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GI and insulin resistance

GI and insulin resistance

A table elsewhere in this issue shows conventional and Système International IG units and rezistance factors for many Rssistance. eFigure 1. Reslstance, the digestive resistnace processes foods with GI and insulin resistance low GI and GL slowly, which reduces blood sugar spikes. This increase in blood volume contributes to an increase to the left ventricular pre-load and an increase in resting cardiac output. By continuing to use our website, you are agreeing to our privacy policy. With this constraint, high- and low-carbohydrate components could be chosen in any order, leading to 4 distinct sequences for the first 2 diets.

GI and insulin resistance -

The diets also provided similar amounts of other nutrients that might affect trial outcomes. The 5 primary outcomes were insulin sensitivity; systolic blood pressure; and low-density lipoprotein LDL cholesterol, high-density lipoprotein HDL cholesterol, and triglyceride levels.

Secondary outcomes included diastolic blood pressure, fasting and 2-hour blood glucose and insulin, and other lipoprotein parameters. Blood pressure was measured by trained and certified staff using a validated automated oscillometric OMRON device 12 at the clinic on 3 days during screening for eligibility; on 1 day during run-in; and on 1 day during the first, second, and third weeks and on 5 days in the final fourth and fifth weeks, during each of the 4 diet periods.

On each occasion, the blood pressure was measured 3 times. The measurements during the last 2 weeks were averaged and constituted the outcome variable for blood pressure, as done previously. Plasma total and lipoprotein cholesterol, triglycerides, and apolipoproteins B, C-III, and E were measured using enzymatic kits or enzyme-linked immunosorbent assay.

Insulin sensitivity was measured by an oral glucose tolerance test, 75 g, during screening and the final 10 days of each diet period.

Blood was sampled at 0, 10, 20, 30, 60, 90, and minutes. Insulin sensitivity was calculated by the index of Matsuda and DeFronzo that uses blood glucose and serum insulin levels at 0, 30, 60, 90, and minutes.

On that day, participants were given the same diet type for that diet period for breakfast, lunch, and dinner, which had a mean , , kcal, respectively, for a typical kcal diet, the same as in the other days of the controlled diet.

Blood was sampled at fixed intervals just before eating breakfast; 30, 60, and 90 minutes after starting breakfast; and hourly thereafter through 12 hours.

This hour meal test is a process variable that determines the differences in blood glucose caused by the differences among the diets in glycemic index and amount of carbohydrate. Diets with higher glycemic index and higher amount of carbohydrate are expected to increase the hour blood glucose AUCi.

Urine collections hour were obtained once during screening and once during the last 2 weeks of each diet period. Data collection personnel were blinded to diet sequence. Information on serious adverse events was collected from participants and their medical records and reported to the institutional review board as required.

The diet contrasts pertaining to the effect of glycemic index were high glycemic index vs low glycemic index in the setting of high total carbohydrate intake and separately in the setting of low total carbohydrate intake.

The trial design also allowed a test of the effects of lowering total dietary carbohydrate, separately in the setting of high—glycemic index and low—glycemic index foods. Although this 4-period study could be analyzed as a factorial design, combining the high- and low-carbohydrate periods to test glycemic index, and combining the high— and low—glycemic index diets to test level of carbohydrate, we considered it likely that glycemic index has a stronger effect when the total carbohydrate intake is high and that carbohydrate level has a stronger effect when the glycemic index is high.

Therefore, a factorial analysis was considered inappropriate. In the protocol-specified analytical plan, the primary analysis is a comparison of the high-carbohydrate, high—glycemic index diet and the low-carbohydrate, low—glycemic index diet, representing a single integrated measure of the hypothesized maximal effect on the 5 primary outcomes of manipulating dietary carbohydrate by reducing its amount and glycemic index.

Because some participants did not provide measures on all outcomes for all diets, multiple imputation analysis was performed for the 5 primary outcomes. There was no qualitative effect of multiple imputation compared with complete case analysis.

