1 June 2018

GI News - June 2018

GI News

GI News is published by the University of Sydney, School of Life and Environmental Sciences and the Charles Perkins Centre. Our goal is to help people choose the high-quality carbs that are digested at a rate that our bodies can comfortably accommodate and to share the latest scientific findings on food and diet with a particular focus on carbohydrates, dietary fibres, blood glucose and the glycemic index.

Publisher:
Professor Jennie Brand-Miller, AM, PhD, FAIFST, FNSA
Editor: Philippa Sandall
Scientific Editor/Managing Editor: Alan Barclay, PhD, APD AN
Contact GI News: glycemic.index@gmail.com

Sydney University Glycemic Index Research Service
Manager: Fiona Atkinson, PhD, APD AN
Contact: sugirs.manager@sydney.edu.au

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FOOD FOR THOUGHT

SWEET TALK 
Hi Alan. I’ve still got a bee in my bonnet about oranges only getting 4½ stars when you ran them through the Australian Health Star Rating system for May GI News despite their being packed with good stuff like vitamin C, fibre, potassium, folate and over 170 different types of phytochemicals that have antioxidant, anti-inflammatory, and anti-cancer effects. I find it hard to believe we have a star rating system that denies an all-natural whole food that comes straight off a tree and that’s been nowhere near a food manufacturing plant the full five. Next, you’ll tell me breast milk only gets 4½ stars. – Cheers, Philippa

Oranges

Hi Philippa. I’m going to disappoint you. Breast milk doesn’t get 4½ stars. It gets three. As Jennie wrote in “Old Nutrition, New Nutrition” (GI News, December 2014) “If breast milk were sold in the dairy compartment, it would have at least two red marks – one for saturated fat and one for sugars – human milk, along with the milk from donkeys and minks, has the highest sugar content (i.e. per cent lactose), of any mammalian milk.” – Cheers, Alan.

Hi Alan. This is heading into a classic Monty Python script. Only three stars for the food that Mother Nature designed for our babies as a perfect nutritional package with all the proteins, fats, vitamins, and minerals they need to grow and thrive and fight infection because it contains lactose? – Cheers, Philippa

Hi Philippa. Well, it’s the sugars problem (as it was with oranges), but this time there’s also no dietary fibre to push the star numbers up. The nub of the problem is that while the real concern is about added sugars in our food supply, we currently can’t separate added sugars from the sugars naturally present in a food or drink on food labels. So current star rating systems use the total sugars which are on the labels for their ratings, and bonus-points for fibre to adjust for less-refined carbohydrates.

Some definitions. “Added sugars” according to the World Health Organisation (WHO) are all the mono- and disaccharides added to foods by food manufacturers, cooks or consumers. “Free sugars” include all those added sugars, plus all the sugars naturally present in honey, syrups (e.g., agave, maple, rice), fruit juices and concentrates. “Total sugars” are the added sugars; plus all the sugars naturally present in honey, syrups, fruit juices and concentrates; plus the naturally occurring sugars in whole foods such as fruit, vegetables, grains, seeds, milk etc. Also, it’s important to remember that Australia’s health star rating system (like traffic lights) is actually meant for processed packaged foods not core foods – minimally processed fruits, vegetables, legumes, nuts and seeds. One solution is to assign 5 stars to all core foods. The ratings system here is currently being reviewed to see what needs to be done to align it better with existing dietary guidelines. Australia’s need updating though of course – Cheers, Alan.

Hi Alan and Philippa. The algorithms that underpin traffic lights and rating stars are based on the old nutrition that has long passed its use-by date. Here are some reasons why.

  • The energy content (calories/kilojoules) of a food is not alone the best way to judge a food – lentils and licorice have the same energy density. 
  • The fat content of food is not alone the best way to judge a food – nuts have more fat and are more energy dense than French fries. 
  • The sugars content is not alone the best way to judge a food – fruit is full of sugars. 
  • The sodium content is not alone the best way to judge a food – soft drinks are low in sodium. 
  • They ignore micronutrients – vitamins, most minerals (other than sodium) and phytochemicals. 
  • They ignore one important proven attribute of foods in the new nutrition – their glycemic load per serving. This factor is proven to influence appetite and the risk of developing diabetes. Appetite matters. 

Appetite is what drives our energy intake. It is not possible to balance energy intake and energy expenditure by counting calories. Firstly, no one knows how many calories they expend each day. Even if you could, the calories on the food label are not precise enough. Secondly, mathematical modelling shows that a small but persistent excess of only 7 calories or 30 kilojoules per day over and above energy requirements for 10 years underlies the current epidemic of obesity. Here in Australia, I’d like to see a food label system that: 
  • Focused on the positive – not just the negative. 
  • Tied in with our dietary guidelines (which need updating). 
  • Rated foods according to their contribution to desirable macronutrient and micronutrient intakes. 
  • Used Adam Drewnowski’s Nutrient Rich Foods Index, which rates individual foods based on their overall nutritional value, as an essential component. 
  • Encouraged higher protein intake, particularly from plant sources like legumes. 
  • Distinguished effectively between naturally occurring and added sugars. 
– Cheers, Jennie

Read more: 

WHAT’S NEW?

WHO ADDED ALL THAT SUGAR TO MAPLE SYRUP? 
Who knew that we could weave such a tangled web when we practice not to deceive, but to inform? Ted Kyle of ConscienHealth reports on Vermont maple producers and legislators protesting an FDA requirement to label all the sugar in maple syrup as added sugar.

Maple syrup  

Vermonters are ticked. It’s time to implement the new Nutrition Facts label and they’re afraid it will give their beloved maple syrup a black eye. The label calls out added sugar. And pure maple sugar is what their syrup is all about. Natural is good, right? But added sugar is bad. So, which will it be? All natural or loaded with added sugar? There’s no doubt in the minds of Vermonters. Congressman Peter Welch summed it up: There are no added sugars. Maple is a pure product. Consumers want pure products. Nothing is more pure than maple syrup. That sounds simple. But the countervailing view is that this lovely syrup has only one purpose. For adding sweetness – in the form of maple sugar – to your food. It’s 67% maple sugar. So, it’s nothing but a source added sugar for your diet.

According to Welch, consumers think that added sugars are the bad stuff, like corn syrup, that big food companies add to unhealthy junk food. So, consumers might think something unnatural has been added to maple syrup if we start telling them it has added sugars. And by the way, honey producers aren’t too happy with this situation, either. The American Honey Producers Association says: “Honey is a pure sugar with no need for added sugars. So, this will mislead the consumer.” By this logic, pure cane sugar would have zero added sugars as well. A tangled web indeed.

Read more: 

THE GOLDILOCKS SOLUTION: TOO MUCH, TOO LITTLE, JUST RIGHT 
There’s considerable concern about the overall quality of our diet, especially the amount of “free sugars” (see Food for Thought for a definition) in the foods we are eating. This is a pretty technical paper, but it makes a useful point: when we go too high (over 25 per cent free sugars) or too low (under 5 per cent) we risk missing out on key nutrients. The researchers found for example, that those following a stringent less than 5% free sugars diet showed a drop in key micronutrients including folate and calcium. Peak intake for most micronutrients, report the researchers, was found in adults consuming between 5% and 15%. They also found that when “core food” intake (that’s the basics such as minimally processed fruits, vegetables, legumes, nuts, seeds, and dairy foods) went down and discretionary foods (that’s treats) went up there was an increase in free sugars intake. No surprises there because that’s how we define a discretionary food (a just-so story).

For his 2014 book, The Ultimate Guide to Sugars and Sweeteners (with Philippa Sandall and Claudia Shwide-Slavin), Alan Barclay put together a couple of diet plans to show what 5 per cent and 10 per cent added sugars look like in an overall healthy 2000-calories (8000 kilojoule) diet. In the nutritional analysis for these plans he includes the amount of added sugars and total sugars (that’s free sugars plus the naturally occurring sugars in whole foods – fruit, vegetables, grains and seeds).

