GI News—September 2014

• Sugars, sweeteners and tooth decay;
• Dr Alan Barclay on alternative sweeteners for weight loss and BGLs; 
• Prof Jennie Brand-Miller on low-carb diets; 
• Emma Sandall talks to Wes Doyle about personal training benefits; 
• Nicole Senior checks out honey and Anneka Manning bakes a batch of honey and nut muesli (granola) bars for lunch boxes; 
• Ottolenghi's roasted sweet potatoes and fresh figs.  

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

Keeping it off. 
From high protein to low-fat, from eating right for your type to eating like a caveman, any calorie deficit diet (burning more calories than you eat) will help you lose weight. The main game is maintaining that weight loss – converting your old eating and lifestyle patterns into new and healthy ones you can live with for a lifetime.

Don’t be tempted to measure success by the number of dress sizes dropped or belt notches tightened. It’s a real achievement to lose 5% of your initial weight in whatever time it takes. If you do want to lose a bit more, take the pressure off for 3 months before you restrict calories again. This will give your body time to adjust to its new engine size. And it will give you practice in learning to listen to your body’s natural signals for feeling hungry and feeling full. An alternating weight loss/weight maintenance pattern like this will help you become a full-time weight maintainer. In theory, preventing weight regain should be a lot easier than losing weight. But, if anything, it is the most critical stage. Regaining weight after you have been on a diet is all too easy. Here’s why.

Your body fights back. Food-seeking behaviour is wired into our brains to make sure we survive when our energy intake is low. So, despite your good intentions, hormones fly into action to stimulate your appetite and encourage food intake.

At your new weight, your body is a smaller engine and it needs less fuel (calories) to run. And if you lost weight rapidly and without exercising, then chances are you also lost proportionally more muscle, making your engine size even smaller.

Another reason why it can be so hard to maintain weight loss is that your resting metabolic rate (RMR) has dropped so your energy expenditure declines by as much as 10%. This is how nature helps animals adapt to the environment in which they live. If food is scarce, the body reduces engine revs so it can get by with less fuel.

The aim of the international PREVIEW study currently underway is to find out the best methods (through diet, exercise and behavioural modification) of helping people with pre-diabetes maintain weight loss and keep diabetes at bay. “Volunteers for this study will have their own team of professionals dedicated to their weight loss and weight loss maintenance, all free of charge,” says Prof Jennie Brand-Miller. “If you live in Sydney (Australia) and are interested in taking part, see below for details for applying or for finding out more about it.”

What's new?

Obesity in grizzlies, a natural adaptation to hibernation. 
Researchers writing in Cell Metabolism report that as grizzly bears become obese in preparation for winter and hibernation, they respond normally to insulin – which prevents the breakdown of fatty tissue. But during hibernation, their insulin effectively stops working. This insulin resistance allows the bears to break down their fat stores throughout hibernation (they don't eat, drink or defecate for up to seven months). They survive on their fat. When they wake up and start eating again, they respond normally to insulin.


Pic: Kevin Corbit

The insulin levels in their blood do not change. The cells that insulin communicates with turn on and off their ability to respond to insulin. When the bears are most obese, they are also the most insulin sensitive, and they become this way by shutting down the activity of a protein called PTEN in their fat cells. “This is in contrast to the common notion that obesity leads to diabetes in humans,” says Dr. Kevin Corbit, of Amgen, Inc. The researchers also found that grizzlies somehow store all of the fuel they need during hibernation in fat tissue, not in liver and muscle, which are common places for fat to accumulate in other animals with obesity.  

Chew on this. 
People with diabetes are at greater risk of developing gum disease (gingivitis and periodontal disease) than people who do not have diabetes. Gum disease is a bacterial infection in the mouth can cause blood glucose levels to rise. The link is inflammation. The build-up of inflammatory substances in the blood can worsen chronic health conditions.

A recent study that involved checking the health and dental insurance records of 338,891 people with one of five conditions (type 2 diabetes, heart disease, cerebrovascular disease, rheumatoid arthritis and pregnancy), found that periodontal therapy can improve health. The researchers report that within 4 years, people who had treatment for gum disease had lower medical costs and fewer hospitalisations compared with people who didn’t have treatment. For example, people with cardiovascular disease and diabetes who had the gum disease treatment had health-care costs that were between 20% and 40% lower.

Gum disease is usually caused by a build-up of plaque on teeth. One of the common signs is bleeding gums. Tips for maintaining healthy teeth and gums include:

• Brushing twice a day with a soft, small-headed toothbrush. 
• Carefully flossing each day. 
• Visiting your dentist every six months for a check up and clean. 
• Eating a healthy diet including plenty of low GI whole grains. 
• Managing your blood glucose levels if you have diabetes. 
• Quitting smoking if you do – people who smoke are 4 times more likely to develop gum disease than people who don’t.

Sugars, sweeteners and tooth decay. 
This is an edited extract from the Ultimate Guide to Sugars and Sweeteners  reproduced courtesy The Experiment Publishing (New York). 

Sugars and starches (highly fermentable carbohydrates) can all contribute to tooth decay, but overall, with the exception of lactose, sugars appear to be more likely to promote tooth decay (be cariogenic) than starches. Whether or not a sugary food or drink will cause tooth decay depends on:

• How much and how often you consume the food or drink 
• The food’s acidity and its buffering power (that’s the food’s ability to minimize the overall acidity) 
• The food’s consistency (texture) and its retention in your mouth 
• Your overall eating and drinking pattern (i.e., how much and how often you eat and drink). 

Your susceptibility to developing tooth decay also depends on your mouth bacteria, the flow rate and composition of your saliva, and whether or not you live in an area that has a fluoridated water supply and/or use fluoride toothpaste.

Consuming added sugars and foods high in added sugars frequently, is clearly associated with an increased risk of developing dental caries, independent of the actual amount you eat or drink. Rather than nibble or sip on them throughout the day, you are probably better off downing them in a single sitting and then brush your teeth with fluoride toothpaste.

Polyols (sugar alcohols) are not well fermented by oral bacteria, nor do they have the acidifying impact on plaque that most sugars do and they generally do not promote tooth decay. Some studies have even suggested that xylitol may be anti-cariogenic, as it has antibacterial properties that act on some of the fermenting bacteria found in plaque.

Nonnutritive sweeteners (NNS) from aspartame to stevia are also not well fermented by oral bacteria, nor do they have the acidifying impact on plaque that most sugars do. So, generally they do not promote tooth decay. However, it comes down to how they are used. For example, “diet” soft drinks that contain NNS are acidic, which means they can still, in theory, contribute to dental erosion. In addition, because they are usually so sweet, most NNS are diluted and bulked up for tabletop use. The bulking agent is frequently maltodextrins, which can be used as a fuel by oral bacteria. So, in theory, some nonnutritive tabletop sweeteners may contribute to tooth decay.

Nicole's Taste of Health

Honey-bunch (you know I love you).
Honey is made by bees after gathering nectar from flowers. It’s a beautiful image and a lovely example of the generosity of Mother Nature (or the greed of man, depending on your world view). It’s also a great example of how food can be regional. Much like winemakers talk of the “terroir’ (soil, climate, topography) influencing the characteristics of wine, the characteristics of honey are influenced by the flowers within gathering distance of the hive. Honey ain’t honey, and aficionados will tell you there are as just as many tasting notes in honey as there in wine. But even the least honey-curious will know there are mild honeys and strong honeys, despite many common brands producing a consistent middle-of-the-road flavour profile through blending.
 

