The glycemic index, glycaemic index, or GI is a measure of the effects of carbohydrates on blood sugar levels. Carbohydrates that break down quickly during digestion, releasing glucose rapidly into the bloodstream, have a high GI; carbohydrates that break down more slowly, releasing glucose more gradually into the bloodstream, have a low GI. For most people, foods with a low GI have significant health benefits. The concept was developed by Dr. David J. Jenkins and colleagues[1] in 1980–1981 at the University of Toronto in their research to find out which foods were best for people with diabetes.
A lower glycemic index suggests slower rates of digestion and absorption of the foods' carbohydrates and may also indicate greater extraction from the liver and periphery of the products of carbohydrate digestion. A lower glycemic response usually equates to a lower insulin demand (but not always) and may improve long-term blood glucose control and blood lipids. The insulin index may also be useful, as it provides a direct measure of the insulin response to a food.
The glycemic index of a food is defined as the area under the two hour blood glucose response curve (AUC) following the ingestion of a fixed portion of carbohydrate (usually 50 g). The AUC of the test food is divided by the AUC of the standard (either glucose or white bread, giving two different definitions) and multiplied by 100.
The effect on blood glucose from a high versus low glycemic index carbohydrateThe average GI value is calculated from data collected in 10 human subjects. Both the standard and test food must contain an equal amount of available carbohydrate. The result gives a relative ranking for each tested food.[2]
The current validated methods use glucose as the reference food, giving it a glycemic index value of 100 by definition. This has the advantages of being universal and producing maximum GI values of approximately 100. White bread can also be used as a reference food, giving a different set of GI values (if white bread = 100, then glucose ≈ 140). For people whose staple carbohydrate source is white bread, this has the advantage of conveying directly whether replacement of the dietary staple with a different food would result in faster or slower blood glucose response. The disadvantages with this system are that the reference food is not well-defined and the GI scale is culture dependent.
GI values can be interpreted intuitively as percentages on an absolute scale and are commonly interpreted as follows:
Classification GI range Examples
Low GI 55 or less most fruits and vegetables (except potatoes, watermelon), grainy breads, pasta, legumes/pulses, milk, products extremely low in carbohydrates (fish, eggs, meat, some cheeses, nuts, cooking oil), brown rice
Medium GI 56 - 69 whole wheat products, basmati rice, sweet potato, table sugar, most white rices (e.g. jasmine)
High GI 70 and above corn flakes, baked potatoes, watermelon, croissants, white bread, extruded breakfast cereals (e.g. Rice Krispies), straight glucose (100)
A low GI food will release glucose more slowly and steadily. A high GI food causes a more rapid rise in blood glucose levels and is suitable for energy recovery after endurance exercise or for a person experiencing hypoglycemia.
The glycemic effect of foods depends on a number of factors such as the type of starch (amylose versus amylopectin), physical entrapment of the starch molecules within the food, fat and protein content of the food and organic acids or their salts in the meal — adding vinegar for example, will lower the GI. The presence of fat or soluble dietary fiber can slow the gastric emptying rate, thus lowering the GI. Unrefined breads with higher amounts of fiber generally have a lower GI value than white breads.[3] Many brown breads, however, are treated with enzymes to soften the crust, which makes the starch more accessible (high GI).
While adding butter or oil will lower the GI of a meal, the GI ranking does not change. That is, with or without additions, there is still a higher blood glucose curve after white bread than after a low GI bread such as pumpernickel.
The glycemic index can be applied only to foods with a reasonable carbohydrate content, as the test relies on subjects consuming enough of the test food to yield about 50 g of available carbohydrate. Many fruits and vegetables (but not potatoes) contain very little carbohydrate per serving, and the average person is not likely to eat 50 g of carbohydrate from these foods. Fruits and vegetables tend to have a low glycemic index and a low glycemic load. This also applies to carrots, which were originally and incorrectly reported as having a high GI.[4] Alcoholic beverages have been reported to have low GI values, but it should be noted that beer has a moderate GI. Recent studies have shown that the consumption of an alcoholic drink prior to a meal reduces the GI of the meal by approximately 15%.[5] Moderate alcohol consumption more than 12 hours prior to a test does not affect the GI.[6]
Many modern diets rely on the glycemic index, including the South Beach Diet, Transitions by Market America and NutriSystem Nourish Diet.[7]
Disease prevention
Several lines of recent scientific evidence have shown that individuals who followed a low GI diet over many years were at a significantly lower risk for developing both type 2 diabetes and coronary heart disease than others. High blood glucose levels or repeated glycemic "spikes" following a meal may promote these diseases by increasing oxidative stress to the vasculature and also by the direct increase in insulin levels.[8] In the past, postprandial hyperglycemia has been considered a risk factor associated mainly with diabetes. However, more recent evidence shows that it also presents an increased risk for atherosclerosis in the non-diabetic population.[9]
Conversely, there are regions such as Peru and Asia where people eat high-glycemic index foods such as potatoes and high GI rices, but without a high level of obesity or diabetes[citation needed]. The high consumption of legumes in South America and fresh fruit and vegetables in Asia likely lowers the glycemic effect in these individuals. The mixing of high and low GI carbohydrates produces moderate GI values.
