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Low-glycaemic diets and health: implications for obesity

Published online by Cambridge University Press:  07 March 2007

Geoffrey Livesey
Geoffrey Livesey
Affiliation:
Independent Nutrition Logic Ltd, Bellrope Lane, Wymondham, Norfolk NR18 0QX, UK
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Abstract

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The present review considers the background to terminology that relates foods, glycaemia and health, including ‘available carbohydrate’, ‘glycaemic index’ (GI), 'glycaemic glucose equivalent', 'glycaemic response index' and 'net carbohydrate', and concludes that central to each of these terms is 'glycaemic load' (GL). GL represents the acute increase in exposure of tissue to glucose determined by foods; it is expressed in ingested glucose equivalents (per 100 g fresh weight or per serving), and is regarded as independent of the state of glucose metabolism from normal to type 2 diabetes mellitus (T2DM). Ad libitum studies in overweight or obese adults and children show that low-GL diets are associated with marked weight benefits, loss of adiposity and reduced food intake. Weight benefits appear on low-glycaemic v. high-glycaemic available carbohydrates, unavailable v. available carbohydrates and protein v. available carbohydrate. Energy intake immediately after lowering of meal GL via carbohydrate exchanges is apparent only after a threshold cumulative intake of >2000 MJ. Various epidemiological and interventional studies are discussed. A relationship between GL and the development of T2DM and CHD is evident. Studies that at first seem conflicting are actually consistent when data are overlaid, such that diets with a GL of >120 glucose equivalents/d would appear to be inadvisable. Whereas certain studies might place GI as being slightly stronger than GL in relationto T2DM risk, this situation appears to be associated with observations in a lower range of GL or when the range of GI is too narrow for accuracy; nevertheless, authors emphasise the importance of GL. Among the studies reviewed, GL offers a better or stronger explanation than GI in various observations including body weight, T2DM in nurses, CHD, plasma triacylglycerols, HDL-cholesterol, high-sensitivity C-reactive protein and protein glycation. Where information is available, the associations between risk factors and GL are either similar or stronger in the overweight or obese, as judged by BMI, and apply to both body weight and blood risk factors. The implications tend to favour a long-term benefit of reducing GL, for which further study is necessary to eliminate any possibility of publication bias and to establish results in clinical trials with overweight and obese patients.

Keywords

ObesityDiabetesCHDHealth markersGlycaemic load
Type
Satellite Symposium on ‘The role of low-glycaemic diets in obesity and health’
Information
Proceedings of the Nutrition Society , Volume 64 , Issue 1 , February 2005 , pp. 105 - 113
Copyright
Copyright © The Nutrition Society 2005

