Download Glycemic Load

Eight Weeks to Wellness
Week 4:
Choose Healthy Carbohydrates
Prepared by
Don Hall, DrPH, CHES and
Gerard McLane,
DrPH, CHES
Prepared
by
Don Hall, DrPH, CHES and
Gerard McLane, DrPH, CHES
© 2013, LifeLong Health. All rights reserved.
1
What are Unhealthy Carbohydrates?
Examples
• Soda pop (soft drinks)
• Sugar, candy sweets
• White bread, pastry, soda crackers
• White rice
• Refined breakfast cereals
• French fries
• Snack foods
© 2013 LifeLong Health
2
Healthy Carbohydrates Are…
• Plant based foods that have not
been highly refined or processed
• High in dietary fiber
• High in antioxidants and
phytochemicals
• Absorbed more slowly, normalizing
blood sugar and insulin levels
• Moderate in calories but high
in nutrition
3
Examples Include
• Fruits
• Vegetables
• Legumes
• Whole grains
These Foods Can Help Prevent…
•
•
•
•
•
•
•
Obesity
High blood pressure
Diabetes
Coronary heart disease
Certain cancers
Strokes
Digestive problems such as constipation and
diverticulosis
Harvard Nutrition Source
Four Healthy Food Goals
Follow these four principles in food choices
that prevent disease and promote health:
1. Eat more fruits and vegetables
2. Choose whole grains
3. Avoid high glycemic foods
4. Eat more high fiber foods
Choosing Healthy Carbohydrate's
USDA, ChooseMyPlate.gov
7
Goal #1: Eat More Fruits & Vegetables
They are…
• High in fiber
• High in antioxidants
• High in nutrients
• Low in calories
• They taste good and
are fun to eat!
USDA, ChooseMyPlate.gov
8
Aim for 5-9 Servings of Fruits and Vegetables Daily
Emphasize
• Dark leafy greens and
cabbage family foods
• Dark yellow or orange
• Tomatoes, onions, and
salads
• Citrus and berries
• And a wide variety of
other colorful fruits and
vegetables
USDA, ChooseMyPlate.gov
Fruit and Vegetables Prevent Strokes
Risk of stroke in men, incidence per 1,000
125
100
Ischemic
121
Hemorrhagic
75
67
50
25
51
42
15
12
0
0- 2
5
8+
Servings of Fruits and Vegetables/Day
JAMA 273(14):1113-1117
• A 20 year followup of 832 men in
the Framingham
Heart Study found:
• That for each
increment of 3
servings of fruits
or vegetables per
day, there was a
45% decrease in
the risk death from
stroke.
Fruits/Vegetables Protect the Heart
1.0
1.00
Risk of Heart Attack (RR)
• InterHeart Study
included 52 nations
• Researchers found that
people eating a high
intake of fruits and
vegetables cut their risk
of a heart attack by
26-42% compared to
those with a low intake
of fruits and vegetables.
InterHeart Study 27,134
0.8
0.74
0.6
0.58
0.4
0.2
0.0
Low
intake
Lancet 364:953-962
Female Male
--High Intake--
Fruits/Vegetables Lower Mortality
Women, probability of dying, mid-life, ages 35-69
As the intake
of vegetables
and fruits goes
from high to
low intake, the
risk of
mortality for
women
increased 38%.
9
8
7
6
5
5th
High
intake
4th
3rd
2nd
Intake by Quintiles
J of Hlth Educ, Vol 28, No. 5, 298-307
1st
Low
intake
Fruits/Vegetables Lower Mortality
Men, probability of dying mid-life, ages 35-69
As the intake
of vegetables
and fruits goes
from high to
low intake, the
risk of
mortality for
men increased
by 30%.
20
n=200,000
18
16
14
12
5th
High
intake
4th
3rd
2nd
Intake by Quintile
J of Hlth Educ, Vol 28, No. 5, 298-307
1st
Low
intake
Fruit/Vegetables are Good Sources of Antioxidants
High Sources in Vegetables
– Cauliflower
– Kale
– Beets
– Eggplant
– Red peppers
– Carrots
– Broccoli
– String beans
– Spinach
– Cabbage
– Potato
– Squash
– Sweet potato
– Garlic, onions
– Corn
– Leaf lettuce
J. Agri. Food Chem. 44: 701, 3426
14
Sources of Antioxidants
High Sources in Fruits
– Blueberries
– Strawberries
– Plums
– Oranges
– Red grapes
– Kiwi
– Pink grapefruit
– White grapefruit
–
–
–
–
–
–
–
Raspberries
Apples
Tomatoes
Bananas
Pears
Melons
White grapes
USDA Nutrition Research Center, Tufts Univ., J. Agri. Food Chem. 44: 701, 3426
15
Vegetable Intake and Colon Cancer
Cancer Prevention Study II
• A very large study
including 764,343 men
and women
• Researchers found that
the risk of colon cancer
decreased with the
increased consumption
of vegetables in the
diet.
