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Glycemic Index

Illustration

The glycemic index is a measure of the ability of a food to raise blood sugar levels after it is eaten. The index compares the blood sugar response to a particular food with the body’s reaction to pure glucose, which is given the value of 100. For example, if a food raises blood sugar only half as much as pure glucose, that food is given a glycemic index of 50. The portion size used to test the glycemic index of various foods is the amount that contains 50 grams of carbohydrate. Some research has used white bread instead of glucose as the standard of comparison for determining the glycemic index of foods. The glycemic index of a food is governed by several factors, such as the form of carbohydrate it contains, the amount and form of fiber it contains, how much processing and cooking it has been subjected to, and the presence of other substances such as protein and fat.

Glycemic load is a related measurement calculated by multiplying the glycemic index of a food by the amount of carbohydrate contained in a typical serving of that food. Glycemic load may be more reliable than glycemic index as a predictor of how a food will affect the blood sugar level. That is because some foods with a high glycemic index (such as carrots) contain such a small amount of carbohydrate in a normal serving that they would not be expected to raise the blood sugar level very much. Carrot juice, on the other hand, which contains a relatively large amount of carbohydrate, would produce a substantial increase in the blood sugar level.

How do people use the glycemic index?

People most often use the glycemic index to choose carbohydrate-containing foods that will only minimally raise their blood sugar levels, with the intent of preventing health problems associated with either high blood sugar or the body’s reaction to rising blood sugar. These health problems may include weight gain, diabetes, the insulin resistance syndrome, hypoglycemia, and heart disease. Foods with a glycemic index of 55 and below are considered ideal for those trying to consume low-glycemic-index foods.

Athletes may choose high-glycemic-index foods after intense exercise, in order to rapidly replenish depleted carbohydrate stores.

What do the advocates say?

The underlying premise for advocating eating low-glycemic-index foods is that high-glycemic-index foods cause a rapid elevation in blood sugar that the body attempts to balance by producing a large amount of insulin. Advocates claim that human physiology is not designed to tolerate these rapid and prolonged elevations in blood sugar and insulin caused by the prevalence of modern, high-glycemic-index foods in the diet. As human civilization has evolved, primitive stone-age diets that featured naturally occurring, low-carbohydrate foods have been replaced, first by unprocessed but higher-carbohydrate agricultural foods such as whole grains and legumes, and more recently by highly processed, low-fiber flours and other starchy foods, plus an increasing amount of sweets. This trend towards higher-glycemic-index foods in the diet is therefore deemed unnatural and hazardous to the healthy functioning of the body.

Research suggests that repeated overproduction of insulin could lead to insulin resistance, in which cells that normally respond to insulin become less sensitive to its effects. Excessive high-glycemic-index foods, high insulin levels, and insulin resistance have been associated with many health concerns, including obesity, type 2 diabetes, heart disease, and some cancers. Changing to a low-glycemic-index diet has been shown in most studies to reduce insulin resistance, help control appetite, improve weight loss results, enhance blood sugar control in diabetics, lower blood levels of total and LDL ("bad") cholesterol, and raise blood levels of HDL ("good") cholesterol.

What do the critics say?

Critics say that the way the glycemic index is measured (one food at a time in quantities that contain a standard amount of carbohydrate) does not resemble the way people usually eat (many items are eaten together in varying portion sizes, often mixing high-carbohydrate with low-carbohydrate foods). They also criticize the complexity the glycemic index concept and the fact that eating large amounts of some low-glycemic-index foods, such as ice cream, would not be unhealthful due to the detrimental effects of other components of these foods, such as animal fats. In the case of type 2 diabetes, critics point out that the glycemic index only measures the short-term effects of foods on blood sugar, whereas studies measuring longer-term effects of high-glycemic-index foods in people with diabetes have found inconsistent results.

In answer to these criticisms, advocates point to the many studies linking diets containing high-glycemic-index foods to common and serious health problems. They insist that the diet can be made more healthful by integrating the glycemic index with other health concepts, such as lowering animal fat consumption, to achieve the best results.

What should I avoid when I want to eat low-glycemic-index foods?

It is not necessary to completely avoid high-glycemic-index foods. When these foods are combined in a meal with low-glycemic-index foods, protein foods, or fat, then the overall glycemic effect is reduced. Of course, to lower the overall glycemic index of the diet, low-glycemic-index foods should be emphasized as much as possible. The basic rules are to reduce intake of concentrated sugars and most potatoes, increase consumption of legumes and most vegetables and fruits, and choose grain products made by traditional methods (for example, pasta, stone-ground flour products, old-fashioned oatmeal) rather than those produced with modern technology (highly refined flour products, low-fiber flaked breakfast cereals, quick-cooking starches, etc.).

The following foods rank highest on the glycemic index. These foods should be avoided or kept to a minimum by those wishing to consume a low-glycemic-index diet

Bread, cereal,and rice to avoid:

  • Rice
  • Rice cakes
  • Most breads, breakfast cereals, snacks, and desserts made with refined flour products

Other starchy foods to avoid:

Fats, oils, and sweets to avoid:

  • Soft drinks, including sweetened fruit drinks and most sports drinks
  • Most cakes and pies
  • Candy and candy bars
  • Granola bars and most sports bars

Vegetables and fruits to avoid:

Best bets

Bread, cereal, rice, and pasta:

Other starchy foods:

  • Legumes and legume products (hummus, baked beans, lentil soup, etc.)
  • Bakery products made with whole grains, bran, whole fruit pieces, and/or nuts

Dairy products and dairy substitutes:

  • Unsweetened milk and milk products
  • Unsweetened yogurt
  • Soy beverages

Vegetables and fruits:

  • Most vegetables and vegetable juices

Are there any groups or books associated with this diet?

The New Glucose Revolution by Jennie Brand-Miller, Thomas MS Wolever, Kaye Foster-Powell, and Stephen Colagiuri. New York: Marlowe & Co., 2003.

The Glucose Revolution Pocket Guide to the Top 100 Low Glycemic Foods by Jennie Brand-Miller, Kaye Foster-Powell, and Thomas MS Wolever. New York: Marlowe & Co., 2000.

University of Sydney Glycemic Index Web site.
www.glycemicindex.com

Bibliography

Brand-Miller J, Wolever TM, Foster-Powell K, Colagiuri S. The New Glucose Revolution. New York: Marlowe & Co, 2003.

Franz MJ. Carbohydrate and diabetes: is the source or the amount of more importance? Curr Diab Rep 2001;1:177-86 [review].

Jenkins DJ, Kendall CW, Augustin LS, et al. Glycemic index: overview of implications in health and disease. Am J Clin Nutr 2002;76:266S-73S [review].

Ludwig DS. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA 2002;287:2414-23 [review].

Pi-Sunyer FX. Glycemic index and disease. Am J Clin Nutr 2002;76:290S-8S [review].

Pawlak DB, Ebbeling CB, Ludwig DS. Should obese patients be counselled to follow a low-glycaemic index diet? Yes. Obes Rev 2002;3:235-43 [review].

Raben A. Should obese patients be counselled to follow a low-glycaemic index diet? No. Obes Rev 2002;3:245-56 [review].

Roberts SB. High-glycemic index foods, hunger, and obesity: is there a connection? Nutr Rev 2000;58:163-9 [review].

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