In the past,
carbohydrates
were classified as simple or complex based on the number of
simple sugars
in the molecule. Carbohydrates composed of one or two simple
sugars like
fructose or sucrose (table sugar; a disaccharide composed of one
molecule of glucose and one molecule of fructose) were labeled simple,
while starchy foods
were labeled complex because starch is composed of long chains
of the
simple sugar,
glucose. Advice
to eat less simple and more complex carbohydrates (i.e., polysaccharides) was based on the assumption
that consuming starchy foods would lead to smaller increases in blood
glucose than sugary foods
(1). This assumption
turned out to be too simplistic since the blood glucose (glycemic) response
to “complex” carbohydrates has been found to vary considerably. A more
accurate indicator of the relative glycemic response to dietary carbohydrates
should be glycemic load, which incorporates the relative quality and quantity of carbohydrates in the diet.
Measuring the Glycemic Index of Foods
To determine the glycemic index of a food, volunteers are typically given
a test food that provides 50 grams of carbohydrate and a control food
(white bread or pure glucose) that provides the same amount of carbohydrate
on different days
(2). Blood samples
for the determination of glucose are taken prior to eating and at regular
intervals after eating over the next several hours. The changes in blood
glucose over time are plotted as a curve. The glycemic index is calculated
as the area under the glucose curve after the test food is eaten, divided
by the corresponding area after the control food is eaten. The value is
multiplied by 100 to represent a percentage of the control food. For example,
a baked potato has a glycemic index of 76 relative to glucose and 108
relative to white bread, which means that the blood glucose response to
the carbohydrate in a baked potato is 76% of the blood glucose response
to the same amount of carbohydrate in pure glucose and 108% of the blood
glucose response to the same amount of carbohydrate in white bread
(3).
In contrast, cooked brown rice has a glycemic index of 55 relative to
glucose and 79 relative to white bread
(4).
In the traditional system of classifying carbohydrates, both brown rice
and potato would be classified as complex carbohydrates despite the difference
in their effects on blood glucose levels.
Physiological Responses to High- versus Low-Glycemic Index Foods
By definition, the consumption of high-glycemic index foods results in
higher and more rapid increases in blood glucose levels than the consumption
of low-glycemic index foods. Rapid increases in blood glucose are potent
signals to the beta-cells of the
pancreas
to increase
insulin secretion
(2). Over the next few hours, the high
insulin levels induced by consumption of high-glycemic index foods may
cause a sharp decrease in blood glucose levels (hypoglycemia). In contrast,
the consumption of low-glycemic index foods results in lower but more
sustained increases in blood glucose and lower insulin demands on pancreatic
beta-cells
(5).
The glycemic index compares the potential of foods containing the same
amount of carbohydrate to raise blood glucose. However, the amount of
carbohydrate consumed also affects blood glucose levels and insulin responses.
The glycemic load of a food is calculated by multiplying the glycemic
index by the amount of carbohydrate in grams provided by a food and dividing
the total by 100
(1). Dietary glycemic load
is the sum of the glycemic loads for all foods consumed in the diet. The
concept of glycemic load was developed by scientists to simultaneously
describe the quality (glycemic index) and quantity of carbohydrate in
a meal or diet.
Type 2 Diabetes Mellitus
After a high-glycemic load meal, blood glucose levels rise more rapidly
and insulin demand is greater than after a low-glycemic load meal. High
blood glucose levels and excessive insulin secretion are thought to contribute
to the loss of the insulin-secreting function of the pancreatic beta-cells
that leads to irreversible
diabetes
(6). High dietary glycemic loads have
been associated with an increased risk of developing type 2 diabetes mellitus
(DM) in several large
prospective
studies. In the Nurses’ Health Study (NHS), women with the highest
dietary glycemic loads were 37% more likely to develop type 2 DM over
a 6-year period than women with the lowest dietary glycemic loads
(7).
Additionally, women with high-glycemic load diets that were low in cereal
fiber were more than twice as likely to develop type 2 DM than women with
low-glycemic load diets that were high in cereal fiber. The results of
the Health Professionals Follow-up Study (HPFS), which followed male health
professionals over six years were similar
(8).
In the NHS II study, a prospective study of younger and middle-aged women,
those who consumed foods with the highest glycemic index values and the
least cereal fiber were also at significantly higher risk of developing
type 2 DM over the next eight years
(9).
The foods that were most consistently associated with increased risk of
type 2 DM in the NHS and HPFS cohorts were potatoes (cooked or French-fried),
white rice, white bread, and carbonated beverages
(6).The
Black Women's Health study, a prospective study in a cohort of 59,000
U.S. black women, found that women who consumed foods with the highest
glycemic index values had a 23% greater risk of developing type 2 DM
over eight years of follow-up compared to those who consumed foods with
the lowest glycemic index values
(10).
In the American Cancer Society Cancer Prevention Study II, which
followed 124,907 men and women for nine years, high glycemic load was
associated with a 15% increased risk of type 2 DM
(11).