1
1.00
0.76
0.62
0.5
0
High
veg.
Low,
men
Low,
women
Vegetable Intake/Day
J of Nat. Cancer Institute, 85(7): 581-2
Cancer Prevention Guidelines
1. Choose predominantly
plant-based diets rich in a
variety of vegetables,
fruits, and legumes.
2. Maintain a healthy body
weight.
3. Take an hour’s brisk walk
daily.
4. Eat five or more servings
of fruits and vegetables
daily.
American Institute for Cancer Research
17
How to Eat More Fruits and Vegetables
• Keep raw vegetables ready-to-eat in clear
containers in the front of your refrigerator.
• Keep a supply of fresh fruit on the table or
counter: oranges, bananas, apples, kiwi.
• Eat more salads including broccoli,
peppers, cabbage, tomatoes, carrots, dark
salad greens, onions, etc.
• Enjoy stir-fry vegetables.
• Add vegetables to soups.
• Eat fruit salads and finish a meal with fruit
as a natural sweet (e.g. oranges, berries,
melon, dates, peaches, honey-crisp
apple).
Dietary Guidelines for Americans
18
Goal #2: Choose Whole Grains
Eat at least 3 or more servings
of whole grains daily:
•
•
•
•
•
•
•
Whole wheat bread
Whole grain cereals
Brown rice
Oatmeal
Whole grain corn
Rye
Amaranth, and Teff, Quinoa
DHHS, Dietary Guidelines for Americans
19
Whole-Wheat Bread and Heart Disease
1.00
Relative
Risk of
Heart
Attack
1.00
0.75
0.50
0.59
0.56
Mixed
Whole-wheat
bread
n=26,437
0.25
0.00
White bread
Kind of Bread Eaten
Arch Intern Med, Vol. 152, P.1416
Whole-grains and Heart Disease
1.2
Risk of Heart Disease (RR)
• Nurses Health Study
• 75,521 women followed
for 10 years
• Risk of coronary heart
disease was reduced by
25% to 50% in those
eating more wholegrains; 3 or more
servings a day.
1.00 1.00
1.0
All women
Nonsmokers
0.75
0.8
0.6
0.49
0.4
0.2
0.0
0.25
2.7
Servings/day of Whole-grains
Amer J Clin Nutr, 70:412-9
Nutrients Remaining in Whole Wheat vs. White Flour
Minerals
Calcium
Magnesium
Phosphorus
Potassium
Zinc
Copper
Manganese
% Remaining
46%
16%
31%
26%
24%
38%
18%
USDA, National Nutrient Database
Vitamins
% Remaining
Pantothenic acid
Vitamin B6
Folic acid
Dietary fiber
43%
13%
59%
21%
53%
Essential fatty acids
Phytochemicals and
antioxidants are also
lost, and protein quality
is impaired
22
Whole Grains and Type 2 Diabetes
• Finnish study:
– 4,300+ men/women
– 10 year study
• Those eating the most
whole-grains had 35%
less type 2 diabetes.
• Those with highest
cereal fiber intake had
61% less diabetes.
1.00
1.00
0.75
0.65
0.50
0.39
0.25
0.00
Low
High
29+ g
Cereal
Fiber
Whole Grain Intake
Amer Jour Clin Nutr 77: 527-529
Whole Grains & Risk of Stroke
Risk of Stroke (RR)
1.00
All women
Never smoked
1.00 1.00
0.75
0.69 0.68
0.50
0.57
0.50
0.25
0.00
None
72,488, women
12 yr follow-up
JAMA 27; 284:1534-40
1/day
3+/day
Whole-grains, Servings/day
Whole Grains & Risk of Mortality
• ARIC study, 15,792
people 45-64, 11 yrs
• Those eating the most
whole-grains had a 48%
decrease in mortality.
• After adjusting for BMI,
exercise, cholesterol,
etc. they still had a 23%
lower risk of dying from
any cause.
1.00
1.00
0.84
0.75
0.66
0.63
0.50
0.52
0.25
0.00
0.1
0.5
1
1.5
3
Whole Grains, Servings/Day
(Quintiles)
Amer Jour Clin Nutr 78: 383-390
Choose a Variety of Grains
• Whole-grain breads
• Multi-grain breads
• Oatmeal breads and
cereals
• Whole-grain rye
• High fiber cereals
• Brown rice
• Pasta
• Barley cereal
Eat at least three or more
servings of whole-grains daily.