Honey, as they say, is “so hot right now” due to the trend of growing your own food. From the mega-trend of growing veggies and herbs in your backyard or balcony is emerging the DIY apiculture (bee-keeping) movement. There are now services  such as Sydney’s Urban Beehive that will install a hive at your place and help keep your buzzing friends healthy, happy and producing your own honey “à la maison”. And there is this book for beginners on the subject. Unfortunately, small scale beekeeping is also encouraged to help save our honey bees, which are under threat from all sides: primarily from colony collapse disorder, but there are other problems as well such as varroa mite and in Australia the risk of Asian bees breeching our borders. Suffice to say we’re all in trouble if the bees disappear because of their pivotal role in pollinating food crops.

From a health perspective, overall honey is no better than table sugar (sucrose) and nutritionally they are very similar. Regular sugar has a glycemic index (GI) or around 65, while the GI of honey can vary quite a bit depending on the proportion of fructose (higher fructose levels means lower GI) and the presence of phytochemicals (including flavonoids) from the flower nectar that appear to slow down absorption and lower the GI. Generally, darker coloured, stronger flavoured honey contains more phytochemicals. Most common blended honeys can have the same or higher GI than cane sugar (sucrose), but some pure wildflower honeys (where bees collect nectar from only one type of flower) have a lower GI, probably due to higher fructose content. For example, Australian eucalyptus honeys such as red gum, yellow box or ironbark have low GI.

The clever thing about honey is that besides tasting wonderful it has all kinds of medicinal uses. It’s great for soothing sore throats (traditionally mixed with lemon juice), more effective than over-the-counter medicines for children’s coughs, and special “active” honeys such as Manuka from New Zealand are used to treat wounds, stomach ulcers, gastroenteritis and fungal infections.

In terms of culinary uses, the options are many and varied, but sometimes the simple things are the best. Fresh wholegrain toast with honey is a reliable classic, as is porridge with a golden drizzle. Personally, I think peanut butter is wonderful with honey on toast. Chinese honey soy chicken is a lovely dalliance between sweet and savoury and exemplifies how honey goes so nicely with meats of all kinds: honey glazed ham is but one famous example (although strangely I can’t come at honey served on bacon as they do in Canada). Naturally honey is gorgeous in baked goods and delicious in hot or cold drinks such as smoothies, cordials, teas and coffee. All this delight from an insect: how wonderful.

Buon appetito!


Nicole Senior is an Accredited Nutritionist, author and consultant who strives to make healthy food taste terrific. You can follow her on Twitter or Facebook or checkout her website

In the GI News Kitchen

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

 
 
Honey and Nut Muesli Bars. 
This recipe is based on one from Supergrains by Chrissy Freer, published by Murdoch Books – it is a particularly popular recipe that we teach in our Healthy Kids Lunch Boxes BakeClasses. Knowing what is going into your muesli bars is the key – it makes them so much healthier and tastier. For a nut-free version, substitute the almonds with 1/3 cup sunflower seeds or pepitas (pumpkin seeds).

• Makes: about 24 
• Preparation time: 15 minutes 
• Baking time: 45-55 minutes 

¾ cup good-quality honey
½ cup sunflower oil or light olive oil
2½ cups traditional rolled oats (oatmeal)
1½ cups puffed millet
½ cup desiccated coconut
1½ teaspoons ground cinnamon
1/3 cup sweetened dried cranberries
½ cup currants
½ cup raw almonds, coarsely chopped (see Baker’s Tips)


Photo: Bree Hutchins

Preheat the oven to 140°C/320°F. Lightly grease a shallow 20 x 30cm (8 x 12in) baking tin and line the base and sides with non-stick baking paper.
Put the honey and oil in a small saucepan over medium heat and stir until well combined and heated through. Set aside.
Put the rolled oats, millet, coconut, cinnamon, cranberries, currants and almonds in a large bowl and mix to combine evenly. Add the honey mixture and stir to combine. Using damp hands, press the mixture firmly into the lined tin. Press the mixture with the back of a spoon to make the surface smooth and even.
Bake for 45–55 minutes or until the surface is dark golden brown all over. Cool completely in the tin before cutting into 24 bars.
Store: These muesli bars will keep in an airtight container for up to 1 week. For extra-crisp muesli bars, store in an airtight container in the fridge.

Per serve (one piece)
725kJ/ 173 calories; 2g protein; 8.5g fat (includes 2g saturated fat; saturated:unsaturated fat ratio 0.3); 21g available carbs (includes 12.5g sugars and 8.5g starch); 2g fibre

Anneka's extra tip for using honey in your baking
If you would like to replace the sugar (such as granulated white, caster or brown) with honey in a baking recipe, simply use the same amount in weight. However, also remember to reduce the amount of liquid ingredients (such as milk or water) in the recipe by 1 tablespoon for every ½ cup sugar to account for both the higher moisture level in the honey as well as its intense sweetness.

Ottolenghi
Roasted sweet potatoes and fresh figs. 
This unusual combination of fresh fruit and roasted vegetables is one of the most popular at Ottolenghi. It wholly depends, though, on the figs being sweet, moist and perfectly ripe. Go for plump fruit with an irregular shape and a slightly split bottom. Pressing against the skin should result in some resistance but not much. Try to smell the sweetness. The balsamic reduction is very effective here, both for the look and for rounding up the flavours. To save you from making it you can look out for products such as balsamic cream or glaze. Serves 4.

4 small sweet potatoes (1kg/2lb 2oz in total)
5 tbs olive oil (1/3 cup/75ml)
2 tbs (40ml) balsamic vinegar (you can use a commercial rather than a premium aged grade)
20g (¾oz) caster sugar
12 spring onions, halved lengthways and cut into 4cm (1½in) segments
1 red chilli, thinly sliced
6 fresh and ripe figs (240g/½lb in total), quartered
150g (5oz) soft goat’s cheese, crumbled (optional)
Maldon sea salt (optional) and black pepper



Preheat the oven to 240C/220C Fan/Gas Mark 9.
Wash the sweet potatoes, halve them lengthways and then cut each again similarly into 3 long wedges. Mix with 3 tablespoons of the olive oil, 2 teaspoons of salt and some black pepper. Spread the wedges out on a baking sheet, skin-side down, and cook for about 25 minutes until soft but not mushy. Remove from the oven and leave to cool down.
To make a balsamic reduction, place the balsamic vinegar and sugar in a small saucepan. Bring to a boil then reduce the heat and simmer for 2–4 minutes, or until it thickens. Be sure to remove the pan from the heat when the vinegar is still runnier than honey; it will continue to thicken as it cools. Stir in a drop of water before serving if it does become too thick to drizzle.
Arrange the sweet potatoes on a serving platter. Heat the remaining oil in a medium saucepan and add the spring onions and chilli. Fry on a medium heat for 4–5 minutes, stirring often, making sure not to burn the chilli, and then spoon the oil, onions and chilli over the sweet potatoes. Dot the figs among the wedges and then drizzle over the balsamic reduction. Serve at room temperature with the cheese crumbled over, if using.

Per serve (without the goat’s cheese)
1890kJ/ 451 calories; 11g protein; 24g fat (includes 6g saturated fat; saturated:unsaturated fat ratio 0.33); 47g available carbs (includes 25g sugars and 22g starch); 6.5g fibre

Recipe reproduced with permission from Jerusalem by Yotam Ottolenghi and Sami Tamimi (Random House) – available from good bookshops and online.
 
