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Dr. Bernard Presser D.C.
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Memphis, TN 38134
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Every autumn, groundhogs double their weight before they head into hibernation. Stuffing themselves sends them into a state of hyperinsulemia (elevated insulin level) which, in humans, is considered a sign of insulin resistance. Insulin resistance in humans can lead to type-2 diabetes. Groundhogs, for some reason, never develop diabetes. Perhaps their natural-food diet has something to do with it. i
A rating system has been devised for humans that is supposed to tell us about blood sugar and (by extension) insulin responses to various carbohydrate foods. The glycemic index has been used to predict, prevent, or palliate everything from diabetes and heart disease to overweight and cancer. Developed in 1981 by David Jenkins, MD, professor of nutrition at the University of Toronto, the glycemic index (GI) was designed to help people with diabetes manage their insulin and blood sugar levels. It's a method of ranking foods based on their immediate effect on blood sugar (blood glucose) levels. The higher the GI number, the more quickly the sugar in the food is absorbed. The belief is that, the more quickly sugar is absorbed, the more rapid the increase in the blood glucose level and the more marked the fluctuations in insulin levels. Foods that consist primarily of carbohydrates are in the lists, not foods that are primarily protein and/or fat. (Proteins and fat have little or no immediate effects on blood sugar.) The only carbohydrates not absorbed by the body are fibers; the rest are converted into glucose (blood sugar) in the body, albeit at different rates of speed.
In the index, foods are rated from 0 to 100. Carbohydrates that break down quickly during digestion, causing blood-glucose levels to increase faster than other carbohydrates, are given the highest GI ratings. Carbohydrates that break down slower and cause blood-glucose levels to rise slower or more gradually have lower ratings. Thus, breads, potatoes, cereals, carrots, corn ships, and sports drinks, for example, all have a high GI value. Milk, yogurt, pasta, nuts, apples, and oranges fall into the low GI category. Fluctuations in insulin levels are assumed to be more marked in the higher-rated foods. Glucose, a refined sugar (stripped of all its other natural food components) requires no digestion and has a GI of 100. It is usually used as the standard by which other carbohydrates are compared and assigned a number relative to glucose. White bread (GI of 70), another refined carbohydrate, may also be used as a standard by which to compare other foods. But, when the white bread standard is used, most foods have a GI about 40% higher than when the glucose standard is used.
Some low-carbohydrate diets recommend use of low GI foods to decrease hunger cravings that can come from rapid fluctuations in insulin levels. "Fat reduction or low-fat foods aren't as important as the food's GI rating," says David S. Ludwig, MD, PhD, director of the obesity program at Children's Hospital, Boston. Insulin is a fat-storing hormone. "So if there's a lot of insulin in circulation, then some of it is going to pick up fat and tuck it into fat cells," says Johanna Burani, MS, RD, author of Good Carbs, Bad Carbs. She contends that, if you choose low-GI foods, you'll feel satisfied, your blood sugar won't spike, and you won't experience a major drop in blood sugar that may cause you to overeat. Others claim that low-GI foods are more bulky and less dense in calories, so you'll feel fuller longer and have more energy and endurance. Sounds good. Yet, a major concern with just monitoring GI is that it ignores other important aspects of nutrition, and does not consider the long-term effects of various foods. Proponents of the GI admit that the reason carbohydrates have gotten a bad reputation is that "most people over-consume refined carbs, which have had most of their nutrients and fiber removed." Some highly processed carbs, such as bagels and white bread, can have high GI ratings. But not all of them. Some low GI carbs are high in fiber and nutrient-dense. But not all of them. There is confusion in the GI story. ii
The terms glycemic index and glycemic load (GL) can be confusing. The glycemic INDEX of a food is the capacity of a portion of that food containing 50 grams (g) AVAILABLE carbohydrate to raise blood glucose compared with 50 g glucose (a refined sugar) in normal glucose-tolerant individuals. "Differences between foods are likely to be exaggerated in individuals with any degree of impairment of glucose tolerance." This can confound the effects of foods on individuals since many people these days have some impairment of glucose tolerance due to over-consumption of refined carbohydrates and artificial sweeteners. The glycemic LOAD of a food is essentially a product of the glycemic index of a food and the AVAILABLE carbohydrate per serving. The GL is an attempt to give a more realistic (by portion or serving) means of comparing meals, foods, or diets for glycemic effects. In this way, a person can have a lower glycemic LOAD by choosing foods with a low glycemic INDEX or by reducing the amount of high-GI carbohydrates consumed, or both. So you could pick foods rated high on the index but limit the amount you eat. Some vegetables that have a HIGH GI (such as carrots), have a LOW GL-based on GI multiplied by the amount of carbohydrates per serving. Are you getting confused yet?