Goal #3: Choose Low Glycemic Foods
Low glycemic foods
protect against…
–
–
–
–
Obesity
High blood pressure
Heart disease
Diabetes
27
Concept of Glycemic Index
• Glycemic index (GI) indicates the effect of
carbohydrate on blood sugar levels.
• High GI foods raise blood insulin and sugar levels
quickly - higher than desirable.
• GI is determined by feeding subjects various
carbohydrate foods and comparing their rise in
glucose levels to equal amounts of sugar (or white
bread) eaten on a previous day.
28
Blood Glucose and Insulin Curves
High energy
storage
zone
After eating:
• White bread (solid line)
Hunger Zone
and then
• Spaghetti (dotted line)
(each food was eaten on
different days)
JAMA, May 8, 287:2415
High insulin response
leads to obesity,
insulin resistance and
exhaustion
High Glycemic Load Meals
• Eating high glycemic load meals, compared to
lower glycemic load meals, results in:
–
–
–
–
Higher 24-hour blood sugar levels
Higher insulin levels
Higher glycosylated hemoglobin levels (HbA1c)
Increased hunger following reactive low blood sugar
• It also results in increased risk for diabetes, obesity,
and coronary heart disease.
JAMA, May 8, 287:2415
30
Glycemic Index and Calorie Intake in Children
• After eating instant oatmeal,
they ate 53% more calories
at supper than after they ate
the steel-cut oats.
JAMA, May 8, 287:2415
150
Calories eaten
after last meal (%)
• Obese children ate either
instant oatmeal or steel-cut
oats—“instant” has a high
glycemic index; “steel-cut” is
low. Calories were identical
for breakfast and lunch. At
supper, they ate at lib.
100
50
0
Low
High
Glycemic Index of Breakfast
Glycemic Index and Obesity
• Rats fed a high glycemic diet compared to rats fed a
low glycemic diet developed marked obesity in 32
weeks.
• In studies conducted with humans, 15 of 16 studies
found lower satiety, increased hunger, and higher
voluntary food intake after eating high vs. low
glycemic index meals.
JAMA, 287:2415
32
Legumes Lower Glucose Levels and CHD Risk
• Legumes are high in fiber
and have a very low
glycemic index.
• Adding 1 cup of legumes
to the diets of 121
diabetics for 3 months
significantly lowered:
– Blood A1C levels
– Body weight and blood
pressure
– Risk of coronary heart
disease
Archives of Internal Medicine 2012;172(21):1653-1660
Glycemic Index of Selected Foods
Foods
Glycemic Index
White Bread
100
Table sugar
84
Baked potato
104
Cheerios
106
Pancake
119
Cornflakes
120
White rice
102
Instant rice
129
Fruit punch/soda pop 95
Banana
88
Pizza
86
Foods
Glycemic Index
Oatmeal
82
Orange juice
75
Bran flakes
74
All bran
72
Pasta
71
Baked beans
60
Apple, raw
51
Skim milk
46
Soy beans (soy milk 43) 35
Peanuts
20
Broccoli
15
Based on a “White Bread Standard”. To convert to the “Glucose Standard”, multiply by 0.7 .
Harvard Nutrition Department, (white bread standard)
34
Glycemic Load
• A better overall indicator is glycemic load (GL):
–
–
–
–
GL = GI X carbohydrate content of foods in grams
Example: glycemic index of mashed potatoes = 122 (use 1.22)
½ cup mashed potatoes has 20 g of carbohydrate
Glycemic load = 20 X 1.22 = 24.4
• GL includes both the GI of a food and how many grams are
eaten.
• Summing the glycemic load of all foods in a day gives the
daily glycemic load.
• In the Nurses Health Study, a daily glycemic load greater
than 150 was linked to a higher risk of heart disease.
American Journal of Clinical Nutrition 71:1455-1461
35
Risk of Heart Disease (RR)
Glycemic Load and Risk of Heart Disease
N = 75,521
2.00
1.98
10 year study
1.50
1.51
1.25
1.00
1.00
1.01
117
145
0.50
0.00
Low glycemic load
161
177
206
High glycemic load
Glycemic Load Quintiles
AJCN, 71:1455-61
Glycemic Load of Common Foods
Food
Glycemic Load
Instant rice, ½ C
Baked potato, sm.
Corn flakes, 2/3 C
White bread, 2 s.
Rye bread, 2 slices
Muesli, 2/3 C
25
20
21
21
19
17
Food
Glycemic Load
Banana, 1
Spaghetti, ½ cup
Apple, 1 fresh
Lentils, ½ C
Carrot, 1
Peanuts, 1 oz.
