Dietary Enigmas

LOW GI eating - Now helping with inflammation - what next

January 30, 2008

Tags: alternative, blood glucose levels, C Reactive Protein, cancer, cancer prevention, diabetes, diet, environment, health, healthy, heart, hypergalecemia, hypotension, inflammation, lose, Low GI, medicine, NIDDM, sustainable living, treha, type 1 diabetes, type 2 diabetes, wellness
Posted in: Low GI

Rarely do I hear or read something from the Medical world that elicits a large YES - maybe they have got the message. Eating LOW GI is the only way eat long term. Doing anything else is plain stupid and will shorten your life and damage your health. Just to hear ‘authors recommend a diet rich in minimally processed, high-fibre, plant-based foods, including vegetables and fruits, whole grains, legumes, and nuts’ is great news and in the next sentence to hear the talking about every meal having small servings of lean protein - oh boy have they heard the message - i hope so. I’ve been saying this for 8 years now and I’m encouraged. To hear them openly talk about high Glucose levels effectively triggering oxidative stress is another milestone.

Read the entire article below and let it sink in.

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January 23, 2008 — Dietary and lifestyle strategies for improving postprandial glucose, lipid profile, markers of inflammation, and cardiovascular health are reviewed in a state-of-the-art paper reported in the January 22 issue of the Journal of the American College of Cardiology.

“The highly processed, calorie-dense, nutrient-depleted diet favored in the current American culture frequently leads to exaggerated supraphysiological post-prandial spikes in blood glucose and lipids,” write James H. O’Keefe, MD, from the Mid America Heart Institute and University of Missouri–Kansas City, and colleagues. “This state, called post-prandial dysmetabolism, induces immediate oxidant stress, which increases in direct proportion to the increases in glucose and triglycerides after a meal. The transient increase in free radicals acutely triggers atherogenic changes including inflammation, endothelial dysfunction, hypercoagulability, and sympathetic hyperactivity.”

Even in individuals without diabetes, postprandial dysmetabolism independently predicts future cardiovascular events. Dietary improvements are associated with dramatic and immediate benefits in postprandial dysmetabolism.

To attenuate the increase in glucose, triglycerides, and inflammation after a meal, the review authors recommend a diet rich in minimally processed, high-fiber, plant-based foods, including vegetables and fruits, whole grains, legumes, and nuts. Other dietary interventions that can significantly ameliorate postprandial dysmetabolism include intake of lean protein, vinegar, fish oil, tea, and cinnamon. Additional benefits may result from calorie restriction, weight loss, exercise, and low-dose to moderate-dose alcohol.

Specific recommendations to improve postprandial glucose and triglycerides are as follows:

• Select high-fiber carbohydrates with low glycemic index, including vegetables, fruits, whole grains, legumes, and nuts.
• At all 3 meals, consume lean protein.
• Eat approximately 1 handful of nuts daily (using a closed fist), consumed with vegetables, grains, berries, or other fruits.
• Eat salad daily, consisting of leafy greens with dressing of vinegar and virgin olive oil.
• Avoid highly processed foods and beverages, particularly those containing sugar, high-fructose corn syrup, white flour, or trans fats.
• Limit portion sizes to modest quantities.
• Maintain normal weight and avoid overweight or obesity. Waist circumference should be less than one half of height in inches.
• Perform physical activity for at least 30 minutes or more daily, of at least moderate intensity.
• For those with no history of substance abuse, consuming 1 alcoholic beverage before or with an evening meal may be considered.

“Experimental and epidemiological studies indicate that eating patterns, such as the traditional Mediterranean or Okinawan diets, that incorporate these types of foods and beverages reduce inflammation and cardiovascular risk,” the review authors write. “This anti-inflammatory diet should be considered for the primary and secondary prevention of coronary artery disease and diabetes.”

J Am Coll Cardiol. 2008;51:249-255.

Learning Objectives for This Educational Activity

Upon completion of this activity, participants will be able to:

1. Describe the clinical importance of postprandial glucose and lipid levels.
2. Identify dietary recommendations to reduce postprandial glucose and lipid levels.

Clinical Context

Approximately one third of Americans are thought to have abnormal glucose homeostasis, and poor diet is a major contributor to this phenomenon. Beyond overt diabetes, glucose intolerance has important clinical implications, as there is a direct linear relationship between glucose levels after a glucose challenge test and the risks for cardiovascular death and all-cause mortality.

Diet also significantly contributes to hyperlipidemia, and a single meal high in saturated fat can immediately raise serum triglyceride levels, oxidative stress, and intravascular inflammation. These factors help explain why some research has suggested that postprandial triglyceride levels are better predictors of cardiovascular risk than fasting triglyceride levels. At the same time, significant reductions in triglyceride levels of 20% to 40% can reduce the risk for coronary artery disease by as much as 40%.

There is good evidence regarding dietary interventions that can prevent hyperglycemia and hyperlipidemia. The current review summarizes the best dietary approaches to achieve these goals.

Study Highlights

• The glycemic index of a food is defined as the incremental increase in the area under the postprandial glucose curve after ingestion of 50 g of a specific amount of food vs that associated with 50 g of oral glucose. Ideal carbohydrates with a low glycemic index include green leafy vegetables such as broccoli and spinach and fruits such as grapefruits and cherries.
• Excess intake of processed carbohydrates leads to a vicious cycle of transient spikes in blood glucose levels, increased insulin production, and reactive hypoglycemia.
• Berries, dark chocolate, red wine, tea, and pomegranates reduce postprandial oxidant stress and inflammation.
• When paired with a high-glycemic-index meal, cinnamon slows gastric emptying and reduces postprandial glucose excursion.
• Nuts also slow gastric emptying and can reduce the impact of high-glycemic-index carbohydrates by as much as half. Nuts also reduce postprandial oxidative protein damage, and consumption of nuts at least 5 times weekly can reduced the risks for coronary artery disease and diabetes by 20% to 50%.
• Vinegar can reduce postprandial glycemia and promotes satiety.
• Lean protein reduces postprandial glucose excursion and improves satiety. Such protein includes egg whites, game meat, skinless poultry breast meat, and whey protein or other nonfat dairy protein.
• Drinking 0.5 to 1 alcoholic drink per day for women and 1 to 2 alcoholic drinks per day for men can reduce cardiovascular risk, and 1 to 2 drinks before a meal can reduce postprandial glucose and insulin levels. However, higher levels of drinking can impair glucose metabolism.
• Exercise acutely lowers glucose and triglyceride levels in a dose-dependent fashion.

Pearls for Practice

• There is a linear relationship between impaired glucose tolerance and mortality, and a fatty meal can lead to immediate increases in serum triglyceride levels. However, reducing triglyceride levels can reduce the risk for coronary artery disease by as much as 40%.
• The current review recommends foods with a low glycemic index such as vegetables and fruits. Other recommended foods include nuts, cinnamon, vinegar, egg whites, and whey protein.