Food for Thought

A high carb diet: is it still the ideal public health message?
The proportion of people with excess body fat has doubled in the last two decades despite all our efforts to slim down. Between half and two-thirds of adults in developed nations are classed as overweight or obese. Men are worse off than women, and our children are affected, too – approximately one in four weigh much more than they should for their age and height. Even our pets are suffering – over quarter of all cats and dogs are classed as overweight and many have diabetes as a result. The food industry has met our demand for ‘diet’ and ‘lite’ foods, low fat foods, sugar substitutes, fat substitutes – you name it, they made it. But this has not stemmed the obesity epidemic. Indeed, some experts feel the food industry and its advertising are partly to blame.

Millions of people around the world are following carbohydrate-modified diets for weight loss as well as general health. And certainly both high protein and low GI diets have caught the public’s attention if diet book sales are anything to go by. With obesity and diabetes reaching epidemic proportions, what’s the best way to lose weight?

Earlier this year, the results of the largest weight loss study ever carried out indicated that a low fat dietary intervention was not a magic bullet for preventing weight regain (JAMA 2006; 295: 39). In contrast, recent studies published in JAMA, The Lancet, American Journal of Clinical Nutrition, American Journal of Epidemiology and International Journal of Obesity, suggest low GI diets have specific beneficial effects over and above that of the conventional low fat diet. But not all studies have been consistent. Are some individuals more likely to see benefits of low GI diets than others? How do high protein diets compare with those that focus on carbohydrate quality, ie. the GI?

Explore the question of carb quantity or quality with some of the world’s leading researchers at a one-day forum in Sydney on September 2 including:

• Prof Jennie Brand Miller from the University of Sydney
• Prof Arne Astrup, Royal Veterinary and Agricultural University, Denmark
• Associate Professor Frank Hu, from Harvard University
• Dr William Yancy from Duke University, USA
• Dr Manny Noakes from the CSIRO, Adelaide
• Dr Anette Buyken from Forschungsinstitut für Kinderernährung in Germany
• Dr Emma Stevenson (or Prof. Clyde Williams) from Nottingham University

Professor Jennie Brand-Miller

‘Carbohydrates, the Glycemic Index and Health’
Click HERE for registration or more information

GI News Briefs

Carb quality, weight loss and heart health

With the obesity epidemic a front-page story, ‘diet wars’ is a hot topic. And at the centre of the debate is the quantity and quality of carbohydrate. What should it be: low carb or slow carbs? The findings of a study by researchers from the University of Sydney’s Human Nutrition Unit and published in July Archives of Internal Medicine clearly show that carb quality really counts for weight loss and heart health. Led by Joanna McMillan-Price, the research team carried out the world’s first 12-week, parallel, randomised, controlled trial to compare systematically the relative effect on weight loss and cardiovascular risk of four low GI and high protein diets. Both high protein and low GI diets will help you shed fat they found, but a diet rich in low GI carbs will also significantly reduce your risk of heart disease.

Speaking to GI News, Joanna McMillan-Price said that: ‘While high protein and low GI diets may seem to be diametrically opposed, they in fact will both reduce glycemic load. That is they both reduce your blood glucose and insulin levels. This fits with what we know about our hunter/gatherer ancestors. Although they ate large amounts of meat when it was available, they also ate large amounts of plant foods (leaves, berries, nuts, seeds) which would have been gathered every day ensuring that their diet was naturally low GI and low GL. And of course whether hunting or gathering, they would have been much more active than we are today.’
– Archives of Internal Medicine 2006; 166:1466–1475


Joanna McMillan-Price

GI Group: So what’s the take home message? First of all, one diet doesn’t have to fit all: What’s important is that you set yourself attainable goals and your diet is one you enjoy and can live with over the longer term. If it involves a lot of sacrifice and discipline on your part (eg no sugar or carbs of any sort), it’s bound to fail sooner or later. Our tips:
Step 1: Focus on reducing saturated fat and eating the good fats instead.
Step 2: Choose low GI smart carbs to maximise body fat loss as well as cardio benefits.
Step 3: Aim to eat at least five serves of vegetables and two serves of fruit every day (preferably of three or more colours) including leafy greens, beans and peas, salad vegetables, pears, apples, oranges etc.
And be active. Get those legs, not the fingers, to do the walking.

Editorial comment from Dr Simin Liu, Department of Epidemiology, UCLA:
‘What should physicians do differently based on the findings of this new study? My best recommendation is to move forward incrementally. For example, as a first step, we should encourage the use of GI and GL concepts in conjunction with caloric density and nutrient composition, especially for ranking high-carbohydrate starchy foods, since the classification of carbohydrates incorporating GI does work better than the “simple vs complex” classification for predicting glucose and insulin responses …. In more practical terms, we need to teach our patients to identify low-GI foods within different food groups … Without any drastic change in regular dietary habits, for example, one can simply replace high-GI grains with low-GI grains and starchy vegetables with less starchy ones and cut down on soft drinks that are often poor in nutrients yet high in GL’
– Archives of Internal Medicine 2006; 166:1438–39


Dr Simin Liu

Keeping the kilos off
People on diets high in slowly digested carbohydrate and low in saturated fat can successfully lose weight and keep it off finds a study presented at the Australian Institute of Food Science and Technology Incorporated Convention in July. University of Melbourne research dietitian Liz Delbridge and her team put 173 overweight or obese people on a 12-week low-energy weight loss diet before switching them randomly to either a high carbohydrate or high protein diet (low–moderate GI carbohydrate choices were recommended for both diets) to maintain their weight. Results showed that a high protein diet had no advantages over a high carbohydrate diet in maintaining weight loss over a 12-month period. ‘Some people lose weight and keep it off, whereas others lose weight and put it all back on again,’ said Ms Delbridge. ‘We wanted to see if the type of diet people adopted after weight loss had an influence on people’s ability to keep the weight off.’
– Australian Institute of Food Science and Technology Incorporated Convention

High GI carbs linked to oxidative stress
We have all received the message that it’s important to eat plenty of anti-oxidant rich fruit and vegetables to fight the bad guys, those free radicals (see below) that have been implicated in the cause of numerous diseases. Free radicals are formed in the environment by things like pollution, cigarette smoke, solvents and pesticides; and in the body as a byproduct of metabolism, wherever oxygen is involved. Recent research has suggested that high blood glucose may also increase free radical production. In a report published in American Journal of Clinical Nutrition, lead author Gladys Block says that ‘increasing intakes of low GI foods such as most fruit, vegetables, dairy products and whole grains may be beneficial in terms of reduced oxidative stress.’ The researchers measured plasma MDA and IsoP concentrations (two widely used markers of oxidative stress – see below) in 292 healthy individuals and found a direct relationship between dietary GI and oxidative stress. In their conclusion they say that: ‘Chronic consumption of high GI foods may lead to chronically high oxidative stress. A low GI diet, not a low carbohydrate diet, appears to be beneficial in reducing oxidative stress.
– American Journal of Clinical Nutrition 2006;84:70–6

GI Group
A free radical is an atom or molecule with at least one unpaired electron, making it especially reactive to other atoms or groups of atoms. If free radicals react with certain chemicals in the body, they may interfere with the ability of cells to function normally.
Oxidative stress is related to the body's ability to eliminate free radicals and can result in cell damage within the body.

Spice notes
Herbs and spices bring more than fragrance and flavour to our food. Research in recent years suggests that some spices such as turmeric, garlic, ginger and cinnamon and chilli may have healthy benefits for our digestion, blood glucose control, fat metabolism and for fighting free radicals.

Cinnamon: Two promising studies report that as little as the equivalent of ¼ teaspoon of cinnamon daily may improve blood glucose control. In the earlier Diabetes Care (Vol 26, pp3215–18) study, Dr Alam Khan from the NWFP Agricultural University in Peshawar, Pakistan gave 60 diabetic men and women between 1 and 6 grams of cinnamon or a wheat flour placebo each day for 20 days. Those who took cinnamon showed significant improvements in blood glucose, LDL cholesterol and triglyceride levels. More recently, researchers from the University of Hannover led by B. Man randomly 79 diabetic volunteers a cinnamon solution (in a capsule) equal to 1 gram of cinnamon or a placebo each day. After four months fasting blood glucose levels improved in the cinnamon group by an average of 1.1 mmol/L (European Journal of Clinical Investigation Vol 36, pp340–44). The GI Group looks forward to seeing some spicy follow up research on cinnamon with controls for overall diet and physical activity levels.