Broccoli, ½ C
Journal of the American Medical Association 287:2415
13
16
8
6
5
3
<1
37
Glycemic Index - Oats
Glycemic Index
Low GI is less than 55
Medium GI = 55-59
High GI = 60+
52
Steel cut oats
55
Oatmeal
Quick oats
65
70
White bread
74
Cheerios
65
Table sugar
0
10
20
30
40
50
60
70
80
90
100 110
Glycemic Index (GI) based on glucose
University of Sydney, Nutrition Department
Glycemic Load Principle
High Glycemic Load Foods
• Snack foods
• Fast foods
• Pastry, cookies
• Sweets
• Soda pop
• White bread/rice
• Refined carbohydrates
• Potatoes
Low Glycemic Load Foods
• Fresh fruit & Vegetables
• Legumes, peas, beans,
garbanzos, soy, tofu
• Nuts
• Whole-grain breads and
cereals including oatmeal
and brown rice
• Protein rich foods
• Healthy fats
39
Women’s Health study
• Women who ate the least fiber
were twice as likely to get
diabetes as those who ate the
most fiber.
• Women with the highest
glycemic index were 51% more
likely to get diabetes then
women who ate the lowest GI
diet.
• Overall risk was 2.5 times higher
on the low fiber, high GI diet.
Risk of Getting Diabetes (RR)
Glycemic Index and Dietary Fiber and Risk of Diabetes
2.5
2.50
2.0
1.80
1.5
1.0
1.00
0.5
0.0
Decreasing fiber
Increasing Glycemic Index
Journal of the American Medical Association 277 (6): 474-477
Goal #4: Eat More High Fiber Foods
Fiber protects against…
– Constipation
– High cholesterol
– Heart disease
– High blood sugar
– Diabetes
– Certain cancers
– Obesity
41
Dietary Fiber
Dietary fiber is found only in plant-based
foods, primarily unrefined foods
– Fruits
– Vegetables
– Legumes (peas and beans)
– Whole grains
– Nuts and seeds
42
Dietary Fiber
Recommended Fiber Intake
Dietary Fiber
• Men 38+ gm/day
• Women 25 gm/day
• Current average intake is
only 10-15 grams/day
Soluble Fiber (best for lowering cholesterol)
• 10-25 grams/day
• Examples: oats and oat bran, psyllium, barley,
oranges, bananas, apples
Institute of Medicine, Dietary Reference Intakes
43
Soluble or Viscous Fiber
Goal
Increase to 10-25
grams per day
Soluble Fiber
grams
Barley, ½ cup cooked
1
Oatmeal, 1 cup cooked
2
Psyllium seeds, ground 1T
5
Apple, banana, peach
1
Orange, grapefruit, pear
2
Beans, cooked, 1 cup
4-6
Broccoli, ½ cup cooked
1
Brussels Sprouts, ½ cup ckd 3
Carrots, ½ cup cooked
1
Source: ATP 3 TLC Guidelines
NIH, Adult Treatment Panel 3 Guidelines
44
Practical Steps To
Increase Your Intake
of High-Fiber Foods
45
DietaryEat
Fiber-Eat
More Fruit
More Fruit
1
Fruit is a good source
of fiber; low in fat and
calories, and
cholesterol-free.
Two or more cups of
fruit per day are
recommended.
USDA National Nutrient Database
Fruits
fiber, g
Apple, 1 medium
Applesauce, canned 1/2 C
Apricots, 3 medium
Banana, 1 medium
Blackberries, fresh, 1 C
Blueberries, frozen, 1 C
Cantaloupe, 1 C pieces
Kiwi, 1 medium
Orange, 1 medium
Peach, 1 medium
Pear, 1 small
Prunes, 1/2 C cooked
Strawberries, raw, 1 C
3.3
1.5
3.8
3.1
7.6
4.2
1.4
2.6
3.1
1.5
4.6
4.7
3.1
46
DietaryEat
Fiber-Eat
More Vegetables
More Vegetables
2
Vegetables are low in fat
and calories and high in
fiber, vitamins, and
minerals.
Three to five or more
servings of vegetables
per day are
recommended.
USDA National Nutrient Database
Vegetables
fiber g
Asparagus, ½ C cooked
Broccoli, ½ C cooked
Brussels sprouts, ½ C ckd
Carrot, ½ C cooked
Coleslaw, ½ C
Green beans, ½ C cooked
Green peas, ½ C cooked
Greens, ½ C cooked
Potato, baked, 1 medium
Summer squash, ½ C ckd
Winter squash, ½ C baked
Sweet potato, 1 med. Baked
Tomato, fresh, 1 medium
1.8
2.6
2.0
2.3
0.9
2.0
4.4
2.1
3.8
1.3
2.9
3.8
1.5
47
Dietary Fiber-Eat
Whole
Grains
Eat MoreMore
Whole
Grains
3
Whole grains are a good
source of fiber. They are
usually low in fat, and they
tend to fill you up.