A study from the University of Sydney in Australia suggests that having a breakfast of white bread and sugar-rich cereals, over time, may make a person susceptible to diabetes, heart disease, and even cancer.[10]
The glycemic index is supported by leading international health organisations including the American Diabetes Association.[11]
Weight control
Recent animal research provides compelling evidence that high GI carbohydrate is associated with increased risk of obesity. In human trials, it is typically difficult to separate the effects from GI and other potentially confounding factors such as fiber content, palatability, and compliance. In one study,[12] male rats were split into high and low GI groups over 18 weeks while mean body weight was maintained. Rats fed the high GI diet were 71% fatter and had 8% less lean body mass than the low GI group. Postmeal glycemia and insulin levels were significantly higher and plasma triglycerides were threefold greater in the high GI fed rats. Furthermore, pancreatic islet cells suffered "severely disorganised architecture and extensive fibrosis." The evidence in this study showed that continued consumption of high glycemic index carbohydrates would likely have led to the development of severe metabolic abnormalities.
Limitations
If a person consumes 50% of his calories from carbohydrates, the glycemic index can enable him to consume the same number of calories and have lower, more stable glucose and insulin levels. The use of the glycemic index, however, is limited by several factors:
The glycemic index does not take into account other factors besides glycemic response, such as insulin response, which is measured by the insulin index and can be more appropriate in representing the effects from some food contents other than carbohydrates.[13]
The glycemic index is significantly altered by the type of food, its ripeness, processing, the length of storage, cooking methods, and its variety (white potatoes are a notable example, ranging from moderate to very high GI even within the same variety[14]).[15]
The glycemic response is different from one person to another, and even in the same person from day to day, depending on blood glucose levels, insulin resistance, and other factors.[15]
The number of grams of carbohydrate impacts blood sugar levels more than the glycemic index. Lowering glycemic index leads to small improvements in A1Cs, but consuming fewer calories, losing weight, and carbohydrate counting would benefit A1Cs more.[15] Carbohydrate impacts glucose levels most profoundly,[16] and two foods with the same carbohydrate content are generally comparable in their effects on blood sugar.[16] A food with a low glycemic index may have a high carbohydrate content or vice versus; this can be accounted for with the glycemic load. Consuming carbohydrates with a low glycemic index and calculating carbohydrate intake would produce the most stable blood sugar levels.
Most of the values on the glycemic index do not show the impact on glucose levels after two hours. Some diabetics may still have elevated levels after four hours.[15]
References
1 DJ Jenkins et al. (1981). "Glycemic index of foods: a physiological basis for carbohydrate exchange." Am J Clin Nutr 34; 362-366
2 Brouns et al. (2005). "Glycaemic index methodology." Nutrition Research Reviews 18; 145-171
3 http://www.norden.org/en/publications/publications/2005-589 Nordic Council of Ministers: Glycemic Index, TemaNord2005:589, Copenhagen 2005.
4 Brand-Miller et al. (2005). The Low GI Diet Revolution: The Definitive Science-based Weight Loss Plan. Marlowe & Company. New York, NY
5 Brand-Miller, in press
6 Godley R, et al. (2008). Eur J Clin Nutrisystem
7 Temelkova-Kurktschiev et al. (2000). "Postchallenge plasma glucose and glycemic spikes are more strongly associated with atherosclerosis than fasting glucose or HbA1c level." Diabetes Care 2000 Dec;23(12):1830-4
8 Balkau et al. (1998) "High blood glucose concentration is a risk factor for mortality in middle-aged nondiabetic men. 20-year follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policemen Study." Diabetes Care 1998 Mar;21(3):360-7
9 White bread breakfast unhealthy? 10 Mar 2008, 1119 hrs IST, ANI - Science - Health & Science - The Times of India
10 Sheard et al. (2004). "Dietary carbohydrate (amount and type) in the prevention and management of diabetes: a statement by the american diabetes association." Diabetes Care;27(9):2266-71
11 Pawlak et al. (2004). "Effects of dietary glycaemic index on adiposity, glucose homoeostasis, and plasma lipids in animals." Lancet;28364(9436):778-85
12 David Mendosa. Insulin Index. July 13, 2003.
13 GI Database.
14 a b c d Janine Freeman, RD, CDE. The Glycemic Index debate: Does the type of carbohydrate really matter?
