1 September 2020

GI News - September 2020

GI News

GI News is published online bi-monthly (during 2020) by the University of Sydney, School of Life and Environmental Sciences and the Charles Perkins Centre, and delivered to the mailboxes of our 97,000 subscribers. 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, FAIFST, FNSA, PhD
Editor: Alan Barclay, PhD, APD
Contact GI News: glycemic.index@gmail.com

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

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FOOD FOR THOUGHT

GLUCOSE LEVELS AND DEMENTIA
Developing dementia as we age is one of our worst fears. We know people with diabetes are at greater risk (1), raising the question of whether high glucose levels are a driver of the abnormalities that are found in the brain of dementia patients. If true, it would mean glucose levels intermediate between healthy and indicative of diabetes, also increase the risk of developing the disease. And if glucose plays a role, then perhaps dietary changes can reduce the chances that we’ll fall victim to this insidious disease.

Dementia

What we already know
Most studies have revealed links between high glycated hemoglobin levels (or HbA1c - a marker of average glucose over 3 months) or after-meal (postprandial) glucose levels, but not fasting glucose levels. One of the most convincing to date was the study by Crane and colleagues published in the New England Journal of Medicine in 2013 (2). It was the first to examine changes in glucose levels per se across time and long-term follow-up of elderly people using a battery of cognitive tests. 

This cohort of over 2000 Americans had no evidence of dementia at baseline when they were an average of 76 years old. Only 10% had diabetes. During the next 7 years they carefully tracked glucose levels and the development of objective signs of dementia. They assessed dementia using a screening questionnaire, followed by a large number of neuro-psychological tests. They measured glycated hemoglobin as well as fasting and random glucose levels. 

Over the next 7 years, 1 in 4 of this cohort developed some form of dementia. They found higher glucose levels increased the risk in a dose-response fashion, even in those without diabetes. Glucose levels at the lower end of the spectrum – ie pre-diabetes – were implicated. The higher the glucose level, the greater the chance of a diagnosis, even after taking into account other risk factors such as blood pressure and exercise. 

Some of us carry gene changes that increase the risk of dementia, particularly one form of the APOE gene, which also increases the risk of stroke and heart disease. But in Crane’s study, it made no difference which form of the gene was carried. 

How does glucose increase the likelihood of dementia? 

High glucose levels could contribute to dementia via several mechanisms. Vascular (blood vessel) dementia is caused by problems with the supply of blood to the brain, typically a series of mini strokes. Glucose itself may have a toxic effect on vascular walls and neurones in the brain. We know that poorly controlled glucose levels increase the risk of kidney disease and blindness in people with type 1 and type 2 diabetes. And the mechanisms are likely to be the same in dementia. 

This process begins with the glycation of proteins in the kidney and eye, whereby glucose molecules bind irreversibly in a way that interferes with the function of enzymes and other proteins. One particular glycated protein called beta-amyloid leads to a gradual increase in deposits in the brain that are detected using techniques such as CT and MRI. Alzheimer’s dementia is characterised by widespread amyloid deposits in the brain. 

Interestingly, there’s a connection with diet composition. In animal models, refined carbohydrates (starches and sugars) have been shown to worsen Alzheimer’s disease, although evidence in humans is lacking. However, the recent study by Melissa Gentreau and colleagues in France (3) found that an afternoon snack based on high glycemic carbohydrates was associated with more dementia, particularly in those that carried one of the high-risk APOE genes. 

The French group did not find any association with the glycemic load of breakfast, lunch or dinner and dementia. The study was well designed with a large number of elderly individuals followed up for an average of 11 years. Unfortunately, observational studies such as this can’t tell us whether high glucose is the cause or effect (i.e., the driver or the passenger). 

We need long term randomised controlled trials to answer this question, including those in animal models of dementia. In the meantime, eating a healthy diet based on high quality carbohydrates (starches and sugars) with a low GI is the best bet for reducing risk of all chronic diseases. 

REFERENCES

  1. Wium-Andersen and colleagues. Risk of dementia and cognitive dysfunction in individuals with diabetes or elevated blood glucose
  2. Crane and colleagues. Glucose Levels and Risk of Dementia
  3. Gentreau and colleagues. Refined carbohydrate-rich diet is associated with long-term risk of dementia and Alzheimer's disease in apolipoprotein E ε4 allele carriers.

Professor Jennie Brand-Miller       
Professor Jennie Brand-Miller holds a Personal Chair in Human Nutrition in the Charles Perkins Centre and the School of Life and Environmental Sciences, at the University of Sydney. She is recognised around the world for her work on carbohydrates and the glycemic index (or GI) of foods, with over 300 scientific publications. Her books about the glycemic index have been bestsellers and made the GI a household word.   

WHAT’S NEW?

LIFESTYLE MAY HELP REDUCE THE RISK OF ALZHEIMER’S DISEASE 

It's estimated that there are currently 50 million people living with dementia globally. Major risk factors for dementia include age, genetics and family history. For example, people who have a gene called APOE4 are at much higher risk of developing Alzheimer’s disease – the most common form of dementia. As explained by Prof. Jennie Brand-Miller in FOOD FOR THOUGHT, there’s also increasing evidence for a link between diabetes and dementia, particularly type 2 diabetes. In fact, some researchers have described Alzheimer’s disease as type 3 diabetes.

Man thinking

 The good news is that there are many things you can do to reduce your risk. In fact, evidence suggests that at least half of the risk of dementia can be attributed to lifestyle factors including diet, exercise and smoking. What’s more, studies show that people at higher risk of Alzheimer’s disease due to having the ApoE4 genotype may benefit even more from making lifestyle changes. 

This was demonstrated in a study published last year in the Journal of the American Medical Association which followed more than 196,000 adults aged 60 year or older for around 8 years. They were divided into low, intermediate or high-risk categories, based on measurement of their genetic risk. The researchers then gave participants a healthy lifestyle score based on whether they smoked, drank alcohol only in moderation, ate a healthy diet and were physically active, dividing them into favourable, intermediate, and unfavourable lifestyle groups. Not surprisingly, those at higher genetic risk were more likely to develop dementia. However, the study found that in those at high genetic risk, following a favourable lifestyle reduced the risk of developing dementia by 32% compared to an unfavourable lifestyle. 

