GI News—November 2013

• David Katz: 'Demonizing saturated fat never helped us much. Canonizing it now won’t help us any either'; 
• Is the origin of type 1 diabetes in the gut?
• Prof Jennie Brand-Miller on reducing the risk of type 2 diabetes;  
• Dr Alan Barclay on the new American Diabetes Association guidelines for adults with diabetes;   
• Nicole Senior on why it's OK to say 'Cheese Please';
• Three delicious recipes to up your veggie intake: Breaded Cauliflower, Zucchini, Quinoa and Egg Slice and Spiced Little Carrots with Chickpea-Sauerkraut Puree. 

GI News 
Editor: Philippa Sandall
Web management and design: Alan Barclay, PhD
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Food for Thought

What’s for dinner? 
Food, choice and serving something delicious for dinner every night, is something many of us take for granted. Foodbank’s 2013 End Hunger Report is a timely reminder that a growing number of families are not so fortunate and have to turn to food relief to put something on the table. ‘Hunger in Australia affects more people than many realise, and families are increasingly relying on food relief due to difficult economic times,’ says Enzo Allara, Chairman of Foodbank Australia. ‘It only takes one unexpected cost or event to tip the balance.’ ‘Family circumstances have become the main driver for people turning to food relief,’ he says ‘with low income and single parent families the largest groups requiring assistance, especially for mealtime staples – cereals, fruit and vegetables, bread, meat and milk.’

These days, demand is outstripping supply. According to Allara, while Foodbank currently provides enough food for 88,000 meals a day, most welfare agencies say it’s not nearly enough as they don’t have sufficient food for the number of families who need their help. ‘Our traditional model of collecting surplus food from manufacturers and retailers is no longer able to meet growing demand, so we’re adopting new solutions, including arranging the manufacture of key staple foods and partnering with farmers for more fresh produce,’ says Allara.

We think it’s really heartening to see so many food companies providing generous support with dairy products, porridge oats, breakfast cereals, pasta, flour, bread, and meat – and good to see some nutritious, low GI staples like milk, oats and pasta on the list. But we gulped a little when we read that the major new beef initiative was designed to supply the charities with more than 130 tonnes of sausages a year.

Ask any doctor or dietitian and you’ll hear that a regular diet of sausages isn’t the best dietary choice for long term health and well being. It’s possibly one of the more disastrous choices. But sausages are something of a no-brainer in the charitable organisation ‘end-hunger’ scenario as they are cheap to make, popular with just about everybody, something of a comfort food and they come ready made so you just have to cook them, you don’t have to think what to do with them as you would with say, a packet of mince. But there’s still that big GULP. Tonnes and tonnes of sausages which are high in kilojoules (calories), saturated fat and sodium, linked to obesity and chronic diseases like diabetes and heart disease, are being given to people who are quite possible at risk already.

We absolutely agree that the first step is to put something on those dinner plates. We would like to see Foodbank and similar organisations take the next step, which is just as important, tell people the best way of cooking and serving them. We turned to our Taste of Health columnist, Nicole Senior for some sizzling tips to make sausages a healthier option for hungry families.



‘The best way to “healthify” the humble sausage is to reduce the amount per serve and fill out the meal with plenty of things we know are good such as vegetables, legumes and whole grains,’ says Nicole. ‘For example: add grilled sausage slices to pasta with vegetables and lentils; or vegetable and chick pea curry with brown rice; or vegetable noodle soup. Even serving a thin grilled sausage (or half a fat one) on a wholegrain roll with onions and coleslaw is a step up from the usual sausage sandwich. And of course you can cook sausages in ways that let much of the fat drain away, such as slicing them in half during cooking (grilling or barbecuing) and draining them on absorbent paper. And further up the chain, food companies need to reduce sodium and fat levels of sausages to reduce the effort and thought required to make them healthier. To improve the nutritional well being of everyone we need to make healthy choices easy choices’.

And if we could wish upon a star, we would wish that these many generous charities find the funds to teach their clients how to turn the food they receive into nutritious, balanced meals as well as ‘teach them to fish’ (so to speak), so that they are better able to feed and nourish their families on a budget when the crisis is over.