Read more: 
JUST AS TASTY, BUT MORE FILLING 
Thirty-two teenagers (average age 15) who volunteered for a randomized, crossover, controlled pilot feeding study rated the low 5% added sugar diet they were given to eat for one week as being just as tasty as the high 25% added sugar diet they tucked into for a second week. (The diets were calorie matched and there was a 4-week washout period in between.) They also reported that they found the low added sugar diet with its adequate fibre intake more filling compared with the high added sugar low fibre diet. Despite this, participants remained weight stable, and there was no difference in weight change between diet conditions.

This is just a small pilot study, but it does clearly suggest that if you have kids with hunger pangs and hollow legs, they won’t mind if you cut back the snacks and foods with added sugars (and we would add added refined starches to this) and boost their fibre intake with the good high-quality carbs – whole fruit, veg, beans and grains. 
CALM DOWN WITH A CUPPA 
This small study aimed to find out if there was a difference drinking tea sweetened with sugar or sucralose or stevia (non-nutritive sweeteners) on people who were stressed. There was a difference. Having a cuppa sweetened with sugar had a calming effect on consumers with acute stress; a cuppa with a non-nutritive sweetener didn’t. The researchers think the reason for the effect may not be sugar’s taste, but its calories.

Tea with sugar  

Read more: 
RUN RODENT
Because there are biological similarities, research scientists find rats and mice valuable trial subjects. However, here at GI News we are wary of publishing the results of rodent studies because they should only be used to back-up and complement the results of human studies, not for scare-mongering. A rodent’s carbohydrate requirements are very different to ours. In particular, they evolved to eat raw seeds, not ripe fruit. Here are two recent studies. We leave you to make up your own mind on their relevance.
Running Rodent
#1 BURP While the sugars added to fizzy drinks are in the firing line, until now, no one thought to look at the added carbon dioxide gas. In this small study, the researchers show that rats downing fizzy drinks over a year gain weight at a faster rate than rats who drank flat soda or tap water. The weight gain was associated with increased production of the appetite hormone ghrelin, which is produced by both rodents and humans. In a parallel study, they also found that the ghrelin levels grew in 20 healthy young men drinking carbonated beverages compared to those who didn’t.

As an aside, did you know rats can’t burp. They can't vomit either, and they don't experience heartburn. Rats can't vomit for several related reasons. They have a powerful barrier between the stomach and the esophagus. They don't have the esophageal muscle strength to overcome and open this barrier by force, which is necessary for vomiting.

Read more: 
#2 GULP The findings of a University of Sydney study published in Physiology and Behaviour, that modelled an added sugars to diet beverage switch in rats suggested swapping to artificially sweetened beverages may help improve metabolic and cognitive impairments that result from too much added sugars. The study included two experiments designed to assess the effect on female rats of switching to either water or a non-nutritively sweetened saccharin-based solution following unlimited access to a sucrose-based sugar solution. Although the results can’t be directly applied to humans the researchers suggest the study is important because it replicates the switch from sugar to non-nutritive sweetener, which is how sweeteners like saccharin are marketed. The authors also highlight a couple of study limitations:
  • Saccharin is a non-nutritive sweetener commonly reported in animal studies to promote weight gain and development of diabetes, but it is not as commonly consumed by humans as other sweeteners such as aspartame, sucralose and stevia, which may have different effects on metabolism. 
  • Previous studies with male rats have not come up with similar results. 
The study has other limitations. The amounts of sugar-sweetened beverages and saccharin were unrealistic because it was way higher than anything people consume. They were fed:
  • Between 33–51% of energy from sugar-sweetened beverages for 4–8 weeks, which works out at 5–7 cans of regular sugar-sweetened soft drink a day over 10–20 years in human terms. 
  • Saccharin intake for the rats was an average of 136mg of saccharin per kg body weight in experiment 1, and 298mg per kg body weight in experiment 2. The Acceptable Daily Intake (ADI) of saccharin for humans is 5mg per kg body weight. So, the rats were fed between 27–59 times the ADI, or around 25 to 60 times more than is considered safe for human consumption. 
Read more: 
YOU CAN’T FOOL A BIRD BRAIN 
Everything about hummingbirds is rapid. It takes only three quick licks to reject water when they expect nectar. The birds pull back their beaks, shake their heads, and spit out the tasteless liquid. They are not fooled by the sugar substitutes in diet sodas. Their preference for sweetness has long been plain, but scientists can now understand the complex biology behind their taste for sugar. In a paper in Science, the team showed how hummingbirds’ ability to detect sweetness evolved from an ancestral savory taste receptor that is mostly tuned to flavors in amino acids. The research underscores how much remains to be learned about taste and other senses says Harvard’s Stephen Liberles. “Sensory systems give us a window into the brain to define what we understand about the world around us,” he said. “The taste system is arguably a really direct line to pleasure and aversion, reward and punishment, sweet and bitter. Understanding how neural circuits can encode these differentially gives us a window into other aspects of perception.”

Hummingbird

Read more: 

PERSPECTIVES WITH DR ALAN BARCLAY

Juiced? 
We have been juicing fruits for a long time. Here’s a short summary. Wine is fermented grape juice – the fermentation process is a way of preserving the fruit– and it looks like we’ve been making it for about 8000 years. Archeologists have found that the people living at Gadachrili Gora and a nearby village 20 miles south of Tbilisi, Georgia, were the world’s earliest known vintners—producing wine on a large scale as early as 6000BC. Now skip a few millenia. Lemonade became popular in the 1500s, and orange juice in the 1700s and we preserved them by adding sugar (sucrose) which in the right amount inhibits bacterial growth (a good thing). Louis Pasteur’s pasteurization process (1864) preceded the development of fresh (unfermented) 100% fruit juices in 1868. In 1930, the first commercial juicing machine was invented and around this time electric refrigeration became affordable. Home juicing became popular in the USA in the 1970s, thanks to affordable home juicers.

Fruit juices

Today, people enjoy 100% fruit juice worldwide and it’s a nutritious choice as the analysis of commercial unsweetened orange juice shows. (And if you are wondering why orange juice rates five stars while a whole orange picked straight from the tree only rates 4½, it’s because Australia’s star rating system currently uses different algorithms for solid foods and for beverages)

Oranges nutrition facts

The American Dietary Guidelines consider 1 cup (240ml) of 100% fruit juice as being equivalent to one serve of fruit, but they also recommend that at least half our recommended serves of fruit should come from whole fruit, which generally contains more dietary fibre and less calories.

What about the sugars? The carbohydrate in fruit and fruit juice is in the form of sugars (fructose, glucose and sucrose principally). Some people point out that fruit juices can provide nearly as much sugars as some sugar sweetened beverages, which nutrition epidemiological studies have associated with weight gain and risk of type 2 diabetes. Do 100% fruit juices pose the same risk? Fortunately, there is now a relatively large body of evidence that can help answer this important question.

Auerbach and colleagues investigated the association of 100% juice consumption with body mass index (BMI) in prospective cohort studies of children. The overall conclusion was that while consumption of 100% fruit juice is associated with a small amount of weight gain in children ages 1 to 6 years, the amount is not clinically significant. (Controlling for total energy intake, they reported that one 180–240ml (6–8oz) serve of 100% fruit juice a day is associated with a 0.087 unit increase in BMI in children aged 1 to 6 years, but not in children aged 7 to 18 years.) Similarly, systematic reviews of the evidence in adults show no detrimental effects of consuming moderate amounts of 100% fruit juice.