In this study, a healthy diet was classified as one that included higher intakes of fruit, vegetables, wholegrains and fish but lower intakes of processed meats, red meats and refined grains. Other research has shown that a higher intake of saturated fat can increase the risk of dementia, particularly in those with the APOE4 gene, while unsaturated fat intake appears to be protective. However, the types of carbohydrate (starches and sugars) in our diet may also play a role. A 2017 study found that in older adults with normal cognitive function (meaning they didn’t have dementia), those consuming a high glycaemic load diet had higher levels of amyloid plaques in their brain. Amyloid plaques are thought to play a role in the development of Alzheimer’s disease. A previous study found an association between the glycaemic load of the diet, blood glucose levels and cognitive performance. 

Read more

Kate Marsh     
Kate Marsh is an is an Advanced Accredited Practising Dietitian, Credentialled Diabetes Educator and health and medical writer with a particular interest in plant-based eating and the dietary management of diabetes and polycystic ovary syndrome (PCOS).    
Contact: Via her website www.drkatemarsh.com.au.

PERSPECTIVES: Dr ALAN BARCLAY

FOOD AND MOOD
Most of us are aware that certain foods and drinks, like chocolate, or a nice hot cuppa, can provide comfort when feeling down, but many would be surprised to learn that there is increasing evidence that the types of foods and drinks we consume on a regular basis can have a more prolonged effect on our mood and brain function. 
Brain map
Why? There are many possible reasons, relating to both the structure and function of our brains and nervous systems: 

Fats on the brain
Did you know that the human brain and nervous system is around 60 % fat? A large proportion of the nerves that comprise the brain and nervous system are surrounded by an insulating substance known as myelin that dramatically increases the rate at which nerve impulses are sent throughout the body. Myelin itself is about 80% fat, and most of the fat is of the poly-unsaturated kind, in particular, omega-3. 

Long-chain varieties of omega-3 fat from seafood (e.g., herring, mackerel, sardine, salmon and tuna) are the best for our brains and nervous system. Shorter-chain varieties like those found in certain nuts and seeds (flaxseed, canola, walnut, wheat germ and soybean oils), and margarines and oils derived from these, can be converted to the long-chain varieties by our body – though not very efficiently. 

Unfortunately, most people do not eat enough essential omega-3 fat these days. Aim to eat oily fish at least 2-3 times a week and small amounts of nuts, seeds and their oils each day. If you don’t like eating seafood, consider taking a fish oil supplement. 

Brain function
Fuel up with smart carbs
Glucose is the preferred fuel for our brain and nervous system, with the typical adult requiring around 110-130 grams a day for optimal mental functioning. About 1/3rd of the glucose is used for brain fuel, and the rest is used for the production of amino acids, neuropeptides, and fats which in turn are used to produce essential neurotransmitters and hormones. The brain has limited ability to store glucose, and therefore optimal brain functioning is dependent upon a continuous supply. Therefore, it should come as no surprise that consuming the right type and amount of carbohydrate throughout the day is essential for everyone interested in optimal mental health and performance. 

The amount of carbohydrate you need depends on many factors such as your age, gender, physical activity level, ethnic background, type of diabetes (if you have it), and medication use (if any). Needless to say that the optimal amount for you is best worked out in conjunction with your Accredited/Registered Dietitian, and other members of your health-care/performance team. As far as the type of carbohydrate is concerned, there is growing evidence that a healthy low glycemic index (GI) diet can improve mental performance, memory and mood. The average GI of most people’s diet is higher than recommended (ideally, the daily average should be less than 45). Therefore, aim to eat at least one serve of low GI carbohydrate with each meal and snack (if you have them), to help reduce your diets average GI. 

Increase serotonin - the “feel-good” neurotransmitter
The “feel-good” brain chemical serotonin is manufactured in the body from the essential amino acid tryptophan, along with essential nutrients like vitamin B6, vitamin C, folate and zinc. Tryptophan is often found to be low in people suffering from depression, and several of the drugs commonly used to treat depression work by increasing brain serotonin levels. Luckily, it is commonly found in high protein foods such as eggs, meat (in particular Turkey and chicken) and beans (legumes). Interestingly, high carbohydrate foods, even though they may not contain any tryptophan, actually increase its availability, because the insulin released when carbohydrates are digested puts other competing amino acids to a different use, easing tryptophan’s entry into our brains. 

Do food additives affect moods?
A popular urban myth is that red cordial makes some children go “ballistic” or hyperactive (often incorrectly described as going “hypo” by some people). While food additives are rarely the cause of hyperactivity in most children, it is worth pointing out that some people (children and adults) may have abnormal reactions to natural and added chemicals in foods. For example, foods high in amines like chocolate, tasty cheese, and many strong seasonings have a negative effect on some people. Others may be sensitive to preservatives (e.g., benzoates (food additive numbers 210-218), gallates (food additive numbers 310-312) and other fat preservers (food additive numbers 319-321)), colours (e.g., Tartrazine (102) Erythrosine (127), and Brilliant Blue (133)) and flavour enhancers (e.g., glutamates (food additive numbers 620-625)). If you suspect you may be sensitive to natural or added food chemicals, discuss it with your doctor, and perhaps arrange a visit to an Accredited/Registered Dietitian with experience in elimination diets. 

Don’t lose your balance
While I have talked about specific nutrients and foods that may improve our mood, it is important that these are consumed as part of a healthy diet that is in line with current Dietary Guidelines. 

Also, it is important to note that the evidence so far does not show that depression or other mental conditions can be prevented or “cured” by diet alone. But a healthy diet may help relieve the symptoms of certain mental illnesses; improve the effectiveness of medication for some of these conditions; and reduce the unpleasant side-effects of some of the medications used to treat these conditions. Of course, see your doctor and Accredited/Registered Dietitian for further advice. 

