1. Prepared by Monique Covey Senior Clinical Dietitian August 2014 Low GI diets – what are they and why are they good for people with Mitochondrial Disease?

2. Outline General Nutrition Diabetes Carbohydrates Glycaemic Index Carbohydrate – amount and spread Low Carbohydrate diets

3. Nutrition for life Adequate nutrition essential in managing mitochondrial disease. Key nutrients –Carbohydrate –Fat –Protein –Vitamins and Minerals Mitochondria use glucose from CHO to form ATP (energy) Low GI diet used to manage IGT and diabetes in mitochondrial disease

4. What happens when carbohydrate is eaten? Glucose Insulin Blood stream Body cell

5. What is Diabetes? Insulin Glucose

6. What are

7. Cereals and grains –Rice Flour-based staples –Bread –Pasta Starchy veggies –Potato & sweet potato –Corn What are carbohydrate foods?

8. Lentils and legumes eg. beans, chickpeas, split peas Milk Yoghurt Custard (not cream or cheese) Fruit Fruit Juice Dried Fruit

9. “Sometimes” foods –Sugar –Cake & biscuits –Ice cream –Soft drinks –Sweets & chocolate –Chips What are carbohydrate foods?

10. Simple? Complex? Starchy? Sugary? Brown vs White Carbs are Carbs They all end up as glucose molecules and are absorbed into the bloodstream The difference is the forms in which they’re eaten and the rate at which they break down to glucose in the gut (GI) CHO glucose

11. Glycaemic Index (GI) A ranking of foods based on their effect on blood sugar levels Reflects both the structure and composition of foods Low GI ≤55 Intermediate 56-69 High ≥70

12. “Fast acting” carbs – cause a sharp rise in BSL =HIGH GI “Slow acting” carbs – gentle rise in BSL (slow release of glucose into blood) =LOW GI Glycaemic Index (GI) HIGH GI = Digested fast LOW GI = Digested slowly

13. Low GI Foods (≤ 55)

14. Moderate GI Foods (56-69)

15. High GI Foods (≥ 70)

16. Useful Websites http://www.gisymbol.com/ http://www.glycemicindex.com/

17. How much Carbohydrate? BreakfastLunchDinner 8 am 10 am 12 noon 3 pm 6 pm 9 pm Aim for an even spread through the day

18. 3 small meals & 3 snacks Aim for: –Breakfast2- 3 serves –Morning tea 1-2 serves –Lunch2-3 serves –Afternoon tea1-2 serves –Dinner 2-3 serves –Supper 1-2 serves Avoid fasting How much Carbohydrate?

19. What is 1 serve of carbohydrate? 15 grams –3 teaspoons sugar –1 slice bread –¼ large Lebanese bread –1/3 cup cooked rice –1 glass milk –2 (small) scoops ice cream –1 medium piece fruit

20. Low CHO diets and mitochondrial disease Minimal evidence Based on Ketogenic diet for patients with refractory seizures that don’t respond to medication. Last resort Very restrictive Needs close medical and dietetic supervision.

21. Summary: Points to remember Adequate nutrition is vital in the management of mitochondrial disease Aim for 3 meals and 3 snacks per day – avoid fasting Include low GI CHO at every meal Low GI diets are not suitable for everyone with mitochondrial disease Seek further advice from your local dietitian QUESTIONS?