Murphy and colleagues investigated the effect of 100% fruit juice on blood glucose and insulin levels in randomised controlled trials which included a range of people including those who were overweight/obese and/or had diabetes. They found that 100% fruit juice had no significant effect on fasting blood glucose, fasting blood insulin or HbA1c. The overall conclusion was that 100% fruit juices have a neutral effect of on glycemic control, and they noted that these findings were consistent with findings from observational studies suggesting that consumption of 100% fruit juice is not associated with increased risk of developing type 2 diabetes.

Sugars (e.g., glucose, fructose and sucrose) and other fermentable carbohydrates (i.e. maltodextrins and starches), provide food for oral bacteria, which lower our plaque and salivary pH, and in turn promote tooth demineralization. This is the main reason why the World Health Organisation recommends we limit our consumption of free sugars to less than 10% of energy – 100% fruit juices are a source of free sugars. However, most of the studies that make up the evidence base for the WHO guideline are based on added sugars – not juices. So, what does the evidence say about 100% fruit juice?

A recent clinical trial by Issa and colleagues found that a range of solid and juiced fruits (e.g. apples, oranges, grapes and tomatoes) could contribute to tooth demineralisation, but there were no significant differences between solid and juiced foods. A review by Touger-Decker and van Loveren found that many factors in addition to free sugars affect the risk of tooth decay, including the form of food or fluid, the duration of exposure, nutrient composition, sequence of eating, salivary flow, presence of buffers, and your personal oral hygiene. In particular, they noted that polyphenols such as tannins in cocoa, coffee, tea, and many fruit juices may reduce the cariogenic potential of foods and drinks. In addition, in a series of experiments in young adults that included fruits and juices (e.g. apples/juice, dates, bananas, orange juice, raisins), Edgar and colleagues found that while juices had a higher acidic potential than whole fruits, they only moderately increased risk compared to sugar-sweetened beverages and confectionery, which conferred a high risk. In summary, 100% fruit juices are not as likely to cause tooth decay as sugar-sweetened beverages or confectionery.

So, overall, the evidence we currently have supports the American Dietary Guidelines allowance of up to 1 cup of 100% juice a day as part of a healthy balanced diet.

Dr Alan Barclay  
Alan Barclay, PhD is a consultant dietitian. He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of  The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).

Contact: You can follow him on Twitter or check out his website.

KEEPING IT GREEN – EATING FOR BODY AND PLANET

ORGANIC – IS IT THE GREENER CHOICE? 
Organic foods are generally perceived to be healthier and better for the environment. But do they live up to this perception?

“Organic” generally refers to plant and animal products grown or raised without artificially made fertilisers, pesticides, growth regulators and other chemicals. Instead they may use natural fertilisers such as compost or manure and manage pests using techniques like crop rotation. The USDA (United States Department of Agriculture) regulates the term “organic” and defines standards that “integrate cultural, biological, and mechanical practices that foster cycling of resources, promote ecological balance, and conserve biodiversity.” In Australia, the government does not regulate the use of “organic”, so you have only the grower’s or manufacturer’s word for it. However, a “certified organic” product is regularly audited by an independent certifying body and must meet their particular requirements, some being stricter than others.

Do organically grown foods taste better? It depends. For example, exotic heirloom fruit and veg can be grown on smaller farms, and produce may be smaller or have lower moisture content therefore intensifying the flavour. The taste of organic meats may reflect a more diverse diet. However, there are other factors at play including the freshness of the produce, the soil and the climate. And a regular apple purchased fresh from the farm generally tastes better than an organic apple that has sat around for weeks in a cold store.

Are organic foods healthier? The jury is still out on this. For example, organic ingredients don’t add health benefits to highly processed foods. An organic cookie is still a “sometimes” food and typically just as high in calories/kilojoules as a regular cookie. For fresh whole foods, the picture is more complicated. A recent scientific review reports that while some organic crops may have slightly higher antioxidant levels the authors conclude that it’s not actually possible to quantify to what extent organic food consumption may affect human health as “there is virtually no published data from (1) long-term cohort studies focusing on chronic diseases (e.g. cardiovascular disease, diabetes, cancer, and neurodegenerative conditions) and (2) controlled human dietary intervention studies comparing effects of organic and conventional diets.”

So, if you want to eat better, buying organic is not the logical first step. The bigger picture is many of us eat too many highly processed “discretionary” foods for which the organic label is irrelevant. Most of us don’t eat enough vegetables, period. As organic veggies are generally more expensive, eating enough conventional vegetables (five-a-day) would have a greater nutritional impact than buying fewer organic vegetables. As for food safety, all food, both organic and conventional, must meet food safety regulations of the country in which it is sold. For example, FSANZ (Food Standards Australia and New Zealand) regulates all foods sold in Australia to ensure any chemical contaminants are in amounts below the maximum residue limit; this limit is set well below the level that could pose a safety risk to consumers.

Are organic farming methods more sustainable? While the answer to this question might seem instinctively “yes”, the scientific jury is still out. According to a recent meta-analysis, organic agricultural systems use 15% less energy. This is possibly because organic systems don’t rely on synthetic fertilisers and pesticides that require a lot of energy to produce. On the other hand, they noted conventional foods use less land (less deforestation) and had a lesser impact on nearby water ecosystems (which means less algal bloom and aquatic dead zones). The same study found that both organic and conventional systems had similar greenhouse gas emissions and comparable impacts on soil acidity (an adverse effect that reduces plant growth).

There is no clear winner when it comes to sustainability and more research still needs to be done. Moreover, organic agriculture is less intensive and therefore is unable to support our population growth projected to be nine billion people by 2050. We can’t feed the world with organic food, but a hybrid approach might work; combining aspects of organic farming methods such as composting and crop rotation with conventional farming to reduce energy usage.

Should I spend extra on organic? 

  • Safety: All foods, organic or conventional, must meet food safety regulations. 
  • Nutrition: For a nutritional boost, just eat more veggies (conventional or organic). 
  • Environment: Organic and conventional methods both have their pros and cons. You would have a greater impact by reducing food waste and eating more plant-based protein options instead of excessive amounts of meat. 
  • Get what you pay for: choose certified organic foods to ensure they really are organic 

Thanks to Rachel Ananin AKA TheSeasonalDietitian.com for her assistance with this article.

 Nicole Senior    
Nicole Senior is an Accredited Nutritionist, author, consultant, cook, food enthusiast and mother who strives to make sense of nutrition science and delights in making healthy food delicious.   Contact: You can follow her on Twitter, Facebook, Pinterest, Instagram or check out her website.

GOOD CARBS FOOD FACTS A TO Z

PEAS 
Eating the youngest, most tender peas shelled straight after picking is a truly sweet experience. Peas are easy to grow and in the right spot with appropriate TLC are generous providers from late spring through the summer months. You keep picking, they keep providing. Most of us outsource the growing and shelling and buy frozen peas – we are busy; they are there. They are just as nourishing, so make the most of this family friendly veg as a side dish or rolled into the spotlight in soups, salads, stir-fries, fritters, frittatas, rice dishes and more. Look for bright pea green unwrinkled pods in season with no splits or blemished. Avoid prepacked trays of shelled peas. Snap frozen peas are a great standby to have in the freezer and are just as nutritious. Check the use-by or best-before date.
Peas
Peas are tricky when it comes to table manners. They can shoot all over the place like little green bullets. Being from British stock we were never allowed to do what seemed the sensible thing to do to a child, turn the fork over and scoop. We had to find a way to squash the peas on to the back of the fork which we eventually discovered we could do if “pre-loaded” with a little mashed potato or pumpkin. We are delighted to see that Debretts now tells us it is OK to “scoop with an upturned fork in more casual or solitary situations”.

