1 November 2020

GI News - November 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, 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

NON-DIGESTIBLE COMPONENTS OF FOOD – SHOULD WE BE EATING MORE? 

Once upon a time, the roughage in food, now called dietary fibre, was regarded as a nuisance, something that might slow the growth of children, just like it did in animals. But in the 1970s two British nutrition scientists, Dennis Burkett and Hugh Trowell, proposed something radical - that dietary fibre might actually be helpful - preventing the development of diseases like type 2 diabetes and colon cancer. In fact, they suggested that nearly every “Western” disease might respond favourably to eating more roughage. 

Roughage

I can still remember raising my eyebrow while listening to Dennis Burkett’s presentation to Sydney scientists in 1980. He showed us a plate-size ‘cow pat’ next to a match box. In the next slide, he showed a typical human stool of a westerner, a few hard pellets, again next to a match box (If you’d like to see more description of human stools, you’ll love the Bristol stool chart (see below)). Today, 50 years later, we know that dietary fibre increases the water content, volume and weight of faeces, and along with that the ability to alter human metabolism in ways we never thought possible. 

Last year, I was lucky enough to join a group of 40 eminent scientists calling themselves the International Carbohydrate Quality Consortium, who met in Palinuro, Italy, to draw up a consensus statement on what we know and don’t know about dietary fibre. The ensuing paper was published in the journal Nutrients recently (see below). 

There is still some confusion and disagreement about the definition of dietary fibre and how it should be measured. Many of us still use the original definition: carbohydrates (and relatively small amounts of other substances) derived from plants that are not digested by our digestive enzymes or absorbed in our small intestine. Hence, they reach the large intestine where a substantial amount is digested by the microbes in our microbiome. Helpful bacteria produce small organic acids that are absorbed into the body, used for our metabolism, and promote insulin sensitivity. 

However, there is much that is not known about dietary fibre, in part because the structure of the plant cell wall which makes up the majority of our dietary fibre has not been fully explored. Added to this, what occurs during chewing and movement through the digestive tract is not clear. The nature and actions of the microbiome are just beginning to be investigated. 

What do we know? Dietary fibre can alter gut function starting in the mouth and ending where the intestinal tract exits the body (the anus). The actual physiological effects depend critically on the properties of individual plant polysaccharides and oligosaccharides (i.e., types of fibre) and also the structural integrity of cell walls, an important part of the architecture of the plant tissue. These effects may include increasing or decreasing salivation, viscosity of the food as it travels down the gut, stomach emptying rate, extent of nutrient digestion and absorption, transit time, faecal bulking, laxation, fermentation, colonic acidity, microbiota amount and composition, binding of mucus, enzymes, hormones, bile acids and other metabolites, which may also be bioactive. Whew! 

Beyond the gut, the established metabolic effects of specific types of fibre include lowering of blood cholesterol and postprandial (after meal) blood glucose, and fasting blood glucose in people with diabetes. In particular, these effects have been observed with isolated viscous fibres such as psyllium, β-glucans, guar gum, glucomannan and pectic polysaccharides. Another plant isolate, inulin, though not viscous, can lower fasting glucose and insulin and fasting LDL-cholesterol while increasing good cholesterol (HDL) in people with diabetes and to a lesser extent in overweight and obese persons. Some manufactures add inulin to yogurt and other products. 

These observations show that fibre is capable of modifying our metabolism. Moreover, fibre-rich sources of edible plants such as pulses, nuts, barley, oats, some vegetables and fruits have been shown to improve long-term control of established chronic-disease risk factors, like blood fats (i.e., cholesterol and triglycerides), glucose, blood pressure and body weight. Many of these beneficial health effects have been attributed to the presence of fibre in these foods. But a distinction needs to be made between natural sources of dietary fibre and purified or modified forms of fibre. The purified forms may not have the same properties that they did as part of the original food. 

Recommendations from the ICQC

  • Dietary fibre is an important part of a sustainable, balanced healthy diet. Consumption is below recommended intake levels for optimal health in many parts of the world and may be decreasing. 
  • We should eat a total of 14 g /1000 Calories (3.3 g / 1000 kilojoules) of dietary fibre a day, ideally from naturally-occurring fibre. 
  • Dietary fibre should be a compulsory part of a food label’s Nutrition facts / information panel. 
  • Labelling should distinguish between fibre that is intrinsic to foods and that added as a functional supplement. 

REFERENCES

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?

