Jan 11 2010

The Glycemic Index and the Glycemic Load

Category: ExplanationJimR @ 9:21 pm


When considering various foods that you might wish to add to a diabetes food list, it can be helpful to know their Glycemic Index rating.

The Glycemic Index, or GI for short, is a list of carbohydrate containing foods that have been rated for their speed of conversion to glucose, and the release of that glucose into the bloodstream, compared to a standard reference value of 100 assigned to pure glucose. Pure glucose being very speedily released into the bloodstream since it does not require any further chemical breakdown by the digestive-system as would other food items.

The higher the numerical grading of a food the faster it is absorbed into the bloodstream compared to other foods of lower numerical value. Examples of this would be the breakfast cereals:

All-Bran with an established GI of 42,
Shredded Wheat with a GI of 67, and
Corn flakes with a GI of 84,

indicating that the carbohydrates in Corn flakes are converted much more quickly into glucose than the other two cereals with All-Bran taking the longest time. A faster release of glucose causes a faster and higher spike in blood sugar elevation, something to be avoided, or at least minimized if possible, leading to the conclusion that All-Bran is a better cereal choice than the others to include on the diabetic food list.

But not all high GI foods are bad and there are times, such as before, during, and after exercising, when they are beneficial. The body reacts to the higher blood glucose by releasing insulin, a hormone that assists the body in building muscle, although we must always keep in mind that the diabetic person’s body has an impaired ability to deal with insulin and higher blood glucose. These matters would be better discussed and commented on by the diabetic’s doctor or qualified health team members.

Many foods, such as proteins and fats, do not contain significant amounts of carbohydrate and are not listed on the glycemic Index.

The glycemic index is a useful tool to aid in choosing carbohydrate containing food items to include in a diabetic food list, enabling an emphasis on those with lower index values. But the inclusion of low GI foods in a diabetic food plan is only one of several considerations in determining an appropriate dietary regimen to follow over the long term.

GI range of values

Low GI values are 55 or less
Medium GI values are 56 to 69
High GI values are 70 and above.

The Glycemic Load
But what if the carbohydrate food we eat is only part of a larger meal that is otherwise devoid of carbohydrates, perhaps a meal of mostly protein and fat, of meat, vegetables, fruits, that have little or no carbohydrate content? In that case, measuring by weight in terms of grams, the carbohydrates would  be only part of the total grams in the meal and from this an adjusted GI value can be obtained by applying a simple formula..

To cover that situation, there is an extension and enhancement of the glycemic index known as the Glycemic Load. The glycemic load derives a set of values from those of the GI by taking into account the quantity, or quantities, of carbohydrates that are actually in the total meal of food item.

It becomes more practical to consider the GL of a food item when it is only a relatively small portion of the food being consumed, even if it is has a high GI rating,.

For a simplified example: when  knowing that one cup of the 84 GI cornflakes weighs about 30 grams, we can easily calculate the proportion of the cornflakes to the weight of the total meal. When being considered as part of a larger breakfast meal of 120 grams weight, it would be 25 percent of the total and that becomes the glycemic load value. 25 percent of the 84 GI is 21, the GL value of the cornflakes in the breakfast.

GL ranges of values
A GL value of 21 is still rather high, the substitution of a lower GI cereal such as Bran flakes or oatmeal porridge  would achieve a much lower GI rating. A GL value below 10 is considered to be low and above 20 is high in the opinion of most nutritionists.

An important decision regarding carbohydrate consumption
A major decision rests on what percentage of carbohydrates will be included in the overall diabetic food plan, whether to follow the American Diabetes Association’s recommendations of a high ratio of carbohydrates, or the opposite approach of lower carbohydrates, or somewhere in between. This is a controversial subject for many health care practitioners and needs careful consideration and discussion elsewhere. There are strong advocates whose differing views are worth hearing, even though a diabetic patient mainly depends on his or her personal physician to provide guidance, much of the management of the diabetic condition is in the hands of the individual diabetic.

The food lists available from this blog-site do provide the nutrient content and information for many common food items, indicating whether high or low on the GI and some food groups in general are summarized. For a very complete listing of GI values the following resources are suggested – although doing the research can get rather complicated and time consuming:

1.  The University of Sydney, Glycemic Index Web site.

2.  David Mendosa, blogger and medical writer.

3. There is also a very good article and explanation by staff of the Linus Pauling Institute at Oregon State University. That explanation references the GI to cardiovascular disease, a major complication of diabetes, and to obesity, to cancer, and to gallbladder disease. With its comments on several other topics of interest, it is worth a read and can be reached at Linus Pauling Institute.

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Jan 06 2010

Establishing Food Plans – Considerations

Category: ExplanationJimR @ 9:12 pm

Different approaches to establishing food plans

The objective of a dietary plan or diabetic food list for the diabetic person is primarily to aid in the control the amounts of glucose in the bloodstream and to keep the glucose levels within as narrow a range as possible so that they do not exceed acceptable levels by too great an amount.

