Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC).

BACKGROUND AND AIMS: The positive and negative health effects of dietary carbohydrates are of interest to both researchers and consumers. METHODS: International experts on carbohydrate research held a scientific summit in Stresa, Italy, in June 2013 to discuss controversies surrounding the utility of the glycemic index (GI), glycemic load (GL) and glycemic response (GR). RESULTS: The outcome was a scientific consensus statement which recognized the importance of postprandial glycemia in overall health, and the GI as a valid and reproducible method of classifying carbohydrate foods for this purpose. There was consensus that diets low in GI and GL were relevant to the prevention and management of diabetes and coronary heart disease, and probably obesity. Moderate to weak associations were observed for selected cancers. The group affirmed that diets low in GI and GL should always be considered in the context of diets otherwise understood as healthy, complementing additional ways of characterizing carbohydrate foods, such as fiber and whole grain content. Diets of low GI and GL were considered particularly important in individuals with insulin resistance. CONCLUSIONS: Given the high prevalence of diabetes and pre-diabetes worldwide and the consistency of the scientific evidence reviewed, the expert panel confirmed an urgent need to communicate information on GI and GL to the general public and health professionals, through channels such as national dietary guidelines, food composition tables and food labels.

A low glycaemic diet improves oral glucose tolerance but has no effect on ß-cell function in C57BL/6J mice.

AIM: Clinical studies have suggested a role for dietary glycaemic index (GI) in body weight regulation and diabetes risk. Here, we investigated the long-term metabolic effects of low and high glycaemic diets using the C57BL/6J mouse model. METHODS: Female C57BL/6J mice were fed low or high glycaemic starch in either low-fat or medium-fat diets for 22 weeks. Oral and intravenous glucose tolerance tests were performed to investigate the effect of the experimental diets on glucose tolerance and insulin resistance. RESULTS: In this study, a high glycaemic diet resulted in impaired oral glucose tolerance compared to a low glycaemic diet. This effect was more pronounced in the group fed a medium-fat diet, suggesting that a lower dietary fat content ameliorates the negative effect of a high glycaemic diet. No effect on body weight or body fat content was observed in either a low-fat diet or a medium-fat diet. Static incubation of isolated islets did not show any differences in basal (3.3 mM glucose) or glucose-stimulated (8.6 and 16.7 mM glucose) insulin secretion between mice fed a low or high glycaemic diet. CONCLUSION: Together, our data suggest that the impaired glucose tolerance seen after a high glycaemic diet is not explained by altered ß-cell function.

Muesli with 4 g oat beta-glucans lowers glucose and insulin responses after a bread meal in healthy subjects.

OBJECTIVE: To evaluate the impact of an extruded muesli product based on beta-glucan-rich oat bran on postprandial glycaemia and insulinaemia. SUBJECT/DESIGN: The study is divided in two series. Blood glucose and serum insulin responses were studied after subjects consuming test meals including a serving of muesli with 3 g (series 1) and 4 g (series 2) of beta-glucans, respectively. The muesli was a component in a single serving packet with muesli and yoghurt. This was served together with white wheat bread in the morning after an overnight fast. The compositions were standardized to contain 50 g available carbohydrates. As a reference meal a serving packet without beta-glucans was included. The study was performed at Applied Nutrition and Food Chemistry, Lund University, Sweden. Nineteen and thirteen healthy volunteers with normal body mass index were recruited for series 1 and 2, respectively. RESULTS: Muesli with 3 g of beta-glucans, included in a mixed bread meal, gave no significant differences in glycaemic response compared to a reference meal without muesli and beta-glucans. In contrast, muesli with 4 g of beta-glucans significantly (P<0.05) lowered the glucose and insulin responses compared to the reference meal. CONCLUSIONS: Muesli enriched with 4 g of beta-glucans reduces postprandial glucose and insulin levels to a breakfast based on high glycaemic index products. A total of 4 g of beta-glucans from oats seems to be a critical level for a significant decrease in glucose and insulin responses in healthy people.

Glycaemic and satiating properties of potato products.