Three or more servings of
whole grains per day are
recommended.
USDA National Nutrient Database
Grains
fiber-g
Bran Flakes cereal, 3/4 C
Grape-Nuts, 1/4 C
Oatmeal, 3/4 C, cooked
Pancakes, three 4” cakes
Pasta, 1C, cooked
Rice, brown, 1C cooked
Rice, white, 1C cooked
Shredded wheat, 1 C
Tortilla, 1, whole corn
Wheaties, 1 C
White bread, 1 slice
Whole-wheat bread, 1 slice
5.3
2.5
3.0
1.5
2.5
3.5
1.4
5.0
1.5
3.0
0.6
1.7
48
Dietary
Fiber-Eat
More Legumes
Eat
More Legumes
4
Legumes are the foods
highest in fiber. They are
also good sources of
protein.
Eat three or more servings
per week. Daily intake is
ideal.
USDA National Nutrient Database
Legumes
fiber g
Black beans, ½ C cooked
7.0
Burrito, bean & cheese, 1 15.0
Chickpeas, ½ C cooked
5.3
Hummus spread, ¼ C
3.8
Lentils, ½ C cooked
7.8
Lima beans, baby, ½ C
7.0
Pinto beans, 1 C cooked
15.4
Tofu, raw, firm, ¼ block
1.9
Tofu, raw, regular, ¼ block
0.3
49
Dietary Fiber-Choose Fruit/Veg Juice
Choose Fruit/Vegetable
Juice
Juice
fiber g
5
Pure fruit and vegetable
juices contribute some
fiber and are good sources
of vitamins.
Look for juices without
added sugar.
USDA National Nutrient Database
Apricot nectar, 6 oz
1.1
Grape juice, 1 C
0.3
Grapefruit juice, ½ C
0.1
Orange juice, 1 C
0.5
Pineapple juice, ½ C
0.5
Tomato juice, 1C
1.0
V-8 juice, 1C
1.9
Soft drink*, 1 can
0.0
* Soft drinks are loaded with
sugar and calories but not
nutrients.
50
Dietary
Fiber-Eat
Nuts
and Seeds
Eat
Nuts and
Seeds
6
Nuts are good sources of
fiber, protein, and
unsaturated fats.
Nuts have been found to
reduce the risk of heart
disease.
USDA National Nutrient Database
Nuts
fiber g
Almonds (23), 1 oz.
Cashews (18), 1 oz.
Filberts (21), 1 oz.
Mixed nuts, 1 oz. deluxe
Peanut butter, 2 T
Peanuts, 1 oz.
Pecans (15 halves), 1 oz.
Pistachios (49), 1 oz.
Sunflower seeds, 1 oz.
Pumpkin seeds (142), 1 oz.
Walnut halves, 1 oz.
3.3
0.9
2.7
1.6
2.6
2.3
2.7
2.9
2.6
1.1
1.9
51
DietaryEat
Fiber-Eat
Less Refined
Less Refined
FoodsFoods
7
Much of the fiber is
removed in refined and
processed foods.
Choose more unrefined,
natural foods.
Sample Foods
fiber g
Apple, 1 med.
Applesauce, canned 1/2 C
Apple juice, 1 cup
Soft drink, 1 can
3.3
1.5
0.2
0.0
Whole-wheat bread, 1 slice 1.7
White bread, 1 slice
0.6
Twinkie, 1
0.1
Soft drinks, ice cream, candy
sugar, butter, margarine
0.0
USDA National Nutrient Database
52
Dietary
Fiber
– Read
Food Labels
Read
Food
Labels
8
• When buying foods,
check the label for
fiber content.
• You will soon learn
which foods are
higher in dietary
fiber.
Nutrition Facts
Serving Size 2.5 oz.
Servings per container
Amount Per Serving
Calories
Calories from fat
(71g)
4
130
25
% Daily Value
Total Fat 3g
5%
Saturated fat 1 g
5%
Polyunsaturated fat 0.5g
Monounsaturated fat 1.5g
Cholesterol 10 mg
4%
Sodium 290 mg
12%
Total Carbohydrate 18g
6%
Dietary fiber 5g
20%
Sugars 1g
Protein 8g
53
Estimating Fiber Intake
Estimating Fiber Intake
• This is a typical
eating record for
a busy person.
• Add up how
much fiber this
person ate for
the day.
