GI News

1 February 2020

GI News - February 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
Editor: Philippa Sandall
Scientific Editor/Managing Editor: Alan Barclay, PhD, APD, AN
Contact GI News: glycemic.index@gmail.com

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

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FOOD FOR THOUGHT

SEAFOOD: GET HOOKED SUSTAINABLY
Dietitian Nicole Senior reports.
If any food could be considered a super food, it’s seafood (fish and shellfish). High in protein, and low in saturated fat, it’s a major source of healthy long-chain omega-3 fats and rich in nutrients such as iron, zinc, selenium, iodine, and vitamin D. And there is strong evidence eating it is good for the heart. Quality observational studies have shown approximately one to two 100-gram (3½-ounce) servings of fatty fish a week – salmon, herring, mackerel, anchovies, or sardines – reduce the risk of heart disease.

Fresh fish
There is also consistent evidence that consuming fish two to three times a week along with leafy greens and other fruit and vegetables daily and low GI carbohydrates can reduce your risk of developing macular degeneration, or help to slow its progression if it has already become established.

HOW MUCH SEAFOOD? Nutrition guidelines around the world suggest adults eat two serves of seafood a week. A serving is 100g (3½oz) of cooked (or 115g/4oz raw), which is around the size of your hand, or the amount in a small can. While battered and deep‐fried fish ’n’ chips are delicious, steamed, broiled/grilled, baked or pan‐fried fish are better options. Boost the health benefits and serve with plenty of vegetables or salad.

WHICH FISH? There is a huge variety of seafood to choose from but we creatures of habit tend to stick to a limited range of our favourites that are quick and easy to prepare and available all year round. However, globally, overfishing is a big problem. Taking pressure off fish stocks means we need to branch out and try different types of seafood. An added bonus is the less popular species tend to be cheaper.

If you want to expand your options, ask the fishmonger about what’s local and abundant or check out the “nose to tail” movement that promotes using all of the animal or in this case, fish. We as citizen-eaters can help by eating “fin to fin” (i.e. the whole fish and not just our favourite boneless, fillets) and not wasting any because throwing seafood in the bin stinks to high heaven and just adds insult to injury (it wastes the already significant environmental costs in producing it). If you have the space, you can bury your seafood scraps in the yard or garden to enrich the soil.

Look online, and you’ll find there are a number of people and organisations already promoting lesser-known fish with tips on how to choose and recipes to get great results. If you want to be adventurous in the kitchen, a good place to start would be Josh Niland’s The Whole Fish Cookbook (Hardie Grant), which is packed with ideas for cooking undervalued and less celebrated fish, and yes, the whole fish.

WHICH FISH IF YOU ARE PREGNANT? Now is the time to be selective. Avoid raw fish (e.g. sashimi, sushi), pre‐cooked prawns and smoked salmon due to the risk of listeria (a bacteria that can cause problems for the unborn child if the mother becomes infected). Fish and seafood are nutritionally important foods during pregnancy but some species contain high levels of mercury and some caution is required. Check your local health authority for which species to limit or avoid, but keep in mind most are OK and seafood provides essential nutrients during pregnancy. In general, predator fish species at the top of the food chain accumulate higher levels of mercury – smaller fish species are lower in mercury. Canned fish products are not high in mercury.

WHAT ABOUT SUSTAINABILITY?
Many people are concerned about seafood sustainability, but the twice a week recommendation for health (around 200g total) is about the amount of fish the EAT-Lancet Planetary Health Diet recommends (28g/day or 196g/week) to eat sustainably within natural limits. In reality most people eat less than this now, so sustainability concerns need not stop you from the twice a week target, provided you choose wisely.

Josh Niland sees sustainability as a three-pronged approach. “First, you have to be aware of the stock status of the species, Second, you have to be aware of the practices of the fishermen who caught your fish. Was it trawled in large nets or individually line caught? Finally, waste minimisation.” He believes we need to give far more consideration to the elements that traditionally would be considered as waste. Many of the world’s most highly desired and loved dishes have been born from the utilisation of waste. Why should fish be different?

Choosing sustainable seafood is important to ensure an ongoing supply for future generations. How? Look for sustainability logos when shopping for packaged seafood, such as the MSC (Marine Stewardship Council) logo. Check out the sustainability status of fresh fish and seafood in your country via websites or apps, such as the SAFS (Status of Australian Fish Stocks).

Read more:

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

WHAT’S NEW?

GO LOW GI – THE DIABETES BENEFITS KEEP STACKING UP
Almost 40 years ago, David Jenkins and colleagues published the first paper to propose that the glycemic index of foods might be an important measure of nutrition quality. “It was introduced back in 1981 to rate the glycemic character of the carbohydrate in individual foods like bread, breakfast cereal, rice, pasta, apples etc,” says Prof Jennie Brand-Miller. “The purpose was to swap one carbohydrate source with another for snacks and in your meals (e.g. replacing a high GI breakfast cereal like corn flakes with a low one like natural muesli).”

High carbohydrate foods
Choosing good carbs that are low or lower GI for your meals or snacks is now a key dietary choice if you have diabetes. Evidence based recommendations about diet and nutrition from the world’s major diabetes organisations advise people with diabetes to use the GI or GL to help them manage blood glucose levels and reduce their risk of complications including diabetic retinopathy and kidney disease.

Check out the latest findings from two important systematic literature reviews and meta-analyses of randomised controlled trials – considered to be the highest level of evidence.

For controlling HbA1c and fasting blood glucose: A systematic review and meta-analysis published in Nutrients in 2018 shows low-GI diets are more effective in controlling HbA1c and fasting blood glucose than higher GI diets and the range of other diets that are typically recommended for people with diabetes including conventional carbohydrate exchange, high fibre and standard diabetic diets.
For reducing risk of type 2 diabetes: A systematic review and meta-analysis published in Nutrients in 2019 shows glycemic index and glycemic load are important markers of food quality and do an excellent job of predicting type 2 diabetes risk for the population as a whole.

International Federation of Gynecology and Obstetrics also recommend a focus on lower GI foods. “Low GI diets are associated with less frequent insulin use and lower birth weight than in control diets, suggesting that it is the most appropriate dietary intervention to be prescribed to patients with GDM,” they say.