Further, in a cohort of over 64,000 Chinese women participating in the
Shanghai Women's Health Study, high glycemic load was associated with a
34% increase in risk of type 2 DM; this positive association was much
stronger among overweight women
(12).
A U.S. ecological study of national data from 1909 to 1997 found
that increased consumption of refined carbohydrates in the form of corn
syrup, coupled with declining intake of dietary fiber, has paralleled
the increase in prevalence of type 2 DM
(13).
Today, high-fructose corn syrup (HFCS) is used as a sweetener and
preservative in many commercial products sold in the United States,
including soft drinks and other processed foods. To make HFCS, the
fructose content of corn syrup (100% glucose) has been artificially
increased; common formulations of HFCS now include 42%, 55%, or 90%
fructose
(13).
When consumed in large quantities on a long-term basis, HFCS is
unhealthful and may contribute to other chronic diseases besides type 2
DM, including obesity and cardiovascular disease.
Cardiovascular Disease
Impaired glucose
tolerance and
insulin
resistance are known to be risk factors for cardiovascular disease
and type 2 DM. In addition to increased blood glucose and insulin
concentrations, high dietary glycemic loads are associated with increased
serum triglyceride concentrations and decreased
HDL
cholesterol concentrations; both are risk factors for cardiovascular disease
(14,
15). High dietary glycemic loads have also been associated with increased
serum levels of C-reactive protein (CRP), a marker of systemic inflammation
that is also a sensitive predictor of cardiovascular disease risk
(16).
In the NHS cohort, women with the highest dietary glycemic loads had a
risk of developing coronary heart disease (CHD) over the next ten years
that was almost twice as high as those with the lowest dietary glycemic
loads
(17). The relationship between
dietary glycemic load and CHD risk was more pronounced in overweight women,
suggesting that people who are insulin resistant may be most susceptible
to the adverse cardiovascular effects of high dietary glycemic loads
(1). A similar finding was reported in a cohort of middle-aged Dutch women followed for nine years
(18).
More recently, a prospective study in an Italian cohort of 47,749 men
and women, who were followed for almost eight years, found that a high
glycemic load was associated with an increased risk of CHD in women but
not in men
(47).
Yet, studies to date have reported mixed results, and more research is
needed to determine if low glycemic index diets decrease the risk for
CHD
(19).
Obesity
In the first two hours after a meal, blood glucose and insulin levels
rise higher after a high-glycemic load meal than they do after a low-glycemic
load meal containing equal calories. However, in response to the excess
insulin secretion, blood glucose levels drop lower over the next few hours
after a high-glycemic load meal than they do after a low-glycemic load
meal. This may explain why 15 out of 16 published studies found that the
consumption of low-glycemic index foods delayed the return of hunger,
decreased subsequent food intake, and increased satiety (feeling full)
when compared to high-glycemic index foods
(20).
The results of several small, short-term trials (1-4 months) suggest that
low-glycemic load diets result in significantly more weight or fat loss
than high-glycemic load diets
(21-23).
Although long-term
randomized
controlled trials of low-glycemic load diets
in the treatment of obesity are lacking, the results of
short-term studies
on appetite regulation and weight loss suggest that low
glycemic-load
diets may be useful in promoting long-term weight loss and
decreasing
the prevalence of obesity. A recent review of six randomized
controlled trials concluded that overweight or obese individuals
who followed a low-glycemic index/load diet experienced greater weight
loss than individuals on a comparison diet that was either a
high-glycemic index diet or an energy-restricted, low-fat diet
(24). The length of the dietary interventions in these trials ranged from five weeks to six months.
Cancer
Evidence that high overall dietary glycemic index or high dietary glycemic
loads are related to cancer risk is inconsistent.
Prospective
cohort studies in the U.S., Denmark, France, and Australia have found no association between
overall dietary glycemic index or dietary glycemic load and breast cancer
risk
(25-28).
In contrast, a prospective
cohort study in Italy reported a positive association between
breast cancer risk and high-glycemic index diets as well as high dietary
glycemic loads
(29). A prospective study in Canada found that postmenopausal but not premenopausal
women with high overall dietary glycemic index values were at increased
risk of breast cancer, particularly those who reported no vigorous physical
activity
(30), while a prospective study
in the U.S. found that premenopausal but not postmenopausal women with high
overall dietary glycemic index values and low levels of physical activity
were at increased risk of breast cancer
(31).
In a French study of postmenopausal women, both glycemic index
and glycemic load were positively associated with risk of breast cancer
but only in a subgroup of women who had the highest waist circumference
(median of 84 cm [33 inches])
(28). Higher dietary glycemic loads were associated with moderately increased
risk of colorectal cancer in a prospective study of U.S. men, but no clear associations
between dietary glycemic load and colorectal cancer risk were observed
in a prospective studies of U.S. men
(32), U.S. women
(32-35), Swedish women
(36), and Dutch men and women
(37).
However, one prospective cohort study of U.S. women found that higher
dietary glycemic loads were associated with increased risk of colorectal
cancer
(38). One
meta-analysis
of case-control and cohort studies suggested that glycemic index and
glycemic load were positively associated with colorectal cancer
(39),
but a more recently published meta-analysis did not find glycemic index
or load to be significantly associated with colorectal cancer
(40).