OBJECTIVE: To investigate glycaemic and satiating properties of potato products in healthy subjects using energy-equivalent or carbohydrate-equivalent test meals, respectively. SUBJECTS AND SETTING: Thirteen healthy subjects volunteered for the first study, and 14 for the second. The tests were performed at Applied Nutrition and Food Chemistry, Lund University, Sweden. EXPERIMENTAL DESIGN AND TEST MEALS: All meals were served as breakfast in random order after an overnight fast. Study 1 included four energy-equivalent (1000 kJ) meals of boiled potatoes, french fries, or mashed potatoes; the latter varying in portion size by use of different amounts of water. The available carbohydrate content varied between 32.5 and 50.3 g/portion. Capillary blood samples were collected during 240 min for analysis of glucose, and satiety was measured with a subjective rating scale. Study 2 included four carbohydrate-equivalent meals (50 g available carbohydrates) of french fries, boiled potatoes served with and without addition of oil, and white wheat bread (reference). The energy content varied between 963 and 1534 kJ/portion. Capillary blood samples were collected during 180 min for analysis of glucose, and satiety was measured using a subjective rating scale. RESULTS: Study 1: boiled potatoes induced higher subjective satiety than french fries when compared on an energy-equivalent basis. The french fries elicited the lowest early glycaemic response and was less satiating in the early postprandial phase (area under the curve (AUC) 0-45 min). No differences were found in glycaemic or satiety response between boiled or mashed potatoes. Study 2: french fries resulted in a significantly lower glycaemic response (glycaemic index (GI)=77) than boiled potatoes either with or without addition of oil (GI=131 and 111, respectively). No differences were found in subjective satiety response between the products served on carbohydrate equivalence. CONCLUSIONS: Boiled potatoes were more satiating than french fries on an energy-equivalent basis, the effect being most prominent in the early postprandial phase, whereas no difference in satiety could be seen on a carbohydrate-equivalent basis. The lowered GI for french fries, showing a typical prolonged low-GI profile, could not be explained by the fat content per se.

Effects of GI vs content of cereal fibre of the evening meal on glucose tolerance at a subsequent standardized breakfast.

OBJECTIVE: To investigate if the improved glucose tolerance previously observed at breakfast following an evening meal with boiled barley kernels derives from colonic events related to the fermentation of the elevated amounts of indigestible carbohydrates present and/or from the low-GI features. SUBJECTS/METHODS: Twenty healthy volunteers aged 19-30 years. DESIGN: High-GI white wheat bread (WWB), WWB+barley dietary fibre (DF) corresponding to the DF content of barley kernels, low-GI spaghetti+ barley DF, spaghetti+double amounts of barley DF (2(*)DF), spaghetti+oat DF, or whole grain barley flour porridge, were provided as late evening meals. At a subsequent standardised WWB breakfast, B-glucose, s-insulin, p-SCFA, p-FFA, and breath hydrogen (H(2)) were measured. RESULTS: The B-glucose response (incremental areas under the curves (IAUC) 0-120 min and total areas under the curves 0-180 min) to the standardized breakfast was significantly lower after consuming spaghetti+2*DF in the evening compared with barley porridge (P=0.012). The spaghetti+2*DF meal also resulted in the highest breath H(2) excretion (P<0.02). The glucose IAUC (0-120 min) after the standardized breakfast was positively correlated to fasting p-FFA (r=0.29, P<0.02), and the total glucose area (0-180 min) was negatively correlated to the p-propionate level (0-30 min) (r=-0.24, P<0.02). CONCLUSIONS: The prolonged digestive and absorptive phase per se, like with a low-glycaemic index (GI) spaghetti evening meal, did not induce overnight benefits on glucose tolerance. Addition of barley DF in high amounts (2*DF) was required to improve overnight glucose tolerance. The correlations observed between glycaemia and p-propionate implicate colonic fermentation as a modulator of glucose tolerance through a mechanism leading to suppressed free fatty acids levels. It is proposed that the overnight benefits on glucose tolerance previously reported for boiled barley kernels is mediated through colonic fermentation of the prebiotic carbohydrates present in this product.

Dietary supplementation with beta-glucan enriched oat bran increases faecal concentration of carboxylic acids in healthy subjects.