THE GOOD CARBS? These whole foods include milk and yoghurt; fruits and berries; starchy vegetables (potatoes, sweet potatoes, sweet corn); legumes (beans, peas, lentils); nuts and seeds; and grains (oats, rice, buckwheat, quinoa etc) and the traditional staple foods we make from them including noodles, pasta and sourdough and grainy breads.

GOING LOW GI Think of it as adding a filter to your regular healthy eating pattern. First, it only applies to the carb-rich fruits, starchy vegetables, legumes and grains you like to eat. Second, it’s flexible and can be tailored to suit a range of dietary patterns from high carb to low; Mediterranean to Asian; paleo to vegetarian/vegan; gluten-free or low FODMAP. Here’s our 2-step approach to going low GI.

Step 1: Swap it: Replace the high GI foods in your diet with low GI ones. You can find out more about how to do this HERE.
Step 2: Don’t overload on carbs: Choosing low GI is not a free pass to pile your plate. Keep carb-rich portions moderate so the glycemic load is moderate too. What’s moderate? It’s about a quarter of your dinner plate (inner rim) or 2–3 small lower GI potatoes such as Carisma, GiLicious, Nadine or Nicola, ½ cup diced orange-fleshed sweet potato or corn kernels or baked beans and ⅓ cup cooked basmati or other lower GI rice or al dente pasta.

Note: The GI does not apply to foods that contain very little carbohydrate like green vegetables, or to protein- and fat-rich foods like meat, fish, chicken, eggs, or cheese that contain no carbohydrate.

FIND THE GI OF YOUR FAVOURITE FOODS
Check out the Good Carbs Food Facts story in each issue. We create a complete nutrition information panel for these whole foods and traditional staples made from them along with their GI value and the GL of a typical serving. Use the search box at the top right-hand column of GI News to search for your favourite foods.

Search the International GI Database on the official website for the glycemic index based in the Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders and Charles Perkins Centre at the University of Sydney: glycemicindex.com.

Read more:

PERSPECTIVES WITH DR ALAN BARCLAY

EATING FOR HEALTHY EYES
The risk of developing eye disease increases as we age, potentially undermining our quality of life. The most common eye diseases associated with ageing are:

Age-related cataracts, a clouding of the normally clear lens of the eye, are a leading cause of vision impairment and blindness.
Diabetic retinopathy is associated with diabetes and is a major cause of visual impairment and blindness. It develops when persistently high blood glucose levels damage the small blood vessels in the retina.
Dry eye disease/syndrome occurs when the eyes don’t make enough tears to stay lubricated. This can make the eyes feel irritated, and in some cases, can also cause vision problems.
Glaucoma, which may cause poor eyesight and can lead to blindness, occurs when the eye’s optic nerve is damaged due to increased pressure in the eye.
Macular degeneration (also known as age-related macular degeneration or AMD) is a leading cause of blindness and severe vision loss. It refers to a group of degenerative diseases of the retina – in particular the macula, which is responsible for central and fine-detail vision.

Eye health goes hand-in-hand with general health. But because of the eye’s constant exposure to light and its high rate of metabolism, some nutrients are especially important.

Blue eyes

The eye is particularly susceptible to oxidative damage, and oxidation and inflammation are implicated in the development of all of the common eye diseases associated with ageing. There is some evidence that dietary antioxidants and anti-inflammatories may help decrease the risk of age-related eye disease. This includes vitamin A, beta-carotene, lutein and zeaxanthin, and vitamins C and E; selenium and zinc; omega-3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid; and omega-6 fatty acid, gamma-linolenic acid.

VITAMINS
Vitamin A is essential for maintaining your eyes’ light-sensing cells (photoreceptors). Insufficient vitamin A may lead to night blindness, dry eyes or blindness, depending on the severity of the deficiency. Liver, egg yolks, and full-cream dairy products are all good sources.

Beta-carotene, a red-orange pigment, can be converted into vitamin A in the small intestine. It’s found in relatively large amounts in fruits and vegetables like cantaloupe/rockmelon, apricots (fresh or dried), orange-fleshed sweet potatoes, kale, spinach, and carrots.

Lutein and zeaxanthin are yellow carotenoid antioxidants known as macular pigments that function as a natural sunscreen. They are concentrated in the macula, the central part of the retina, which is a layer of light-sensitive cells on the back wall of the eye. Consuming foods rich in lutein and zeaxanthin can reduce the risk of chronic eye diseases including age-related macular degeneration and cataracts. Kale, spinach, parsley, green peas, lettuce, squash, Brussels sprouts and pistachios are among the best sources. Egg yolks, broccoli, pumpkin, asparagus and sweet corn are also good sources. Carotenoids are better absorbed when eaten with fats or oils, so dress your vegetables and salads.

Vitamin C (ascorbic acid) is an antioxidant found in fruits and vegetables. There is some evidence it lowers the risk of developing cataracts. When taken in combination with other essential nutrients, it can slow the progression of age-related macular degeneration and visual acuity loss. Many fruits and vegetables are rich in vitamin C including berries, broccoli, Brussels sprouts, cabbage, cantaloupe/rockmelon, cauliflower, capsicum/bell peppers, citrus fruits, guavas and tomatoes.

Vitamin E is a group of fat-soluble antioxidants that protect fatty acids from harmful oxidation and thus protect cells in the eyes from unstable molecules called free radicals, which break down healthy tissue. Almonds, peanuts, sunflower seeds, and vegetable oils like safflower oil and wheat-germ oil are some of the best dietary sources of vitamin E.

MINERALS
Selenium is a powerful antioxidant. When combined with carotenoids and vitamins C and E, it can help reduce the risk of advanced age-related macular degeneration. Foods rich in selenium include seafood (shrimps/prawns, crab, salmon, halibut), poultry and eggs, Brazil nuts, enriched noodles, and brown rice (depending where it is grown). Zinc is a part of many essential enzymes. It plays a vital role in bringing vitamin A from the liver to the retina to produce melanin, a protective pigment in the eyes.

Zinc is highly concentrated in the eye, mostly in the retina and choroid, the vascular tissue layer lying under the retina. It also appears to be involved in the formation of visual pigments in the retina. For this reason, zinc deficiency may lead to night blindness. Good sources include meat, seafood (fish and shellfish), poultry, dairy milk and yoghurt and peanuts.