Full details are given in the online appendix eFigure 1 in Supplement 2. The distribution of within-person differences in response variables for pairs of diets was analyzed using the t.

test function of R version 3. This provides estimates of average effect, standard error of the estimate, and limits of confidence intervals for selected confidence coefficients.

Statistical visualization and additional analyses such as multiple imputation sensitivity analysis and tests for carryover effects were also performed using R.

We used standard assessments of carryover effects in crossover designs based on the comparison of distributions of sums of outcomes between groups of participants receiving treatments in different orders. One hundred sixty-three participants completed at least 2 diets and were included in the analysis of outcomes Figure 1.

For any pair of diets, there were to participants. The trial ended when at least participants completed at least 2 diets, as planned.

Participants lost an average of 1 kg of body weight from baseline to the end of each diet period, the same for each diet type. Urinary sodium and potassium excretion were similar during each diet period.

At the high dietary carbohydrate content, the low— compared with the high—glycemic index level significantly reduced insulin sensitivity from 8. At the low carbohydrate content, the low— compared with the high—glycemic index level did not affect insulin sensitivity but increased fasting blood glucose level by 2.

Mean glucose and insulin levels during the oral glucose tolerance test are shown in eFigure 2 in Supplement 2. Glycemic index level did not affect HDL cholesterol level or systolic blood pressure or diastolic blood pressure.

A low compared with a high dietary carbohydrate content did not affect insulin sensitivity at either the high— or the low—glycemic index level Figure 3 and Table 3. A low compared with a high dietary carbohydrate content significantly lowered plasma total triglycerides at both high— and the low—glycemic index levels.

There was no evidence of additive effects of glycemic index level and dietary carbohydrate content on any of the outcomes. A sensitivity analysis restricted to the participants who completed all 4 diets yielded results similar to the primary analyses eTable 5 in Supplement 2. Serious adverse events occurred in 7 participants: injuries from automobile crashes 3 participants , kidney stone 1 , acute asthma 1 , osteomyelitis 1 , and pneumonia 1.

None were judged to be related to the study procedures. There were no unintended or unanticipated effects. All 4 study diets were associated with lower systolic blood pressure by 7 to 9 mm Hg Table 3 and diastolic blood pressure by 4 to 6 mm Hg eTable 3 in Supplement 2.

Paradoxically, the low—glycemic index, high-carbohydrate diet compared with the high—glycemic index, high-carbohydrate diet decreased insulin sensitivity and increased LDL cholesterol and LDL apolipoprotein B levels while other dietary factors that affect LDL levels such as saturated fat, cholesterol, and fiber were held constant.

These findings are contrary to our hypotheses on glycemic index. As we found previously in the OmniHeart trial, 8 the beneficial effects of the DASH diet can be improved modestly by reducing its carbohydrate content.

Lowering the carbohydrate content and compensating the reduced calories with unsaturated fat and protein substantially lowered triglycerides and VLDL levels and slightly lowered diastolic blood pressure, confirming previously established findings. Thus, the new information in the present study is that composing a DASH-type diet with low—glycemic index foods compared with high—glycemic index foods does not improve CVD risk factors and may in fact reduce insulin sensitivity and increase LDL cholesterol.

We found that a low compared with a high glycemic index of a high-carbohydrate diet decreased insulin sensitivity measured by an oral glucose tolerance test. Fasting glucose level was higher on low—glycemic index than high—glycemic index dietary carbohydrate as previously reported. However, a low—glycemic index diet did not affect insulin sensitivity in other studies in which body weight either remained constant during the trial or decreased by a similar amount in the high— and low—glycemic index groups.

We chose a 5-week duration of the intervention feeding periods based on results of previous studies, which suggested that 5 weeks was sufficient to detect changes in our outcomes trial protocol in Supplement 1. A recent meta-analysis of 14 trials that had durations of at least 6 months found no effect of lowering glycemic index on lipids or fasting glucose, although fasting insulin was reduced.