In the News

Scapegoats, saints, and saturated fats: old mistakes in new directions. 
A recent commentary piece in the British Medical Journal suggests that saturated fat is not really so bad after all. Is the author right? Is it time to absolve saturated fat? Not at all says Dr David Katz pointing out that it was never time to demonize it in the first place. ‘We vilified saturated fat, and were almost certainly silly to do so. Now, some seem on a mission to canonize it – and that is at least as silly. Diets can be lower, or higher, in saturated fat content and be crummy either way. There is no evidence of long-term health benefit from the wilful addition to the diet of saturated fat.’ In this edited extract of his Huffington Post piece (reprinted with permission) David Katz lays out his case that we are ill-served to think of saturated fat as either scapegoat, or martyred saint.

‘Ancel Keys was never really wrong.The case against saturated fat, its implication in the development of atherosclerosis, inflammation, and chronic diseases, notably heart disease, involves a vast expanse of research over many years by thousands of researchers around the world. Keys was among the first to emphasize the association between saturated fat intake and heart disease. He looked at rates of disease around the world and correctly noted that heart disease was more common in societies that ate more meat and dairy. His mistake may have been to look past that dietary pattern for the “active ingredient” in it, which led to the convictions of dietary cholesterol, saturated fat, and to a lesser extent overall dietary fat.

Ancel Keys wasn’t entirely right. Saturated fat is not one food component; it’s a category. Just as polyunsaturated fats include the anti-inflammatory omega-3s, and the pro-inflammatory omega-6s (and even that is over simplified), so does the saturated fat class contain a diversity of members. One of them, stearic acid, found in dark chocolate among other places, is now clearly established to be innocuous. Another, lauric acid, predominant in coconut oil among other places, may prove to be as well. But still others, such as palmitic acid and myristic acid, appear to be substantially guilty as charged, contributing to inflammation and atherosclerosis. The body of relevant evidence is expansive.

What this means is that even if there are harms attached to some saturated fats, summary judgment against the whole clan was never valid. The combination of parsing and over-simplification invites the devils in the details to run amok. That clearly happened here. If we focus only on cutting saturated fat, we can find new ways to eat badly. We have, over the years, done exactly that. Of note, we can do the same when cutting carbs, or gluten, or fructose, or sugar, or meat, or grains, or salt, or wheat, too. Diet never was, and never will be, a single ingredient enterprise. The whole recipe matters.

Demonizing saturated fat never helped us much. Canonizing it now won’t help us any either. All who share a concern for eating well and the health advances that can come from it must band together to renounce the perennial branding of this, that, or the other food component as scapegoat, or saint. It is, and always was, the big picture - the overall dietary pattern, and for that matter lifestyle pattern that matters. We could cut saturated fat and eat better, or worse, depending on what we eat instead.

A bounty of science along with an application of sense points very reliably to variations on the theme of optimal eating for Homo sapiens. We could all get there from here, and by so doing, add years to life, add life to years, and love food that loves us back. None of this will happen though if we replace the follies of history with old mistakes in new directions.’



 – David Katz’ latest book, Disease-Proof: The remarkable truth about what makes us well is available at bookstores throughout the US and Canada and online HERE.

Dr Alan Barclay says: "While it is wise to reduce the amount of saturated fat you consume, what you replace it with is vitally important. Either unsaturated fats or low GI carbohydrates are the best choice. To ensure the right balance of fats consumed, we recommend that for every gram of saturated fat you consume you eat 2 g of unsaturated fat (like those found in extra virgin olive oil, avocado, nuts, seeds, fatty fish, etc.), or in other words, your saturated fat : unsaturated fat ratio is less than 0.33. To help you achieve this, we are now including saturated: unsaturated fat ratios in all of the recipes published in GI News". 