Johanna's Italian Kitchen
American dietitian and author of Good Carbs, Bad Carbs, Johanna Burani, shares her favourite recipes with a low or moderate GI. For more information, check out Johanna's website. The photographs are by Sergio Burani. His food, travel and wine photography website is photosbysergio.com.



Lavender-scented blueberry jam. 
There is honey. And then there is lavender honey from Assisi. There are blueberries. And then there are blueberries from the southern shore towns of New Jersey. Put these two magnificent foods together in a pot for about an hour, add a hint of lemon and you’ll have a hauntingly delicious jam (with a moderate GI value). All of this from just three wholesome, natural ingredients. When our blueberries are in season, I buy large quantities and make this jam and hope it lasts until the season returns again. Jam may be stored in the refrigerator for a few weeks, or in the freezer for one year or it can be canned using traditional methods. Makes 10 cups and provides eighty 2-tablespoon servings (30ml) 

6 pints fresh blueberries (approximately 5 lb/2¼ kg)
2 cups lavender honey 
1 tbs (15ml) fresh lemon juice 
Zest ½ lemon



Remove stems from the blueberries. Wash the blueberries and pat them dry. Place them in a large enamelled cast-iron casserole (dutch oven). Add the lemon juice and zest. Mix well. Bring the blueberry mixture to a boil (about 10 minutes), then reduce heat to medium low and cook for approximately 45–50 minutes. Stir occasionally, scraping down the sides of the pot. 

Per serve (2 tbs or 30ml) 
176kJ/ 42 calories; 0g protein; 0g fat; 10g available carbs; 1g fibre

Putting the Fun Back into Fitness with Emma Sandall

Personal training.
In this past year I have been discovering the simple pleasure of a gym workout – pulling and pushing exercises, which give you the chance to focus on training and recruiting specific muscles, thereby building strength and endurance. With weight training you are not only increasing strength, you are also increasing your basal metabolic rate, as, simply put, muscle burns more energy than fat. I have been having personal training sessions with Wes Doyle at Vision Personal Training Randwick, and he has taught me a great deal about strength and also about myself. I asked him about personal training and how he got started.

“Initially I started off as a client of Vision Personal Training Randwick," said Wes. "I was getting married, and I was very busy with my role as a national operations manager, travelling and working long hours. I’ve always been very active and wanting to own and run my own business. This career change combined my passions: business and fitness. Why the Vision program? It focuses on emotions, education, eating and exercise and provides clients with online tracking food and exercise diary. Here, we care when you don’t turn up, so we will call you; we care what your goal is; we care by making sure you are on a journey to getting results. The best thing about being a personal trainer is seeing people developing self confidence.”



Who are your clients and what are their goals? 
“Eighty percent of our clients are here for some form of weight loss, toning or sculpting. The remainder are people who see the value in being coached for a specific program. It’s a bit like a having a tennis coach, or business coach. There are not many people who are self motivated to do exercise, including me! Having a trainer helps you train at your maximum capacity, each and every time. Relapsing and falling off the wagon is normal, and is part of the journey. You need to stop thinking about the destination, and enjoy the small changes along the way.”

How long is a session and what does it entail? 
“A session is 30 minutes. What we do with a client at each session depends on their stage of change. At the start, we focus on the emotions around eating, education about what to eat, then a weekly food plan, and finally the exercise. Emotions, Education, Eating and Exercise. For best results, we recommend having at least two sessions a week (that’s less than one percent of your week). It’s the 42 meals in the week that count the most, not the exercise.”

How do you keep people motivated?
“Everyone is different. Most people are on a journey, so we work with where they are at, and what encourages them to put one foot in front of the other each day. We’re here to give honest feedback and help them develop ways to move forward. Currently I train clients from 26 to 78. My personal passion is training businessmen. They are always too busy to look after their health.”

How do you filter fitness fads and the fact/fiction of new information?
“Always have the client’s readiness to change, goals, and capabilities front of mind. A 45-year-old mother of two won’t want to be doing a clean and press.

What is the most important tip about fitness you can give someone?
“Eat less, move more. It doesn’t have to be hard work, it needs to be smart. This is why we focus on education. PS – don’t Google, there are millions of confusing pages.”

Emma Sandall is an ex-ballerina turned fitness and health guru. She teaches and coaches dance, fitness and Pilates and writes and produces video for all things movement related. Emma runs Body Playground, a space to activate and inspire body and soul. Email: emma@bodyplayground.com.au

Update with Dr Alan Barclay

Sweet nothings? 
Artificial or non-nutritive sweeteners (NNS) have been around for over a century, helping people to enjoy sweet foods and drinks without the unwanted calories or carbohydrate that can contribute to weight gain on the one hand and raise blood glucose levels on the other when consumed in excess. Few would argue that NNS do not raise blood glucose levels. Some are suggesting that non-nutritive sweeteners may not actually help people lose weight. A new systematic review helps shed some light. First of all, let's look at the two major kinds of research study designs.

Randomised controlled trials (RCTs) are considered the “gold standard” research design as they can prove that intervention A causes health outcome B, while all other known factors (known as confounders) have been accounted for by randomisation. For example, two groups of people are given two different diets (X and Y) and their health status is measured over a period of several years. Individuals consuming diet X, which has a low GI, have a decreased risk of developing type 2 diabetes but individuals consuming diet Y, which has a high GI, increase their risk of developing diabetes. Using this example, we can conclude that high GI diets cause type 2 diabetes.

Observational studies. In these, large groups 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., 5-20 years). Unlike RCTs, observational studies can only provide evidence of statistical associations between foods/nutrients/dietary patterns and health – they cannot prove that something is actually caused by a particular food/nutrient/dietary pattern. Also, it is not possible to control for all confounders in observational studies, and our tools of observation (e.g., a food frequency questionnaire for measuring a person’s usual food intake) are imperfect.



Sweeteners and soft drinks. The recent systematic review by Paige Miller and Vanessa Perez in the United States looked at all published randomised controlled trials and observational studies and body weight. They found that use of low/no calorie sweeteners led to small but statistically significant improvements in body weight, body mass index (BMI), fat mass and waist circumference in randomised controlled trials. In prospective cohort studies, however, use of low/no calorie sweeteners was not associated with improvements in body weight or fat mass, but was in fact significantly associated with slightly higher BMI. They concluded “that substituting LCS [low/no calorie sweeteners] options for their regular-calorie versions results in a modest weight loss, and may be a useful dietary tool to improve compliance with weight loss or weight maintenance plans”.

Overall, the evidence from the randomised controlled trials is more powerful than the evidence from the observational studies.

Along similar lines, a new systematic review investigating the association between regular and NNS sweetened drinks in observational studies found that both were modestly associated with the risk of developing type 2 diabetes, with regular varieties being slightly more strongly associated than their NNS alternatives. The reason that NNS sweetened foods and drinks are associated with weight gain and risk of type 2 diabetes could be that people usually drink regular or NNS beverages when consuming other highly processed foods (crisps, chips (French fries), pizza, fried fish, chicken, burgers, savoury snacks, pastries, etc...), or alcohol (scotch and diet coke anyone?), and that it’s the overall poor dietary pattern that's really to blame, not the sweeteners themselves.

