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.
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:
1 January 2020
FOOD FOR THOUGHT
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.
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:
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:
- PROTEIN QandA: OUR EXPERTS ANSWER YOUR QUESTIONS
- Nutrient Reference Values: Protein
- High-protein diet is bad for kidney health: unleashing the taboo
- Changes in Kidney Function Do Not Differ between Healthy Adults Consuming Higher- Compared with Lower- or Normal-Protein Diets: A Systematic Review and Meta-Analysis.
- Efficacy of low-protein diet in diabetic nephropathy: a meta-analysis of randomized controlled trials
- Effect of whole soy and purified isoflavone daidzein on renal function--a 6-month randomized controlled trial in equol-producing postmenopausal women with prehypertension.
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.
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.
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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Nutritional analysis To analyse Australian foods, beverages, processed products and recipes, we use FoodWorks which contains the AusNut and Nuttab databases. If necessary, this is supplemented with data from www.calorieking.com.au or http://ndb.nal.usda.gov/ndb/search.
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© ®™ The University of Sydney, Australia
1 December 2019
GI News - December 2019
GI News is published online every month by the
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Publisher: Professor Jennie Brand-Miller, AM, PhD, FAIFST, FNSA
Editor: Philippa Sandall
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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.
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.
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.
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.
PRODUCT REVIEW
DRIED FRUITS: 5 FIBRE BOOSTERS
Eating dried fruit is a
great snack or natural sweetener in porridge oats or muesli. It not only
helps you get those 2 plus serves of fruit a day, it adds to your
intake of fibre, antioxidants, prebiotics, vitamins and minerals.
Drying fruit keeps bacteria at bay by reducing water content
(from around 90% down to around 5–35%) and concentrating the sugars. Sun
drying is still carried out in many parts of the world – Turkish
sun-dried apricots, for example, are much sought after. Most fruits (and
vegetables) are dried in dehydrators. Processors typically add sulfur
dioxide (E220) to ensure they keep their appealing colour and texture
and prevent them from oxidising and browning. Organic versions may not
have good looks, but they are equally delicious, if not more so. Check
out the GI, kilojoules (calories), carbs and fibre of five popular dried
fruits.
DRIED APRICOTS
GI 31
DATES
GI 39–45
DRIED FIGS
GI 61
PRUNES (DRIED PLUMS)
GI 40
RAISINS
GI 49
Read more:
PERSPECTIVES WITH DR ALAN BARCLAY
DRIED FRUITS KEEP IT REGULAR
The World Health Organisation
classifies traditional dried fruits like apples, apricots, dates, figs,
prunes, pears, raisins and sultanas as “fruit”, and like fresh fruit,
their natural sugars content is not defined as “free sugars”. In
contrast, some dried fruits such as blueberries, cranberries, cherries,
strawberries and mangoes are often infused with sugar syrup or fruit
juices prior to drying – although these fruits can also be dried without
any infusion, which adds to consumer confusion. Candied fruits such as
pineapples and papaya have a high added sugar content, but this is
generally not mentioned on food labels. Check the nutrition information
panel.
There are a number of reasons why sugar and or/sugar syrups are added to dried fruit:
- It improves palatability to tart fruits (e.g. cranberries) by adding sweetness.
- It helps a sweet fruit remain soft throughout its shelf life since sugar and sugar syrups act as natural humectants (a kind of food additive used to reduce moisture loss).
- Sugar and or/sugar syrups also have a preservative function by helping to reduce the water activity within the fruit, decreasing microbial growth.
Dried fruits are high in a range of dietary fibres and other bioactive compounds with prebiotic effects (e.g. polyphenols), while some dried fruits (e.g., prunes and apricots) also contain high levels of the sugar alcohol sorbitol, which has laxative properties and also increases stool weight.
GUT HEALTH is of major public health importance around the world and low stool weight, delayed gut transit time and alterations in the gut microbiome along with their associated metabolites (e.g. short-chain fatty acids), are key risk factors for common gastrointestinal disorders (e.g. constipation, diverticular disease, colorectal cancers, etc.), all of which can be manipulated via the diet. For example, increased stool weight is one of the major mechanisms underlying the relationship between high intakes of dietary fibre and reduced risk of colorectal cancer.