Chilli: Research in recent years has provided some evidence that capsaicin, the chemical that gives chilli peppers their bite, can raise your metabolic rate. But the studies have tended to be small, or used supplements rather than the real thing and certainly not definitive. Hot off the press from the American Journal of Clinical Nutrition (2006;84:63–9) comes news that will be popular with spice lovers; a meal containing freshly chopped chilli may help reduce insulin levels. Kiran Ahuja and researchers from the University of Tasmania’s School of Life Sciences compared the effects of a chilli meal after four weeks of eating bland (spice-free) meals and a chilli meal after four weeks of spicy meals, with eating a bland meal after four weeks of bland meals. In their randomised, crossover intervention study with 36 participants, they found that eating a chilli meal reduced the amount of insulin required to bring down postprandial blood glucose levels. Their results also suggested that the effect is likely to be more pronounced in individuals with a greater BMI (equal to or greater than 26) and when chilli was regularly eaten. Medscape members can read further information on this study at www.medscape.com.


photo: Scott Dickinson

High GI diets and fatty liver disease
As the incidence of obesity in adults and children increases, so does non-alcoholic fatty liver disease (NAFL) – excess fat in the liver. It is strongly associated with insulin resistance and relatively common in people with type 2 diabetes. Currently there are no effective treatments other than weight loss, which makes the findings of a new Italian study published in the American Journal of Clinical Nutrition timely. Valtueña and colleagues suggest that a low GI diet may help people with NAFL more than low carb or high fibre diets and be a complementary tool for preventing or treating it. In their cross sectional study of 247 healthy individuals, the researchers looked at dietary correlations with NAFL assessing the effects of both the quality and quantity of carbohydrate. They found that the GI of the diet is a good marker for fatty liver. The higher the GI, the greater the prevalence of fatty liver, especially in insulin resistant people. In an editorial in the same issue, Prof David Jenkins calls for further studies to ‘assess whether a low-GI diet, given as an intervention, makes a difference in the natural history of NAFL.’
– American Journal of Clinical Nutrition 2006;84:136-42
– American Journal of Clinical Nutrition 2006;84:3-4 (Editorial)

GI Values Update

The latest GI values from SUGiRS

Beans, Peas and Legumes
Casa Fiesta Refried Beans, GI 38

Beverages – Milk
Pura Light Start, GI 30
Pura Tone, GI 30
Pura HiLo, GI 20
Pura Skimmer, GI 20
Big M Chocolate flavoured milk, GI 37
Big M Strawberry flavoured milk, GI 37

Bread
Bakers Delight Wholemeal Country Grain, GI 53



For details of nominal serve sizes, available carbohydrate and GL check out the GI database at www.glycemicindex.com

For more information about GI testing at Sydney University, please contact:
Fiona Atkinson sugirs@mmb.usyd.edu.au
Research Manager, Sydney University Glycemic Index Research Service (SUGiRS).
Human Nutrition Unit, Department of Biochemistry (GO8)
Sydney University, NSW 2006 Australia


Fiona Atkinson

Low GI Food of the Month

Split Peas: More Than a Winter Warmer
Like other low GI legumes (pulses), protein-rich split peas are a nutritional storehouse. They are an excellent source of fibre, vitamin C, along with some iron, zinc and B group vitamins. When you cook them, they more than double in weight and when you eat them, you’ll feel satisfied for longer. You don’t need to soak them before cooking, but rinse them thoroughly in a colander first. Yellow or green split peas (GI 32) come from a variety of garden pea with the husk removed. They tend to disintegrate when cooked for long periods and are associated with comfort foods like pea and ham soup and (yellow split peas) for Indian dhal or to make patties and purees. But they can be more than a winter warmer. You can also use them for fairly fast food for summery salads, too as you’ll discover in the following recipe.

Low GI Recipe of the Month

Split Pea, Watercress and Goat’s Curd Salad
This salad created by Kate Tait for June 2006 Delicious magazine is a deliciously complete meal in itself and can be prepared, cooked and served in around 30 minutes.


Kate Tait - photo by Petrina Tinslay

You can buy ready roasted capsicum and goat’s curd cheese from delis, gourmet food shops and larger supermarkets.

1 cup (200 g) green split peas
1 tablespoon olive oil
Juice of 1 lemon
2 teaspoons ground coriander
½ teaspoon ground ginger
1 red onion, very finely chopped
1 bunch watercress, stalks trimmed (to give 3 cups sprigs)
2 roasted red capsicums, cut into strips
¼ cup goat’s curd or soft goat’s cheese

Cook the split peas in a saucepan of boiling water for 15–18 minutes until tender, but firm to the bite. Meanwhile, make the dressing by placing the oil, lemon juice, spices and onion in a large bowl and whisking until combined. Drain the peas well and add to the dressing. Season to taste if desired and toss to combine. Stand for 10 minutes to let the flavours absorb then toss with the watercress sprigs and capsicum strips. Divide evenly among four plates and top with goat’s curd.

Per serving: Energy: 1155 kJ/276 Cal; Protein: 17 g; Carbohydrate: 28 g; Fibre: 7.6 g; Fat: 8.8 g (includes saturated fat 2.4 g)

Your Success Stories

Bedrich: Little changes – Big difference
‘For 15 years I ran my own small company in Prague. During those 15 years I spent a lot of time driving or sitting at a desk, developing software applications and seeing clients. Many times I would miss meals and I would end up eating on the run or I would miss meals completely and have a huge meal late at night. The result was my weight soared from 76 kg when the company began to a peak of 97 kg during 2005. My energy levels were not good, I felt unhealthy, and worse, a blood glucose test in 2004 showed that my 2-hour blood glucose levels were too high. Both my mother and father had type 2 diabetes and, at 55, I knew I needed to make some changes but didn't know how or where to begin.

Everything changed for me when I visited my daughter in Australia for 3 months in late 2005. She told me about the GI and the importance of daily exercise. I began eating oats with fresh fruit for breakfast and for lunches I would make my own sandwiches using capeseed rolls, salad and a cheese slice. I used avocado instead of butter. We always had a salad with dinner that contained different beans and vegetables. We typically ate poached chicken breast or tinned fish but would also have lean cut steaks on a BBQ. Another major change was daily walking to and from the bus or train station. When I left in late February 2006, my weight had dropped to 82 kg. Best of all I just felt so much better.

Today back in Prague my weight is 84 kg nearly four months later. I continue to choose low GI carbohydrates in place of the old high GI versions I ate before Australia and am now walking to the train station to get to work leaving the car behind. I am confident I will be able to maintain my new weight with these new but easy changes.’



David Lee Nall says: ‘Taking care of yourself is the best way to take care of others.’
‘I was living the American dream: I had a beautiful family, a new house, four cars, and a business that was grossing seven figures. I had come a long way for a skinny, dyslexic kid who had been a poor student. But in the midst of all this hard-earned success, my weight had climbed to 245 pounds, my energy levels were flagging, and I discovered some tumors on my stomach and lower back. Although the tumors were diagnosed as benign, the health scare was a wake-up call. I wasn’t even 30 years old. My son was only four. I wanted to be around to see him grow up.

On 1 December 2004, I decided to change my life once and for all. I made the decision to start taking care of myself. I bought healthy foods, watched what I ate, and restructured my exercise routine. And I resolved to enter the 2006 Texas Shredder Classic, a natural, drug-tested, body building contest.
I began eating small, frequent meals totalling 350 grams of protein, 300 grams of carbohydrates and 40 grams of fat daily. However, I was getting headaches and always feeling hungry. Then I found out about glycemicindex.com. By choosing slow carbs, I was able to lose weight without feeling hungry and sustain my intense workouts. Five days a week I did 30 minutes of high intensity cardio workouts and weight training, with 45 minutes of cardio on the weekends. After losing a total of 59 pounds and dropping my waist size from 42 inches to 32 inches, I placed second in my class at the body building contest.

But the real reward was how I felt: I hadn’t felt this good since I was in high school, when I’d first started weight lifting and strength training as a way to overcome the weak knees that prevented me from playing sports. Today, I still manage my franchise business, but because I enjoy seeing people undergo the same kind of transformation I went through I also have my own personal trainer business. My motto is that no one is ever too old to adopt a healthy lifestyle; the body has an amazing ability to heal and renew itself.’
www.davidleenall.com



Send Us Your Success Story!

Books, DVDs, Websites: What’s New?

The Low GI Diet
Revised and updated Australian and New Zealand edition.
Prof Jennie Brand-Miller, Kaye Foster-Powell and Joanna McMillan Price.



