Printable Version
Dietary glycemic index and the regulation of body weight.
Effect of processing on nutritionally important starch fractions in rice varieties.
Metabolic and hormonal effects of five common African diets eaten as mixed meals: the Cameroon Study.
Does dietary sugar and fat influence longevity?
Glycaemic index of cereal products explained by their content of rapidly and slowly available glucose.
Determination of the glycaemic index of foods: interlaboratory study.
Prolongation of satiety after low versus moderately high glycemic index meals in obese adolescents.
Whole grain consumption and weight gain: a of the epidemiological evidence, potential mechanisms and opportunities for future research.
Dietary glycemic index and the regulation of body weight.
Digestion rate of legume carbohydrates and glycemic index of legume-based meals.
High-complex carbohydrate or lente carbohydrate foods?.
Carbohydrate fractions of legumes: uses in human nutrition and potential for health.
New legume sources as therapeutic agents.
The delivery rate of dietary carbohydrates affects cognitive performance in both rats and humans.
Should obese patients be counselled to follow a low-glycaemic index diet? No.
Should obese patients be counselled to follow a low-glycaemic index diet? Yes.
Glycaemic glucose equivalent: combining carbohydrate content, quantity and glycaemic index of foods for precision in glycaemia management.
Fructose prefeeding reduces the glycemic response to a high-glycemic index, starchy food in humans.
Western diet and Alzheimer's disease. [Article in Italian].
Influence of dietary carbohydrates and glycaemic response on subjective appetite and food intake in healthy elderly persons.
Glycemic index and disease.
Glycemic index and obesity.
International table of glycemic index and glycemic load values: 2002.
Effect of food composition of mixed food on glycemic index. [Article in Chinese].
The influence of dietary composition on energy intake and body weight.
Capacity of edible seaweeds to modify in vitro starch digestibility of wheat bread.
Dietary patterns and their associations with obesity in the Brazilian city of Rio de Janeiro.
Use of quality control indices in moderately hypocaloric Mediterranean diet for treatment of obesity.
Healthy lifestyles in Europe: prevention of obesity and type II diabetes by diet and physical activity.
Glycemic Index

The Glycemic Index (GI) is an important theoretical concept in attempting to understand nutritional processes. It is a number (usually in the range 10 to 100) characteristic for a particular type of food, relating to how quickly your blood-sugar level goes up after you eat some of that food. This property varies greatly between different foods.
For a long introductory article on the Glycemic Index, see:

In general the ideal is a low index-figure, which implies that blood-sugar level rises only slowly, i.e. that the food is digested slowly. In such a case the body's digestive system has time to deal with the food in the most appropriate fashion. This may be compared to the "delayed release" capsules available for some drugs; and in fact one author goes so far as to suggest that one should regard food as a drug whose prime function is to control blood-sugar level.

Low GI (slow change of blood-sugar level) is especially important for sufferers from diabetes, since in this disease the body's normal regulatory mechanism for blood-sugar does not function correctly; and inappropriate levels, over the long-term, cause many consequential problems. Conversely, a regular diet of high-GI foods (such as high-sugar foods), tends to be associated with just these kind of problems -- and may in fact have a causative role in the development of diabetes. This disease is now extremely common in "developed" countries, and its incidence seems to be increasing

It is also suggested that low-GI foods may be beneficial in providing a greater feeling of satiety, thus discouraging overeating and helping to avoid the development of obesity. Unfortunately however, there are at present a number of limitations, and the Glycemic Index is less useful for practical purposes than one might hope. Some of the problems are discussed below.

How is GI measured?

As might be expected, eating a dose of sugar makes the blood-sugar level increase almost immediately. After about 2 hours however (if no more food is eaten), the blood-sugar level reaches a peak and then slowly declines as the body deals with this "fuel" intake. Other types of food, such as legumes, tend to be digested more slowly and the peak level is lower and "flatter". A rapidly-digested food such as sugar is normally employed as a convenient reference-standard.

The usual test-procedure is that after a pre-test fasting period (commonly 8 hours), a standard amount of the food (commonly 80 grams) is eaten; and at a given time (2 hours) after eating, the blood-sugar concentration (mg/100ml) is measured. This figure is then compared to the level found 2 hours after a "standard" meal, commonly the same weight of glucose (or sometimes white bread, which like glucose is digested quickly). The ratio of the two concentrations, expressed as a percentage, is the Glycemic Index for that type of food. (Sometimes a more sophisticated measure is used in which the blood-sugar level is measured at several different times and the "area under the curve" (AUC) is calculated.)

Glycemic Load

Another figure sometimes quoted is Glycemic Load (GL). This is simply the amount of carbohydrate in the food eaten (e.g. in the test-meal used to measure GI), in grams, "scaled" by multiplying by the GI. So if the 80g test-meal contained 4g of carbohydrate, and the GI for that food was 50 (%), or 0.5, the Glycemic Load would be 2 (grams).

The thought behind this is that one would like to be able to assess the effect on blood-sugar of "real" food-intake, and such effect obviously depends on the amount eaten, not just the type of food. More specifically, the effect is presumed to depend mainly on the amount (and type) of carbohydrate, since the other food components, protein and fat, are digested much more slowly. Extending the idea, one might calculate the GL figure for each (carbohydrate) component of a given meal, and add them up to give the total GL; which could be thought of as the weight of "pure" sugar which would be expected to produce an equivalent blood-sugar effect.

General guidelines

Because of the limitations of our present state of knowledge, however, the apparent exactness implied by GI figures is rather deceptive (see below). General guidelines, rather than mathematical precision, are probably the most one should expect.

Originally it was assumed that a clear-cut distinction could be made between the glycemic effects of different types of carbohydrates as classified according to well-known categories; sugars versus starches, or on the basis of size of molecule -- "simple" carbohydrates (e.g. sugar) versus "complex" carbohydrates (as found e.g. in whole-grains). But it has turned out that in practice it is not really possible to predict in advance which foods will have high or low GI values. Current research thus falls back on a descriptive classification into "RAC" and "SAC" ("rapidly available" and "slowly available") carbohydrate types; but it is not yet clear just what is the crucial factor causing this difference.

  • Sugary foods generally have high GI.
  • Legumes (e.g. beans, lentils) generally have low GI.
  • Raw foods have lower GI than the same foods when cooked.
  • Less-processed foods have lower GI than the processed version (e.g.
    whole-grains compared to flour) .

Practical limitations

Here we sketch some of the factors which at present tend to limit the usefulness of available Glycemic Index data

Non-comparable measurements

As can be seen from the outline description already given, GI measurement is a somewhat tedious process; and (as usual for bio-measurements) one needs to take the average result for a large number of persons. Experiments thus usually compare a rather limited range of foods, in a given study. For this reason, and of course as a reliability check, to get an overall picture we need to use data from many different sources. But there are a number of important factors which are unfortunately often not the same between different investigations, and which may make the results not directly comparable.

Here are a few examples of such difficulties, which can be particularly misleading for those lacking scientific training:

  • The high-GI "standard" food (GI=100) is often glucose, but sometimes another food is used. If this is clearly stated, then a correction-factor can be applied -- but some authors neglect to do this.
  • The amount of the meal is often 80g, but sometimes 100g or some other figure. (And in this regard one could perhaps ask whether it would not be better to use, instead of a fixed absolute amount, an amount constant in some other aspect, e.g. in proportion to the test-person's body-weight. To overcome this problem, a different measure called "Glycemic Glucose Equivalent" (GGE) has been proposed. But there is at present little published data giving GGE figures.)
  • The time of measurement is commonly 2 hours after the test-meal, but in some cases 3 hours; and the pre-test fasting period may also vary.
  • The number of persons tested has a great influence on the accuracy of the result. So a test on 100 persons, producing a GI result of (say) 30, might (or might not) be in fact consistent with a test on only 5 persons which came up with a GI result of 50. To decide, one needs to know more details.
  • Food from different sources (e.g. crops grown in different conditions or in different regions) may have different properties.
  • The exact cooking or processing method of the test-food may be of great significance, but this can be difficult to standardise between different investigations.

