the standard is said to be 100. For example, if the blood glucose response of a person to one food is exactly half of their response to glucose, then the GI of that food is 50. Most subjects will fall within the same range, especially on repeated testing.

How will the GI of meals or food combinations be communicated?
There is no prohibition in the program of providing information on the GI of food combinations such as breakfast cereal and milk. If the GI values of each of the meal components are known, and no further cooking takes place that could affect the GI, the GI of the meal can be calculated using the GI values and the carbohydrate content of each of the components.

How will the program ensure consumers continue to get accurate information?
Foods in the program will be required to undergo re-testing for their GI if there is any change in product formulation. All product labels and advertising that use the symbol or mention the program are pre-approved by Glycemic Index Limited. Glycemic Index Limited is not responsible, though, for the accuracy and legality of labels and marketing claims of the foods in the program.

Who is Glycemic Index Limited?PerforMAX
Glycemic Index Limited is a non-profit company formed by the University of Sydney, Diabetes Australia, and the Juvenile Diabetes Research Foundation to run the GI Symbol Program. It represents Australia’s peak body of Glycemic index research and education.  And, that makes it just about bullet-proof.
Glycemic Index Limited supplied much of the data for this article.

How do I use it?

Burgen Soy and Lin Seed breadI use it every time I go shopping. My 8 yo daughter actually hunts through the shelves and makes a big song and dance about finding something new with a label … I used it to get my local supermarket to stock low-GI breads.

Are you missing good tasting breads?

The people at Burgen, Tip Top [both are brands from George Weston Foods, a company with healthy food roots] and Vogels [made under license by Goodman Fielder, another company with a healthy foods history] as well as Country Life [diet specialist bakers]   have all gone out of their way to develop low-GI breads and proudly display their labels. Good tasting low- GI bread is there for the taking on your supermarket shelves.

Major companies like Nestles, Cadbury Schweppes, Dairy Farmers, Bulla and others have developed low-GI foods …. more on that tomorrow along with the story behind the new world-wide standardisation in testing.  Low GI Bread

 

 

 

 

 

 

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The Glycemic Index for Dummies - Glucose Loading????

A new concept, called the Glycemic load (GL), which was developed by scientists from Harvard University, USA, “fine tunes” the Glycemic Index (GI) concept. It is a little more complicated.

The Glycemic index (GI) is a numerical system of measuring how much of a rise in circulating blood sugar a carbohydrate triggers—the higher the number, the greater the blood sugar response. So a low GI food will cause a small rise, while a high GI food will trigger a dramatic spike. A GI of 70 or more is high, a GI of 56 to 69 inclusive is medium, and a GI of 55 or less is low.

The Glycemic load (GL) is a relatively new way to assess the impact of carbohydrate consumption that takes the Glycemic index into account, but gives a fuller picture than does Glycemic index alone. A GI value tells you only how rapidly a particular carbohydrate turns into sugar. It doesn’t tell you how much of that carbohydrate is in a serving of a particular food. You need to know both things to understand a food’s effect on blood sugar. That is where Glycemic load comes in. The carbohydrate in watermelon, for example, has a high GI. But there isn’t a lot of it, so watermelon’s Glycemic load is relatively low.

A GL of 20 or more is high, a GL of 11 to 19 inclusive is medium, and a GL of 10 or less is low.

GL tableThe GI of apples is 38 and the GL of one medium apple is 5. This means that eating one apple will have hardly any effect on blood glucose levels. If you eat an entire 500 g packet of dried apples, however, its GL would be 50, which means that it will have a huge effect on your blood glucose levels, despite its being low GI. This brings us back to the old principle that there is no license to overindulge in “good” or “bad” foods. But should you indulge in watermelon, it will have an even greater effect on blood glucose levels, due to its high GI value!

The GI of  the average brown bread is high (GI = 81) and the GL of two slices (2 x 40 g slices) is also high (GL = 32), because the quantity of carbohydrate in a hand-cut slice of bread is substantial. This means that a sandwich made with two slices of brown bread will have a marked effect on blood glucose levels as the bread will have an “oomph” of 32. On the other hand, if you use a thin slice of bread (30 g bread) as part of a mixed meal containing low GI baked beans, ham and salad vegetables, the GL of the meal will be lower and more acceptable (GL = 22). Note that the two slices of bread on their own have a higher GL than an entire meal, in which only one thin slice of bread is used in combination with other low GI foods.

The Glycemic load (GL) of one slice of seed loaf is only 8. In contrast to this, a single hand-cut slice of brown or white bread has a GL of 16. This means that ordinary brown or white bread will spike blood glucose levels (higher GL), and the seed loaf will not (lower GL), but this still doesn’t mean that you can over-indulge in seed loaf. Fortunately, seed loaf is more filling and it is not as easy to over-indulge in this bread, as it is to over-indulge in brown or white bread.