Two separate meta-analyses reported that high dietary glycemic loads
were associated with increased risk of endometrial cancer
(39, 41). Although there is some
evidence that hyperinsulinemia (elevated serum insulin levels) may promote
the growth of some types of cancer
(42),
more research is needed to determine the effects of dietary glycemic load
and/or glycemic index on cancer risk.
Gallbladder Disease
Results of two studies indicate that dietary glycemic index and
glycemic load may be positively related to risk of gallbladder disease.
Higher dietary glycemic loads were associated with significantly
increased risks of developing gallstones in a cohort of men
participating in the Health Professionals Follow-up Study
(43) and in a cohort of women participating in the Nurses' Health Study
(44). Likewise, higher glycemic index diets were associated with increased risks of gallstone disease in both studies
(43-44).
However, more epidemiological and clinical research is needed to
determine an association between dietary glycemic index/load and
gallbladder disease.
Diabetes Mellitus
Low-glycemic index diets appear to improve the overall blood glucose
control in people with type 1 and type 2 diabetes mellitus (DM). A
meta-analysis
of 14
randomized
controlled trials that included 356 diabetic patients found that low-glycemic
index diets improved short-term and long-term control of blood glucose
levels, reflected by clinically significant decreases in fructosamine
and hemoglobin A1C levels
(45). Episodes
of serious hypoglycemia are a significant problem in people with type
1 DM. In a study of 63 men and women with type 1 DM, those randomized
to a high-fiber, low-glycemic index diet had significantly fewer episodes
of hypoglycemia than those on a low-fiber, high-glycemic index diet
(46).
Lowering Dietary Glycemic Load
Some strategies for lowering dietary glycemic load include:
• Increasing the consumption of whole grains, nuts, legumes, fruits, and
nonstarchy vegetables
• Decreasing the consumption of starchy high-glycemic index foods like
potatoes, white rice, and white bread
• Decreasing the consumption of sugary foods like cookies, cakes, candy,
and soft-drinks
See the table below for the glycemic index and glycemic
load values of selected foods
(4). Foods
with higher glycemic index values are at the top of the table, while foods
with lower glycemic index values are at the bottom of the table. To look
up the glycemic index values for other foods, visit the
University
of Sydney’s GI Web site.
Glycemic Index and Glycemic
Load Values for Selected Foods
(Relative to Glucose)
|
| Food |
Glycemic Index
(Glucose=100)
|
Serving size
|
Carbohydrate per serving (g)
|
Glycemic Load per serving
|
Dates, dried |
103
|
2 oz
|
40
|
42
|
Cornflakes |
81
|
1 cup
|
26
|
21
|
Jelly beans |
78
|
1 oz
|
28
|
22
|
Puffed rice cakes |
78
|
3 cakes
|
21
|
17
|
Russet potato (baked) |
76
|
1 medium
|
30
|
23
|
Doughnut |
76
|
1 medium
|
23
|
17
|
Soda crackers |
74
|
4 crackers
|
17
|
12
|
White bread |
73
|
1 large slice
|
14
|
10
|
Table sugar (sucrose) |
68
|
2 tsp
|
10
|
7
|
Pancake |
67
|
6" diameter
|
58
|
39
|
White rice (boiled) |
64
|
1 cup
|
36
|
23
|
Brown rice (boiled) |
55
|
1 cup
|
33
|
18
|
Spaghetti, white; boiled 10-15 min |
44
|
1 cup
|
40
|
18
|
Spaghetti, white; boiled 5 min |
38
|
1 cup
|
40
|
15
|
Spaghetti, whole wheat; boiled |
37
|
1 cup
|
37
|
14
|
Rye, pumpernickel bread |
41
|
1 large slice
|
12
|
5
|
Oranges, raw |
42
|
1 medium
|
11
|
5
|
Pears, raw |
38
|
1 medium
|
11
|
4
|
Apples, raw |
38
|
1 medium
|
15
|
6
|
All-Bran™ cereal |
38
|
1 cup
|
23
|
9
|
Skim milk |
32
|
8 fl oz
|
13
|
4
|
Lentils, dried; boiled |
29
|
1 cup
|
18
|
5
|
Kidney beans, dried; boiled |
28
|
1 cup
|
25
|
7
|
Pearled barley; boiled |
25
|
1 cup
|
42
|
11
|
Cashew nuts |
22
|
1 oz
|
9
|
2
|
| Peanuts |
14
|
1 oz
|
6
|
1
|
Written in December 2005 by:
Jane Higdon, Ph.D.
Linus Pauling Institute
Oregon State University
Updated in February 2009 by:
Victoria J. Drake, Ph.D.
Linus Pauling Institute
Oregon State University
Reviewed in February 2009 by:
Simin Liu, M.D., M.S., M.P.H., Sc.D.
Professor and Director, Program on Genomics and Nutrition
Professor of Epidemiology and Medicine
UCLA School of Public Health
Last updated 4/38/2010 Copyright 2003-2011 Linus Pauling Institute
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