![[COLLAGE]](http://www.glycemicindex.com/blog/2009/nov2009/collage_nov09.jpg)
How to read articles about health and healthcare
By Dr Alicia White
‘If you’ve just read a health-related headline that’s caused you to spit out your morning coffee (“Coffee causes cancer” usually does the trick) it’s always best to follow the Blitz slogan: “Keep Calm and Carry On”. On reading further you’ll often find the headline has left out something important, like “Injecting five rats with really highly concentrated coffee solution caused some changes in cells that might lead to tumours eventually. (Study funded by The Association of Tea Marketing.)”
The most important rule to remember: “Don’t automatically believe the headline”. It is there to draw you into buying the paper and reading the story. Would you read an article called “Coffee pretty unlikely to cause cancer, but you never know”? Probably not.
Before spraying your newspaper with coffee in the future, you need to interrogate the article to see what it says about the research it is reporting on. Bazian (the company I work for) has interrogated hundreds of articles for Behind The Headlines on NHS Choices, and we’ve developed the following questions to help you figure out which articles you’re going to believe, and which you’re not. It’s not possible to cover all the questions that need to be asked about research studies in a short article, but we’ve covered some of the major ones.
Mediterranean diet and managing diabetes
Consuming a Mediterranean style diet is more effective for diabetes management than a low-fat diet, reports a new study published in Annals of Internal Medicine. ‘Participants assigned to the Mediterranean-style diet lost more weight and experienced greater improvements in some glycemic control and coronary risk measures than did those assigned to the low-fat diet,’ wrote the researchers led by Katherine Esposito from the Second University of Naples. In addition to improvements in blood glucose management, the Mediterranean-style diet also delayed the need for anti-hyperglycemic (blood glucose lowering) drug therapy. ‘Perhaps most important, the findings reinforce the message that benefits of lifestyle interventions should not be overlooked despite the drug-intensive style of medicine fueled by the current medical literature,’
Esposito and her co-workers recruited 215 overweight people with newly diagnosed type-2 diabetes and randomly assigned them to consume the Mediterranean-style diet or a low-fat diet. After four years, only 44% of people in the Mediterranean-style diet group required anti-hyperglycemic drug treatment, compared to 70% in the low-fat diet group.
What did they eat? The Mediterranean diet was rich in vegetables and whole grains and low in red meat, which was replaced with poultry and fish. The low-fat diet was based on American Heart Association guidelines; it too was rich in whole grains and restricted additional fats, sweets, and high-fat snacks. The researchers note two primary limitations of their study: 1) it was not double-blind, and 2) dietary intakes were self-reported.
GI Group: We know that you are going to be asking exactly the same questions we did: what exactly did the people on the Mediterranean diet eat? We have tried to contact the authors, but at time of publication, had not had a reply. So we asked Johanna Burani who spends a great deal of time in Italy for some comments. ‘I think they are recommending LOTS of vegetables (all kinds) and LOTS of beans (pinto, chickpeas, kidney, garbanzo) and fruit. Under normal conditions, people in Italy wouldn't willingly choose wholewheat pasta or brown rice but maybe the authors got them to eat these whole grains for the study. I really think the thrust would be towards vegetables and beans -– at least for everyone out here in the trenches.’
Meal timing and weight gain
A new study published in Obesity (in mice) suggests that it’s not just how much you eat, but when you eat it, that influences weight gain. ‘How or why a person gains weight is very complicated, but it clearly is not just calories in and calories out,’ said Prof Fred Turek, director of the Center for Sleep and Circadian Biology at Northwestern University. ‘We think some factors are under circadian control. Better timing of meals … could be a critical element in slowing the ever-increasing incidence of obesity.’
To test whether ‘when you eat’ can affect body weight, the researchers studied two groups of mice and found simply modifying their feeding time alone greatly affected their body weight. Over the six-week study period, the group of mice that ate as much as they liked of a high-fat diet during their normal sleeping hours (our day time) gained significantly more weight than the mice eating the same type and amount of food during their naturally wakeful hours (our night time) although both groups of mice had actually consumed about the same amount of calories and performed the same amount of exercise over the six weeks.