The bottom line. Current scientific evidence indicates that non-nutritive sweeteners are safe to consume in moderate amounts, and that they can be useful for reducing some people's consumption of added nutritive sweeteners, helping them to lose weight, provided they do not treat themselves with other highly processed foods and drinks as a reward for avoiding the added sugars!



GI Symbol Program
Dr Alan W Barclay PhD,
Chief Scientific Officer,
Glycemic Index Foundation (Ltd):
alan.barclay@gisymbol.com
www.gisymbol.com

GI testing
Fiona Atkinson,
Research Manager,
Sydney University Glycemic Index Research Service:
sugirs.manager@sydney.edu.au
 
GI database
www.glycemicindex.com

Q&A and New Product News

Prof Jennie Brand-Miller answers your questions. 



If carbs increase my blood glucose levels, wouldn’t a low-carb diet (or even a very low one) make better sense for managing it? 
I am often asked about this. In theory, a low-carbohydrate diet seems a logical choice if your aim is simply to reduce blood glucose levels. But presumably your goal is long-term, optimum health with good glycemic control and reduced risk of chronic disease. If so, very low-carbohydrate diets need a little caution because you will be missing out on the micronutrients, antioxidants, phytochemicals and fibre that plant foods (fruit, starchy vegetables, legumes and grains) provide. In studies that tracked individuals for long periods of time, those eating the least amount of carbohydrate and very high amounts of protein had almost double the risk of dying during the follow up period, especially from cardiovascular disease. You might also find this very low carbohydrate diet so extreme that it's hard to lead a normal social life and enjoy eating because you have to exclude so many favourite foods (think potatoes, oranges and honey).

The authors of a critical review recently published in Nutrition in July 2014, call for a complete reappraisal of dietary guidelines for diabetes management and they present evidence for dietary carbohydrate restriction as the first approach in diabetes management. Some of these authors have themselves adopted a very low-carb diet to manage their blood glucose. I do think there is some truth in the benefit of modest reductions in carbohydrate intake (to say 40–45% energy). However, I’m not in favour of further reduction because it’s just too hard for most people to comply. Conversely, I'm not recommending an increase in carbohydrate intake to 65% of calories to someone with diabetes; it strikes me as "pushing the envelope" too far.

Apart from being difficult to sustain over the long term, a major concern with very low-carb diets is the potential for high saturated fat intake and its health repercussions. Even a single meal high in saturated fat can have an adverse effect on blood vessels by inhibiting vasodilation, the normal increase in the diameter of blood vessels that occurs after a meal. In meta-analyses, the short-term and long-term effects of a low carb diet includes an increase in LDL cholesterol. Compounding this, there may be a low intake of micronutrients that are protective against chronic disease. For this reason, a vitamin and mineral supplement is usually an essential accompaniment to a low carb diet.

I believe that very low-carb diets are unnecessarily restrictive (bread, potato, rice, grains and most fruits are off the menu) and may spell trouble in the long term if poor quality food takes the place of high quality carbohydrate. Modestly higher protein/low GI diets strike me as a happy medium between low fat and low carb-diets – you can have your carbs, but choose them carefully.

Product News 
World’s Best Diet.
This is a diet without deprivation that’s designed to satisfy the senses as well as the stomach. The book is based on the Diogenes study, one of the world’s largest dietary studies, and combines a higher protein intake with low-GI carbs, which has been proven to prevent weight regain creep. Explaining how it works, the authors say: “Our research, and that of other nutrition scientists, has shown that the body’s food regulation mechanisms are quite complicated, but that one thing is quite simple: in order to sustain our weight over periods of months and years, we have to stay satisfied and enjoy food – preferably three times a day. A food culture that leaves out whole food groups is simply too restrictive for enjoyment and long-term sustainability ... The less restrictive a dietary change is, and the less prohibitive of common foods it is, the easier it is to stick to. The ‘state of slim’ requires enjoyment, and this is wonderful news for dieters everywhere.”

The authors have carried out numerous studies over the past 20 years looking at ways to create greater satiety with fewer calories and without eliminating entire food groups. They write: “If we can eliminate constant hunger pangs and create enjoyable satiety, we have the best defence against overeating. In other words, the solution to successful long-term weight control is to feel full and satisfied at the end of eating, and then hunger should take hours to return.” The five key principles of World’s Best Diet are:

• Eat fewer carbohydrates and more protein than you currently eat. The ideal ratio of carbs to protein is 2:1. 
• Opt for low-GI carbohydrates instead of high GI ones. 
• Limit your intake of saturated fat. 
• Choose low-fat dairy products. 
• Eat whole-grain products, the less refined the better. 

 —World’s Best Diet by Christian Bitz and Professors Jennie Brand-Miller, Arne Astrup and Susan B. Roberts (Penguin Australia) is available from bookshops and online. It includes menu plans and 92 recipes and is fully photographed throughout. 

Backyard Bees. 
“Beevangelist,” Doug Purdie, has written a comprehensive guide to keeping bees. He reckons that once introduced to the charms of beekeeping and the taste of warm honeycomb direct from the hive, you’ll be hooked. His book covers installing and maintaining a hive through the seasons and includes stories from enterprising beekeepers from all walks of life plus 20 recipes for all that honey you’ll be harvesting. Doug, along with his partner at The Urban Beehive, maintains more than 50 beehives on city rooftops, balconies, backyards and in community gardens around Sydney. He runs beginner beekeeping courses and is president of the Sydney branch of the Amateur Beekeepers’ Association.



—Backyard Bees by Doug Purdie (Murdoch Books) is available from bookshops and online.

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GI News—August 2014

• Nutrient density: Prof. Jennie Brand-Miller answers your questions;
• Alan Barclay discusses the role of family environment in the expression of diabetes genes; 
• Weight gain where there's a family history of type 2 diabetes; 
• Nutritional strategies for preventing and managing type 2 diabetes; 
• Focus on prunes. Nicole Senior checks out the benefits of prunes, Anneka Manning whips up a batch of prune and almond brownies and Chrissy Freer serves up baked barley puddings with port-poached prunes; 
• Taste Planner's mustard and rosemary pork with roast pears.  

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Food for Thought

It’s all in the family. 
The road to type 2 diabetes can run in the family. In fact, a family history of diabetes is a major risk factor. What are your odds? It’s estimated that having:

• one parent with diabetes doubles your risk 
• both parents with diabetes increases your risk up to six times 
• a brother or sister with type 2 diabetes increases your risk more than four times. 

Don’t be despondent. Even if type 2 diabetes or pre-diabetes runs in your family, there’s plenty you can do to keep diabetes at bay. For example, clinical trials have shown that three out of five people with pre-diabetes can avoid type 2 diabetes simply by improving their diet, losing a bit of weight (and keeping it off) and becoming (and staying) more active.

PREVIEW, an international study involving 8 different countries and 15 partners, is currently underway to identify the most efficient lifestyle intervention pattern for preventing type 2 diabetes in people who have pre-diabetes, are overweight or obese (i.e. at high risk). “The aim of this study is to find out the best methods (through diet, exercise and behavioural modification) of maintaining weight loss and keeping diabetes at bay. Volunteers for this study will have their own team of professionals dedicated to their weight loss and weight loss maintenance, all free of charge,” says Prof Jennie Brand-Miller.