But perhaps the most significant problem is that a great proportion of the GI investigations have been carried out on diabetic patients (because of its practical importance in this disease). It appears highly problematic to try and compare GI figures found in such patients, where the blood-sugar metabolism is known to be disturbed (and where, also, the type and severity of the disease may differ widely), with figures found in tests on non-diabetic subjects.

In the early days, when relatively few measurements had actually been made, ambitious "ranking" tables for various foods with (as it now appears) somewhat spurious apparent precision were constructed. In fact, given the tendency of many authors to copy uncritically (or even blindly) from each other, much of this potentially misleading data is still around today, and still presented as "gospel".

But all the above factors, and no doubt others as well, mean that for a given type of food one will often find quite wildly different GI figures quoted (e.g. for carrots, 16% to 80%; for bread, 40% to 85%). Some of these apparent discrepancies may be resolvable by assessing the exact details of the investigations concerned -- provided these can be found.

Experimental data and real life

Even if the above-mentioned incompatibilities of different measurements could be standardised or allowed for, there is another fundamental difficulty in making practical use of GI figures.

In experiments, the investigator usually tries to simplify the conditions as much as possible. But in real life one will in most cases eat not just one food alone (after a standard fasting period), but rather a series of meals each combining several different foods.

As mentioned above, the "Glycemic Load" concept on the face of it does offer a simple way of calculating the combined effect. But, unfortunately, this simple addition procedure is not necessarily a reliable predictor. The different foods interact in complex ways, and the real rate of absorption is characteristic of that particular combination. For example, it is found that the fat component of a meal -- not directly taken account of in the GL calculation -- tends to slow the rise in blood-sugar. Even food-additives which in themselves have little or no nutritional value can modify the glycemic effect. It has also been shown that certain foods eaten some time previously can markedly influence the glycemic impact of the current meal -- but there may be no effect if the foods are both consumed at the same time.

Some interesting and valuable work has been done to compare the overall glycemic effect of "typical" meals, in a few relatively simple cases; but then of course the problems of comparability between different studies are even more difficult.

The whole field is the subject of ongoing research. No doubt in due ourse matters will become clearer; but at present, although the glycemic effect of food intake is an important (but often neglected) aspect which certainly deserves serious consideration, caution seems appropriate in using published GI data as a precise guide in diet-planning.

If you nevertheless want to check out reported findings for various foods, here are a few interesting links:

[Classifies common foods into high/ medium/ low-GI groups.]

[Database with results of tests for a large number of foods, quoting journal references and other details.]

[Edited version of the above database.]


In summary, Glycemic Index is undoubtedly an important factor to bear in mind when trying to optimise your diet -- but the well-known proverb has literal relevance here: "The proof of the pudding is in the eating!" Let practical experience be your ultimate guide.


Lipids 2003 Feb;38(2):117-21
Dietary glycemic index and the regulation of body weight.

Ludwig DS.
Department of Medicine, Children's Hospital, Boston, Massachusetts 02115, USA.

Prevalence rates of overweight and obesity have risen precipitously in the United States and other developed countries since the 1960s, despite comprehensive public health efforts to combat this problem. Although considerable attention has been focused on decreasing dietary fat and increasing physical activity level, the potential relevance of the dietary glycemic index to obesity treatment has received comparatively little scientific notice. This examines how the glycemic and insulinemic responses to diet may affect body weight regulation, and argues for the potential utility of low glycemic index diets in the prevention and treatment of obesity and related complications.
PMID: 12733742

Int J Food Sci Nutr 2003 Jan;54(1):27-36
Effect of processing on nutritionally important starch fractions in rice varieties.
Rashmi S, Urooj A.
Department of Studies in Food Science & Nutrition, University of MysoreManasagangotri, Mysore 570 006, India.

In the present study the effect of processing on starch fractions (rapidly digestible starch (RDS), slowly digestible starch (SDS) and resistant starch) were measured, using controlled enzymic hydrolysis with pancreatin and amyloglucidase, in six rice varieties; namely, BT rice, Gauri rice, Sona masoori, parboiled rice, Salem parboiled rice, and steamed rice. The processes studied were pressure cooking, boiling, steaming and straining. Rapidly available glucose (RAG) was also measured to derive a Starch Digestion Index (SDI). Cooking of rice by different methods decreased the amylose content. The degree of gelatinization ranged from 56 to 95, with pressure cooking resulting in the maximum degree. The starch fractions varied depending on the cooking method. Significant inverse correlations were seen between RDS and SDS (r = 0.40, P < 0.05), and between amylose and SDI (r = 0.60, P < 0.01). RAG and RDS related positively (r = 0.90, P < 0.01). The SDI of rice varieties cooked by the boiling and straining method were significantly higher (P < 0.05). The results emphasize that cooking methods influence the nutritionally important starch fractions in rice varieties.
PMID: 12701235

Eur J Clin Nutr 2003 Apr;57(4):580-5
Metabolic and hormonal effects of five common African diets eaten as mixed meals: the Cameroon Study.
Mbanya JC, Mfopou JK, Sobngwi E, Mbanya DN, Ngogang JY; Cameroon Study.
Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences University of Yaounde 1, Cameroon.

OBJECTIVE: To evaluate glycaemic and insulinaemic index and in vitro digestibility of the five most common Cameroonian mixed meals consisting of rice+tomato soup (diet A), bean stew+plantains (B), foofoo corn+ndole (C)yams+groundnut soup (D), and koki beans+cassava (E). SUBJECTS: Ten healthy non-obese volunteers, aged 19-31 y, with no family history of diabetes or hypertension. INTERVENTIONS: A 75 g oral glucose tolerance test followed by the eating of the test diets with carbohydrate content standardized to 75 g every 4 days with blood samples taken at 0, 15, 30, 60, 120 and 180 min. In vitro digestion of each diet according to Brand's protocol. MAIN OUTCOME MEASURES: Plasma glucose, cholesterol, triglyceride, insulin and C-peptide, with calculation of glycaemic and insulinaemic index defined as the area under the glucose and insulin response curve after consumption of a test food divided by the area under the curve after consumption of a control food containing the same amount of carbohydrate, and digestibility index. RESULTS: Glycaemic index (GI) varied from 34.1 (diet C) to 52.0% (diet E) with no statistical difference between the diets, and insulinaemic index varied significantly from 40.2% (C) to 70.9% (A) (P=0.03). The digestibility index varied from 18.9 (C) to 60.8% (A) (P<0.0001), and did not correlate with glycaemic or insulinaemic indices. However, carbohydrate content correlated with GI (r=0.83; P=0.04), digestibility index (r=-0.70; P<0.01), and insulinaemic index (r=0.91; P<0.01). Plasma C-peptide and plasma lipids showed little difference over 180 min following the ingestion of each meal. CONCLUSIONS: Glycaemic index of these African mixed meals are relatively low and might not be predicted by in vitro digestibility index.
PMID: 12700620

Med Hypotheses 2003 Jun;60(6):924-9
Does dietary sugar and fat influence longevity?
Archer VE.
Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA.