Glycemic Index Glycemic Load A big problem is that tightly controlled
Low 55 or under 10 or under nutrition studies are extremely difficult to
Medium 56-69 11-19 do. There are far too many variables when it
High 70 or above 20 or above comes to dealing with real, live people and
their foods. iii
It is Walter Willett, MD, professor at the Harvard School of Public Health, and his colleagues who took the concept of the GI and expanded it into the GL. Following the GL is a bit different than following the GI. For example, some foods with a high GI actually have minimal effects on blood sugar levels when eaten in normal quantities, while other foods with a low GI are potentially problematic. For example, a large carrot and a cup of spaghetti (refined flour) have similar GIs. Yet the carrot contains only 5 g of "available" carbs (it is mostly water), while the spaghetti contains 38 grams. This gives them GLs of 2 and 16, respectively. Thus, they have dramatically different immediate effects on blood sugar. Watermelon, pineapple, carrots and other fruits and vegetables with a high GI turn out to have low GLs. Conversely, pasta, bagels, and other starchy, carbohydrate-dense foods-especially those made with refined flours-are higher on the GL than on the GI.
Other low GL carbohydrates include salad vegetables, green veggies, beans, and legumes, while high GL carbs include most breads and sweets. Like the GI, the GL cannot be the only consideration in a healthful diet. White sugar (sucrose) has a low GL, but that does NOT mean it's a GOOD food-on the contrary, it is a nonfood that takes rather than gives to the body. iv
Remember, insulin is a hormone whose primary role is to control the transport of glucose, the body's main energy source, from the bloodstream into the cells where it is burned. An insulin deficiency impairs the body's ability to get glucose into the cells. Insulin resistance is a state in which sufficient (or even too much) insulin is present in the bloodstream, but it cannot get into the cells where it is needed, creating a deficiency. In either case, glucose accumulates in the blood, leading to diabetes and other ills.