‘Can I say how easy the Low GI Diet is to follow, and also The GI Diet Cookbook is excellent. I’ve got so much more energy and feel really well on it.’ – Pernille

The Low GI Diet is the science-based, 12-week Action Plan built around low GI smart carbs and smart moves to help you lose up to 10 per cent of your current body weight. Each week you will have a food goal, an exercise goal, an activity goal plus some food for thought. This revised edition has been updated with more recipes plus your low GI Diet pantry, It also includes:

• The best way to balance protein and carbohydrate
• The tools and tips you need to maintain weight loss for life
• Quick and easy recipes, meal plans and a menu survival guide for eating out
• Simple and practical ways to build more activity into your day
• The at-a-glance GI tables.

ANZ edition: The Low GI Diet, Hachette Livre Australia; Hachette Livre NZ
UK edition: The Low GI Diet, Hodder Mobius
US edition: The Low GI Diet Revolution, Marlowe & Company

Feedback—Your FAQs Answered

What is the law in relation to making a low GI claim on a product in Australia? I have noticed all sorts of claims on various products and seen brands that use a symbol similar to the official GI symbol. I think that this could be rather misleading to shoppers.
Alan Barclay of Diabetes Australia gets asked about this regularly. Here’s what he wrote in a recent issue of ‘Conquest’.

Claims about the GI of foods are currently not regulated under Australian food law. Manufacturers are free to make claims provided they are not false or misleading. They should print the GI value of the food on the food label, to help you to verify the claim. A food with a low GI should have a value less than or equal to 55. There are a number of brands that make low GI claims but do not provide a GI value or definition of what low GI means on the label. Unfortunately, you have no way of verifying whether the claim is legitimate. To do so you’d need to be carrying around the latest version of The Shopper’s Guide, have a mobile phone (call one of Diabetes Australia's dietitians on 1300 136 588) or have internet access through your mobile phone (check the GI database at www.glycemicindex.com). Without verification, it’s probably sensible not to trust the claim because you have no idea whether the food was tested following the standardised procedure by an accredited lab.

You may also see products claiming to be ‘low glycemic’ or ‘diabetic friendly’ leaving it open as to whether it’s low GI, low GL, or low glycemic response. Be cautious with these claims as the product could actually be low carb (check the nutrition label). Manufacturers making these claims may not be intending to mislead the consumer, they simply may not understand the difference. It’s useful to write and ask what they mean and where the food was tested. There are a number of foods that use low GI logos that are similar to the Glycemic Index Tested logo. Some of these cases have been pursued through legal channels.

• Consumers in Australia or New Zealand who have concerns about GI label claims, should contact FSANZ and/or the Australian Competition and Consumer Commission (ACCC).
• Consumers in the USA and Canada can contact the Food and Drug Administration's Office of Compliance at the Center for Food Safety and Applied Nutrition (for USA) and the Canadian Food Inspection Agency (for Canada).

And remember when it comes to reading labels, GI is only part of the picture –don't forget to check the nutrition panel for the fat, salt, and kilojoule/calorie content per serving.


Alan Barclay

The GI Symbol Program: This international symbol is a guarantee that the product meets strict nutritional criteria. Glycemic Index Limited is a non-profit company established to run the GI Symbol Program. Its members are: the University of Sydney, Diabetes Australia and the Juvenile Diabetes Research Foundation. For more information, visit www.gisymbol.com.



I work third shift, four days a week from 2100 to 0600–0700. Sometimes I eat before I go to bed and other times I skip it. When I get up I eat the main meal of the day at 1700–1800 and leave for work shortly after. I have a 15-minute break every two hours and an hour lunch break at 0200 am when I usually eat yoghurt. I have put on weight although I haven’t changed my eating habits. I just don’t know when, how, and what to eat.
Shift work can be a problem, especially for people with diabetes says dietitian Kaye Foster-Powell. Like anyone else who needs to get rid of excess weight, it’s important to talk to a dietitian about total daily food requirements and where and how meals, snacks and activity could be distributed over the day/night. She says that there are a couple of key points that can help shift workers shift excess weight.

The first is sleep. There are studies that show that just small amounts of less sleep than needed (as little as 20 minutes) are associated with weight gain. Here at GI News we aren’t experts on how disrupting the body’s normal circadian rhythm affects biological systems, but weight gain could be simply a consequence of inadequate sleep – 6–7 hours sleep is less than normally recommended for most people.

Secondly, having some structure to meals and snacks also helps. So for someone on third shift, for example, a main at 1700–1800 hours, a snack at 2300 hours, lunch at 0200 and breakfast at 0700–0800 hours would be a useful starting point.

In addition, new research by Medical Research Council scientists at the MRC Laboratory of Molecular Biology in the UK and published in Current Biology has found a major clue to why shift workers suffer from increased incidence of heart disease and metabolic illnesses. The daily ‘body clock’ determines which enzymes are produced by the liver at which time of day and night. This means that the liver’s ability to process meals follows a regular daily progression. Dr Michael Hastings, who led the research, explains: ‘When our body clocks are disturbed (by shift work or jet lag) so as to cause a mismatch between when and what we eat and what the body is able to process at meal times, nutrients are handled less effectively, for example fats will not be cleared from the blood stream and blood sugar levels will not be regulated appropriately.’
– Medical Research Council Press Release
– Current Biology, Vol 16, 1107-1115, 06 June 2006


Kaye Foster-Powell

What’s the GI of a Caffé Latte and Cappuccino?
Most milky drinks will have a low GI and won’t add too many kilojoules/calories either so long as you don’t sweeten them with more than a teaspoon or so of sugar and you say no to those flavoured syrups lined up on the counter. In fact a caffé latte, cappuccino, café au lait or flat white can be the perfect mid-morning snack and an easy way to help you get your two to three serves of dairy foods a day. Regular or skim, milk has a low GI (27–34) – a combination of the moderate glycemic effect of its sugar (lactose) plus milk protein, which forms a soft curd in the stomach and slows down stomach emptying. Regular whole milk is high in saturated fat, but these days there’s a wide range of reduced fat milks including low fat and skim types. If you prefer soy milk (GI 36–45 reduced fat) make sure you opt for calcium fortified and of course, reduced fat. Note that rice milk is not a suitable substitute; it has a high GI (79). How much milk are you getting with your coffee? Well, to some extent it depends on the barista and where you buy it. But here are some standard definitions.

• A caffe latte is a single shot of espresso with steamed milk – approximately a 3:1 ratio of milk to coffee.
• A cafe au lait is similar except it is generally made with brewed coffee instead of espresso in a ratio of 1:1 milk to coffee.
• Cappuccino is traditionally equal parts espresso, steamed milk and frothed milk.
• Flat white is similar to a cappuccino, but with latte proportions of foam.

What’s the GI of cornstarch?
We are often asked about the GI of starchy thickeners from arrowroot and cornstarch, to kudzu root powder and instant tapioca. These silky powders thicken sauces and soups and pie fillings without adding fat or going lumpy. All you do is mix about a teaspoon of the starch into a tablespoon of water, whisk into the liquid you are thickening, and cook for about a minute, stirring constantly to remove the slightly starchy flavour. These proportions will make about 1 cup (250 ml) of a medium-thick sauce. None of these thickeners has been GI tested as far as we know; we haven’t seen any published results. However, you are only using very small amounts diluted in a cup or more of liquid or pie filling. So the GI of the recipe will depend really on what you are making. However, here are some alternative ideas for thickening sauces and soups.

Sauces: Simply reducing the sauce will thicken it and intensify the flavour.
Soups: For vegetable soups, puree some of the cooked vegetables then stir them back into the soup to thicken. Added grated starchy vegetables like sweet potato or yams will also thicken a vegetable soup; or stale, well-crumbled breadcrumbs (sourdough or grainy of course) to a mushroom soup. For a creamy soup you can stir in a little light evaporated milk or low fat yoghurt. Pureed cooked or canned white beans will also thicken a vegetable soup.

In June GI News in the piece on toppings (‘Test Is Best’) you seemed to say that eating fat reduces the GI of a food (and thus would seem to be a good thing). In Feedback in the same issue you seem to say that eating a fat does not reduce the need for insulin and thus presumably does not help one. What’s the story?
It can be confusing. Here are the facts, one at a time.