Read more

Dr Alan Barclay
Alan Barclay, PhD is a consultant dietitian and chef (Cert III). 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, LinkedIn or check out his website.

DIABETES CARE

BRAIN HEALTH

The brain is the organ in the body that scientists know the least about. What we do know is that for its size (around 1.4 kg for an adult) it uses a disproportionate amount of resources. The brain is 2% of body mass but consumes 20% of the oxygen we inhale, and this is largely spent on transmission of electrical impulses from one brain region to another or out to muscles and internal organs. In close concert to oxygen consumption in the brain is the use of glucose as the main energy source. The delivery of glucose and oxygen to the brain via the blood is tightly correlated with brain activity, and remains almost constant throughout the day and our lives. This scenario is quite distinct from organs such as muscles, the liver and fat tissue where glucose uptake is controlled by the hormone insulin. This is not to say that insulin doesn’t have a role in the brain, but we will return to that story shortly.

Brain energy

The latest figures for Australia have two chronic brain diseases, Alzheimer’s disease (AD) and Stroke, as second and fourth leading causes of death respectively (1). The main risk factor for both diseases is ageing, with the increase in human longevity afforded by modern medicine and good cardiovascular health, contributing to the rapid rise of AD as an unintentional side effect. Brain diseases can be broken down into those affecting the blood supply and those affecting the brain tissue itself. Stroke is a vascular disease and the risk factors for, and drugs effective against, are very similar to heart disease. AD is the result of the loss of brain tissue from areas that contribute to memory and spatial awareness although AD shares some of the same risk factors as the vascular diseases such as smoking, high blood pressure, obesity and diabetes (2). 

Indeed, AD has been referred to by some researchers as type 3 diabetes (3). This is based on experiments that showed similarities in the downstream molecular features of AD brains and the liver, for example, in those with type 2 diabetes. It might seem strange to be talking about insulin resistance in the brain when we know that glucose uptake into the brain is independent of insulin. However, insulin still affects the utilisation of glucose within the brain and probably acts as a neuron protective factor. Although there is evidence for changes in the AD brain consistent with type 2 diabetes, it seems more likely that the disease is a culmination of small effects of many different factors and processes that include diabetes, being female and having fewer years of education (4). 

In the AD brain there is build-up of two proteins called beta-amyloid and tau. Beta-amyloid was thought to be the main problem but experimental drugs that remove amyloid have so far failed to stop disease progression. This has led to researchers and drug companies to redirect their focus to tau, oxidative stress and inflammation but there is no other obvious target to date. A likely scenario is that a successful future drug will be a combination of medicines that address multiple targets including insulin resistance. 

In the absence of a cure, is it possible to slow or prevent AD at present? Well not smoking, eating a balanced healthy diet, maintaining physical and mental activity into old age are all proven ways of reducing your risk. Yet, the answer may ultimately lie in your genes – individuals with one or both parents with AD have an incrementally higher risk of developing the disease themselves. In the not too distant future, your GP armed with your sequenced genome, will be able to advise you what food, drinks or exposures to avoid from an early age, and also what drugs you might need in middle to old age to slow AD. This is referred to as precision medicine and will be a common approach in the future management of all diseases. 

References:

  1. Causes of Death, Australia, 2018 Australian Bureau of Statistics; 2019.
  2. Livingston and colleagues. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.
  3. de la Monte and colleagues. The 20-Year Voyage Aboard the Journal of Alzheimer's Disease: Docking at 'Type 3 Diabetes', Environmental/Exposure Factors, Pathogenic Mechanisms, and Potential Treatments.
  4. Chami and colleagues. The rise and fall of insulin signaling in Alzheimer's disease

 A/PROF GREG SUTHERLAND
A/PROF GREG SUTHERLAND is a research and teaching academic in the Charles Perkins Centre (CPC) at the University of Sydney. His research interest is neurodegenerative diseases including alcohol-related brain damage and Alzheimer’s disease (AD). In the CPC he leads the ‘Brain and Body’ node that aims to understand how diseases like diabetes increase the risk of brain disorders such as AD.
Contact: via the CPC Brain and body node.

YOUR GI SHOPPING GUIDE

MINDFUL CARBS
Researchers have been trying to identify foods that are able to slow the decline of our brains as we age and the development of Alzheimer’s disease. Berries, beans and whole grains are just 3 of the 10 foods that have been identified as brain-healthy foods in the MIND diet (a combination of the Mediterranean and Dietary Approaches to Stop Hypertension (DASH), diets) that also contain good carbs. One of the things these foods also have in common is their low GI, as you’ll see below.

MINDful foods

PWD   

Berries
Serving size, ½ cup (approximately 75g/2½ oz) 

Starchy snack 

Beans
Serving size, ½ cup (approximately 85g/3oz) 

Starchy snack 

Whole grains 

Starchy snack   

Read more:

 Kaye Foster-Powell     
Kaye Foster-Powell is an Accredited Practising Dietitian who has worked with people with diabetes for 30 years. She was co-author of the original series of international, best-selling books on the glycemic index. She conducts a specialized private practice for people with diabetes in the Blue Mountains, west of Sydney, Australia.    
Contact: Via her website.

GOOD CARBS FOOD FACTS

PLANTAINS 

I once visited a friend and found a giant bunch of what I thought were bananas on her back patio. I learned they were actually plantains. A Filipino friend had given them to her from his own garden. She was keen to give some away as she had way too many and unsure what to do with them. Well, I love a food challenge and can’t bear to let food go to waste so I gratefully accepted her offer and snapped off a dozen or so from the bunch and let the World Wide Web guide me on a journey of discovery.

PLANTAINS

Plantains are also known as cooking bananas and are starchy rather than sweet. As the name suggests they are always eaten cooked. They can be eaten ripe or unripe (green) and the starchy unripe form has a neutral flavour similar to potato. They are a major staple in central and West Africa, the Caribbean, Central America and the northern parts of South America, and indigenous to tropical South East Asia. They provide a surprising 25% of the carbohydrate requirements of 70 million people in Africa alone. They are a useful food crop because they bear fruit all year. 