In addition, the GL of a roll (equivalent to two slices of bread) is more than 20, and that of a bagel (equivalent to three slices of bread) is more than 30. Imagine what this does to blood glucose levels, as the GI is also high!

From this we can see that it is quite acceptable to include small quantities of high GI foods in a meal, as long as the bulk of the meal contains lower GI carbohydrate foods (vegetables, fruit, low GI starches, legumes and/or dairy).

New evidence associates high GL meals with an increased risk for heart disease and diabetes, especially in overweight and insulin-resistant people. Therefore, it is advisable to restrict the GL of a typical meal to between 20 and 25 as far as possible, but definitely to keep it below 30. The GL of a typical snack should preferably be between 10 and 15, but if your meals are all close to 30, the total of your snacks should be no more than 10. This means that you would have to eat fruit for snacks, in order to keep your total daily GL below 100, as the GL of fruit is usually below 10.

The GI indicates the extent to which a food will raise blood glucose levels, whereas the GL is the “power” or “push” behind the GI.

High GI and high GL means trouble – blood glucose levels will shoot up. This means the food in question will have a lot of “power” behind the already high GI, and even a small portion will have a marked effect. Examples of this are potatoes and regular bread.  These foods are high in carbohydrates and therefore a small portion already contains a lot of carbohydrate. In addition they have high GI values, which aggravate the effect on blood glucose levels.

Low GI combined with a high GL will also impact on blood glucose levels. Remember that the GL is based on the quantity of carbohydrate in a food, and represents the GI in portion size. So the more carbohydrate there is in a food, the higher its GL i.e. the more “power” or “push” behind the GI.

So even low GI foods, if eaten in large quantities, can affect blood glucose levels quite significantly, especially if they are concentrated sources of carbohydrates e.g. most cakes, dried fruit and dried fruit bars, fruit juices, crisps, chocolates, etc. Crisps and chocolates are also high in fat and/or saturated fat, making them undesirable.

And lastly, a high GI food with a low GL will not necessarily affect blood glucose levels significantly. A good example here is the high GI vegetables (carrots, pumpkin, etc). They contain only a little carbohydrate and therefore, in normal portion sizes, will not impact on blood glucose levels even though they have a high GI, as there is not enough “power” behind the high GI. The proviso is, though, that they are not eaten with other high GI or GL foods.

Three meals per day should add up to a GL of between 55 and 70, as most people will add salad and/or fruit to breakfasts and light meals, which also contribute to the GL. This leaves 30 – 45 GL points for snacks and drinks, as most of these have a GL of 10 – 15, except for fruit, which has a GL of below 10.

The aim is to keep the total GL per day under 100.

A little more complicated but worth the effort!

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The Glycemic Index for Dummies - The Dawning!

Let me say, right at the outset, this is not another fad diet!  It is so important to the management of diabetes that we will be concentrating on it all week.

My sister-in-law: Dr. Laurel Morris , a published author with her Good Eating Guide, put me onto it nearly a decade ago.  I have been fascinated with it ever since.

At first I thought the Glycemic Index [GI] was just a fancy way of getting you to skip simple carbohydrates (sugar, processed foods) in favour of complex carbohydrates (pasta is the one I remember). Imagine my surprise when I turned to the list of GI ratings and found that potato chips and low-fat ice cream were considered low-GI foods, Glycemic Index GraphCoke and table sugar were intermediate, and bran flakes, rice cakes, and dried dates were considered high GI!

And, so much of its development has been right here at Sydney University ….and, Australia recently took a giant step with a public health initiative that provides consumers with a credible signpost to healthier food choices using the now internationally recognised benefits of GI and sound nutrition. A GI label!

A little history…

The G.I. Factor, was first published in Australia in 1996.

The lead author, Jennie Brand-Miller, Ph.D., is Professor of Human Nutrition in the Human Nutrition Unit, Department of Biochemistry at the University of  Sydney, and the author of more than 200 research papers, including 60 on the Glycemic Index.

In addition to her book, this was published in the U.S. in 1999 as The Glucose Revolution and a sequel, The Glucose Revolution Life Plan, a year later  -the Professor has also written hundreds of articles for peer-reviewed journals. She is widely recognized as one of the world’s leading authorities on the Glycemic Index. You will hear from her later this week.
 
She’s all ours folks! – another Aussie deserving of and getting international recognition in the field of health.

Ever since Jennie Brand-Miller came out with the first Australian edition of her book in 1996, she wanted to get it published in North America. But it wasn’t until an American publisher named Matthew Lore was diagnosed with diabetes in 1996 that it began to happen.