“Here at the University of Sydney, we’re going to compare two diets and two forms of exercise. So first of all we will randomise eligible participants with pre-diabetes to either a high protein/low GI diet, or to the conventional healthy diet. Then we will split each dietary group into two again. One group will be doing the equivalent of 150 minutes a week of moderate intensity exercise, like a brisk walk. The other group will do something that’s a little bit more intense, it will involve puffing but they only have to do half as many minutes per week. So what we’re doing is we’re going to build up slowly with the help of exercise physiologists to doing, say, 15 minutes five days a week where you puff.

The 3-year study itself is in two parts. For the first 8 weeks (phase 1), we will get participants to lose about 8% of their body weight using meal replacement milkshakes – we provide all the milkshakes. Those who lose 8% of their body weight are then eligible for phase 2, the maintaining weight loss phase. We are trying to prevent our successful losers from putting the weight back on. If you live in Sydney (Australia) and are interested in taking part, see below for details for applying or for finding out more about it.” 

What's new?

Know your family medical history.
A family history of type 2 diabetes was associated with a higher incidence of diabetes reports a study in Diabetologia. The greatest risk was observed in those with two parents with type 2 diabetes and those whose parents had been diagnosed with diabetes at a younger age, an effect largely confined to a maternal family history.

Family history of diabetes increases the risk of pre-diabetes by 26 percent. 
Pre-diabetes can take two forms: impaired fasting glycaemia (IFG) where levels of glucose are higher than normal but not high enough to be classed as diabetes; and impaired glucose tolerance (IGT) where blood glucose levels are abnormal due to increased insulin resistance. When Fritsche and colleagues from the German Centre for Diabetes Research analysed the records of 8106 individuals who did not have type 2 diabetes, they found 2624 had IFG and/or IGT. When they went on to analyse whether having at least one first degree relative with diabetes was associated with pre-diabetes, they found that a family history of diabetes increased the risk for pre-diabetes by 26% when the analysis took account of age, sex, and BMI. Writing in Diabetelogia, they conclude: “We found that family history is an important risk factor for pre-diabetes, especially for combined IGT and IFG. Its relevance seems to be more evident in the non-obese.”

Weight gain when there's a family history of type 2 diabetes. 


Professor Lesley Campbell. 

Healthy people with a genetic predisposition to type 2 diabetes gain more weight overeating over the short term than their non-genetically-prone counterparts. In a 28-day study undertaken at Sydney's Garvan Institute of Medical Research, scientists set out to mimic the kind of overfeeding that typically takes place during feasting periods like Christmas. Seventeen (otherwise healthy) people with a family history of type 2 diabetes, along with 24 people without any family history, took part in the research. The groups were matched for age, weight and lifestyle. Each person was asked to eat 1250 calories (5230 kJ) a day beyond their energy requirements – all carefully calculated in advance. They were given a variety of high-fat snacks such as crisps, chocolate bars and dairy desserts to supplement their normal diets. Their weight, fat distribution and blood insulin levels were measured at the start of the project, after 3 days and at 28 days. On average, the people with a family history of diabetes gained over a kilogram more than the rest (3.4 kg as opposed to 2.2 kg) over 28 days. They also had more insulin circulating in their systems after only 3 days, before they showed any detectable difference in weight gain from the other group.

“It’s already well-known that relatives of people with type 2 diabetes are more likely to develop it themselves,” said Professor Campbell, senior researcher at Garvan and Director St Vincent’s Diabetes Services. “We wanted to challenge these individuals with overfeeding while they were still young and healthy, without any metabolic impairments. Our study shows just how quickly the body reacts to overeating, and how harmful it can be in susceptible people. While we expected differences between the two groups, we were surprised by the amount of extra weight the diabetes-prone group gained.”

At the end of the study, participants were helped to lose weight, with both groups being equally successful. The “biggest loser” came from the group with a family history of diabetes.

Nutritional strategies for preventing and managing type 2 diabetes. 

Professor Frank Hu. 

Writing in The Lancet, Professor Frank Hu and colleagues review the evidence on the dietary components and nutritional strategies for preventing and managing type 2 diabetes. “The quality of dietary fats and carbohydrates consumed is more crucial than is the quantity of these macronutrients,” they conclude. “Diets rich in wholegrains, fruits, vegetables, legumes, and nuts; moderate in alcohol consumption; and lower in refined grains, red or processed meats, and sugar-sweetened beverages have been shown to reduce the risk of diabetes and improve glycemic control and blood lipids in patients with diabetes. With an emphasis on overall diet quality, several dietary patterns such as Mediterranean, low glycemic index, moderately low carbohydrate, and vegetarian diets can be tailored to personal and cultural food preferences and appropriate calorie needs for weight control and diabetes prevention and management.”

Nicole's Taste of Health

A dark horse. 
I’m attracted to black foods. I’m not sure why: perhaps it because they are so unusual and mysterious? Perhaps it is because it is unlikely that something so unattractive and sinister looking can actually be edible? Just think Japanese nori (seaweed), eggplant, squid ink, black beans and Vegemite (yeast extract spread). But my all-time favourite black food is the humble prune. You’d just never expect these shrivelled little uglies to taste as good as they do, and their nutritional goodness is also surprising. This dark horse is actually a dried plum, which probably explains why they are low GI and such a rich source of nutrients and phytochemicals. Calling them dried plums also seems to make them sound so much more attractive, and goes some way to make up for their shortcomings in the looks department.



The best plum variety to dry into prunes is the Ente, developed by French monks in the thirteenth century, and the prunes are called D’Agen. They are a good source of vitamins A and C, and contain potassium, calcium and iron. But I suppose they are most famous for their effect on the bowels. Prunes are renowned for getting things moving and this is due to their fibre and natural sorbitol content. Both whole prunes and prune juice have provided relief to those suffering constipation for generations, and are the go-to natural cure recommended by just about everybody. Nowadays of course, we know they are high in FODMAPS (poorly digested carbohydrates) that have adverse effects for many people with IBS (Irritable Bowel Syndrome), but this is a small detail in their otherwise glowing report card.

Prunes are more than their goody-two-shoes reputation: they taste delicious and are marvellously versatile. Traditionally served at breakfast as compote or on top of cereal, they offer so much more than a healthy start to the day. They are compact and travel well making them the perfect snack on-the-go, especially mixed with nuts and particularly those with bitter flavour notes like walnuts and pecans which provide good contrast to the rich sweetness of the prunes. Their sweetness and gooey texture are ideal for making uber-trendy bliss balls (or protein balls), and add richness to cakes, loaves and slices, and especially yummy when partnered with cocoa (See Anneka’s delightful recipe below). Their slightly tart sweetness and exotic colour make them sensational in crumbles, puddings and tarts. And prunes work well in savoury dishes too: who could forget the retro-classic Devils on Horseback – prunes wrapped in bacon (there are those dark horses again). They also add contrasting sweetness to poultry stuffing, sauces for pork and game meats, tagines, chutneys and cheese platters.

I read on the Australian Prunes website that the French so love prunes, they often present a beautifully wrapped box of them as a gift instead of chocolates. I’m not sure they’d have quite the same impact elsewhere in the world. What about chocolate coated prunes? Now there’s a winner, and something like ‘D’Agen au chocolat’ has a lovely ring to it!

Buon appetito!


Nicole Senior is an Accredited Nutritionist, author and consultant who strives to make healthy food taste terrific. You can follow her on Twitter or Facebook or checkout her website

In the GI News Kitchen

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

 
 
Prune and Almond Brownies
Cocoa, prunes, almond meal and buttermilk are all key ingredients in making these brownies moist, fudgy and rich (just the way brownies should be)…without a square of chocolate or a cube of butter in sight. You’ll be amazed how good they taste too. Our guesstimate is that they are low GI too.

