Showing posts with label Glycemic Index. Show all posts
Showing posts with label Glycemic Index. Show all posts

Tuesday, August 20, 2013

Mediterranean Diet, Glycemic Load & Diabetes

We know from several recent posts that the Mediterranean Diet is good for your heart & your brain.  It turns out that the more you adhere to the Mediterranean Diet, the lower your risk for developing diabetes, as demonstrated by an observation study published early online this month in Diabetologia.  You remember the Mediterranean Diet, right?  Plenty of fruits & vegetables.  Nuts & legumes.  Olive oil.  Nuts & legumes.  Whole grains & cereals.  Some fish & chicken but minimal beef & dairy.  And let's not forget the wine in moderation (averaging not allowed).  What's so special about this particular "diet"?  Especially because "Mediterranean" refers to a geographic region that is encompassed by multiple & varied ethnicities, religions & cultures such that each has its own variation on a theme.

So even as we attempt to figure out what makes this way of eating so healthy, others have looked at the glycemic index as a means to replicate benefit on a more global scale.  Recall that glycemic index refers to a foods innate ability to raise blood sugar.  This value doesn't change.  Glycemic load, which is calculated as glycemic index multiplied by serving size, takes into account how much food one is consuming.  Thus, this value can change.  And as the 22,295 Greek participants followed for 11+yrs showed, glycemic load is associated risk for diabetes.  So pay attention not only to what you eat but how much of it you consume.  It's not just quality but quantity, too.



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Thursday, August 30, 2012

What's the Best Way to Lose Weight?

I'm a lumper, not a splitter.  In other words, I look for the big picture, rather than get caught up in the details.   As it turns out, even the questions I get asked can often be boiled down into variations on a theme.  The most common question?  What is the best . . . ?  Elsewhere, I've already mentioned what I think is the best medication:  it's the one you can afford, that you're willing to administer as directed as often as directed, that will bring about the desired results (benefits) without any side effects.  After all, it may be the best drug in the whole wide world, but if it's too expensive, then what good it is to you?

Think about Egrifta and the recent 20 week study demonstrating improvement in cognitive function in patients w/normal cognitive function and in those w/mild cognitive impairment.  Sounds like a winner, right?  Who wouldn't want such a drug, especially when it was also linked to a 7.4% decrease in body fat!  Well, do you have $46/d burning a hole in your pocket?  If not, let's move on.  

Along the same lines, I'm often asked what's the best way to lose weight?  Certainly NBC's Biggest Losers showed that if you take someone out of their everyday environment, make them exercise 4hrs/d and then feed them only 70% of their estimated baseline metabolic needs, they can lose over a 100 pounds in just 6 months.

But what about the rest of us (who can't leave work & families)?  In a small (157 participants, mostly female, avg 39yo, avg BMI 32), short (12 wk) trial published online earlier this week in Nutrition Journal, the authors concluded that dietary approaches based upon either portion control, low energy density, or low glycemic index all led to similar statistically significant weight loss.  Furthermore, they noted improvements in body composition & metabolic syndrome risk factors.

Bottom line:  In order to lose weight, the important point is to change one's way of eating.  No one way is head & shoulders above the rest.  As in all things medical, tailor your approach to the patient.  As Yoda said, "Do or do not.  There is no try."



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Friday, June 29, 2012

Low Carb Diet vs Heart Disease in Women

Anyone remember the tagline for 1978's Jaws 2?  "Just when you thought it was safe to go back in the water . . ."  Well, after yesterday's small short study of low carb vs low glycemic index vs low fat diets, all seemed well in nutrition-land, as much as one can expect from small short studies.  That is, until Dr. Dean D pointed out a study released almost contemporaneously in BMJ which concluded that low carb diet was associated w/heart disease.

More specifically, the authors studied 43,396 Swedish women, 30-49yo @ baseline & free of heart disease, and followed for close to 16yrs.  Decrease in carbohydrate consumption, increase in protein consumption, and increase in low carb:high protein score were all statistically significantly associated with increase risk of incident (initial) cardiovascular disease.