There are currently a small number of high-quality human studies that show some benefits of traditional dried fruits (e.g. prunes) in some areas of gut health (e.g., stool weight/frequency). Like many areas of research, more studies are warranted to extend our knowledge of the potential beneficial impact for public health, particularly investigating the full range of dried fruits and investigating the relative contribution of dietary fibre and sorbitol to these effects.
DRIED FRUITS AND DENTAL HEALTH There is some concern about the potential impact of dried fruit on dental health, particularly dental caries – where bacteria in dental plaque ferment free sugars resulting in acid production. Free sugars can come from both sugary and starchy foods (certain starches are broken down into the sugar glucose in the mouth by salivary amylase). When the acid level (pH) falls below 5.5 in the mouth, tooth enamel can soften. After repeated insults it can result in the formation of tooth cavities, eventually resulting in dental caries.
For dried fruit to contribute to dental caries, the sugars present in the food matrix need to be solubilised and diffuse into dental plaque. The rate of solubilisation depends on the location of the sugars in the dried fruit matrix (inside or outside the cellular structure), the fruit texture, and the force and frequency of chewing. Other influential factors include plaque thickness, the length of time dried fruit stays in the mouth allowing the sugars to dissolve, and the buffering capacity of saliva (which affects acid levels in the mouth). The different categories of dried fruit may, therefore, behave differently in the mouth.
With a pH of 7, saliva is the tooth’s natural protective mechanism, buffering the effect of oral acids. Following each eating episode, there is a time lapse of approximately 40 minutes before resting oral pH is restored. Therefore, eating less sugary and starchy foods between main meals may help decrease the risk of dental caries.
A recent systematic review addressed the perception that dried fruit adheres to teeth and is detrimental to teeth because of its sugars content. No randomised controlled trials were identified that explored dental caries as an outcome per se, as this would be unethical. One observational study was identified but the intake of dried fruit was too low for any meaningful analysis. One study investigated the effect of whole and juiced fruits and vegetables and whole raisins individually on net demineralisation of enamel compared with positive and negative controls, and found statistically significant net demineralisation with all test foods compared with the negative control, suggesting that raisins were not more detrimental to teeth than fresh fruits or vegetables.
Studies of oral clearance have used different methods and endpoints, and improved techniques for assessment are needed. A recent systematic review found one study that compared subjective perceptions of the stickiness of 21 foods in 315 adults with an objective measure of retention of 9–30g portions of the same foods in 5 young adults. There was a low correlation between perceived stickiness and oral clearance rates (r=0.46) suggesting that most people cannot accurately assess the stickiness of foods. This study also showed low to intermediate retention (based on dry weight retained) for raisins and figs respectively, and intermediate clearance rates (weight retained with time). Another study also measured food retention of 48 snacks and found that dates were ranked 15/48 for carbohydrate retention at 5 minutes, and raisins were ranked 29. This study also suggested that dried fruits do not adhere to teeth more than alternative snacks, such as cookies (biscuits), crackers, apple pie and candies (sweets). A third study that measured the quantity of oral lactic acid production as a marker of oral clearance concluded that foods containing sugars, but no starch, clear the oral cavity more rapidly than starch-containing foods.
It would, therefore, seem prudent to re-evaluate the concept of “sticky” foods and the effect of dried fruits on dental health in general.
DIETARY GUIDELINES encourage us to consume more fruit, with most recommending we aim for a minimum of 2 serves each day including fresh, frozen, canned and traditionally dried fruit. However, few of us do get 2 serves a day; and dried fruit makes up only a small fraction of our total fruit intake. Here are the recommendations for the USA, the UK and Australia.
- USA – all forms of fruits, including fresh, canned, dried, and frozen, are recommended as part of a healthy eating pattern and ½ a cup of dried fruit is considered equivalent to 1 cup of fresh fruit.
- UK – dried fruit is also considered a healthy option equivalent to fresh, canned or frozen fruits and one serve is based on a portion size of approximately 30g (1oz). However, to reduce the risk of tooth decay, it is recommended that dried fruits are eaten with main meals and not as snacks.
- Australia – unlike the USA and UK, dried fruits are not considered an everyday food due to their “stickiness”, and higher energy density. Like the UK, a 30g (1oz) portion is considered an appropriate serve size, but to be consumed only occasionally. High quality scientific evidence does not support current advice in Australia to limit dried fruit consumption.
