GI Symbol News with Dr Alan Barclay

Dr Alan Barclay



Lowering the GI of fast food and convenience meals

Food companies around the globe have made concerted efforts to reduce sodium/salt, saturated and trans fats in the food supply. In Australia, for example, the Heart Foundation’s Tick program estimates it has helped remove 235 tonnes of salt from the Australian food supply, and Australian margarine manufacturers almost completely removed trans fatty acids from table margarine over a decade ago. But what about the carbohydrates (the sugars and starches) in fast food and convenience meals?



There has been some effort to reduce the amount of added sugars in fast food and convenience meals. For example, diet and no-added sugar versions of soft drinks are readily available at fast food outlets and in convenience stores throughout the nation, potentially helping us to decrease our total kilojoule intake – although the evidence for this is by no means conclusive.



Some Australian food companies have, or are pledging to, reduce the amount of added sugars in their bread rolls – a move that you could reasonable argue is more hype than substance as it is unlikely to have a significant impact on the kilojoules in the bread rolls as sugars actually provide slightly less kilojoules than the starches that will replace them. Look at the numbers and see for yourself – 15.7 kJ/g (3.75 calories/g) in sugars against 17.5 kJ/g (4.2 calories/g) in starches. Bread rolls are not a major source of added sugars in Australia anyway, with an average 90 gram roll containing around 5 grams of sugar and the picture in the USA is essentially the same. Some fast food outlets are now offering wholemeal or wholegrain bread options. While these are more nutritious in many ways than regular white bread, containing more dietary fibre and a number of important vitamins and minerals, most still have a relatively high GI.



Indeed, the main sources of carbohydrate in fast food and convenience meals with very few exceptions (see our table in Food for Thought) have a high or medium GI. Unfortunately the most commonly consumed forms of bread, potato and rice have, on average, high GI values, and these form the basis of most fast food and convenience meals like the buns for burgers and hot dogs, potato chips/French fries, and rice. The notable exceptions to the rule are pasta – and some noodle-based dishes and some sushi. It wouldn’t be too hard to make the switch to low GI options in popular fast food and convenience meals as low GI breads, potatoes and rices are around and could be used instead of the current high GI varieties if the will was there.





Healthy low GI sushi from keepin it fresh..



A more concerted effort needs to be made by the fast and convenience food industry to ensure that when they do replace saturated fat, trans fat and/or added sugars in their products, they use healthier alternatives. In particular, when it comes to carbohydrates, they should ensure that they use healthy low GI alternatives, otherwise it is highly unlikely that the new improved formulations with all their accompanying nutrition and health claims, health marks and endorsements will provide any real health benefits.



For more information on why it is highly unlikely that the new improved formulations with all their accompanying nutrition and health claims, health marks and endorsements will provide any real health benefits if they don't use healthy low GI carbs too, please feel free to contact me: alan@gisymbol.com







For more information about the GI Symbol Program

Dr Alan W Barclay, PhD

Chief Scientific Officer

Glycemic Index Foundation (Ltd)

Phone: +61 (0)2 9785 1037

Mob: +61 (0)416 111 046

Fax: +61 (0)2 9785 1037

Email: alan@gisymbol.com

Website: www.gisymbol.com

GI Update

GI Q&A with Prof Jennie Brand-Miller







If additional fat and protein cause lower glycemic responses, shouldn’t you advocate higher protein or higher fat diets for people with diabetes?

Yes and no. It’s a matter of degree and quality, rather than quantity. This type of diet shouldn’t be taken to extremes because very low carb diets have little to recommend them – they are difficult to sustain and they don’t reduce the risk of chronic disease. If your preference is to eat more protein and fat and moderately reduce carbohydrate intake, then go ahead. The US-based Joslin Clinic for people with diabetes recommends a diet with 40% of energy from carbohydrates (that’s lower than is typical in the US), with a greater proportion of protein and good fats. The emphasis should be on quality – good fats, low GI carbs and nutritious protein sources such as fish, poultry, lean red meat, tofu and legumes. If your preference is for higher carbohydrate intake, then that’s OK too, but the quality of those carbs is of paramount importance.