Since the glycemic index was proposed as an alternative system for classifying carbohydrate-containing foods, several hundred scientific articles and many popular diet books have been published on this topic. "However, the clinical significance of the glycemic index remains the subject of debate." v
SOUNDS GOOD, BUT
Probably hundreds of studies have been conducted on GI and GL diets, mostly focused on diabetes. One typical study -- a meta-analysis of several trials involving more than 350 people with diabetes - concluded that a low GL diet improved both long- and short-term "management" of blood sugar levels. Other studies in diabetic patients indicated that replacing high-GI carbohydrates with low-GI forms improves control of blood sugar and, among those treated with insulin, reduces episodes of low blood sugar. Some studies showed that a low-GI diet reduced markers of blood sugar function (such as glycated hemoglobin and glycated proteins); others did not. Some showed that a low-GI diet was associated with improvements in disorders of blood sugar and insulin; others found no association at all. There are studies that concluded it is the fiber in carbohydrates that improves blood sugar control. (Low GI and GL carbs generally have more fiber than high GI and GL carbs.) Other studies concluded there was no significant association between fiber intake and blood sugar or insulin improvement. Some studies linked a high GI or GL diet with an increased risk for developing diabetes "over time", while others didn't make such a direct connection. vi
The GI is "highly variable, not physiological, cannot reliably predict mixed meal responses, difficult to learn and follow, and has inconsistent effects on markers of glycemic control and other aspects of metabolic control in people with diabetes." Researchers recommend that diabetics test and record their own blood glucose levels two hours after meals to determine what actually happens to their blood sugar levels as compared to what was expected based on the GI or GL of the foods eaten. vii
A recent study found no significant correlation between the GI of food consumed and blood-sugar levels. Researcher Elizabeth Mayer-Davis, PhD, told the Associated Press that: "The glycemic index is sufficiently flawed as an index, in that it is not helpful for scientists or people trying to create a healthy diet." The GI does "not seem to be useful in understanding how diet impacts health, and use of the Glycemic Index may not be an effective way to identify foods for optimal health." viii
A large, multi-year Harvard study found that overweight women who ate a high GL diet were twice as likely to develop coronary heart disease as their thinner counterparts who ate low GL foods. But was the cause the high GL diet or their excess weight? It is accepted that refined carbohydrates are depleted in or devoid of nutrients and fiber, that they are empty calories that can add excess weight. Yet some studies have shown that low GI or GL weight-reduction diets do NOT provide any added benefit in promoting weight loss. Some studies found that people eating a low-GI diet feel full longer and tend to eat less. Overweight individuals experienced improved weight reduction, lowered blood pressure and cholesterol, triglycerides, blood sugar, and insulin levels. However, many studies found there was no significant weight loss. One trial reported a slight decrease in LDL (so-called "bad") cholesterol and a "tendency" for a decrease in total cholesterol, but no significant differences between folks on a low-GI diet and those on a high-GI diet when it came to insulin, insulin resistance, pancreatic function, triglycerides, HDL cholesterol, appetite, and body-weight regulation. "Existing evidence that low-glycemic-index diets are an effective tool for achieving weight reduction is, at present, contradictory."
Overweight people do not necessarily eat more carbohydrates than those of normal weight. But they are more inclined to eat an excess of refined carbohydrates such as white bread, pasta, and sweets. Overly-processed foods high in refined sugars and starches are the villains. It's the kind of carbohydrates consumed, not the amount. The GI has been promoted in many diet books for weight loss, with the premise that high-GI foods cause your body to convert more carbs to fat. But studies have shown inconsistent effects of high-GI foods compared with low-GI foods on hunger, satiety, and weight loss. Not all refined carbohydrates are restricted on a low-GI diet. When all refined carbs are restricted then, yes, excess fat and weight can be lost. ix
Studies have linked high-GI or GL diets with increased risk of coronary heart disease. For example, cholesterol and LDL (so-called "bad") cholesterol levels may be higher while HDL (so-called "good") cholesterol levels may be lower. (Keep in mind that some "risk factors" for heart disease are still theoretical.) Yet, researchers admit they cannot exclude the possibility that low-GI or GL diets contain more nutrients needed for cholesterol, blood sugar and insulin metabolism--such as chromium, B vitamins, zinc, manganese, magnesium, etc.-than do high- GI or GL diets. In other words, they don't know what's doing what. And study results are inconsistent. High-GI or GL diets have been linked to increased risk of gallbladder disease, elevations in C-reactive protein (a marker of inflammation) and triglycerides. But a cause-and-effect relationship cannot be established. x
Since a low GI or GL diet reduces the consumption of many refined carbohydrates, virtually anyone following such a regime may experience some health benefits. Definite connections have been made between refined carbohydrates and diabetes, other blood sugar and insulin disruptions, heart disease, weight gain, gallbladder problems, elevations in triglycerides and cholesterol, and a plethora of other ills. Still, all is not sweet for the GI.