References

Agus, MS, Swain, JF, Larson, CL, Eckert, EA & Ludwig, DS (2000) Dietary composition and physiologic adaptations to energy restriction. American Journal of Clinical Nutrition 71, 901–907.CrossRefGoogle ScholarPubMed
Anderson, JW, Randles, KM, Kendall, CW & Jenkins, DJ (2004) Carbohydrate and fiber recommendations for individuals with diabetes: a quantitative assessment and meta-analysis of the evidence. Journal of the American College of Nutrition 23, 5–17.Google Scholar
Anfinsen, J, Wolver, T, Solar, M, Hitcher, E & & Wolff, PD (2004) Methods and systems for determining and controlling glycaemic responses. US Patent Application no. 0043106 A1.Google Scholar
Atkins, R (2003) Dr Atkins New Diet Revolution. London: Vermillion.Google Scholar
Atkins-Nutritional (2004) Food products. http://atkins.com/Archive/2001/12/21-627515.html accessed on 22 July 2004.Google Scholar
Bjorck, I, Liljeberg, H & Ostman, E (2000) Low glycaemic-index foods. British Journal of Nutrition 83, Suppl. 1, S149–S155.Google Scholar
Bouche, C, Rizkalla, SW, Luo, J, Vidal, H, Veronese, A, Pacher, N, Fouquet, C, Lang, V & Slama, G (2002) Five-week, low-glycemic index diet decreases total fat mass and improves plasma lipid profile in moderately overweight nondiabetic men. Diabetes Care 25, 822–828.Google Scholar
Brand-Miller, J, Hayne, S, Petocz, P & Colagiuri, S (2003) Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 26, 2261–2267.Google Scholar
Brand-Miller, JC, Holt, SH, Pawlak, DB & McMillan, J (2002) Glycemic index and obesity. American Journal of Clinical Nutrition 76, 281S – 285S.CrossRefGoogle ScholarPubMed
Brehm, BJ, Seeley, RJ, Daniels, SR & D'Alessio, DA (2003) A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. Journal of Clinical Endocrinology and Metabolism 88, 1617–1623.Google Scholar
Brooks, B, Molyneaux, L, Zilkens, R, Ross, G & Yue, DK (1998) The use of acarbose in type 2 diabetic patients in secondary failure: effects on glycaemic control and diet induced thermogenesis. Diabetes Research and Clinical Practice 42, 175–180.Google Scholar
Ebbeling, CB, Leidig, MM, Sinclair, KB, Hangen, JP & Ludwig, DS (2003) A reduced-glycemic load diet in the treatment of adolescent obesity. Archives of Pediatrics and Adolescent Medicine 157, 773–779.CrossRefGoogle ScholarPubMed
Egger, M, Dave-Smith, G, Schneider, M & Minder, C (1997) Bias in meta-analysis detected by a simple, graphical test. British Medical Journal 315, 629–634.CrossRefGoogle ScholarPubMed
Flint, A, Moller, BK, Raben, A, Pedersen, D, Tetens, I, Holst, JJ & Astrup, A (2004) The use of glycaemic index tables to predict glycaemic index of composite breakfast meals. British Journal of Nutrition 91, 979–989.Google Scholar
Food and Agriculture Organization (1998) Carbohydrates in Human Nutrition. FAO Food and Nutrition Paper no. 66. Rome: FAO.Google Scholar
Food and Drug Administration (2004) Factsheet: Carbohydrates. http://www.fda.gov/oc/initiatives/obesity/factsheet.html accessed on 22 July 2004.Google Scholar
Ford, ES & Liu, S (2001) Glycemic index and serum high-density lipoprotein cholesterol concentration among US adults. Archives of Internal Medicine 161, 572–576.Google Scholar
Foster, GD, Wyatt, HR, Hill, JO, McGuckin, BG, Brill, C, Mohammed, BS, Szapary, PO, Rader, DJ, Edman, JS & Klein, S (2003) A randomized trial of a low-carbohydrate diet for obesity. New England Journal of Medicine 348, 2082–2090.CrossRefGoogle ScholarPubMed
Foster-Powell, K & Miller, JB (1995) International tables of glycemic index. American Journal of Clinical Nutrition 62, 871S – 890S.Google Scholar
Frost, G, Leeds, AA, Dore, CJ, Madeiros, S, Brading, S & Dornhorst, A (1999) Glycaemic index as a determinant of serum HDL-cholesterol concentration. Lancet 353, 1045–1048.CrossRefGoogle ScholarPubMed
Gannon, MC, Nuttall, FQ, Saeed, A, Jordan, K & Hoover, H (2003) An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. American Journal of Clinical Nutrition 78, 734–741.Google Scholar
Harding, AH, Sargeant, LA, Welch, A, Oakes, S, Luben, RN, Bingham, S, Day, NE, Khaw, KT & Wareham, NJ (2001) Fat consumption and HbA(1c) levels: the EPIC-Norfolk study. Diabetes Care 24, 1911–1916.Google Scholar
Jenkins, DJ, Wolever, TM, Taylor, RH, Barker, H, Fielden, H, Baldwin, JM, Bowling, AC, Newman, HC, Jenkins, AL & Goff, DV (1981) Glycemic index of foods: a physiological basis for carbohydrate exchange. American Journal of Clinical Nutrition 34, 362–366.Google Scholar
