GI and Diabetes Treatment and Prevention

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Although different carbohydrates do produce differing glycemic responses, to be of benefit clinically, this benefit should translate into long-term improvements in glycemia or lipids. Table 2 summarizes the research comparing high versus low GI diets on glucose and lipid outcomes in studies with a minimum duration of 2 weeks [14-28]. Examining the data reveals no clear trend in outcome benefits. A meta-analysis of GI diets in persons with diabetes reported a reduction in HbA1c by 0.4% units (a 7.4% decrease) from

Table 3. Epidemiologic studies on glycemic index (GI), glycemic load (GL), and fiber and effect on insulin resistance and risk of diabetes

Positive association

Nurses Health Study 1997 [4]

Health Professional Study

Framingham Offspring Cohort 2004 [33]

GI/GL associated with risk of developing diabetes GI/GL associated with risk

GI/GL associated with prevalence of insulin resistance

Negative association

Atherosclerosis Risk in Communities Study (ARIC) 2002 [34]

No association GI/GL and risk developing diabetes

No association between GI and fasting insulin No association between GI/GL with insulin-resistant diseases; fiber beneficial association No association between GI/GL and insulin resistance; fiber beneficially associated with insulin resistance No association between GI/GL and insulin sensitivity and adiposity; fiber beneficial association

Inter99 Study 2005 [35]

Insulin

Resistance and Atherosclerosis Study (IRAS) 2005 [6]

Iowa Women's Study 2000 [31]

Zutphen Elderly Study 2000 [32]

low GI diets compared to high GI diets and a reduction in HbA1c from baseline by 0.35% units [29]. However, included in the meta-analysis are two studies not included in table 2. In the study by Gilbertson et al. [7], there were no significant differences in the GI of the diets at study end in the study arms. Thus, it is questionable if the lowering of the GI in one study arm can be attributed to differences in GI. In the study by Giacco et al. [30], 50g of fiber are included in the low GI group. Fiber and GI are not necessarily the same and therefore it is unknown if the effect on glucose response is due to the low GI of the diet or to the fiber content. These two studies account for 47% of the total subjects in the meta-analysis.

Early epidemiological studies suggest that a low GI/GL diet may play a role in the prevention of diabetes [4, 5]. Table 3 summarizes the outcomes from later studies and from countries other than the United States. Whereas, 3 studies report a positive association between low GI/GL diets and the risk of developing diabetes or insulin resistance, 5 do not. Interestingly, in 3 studies fiber was positively associated with insulin sensitivity, whereas GI/GL was not.

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