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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 A LifeLong Health product. Click to edit Master title style Thank you for your attention 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: – – – – – – 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: • • • • Improving health habits Fitness and weight Nutrition and eating Mental & emotional health – To help your participants prevent disease and enjoy lifelong health A LifeLong Health product. 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