• Makes 32 
• Preparation time: 15 minutes (+ cooling time) 
• Baking time: 25 minutes 

200g (7oz) pitted prunes, chopped
1 cup water
75g (2½oz) cocoa powder
¼ cup plain wholemeal spelt flour (see Baker’s Tips)
2 teaspoons baking powder
1 cup almond meal
½ cup LoGiCane sugar (See Baker’s Tips)
2 eggs, at room temperature,
1/3 cup sunflower or light olive oil, plus extra for greasing
¼ cup buttermilk
1 tsp natural vanilla essence or extract
1 tsp icing sugar (optional), to dust



Preheat the oven to 180°C/350°F (160°C/320°F fan-forced). Lightly brush a 16 x 26cm/7 x11in (base measurement) slice tin with a little oil to grease and then line with a piece of non-stick baking paper.
Combine the prunes and water in a small saucepan. Bring to a simmer over medium heat, reduce heat to low and simmer for 5 minutes, stirring occasionally, until almost all the water has evaporated and the mixture is pulpy. Transfer to a bowl and set aside to cool to room temperature.
Sift together the cocoa powder, flour and baking powder, returning any husks from the flour to the mixture. Stir in the almond meal and sugar.
In a separate bowl, combine the cooled prune pulp, eggs, oil, buttermilk and vanilla and use a fork to combine evenly. Add to the dry ingredients and use a spatula or large metal spoon to fold together until just combined.
Pour the mixture into the prepared tin and smooth the surface with the back of a spoon. Bake in preheated oven for 25 minutes or until moist crumbs cling to a skewer inserted into the center. Cool in the tin.
Cut into 32 portions and serve sprinkled with icing sugar, if desired. These brownies will keep in an airtight container at room temperature for up to 4 days.

Baker’s tips 

• You can use plain wholemeal flour or buckwheat flour in place of the spelt flour if you wish. 
• You can use raw sugar in place of the LoGICane sugar if you wish. 

Per serve (one small piece)
350kJ/ 85 calories; 2g protein; 5g fat (includes 0.8g saturated fat; saturated:unsaturated fat ratio 0.2); 8g available carbs (includes 5.5g sugars and 2.2g starch); 1g fibre

Cooking with Supergrains author, Chrissy Freer 
Baked Barley Puddings with Port-poached Prunes.
Remember the milk puddings of childhood? This one is for grown-ups. It’s deliciously low GI and you can make it with regular or reduced fat milk and if it’s for the whole family, poach the prunes in water or green tea rather than port. Serves 4.

1 cup cooked pearl barley
2 eggs
1½ cups milk
2 tbs caster (superfine) sugar
1 tsp vanilla extract
½ tsp ground nutmeg, to sprinkle

Poached prunes
100g/3½oz pitted prunes, quartered
2 tbs light brown sugar
2 tbs port



Preheat oven to 160C/315F. Lightly grease four 150ml/5fl.oz. ovenproof ramekins and place on a large baking tray.
Divide the barley evenly among the greased ramekins. Whisk the eggs, milk, sugar and vanilla until well combined and pour evenly over the barley. Sprinkle the top of each pudding with a little nutmeg and bake for 30 minutes or until puffed and just set. The puddings should have a slight wobble in the centre. Set aside to cool. Meanwhile ...
Poach the prunes in a medium saucepan with the sugar, port and ¼ cup water, stirring to dissolve the sugar. Bring to the boil, then reduce the heat to low and simmer for 5 minutes or until the prunes are syrupy. Remove from heat and allow to cool a little.
Serve the puddings warm or chilled topped with the poached prunes.

Per pudding (made with reduced fat milk) 
1145kJ/ 278 calories; 8.5g protein; 7g fat (includes 3g saturated fat; saturated:unsaturated fat ratio 0.75); 42g available carbs; 4g fibre

Supergrains (Murdoch Books/Random House) is available from good bookshops and online.

Meal planning made easy with Taste Planner. 
Taste Planner provides personalised meal plans including diabetes-friendly plans that you can access on your mobile (cell), laptop, desktop or tablet. They are offering GI News readers a 28-day free trial plus 24 weeks with 50% off. After your free trial subscription period, you would pay $3.98 every 28 days for meal plans. Enter coupon code GINEWS on the payment details page to redeem your 50% discount. For a taste of Taste Planner, try ...

Chrissy Freer’s Mustard and Rosemary Pork with Roast Pears.
Serves 4.

4 pears, unpeeled, cored, cut into 3/4in/2cm-thick wedges 
2 red onions, cut into thick wedges 
Olive oil spray 
2 tbs balsamic vinegar 
2 tbs wholegrain mustard 
2 tsp chopped fresh rosemary 
1 tsp finely grated lemon rind/zest 
1 tbs olive oil 4 (about 4oz/125g each) pork loin steaks 
3½oz/100g baby spinach leaves 
Steamed green beans, to serve 



Preheat the oven to 400°F/200°C. Line two baking trays with non-stick baking paper. 
Place the pear and onion wedges on one of the trays. Spray with oil, drizzle with half the vinegar and bake in the oven for 25 minutes or until the pears are golden and tender. Meanwhile ... 
Combine the mustard, rosemary and lemon rind in a bowl. Heat the olive oil in a large non-stick frying pan over high heat. Cook the pork for 2 minutes each side or until golden. Remove from heat. Spread one side of each pork steak with mustard mixture. Transfer to the second baking tray and bake in the oven for 6–7 minutes or until cooked through. 
Place the pear, onion, spinach and remaining vinegar in a bowl, and toss to combine. Divide pear mixture and pork steaks among serving plates. Serve with beans. (Recipe and photo courtesy www.taste.com.au; Photo credit: Rob Palmer.) 

Per serve 
1325kJ/330 calories; 30g protein; 7g fat (includes 1g saturated fat; saturated:unsaturated fat ratio 0.2); 30g available carbs; 11g fibre 

Johanna's Italian Kitchen
American dietitian and author of Good Carbs, Bad Carbs, Johanna Burani, shares her favourite recipes with a low or moderate GI. For more information, check out Johanna's website. The photographs are by Sergio Burani. His food, travel and wine photography website is photosbysergio.com.



Lemon-laced Roasted Eggplant. 
Eggplant (aubergine) tastes great with cooked tomatoes. True. But have you ever eaten plain broiled eggplant with fresh lemon juice sprinkled on top? Dynamite! Simple, quick and delicious. End of story. Servings: 6

2 large eggplants (1¼lbs or 0.6kg each)
3 large cloves of garlic, sliced
sea salt and freshly ground pepper to taste
1 tsp dried oregano
1/4 cup (60ml) extra virgin olive oil
2 tbs (30ml) fresh lemon juice
5-6 sprigs fresh parsley, coarsely chopped



Preheat oven to 400F (200C). Line a baking pan with foil or baking paper.
Cut the eggplants in half lengthwise. Cut each half lengthwise in half again. Cut each of the 8 resulting strips in half crosswise. Place them in a large bowl with the garlic, sprinkle with salt and pepper, add the oregano and then the oil. Mix well.
Place eggplant pieces in the prepared baking pan. Roast eggplant for 25 minutes until soft and browned. Remove eggplant from oven, place in a serving bowl, toss with the lemon juice and parsley. Serve immediately.