Foods
_
Egg
Toast, white bread
Butter and jam
Glass of milk
Turkey sandwich
Coke
Chips
Meat loaf
Dinner roll (white)
Salad with dressing
Coffee with cream
Cheese cake
Total fiber intake (g)
fiber g
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
54
KeepKeep
TrackTrack
of Fiber
Intake
of Fiber
Intake
Did you come up
with the same total?
Is this sufficient
fiber for a day?
Keep records on
how well you do for
a day.
USDA National Nutrient Database
Foods
Egg
Toast, white bread
Butter and jam
Glass of milk
Turkey sandwich
Coke
Chips
Meat loaf
Dinner roll (white)
Salad with dressing
Coffee with cream
Cheese cake
Total fiber intake (g)
fiber g
0
0.3
0.2
0
1
0
0.4
0
0.3
2
0
0.2
4.4
55
Quiz
Fiber Quiz
1. Fiber is found only in _____ _____ foods.
2. Dietary fiber helps prevent _____ and _____, two leading
health problems.
3. The recommended intake of fiber is __to __ g per day.
4. The average intake of fiber is about __to __ g per day.
5. Which food is highest in dietary fiber: an apple, a cup of
Wheaties® dry cereal, or 1/2 cup of peas?
6. T or F Nuts and seeds are not a good source of fiber?
7. T or F Whole grains can help lower cholesterol levels?
8. You should eat _____ or more servings of fruits and
vegetables (high in dietary fiber) every day.
56
Week 4 Assignments
1. Read Week-4, “Choosing
Healthy Carbohydrates”
2. Keep track of how much fiber
you eat one day this week
(see page 20).
3. Continue tracking exercise
miles and other health goals.
4. Reduce refined carbohydrates
5. Track how many healthy
carbohydrates you eat daily.
– Aim for 3+ servings of whole
grains daily, and
– 3+ servings of legumes weekly
Be*Healthy iPhone App
• Use the iPhone App called
Be*Healthy to get an
accurate estimate of your:
– Health status and wellness
score
– Health age appraisal
– Projected life expectancy
– Guidelines for adding years
to your life
– Watch slide shows to know
how to make changes
– Track your progress all year
Available on Apple’s iTunes App Store
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A LifeLong Health Presentation
Enjoy Your Adventure
to Better Health
www.myLifeLongHealth.Org
Be*Healthy Pro iPad App
• An attention getting health
awareness tool for use at:
–
–
–
–
–
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Health fairs
Employee wellness programs
Church groups
Health classes
Doctor’s and Dentist’s offices
Fitness centers
• Complete interactive
Lifestyle Assessment on iPad
• Print a Personal Wellness
Report to a Wi-Fi AirPrint
equipped printer or send
report to an email address
Available on Apple’s iTunes App Store
Assessment includes questions on fitness,
weight, nutrition, mental and emotional
health, health habits, blood pressure, BMI,
and a variety of other optional health
screening tests including aerobic capacity.
A LifeLong Health product.
Be*Healthy Pro iPad App
Lifestyle assessment is based
on findings from:
– Harvard’s Professional
Follow-up and Nurses
Health studies, and
– LLU’s Adventist Health study
• Assessment Includes:
– 14 lifestyle factors and
– 9 health screening tests
(optional)
– Strongly linked to better
health and a longer life.
Available on Apple’s iTunes App Store
A 2 page personal wellness
report includes:
– Health age and longevity
appraisal
– Years of potential added life
by making changes
– Personal recommendations
and preventive actions for:
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Improving health habits
Fitness and weight
Nutrition and eating
Mental & emotional health
– To help your participants
prevent disease and enjoy
lifelong health
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Additional Slides
• Additional slides on this
topic available to add
into your presentation if
desired but not
necessary.
Glycemic Standards - using glucose
Glycemic Index (GI)
Low GI
Less than 55
Medium GI 56-59
High GI
60 or more
Glycemic Load (GL)/Food
Low GL
10 or less
Medium GL 11-19
High GL
20 or more
Glycemic Load/Day
Low GL
Less than 80
High GL
150 or more
A GL of 150 or higher was linked
to a high risk of heart disease in
the Women's Health Study.
University of Sydney
64
Grains – Glycemic Index
Food
French bread
White rice
Corn chips
English muffin
Doughnut
Waffle
Bread, White
Taco shells
Rye bread
Whole wheat bread
G.I.
136
126
125
110
108
109
100
97
92
98
Food
Pastry
Rice (Basmati), white
Pita bread
Brown rice
Oatmeal cookie
Sweet corn
Pound cake
WW bread, stone ground
Steel-cut Oats
Bulgur
Oat bran bread
G.I.