 Peas nutrition facts
 Source: The Good Carbs Cookbook

IN THE GI NEWS KITCHEN

THE GOOD CARBS COOKBOOK 
The Good Carbs Cookbook (by Alan Barclay, Kate McGhie and Philippa Sandall) published by Murdoch Books helps you choose the best fruits, vegetables, beans, peas, lentils, seeds, nuts and grains and explains how to use them in 100 refreshingly nourishing recipes to enjoy every day, for breakfast, brunch, lunch, dinner and dessert. The recipes are easy to prepare, (mostly) quick to cook, long in flavour and full of sustaining goodness, so you feel fuller for longer. There is a nutritional analysis for each recipe and tips and helpful hints for the novice, nervous, curious or time-starved cook.

THE GOOD CARBS COOKBOOK

OMELETTE WITH GARDEN PEAS, FETA AND MINT 
There are times when the yearning for an omelette is overwhelming, but for some reason, many cooks shy away from this gloriously simple light meal. Practice makes perfect, but don’t be too fussed about how it looks when turned out. The refreshing, lively filling makes up for any imperfection in the looks department. Ring the filling changes as you fancy: cooked prawns, flaked cooked fish, diced fresh tomato and plenty of fresh chopped herbs are all delicious options. And if you are a family of smaller eaters, it will easily serve three people as a light meal with a slice of grainy bread and a garden salad with ripe-red tomatoes. Preparation time: 15 minutes • Cooking time: 8 minutes • Serves: 2

THE GOOD CARBS COOKBOOK

⅔ cup (100g/3½oz) cooked peas
1 tablespoon olive oil
1 teaspoon finely grated lemon zest
2 spring onions (scallions), finely sliced
6 eggs (60g/2oz eggs)
Salt flakes and freshly ground pepper
2 tablespoons butter
½ cup (60g/2oz) crumbled feta
3 tablespoons shredded mint leaves

Put the peas in a bowl with the oil, lemon zest, and spring onions. • Whisk the eggs with salt and pepper in a bowl. Heat the butter in a large non-stick pan over medium heat. When the butter foams and turns nut brown, add eggs and gently cook, without stirring for about 3 minutes or until large curds form. Reduce the heat to medium-low and using a broad spatula gently push the eggs around in the pan until they are almost set. Spoon the pea mixture, feta and mint over the top, and with the aid of the spatula, gently roll the omelette up and over the filling. This is easier if you hold the pan at a slight angle to assist the rolling. Cook for 1 minute more and then slide the omelette onto a plate. Divide into two and serve topped with extra mint and spring onion if you wish.

Per serve 
2350kJ/560 calories; 28g protein; 47g fat (includes 21g saturated fat; saturated : unsaturated fat ratio 0.81); 6g available carbs (includes 2g sugars and 4g starches); 4g fibre; 740mg sodium; 310mg potassium; sodium : potassium ratio 2.4

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Nutritional analysis To analyse Australian foods, beverages, processed products and recipes, we use FoodWorks which contains the AusNut and Nuttab databases. If necessary, this is supplemented with data from www.calorieking.com.au or http://ndb.nal.usda.gov/ndb/search.

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1 May 2018

GI News - May 2018

GI News

GI News is published by the University of Sydney, School of Life and Environmental Sciences and the Charles Perkins Centre. Our goal is to help people choose the high-quality carbs that are digested at a rate that our bodies can comfortably accommodate and to share the latest scientific findings on food and diet with a particular focus on carbohydrates, dietary fibres, blood glucose and the glycemic index.

Publisher:
Professor Jennie Brand-Miller, AM, PhD, FAIFST, FNSA
Editor: Philippa Sandall
Scientific Editor/Managing Editor: Alan Barclay, PhD, APD AN
Contact GI News: glycemic.index@gmail.com

Sydney University Glycemic Index Research Service
Manager: Fiona Atkinson, PhD, APD AN
Contact: sugirs.manager@sydney.edu.au

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FOOD FOR THOUGHT

WHY IS PUSS PORTLY? 
As our waistlines have expanded, so have those of our pets. The Association for Pet Obesity Prevention’s ninth annual clinical survey (2016) reports that nearly 54 percent of dogs and 59 percent of cats were clinically overweight or obese in the US. To put some numbers on that, they reckon that equals an estimated 41.9 million dogs and 50.5 million cats (based on 2016 pet population projections provided by the American Pet Products Association). Being overweight puts puss and puppy at an increased risk for weight-related disorders such as type 2 diabetes, osteoarthritis, hypertension and many cancers.

Portly puss

A recent Swedish cross-sectional study using data from medical records for cats visiting an academic medical centre and from a questionnaire on insured cats found that the factors associated with increased risk of puss being obese were: “Eating predominantly dry food, being a greedy eater, and inactivity”.

What’s the ideal weight for a cat? The Cat Bible author and Radio Pet Lady, Tracie Hotchner, says “it is hard to judge since cats come in so many shapes and sizes. However, if your cat has a belly that hangs down and swings when she walks, you need to make some plans to reduce her weight. Oftentimes this will simply mean removing all dry food and feeding canned or raw instead, which research shows is the best diet for every cat.”

Dry food is not appropriate for domestic cats she says. “Numerous veterinarians who share my dismay over the widespread use of dry food are concerned about a cat's digestive system being challenged to process foods it is not designed to eat. Cats are not ‘little dogs’ yet a dry food developed for canines was then manipulated to give to cats.” Hotchner views dry food for cats as an addictive harmful source of nutrition which she calls ‘kitty crack’ as she believes it encourages felines to consume carbohydrate-heavy plant-based food sources which their body is not designed to digest and metabolize. Keep in mind the wild ancestors of puss snoozing on the sofa were obligate carnivores and their diet was essentially the small animals they hunted. Despite appearances, the domestic cat still closely resembles its wild ancestor.

Who thought of dried food for cats and dogs? And when? It has a fascinating past as GI News editor Philippa Sandall discovered researching Seafurrers, her book on ships’ cats. The story goes that in the late 1850s, an Ohio electrician named James Spratt journeyed to London to sell lightning rods. He noticed dogs hanging around the docks at Portsmouth tucking into scraps of hardtack (ship’s biscuit) and had a eureka moment. He patented a similar biscuit for dogs (they can digest carbohydrate-based foods) and the rest is history. Spratt’s Patent Meal Fibrine Dog Cakes were a baked mixture of wheat, beet root, and vegetables bound together with beef blood. Dried food (kibble) for cats followed.

To whet your appetite, here’s a World War 2 “dry food incident” reported by a 17-year-old Massachusetts seaman who saved the ship’s cat after they were torpedoed. “We were in the lifeboat seven and a half days with not much to eat besides hardtack,” he said. “The cat didn’t like hardtack and wouldn’t eat a bite until some flying fish landed in the boat. Before we got to shore, though, she ate hardtack and liked it.” It’s likely the lifeboat lad improvised a grainy seafood salad to tempt puss’s taste buds (and his own) by tossing crumbled hardtack with flying fish flakes moistened with a little water and puss focussed her attention on the fishy bits surmises Seafurrers author Philippa Sandall.

Read more: 

WHAT’S NEW?

DIABETES IN CATS 
Diabetes in cats resembles type 2 diabetes in people. The causes aren’t fully understood, but both genetic and environmental factors are believed to contribute. However, for those quick to point the wagging finger at “sugar” causing obesity and diabetes, cats don’t eat sugar. They don’t have a sweet tooth. A small Swedish case-control study using a web‐based questionnaire sent to owners of cats with diabetes and cats without diabetes (the control) found indoor confinement, being a greedy eater, and being overweight were associated with an increased risk of diabetes. As dry food is commonly fed to cats worldwide, “the association found between dry food and an increased risk of diabetes in cats assessed as normal weight by owners warrants further attention” say the authors.

Fat cat

In Perspectives this month, Alan Barclay looks at the pancreas, what it is and what it does, and why understanding the causes of diabetes are complicated in people let alone in cats.