FIBRE AND BODY WEIGHT 

The role of dietary fibre in weight management has been investigated for many decades and is still debated. A recently published systematic review and meta-analysis of randomised controlled trials sheds more light on the subject by specifically investigating the effect of viscous dietary fibres on body weight, waist circumference, body mass index (BMI), and body fat, independent of energy (kilojoule/calorie) reduction. 

Psyllium

 Agar, alginate, β-glucan, guar gum, konjac, viscous fiber blend (konjac, alginate, and xanthan), psyllium and xanthan gum are all common kinds of viscous dietary fibres that are found naturally in foods, are added as ingredients, or can be consumed as fibre supplements, and were included in the systematic review. 

There was a total of 62 trails including 3,877 people, with an average age of 51 years (range 16 – 70 years), and a baseline body mass index (BMI) of 27 (range 19 - 33) kg/m2. Around one fifth (18%) of participants had diabetes and/or the metabolic syndrome and over a third (37%) were at risk of cardiovascular disease (e.g., heart disease or stroke). The main findings were: 

  • consuming 8 g (range 0.8 - 36 g) of viscous fibre a day leads to a 0.33 kg decrease in body weight over 8 weeks (range 4-52 weeks), with evidence that the longer people consume the soluble dietary fibre, the more weight they lose. 
  • consuming 7 g (range 2.3 - 36 g) of viscous fibre a day leads to a 0.63 cm decrease in waist circumference over 12 weeks (range 4-52 weeks), with evidence that the longer people consume the soluble dietary fibre, the smaller their waist circumference. 
  • consuming 6 g (range 1.3 - 36 g) of viscous fibre a day leads to a 0.28 kg/m2 decrease in BMI over 8 weeks (range 4-52 weeks). 
  • consuming 9 g (range 3 - 36 g) of viscous fibre a day did not quite lead to a statistically significant decrease (-0.78%, P=0.05) in body fat over 8 weeks (range 4-52 weeks). 

While the reductions in weight, BMI and waist circumference are not huge by any measure, they were all independent of energy (kilojoule/calorie) reduction and are comparable to other popular dietary approaches like the Mediterranean-style diet (0.29 kg reduction in body weight), low-carbohydrate diet (0.48 kg reduction in body weight) and high–dietary pulses (legumes) diet (0.34 kg reduction in body weight). 

Therefore, making sure you include more soluble dietary fibre in your diet may have some added benefits if you are trying to lose weight or get into shape. 

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.

PERSPECTIVES: Dr ALAN BARCLAY

FIBRE AND GLYCEMIC INDEX 

There is a common belief that foods that are high in fibre do not raise blood glucose levels as much as those that are low in fibre, and therefore “high fibre” can be used as a surrogate marker for “low GI” when shopping for foods. Is this belief valid? 

Short-grain Brown rice

Before I can answer this question, it’s important to consider what information about carbohydrates can be found on most food labels around the globe. 

Carbohydrates and food labelling 

As discussed in previous editions of GI News, currently, in most parts of the world, only very basic information about carbohydrate is included on food labels. Unfortunately, Nutrition Facts / Information panels are not mandatory in many parts of the world, and in places where they are, only total (available) carbohydrate (i.e., all maltodextrins, starches and sugars) and total sugars (e.g., all naturally occurring and added sugars) are generally included. 

Dietary fibre, which is a kind of carbohydrate, is not a mandatory component of the Nutrition Facts / Information panel in most countries at present, with the exceptions being Canada and the United States of America (USA). In some nations, it must be included under certain circumstances, like when a fibre claim is made, and in many countries, it can also be included as voluntary information. 

Unfortunately, the GI is not a mandatory component of food labels in any part of the world at present. However, voluntary GI labelling scheme’s do exist in many countries, including Australia, China, India, New Zealand, Singapore, South Africa and the USA. 

Total carbohydrate and blood glucose levels 

People with diabetes – in particular those that use insulin – can use the information about the total amount of available carbohydrate on food labels to help manage their blood glucose levels. Carbohydrate counting – whether using gram (g) amounts, 10 g portions or 15 g exchanges – has been proven in randomised controlled trials to significantly lower glycated haemoglobin (HbA1c), the 3-month average of blood glucose levels, by 0.35% - 0.64% points in people with type 1 diabetes. While it may sound small, lowering HbA1c by 0.5% points may reduce the risk of deaths related to diabetes by around 10%, heart attack by 7%, and microvascular complications (e.g., retinopathy, neuropathy, nephropathy, etc…) by around 18%. 