- Dried Fruit and Public Health: What Does the Evidence Tell Us?
- Eat well - NHS
- DIETARY GUIDELINES FOR AMERICANS 2015-2020
- The Australian Dietary Guidelines
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.
GOOD CARBS FOOD FACTS
PRUNES
Prunes, says dietitan Nicole Senior, are actually
dried plums. This 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
for prunes is the sweet D’Agen variety, which reduce down to one third
of their original moisture content when dried. While plums only last a
couple of weeks or two fresh, drying makes them available year round. In
these waste-conscious times it’s good to remember that drying fruit is
an age-old method for preserving a bountiful and seasonal harvest. They
are typically harvested and dried within 24 hours on the farms where
they are grown.
Prunes are a good source of vitamins A and C, and contain
potassium, calcium and iron. But they are most famous for their effect
on the bowels. They get things moving due to their fibre and natural
sorbitol content. Both whole prunes and prune juice have provided relief
to those suffering from 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
Good Carbs Kitchen). Their slightly tart sweetness and exotic colour
make them sensational in crumbles, puddings and tarts. They work well in
savoury dishes too and add contrasting sweetness to poultry stuffing,
sauces for pork and game meats, tagines, chutneys and cheese platters.
Sources:
AusFoods, 2019 and The Good Carbs Cookbook (Murdoch Books)
THE GOOD CARBS KITCHEN
MAKING THE MOST OF DRIED FRUIT
PRUNE AND ALMOND BROWNIES
0:15 Prep • 0:25 Cook • 32 Servings • Chocolate treat • Festive fare
INGREDIENTS
200g (7oz) pitted prunes, chopped
1 cup water
75g (2½oz) cocoa powder
¼ cup plain wholemeal spelt flour or plain wholemeal flour
2 teaspoons baking powder
1 cup almond meal
½ cup raw sugar
2 eggs, at room temperature,
⅓ cup sunflower or light olive oil, plus extra for greasing
¼ cup buttermilk
1 teaspoon natural vanilla essence or extract
1 teaspoon icing sugar (optional), to dust
METHOD
Preheat
the oven to 180°C/350°F (160°C/320°F fan-forced). Lightly brush a 16 x
26cm / 7 x 11in (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
centre. 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.
NUTRITION
Per serve 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
RECIPE
Anneka Manning, BakeClub
CRISPY CAULIFLOWER WITH BUCKWHEAT AND PINENUTS
Prep: 10 mins • Cook: 30 mins • Serves: 6 • Gluten free • Vegan / Vegetarian
1 medium cauliflower
2 tablespoons olive oil
sea salt flakes
¾ cup raw buckwheat groats, rinsed
⅔ cup medium pitted black olives, roughly chopped
2 tablespoons salted capers, rinsed and drained
3 tablespoons toasted pine nuts
2 tablespoons currants
Dressing
1 garlic clove, crushed
1 handful parsley, chopped
⅓ cup olive oil
2 tablespoons lemon juice
sea salt flakes and freshly ground pepper
METHOD
Preheat
the oven to 190°C/375°F (fan 170°C/325°F). Line a baking tray with
baking paper. • Rinse the cauliflower and cut through the thick core
into quarters. Cut each quarter into thick slices and put into a bowl.
If you prefer, cut them into large florets. Pour over the oil, sprinkle
with a little salt and toss. Arrange the cauliflower on the tray and
roast for 20–25 minutes, or until crispy and slightly charred. Set aside
to cool.
While the cauliflower is roasting, bring a
pot of water to the boil, tip in the buckwheat and simmer for 8–10
minutes, or until al dente. Drain, rinse and leave to cool to room
temperature.
Whisk together the dressing ingredients,
adding salt and pepper to taste, to make a chunky thick dressing. Watch
the amount of salt you use, as both the capers and olives will provide a
briny tang.
Put the cauliflower, buckwheat, olives,
capers, pine nuts and currants in a bowl. Pour over the dressing and
lightly tumble together. Serve at room temperature.