This trial did not address the effect of glycemic index in a typical US diet. Rather we studied a low compared with a high glycemic index in a DASH-type diet. However, we do not attribute the null findings on glycemic index to the healthfulness or specific content of the DASH diet.

For example, in several European studies 19 , 23 , 31 , 32 and one in Brazil, 22 the researchers gave or prescribed selected foods to the participants to use in their own diets instead of providing complete diets that differed from their usual diets. In these studies, lowering glycemic index did not increase insulin sensitivity or improve blood pressure, HDL cholesterol level, or triglyceride level; LDL cholesterol level decreased in one of these studies 19 but did not change in the others.

We showed in a subsample of the participants that the glycemic index values of individual foods computed from dietary tables, when assembled into meals, produced expected differences in blood glucose AUCi over 12 hours, a process variable, thus confirming previous results.

These results suggest that lowering glycemic index or lowering carbohydrates for breakfast, lunch, and dinner reduces blood glucose during 12 hours without any further reduction from lowering both together. Thus, the effects of these 2 changes in dietary carbohydrate were not additive, suggesting a plateau effect, as also found in a similar study.

After we started this trial, reports of trials that involved glycemic index have accumulated. A meta-analysis of 28 trials found that lowering glycemic index did not affect HDL cholesterol or triglyceride levels and lowered LDL cholesterol level only if fiber content was also increased.

There were no increases in foods or nutrients in the low—glycemic index, high-carbohydrate diet that have known effects to raise LDL levels. In fact, the low—glycemic index, high-carbohydrate diet contained slightly less dietary cholesterol and more fiber than the other diets, but these differences would have lowered not raised LDL levels.

Low—glycemic index diets did not lower blood pressure. We also did not study the influence of glycemic index on weight loss. Lowering glycemic index may improve weight loss 6 or maintenance 40 , 41 according to a meta-analysis 6 and some more recent clinical trials, 40 , 41 although others did not find an advantage of low—glycemic index diets.

This trial oversampled black individuals because of their greater burden of type 2 diabetes and CVD that could be modifiable by dietary change.

The results were similar in black and white participants. The main dietary contrast of interest, high vs low glycemic index, included participants, exceeding the goal of However, the number of participants for each dietary contrast ranged from to Still, the precision of estimation of effects, as shown by the confidence intervals, was adequate for clinically relevant inference on the risk factors of interest.

In this 5-week controlled feeding study, diets with low glycemic index of dietary carbohydrate, compared with high glycemic index of dietary carbohydrate, did not result in improvements in insulin sensitivity, lipid levels, or systolic blood pressure.

Corresponding Author: Frank M. Sacks, MD, Department of Nutrition, Harvard School of Public Health, Huntington Ave, Boston, MA fsacks hsph. Author Contributions: Dr Sacks had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Acquisition, analysis, or interpretation of data: Sacks, Carey, Anderson, Miller, Copeland, Charleston, Harshfield, Laranjo, McCarron, Yee, Appel. Drafting of the manuscript: Sacks, Carey, Anderson, Copeland, Laranjo, Swain. Critical revision of the manuscript for important intellectual content: Sacks, Carey, Anderson, Miller, Charleston, Harshfield, McCarron, White, Yee, Appel.

Administrative, technical, or material support: Carey, Miller, Copeland, Harshfield, Laranjo, Swain, Appel. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Sacks was an expert witness in litigation involving POM Wonderful, Hershey, Unilever, and Keebler.

No other disclosures were reported. The funding agency provided critical review of the research grant application and the protocol and monitored the progress of the study.

These companies were not involved in the design, execution, analysis, interpretation, or manuscript writing or critique. Additional Contributions: We thank David S.

We also thank the Frederick Church of the Brethren, Frederick, Maryland, which provided space for distribution of food to study participants. full text icon Full Text. Download PDF Top of Article Abstract Introduction Methods Results Discussion Conclusions Article Information References.

Figure 1. Participant Screening, Enrollment, and Follow-up in the OmniCarb Study. View Large Download. Figure 2. Effect of the Study Diets on Blood Glucose and Insulin Levels Over 12 Hours. Figure 3. Effect of Study Diets on Main Outcomes. Table 1. Nutrient Targets and Content of the 4 Study Diets a.

