The Glycemic Index

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The Glycemic Index

Postby JeffN » Sat Apr 02, 2011 12:11 pm

As I’ve been saying for decades, the GI/GL is basically worthless.

Potatoes & Diabetes: Dietary Trends & Truths About Taters
http://www.drmcdougall.com/forums/viewt ... 1&start=15

Q & A with David Richards, D.C., M.D
Do you recommend that diabetics avoid white potatoes?
https://www.facebook.com/notes/national ... 3052782614



Dietary Surveys and Nutritional Epidemiology
Low-, medium- and high-glycaemic index carbohydrates and risk of type 2 diabetes in men

http://journals.cambridge.org/action/di ... 451000485X

Abstract

Findings on dietary glycaemic index (GI) and glycaemic load (GL) as risk factors for type 2 diabetes have been controversial. We examined the associations of dietary GI and GL and the associations of substitution of lower-GI carbohydrates for higher-GI carbohydrates with diabetes risk in a cohort of Finnish men. The cohort consisted of 25 943 male smokers aged 50–69 years. Diet was assessed, at baseline, using a validated diet history questionnaire. During a 12-year follow-up, 1098 incident diabetes cases were identified from a national register. Cox proportional hazard modelling was used to estimate the risk of diabetes, and multivariate nutrient density models were used to examine the effects of substitution of different carbohydrates. Dietary GI and GL were not associated with diabetes risk; multivariate relative risk (RR) for highest v. lowest quintile for GI was 0·87 (95 % CI 0·71, 1·07) and for GL 0·88 (95 % CI 0·65, 1·17). Substitution of medium-GI carbohydrates for high-GI carbohydrates was inversely associated with diabetes risk (multivariate RR for highest v. lowest quintile 0·75, 95 % CI 0·59, 0·96), but substitution of low-GI carbohydrates for medium- or high-GI carbohydrates was not associated with the risk. In conclusion, dietary GI and GL were not associated with diabetes risk, and substitutions of lower-GI carbohydrates for higher-GI carbohydrates were not consistently associated with a lower diabetes risk. The associations of dietary GI and GL with diabetes risk should be interpreted by considering nutritional correlates, as foods may have different properties that affect risk.
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Re: The Glycemic Index

Postby JeffN » Mon Apr 17, 2017 6:59 am

Original Investigation
Effects of High vs Low Glycemic Index of Dietary Carbohydrate on Cardiovascular Disease Risk Factors and Insulin Sensitivity
The OmniCarb Randomized Clinical Trial
JAMA. 2014;312(23):2531-2541. doi:10.1001/jama.2014.16658

http://jamanetwork.com/journals/jama/fu ... le/2040224

Abstract

IMPORTANCE
Foods that have similar carbohydrate content can differ in the amount they raise blood glucose. The effects of this property, called the glycemic index, on risk factors for cardiovascular disease and diabetes are not well understood.

OBJECTIVE
To determine the effect of glycemic index and amount of total dietary carbohydrate on risk factors for cardiovascular disease and diabetes.

DESIGN, SETTING, AND PARTICIPANTS
Randomized crossover-controlled feeding trial conducted in research units in academic medical centers, in which 163 overweight adults (systolic blood pressure, 120–159 mm Hg) were given 4 complete diets that contained all of their meals, snacks, and calorie-containing beverages, each for 5 weeks, and completed at least 2 study diets. The first participant was enrolled April 1, 2008; the last participant finished December 22, 2010. For any pair of the 4 diets, there were 135 to 150 participants contributing at least 1 primary outcome measure.

INTERVENTIONS
(1) A high–glycemic index (65% on the glucose scale), high-carbohydrate diet (58% energy); (2) a low–glycemic index (40%), high-carbohydrate diet; (3) a high–glycemic index, low-carbohydrate diet (40% energy); and (4) a low–glycemic index, low-carbohydrate diet. Each diet was based on a healthful DASH-type diet.

MAIN OUTCOMES AND MEASURES
The 5 primary outcomes were insulin sensitivity, determined from the areas under the curves of glucose and insulin levels during an oral glucose tolerance test; levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides; and systolic blood pressure.