In Africa, plantains are usually fried or roasted, while in the Caribbean they are boiled and mashed. In Central and South America plantains can be boiled and mashed, or made into chips, patties or dumplings and fried. In these cuisines, plantains provide a neutral palette on which to add flavoursome savoury dishes. In India, Indonesia and the Philippines they tend more to the sweeter side of things, such as steamed plantain and coconut cake, or simply fried and sprinkled with sugar or syrup. Plantains can also be dried and ground into flour. 

Nutritionally, plantains are around one fifth carbohydrate, of which around half is starch and half is sugars. They are very low in protein and fat and a source of fibre. They also provide useful amounts of vitamin A, C, B6 and potassium. The glycemic index of plantain varies according to the cultivar, how ripe it is and how it is prepared. Unripe, green plantain is generally low GI but some cultivars can be medium or even high when boiled. 

You might wonder what I did with my plantains. I went savoury with a Cayeye and Cabeza de Gato (Colombian mashed green plantain) and then sweet with Caramelised Plantains. If you’re not lucky enough to have a neighbour growing them to share, you can find them in greengrocers and markets, especially in places where immigrants who traditionally eat them live.

Plantains
Source: USDA, 2020

Nicole Senior     
Nicole Senior is an Accredited Practising Dietitian, author, consultant, cook and food enthusiast 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.

THE GOOD CARBS KITCHEN

BARBECUED SALMON AND KALESLAW WITH HONEY & LIME DRESSING
0:15 Prep • 4 Serves • Main • Every day
 
BARBECUED SALMON AND KALESLAW WITH HONEY

INGREDIENTS
4 x 100g boneless, skinless salmon fillets
2 teaspoons lime juice, plus extra lime wedges, to serve
¼ teaspoon ground coriander ¼ teaspoon ground cumin
1 x 400g packet fresh kaleslaw, dressing discarded
1 x 400g can no-added-salt chickpeas, rinsed, drained
¼ cup coriander leaves, plus extra, to garnish
Lime & honey dressing
Zest and juice of 2 limes
2 teaspoons honey
¼ teaspoon ground cumin 

METHOD
Season the salmon fillets with lime juice, ground coriander and cumin. Stand for 5 minutes. 

Combine kaleslaw, chickpeas and coriander in a large bowl. Make lime and honey dressing: Combine all of the ingredients in a small bowl and whisk until mixed. Pour the dressing over the salad and toss to mix well. Cover and chill. 

Meanwhile, heat a barbecue hot plate or chargrill pan over a high heat. Spray salmon with olive oil and cook for 2 minutes, then reduce heat to medium. Turn the salmon and cook for a further 2–3 minutes, or until cooked to your liking. 

Divide the prepared kaleslaw between four serving plates and top with the barbecued salmon. Serve with coriander leaves and lime wedges. 

NUTRITION
Per serve 1828kJ/437 calories; 29g protein; 24.8g fat (includes 4.4g saturated fat; saturated : unsaturated fat ratio 0.2); 19g available carbohydrate (includes 8g sugars and 11g starch); 8.6g fibre; 89mg sodium

RECIPE AND IMAGE

Courtesy of Australian Healthy Food Guide magazine.

Australian Healthy Food Guide

For more healthy recipe inspiration and expert advice, visit healthyfoodguide.com.au

SESAME AND MOCHI MOON CAKES
0:45 Prep • 0:20 Cook • 5 Servings • Special occasion

SESAME AND MOCHI MOON CAKES

INGREDIENTS

Outer layer of moon cake:
1 ½ tablespoons of unsalted butter
1 tablespoon stevia or other non-nutritive sweetener
1 teaspoon matcha powder
2 teaspoons condensed milk
1 tablespoon whipping cream
1 teaspoon milk powder
1/3 cup plain flour
1 ½ tablespoon cornstarch
1 whole egg 

Sesame filling:
70g cooked/canned white kidney beans
40g black sesame powder
1 tablespoon stevia or other non-nutritive sweetener
10g honey
1 tsp peanut oil 

Mochi:
25g milk
10g stevia or other non-nutritive sweetener
25g glutinous rice flour
5g peanut oil 

METHOD
You will need cling wrap, food processor and moon cake molds. 

To make the outer layer of moon cake: 

Use a mixer to whisk the butter, stevia and condensed milk together. Add the matcha powder whipping cream into the mixture. Add the other dry ingredients (milk powder, plain flour, cornstarch) and combine well. Use a sheet of cling wrap to wrap the mixture, place in the fridge for two hours. 

To make the sesame filling: 

Put the sesame powder, white kidney beans, stevia, and honey into the food processor and puree the mixture. Heat a pan with the peanut oil, and pan fry the bean and sesame mixture until it turns black and shiny. Set aside and let cool. Once the mixture has cooled down, divide it into 5 serves. 

To make the mochi: 

Combine milk, stevia, glutinous rice flour and peanut oil in a bowl and mix well. Microwave on low power for 5 minutes or until the surface turns to a milky colour. Let cool. Divide the mixture into 5 serves. 

To make the mooncake: 

Whisk 1 whole egg. 

Take the outer layer of moon cake out of the fridge, cut into 5 serves. Then, fold the mochi into the black sesame fillings. After that, fold the black sesame fillings into the outer layers of moon cake. Pre-heat the oven to 200 degrees. Bake the moon cakes for 5 minutes. Brush 1 tablespoon of whisked egg onto the moon cakes. Bake the moon cakes at 180 degrees for another 5 minutes. Brush the remaining whisked egg onto the moon cakes. Bake for another 3 minutes or until the surface is no longer moist. Let cool. Serve cold. 

TIPS

  • Stevia and other non-nutritive sweeteners do not contain added sugars, so they do not raise blood glucose or insulin levels. They are also low in calories compared to added sugars. 