Of course human studies are needed to determine if timing of food intake influences our body weight, but this study suggests that late-night eating may be worse, in terms of weight gain, than eating during normal waking hours says Fred Turek.
GI Group: This study, while only in mice, may also have implications for shift workers.
Age difference and low GI diets
A study published in Diabetologia reports that the benefits of a low GI diet appear to be more pronounced in young adult mice (16 weeks) than in older mice (44 weeks). The dietary intervention involved ‘wild type’ mice and (sorry to be technical here) specially bred mice whose glucose-dependent insulinotropic polypeptide receptor had been knocked out. The study calls them ‘Gipr genotype mice’.
Compared with the young mice on a low GI diet, the young mice on a high GI diet gained a significant amount of weight along with more body fat and reduced insulin sensitivity. With the older mice, the story is more complicated. Though body fat also slightly increased in high GI vs low GI older ‘wild type’ mice, there were no significant changes in their body weight and estimated insulin sensitivity. However, the older Gipr genotype mice on a high GI diet showed significantly lower cumulative net energy intake, increased locomotor activity and improved markers of insulin sensitivity suggesting, say the authors, that inactivation of GIP signalling in aged animals on a high-GI diet could be beneficial.
 | New GI Symbol |
In search of the ultimate Greek salad ... and purslane 
On holiday in the sunny Greek islands in peak season, the Greek salad turned out to be my best option for getting my daily fix of greens and providing the perfect counterfoil to our meals of barbecued octopus, lamb souvlaki or grilled fish. It was invariably reasonably priced and I ended up chowing down on one each day, sometimes two, so I had ample opportunities to critically analyse them.
The salad typically comprised the usual base of tomato pieces but these were red, ripe and full-flavoured. Mixed in were rounds of cucumber plus capsicum, purple onion, black or green olives in oil, topped with a slab of Greek fetta and a sprinkle of dried oregano. It was served at room temperature with little bottles of Greek olive oil and vinegar to dress it. The fetta was a real surprise. Not salty/briny fetta as we find in Australia but softer lightly salted fetta that had a creamy texture somewhere between firm tofu and thick Greek yoghurt.
Each island offered its own variation on the basic ingredients. On Santorini, large home-grown capers were added, sometimes with pickled caper bush leaves, which added a pleasant tang, sometimes fresh oregano leaves. On Rodos, we dined on one with cherry tomatoes and finely-sliced fennel which was delicious. On Crete, baby rocket was mixed in. Another had a huge garnish of purslane (pigweed) sitting on top.
Nutritionally the humble Greek salad is a winner and a god-send for tourists. It’s an easy light meal in itself with bread or an accompaniment to barbecued fish or meat. It gives you at least three serves of vegetables, adds the super power of tomatoes with their lycopene and vitamin C, is high in fibre and antioxidants. If you add olive oil, this will boost the absorption of the fat-soluble antioxidants (I always did – it made a nice ‘sauce’ for the crusty bread to soak up).
Its only drawback is of course the higher than usual salt level thanks to the olives and fetta. Based on Australian figures, I estimate this to be around 900 mg from 5 black olives and 80 g of fetta but of course it will depend on the make (the fetta I sampled in Greece tasted decidedly mild in salt). This sodium figure is on par with a 50 g snack pack of pretzels so it’s up there with other salted foods. Of course you can reduce this at home by using fewer olives (just slice into slivers so you get a hint of olive without the full salt hit) and buying a salt-reduced fetta.
I visited Crete in search of the traditional Med Diet and one of its chief ingredients, purslane, a native wild green that grows wild on Crete and is a rich source of ALA, one of the simpler omega-3 fatty acids. Researchers have hypothesised that purslane is one of the reasons why the Med Diet is so beneficial to health. But I was disappointed. Despite my queries around Heraklion and Rethymo, I never managed to find any in markets or cafes. Waiters looked blankly at me. All was not wasted as it turned up in Turkey (another Med Diet country with more olive trees than I’ve ever seen growing on every spare metre of land). There it was in a simple salad with a light creamy dressing at a roadside taverna. Served with three other vegetable dishes as a mixed entree before our main course. It had a delicious flavour, crunchy and a tangle of green tuberous stems and bright green leaves. I enjoyed every mouthful.