FATS
Omega-3 fatty acids (eicosapentaenoic acid or EPA and docosahexaenoic acid or DHA) are important for eye health. DHA is found in high amounts in the retina, where it may help maintain eye function, and help decrease oxidative stress and inflammation. It’s also important for brain and eye development during infancy. DHA deficiency may impair vision, especially in children. The best dietary sources are oily seafood like salmon, trout, herring, sardines, crab and shrimps/prawns.

Gamma-linolenic acid (GLA) is an omega-6 fatty acid that appears to have anti-inflammatory properties. Sources include evening primrose oil and hemp seed oil.

CARBOHYDRATES
Carbohydrates (sugars and starches) have the greatest impact on our blood glucose levels. Consuming too much carbohydrate overall or too many high GI carbohydrates can lead to persistently high blood glucose levels and increase your risk of developing diabetic retinopathy, macular oedema, cataracts and glaucoma.

Talk to an Accredited/Registered dietitian to find out how much carbohydrate is right for you, and enjoy the low or lower GI varieties including quality wholegrains (e.g., grainy bread, al dente wholewheat pasta), legumes (beans, lentils and chickpeas), fruit and veggies (apples, pears, corn, peas, sweet potato, butternut pumpkin), dairy milk and yoghurt.

PUTTING IT ALL ON YOUR PLATE:
To help maintain optimal eye health, eat more fruits and vegetables, enjoy moderate amounts of quality meat, seafood and/or poultry and make most of low or lower GI carbohydrates.

Read more:

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 or check out his website.

DIABETES CARE

DIABETIC EYE DISEASES
Ophthalmologist Dr Shanel Sharma explains why it’s vital to be vigilant if you have diabetes and why the eye is vulnerable to damage from the complications of diabetes.

Diabetes is the most common cause of blindness for people between 20 and 65 and diabetic eye diseases can affect anyone with diabetes whether type 1 or type 2. Chronically high blood glucose levels over time damage blood vessels throughout the body. Our small blood vessels are the most vulnerable and are affected first. These include the small blood vessels supplying our eyes, kidneys and our peripheral limbs (toes). People with chronically elevated blood glucose levels have substantially more, and more severe, retinopathy than those with lower blood glucose levels.

What happens in the eye is that the blood vessels become damaged and develop micro-aneurysms, start to bleed causing haemorrhages and stop carrying blood, resulting in retinal ischaemia. Ischaemic retina causes the release of a protein (VEGF – vascular endothelial growth factor), resulting in the development of sick and abnormal blood vessels, which can bleed or cause tractional retinal detachment and loss of vision. The other major way people lose sight is from diabetic macular oedema, from leaking of blood product into the macular. The macular is the part of the eye that allows one to read, look at people’s faces, or do any fine detailed work.

The eye
As there is usually a 10–15-year delay in chronically high BGLs and appearance of diabetic eye diseases, it is important to control BGLs well from the start. Although the damage to the eye is irreversible, early detection and treatment can reduce the risk of blindness by up to approximately 95%.

If you are diagnosed with diabetic retinopathy, don’t despair. Good blood glucose control can reduce its progression. People with diabetes who follow healthy eating principles can reduce their HbA1c levels by 1 to 2 percentage points. On a low GI diet, they can reduce can HbA1c levels by another 0.5 percentage points. While this may not sound significant, a decrease of just 1 percentage point in HbA1c levels will decrease the common complications of diabetes by 19% to 43%. Talk to your doctor or diabetes educator.

Reducing blood pressure helps too. The UK Prospective Diabetes Study showed a reduction of 10mmHg systolic and 5mmHg diastolic reduces the rate of retinopathy by 30%.

As diabetic eye diseases most commonly have no symptoms, it is essential to ensure that you are being screened regularly by your GP, optometrist or your ophthalmologist. Symptoms that are associated with diabetic eye diseases can include intermittent blurred vision, difficulty with focusing, loss of contrast, double vision or distortion to your vision. Additionally, diabetes is an independent risk factor for developing other eye diseases such as cataracts and glaucoma.

Protecting your eyesight is one of the most important things you can do to ensure quality and enjoyment of life.

Read more:

YOUR GI SHOPPING GUIDE

MILK
We aren’t buying into the milk/fake milk debate. We know people have a whole range of reasons (health, cultural, religious, environmental, ethical) for choosing plant milks rather than dairy. We do recommend you check the ingredient list for plant milks and choose one with added calcium and B12.

Milk
For people with diabetes – Many people count grams of carbohydrate or use 15g Carbohydrate Exchange or 10g Portions to help match their insulin or blood glucose lowering medication to their requirements. We have included both. A 15g Exchange includes food with 12–18g carbohydrate and a 10g Portion 7.6–12.5g of carbohydrate.

Dairy
Cow’s milk, full fat (4%)
GI 30 (27–34)
Serving: 1 cup (250ml/9 fl oz)

Cow’s milk, reduced fat (1–2%)
GI 29 (20–30)
Serving: 1 cup (250ml/9 fl oz)

Cow’s milk, low/no fat, skim (less than 1%)
GI 29 (20–30)
Serving: 1 cup (250ml/9 fl oz)

Plant milks
Almond milk, unsweetened
GI 25
Serving: 1 cup (250ml/9 fl oz)

Oat milk
GI 69
Serving: 1 cup (250ml/9 fl oz)

Rice milk, regular
GI 79
Serving: 1 cup (250ml/9 fl oz)

Rice milk, low fat
GI 92
Serving: 1 cup (250ml/9 fl oz)

Soy milk, regular, added calcium,
GI 30 (24–37)
Serving: 1 cup (250ml/9 fl oz)

Soy milk, reduced/low fat, added calcium,
GI 36 (34–38)
Serving: 1 cup (250ml/9 fl oz)

Read more:

www.glycemicindex.com

GOOD CARBS FOOD FACTS

BROCCOLI
Broccoli is part of the brassica family of vegetables (also known as cruciferous vegetables) that includes cabbage and Brussels sprouts. It has been around since Roman times and still popular in Italy; the name comes from the Italian word broccoli meaning the flowering crest of a cabbage. We eat the large flowering head of the plant. Broccolini is a newer incarnation with long slender stems and smaller heads, and also known as sprouting broccoli – they are nutritionally the same. They all contain cancer-fighting phytochemicals including sulforaphane. Broccoli is also a good source of the B vitamin folate for a healthy heart, vitamin C for immunity and fibre for digestive health.