GLITCHES IN THE GI
The GI was originally conceived as an inherent property of food, not as an individual human response to food. As such, any food would theoretically have a consistent and reproducible response from person to person, no matter what other foods are eaten at the same time. But it doesn't work that way. People are unique individuals who respond to various foods differently. For example, the way people reduce the upsurge of blood sugar following a meal differs, with some taking much longer than 2 hours to get their blood sugar down to normal. Differences in GIs between foods become less as longer time frames for handling blood sugar are used to measure GI. This means that an immediate spike in blood sugar after a food is eaten does not necessarily mean the person is or is not having (or is going to have) a problem because of that food. Nor does it mean that the food is or is not nutritious or healthful. xi
While weight loss produces substantial improvements in blood sugar control and the processing of fats, lowering the GI "has little effect on glycemic control." One research team found that a typical Western diet--high in red meat, processed meat, French fries, pasteurized dairy products, refined grains, and sweets--is implicated in the development of diabetes twice as much as a "prudent" diet-high in vegetables, fruit, fish, poultry, and whole grains. It wasn't the amount of high-GI carbohydrates or the amount of any carbohydrates. It was the quality of the food. Whole, natural, un-fooled-around-with real foods-whether high in carbohydrates or not-did not cause disease or imbalance or dysfunction. xii
Initially, it was believed that carbohydrates rich in soluble fiber had the lowest GIs. But, there are other factors involved. A low GI is given to foods which are rich in fat as well as carbohydrates, or when fructose contributes significantly to the total carbohydrate content. Thus, fruits high in glucose, such as grapes, have a higher GI than those high in fructose. Intact whole grains are associated with a lower GI than when grains are extensively processed and the cellular structure destroyed. Whole fruits have a lower GI than pureed forms, despite the similar content of total sugars. The same kind of bread in one locale can have a different GI than that from a different locale, perhaps due to fermentation time (which decreases production of organic acids, lowering the GI) and/or the amount of whole grains with their cell wall intact (which may also lower the GI).
The most refined carbohydrates cause the most problems-blood sugar disruptions, abnormally high insulin, insulin resistance, an overworked pancreas, excess amounts of fat laid down in the body, and others. And, other-over-processed, altered nonfoods also contribute to these ills. For example, trans fatty acids appear to increase the risk of type 2 diabetes "substantially." But the distinction important here is REFINED carbohydrates versus unrefined, natural whole food carbohydrates. The GI does NOT make that distinction. xiii
The GI of an individual food can vary widely depending on its type, the way it's processed, and the way it's prepared. Although the GI is a ranking of how quickly a food breaks down in your body and releases its sugar (natural or added) into your bloodstream, it is not an accurate measure of what really happens in your body. In fact, the GI does not give a clear picture of the food or the individual eating it. Different people will respond differently to the same food. Each person will respond differently at different times to the same food. In theory, the GI of a food should be the same at any time of the day. In reality, the rise in blood sugar is highest at breakfast (after a 10-12 hour overnight fast) than at other periods. A food contributing relatively little carbohydrate could have a high GI, and not need to be restricted. An example is carrots; when they are overcooked, they have a high GI, but otherwise, they have a low contribution to blood sugar spikes. xiv
Even for foods that require no preparation before eating, such as whole milk and ice cream, the GI varies from 11 to 40 and from 36 to 68, respectively. Actually, the variability of GIs for many individual foods exceeds the GIs calculated for mixed meals! So, no one can really tell people that the GI of a food is predictable. The ripeness of fruit affects the GI. As ripeness progresses, the GI increases or decreases. Changing the particle size of some foods changes their GIs. For example, the GI of a 1-inch cube of potato can increase by 25% just by mashing the cube. Whole apples, apple puree, and apple juice all have different glucose and insulin effects. Finely ground flour has a different effect than coarsely-chopped grains.
