1 April 2018

GI News - April 2018

GI News

GI News is published by the University of Sydney, School of Life and Environmental Sciences and the Charles Perkins Centre. Our goal is to help people choose the high-quality carbs that are digested at a rate that our bodies can comfortably accommodate and to share the latest scientific findings on food and diet with a particular focus on carbohydrates, dietary fibres, blood glucose and the glycemic index.

Publisher:
Professor Jennie Brand-Miller, AM, PhD, FAIFST, FNSA
Editor: Philippa Sandall
Scientific Editor/Managing Editor: Alan Barclay, PhD, APD AN
Contact GI News: glycemic.index@gmail.com

Sydney University Glycemic Index Research Service
Manager: Fiona Atkinson, PhD, APD AN
Contact: sugirs.manager@sydney.edu.au

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FOOD FOR THOUGHT

HORSE SENSE FOR WEIGHT LOSS 
David Katz
David L. Katz, MD, discusses the implications of the JAMA study that compared low-fat and low-carbohydrate diets for weight loss and health improvement and also profiled the genes of the participants to determine if the genetic patterns thought to predict success on a given diet actually did so. The following edited extract is reproduced with his permission.

“The study, run by Professor Christopher Gardner at Stanford University, randomized over 600 adults to either a fat-restricted or carbohydrate-restricted diet making both diets as ‘good’ as possible. The result was that significant weight loss, and health improvement measured in all the usual ways, occurred in both treatment assignments. Going from the generally poor baseline diet that prevails in America to either a healthy, low-fat diet that emphasized vegetables, and whole, minimally processed foods; or to a healthy low-carbohydrate diet that also emphasized vegetables, and whole minimally processed foods produced significant, and very comparable benefits.

Study participants were not told to track or reduce calories, but by shifting to a much higher-quality diet, they did so as a by-product. Both groups cut their daily calorie intake by about 500 to 600 kcal daily (2100–2510 kilojoules), and lost the amount of weight that would portend. They achieved this by eating wholesome foods in sensible combinations, and by applying some rules and discipline to diets that had neither at the start.

Genetic markers of expected success on one type of diet versus the other proved to be of no value. Weight loss in each diet arm was indistinguishable between those with a genetic profile saying they should do especially well, and those with profiles suggesting they should struggle. Nutrigenomically customized weight loss, despite the buzz it generates, is clearly not ready for prime time.

The study also found no relationship between baseline insulin status and success on a given diet assignment. The high-profile claims that weight loss is all about reducing carbs to reduce insulin prove to be apocryphal. A shift to wholesome foods in sensible combinations is effective at lowering weight and improving health regardless of fat or carbohydrate levels, even among those with insulin resistance at the start.

Fundamentally, then, this study suggests that the best way to lose weight and improve health with diet is not by fixating on macronutrients or calories, but by eating wholesome foods in some sensible combination, and emphasizing whole, minimally processed plant foods. The study also indicates that the fundamentals of generally healthful eating pertain to us all, regardless of our genes or insulin levels.

Boy with horse

These findings of science may surprise some, but they don’t much surprise me, and the reason is – sense. Horse sense, in particular. With horses, as with every species other than our own, we tend to think about the kind of diet that is generally right for the kind of animal, rather than the need to customize diet to each individual. Of course, the one does not preclude the other; horses can all be fed like horses, but some horses will need extra grain to maintain their weight, some will do better on certain varieties of hay. But from the start, the focus is on the common theme of a healthful diet for an entire species, and only after that, variations on the theme.

The DIETFITS study findings collectively indicate that the fundamentals of a health-promoting dietary pattern for Homo sapiens matter more than customizing on the basis of inter-individual variations. As with horses, the one does not preclude the other – but the science we own at present better empowers us to customize diet based on preference, rather than genes. It is good to know that when it comes to dietary patterns that are best for health, we do have choices among the variants on a common theme.

Dr. Katz proudly notes that DIETFITS Principal Investigator, Prof. Gardner, is a science advisor to his company, DQPN, LLC, devoted to reinventing dietary intake assessment for the digital age.