To retain its nutritional goodness and “fight-o-chemical” power, cook broccoli as lightly as possible – do not boil. As with all vegetables, broccoli can be lightly steamed or microwaved and dressed with a little extra virgin olive oil and perhaps lemon juice, pepper, chilli, or herbs of your choice. For an Asian direction, try soy, honey and sesame seeds. Take care not to overcook and leave some crispness and the rich green colour. To ensure the stems cook through before the florets go mushy, cut a cross into the base of the stem with a small sharp knife to quicken cooking. For added delight, sprinkle over slivered almonds (or any nut really) that have been gently toasted.

Source: AusFoods, 2019

THE GOOD CARBS KITCHEN

BAKED WHOLE SNAPPER WITH MOROCCAN SPICE PASTE
0:15 Prep (+ 30 marinating) • 0:25 Cook • 4 Servings • Main Meal • Easy Entertaining

INGREDIENTS
½ cup firmly packed coriander (cilantro) leaves + extra to garnish
½ cup firmly packed mint leaves + extra to garnish
1 long red chilli seeded and finely chopped
1 garlic clove crushed
1 teaspoon finely grated ginger
1 teaspoon ground cumin
1 tablespoon lemon juice
2 teaspoons olive oil
1 whole snapper (1kg/2lb 4oz), scaled and gutted
1 lemon thinly sliced

METHOD
Finely chop the herbs, chilli, garlic, ginger and cumin in a food processor. Add the lemon juice, olive oil and 1–2 tablespoons of water or enough to make a smooth paste. Process until smooth.

Cut three deep diagonal slashes through the skin and down to the bone on each side of the snapper. Place in a large non-metallic dish and fill the cavity with the lemon slices. Spread the spice paste over the fish and turn to coat well. Cover and refrigerate for 30 minutes.

Preheat the oven to 220°C (425°F).

Place the fish on a large paper-lined baked tray and bake for 20–25 minutes until the thickest part flakes easily with a fork. Serve garnished with extra coriander and mint leaves.

Tip: You can replace the snapper with 2 x 500g baby snappers. The cooking time will decrease to 15-20 minutes.

NUTRITION
Per serve 1185 kJ/285 calories; 52g protein; 7g fat (includes 1.5g saturated fat; saturated : unsaturated fat ratio 0.3); 2g available carbs (includes 1g sugars and 1g starch); 2.2g fibre; 219mg sodium; 1258mg potassium; sodium : potassium ratio 0.2

RECIPE
Chrissy Freer, Book (The Anti-inflammatory Cookbook, Murdoch Books)

SALT-BAKED SNAPPER
0:20 Prep • 0:40 Cook • 4 Servings • Entertaining

INGREDIENTS
2 whole snapper, about 350g (12oz) each
1 lemon, sliced
1 bunch fresh coriander (cilantro), roots, stems and leaves, roughly chopped
1.5kg coarse sea salt
2 egg whites, beaten
2 stalks lemongrass, roughly chopped

METHOD
Preheat oven to 200°C (400°F).

Clean the snapper and put lemon slices and 1 tablespoon of the chopped coriander in the cavity and season.

Combine the salt, egg whites, lemongrass and remaining chopped coriander in a large bowl.

Spread a layer of the salt mixture in a baking dish and top with snapper. Then completely cover fish with remaining salt mixture. You don’t want to be able to see any fish at all.

Bake in hot oven for 40 minutes. The salt mixture will turn to a hard crust that you can crack with the back of a knife – this is fun to do at the table for guests. Then take out the steaming whole fish, brushing off any excess salt.

NUTRITION
Per serve 785kJ/190 calories; 38g protein; 3g fat (includes 1g saturated fat; saturated : unsaturated fat ratio 0.5); 1g available carbs (includes 0.8g sugars and 0.2g starch); 1g fibre; 3027mg sodium; 887mg potassium; sodium : potassium ratio 3.4

RECIPE
Ian Hemphill with recipes by Kate Hemphill, Spice Notes and Recipes.

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1 January 2020

GI News - January 2020

FOOD FOR THOUGHT

MEATY MATTERS
Dietitian Nicole Senior ponders finding health in the happy medium Eating meat kick-started the evolution of modern big-brained humans. But we can actually live long and healthy lives without eating it, and many millions do. However, it’s a highly nutritious food that provides us with essential nutrients more difficult to obtain from plant foods.

portion of meat on dinner plate
Source: Reversing Diabetes (Murdoch Books)

Red meat, for example, is rich in iron necessary for healthy blood, zinc for immunity and vitamin B12 for healthy DNA and cell division. Sure, there are vegetarians who thrive on a meatless diet, but there are also those who don’t and take nutrient supplements to make up the shortfall. In some poor countries, where people cannot afford to eat meat, iron-deficiency anaemia is one of the most common childhood diseases. But meat poses ethical questions around the environment – red meat has the highest environmental footprint – and animal welfare.

While it’s true livestock contribute to environmental problems, the environmental argument against meat has been infused with emotion and ideology as to whether we should eat meat at all. Veganism is rising, with the extremists in the movement taking a militant approach going so far as trespassing on farms and causing damage.

The picture has also been muddied by the rampantly excessive consumption of meat in some rich countries and the environmentally damaging effects of factory farming, the vast scale of commercialised livestock production where animals become a unit in a production line, and the scandals in Australia over the cruel export and slaughter methods of live cattle and sheep, and more recently what happens to race horses that have passed their use-by date (in our book). For many people the way we treat farm animals is no longer acceptable and higher moral standards are being demanded.

In a way, meat offers nutritional insurance for reckless eating and incompetent cooking whereas plant-based eating requires a new diligence both for nutritional balance and enjoyment. The degree of difficulty of a meatless diet is much higher than an omnivorous diet. Maybe rather than blindly following all the vegan marketing hype (not all vegan products are healthy), we just need to be more mindful of our diet generally? For example, reducing the amount of nutrient-poor, highly processed foods we eat, learning to grow and cook our own food, only buying what we can eat, and not throwing food in the bin (which wastes the resources that went in to producing it and produces greenhouse gases in landfill).

The question of how much meat we can get away with eating and still look after our health and the environment is hotly debated and depends on a myriad of factors including: location/region, climate, production method, land and water use, feed type, animal genetics, waste management, supply chain efficiency, transport and wastage.