GI and blood glucose levels 

There is good evidence from randomised controlled trials that choosing mostly low GI foods and meals instead of high GI alternatives lowers HbA1c by 0.5% points in people with diabetes. 

Sugars and blood glucose levels 

Surprising to most, the total amount of sugars in a food or meal is not useful from a blood glucose management perspective, for several reasons: 

  • The GI of commonly consumed sugars (naturally occurring and added) ranges from a low of around 20 for the sugar fructose to a high of 105 for the sugar maltose. 
  • Commonly added sugars like sucrose, high-fructose corn syrups and most honeys, have GI values in the 60’s and therefore are medium GI. 
  • Sugars are not the only kind of carbohydrate that effect blood glucose levels – maltodextrins and starches also raise them, and they are all included as a part of total carbohydrate in Nutrition Facts / Information panels. 

This is why, for people with diabetes, total carbohydrate is a more useful component of Nutrition Facts / Information panels than sugars. 

Dietary fibre and blood glucose levels 

Jason Bao and colleagues recently investigated the effect of 121 different foods and 13 mixed-meals in 1000 kJ (240 Calorie) or 2000 kJ (480 Calorie) portions, respectively, on blood glucose and insulin levels. The foods and meals all had widely differing amounts of carbohydrate, fat, protein and dietary fibre, reflecting what we commonly consume in our regular diets. Consistent with the evidence from clinical trials in people with diabetes that investigated the effect of either total available carbohydrate or GI on blood glucose levels, they found that the foods glycemic load, which is the product of available carbohydrate and GI (GL = GI x available carbohydrate per serve ÷ 100), was the strongest predictor of a foods and meals effect on blood glucose and insulin levels. 

Perhaps surprisingly, for individual foods containing between 0 and 24 grams of fibre and meals containing between 0 and 21 g of fibre, total fibre content was not a predictor of either blood glucose or insulin response for the foods or meals. 

While this may sound surprising, its important to remember that there are a large number of factors that determine a foods GI, including (but not limited to): 

  • type and amount of sugars 
  • type and amount of starch (i.e., amylose or amylopectin) 
  • starch gelatinisation
  • acidity (pH)
  • polyphenol content 
  • type of dietary fibre 

There is evidence that viscous dietary fibres like agar, alginate, β-glucan, guar gum, konjac, pectin, psyllium and xanthan gum do help lower the glycemic index of foods or meals. However, other types of dietary fibre may not have the same effect, particularly when processed. Unfortunately, the type of dietary fibre is not included in mandatory Nutrition Facts / Information panels anywhere in the world at present. 

Therefore, total dietary fibre is not a useful surrogate for GI (or GL) with respect to the effects of individual foods or meals on blood glucose levels. Just because a food or meal is high in fibre does not mean it will have a low GI. 

The GI and GL are the best predictors of a food or meals effect on blood glucose levels 

Therefore, if you want to know how a food will affect your blood glucose levels, look at the amount of total available carbohydrate per serve (based on the amount you will be eating – which is not necessarily the same as what is printed on the pack) and the foods GI. Sydney University’s GI Research Service lists the GI values for hundreds of foods on its website www.glycemicindex.com which can be accessed for free on your PC, tablet or smart phone when shopping. 

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

FIBRE AND DIABETES 

People with diabetes are usually encouraged to include more fibre-rich foods in their diet. The importance of this has been confirmed in a recently published systematic review and meta-analysis looking at the role of dietary fibre and whole grains in diabetes management. 

Legumes

The scientists combined the findings of 44 studies involving people with type 1 diabetes, type 2 diabetes and prediabetes. This included two prospective cohort studies (which follow groups of people over time and compare them for different outcomes) and 42 controlled trials (where people are allocated to different treatment groups and the outcomes of those treatments are compared). Some studies used high fibre foods and others used fibre supplements. 

The cohort studies showed a reduction in premature death in those eating a higher fibre diet, with a clear dose response, meaning that as fibre intake increased, the risk of death decreased. The controlled trials that included between 433 and 1807 people, found that increasing fibre intake resulted in improvements in blood glucose levels, blood fats (cholesterol and triglyceride), body weight and measures of inflammation. However, in this systematic review, no differences were seen between different types of fibre or the source of the fibre (food or supplements), most likely due to the smaller number of people included. There are of course other benefits of getting most of your fibre from a wide diversity of plant foods, particularly for your gut microbiome. 