Table 2. Table 3. Primary Outcomes at Baseline and at the End of Feeding on Each Diet a. Audio Author Interview Glycemic Index, Cardiovascular Disease, and Insulin Sensitivity. Video Interview. JAMA Report Video. Supplement 1.

Supplement 2. eFigure 1. Multiple imputation eFigure 2. Oral glucose tolerance testing, glucose and insulin eTables 1a to 1u. Daily menus for 7 days for the 4 study diets at , , and kcal eTable 2. Urinary nitrogen, creatinine, sodium, and potassium eTable 3.

Outcomes eTable 4. Apolipoproteins B, C-III and E; and lipoprotein cholesterol and triglyceride eTable 5. Main results for constant cohort; Participants who completed all 4 diets eTable 6: Systolic BP Primary Outcome eTable 7: Diastolic BP eTable 8: HDL cholesterol Primary Outcome eTable 9: LDL cholesterol Primary Outcome eTable Triglycerides Primary Outcome eTable Total Cholesterol eTable Non-HDL Cholesterol eTable Fasting Glucose eTable Fasting Insulin eTable HOMA Index of Insulin Resistance eTable Insulin sensitivity determined from serum glucose and insulin levels during an oral glucose tolerance test Primary Outcome.

Wolever TM, Jenkins DJ, Jenkins AL, Josse RG. The glycemic index: methodology and clinical implications. Am J Clin Nutr. PubMed Google Scholar. Atkinson FS, Foster-Powell K, Brand-Miller JC. International tables of glycemic index and glycemic load values: Diabetes Care. PubMed Google Scholar Crossref.

Wolever TM, Gibbs AL, Mehling C, et al. The Canadian Trial of Carbohydrates in Diabetes CCD , a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein.

Reynolds RC, Stockmann KS, Atkinson FS, Denyer GS, Brand-Miller JC. Effect of the glycemic index of carbohydrates on day-long 10 h profiles of plasma glucose, insulin, cholecystokinin and ghrelin. Eur J Clin Nutr. Fabricatore AN, Ebbeling CB, Wadden TA, Ludwig DS. Continuous glucose monitoring to assess the ecologic validity of dietary glycemic index and glycemic load.

Livesey G, Taylor R, Hulshof T, Howlett J. Glycemic response and health: a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes. Appel LJ, Moore TJ, Obarzanek E, et al; DASH Collaborative Research Group.

A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. Appel LJ, Sacks FM, Carey VJ, et al; OmniHeart Collaborative Research Group. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial.

de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study.

Estruch R, Ros E, Salas-Salvadó J, et al; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet.

Michaud DS, Fuchs CS, Liu S, Willett WC, Colditz GA, Giovannucci E. Dietary glycemic load, carbohydrate, sugar, and colorectal cancer risk in men and women.

Cancer Epidemiol Biomarkers Prev. White WB, Anwar YA. Evaluation of the overall efficacy of the Omron office digital blood pressure HEM monitor in adults. Blood Press Monit. Matsuda M, DeFronzo RA.

Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Gannon MC, Nuttall FQ, Westphal SA, Fang S, Ercan-Fang N. Acute metabolic response to high-carbohydrate, high-starch meals compared with moderate-carbohydrate, low-starch meals in subjects with type 2 diabetes.

Ludbrook J. Multiple inferences using confidence intervals. Clin Exp Pharmacol Physiol. Jones G, Kenward MG. Design and Analysis of Cross-Over Trials. Second Ed. Boca Raton, FL: CRC Press; Mensink RP, Katan MB. Effect of dietary fatty acids on serum lipids and lipoproteins: a meta-analysis of 27 trials.

Arterioscler Thromb. Obarzanek E, Sacks FM, Vollmer WM, et al; DASH Research Group. Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hypertension DASH Trial. Sloth B, Krog-Mikkelson I, Flint A, et al.