Simultaneous consideration of the influence of the different types of carbohydrates and fats in human diets on mortality rates (especially the diseases of aging), and the probable retardation of such diseases by caloric restriction (CR) leads to the hypothesis that restriction of foods with a high glycemic index and saturated or hydrogenated fats would avoid or delay many diseases of aging and might result in life extension. Many of the health benefits of CR might thereby be available to humans without the side effects or unacceptability of semi-starvation diets.
PMID: 12699727

Br J Nutr 2003 Mar;89(3):329-40
Glycaemic index of cereal products explained by their content of rapidly and slowly available glucose.
Englyst KN, Vinoy S, Englyst HN, Lang V.
Englyst Carbohydrates - Research & Services Ltd, 2 Venture Road, Chilworth Science Park, Hampshire SO16 7NP, UK.

Elucidating the role of carbohydrate quality in human nutrition requires a greater understanding of how the physico-chemical characteristics of foods relate to their physiological properties. It was hypothesised that rapidly available glucose (RAG) and slowly available glucose (SAG), in vitro measures describing the rate of glucose release from foods, are the main determinants of glycaemic index (GI) and insulinaemic index (II) for cereal products. Twenty-three products (five breakfast cereals, six bakery products and crackersand twelve biscuits) had their GI and II values determined, and were characterised by their fat, protein, starch and sugar contents, with the carbohydrate fraction further divided into total fructose, RAG, SAG and resistant starch. Relationships between these characteristics and GI and II values were investigated by regression analysis. The cereal products had a range of GI (28-93) and II (61-115) values, which were positively correlated (r(2)) 0.22, P<0.001). The biscuit group, which had the highest SAG content (8.6 (SD 3.7) g per portion) due to the presence of ungelatinised starch, was found to have the lowest GI value (51 (SD 14)). There was no significant association between GI and either starch or sugar, while RAG was positively (r(2)) 0.54P<0.001) and SAG was negatively (r(2)) 0.63, P<0.001) correlated with GI. Fat was correlated with GI (r(2)) 0.52, P<0.001), and combined SAG and fat accounted for 73.1% of the variance in GI, with SAG as the dominant variable. RAG and protein together contributed equally in accounting for 45.0 % of the variance in II. In conclusion, the GI and II values of the cereal products investigated can be explained by the RAG and SAG contents. A high SAG content identifies low-GI foods that are rich in slowly released carbohydrates for which health benefits have been proposed.
PMID: 12628028

Eur J Clin Nutr 2003 Mar;57(3):475-82
Determination of the glycaemic index of foods: interlaboratory study.
Wolever TM, Vorster HH, Bjorck I, Brand-Miller J, Brighenti F, Mann JI, Ramdath DD, Granfeldt Y, Holt S, Perry TL, Venter C, Xiaomei Wu.
Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.

OBJECTIVE:: Practical use of the glycaemic index (GI), as recommended by the FAO/WHO, requires an evaluation of the recommended method. Our purpose was to determine the magnitude and sources of variation of the GI values obtained by experienced investigators in different international centres. DESIGN:: GI values of four centrally provided foods (instant potato, rice, spaghetti and barley) and locally obtained white bread were determined in 8-12 subjects in each of seven centres using the method recommended by FAO/WHO. Data analysis was performed centrally. SETTING:: University departments of nutrition. SUBJECTS:: Healthy subjects (28 male, 40 female) were studied. RESULTS:: The GI values of the five foods did not vary significantly in different centres nor was there a significant centrexfood interaction. Within-subject variation from two centres using venous blood was twice that from five centres using capillary blood. The s.d. of centre mean GI values was reduced from 10.6 (range 6.8-12.8) to 9.0 (range 4.8-12.6) by excluding venous blood data. GI values were not significantly related to differences in method of glucose measurement or subject characteristics (age, sex, BMI, ethnicity or absolute glycaemic response). GI values for locally obtained bread were no more variable than those for centrally provided foods. CONCLUSIONS:: The GI values of foods are more precisely determined using capillary than venous blood sampling, with mean between-laboratory s.d. of approximately 9.0. Finding ways to reduce within-subject variation of glycaemic responses may be the most effective strategy to improve the precision of measurement of GI values.European Journal of Clinical Nutrition (2003) 57, 475-482. doi:10.1038/sj.ejcn.1601551
PMID: 12627186

Pediatrics 2003 Mar;111(3):488-94
Prolongation of satiety after low versus moderately high glycemic index meals in obese adolescents.
Ball SD, Keller KR, Moyer-Mileur LJ, Ding YW, Donaldson D, Jackson WD.
Center for Pediatric Nutrition Research, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City 84132, USA.

BACKGROUND: One in 5 American children is overweight, despite a decrease in total fat consumption. This has sparked an interest in the carbohydrate composition of diets, including the glycemic index (GI). OBJECTIVE: To investigate whether a low-GI meal replacement (LMR) produced similar metabolichormonal, and satiety responses in overweight adolescents as a low-GI whole-food meal (LWM) when compared with a moderately high-GI meal replacement (HMR). METHODS: Randomized, crossover study comparing LMR, HMR, and LWM in 16 (8 male/8 female) adolescents during 3 separate 24-hour admissions. The meal replacements consisted of a shake and a nutrition bar. Identical test meals were provided at breakfast and lunch. Metabolic and hormonal indices were assessed between meals. Measures of participants' perceived satiety included hunger scales and ad libitum food intake. RESULTS: The incremental areas under the curve for glucose were 46% and 43% lower after the LMR and LWM, respectively, compared with the HMR. Insulin's incremental area under the curve was also significantly lower after both low GI test meals (LMR = 36%; LWM = 51%) compared with the HMR. Additional food was requested earlier after the HMR than the LMR (3.1 vs 3.9 hours, respectively), although voluntary energy intake did not differ. CONCLUSIONS: Differences in insulin response between the meal replacements occurred, and prolongation of satiety after the LMR, based on time to request additional food, was observed. We speculate that the prolonged satiety associated with low GI foods may prove an effective method for reducing caloric intake and achieving long-term weight control.
PMID: 12612226

Proc Nutr Soc 2003 Feb;62(1):25-9
Whole grain consumption and weight gain: a of the epidemiological evidence, potential mechanisms and opportunities for future research.
Koh-Banerjee P, Rimm EB.
Departments of Nutrition.

The epidemiological data that directly examine whole grain v. refined grain intake in relation to weight gain are sparse. However, recently reported studies offer insight into the potential role that whole grains may play in body-weight regulation due to the effects that the components of whole grains have on hormonal factors, satiety and satiation. In both s and observational studies the intake of whole-grain foods was inversely associated with plasma biomarkers of obesity, including insulin, C-peptide and leptin concentrations. Whole-grain foods tend to have low glycaemic index valuesresulting in lower postprandial glucose responses and insulin demand. High insulin levels may promote obesity by altering adipose tissue physiology and by enhancing appetite. The fibre content of whole grains may also affect the secretion of gut hormones, independent of glycaemic response, that may act as satiety factors. Future studies may examine whether whole grain intake is directly related to body weight, and whether the associations are primarily driven by components of the grain, including dietary fibre, bran or germ.
PMID: 12740053

Lipids 2003 Feb;38(2):117-21
Dietary glycemic index and the regulation of body weight.
Ludwig DS.
Department of Medicine, Children's Hospital, Boston, Massachusetts 02115, USA.