NUTRITION
Per serve 894 kJ/213 calories; 4.5g protein; 12.0g fat (includes 5.2g saturated fat; saturated : unsaturated fat ratio 0.76); 21g available carbohydrate; 3.7g fibre; 64mg sodium; 133mg potassium; sodium : potassium ratio 0.5

RECIPE

Shannon Shanshan Lin
Shannon Shanshan Lin is an is an Accredited Practising Dietitian and Credentialled Diabetes Educator with a particular research interest in culturally and linguistically and indigenous populations. She has been actively involved in the various committees both national and internationally, including the Australian Diabetes Educators Association, Global Chinese Diabetes Association and Beijing Key Laboratory of Nutrition Intervention for Chronic Disease. Contact: You can contact her via Wechat (ID= shannon033)

COPYRIGHT AND PERMISSION

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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.

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1 July 2020

GI News - July 2020

GI News

GI News is published online every month by the University of Sydney, School of Life and Environmental Sciences and the Charles Perkins Centre, and delivered to the mailboxes of our 97,000 subscribers. 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, PhD
Editor: Alan Barclay, PhD, APD
Contact GI News: glycemic.index@gmail.com

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

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FOOD FOR THOUGHT

MAPPING POSTPRANDIAL RESPONSES SETS THE SCENE FOR TARGETED DIETARY ADVICE 
A new study finds that machine learning can predict differences between people in how they respond to meals If you are managing to stay lean in today’s obesogenic environment (lucky you!), you might suspect that it’s your good genes and/or disciplined adherence to a healthy diet and lifestyle. On the other hand, if you’ve struggled with body fat and dieting for most of your life, you live in hope there’s a specific type of diet (or perhaps better still, a drug) that’s perfect for you… if only you could identify which one. Enter Personalised Nutrition.

Healthy range of foods

In the June issue of the prestigious journal Nature Medicine, Sarah Berry and her colleagues took a major step in that direction. They presented the findings of PREDICT (1), a large-scale study involving ~1000 people, including twins and other adults from the US and UK. Using machine learning, the goal was to use the data to derive ‘algorithms’ (mathematical formulas) that predict a person’s postprandial (after-meal) responses, that is, the rise in glucose, insulin and triglycerides (fats) in the blood after meals of varying composition.

The end-game of this kind of research is the ability to give scientifically valid ‘personalised’ dietary advice based on factors such as age, body mass index (BMI), specific genes, large bowel microbial flora (the “micobiome”) and postprandial responses.

But the findings were not what they expected. They found much more person-to-person variation than was expected, but differences in genes, the gut microbiome and insulin levels explained only a minor proportion of the differences.

By contrast, they were surprised to find a person’s response to the same foods was fairly predictable and reproducible. Food composition and macronutrient (carbohydrate, fat and protein) distribution explained some of the variation in post-meal blood glucose levels, but not in triglyceride levels. And interestingly, blood glucose responses did not predict triglyceride levels; indeed, they warned that advice based just on glucose responses (such as flash glucose monitoring) alone would be misleading.

From our point of view, the associations between the carbohydrate content of meals, post-meal blood glucose levels and other factors were among the most interesting findings. High blood glucose levels after meals are a well-established predictor of type 2 diabetes, the metabolic syndrome, fatty liver, and cardiovascular disease (2).

We have known for a long time that people vary widely in their ‘glucose tolerance’, i.e. the absolute blood glucose response to a carbohydrate challenge. In a lean, active person, the area under the curve (AUC) after a 50 g glucose challenge can be as low as 50 units, but in a sedentary person with a family history of type 2 diabetes, it can be 400 units, an 8-fold difference. Higher AUC means the beta-cells (insulin producing) in the pancreas are working hard. If you have a family history, your pancreas may not have what it takes to do this without becoming dysfunctional over time.

We know that glucose tolerance worsens (measured as higher AUC) with age, increased body weight and sedentary lifestyle. We also know that the background diet is important – low carbohydrate consumption is associated with a higher glycemic response to a glucose challenge. However, it’s reversible - just a day or so of higher carbohydrate intake will improve glucose tolerance.

Is there an optimal diet composition for your body? Is one diet better than another for you but not me? Does human evolution play a role here? Yes! Many different diets can reduce blood glucose responses on a day-to-day basis. Indeed, we have argued that this is one of key mechanisms behind the success of the Mediterranean diet, low GI diets, vegetarian diets based on legumes and lower carbohydrate diets.

Logically, reductions in blood glucose can also be achieved with carefully planned, very-low-carbohydrate diets (50-100 g/day), with parallel improvements in body weight and HbA1c (glycated haemoglobin) in people with type 2 diabetes (3). However, it would be very easy to choose a poor quality very-low-carbohydrate diet and it may be hard to sustain in the longer-term. It may not be as effective (or as easy) as changing the kind (quality) of carbohydrate.

For a given amount of carbohydrate, the glycemic index of a food predicts the degree of glycaemia relative to a standard reference food. Choosing a diet based on low GI foods such as pasta, legumes, most fruit, milk, yogurt and specific types of rice and bread can halve the AUC and reduce HbA1c in individuals with diabetes. Furthermore, meta-analyses of observational studies confirm that diets based on low GI food choices are associated with reduced risk of type 2 diabetes (4) and cardiovascular disease (5). The relative risk reduction is biologically significant, similar to increasing the amount of exercise or dietary fibre.

In our view, the potential of personalised nutritional guidance versus standard advice (national dietary guidelines) to improve weight control is far from proven. In many ways, the findings of PREDICT are important because they challenge so much of the prevailing hype.

REFERENCES:

  1. Berry S, and colleagues. Decoding human postprandial responses to food and their potential for precision nutrition: the PREDICT 1 study
  2. The DECODE group. European Diabetes Epidemiology Group. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria
  3. Wycherley TP, and colleagues. Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials
  4. Livesey G, and colleagues. Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes: A Systematic Review and Updated Meta-Analyses of Prospective Cohort Studies
  5. Livesey G, and colleagues. Coronary Heart Disease and Dietary Carbohydrate, Glycemic Index, and Glycemic Load: Dose-Response Meta-analyses of Prospective Cohort Studies

Professor Jennie Brand-Miller       
Professor Jennie Brand-Miller holds a Personal Chair in Human Nutrition in the Charles Perkins Centre and the School of Life and Environmental Sciences, at the University of Sydney. She is recognised around the world for her work on carbohydrates and the glycemic index (or GI) of foods, with over 300 scientific publications. Her books about the glycemic index have been bestsellers and made the GI a household word.   