Is the origin of type 1 diabetes in the gut? 
An in depth review by Outi Vaarala (Immune Response Unit, Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland) published in Current Diabetes Reports  looks at the role of the intestinal microbiota in type 1 diabetes. Here’s the Abstract:



‘The role of intestinal microbiota in immune-mediated diseases, such as type 1 diabetes, has deservedly received a lot of attention. Evidently, changes in the intestinal microbiota are associated with type 1 diabetes as demonstrated by recent studies. Children with beta-cell autoimmunity have shown low abundance of butyrate-producing bacteria and increase in the abundance of members of the Bacteroidetes phylum in fecal microbiota. These alterations could explain increased gut permeability, subclinical small intestinal inflammation, and dysregulation of oral tolerance in type 1 diabetes. However, these studies do not provide evidence of the causative role of the gut microbiota in the development of beta-cell autoimmunity, yet. In animal models, the composition of gut microbiota modulates the function of both innate and adaptive immunity, and intestinal bacteria are regulators of autoimmune diabetes. Thus, prevention of type 1 diabetes could, in the future, be based on the interventions targeted to the gut microbiota.’

What’s new? 
The Bread And Butter Project. 
Bourke Street Bakery co-owner Paul Allam was inspired to set up The Bread And Butter Project following a trip to Mae Sot on the Thai-Burmese border, where at the invitation of a local orphanage, he taught a group of Karen refugee women how to bake bread and helped establish a social business to support these women and the orphanage.



Back home, Paul along with his business partner and friend, David McGuinness, have used their baking skills and community spirit to set up a social enterprise bakery to empower the disadvantaged in Sydney – the current trainees are all refugees. If you live in Sydney, here’s where you can buy their sourdough bread.

Philippa’s cookbook shelf.
 #1 The Gentle Art of Preserving (Kyle Books): I picked this up because it has a whole chapter on fermenting including making water kefir, creamy yoghurt and labne (strained yoghurt). I was also curious to read what they said about preserving plums because when I was growing up we had four plum trees and my mother’s summer days were busy bottling plums and making jam and chutney. And although I would help her, I realised too late that I didn’t have her recipes. This book is a collection of Katie and Giancarlo Caldesi’s favourites including Italian cured charcuterie, jams and chutneys, pickling, fermenting, freezing and pressure canning.

#2 Smashing Plates (Kyle Books): I have always loved Greece and Greek food. A tag line ‘Greek flavours redefined’ was irresistible. What would Maria Elia do with traditional slow-roasted lamb (she marinates it with lemons, dill, cinnamon and cumin, wraps in paper and roasts for four hours). How easy is that? But it’s her salads and sides that will be crowd pleasers for GI News readers and her deliciously simple ways to up the veggie intake – Carrot Tabbouleh, a choice of Potato, Parsnip or Pomegranate Skordalia, Broad Beans and Mint Houmous, Lemon and Dill Braised Broad Beans, White Bean, Artichoke and Basil Houmous, Lemon and Oregano Roasted Tomatoes with Kefalotyri (or Pecorino) and Tomato Bulgar Pilau.

Nicole's Taste of Health

Say Cheese! 
It’s no wonder ‘cheese’ is the word most often used to make us smile for photographs: even the thought of it makes us happy. The story of cheese as a preservation method for milk through to artisanal masterpieces and myriad types, flavours, textures and culinary uses today, is a fascinating one.

The favoured theory of how cheese was born is that over 7,000 years ago, nomadic shepherds in the Middle East were carrying milk in a bag made from the stomach of a goat or sheep and the milk curdled. What they accidentally discovered was the milk reacted with the enzymes (rennet) in the stomach lining and caused the curd (solid), to separate from the whey (liquid), in a process used to this day to make cheese.

Four simple ingredients make up most standard cheese; milk, rennet, salt and lactic acid bacteria, which together create a wide range of flavour compounds which give cheese its unique flavour. In a kind of magical conjuring double-act between Mother Nature and cheese-makers; tweaking the type of bacteria added, salt, moisture levels and aging time can produce thousands of different types of cheese. To keep your cheese nice, store it loosely wrapped in wax paper inside a container or plastic bag to prevent trapped moisture causing mould, and to prevent the cheese picking up odours and flavours from plastic and other foods in the fridge.