Prevalence rates of overweight and obesity have risen precipitously in the United States and other developed countries since the 1960s, despite comprehensive public health efforts to combat this problem. Although considerable attention has been focused on decreasing dietary fat and increasing physical activity level, the potential relevance of the dietary glycemic index to obesity treatment has received comparatively little scientific notice. This examines how the glycemic and insulinemic responses to diet may affect body weight regulation, and argues for the potential utility of low glycemic index diets in the prevention and treatment of obesity and related complications.
PMID: 12733742

Int J Food Sci Nutr 2003 Mar;54(2):119-26
Digestion rate of legume carbohydrates and glycemic index of legume-based meals.
Araya H, Pak N, Vera G, Alvina M.
Faculty of Medicine, Human Nutrition Center, University of Chile, PO Box, Correo 21, Santiago, Chile.

A study was performed to examine the rate of digestion of available carbohydrate in legumes and its mixtures with cereals, prepared as commonly eaten. The legumes and cereals studied were lentil (Lens sculenta), pea (Pisum sativum)bean (Phaseolus vulgaris, var tortola), rice (Oryza sativa) and spaghetti. Foods were purchased at the city market. Total starch content and the carbohydrate digestion rates were determined using the enzymatic method proposed by Englyst et al. Total starch levels ranged from 7.78 g/100 g in cooked flour bean to 20.6 g/100 g in a bean-spaghetti dish, and dietary fiber contents ranged from 2.4 g/100 g in a cooked 70:30 lentil-rice mixture to 5.26 g/100 g in a cooked whole bean. The rapid digestion rate carbohydrates showed values from 4.8 in the bean soup to 8.9 in the bean-spaghetti combination. The same results show, expressed as rapid available glucose (RAG), the amount of rapid carbohydrate/100 g food or meal as eaten, and as the starch digestion index (SDI), the percentage of rapid carbohydrate digestion rate in relation to the total amount of carbohydrate. The RAG values ranged between 5.0 for cooked beans and 10 for cooked beans and spaghetti, and the SDI ranged between 40 for cooked pea flour and 62 for cooked bean flour. Legumes prepared as soup showed a higher rapid digestion rate than legumes prepared as whole grain. The bean-spaghetti based-meal and the lentil-based meal showed glycemic index mean and standard deviation values of 76.8 +/- 43.4 and 49.3 +/- 29.5, RAG values of 7.0 and 6.0, and SDI values of 57 and 54, respectively. The knowledge of the importance of the carbohydrate digestion rates in human health in increasing, and probably will soon be used in the development of the food pyramid. The foods with a moderate fraction of rapid digestion rate, such as legumes, should be included in the base of the pyramid.
PMID: 12701368

Am J Med 2002 Dec 30;113 Suppl 9B:30S-37S
High-complex carbohydrate or lente carbohydrate foods?
Jenkins DJ, Kendall CW, Augustin LS, Vuksan V.
Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Current dietary guidelines of the American Diabetes Association emphasize the importance of minimizing risk factors for cardiovascular disease while maximizing diabetes control. Potential advantages are seen for increased monounsaturated fat intake, but only the quantity rather than the quality of the carbohydrate is considered important. However, of the carbohydrate issue suggests that many cultures now at high risk of diabetes originally consumed starchy staples higher in fiber and with a lower glycemic index than eaten currently. Furthermore, diets high in cereal fiber have been associated with improved glycemic control, and low glycemic index diets resulted in reduction in glycosylated proteins in type 1 and 2 diabetes. Finally, large cohort studies have demonstrated beneficial effects of cereal fiber and low glycemic index carbohydrate foods in reducing the risk both for diabetes and cardiovascular disease. The effect of insoluble cereal fiber is not readily explained, but a low glycemic index may result from a slower rate of carbohydrate absorption. Increased meal frequency as a model for reducing the rate of carbohydrate absorption has been shown to reduce day-long glucose and insulin levels in type 2 diabetes and reduce serum lipids in nondiabetic subjects. Therefore, there appears to be a potential role for low glycemic index, high-cereal fiber foods for prevention and treatment of diabetes. Both the nature of the dietary fat and the carbohydrate should be considered as potentially modifiable factors that together with weight control and exercise may play a role in diabetes and cardiovascular disease prevention and treatment.
PMID: 12566136

Br J Nutr 2002 Dec;88 Suppl 3:S293-306
Carbohydrate fractions of legumes: uses in human nutrition and potential for health.
Guillon F, Champ MM.
URPOI & UFDNH, National Institute for Agronomic Research (INRA), Rue de la Geraudiere, BP 71627, 44316 Nantes Cedex, 03, France.

Starch and fibre can be extracted, using wet or dry processes, from a variety of grain legumes and used as ingredients for food. alpha-Galactosides can be isolated during wet processes from the soluble extract. Starch isolates or concentrates are mostly produced from peas, whereas dietary fibre fractions from peas and soyabean are commercially available. The physico-chemical characteristics of fibre fractions very much depend on their origin, outer fibres being very cellulosic whereas inner fibres contain a majority of pectic substances. Inner fibres are often used as texturing agents whereas outer fibres find their main uses in bakery and extruded products, where they can be introduced to increase the fibre content of the food. Most investigations on impacts on health have been performed on soyabean fibres. When positive observations were made on lipaemia, glucose tolerance or faecal excretion, they were unfortunately often obtained after non-realistic daily doses of fibres. Legume starches contain a higher amount of amylose than most cereal or tuber starches. This confers these starches a lower bioavailability than that of most starches, when raw or retrograded. Their low glycaemic index can be considered as beneficial for health and especially for the prevention of diseases related to insulin resistance. When partly retrograded, these starches can provide significant amount of butyrate to the colonic epithelium and may help in colon cancer prevention. alpha-Galactosides are usually considered as responsible for flatus but their apparent prebiotic effects may be an opportunity to valorize these oligosaccharides.
PMID: 12498630

Br J Nutr 2002 Dec;88 Suppl 3:S287-92
New legume sources as therapeutic agents.
Madar Z, Stark AH.
The Hebrew University of Jerusalem, Faculty of Agricultural, Food and Environmental Quality Sciences, Institute of Biochemistry, Food Science and Nutrition, P.O. Box 12, Rehovot, 76100, Israel.

This evaluates the potential health benefits of three legume sources that rarely appear in Western diets and are often overlooked as functional foods. Fenugreek (Trigonella foenum graecum) and isolated fenugreek fractions have been shown to act as hypoglycaemic and hypocholesterolaemic agents in both animal and human studies. The unique dietary fibre composition and high saponin content in fenugreek appears to be responsible for these therapeutic properties. Faba beans (Vicia faba) have lipid-lowering effects and may also be a good source of antioxidants and chemopreventive factors. Mung beans (Phaseolus aureus, Vigna radiatus) are thought to be beneficial as an antidiabetic, low glycaemic index food, rich in antioxidants. Evidence suggests that these three novel sources of legumes may provide health benefits when included in the daily diet.
PMID: 12498629

Psychopharmacology (Berl) 2003 Feb;166(1):86-90
The delivery rate of dietary carbohydrates affects cognitive performance in both rats and humans.
Benton D, Ruffin MP, Lassel T, Nabb S, Messaoudi M, Vinoy S, Desor D, Lang V.
Department of Psychology, University of Wales Swansea, Singleton Park, Swansea, SA2 8PP UK.