There will be spikes in blood glucose levels after eating a meal or snack that will vary based on the type of food eaten and its carbohydrate content and the speed in which the resulting glucose is produced when digestion of the food takes place. That is why it is good to know, when compiling a diabetes food list, which foods are the source of the highest carbohydrate content and are the speediest broken down to glucose,  so that they can be eliminated or at least limited in quantity. Those can be identified by reference to the Glycemic Index and Glycemic Load index avail able elsewhere on this site.

To maintain glucose levels as evenly as possible throughout the day it is often suggested that meals should be of about the same size and interspersed with snacks, rather than any one meal being much larger than the others.

The essential nutrients needed by the body for its energy and maintenance are obtained from the carbohydrates, proteins, and fats in the foods consumed each day. Those foods are broken down to their nutritional chemical components in the digestion process and released through the walls of the intestine to be carried in the bloodstream to the many organs of the body where they are then selectively taken up as required into the body’s millions of cells.

When present, the carbohydrate fraction of the foods is the main source of glucose in the bloodstream and so it is the carbohydrate content of foods that is the major factor around which diabetic food plans are constructed. The more carbohydrates there are, the more glucose will end up in the blood stream. After a meal or snack, when glucose is produced, the impaired body mechanisms of the diabetic person in the production of insulin, needed to conduct the glucose into the cells that require it, and the desensitized sensors on the outer membranes of those cells, results in the unhealthy levels of the glucose remaining in the blood.

From that statement the question could be asked:
“Then why not reduce the amounts of carbohydrate to a minimum so that less glucose is produced to overload the bloodstream?”

That is a good question that would seem to require an answer in the affirmative. But the diabetic associations of most countries do not seem to concur.

The High Carbohydrate approach
The ADA (American Diabetes Association) and others recommend what can be considered a high carbohydrate diet of 50 to 60 percent Carbohydrates, 15 to 20 percent proteins, and 25 to 30 percent fats based on total calories consumed. A calorie is the unit applied to the measurement of energy provided by components of food.

The Low Carbohydrate approach
Although in the minority, many physicians advocate an “Anti-ADA” approach that, conversely, recommends a low carbohydrate content in meals to minimize the amount of glucose that can enter the bloodstream.

A number of books have been published by doctors providing details on diets that have successfully brought their patients to a reversal or near reversal of their diabetic condition or at least a very good control of their glucose levels. The carbohydrate content of those diets is low, from about 20 to 35 percent. There are many different versions, you’ve probably heard of the Dr.Atkins and South Beach Diets, but there are others, some less extreme than those.

The American Academy of Family Physicians defines low carbohydrate diets as:
“Low-carbohydrate diets restrict caloric intake by reducing the consumption of carbohydrates to 20 to 60 g per day (typically less than 20 percent of the daily caloric intake). The consumption of protein and fat is increased to compensate for part of the calories that formerly came from carbohydrates.”

It should also be noted that the American Diabetes Association, after carrying out their own clinical studies with patients on a low carbohydrate diet, agreed that the low carbohydrate was successful in achieving lower blood glucose levels. However, their stated opinion was that such a diet was not likely to be adhered to for a sufficiently long period of time and they therefore keep to their current recommendations regarding carbohydrates. For additional information on lower carbohydrate foods, see our companion site: Diabetic Menu Guide and the reference to low carbohydrate effectiveness can be found in our post :  Low Carbohydrate Approach.

There are other health concerns voiced by members of the medical and health care profession in which reservations are expressed regarding the adoption of a low calorie diet.

Caution:
All matters of diet, exercise, weight-loss, and especially any changes being contemplated, should be discussed with your doctor who will provide guidance on your treatment and should refer you to other health care professionals for more complete answers if necessary.

One other factor regarding carbohydrates is that they exist in several different forms that are usually classified as either “simple” or “complex”. The difference being in their chemical structure that results in a speedier breakdown to glucose for the simple form and a longer time for the complex forms. This makes the complex forms generally more favorable to include in a diabetic menu plan and a special index, known as the Glycemic Index, has been devised to rate the varying speeds of conversion of carbohydrates to glucose.

Vegetarian, Vegan, and Others
There are other dietary approaches that are effective in the management and control of blood glucose and that do not so much emphasize the carbohydrate content of foods. Among these are the Vegetarian and Vegan life styles that have many virtues from a viewpoint of nutrition. They concentrate on vegetables and fruits that are automatically low on the Glycemic Index, the speed in which their carbohydrate content is converted to glucose.

However, in North America, only a small percentage of the population follow a vegetarian or vegan regime, we are a meat-eating and fat-rich food consuming nation.

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