84
83
82
79
79
78
77
76
74
69
68
65
Cereals – Glycemic Index
Food
Barley, pearled, ckd
All-bran
Oatmeal, old fashioned
Whole wheat, quick
Kellogg’s mini-wheats
Bran chex
Wheat kernels, whole
LIFE cereal
Grape-nuts
G.I.
36
60
70
77
81
83
84
94
96
Food
G.I.
Corn meal
Shredded wheat
Cream of wheat
Millet
Cheerios
Corn chex
Corn flakes
Rice chex
98
99
100
101
106
118
119
127
66
Fruits – Glycemic Index
Food
Cherries
Grapefruit
Apricots, dried
Pear
Apple
Apple juice
Peach
Orange
G.I.
32
36
44
53
54
57
60
63
Food
G.I.
Grapes
66
Orange juice
74
Banana
77
Apricots
81
Raisins
91
Apricots, canned syrup 91
Pineapple
94
Watermelon
103
67
Legumes & Vegetables Glycemic Index
Legumes
Soy beans
Soy milk
Lentils
Kidney beans
Butter beans
Split peas
Pinto beans
Chick peas
Peanuts
G.I.
26
44
41
42
44
45
55
60
21
Vegetables
Parsnips
Potato baked
French fries
Pumpkin
Potato steamed
Beets
Sweet corn
Sweet potato
Carrot
Green peas
Broccoli, greens, cabbage
cauliflower, s. squash
G.I.
139
121
107
107
93
91
78
77
70
68
20
68
Sugars – Glycemic Index
Sugars
G.I.
Fructose
32
Lactose
65
Honey
83
HF corn syrup
89
Sucrose (table sugar) 92
Glucose
137
Maltose
150
Misc. foods
Milk, skim
Milk, full fat
Yogurt, sweetened
Tomato soup
Ice cream, full fat
Coca Cola
Soft drink
Soda crackers
Dates, dried
Tofu frozen dessert
G.I.
46
39
51
54
87
90
97
106
146
164
69
Glycemic Index and Obesity
• Rats fed a high glycemic diet compared to rats fed a
low glycemic diet develop marked obesity in 32
weeks.
• In 16 human studies, 15 studies found lower
satiety, increased hunger, and higher voluntary
food intake after eating high vs. low glycemic index
meals.
JAMA 287:2415
70
Glycated Hemoglobin (A1C)
• An A1C test indicates the average blood
glucose concentration over the past three
months
– This test is a screening tool for metabolic
syndrome or diabetes ( an A1C of 7.0 or higher
may indicate diabetes)
– It also predicts increased risk of heart disease and
overall mortality even for people without
diabetes
British Medical Journal Vol. 322:1-6
71
Study Findings
• An increase of 1% in glycated hemoglobin is
associated with roughly a:
– 30% increase in mortality from all causes
– 40% increase in mortality from coronary heart
disease
British Medical Journal Vol. 322:1-6
72
Glycated Hemoglobin and Coronary
Heart Disease
5.0
5.20
4.0
3.0
2.0
1.0
2.74
2.77
5-5.4%
5.5-6.9%
1.00
0.0
<5%
n=4662
7.0+%
Glycated Hemoglobin Levels
British Medical Journal Vol. 322:1-6
73
Glycated Hemoglobin and Mortality
from All Causes
3.0
2.64
2.0
2.07
1.0
1.41
1.00
0.0
n=4662
<5%
5-5.4%
5.5-6.9%
7.0+%
Glycated Hemoglobin Levels
British Medical Journal Vol. 322:1-6
74
Prevention Strategy
• Reduce the average blood sugar level of the
general population to achieve a glycated
hemoglobin level less than 5.0% by:
– Decreasing excess body fat
– Increasing the level of physical activity
– Improving eating habits
• Decrease the glycemic load in the diet
• Eat less refined carbohydrates and more foods high in
dietary fiber
75
Dietary Fiber and Blood Glucose
• Study design
– 8 diabetic men, 24-week crossover study
– Ate 6+ servings of high-fiber oat bran bread,
muffins, or cereal per day (controls ate white
bread)
• Dietary fiber increased from 19 to 34 g/day
• 18 g fiber/day from oat bran (9 g soluble fiber)
• Results
– Glucose, insulin, and cholesterol levels improved
significantly.