Photo: Ian Hofstetter, The Low GI Vegetarian Cookbook (Hachette Australia)

Cheese is one of the richest food sources of calcium that is highly bio-available, which makes sense when you consider it a concentrated form of milk. Many of us – especially women, children and teenagers – don’t get enough calcium so perhaps we should ‘say cheese’ more often. Until recently, the prevailing thought about cheese was one of a nutrition trade-off: sure, it’s rich in calcium, phosphorous, protein, vitamins A, B12, riboflavin and zinc, but what about all that saturated fat and salt?

Emerging research has been reassuring and points to the idea that there’s something about dairy – including cheese – that appears to offset the negative nutrients it contains. Population studies have found no association between cheese intake and risk of ischemic heart disease, but rather that eating cheese is associated with a REDUCED risk of cardiovascular disease, stroke and high blood pressure. Exactly why this is the case is not certain, although the fermentation process and perhaps calcium are implicated. Cheese and dairy foods are at the frontline of the paradigm shift taking place in the nutrition world that puts the whole food and not just its key nutrients at the centre of their effects on health.

Many kids could do with eating more cheese to get their daily calcium and to replace less nutritious snacks. While even your kids could tell you cheese is good for bones, cheese is also good for teeth. It inhibits tooth decay (is non-cariogenic), and provides a protective coating for teeth (cariostatic ) due to its casein (protein), calcium and phosphate which buffer plaque pH by reducing tooth enamel solubility and bacterial adherence. This tooth-friendly status makes it an excellent snack to eat away from home when they can’t brush their teeth. There’s no need to buy processed, packaged types: just take a slice off the old block and pop it into a container. It goes wonderfully well with cherry tomatoes, celery, carrot sticks and apple. As an after school snack, cheesy toast is easy-peasy (on wholegrain, low GI bread of course).

Typically the harder the cheese, the more calcium it contains: cheddar trumps gooey camembert and Swiss trumps stinky brie. Cream cheese is a mixture of cheese and cream so there’s less goodness to speak of; sadly, cream and butter are not blessed with the health benefits of milk, cheese and yoghurt. And processed cheese spread? Enough said. I’ve heard people say they are lactose intolerant as a reason for passing on the cheese plate however hard cheese has zero lactose, and softer cheeses contain very little: ricotta contains less than one tenth of one percent lactose (and you can check lactose content within the nutrition information panel – it will be the carbohydrate and/or sugars content).

Having said all this, we probably need to stop short of gay abandon in the cheese department. It is unlikely that ‘plastic’ cheese in a can (low calcium, high salt) sprayed over hot dogs (processed meat and high GI carbohydrate) is going to be of benefit to health, but there’s no need to ‘hold the cheese’ on your salad sandwich or miss out on the golden gooey goodness of melted cheese on your lasagne, or sprinkle of parmesan on your spaghetti. A little bit of cheese can go a long way to add flavour and protein to a meal or snack. The (newly revised) Dietary Guidelines for Australians sum up the situation by suggesting to limit cheese to 2–3 serves a week or choose reduced fat types, and warn against too much of the saltier cheeses such as fetta: sounds prudent and reasonable.

When all this cheese science is melted down, you’re better off (and always have been) eating a core food like cheese than consuming so-called ‘discretionary foods’ like sweets, soft drinks and fried savoury snacks. This reassurance about cheese is good news for those who prefer the cheese plate than the dessert menu but of course the biggest issue for us all is avoiding weight gain so perhaps we’d all be better off with herbal tea after dinner!



Nicole Senior is an Accredited Practising Dietitian and Nutritionist, author, speaker, consultant, and commentator with an interest in how we can learn to love good food that's good for us.

In the GI News Kitchen

Family Baking, Anneka Manning, author of Bake Eat Love. Learn to Bake in 3 Simple Steps and founder of Sydney’s BakeClub, shares her delicious ‘better-for-you’ recipes for snacks, desserts and treats the whole family will love. Through both her writing and cooking school, Anneka teaches home cooks to bake in practical and approachable yet inspiring ways that assure success in the kitchen.