Read more: 

HIGH FIBRE DIET MAY HELP MANAGE BGLS 
A high fibre diet rich in good carbs (fruit, veg, beans and grains) can help people with type 2 diabetes manage their blood glucose levels – and it seems to do this by changing the bacteria in the gut. The findings of a recent study showed a diversified high-fibre diet can promote some 15 strains of gut bacteria that produce short-chain fatty acids that can help in reducing inflammation in the gut, help regulate hunger and also provide energy to gut cells. “It’s early days,” says study leader Prof Liping Zhao from Rutgers University, “but it lays the foundation and opens the possibility that fibres targeting this group of gut bacteria could eventually become a major part of your diet and your treatment”. The research reinforces the fact that eating certain kinds of carbohydrate foods rich in dietary fibres can help restore the gut microbiota responsible for better digestion and overall health.

Fiber

Read more: 
IT’S NOT JUST IN YOUR HEAD: SEROTONIN AND OBESITY 
Maybe it’s not on the tip of every tongue writes Ted Kyle in ConscienHealth. But serotonin is a bit more familiar than most neurotransmitters. Most people think of it as a happy hormone for the central nervous system that becomes depleted in a state of depression. However, the gastrointestinal system has far more of it than the central nervous system. And new research now tells us that in the small intestine, this substance might influence obesity and metabolic health.

Scientists have long known that serotonin in the brain plays a role in eating behaviour. Food intake is higher when levels of this hormone are lower in the brain. But animal studies have suggested a very different relationship between serotonin and obesity in the gut. There, it seems to promote obesity and higher blood glucose levels. Now, we have confirmation in humans that this is true. Richard Young and colleagues showed that the small intestines of people with obesity produce more serotonin. In fact, the levels were twice as high when compared to normal controls. The gut secretes this hormone in response to glucose and it appears to play a role in developing obesity and diabetes.

This research is important for two related reasons says Kyle. First, it gives us more insight into how both obesity and diabetes develop, and why some people are more susceptible than others. In their research, Young et al found more cells that produce serotonin in the small intestines of people with obesity than in those at a normal weight. With a better understanding of this pathway, we might have a promising new target for treating obesity and diabetes. Says Young: “This has revealed new ways that we may be able to control the release of serotonin from within the gut, and in turn, further improve the outlook for people living with obesity.”

Read more: 

PERSPECTIVES WITH DR ALAN BARCLAY

THE PANCREAS – UNLOVED, BUT ESSENTIAL 
The pancreas is an essential organ responsible for both the digestion of food and blood glucose regulation. It was first identified by Greek anatomist and surgeon, Herophilus, around 2300 years ago. A few hundred years later, Rufus of Ephesus, another Greek anatomist, gave the pancreas its name. “Pancreas” originally meant sweetbread, a name that is still commonly used in culinary circles for calf or lamb pancreas.

The pancreas is located behind the stomach in the upper left part of the abdomen. It is surrounded by other organs including the stomach, small intestine (duodenum), liver, and spleen. It is spongy, about 15–25cm (6–10in) long, 2.5cm (1in) thick, and is shaped a bit like a flattened pear or a fish extended horizontally across the abdomen. The bulk (95%) of the pancreas consists of tissues and cells that produce pancreatic secretions for the digestion of carbohydrates, fats and proteins. The remainder consists of little islands of cells called islets of Langerhans. These look a bit like small bunches of grapes and produce hormones that regulate blood glucose and help regulate pancreatic digestive secretions.


The Pancreas

Source: www.medicalook.com

Food digestion Once food has been chewed in the mouth, then mulched and partially digested in the stomach by acids, it is released into the first part of the small intestine known as the duodenum. The pancreas then releases its own digestive juices and enzymes into the partially digested food, via a small duct connected to the duodenum. Pancreatic juices contain enzymes that help breakdown carbohydrate, fat and protein. They are activated once they reach the duodenum to prevent the protein-digesting enzyme trypsin from breaking down the proteins in the pancreas itself, or in its duct. Other enzymes produced by the pancreas and released into the duodenum include amylase (to break down starches and maltodextrins into sugars) and lipase (to break down fats into monoglycerols and fatty acids). The pancreas also secretes sodium bicarbonate, which helps to neutralise the stomach acids in the partially digested food.

Blood glucose hormones Two of the most important pancreatic hormones are insulin produced by beta cells and glucagon produced by alpha cells in the islets of Langerhans which manufacture and release these hormones directly into the bloodstream.

Insulin regulates the metabolism of carbohydrates, fats and protein by promoting the absorption of glucose from the blood into liver, fat and muscle cells. In these cells the absorbed glucose is converted into either glycogen (a kind of starch found in the liver and muscles) via a process known as glycogenesis or fats (triglycerides) via lipogenesis. Circulating insulin also affects the synthesis of proteins in a wide variety of cells and tissues. It is therefore an anabolic hormone, promoting the conversion of small molecules in the blood into large molecules inside the cells.

Glucagon stimulates the liver to break down glycogen into glucose, which is then released into the blood. It also activates gluconeogenesis, the conversion of certain amino acids from proteins into glucose. Finally, it facilitates the breakdown of stored fat (triglycerides) into fatty acids for use as fuel by cells. It is therefore a catabolic hormone, promoting the breakdown of large molecules in cells into smaller molecules in the blood.

Pancreatic beta cells are sensitive to blood glucose concentrations. When glucose levels are high, they secrete insulin into the bloodstream and when glucose levels are low, secretion of insulin is inhibited. On the other hand, alpha cells secrete glucagon into the blood in the opposite manner to insulin: when blood glucose levels are low, or in response to vigorous exercise, secretion is increased, and when blood glucose levels are high, secretion is decreased.

The secretion of insulin and glucagon into the blood in response to changes in blood glucose concentrations is the primary mechanism of blood glucose homeostasis. In other words, the two hormones work in partnership with each other to keep blood glucose levels balanced. Optimal maintenance of blood glucose levels is critical to the functioning of key organs including the brain and nervous system, liver, and kidneys.

If the beta cells are destroyed by an autoimmune reaction, insulin can no longer be synthesized or secreted into the blood in sufficient quantities. This results in the development of type 1 diabetes. In type 2 diabetes, the destruction of beta cells is less pronounced than in type 1 diabetes and is not primarily due to an autoimmune process. The exact cause of type 2 diabetes is not fully understood but people have a reduced number of islet beta cells, and of those that survive there is a reduced secretory function, and there is also frequently (but not always) peripheral tissue insulin resistance (the insulin that is produced does not work as efficiently in the target cells as it should). Type 2 diabetes is also characterized by high rates of glucagon secretion which are less responsive to the concentration of glucose in the blood, but insulin is still secreted into the blood in response to concomitantly increasing blood glucose concentrations. As a result, insulin levels are typically much higher than they are in people without type 2 diabetes.

Read more: 



Dr Alan Barclay  
Alan Barclay, PhD is a consultant dietitian. He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of  The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).

Contact: You can follow him on Twitter or check out his website.

KEEPING IT GREEN – EATING FOR BODY AND PLANET

LOW ENERGY LIVING 
We use a lot of energy in our everyday lives. Cast your mind back to the last power outage. Did your heart sink as you realised that your mobile battery was at 2%, you couldn’t watch TV or make microwave popcorn and the ice-cream in the fridge melted? The minor and temporary inconvenience of a power outage is the tip of a very large energy iceberg.

Each year we are using more and more energy. One way of measuring how much more we are using is Overshoot Day. In 2017, August 2 was Overshoot Day says the Global Footprint Network. What this means is that in just over seven months, we, the world’s population, had used up the natural resources such as food and fuel Earth can generate in twelve months. As Overshoot Day moves earlier and earlier each year, we dip more and more into the super fund of natural resources we should be saving for our children’s and their children’s future. What can we do to make a difference? We can start with adopting some everyday habits that help to reduce our energy use. We don’t necessarily have to go without; but we need to be more aware of the energy we use in our daily lives, be more energy efficient and waste less.