BACKGROUND/OBJECTIVE: Carboxylic acids (CAs), especially butyric acid, have been suggested to counteract colonic diseases, such as ulcerative colitis and colon cancer. Colonic formation of CAs can be influenced by the diet, but the concentrations and pattern formed need to be evaluated for different food products in humans. To elucidate how the colonic concentration of CAs in healthy subjects is influenced by dietary supplementation with oat bran, and whether the concentration varies over time and during consecutive days. SUBJECTS/METHODS: Twenty-five healthy subjects (age 24+/-1.3) were recruited to the study. The subjects were given 40 g beta-glucan enriched oat bran per day, corresponding to 20 g dietary fibre, in 4 slices of bread. CAs were analysed in faeces during three consecutive days after 0, 4, 8 and 12 weeks on this diet. RESULTS: The concentration of acetic, propionic, butyric, isobutyric and isovaleric acid was higher (P<0.05-0.001) after 8 weeks on the oat bran diet as compared with values at entry, whereas that of lactic acid was lower (P<0.05). After 12 weeks, the concentrations of acetic, propionic and isobutyric acid were still higher and that of lactic acid lower. The variation between individuals was considerable, whereas in the same individuals there was little variation. CONCLUSIONS: Oat bran increased the faecal concentration of CAs after 8 weeks, indicating an increased concentration also in the distal colon. The concentration of all main acids increased, except for lactic acid, which decreased. Oat bran may therefore have a preventive potential adjunct to colonic diseases.

Determination of glycaemic index; some methodological aspects related to the analysis of carbohydrate load and characteristics of the previous evening meal.

OBJECTIVES: To determine the possible differences in glycaemic index (GI) depending on (1) the analytical method used to calculate the 'available carbohydrate' load, that is, using carbohydrates by difference (total carbohydrate by difference, minus dietary fibre (DF)) as available carbohydrates vs available starch basis (total starch minus resistant starch (RS)) of a food rich in intrinsic RS and (2) the effect of GI characteristics and/or the content of indigestible carbohydrates (RS and DF) of the evening meal prior to GI testing the following morning. DESIGN: Blood glucose and serum insulin responses were studied after subjects consuming (1) two levels of barley kernels rich in intrinsic RS (15.2%, total starch basis) and (2) after a standard breakfast following three different evening meals varying in GI and/or indigestible carbohydrates: pasta, barley kernels and white wheat bread, respectively. SUBJECTS: Healthy adults with normal body mass index. RESULTS: (1) Increasing the portion size of barley kernels from 79.6 g (50 g 'available carbohydrates') to 93.9 g (50 g available starch) to adjust for its RS content did not significantly affect the GI or insulin index (11). (2) The low GI barley evening meal, as opposed to white wheat bread and pasta evening meals, reduced the postprandial glycaemic and insulinaemic (23 and 29%, respectively, P < 0.05) areas under the curve at a standardized white bread breakfast fed the following morning. CONCLUSION: (1) Increasing portion size to compensate for the considerable portion of RS in a low GI barley product had no significant impact on GI or II. However, for GI testing, it is recommended to base carbohydrate load on specific analyses of the available carbohydrate content. (2) A low GI barley evening meal containing high levels of indigestible carbohydrates (RS and DF) substantially reduced the GI and II of white wheat bread determined at a subsequent breakfast meal.

Effects of GI and content of indigestible carbohydrates of cereal-based evening meals on glucose tolerance at a subsequent standardised breakfast.

OBJECTIVE: To evaluate the impact of four low-glycaemic index (GI) and one high-GI cereal-based evening meals on glucose tolerance at a subsequent standardised breakfast. DESIGN: Wheat kernels, barley kernels, spaghetti, spaghetti with added wheat bran and white wheat bread (WWB) were consumed in the evening in a random order at five different occasions. At the subsequent breakfast, blood glucose, serum insulin, plasma short chain fatty acid, plasma free fatty acid (FFA) and breath hydrogen were measured. SETTING: The study was performed at Applied Nutrition and Food Chemistry, Lund University, Sweden. SUBJECTS: Fifteen healthy volunteers were recruited. One subject was later excluded owing to abnormal blood glucose values. RESULTS: The blood glucose response (0-120 min) to the standardised breakfast was significantly lower after consuming barley kernels in the evening compared with evening meals with WWB (P=0.019) or spaghetti+wheat bran (P=0.046). There were no significant differences in insulin concentrations at breakfast. Breath hydrogen excretion at breakfast was significantly higher after an evening meal with barley kernels compared with WWB, wheat kernels or spaghetti (P=0.026, 0.026 and 0.015, respectively), and the concentration of plasma propionate at breakfast was significantly higher following an evening meal with barley kernels compared with an evening meal with WWB (P=0.041). In parallel, FFA concentrations were significantly lower after barley kernels compared with WWB (P=0.042) or spaghetti evening meals (P=0.019). CONCLUSIONS: The improved glucose tolerance at breakfast, following an evening meal with barley kernels appeared to emanate from suppression of FFA levels, mediated by colonic fermentation of the specific indigestible carbohydrates present in this product, or, to the combination of the low-GI features and colonic fermentation.

