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Starchy Foods and Glycemic Index

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Starchy Foods and Glycemic Index David J.A. Jenkins, MD, PhD Thomas M.S. Wolever, MD, Starchy Foods and PhD Glycemic Index Alexandra L. Jenkins, RD Different starchy foods produce different glycemic the glycemic impact of the diet could be kept constant responses when fed individually, and there is some regardless of the variety of carbohydrate foods used (3,4). evidence that this also applies in the context of the Later studies by Crapo and colleagues (5-8) focused mixed meal. A major reason appears to relate to the on the differences between starchy foods of similar mac- rate at which the foods are digested and the factors ronutrient composition. Differences in both glucose and influencing this. A similar ranking in terms of glycemic response to specific foods is seen independent of the insulin responses were observed, and it was postulated carbohydrate tolerance status of the groups tested. that possible differences in rates of digestion of the foods Potentially clinically useful starchy foods producing were responsible. These differences in rates of digestion relatively flat glycemic responses have been identified. of starchy foods were subsequently confirmed (Fig. 1) Many of these are considered ethnic or traditional and and related to the glycemic responses observed in both include legumes; pasta; grains such as barley, parboiled normal and diabetic individuals (9,10). rice, and bulgur (cracked wheat); and whole-grain From the beginning of the 1980s, many tests of single breads such as pumpernickel. Specific incorporation foods (11-28) and mixed meals (24,29-35) have been of these foods into diets has been associated with undertaken in both normal and diabetic subjects. How- reductions in low-density lipoprotein cholesterol and triglyceride levels in hyperlipidemia and with improved ever, because of a lack of standardization of methods blood glucose control in insulin-dependent diabetic of data presentation, the results of different studies were patients. To facilitate identification of such foods, it has not always directly comparable. In 1981, the concept been suggested that the glycemic response should be of the glycemic index (Gl) was proposed as a method indexed to a standard (e.g., white bread) to allow of assessing and classifying the glycemic response to comparisons to be made between the glycemic index of carbohydrate foods (11). It was hoped that this would foods tested in different groups of subjects. The scope allow foods to be compared more readily. It would also of application of this principle is subject to further allow the experience of different investigators to be investigation. It may be used to expand the range of pooled by indexing the foods tested to a common stan- possibly useful starchy foods for trial in the diets of dard. Initially, glucose was used, but this proved to be diabetic patients. Diabetes Care 11:149-59, 1988 less acceptable for routine use than white bread of known composition. The Gl was therefore defined as incremental blood glucose area after food x 100 ifferent carbohydrate foods produce different corresponding area after equicarbohydrate portion of white bread glycemic responses despite an apparent lack of difference in macronutrient composition (1,2). The classification of carbohydrate foods D From the Department of Nutritional Sciences, Faculty of Medicine, and the was first put on a systematic basis by Otto and col- Division of Endocrinology and Metabolism, St. Michael's Hospital, University leagues (3,4), who, after testing foods, allowed carbo- of Toronto, Toronto, Ontario, Canada. Address correspondence and reprint requests to David J. A. Jenkins, Depart- hydrate incorporation into the diabetic diet in propor- ment of Nutritional Sciences, Faculty of Medicine, University of Toronto, To- tion to the glycemic response they produced. In this way ronto, Ontario M5S 1A8, Canada. DIABETES CARE, VOL. 11, NO. 2, FEBRUARY 1988 149 GLYCEMIC INDEX ^ 7 — ^^* Wholemeal Bread •^ E / Miolcn- E E 5 y^ ^^^l-Tlte Spaghetti Rice y' /^^^^Nuict Potato W n 4 / ^ ^S^, Wliolen eal Spaghetti p.c Oats uO ^ ^^ y^^/yr ^^^^^^ Porrid i3 fat Peas 2-5 2 e d FIG. 1. Increase in concentration over 5 lysat bohy h of products of starch digestion, mea- o.2 0 sured as glucose after acid hydrolysis, subsequent to incubation of 2 g available .E 0 12 3 4 carbohydrate portions of foods with pooled human saliva and pancreatic Time (hours) juice. By applying this approach to data from different groups made (38). However, when considering the relative gly- of subjects and different centers (12), it has been pos- cemic effects of different foods, i.e., the glycemic index, sible to begin to classify a substantial number of foods there is in fact some evidence for agreement among in terms of their glycemic responses (Table 1). different groups (Table 1). Foods that have been shown to have low glycemic Early