NUTRITION
Per serve
1505kJ/ 360 calories; 6g protein; 27g fat (includes 3.5g saturated fat;
saturated : unsaturated fat ratio 0.15); 21g available carbs (includes
5.5g sugars and 15.5g starches); 5.5g fibre; 255mg sodium; 505mg
potassium; sodium : potassium ratio 0.5.
RECIPE
Kate McGhie,
The Good Carbs Cookbook, Murdoch Books.
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Nutritional analysis To analyse Australian foods, beverages, processed products and recipes, we use FoodWorks which contains the AusNut and Nuttab databases. If necessary, this is supplemented with data from www.calorieking.com.au or http://ndb.nal.usda.gov/ndb/search.
Disclaimer GI News endeavours to check the veracity of news stories cited in this free e-newsletter by referring to the primary source, but cannot be held responsible for inaccuracies in the articles so published. GI News provides links to other World Wide Web sites as a convenience to users, but cannot be held responsible for the content or availability of these sites. All recipes that are included within GI News have been analysed however they have not been tested for their glycemic index properties by an accredited laboratory according to the ISO standards.
© ®™ The University of Sydney, Australia
1 November 2019
GI News - November 2019
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Publisher: Professor Jennie Brand-Miller, AM, PhD, FAIFST, FNSA
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FOOD FOR THOUGHT
NICOLE SENIOR TAKES A LOOK AT THE LARGE PINK ELEPHANT IN THE ROOM
“Seeing
pink elephants” is an expression describing drunken hallucinations, and
a pink elephant is the name of a cocktail containing vodka, cranberry
juice, raspberry liqueur and limoncello (lemon liqueur). The expression
“the elephant in the room” describes a huge and obvious issue not being
addressed. As we head into the festive season, let’s talk about alcohol –
the large pink elephant in the room.
There’s a lot of talk among diet tribes about all carbs (starches
and sugars) being fattening and in particular, about sugar being
poison, however when it comes to the “diet wars” we don’t hear much
about alcohol. Unlike sugars, alcohol is a poison, albeit government
revenue-generating poison. Considering Australian adults consume 4.8% of
their daily kilojoules (calories) from alcoholic beverages, you have to
wonder why alcohol has escaped being hit by the blame train.
- Is it the power and influence of the alcohol industry?
- Is it because alcohol is fun and we’re in denial?
- Is it because we’re clueless about the adverse health effects and high kilojoule/calorie content?
Let’s be clear: alcohol is high in kilojoules (calories). While carbohydrate provides 16kJ (4 calories) per gram and protein provides 17kJ (4.2 calories) per gram, alcohol provides 29kJ (7 calories) per gram. And being tipsy tends to make us more uninhibited with what we eat – alcohol is a well-known appetite stimulant.
While the sugar-quitting folk warn about the sugar content of drinks, and low-carb beer has a sizeable market following among the “health conscious”, the numbers tell a different story. Most of the kilojoules in alcoholic drinks come from alcohol, not sugars. Low-alcohol beer beats low-carb beer when it comes to being health and weight-friendly, and for staying in better control of how much and what kinds of food you eat with it.
5 POPULAR DRINKS Let’s look at where the kilojoules (calories) come from in 5 popular drinks. Sugars or alcohol? Note that the percentages don’t add up to 100, because there are also starches and proteins present that contribute total energy. We have rounded the figures.
Table reproduced and adapted with permission from The Ultimate Guide to Sugars and Sweeteners (The Experiment Publishing, New York).
And did you know excess alcohol consumption is a key risk factor for breast cancer? Breastcancer.org reports women who have three alcoholic drinks per week have a 15% higher risk of breast cancer than women who don’t drink any alcohol.
I won’t go into the cultural problem we have with consuming way too much alcohol here, or the health and social costs, except to say they are MAMMOTH. It costs us as a society a lot to drink so much. I love a nice glass of wine or beer, but it would be good to be part of a culture in which getting drunk is not considered normal.
Fighting excessive alcohol consumption is a fight worth having, with no nutritional downsides. Let’s quit the one-nutrient-at-a-time skirmishing and take on a real enemy. Let’s do battle and fight to have the calories/kilojoules clearly printed in at least 10-point type on the label of all alcoholic drinks.
Read More:
WHAT’S NEW?
DOES DRINKING LESS SUGAR MEAN DRINKING MORE ALCOHOL?