Catherine Saxelby is an accredited dietitian and nutritionist and runs the Foodwatch Nutrition Centre. Her latest publication is The Shopper's Guide to Light Foods for Weight Loss (available as a PDF). For more information, visit foodwatch.com.au.
American dietitian and author of Good Carbs, Bad Carbs, Johanna Burani, shares favourite recipes with a low or moderate GI from her Italian kitchen. For more information, check out Johanna's website. The photographs are by Sergio Burani. His food, travel and wine photography website is HERE.
![[JOHANNA]](http://www.glycemicindex.com/blog/2008/sept08/joanna175.jpg)
Matteo’s chickpea soup
My son, Matteo, who lives in Friuli, was visiting us recently. He loves to cook, so I asked him to suggest a recipe off the top of his head that I could develop for GI News. Being a creative cook, Matteo just thinks in terms of good, fresh ingredients and then invents something scrumptious. So he gave me a list of eight ingredients that he uses to make a chickpea soup. I worked out the quantities and cooking times and added a few personal touches of my own. The recipe below is our combined effort. I prepared two versions of the soup, one with dry and the other with canned chickpeas. Italians never use canned beans. But for those unaccustomed to cooking with some advanced preparation (albeit minimal), I wanted to present a quicker version. Surprisingly, the tastes were quite similar to each other, with the dried chickpea version tasting a bit more earthy.
Servings: 7 (approx. 1 cup each)
225 g (8 oz/1 1/3 cups) dried chickpeas or 1½ x 600 g (19 oz) cans chickpeas, rinsed and drained
2 medium carrots, cut into ½ cm (¼-inch) horizontal slices
1 small onion (yellow or red), sliced
1–2 cloves garlic, minced
4 sprigs flat-leaf parsley, leaves only
1 heaping tablespoon fresh rosemary, needles only
1 tablespoon extra virgin olive oil
1 cup crushed canned tomatoes, San Marzano type
6 cups vegetable broth (homemade if possible) for the dried chickpeas; 3 cups for the canned chickpeas
1 tablespoon kosher salt or sea salt (or to taste)
30 g (1 oz) medium pasta shells
Per serving
Energy: 560 kJ/ 140 cals; Protein 6 g; Fat 3 g (includes 0 g saturated fat and 0 mg cholesterol); Carbs23 g; Fibre 5 g.
Cut back on the food bills and enjoy fresh-tasting, easily prepared, seasonal, satisfying and delicious low or moderate GI meals that don’t compromise on quality and flavour one little bit with Money Saving Meals author Diane Temple. People often say to me, ‘I’d love to eat more fresh fish or seafood, but it’s too expensive.’ To celebrate the 20th anniversary of the Sydney Seafood School this November, Roberta Muir the School’s Manager, suggested this relatively inexpensive seafood dish. For more money-saving recipes, visit Diane’s website.
Barbecued chilli octopus with red capsicum & tzatziki
‘You can use calamari, cuttlefish or squids (cut into strips), large green prawns/shrimp (omit the boiling water) for this dish if you prefer,’ says Roberta. Although the recipe uses 1/2 cup of olive oil for the marinade, this isn't actually cooked with the octopus. In our recipe analysis we have assumed a couple of tablespoons of oil sticks during cooking. We haven't priced this one as the cost of seafood can vary from place to place and week to week.
Serves 4
500 g (1 lb 2 oz) baby octopus, cleaned and quartered
½ cup extra virgin olive oil, for marinating
2 cloves garlic, finely sliced
3 small red chillies, seeded and finely chopped
1½ teaspoons chopped oregano leaves
2 red capsicums, seeded and cut into chunks
Tzatziki
1 small Lebanese cucumber
1 clove garlic, crushed
200 g (7 oz) tub Greek-style plain yoghurt (reduced fat)
Salt and freshly ground black pepper, to taste
Per serving
Energy: 1050 kJ/ 250 cals; Protein 26 g; Fat 12 g (includes 2.5 g saturated fat and 249 mg cholesterol); Carbs 9 g; Fibre 2 g.