High fibre foods, such as wholegrains, legumes, fruit and starchy vegetables, are also often rich in available carbohydrate (e.g., starches and sugars). But despite some people advocating low carb diets for diabetes management and weight loss, the authors of this paper found no evidence to suggest that relatively high intake of these carbohydrate-rich foods negatively affect blood glucose or weight management. 

Based on their findings, the authors recommend that people with diabetes or prediabetes should increase their fibre intake to at least 35g per day. Considering the average Australian adult only consumes around 23g per day, and intakes are even lower in most other developed nations, this means increasing fibre intake by at least one-third. 

A good place to start would be aiming for your ‘2 and 5’ fruit and veg each day. Switching refined grains (such as white bread and highly processed low fibre breakfast cereals) to wholegrains (such as dense grainy breads and traditional rolled oats) and incorporating legumes (lentils, chickpeas and dried/canned beans) into your meals regularly are also great ways help to boost fibre intake. 

References

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.

YOUR GI SHOPPING GUIDE

HIGH FIBRE FOODS
You might be familiar with the dietary recommendation to include high fibre, low GI foods but you would be misled to think that all high fibre foods were low GI. Brown rice and wholemeal bread are two common examples of high fibre, high GI foods. The fibre in these cereal grains is predominantly insoluble fibre, which is great for bowel regularity but isn’t as effective at slowing carbohydrate digestion as soluble fibre. Barley and oats, on the other hand, have higher proportions of soluble fibres and lower GI values. In the tables below, pearl barley, wholemeal bread, porridge and brown rice are ranked from highest to lowest fibre per serve but the pearl barley and porridge have the lower GI and GL values, despite their differences in fibre content.

Barley

PWD   

Pearl Barley, cooked
Serving size, ½ cup (95g/3 ½ oz) 

fiberous food


Wholemeal bread

Serving size, 2 slices (64g/2 oz) 

fiberous food


Porridge, made from rolled oats - cooked

Serving size, ½ cup (approximately 130g/4 ½ oz) 

fiberous food


Brown rice - medium grain

Serving size, ½ cup (approximately 80g/3oz)

fiberous food

 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

YAMS

Living in Australia, my exposure to the celebration of Thanksgiving was through the American TV shows I watched growing up. I know turkey plays a central role on the thanksgiving table, but I also know candied yams are a traditional side-dish. As thanksgiving is coming, it got me thinking about yams, as I don’t think I’ve ever eaten them. 

Yams

But wait, I’ve eaten sweet potato and isn’t that the same thing? No. Although the terms are used interchangeably in North America, sweet potatoes (ipomoea batatas) and true yams (Dioscoreaceae) are different things altogether. Although they are both root vegetables (tubers), they aren’t even in the same botanical family. Yams are part of the lily family. Candied yams enjoyed at Thanksgiving aren’t yams at all but sweet potato. 

Most yams are grown in Africa and they’re also native to Asia. Yams are cylindrical and come in different sizes, including some that can be up to 25kg each! The most common African species have dark brown, rough skin and white (Dioscorea rotundata) or yellow flesh (dioscorea cayennensis). The white yam was (dioscorea alata) first cultivated in Asia and is known as uhi in Hawaii. The Chinese yam is Dioscorea polystachya. In New Zealand and Polynesia Oxalis tuberosa are referred to as yams, or Oca in Spanish and are only 2-3 cm long. 

Yams are starchier and drier than sweet potato and typically ground into a paste known in Africa as Iyan, but they can be cooked in many ways. Most yams need to be cooked as eating them raw can cause illness. Boiling, frying or roasting are common, and similar to other starchy vegetables they provide a neutral base on which to serve savoury or sweet dishes. If you’d like to give them a try, find them at specialty greengrocers and perhaps make this African Yam Stew or Yam fries

Nutritionally, yams have high water content, are low in protein, virtually fat-free and contain around 27% carbohydrate of which most is starch. They are a good source of potassium, fibre and also contain vitamin B6 and vitamin C. The yellow flesh varieties are loaded with carotenoid antioxidants. The glycemic index (GI) varies by species. The common African species are medium to high GI, while the New Zealand and Chinese species are low GI.