Reducing
the intake of sugary drinks is presently quite important to many public
health advocates. Taxes on sweet drinks are one effective way to do
this. And advocates are convinced that the result will be better health –
less obesity and less diabetes. But it’s worth asking: what will take
the place of those sugary drinks? New data from Australia suggests that
alcohol might be part of the answer. ConscienHealth’s Ted Kyle reports.
OBSERVATIONS OF ALCOHOL AND SUGARY DRINKS Tommy Wong and
colleagues looked at self-reported alcohol and sugar sweetened beverage
(SSB) consumption. They also analyzed waist circumference measures. Data
came from the 2012 Australian Health Survey.
Overall, about a third of adults drank no SSBs. But it turns out that
those adults made up for the calories from sugar with calories from
alcohol. A substitution model found no difference in waist circumference
when trading SSBs for alcohol. In other words, they found no evidence
here that people who swapped alcohol for sugar did better on this
indicator for obesity.
HUMANS PUSH BACK Humans
are tricky creatures. Push them to do something you want and they find
ways to push back. History is littered with strong responses to
constraints on beverage choices. The Tea Party and the Whisky Rebellion
are just two examples that come to mind.
Rebellion
isn’t the only response. People adapt in unpredictable ways. For
example, seltzer is an increasingly trendy alternative to sugary sodas.
Smart people don’t drink soda, right? But hey, we need a dash of
pleasure with our seltzer. So, voilà . We have a trend in hard
(alcoholic) seltzers in the US. White Claw is a brand that embodies this
trend and it’s become so popular that there’s a nationwide shortage.
Tax policy plays a role, too, because taxes are lighter on these
seltzers than on distilled spirits. Unintended consequences everywhere
you look.
PITFALLS OF A NARROW FOCUS The systems
that drive obesity are complex and adaptive. Push on one thing and the
systems push back somewhere else. Simply taxing sweet beverages sounds
like a good idea. But it’s worth watching to see how all these human
systems adapt.
And we might do well to think more
broadly, as one of the co-authors of the Wong paper, Prof Jennie
Brand-Miller, told us recently: “Humans have always liked to drink
calories, starting with day one. I think the harms of excessive soft
drink consumption pale in comparison to alcohol. And Australia’s
experience tells us that we shouldn’t expect declining consumption of
soft drinks to make any difference to obesity trends. If we focus more
on calories from alcohol, we might get somewhere.”
Indeed.
A serving of breast milk – nature’s perfect food – has 17 grams of
sugars. Will we wean humans from sweet and pleasurable beverages? Maybe
not. So perhaps a more nuanced and thoughtful approach to promoting
healthful behaviors would be wise.
Read more:
PRODUCT REVIEW
5 DRINKS FOR THE DESIGNATED DRIVER
Drinking lubricates
most social functions. It’s one of life’s pleasures. Plain water is
unquestionably the best option, but it’s rarely the first choice when
drinking socially with family, friends and colleagues. Mineral water
(still or sparkling) with ice and a slice of lemon is socially more
acceptable and contains relatively small amounts of sodium, potassium,
magnesium and calcium. However, there’s an increasingly large variety of
beverages out there for the designated driver and for those who don’t
drink alcohol for health or religious/cultural reasons. Here we take a
look at some of the more popular soft options.
ORANGE JUICE
Ingredients: Oranges.
On
average, 1 cup (250ml) of freshly squeezed orange juice has 375kJ (90
calories); 19g carbohydrate (sugars), a low GI (50) and medium glycemic
load (10). It’s a good source of vitamin C. Tip: Add mineral water and
ice cubes and make it a long drink to sip.
COCA-COLA™ CLASSIC
Ingredients: Carbonated Water, Sugar, Colour (150d), Food Acid (338), Flavour, Caffeine.
- 1 cup (250ml) has 450kJ (108 calories); 27g carbohydrate (sugars), a medium GI (63) and medium glycemic load (17).
- A 375ml can has 670kJ (160 calories); 40g carbohydrate (sugars), and bumps the glycemic load up to high (25).
PEPSI MAX™
Ingredients: Carbonated Water, Colour (Caramel e150d), Sweeteners (Aspartame, Acesulfame K), Acids (Phosphoric Acid, Citric Acid), Flavourings (including Caffeine), Preservative (Potassium Sorbate). Contains a source of Phenylalanine.
