Presentation on theme: "Gushers and Tricklers: Practical Use of the Glycemic Index"— Presentation transcript:
1Gushers and Tricklers: Practical Use of the Glycemic Index Johanna Burani, MS, RD, CDEAmerican Diabetes AssociationSouthern Regional ConferenceMarco Island, FloridaMay 26, 2006
2Introduction Let’s discuss: Glycemic Index Glycemic Load Health BenefitsWhat to EatCase StudyHands-on Activities
3Glycemic Index (GI) What is the glycemic index? A scale that ranks carbohydrates by how much they raise blood glucose levels compared to a reference food.
4Glycemic Index (GI): Ranking Low 0 – 55Moderate 56 – 69High or more
5Glycemic Index (GI): Protocol 25 or 50 grams carbohydrate of test food.Blood samples taken:1st hour: every 15 minutes2nd hour: every 30 minutes3rd hour: every 30 minutes*3. Values plotted; AUC calculated.4. Test food response compared to reference food response.5. Average GI of 8-10 volunteers = GI of test food.* DM volunteers only.
6Glycemic Index (GI): Sample Graphs Adapted from Good Carbs Bad Carbs Reprinted courtesy of Marlowe & Company.
8Factors Influencing GI Ranking Type of StarchAmyloseAmylopectinAbsorbs less waterMolecules form tight clumpsSlower rate of digestionAbsorbs more waterMolecules are more openFaster rate of digestionLower GIKidney beans (28)Uncle Ben’s converted LG rice (50)Higher GIRusset potato (85)Glutinous rice (98)
9Factors Influencing GI Ranking Type of starchPhysical entrapment
10Factors Influencing GI Ranking Physical EntrapmentBran acts as a physical barrier that slows down enzymatic activity on the internal starch layer.Lower GI All Bran (38)Pumpernickel bread (50)Higher GI Bagel (72)Corn Flakes (92)BranEndospermGerm
11Factors Influencing GI Ranking Type of starchPhysical entrapmentViscosity of fiber
12Factors Influencing GI Ranking Viscosity of FiberViscous, soluble fibers transform intestinal contents into gel-like matter that slows down enzymatic activity on starch.Lower GIApple (40)Rolled oats (51)Higher GIWhole wheat bread (73)Cheerios (74)
13Factors Influencing GI Ranking Type of starchPhysical entrapmentViscosity of fiberSugar content
15Factors Influencing GI Ranking Type of starchPhysical entrapmentViscosity of fiberSugar contentFat and protein content
16Factors Influencing GI Ranking Fat & Protein ContentFat and protein slow down gastric emptying, and thus, slows down digestion of starch.Lower GIPeanut M&M’s (33)Potato chips (54)Special K (69)Higher GIJelly beans (78)Baked potato (85)Corn Flakes (92)
17Factors Influencing GI Ranking Type of starchPhysical entrapmentViscosity of fiberSugar contentFat and protein contentAcid content
18Factors Influencing GI Ranking Acid ContentAcid slows down gastric emptying, and thus, slows down the digestion of starch.Lower GISourdough wheat bread (54)Higher GIWonder white bread (73)
19Factors Influencing GI Ranking Type of starchPhysical entrapmentViscosity of fiberSugar contentFat and protein contentAcid contentFood processing
21Factors Influencing GI Ranking Type of starchPhysical entrapmentViscosity of fiberSugar contentFat and protein contentAcid contentFood processingCooking
22Factors Influencing GI Ranking CookingCooking swells starch molecules and softens foods, which speeds up the rate of digestion.Lower GIAl dente spaghetti – boiled 10 to 15 minutes (44)Higher GIOver-cooked spaghetti – boiled 20 minutes (64)
23Factors Influencing GI Ranking Type of starchCookingPhysical entrapmentFood processingViscosity of fiberAcid contentSugar contentProtein contentFat contentHow does all this affect our glycemic levels?How does all this make us feel after eatingcarbohydrate-containing foods?