A dietary exchange of common bread for tailored bread of low glycaemic index and rich in dietary fibre improved insulin economy in young women with impaired glucose tolerance.

OBJECTIVE: To study the possibility of improving blood lipids, glucose tolerance and insulin sensitivity in women with impaired glucose tolerance and a history of gestational diabetes by merely changing the glycaemic index (GI) and dietary fibre (DF) content of their bread. DESIGN: Randomized crossover study where test subjects were given either low GI/high DF or high GI/low DF bread products during two consecutive 3-week periods, separated by a 3-week washout period. An intravenous glucose tolerance test followed by a euglycaemic-hyperinsulinaemic clamp was performed on days 1 and 21 in both the high- and low-GI periods, to assess insulin secretion and insulin sensitivity. Blood samples were also collected on days 1 and 21 for analysis of fasting levels of glucose, insulin, HDL-cholesterol and triacylglycerols (TG). SETTING: Lund University, Sweden. SUBJECTS: Seven women with impaired glucose tolerance. RESULTS: The study shows that a modest dietary modification, confined to a lowering of the GI character and increasing cereal DF of the bread products, improved insulin economy as judged from the fact that all women lowered their insulin responses to the intravenous glucose challenge on average by 35% (0-60 min), in the absence of effect on glycaemia. No changes were found in fasting levels of glucose, insulin, HDL-cholesterol or TG. CONCLUSION: It is concluded that a combination of low GI and a high content of cereal DF has a beneficial effect on insulin economy in women at risk of developing type II diabetes. This is in accordance with epidemiological data, suggesting that a low dietary GI and/or increased intake of whole grain prevent against development of type II diabetes. SPONSORSHIP: Supported by grants from Cerealia Research Foundation.

Vinegar dressing and cold storage of potatoes lowers postprandial glycaemic and insulinaemic responses in healthy subjects.

OBJECTIVE: To investigate the effects of cold storage and vinegar addition on glycaemic and insulinaemic responses to a potato meal in healthy subjects. SUBJECTS AND SETTING: A total of 13 healthy subjects volunteered for the study, and the tests were performed at Applied Nutrition and Food Chemistry, Lund University, Sweden. Experimental design and test meals:The study included four meals; freshly boiled potatoes, boiled and cold stored potatoes (8 degrees C, 24 h), boiled and cold stored potatoes (8 degrees C, 24 h) with addition of vinaigrette sauce (8 g olive oil and 28 g white vinegar (6% acetic acid)) and white wheat bread as reference. All meals contained 50 g available carbohydrates and were served as a breakfast in random order after an overnight fast. Capillary blood samples were collected at time intervals during 120 min for analysis of blood glucose and serum insulin. Glycaemic (GI) and insulinaemic indices (II) were calculated from the incremental areas using white bread as reference. RESULTS: Cold storage of boiled potatoes increased resistant starch (RS) content significantly from 3.3 to 5.2% (starch basis). GI and II of cold potatoes added with vinegar (GI/II=96/128) were significantly reduced by 43 and 31%, respectively, compared with GI/II of freshly boiled potatoes (168/185). Furthermore, cold storage per se lowered II with 28% compared with the corresponding value for freshly boiled potatoes. CONCLUSION: Cold storage of boiled potatoes generated appreciable amounts of RS. Cold storage and addition of vinegar reduced acute glycaemia and insulinaemia in healthy subjects after a potato meal. The results show that the high glycaemic and insulinaemic features commonly associated with potato meals can be reduced by use of vinegar dressing and/or by serving cold potato products.

Glucose and insulin responses to porridge and gruel meals intended for infants.