Per serve
560kJ/135 calories; 2g protein; 10g fat (includes 1g saturated fat; saturated:unsaturated fat ratio 0.1); 5g available carbs; 7g fibre

Putting the Fun Back into Fitness

Walking is a surprisingly effective form of exercise for people with diabetes or those trying to prevent it.
It doesn’t really matter who you are or what type of diabetes you have, if you want to be around and in good shape to enjoy your life, your family and your friends, you have to get some exercise. There are really only two requirements when it comes to exercise. One is that you do it. The other is that you continue to do it say authors Jennie Brand-Miller, Kaye Foster-Powell, Alan Barclay and Stephen Colagiuri in the new ebook edition of The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia; to be published 26 August 2014).



Why push yourself to exercise? Exercising muscles need fuel and the fuel they need most is glucose. So as soon as you start moving your muscles they’ll start burning up glucose. First they’ll use their own stores of glucose (that’s glycogen); then they’ll call on the liver for some of its stores, all the time drawing the glucose out of the blood and lowering your blood glucose levels.

A study in Diabetes Care provides convincing proof that regular walking can provide significant health benefits for very little cost. A group of nearly 200 people with type 2 diabetes were given physical activity counselling every three months for two years. Some took it more seriously than others. The researchers found that those walking 2–5km (2400–6400 steps) more than usual each day achieved the most benefits for their diabetes.

“When I was recently diagnosed with type 2 diabetes, at the age of 75, I was horrified when my doctor suggested I go for a walk each day. ‘Walk? The furthest I ever walk is to the driveway!’ I said. But I wanted to manage my diabetes and to do that I really had to lose some weight, so I began walking every morning, with my husband. After six weeks I could walk 40–50 minutes a day quite easily. And I had lost 5kg. I feel so much better for it and I can do things I haven’t done in years. – Betty

Is it fun or is it exercise? According to the findings of two small studies from the Cornell Food and Brand Lab published in Marketing Letters, if you think of being physically active as a “fun run” or as a well-deserved break, you’ll eat less afterwards. Think of it as exercise or as a workout and you'll later eat more to reward yourself.

Adults were led on a 2 km walk around a small lake and were either told it was going to be an exercise walk or a scenic walk. In the first study, 56 adults completed their walk and were then given lunch. Those who believed they had been on an exercise walk served and ate 35% more chocolate pudding for dessert than those who believed they had been on a scenic walk. In the second study, 46 adults were given mid-afternoon snacks after their walk. Those thinking they taken an exercise walk ate 206 more calories of M&Ms, which was over twice as much – 124% more – than those who had been told they were on a scenic walk. “Viewing their walk as exercise led them to be less happy and more fatigued,” says lead author, Carolina Werle, professor at Grenoble Ecole de Management in France.

For beginning or veteran exercisers, the bottom line is this says Brian Wansink, author and Director of the Cornell Food and Brand Lab: “Do whatever you can to make your workout fun. Play music, watch a video, or simply be grateful that you're working out instead of working in the office. Anything that brings a smile, is likely to get you to eat less.”

Update with Dr Alan Barclay

Dr Alan Barclay

Families share more than their genes
As we describe in food for thought this issue, the road to type 2 diabetes can run in the family. One of the main reasons is genetic – you are genetically very similar to your biological parents and siblings. Your height, amount of muscle, the size of your essential organs and amount and location of your body fat is partially determined by your genes, and this in turn affects your insulin sensitivity, amongst many other things.

We tend to overlook, or perhaps downplay, the role of the family environment in the expression of those diabetes genes. As well as inheriting genes, we tend to inherit a “lifestyle”. If your parents were always active and encouraged you to participate in team sports, bicycle riding, walking, dancing, etc., chances are they and you will have reduced the risk of developing type 2 diabetes, as you will all have more muscle, a lower amount of body fat and less insulin resistance than if your lifestyle was a sedentary one.

We also inherit eating habits. Our family background is a powerful predictor of our family’s diet. It’s well established that type 2 diabetes is more common among certain groups including people from the Middle East, South Europe, South Asia, Indigenous Australians, Maoris, Pacific Islanders, African Americans, Hispanic Americans and American Indians compared with people from an Anglo-Celtic background, for example. Again, along with their genes, they inherited their ancestors’ eating patterns built around their traditional foods and drinks and ways of preparing and eating foods. These dietary and cultural patterns undoubtedly influence the expression of diabetes genes.

There is strong evidence that both the traditional Mediterranean diet and certain traditional Asian cuisines like traditional Japanese diets are associated with longevity and a lower risk of developing chronic diseases like type 2 diabetes, despite being composed of very different foods, with very different macronutrient profiles – Mediterranean diets are relatively high in fat whereas most Asian diets are very high in carbohydrate and low in fat. What these traditional eating patterns have in common, however, as discussed in What’s New in this issue is that they were built around naturally low GI, minimally processed whole foods.



Of course, that was then. Nowadays, like the rest of us, people living in Asia and around the Mediterranean are adopting more typical Western diets with more refined and processed foods. Indeed, a large population-based study carried out in Western European found that the average GI of the typical Greek diet was 57, whereas in Japan the average dietary GI was 64. A low GI diet has an average GI ≤ 45, so the typical diets of both countries now fall well outside the low GI category and may explain in part each nation’s rising diabetes prevalence rates.

Dietary modelling conducted at the University of Sydney showed that by simply swapping medium to high GI foods with lower GI equivalents in modern Asian and Greek cuisines, you can reduce average dietary GI down to the recommended range. This simple “swap it don’t stop it” approach is one way of improving dietary quality, and it works with a range of cuisines, meaning people can continue to enjoy the foods they love, and it doesn’t have to ruin their social or cultural life. This is one reason why low GI diets are sustainable in the long-term.

So, even if you have a strong family history of type 2 diabetes, don’t think that it is inevitable that you and your children will develop it. Be an active family and use the “swap it don’t stop it” approach to improve your eating habits. This long term recipe for success will help you prevent, or at the very least delay, the onset of type 2 diabetes.



GI Symbol Program
Dr Alan W Barclay PhD,
Chief Scientific Officer,
Glycemic Index Foundation (Ltd):
alan.barclay@gisymbol.com
www.gisymbol.com

GI testing
Fiona Atkinson,
Research Manager,
Sydney University Glycemic Index Research Service:
sugirs.manager@sydney.edu.au
 
GI database
www.glycemicindex.com

Q&A and New Product News

Prof Jennie Brand-Miller answers your questions. 


Everyone seems to be talking about “nutrient density” these days. Can you explain simply what this actually means and why it seems to matter so much?
Nutrient density is about quality over quantity. Nutrient-dense foods are those which contribute greater amounts of beneficial nutrients (vitamins and minerals) per calorie (kilojoule) to your overall diet. By selecting these foods first, it allows you to obtain all the nutrients you need in your diet without exceeding your energy needs. It is wise for everyone to opt for mostly nutrient-dense foods to maximise nutritional intake and manage their weight but this is particularly important during pregnancy when a Mum’s need for essential nutrients increases more than her energy (calorie/kilojoule) needs.