Recipe supplied by FISHline, Sydney Fish Market’s free consumer advisory service. Visit the FISHline pages at http://www.sydneyfishmarket.com.au/ for more great seafood recipes, advice on seafood purchasing, storage and cooking, species information and answers to frequently asked seafood questions.
Myth: The Mediterranean diet is healthy because of the olive oil.![[NICOLE]](http://www.glycemicindex.com/blog/2007/dec2007/nicole125.jpg)
Nicole Senior
Fact: The Mediterranean diet is healthy because it contains of variety of protective foods.
Everybody has heard good things about the Mediterranean diet. Typically we hear it’s good for the heart, and this is true as evidenced by the lower rates of heart disease experienced in countries surrounding the Mediterranean Sea. However most people when asked what’s healthy about it almost always say olive oil. This is an oversimplification because the traditional Mediterranean diet – predominantly plant food based – contains a bounty of foods with known protective effects: vegetables, fruits, grains, legumes, nuts, herbs and spices, fish and small servings of alcohol and red meat. The mechanism of protection is still not fully understood, and there are likely to be many different protective effects offered by different foods. And there are non-diet factors. For many traditional communities around the Mediterranean, their lives are simpler, more active and religion is central to everyday life. One could postulate that religion is crucial to the health benefits of Mediterranean diet!
Why the question ‘what’s healthy about the Mediterranean diet?’ is important, is because foods of the Mediterranean are not universally available or liked. I’ve met people who just don’t like the taste of olive oil. While olive oil is a healthy choice, it may actually have a neutral effect on heart health by displacing bad fats rather than actively protecting by itself. Olive oil is primarily monounsaturated and the Heart Foundation Australia’s evidence-based position on monounsaturated fats is “there is little evidence that mono-unsaturated fat has an independent effect on coronary endpoints”. In simple terms, this means don’t rely on mono-unsaturated fats alone to prevent a heart attack. Another component of olive oil often mentioned is the antioxidants (polyphenolic compounds), particularly high in extra-virgin olive oil. These are likely to be beneficial, however not unique to olive oil. Thousands of phytochemicals exist across all plant foods.
An even better result may be achieved with a modified Mediterranean diet using sunflower or canola oil. This is because polyunsaturated fats have greater cholesterol lowering effects, and because of the known benefits of omega-6 and omega-3 fats. This idea of a Mediterranean-style diet using different oil – namely canola oil and margarine – yielded spectacular results in the famous Lyon Heart Study. This seminal study showed an impressive 76% reduction in risk of death or major coronary events (e.g. heart attack, stroke etc) in patients who had previously had a heart attack (and thus at high risk) after following a modified Mediterranean diet for 27 months. While a Mediterranean diet with olive oil attracts passionate supporters, it’s not the only cardio-protective diet.
If you want to eat a healthy diet, then try to take all the leaves out of the Mediterranean diet book rather than just the page on olive oil or you’re bound to come up short on benefits. A heart-healthy diet is a whole rather than one or two parts, and can be adapted to suit individual and cultural preferences.
If you’d like to learn more about heart-friendly foods and how you can combine them in ways to suit you, check out Nicole’s books at http://www.eattobeatcholesterol.com.au/![[SUN]](http://www.glycemicindex.com/blog/2008/oct08/nicole_books300.jpg)
Why not the Australian Aboriginal diet for health and weight loss?
The Mediterranean diet; a mixture of fruit, nuts, vegetables, seafood, pasta and olive oil has been sold so much as the healthy diet by nutritionists and the medical profession in recent years, that many people think they have to move to Crete or Italy to survive. But as usual, the Professor is here to throw a spanner into the works.
Not only does the real Mediterranean diet hardly still exist in the Mediterranean in its real form, but it’s probably no more healthy than the traditional Aboriginal diet, the Nordic diet, the Hunza diet, the Okinawa diet – or any of a number of other forms of ‘native’ diet eaten traditionally by inhabitants of a particular region before the advent of industrialisation of foods, domestication of animals and proliferation of ‘fast’ foods.