Our energy-saving tips 
Transport 

  • Walk, ride a bike, carpool or take public transport – it saves money and reduces your carbon footprint as well as increasing your activity levels. Talk about win, win, win! 
Shopping 
  • Buy healthy whole foods such as oats, brown rice, vegetables, fruit, milk, fresh meat, legumes and eggs, and cut back on (cut out?) highly processed packaged foods that require more energy to produce in the first place and are likely high in salt, saturated fats and highly refined carbohydrates (starches and sugars) that spike BGLs. 
  • Plan your meals and shopping trips to avoid emergency fast food drive-throughs and pizza deliveries. 
Cooling and heating 
  • Adjust your air-conditioning thermostat to more moderate settings to make it use less energy, such as 18–20 degrees Celsius in winter and 25–27 degrees in summer. 
  • Wear more clothes in winter to save on heating (and remember keeping yourself warm uses kilojoules/calories and every little bit helps). 
  • Close the door on rooms you’re not using and exclude draughts. 
Washing 
  • To save energy on water-heating, wash clothes in cold water, only run the dishwasher when its full (and in the middle of the night for off-peak energy pricing), keep showers short and install a water-saving shower head and flow-limiters on taps. 
  • Air-dry clothes rather than use a clothes dryer. 
Storage 
  • Ensure your fridge is set to the correct temperature – around 3–4 degrees Celsius and get rid of that extra fridge – it’s costing you a lot to run. 
  • Don’t open the fridge door too much so it doesn’t have to work as hard to stay cold. 
Cooking 
  • Use the BBQ outside on hot days – cooking inside heats the house and makes your cooling system work harder. 
  • Use your microwave oven or pressure cooker rather than your oven – it is more energy efficient. 
  • Defrost frozen foods in the fridge overnight instead of in the microwave. 
  • Use the correct size burner for your saucepan – excess heat wastes energy. 
  • If using your oven, think about cooking two things at once. 
Thanks to Rachel Ananin AKA TheSeasonalDietitian.com for her assistance with this article.

 Nicole Senior    
Nicole Senior is an Accredited Nutritionist, author, consultant, cook, food enthusiast and mother who strives to make sense of nutrition science and delights in making healthy food delicious.   Contact: You can follow her on Twitter, Facebook, Pinterest, Instagram or check out her website.

GOOD CARBS FOOD FACTS A TO Z

ORANGES 
The golden glow of oranges in the midst of a grey winter lift spirits. It’s not just colour. Their sweet acidity makes them a versatile ingredient in the kitchen (variety doesn’t matter so much, although some recipes specify blood oranges or Seville oranges for colour or flavour). Whole oranges (skin and all), segments, juice and zest are used in every category of cooking from salads, soups, sauces, meat, fish, poultry to desserts and baking.

As citrus fruit does not ripen further once it has been picked, choose ripe oranges that smell like oranges with no hint of fermenting aromas. Heavy fruits with fine-grained skin are juiciest. Avoid soft, bruised or wrinkled fruit as well as spongy soft ones. They keep for up to two weeks in the refrigerator and almost as well at room temperature. They also yield more juice at room temperature. Their sturdy peel protects them and they require no further wrapping.

Oranges nutrition facts
 Source: The Good Carbs Cookbook

IN THE GI NEWS KITCHEN

THE GOOD CARBS COOKBOOK 
The Good Carbs Cookbook (by Alan Barclay, Kate McGhie and Philippa Sandall) published by Murdoch Books helps you choose the best fruits, vegetables, beans, peas, lentils, seeds, nuts and grains and explains how to use them in 100 refreshingly nourishing recipes to enjoy every day, for breakfast, brunch, lunch, dinner and dessert. The recipes are easy to prepare, (mostly) quick to cook, long in flavour and full of sustaining goodness, so you feel fuller for longer. There is a nutritional analysis for each recipe and tips and helpful hints for the novice, nervous, curious or time-starved cook.

THE GOOD CARBS COOKBOOK

FREGOLA AND BLOOD ORANGE SALAD WITH FENNEL 
Every ingredient in this lively salad says Italy. Red-fleshed blood oranges were developed in Sicily, while subtle, aniseedy fennel is everywhere in Italy. Fregola is a type of Sardinian pasta, not dissimilar to couscous. During processing, the durum wheat flour is mixed with water, rolled into tiny pebbles, sundried and roasted giving it a rustic quality. The flavour is improved if the fregola is cooked in a flavoursome stock. It should take no more than 10–12 minutes of cooking to be al dente. You can substitute with Israeli (pearl) couscous or orzo if you wish. Preparation time: 25 minutes •Cooking time: 12 minutes • Serves: 6

FREGOLA AND BLOOD ORANGE SALAD WITH FENNEL

2 cups fregola
4 blood oranges
4 flat anchovy fillets, drained
1 garlic clove, peeled
½ teaspoon chilli flakes
3 tablespoons lemon juice
3 tablespoons olive oil
1 medium fennel bulb, trimmed and thinly sliced
freshly ground pepper

Bring a medium pan of salted water to the boil and add the fregola. Boil for about 15 minutes or until cooked through. Drain, refresh under cold water and set aside to drain and dry. • Slice the peel and white pith from the oranges and slice into thin rounds. Arrange in a circular pattern on a serving dish. • Mash the anchovies with the garlic and chilli flakes and then whisk in the lemon juice and oil. • Put the well-drained and cooled fregola and the fennel in a bowl, add the anchovy dressing and toss to combine all the ingredients. Pile the mixture on top of the oranges and season generously with pepper.

Per serve 
1050kJ/250 calories; 6g protein; 10g fat (includes 1.5g saturated fat; saturated : unsaturated fat ratio 0.18); 33g available carbs (includes 8.5g sugars and 24.5g starches); 4.5g fibre; 165mg sodium; 315mg potassium; sodium : potassium ratio 0.52

ANNEKA MANNING’S BAKE CLUB 
ANNEKA MANNING
Anneka Manning is an author, food editor, cooking teacher, home economist, mother of two and the founder of BakeClub. With over 27 years' experience, she specialises in teaching the ‘why’ behind the ‘how’ of baking, giving home cooks the know-how, understanding and skill to bake with confidence and success, every time. You can follow her on Twitter, Facebook or check out her website.

MANDARIN ROASTED ALMOND CAKES. 
These gluten-free cakes are a play on the original (and wonderful) Middle Eastern orange cake from the one-and-only Claudia Roden. The ground roasted almonds give a lovely ‘toasted’ flavour but you can substitute pre-ground almond meal. To roast and grind the almonds, spread on an oven tray and place in an oven preheated to 180°C/350°F for 8-10 minutes or until aromatic. Cool on the tray before processing in a food processor until finely ground. Makes: 12 • Prep: 20 minutes (+ 30 minutes simmering and 15 minutes cooling time) • Bake: 15–18 minutes

MANDARIN ROASTED ALMOND CAKES

2 large mandarins
olive oil spray, to grease
½ cup instant polenta
80g (2½oz) natural almonds, roasted, finely ground
½ tsp baking powder
3 eggs, at room temperature
¾ cup raw caster sugar
2 tsp natural vanilla essence or extract icing sugar, to dust (optional)

Put the mandarins (skin and all) in a small saucepan and cover with water. Bring to the boil and simmer for 30 minutes or until very soft when tested with a skewer. You may need to place a small saucer over the mandarins to keep them submerged. Remove from the water and set aside to cool slightly. • Meanwhile preheat the oven to 180°C (350°F). Brush a 12-hole 80ml (⅓-cup) muffin tin with the melted butter to grease. • Combine the polenta, roasted almond meal, and baking powder in a medium bowl and mix well to combine evenly. • Quarter the mandarins and remove and discard any centre core or seeds. Puree in a food processor or blender until smooth. • Put the eggs, sugar and vanilla in a medium mixing bowl and use an electric mixer with a whisk attachment to whisk until very thick and pale and a ribbon trail forms when the whisk is lifted. Add the mandarin puree and use a spatula or large metal spoon to fold in until just combined. Add the polenta mixture and fold together until evenly combined. • Divide the mixture evenly among the muffin holes (pouring the mixture from a jug or using a ladle works well). • Bake in preheated oven for 15-18 minutes or until the cakes are firm to the touch on the top and cooked when tested with a skewer. Remove from the oven and cool in the tin for 10 minutes. Use a palette knife to ease the cakes out of the tin and transfer to a wire rack. Serve warm or at room temperature dusted with a little icing sugar if you wish.

