The presentation in detail covers the Glycemic index and glycemic load of various kinds of food. The standard calculation of Glycemic index and GLycemic load.
Moreover, it covers the food processing effects that can alter the glycemic load and glycemic index like gelatinization, retrogradation, cooking, annealing, etc.
The presentation in detail covers the Glycemic index and glycemic load of various kinds of food. The standard calculation of Glycemic index and GLycemic load.
Moreover, it covers the food processing effects that can alter the glycemic load and glycemic index like gelatinization, retrogradation, cooking, annealing, etc.
Nutritional assessment using anthropometric, biochemical, clinical, and dietary methods with a larger understanding of anthropometric methods used in Ethiopia
Glycemic Index vs. Glycemic Load: What's the Difference? - Johanna Burani, MS...Nutrition Works, LLC
What is the difference between glycemic index and glycemic load? What does each tell about a carbohydrate? Johanna Burani, MS, RD, CDE explains these differences and the calculations involved.
[Also available with narration at http://www.EatGoodCarbs.com]
A Glycemic index (GI) is basically a ranking system of our carbohydrates that describes how quickly your food will influence your blood sugar level.
This GI tool gives an idea of the rate of absorption and digestion of your carbohydrates.
The GI has been classified in three categories - low, medium and high GI.
The high glycemic index foods are quickly broken down in your intestine and cause a rapid spike in blood sugar levels after consumption.
The moderate glycemic index foods get broken slightly slow in your intestine than high GI. These foods may also spike your blood sugar but not instantly.
Low-GI foods are best for your health if you want to stay healthy and lean.
The purpose of a low GI diet is to provide sustained energy levels and prevent the instant rise of blood glucose levels.
Low GI foods do not spike your blood sugar. Because of this, they reduce the risk of having diabetes.
The glycemic index only tells what food increases blood glucose but fails to describe how much food we should take at a particular time.
Therefore, Glycemic Index is not a perfect system but a helpful tool for calculating glycemic load.
Glycemic load gives a more accurate picture of your food. It describes the effect of a specific amount of carbohydrates on blood glucose levels.
Overall, glycemic load minimizes the limitation of glycemic index.
Glycaemic Index A Practical Measure For Maintaining A Healthy DietGeoffreyOsullivan
An overview of methods to determine the effect of increased blood glucose after eating certain foods and linking this to desease risk and improved health
Nutritional assessment using anthropometric, biochemical, clinical, and dietary methods with a larger understanding of anthropometric methods used in Ethiopia
Glycemic Index vs. Glycemic Load: What's the Difference? - Johanna Burani, MS...Nutrition Works, LLC
What is the difference between glycemic index and glycemic load? What does each tell about a carbohydrate? Johanna Burani, MS, RD, CDE explains these differences and the calculations involved.
[Also available with narration at http://www.EatGoodCarbs.com]
A Glycemic index (GI) is basically a ranking system of our carbohydrates that describes how quickly your food will influence your blood sugar level.
This GI tool gives an idea of the rate of absorption and digestion of your carbohydrates.
The GI has been classified in three categories - low, medium and high GI.
The high glycemic index foods are quickly broken down in your intestine and cause a rapid spike in blood sugar levels after consumption.
The moderate glycemic index foods get broken slightly slow in your intestine than high GI. These foods may also spike your blood sugar but not instantly.
Low-GI foods are best for your health if you want to stay healthy and lean.
The purpose of a low GI diet is to provide sustained energy levels and prevent the instant rise of blood glucose levels.
Low GI foods do not spike your blood sugar. Because of this, they reduce the risk of having diabetes.
The glycemic index only tells what food increases blood glucose but fails to describe how much food we should take at a particular time.
Therefore, Glycemic Index is not a perfect system but a helpful tool for calculating glycemic load.
Glycemic load gives a more accurate picture of your food. It describes the effect of a specific amount of carbohydrates on blood glucose levels.
Overall, glycemic load minimizes the limitation of glycemic index.
Glycaemic Index A Practical Measure For Maintaining A Healthy DietGeoffreyOsullivan
An overview of methods to determine the effect of increased blood glucose after eating certain foods and linking this to desease risk and improved health
Das ist ein Vortrag, den Dr. Clarence P. Davis im Jahre 2007 im Rahmen eines Anti-Aging Kongresses in Paris gehalten hat. Er beinhaltet theoretisches Basis- und Hintergrundswissen zu den verschiedenen Diaettypen, sowie einige praktische Beispiele aus dem aerztlichen Alltag. Der Vortrag ist auf einem hohen Niveau und richtet sich ausschliesslich an professionelle Leser mit fundierten Vorkenntnissen.