People (including scientists) get carried away with specific diets and components of diets, which they consider to be the elixir for good health, based on the fact that they have been eaten for thousands of years. But humans have existed in all parts of the world for thousands of years and have eaten a wide variety of localized foods. Hence, it’s the common ingredients of such ‘native’ foods that are likely to have the positive benefits, rather than the particular foods themselves. For example, it’s known that native Australian fruits and vegetables are high in anti-oxidants, and the native fish and animal meats are lean and extremely low fat (i.e. healthy).
Recently, your own humble Professor has been involved in a study comparing inflammation markers in the bloodstream of a number of people after a meal of kangaroo (a ‘native’ food), compared to a meal of wagyu beef (a domesticated animal food). Wagyu was only bred into existence about two decades ago. It is reasonably high in fat (although not as bad as some other meat breeds on the market). Kangaroo, on the other hand, has been around for eons, and is very low in fat (in fact hardly any). In the Australian study (yet to be published), kangaroo didn’t increase inflammation, whereas wagyu did.
So why bother with the Mediterranean diet, when here in Australia we have possibly one of the world’s healthiest diets on our doorstep. Although it’s not likely to exist, except in trendy middle class restaurants these days, here is a sample of what you might have expected in the traditional Australian Aboriginal diet:
| Land food | Water food | Sky food |
| Kangaroo (now marketed as ‘Kroo’), wallaby, emu, goanna, snakes and grubs | Fish, crayfish/yabbies, lobster, prawns/shrimp, crabs, octopus, squid | Duck, goose, native pigeon, mutton bird, swamp fowl, pheasant |
| Natives berries and fruits, native vegetables, yams and seeds | Water plants | Bats |
‘Who would have thought beans and legumes could be a base foodstuff in so many dishes ... even desserts!’ – Libby
‘My husband has type 2 diabetes and in the honeymoon period of the six months after our wedding, the two of us gained so much weight because we were enjoying lots of meals out and were not monitoring our diets closely. The weight gain led his HbA1c to creep up to 8.2. It was looking like insulin might be on the cards, so he made the decision it was crunch time for the diet. We already knew about GI eating plans and had several books, but we had not applied it consistently till then. That was back in May. Within two months I had lost 8 kg (17 pounds), he had lost 6 kg (13 pounds), his cholesterol dropped back into the healthy range and the HbA1c is back down to 7.1. It became a really consistent effort when we began to write about it on a website we are building together: http://www.lowgicooking.com/
On this website, I’m posting all the recipes I cook, so there is about one a day (except when I repeat meals). My husband has taken all the photos (not to mention done the web development), and I plan and cook all the meals. Both of us agree that the best part is we don’t really feel like we are dieting, because we are eating until we are well and truly full, but simply choosing good carbs, good fats, LOTS of fruit, vegetables, nuts and whole grains and only eating out very rarely. All of this is thanks to the great, long-term research work by the Uni of Sydney which we really appreciate and believe will add years to our lives. Who would have thought beans and legumes could be a base foodstuff in so many dishes ... even desserts! The next step we’re planning is to buy our own home mini flourmill so we can make our own delicious wholegrain flours.’
Libby and family in the kitchen
Send us your GI success story.
![[ALAN]](http://www.glycemicindex.com/blog/2009/april2009/alan125.jpg)
Alan Barclay
Low GI pearl couscous
Blu Gourmet Pearl Couscous (GI 52) now carries the GI Symbol. Unlike traditional couscous, pearl couscous which takes its name from its pearl-like shape and size is often described as a ‘toasted pasta specialty’. Like regular pasta, it is made from hard (durum) wheat and water. But instead of being dried, it is toasted in an open flame oven. It has a rich, nutty flavour and a chewy texture, with a smooth, almost buttery mouth feel. It makes a perfect side dish to meat, poultry, or fish instead of potatoes, rice, or traditional pastas or couscous. It cooks in around 10 minutes by the absorption method – just like rice – and you can also use it in a variety of dishes – just like rice and other pastas.