The produce aisles are where you’ll find nutrient-dense foods – fruits, vegetables, legumes (dried beans and lentils), whole grains, nuts, seeds, fish, lean meats and poultry and lower fat dairy products. Foods with a high nutrient density are largely those which tend to be less processed and most come from the plant kingdom. If they are rich in carbohydrate, they should have a low GI. These include:

• Vegetables and fruit For maximum nutrition aim for a wide variety of different coloured fruit and vegetables each day and make these the basis of your meals and snacks. 
• Low GI grains, preferably wholegrain foods These will provide more nutrients and fibre than highly processed, refined grains. Think thick-cut, traditional oats, brown (or black or red) rice, quinoa, pearl barley, burghul, buckwheat and wholewheat pasta or noodles and low GI, high fibre breakfast cereals or dense wholegrain breads. 
• Legumes Lentils, chickpeas, kidney beans, cannellini beans, borlotti beans, butter beans, black-eye beans and navy beans are all low GI, nutritious, economical and versatile. Cook your own or use the convenient canned versions. 
• Nuts and seeds Nuts and seeds are rich in the healthy fats and a packed with a variety of vitamins and minerals including iron, zinc and magnesium. Add them to meals or eat them as a snack. Nut and seed spreads (such as tahini) are a nutritious alternative to butter.
• Lean protein foods Lean meats, poultry, fish, seafood, tofu and eggs supply important vitamins and minerals including iron, zinc, vitamin B12 (animal products only) and omega-3 fats (fish and seafood) in addition to protein. 
• Dairy or soy products or alternatives Milk, soy milk and yoghurt provide protein and all important calcium. If choosing soy milk or other milk alternatives such as rice or oat milk (these latter two have high GI values), make sure you choose brands with added calcium, and if you are vegetarian look for one with added vitamin B12. If you don’t eat dairy products or calcium-fortified alternatives you will need to incorporate other calcium-rich foods such as hard tofu, almonds, dried figs, unhulled tahini, Asian greens, Kale and broccoli. 

Random House Australia has recently given me a review copy of Jerusalem by chefs Yotam Ottolenghi and Sami Tamimi. I have to say this cookbook is like having a bible of nutrient-dense, low GI recipes. It makes eating the nutrient-dense, low GI way deliciously easy.

And it’s probably not hard to work out the nutrient-poor foods – this includes things like sweet biscuits, cakes, pastries, confectionery, chips/fries, crisps and other savoury snacks, and soft drinks – these foods are high in energy but provide little in the way of nutrition and are best kept for occasional treats rather than everyday choices.

Product News. 
Eating for Eye Health.
Macular degeneration (MD) is the name given to a group of degenerative diseases of the retina that cause progressive, painless loss of central vision, affecting the ability to see fine detail, drive, read and recognise faces. There’s no cure, but there are treatment options that can slow down its progression, depending on the stage and type of the disease (wet, dry, and other forms). The earlier it is detected, the more vision you are likely to retain. Exactly what causes MD is not fully understood, but it runs in families – if you have a parent with MD, you have a 50% risk of suffering from it yourself. You can’t change your genes but you may reduce the risk of macular degeneration as you age or slow down the progression of the disease by making positive diet and lifestyle changes. Here’s what the Macular Degeneration Foundation advises:

• Have an eye test and make sure the macula is checked 
• Don’t smoke 
• Keep a healthy lifestyle, control weight and exercise regularly 
• Eat a healthy well-balanced diet 
• Eat fish two to three times a week, dark green leafy vegetables and fresh fruit daily, and a handful of nuts a week. Limit the intake of fats and oils 
• Choose low glycemic index (GI) carbohydrates instead of high GI whenever possible 
• In consultation with your doctor, consider a suitable supplement Use an Amsler grid daily to check for symptoms of macular degeneration 
• Provide adequate protection for your eyes from sunlight exposure, including for those who are very young 

Eating for Eye Health (Ita Buttrose and Vanessa Jones ), a practical guide to cooking for nutrition and wellbeing, contains over 90 recipes to ensure that eating for good eye health comes with a great taste (New Holland Publishing).

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GI News—July 2014

• Pre-diabetes: Prof. Jennie Brand-Miller answers your questions;
• Why fermented foods like yoghurt are low GI; 
• Homemade spelt and wattleseed flour bread; 
• Canola bread diet reduces BGLs and LDL cholesterol;
• Nicole Senior checks out the benefits of yoghurt and Anneka Manning whips up a batch of fruity-yoghurt muffins; 
• Taste Planner's black rice salad with pork and cashews; 
• Karate keeps you fit and active.  

GI News 
Editor: Philippa Sandall
Management and design: Alan Barclay, PhD
Contact: info@gisymbol.com
Technical problems or faults: smb.ginewstech@sydney.edu.au
GI testing: sugirs.manager@sydney.edu.au

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Food for Thought

Watch out for Weight Creep. 
Struggling to zip up your favourite jeans? Join the ever-expanding Weight Creep Club. For most people, weight gain isn’t a sudden event. It is very gradual. From our mid-to-late twenties, most of us notice the numbers on the scale edging up, typically around a pound or 450 grams a year. A pound doesn’t sound like anything to be too concerned about. But the pounds add up. Suddenly it’s 10 years on and you’re 10 pounds (about 4 kilograms) heavier thanks the weight-creepy combo of aging, a sedentary lifestyle, no time for exercise, too much stress and too little sleep, accompanied by a healthy appetite to power you through your busy day.

Despite our fast-paced lives with work, family and social commitments, the pace inside us slows down with the passing decades – our metabolic rate slows and we start to lose our metabolically active (i.e. calorie-crunching) lean muscle mass. This is when we start gaining weight and increasing our risk of type 2 diabetes and cardiovascular disease, and some cancers (breast and bowel). So, 10 pounds is something to be concerned about.

Carrying extra body fat around the waist tends to go hand in hand with type 2 diabetes. Like weight creep, it doesn’t happen overnight. Before people develop type 2 diabetes, they have pre-diabetes – blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes.

Pre-diabetes has no clear symptoms. It just creeps up as weight creeps up. Left untreated, it can develop into type 2 diabetes along with the risk of complications associated with diabetes such as heart attacks and stroke. The good news is that clinical trials have shown that three out of five people with pre-diabetes can avoid type 2 diabetes by improving their diet, becoming more active and losing a bit of weight. But this isn’t a quick, “all-better-now” fix. It’s ongoing. Staying motivated and keeping the weight off matters to keep diabetes at bay. Regaining lost weight through weight creep is very common among people with pre-diabetes.

Modestly increasing protein content and modestly reducing overall dietary GI helped overweight men and women, who had undergone recent major weight loss, to maintain their lower weight, was the key finding of the landmark Diogenes Study.  The researchers reported that both lower GI diets and higher-protein diets were equally effective in preventing weight regain. But that people in the group which combined both lower GI and higher-protein strategies continued to lose weight over the 26 weeks of the study.

This original Diogenes study was just six months. Now the researchers are looking longer term with the 3-year international PREVIEW Study. “Its primary goal is to identify the most efficient lifestyle intervention pattern for preventing type 2 diabetes in people who are pre-diabetic overweight or obese (i.e. at high risk),” says Prof Jennie Brand-Miller. “The aim of this study is to find out the best methods (which diet, which exercise strategy and behavioural modification) of maintaining weight loss and keeping type 2 diabetes at bay. Volunteers for this study will have their own team of professionals dedicated to their weight loss and weight loss maintenance, all free of charge.”

The University of Sydney, one of eight sites around the world taking part in the study, is recruiting participants now. If you are interested in taking part, see below for details for applying or for finding out more about it.