15 a b The Glycemic Index and Diabetes. Joslin Diabetes Center.
A lower glycemic index suggests slower rates of digestion and absorption of the foods' carbohydrates and may also indicate greater extraction from the liver and periphery of the products of carbohydrate digestion. A lower glycemic response usually equates to a lower insulin demand (but not always) and may improve long-term blood glucose control and blood lipids. The insulin index may also be useful, as it provides a direct measure of the insulin response to a food.
The glycemic index of a food is defined as the area under the two hour blood glucose response curve (AUC) following the ingestion of a fixed portion of carbohydrate (usually 50 g). The AUC of the test food is divided by the AUC of the standard (either glucose or white bread, giving two different definitions) and multiplied by 100.
The effect on blood glucose from a high versus low glycemic index carbohydrateThe average GI value is calculated from data collected in 10 human subjects. Both the standard and test food must contain an equal amount of available carbohydrate. The result gives a relative ranking for each tested food.[2]
The current validated methods use glucose as the reference food, giving it a glycemic index value of 100 by definition. This has the advantages of being universal and producing maximum GI values of approximately 100. White bread can also be used as a reference food, giving a different set of GI values (if white bread = 100, then glucose ≈ 140). For people whose staple carbohydrate source is white bread, this has the advantage of conveying directly whether replacement of the dietary staple with a different food would result in faster or slower blood glucose response. The disadvantages with this system are that the reference food is not well-defined and the GI scale is culture dependent.
GI values can be interpreted intuitively as percentages on an absolute scale and are commonly interpreted as follows:
Classification GI range Examples
Low GI 55 or less most fruits and vegetables (except potatoes, watermelon), grainy breads, pasta, legumes/pulses, milk, products extremely low in carbohydrates (fish, eggs, meat, some cheeses, nuts, cooking oil), brown rice
Medium GI 56 - 69 whole wheat products, basmati rice, sweet potato, table sugar, most white rices (e.g. jasmine)
High GI 70 and above corn flakes, baked potatoes, watermelon, croissants, white bread, extruded breakfast cereals (e.g. Rice Krispies), straight glucose (100)
A low GI food will release glucose more slowly and steadily. A high GI food causes a more rapid rise in blood glucose levels and is suitable for energy recovery after endurance exercise or for a person experiencing hypoglycemia.
The glycemic effect of foods depends on a number of factors such as the type of starch (amylose versus amylopectin), physical entrapment of the starch molecules within the food, fat and protein content of the food and organic acids or their salts in the meal — adding vinegar for example, will lower the GI. The presence of fat or soluble dietary fiber can slow the gastric emptying rate, thus lowering the GI. Unrefined breads with higher amounts of fiber generally have a lower GI value than white breads.[3] Many brown breads, however, are treated with enzymes to soften the crust, which makes the starch more accessible (high GI).
While adding butter or oil will lower the GI of a meal, the GI ranking does not change. That is, with or without additions, there is still a higher blood glucose curve after white bread than after a low GI bread such as pumpernickel.
The glycemic index can be applied only to foods with a reasonable carbohydrate content, as the test relies on subjects consuming enough of the test food to yield about 50 g of available carbohydrate. Many fruits and vegetables (but not potatoes) contain very little carbohydrate per serving, and the average person is not likely to eat 50 g of carbohydrate from these foods. Fruits and vegetables tend to have a low glycemic index and a low glycemic load. This also applies to carrots, which were originally and incorrectly reported as having a high GI.[4] Alcoholic beverages have been reported to have low GI values, but it should be noted that beer has a moderate GI. Recent studies have shown that the consumption of an alcoholic drink prior to a meal reduces the GI of the meal by approximately 15%.[5] Moderate alcohol consumption more than 12 hours prior to a test does not affect the GI.[6]
Many modern diets rely on the glycemic index, including the South Beach Diet, Transitions by Market America and NutriSystem Nourish Diet.[7]
Disease prevention
Several lines of recent scientific evidence have shown that individuals who followed a low GI diet over many years were at a significantly lower risk for developing both type 2 diabetes and coronary heart disease than others. High blood glucose levels or repeated glycemic "spikes" following a meal may promote these diseases by increasing oxidative stress to the vasculature and also by the direct increase in insulin levels.[8] In the past, postprandial hyperglycemia has been considered a risk factor associated mainly with diabetes. However, more recent evidence shows that it also presents an increased risk for atherosclerosis in the non-diabetic population.[9]
Conversely, there are regions such as Peru and Asia where people eat high-glycemic index foods such as potatoes and high GI rices, but without a high level of obesity or diabetes[citation needed]. The high consumption of legumes in South America and fresh fruit and vegetables in Asia likely lowers the glycemic effect in these individuals. The mixing of high and low GI carbohydrates produces moderate GI values.
