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Glycemic Index, Carbs and Weight Control
Weight Loss and Blood Glucose Benefits of the Glycemic Index
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Glycemic Index, Carbs & Weight Control

Glycemic Index & Carbohydrates
The glycemic index of each dietary carbohydrate provides a measure of its ability to raise post-prandial blood glucose values. High glycemic index foods give higher post-prandial blood glucose levels than low glycemic index foods when compared to a standard of white bread or glucose. It has been demonstrated that the glycemic index of a carbohydrate provides a good predictor of the insulin response to that food. The nutritional branch of the WHO endorses the use of the glycemic index as a method of categorising carbohydrates as this provides information on the likely metabolic effects of that carbohydrate. Low glycemic index diets have been shown by ourselves and others to reduce fasting and post-prandial insulin, glucose, tryglyceride and non-esterified fatty acid concentrations. In addition these diets increase HDL-cholesterol and decrease fasting total cholesterol, while improving in-vivo and in-vitro insulin mediated glucose uptake. Prospective studies have demonstrated that low glycemic carbohydrates improve insulin sensitivity in subjects with diabetes, obesity and CHD, as well as those at risk of CHD. Intervention studies using low glycemic index diets have shown VLDL concentrations are lowered and one recent study has reported an increase in HDL concentrations in a small cohort of type 2 diabetic subjects. From the above studies we conclude that low glycemic index diets have been associated with a wide range of benefits on the established metabolic risk factors for CHD.

Low Glycemic Diets
Our most recent work has provided insight into the mechanisms by which low glycemic diets improve insulin sensitivity. We have shown that low glycemic index diets improve both adipocyte insulin-mediated glucose uptake in-vitro and insulin sensitivity in-vivo as assessed by the post-prandial fall in non-esterified fatty acids (NEFA) levels. The literature suggests that a 10 percent fall in the glycemic index of a diet will result in a 30 percent increase in insulin sensitivity. These observations support the commonly held hypothesis that reducing post-prandial NEFA levels optimises insulin stimulated glucose uptake in muscle, thereby increasing insulin sensitivity. Reducing post-prandial NEFA levels is important as their concentration has a rate-limiting effect on hepatic VLDL synthesis. High levels of VLDL production result in reduced HDL-cholesterol and increases in the formation of atherogenic small dense LDL. In a large cross-sectional study (2200 healthy adults) we have demonstrated that the glycemic index of the diet is a greater determinant of HDL cholesterol than any other aspect of the diet, be it fat or dietary fibre. The Framingham study found that a 3 percent decrease in female and a 2 percent decrease in male cardiovascular morbidity was associated with a 0.026mmol/l increase in HDL-cholesterol. In our study, the HDL-cholesterol of the women in the lowest quintile for glycemic index was 0.25mmol/l higher than for the women in the highest quintile. Extrapolating from published data this difference would translate to a 29 percent reduction in CHD morbidity. The corresponding potential decrease in male CHD morbidity would be 7 percent reflecting the 0.09 mmol/l difference in HDL-cholesterol between the lowest and the highest glycemic index quintiles, this has been confirmed recently by Willitts team. Also prospective evidence suggests that low glycemic diets will lower total cholesterol, affect clotting through suppression of plasminogen activator inhibitor compound 1, reduce blood pressure and induce weight loss.

Source: Dr Gary Frost, Head of Nutritional and Dietetics/Senior Lecturer, Hammersmith Hospital, London.

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