Granted, this isn't a randomized controlled trial able to demonstrate cause & effect.  But given the numbers & duration, it's certainly worrisome to recommend low carb diet as a lifestyle, especially if you're a youngish Swedish female.





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Thursday, June 28, 2012

Energy Expenditure: Low Carb vs Low Glycemic vs Low Fat Diets

As you know, I tend to be a lumper rather than a splitter.  I look for common themes rather than unique storylines.  Along those lines, I view low carb & low glycemic index diets as variations on a theme:  less than typical carbohydrate consumption.  But a study published yesterday in JAMA suggests that low carb diet results in less reduction in resting energy expenditure (REE) & total energy expenditure (TEE) compared to low glycemic diet which in turn has less reduction in REE & TEE compared to low fat diet.

The authors arrived at their conclusion via a very clever crossover study in which each of 21 overweight or obese adult avg 30yo avg body mass index 34.4kg/m2 served as his/her own control.  In other words, over the course of 12 weeks, the subjects consumed an isocaloric diet of various composition for 4 weeks in a randomized fashion.  The typical high glycemic load, low fat diet gathered 60% of its energy from carbohydrates w/20% from fat & protein each.  The low glycemic index, moderate glycemic load diet obtained 40% of its energy from carbohydrates & fat each w/20% from protein whereas the low carb, low glycemic load diet obtained 10% of its energy from carbohydrates, 60% from fat & 30% from protein.

My first reaction is that it's a sad commentary on our times when a 12 week study of 21 subjects garners national headlines.  But on further introspection, I find myself wondering if I'm ready to make recommendations to a large proportion of the population based upon such a small, short study.  Let's just say that this study makes for excellent hypothesis development.





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Thursday, January 6, 2011

Colorectal Cancer vs Glycemic Load

The latest in a series of studies looking for an association between glycemic load and colorectal cancer was just published following 73,061 Chinese women for an average of 9 years.  The answer appears to remain the same:  no link, whether you look at the PLCO study, Multiethnic Cohort study, or a recent meta-analysis of 12 other studies.  So while I don't advocate consumption of high glycemic load nutrition, at least there appears to be no harm with regards to colorectal cancer. 

By the way, glycemic load is defined as glycemic index multiplied by absorbable (or net) carbohydrates, which are based upon serving size.  So the more servings you eat of any food, the higher your glycemic load, even though the glycemic index of that item hasn't changed.  That's why that pint of ice cream is so bad for you - it actually contains several (usually four) servings that can easily be consumed by one person in one setting.  This also means that the higher the fiber content in your food item, the more likely it is to have a the lower absorbable carbohydrate compared to a similar portion of a similar food with less fiber. 

So learn to read ingredient labels.  Or at least avoid processed foods found in boxes & containers and choose fruits & vegetables from the produce section of your supermarket.  While it may not make a difference for your colorectal cancer risk, it will certainly improve other aspects of your health.

Saturday, November 27, 2010

How to Raise Your HDL

Low HDL (usually thought of as <40mg/dL in men & <50mg/dL in women) is the bane of physicians.  Regardless of LDL, the lower your HDL, the greater your risk of heart disease.  However, we don't really have an easy way to increase HDL dramatically. 

As physicians, we recommend strenuous intense exercise but we know how far that's gotten us.  Wine makes a small increase but as we all know, too much of a good thing isn't.  Niacin works but most won't tolerate the flushing & tingling side effects from doses high enough to make an impact.  Fibrates can raise HDL some but requires a prescription.  Of the statins used to lower LDL, only rosuvastatin raises HDL to some extent but doesn't have many outcomes studies yet.  If you're diabetic, pioglitazone raises HDL while rosiglitazone tends to lower HDL.  Recently, at the American Heart Association's annual meeting, researchers announced their findings that Merck's experimental anacetrapib increased HDL substantially in a late phase clinical trial (by inhibiting cholesteryl ester transferase protein (CETP), if you must know).  But it will probably be a while before this wonder drug hits the market, at which point we'll learn about its potential side effects (and financial cost).