 
Zucchini, quinoa and egg slice.
This simple savoury slice makes a fabulous light meal accompanied by a green salad or a perfect snack – a nutritious addition to any school or work lunch box. Serves: 8 with salad as a light meal or 12 as a snack

1/3 cup white quinoa
1/3 cup water
1 tbsp olive oil
1 brown onion, chopped
100g (3½oz) shortcut bacon rashers, chopped
350g (12oz) zucchini (courgettes), coarsely grated
5 eggs, lightly whisked
40g (1½oz) finely shredded parmesan
½ cup coarsely chopped flat leaf parsley
Freshly ground black pepper, to taste
1/2 cup self-raising flour
75g (2½oz) feta, coarsely crumbled (optional)



Preheat the oven to 180°C (350°F). Lightly grease an 18 x 28cm/7 x 11in (base measurement) shallow slice tin and then line the base and two long sides with one piece of non-stick baking paper.
Place the quinoa and water in a small saucepan. Bring to the boil over high heat. Reduce heat to low, cover the saucepan and simmer gently for 12 minutes or until all the water is absorbed and the quinoa is tender. Remove from heat. Meanwhile, heat the olive oil in a frying pan over medium-high heat and cook the onion and bacon, stirring occasionally, for 5–8 minutes or until the onion is soft and starting to colour.
Transfer to a large bowl. Add the quinoa, zucchini, eggs, parmesan, parsley and pepper to the onion mixture and stir with a wooden spoon to combine. Add the flour and stir to combine.
Spoon the mixture into the lined tin and use the back of a spoon to smooth the surface. Sprinkle with the feta if using.
Bake in preheated oven for 30 minutes or until cooked when tested with a skewer. Stand in the pan for 5 minutes before turning onto a cutting board.
Serve warm or cold with a salad for a light meal or as a snack.
Baker’s Tip This slice will keep in an airtight container for up to 2 days. 

Per serve
885 kJ/ 210 calories; 14 g protein; 12 g fat (includes 4 g saturated fat; saturated:unsaturated fat ratio 0.33); 12 g available carbs; 2 g fibre

Here's how you can 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 our Money Saving Meals including these Spiced little carrots with chickpea-sauerkraut puree from Vedge.

Spiced Little Carrots with Chickpea-Sauerkraut Puree.
Serves 8

4 tbsp olive oil
1 tbsp Montreal Steak Spice Blend (see below)
2 tsp sherry vinegar
1½ tsp salt
½ tsp ground cloves
2 medium garlic cloves, 1 minced and 1 smashed
2 pounds (1 kg) young or baby carrots, tops removed, leaving 1 inch (2.5cm) of stem intact (substitute ‘baby-cut’ carrots if necessary)
2 cups cooked chickpeas or one 15-ounce (400g) can chickpeas, rinsed and drained
¾ cup bottled sauerkraut with 2 tbsp of its juice
2 tbsp minced fresh dill
2 tbsp Dijon mustard
1 tsp freshly ground black pepper



Preheat the oven to 350°F/180C.
In a medium bowl, whisk 2 tablespoons of the olive oil, the steak spice blend, vinegar, ½ teaspoon of the salt, the cloves, and the minced garlic. Add the carrots and toss until combined.
Transfer the carrots to a sheet pan, cover with aluminum foil so that they will steam through, and roast until fork-tender, 15 to 18 minutes.Remove the foil and continue to roast until the carrots are soft, an additional 3 to 5 minutes. Remove the pan from the oven and allow the carrots to cool.
Meanwhile, to make the puree, combine the chickpeas, sauerkraut and its juice, dill, mustard, pepper, remaining 2 tablespoons olive oil, remaining 1 teaspoon salt, and the smashed garlic clove in a food processor. Process into a smooth, hummus-like consistency.
To serve, spread the bean puree onto a serving plate and arrange the carrots, either still warm or fully cooled, on top.

To make the spice blend, grind the following spices separately to achieve a uniform consistency: 2 tbsp coarse sea salt, 2 tbsp black peppercorns, 1 tsp caraway seeds, 1 tsp coriander seeds, 1 tsp cumin seeds and 1 tsp fennel seeds. Mix together with 1 tsp celery seeds.