OBJECTIVE: The objective was to determine the glycaemic index (GI) and insulinaemic index (II) of some common products intended for infants; that is, three commercial porridges and one gruel. Also, the influence of added fruit components to porridge on postprandial metabolic responses was studied by comparing corresponding data with a matched model product without fruit. DESIGN: The volunteers were served the test products in random order following an overnight fast. A white bread was included as a reference product. Capillary blood samples were collected before and during 3 h after the meals. SETTING: The study was performed at the Department of Applied Nutrition and Food Chemistry, Lund University, Sweden. SUBJECTS: A total of 10 healthy volunteers, six men and four women, aged 24-41 y, with normal body mass indices, were recruited. RESULTS: The GIs (67-75) of the commercial porridges and gruel were significantly lower than for the white bread reference (P < 0.05). In contrast, the GI (79) of the model product (porridge without fruit) could not be distinguished from the reference. The IIs (112-149) for the commercial products and model products, respectively, were not significantly different from the reference. CONCLUSIONS: : The commercial porridges and gruel gave unexpectedly low GIs. In contrast, high IIs were noted. The inconsistency between GI and II could probably be explained by the insulinotrophic effect of the milk component in the products. The fruit and fruit juice added to some of the products had only minor effect on postprandial glycaemia. SPONSORSHIP: The Swedish Council for Forestry and Agricultural Research.

Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects.

OBJECTIVE: To investigate the potential of acetic acid supplementation as a means of lowering the glycaemic index (GI) of a bread meal, and to evaluate the possible dose-response effect on postprandial glycaemia, insulinaemia and satiety. SUBJECTS AND SETTING: In all, 12 healthy volunteers participated and the tests were performed at Applied Nutrition and Food Chemistry, Lund University, Sweden. INTERVENTION: Three levels of vinegar (18, 23 and 28 mmol acetic acid) were served with a portion of white wheat bread containing 50 g available carbohydrates as breakfast in randomized order after an overnight fast. Bread served without vinegar was used as a reference meal. Blood samples were taken during 120 min for analysis of glucose and insulin. Satiety was measured with a subjective rating scale. RESULTS: A significant dose-response relation was seen at 30 min for blood glucose and serum insulin responses; the higher the acetic acid level, the lower the metabolic responses. Furthermore, the rating of satiety was directly related to the acetic acid level. Compared with the reference meal, the highest level of vinegar significantly lowered the blood glucose response at 30 and 45 min, the insulin response at 15 and 30 min as well as increased the satiety score at 30, 90 and 120 min postprandially. The low and intermediate levels of vinegar also lowered the 30 min glucose and the 15 min insulin responses significantly compared with the reference meal. When GI and II (insulinaemic indices) were calculated using the 90 min incremental area, a significant lowering was found for the highest amount of acetic acid, although the corresponding values calculated at 120 min did not differ from the reference meal. CONCLUSION: Supplementation of a meal based on white wheat bread with vinegar reduced postprandial responses of blood glucose and insulin, and increased the subjective rating of satiety. There was an inverse dose-response relation between the level of acetic acid and glucose and insulin responses and a linear dose-response relation between acetic acid and satiety rating. The results indicate an interesting potential of fermented and pickled products containing acetic acid.

Glycaemic index methodology.

The glycaemic index (GI) concept was originally introduced to classify different sources of carbohydrate (CHO)-rich foods, usually having an energy content of >80 % from CHO, to their effect on post-meal glycaemia. It was assumed to apply to foods that primarily deliver available CHO, causing hyperglycaemia. Low-GI foods were classified as being digested and absorbed slowly and high-GI foods as being rapidly digested and absorbed, resulting in different glycaemic responses. Low-GI foods were found to induce benefits on certain risk factors for CVD and diabetes. Accordingly it has been proposed that GI classification of foods and drinks could be useful to help consumers make 'healthy food choices' within specific food groups. Classification of foods according to their impact on blood glucose responses requires a standardised way of measuring such responses. The present review discusses the most relevant methodological considerations and highlights specific recommendations regarding number of subjects, sex, subject status, inclusion and exclusion criteria, pre-test conditions, CHO test dose, blood sampling procedures, sampling times, test randomisation and calculation of glycaemic response area under the curve. All together, these technical recommendations will help to implement or reinforce measurement of GI in laboratories and help to ensure quality of results. Since there is current international interest in alternative ways of expressing glycaemic responses to foods, some of these methods are discussed.

Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low-glycemic index diet in type 2 diabetic patients.