76
Oat Bran, Metabolic Changes
• Total glucose response
dropped 46%
• Insulin response dropped
19%
• Total cholesterol levels
dropped 14%
• LDL cholesterol levels
dropped 23%
• HDL levels increased 8%
JADA, 96:1254-1261
250
200
150
100
50
0
Glucose
Insulin
Chol
LDL-C
White bread
Oat bran bread
77
Fiber Intake and Heart Disease
100
81
83
71
75
59
Relative
Risk of
50
Heart
Attack
Low fiber
High fiber
25
0
Dietary
fiber
JAMA 275(6): 447-451
Fruit fiber Vegetable
fiber
Cereal
fiber
78
Fiber and Heart Disease
Fiber Source
Relative Risk of MI*
Fruits
Vegetables
Cereals
0.79 (21% decreased risk)
0.78 (22% decreased risk)
0.71 (29% decreased risk)
“... higher intake of dietary fiber, particularly from cereal
and grain sources, can reduce substantially the risk of
coronary heart disease.”
* Decreased risk of heart attack for every 10 gram increase
in fiber
JAMA 275(6): 447-451
79
Decreased Coronary Risk From
Eating Specific Foods
Heart Attack Risk
Ate cold breakfast cereal
2-4 times/week v. seldom
0.83
1.0
Ate carrots 2-4 times/week
v. seldom ate carrots
0.59
1.0
Ate an apple daily v.
seldom ate apples
0.82
1.0
Ate peas daily v. no peas
0.52
1.0
JAMA 275(6): 447-45
80
Plant Stanols/Sterols
• A substance found in plants (soy beans) that lowers
cholesterol
• It is put in margarine. Examples include:
– Benecol
– Take Control
• Research shows that if you eat 2 grams/day of
plant stanols/sterols you can lower cholesterol by
about 6-15 percent
NCEP, ATP 3, Guide to Therapeutic Lifestyle Change
81
Fruit and Vegetable Intake
and Risk of Stroke
1.0
1.00
Relative Risk
• Nurses’ health study
• Nurses who ate the most fruits
and vegetables (top 20%) had a
31% lower risk of stroke than
people who ate the fewest
(bottom 20%).
• For every serving of fruit or
vegetable eaten per day, the
risk of stroke drops 6%
0.8
0.69
0.6
0.4
0.2
0.0
Lowest
<3/Day
Highest
8+/Day
Fruit/Vegetable Intake by
Servings/Day
JAMA, 282;13, 1233-1239, Oct. 6
82
Foods Most Protective
Against Risk of Stroke
• Cruciferous vegetables
(e.g. broccoli, cabbage,
cauliflower, brussel
sprouts)
• Green leafy vegetables
• Citrus fruits
• Vitamin C-rich fruits and
vegetables
Ref. JAMA, p. 1233, Oct. 6, 1999
JAMA, Oct. 6, Vol 282, No. 13, 1233-39
83
Plasma Vitamin C and Mortality
from All Causes
1.00
Relative Risk
1.00
0.75
0.78
0.61
0.50
0.55
0.50
4th
5th
0.25
0.00
1st
n=19,496
2nd
3rd
Plasma Vitamin C Quintiles
The Lancet Vol 357:657-663, March 3
84
Summary Findings
• For each increase of 20 micro mol/L in
plasma vitamin C (equivalent to one serving
of fruits or vegetables), mortality rates fell
by:
– 15% for cancer
– 30% for cardiovascular disease
– 20% for death from any cause
The Lancet Vol 357:657-663
85
Fruits and Antioxidants
• Fruits are excellent sources of antioxidants
– Blueberries
– Strawberries
– Cantaloupe and other melons
– Kiwi
– Citrus: oranges, grapefruit, lemons, tangerines
• Fruits are nature’s desserts. Enjoy them daily.
Fresh fruits are best when available.
Dietary Guidelines for Americans
86
• Study of 4,400 American
adults
• Men and women who ate a
diet high in red and
processed meats, refined
grains and sugar, and low in
fresh fruits and vegetables -doubled their risk of colon
cancer.
Amer. Jour. Of Epid.;148:4-16.
Colon Cancer (RR)
Diet and Colon Cancer
200
150
100
50
0
Two Diet Patterns
Low in meat, high fruits & veg
High meat, low fruits & veg
87
Calculate – Glycemic Load of a Carrot
• Glycemic index of a carrot is _____.
© LifeLong Health
88
Calculate – Glycemic Load of a Carrot
• Glycemic index of a carrot is 68.
• How many grams of carbohydrate in one
medium carrot? _____
© LifeLong Health
89
Calculate – Glycemic Load of a Carrot
• Glycemic index of a carrot is 68.
• How many grams of carbohydrate in one
medium carrot? 6 grams
• Glycemic load = __________.
© LifeLong Health
90
Calculate – Glycemic Load of a Carrot
• Glycemic index of a carrot is 68.
• How many grams of carbohydrate in one
medium carrot? 6 grams
• Glycemic load = 0.68 X 6 = 4.1
© LifeLong Health
91