24GL = GI/100 x CHO (grams) per serving Glycemic Load (GL): What does it mean?Glycemic load measures the degree ofglycemic response and insulin demand produced by a specific amount of a specific food.Glycemic load reflects both the quality andthe quantity of dietary carbohydrates.GL = GI/100 x CHO (grams) per servingExample: GL of an apple = 40/100 x 15g = 6g
25Glycemic Load (GL): Calculation 1/2 cup converted, LG rice38/100 x 22g=8 g1/2 cup glutinous rice98/100 x 29g28 g2 1/4 Tbsp glutinous rice98/100 x 8g=8 g1 2/3 cups converted, LG rice38/100 x 73g28 g
27GI vs. GL Glycemic Index: ranks carbohydrates based on their immediate blood glucose response.GI = glycemic qualityGlycemic Load: helps predict blood glucoseresponse to specific amount of specific carbohydrate food.GL = glycemicqualityquantity
28Are there any documented benefits to lowering the GI of one’s diet? Benefits of Low GI DietAre there any documented benefits to lowering the GI of one’s diet?YES!type 2 DM riskBG levelscholesterol levelsheart disease riskweight
29Benefits of Low GI Diet Low GI diet helps lower blood glucose levels. Meta-analysis of 14 studies, 356 subjects (types 1 & 2 DM), 2-52 weeks durationMean difference- 7.4% in glycated proteins over & above reduction from high GI diet.- 0.43% points in HbA1c over & above reduction from high GI dietBrand-Miller et al. Diabetes Care ; 26; 2263.
30Benefits of Low GI Diet Low GI diet helps lower blood glucose levels. EURODIAB IDDM Complications Study, 19962,054 people, y, with type 1 DMGIHbA1cLowest quartile58-786.04Highest quartile86-1126.60Buyken et al. Am J Clin Nutr ; 73; 578.
31Benefits of Low GI Diet Low GI diet improves lipid levels. GI HDL-C NHANES III,13,907 American adults, 20+ yGIHDL-CLowest quintile52.51Highest quintile49.42Ford & Liu. Arch Intern Med. 2001; 161;
32Benefits of Low GI Diet Low GI diet improves lipid levels. 23 obese young adults, y, BMI > 27, 12 mos. durationGLTot. chol.LDLHDLTGAd libitum low GL diet53-8.5-9.712.2-37.2Low calorie, low fat diet77-6.2-7.41.1-19.1Ebbling et al. Am J Clin Nutr. 2005; 81; 981.
33Calculated odds ratios (lowest > highest quintiles) Benefits of Low GI DietLow GI diet aids in weight control.Nurses’ Health Study,74,091 women, yCalculated odds ratios (lowest > highest quintiles)BMI (≥30)n = 6,400Major weight gain(≥25kg) n = 657Whole grains-19%-23%Refined grains+18%+26%Dietary fiber-34%-49%Lin et al. Am J Clin Nutr. 2003; 78; 923.
34Benefits of Low GI Diet Low GI diet aids in weight control. Post low GI MNT counseling, 21 subjects, y, 3-36 mos.pre LGI-MNTpost LGI-MNTBurani & Longo. Diabetes Educ. 2006; 32; 83.
35Benefits of Low GI Diet Low GI diet decreases risk of heart disease. Nurses’ Health Study,75,521 adult women, y, free of CHD10 year follow-up: 761 cases of CHDRelative risk of CHDGL highest quintile1.98GI highest quintile1.31Lin et al. Am J Clin Nutr. 2000; 71;
36Benefits of Low GI Diet Low GI diet decreases risk of heart disease. Nurses’ Health Study,78,779 women, y, free of CVD18 year follow-up: 1,020 stroke cases documentedRelative riskCHO intake (all subjects)2.05 for hemorrhagic strokeCHO intake (BMI ≥ 25)2.13 for total stroke3.84 for hemorrhagic strokeGL intake (BMI ≥ 25)1.61 for total strokecereal fiber (all subjects)0.66 for total stroke0.51 for hemorrhagic strokeOh et al. Am J Epid. 2005; 161;
37Benefits of Low GI Diet Low GI diet decreases risk of diabetes. Nurses’ Health Study,65,173 US women y, free of DM6 year follow-up: 915 cases of type 2 DMRelative riskGI1.37GL1.47cereal fiber0.72GL cereal fiber2.50Salmeron et al. JAMA. 1997; 277; 472.
38Benefits of Low GI Diet Low GI diet decreases risk of diabetes. Health Professionals’ Follow-up Study,42,759 US men y, free of DM6 year follow-up: 523 cases of type 2 DMRelative riskGI1.37cereal fiber0.70GL cereal fiber2.17Salmeron et al. Diabetes Care. 1997; 20; 245.
40What Should I Eat? 2005 Dietary Guidelines Balance calories in with calories out.Eat balanced diet with variety of nutrient-dense foods and beverages.Consume 2 cups fruit, 2½ cups vegetables per day. (2,000 calories intake)Choose whole grains for at least half of daily grain consumption.Consume 3 cups FF/LF milk or equivalent.Keep fat consumption 20-35% of daily calories. (mono & polyunsaturated)Consume less than 2300 mg sodium/day.Choose foods with little added sugar or caloric sweeteners.Drink alcohol in moderation.Practice food safety handling and preparing rules.