1. Eating any carbohydrate raises blood glucose and insulin levels.
2. Adding fat or replacing some of the carbohydrate with fat will reduce the glycemic response.
3. But the insulin response is unchanged.
4. We don't want people to lower blood glucose values by adding saturated fats (cheese, butter etc) because that increases the risk of cardiovascular disease. It's much more helpful to choose a low GI carbohydrate food!
5. We don't want people to lower blood glucose values by adding excessive amounts of ANY fat (saturated or unsaturated) because that increases energy intake and compromises weight control. That's not to say that we should avoid good fats, it's a matter a moderation.
6. Mixed meals containing a mix of protein, fat and carbohydrate tend to have a lower GI than single high carbohydrate foods like bread and rice.
7. The glycemic and insulin response to mixed meals can be nicely predicted by (1) the total carbohydrate content of the meal and (2) the GI of the component carbohydrate foods.
8. The usual cut-offs for high, medium and low GI (70, 56 to 69, less than 55) are meant for single high-carbohydrate foods, not mixed meals. Because the range of GI will be narrower for mixed meals, a different set of cut-offs need to be developed. We won't know what those cut-offs should be until we've tested dozens of mixed meals. With the increasing trend to test the GI of ‘meal replacements’, that may not be far off.

The bottom line: In the meantime, our advice is to choose lean proteins, good fats (unsaturated), plenty of fruit and vegetables and good carbs (low GI wholegrains) in the proportions you enjoy. If you are trying to lose weight, control the portion sizes and get a total of 60 minutes of incidental and deliberate activity each day.



Look it up in our A–Z: The GI Glossary (continued)
Ketones Our bodies need to maintain a minimum threshold level of glucose in the blood to provide energy for our brain and central nervous system. If for some reason, glucose levels fall below this threshold, (a very rare state called hypoglycemia) the brain will make use of ketones – a by-product of the breakdown of the body’s fat stores. Ketones are strong acids, and when they are produced in large quantities they can upset the body’s delicate acid-base balance. They are normally released into the urine, but if levels are very high or if the person is dehydrated, they may begin to build up in the blood. High blood levels of ketones may cause fruity-smelling breath, loss of appetite, nausea or vomiting, and fast, deep breathing. In severe cases, it may lead to coma and death. In a pregnant woman, even a moderate amount of ketones in the blood may harm the baby and impair brain development. Large amounts of ketones in the urine may signal diabetic ketoacidosis, a dangerous condition that is caused by very high blood glucose levels.

Ketosis is the metabolic state when the body is burning fat for fuel. Normally carbohydrates are the main source of fuel for your brain, heart and many other organs.

Kilojoule or kJ is the metric system for measuring the amount of energy produced when food is completely metabolised in the body. The Calorie is the imperial measure of energy, and can be calculated from the number of kilojoules by dividing by 4.2.

Lipids or fats are found in the blood and the walls of all of the body’s cells. The most common lipids are cholesterol and triglycerides (sometimes called triacylglycerols).

LDL cholesterol see Cholesterol

Millimole (mmole) is a unit for measuring the concentration of glucose, cholesterol, triglycerides and other substances in a certain volume of blood – usually 1 litre (L).
Mono-unsaturated fat is found in large quantities in olive and canola oil, and some nuts and seeds. Like all fats, mono-unsaturated fats are high in kilojoules. Mono-unsaturated help lower LDL cholesterol levels and are thought to help reduce the risk of heart attack and stroke.

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GI News—July 2006

In This First Anniversary Issue:

• Food for Thought
  —Slow Carb Not Low Carb
  
• GI News Briefs
  —Unite for Diabetes
  —The Rice Factor
  —Foretelling Early Insulin Resistance
  —GI: The Real Meal Deal
  
• GI Values Updates
  —Breakfast Cereals and Beverages
  
• Low GI Food of the Month
  —Do You Have the GI for Fresh Rhubarb Stalks?
  
• Low GI Recipe of the Month
  —Diane Temple’s Sweet Potato and Lentil Bake
  
• Success Stories
  —‘A Low GI Diet – Best Thing I've Done in a Long Time’ Says Lorraine
  —Jaws Drop at the Gym When Margaret Walks In
  
• What's New?
  —Weight Loss for Food Lovers
  
• Feedback—Your FAQs Answered
  
  1. What’s the GI of meat, chicken, fish, eggs and cheese? I can’t find these foods in the GI database.
     
  2. I have heard that pasta made of strong wheat flour (such as durum) has a lower GI than pasta made of softer wheat flour. Is this true?
     
  3. I've been following The Low GI Diet and have noticed some recipes include the use of filo pastry. Does filo pastry have a low GI? I love spinach pastries and even vegetable pies, but I am wondering if pastries have a high GI value?
     
  4. I have read in some GI lists that fresh coconut is low GI, is this true? Coconut does not seem to be on your list!
     
  5. Look it up in our A–Z: The GI Glossary continued
• Events
  —Carbohydrates, Glycemic Index and Health: The State of the Art
  —Dietary Study for Women with PCOS

Welcome to our first anniversary issue. We would like to thank the thousands of subscribers and visitors who have made the newsletter such a success and whose comments and questions have played a key role in shaping the newsletter over the first twelve months.

The GI Group launched GI News a year ago to make available to a broader audience the latest scientific research covering carbohydrates and health (including both positive and negative GI research results), diet and weight loss; diabetes; heart disease; and PCOS along with the latest published GI values. To help people incorporate more of the right carbs into their own diet and lifestyle, we also included information on low GI foods and a recipe or two. And to inspire and motivate we added blood glucose control ‘success stories’. We wanted to hear what our visitors had to say, too. That’s why we set GI News up as a blogspot to allow people to post their own comments or send questions to the GI Group for more detailed answers.

Since posting our first issue on 11 July 2005, we have clocked up around 250,000 visitors and have more than 16,000 subscribers from right around the world. We are pretty proud of this result as we don’t have any sponsorship or advertising dollars to spend on promotion. To receive our free e-newsletter each month, all you have to do is click the SUBSCRIBE link in the right-hand column. Your email address will be kept strictly confidential and you can unsubscribe at any time. We hope you enjoy our first anniversary issue and please pass the link on to friends and colleagues you feel will find the site useful.

GI News Editor: Philippa Sandall
Web Design and Management: Scott Dickinson

Food for Thought

Slow Carb Not Low Carb
In May, ‘News Brief’ reported on a woman who was hospitalised for life-threatening ketoacidosis after following the Atkins diet. We then listed the reasons why we advocated a low GI diet rather than a low carbohydrate diet. Some of our readers admonished us for our stance. Here are their comments and our responses.

1. Opposers of low carb regimes tend to stick to criticism that are really directed to the so called ‘induction phase’ which lasts only two weeks. After that, dieters on Atkins can and should consume a great variety of green, leafy nutritious vegetables, among many others, like mushrooms, eggplant, peppers, broccoli, cauliflower etc. Atkins never encourages you to eat zero carbs. 20 grams for the first 2 weeks, and you raise those levels after that.
   Yes, that’s true, criticism is often aimed at the induction phase but it’s also true that the second phase is restricted in carbohydrates (around 50 grams a day) too, and adherents are encouraged to return to the induction phase (20 grams a day) if weight loss slows. Furthermore, because Atkins recognised that the diet was not nutritionally balanced, a vitamin and mineral supplement program is compulsory.
   
   The study by Yancy et al (Annals of Internal Medicine 2004: 140; 769) compared an Atkins diet with a prudent (low fat but high GI) diet in 120 overweight volunteers. Those following the Atkins diet lost twice as much weight in 24 weeks but read the small print. Specifically, adverse effects occurred more frequently in the low-carbohydrate diet group than in the low-fat diet group, including constipation (68% vs. 35%; P < p =" 0.03)," p =" 0.02)," p =" 0.01)," p =" 0.006)." style="font-style: italic;">Annals of Internal Medicine 2004; 140: 778), two persons on the low carbohydrate diet died, and a third was hospitalised. No such adverse events were recorded in those following the high carbohydrate diet.
   
   
2. There might have been some underlying health reasons for the ketoacidosis you mention.
   The case of a woman who was hospitalised for life-threatening ketoacidosis was written up in The Lancet (Chen TY, Smith W, Rosenstock JL, Lessnau KD The Lancet – Vol. 367, Issue 9514, 18 March 2006, Page 958). The precipitating factor, whatever her individual vulnerability, was strict adherence to a low carbohydrate diet. Fortunately, most people don’t or can’t adhere strictly to the Atkins diet.
   