Different types of a particular food can have different GIs. Different types of rice, for example, have different GIs. Pastas also have different GIs, though they are made of the same flour. Macaroni, star pastina, and spaghetti are 68, 54, and 45, respectively. Grinding, rolling, pressing, or even thoroughly chewing a kernel or other starch food can disrupt the granules and affect GI. Rolling or pressing foods, as is done in processing many grains, disrupts the outer germ layer and granules and increases GI. The use of heat and moisture in processing affects starch granules, making them less digestible. Starch can also form insoluble complexes with proteins, such as occurs when foods are browned (Maillard reaction), making it unavailable for digestion and absorption. The cooking method affects the GI beyond the effects of mashing or pureeing food. For example, when potatoes are cooked, the starch granules gelatinize and become digestible. But when the potatoes are cooled, the gelatinization reverses and about 12% of the potato starch cannot be absorbed. The heat used, the amount of water, and the time of cooking all have significant effects on the GI. Thus, the more a starch-containing food is cooked, moistened, ground, or pressed, the more it will be digested (except for the part that becomes insoluble) and, supposedly, the more it can affect the blood sugar. One study found that pressure-cooked white (refined) rice was 30% lower on the GI than any other type of cooked rice. A pressure cooker heats at very high temperatures, denaturing nutrients. If you are interested in nutritional value rather than GI, you could eat brown (unrefined) rice, preferably soaked and steamed. xv
All these factors belie the concept that a food has a definitive GI, because the GI depends on what was done to the food-processing, storing, ripening, cutting, and cooking. Add to this the fact that people do not usually eat one food at a time; they eat meals or snacks made up of two or more macronutrients-protein, fats, and carbohydrates. When combinations of these macronutrients are studied, three things become obvious: (1) the higher the proportion of carbohydrate in a specific food (as opposed to protein and fat), the higher the GI; (2) even when foods contain the same amount of carbohydrate, there are up to 10-fold differences in the immediate blood sugar effect among them; and (3) a mixed meal of carbohydrate, protein, and fat will have a different and variable (changeable) blood sugar response depending on the proportions of each nutrient. Thus, the blood sugar responses of a food eaten alone or in combination with other foods can be quite different. The GI is thought to directly reflect the rate of digestion of a food and HOW FAST your blood sugar rises. What happens after that is unknown as far as the GI is concerned. Some evidence indicates that the amount of insulin rises and blood sugar decreases earlier when a food is rated lower on the GI.
Protein-rich foods (such as meats, seafood, eggs) increase insulin secretion without increasing blood sugar concentrations. The blood sugar response does not change much or actually decreases, yet the insulin response increases. As more protein is consumed WITH carbohydrate, the insulin response will increase but blood sugar will not change much. Adding fat to a carbohydrate meal has similar results-insulin secretion is enhanced even though blood sugar response decreases. Therefore, the insulin response to a carbohydrate food varies with the amount of protein, fat, or both, with which it is eaten. Many foods do not contain carbohydrates ONLY, but are mixed with proteins and/or fats. This means that some foods may have a lower GI but would not be recommended for other reasons. For example, M&Ms peanuts and raspberry smoothies have low GIs because they contain some protein and large amounts of fat. Yet, from a nutritional standpoint, they are loaded with refined sugars and other undesirable contents that would not qualify them as healthful or beneficial foods. White potatoes are very high on the index, but if you eat them with meat or cheese, they are digested more slowly. If you mash a potato, it moves up even higher on the GI. Other foods may have high GIs but be nutritionally advantageous. They get a bum rap. Potatoes are one example.