Per cake 
Energy: 560kJ/130cals; Protein 3.5g; Fat 5g (includes 1g saturated fat; saturated : unsaturated fat ratio 0. 25); Available carbohydrate 18.5g (includes 15g sugars, 3.5g starches); Fibre 1g; Sodium 40mg; Potassium 95mg; sodium to potassium ratio 0.42

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Nutritional analysis To analyse Australian foods, beverages, processed products and recipes, we use FoodWorks which contains the AusNut and Nuttab databases. If necessary, this is supplemented with data from www.calorieking.com.au or http://ndb.nal.usda.gov/ndb/search.

Disclaimer GI News endeavours to check the veracity of news stories cited in this free e-newsletter by referring to the primary source, but cannot be held responsible for inaccuracies in the articles so published. GI News provides links to other World Wide Web sites as a convenience to users, but cannot be held responsible for the content or availability of these sites. All recipes that are included within GI News have been analysed however they have not been tested for their glycemic index properties by an accredited laboratory according to the ISO standards.

© ®™ The University of Sydney, Australia

1 April 2018

GI News - April 2018

GI News

GI News is published by the University of Sydney, School of Life and Environmental Sciences and the Charles Perkins Centre. Our goal is to help people choose the high-quality carbs that are digested at a rate that our bodies can comfortably accommodate and to share the latest scientific findings on food and diet with a particular focus on carbohydrates, dietary fibres, blood glucose and the glycemic index.

Publisher:
Professor Jennie Brand-Miller, AM, PhD, FAIFST, FNSA
Editor: Philippa Sandall
Scientific Editor/Managing Editor: Alan Barclay, PhD, APD AN
Contact GI News: glycemic.index@gmail.com

Sydney University Glycemic Index Research Service
Manager: Fiona Atkinson, PhD, APD AN
Contact: sugirs.manager@sydney.edu.au

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FOOD FOR THOUGHT

HORSE SENSE FOR WEIGHT LOSS 
David Katz
David L. Katz, MD, discusses the implications of the JAMA study that compared low-fat and low-carbohydrate diets for weight loss and health improvement and also profiled the genes of the participants to determine if the genetic patterns thought to predict success on a given diet actually did so. The following edited extract is reproduced with his permission.

“The study, run by Professor Christopher Gardner at Stanford University, randomized over 600 adults to either a fat-restricted or carbohydrate-restricted diet making both diets as ‘good’ as possible. The result was that significant weight loss, and health improvement measured in all the usual ways, occurred in both treatment assignments. Going from the generally poor baseline diet that prevails in America to either a healthy, low-fat diet that emphasized vegetables, and whole, minimally processed foods; or to a healthy low-carbohydrate diet that also emphasized vegetables, and whole minimally processed foods produced significant, and very comparable benefits.

Study participants were not told to track or reduce calories, but by shifting to a much higher-quality diet, they did so as a by-product. Both groups cut their daily calorie intake by about 500 to 600 kcal daily (2100–2510 kilojoules), and lost the amount of weight that would portend. They achieved this by eating wholesome foods in sensible combinations, and by applying some rules and discipline to diets that had neither at the start.

Genetic markers of expected success on one type of diet versus the other proved to be of no value. Weight loss in each diet arm was indistinguishable between those with a genetic profile saying they should do especially well, and those with profiles suggesting they should struggle. Nutrigenomically customized weight loss, despite the buzz it generates, is clearly not ready for prime time.

The study also found no relationship between baseline insulin status and success on a given diet assignment. The high-profile claims that weight loss is all about reducing carbs to reduce insulin prove to be apocryphal. A shift to wholesome foods in sensible combinations is effective at lowering weight and improving health regardless of fat or carbohydrate levels, even among those with insulin resistance at the start.

Fundamentally, then, this study suggests that the best way to lose weight and improve health with diet is not by fixating on macronutrients or calories, but by eating wholesome foods in some sensible combination, and emphasizing whole, minimally processed plant foods. The study also indicates that the fundamentals of generally healthful eating pertain to us all, regardless of our genes or insulin levels.

Boy with horse

These findings of science may surprise some, but they don’t much surprise me, and the reason is – sense. Horse sense, in particular. With horses, as with every species other than our own, we tend to think about the kind of diet that is generally right for the kind of animal, rather than the need to customize diet to each individual. Of course, the one does not preclude the other; horses can all be fed like horses, but some horses will need extra grain to maintain their weight, some will do better on certain varieties of hay. But from the start, the focus is on the common theme of a healthful diet for an entire species, and only after that, variations on the theme.

The DIETFITS study findings collectively indicate that the fundamentals of a health-promoting dietary pattern for Homo sapiens matter more than customizing on the basis of inter-individual variations. As with horses, the one does not preclude the other – but the science we own at present better empowers us to customize diet based on preference, rather than genes. It is good to know that when it comes to dietary patterns that are best for health, we do have choices among the variants on a common theme.

Dr. Katz proudly notes that DIETFITS Principal Investigator, Prof. Gardner, is a science advisor to his company, DQPN, LLC, devoted to reinventing dietary intake assessment for the digital age.

About David L. Katz 
• Director, Yale University Prevention Research Center; Griffin Hospital
• Immediate Past-President, American College of Lifestyle Medicine
• Senior Medical Advisor, Verywell.com
• Founder, The True Health Initiative

Read more:

WHAT’S NEW?

VEG OR MED FOR WEIGHTLOSS AND HEART HEALTH? 
Take your pick! According to research published in the American Heart Association’s journal Circulation, vegetarian and Mediterranean diets are likely equally effective in reducing the risk of heart disease and stroke. The study included 107 healthy but overweight participants, ages 18–75, who were randomly assigned to follow either a low-calorie vegetarian diet (which included dairy and eggs), or a low-calorie Mediterranean diet for three months. The Mediterranean diet included poultry, fish and some red meat as well as fruits, vegetables, beans and whole grains. After three months, the participants switched diets for another three months. Most participants were able to stay on both diets. Researchers found participants on either diet:

  • lost about 3 pounds (1.4kg) of body fat 
  • lost about 4 pounds (1.8kg) of weight overall and 
  • experienced about the same change in body mass index (BMI). 
The vegetarian diet however, was more effective at reducing LDL (the “bad”) cholesterol, while the Mediterranean diet resulted in greater reductions in triglycerides, high levels of which may increase the risk for heart attack and stroke.
Mediterranean diet
Read more:
VEGAN DIET MAY REDUCE DIABETES RISK 
In overweight adults with no history of diabetes, a low-fat, plant-based vegan diet can reduce visceral fat and improve both pancreatic beta-cell function and insulin resistance, potentially decreasing the risk of type 2 diabetes, according to researchers from the Physicians Committee for Responsible Medicine. (Measuring the function of beta cells, which store and release insulin, can help assess future type 2 diabetes risk.)