When he learned that he had diabetes he began searching the Web for dietary guidance other than the exchange lists that his doctor had told him about. There he found an online review of the first Australian edition of The G.I. Factor.
Wondering if any American publisher had picked up the book, he wrote to Jennie. The rest is history, with the North American publication of The Glucose Revolution.

So, what is it?

The GI ranks foods on how they affect blood glucose levels within two or three hours after eating. Carbohydrates that we digest quickly have the highest GI’s. Our blood glucose levels shoot up fast and high.

Carbohydrate has the most immediate effect on blood glucose. The other components of our diet—protein and fat—work much more slowly. The proportion of carbohydrate that we need in our diet is a matter of raging debate between advocates of traditional diets such as the exchange lists and carbohydrate counting, on one hand, and low-carb diets, on the other. But they all agree that we need some carbs. The GI addresses the quality of the carbohydrate in our diets, not the quantity. The qualitative difference between different carbohydrates is how quickly they break down during digestion. Those that break down quickly cause your blood glucose quickly to rise higher and are assigned a higher GI value.

 Glycemic Index Table

Low GI Foods include…Bean Birds
• Wholegrain breakfast cereals based on oats, barley and psyllium
• Breads with whole grain kernels, stone-ground flour, sourdough
• Most fruits and vegetables (not potatoes)
• Basmati or Doongara rice
• Pasta, noodles, quinoa
• Legumes and dahls
• Yoghurt and milks

Coming up this week ….

Using GI every day and the brand new GI food label and the story behind it.  The low-down on  GI Loading and my own personal list of go/no-go foods that has lowered my HbA1c … easy to remember and easy to follow!

Even though the GI revolution is not just another diet, there are days when I agree with Woody Allen: someday they’ll decide the real health foods are tobacco, steak, and beer.

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Diabetes, Alcohol, and Living the Good Life

I have had diabetes long enough to take it for granted that I have to control it every day. At the same time I know that I have to make each day as good a day as it can be.

To live a good life with diabetes means first that we control our blood glucose. But it also means enjoying the good things in life.

For me living the good life with diabetes starts with enjoying the exercise that I know I Espressoneed at least every other day. Everyone likes to do different things, but the exercise that I like to do most is to walk early in the morning.

The other reward I usually promise myself is to stop afterwards at my favourite coffee shop for a triple espresso. I always keep the promises that I make to myself.  We diabetics learn the value of that!

Not everyone takes it for granted that people with diabetes can enjoy the good life. If I have an alcoholic drink in a business meeting about diabetes, eyebrows are often raised.

Your doctors will probably ask you how much you drink. They will warn you about the dangers of drinking too much. But if you tell them that you don’t drink any alcohol, they may not tell you what they know about abstinence.

That’s because our response to different amounts of alcohol is quite unusual. It’s not something that could be plotted on a straight line. It is “a U-shaped curve.”

U-CurveWe now have solid evidence that abstinence is worse for you than moderate consumption. This is one of the major findings that jump out from a review of the professional, peer-reviewed literature on alcohol and diabetes in the huge Medline database.

The main problem is that a large number of us simply aren’t moderate in our consumption of alcohol. For these people the choice is between heavy use and abstinence. Doctors simply don’t want to take the chance that if you start drinking on their advice, you won’t know when to quit. Others should not consume alcohol because of the medication they take for diabetes or other conditions. Always check with your doctor or chemist.

If anything, heavy consumption of alcohol is worse for you than being a teetotaller. “The short-term risks of heavy or continuous alcohol intake include hypoglycemias, glucose intolerance, and ketone and lactate accumulation,” according to “Alcohol and the NIDDM Patient” reported in ‘Diabetes Care’.  “In the long term, heavy alcohol intake is associated with an increased prevalence of cancer, hypertension, and cirrhosis of the liver and symptomatic neuropathy.”

A recent study found that insulin resistance “is minimal in individuals with regular mild to moderate alcohol consumption and increases in both heavy drinkers and subjects without any alcohol consumption.” A comprehensive review of the literature concluded, “Compared with no alcohol use…moderate alcohol consumption is associated with…a decreased incidence of heart disease in persons with diabetes.”

In another study conducted at the University of Padova Medical School in Italy, tested insulin sensitivity by measuring tolerance to glucose while people drank the equivalent of about three drinks of beverage alcohol.

The researchers conclude that light or moderate consumption of alcohol improves insulin sensitivity and may reduce potential cardiac complications of diabetes.

Most if not all of these studies define moderate alcohol consumption as one to three drinks a day. That’s also the sweet spot on alcohol’s U-shaped curve.

Cheers!  But do have a chat with your doctor first; especially, if like me, you are on a cocktail of tablets to control your BGL.

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