A medium-size potato is one of the best sources of potassium, easily beating bananas. As long as you eat the skin, it's also a good source of vitamin C (unless overcooked), B vitamins (notably folate), magnesium, and iron. The more colorful potatoes (yellow, red, purple) provide extra phytochemicals including carotenoids (such as beta carotene, lutein, and zeaxanthin), and flavonoids. Varieties with deep red or purple flesh can be as rich in antioxidants as kale, Brussels sprouts, or spinach. HOW potatoes are cooked will affect the blood sugar-response. Cold potatoes elicit nearly a 40% lower response than hot potatoes. The lower blood sugar cannot be accounted for simply by a reduction in the amount of digestible starch. There is more that is not yet known. A 2006 study reported that potatoes-boiled, mashed, or French fries-may increase risk of diabetes. The biggest risk was in obese individuals and in those eating the most French fries. Not surprising. Does it indict potatoes? Obesity, overcooking, mashing, and trans fats, yes, but not necessarily the potato. xvi
Blood sugar levels are significantly higher after people drink caffeinated coffee than after drinking decaffeinated coffee or a control beverage. Caffeine evidently impairs glucose tolerance by inducing a rise in blood sugar concentrations. If you have coffee with your meal, you can up your blood sugar even if you eat low-GI foods. xvii
The extent to which the fiber in a food is responsible for its GI is still debated. So far, fiber seems to have very little relation. Comparisons between brown and white rice, whole-grain and white spaghetti, and whole-wheat and white bread show only small differences in the GI although fiber contents are quite different. Whole grains are superior to refined grains, but you can't always determine this by their GI.
Sucrose (white sugar) has a rating that is relatively low at 65. The GI of fructose is 23; lactose is 46. Thus, even refined (stripped) sugars--missing nutrients and other food factors needed to balance the sugar response, aid the body in handling the sugar properly, and nourish the cells-may have relatively low GI ratings. Studies have found NO relation between the sugar (yes, even white sugar) content in foods and their GI ratings! Adding white sugar to a meal has no effect on the GI of the meal. One research team actually suggested that "moderate amounts of sucrose [white sugar] in meals may actually improve glycemic [blood sugar] response..."
An increase in the acidity of a meal can greatly lower its GI rating. Having vinegar in a meal, for instance, will affect the blood sugar response. Sourdough bread eaten at a meal can result in different GIs, depending on its content of organic acids.
The values in the GI are based on eating the foods on an empty stomach. So, if you've eaten recently, high-GI foods will break down slower and lower the GI. Meal size, the amount of fat eaten with the food and the variety of foods eaten together skews the GI-bottom line. It is good to limit your intake of (or totally avoid) some high-index foods, such as white bread, Coco Pops, and jelly beans. But there is no reason to avoid all foods high on the index-many are very nutritious, such as carrots, parsnips, pineapple, and watermelon. Watermelon, for instance, is NOT high in starch OR sugar content, yet it has a high GI (72). "Sweet" potatoes have a GI of 52 while baked red potato has a GI of 93. Many foods rated low on the index are really nonfoods that should be avoided, such as chocolate cake made from packet mix with chocolate frosting, converted white rice, and instant pudding. The GI cannot be used as a measure to identify the healthfulness or nutritional value of foods. xviii
One research team noted that a Mediterranean-type diet-acclaimed as a healthful way to eat-has a high carbohydrate content, thus may not be ideal for patients with diabetes or other conditions associated with insulin resistance or cardiovascular disease. This type of diet includes plenty of fruits and vegetables, grains, fish, and olive oil. The alternative suggested was to substitute spaghetti and potato dumplings for the other starchy foods typical of the Mediterranean diet because they have a low blood sugar response. White flour spaghetti and overcooked boiled potatoes mixed with white flour-neither a good source of nutrients or fiber-had low blood sugar responses. Obviously, the immediate blood sugar response does not tell the whole story! xix