RATIONALE: Glucose is the main metabolic fuel of the brain. The rate of glucose delivery from food to the bloodstream depends on the nature of carbohydrates in the diet, which can be summarized as the glycaemic index (GI). OBJECTIVES: To assess the benefit of a low versus high GI breakfast on cognitive performances within the following 4 h. METHODS: The influence of the GI of the breakfast on verbal memory of young adults was measured throughout the morning in parallel to the assessment of blood glucose levels. The learning abilities of rats performing an operant-conditioning test 3 h after a breakfast-like meal of various GI was also examined. RESULTS: A low GI rather than high GI diet improved memory in humans, especially in the late morning (150 and 210 min after breakfast). Similarly, rats displayed better learning performance 180 min after they were fed with a low rather than high GI diet. CONCLUSION: Although performances appeared to be only remotely related to blood glucose, our data provide evidence that a low GI breakfast allows better cognitive performances later in the morning.
PMID: 12488949

Obes Rev 2002 Nov;3(4):245-56
Comment in:
Obes Rev. 2002 Nov;3(4):233.
Obes Rev. 2003 Feb;4(1):73-4.

Should obese patients be counselled to follow a low-glycaemic index diet? No.
Raben A.
Research Department of Human Nutrition, Centre for Advanced Food Studies, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark.

In diabetes research the glycaemic index (GI) of carbohydrates has long been recognized and a low GI is recommended. The same is now often the case in lipid research. Recently, a new debate has arisen around whether a low-GI diet should also be advocated for appetite- and long-term body weight control. A systematic was performed of published human intervention studies comparing the effects of high- and low-GI foods or diets on appetite, food intake, energy expenditure and body weight. In a total of 31 short-term studies (< 1 d), low-GI foods were associated with greater satiety or reduced hunger in 15 studies, whereas reduced satiety or no differences were seen in 16 other studies. Low-GI foods reduced ad libitum food intake in seven studies, but not in eight other studies. In 20 longer-term studies (< 6 months), a weight loss on a low-GI diet was seen in four and on a high-GI diet in two, with no difference recorded in 14. The average weight loss was 1.5 kg on a low-GI diet and 1.6 kg on a high-GI diet. To conclude, there is no evidence at present that low-GI foods are superior to high-GI foods in regard to long-term body weight control. However, the ideal long-term study where ad libitum intake and fluctuations in body weight are permitted, and the diets are similar in all aspects except GI, has not yet been performed.
PMID: 12458971

Obes Rev 2002 Nov;3(4):235-43
Comment in:
Obes Rev. 2002 Nov;3(4):233.

Should obese patients be counselled to follow a low-glycaemic index diet? Yes.
Pawlak DB, Ebbeling CB, Ludwig DS.
Department of Medicine, Children's Hospital, Boston, MA 02115, USA.

A reduction in dietary fat has been widely advocated for the prevention and treatment of obesity and related complications. However, the efficacy of low-fat diets has been questioned in recent years. One potential adverse effect of reduced dietary fat is a compensatory increase in the consumption of high glycaemic index (GI) carbohydrate, principally refined starchy foods and concentrated sugar. Such foods can be rapidly digested or transformed into glucose, causing a large increase in post-prandial blood glucose and insulin. Short-term feeding studies have generally found an inverse association between GI and satiety. Medium-term s have found less weight loss on high GI or high glycaemic load diets compared to low GI or low glycaemic load diets. Epidemiological analyses link GI to multiple cardiovascular disease risk factors and to the development of cardiovascular disease and type 2 diabetes. Physiologically orientated studies in humans and animal models provide support for a role of GI in disease prevention and treatment. This examines the mechanisms underlying the potential benefits of a low GI diet, and whether such diets should be recommended in the clinical setting.
PMID: 12458970

Asia Pac J Clin Nutr 2002;11(3):217-25
Glycaemic glucose equivalent: combining carbohydrate content, quantity and glycaemic index of foods for precision in glycaemia management.
Monro JA.
Food Industry Science Centre, New Zealand Institute for Crop and Food Research, Palmerston North.

The glycaemic index (GI) is the blood glucose response to carbohydrate in a food as a percentage of the response to an equal weight of glucose. Because GI is a percentage, it is not related quantitatively to food intakes, and because it is based on equi-carbohydrate comparisons, GI-based exchanges for control of glycaemia should be restricted to foods providing equal carbohydrate doses. To overcome these limitations of GI, the glycaemic glucose equivalent (GGE), the weight of glucose having the same glycaemic impact as a given weight of food, is proposed as a practical measure of relative glycaemic impact. To illustrate the differences between GGE and GI in quantitative management of postprandial glycaemia, published values for carbohydrate content, GI and serving size of foods in the food groupings, breads, breakfast cereals, pulses, fruit and vegetables, were used to determine the GGE content per equal weight and per serving of foods. Food rankings and classifications for exchanges based on GGE content were compared with those based on GI. In all of the food groupings analysed, values for relative glycaemic impact (as GGE per 100 g food and per serving) within each of the categories, low, medium and high GI were too scattered for GI to be a reliable indicator of the glycaemic impact of any given food. Correlations between GI and GGE content per serving were highest in food groupings of similar carbohydrate content and serving size, including breads (r = 0.73) and breakfast cereals (r = 0.8), but low in more varied groups including pulses (r = 0.66), fruit (r = 0.48) and vegetables (r = 0.28). Because of the non-correspondence of GI and GGE content, food rankings by GI did not agree with rankings by GGE content, and placement of foods in GI-based food exchange categories was often not appropriate for managing glycaemia. Effects of meal composition and food intake on relative glycaemic impact could be represented by GGE content, but not by GI. Because GGE is not restricted to equicarbohydrate comparisons, and is a function of food quantity, GGE may be applied, irrespective of food or meal composition and weight, and in a number of approaches to the management of glycaemia. Accurate control of postprandial glycaemia should therefore be achievable using GGE because they address the need to combine GI with carbohydrate dose in diets of varying composition and intake, to obtain a realistic indication of relative glycaemic impact.
PMID: 12230236

J Nutr 2002 Sep;132(9):2601-4
Fructose prefeeding reduces the glycemic response to a high-glycemic index, starchy food in humans.
Heacock PM, Hertzler SR, Wolf BW.
School of Allied Medical Professions-Medical Dietetics Division, The Ohio State University, Columbus, OH 43210-1234, USA.

The study objective was to determine whether a small dose of fructose administered before or simultaneously with a high glycemic index, starchy food decreases postprandial glycemic response. Nondiabetic healthy adults (n = 31; mean +/- SEM: age, 26 +/- 1 y; weight, 66.1 +/- 2.6 kg; body mass index, 23.3 +/- 0.6 kg/m(2)) were studied in a randomized crossover design. Treatments consisted of 50 g available carbohydrate from instant mashed potatoes fed alone (control) or with 10 g fructose fed 60, 30 or 0 min before the potato meal. Capillary finger-stick blood samples were analyzed for glucose concentration at -60, -30, 0, 15, 30, 45, 60, 90 and 120 min relative to the ingestion of the potato meal. Compared with the control, the positive incremental area under the glucose curve was reduced 25 and 27% (P < 0.01) when fructose was fed either 60 or 30 min before the meal, respectively. In contrast to previous studies demonstrating that immediate administration of a small amount of fructose lowers the glycemic response to a glucose solution, we found that fructose must be consumed before a starchy food to reduce postprandial glycemia.
PMID: 12221216

Epidemiol Prev 2002 May-Jun;26(3):107-15
Western diet and Alzheimer's disease. [Article in Italian]
Berrino F.
Unita di epidemiologia, Istituto nazionale per lo studio e la cura dei tumori, via Venezian 1, 20133 Milano.