About David L. Katz 
• Director, Yale University Prevention Research Center; Griffin Hospital
• Immediate Past-President, American College of Lifestyle Medicine
• Senior Medical Advisor, Verywell.com
• Founder, The True Health Initiative

Read more:

WHAT’S NEW?

VEG OR MED FOR WEIGHTLOSS AND HEART HEALTH? 
Take your pick! According to research published in the American Heart Association’s journal Circulation, vegetarian and Mediterranean diets are likely equally effective in reducing the risk of heart disease and stroke. The study included 107 healthy but overweight participants, ages 18–75, who were randomly assigned to follow either a low-calorie vegetarian diet (which included dairy and eggs), or a low-calorie Mediterranean diet for three months. The Mediterranean diet included poultry, fish and some red meat as well as fruits, vegetables, beans and whole grains. After three months, the participants switched diets for another three months. Most participants were able to stay on both diets. Researchers found participants on either diet:

  • lost about 3 pounds (1.4kg) of body fat 
  • lost about 4 pounds (1.8kg) of weight overall and 
  • experienced about the same change in body mass index (BMI). 
The vegetarian diet however, was more effective at reducing LDL (the “bad”) cholesterol, while the Mediterranean diet resulted in greater reductions in triglycerides, high levels of which may increase the risk for heart attack and stroke.
Mediterranean diet
Read more:
VEGAN DIET MAY REDUCE DIABETES RISK 
In overweight adults with no history of diabetes, a low-fat, plant-based vegan diet can reduce visceral fat and improve both pancreatic beta-cell function and insulin resistance, potentially decreasing the risk of type 2 diabetes, according to researchers from the Physicians Committee for Responsible Medicine. (Measuring the function of beta cells, which store and release insulin, can help assess future type 2 diabetes risk.)

The study randomly assigned 73 participants with no history of diabetes either to an intervention or control group in a 1:1 ratio. For 16 weeks, participants in the intervention group followed a low-fat vegan diet based on fruits, vegetables, whole grains, and legumes with no calorie limit. The control group made no dietary changes. Neither group changed exercise or medication routines.

Based on mathematical modeling, the researchers determined that those on a plant-based diet increased meal-stimulated insulin secretion and beta-cell glucose sensitivity, compared to those in the control group. The plant-based diet group also experienced a decrease in blood glucose levels both while fasting and during meal tests. Physicians Committee researchers posit that because the intervention group experienced weight loss, including loss of body fat, their fasting insulin resistance decreased (i.e. improved), and their beta-cell function improved as a result.

Read more:
HEALTH BENEFITS OF SWAPPING ANIMAL PROTEINS FOR PLANT PROTEINS 
Substituting one to two servings of animal proteins with plant proteins every day could lead to a small reduction in the three main cholesterol markers for cardiovascular disease prevention. The health benefits could be even greater if people combined plant proteins with other cholesterol-lowering foods such as viscous, water soluble fibres from oats, barley and psyllium, and plant sterols, said lead author of the study, Dr John Sievenpiper of St. Michael's Hospital.

The study (a systematic review and meta-analysis of 112 randomized control trials in which people substituted plant proteins for some animal proteins in their diets for at least three weeks) looked at the impact of replacing animal protein with plant protein on three key markers for cholesterol: low-density lipoprotein cholesterol (LDL or “bad” cholesterol, which contributes to fatty build-ups in arteries and raises the risk for heart attack, stroke and peripheral artery disease); non-high density lipoprotein cholesterol (non-HDL-C, or total cholesterol minus HDL or healthy/good cholesterol) and apolipoprotein B (the proteins in bad cholesterol that clog arteries).

Dr. Sievenpiper said the review indicated that replacing one to two servings of animal proteins with plant proteins every day -- primarily soy, nuts and pulses (dried peas and beans, lentils and chickpeas) -- could reduce the main cholesterol markers by about 5 per cent. “That may not sound like much, but because people in North America eat very little plant protein, there is a real opportunity here to make some small changes to our diets and realize the health benefits,” he said.

Vegan diet

Read more:
PARENTING IN THE FACE OF OBESITY AND EATING DISORDERS 
Childhood obesity is a reality for one in five children in the USA. Five million young people are living with severe obesity. At the same time, half a million US teens are living with an eating disorder. Parents and healthcare providers can’t afford to neglect either of these very real problems.