WHAT’S NEW?

IS ONE WEIGHT LOSS DIET MORE EFFECTIVE THAN OTHERS? 

If you’re trying to lose weight, there’s no shortage of ‘diets’ and weight loss programs promising impressive results. But is there really one type of diet that is more effective than others?

Person on scales

A new study published in the April edition of the British Medical Journal (BMJ) set out to answer this question. The researchers conducted a systematic review and meta-analysis looking at the effect of different dietary macronutrient patterns and popular diet programs on weight loss and improvement of cardiovascular risk factors in overweight adults. They included 121 randomised controlled trials involving almost 22 000 subjects. The diets included low fat, low carbohydrate and popular named diets such as Atkins, Zone, DASH (Dietary Approaches for Stopping Hypertension) and Ornish.

When they compared these diets to usual or control diets, low fat (such as Ornish), low carbohydrate (such as Atkins and Zone) and moderate macronutrient diets (such as DASH and Mediterranean) all resulted in moderate weight loss at 6 months but not 12 months. The average weight loss at 12 months was 2kgs and any differences between the diets are described as being trivial to small.

At six months, each of these diets also reduced blood pressure and the low fat and moderate macronutrient diets reduced levels of ‘bad’ LDL cholesterol. However, these improvements almost disappeared by 12 months.

The authors conclude that people wanting to make dietary changes to lose weight should choose the diet they prefer. This is an important point. For example, an older study comparing four different diets with different macronutrient ratios (Atkins, Ornish, Zone and Weight Watchers) found that weight loss was similar on all four diets and what predicted success was cutting kilojoules and being able to stick to the diet.

This new study, and previous research comparing different diets for weight loss, show us that there are different ways to achieve the same result – it’s not one size fits all. The key is to find an eating plan you can adopt for the long-term as this is the only way to lose weight and keep it off.

Read more:


Kate Marsh     
Kate Marsh is an is an Advanced Accredited Practising Dietitian, Credentialled Diabetes Educator and health and medical writer with a particular interest in plant-based eating and the dietary management of diabetes and polycystic ovary syndrome (PCOS).    
Contact: Via her website www.drkatemarsh.com.au.

PERSPECTIVES: Dr ALAN BARCLAY

PUBLIC HEALTH NUTRITION COMPARED TO PERSONALISED DIETARY ADVICE 

Diet-related health conditions like obesity, type 2 diabetes, heart disease and certain cancers (e.g., bowel) are increasing all around the globe and governments are struggling to cope with their economic costs as are individuals with their social, psychological and financial costs.

Strategies for reducing their burden range from public health nutrition at one end of the intervention spectrum, using a systems approach to sustainably re-shape the food and nutrition supply, and at the other, there is personalized dietary advice ideally provided by suitably qualified health professionals like dietitians and nutritionists. While the two are not mutually exclusive, they often do play complimentary roles.

Public Health Nutrition 

The epitome of public health nutrition is the federal government’s Dietary Guidelines that provide advisory statements for the general population (i.e., healthy children, adolescents and adults). They are very similar around the globe. Australia’s most recent version published in 2013 advises people to:

  1. Be physically active and choose amounts of nutritious food and drinks to meet energy needs. 
  2. Drink plenty of water and enjoy a wide variety of nutritious foods from the five food groups every day:
    - plenty of vegetables, including different types and colours, and legumes/beans
    - fruit
    - grain (cereal) foods, mostly wholegrain and/or high fibre varieties, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley
    - lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans
    - milk, yoghurt, cheese and/or their alternatives, mostly reduced fat (reduced fat milks are not suitable for children under the age of 2 years). 
  3. Limit intake of foods containing saturated fat, added salt, added sugars and alcohol. 
  4. Encourage, support and promote breastfeeding. 
  5. Care for your food; prepare and store it safely. 

The Guidelines stated aims are to:
  • promote health and wellbeing; 
  • reduce the risk of diet-related conditions, such as high cholesterol, high blood pressure and obesity; and 
  • reduce the risk of chronic diseases such as type 2 diabetes, cardiovascular disease and some types of cancers. 
They are primarily used by health professionals, policy makers, educators, food manufacturers, food retailers and researchers, so they can find ways to help people eat healthy diets.

In theory, Dietary Guidelines apply to all healthy people, as well as those with common health conditions such as being overweight. However, they do not apply to people who need special dietary advice for a medical condition like diabetes or heart disease, or to the frail elderly.

In some countries like the USA, they are updated every 5 years and as such they are based on the most recent and best available scientific evidence. Unfortunately, in others, like Australia, they are not updated on a regular basis and may be scientifically outdated.
A healthy diet
Personalised dietary advice 

Ideally, people with specific diet-related health conditions like obesity, type 2 diabetes, heart disease, cancer, etc… will see a registered/accredited dietitian or nutritionist for personalised dietary advice.

A dietitian/nutritionist assesses your:
  • vital statistics (height, weight, waist circumference, etc…), 
  • biochemistry (blood glucose, insulin, blood proteins, iron status, etc..) and 
  • eating and drinking habits (diet recall, food frequency, etc…), 
to form an overall picture of your nutritional status.

Based on this, they will then work out what area of your diet needs improvement, if any, and what changes can be made based on your own:
  • personal goals (weight loss, weight gain, blood glucose, pressure, cholesterol, etc…), 
  • food preferences, 
  • family situation, 
  • cultural background, and 
  • finances. 
Depending on your needs, a structured menu plan may be provided, tailor-made to your own unique requirements.

Shopping lists, information sheets and other written materials (e.g., booklets) may also be provided, depending on your own personal needs.