Alzheimer Disease, characterised by a global impairment of cognitive functions, is more and more common in Western societies, both because of longer life expectancy and, probably, because of increasing incidence. Several hints suggest that this degenerative disease is linked to western diet, characterised by excessive dietary intake of sugar, refined carbohydrates (with high glycaemic index), and animal product (with high content of saturated fats), and decreased intake of unrefined seeds--cereals, legumes, and oleaginous seeds--and other vegetables (with high content of fibres, vitamins, polyphenols and other antioxidant substances, phytoestrogens) and, in several populations, of sea food (rich in n-3 fatty acids). It has been hypothesised, in fact, that AD, may be promoted by insulin resistance, decreased endothelial production of nitric oxide, free radical excess, inflammatory metabolites, homocysteine, and oestrogen deficiency. AD, therefore, could theoretically be prevented (or delayed) by relatively simple dietary measures aimed at increasing insulin sensitivity (trough reduction of refined sugars and saturated fats from meat and dairy products), the ratio between n-3 and n-6 fatty acids (e.g. from fish and respectively seed oils), antioxidant vitamins, folic acid, vitamin B6, phytoestrogens (vegetables, whole cereals, and legumes, including soy products), vitamin B12 (bivalve molluscs, liver), and Cr, K, Mg, and Si salts. This comprehensive improvement of diet would fit with all the mechanistic hypotheses cited above. Several studies, on the contrary, are presently exploring monofactorial preventive strategies with specific vitamin supplementation or hormonal drugs, without, however, appreciable results.
PMID: 12197047

Int J Food Sci Nutr 2002 Jul;53(4):305-16
Influence of dietary carbohydrates and glycaemic response on subjective appetite and food intake in healthy elderly persons.
Kaplan RJ, Greenwood CE.
Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, FitzGerald Building, 150 College Street, Toronto, Ontario, Canada M5S 3E2.

Increased satiety and decreased food intake are reported following the consumption of low glycaemic index (GI) foods, which gradually increase blood glucose. This observation, however, is not uniformly supported and few studies have examined the impact of different GI foods on satiety and intake in the elderly. After an overnight fast, 10 men and 10 women (aged 60-82 years) consumed similar amounts of available carbohydrate as high (glucose drink or potatoes) or low (barley) GI foods or a non-energy placebo drink on four mornings. Blood glucose and subjective appetite were measured throughout a 120 min post-ingestion period, followed by consumption of an ad libitum lunch. Differences in plasma glucose after test food ingestion (glucose > potatoes > barley > placebo; P < 0.03) did not predict subjective appetite or lunch intake. Potatoes increased subjective satiety the most, followed by barley, then glucose, which trended towards greater satiety than placebo. Potatoes led to less hunger than placebo (P = 0.0023) and less prospective consumption than the other three foods (P < 0.0083), and potatoes and barley led to greater fullness than glucose and placebo (P < 0.0001). Lunch intake was decreased, compared with placebo (502 +/- 47 kcal, P < 0.031), by potatoes (405 +/- 40 kcal) and barley (441 +/- 41 kcal); however, only potatoes (41.9 +/- 12.3%) led to greater compensation at lunch for test food ingestion compared with glucose (11.9 +/- 9.5%, P = 0.016). These results suggest that elderly subjects are sensitive to the effects of different foods on subjective appetite and food intake, and that the GI of the foods tested did not predict their effects on satiety and food intake.
PMID: 12090026

Am J Clin Nutr 2002 Jul;76(1):290S-8S
Glycemic index and disease.
Pi-Sunyer FX.
Obesity Research Center, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA.

It has been suggested that foods with a high glycemic index are detrimental to health and that healthy people should be told to avoid these foods. This paper takes the position that not enough valid scientific data are available to launch a public health campaign to disseminate such a recommendation. This paper explores the glycemic index and its validity and discusses the effect of postprandial glucose and insulin responses on food intake, obesity, type 1 diabetes, and cardiovascular disease. Presented herein are the reasons why it is premature to recommend that the general population avoid foods with a high glycemic index.
PMID: 12081854

Am J Clin Nutr 2002 Jul;76(1):281S-5S
Glycemic index and obesity.
Brand-Miller JC, Holt SH, Pawlak DB, McMillan J.
Human Nutrition Unit, School of Molecular and Microbial Biosciences, University of Sydney, NSW, Australia.

Although weight loss can be achieved by any means of energy restriction, current dietary guidelines have not prevented weight regain or population-level increases in obesity and overweight. Many high-carbohydrate, low-fat diets may be counterproductive to weight control because they markedly increase postprandial hyperglycemia and hyperinsulinemia. Many high-carbohydrate foods common to Western diets produce a high glycemic response [high-glycemic-index (GI) foods], promoting postprandial carbohydrate oxidation at the expense of fat oxidation, thus altering fuel partitioning in a way that may be conducive to body fat gain. In contrast, diets based on low-fat foods that produce a low glycemic response (low-GI foods) may enhance weight control because they promote satiety, minimize postprandial insulin secretion, and maintain insulin sensitivity. This hypothesis is supported by several intervention studies in humans in which energy-restricted diets based on low-GI foods produced greater weight loss than did equivalent diets based on high-GI foods. Long-term studies in animal models have also shown that diets based on high-GI starches promote weight gain, visceral adiposity, and higher concentrations of lipogenic enzymes than do isoenergetic, macronutrientcontrolled, low-GI-starch diets. In a study of healthy pregnant women, a high-GI diet was associated with greater weight at term than was a nutrient-balanced, low-GI diet. In a study of diet and complications of type 1 diabetes, the GI of the overall diet was an independent predictor of waist circumference in men. These findings provide the scientific rationale to justify randomized, controlled, multicenter intervention studies comparing the effects of conventional and low-GI diets on weight control.
PMID: 12081852

Am J Clin Nutr 2002 Jul;76(1):5-56
Comment in:
Am J Clin Nutr. 2003 Apr;77(4):994; author reply 994-5

International table of glycemic index and glycemic load values: 2002.
Foster-Powell K, Holt SH, Brand-Miller JC.
Human Nutrition Unit, School of Molecular and Microbial Biosciences, University of Sydney, NSW, Australia.

Reliable tables of glycemic index (GI) compiled from the scientific literature are instrumental in improving the quality of research examining the relation between GI, glycemic load, and health. The GI has proven to be a more useful nutritional concept than is the chemical classification of carbohydrate (as simple or complex, as sugars or starches, or as available or unavailable), permitting new insights into the relation between the physiologic effects of carbohydrate-rich foods and health. Several prospective observational studies have shown that the chronic consumption of a diet with a high glycemic load (GI x dietary carbohydrate content) is independently associated with an increased risk of developing type 2 diabetes, cardiovascular disease, and certain cancers. This revised table contains almost 3 times the number of foods listed in the original table (first published in this Journal in 1995) and contains nearly 1300 data entries derived from published and unpublished verified sources, representing > 750 different types of foods tested with the use of standard methods. The revised table also lists the glycemic load associated with the consumption of specified serving sizes of different foods.
PMID: 12081815

Wei Sheng Yan Jiu 1999 Nov;28(6):356-8
Effect of food composition of mixed food on glycemic index. [Article in Chinese]
Cui H, Yang Y, Bian L, He M.
Institute of Nutrition and Food Hygiene, Chinese Academy of Preventive Medicine, Beijing 100050, China.