Khaw, KT, Wareham, N, Luben, R, Bingham, S, Oakes, S, Welch, A & Day, N (2001) Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European prospective investigation of cancer and nutrition (EPIC-Norfolk). British Medical Journal 322, 15–18.Google Scholar
Liu, P, Perry, T & Monro, JA (2003) Glycaemic glucose equivalent: validation as a predictor of the relative glycaemic effect of foods. European Journal of Clinical Nutrition 57, 1141–1149.CrossRefGoogle ScholarPubMed
Liu, S, Manson, JE, Buring, JE, Stampfer, MJ, Willett, WC & Ridker, PM (2002) Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. American Journal of Clinical Nutrition 75, 492–498.Google Scholar
Liu, S, Manson, JE, Stampfer, MJ, Holmes, MD, Hu, FB, Hankinson, SE & Willett, WC (2001) Dietary glycemic load assessed by food-frequency questionnaire in relation to plasma high-density-lipoprotein cholesterol and fasting plasma triacylglycerols in postmenopausal women. American Journal of Clinical Nutrition 73, 560–566.CrossRefGoogle ScholarPubMed
Liu, S, Willett, WC, Stampfer, MJ, Hu, FB, Franz, M, Sampson, L, Hennekens, CH & Manson, JE (2000) A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. American Journal of Clinical Nutrition 71, 1455–1461.Google Scholar
Livesey, G (2001) A perspective on food energy standards for nutrition labelling. British Journal of Nutrition 85, 271–287.CrossRefGoogle ScholarPubMed
Livesey, G (2002a) Approaches to health via lowering of postprandial glycaemia. British Journal of Nutrition 88, 741–744.Google Scholar
Livesey, G (2002b) Thermogenesis associated with fermentable carbohydrate in humans, validity of indirect calorimetry, and implications of dietary thermogenesis for energy requirements, food energy and body weight. International Journal of Obesity and Related Metabolic Disorders 26, 1553–1569.CrossRefGoogle ScholarPubMed
Livesey, G (2003) Health potential of polyols as sugar replacers, with emphasis on low glycaemic properties. Nutrition Research Reviews 16, 163–191.Google Scholar
Ludwig, DS (2003) Dietary glycemic index and the regulation of body weight. Lipids 38, 117–121.Google Scholar
McCance, R & Lawrence, R (1929) The Carbohydrate Content of Foods.Medical Research Council Special Report Series no 135. London: H. M. Stationery Office.Google Scholar
McKeown, NM, Meigs, JB, Liu, S, Saltzman, E, Wilson, PW & Jacques, PF (2004) Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 27, 538–546.Google Scholar
Melanson, KJ, Westerterp-Plantenga, MS, Campfield, LA & Saris, WH (1999a) Appetite and blood glucose profiles in humans after glycogen-depleting exercise. Journal of Applied Physiology 87, 947–954.Google Scholar
Melanson, KJ, Westerterp-Plantenga, MS, Saris, WH, Smith, FJ & Campfield, LA (1999b) Blood glucose patterns and appetite in time-blinded humans: carbohydrate versus fat. American Journal of Physiology 277, R337–R345.Google ScholarPubMed
Mendosa, D (2004) Net carbs. http://www.mendosa.com/netcarbs.htm accessed 22 July 2004.Google Scholar
Meyer, KA, Kushi, LH, Jacobs, Dr jr, Slavin, J, Sellers, TA & Folsom, AR (2000) Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. American Journal of Clinical Nutrition 71, 921–930.CrossRefGoogle ScholarPubMed
Monro, J (2003) Redefining the glycemic index for dietary management of postprandial glycemia. Journal of Nutrition 133, 4256–4258.Google Scholar
Monro, JA (2002) Glycaemic glucose equivalent: combining carbohydrate content, quantity and glycaemic index of foods for precision in glycaemia management. Asia Pacific Journal of Clinical Nutrition 11, 217–224.Google Scholar
Pawlak, DB, Ebbeling, CB & Ludwig, DS (2002) Should obese patients be counselled to follow a low-glycaemic index diet? Yes. Obesity Reviews 3, 235–243.CrossRefGoogle ScholarPubMed
Pawlak, DB et al. (2003) Cited by Brand–Miller J (2003) FL, USA Member's Proceedings of the Calorie Control Council.Google Scholar
Price, J, Brand-Miller, J, O'Neill, K & Petocz, P (2004) The effects of 4 diets varying in glycemic load, carbohydrate and protein content, on weight loss and body composition. In Proceedings of the Australasian Society for the Study of Obesity 12th Annual Scientific Meeting(In the Press).Google Scholar
Raben, A (2002) Should obese patients be counselled to follow a low-glycaemic index diet? No. Obesity Reviews 3, 245–256.CrossRefGoogle ScholarPubMed
Ramdath, DD, Isaacs, RL, Teelucksingh, S & Wolever, TM (2004) Glycaemic index of selected staples commonly eaten in the Caribbean and the effects of boiling v. crushing. British Journal of Nutrition 91, 971–977.Google Scholar
Salmeron, J, Ascherio, A, Rimm, EB, Colditz, GA, Spiegelman, D, Jenkins, DJ, Stampfer, MJ, Wing, AL & Willett, WC (1997a) Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 20, 545–550.Google Scholar