No difference in body weight decrease between a low-glycemic-index and a high-glycemic-index diet but reduced LDL cholesterol after wk ad libitum intake of the low-glycemic-index diet.

Not getting enough exercise can affect the way insulin regulates blood sugar levels. According to the American Diabetes Association , physical activity plays a vital role in keeping blood sugar levels steady. Aim for around 30 minutes of exercise per day, at least 5 days per week.

A person can also add more activity to their daily routine by taking the elevator instead of the stairs, going for a walk during their lunch break, or using a standing desk. It is common in prediabetes, a condition that can progress to type 2 diabetes.

Diet plays an essential role in preventing insulin resistance. Adding more foods that are high in fiber, protein, and heart-healthy fats to the diet can be beneficial. Managing underlying health conditions, getting plenty of sleep, and managing stress levels can also help promote overall health and improve insulin resistance.

A diagnosis of prediabetes does not mean that you will definitely advance to diabetes, though it is a high risk factor. The good news is that prediabetes is reversible. These include reducing total carbohydrate intake; switching from processed carbs to high fiber, low GI carbs; losing weight; doing daily exercise; getting good quality sleep for 7—9 hours a night; and managing stress.

Low insulin sensitivity can cause blood sugar levels to rise, which may lead to type 2 diabetes. Learn more about natural ways to improve insulin…. Insulin helps the body use glucose to produce energy. Insulin resistance occurs when excess sugar circulates in the body.

Over time, it can lead to…. What is insulin stacking? Read on to learn more, such as what it means, how insulin helps manage diabetes, and how to avoid overcorrecting.

A low-carb diet is one strategy to help manage diabetes symptoms and reduce the risk of complications. In this article, learn why a low-carb diet…. Researchers said baricitinib, a drug used to treat rheumatoid arthritis, showed promise in a clinical trial in helping slow the progression of type 1….

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Medical News Today. Health Conditions Health Products Discover Tools Connect. Diet tips to improve insulin resistance. Medically reviewed by Kim Rose-Francis RDN, CDCES, LD , Nutrition — By Adam Felman — Updated on March 3, Foods to eat Foods to limit Diet tips Understanding insulin resistance Causes Summary Dietary choices that support insulin sensitivity include non-starchy vegetables, whole grains, and citrus fruits.

Foods to eat. Share on Pinterest A balanced diet may help people manage their blood sugar levels. Foods to limit. Nutrition resources For more science-backed resources on nutrition, visit our dedicated hub.

Was this helpful? Diet tips. Share on Pinterest The Mediterranean diet can improve insulin sensitivity. Glycemic index. Understanding insulin resistance. Share on Pinterest Sleep problems might increase insulin resistance.

Q: Does prediabetes always turn into diabetes? A: A diagnosis of prediabetes does not mean that you will definitely advance to diabetes, though it is a high risk factor. Natalie Butler, RD, LD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

How we reviewed this article: Sources. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations.

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What to know about insulin resistance Medically reviewed by Lauren Castiello, RN. Useful tips to help avoid insulin stacking Medically reviewed by Kelly Wood, MD. A guide to low-carb diets for diabetes.

Snd Journal volume 8Lnsulin number: 5 Cite this article. Metrics details. The Omega- fatty acids for athletes of GI and insulin resistance epidemic of obesity and type insuliin GI and insulin resistance suggests that new nutritional strategies insuln needed insulni the Dairy-free milkshakes is to insylin overcome. A promising nutritional approach suggested by this thematic review is metabolic effect of low glycaemic-index diet. The currently available scientific literature shows that low glycaemic-index diets acutely induce a number of favorable effects, such as a rapid weight loss, decrease of fasting glucose and insulin levels, reduction of circulating triglyceride levels and improvement of blood pressure. Based on associations between these metabolic parameters and risk of cardiovascular disease, further controlled studies on low-GI diet and metabolic disease are needed. Peer Review reports. GI and insulin resistance


Should You follow Glycemic Index IF You Are Diabetic? - Glycemic Index and Diabeties

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