RESULTS
At high dietary carbohydrate content, the low– compared with high–glycemic index level decreased insulin sensitivity from 8.9 to 7.1 units (−20%, P = .002); increased LDL cholesterol from 139 to 147 mg/dL (6%, P ≤ .001); and did not affect levels of HDL cholesterol, triglycerides, or blood pressure. At low carbohydrate content, the low– compared with high–glycemic index level did not affect the outcomes except for decreasing triglycerides from 91 to 86 mg/dL (−5%, P = .02). In the primary diet contrast, the low–glycemic index, low-carbohydrate diet, compared with the high–glycemic index, high-carbohydrate diet, did not affect insulin sensitivity, systolic blood pressure, LDL cholesterol, or HDL cholesterol but did lower triglycerides from 111 to 86 mg/dL (−23%, P ≤ .001).

CONCLUSIONS AND RELEVANCE
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. In the context of an overall DASH-type diet, using glycemic index to select specific foods may not improve cardiovascular risk factors or insulin resistance.


The effects of potatoes and other carbohydrate side dishes consumed with meat on food intake, glycemia and satiety response in children
Citation: Nutrition & Diabetes (2016) 6, e195;
doi:10.1038/nutd.2016.1


Abstract
Background:
The effect of carbohydrate (CHO) foods on blood glucose (BG) is ranked by their glycemic index (GI). Boiled and mashed potatoes (BMPs) are ranked as high GI foods, whereas pasta and rice have moderate GI rankings. The objective of this study was to compare ad libitum consumption of common CHO dishes consumed with meat on meal-time food intake and post-meal satiety, BG, insulin and gut hormones in 11- to 13-year-old normal weight children.

Methods:
Two randomized crossover studies were conducted. At weekly intervals, children (experiment 1: 12 males (M), 8 females (F); experiment 2: 6M, 6 F) received in random order 1 of 5 CHO side dishes of rice, pasta, BMP, fried French fries (FFF) or baked French fries (BFF) eaten freely together with a fixed amount of lean beef (100 g). In experiment-1, food intake over 30 min and subjective appetite were measured for 120 min. In experiment-2, the same outcomes were measured along with BG, plasma insulin and gut hormones.

Results:
The results for boys and girls were pooled as sex was not a factor. In both experiments, children consumed 30–40% less calories at meals with BMP (P<0.0001) compared with all other treatments, which were similar. BMP increased satiety, expressed as a change in appetite per kilocalorie, more than all other treatments (P<0.0001). FFF resulted in the lowest (P<0.0001) glucose and insulin at meal end and post-meal and peptide YY (PYY) post-meal. Blood measures were similar among all other treatments.

Conclusions:
The physiological functions of CHO foods consumed ad libitum at meal time on food intake, appetite, BG, insulin and gut hormone responses in children is not predicted by the GI.
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Re: The Glycemic Index

Postby JeffN » Wed May 03, 2017 8:53 pm

1) White Potatoes, Human Health, and Dietary Guidance
Adv. Nutr. 4: 393S–401S, 2013; doi:10.3945/an.112.003525

http://advances.nutrition.org/content/4/3/393S.full.pdf

The white potato is a concentrated source of carbohydrate, dietary fiber, and resistant starch and continues to be the staple food of choice for many cultures. The white potato is also a concentrated source of vitamin C and potassium. Two of the nutrients in white potatoes, dietary fiber and potassium, have been designated as nutrients of concern in the 2010 Dietary Guidelines for Americans. Potatoes are often maligned in nutrition circles because of their suspected link to obesity, and popular potato foods often contain more fat calories than carbohydrate calories. Some food guides do not include potatoes in the vegetable group because of their association with high-fat diets. However, potatoes should be included in the vegetable group because they contribute critical nutrients. All white vegetables, including white potatoes, provide nutrients needed in the diet and deserve a prominent position in food guides.