   
3. No diet is really recommended for ill or pregnant people.
   Pregnant women have to eat and the diet they eat affects their baby’s development. We use the word ‘diet’ in the sense of ‘eating plan’ (as defined by most dictionaries), not restricted energy intake. We agree that it’s not a good idea to restrict energy intake during pregnancy (one reason being the adverse effect of ketones on fetal development). But it’s vitally important that women eat a healthy diet throughout their pregnancy and throughout their reproductive years – because not every pregnancy is planned. A low GI diet fits the bill perfectly, a low carbohydrate diet doesn’t (and you appear to agree). If a diet’s not good for a developing fetus, why would it be good for anyone else?
   
   
4. It is not true that consuming bad fats is unavoidable. You can and should avoid them and stay within Atkins.
   If carbohydrates occupy only 10% of your energy intake (i.e. you eat about 50 grams of carbohydrates per day), then the other 90% of energy must come from a mix of protein and fat. The upper limit on protein intake by humans is around 40% of their calories (kilojoules) because of limits on the liver’s capacity to produce urea. By a process of deduction, that means more than 50% (and more often 60%) of energy comes from fat. Even if you ate a perfectly healthy balanced diet with a P:M:S: ratio of 1:1:1 (polyunsaturated, monounsaturated, saturated fat), you’d be consuming about 20% of your calories as saturated fat. The recommendation is less than 10%.
   
   
5. I love carbs, I could be happy with a GI diet, and I will resort to it as soon as I reach my goal weight, but losing weight with GI diets is complicated because as soon as you surpass the level of carbs you can consume, you stop losing weight and start gaining.
   That was the claim Atkins made but he had no scientific evidence to back that. To our knowledge, there’s still no evidence. Indeed, recent studies suggest that people find it very hard to stick to a diet with so little carbohydrate (too much discipline is needed) and eventually re-gain the weight they lost. Is there any point in losing weight and then re-gaining it? Wouldn’t it be better to align food habits with something that’s not only healthy, helps you lose weight and keep it off for good?
   
   
6. As soon as I can start incorporating more carbs into my diet, they will be of the low glycemic load kind.
   That’s good. Why not cut to the chase early?
   
   
7. There should really be no quarrel between low glycemic and Atkins because they are fundamentally the same. The diets you should be strongly opposing are the low caloric and the low fat diets.
   No, that’s incorrect. Atkins wants to ditch carbs. Low GI diets can be moderately or even very high in carbs, but of the low GI kind. If Atkins had known what we know now, he would have seen ways to lower insulin levels without cutting the carbs. He recognised that high insulin levels interfered with weight control, but he did not have sufficient knowledge to work out the best way to lower insulin. Remember he had no training in nutrition.
   
   
8. The truth is that Atkins works. Once you get to your equilibrium level, then you can do low GL and stay in a narrow weight band.
   Yes, we agree that Atkins works in the short term. But not the long term. So what’s the point in following such a diet?

James Krieger, M.S., M.S. 20/20 Lifestyles Research Associate, PRO Club (http://www.proclub.com) and Editor, Journal of Pure Power (http://www.jopp.us) makes the point that: ‘You lose fat, water, and muscle’ is true of ANY diet. My recent meta-regression, published in the February 2006 issue of AJCN, shows quite clearly that fat loss is significantly higher on ketogenic diets, even after control for energy intake. Fat-free mass loss was also greater, but not by a large amount.


James Krieger

‘There is no apparent metabolic advantage associated with ketosis during dieting’ report researchers from the Department of Nutrition, Arizona State University, Inflammation Research Foundation, Marblehead and Conscious Cuisine, Scottsdale in the May issue of the American Journal of Clinical Nutrition. In summarising their findings, Prof. Carol Johnson says: ‘In the current study, the ketogenic low-carb diet did not offer any significant metabolic advantage over the nonketogenic low-carb diet. Both diets were effective at reducing total body mass and insulin resistance, but, because blood ketones were directly related to LDL-cholesterol concentrations and because inflammatory risk was elevated with adherence to the ketogenic diet, severe restrictions in dietary carbohydrate are not warranted. Furthermore, the nonketogenic low-carb diet was associated with feelings of high energy and a more favorable mood profile than was the ketogenic low-carb diet.’ They recommend anyone wanting to follow a low-carb diet to choose low-fat meats and dairy products, and eat 8–9 servings of fruit and vegetables and 100–125 grams of carbohydrate a day.

GI News Briefs

Unite for Diabetes
During the last 20 years, the total number of people worldwide with diabetes has risen from 30 million to 230 million according to the International Diabetes Federation. The number is expected to reach 350 million by 2025. The top five countries with the most diabetes sufferers in 2003 were India 35.5 million, China 23.8 million, USA 16 million, Russia 9.7 million and Japan 6.7 million.



Facing the facts:

• There are 6 million new diabetes sufferers in the world each year.
• Half of all diabetes sufferers around the globe do not know they have it. In some parts of the world 80% of sufferers don't know.
• Diabetes raises the sufferer's risk of developing a cardiovascular disease by two to four times. Cardiovascular disease, the number one cause of death in the industrial world, will soon be the number one cause of death globally.
• Diabetes is now the fourth biggest cause of death worldwide.
• Every ten seconds someone in the world dies as a result of having diabetes – 3 million deaths a year.
• Good control of blood glucose levels significantly reduces the diabetes patients’ risk of developing complications. Managing hypertension and raised blood lipids is also crucial.

Diabetes is threatening to overwhelm future medical services if left unchecked. The International Diabetes Federation (IDF) is leading a worldwide ‘Unite for Diabetes’ campaign to have the United Nations recognise the global burden of diabetes. Why a UN resolution? If governments begin now by promoting low-cost strategies to alter diet, increase physical activity and modify lifestyles, the advance can be reversed. The proposed resolution would recognise the need for prevention and acknowledge the special needs of children and adolescents, the elderly, pregnant women, migrant populations and indigenous peoples. The aim is for the UN Resolution to be declared on World Diabetes Day 2007 (November 14). For more information about the campaign, visit www.unitefordiabetes.org.
– International Diabetes Federation Press Release from the American Diabetes Association’s 66th Scientific Sessions



The Rice Factor
Heart disease and diabetes are serious health problems in Japan just as they are in many other parts of the world. In fact, heart disease is the second leading cause of all deaths and more than 6.7 million people in Japan have diabetes. Will adopting a low GI or low GL diet reduce the risk? So far, most studies showing the beneficial effects of low GI and GL diets have been carried out in the US, Europe and Australia with people who eat western diets. What happens in Asia where rice is the staple? In Japan, for example, rice contributes 43% to total carb intake and 29% to energy intake (calories).

Japanese researchers have found positive correlations between dietary GI and body mass index, serum triglyceride levels, fasting plasma glucose and HbA1c; and between GL and serum triglyceride levels, fasting plasma glucose and decreased levels of high-density lipoprotein (HDL), or good, cholesterol. They published the results of their cross-sectional study of 1354 healthy Japanese women eating a traditional diet based on a self-administered diet-history questionnaire in AJCN (May 2006). The main contributor to the GI and GL of the women’s diet was white rice (59%) followed by confectionary (11%), fruit (7%), sugars (6%), bread (4%), noodles (3%), other rice (3%), and potatoes (3%). The authors make the point that although the results may not be extrapolated into the general Japanese population (the subjects were selected Japanese female farmers), they should ‘provide valuable insight from a prevention perspective.’
– Am J Clin Nutr 2006;83: 11161–9



Fortelling Early Insulin Resistance
‘Insulin resistance not only predisposes individuals to type 2 diabetes, it is also a major risk factor for cardiovascular disease,’ says Timothy Graham, MD, a researcher at Beth Israel Deaconess Medical Center (BIDMC). ‘In the clinical setting however, it is often difficult to distinguish individuals with and without insulin resistance.’ Insulin resistance develops when the body's muscles, fat and liver cells lose the ability to respond to the hormone insulin.

Elevated levels of a molecule called retinol-binding-protein-4 (RBP4) can foretell early stages of insulin resistance, a major cause of type 2 diabetes as well as heart disease, reveal BIDMC researchers writing in The New England Journal of Medicine.

The researchers were looking to see whether levels of RBP4 correlated with the presence or absence of insulin resistance in three groups and they repeated the measurements after exercise training for one group. They found that RBP4 levels were higher in all cases in which insulin resistance was high. Elevated RBP4 was also closely associated with increased BMI, waist-to-hip ratio, serum triglyceride levels, and systolic blood pressure, as well as decreased levels of high-density lipoprotein (HDL), or good, cholesterol. All the people who improved their insulin sensitivity with exercise also lowered their serum RBP4 levels. Among the third who did not improve their insulin sensitivity, neither did their RBP4 levels go down.