In order to study the effect of protein, fat and dietary fiber on glycemic index(GI) of mixed food, the response of blood glucose and plasma insulin to nine diets with different components of food were tested by using glucose oxidase and radioimmunoassay. Glycemic index of 9 mixed foods show as follows, rice: 83.2 +/- 3.1, rice + stir fry pork: 72.0 +/- 14.0, rice + stir fry pork and celery: 57.1 +/- 11.2, rice + stir fry garlic sprout: 57.9 +/- 7.8, rice + stir fry garlic sprout and eggs: 62.8 +/- 16.7, steamed bread: 80.1 +/- 22.5, steamed bread + butter: 68.0 +/- 16.3, and steamed bread + beef: 49.4 +/- 22.8. Protein(P, beta 1 = -0.696, P < 0.01) and dietary fiber(Fi, beta 2 = -7.364, P < 0.01) can reduce the blood glucose response and were significantly related to GI. Fat also can inhibit the increment of blood glucose, but there is no significant relation with GI. When the co-ingestion of protein with carbohydrate, the serum insulin response increased greatly and the glycemic response reduced. The addition of fat can reduce the glycemic response without change in serum insulin. Dietary fiber can reduce the serum insulin response and inhibit the glycemic response. CONCLUSION: Protein and dietary fiber of mixed food could markedly affect the glycemic index of foods and reduced the blood glucose response.
PMID: 12016989

J Am Coll Nutr 2002 Apr;21(2):140S-145S
The influence of dietary composition on energy intake and body weight.
Roberts SB, McCrory MA, Saltzman E.
Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts 02111, USA.

We evidence regarding the influence of dietary fat, fiber, the glycemic index and sugar on energy intake and body weight. Although data from comprehensive long-term studies are lacking, published investigations suggest that the previous focus on lowering dietary fat as a means for promoting negative energy balance has led to an underestimation of the potential role of dietary composition in promoting reductions in energy intake and weight loss. More randomized s are needed to examine the relative utility of different putative dietary factors in the treatment of obesity.
PMID: 11999542

Nahrung 2002 Feb;46(1):18-20
Capacity of edible seaweeds to modify in vitro starch digestibility of wheat bread.
Goni I, Valdivieso L, Gudiel-Urbano M.
University Complutense Madrid, Faculty of Pharmacy, Department of Nutrition, Avda. Complutense s/n Ciudad University, E-28040 Madrid, Spain.

The capacity of two species of edible seaweeds (Wakame, Undaria pinnatifida and Chondrus, Chondrus crispus) to modify the rate of white bread starch digestibility by an in vitro digestion system, as well as glucose retardation index and apparent viscosity were studied. Both Algae showed different effect on glucose retardation index. While Wakame did not make difficult dialysis of glucose, it only retained 2.50 +/- 2.99% to respect a negative control. Chondrus impaired the diffusion of a 28.70 +/- 2.35% of glucose, which are very close to those of citrus pectin (31.50 +/- 4.12%). On the other hand, viscosity of Chondrus solution was higher than Wakame and slightly lower than citrus pectin solution. The analysis showed a very low content of total starch in Wakame (0.51%) and Chondrus (0.47%). Algae reduced the digestion of white bread starch. The profile of starch hydrolysis was characteristic for each alga. Glycaemic index estimated from the degree of starch hydrolysis within 90 min was low (79) with respect to white bread (value 100). Seaweeds showed a suitable capacity to modify in vitro starch digestibility of white bread. Chondrus produces a more pronounced response. This fact seem to be due to different composition of samples.
PMID: 11890047

Obes Res 2002 Jan;10(1):42-8
Dietary patterns and their associations with obesity in the Brazilian city of Rio de Janeiro.
Sichieri R.
Instituto de Medicina Social, State University of Rio de Janeiro, UERJ, Brazil.

OBJECTIVE: To evaluate the dietary patterns of adults living in the city of Rio de Janeiro, Brazil and their associations with body mass index (BMI). RESEARCH METHODS AND PROCEDURES: A survey was conducted in 1996 in a probabilistic sample of 2040 households. Weight and height were measured and food intake was based on an 80-item semi-quantitative food frequency questionnaire. Dietary patterns were identified through factor analysis. RESULTS: More than one-third of the adult population (20 to 60 years old) was overweight (BMI = 25 to 29.9 kg/m(2)), and 12% were obese (BMI >or= 30 kg/m(2)). Three major dietary patterns were identified: mixed pattern when all food groups and items had about the same factor loading, except for rice and beans; one pattern that relies mainly on rice and beans, which was called a traditional diet; and a third pattern, termed a Western diet, where fat (butter and margarine) and added sugar (sodas) showed the highest positive loading and rice and beans were strong negative components. Among men, the Western diet also included deep-fried snacks and milk products with high positive values. The traditional diet was associated with lower risk of overweight/obesity in logistic models adjusted for dieting, age, leisure physical activity, and occupation (13% reduction in men and 14% reduction in women comparing the traditional and Western diets). DISCUSSION: Factors contributing to the effects of the Brazilian traditional diet may include low-energy density, high-dietary fiber content, incorporation of low glycemic index foods such as beans, or a relatively low food variety.
PMID: 11786600

Diabetes Nutr Metab 2001 Aug;14(4):181-
Use of quality control indices in moderately hypocaloric Mediterranean diet for treatment of obesity.
De Lorenzo A, Petroni ML, De Luca PP, Andreoli A, Morini P, Iacopino L, Innocente I, Perriello G.
Human Nutrition Unit, University of Rome Tor Vergata, Scientific Institute S. Lucia, Italy.

A large number of studies have been published on very-low calorie diets and markedly hypocaloric dietary regimens for treatment of obesity. However, scanty data are available on moderately hypocaloric diets based on the Mediterranean diet model. We evaluated the efficacy and safety of a moderately hypocaloric Mediterranean diet (MHMD) by assessing changes in body composition and in metabolic profile in 19 obese women, aged 32+/-4 years, body weight 84.7+/-9.6 kg, body mass index (BMI) 33.67+/-2.61 kg/m2. The energy content of the diet (mean 6.5 MJ/day) matched the resting metabolic rate and its content in macronutrients (55% carbohydrate, 25% fat, 20% protein, 30 g fibre) was based on the Italian Recommended Dietary Allowances (LARN). Based on the Mediterranean diet model, available nutritional indices like the animal/vegetable protein ratio, the Cholesterol/Saturated Fat Index, the Glycaemic Index, the Atherogenic Index, the Thrombogenic Index and the Mediterranean Adequacy Index were taken into account in elaborating diets. At baseline and after 2 months, body composition by dual energy X-ray absorptiometry, metabolic profile, uric acid, fibrinogen and oral glucose tolerance test (OGTT) were assessed. Following MHMD, body weight decreased to 78.1+/-10.5 kg and BMI to 31.18+/-2.74 kg/m2. Total (-4.9+/-0.9 kg) and segmental fat mass decreased, no significant loss of total and segmental lean body mass was observed. No decrease of fasting blood glucose (5.05+/-0.45 vs 4.98+/-0.43 mmol/l, NS), of the area under the curve (AUC) for glucose (29.50+/-6.24 vs 28.07+/-5.29, NS) as well as of HDL-cholesterol (1.30+/-0.30 vs 1.33+/-0.33 mmol/l, NS) and of triglycerides (1.70+/-1.00 vs 1.46+/-0.66 mmol/l, NS) was observed. However, a significant decrease of basal insulin (11.48+/-6.77 vs 8.07+/-4.17 mU/ml, p<0.01) as well as of the AUC for insulin (263+/-118 vs 208+/-82,p<0.005), of total (5.40+/-1.04 vs 4.97+/-0.92 mmol/l,p<0.05) and LDL-cholesterol (3.36+/-1.07 vs 2.90+/-0.74 mmol/l,p<0.005), of uric acid (0.30+/-0.06 vs 0.28+/-0.05 mmol/l,p<0.01) and fibrinogen (359+/-78 vs 324+/-87 mg/100 ml, p<0.0001) was observed. In conclusion, MHMD prevents loss of fat-free mass and improves metabolic parameters in obese people. We advocate a wider use of nutritional indices and body composition assessment as tools for quality control of hypocaloric diets.
PMID: 11716286

Public Health Nutr 2001 Apr;4(2B):499-515
Healthy lifestyles in Europe: prevention of obesity and type II diabetes by diet and physical activity.
Astrup A.
Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Denmark.