The EAT-Lancet Commission on Food, Planet, Diet and Health report published in February 2019 took a global approach that aimed to incorporate nutritional needs and environmental limits needs with a Planetary Health Diet. It is a plant-based diet with 14g a day of beef/lamb/pork (98g/week) with a range of 0–28g/day, 29g poultry per day (203g/week), 28g of fish per day (196g/week) and 13g of egg per day (about 2 eggs/week). This report has drawn both congratulations and criticism in equal measure. The harshest criticism has been directed at the very small amounts of meat, which are less than previously proposed for environmental sustainability and less than currently recommended in dietary guidelines. We shall wait to see how the rest of the world takes on their recommendations.

While high intensity factory farming such as feed lot cattle is seen as unacceptable to most on both environmental and ethical grounds, the agricultural story around meat production isn’t all bad. In Australia, for example, most cattle and sheep are grass-fed on marginal land unsuitable for crops. Integrated farming is a better and more sustainable way forward and this approach involves mixing animal and plants on the same farm to allow for maximum output through nutrient cycling and minimal pollution.

It is unrealistic to think we will all stop eating meat to save the environment or to “be kind” to animals, however, we can produce meat in a much more sustainable and ethical way, and we can eat less meat to minimise our environmental impact. There’s no need to banish meat from your dinner plate – just cut back so it’s a tasty side show rather than the main event. We as citizen-eaters can help by eating animals “nose-to-tail” (not just our favourite bits) and not wasting any because throwing animal foods in the bin just adds insult to injury (it wastes the already significant environmental costs in producing it).

Australian ex-food-critic-turned-farmer, TV presenter and author Matthew Evans says we will need to pay more for meat that meets our higher moral expectations, “The simplest way to better impact the animals, the land, the farmer, is to perhaps eat meat less often, but spend more on it.” And remember eating less red meat is easy because there is (sustainably sourced) fish, chicken and pork with smaller environmental footprints as well as good plant sources of protein that we should be eating more of. This dietary strategy when taken on by the population will send a message to producers that they can use less intensive, kinder and more sustainable methods to produce animal foods, and can ramp up sustainable plant food production to meet demand.

My takeout message is this – meat is nutritionally important, but we in rich countries should eat less; and only our fair share. We need to focus on farming animals (and crops) more sustainably and with minimal environmental impact.

Avowed carnivores and vegans are dietary extremes while health is so often found in the happy medium. If we ate according to health guidelines, both our own health and the health of the planet and all the people living on it could be improved!

Read More:

WHAT’S NEW?

A RED MEAT ISSUE FLAMES UP
Five – yes, five – papers in the Annals of Internal Medicine published in October 2019 whipped up a flaming hot controversy about nutrition guidance broadly and red meat specifically reports ConscienHealth’s Ted Kyle. The bottom line from all these papers? Maybe we need to admit that the evidence for harm to health from red meat is not so hard and fast as some people like to think.

Meat cooking
Using GRADE criteria, the certainty about the effects of red meat on health is low. Thus, recommendations to eat less red meat for better health are weak. In other words, there are indeed different and valid ways to look at the issue of red meat in the diet.

Harvard’s Frank Hu doesn’t like applying GRADE standards to nutrition advice. “It’s really problematic and inappropriate to use GRADE to evaluate nutrition studies,” he says. One big problem he has with the GRADE system is that it takes randomized, controlled studies to be the gold standard of evidence. Observational data provides weaker evidence. Such thinking is OK for evaluating drugs. But he wrote in 2015 that the standard should be different for nutritional epidemiology: “Some researchers consider RCTs as the be-all and end-all of causal inference. This sentiment may be appropriate in the pharmaceutical industry, but the drug trial paradigm cannot be readily translated for use in the nutritional sciences.”

However, it’s worth saying that standards for scientific rigor were not invented by the pharmaceutical industry. The lead on one of these five papers, Bradley Johnston, explains: “Regarding the reaction among some in the nutrition research community … we are sympathetic to the discomfort of acknowledging the low-quality evidence in one’s field. It seems to us, however, that pretending that the rules of evidence differ across fields because the feasibility of definitive studies is not possible in one’s particular field is a poor solution to the problem. We believe it is important to apply common standards for assessing the certainty of evidence across health-care fields.”

So, what are we to think about red meat? The evidence to say that we’re eating more red meat than we should for our own health is weak. However, we do have other reasons to believe that eating less red meat would be a good thing. Red meat is pretty hard on this planet we share. A little red meat probably won’t kill you. But too much of it might indirectly contribute to killing lots of people through climate change.

Regardless of those facts, opinions and feelings will drive behaviour. Some people are really attached to the red meat in their diets. Others have strong passions for avoiding it.

It’s not easy to be objective about nutrition, but it’s worth a try. Dennis Bier explained this to the New York Times: “The rules of scientific proof are the same for physics as for nutrition.”

Read more:

ConscienHealth News
Click here, here, here, here, and here for these five papers
For further reporting, click here, here, here, and here

PRODUCT REVIEW

4 RED MEATS
Nutritious red meats are valuable for their protein, iron, zinc and vitamin B12. In Product Review, we check out how four of these meats provide the key nutrients per serving so you can compare farmed animals with game. We follow the Australian Dietary Guidelines for servings – a serving of red meat is 65g cooked meat or 100g (3½oz) raw meat.

Fillet steak, lean, raw
Serving: 100g/3½oz
570kJ/ 136 calories; 22 g protein; 5g fat (includes 2g saturated fat; saturated : unsaturated fat ratio 0.7); 57mg sodium; 380mg potassium; sodium : potassium ratio 0.2; 2.2mg iron; 3.8mg zinc; 1.9ug vitamin B12.

Lamb tenderloin (fillet), lean, raw
Serving: 100g/3½oz
485kJ/ 116 calories; 20g protein; 4g fat (includes 1.5g saturated fat, saturated : unsaturated fat ratio 0.6); 70mg sodium; 370mg potassium; sodium : potassium ratio 0.2; 2.1mg iron; 2.9mg zinc; 1.3ug vitamin B12.