- 1 cup (250ml) has 4kJ (1 calorie); 0.2g carbohydrate.
- A 375ml can has 6kJ (1.5 calories); 0.2g carbohydrate.
REMEDY ORGANIC KOMBUCHA
Ginger Lemon Ingredients: Certified organic raw kombucha, (pure water, wild kombucha culture, organic black tea, organic green tea), organic ginger, naturally fermented organic glucose (erythritol), organic lemon, organic stevia (steviol glycosides).
- 1 cup (250ml) has 75kJ (17 calories); 4g carbohydrate.
- A 330ml bottle has 99kJ (23 calories); 5g carbohydrate.
While you can buy commercial brands, many people make their own. We turned to Taste.com for a recipe, but we reduced their serving size down to 1 cup (250ml). Ingredients: 1.25 litres lemonade (chilled), ½ cup lime juice cordial, 1 teaspoon Angostura bitters, 1 cup small ice cubes, Angostura bitters to serve, lemon slices to serve
- 1 cup (250ml) has 509kJ (121 calories); 29g carbohydrate.
PERSPECTIVES WITH DR ALAN BARCLAY
ALCOHOLIC BEVERAGES: A GOOD SERVANT BUT A CRUEL MASTER
People
have been drinking alcoholic beverages for thousands of years – partly
due to their intoxicating effects and partly due to the fact that they
once provided a safer means of hydration when clean water was scarce.
For many people around the world today, an alcoholic drink is a
regular and enjoyable part of meals and many other social occasions like
weddings, parties, etc. There is some evidence that people who drink
small quantities of alcohol on a regular basis may have better health
outcomes than those who do not drink at all, but these findings have
been recently challenged. Heavy drinking has no health benefits and
studies consistently report that abstainers have better health outcomes
than heavy drinkers.
In terms of nutrition, alcohol is
the only substance that is both a food providing energy and a drug
affecting brain and nervous system function.
ALCOHOL IS A CONCENTRATED FORM OF ENERGY
Pure alcohol provides 29 kilojoules (7 calories) of energy for every
gram consumed – second only to fats (37kJ/9 calories per gram) in
energy density. Moderate drinkers (1 to 2 standard drinks per day, or 10
to 20 grams of pure alcohol per day) usually consume alcoholic
beverages as added energy – on top of their normal food intake.
Alcoholic beverages may also stimulate appetite, further increasing
energy intakes. For these reasons, some moderate drinkers may
inadvertently develop a “beer belly”. Heavy drinkers, on the other hand,
usually consume alcoholic beverages instead of food, and consequently
are often underweight and malnourished.
ABSORPTION AND METABOLISM
When consumed, alcohol is very rapidly absorbed into the blood stream
from the stomach and small intestine, as it does not require any
digestion, and can consequently bring on the familiar feelings of
euphoria within minutes if it is consumed on an empty stomach. Around 2
to 10 percent of the alcohol we drink is lost through urine, sweat, or
the breath (this is the basis for the breath test for drunkenness),
whereas the other 90 to 98 percent is metabolized in the stomach and
liver.
Alcohol metabolism begins in the stomach with an
enzyme called alcohol dehydrogenase which converts it to acetaldehyde
which in turn is converted to acetate and then acetyl CoA a key energy
molecule for most of our body’s cells:
Women produce less alcohol dehydrogenase than men, which is one
of the reasons why they are more affected by alcohol than men of the
same body size. Acetaldehyde is a highly reactive and toxic compound
that is responsible for many of the damaging effects of excessive
alcohol consumption. Excess NADH produced in the first two steps of the
metabolism of alcohol inhibits the production of glucose in the liver
(via gluconeogenesis) and also inhibits the burning of fatty acids. This
is one reason why too much alcohol can cause people with diabetes who
take insulin or certain blood glucose lowering drugs to have a hypo.
Most
alcohol is metabolised in the liver, and there is a limit to how much
it can handle – about 15 grams (or 1½ standard drinks) an hour – so
excess amounts can build up in the blood rapidly if you drink more than 1
or 2 Standard drinks (a Standard drink contains 10g of pure alcohol) an
hour.