A study in Pediatrics however reports that encouraging teens to diet can do lasting harm. Teens who receive diet talk from their parents are more likely to have problems with obesity as adults. But that’s not all. These teens are also more likely to have issues with binge eating, unhealthy weight-related behaviours, and body dissatisfaction in adulthood.

Most troubling, though, is the finding that this cycle repeats. As parents, these young adults are more likely to inflict that diet talk on their own children. The cycle repeats. ConscienHealth’s Ted Kyle reports on that confusing four-letter word and what parents should do.

Everyone has a diet, meaning their pattern for eating day after day. But in the context of going on a diet, it becomes a verb – dieting. And that’s where the problem starts. Short-term, highly restrictive diets are not a prescription for long-term health. Nonetheless, people consume great volumes of information about diets: low carb, low fat, Mediterranean, vegetarian, flexitarian, DASH, and the list goes on. Some of these can be the foundation for a sustainable pattern of eating for good health. Others can be severely restrictive and unsustainable. What is clear is that parenting requires attention to the severe harm that four letter word, “diet,” can do. Great harm can result when a parent encourages a child to diet. So, what should parents do and say?

The most basic advice is simple: unconditional love. Beyond that basic impulse for all parenting, the American Academy of Pediatrics (AAP) points to some basics for preventing both obesity and eating disorders in teens.
  • Discourage dieting. 
  • Model a sustainable healthy pattern for eating. 
  • Promote a positive body image. 
  • Plan for family meals. 
  • Talk health, not weight. 
  • Pay attention to bullying and mistreatment. If you see clues that something is wrong, follow up. Schools and teachers have an obligation to help. 
  • Seek out real help for obesity. Talk to your pediatrician. Seek out a qualified program with specialists who understand that obesity is a biological issue – not a character flaw or the product of bad parenting. 
Read more:

PERSPECTIVES WITH DR ALAN BARCLAY

DIABETES TIMES FIVE 
While we have known about diabetes for several thousand years, our knowledge and understanding of its causes, pathophysiology and management is constantly evolving. One of the more important areas of research that doesn’t receive the attention it deserves is how we classify the different types. It’s important because it affects how we manage the condition (e.g., with pharmaceuticals, dietary strategies, etc) and also how we pay for its management (Pharmaceutical benefits; Health Insurance rebates, etc).

The current diabetes classification system, with which most people are familiar, was developed back in 1979 and lists four types:

  1. Insulin-dependent or type 1 diabetes 
  2. Non-insulin-dependent or type 2 diabetes 
  3. Gestational diabetes 
  4. Diabetes associated with other syndromes or conditions (e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as in the treatment of HIV/AIDS or after organ transplantation). 
Classifying diabetes into type 1 and type 2 relies primarily on the presence (type 1) or absence (type 2) of autoantibodies against pancreatic islet Beta (B)-cell antigens and age at diagnosis (younger for type 1 diabetes). With this approach, 75–85% of patients are classified as having type 2 diabetes. Of the fourth group, diabetes associated with other syndromes or conditions, latent autoimmune diabetes in adults (LADA) affects less than 10% of people with diabetes, is defined by the presence of glutamic acid decarboxylase antibodies (GADA), is phenotypically indistinguishable from type 2 diabetes at diagnosis, but becomes increasingly similar to type 1 diabetes over time.

Perhaps unsurprisingly, scientists and physicians have been thinking for some time that the current classification system presents challenges to the diagnosis and treatment of people with diabetes, in part due to its conflicting and confounding definitions of type 1, type 2, and LADA.

Back in 2016, a group of US scientists proposed a new B-cell-centric classification of diabetes, based on the presupposition that all diabetes originates from a common denominator – the abnormal pancreatic B-cell. It recognized that interactions between genetically predisposed B-cells with a number of factors, including insulin resistance, susceptibility to environmental influences, and immune dysregulation/inflammation, lead to the range of diabetes sub-types within the spectrum of diabetes. Individually or in concert, and often self-perpetuating, these factors contribute to B-cell stress, dysfunction, or loss through at least 11 distinct pathways. The authors concluded that this classification system enabled “Available, yet underutilized, treatments [to] provide rational choices for more personalized therapies that target the individual mediating pathways of hyperglycemia at work in any given person with diabetes, without the risk of pharmacologically-related hypoglycemia or weight gain or imposing further burden on the B-cells”. To-date, there is little evidence that the B-cell–centric classification of diabetes has been adopted.