Venison, lean, raw
Serving: 100g/3½oz
415kJ/ 100 calories; 22g protein; 1.1g fat (includes 0.5g saturated fat, saturated : unsaturated fat ratio 0.8); 58mg sodium; 380mg potassium; sodium : potassium ratio 0.2; 3.1mg iron; 4.4mg zinc; 1.6ug vitamin B12.

Kangaroo, lean, raw
Serving: 100g/3½oz
400kJ/ 95 calories; 21g protein; 1g fat (includes 0.3g saturated, saturated : unsaturated fat ratio 0.4); 40mg sodium; 350mg potassium; sodium : potassium ratio 0.1; 3.4mg iron; 2.3mg zinc; 1.9ug vitamin B12.

PERSPECTIVES WITH DR ALAN BARCLAY

Kidneys, kidney disease and protein
Most people have two bean-shaped kidneys, each about the size of a clenched fist, in the rear left and right sides of their torso, just below their ribs. They have many essential functions (e.g., regulating blood pressure, producing hormones and activating vitamin D), but most importantly they filter our blood and remove excess body fluids and wastes for elimination in the urine. They are able to balance out body fluid, electrolyte (salts) and acid (pH) levels so that all of our organs function optimally, despite our consumption of a variety of fluids from foods and beverages, and fluid losses from physical activity and sweating. Here’s how they do it.

NORMAL KIDNEY FUNCTION
Blood flows from the aorta (the main blood vessel from the heart) into the kidneys via the renal artery. Within the kidney, the parts that filter the blood are called nephrons. Within each nephron is a glomerulus, a bulb-like capsule which contains tiny blood vessels that look a bit like a loosely wound ball of wool.

When the kidney is functioning normally, these tiny blood vessels have a large number of fine holes. They work a bit like sieves, allowing water, some salts (e.g., sodium, potassium, calcium, phosphorus) and waste products to pass through, but they are too small to allow red and white blood cells, and most blood proteins, to leak out. The exact composition of the filtered fluids (filtrate) depends on the body’s requirements for essential minerals like sodium and potassium, the acid-base balance (pH), and concentration of wastes from general metabolism.

Eventually, the filtrate from each nephron flows together and enters collecting ducts within the kidney, where the concentration of the final urine product is determined. The urine then travels through the ureters to the urinary bladder for temporary storage before voluntary urination.

Kidney function is evaluated based on the glomerular filtration rate (the rate at which the kidneys form filtrate) and the amount of the protein albumin lost in the urine. In health, glomerular filtration rates are greater than 90mL/minute, and there is essentially no albumin in the urine.

KIDNEY DISEASES
Nephrotic syndrome occurs when the glomeruli are damaged, increasing the size of the filtration holes, and therefore decreasing their ability to prevent proteins (e.g., albumin, lipoproteins, clotting factors and immunoglobulins) from escaping into the urine. The loss of these proteins can lead to serious health problems including oedema, high cholesterol levels, blood clotting and immune issues. Nephrotic syndrome can be caused by infections, immune disorders, chemical damage (from medications or illicit drugs), or poorly managed diabetes.

Chronic kidney disease is characterised by gradual, irreversible deterioration of the nephrons. Because we have a lot of nephrons, chronic kidney disease develops over many years without causing any symptoms. People are therefore often diagnosed late in the course of the illness, after most kidney function has been lost. Like the nephrotic syndrome, damage to the blood vessels in the nephrons leads to excessive loss of proteins in the urine, which can lead to serious health problems including oedema, high cholesterol, blood clotting and immune issues. Additionally, the nephrons lose their ability to maintain electrolyte (e.g., sodium and potassium) levels, acid-base balance (e.g., uric acid and phosphorus levels) and uraemia (the level of urea – the waste product of protein metabolism – in the blood). The more common causes of chronic kidney disease include diabetes and hypertension (chronically high blood pressure).

PROTEIN AND KIDNEY FUNCTION
The Recommended Dietary Intake (RDI) of protein for women is 0.75 g per kg body weight, and for men it is 0.84g per kg. High protein diets provide more than 1.2g per kg body weight and lower protein diets less than 0.6 g per kg body weight.

Unlike carbohydrate which is stored as glycogen in our muscles and liver, and fat which is stored as triglycerides in our fat cells, we have a limited capacity to store protein. If we eat more protein than our body’s require, some of it can be converted to glucose in the process of gluconeogenesis (see July 2019 edition of GI News). The metabolic process of converting proteins (or more specifically amino acids – the building blocks of proteins) to glucose leads to the production of ammonia, which in turn is converted to urea and excreted in the urine.

HIGH PROTEIN DIETS AND KIDNEY FUNCTION
High protein diets increase glomerular filtration rates, which increases the pressure within the glomerulus and may cause damage in susceptible people. High protein diets also increase urea production. On the other hand, lower protein diets decrease the pressure within the glomerulus and produce less urea.

The highest quality evidence available to date suggests that high protein diets do not have a negative effect on the glomerulus in people with healthy kidneys as the glomerulus is able to cope with the increased pressure and higher urea content.

However, in people with nephropathy/chronic kidney disease, the increased glomerular pressure caused by a high protein diet may lead to increased protein (e.g., albumin) loss in the urine and consequently increase the rate of progression of kidney disease. Therefore, a lower protein diet of 0.6–0.8 per kg body weight is generally recommended to people with existing nephropathy/chronic kidney disease. The problem is, chronic kidney disease develops over many years without causing any symptoms, so some high-risk people (e.g., people with diabetes) may have the condition but not know it.

Finally, for people with nephropathy/chronic kidney disease, approximately half of the proteins should come from plant sources (e.g., beans, lentils, chickpeas, etc...), as there is some evidence that they place less stress on the kidneys than animal sources.

Read more:

GOOD CARBS FOOD FACTS

BULGUR
Making wheat into bulgur (also spelled bulgar, bulghur, burghul and bourghul) has been an integral part of Middle Eastern cuisine for thousands of years. These days, you can still see villagers preparing it the traditional way: boiling the wheat in huge pots, spreading the cooked berries or groats over flat roof tops to dry, then cracking the hardened kernels into coarse pieces and sieving them into different sizes. Don’t confuse it with cracked wheat, which is simply that, and can take up to an hour to cook.