IMMEDIATE EFFECTS Of course, the most
immediate affect we associate with drinking alcohol is its effect on the
brain and nervous system. Most people think that alcohol is a stimulant
because it seems to relieve inhibitions. It is in fact a nervous system
depressant. Inhibitions decrease first because inhibitory nerves are
more easily sedated than excitatory nerves. Judgement and reasoning are
affected first as the alcohol sedates our brain’s frontal lobes first.
Next, speech and vision centres are affected – speech becomes slurred
and vision becomes blurry. Coordination is affected next, walking
becomes staggered. Finally, the conscious brain is subdued, and you pass
out, preventing the consumption of more alcohol.
It’s
well known that alcohol increases the frequency of urination – indeed,
it is the origin of the euphemism for excessive drinking – “getting
pissed”. Alcohol depresses the release of anti-diuretic hormone from the
pituitary gland. This hormone makes the kidneys re-absorb water, so by
reducing its production, more is released into the bladder and thirst
increases. Drinking more alcoholic beverages to quench the thirst will
of course only make the situation worse. This is why it is important to
have a non-alcoholic drink as a spacer between alcoholic drinks – it
will help reduce dehydration, one of the more unpleasant symptoms of a
hangover.
LONGER-TERM EFFECTS The liver prefers
to use fatty acids for fuel, but when alcohol is around, it is forced to
use it (alcohol) as a fuel, which can lead to a build-up of fatty acids
in the liver and an increase in triglycerides in the blood when
consumed in excessive amounts. Frequent excessive drinking may therefore
lead to what is known as fatty liver disease (excessive fat
accumulation in the liver), which in turn may lead to fibrosis and then
cirrhosis if heavy drinking and poor nutrition continue for extended
periods of time.
Nutrient deficiencies are virtually
inevitable in heavy drinkers, because alcoholic beverages may displace
food and alcohol interferes with the body’s use of certain nutrients,
making some ineffective even if they are present. For example, small
intestinal cells may not be able to absorb certain B group vitamins like
thiamin, folate and B12 effectively, liver cells lose their ability to
activate vitamin D efficiently, and retinal cells in the eye are not
able to utilise vitamin A efficiently. The latter being one of the
origins of the old saying for those who are completely inebriated:
“blind drunk”.
There may be some social benefits to
moderate alcohol consumption but none for heavy drinking: Alcohol is a
good servant but a cruel master.
Read more:
- Do "Moderate" Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality
- Eat for health: alcohol
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.
GOOD CARBS FOOD FACTS
GRAPES
Wine is generally destiny for grapes. It seems that
was why we first began cultivating them and (mostly) why we still do.
Some 76,000 square kilometres (about 47,225 square miles) of Earth’s
surface is dedicated to grape growing and over 70% of the harvest is for
wine-making. In the kitchen, grapes are typically more garnish than
main event, but you can make delicious jams, and jellies, cakes and
tarts with them. Most of us however are happy to pick them from the
bunch, serve them with cheese or add them to salads and fruit salads. To
expand the culinary repertoire, we have included two recipes by Kate
McGhie in the Good Carbs Kitchen to try: Pork Meatballs with Fresh
Grapes and Wild Rice with Fresh Grapes, Walnuts and Feta.
New season’s grapes start arriving in the produce aisles in
summer. Taste one to check for sweetness as they don’t continue to ripen
once they have been picked. Look for bunches as inviting as those in a
still-life painting: plump fruit attached to moist flexible stems. The
powdery bloom, more visible on dark-coloured grapes than on pale ones,
is an important sign of freshness; it fades with time and handling.
Avoid any sticky, split or wrinkled grapes on withered or limp stems.
It’s also worth smelling them to make sure they aren’t starting to
ferment. Store unwashed grapes in a plastic bag in the refrigerator and
rinse just before using or eating. They should keep for about a week.
It’s fun to freeze little bunches to make “grape blocks” for children to
snack on.