2) White Vegetables: Glycemia and Satiety in the international journal,
Adv. Nutr. 4: 356S–367S, 2013; doi:10.3945/an.112.003509.

http://advances.nutrition.org/content/4/3/356S.full.pdf

The objective of this review is to discuss the effect of white vegetable consumption on glycemia, satiety, and food intake. White vegetables is a term used to refer to vegetables that are white or near white in color and include potatoes, cauliflowers, turnips, onions, parsnips, white corn, kohlrabi, and mushrooms (technically fungi but generally considered a vegetable). They vary greatly in their contribution to the energy and nutrient content of the diet and glycemia and satiety. As with other foods, the glycemic effect of many white vegetables has been measured. The results illustrate that interpretation of the semiquantitative comparative ratings of white vegetables as derived by the glycemic index must be context dependent. As illustrated by using the potato as an example, the glycemic index of white vegetables can be misleading if not interpreted in the context of the overall contribution that the white vegetable makes to the carbohydrate and nutrient composition of the diet and their functionality in satiety and metabolic control within usual meals. It is concluded that application of the glycemic index in isolation to judge the role of white vegetables in the diet and, specifically in the case of potato as consumed in ad libitum meals, has led to premature and possibly counterproductive dietary guidance.


3) Low-, medium- and high-glycaemic index carbohydrates and risk of type 2 diabetes in men
British Journal of Nutrition, Volume 105, Issue 8
April 2011 , pp. 1258-1264

https://www.cambridge.org/core/journals ... ore-reader

Abstract

Findings on dietary glycaemic index (GI) and glycaemic load (GL) as risk factors for type 2 diabetes have been controversial. We examined the associations of dietary GI and GL and the associations of substitution of lower-GI carbohydrates for higher-GI carbohydrates with diabetes risk in a cohort of Finnish men. The cohort consisted of 25 943 male smokers aged 50–69 years. Diet was assessed, at baseline, using a validated diet history questionnaire. During a 12-year follow-up, 1098 incident diabetes cases were identified from a national register. Cox proportional hazard modelling was used to estimate the risk of diabetes, and multivariate nutrient density models were used to examine the effects of substitution of different carbohydrates. Dietary GI and GL were not associated with diabetes risk; multivariate relative risk (RR) for highest v. lowest quintile for GI was 0·87 (95 % CI 0·71, 1·07) and for GL 0·88 (95 % CI 0·65, 1·17). Substitution of medium-GI carbohydrates for high-GI carbohydrates was inversely associated with diabetes risk (multivariate RR for highest v. lowest quintile 0·75, 95 % CI 0·59, 0·96), but substitution of low-GI carbohydrates for medium- or high-GI carbohydrates was not associated with the risk. In conclusion, dietary GI and GL were not associated with diabetes risk, and substitutions of lower-GI carbohydrates for higher-GI carbohydrates were not consistently associated with a lower diabetes risk. The associations of dietary GI and GL with diabetes risk should be interpreted by considering nutritional correlates, as foods may have different properties that affect risk.


4) Effects of High vs Low Glycemic Index of Dietary Carbohydrate on Cardiovascular Disease Risk Factors and Insulin Sensitivity
The OmniCarb Randomized Clinical Trial
JAMA. 2014;312(23):2531-2541. doi:10.1001/jama.2014.16658

http://jamanetwork.com/journals/jama/fu ... le/2040224

Abstract

IMPORTANCE
Foods that have similar carbohydrate content can differ in the amount they raise blood glucose. The effects of this property, called the glycemic index, on risk factors for cardiovascular disease and diabetes are not well understood.

OBJECTIVE
To determine the effect of glycemic index and amount of total dietary carbohydrate on risk factors for cardiovascular disease and diabetes.

DESIGN, SETTING, AND PARTICIPANTS
Randomized crossover-controlled feeding trial conducted in research units in academic medical centers, in which 163 overweight adults (systolic blood pressure, 120–159 mm Hg) were given 4 complete diets that contained all of their meals, snacks, and calorie-containing beverages, each for 5 weeks, and completed at least 2 study diets. The first participant was enrolled April 1, 2008; the last participant finished December 22, 2010. For any pair of the 4 diets, there were 135 to 150 participants contributing at least 1 primary outcome measure.

INTERVENTIONS
(1) A high–glycemic index (65% on the glucose scale), high-carbohydrate diet (58% energy); (2) a low–glycemic index (40%), high-carbohydrate diet; (3) a high–glycemic index, low-carbohydrate diet (40% energy); and (4) a low–glycemic index, low-carbohydrate diet. Each diet was based on a healthful DASH-type diet.