BULGUR
This versatile, nutty-tasting, wholegrain is available in supermarkets, natural/organic health food stores and Middle Eastern produce stores. If you are lucky, you’ll have a choice of grades – fine (#1), medium (#2), coarse (#3), and very coarse (#4). You can make pilafs with medium, coarse, and very coarse bulgur. Tabbouleh and kibbe are best made with fine bulgur. As it’s been parboiled, it needs little cooking and, in most cases, nothing more than a good soak in hot water. Check out the manufacturer’s instructions.

Sources: AusFoods, 2019 and The Good Carbs Cookbook (Murdoch Books)

THE GOOD CARBS KITCHEN

LAMB, FETTA AND BULGUR MEATBALLS
0:25 Prep • 0:45 Cook • 6 Servings • Family fare

INGREDIENTS
500g (1lb 2oz) lean minced (ground) beef
1 large onion, finely chopped
⅔ cup (90g/3oz) crumbled fetta
2 tablespoons chopped mint
1 teaspoon ground cinnamon
1 cup (175g/6oz) fine bulgur
2 garlic cloves, crushed salt flakes and freshly ground pepper
¼ cup olive oil
Extra 3 large onions, thinly sliced 400g (14oz) can chopped tomatoes
1 cup water

METHOD
Put the mince, chopped onion, fetta, mint, cinnamon, bulgur, and half the garlic in a bowl with salt and pepper to taste. Clump the mixture together with your hands to mix well and then cover and set aside for 1 hour. Scoop the mixture and shape into small rounds about the size of golf balls.

Heat the olive oil in a deep non-stick pan and then add the sliced onion and cook for about 7 minutes or until the onions are soft but not coloured. Stir in the remaining garlic and cook for a further 1 minute. Add the tomatoes including the juice, with the water and salt and pepper to taste. Bring the mixture to a gentle simmer and then place the meatballs evenly on top. Pour in enough water to come about two-thirds of the way up the contents of the pan. Cover the pan, reduce the heat and gently simmer for about 35 minutes or until the meatballs are tender and cooked.

NUTRITION
Per serve 1650kJ/ 395 calories; 26g protein; 21g fat (includes 7g saturated fat; saturated : unsaturated fat ratio 0.5); 23.5g available carbs (includes 5g sugars and 18.5g starch); 6g fibre; 295mg sodium; 610mg potassium; sodium : potassium ratio 0.5

RECIPE
The Good Carbs Cookbook, Murdoch Books.

ROSEMARY LAMB AND VEGETABLE KEBABS WITH LEMON CRACKED WHEAT
0:30 (+ 2 hours marinating and 15 minutes cooling) Prep • 0:30 Cook • 4 Servings • Family fare • Barbecue

INGREDIENTS
12 rosemary stems
1½ tablespoons olive oil
2 garlic cloves, crushed
2 tablespoons lemon juice
½ teaspoon cracked black pepper
500g (1lb2oz) lean lamb, cut into 3cm (1¼in) cubes
250g (9oz) small button mushrooms
1 large yellow capsicum (pepper), cut into 3cm (1¼in) pieces
1 large red onion, cut into wedges
3 small zucchini (courgettes), thickly sliced
250g (9oz) cherry tomatoes lemon wedges, to serve

Lemon cracked wheat
1 cup cracked wheat
2 tablespoons lemon juice
2 teaspoons grated lemon zest
2 spring onions (scallions) finely chopped
1 large handful parsley leaves, finely chopped

METHOD
Remove three-quarters of the leaves from the base of each rosemary stem. (If rosemary stems are unavailable, wooden or metal skewers can be used. Soak wooden skewers in water for 30 minutes before use to prevent them from burning during cooking.)

Finely chop one-third of the leaves, discarding the remaining leaves, and set the stems aside. Place the chopped rosemary, oil, garlic, lemon juice and pepper in a glass bowl and mix to combine. Add the lamb and stir to coat, then cover and refrigerate for 2 hours.

Meanwhile, to make the lemon cracked wheat, bring 1¼ cups water to the boil in a saucepan. Add the cracked wheat, reduce the heat and simmer for 15 minutes or until the liquid has been absorbed. Fluff the cracked wheat with a fork, then transfer to a bowl to cool for 15 minutes. Fold in the lemon juice, lemon zest, spring onions and parsley. Cover and refrigerate until needed.

Preheat a chargrill pan or barbecue plate to medium. Thread the lamb, mushrooms, capsicum, onion, zucchini and tomatoes onto the rosemary stems. Cook the kebabs, turning occasionally, for 8-10 minutes or until done to your liking. Serve the kebabs with the lemon cracked wheat and lemon wedges.

NUTRITION
Per serve 2070kJ/ 395 calories; 37g protein; 16g fat (includes 4g saturated fat; saturated : unsaturated fat ratio 0.33); 43g available carbs (includes 7g sugars and 36g starch); 13g fibre; 100mg sodium; 1280mg potassium; sodium : potassium ratio 0.08

RECIPE
Reversing Diabetes, Murdoch Books.

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1 December 2019

GI News - December 2019

FOOD FOR THOUGHT

FOOD, DIET AND HEALTH: HOW YOU CAN CHECK THE EVIDENCE
Low carb diets. Low fat diets. Owning a dog. Eating leafy greens. Fermented foods. Dairy foods. Eggs. Salt. Sugar. We are bombarded with conflicting messages about food, diet and health in the media and on-line. Universities and research organisations keen to promote their staff and their findings in turn bombard the media with often inflated press releases. How do we work out who or what to believe? In Food for Thought, Dr Alan Barclay explains the different kinds of evidence and how compelling it is, or isn’t.

Evidence pyramid

THE STUDY: HOW COMPELLING IS THE EVIDENCE?

1. RANDOMISED CONTROLLED TRIALS (RCTS) ARE CONSIDERED THE “GOLD STANDARD”, providing the highest level of evidence, as they can prove that intervention A improves health outcome B, while all other known factors (known as confounders such as age, gender, body mass index, etc.) have been accounted for by the randomisation process. The process of studying people tends to improve their health independent of the intervention itself, because people know that they are being monitored and are more conscious of their health, and are consequently being more careful about what they eat and drink, so having a control group is vital. Only randomised controlled trials are able to show that a particular intervention causes a particular outcome.