Cluster table

The most recent (2018) diabetes classification system has been conceived by Swedish scientists. They developed a 5-cluster system based on the analysis of nearly 9000 people aged 0–96 years who developed diabetes between 2008 and 2016.

Modelling the new system in 500–3500 additional Swedish and Finnish people demonstrated that it was superior to the current diabetes classification system, because it identified people at high risk of diabetic complications (e.g., kidney and eye disease) at diagnosis and provided information about underlying disease mechanisms, thereby guiding choice of therapy.

This new analysis provides another important step towards a more precise, clinically useful stratification of diabetes, representing an important step towards precision medicine in diabetes. It is of course important to note that the new classification system was based on people primarily from northern Europe, with limited non-Scandinavian representation, and the applicability of this strategy to people of other ethnicities needs to be assessed before the model can be adopted globally.

Read more:
Dr Alan Barclay  
Alan Barclay, PhD is a consultant dietitian. He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of  The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).

Contact: You can follow him on Twitter or check out his website.

KEEPING IT GREEN – EATING FOR BODY AND PLANET

THE LAST STRAW 
Single use straws made sense when contaminated cups were an issue. Thanks to improved hygiene standards, catching infectious diseases from drinking vessels is less of an issue but now we have bigger things to worry about. Disposable plastic drinking straws are an environmental disaster.

Straws  

The problem with straws Unable to be recycled, plastic straws are used for 20 minutes at most, then remain intact for hundreds of years. At the popular Manly Beach in Sydney, Australia, scuba diver Kasey Turner found 319 straws during a 20-minute snorkel. Only 1 day later she returned and found an additional 294 straws at the same spot! The following weekend she repeated this exercise and found a further 150 straws, showing just how quickly these straws accumulate. And they’re everywhere. According to the Ocean Conservancy’s 2017 Report, straws made the list of top 10 pollutants littering international coastlines.

Besides making a mess, straws do terrible damage to aquatic life. A video posted in 2015 showing a plastic drinking straw being painfully extracted from the nostril of a turtle off Costa Rica (the video has a warning that it may be inappropriate for some users because it is so upsetting). Straws are even swallowed by seabirds, which then puncture vital organs or block airways leading to a horrible death.

Compostable drinking straws are not much better than plastic straws as very few people compost them, and they are not designed to break down in the ocean. Even if some plastic straws do manage to break down, they become smaller microplastics that fish then eat, and we then eat those fish, plastic and all (yuk). By 2025 it’s been projected there will be more plastic than fish in the oceans.

Straws don’t always suck Straws do have some great uses. Not only do they give us that Instagram perfect pout as we sip on a cocktail, they also keep ladies’ lipstick intact, and make for a less messy drinking experience for kids (especially in the car). Straws can also reduce contact between sugary drinks and teeth, which helps prevent cavities and dental erosion. As straws send liquid to the back of the mouth they reduce flavour exposure for those suffering from nausea (e.g during chemotherapy or morning sickness). Bendy straws also make drinking easier for the less-able, such as the ill, frail, or those with coordination and movement difficulties.

Do you really need a straw? You don’t drink beer or wine through a straw, so why not just say “no straw please”. Your drinks taste just as good (probably better) without a plastic straw. Perhaps a bit more “slow eating” (and drinking) would help. Straws tend to go with grab ‘n go drinks with bubbles and sugar. Let’s face it, we could do with less of these. Taking water with you in a re-usable bottle has health and environmental benefits.