OBJECTIVE: To evaluate the effects of varying the glycemic index (GI) of carbohydrate-rich foods on metabolic control in type 2 diabetic patients. RESEARCH DESIGN AND METHODS: In a randomized crossover study, 20 patients, 5 women and 15 men, were given preweighed diets with different GIs during two consecutive 24-day periods. Both diets were composed in accordance with dietary recommendations for people with diabetes. The macronutrient composition and type and amount of dietary fiber were identical. Differences in GI were achieved mainly by altering the structure of the starchy foods. RESULTS: Peripheral insulin sensitivity increased significantly and fasting plasma glucose decreased during both treatment periods. There was a significant difference in the changes of serum fructosamine concentrations between the diets (P < 0.05). The incremental area under the curve for both blood glucose and plasma insulin was approximately 30% lower after the low- than after the high-GI diet. LDL cholesterol was significantly lowered on both diets, with a significantly more pronounced reduction on the low-GI diet. Plasminogen activator inhibitor-1 activity was normalized on the low-GI diet, (-54%, P < 0.001), but remained unchanged on the high-GI diet. CONCLUSIONS: A diet characterized by low-GI starchy foods lowers the glucose and insulin responses throughout the day and improves the lipid profile and capacity for fibrinolysis, suggesting a therapeutic potential in diabetes.

Bioavailability of starch in various wheat-based bread products: evaluation of metabolic responses in healthy subjects and rate and extent of in vitro starch digestion.

Glucose and insulin responses to bread products were evaluated in healthy subjects. Also studied were the rate of in vitro starch digestion and the content of in vitro resistant starch (RS). Three white-wheat-bread (WWB) products varying in crust-crumb ratio and monoglyceride addition, three bread products with a high soluble fiber content (HSFB), and two coarse-wheat breads (CB) were included. The metabolic responses to WWBs were in general higher than those to CB and HSFB products. The most prominent reduction in metabolic responses was noted with the CBs with intact kernels and the HSFBs with oat bran. The starch in these products was also more slowly released from a dialysis tubing after enzyme incubation of chewed samples. The RS content ranged from 0 to 1.7 g/100 g starch. HSFBs and the CB with intact kernels showed a higher satiety score than did the WWBs immediately after the test meal.

Delayed gastric emptying rate as a potential mechanism for lowered glycemia after eating sourdough bread: studies in humans and rats using test products with added organic acids or an organic salt.

The possible effects of organic acids or an organic salt on the rate of gastric emptying was studied to identify the cause for reduced postmeal responses of blood glucose and insulin to foods containing such components, eg, sourdough bread. Paracetamol was included in bread products with added lactic acid or sodium propionate and used as a marker for the rate of gastric emptying in healthy subjects. In parallel, postprandial glycemia, insulinemia, and satiety were evaluated. The influence of lactic acid, propionic acid, and sodium propionate was also studied in rats after they were tube-fed with glucose solutions. The bread products with lactic acid or sodium propionate both lowered blood glucose and insulin responses. The bread with sodium propionate also prolonged satiety. The reason for the lowered metabolic responses with sodium propionate was probably a lowered gastric emptying rate, as judged from reduced blood paracetamol concentrations; there was no such effect observed with bread with added lactic acid. A similar amount of lactic acid in solution tube-fed to rats did not affect the disappearance of glucose from the stomach. In contrast with the finding in humans, sodium propionate had no effect on the rate of gastric emptying in rats whereas an equimolar solution of propionic acid reduced gastric emptying rate in rats. Possibly, less of this acid was produced in the gastric contents after a bolus load of a sodium propionate solution (in rats) than in an eating situation. Also, the pH and/or the osmolarity may be important, and when provided in excessive amounts, lactic acid reduced the gastric emptying rate in rats. A hydrochloric acid solution of similar pH was much less effective in this respect.

Inconsistency between glycemic and insulinemic responses to regular and fermented milk products.

BACKGROUND: Foods with a low glycemic index are increasingly being acknowledged as beneficial in relation to the insulin resistance syndrome. Certain organic acids can lower the glycemic index of bread products. However, the possible effect of acids in fermented milk products on the glycemic index and on insulinemic characteristics has not been addressed. The metabolic effects of fermented milk or pickled products used as additives to mixed meals have also not been addressed. OBJECTIVES: One objective was to characterize the glycemic and insulinemic responses after intake of regular or fermented milk products (study 1). In addition, the acute metabolic effect of fermented milk (yogurt) and pickled cucumber as supplements to a traditional breakfast based on a high-glycemic index bread was evaluated (study 2). DESIGN: Ten healthy volunteers were served different breakfast meals after an overnight fast. Capillary blood samples were collected before and during 2 (study 1) or 3 (study 2) h after the meal. White-wheat bread was used as a reference meal in both studies. RESULTS: The lactic acid in the fermented milk products did not lower the glycemic and insulinemic indexes. Despite low glycemic indexes of 15-30, all of the milk products produced high insulinemic indexes of 90-98, which were not significantly different from the insulinemic index of the reference bread. Addition of fermented milk (yogurt) and pickled cucumber to a breakfast with a high-glycemic index bread significantly lowered postprandial glycemia and insulinemia compared with the reference meal. In contrast, addition of regular milk and fresh cucumber had no favorable effect on the metabolic responses. CONCLUSIONS: Milk products appear insulinotropic as judged from 3-fold to 6-fold higher insulinemic indexes than expected from the corresponding glycemic indexes. The presence of organic acids may counteract the insulinotropic effect of milk in mixed meals.