For more information, visit https://www.timberlandmedical.com
This presentation is by Dr LO SIAW PING, a visiting dietician at Timberland Medical Centre
Timberland Medical Centre is a private hospital that has been in operation since 1994. We are strategically located at the 3rd Mile roundabout on Jalan Rock, Kuching, Sarawak, East Malaysia. Our hospital is 10 minutes from the Kuching International Airport and 15 minutes from the Central Bus Terminal. We continually seek to improve and upgrade our services and facilities, as we strive to provide the best medical care for our patients and customers.
Diabetes is raising health concern in India today. Heart health, impaired blood sugar levels are concerns for common man. Heart health and diabetes are categorised as lifestyle conditions. This case study represents dietary and nutritional management for both the conditions.
This is a collection of ‘comics’ and graphics
created during the first wave of Covid-19 occupation of planet earth.
They are in no special order — just published in this slide show in sync with how they were published here:
http://punch-webcomic.blogspot.com
Let’s hope we survive well enough to offer subsequent parts.
dave riley
April 5th, 2020
This is a gallery of bushfire and climate change comics generated in the satirical collage workshop of Dave Riley during the time when so much of Australia caught on fire.
This is gallery selection of racism and refugees comics, generated in the satire workshop of Dave Riley.
Day in and day out production is warehoused here:
http://punch-webcomic.blogspot.com/
A personal meditation on the experience of Fibromyalgia, containing,what may be, some useful lifestyle tips for the newly ill.
More webcomics: http://www.punchratbag.org/
Countering the racist lies & building solidarity with refugeesRatbag Media
Talk presented by Peter Benedek,
Focus of this is on countering the dangerous, racist lies – from politicians, from media – that create climate of fear, of scapegoating. Just what is behind this “fortress Australia” policy?
As Alex – Tamil spokesperson for the boat currently in Indonesia, where a recent hunger strike was held – told GLW: “When people are fleeing war and genocide, how can a country think protecting themselves is more important than helping these people? The world is for all of humankind, we are just like you except we do not have a country.”
“We are refugees and we want to get away from genocide”, Alex said. “There are women and children on board here. And we are not animals, we are people, but we are being treated inhumanely.”
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. Gushers and Tricklers: Practical Use of the Glycemic Index Johanna Burani, MS, RD, CDE American Diabetes Association Southern Regional Conference Marco Island, Florida May 26, 2006
2.
3. What is the glycemic index? Glycemic Index (GI) A scale that ranks carbohydrates by how much they raise blood glucose levels compared to a reference food.
6. Glycemic Index (GI): Sample Graphs Adapted from Good Carbs Bad Carbs Reprinted courtesy of Marlowe & Company.
7.
8.
9.
10. Factors Influencing GI Ranking Physical Entrapment Endosperm Bran Germ Bran acts as a physical barrier that slows down enzymatic activity on the internal starch layer. Lower GI All Bran (38) Pumpernickel bread (50) Higher GI Bagel (72) Corn Flakes (92)
11.
12. Factors Influencing GI Ranking Viscosity of Fiber Viscous, soluble fibers transform intestinal contents into gel-like matter that slows down enzymatic activity on starch. Lower GI Apple (40) Rolled oats (51) Higher GI Whole wheat bread (73) Cheerios (74)
16. Factors Influencing GI Ranking Fat & Protein Content Fat and protein slow down gastric emptying, and thus, slows down digestion of starch. Lower GI Peanut M&M’s (33) Potato chips (54) Special K (69) Higher GI Jelly beans (78) Baked potato (85) Corn Flakes (92)
17.
18. Factors Influencing GI Ranking Acid Content Acid slows down gastric emptying, and thus, slows down the digestion of starch. Lower GI Sourdough wheat bread (54) Higher GI Wonder white bread (73)
19.
20. Factors Influencing GI Ranking Food Processing Highly processed foods require less digestive processing. Lower GI Old fashioned, rolled oats (51) Higher GI Quick, 1-minute oats (66)
21.