Sources
AusFoods, 2019 and The Good Carbs Cookbook (Murdoch Books)
THE GOOD CARBS KITCHEN
PORK MEATBALLS WITH FRESH GRAPES
0:25 Prep • 0:25 Cook • 6 Servings • Family friendly • Main meal
INGREDIENTS
600g (1lb 5oz) minced (ground) pork
2 shallots, finely chopped
2 garlic cloves, crushed
3 tablespoons chopped hazelnuts
Sea salt flakes and freshly ground pepper
Plain (all purpose) flour, for coating
100g (3½oz) sultanas
150ml (5fl oz) hot black tea
2 tablespoons olive oil
3 teaspoons butter
1 onion, finely chopped
1½ cups seedless black grapes
200ml (7fl oz) chicken stock
2 tablespoons finely chopped flat-leaf parsley
METHOD
Put
the pork, half of the shallot, garlic, and hazelnuts in a bowl, and
season to taste with salt and pepper. Wet your hands and clump the
mixture together. Form the mixture into tiny balls about the size of a
golf ball, then toss in flour to coat.
Put the sultanas in a small bowl and pour over the hot tea. Leave for 10 minutes to plump.
Heat
the oil and butter in a sturdy pan, over medium heat, and fry the
meatballs, in batches if necessary, moving them around the pan to colour
evenly, for about 10 minutes or until cooked. Add the remaining
shallot, cover the pan, reduce the heat to low, and cook gently until
softened. Add the plumped sultanas with the tea, grapes and stock.
Simmer gently for 10 minutes with the lid off, or until the sauce
reduces and thickens slightly. Sprinkle with parsley just before
serving.
TIP
Black grapes are particularly
delicious in this recipe however for a striking effect you may like to
use a mixture of coloured grapes. Other herbs to consider include sage,
thyme, marjoram or tarragon.
NUTRITION
Per serve
1605kJ/ 385 calories; 22g protein; 21g fat (includes 6g saturated fat;
saturated : unsaturated fat ratio 0.4); 26g available carbs (includes
21.5g sugars and 4.5g starches); 3g fibre; 200mg sodium; 635mg
potassium; sodium : potassium ratio 0.3.
RECIPE
Kate McGhie,
The Good Carbs Cookbook, Murdoch Books.
WILD RICE WITH FRESH GRAPES, WALNUTS AND FETA
0:25 Prep • 0:45 Cook • 6 Servings • Gluten free • Vegetarian • Side dish or light meal
INGREDIENTS
1 cup wild rice
2 cups vegetable stock
Sea salt flakes and freshly ground pepper
1 large orange
⅓ cup extra virgin olive oil
¼ cup fresh orange juice
1 tablespoon red wine vinegar
2 cups seedless grapes, halved if preferred
2 spring onions (scallions) trimmed and sliced
½ cup diced celery
⅔ cup walnut pieces
⅓ cup crumbled feta
3 tablespoons roughly chopped curly-leaf parsley
3 tablespoons chopped mint leaves
METHOD
Rinse
the wild rice under cold running water, drain and put into a pot with
the stock over medium heat. Bring to the boil and then reduce the heat
to low and simmer uncovered for 45 minutes or until the rice is al dente
– it should have a nutty bite to it when cooked. Drain off the excess
liquid from the pot, cover and allow the rice stand for 10 –15 minutes.
Cut
the peel and white pith from the orange and cut the flesh in to thin
segments over a bowl to catch the juice. Whisk the juice together with
the oil and vinegar and add salt and pepper to taste.
Tip
the rice into a large bowl and add the orange segments, grapes, spring
onions, celery and walnuts. Pour over the dressing and toss. Sprinkle
with feta, parsley and mint before serving.
TIP
Try a mix of coloured grapes and for a stunning garnish, sprinkle over pomegranate seeds before serving.
NUTRITION
Per serve
1380kJ/ 330 calories; 10g protein; 26g fat (includes 4g saturated fat;
saturated : unsaturated fat ratio 0.2); 14g available carbs (includes
13.5g sugars and 0.5g starches); 5g fibre; 350mg sodium; 445mg
potassium; sodium : potassium ratio 0.8.
RECIPE
Kate McGhie,
The Good Carbs Cookbook, Murdoch Books.
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Nutritional analysis To analyse Australian foods, beverages, processed products and recipes, we use FoodWorks which contains the AusNut and Nuttab databases. If necessary, this is supplemented with data from www.calorieking.com.au or http://ndb.nal.usda.gov/ndb/search.
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© ®™ The University of Sydney, Australia
1 October 2019
GI News - October 2019
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
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