Dr Barbara Kahn

Barbara Kahn, MD, Chief of the Division of Diabetes, Endocrinology and Metabolism at BIDMC and Professor of Medicine at Harvard Medical School says: ‘Collectively, these findings tell us that RBP4 is a useful marker for therapeutic improvement and that this protein could play a causal role in insulin resistance in humans. Because RBP4 levels consistently corresponded with insulin resistance – even among lean subjects whose genetic risk for the development of diabetes might otherwise be overlooked – this protein could be an important marker for type 2 diabetes among the general population. Being able to determine diabetes risk well before the onset of symptoms could provide an important opportunity for patients to take preventive measures,’ she adds. ‘For those who are overweight or sedentary, this could mean making changes to their diet and fitness routines. For those who are lean and fit, but have a family history of type 2 diabetes, this could mean taking antidiabetic medication. Either way, these findings could help clinicians to better manage this growing epidemic.’
– NEJM 354:2552–2563; BIDMC Press Release

GI: The Real Meal Deal
Recent criticism of the GI has focused on unpredictable outcomes of blood glucose values in meals because of variations in fat, protein and fibre levels.

Researchers in the University of Toronto's Department of Nutritional Sciences and the University of Sydney’s Human Nutrition Unit have some reassurance for people with diabetes and carb-counters. The glycemic index (GI), the table that lists the quality of carbohydrates in more than 750 common foods, works just as predictably whether subjects consume a single portion of one item, or a normal meal. ‘The good news it that the GI index works’ says Prof. Tom Wolever. ‘For sensible people it makes a lot of sense. It's simple proportional measure – like mixing paint.’

Concerned about the methodology of recent studies done elsewhere showing unpredictable responses, Wolver and his associate, Prof. Jennie Brand-Miller of the University of Sydney, each conducted studies on two groups of healthy subjects. Fourteen different test meals were used in Sydney and Toronto, and the food combinations reflected typical breakfast choices such as juice, bagels and cream cheese, etc. Despite the variations in food, blood glucose responses remained consistent with GI measures.

‘We had previously done much smaller studies. We revisited the question, using more meals and variety in two different centres with judiciously selected foods. I was startled by the degree of predictability,’ says Wolever. ‘The carbohydrate, fat and protein composition of the meals varied over a wide spectrum. The glucose responses varied over a five-fold range range, and 90 per cent of the variation was explained by the amount of carbohydrate in the meal and the GI values of the foods as given in published GI tables. The concept works.’ The results are published in the June issue of the American Journal of Clinical Nutrition.
– Am J Clin Nutr 2006;83:1306–12; University of Toronto press release

GI Values Update

Breakfast Cereals and Beverages
The latest GI values from SUGiRS.

Breakfast cereal
Morning Sun Muesli GI 49

Beverages
Ribena blackcurrant fruit syrup (prepared with water according to the instructions) GI 52
Schweppes lemonade GI 54



In publishing the GI values of two sweetened drinks, Kaye Foster-Powell reminds parents that they are definitely not an everyday beverage. Here’s why.

‘Liquid calories are a little stealthier than most, in that they tend to sneak past the satiety centre in our brain, which would normally help to stop us from overeating,’ she says. ‘This isn’t to say that we should all avoid full-strength soft drinks, but to keep on the healthy diet food-frequency scale, consumption ought to rank as “occasional”(or even “keep for a treat” if you’re trying to lose weight) and definitely not be everyday. If consumption figures are any indication, an increase in sugar-sweetened soft drinks and cordials is contributing to our child obesity problem. Not only have fatter children been found to have higher consumption, but overall, our children are drinking more of these sweetened drinks than we ever did when we were kids. And of course the increase in serving size from the old fashioned 8 oz (240 ml) to the current 600 ml ‘buddy’ doesn't help. It isn't only soft drinks and cordials that are the problem either. Too much fruit juice, sweetened or unsweetened, is an easy way for us to gulp down extra calories.’

For more information about GI testing at Sydney University, please contact:
Fiona Atkinson sugirs@mmb.usyd.edu.au
Research Manager, Sydney University Glycemic Index Research Service (SUGiRS).
Human Nutrition Unit, Department of Biochemistry (GO8)
Sydney University, NSW 2006 Australia

Low GI Food of the Month

Do You Have the GI for Fresh Rhubarb Stalks?
No. Despite being popularised by celeb chefs as a great low GI food in their TV shows and books, fresh rhubarb contains so little carbohydrate (less than 2 grams per 100 grams), that it is actually not possible to measure its GI. But if you like to crunch raw rhubarb, pile your plate high and enjoy a veggie that’s a great source of vitamin C and potassium and a good source of fibre with virtually no calories and certainly no fat. However, most of us find eating rhubarb this way a little hard to take: unbearably tart and way too crunchy. And so we cook it and sweeten it. And that’s where the carbs come in along with the calories (kilojoules) – and the GI. Sugar is probably the favourite sweetener (brown sugar is hard to beat) and many recipes recommend around 120 g/4 oz sugar (or even more – they call it ‘to taste’) to 450 g/1 lb chopped rhubarb stems. However, you can sweeten rhubarb in other lower GI ways: try combining it fifty/fifty with chopped (low GI) apple, a little grated ginger root, the juice of 1 orange and about 3 tablespoons of pure floral honey … or leave out the ginger and orange and bake it with a couple of split vanilla beans. The options are endless as you’ll find if you check out the ‘Rhubarb Recipe Collection’ on www.rhubarbinfo.com/recipe-index.html



Rhubarb is a leafy vegetable from the buckwheat family (it’s a cousin of sorrel) but in 1947 the US Customs Court in Buffalo New York classified it as a fruit because that’s mostly how we eat it. The red stems are the edible bit; the leaves are toxic. When shopping, choose bunches with slender, younger stems that are dark pink to red. The thicker the stalk the stringier it gets. It is a very versatile veg (fruit). Just trim the ends, remove the leaves and cut the stems into 2.5 cm (1 inch) chunks. It cooks down to a syrupy liquid in minutes so don’t add too much water and watch the pot. You can also cook it in the microwave or bake it in the oven.

Low GI Recipe of the Month

Diane Temple’s Sweet Potato and Lentil Bake


Diane Temple

Freelance home economist and former dietitian Diane Temple created this colourful dish especially for GI News. It is quick to prepare, full of flavour, and an easy way to get some of the five serves of vegetables you need every day. Serve with a mixed lettuce salad dressed with olive oil and lemon juice. It’s all you’ll need. If you use fresh capsicum (pepper), add it to the pan with the onion and garlic. For professional recipe development or testing you can contact Diane on tel 612 9958 3165; email: diane.temple@bigpond.com

Preparation time: 20 minutes
Cooking time: 45 minutes
Serves: 4

450 g (1 lb) sweet potato, peeled, halved lengthwise and sliced thinly
2 teaspoons olive oil
1 medium onion, chopped
3 cloves garlic, crushed
1 teaspoon chopped fresh rosemary
400 g (14 oz) can diced tomatoes
400 g (14 oz) can brown lentils, drained
¼ cup drained and chopped fire roasted marinated red pepper (capsicum) strips or ¼ fresh red capsicum (pepper) diced
2 tablespoons chopped fresh parsley
1/3 cup frozen peas
freshly ground black pepper
1 cup grated, reduced-fat pizza cheese

• Preheat oven to 180ºC (350ºF). Steam or microwave sweet potato until cooked. Set aside to cool.
• Meanwhile, in a large non-stick frying pan, heat the oil and cook onion, garlic and rosemary until soft, about 3–4 minutes. Add the tomatoes, bring to the boil and then reduce the heat and simmer for 5 minutes. Stir through the lentils, red peppers, parsley and peas. Season to taste with freshly ground black pepper and cook for 2 minutes or until the mixture is just heated through.
• In a 1½ litre (6-cup) baking dish, spoon in half the lentil sauce, then layer with half the sweet potato and half the cheese. Add remaining lentil sauce, then the sweet potato. Sprinkle the remaining cheese over the top. Bake in the oven for 30–35 minutes or until cheese has melted and top is lightly golden.

Nutritional analysis per serving
We have included a nutritional analysis using standard pizza cheese and reduced fat pizza cheese. As you can see, there’s not a great deal of difference nutritionally in this recipe. So, if reduced fat pizza cheese is not on the supermarket shelf, use pizza cheese and you'll still be enjoying a reasonably low fat meal with lots of delicious veggies.