22. Factors Influencing GI Ranking Cooking Cooking swells starch molecules and softens foods, which speeds up the rate of digestion. Lower GI Al dente spaghetti – boiled 10 to 15 minutes (44) Higher GI Over-cooked spaghetti – boiled 20 minutes (64)
23. How does all this affect our glycemic levels? How does all this make us feel after eating carbohydrate-containing foods? Type of starch Physical entrapment Viscosity of fiber Sugar content Fat content Protein content Acid content Food processing Cooking Factors Influencing GI Ranking
24. Glycemic Load (GL): What does it mean? Glycemic load measures the degree of glycemic response and insulin demand produced by a specific amount of a specific food. Glycemic load reflects both the quality and the quantity of dietary carbohydrates. GL = GI/100 x CHO (grams) per serving Example: GL of an apple = 40/100 x 15g = 6g
25. Glycemic Load (GL): Calculation 28 g = 98/100 x 29g 1/2 cup glutinous rice 8 g = 38/100 x 22g 1/2 cup converted, LG rice 28 g = 38/100 x 73g 1 2/3 cups converted, LG rice 8 g = 98/100 x 8g 2 1/4 Tbsp glutinous rice
27. GI vs. GL Glycemic Index: ranks carbohydrates based on their immediate blood glucose response. GI = glycemic quality Glycemic Load: helps predict blood glucose response to specific amount of specific carbohydrate food. GL = glycemic quality quantity
28. Benefits of Low GI Diet Are there any documented benefits to lowering the GI of one’s diet? YES! BG levels cholesterol levels weight heart disease risk type 2 DM risk
29. Benefits of Low GI Diet Low GI diet helps lower blood glucose levels. Meta-analysis of 14 studies, 356 subjects (types 1 & 2 DM), 2-52 weeks duration Mean difference - 7.4% in glycated proteins over & above reduction from high GI diet. - 0.43% points in HbA1c over & above reduction from high GI diet Brand-Miller et al. Diabetes Care. 2003; 26; 2263.
30. Benefits of Low GI Diet Low GI diet helps lower blood glucose levels. EURODIAB IDDM Complications Study, 1996 2,054 people, 15-60 y, with type 1 DM Buyken et al. Am J Clin Nutr. 2001; 73; 578. 6.60 86-112 Highest quartile 6.04 58-78 Lowest quartile HbA1c GI
31. Benefits of Low GI Diet Low GI diet improves lipid levels. NHANES III, 1988-1994 13,907 American adults, 20+ y Ford & Liu. Arch Intern Med. 2001; 161; 572-576. 49.42 Highest quintile 52.51 Lowest quintile HDL-C GI
32. Benefits of Low GI Diet Low GI diet improves lipid levels. 23 obese young adults, 18-35 y, BMI > 27, 12 mos. duration Ebbling et al. Am J Clin Nutr. 2005; 81; 981. -19.1 1.1 -7.4 -6.2 77 Low calorie, low fat diet -37.2 12.2 -9.7 -8.5 53 Ad libitum low GL diet TG HDL LDL Tot. chol. GL
33. Benefits of Low GI Diet Nurses’ Health Study, 1984-1996 74,091 women, 38-63 y Lin et al. Am J Clin Nutr. 2003; 78; 923. Calculated odds ratios (lowest > highest quintiles) Low GI diet aids in weight control. -49% -34% Dietary fiber +26% +18% Refined grains -23% -19% Whole grains Major weight gain (≥25kg) n = 657 BMI (≥30) n = 6,400
34. Benefits of Low GI Diet Burani & Longo. Diabetes Educ. 2006; 32; 83. Low GI diet aids in weight control. Post low GI MNT counseling, 21 subjects, 21-89 y, 3-36 mos. pre LGI-MNT post LGI-MNT
35. Benefits of Low GI Diet Low GI diet decreases risk of heart disease. Nurses’ Health Study, 1984-1994 75,521 adult women, 38-63 y, free of CHD 10 year follow-up: 761 cases of CHD Lin et al. Am J Clin Nutr. 2000; 71; 1455-1461. 1.31 GI highest quintile 1.98 GL highest quintile Relative risk of CHD
36. Benefits of Low GI Diet Low GI diet decreases risk of heart disease. Nurses’ Health Study, 1980-1999 78,779 women, 38-63 y, free of CVD 18 year follow-up: 1,020 stroke cases documented Oh et al. Am J Epid. 2005; 161; 161-169. 0.66 for total stroke 0.51 for hemorrhagic stroke cereal fiber (all subjects) 1.61 for total stroke GL intake (BMI ≥ 25) 2.13 for total stroke 3.84 for hemorrhagic stroke CHO intake (BMI ≥ 25) 2.05 for hemorrhagic stroke CHO intake (all subjects) Relative risk
37. Benefits of Low GI Diet Low GI diet decreases risk of diabetes. Nurses’ Health Study, 1986-1992 65,173 US women 40-65 y, free of DM 6 year follow-up: 915 cases of type 2 DM Salmeron et al. JAMA. 1997; 277; 472. 2.50 GL cereal fiber 0.72 cereal fiber 1.47 GL 1.37 GI Relative risk
38. Benefits of Low GI Diet Low GI diet decreases risk of diabetes. Health Professionals’ Follow-up Study, 1986-1992 42,759 US men 40-75 y, free of DM 6 year follow-up: 523 cases of type 2 DM Salmeron et al. Diabetes Care. 1997; 20; 245. 2.17 GL cereal fiber 0.70 cereal fiber 1.37 GI Relative risk
40. What Should I Eat? 2005 Dietary Guidelines Balance calories in with calories out. Eat balanced diet with variety of nutrient-dense foods and beverages. Consume 2 cups fruit, 2½ cups vegetables per day. (2,000 calories intake) Choose whole grains for at least half of daily grain consumption. Consume 3 cups FF/LF milk or equivalent. Keep fat consumption 20-35% of daily calories. (mono & polyunsaturated) Consume less than 2300 mg sodium/day. Choose foods with little added sugar or caloric sweeteners. Drink alcohol in moderation. Practice food safety handling and preparing rules.