MAIN OUTCOMES AND MEASURES
The 5 primary outcomes were insulin sensitivity, determined from the areas under the curves of glucose and insulin levels during an oral glucose tolerance test; levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides; and systolic blood pressure.

RESULTS
At high dietary carbohydrate content, the low– compared with high–glycemic index level decreased insulin sensitivity from 8.9 to 7.1 units (−20%, P = .002); increased LDL cholesterol from 139 to 147 mg/dL (6%, P ≤ .001); and did not affect levels of HDL cholesterol, triglycerides, or blood pressure. At low carbohydrate content, the low– compared with high–glycemic index level did not affect the outcomes except for decreasing triglycerides from 91 to 86 mg/dL (−5%, P = .02). In the primary diet contrast, the low–glycemic index, low-carbohydrate diet, compared with the high–glycemic index, high-carbohydrate diet, did not affect insulin sensitivity, systolic blood pressure, LDL cholesterol, or HDL cholesterol but did lower triglycerides from 111 to 86 mg/dL (−23%, P ≤ .001).

CONCLUSIONS AND RELEVANCE
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. In the context of an overall DASH-type diet, using glycemic index to select specific foods may not improve cardiovascular risk factors or insulin resistance.


5) The effects of potatoes and other carbohydrate side dishes consumed with meat on food intake, glycemia and satiety response in children
Nutrition & Diabetes (2016) 6, e195;
doi:10.1038/nutd.2016.1

Abstract
Background:
The effect of carbohydrate (CHO) foods on blood glucose (BG) is ranked by their glycemic index (GI). Boiled and mashed potatoes (BMPs) are ranked as high GI foods, whereas pasta and rice have moderate GI rankings. The objective of this study was to compare ad libitum consumption of common CHO dishes consumed with meat on meal-time food intake and post-meal satiety, BG, insulin and gut hormones in 11- to 13-year-old normal weight children.

Methods:
Two randomized crossover studies were conducted. At weekly intervals, children (experiment 1: 12 males (M), 8 females (F); experiment 2: 6M, 6 F) received in random order 1 of 5 CHO side dishes of rice, pasta, BMP, fried French fries (FFF) or baked French fries (BFF) eaten freely together with a fixed amount of lean beef (100 g). In experiment-1, food intake over 30 min and subjective appetite were measured for 120 min. In experiment-2, the same outcomes were measured along with BG, plasma insulin and gut hormones.

Results:
The results for boys and girls were pooled as sex was not a factor. In both experiments, children consumed 30–40% less calories at meals with BMP (P<0.0001) compared with all other treatments, which were similar. BMP increased satiety, expressed as a change in appetite per kilocalorie, more than all other treatments (P<0.0001). FFF resulted in the lowest (P<0.0001) glucose and insulin at meal end and post-meal and peptide YY (PYY) post-meal. Blood measures were similar among all other treatments.

Conclusions:
The physiological functions of CHO foods consumed ad libitum at meal time on food intake, appetite, BG, insulin and gut hormone responses in children is not predicted by the GI.



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Re: The Glycemic Index

Postby JeffN » Fri Sep 28, 2018 5:28 am

Review
Relevance of the Glycemic Index and Glycemic Load for Body Weight, Diabetes, and Cardiovascular Disease
Nutrients 2018, 10, 1361; doi:10.3390/nu10101361
http://www.mdpi.com/journal/nutrients


Abstract: Despite initial enthusiasm, the relationship between glycemic index (GI) and glycemic response (GR) and disease prevention remains unclear. This review examines evidence from randomized, controlled trials and observational studies in humans for short-term (e.g., satiety) and long-term (e.g., weight, cardiovascular disease, and type 2 diabetes) health effects associated with different types of GI diets. A systematic PubMed search was conducted of studies published between 2006 and 2018 with key words glycemic index, glycemic load, diabetes, cardiovascular disease, body weight, satiety, and obesity. Criteria for inclusion for observational studies and randomized intervention studies were set. The search yielded 445 articles, of which 73 met inclusion criteria. Results suggest an equivocal relationship between GI/GR and disease outcome. The strongest intervention studies typically find little relationship among GI/GR and physiological measures of disease risk. Even for observational studies, the relationship between GI/GR and disease outcomes is limited. Thus, it is unlikely that the GI of a food or diet is linked to disease risk or health outcomes. Other measures of dietary quality, such as fiber or whole grains may be more likely to predict health outcomes. Interest in food patterns as predictors of health benefits may be more fruitful for research to inform dietary guidance.
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Re: The Glycemic Index

Postby JeffN » Tue Jan 21, 2020 6:53 am

As I’ve been saying for decades, the GI/GL is basically worthless.