Follow-up appointments cover how well you are feeling and how you are managing with your dietary changes, assessment of your vital statistics and biochemistry, and general progress towards your goals, trouble‑shooting and further refinement of your personalised eating plan.

It is easy to see that public health nutrition epitomised by Dietary Guidelines is by necessity very different from personalised nutrition advise provided by a qualified health professional. Unfortunately, sometimes debates about what constitutes a healthy diet get heated and the two are conflated, with some fad diet advocates erroneously believing that dietitians/nutritionists simply advise everyone regardless of their personal circumstances to follow the latest version of the Dietary Guidelines. The reality is that both public health nutrition and personalised dietary advice can help people purchase healthy, affordable foods to ensure they enjoy a sustainable diet that will help them achieve optimal health, whatever their circumstances.

Read more:
 Dr Alan Barclay
Alan Barclay, PhD is a consultant dietitian and chef (Cert III). 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, LinkedIn or check out his website.

DIABETES CARE

INDIVIDUALS FASTING BLOOD GLUCOSE AND INSULIN ARE STRONG PREDICTORS OF THE WEIGHT LOSS RESPONSE TO DIETS WITH DIFFERENT MACRONUTRIENT COMPOSITION IN A LONG-TERM STUDY 

Efforts to identify a single optimal diet for the treatment of overweight and obesity have so far failed.

Scales

Overall, the body of scientific evidence from randomised controlled trials (RCTs) indicate that in order to lose weight, individuals need to consume less energy (kilojoules/calories) than they are expending through their physical activities and basal metabolic rate. Dietary energy can come from a range of different diets with varying macronutrient contents. The macronutrients are carbohydrate, fat, protein and arguably alcohol (although not officially a macronutrient, for some people it is a significant source of energy). One size does not fit all, and the best diet for most people is the one that they can stick to (the one that suits their cultural, religious, familial and personal food preferences, and budget) in the long run.

Due to the high cost of conducting RCTs, most are short-term (conducted over a period of 3-6 months) and few are long-term studies (at least 2 years). Short-term studies often do suggest that one dietary pattern is superior to another, but these results rarely hold true after 12 months in the rare instances that they last that long, and differences usually completely disappear by 2 years as people develop diet fatigue and are no longer able to maintain the disruptions to their family, religious and social lives.

Because they are rare, when a well-designed long-term RCT is conducted, we should pay attention to the results. Back in 2010, a group of American scientists randomised around 300 people to one of two diets and followed them up for 2 years: 

  • One of the diets was low-carbohydrate, which consisted of limited carbohydrate intake (20 g per day for 3 months) in the form of low–glycemic index vegetables with unrestricted consumption of fat and protein. After 3 months, people in the low-carbohydrate diet group increased their carbohydrate intake (5 g per day per week) until a stable and desired weight was achieved. 
  • The other was a reduced energy (1200 to 1800 calories (5000 to 7500 kJ) per day) low-fat diet that provided no more than 30% of calories from fat. 
Weight loss was significant at 1 year (a decrease of approximately 11 kg) and 2 years (7 kg), however, there were no differences in weight, body composition, or bone mineral density between the two different diet groups at any time point.

However, a group of Danish scientists worked with the original American scientists last year, re-analysing the study data according to whether the people in the study had prediabetes (blood glucose between 5.6-6.9 mmol/L) or high fasting blood insulin. After 2 years, participants with prediabetes and high fasting insulin lost 7.2 kg more with the low-fat compared to the low-carbohydrate diet, whereas those with prediabetes and low fasting insulin tended to lose 6.2 kg more on the low-carbohydrate diet than low-fat diet.

This new analysis of a well-designed long-term randomised controlled trial helps explain why there is not one single optimal diet for the treatment of overweight and obesity. Tailor-making dietary advice to suit the specific needs of individuals is the direction we need to be heading in.

Read more:

 Dr Alan Barclay
Alan Barclay, PhD is a consultant dietitian and chef (Cert III). 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, LinkedIn or check out his website.

YOUR GI SHOPPING GUIDE

WHICH STARCHY SNACK FOODS? 

Spending more time at home means easier access to food, especially unplanned extras, like snacks. Ideally snacks are chosen from core foods - things like a piece of fruit, a handful of nuts, a hard-boiled egg or a slice of wholegrain bread - and make a valuable nutrient contribution to our diet. More popular options like crispy, crunchy crisps and cookies don’t give us much except starchy carbohydrate that add to the glycemic load of the diet. Here we’ve taken a look at how the GI and GL of starchy snack foods compares.

Starchy snack

PWD

Popcorn (commercial microwave popcorn) 
GI 51-67
Serving: 1 small bag (25g/1oz)
Starchy snack

Potato chips/crisps 
GI 51-60
Serving: 1 single serve bag (50g/1 ¾oz)
Starchy snack

Flavoured extruded crispy packaged snack 
GI 74-90
Serving: 1 single serve bag (50g/1 ¾oz)
Starchy snack

Wholegrain rye crackers 
GI 59-74
Serving: 2 large crackers (20g/ ¾oz)
Starchy snack

Plain crackers - white flour based, e.g., Soda cracker or Sao
GI 63-78
Serving: 3 large, or 6 small crackers (20g/ ¾oz)
Starchy snack

Puffed Rice cake 
GI 82-91
Serving: 3 thick or 5 thin rice cakes (30g/1oz)
Starchy snack

Oatmeal biscuit or cookie 
GI 45-55
Serving: 2 cookies (20g/3/4 oz)
Starchy snack

Read more:

 Kaye Foster-Powell     
Kaye Foster-Powell is an Accredited Practising Dietitian who has worked with people with diabetes for 30 years. She was co-author of the original series of international, best-selling books on the glycemic index. She conducts a specialized private practice for people with diabetes in the Blue Mountains, west of Sydney, Australia.    
Contact: Via her website.