41. Caution! Do not focus exclusively on achieving a low glycemic load diet with all low glycemic index food choices. Result could be: high fat low carbohydrate low fiber calorically dense Instead…
42. A Better Idea Aim for a well-balanced diet that includes low glycemic index carbohydrates. Use glycemic load as a guide for controlling portions. Hint: Low GI CHOs allow for larger portions , while regulating the GL. High GI CHOs require smaller portions to regulate the GL.
48. What Should I Eat? Eat high-fiber breakfast cereals (oats, bran, barley) How to increase consumption of low GI foods Add berries, nuts, flaxseed and cinnamon to high GI cereals. OR
49. What Should I Eat? Choose dense, whole grain and sourdough breads and crackers. How to increase consumption of low GI foods Add a heart-healthy protein and/or condiment to high GI breads and crackers. OR
50. What Should I Eat? Include 5-9 servings of fruits and vegetables every day. How to increase consumption of low GI foods No ifs, ands or buts – just do it! (Mom was right.) OR
51. What Should I Eat? Replace white potatoes with yams or sweet potatoes. How to increase consumption of low GI foods Try canned new potatoes, or just eat smaller portion of high GI potatoes. OR
52. What Should I Eat? Eat less refined sugars and convenience foods (soda, sweets, desserts, etc.) How to increase consumption of low GI foods Combine nuts, fruit, yogurt, ice cream with commercial sweets – just watch portion sizes. OR
53. Case Study – “Amy” Before 38 YO administrative assistant Married, no children Height: 5’7” Weight: 320 lbs. BMI: 50 (severe obesity) Type 2 DM since age 35 A1c: 6.3 (Glucophage 500 mg) BP: 148/90 (Altace 10 mg)
54. Case Study – Amy’s Before Diet Breakfast: toasted bagel with cream cheese, 16 oz. orange juice, large coffee with whole milk Lunch: 6” roast beef & cheese sub sandwich w/ mayo, 20 oz. diet Pepsi Snack: (“all afternoon long”) 13 oz. bag Hershey miniature chocolate bars Dinner: ½ box macaroni & cheese (made w/ 2% milk), 3 beef hot dogs on buns, water Snack: 1 ½ cups ice cream 6250 Kcal: 43% CHO (666g), 11% PRO (173g), 46% fat (321g) GI = 57 (moderate) GL = 352 ( very high)
55. Case Study – Amy’s After Diet Breakfast: 2 slices 100% WW toast, 1 Tbsp natural, NSA peanut butter, 1 Tbsp all-fruit jelly, 1 cup fresh strawberries, large coffee w/ skim milk Lunch: 4 oz. grilled chicken breast, large green salad with varied fresh vegetables & 2 Tbsp vinaigrette dressing, small boiled sweet potato, orange, diet iced tea Snack: 6 oz. light yogurt, ½ cup cherries (frozen) Dinner: 4 oz. grilled salmon w/ lemon juice, 1 cup pasta w/ 1 cup broccoli rabe, 1 Tbsp olive oil, water Snack: apple 2150 Kcal: 47% CHO (251g), 19% PRO (104g), 34% fat (82g) GI = 39 (low) GL = 61 (low)
57. Case Study – “Amy” After Weight: 205 lbs BMI: 32 (mild obesity) A1c: 5.2 BP: 120/60, RHR 47 Medications: none.
58. Patient Empowerment Model The patient makes self-directed, informed decisions about personal behavioral changes.
59. Practitioner’s Empowerment Model The practitioner makes self-directed, informed decisions about professional educational changes.
60. high glucose response (high GI) low glucose response (low GI) Plasma glucose response (mmol/L) from a high vs. low GI food. The change in blood glucose concentration over time is expressed and calculated as the area under the curve (AUC) (Wolever et al, 1991). www.glycemicindex.com [email_address]