GI testing by an accredited laboratory

North America

Dr Alexandra Jenkins

Glycemic Index Laboratories

36 Lombard Street, Suite 100

Toronto, Ontario M5C 2X3 Canada

Phone +1 416 861 0506

Email info@gilabs.com

Web www.gilabs.com



Australia

Fiona Atkinson







Research Manager, Sydney University Glycemic Index Research Service (SUGiRS)

Human Nutrition Unit, School of Molecular and Microbial Biosciences

Sydney University

NSW 2006 Australia

Phone + 61 2 9351 6018

Fax: + 61 2 9351 6022

Email sugirs@mmb.usyd.edu.au

Web www.glycemicindex.com



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Four people on rimonabant had killed themselves

A major trial linked the drug to a slightly higher suicide rate. The trial wasn't testing the drug's weight loss benefits, but whether it might prevent heart problems. It was supposed to follow more than 18,000 patients in 42 countries for three years. Roughly half were given rimonabant while the other half were given a placebo. European officials shut it down and pulled the drug from the market. It was never licensed in the United States, but was sold as Acomplia, Riobant, Slimona, as well as under other names in Europe. "Obviously the suicides are tragedies," said Eric Topol, director of Scripps Translational Science Institute and the study's lead author. "But we accept trade-offs in medicine and the psychiatric side effects might have been acceptable if we had found greater cardiovascular benefits later," he said.

He said rimonabant might still have been useful for fighting obesity, and that measures like stomach stapling surgeries also come with significant risk. Other experts disagreed. "Any mortality associated with cardiovascular preventive therapy is generally viewed as unacceptable," wrote Matthijs Boekholdt and Ron Peters of the department of cardiology in the Academic Medical Center in Amsterdam, in an accompanying commentary.
Source: MSNBC

Zeltiq: hottest new weight-loss procedure, freeze hard-to-shift flab to death

Zeltiq uses a cooling method called cryolipolysis to target, chill and break down fat cells. Experts are heralding the non-invasive procedure as a revolutionary new concept in weight loss. 'For years, we've been heating fat to melt it away,' says new York dermatologist Dr David Goldberg, who was involved in the clinical trials of Zeltiq. 'Now it appears that the opposite approach is more effective than other non-invasive procedures.' Tests have shown that just one treatment is capable of destroying up to 25 per cent of fat cells in the area. Source: DailyMail.

GI News—August 2010

• Don’t sweat the small stuff when counting carbs
• Should I count up my GI values each day?
• So you think you can dance? So what should you eat?
  
• Do calories on menus help us make better food choices?
• How accurate are calorie and carb counts on labels?
• Low GI diet improves insulin sensitivity in women with PCOS

Most of us have great faith in numbers, especially ones that are boldly printed in black and white on labels and in books. But a number of studies suggest that if you want to count calories (kilojoules) or need to count your carbs, you also need to be aware that the numbers you see printed aren’t precise figures at all. They are just ballpark figures. ‘It’s a fact of life that even the most processed of foods never contain the exact amount of carbohydrate in a serve that the label says while the figures given in food tables will be average or typical not precise amounts. So, don’t get too carried away thinking that by counting every gram of carbohydrate you eat or drink and every 0.05 of a unit of insulin you take your blood glucose levels will be perfect,’ writes Dr Alan Barclay in Food for Thought. ‘It just doesn’t happen like this.’

Good eating, good health and good reading.

Editor: Philippa Sandall
Web management and design: Alan Barclay, PhD

Food for Thought

Don’t sweat the small stuff when counting carbs


Pediatric dietitian Carmel Smart

Most people with type 1 diabetes on conventional insulin regimens (twice daily injections) need to eat similar amounts of carbohydrate-containing foods, at regular times over the day. For those on intensive insulin regimens, while it is still important to maintain a regular eating pattern, the days of matching foods to a rigid insulin regime are long gone.