Standard pizza cheese
Kj: 1110
Calories: 265
Fat: 10 g (sat fat 4.5 g)
Protein: 17 g
Fibre: 7 g

Reduced fat pizza cheese
Kj: 1053
Calories: 251
Fat: 8 g (sat fat 3 g)
Protein: 18 g
Fibre: 7 g

Your Success Stories

‘A low GI diet – best thing I've done in a long time’ says Lorraine
‘I started hearing about low GI diets back in 2004 but only looked into them properly in early 2005. At the time I weighed 90 kg which was at least 20 kg over a healthy weight. Ironically, I work in the fresh produce industry, I had a good working knowledge of nutrition and healthy eating guidelines plus I have quite good cooking skills. Previous attempts at calorie-controlled diets failed because the hunger pangs would win out in the end. And a few months going low carb in search of a quick fix left me heavier than ever.

After reading up on GI principles and seeing that this clearly wasn’t another complicated fad diet I opted to join an excellent online site offering a personalised GI diet plan. Pretty quickly I could see that I hadn't been eating regularly enough, my food choices hadn’t been ideal, there hadn’t been enough variety in my diet and that my portion control had been non-existent.

Today I am 21 kg lighter and have a healthy BMI (body mass index). I maintain my weight by a combination of sensible portion control and food selection. Fruit, vegetables, salads and pulses are now the major part of my diet. Pasta/rice/bread and potatoes are limited to much smaller portions and are always the wholegrain version. I limit meat to two or three small portions per week (red meat just once a week) and I try to include a low-fat dairy item every day. I've found that the GI principles are flexible enough to be applied to eating out, holidays, special occasions and so forth. It’s a rare event when I'm faced with a choice where nothing is suitable. Not everything I eat is low GI by any means, but certainly the majority.

Medically speaking I feel much fitter. An asthmatic condition has all but disappeared and I am confident that I have halted what would have been an inevitable slide into diabetes, heart disease and a host of other more minor complaints.’

Jaws dropped at the gym when Margaret walked in
‘I was 60 years old last July. When I saw the photos of me at my surprise birthday party I was depressed at the amount of fat that had accumulated around my midriff! I weighed 80 kg and should have weighed 65 kg. I set out to put this right by eating ‘diet’ and ‘low fat’ foods along with my regular gym sessions and lots of walking. I was attending my local gym on average five times weekly for aquarobics and Pilates. Nothing was working. Very frustrating and even more depressing! I attended a session at the local RSL Club at which Dr Sandra Cabot was speaking about the effects of high GI carbs and sugar in foods and their impact on the syndrome X condition. It just clicked with me that I was going down the wrong path to achieve weight loss. I weighed 82.7 kg that day.

By 24 January 2006, I weighed 76 kg and my doctor was impressed! My subsequent blood glucose, cholesterol tests were all in normal range. They were all raised to upper levels of normal range in the previous year. Exactly one year on from my 60th birthday I am 72 kg and my BMI = 26.4, a bit too high still. Waist is 84 cm and hip 111 cm. I am wearing size 14 much better than the 16–18s of last year! I feel great but know that a few less kilos would be preferable. My goal is 68 kg. However, I have so much more energy for all the activities of daily life including an upcoming trip to China, Northern Thailand and Nepal assured in the knowledge that I will have the energy to enjoy fully all that these countries have to offer. All the people who attend my gym classes have remarked on how great I look and want to know what the ‘secret’ is!’

Send Us Your Success Story!

Books, DVDs, Websites: What’s New?

Weight Loss for Food Lovers by Dr George Blair-West

Question: Why is it that over 80% of people who lose weight eventually regain what they lose and often more?
Answer: Because dieting is not about what we eat, it is about why we eat. Diets typically fail to recognise that food is the world’s most addictive substance. Craving food is much more widespread than craving nicotine, alcohol and other substances.



‘It’s not what in your mouth, it’s what’s in your mind’ says George Blair-West. As Director of Psychophysiology at the Obesity Rehabilitation Unit at River City Private Hospital in Brisbane and a weight-loss group psychotherapist, his particular area of interest is helping people maintain long term weight loss. This isn’t another diet book. There’s not a food menu or recipe in sight. Weight Loss for Food Lovers talks about motivation and sabotage, and provides practical strategies to help people maximise their chances of success whatever diet they embark on. When talking about carbs, Blair-West opts for the glycemic load (GL) approach and includes a GL table of foods derived from The New Glucose Revolution (Brand-Miller, Foster-Powell and Colagiuri). But you need the serving size to put the good doctor’s advice into practice. Go to The New Glucose Revolution Shopper’s Guide 2006 or www.glycemicindex.com for GI, GL, carbs per serving and the serving size.

For more information: www.weightlossforfoodlovers.com

Feedback—Your FAQs Answered

What’s the GI of meat, chicken, fish, eggs and cheese? I can’t find these foods in the GI database.
The GI is a measure of carbohydrate quality. Meat, eggs, fish and cheese are protein foods so they don’t have a GI because they have either no carbs, or so little the GI can’t be measured.



Eaten alone protein foods like these have very little effect on your blood glucose levels. It’s carbohydrates that are mainly responsible for the rise and fall in blood glucose after meals. Foods that are high in carbs include:

• Cereal grains (rice, wheat, oats, barley and rye and anything made from them like bread, breakfast cereals, pasta and noodles)
• Starchy vegetables like potatoes, taro, yams, sweet corn and sweet potatoes. Most green or salad vegetables have so little carbohydrate we can’t measure the GI
• Legumes (pulses) including beans, chickpeas, lentils and split peas
• Fruit such as apples, pears, peaches, oranges, strawberries, mangoes, bananas and melons
• Dairy foods like milk, ice cream and yoghurt (but not cheese which is a protein food, or butter or cream which are mostly fat)

I have heard that pasta made of strong wheat flour (such as durum) has a lower GI than pasta made of softer wheat flour. Is this true?
We asked Prof. Jennie Brand-Miller to answer this. She says: ‘My understanding is that durum wheat is a very hard wheat and that makes it ideal for pasta manufacture. It gives the pasta its lovely golden colour because the aleurone layer is included with the endosperm fraction. Hardness and strength are two different things. Hardness refers to how the grain cracks up in the milling process, while strength refers to its protein content. Many Australian wheats, for example, are both hard and strong at the same time, making them highly desirable for many applications, especially bread making.’



She goes on to say, ‘I have seen data showing that pasta made from any old wheat has a relatively low GI. It's the low degree of gelatinisation (low moisture dough) that makes it low GI. The high protein content might help a little but it’s not the major factor. If you make bread from durum wheat, it will have a high GI because bread making allows for full gelatinisation. If you overcook pasta (perhaps canning too), then it will become more highly gelatinised and that will increase its GI. For the most part, properly cooked pasta (al dente) has a GI of 40–50.’

I've been following The Low GI Diet and have noticed some recipes include the use of filo pastry. Does filo pastry have a low GI? I love spinach pastries and even vegetable pies, but I am wondering if pastries have a high GI value?
Pastry by itself hasn’t been GI tested. It’s not something you normally eat as a meal. But the real problem with most shortcrust and flaky pastry products is that they tend to be very high in fat, particularly saturated fat (remember the ingredients for making pastry are essentially flour and butter with a little water plus sugar for a sweet pastry). The reason we include occasional recipes with filo pastry is that you can get that lovely crisp in the mouth pastry feel with a lot less fatty pastry. Just 2 or 3 sheets of filo lightly sprayed with olive oil (not melted butter) will do the job. So a spinach triangle or a vegetable pie made with filo can provide a nourishing and tasty meal and help you achieve those five serves of veggies a day – providing you make sure it’s got lots of veggie filling and just a little filo pastry! Catherine Saxelby’s Fresh Plum and Ricotta Strudel made with a few sheets of filo shows you how you can up your fruit intake with a delicious low fat, low GI dessert. You’ll find the recipe in our January 2006 GI Newsletter.


Photo: Ian Hofstetter, The Low GI Diet Cookbook

I have read in some GI lists that fresh coconut is low GI, is this true? Coconut does not seem to be on your list!
Coconut is a nut (not a fruit) and it has not been GI tested. It contains very little carbohydrate per serving (just 1 g in a 15 g portion) and it is virtually impossible to GI test. But it is high in fat (5 g in a 15 g portion) and the fat it contains is nearly 90 per cent saturated. So use very small amounts of coconut products such as coconut milk or desiccated coconut in your cooking.