41Caution!Do not focus exclusively on achieving a low glycemic load diet with all low glycemic index food choices.Result could be: high fatlow carbohydratelow fibercalorically denseInstead…
42A Better IdeaAim for a well-balanced diet that includes low glycemic index carbohydrates. Use glycemic load as a guide for controlling portions.Hint:Low GI CHOs allow for larger portions, while regulating the GL.High GI CHOs require smaller portions to regulate the GL.
43Pictures of Low/High GI Meals & Snacks GI = GL = 48GI = GL = 31
44Pictures of Low/High GI Meals & Snacks GI = GL = 48GI = GL = 22
45Pictures of Low/High GI Meals & Snacks GI = GL = 19GI = GL = 1
46Pictures of Low/High GI Meals & Snacks GI = GL = 32GI = GL = 12
47Pictures of Low/High GI Meals & Snacks GI = GL = 31GI = GL = 16
48How to increase consumption of low GI foods What Should I Eat?How to increase consumption of low GI foodsEat high-fiber breakfast cereals(oats, bran, barley)ORAdd berries, nuts, flaxseed and cinnamonto high GI cereals.
49How to increase consumption of low GI foods What Should I Eat?How to increase consumption of low GI foodsChoose dense, whole grain and sourdough breads and crackers.ORAdd a heart-healthy protein and/or condiment to high GI breads and crackers.
50How to increase consumption of low GI foods What Should I Eat?How to increase consumption of low GI foodsInclude 5-9 servings offruits and vegetables every day.ORNo ifs, ands or buts – just do it!(Mom was right.)
51How to increase consumption of low GI foods What Should I Eat?How to increase consumption of low GI foodsReplace white potatoes withyams or sweet potatoes.ORTry canned new potatoes, or just eatsmaller portion of high GI potatoes.
52How to increase consumption of low GI foods What Should I Eat?How to increase consumption of low GI foodsEat less refined sugars and convenience foods (soda, sweets, desserts, etc.)ORCombine nuts, fruit, yogurt, ice cream with commercial sweets – just watch portion sizes.
53Case Study – “Amy” 38 YO administrative assistant Married, no children Height: 5’7”Weight: 320 lbs.BMI: 50 (severe obesity)Type 2 DM since age 35A1c: 6.3 (Glucophage 500 mg)BP: 148/90 (Altace 10 mg)Before
546250 Kcal: 43% CHO (666g), 11% PRO (173g), 46% fat (321g) Case Study – Amy’s Before DietBreakfast: toasted bagel with cream cheese, 16 oz. orange juice, large coffee with whole milkLunch: 6” roast beef & cheese sub sandwich w/ mayo, 20 oz. diet PepsiSnack: (“all afternoon long”) 13 oz. bag Hershey miniature chocolate barsDinner: ½ box macaroni & cheese (made w/ 2% milk), 3 beef hot dogs on buns, waterSnack: 1 ½ cups ice cream6250 Kcal: 43% CHO (666g), 11% PRO (173g), 46% fat (321g)GI = 57 (moderate)GL = 352 (very high)
552150 Kcal: 47% CHO (251g), 19% PRO (104g), 34% fat (82g) Case Study – Amy’s After DietBreakfast: 2 slices 100% WW toast, 1 Tbsp natural, NSA peanut butter, 1 Tbsp all-fruit jelly, 1 cup fresh strawberries, large coffee w/ skim milkLunch: 4 oz. grilled chicken breast, large green salad with varied fresh vegetables & 2 Tbsp vinaigrette dressing, small boiled sweet potato, orange, diet iced teaSnack: 6 oz. light yogurt, ½ cup cherries (frozen)Dinner: 4 oz. grilled salmon w/ lemon juice, 1 cup pasta w/ 1 cup broccoli rabe, 1 Tbsp olive oil, waterSnack: apple2150 Kcal: 47% CHO (251g), 19% PRO (104g), 34% fat (82g)GI = 39 (low)GL = 61 (low)
58Patient Empowerment Model The patient makes self-directed, informed decisions about personal behavioral changes.
59Practitioner’s Empowerment Model The practitioner makes self-directed, informed decisions about professional educational changes.
firstname.lastname@example.org www.glycemicindex.com high glucose response (high GI)low glucose response (low GI)Plasma glucose response (mmol/L) from a high vs. low GI food. The change in blood glucose concentration over time is expressed and calculated as the area under the curve (AUC) (Wolever et al, 1991).