Per serve 
765 kJ/ 180 calories; 4.5 g protein; 10.5 g fat (includes 1.5 g saturated fat; saturated:unsaturated fat ratio 0.14); 14.5 g available carbs; 7.5 g fibre

 – Recipe from Vedge: 100 Plates Large and Small That Redefine Vegetable Cooking, copyright © Rich Landau and Kate Jacoby, 2013. Reprinted by permission of the publisher, The Experiment.

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 photosbysergio.com.



Breaded Cauliflower.
My grandmother, and hence, my mother and aunts, breaded everything. This recipe can work for a wide variety of vegetables (especially zucchini, eggplant, butternut squash, fennel, celery, etc.) and also for fish, chicken, beef and pork filets. Servings: (8 approximately 1-cup serves)

1 large head of fresh cauliflower
1/2 cup seasoned breadcrumbs
1/4 cup grated parmigiano reggiano
1/3 cup egg whites
1-2 tbsp extra virgin olive oil



Cover the bottom of a 9x13in (22cm x 33cm) jelly roll pan with parchment paper or no-stick cooking spray. Preheat oven to 400 degrees F (200C).
Remove the outer leaves and stem base of the cauliflower. Separate florets into bite-size pieces. Place the florets into a steamer and cook for 5-8 minutes. Set aside to cool.
In a small bowl mix the breadcrumbs and cheese. Set aside.
Place the florets in a large shallow bowl. Pour eggs whites over them and mix well. Arrange the florets in the prepared pan.
Sprinkle the breadcrumb mixture on top, turning them over to cover both sides. Drizzle oil over the florets. Bake for 30 minutes, turning once. Serve hot.

Per serve
350kJ/ 85 calories; 5g protein; 3g fat (includes less than 1g saturated fat; ; saturated:unsaturated fat ratio 0.33); 11g available carbs; 4g fibre

We Are What We Ate

Trading cheese has a long tradition 
In her ‘Say Cheese’ piece in this issue, Nicole Senior reminds us of the pleasure of a good piece of cheese. It’s certainly a food that’s long had value and currency for consumers as the following extracts will show. First, here’s what Daniel Defoe wrote about cheese in his Tour Through the Whole Island of Great Britain. 

‘All the lower part of this county [Wiltshire], and also of Gloucestershire, adjoining, is full of large feeding farms, which we call dairies, and the cheese they make, as it is excellent good of its kind, so being a different kind from the Cheshire, being soft and thin, is eaten newer than that from Cheshire. Of this, a vast quantity is every week sent up to London, where, though it is called Gloucestershire cheese, yet a great part of it is made in Wiltshire, and the greatest part of that which comes to London, the Gloucestershire cheese being more generally carried to Bristol, and Bath, where a very great quantity is consumed, as well by the inhabitants of two populous cities, as also for the shipping off to our West-India colonies, and other places. This Wiltshire cheese is carried to the river of Thames, which runs through part of the county, by land carriage, and so by barges to London.

Again, in the spring of the year, they make a vast quantity of that we call green cheese, which is a thin, and very soft cheese, resembling cream cheeses, only thicker, and very rich. These are brought to market new, and eaten so, and the quantity is so great, and this sort of cheese is so universally liked and accepted in London, that all the low, rich lands of this county, are little enough to supply the market; but then this holds only for the two first summer months of the year, May and June, or little more. Besides this, the farmers in Wiltshire, and the part of Gloucestershire adjoining, send a very great quantity of bacon up to London, which is esteemed as the best bacon in England, Hampshire only excepted: This bacon is raised in such quantities here, by reason of the great dairies, as above, the hogs being fed with the vast quantity of whey, and skim’d milk, which so many farmers have to spare, and which must, otherwise, be thrown away.’

Want to know more about this ‘green cheese’? Here’s what Andrew Dalby says in his very readable Cheese, A Global History from Reaktion Books’ deliciously digestible Edible series.