Estimating the reliability of glycemic index values and potential sources of methodological and biological variability
The American Journal of Clinical Nutrition, Volume 104, Issue 4, October 2016, Pages 1004–1013, https://doi.org/10.3945/ajcn.116.137208
Published: 07 September 2016

https://academic.oup.com/ajcn/article/1 ... 04/4557132

ABSTRACT
Background: The utility of glycemic index (GI) values for chronic disease risk management remains controversial. Although absolute GI value determinations for individual foods have been shown to vary significantly in individuals with diabetes, there is a dearth of data on the reliability of GI value determinations and potential sources of variability among healthy adults.

Objective: We examined the intra- and inter-individual variability in glycemic response to a single food challenge and methodologic and biological factors that potentially mediate this response.

Design: The GI value for white bread was determined by using standardized methodology in 63 volunteers free from chronic disease and recruited to differ by sex, age (18–85 y), and body mass index [BMI (in kg/m2): 20–35]. Volunteers randomly underwent 3 sets of food challenges involving glucose (reference) and white bread (test food), both providing 50 g available carbohydrates. Serum glucose and insulin were monitored for 5 h postingestion, and GI values were calculated by using different area under the curve (AUC) methods. Biochemical variables were measured by using standard assays and body composition by dual-energy X-ray absorptiometry.

Results: The mean ± SD GI value for white bread was 62 ± 15 when calculated by using the recommended method. Mean intra- and interindividual CVs were 20% and 25%, respectively. Increasing sample size, replication of reference and test foods, and length of blood sampling, as well as AUC calculation method, did not improve the CVs. Among the biological factors assessed, insulin index and glycated hemoglobin values explained 15% and 16% of the variability in mean GI value for white bread, respectively.

Conclusions: These data indicate that there is substantial variability in individual responses to GI value determinations, demonstrating that it is unlikely to be a good approach to guiding food choices. Additionally, even in healthy individuals, glycemic status significantly contributes to the variability in GI value estimates. This trial was registered at clinicaltrials.gov as NCT01023646.

Blood glucose response is affected by several additional factors: differing physical structure of apparently similar foods, food processing or preparation method (45), and meal consumption patterns (single or mixed meals) (11, 22, 46), which can contribute to the marked inter- and intra-individual variation observed in the GI value of foods. These factors, together with those described in this paper, document that there are far too many exceptions that influence the accuracy and precision of GI values calculations for them to be used as a basis for making food-based recommendations. Additionally, GI values do not reflect the nutritional quality of the food, further questioning their clinical relevance.

In summary, our data indicate substantial variability in GI value determinations for white bread despite the use of standardized methodology and multiple testing in a large number of healthy volunteers. The high degree of variability demonstrates that there is potential to misclassify foods into the 3 commonly used GI categories (low, medium, and high), which would result in the inability to distinguish between foods, thus invalidating the practical applicability of the GI value. Additionally, our results indicate that the variability was explained in part by differences in baseline HbA1c and insulin index, suggesting that longer-term glycemic control and insulin response, even in normoglycemic individuals, affect the GI value. The impact of these findings on GI estimates and subsequent associations with chronic disease risk needs to be considered.
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Re: The Glycemic Index

Postby JeffN » Fri Jun 10, 2022 12:33 pm

starchy vegetables, including white potatoes, merit a category reassignment and a more prominent place in dietary guidance.