It is often ASSUMED that the blood sugar response to a food predicts the insulin response. Not so. For instance, as a person increases the amount of a carbohydrate food he/she eats, the amount of insulin does NOT increase proportionately. Blood insulin responses increase at a much faster rate than do blood sugar responses. You can't predict that the insulin effect expected from a 50-gram portion of a particular food would be doubled by eating a 100-gram portion. Thus, the insulin response has to be regarded as "a moving target" that will depend more on the portion size than on the GI of a food. Insulin responses after a meal are not closely related to the carbohydrate content or to the blood sugar effects of the foods. The blood sugar response accounts for only 23% of the variability in elevated insulin levels. This implies that many factors other than an increase in blood sugar will influence the amount of insulin secreted. Look what happens when you compare the INSULIN response of foods instead of the BLOOD SUGAR response: Potatoes are a high-GI food, considered "bad." Baked beans and lentils are low-GI, considered "good." Yet they release insulin at rates of 284 (pmol/L) for potatoes, 504 for baked beans, and 325 for lentils. Thus, of these foods, potatoes produce the least effect on insulin per gram of carbohydrate. All milk products, fermented or not, elicit very high insulin responses. Yet most milk products, such as yogurt, milk and ice cream, are low on the GI. xx
It appears that the GI has been made to be much more important than it really is. Considering the many complexities, inconsistencies, and contradictions to nutritional common sense, the GI deteriorates into hash. Stay away from refined carbohydrates and eat whole, natural real foods. This is much simpler. It will have a much bigger impact on your health. And it will allow your brain to ponder other puzzles. For example, a Japanese study found that people with diabetes who attended a comedy show after eating had an increase in blood sugar 36% lower than those attending a boring lecture. So, is laughter really the best medicine? xxi
This website has excellent nutritional protocols for blood sugar metabolism which are available in conjunction with the Symptom Survey. Take the Symptom Survey to discover specifically what nutrition you need for your individual health problems. I want to emphasize that the nutrition I recommend CANNOT be purchased in any retail store: so-called "health food" store, drug store, super market, etc. The nutrition I recommend will help rebuild your body and restore your health. Those other products will only give you a pharmaceutical (drug) effect. They will attempt to deal with your symptoms, which is the ONLY thing any drug can do, while leaving the state of your health unchanged.
i Christian Millman, "Ground Hogs Hold the Key," Better Homes & Gardens, June 2003, p.296.
ii HealthNews, Dec 2005,11(12): 8; Barbara Tunick, "Rise and Fall," Veg Times, May 2004, 321: 75-79.
iii Mark Daly, Lancet, 28 Aug 2004, 364(9436): 736-7; AZ Lawrence, Eating Well, Summer 2004,3(1):18.
iv Julian Whitaker, Health & Healing, Oct 2005, 15(10): 3-6.
v David Ludwig, JAMA, 8 May 2002, 287(18): 2414-23.
vi Julian Whitaker, Health & Healing, Oct 2005, 15(10): 3-6; Walter Willett et al, Am J Clin Nutr, July 2002, 76(1)suppl:274S-80S; Eun Ju Yang et al, Am J Clin Nutr, June 2003, 77(6): 1426-33; Nadine Sahyoun et al, Am J Clin Nutr, Sept 2005, 82(3): 547-52; J Brand-Miller et al, Diab Care, Aug 2003, 26(8): 2261-67; Arturo Jimenex-Cruz et al, Nutr Res, Jan 2004, 24(1): 19-27; J Stevens et al, Diab Care, Oct 2002, 25(10): 1715-21; MB Schulze et al, Am J Clin Nutr, 2004, 80: 348-56.
vii Vladimir Vuksan, J Am Coll Nutr, Feb 2004, 23(1): 1-4; Jennie Brand-Miller, Am J Clin Nutr, Aug 2004, 80(2): .243-44; HealthNews, Mar 2005, 11(3): 6-7.
viii Tufts Univ Health & Nutr Lttr, June 2006, 24(4): 8; Hlth News, May 2006, 12(5): 12.