Yams
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

GRILLED VEGETABLE and RICOTTA STACK
0:30 Prep • 4 Serves • Main • Every day 

GRILLED VEGETABLE and RICOTTA STACK

INGREDIENTS
200g reduced-fat fresh ricotta
2 tablespoons finely chopped chives
1 teaspoon lemon zest
150g store-bought roasted red capsicum, diced
2 tablespoons chopped flat-leaf parsley
1 tablespoon balsamic vinegar
1 small eggplant, thinly sliced
1 x 400g can no-added-salt brown lentils, rinsed, drained
2 medium zucchini, thinly sliced
450g sweet potato, peeled, thinly sliced
4 tablespoons balsamic glaze, to serve 

METHOD
Combine ricotta, chives and lemon zest in a bowl. Season with cracked black pepper. Set aside. Combine the capsicum, the parsley, balsamic vinegar and 1 teaspoon of olive oil in a bowl; set the mixture aside. 

Preheat a large chargrill pan or barbecue hotplate over high heat. Spray all of the vegetables lightly with olive oil. Grill vegies for 3–4 minutes each side, or until lightly charred and tender, then set aside to cool. 

To serve, divide the eggplant among four serving plates. Spread each with a spoon of ricotta mixture and spoon over some of the lentils. Top with zucchini, another layer of the ricotta, some more lentils and finally the sweet potato. Finish with a large spoonful of the capsicum mixture and drizzle with balsamic glaze. Serve 

NUTRITION
Per serve 1262kJ/302 calories; 12.1g protein; 6.6g fat (includes 0.9g saturated fat; saturated : unsaturated fat ratio 0.2); 42.7g available carbohydrate (includes 18.6g sugars and 24.1g starch); 10.2g fibre; 35mg sodium

RECIPE AND IMAGE

Recipe by: Chrissy Freer, Courtesy of Australian Healthy Food Guide magazine.

Australian Healthy Food Guide

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

HOT AND SOUR SOUP
0:05 Prep • 0:15 Cook • 4 Servings • Soup 

HOT AND SOUR SOUP  

INGREDIENTS
¼ Cup dried wood ear mushrooms (black fungus)
1/3 Cup dried shiitake mushrooms
4 Cups water
1 Cup enoki mushrooms
1 medium carrot
½ block (250g) firm tofu, cubed
½ Tablespoon soy sauce (salt-reduced or dark soy sauce is preferred)
2 Tablespoons Chinese black vinegar 

METHOD
Preparation
Gently rinse wood ear mushrooms and dried shiitake mushrooms with water. Soak each of them with 2 cups of warm water in two big bowls. Rehydrate for 30 minutes or until tender. 

Next, peel the carrot and chop into cubes. Slice shiitake mushrooms into strips. Remove tough ends of wood ear mushrooms, then chop into bite-sized pieces. 

Reserve the marinating water from the shiitake mushrooms, 2 cups in total. 

Cooking
Add water plus the 2 cups of marinating water (from above) into a pot. Heat over medium-high heat. Add all mushrooms, carrot and tofu to the pot. Cook until the water is simmering. 

Add soy sauce and turn down to medium-low heat. Remove the pot from the stove. Add the vinegar and stir to mix well. Serve hot. 

Decorate with sliced Chinese shallots. 

TIPS 

  • Use gluten free soy sauce for a gluten free dish. 
  • For more protein, add whisked egg or shrimps (prawns) into the soup. 

DID YOU KNOW? 

Dark soy sauce is less salty than regular soy sauce. Dark soy sauce is darker, thicker and sweeter due to the 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. 

This soup is one of the Chinese restaurant favourites at all times. 

Did you know about the mushrooms used in this recipe? 

- Wood ear mushrooms are named as such because they look like ears. When they are fresh or rehydrated, they have a great spongy texture. They are often sold dry in all local Asian stores. 

- Dried shiitake mushrooms are much more flavoursome than the fresh variety. Fresh shiitake mushrooms can be replaced in this recipe, but you may need a full cup of them to get a similar flavour. They are also available in all local Asian stores. 

- Enoki mushrooms are also called winter mushrooms or golden needle mushrooms with thin white stalks topped with little white buttons at the end. They are often available fresh in local Asian stores. 

NUTRITION 

Per serve 683 kJ/163 calories; 13g protein; 5g fat (includes 0.7g saturated fat; saturated : unsaturated fat ratio 0.16); 13g available carbohydrate; 4g fibre; 123mg sodium; 348mg potassium; sodium : potassium ratio 0.35

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 Wechat (ID= shannon033).

COPYRIGHT AND PERMISSION

 University of Sydney

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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 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)