Food properties affecting the digestion and absorption of carbohydrates.

Carbohydrate foods differ considerably in their effects on postprandial glucose and insulin responses. Qualitative differences among starchy foods are particularly intriguing because of the dominance of starch in human diets. This paper focuses on food properties in cereal (eg, pasta, bread, Arepas, and porridge) and legume products (eg, red kidney beans and lentils) that affect metabolic responses to starch. Studies in healthy subjects have found that postprandial blood glucose and insulin responses are greatly affected by food structure. Any process that disrupts the physical or botanical structure of food ingredients will increase the plasma glucose and insulin responses. The glycemic responses to bread products were reduced by the use of ingredients with an intact botanical or physical structure or a high amylose content or by enrichment with viscous dietary fiber. However, the important of a moderate increase in the amylose-amylopectin ratio and the naturally occurring levels of viscous cereal fiber is less clear. The rate of starch digestion in vitro was shown to be a key determinant of metabolic responses to most products. Assuming the sample preparation mimics chewing, in vitro enzymic procedures can be used to facilitate ranking. One such procedure, based on chewed rather than artificially disintegrated products, was recently developed and correlates well with glycemic and insulinemic indices for several starchy foods.

Glucose and insulin responses to barley products: influence of food structure and amylose-amylopectin ratio.

Postprandial glycemic and insulinemic responses and satiety with various barley products were evaluated in normal subjects. Also studied were the rate of in vitro starch digestion and the content of in vitro resistant starch (RS). Products tested were boiled intact (rice extender) and milled kernels (porridge) from four barley genotypes of Glacier with different amylose-amylopectin ratios (7-44% amylose). All barley products elicited lower metabolic responses and higher satiety scores when compared with white wheat bread. The lente behavior of the boiled flours was probably due to the viscous properties of the beta-glucans. However, the boiled flours produced higher glucose and insulin responses than did the corresponding boiled kernels. The impact of amylose: amylopectin on the metabolic responses was marginal. The high-amylose products released starch more slowly from a dialysis tubing during enzymic incubation of chewed samples compared with the corresponding products with less amylose. The RS content ranged from 0.4% in waxy to 5.6% in the high-amylose flour product (starch basis).

Effect of the glycemic index and content of indigestible carbohydrates of cereal-based breakfast meals on glucose tolerance at lunch in healthy subjects.

BACKGROUND: Diets with a low glycemic index (GI) have been shown to improve glucose tolerance in both healthy and diabetic subjects. Two potential mechanisms are discussed in relation to long-term metabolic effects: a decreased demand for insulin in the postprandial phase and formation of short-chain fatty acids from fermentation of indigestible carbohydrates in the colon. OBJECTIVE: The objective was to study the effect of the GI and the indigestible carbohydrate--resistant starch (RS) and dietary fiber (DF)--content of cereal-based breakfasts on glucose tolerance at a second meal (lunch) in healthy subjects. DESIGN: The effects of 7 test breakfasts with known GIs (GI: 52-99) and RS + DF contents (2-36 g) were evaluated. White-wheat bread was used as a reference breakfast (high GI, low RS + DF content). Glucose and insulin responses after the second meal were measured in healthy subjects. In addition, the satiating capacity of 4 of the 7 test breakfasts was estimated before and during the second meal. RESULTS: Two of the 4 low-GI breakfasts improved glucose tolerance at the second meal. Only these 2 breakfasts were capable of postponing the in-between-meal fasting state. There was no measurable effect of fermentable carbohydrates on glucose tolerance at the second meal. The highest satiety score was associated with the barley breakfast that had a low GI and a high RS + DF content. CONCLUSIONS: Glucose tolerance can improve in a single day. Slow absorption and digestion of starch from the breakfast meal, but not the content of indigestible carbohydrates in the breakfast meal, improved glucose tolerance at the second meal (lunch).