Look it up in our A–Z: The GI Glossary continued

Atherosclerosis or hardening of the arteries is a slow progressive disease and can go virtually unnoticed until it produces problems such as angina or a heart attack. Most heart disease, whatever form it takes, is caused by atherosclerosis—clogging on the inside wall of the arteries through the slow build up of fatty deposits (called plaques) which narrows the arteries and reduces the blood flow. This is not just a ‘plumbing’ problem, but one in which inflammation plays a key role. Atherosclerosis can affect the arteries elsewhere in the body including the brain, kidneys, and the arms and legs. When the arteries to the heart are affected and blood flow is reduced, the heart muscle doesn’t get enough oxygen for pumping blood, and eventually this causes central chest pain (angina pectoris). Elsewhere in the body when blood flow is restricted by atherosclerosis there’s a similar effect: in the legs, it can cause muscle pains on exertion; in the brain, it can lead to a variety of problems from ‘funny turns’ to strokes. An even more serious consequence of is when a thrombosis (blood clot) forms over a patch of atherosclerosis on an artery. This process can occur anywhere in the arterial system and lead to a complete blockage of the artery. The consequences can range from a small heart attack to sudden death.

Beta cells The cells in the pancreas that produce insulin. They are found grouped together in the Islets of Langerhans.

Blood pressure The pressure of the blood on the walls of the blood vessels caused by the beating of the heart. Every body has blood pressure, although not everyone’s blood pressure is high. Hypertension is defined as having blood pressure above 140/90 mm HG. An abnormal blood pressure is considered to be 120/80.

Carbohydrate, a vital source of energy found in all plants, is the starchy part of foods like rice, bread, legumes, potatoes, and pasta and the sugars in foods like fruit, milk and honey. Cheap, plentiful and sustainable, it is the most widely consumed substance in the world after water and the basis for a healthy diet. Some foods contain a large amount of carbohydrate (such as cereals, potatoes, and legumes) while other foods such as carrots, broccoli and salad vegetables are very dilute sources. The simplest form of carbohydrate is glucose, which is a universal fuel for our body cells, the only fuel source for our brain, red blood cells and a growing foetus, and the main source of energy for our muscles during strenuous exercise.

Cholesterol is a soft, waxy substance found in the blood and in all the body's cells. It's an important part of a healthy body because it is part of the walls around all of our cells, and is a major component of many of the hormones our body’s produce. Most of the cholesterol in our body does not come from the foods we eat, but is in fact manufactured by the liver. High levels of cholesterol in the blood may lead to blocked arteries, heart attack and stroke. Cholesterol and other fats can't dissolve in the blood. They have to be transported to and from the cells by special carriers called lipoproteins. There are several kinds, but the most common ones are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

Coeliac disease is a condition where the lining of the small intestine is damaged due to an immune reaction from your own body to a small protein known as gluten. Gluten is found in certain grain foods like wheat, rye, triticale and barley, and in much smaller amounts in oats (as a contaminant). The only treatment for coeliac disease at present is a gluten-free diet.

Diabetes
Type 1 diabetes is characterised by high blood glucose levels due to the body’s complete inability to produce insulin. It occurs when the body’s immune system attacks the insulin-producing Beta cells in the pancreas and destroys them. The pancreas then produces very little or no insulin. Type 1 diabetes occurs most often in young people but can develop in adults.

Type 2 diabetes is characterised by high blood glucose levels caused by an insufficiency of insulin and the body’s inability to use insulin efficiently. It is thought to occur when the body becomes resistant to insulin. The pancreas compensates initially by producing more insulin, then eventually becomes exhausted and produces insufficient insulin. Type 2 diabetes occurs most often in middle-aged and older people but is being seen increasingly in younger adults and teenagers.

Gestational diabetes can occur during pregnancy, but usually goes away after the baby is born. Hormones released by the placenta during pregnancy reduce the effectiveness of the mother’s insulin. It is usually managed successfully with healthy eating and regular physical activity, but in some cases extra insulin is needed.

Dyslipidaemia abnormal levels or composition of the blood fats known as cholesterol and triglycerides.

Fat provides lots of kilojoules/calories – more than protein or carbs per gram – so you only need a small amount each day. The message today is know your fats. Focus on the good ones (mono- and poly-unsaturated fats) and give the bad fats (trans fats and saturated fats) the flick.
Saturated fats are solid at room temperature. These are the fats on meat or chicken skin, and in butter, cheese, palm oil and coconut oil. We don’t actually need to eat any saturated fat, since the body can make all it requires, but it is fairly difficult not to eat some, since all fats are actually mixtures of saturated and unsaturated fats.
Unsaturated fat is liquid at room temperature. These good mono- and polyunsaturated fats provide you with essential fatty acids that form your cell membranes; help you absorb the fat-soluble vitamins A, D, E and K; form part of your body’s hormones; provide insulation; and help you absorb some anti-oxidants from fruit and vegetables.
Trans-fats are produced during manufacture and behave like saturated fat in a product (increasing its firmness), as well as in our bodies (increasing the risk of heart attack). Foods high in trans fats include fried fast foods, some margarines, crackers, cookies and snack – so read the label before you buy these foods.

Fatty liver is the build up of excessive amounts of triglycerides and other fats inside liver cells; also known as steatohepatitis or NASH (Non-Alcoholic Steato-Hepatitis).

Fibre Dietary fibre only comes from plant foods – the outer bran layers of grains (corn, oats, wheat and rice and in foods containing these grains), fruit and vegetables and nuts and legumes (dried beans, peas and lentils). We need about 30 grams of fibre a day for bowel health and to keep regular. There are two types of fibre—soluble and insoluble—and there is a difference.
Soluble fibres are the gel, gum and often jelly-like components of apples, oats and legumes. By slowing down the time it takes for food to pass through the stomach and small intestine, soluble fibre can lower the glycemic response to a food. Good sources include: oatmeal, oat bran, nuts and seeds, legumes (beans, peas and lentils), apples, pears, strawberries and blueberries.
Insoluble fibres are dry and bran-like and commonly called roughage. All cereal grains and products that retain the outer coat of the grain they are made from are sources of insoluble fibre, eg wholemeal bread and All-Bran®, but not all foods containing insoluble fibre are low GI. Insoluble fibres will only lower the GI of a food when they exist in their original, intact form, for example in whole grains of wheat. Here they act as a physical barrier, delaying access of digestive enzymes and water to the starch within the cereal grain. Good sources include: wholegrains, wholewheat breads, barley, couscous, brown rice, bulghur, wheat bran, seeds, and most vegetables.

Fructose or fruit sugar is an alternative sweetener that is nearly twice as sweet as table sugar but provides the same amount of kilojoules. As the name suggests, it is found naturally in most fruits.

To be continued next month.

Events

Carbohydrates, Glycemic Index and Health: The State of the Art
Millions of people around the world are following carbohydrate-modified diets for weight loss as well as general health, judging from the sales figures for popular diet books including, Atkins’ New Diet Revolution, The Zone, The South Beach Diet, The Glucose Revolution, and at least two dozen other titles. With regard to low glycemic index diets, major studies have been published in JAMA, The Lancet, AJCN, American Journal of Epidemiology and International Journal of Obesity in the last three years suggesting beneficial effects on appetite, energy metabolism or body weight. Other recent studies have been inconsistent. How do we distinguish between the good and poor research in this field? What is the difference between low glycemic load and low glycemic index? How do approaches that aim to reduce carbohydrate amount compare with those that focus on carbohydrate quality, specifically GI? Are some individuals more likely to see benefits of low GI diets than others? Are these diets safe over the long term? This ‘state of the art’ one-day symposium in Sydney, Australia on 2 September 2006 will provide a forum for the vigorous exploration of these questions.



The sponsor: The University of Sydney Nutrition Research Foundation
The convenors: Prof Jennie Brand-Miller, Human Nutrition, The University of Sydney, Australia and Prof David Ludwig, Boston Children’s Hospital, USA
For more information
Ms Elisabeth Eaton
GI Symposium Secretariat, PO Box 949, Kent Town SA 5071, Australia
phone +618 8363 1307; Fax +618 8363 1604
email FI2006@fcconventions.com.au

Dietary Study for Women with PCOS
The University of Sydney is conducting a dietary study for women with PCOS. If you live in Sydney, Australia, are aged 18–40 with PCOS and are not taking the pill or trying to conceive, contact pcosdietstudy@nnd.com.au for more details.

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