One way or another, most people with type 1 diabetes still count carbs, especially those on multiple daily injections and pumps. They typically count their carbs in 1 gram increments, 10g portions or 15g exchanges to adjust their mealtime insulin dose to carbohydrate intake. The question then arises as to how precise their carb counts need to be, as many clinicians believe that counting in gram increments is necessary to achieve optimal glycemic control, particularly for people on insulin pump therapy.

According to pediatric dietitian Carmel Smart and researchers from the University of Newcastle and John Hunter Children's Hospital, there’s no need to sweat the small stuff as there’s room for 10 grams error either way. In a study published in Diabetic Medicine, they found that with children using intensive insulin therapy, a single mealtime insulin dose calculated for 60g carbohydrate maintained postprandial blood glucose levels for meals containing between 50–70g carbs. The authors concluded a single mealtime insulin dose will cover a range of carbohydrate amounts without deterioration in postprandial control.

Which is just as well, as the latest study from this team in Diabetic Medicine reports that although children with type 1 diabetes and their caregivers (usually Mum) can estimate the carbohydrate content of meals with reasonable accuracy, large meals tended to be underestimated and snacks overestimated. ‘Very little is actually known about the ability of children to count carbs and whether one particular method (grams, portions or exchanges) for assessing carbs is better in this age group than others,’ writes Smart. ‘So we thought we would find out what they really know.’

The researchers asked 102 children and teenagers (aged 8–18 years) on intensive insulin therapy and 110 caregivers to independently estimate the carb content of 17 standardized meals using whichever method of method they had been taught (gram increments, 10g portions or 15g exchanges). ‘We found that teaching children and their caregivers carb counting in gram increments did not improve accuracy compared with carb portions or exchanges. The longer children had been carb counting the greater the mean percentage error. Core foods in non-standard quantities were most frequently inaccurately estimated, while individually labelled foods were most often accurately estimated,’ they write.

Of course, as GI News readers know, it's not just the quantity of carbs that counts, it's the quality. Smart's study published in Diabetes Care reported that substituting healthy low GI foods for high GI choices helps reduce post-meal hyperglycemia and is good for the whole family. 'In addition, young people with diabetes should try to always inject before they eat as this assists blood glucose control,’ says Smart.



Reality check on carb amounts in food. ‘Don't get too carried away thinking that by counting every gram of carbohydrate you eat and every 0.05 of a unit of insulin you take your blood glucose levels will be perfect,’ writes Dr Alan Barclay in The Diabetes and Pre-diabetes Handbook. ‘It just doesn't happen like this. It's a fact of life that even the most processed of foods never contain exactly the same amount of carbohydrate in a serve as the label says.’

How does this happen? Well, what's printed on the label is actually an average amount of carbohydrate per serving or per 100g for that food. There are small and completely natural variations in the amount of carbohydrate in food depending on where it is grown and the actual crop variety (different wheats and rices, for example, can have a different carb quantity and quality). Manufacturing and processing techniques produce small variations, too. This, along with the small differences you introduce each time you prepare yourself a ‘serve’ all adds up. So you can see how easily a 10–20% variation in the carbohydrate content of a food from what is printed on a food label can happen.

It’s not illegal either: food regulators such as Food Standards Australia and New Zealand recognise the natural variability of foods and allow for this with a 20-45% variation acceptable under the labelling regulations. This further highlights the impracticalities of ‘precisely’ counting carbs in 1 gram increments.

And for low carbers, there is international agreement that carbohydrate should not be restricted in children and adolescents with type 1 diabetes as it may have seriously harmful effects on their growth and development.

For more information contact: carmel.smart@hnehealth.nsw.gov.au