Salmeron, J, Manson, JE, Stampfer, MJ, Colditz, GA, Wing, AL & Willett, WC (1997b) Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. Journal of the American Medical Association 277, 472–477.Google Scholar
Samaha, FF, Iqbal, N, Seshadri, P, Chicano, KL, Daily, DA, McGrory, J, Williams, T, Williams, M, Gracely, EJ & Stern, L (2003) A low-carbohydrate as compared with a low-fat diet in severe obesity. New England Journal of Medicine 348, 2074–2081.Google Scholar
Schenk, S, Davidson, CJ, Zderic, TW, Byerley, LO & Coyle, EF (2003) Different glycemic indexes of breakfast cereals are not due to glucose entry into blood but to glucose removal by tissue. American Journal of Clinical Nutrition 78, 742–748.Google Scholar
Schulze, MB, Liu, S, Rimm, EB, Manson, JE, Willett, WC & Hu, FB (2004) Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. American Journal of Clinical Nutrition 80, 348–356.Google Scholar
Slabber, M, Barnard, HC, Kuyl, JM, Dannhauser, A & Schall, R (1994) Effects of a low-insulin-response, energy-restricted diet on weight loss and plasma insulin concentrations in hyperinsulinemic obese females. American Journal of Clinical Nutrition 60, 48–53.Google Scholar
Sloth, B, Krog-Mikkelsen, I, Flint, A, Tetens, I, Bjorck, I, Vinoy, S, Elmstahl, H, Astrup, A, Lang, V & Raben, A (2004) No difference in body weight decrease between a low-glycemic-index and a high-glycemic-index diet but reduced LDL cholesterol after 10-wk ad libitum intake of the low-glycemic-index diet. American Journal of Clinical Nutrition 80, 337–347.Google Scholar
Smits-Van Prooije, A, De Groot, A, Dreef-Van der Meulen, H & Sinkeldam, E (1990) Chronic toxicity and carcinogenicity study of isomalt in rats and mice. Food and Chemical Toxicology 28, 243–251.CrossRefGoogle ScholarPubMed
Sondike, SB, Copperman, N & Jacobson, MS (2003) Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. Journal of Pediatrics 142, 253–258.CrossRefGoogle ScholarPubMed
Spengler, M & Boehme, K (1984) Tolerance and Acceptance of Isomalt. Study 26. Report no. 13850. Wuppertal, Germany: Bayer AG Pharmaceuticals Division.Google Scholar
Spengler, M, Somogyi, J, Pletcher, E & Boehme, K (1987) Tolerability, acceptance and energetic conversion of isomalt (Palatinit(r)) in comparison with sucrose. Aktuelle Ernahrungsmedizin 12, 210–214.Google Scholar
Spieth, LE, Harnish, JD, Lenders, CM, Raezer, LB, Pereira, MA, Hangen, SJ & Ludwig, DS (2000) A low-glycemic index diet in the treatment of pediatric obesity. Archives of Pediatrics and Adolescent Medicine 154, 947–951.CrossRefGoogle ScholarPubMed
Stratton, IM, Adler, AI, Neil, HA, Matthews, DR, Manley, SE, Cull, CA, Hadden, D, Turner, RC & Holman, RR (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. British Medical Journal 321, 405–412.Google Scholar
SUGiRS (2002) Glycaemic Index Report – Isomalt Sydney, New South Wales Sydney University's Glycaemic Index Research Service, Human Nutrition Unit, Sydney University.Google Scholar
Thiebaud, D, Jacot, E, Schmitz, H, Spengler, M & Felber, JP (1984) Comparative study of isomalt and sucrose by means of continuous indirect calorimetry. Metabolism 33, 808–813.Google Scholar
Thorburn, AW, Brand, JC, O'Dea, K, Spargo, RM & Truswell, AS (1987) Plasma glucose and insulin responses to starchy foods in Australian aborigines: a population now at high risk of diabetes. American Journal of Clinical Nutrition 46, 282–285.Google Scholar
van Dam, RM, Visscher, AW, Feskens, EJ, Verhoef, P & Kromhout, D (2000) Dietary glycemic index in relation to metabolic risk factors and incidence of coronary heart disease: the Zutphen Elderly Study. European Journal of Clinical Nutrition 54, 726–731.CrossRefGoogle ScholarPubMed
Warren, JM, Henry, CJ & Simonite, V (2003) Low glycemic index breakfasts and reduced food intake in preadolescent children. Pediatrics 112, e414.CrossRefGoogle ScholarPubMed
Westman, EC, Yancy, WS, Edman, JS, Tomlin, KF & Perkins, CE (2002) Effect of 6-month adherence to a very low carbohydrate diet program. American Journal of Medicine 113, 30–36.Google Scholar
Wolever, TM & Mehling, C (2002) High-carbohydrate–low-glycaemic index dietary advice improves glucose disposition index in subjects with impaired glucose tolerance. British Journal of Nutrition 87, 477–487.CrossRefGoogle ScholarPubMed
Yancy, WS Jr, Olsen, MK, Guyton, JR, Baskt, RP & Westman, EC (2004) A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Annals of Internal Medicine 140, 769–777.Google Scholar