The prevalence of obesity is increasing rapidly in all age groups in most EU-countries and is one of the fastest growing epidemics, now affecting 10-40% of the adult population. Obesity increases the risk of serious co-morbidities such as type 2 diabetes, cardiovascular disease, certain cancers and reduced life expectancy, and these complications may account for 5-10% of all health costs in EU countries. The risk of diabetes is particularly increased by obesity, and 80-95% of the increase in diabetes can be attributed to obesity and overweight with abdominal fat distribution. There is robust evidence from cross-sectional and longitudinal studies to support that an energy-dense, high fat diet and physical inactivity are independent risk factors for weight gain and obesity. Furthermore, interaction between dietary fat and physical fitness determine fat balance, so that the obesity promoting effect of a high fat diet is enhanced in susceptible subjects, particularly in sedentary individuals with a genetic predisposition to obesity. Ad libitum consumption of diets low in fat and high in protein and complex carbohydrates, with a low glycaemic index, contributes to the prevention of weight gain in normal weight subjects. It also causes a spontaneous weight loss of 3-4 kg in overweight subjects, and has beneficial effects on risk factors for diabetes and CVD. To prevent obesity and diabetes there are grounds for recommending the combination of increasing daily physical activity level to a PAL-value of at least 1.8 and reducing dietary fat content to 20-25 energy-% in sedentary subjects, and to 25-35% in more physically active individuals.
PMID: 11683545

on the Adriatic Coast
The Anti-Aging Fasting Program consists of a 7-28 days program (including 3 - 14 fasting days). 7-28-day low-calorie diet program is also available .
More information
    The anti-aging story (summary)
Introduction. Statistical review. Your personal aging curve
  Aging and Anti-aging. Why do we age?
    2.1  Aging forces (forces that cause aging
Internal (free radicals, glycosylation, chelation etc.) 
External (Unhealthy diet, lifestyle, wrong habits, environmental pollution, stress, poverty-change "poverty zones", or take it easy. etc.) 
    2.2 Anti-aging forces
Internal (apoptosis, boosting your immune system, DNA repair, longevity genes) 
External (wellness, changing your environment; achieving comfortable social atmosphere in your life, regular intake of anti-aging drugs, use of replacement organs, high-tech medicine, exercise)
    2.3 Aging versus anti-aging: how to tip the balance in your favour!
    3.1 Caloric restriction and fasting extend lifespan and decrease all-cause mortality (Evidence)
      Human studies
Monkey studies
Mouse and rat studies
Other animal studies
    3.2 Fasting and caloric restriction prevent and cure diseases (Evidence)
Hypertension and Stroke
Skin disorders
Mental disorders
Neurogical disorders
Asthmatic bronchitis, Bronchial asthma
Bones (osteoporosis) and fasting
Arteriosclerosis and Heart Disease
Cancer and caloric restriction
Cancer and fasting - a matter of controversy
Eye diseases
Chronic fatigue syndrome
Sleeping disorders
Rheumatoid arthritis
Gastrointestinal diseases
    3.3 Fasting and caloric restriction produce various
      biological effects. Effects on:
        Energy metabolism
Lipids metabolism
Protein metabolism and protein quality
Neuroendocrine and hormonal system
Immune system
Physiological functions
Reproductive function
Cognitive and behavioral functions
Biomarkers of aging
    3.4 Mechanisms: how does calorie restriction retard aging and boost health?
        Diminishing of aging forces
  Lowering of the rate of gene damage
  Reduction of free-radical production
  Reduction of metabolic rate (i.e. rate of aging)
  Lowering of body temperature
  Lowering of protein glycation
Increase of anti-aging forces
  Enhancement of gene reparation
  Enhancement of free radical neutralisation
  Enhancement of protein turnover (protein regeneration)
  Enhancement of immune response
  Activation of mono-oxygenase systems
  Enhance elimination of damaged cells
  Optimisation of neuroendocrine functions
    3.5 Practical implementation: your anti-aging dieting
        Fasting period.
Re-feeding period.
Safety of fasting and low-calorie dieting. Precautions.
      3.6 What can help you make the transition to the low-calorie life style?
        Social, psychological and religious support - crucial factors for a successful transition.
Drugs to ease the transition to caloric restriction and to overcome food cravings (use of adaptogenic herbs)
Food composition
Finding the right physician
    3.7Fasting centers and fasting programs.
  Food to eat. Dishes and menus.
    What to eat on non-fasting days. Dishes and menus. Healthy nutrition. Relation between foodstuffs and diseases. Functional foods. Glycemic index. Diet plan: practical summary. "Dr. Atkins", "Hollywood" and other fad diets versus medical science

Bread, cereals, pasta, fiber
Glycemic index
Meat and poultry
Sugar and sweet
Fats and oils
Dairy and eggs
Nuts and seeds
Food composition

  Anti-aging drugs and supplements
    5.1 Drugs that are highly recommended
      (for inclusion in your supplementation anti-aging program)
        Vitamin E
Vitamin C
Co-enzyme Q10
Lipoic acid
Folic acid
Flavonoids, carotenes
Vitamin B
Vinpocetine (Cavinton)
Deprenyl (Eldepryl)
    5.2 Drugs with controversial or unproven anti-aging effect, or awaiting other evaluation (side-effects)
        Phyto-medicines, Herbs
      5.3 Drugs for treatment and prevention of specific diseases of aging. High-tech modern pharmacology.
        Alzheimer's disease and Dementia
Immune decline
Infections, bacterial
Infections, fungal
Memory loss
Muscle weakness
Parkinson's disease
Prostate hyperplasia
Sexual disorders
Stroke risk
Weight gaining
    5.4 The place of anti-aging drugs in the whole
      program - a realistic evaluation
    6.1 Early diagnosis of disease - key factor to successful treatment.
      Alzheimer's disease and Dementia
Cataracts and Glaucoma
Genetic disorders
Heart attacks
Immune decline
Infectious diseases
Memory loss
Muscle weakness
Parkinson's disease
Prostate hyperplasia
Stroke risk
Weight gaining
    6.2 Biomarkers of aging and specific diseases
    6.3 Stem cell therapy and therapeutic cloning
    6.4 Gene manipulation
    6.5 Prosthetic body-parts, artificial organs
Bones, limbs, joints etc.
Heart & heart devices
    6.6 Obesity reduction by ultrasonic treatment
  Physical activity and aging. Experimental and clinical data.
        Aerobic exercises
Weight-lifting - body-building
Professional sport: negative aspects
  Conclusion: the whole anti-aging program
    9.1 Modifying your personal aging curve
      Average life span increment. Expert evaluation.
Periodic fasting and caloric restriction can add 40 - 50 years to your lifespan
Regular intake of anti-aging drugs can add 20-30 years to your lifespan
Good nutrition (well balanced, healthy food, individually tailord diet) can add 15-25 years to your lifespan
High-tech bio-medicine service can add 15-25 years to your lifespan
Quality of life (prosperity, relaxation, regular vocations) can add 15-25 years to your lifespan
Regular exercise and moderate physical activity can add 10-20 years to your lifespan
These approaches taken together can add 60-80 years to your lifespan, if you start young (say at age 20). But even if you only start later (say at 45-50), you can still gain 30-40 years

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    9.2 The whole anti-aging life style - brief summary 
    References eXTReMe Tracker
        The whole anti-aging program: overview

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