‘It was called green not from its colour but from its freshness, and this metaphor goes a long way back. In ancient Athens in the late fifth century BC, every month on the day of the new moon was held a fair called simply ho chloros tyros, “the Green Cheese”. We know this because of the advice reported in a lawsuit, that if one were looking for a man from Plataiai one would be sure to find him at this fair. Plataiai was a small hill town a few miles north of Athens: therefore we know that the economy of nominally independent Plataiai depended almost wholly on supplying fresh cheese to Athens. This is what big cities do to their neighbours. Ancient Rome liked its young Vestine cheese from the nearby Apennines: the best was from campus Caedicius, says Pliny. Nearly two thousand years later London and Bristol drew Wiltshire dairy farmers into producing green cheese to be dispatched in barges eastwards down the Thames and westwards down the Avon; and at the same moment Paris called on Viry, Vincennes and Montreuil for its fresh cream cheeses and on Neufchâtel and the Pays de Brie for fine cheese that required just a little longer to mature (ten days in the case of Neufchâtel).’

GI Symbol News with Dr Alan Barclay

Dr Alan Barclay

New American Diabetes Association (ADA) nutrition guidelines for adults with diabetes. 
The ADA has published its latest edition of the Nutrition Therapy Recommendations for the Management of Adults With Diabetes, the first major update in 5 years. Perhaps unsurprisingly, they are evolutionary rather than revolutionary. One of the more important aspects of the ADA guidelines is their Goals of nutrition therapy. While they importantly set targets for common diabetes complications risk factors, they equally importantly put these into the context of the cultural aspects of food, eating and mealtimes.

• “To address individual nutrition needs based on personal and cultural preferences, health literacy and numeracy, access to healthful food choices, willingness and ability to make behavioural changes, as well as barriers to change.” 
• “To maintain the pleasure of eating by providing positive messages about food choices while limiting food choices only when indicated by scientific evidence.” 
• “To provide the individual with diabetes with practical tools for day-to-day meal planning, rather than focusing on individual macronutrients, micronutrients, or single foods.” 

After all, food is one of life’s pleasures whether you have diabetes or not – there is absolutely no point in avoiding any particular food or drink unless there’s good evidence to do so.

One of the most debated issues over the past few millennia has been how much carbohydrate (sugars and starches), fat and protein can or should a person with diabetes eat? In line with its broader goals, the ADA states that:

• “Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals.” 

In practice, this means that a person with diabetes should work with their dietitian and other members of their health-care team to nut out what is best for them as an individual, rather than follow the latest fad diet.

Recommendations for saturated (less than 10% of kilojoules/calories) and trans fat (as little as possible) and sodium (less than 2,300 mg/day) are the same as those for the general population.

Importantly for readers of GI News, the latest ADA Guidelines now incorporate specific recommendations for use of the glycemic load (GL = GI x grams available carbohydrate per serve) for the management of diabetes. This means that all of the evidence-based recommendations for the management of diabetes from the major diabetes organisations around the globe now advise people to use of the GI or GL as part of the nutritional management of diabetes, including the Canadian Diabetes Association and Diabetes UK.

Although it is possible to lower the GL of your diet by either eating a low carb diet, or by eating a moderate or even high carb diet but with more low GI foods, the scientific evidence about the benefits of low GL diets is based on studies where people ate moderate amounts of healthy low GI foods – carbohydrates were about 40–50% of their total calories (kilojoules).

Here’s how you can enjoy a low GL diet. Simply use the low GI swap it approach. Choose the food/drink within each food group/category that has the lowest GI value (and that is a healthy choice overall, of course). Because foods within a group/category by definition have similar macronutrient (carbohydrate, fat and protein) contents, by choosing the food with the lowest GI, in most cases you are also choosing the food with the lowest GL. You can use our new Simple Low GI Swaps tool on our updated website www.gisymbol.com.



The GI Symbol helps you identify healthy foods and drinks with both a lower GI and GL.

The GI Symbol, making healthy low GI choices easy choices



For more information about the GI Symbol Program
Dr Alan W Barclay, PhD
Chief Scientific Officer
Glycemic Index Foundation (Ltd)
Phone: +61 (0)2 9785 1037
Mob: +61 (0)416 111 046
Fax: +61 (0)2 9785 1037
Email: alan.barclay@gisymbol.com
Website: www.gisymbol.com

GI Update with Prof Jennie Brand-Miller

Prof Jennie Brand-Miller answers your questions. 