Multiple Metrics of Carbohydrate Quality Place Starchy Vegetables Alongside Non-starchy Vegetables, Legumes, and Whole Fruit
Front. Nutr., 02 May 2022 | https://doi.org/10.3389/fnut.2022.867378

https://www.frontiersin.org/articles/10 ... 67378/full

Background: Starchy vegetables, including white potatoes, are often categorized as “lower-quality” carbohydrate foods, along with refined grains, 100% fruit juices, sweetened beverages, and sugars, snacks and sweets. Among “higher-quality” carbohydrates are whole grains, non-starchy vegetables, legumes, and whole fruits.

Objective: To apply multiple nutrient profiling (NP) models of carbohydrate quality to foods containing >40% carbohydrate by dry weight in the USDA Food and Nutrient Database for Dietary Studies (FNDDS 2017-18).

Methods: Carbohydrate foods in the FNDDS (n = 2423) were screened using four recent Carbohydrate Quality Indices (CQI) and a new Carbohydrate Food Quality Score (CFQS-4). Cereal products containing >25% whole grains by dry weight were classified as whole grain foods.

Results: Based on percent items meeting the criteria for 4 CQI scores, legumes, non-starchy and starchy vegetables, whole fruit, and whole grain foods qualified as “high quality” carbohydrate foods. Distribution of mean CFQS-4 values showed that starchy vegetables, including white potatoes placed closer to non-starchy vegetables and fruit than to candy and soda.

Conclusion: Published a priori determinations of carbohydrate quality do not always correspond to published carbohydrate quality metrics. Based on CQI metrics, specifically designed to assess carbohydrate quality, starchy vegetables, including white potatoes, merit a category reassignment and a more prominent place in dietary guidance.
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Re: The Glycemic Index

Postby JeffN » Fri Dec 09, 2022 10:37 am

“Potato and Bean diets low in energy density were equally effective in reducing insulin resistance and promoting weight loss in individuals with impaired blood glucose control."


Low-Energy Dense Potato- and Bean-Based Diets Reduce Body Weight and Insulin Resistance: A Randomized, Feeding, Equivalence Trial
Published Online:11 Nov 2022

https://doi.org/10.1089/jmf.2022.0072

https://www.liebertpub.com/doi/10.1089/jmf.2022.0072

Abstract

We evaluated the effect of diets low in energy density (1 kcal/g) and high in either potatoes (Potato) or pulses (Bean) on blood glucose control in participants with insulin resistance. We hypothesized that the Potato and Bean diets would have equivalent effects. This was an 8-week randomized, parallel design, controlled feeding study comparing Potato and Bean diets (50–55% carbohydrate, 30–35% fat, 15–20% protein). Equivalence was prespecified as the mean change in the blood glucose concentration for Potato that was within ±20% of the Bean diet. Thirty-six participants (age: 18–60 years, body mass index: 25–40 kg/m2) with insulin resistance (homeostatic model assessment of insulin resistance [HOMA-IR] >2) were enrolled. Body weight was measured, and subjects underwent a mixed meal tolerance test at baseline and after 8 weeks. Intent-to-treat (ITT) and completer analyses were conducted. Equivalence between the two diets in the area under the curve for serum glucose was attained within ±10%, but the reduction from baseline was not statistically significant. For the Bean diet, insulin (area under the response curve: −2136.3 ± 955.5 mg/[dL∙min], P = .03) and HOMA-IR (−1.4 ± 0.6, P = .02) were lower compared with baseline. ITT and completer analyses were similar, except that HOMA-IR was also reduced by the Potato diet (−1.3 ± 0.6, P < .05). Compliance with the diets was 87–88%, and body weight was reduced in both diets (Potato: −5.6% ± 0.6%; Bean: −4.1% ± 0.6%, P < .001) with no significant difference between the two diets. Potato and Bean diets low in energy density were equally effective in reducing insulin resistance and promoting weight loss in individuals with impaired blood glucose control.
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Re: The Glycemic Index

Postby MINNIE » Sat Dec 10, 2022 4:33 pm

THANK YOU!

This is really important for people to understand.

It's sad to think that obese and/or diabetic and pre-diabetic people are warned away from potatoes, on a false premise.

They would be better off thinking of potatoes (properly prepared) as medicine. Medicine that's cheap and readily available with - no prescription.

Actually if doctors started prescribing potatoes (with no added fat, dairy and moderate salt) their patients would actually get better.
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