studies with four starchy foods (bread, potato, responses include whole-grain (as opposed to whole rice, and corn) demonstrated the same order of ranking meal) cereals (15), pasta (17,36), and legumes (13,21,37). of the glycemic and insulin responses when these foods It was suggested that inclusion of such foods in the diets were tested in nondiabetic compared with diabetic vol- of patients with diabetes might aid dietary management unteers (6,8). Since then, several studies have shown by improving diabetes control. similarities in the ranking of responses to a wide range of foods tested in nondiabetic, NIDDM (13), and insu- lin-dependent diabetic (IDDM; 15-1 7) subjects. On the other hand, many studies do not agree (Table 1). OBJECTIONS TO GLYCEMIC INDEX More recently, it has been maintained that consider- ation of average glycemic responses is inadequate be- Objections to the Gl concept were raised early (38) and cause they may conceal large differences in response in have not been resolved (34,39). These objections have different individuals (39). This objection would be of resulted in a statement from the recent NIH consensus major clinical importance if the variability in response conference on diet and exercise in non-insulin-depen- between patients was such that certain individuals con- dent diabetes (NIDDM) that recommended against the sistently failed to show the expected differences in gly- use of Gl in the dietary management of diabetes (40). cemic responses between foods. The prescription of a The concern revolves around 3 major issues: 7) large diet containing foods of lower Gl would certainly not individual variation in responses, 2) lack of agreement result in lower postprandial blood glucose responses among different centers, and 3) lack of difference be- throughout the day. Unless these individuals could be tween mixed meals. In addition, it has been pointed out readily identified, the clinical application of Gl data that there are no studies showing long-term benefits of would indeed be limited and inappropriate if the num- low-GI foods (38,40). For these reasons it has been ber of patients who failed to show a consistent response maintained that the Gl has no clinical utility (34,38- was large. In view of the substantial coefficient of vari- 40). ation often seen in the GI to single foods, this negative Individual variation in glycemic responses. There are outcome is a real possibility. large differences among individuals with respect to the We have therefore examined the individual data that absolute level of blood glucose achieved after meals. formed the basis for recently published papers. In these Factors that have been suggested to influence this in- studies several low-GI foods were taken by different di- clude the presence and type of diabetes (38,41,42), age, abetic patients (Table 2; 15,16). Such a range of foods sex, body weight, and race (40). It has therefore been might be exchanged for foods of higher Gl in the diets stated that glycemic responses to foods should be tested of diabetic patients. We therefore considered it clinically in the specific group for which recommendations are relevant to determine whether the overall response to 150 DIABETES CARE, VOL. 11, NO. 2, FEBRUARY 1988 D.J.A. JENKINS, T.M.S. WOLEVER, AND A.L JENKINS TABLE 1 Mean glycemic index (Gl) values of foods adjusted proportionately so that Gl of white bread = 100 Food Gl values* Subjectst Mean Gi Breads Rye Crispbread 90", 100 C,A 95 Whole meal 89 G 89 Whole grain, i.e., pumpernickel 58", 78a C,G 68 Wheat White 100 (defined) A-K,M 100 Whole meal 93", 96, 100, 104, 106 C,G,B,A,J 100 ± 2 Pasta Macaroni White, boiled 5 min 64" I 64 Spaghetti Brown, boiled 15 min 61" A 61 White, boiled 15 min 46", 59", 68", 72C I,B,C,A 61 ± 6" White, boiled 5 min 45" I 45 Protein enriched 38b I 38 Star pasta White, boiled 5 min 54" I 54 Cereal grains Barley (pearled) 31C F 31 Buckwheat 74 A 74 Bulgur 65C G 65 Millet 103 A 103 Rice Brown 65", 96 N,A 81 Instant, boiled 1 min 65" H 65 Instant, boiled 6 min 121" L 121 Polished, boiled 5 min 58C H 58 Polished, boiled 15 min 68-, 70", 73", 78a, 83", 104 M,L,C,B,H,A 79 ± 5" Parboiled, boiled 5 min 54C H 54 Parboiled, boiled 25 min 58", 66", 72C, 78" D,H,E,R 65 ± 4J Rye kernels 47C G 47 Sweet corn 66C, 67" 85", 86, 87, 90 E,L,R,A,J,D 80 ± 4" Wheat kernels 63C G 63 Breakfast cereals All Bran 71", 74a, 76" B,A,N 74 ± 1b Cornflakes 107", 116, 121" L,A,B 115 ± 4 Muesli 96 A 96 Porridge oats 71a, 88", 93, 96 A,C,K,B 87 ± 6 Puffed rice 132" L 132 Shredded wheat 97 A 97 Weetabix 109 A 109 Cookies Digestive 77, 86 B,A 82 Oatmeal 78 A 78 Rich tea 80 A 80 Plain crackers (water biscuits) 91 A 91 Root vegetables Potato Instant 116, 119" A,L 118 Mashed 100 J 100 New, boiled 67", 75, 78", 101 C,B,L,A 80 ± 7 Russett, baked 112, 134~, 137a E,R,D 128 ± 8 Sweet 70a A 70 Yam 74 A 74 Legumes Baked beans (canned) 60c A 60 Bengal gram dal 7C, 16C J,M 12 Butter beans 39C, 52C J,A 46 DIABETES CARE, VOL.
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