The study randomly assigned 73 participants with no history of diabetes either to an intervention or control group in a 1:1 ratio. For 16 weeks, participants in the intervention group followed a low-fat vegan diet based on fruits, vegetables, whole grains, and legumes with no calorie limit. The control group made no dietary changes. Neither group changed exercise or medication routines.

Based on mathematical modeling, the researchers determined that those on a plant-based diet increased meal-stimulated insulin secretion and beta-cell glucose sensitivity, compared to those in the control group. The plant-based diet group also experienced a decrease in blood glucose levels both while fasting and during meal tests. Physicians Committee researchers posit that because the intervention group experienced weight loss, including loss of body fat, their fasting insulin resistance decreased (i.e. improved), and their beta-cell function improved as a result.

Read more:
HEALTH BENEFITS OF SWAPPING ANIMAL PROTEINS FOR PLANT PROTEINS 
Substituting one to two servings of animal proteins with plant proteins every day could lead to a small reduction in the three main cholesterol markers for cardiovascular disease prevention. The health benefits could be even greater if people combined plant proteins with other cholesterol-lowering foods such as viscous, water soluble fibres from oats, barley and psyllium, and plant sterols, said lead author of the study, Dr John Sievenpiper of St. Michael's Hospital.

The study (a systematic review and meta-analysis of 112 randomized control trials in which people substituted plant proteins for some animal proteins in their diets for at least three weeks) looked at the impact of replacing animal protein with plant protein on three key markers for cholesterol: low-density lipoprotein cholesterol (LDL or “bad” cholesterol, which contributes to fatty build-ups in arteries and raises the risk for heart attack, stroke and peripheral artery disease); non-high density lipoprotein cholesterol (non-HDL-C, or total cholesterol minus HDL or healthy/good cholesterol) and apolipoprotein B (the proteins in bad cholesterol that clog arteries).

Dr. Sievenpiper said the review indicated that replacing one to two servings of animal proteins with plant proteins every day -- primarily soy, nuts and pulses (dried peas and beans, lentils and chickpeas) -- could reduce the main cholesterol markers by about 5 per cent. “That may not sound like much, but because people in North America eat very little plant protein, there is a real opportunity here to make some small changes to our diets and realize the health benefits,” he said.

Vegan diet

Read more:
PARENTING IN THE FACE OF OBESITY AND EATING DISORDERS 
Childhood obesity is a reality for one in five children in the USA. Five million young people are living with severe obesity. At the same time, half a million US teens are living with an eating disorder. Parents and healthcare providers can’t afford to neglect either of these very real problems.

A study in Pediatrics however reports that encouraging teens to diet can do lasting harm. Teens who receive diet talk from their parents are more likely to have problems with obesity as adults. But that’s not all. These teens are also more likely to have issues with binge eating, unhealthy weight-related behaviours, and body dissatisfaction in adulthood.

Most troubling, though, is the finding that this cycle repeats. As parents, these young adults are more likely to inflict that diet talk on their own children. The cycle repeats. ConscienHealth’s Ted Kyle reports on that confusing four-letter word and what parents should do.

Everyone has a diet, meaning their pattern for eating day after day. But in the context of going on a diet, it becomes a verb – dieting. And that’s where the problem starts. Short-term, highly restrictive diets are not a prescription for long-term health. Nonetheless, people consume great volumes of information about diets: low carb, low fat, Mediterranean, vegetarian, flexitarian, DASH, and the list goes on. Some of these can be the foundation for a sustainable pattern of eating for good health. Others can be severely restrictive and unsustainable. What is clear is that parenting requires attention to the severe harm that four letter word, “diet,” can do. Great harm can result when a parent encourages a child to diet. So, what should parents do and say?

The most basic advice is simple: unconditional love. Beyond that basic impulse for all parenting, the American Academy of Pediatrics (AAP) points to some basics for preventing both obesity and eating disorders in teens.
  • Discourage dieting. 
  • Model a sustainable healthy pattern for eating. 
  • Promote a positive body image. 
  • Plan for family meals. 
  • Talk health, not weight. 
  • Pay attention to bullying and mistreatment. If you see clues that something is wrong, follow up. Schools and teachers have an obligation to help. 
  • Seek out real help for obesity. Talk to your pediatrician. Seek out a qualified program with specialists who understand that obesity is a biological issue – not a character flaw or the product of bad parenting. 
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PERSPECTIVES WITH DR ALAN BARCLAY

DIABETES TIMES FIVE 
While we have known about diabetes for several thousand years, our knowledge and understanding of its causes, pathophysiology and management is constantly evolving. One of the more important areas of research that doesn’t receive the attention it deserves is how we classify the different types. It’s important because it affects how we manage the condition (e.g., with pharmaceuticals, dietary strategies, etc) and also how we pay for its management (Pharmaceutical benefits; Health Insurance rebates, etc).

The current diabetes classification system, with which most people are familiar, was developed back in 1979 and lists four types:

  1. Insulin-dependent or type 1 diabetes 
  2. Non-insulin-dependent or type 2 diabetes 
  3. Gestational diabetes 
  4. Diabetes associated with other syndromes or conditions (e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as in the treatment of HIV/AIDS or after organ transplantation). 
Classifying diabetes into type 1 and type 2 relies primarily on the presence (type 1) or absence (type 2) of autoantibodies against pancreatic islet Beta (B)-cell antigens and age at diagnosis (younger for type 1 diabetes). With this approach, 75–85% of patients are classified as having type 2 diabetes. Of the fourth group, diabetes associated with other syndromes or conditions, latent autoimmune diabetes in adults (LADA) affects less than 10% of people with diabetes, is defined by the presence of glutamic acid decarboxylase antibodies (GADA), is phenotypically indistinguishable from type 2 diabetes at diagnosis, but becomes increasingly similar to type 1 diabetes over time.

Perhaps unsurprisingly, scientists and physicians have been thinking for some time that the current classification system presents challenges to the diagnosis and treatment of people with diabetes, in part due to its conflicting and confounding definitions of type 1, type 2, and LADA.

Back in 2016, a group of US scientists proposed a new B-cell-centric classification of diabetes, based on the presupposition that all diabetes originates from a common denominator – the abnormal pancreatic B-cell. It recognized that interactions between genetically predisposed B-cells with a number of factors, including insulin resistance, susceptibility to environmental influences, and immune dysregulation/inflammation, lead to the range of diabetes sub-types within the spectrum of diabetes. Individually or in concert, and often self-perpetuating, these factors contribute to B-cell stress, dysfunction, or loss through at least 11 distinct pathways. The authors concluded that this classification system enabled “Available, yet underutilized, treatments [to] provide rational choices for more personalized therapies that target the individual mediating pathways of hyperglycemia at work in any given person with diabetes, without the risk of pharmacologically-related hypoglycemia or weight gain or imposing further burden on the B-cells”. To-date, there is little evidence that the B-cell–centric classification of diabetes has been adopted.

Cluster table

The most recent (2018) diabetes classification system has been conceived by Swedish scientists. They developed a 5-cluster system based on the analysis of nearly 9000 people aged 0–96 years who developed diabetes between 2008 and 2016.

Modelling the new system in 500–3500 additional Swedish and Finnish people demonstrated that it was superior to the current diabetes classification system, because it identified people at high risk of diabetic complications (e.g., kidney and eye disease) at diagnosis and provided information about underlying disease mechanisms, thereby guiding choice of therapy.

This new analysis provides another important step towards a more precise, clinically useful stratification of diabetes, representing an important step towards precision medicine in diabetes. It is of course important to note that the new classification system was based on people primarily from northern Europe, with limited non-Scandinavian representation, and the applicability of this strategy to people of other ethnicities needs to be assessed before the model can be adopted globally.

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Dr Alan Barclay  
Alan Barclay, PhD is a consultant dietitian. He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of  The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).

Contact: You can follow him on Twitter or check out his website.