So what do we do in the meantime?  In a small, short 4 week study published this month, authors asked 18 men & 25 women (average age 38-39 years old), all overweight or obese, to restrict both their caloric intake (down to 1800kcal/d for men & (1400kcal/d for women) and the resultant fraction of carbohydrates (on average from 55% down to 33% and from 53% down to 30%, respectively), commonly referred to as a "low carb" diet (goal <100g/d).  They were instructed to maintain their current level of physical activity.  In fact, the men were able to drop their average caloric intake down to 1307kcal/d while the women achieved 1243kcal/d.

As a result, men lost 4.7kg on average while women lost 2.4kg, resulting in significant decreases in body mass index.  Furthermore, in the short term, both men & women decreased their waist circumference, body fat percentage, systolic blood pressure, total cholesterol, triglycerides, and insulin.  Most importantly, men increased their HDL from 0.83mmol/L (32mg/dL) to 0.96mmol/L (37mg/dL).  While this increase isn't enough to get these men out of harm's way (generally thought of >60mg/dL), it's certainly a step in the right direction without risk of drug side effects.  Unfortunately, women demonstrated no significant increase in HDL.

It should be noted that this kind of eating wasn't easy to achieve.  The researchers gave food products to minimize noncompliance since it was expensive to stay on this diet.  In fact, only 7 of the 18 men were able to reach their goal of consuming <100g/d of carbohydrates. 

What can we glean from this study?  Well, it supports many other studies that have demonstrated an improvement in HDL by decreasing caloric intake and weight loss.  However, it's not clear whether the increase in HDL was due to the caloric restriction, the decrease in carbohydrate consumption, or the weight loss.  Let's not lose sight of the fact that this was a small, short study.  But given the costs of most new drugs upon hitting the market and the relative lack of side effects (aside from the cost of food), it seems reasonable to recommend again that we eat less (carbs).

Friday, November 26, 2010

Eat More Protein + Low Glycemic Meals to Maintain Weight Loss

Continuing yesterday's theme (I hope you all had a wonderful Thanksgiving, by the way) of "which is better", there continues to be debate as to whether glycemic index (GI) & load (GL) really matters when it comes to nutrition, and whether high protein or low protein meals are better for you.  In fact, think back to yesterday's big meal.  Did you consume low or high GI foods?  Presumably you had plenty of protein in the form of turkey (turducken, anyone?) and ham.

To address this question, the authors studied 548 participants who had lost 8% body weight (average 11kg) while completing an 800kcal/day diet (extremely low calories!) who were randomized to either control, low protein + low GI, low protein high GI, high protein + low GI, or high protein + high GI for 26 weeks.  Fat content was kept at 25% caloric intake regardless of meal composition.  15 glycemic points were supposed to separate low from high GI while 12% protein calories were supposed to separate those on low vs high protein diets.  The participants were allowed to consume as many calories as they choose as the authors also wanted to determine which diet better satiated the participants.

After completion of the study, the authors discovered that only those on high GI + low protein diet regained some weight (average 1.67kg).  In fact, those assigned to high protein diets regained less weight compared to those randomized to low protein, and those assigned to low GI diets regained less weight compared to those randomized to high GI.  They also reported that more participants assigned to low GI diets completed the study than those randomized to high GI, and likewise for high protein vs low.  What's noteworthy is that these findings were obtained despite only achieving 5 glycemic points & 5% protein calorie separation between the groups.

The editorialists were actually quite warm to these findings, suggesting more reseach but noting the practicality of the low GI + high protein diet for weight maintenance.  As for our patients, I'd suggest Sugar Busters, South Beach, Zone, and the Mediterranean Diet as prime examples.  And for those who aren't interested in reading books, low GI + high protein boils down to what our parents told us.  Eat our veggies & meat.  Just remember to moderate/minimize our consumption of processed grains.