I know that type 2 diabetes is one of the fastest growing chronic diseases worldwide. Do we know why this is so and what people like me (it runs in my family) can do to prevent getting it? 
The global increase in the prevalence of type 2 diabetes is being driven by the rise in overweight and obesity in all age groups. The reasons behind our weight gain creep are complex but include a simultaneous increase in global food abundance together with increased sedentariness and decreased physical activity during both work and possibly leisure time. Recent studies have also indicated that a deviation from the normal sleeping pattern of 7–8 hours sleep per night, particularly short duration of sleep, increases appetite and promotes obesity and its related diseases (e.g. type 2 diabetes and cardiovascular disease).

There are two ways to prevent type 2 diabetes: by preventing weight gain in the first place and by preventing people who already have pre-diabetes from progressing to diabetes with weight loss and maintenance. The main drivers in both situations are changes in dietary and physical activity patterns, but we also need to address disturbed sleep patterns and workplace stress. Unfortunately, despite convincing evidence from clinical trials that type 2 diabetes can be prevented or delayed through intensive lifestyle interventions resulting in weight loss, the reality is that weight regain and incremental weight ‘creep’ are very common. It is possible that this may jeopardise diabetes prevention and it remains to be seen the effect of a longer period of weight maintenance on prevention.

The recent Diogenes Study (Diet, Obesity and Genes) identified two dietary factors associated with shorter-term prevention of weight regain after prior weight loss: higher protein intake and lower glycaemic index (GI). The findings showed that overweight and obese participants assigned to the combination of modestly higher protein and lower GI ad libitum had significantly better completion rates and weight maintenance after six months as compared with the official dietary guidelines. Indeed, those consuming the high protein-low GI combination diet continued to lose weight during the weight maintenance phase and were twice as likely to have maintained a 5% weight loss compared to the other groups.

Here at the University of Sydney we are one of eight sites around the world taking part in the 3-year international PREVIEW Study. Its primary goal is to identify the most efficient lifestyle intervention pattern for the prevention of type 2 diabetes in people who are pre diabetic overweight or obese individuals (i.e. those at high risk of diabetes). The aim of this study is to find out the best methods (through diet, exercise and behavioural modification) of maintaining weight loss and keeping diabetes at bay. Individuals taking part in this study will have their own team of professionals dedicated to their weight loss and weight loss maintenance, all free of charge. We are recruiting participants now. If you are:

• Between the ages of 25–45 or 55–70 years 
• Overweight 
• Have a blood relative with diabetes 
• Been told you have pre-diabetes or impaired glucose tolerance you may be eligible to participate. 

This brochure will tell you about the study and how you can take part if you are eligible.

New GI Values from SUGiRS
Sustagen® Diabetic now has the GI Symbol 
Sustagen has been around a long time. It is a supplement designed for people finding it difficult to meet their nutritional requirements through regular food alone. There are a variety of products for specific purposes. Nestle Health Science have just launched Sustagen® Diabetic (vanilla flavour), specifically formulated to be low GI (34) for people with diabetes or pre-diabetes (type 1 or type 2) who are not eating well, or have a poor appetite, or are ill or recovering from illness. It provides essential nutrition without negatively impacting blood glucose levels. To be used under medical supervision.

• To make 1 serving, mix 7 level of scoops with 210ml water (or milk), stir and serve chilled or warmed (210ml is about ¾ cup).
• Nutrition information for 1 serving mixed with water: 25g carbohydrate and 8g fibre, 11g protein, 11g fat
• Glycemic load (GL) 1 serving = 3 
• For more information: www.sustagen.com.au 

GI testing by an accredited laboratory
North America
Dr Alexandra Jenkins
Glycemic Index Laboratories
20 Victoria Street, Suite 300
Toronto, Ontario M5C 298 Canada
Phone +1 416 861 0506
Email info@gilabs.com
Web www.gilabs.com

Australia
Fiona Atkinson
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 www.glycemicindex.com

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