Where does it come from? Blu Gourmet Pearl Couscous is produced by Osem in Israel. In the US and Canada you will find it marketed as Osem Israeli Couscous or Osem Toasted Pasta and you can even buy it from Amazon. Here in Australia, It is on the shelves in Coles supermarkets and many independent grocers and delis. For those of you who need to count your carbs, ½ cup cooked pearl couscous has around 20 g carbs and a GL of 10.
Product ambassador, chef Gabriel Gate, has developed a number of recipes using pearl couscous. Here’s the one we tried: Gourmet Pearl Couscous Salad with Vegetables and Cashew Nuts and a Sesame Dressing. You’ll find it will serve around 10 people at a barbecue and is a great way to use up leftover vegetables. Serves 6.
250 g (9 oz) pearl couscous,
juice of 1 lemon,
2 tablespoons salt-reduced soy sauce,
½ teaspoon sesame oil,
½ a red chilli, finely sliced,
3 tablespoon extra virgin olive oil,
about 80 g (3 oz) roasted unsalted cashew nuts,
½ cup coriander leaves,
1 cup cooked corn kernels (canned is fine),
200 g (7 oz) cooked green beans, cut into small pieces,
300 g (10 oz) cooked butternut pumpkin cubes
GI Q&A with Prof Jennie Brand-Miller
‘I have seen numerous studies stating that chewing food completely (20–30 times) is beneficial in suppressing appetite. However, if we chew an apple before swallowing, is the GI value that of an apple or of apple juice?’ – Norm
Hi Norm, the GI of a food (or beverage) is based on scientific testing of real foods in real people in the state in which they are normally consumed – so when testing, an apple is crunched and chewed in the normal way and the subsequent GI value is for a chewed and digested apple – skin and all. If you chewed the apple over and over again in the mouth until it’s a very soft mash, then chances are the glucose and insulin response will be higher. We know what happens if we chew bread and pasta for longer before swallowing. This produces a higher glucose response because saliva contains the enzyme amylase that begins the process of starch digestion. In fact, these studies showed that a minute or two of chewing caused over half the starch in bread to be digested before it was swallowed. The pasta, however, was more resistant to digestion in the mouth, partly because of its hard texture.
Here’s how scientists measure a food’s GI value (you’ll find lots more information on our website: http://www.glycemicindex.com/). ‘To determine a food’s GI value, measured portions of the food containing 10–50 grams of carbohydrate are fed to 10 healthy people after an overnight fast. Finger-prick blood samples are taken at 15–30 minute intervals over the next two hours. These blood samples are used to construct a blood sugar response curve for the two hour period. The area under the curve (AUC) is calculated to reflect the total rise in blood glucose levels after eating the test food. The GI rating (%) is calculated by dividing the AUC for the test food by the AUC for the reference food (same amount of glucose) and multiplying by 100. The use of a standard food is essential for reducing the confounding influence of differences in the physical characteristics of the subjects. The average of the GI ratings from all ten subjects is published as the GI of that food.’
GI testing by an accredited laboratory
North America
Dr Alexandra Jenkins
Glycemic Index Laboratories
36 Lombard Street, Suite 100
Toronto, Ontario M5C 2X3 Canada
Phone +1 416 861 0506
Email info@gilabs.com
Web http://www.gilabs.com/
Australia
Fiona Atkinson![[FIONA]](http://www.glycemicindex.com/blog/2009/may2009/fiona125.jpg)
Research Manager, Sydney University Glycemic Index Research Service (SUGiRS)
Human Nutrition Unit, School of Molecular and Microbial Biosciences
Sydney University
NSW 2006 Australia
Phone + 61 2 9351 6018
Fax: + 61 2 9351 6022
Email sugirs@mmb.usyd.edu.au
Web http://www.glycemicindex.com/
New Zealand
Dr Tracy Perry
The Glycemic Research Group, Dept of Human Nutrition
University of Otago
PO Box 56 Dunedin New Zealand
Phone +64 3 479 7508
Email tracy.perry@stonebow.otago.ac.nz
Web glycemicindex.otago.ac.nz
See The New Glucose Revolution on YouTube
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