ix Susan Raatz et al, J Nutr, Oct 2005, 135(10): 2387-91; HealthNews, Aug 2005, 11(8):8; Birgitte Sloth et al, Am J Clin Nutr, Mar 2005, 81(3): 722-4; Acres USA, Apr 2005, 35(4): 37; Birgitte et al, Am J Clin Nutr, Aug 2004, 80(2): 337-47; F Xavier Pi-Sunyer, "Glycemic index and disease," Am J Clin Nutr, July 2002, 76(1) suppl: 290S-8S; K Oh et al, Am J Epidem, 15 Jan 2005, 161(2): 161-9; Susan Roberts, Nutr Clin Care, Jan-Apr 2003, 6(1): 20-6; Earl For & Simin Liu, J Am Coll Nutr, Feb 2006, 25(1): 1125; Z Fajcsak et al, J Am Coll Nutr, Feb 2006, 25(1): 1128; Janette Brand-Miller et al, Am J Clin Nutr, Jul 2002, 76(1)suppl: 281S-5S; Dorota Pawlak et al, Lancet, 28 Aug 2004, 364(9436): 778-85.
x Anthony Leeds, Am J Clin Nutr, July 2002, 76(1)suppl:.286S-89S; Julian Whitaker, Hlth & Healing, Oct 2005, 15(10): 3-6; D Lukaczer et al, Nutr, 2006, 22(.2): 104-13; Mark Pereira et al, JAMA, 24 Nov 2004, 292(20): 2482-90.
xi F Xavier Pi-Sunyer, "Glycemic index and diease," Am J Clin Nutr, July 2002, 76(1)suppl: 290S-98S.
xii Leonie Heilbronn et al, J Am Coll Nutr, Apr 2002, 21(2): 120-27; HealthFacts, Feb 2002, 26(2): 3.
xiii T Perry et al, New Zealand Med J, 28 Apr 2000, 113: 140-42; Tony Edwards, What Doctors Don't Tell You, Mar 2003, 13(12): 1-4.
xiv Guy Nantel, Nutr Rev, May 2003, 61(5)suppl: 34S-39S.
xv F Xavier Pi-Sunyet, Am J Clin Nutr, July 2002, 76(1)suppl: 290S-98S; HN Larsen et al, Euro J Clin Nutr, 2000, 54, cited in Women's Health Letter, June 2001, 7(6): 7.
xvi UC Berkeley Wellness Lttr, May 2005, 21(8): 4-5; G Fernandes et al, JADA, Apr 2005, 105(4): 557-62; Nadine Najjar, et al, Nutr Res, Dec 2004, 24(12): 993-1004; Thomas Halton, et al, Am J Clin Nutr, Feb 2006, 83(2): 284-90; Simon Schenk et al, Am J Clin Nutr, Oct 2003, 78(4): 742-48.
xvii KL Johnston et al, Am J Clin Nutr, 2003, 78: 728-33.
xviii F Xavier Pi-Sunyer, Am J Clin Nutr, July 2002, 76(1)suppl: 290S-98S; Michele Bloomquist, Shape, May 2003, p.170; Janette Brand- Miller, Am J Clin Nutr, Apr 2003, 77(4): 994-95; UC Berkeley Wellness Lttr, Dec 2003, 20(3): 1-2; Nutr Clin Care, Jan-Apr 2003, 6(1): 41-42; Robin Edelman, "Cereal Clues," Eating Well, Winter 2003, 1(3): 15; DS McLaren, Nutr, 2000, 16: 151-52; Karyl Rickard et al, JADA, Oct 2001, 101(10): 1202-05; Wm Douglass, Real Health Brkthrghs, Jan 2004, 3(8): 7-8.
xix Gabriele Riccardi et al, Nutr Rev, May 2003, 61(5)suppl: 56S-60S.
xx F Xavier Pi-Sunyer, Am J Clin Nutr, July 2002, 76(1)suppl: 290S-98S; Elin Ostman et al, Am J Clin Nutr, July 2001, 74(1): 96-100.
xxi Clin Pearls News, Nov 2000, 10(11): 209; HlthNews, July 2003, 9(7): 11.
Originally published as an issue of Nutrition News and Views, reproduced with permission by the author, Judith A. DeCava, CNC, LNC.