A study from the University of Sydney in Australia suggests that having a breakfast of white bread and sugar-rich cereals, over time, may make a person susceptible to diabetes, heart disease, and even cancer.[10]
The glycemic index is supported by leading international health organisations including the American Diabetes Association.[11]
Weight control
Recent animal research provides compelling evidence that high GI carbohydrate is associated with increased risk of obesity. In human trials, it is typically difficult to separate the effects from GI and other potentially confounding factors such as fiber content, palatability, and compliance. In one study,[12] male rats were split into high and low GI groups over 18 weeks while mean body weight was maintained. Rats fed the high GI diet were 71% fatter and had 8% less lean body mass than the low GI group. Postmeal glycemia and insulin levels were significantly higher and plasma triglycerides were threefold greater in the high GI fed rats. Furthermore, pancreatic islet cells suffered "severely disorganised architecture and extensive fibrosis." The evidence in this study showed that continued consumption of high glycemic index carbohydrates would likely have led to the development of severe metabolic abnormalities.
Limitations
If a person consumes 50% of his calories from carbohydrates, the glycemic index can enable him to consume the same number of calories and have lower, more stable glucose and insulin levels. The use of the glycemic index, however, is limited by several factors:
The glycemic index does not take into account other factors besides glycemic response, such as insulin response, which is measured by the insulin index and can be more appropriate in representing the effects from some food contents other than carbohydrates.[13]
The glycemic index is significantly altered by the type of food, its ripeness, processing, the length of storage, cooking methods, and its variety (white potatoes are a notable example, ranging from moderate to very high GI even within the same variety[14]).[15]
The glycemic response is different from one person to another, and even in the same person from day to day, depending on blood glucose levels, insulin resistance, and other factors.[15]
The number of grams of carbohydrate impacts blood sugar levels more than the glycemic index. Lowering glycemic index leads to small improvements in A1Cs, but consuming fewer calories, losing weight, and carbohydrate counting would benefit A1Cs more.[15] Carbohydrate impacts glucose levels most profoundly,[16] and two foods with the same carbohydrate content are generally comparable in their effects on blood sugar.[16] A food with a low glycemic index may have a high carbohydrate content or vice versus; this can be accounted for with the glycemic load. Consuming carbohydrates with a low glycemic index and calculating carbohydrate intake would produce the most stable blood sugar levels.
Most of the values on the glycemic index do not show the impact on glucose levels after two hours. Some diabetics may still have elevated levels after four hours.[15]
References
1 DJ Jenkins et al. (1981). "Glycemic index of foods: a physiological basis for carbohydrate exchange." Am J Clin Nutr 34; 362-366
2 Brouns et al. (2005). "Glycaemic index methodology." Nutrition Research Reviews 18; 145-171
3 http://www.norden.org/en/publications/publications/2005-589 Nordic Council of Ministers: Glycemic Index, TemaNord2005:589, Copenhagen 2005.
4 Brand-Miller et al. (2005). The Low GI Diet Revolution: The Definitive Science-based Weight Loss Plan. Marlowe & Company. New York, NY
5 Brand-Miller, in press
6 Godley R, et al. (2008). Eur J Clin Nutrisystem
7 Temelkova-Kurktschiev et al. (2000). "Postchallenge plasma glucose and glycemic spikes are more strongly associated with atherosclerosis than fasting glucose or HbA1c level." Diabetes Care 2000 Dec;23(12):1830-4
8 Balkau et al. (1998) "High blood glucose concentration is a risk factor for mortality in middle-aged nondiabetic men. 20-year follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policemen Study." Diabetes Care 1998 Mar;21(3):360-7
9 White bread breakfast unhealthy? 10 Mar 2008, 1119 hrs IST, ANI - Science - Health & Science - The Times of India
10 Sheard et al. (2004). "Dietary carbohydrate (amount and type) in the prevention and management of diabetes: a statement by the american diabetes association." Diabetes Care;27(9):2266-71
11 Pawlak et al. (2004). "Effects of dietary glycaemic index on adiposity, glucose homoeostasis, and plasma lipids in animals." Lancet;28364(9436):778-85
12 David Mendosa. Insulin Index. July 13, 2003.
13 GI Database.
14 a b c d Janine Freeman, RD, CDE. The Glycemic Index debate: Does the type of carbohydrate really matter?
15 a b The Glycemic Index and Diabetes. Joslin Diabetes Center.
Sources: wikipedia