2. OBSERVATIONAL STUDIES PROVIDE MEDIUM LEVEL EVIDENCE because scientists are simply observing and measuring people’s behaviour at a point in time, or over a particular time frame, without randomising them to groups and providing different dietary interventions. The best epidemiological evidence comes from large prospective cohort studies where large groups (typically thousands) of people have a medical check-up, their dietary patterns are measured, and they are followed up regularly for long periods of time (e.g., 5–25 years).

Observational studies can’t provide as high a level of evidence as RCTs can as it is not possible to control for all confounders (e.g. people who are already overweight may drink more beverages than those who aren’t, as fluid requirements are proportional to body size, and being overweight is an independent risk factor for developing many chronic diseases), and our tools of observation (e.g. a food frequency questionnaire for measuring a person’s usual food and drink intake) are imperfect. Observational studies are only able to prove that event A is associated with outcome Z. It’s possible that unknown or unmeasured intermediary factors (B, C, D, E, etc) are involved. They are not able to prove that event A causes outcome Z – only RCTs can.

3. ANIMAL STUDIES ONLY PROVIDE LOW LEVELS OF SCIENTIFIC EVIDENCE, however, they can be used to generate hypotheses that can be tested in human populations (either using RCTs or observational studies) and to investigate hypothesised physiological mechanisms in experiments that cannot be ethically conducted in people. They are also used to determine the toxic dose of novel ingredients, like food additives, for example, and results are extrapolated to people using a large safety factor (typically 100 x).

HOW SCIENTISTS REVIEW EVIDENCE: 3 THINGS YOU NEED TO KNOW 1. SYSTEMATIC LITERATURE REVIEWS are based on careful searches of scientific databases (e.g., PubMed, EMBASE, CINAHL, and Cochrane Library) with pre-determined search terms looking for all of the research published on a particular topic over a long period of time (ideally with no time constraints). Once all studies have been identified, researchers then go through each paper’s reference lists to make sure as best as possible that they have not missed any additional evidence. The data from each paper is then extracted and the results summarised in a table. The quality of each study is also rated or graded. Strong conclusions can be drawn from the summarised data.

2. META-ANALYSES can be performed when three or more similarly designed studies on a particular health outcome have been published in scientific journals. The outcome data from each study is entered into specialised software and weighted according to the study size and statistical significance. A final summary statistic is given that indicates whether an intervention is effective, and if so, how effective.

3. SYSTEMATIC LITERATURE REVIEWS AND META-ANALYSES OF RANDOMISED CONTROLLED TRIALS are considered the highest level of evidence. Cochrane reviews are a good example of this method. You can also do systematic reviews and meta-analyses of observational studies. However, because the underlying study design is not as robust as the randomised controlled trials, they are not considered to be as high a level of evidence as a Cochrane review, for example.

WHAT DOES IT ALL MEAN?
If the latest study broadcast in the news is:

A systematic literature review and meta-analysis of randomised controlled trials then the results are worth taking notice of if the people involved are similar to you, and live under similar circumstances.
A systematic literature review and meta-analysis of observational studies then the results are interesting, but a randomised controlled trial in humans that studied the same effect would be necessary to prove that the relationship was causal.
A systematic literature review and meta-analysis based on an animal study or in vitro (test-tube) study, then more research in people is needed to prove the hypothesis.

Source: www.dralanbarclay.com

WHAT’S NEW?

3 FIXES FOR A MEDIA DIET OF QUESTIONABLE SCIENCE
Will leafy green vegetables prevent dementia? Or does living near heavy traffic cause it? ConscienHealth’s Ted Kyle summarises John Ioannidis’ JAMA opinion piece describing our woeful current media diet of questionable science and minor issues, while serious and substantial health concerns get little attention.

Mad scientist
1. FOCUS ON BIGGER ISSUES
Scientific articles are getting more attention these days in the media. Ioannidis looked at the top 100 papers ranked by how much media attention they received. Altimetric scores were the measure. He found roughly half of the stories dealt with health and lifestyle. But the focus was mostly on trivial issues like coffee’s effect on lifespan. Even if it’s real, it’s not really big. Pointless arguments about fats versus carbs are big too.

Ioannidis says the answer is obvious. Focus on bigger issues, like tobacco and obesity. Those subjects received relatively little attention, he said. He did find one bright spot, though. Exercise is both important for health and amply covered in the media.

2. FOCUS ON CLEAR RESULTS
Because scientific controversies get so much attention, the public gets many conflicting messages. For example, Ioannidis pointed to recent controversial papers regarding red meat. Media attention, as measured by Altimetric, went sky high on these studies.

This kind of food fight is unhelpful, he writes: “Some expert advocates in these fields have a large number of followers in social media that broadcast their beliefs and attack opponents as being unethical, conflicted individuals. Perhaps this behavior is based on good intentions (e.g., to save lives), but heated advocacy is unsuitable for thoughtful, disinterested scientific exchange. It seems more akin to religious dedication to intolerant sects. Promoting such conflicts in the media offers little public benefit.”

3. STOP HYPING OBSERVATIONAL FINDINGS
Most of the high-scoring health and lifestyle articles were based on observational research. What’s more, those observational studies attract extreme news coverage. More so than randomized, controlled studies with null results. In other words, once a supposition arises from a weak observational study, even a well-controlled study might not kill it.

Ioannidis says that observational research should be rare in high-impact journals (like JAMA). Instead, they should appear mostly in journals for specialized audiences, with appropriate caveats. Press releases for such studies should fade away.

Sensation has always sold newspapers. And today, it provides great clickbait. But serious health journalists can do better. They would do well to pay attention to Ioannidis.

Read more:

ConscienHealth News
Click here for the Ioannidis viewpoint in JAMA.

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1 February 2020

GI News - February 2020

FOOD FOR THOUGHT

WHAT’S NEW?

PERSPECTIVES WITH DR ALAN BARCLAY

DIABETES CARE

YOUR GI SHOPPING GUIDE

GOOD CARBS FOOD FACTS

THE GOOD CARBS KITCHEN

COPYRIGHT AND PERMISSION

1 January 2020

GI News - January 2020

FOOD FOR THOUGHT

WHAT’S NEW?

PRODUCT REVIEW

PERSPECTIVES WITH DR ALAN BARCLAY

GOOD CARBS FOOD FACTS

THE GOOD CARBS KITCHEN

COPYRIGHT AND PERMISSION

1 December 2019

GI News - December 2019

FOOD FOR THOUGHT

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