GOOD CARBS FOOD FACTS

CITRUS 
I know its winter because the citrus trees in my neighbourhood are laden with fruit. The citrus fruit family has something for everyone, whether it be the sweet and juicy orange, the cute and easy to peel mandarin, the gorgeously fragrant lime, the cook’s favourite lemon or bittersweet grapefruit. Then there are the more exotic citrus fruits such as the gigantic pomello (aptly named citrus maxima), the oh-so-hip Japanese yuzu or the gorgeous pot plant and preserve favourite, cumquat. There really is a citrus fruit for everybody but the whole citrus family shares the qualities of intensely exhilarating refreshment and beautifully bright colours.
Citrus
Citrus is famous for its fresh zing, both in your mouth and in the air around you when you peel them. For cooks, their sour astringency makes them ideal to partner with creamy or fatty foods as they ‘slice through’ the richness for an altogether more satisfying taste sensation. This is used to great effect in Asian savoury dishes, in the famous French dish duck a l’orange and my grandma’s specialty lemon butter (or lemon curd). Citrus zest packs amazing flavour. Use a microplane or zester and add zest to baking, sauces and anything with a citrus ingredient to turn up the citrus flavour volume to the max. The sourer the citrus, the better they balance with sweetness, so lemon and lime cakes taste divine and lemon curd is sunshine and happiness on a spoon.

Citrus are also perfect for juicing but limit to small amounts and eat mostly whole fruit to preserve all their nutritional goodness and fibre. If you only drink citrus you juice yourself this puts a natural brake on your intake. And once you’ve experienced the joy of freshly squeezed, it’s hard to go back.

Citrus fruits are a powerhouse of nutrition. They are perhaps best known for their vitamin C content, however this is only part of their good news story. They are packed with natural phytochemicals with a laundry list of health benefits including antioxidant, anti-inflammatory and anti-cancer properties. All this and they are also low GI.

CousCous
Source: AusFoods, 2019

Nicole Senior     
Nicole Senior is an Accredited Practising Dietitian, author, consultant, cook and food enthusiast 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.

THE GOOD CARBS KITCHEN

QUICK CHICKEN and VEGETABLE SOUP WITH GREMOLATA
0:20 Prep • 4 Serves • Main • Every day

QUICK CHICKEN and VEGETABLE SOUP WITH GREMOLATA

INGREDIENTS 
1 tablespoon olive oil
1 leek, chopped
2 x 400g packets fresh pre-chopped soup vegetables
5 cups reduced-salt chicken stock
2 cups shredded or chopped BBQ chicken
4 small slices rye bread, toasted, to serve

Gremolata
¼ cup chopped flat-leaf parsley
2 tablespoons lemon thyme leaves
1 garlic clove, crushed
3 tablespoons fresh grated Parmesan

METHOD 
Place the olive oil in a large, heavy-based pan on medium-high heat. Add the chopped leek; sauté for 2–3 minutes, or until just softening. Add vegetables; cook, stirring for 1–2 minutes.

Add stock to pan and bring the mixture to the boil. Cover, reduce the heat and simmer for10 minutes. Add chicken, stir to heat through. Add an additional ½–1 cup of water, if the soup needs more liquid. Season with cracked black pepper.

Meanwhile, make gremolata: Combine all the ingredients in a small bowl. Season and mix well.

Divide soup between serving bowls. Top with gremolata and serve with rye toast.

NUTRITION 
Per serve 1691kJ/405 calories; 34g protein; 14.6g fat (includes 4.8g saturated fat; saturated : unsaturated fat ratio 0.5); 28g available carbs (includes 9g sugars and 19g starch); 11.5g fibre; 414mg sodium

RECIPE AND IMAGE
Courtesy of Australian Healthy Food Guide magazine.

Australian Healthy Food Guide

For more healthy recipe inspiration and expert advice, visit healthyfoodguide.com.au

WOOD EAR MUSHROOM and ENOKI MUSHROOMS SALAD 
0:15 Prep • 0:08 Cook • 4 Servings • Entrée • Vegetarian

WOOD EAR MUSHROOM and ENOKI MUSHROOMS SALAD

INGREDIENTS 
½ cup dried wood ear mushrooms
1 cup celery
1 cup enoki mushroom
4 cups water
1 tablespoon soy sauce (salt-reduced or dark soy sauce is preferred)
2 tablespoons Chinese black vinegar
1 teaspoon sesame oil
1 teaspoon ginger
2 teaspoons white sesame seeds (optional)
Oil for cooking (2-3 tablespoons)

METHOD 
Preparation 
Gently rinse the wood ear mushrooms with tap water. Soak with 2 cups of warm water in a big bowl. Rehydrate for 30 minutes or until tender. Prepare the celery by chopping it into small pieces. Remove tough ends of wood ear mushrooms, then chop into bite-sized pieces. Grate the ginger.

Cooking 
Add the water to a pot, and then add the wood ear mushrooms and enoki mushrooms to it. Brining the water to a simmer. Transfer the mushrooms to the dish, and combine with the celery, soy sauce, Chinese black vinegar, ginger, and sesame oil.

Top with white sesame seeds (optional) and serve.

TIPS • For a nut-free and gluten-free dish, use gluten-free soy sauce.

DO YOU KNOW? Dark soy sauce is less salty than the regular soy sauce. Dark soy sauce is darker, thicker and sweeter due to added molasses. It is often used for seasoning and dipping. You can use dark soy sauce to replace regular soy sauce in stir-fries, stews and casseroles.

NUTRITION 
Per serve Energy: 152kJ/36 Calories; 1.8g protein; 2.1g fat (includes 0.3g saturated fat; saturated : unsaturated fat ratio 0.2); 1g available carbs (includes 0.5g sugars and 0.5g starches); 1.2g fibre; 227mg sodium; 252mg potassium; sodium : potassium ratio 0.9.

RECIPE

Shannon Shanshan Lin
Shannon Shanshan Lin is an is an Accredited Practising Dietitian and Credentialled Diabetes Educator with a particular research interest in culturally and linguistically and indigenous populations. She has been actively involved in the various committees both national and internationally, including the Australian Diabetes Educators Association, Global Chinese Diabetes Association and Beijing Key Laboratory of Nutrition Intervention for Chronic Disease. Contact: You can follow her on.