But I’m a sucker for straws! For those of you who can’t give up your straws, there are alternatives, and trendy ones at that. Some bars and cafes already have stainless steel, re-useable straws. You already use their metal cutlery, so why not a metal straw? Metal straws have the added benefit of becoming chilled, which makes your drink even more refreshing, and no plastic taste. You can even buy a stainless-steel straw for home-use and they often come with a cleaning brush. Other plastic straw alternatives include copper, glass and bamboo straws. You can even buy straws from Harvest Straws made from (would you believe it) straw! That’s right, straws have come full circle and are now once again made of wheat or rye straw.

Keeping it green, in a nutshell 

  • Single-use plastic straws are an environmental disaster and can be devastating to marine life. 
  • To reduce plastic pollution, asks for drinks with “no straw please” 
  • For straw devotees, try a reusable drinking straw. 
Thanks to Rachel Ananin AKA TheSeasonalDietitian.com for her assistance with this article.

 Nicole Senior    
Nicole Senior is an Accredited Nutritionist, author, consultant, cook, food enthusiast and mother who strives to make sense of nutrition science and delights in making healthy food delicious.   Contact: You can follow her on Twitter, Facebook, Pinterest, Instagram or check out her website.

GOOD CARBS FOOD FACTS A TO Z

QUINOA 
Quinoa ticks so many boxes – tasty, quick cooking, packed with nutrition, gluten free, versatile and colourful it features in soups, salads, sides, mains, desserts and snacks. It is now grown around the world. What a tasty success story. While it may currently be the trendiest grain on the block, it’s not so very long ago that none of us outside the Altiplano had heard of it. But it has always been the Americas other major grain. But, unlike corn (maize), the rest of the world forgot about it for several hundred years. How come the comeback? Three enthusiastic Americans—Stephen Gorad, Don McKinley and David Cusack of the Quinoa Corporation (now Ancient Harvest brand) put quinoa on our plates.

Spice roasted cauliflower, quinoa and petipa pilaf
The recipe shown in the photograph is Chrissy Freer’s Spice roasted cauliflower, quinoa and petipa pilaf courtesy Australian Healthy Food Guide.

To rinse or not to rinse? 
Like many seeds, quinoa arms itself with bitter-tasting compounds in its outer skin to deter the unwelcome attention from insects and birds. In this case it’s saponins. Most quinoa has been treated in some way to remove the saponins before being packaged for sale, but it’s probably a good idea to pop the grains in a sieve and run them under cold water first. Saponins are phytochemicals found in very small amounts in many plants including veggies (peas, soybeans) and herbs. They tend to pass straight through us as they are poorly absorbed by our bodies. Heating destroys them. Naming rights comes from the soapwort plant (Saponaria officinalis)—its root was used as soap (Latin sapo “soap”) as they have a natural foaming tendency. With natural cleaning products making a comeback, there’s growing interest in using saponins for making natural detergents.

Chia nutrition facts
 Source: The Good Carbs Cookbook

IN THE GI NEWS KITCHEN

THE GOOD CARBS COOKBOOK 
The Good Carbs Cookbook (by Alan Barclay, Kate McGhie and Philippa Sandall) published by Murdoch Books helps you choose the best fruits, vegetables, beans, peas, lentils, seeds, nuts and grains and explains how to use them in 100 refreshingly nourishing recipes to enjoy every day, for breakfast, brunch, lunch, dinner and dessert. The recipes are easy to prepare, (mostly) quick to cook, long in flavour and full of sustaining goodness, so you feel fuller for longer. There is a nutritional analysis for each recipe and tips and helpful hints for the novice, nervous, curious or time-starved cook.

THE GOOD CARBS COOKBOOK

MIXED GRAINS SALAD WITH MARINATED ZUCCHINI 
Slow cooking barley combines with quick-cooking quinoa in this refreshing salad. The grains soak up the bold flavours giving this Med-style dish real bite and substance. Serves: 6 • Preparation time: 40 minutes Cooking time: 30 minutes

MIXED GRAINS SALAD WITH MARINATED ZUCCHINI

6 small zucchini (courgettes)
About ¼ cup olive oil
Salt flakes and freshly ground pepper
2 garlic cloves, crushed
¼ cup red wine vinegar
1 tablespoon caster sugar
3 tablespoons torn mint leaves
3 tablespoons torn parsley leaves

Mixed grains salad
1 cup pearl barley, cooked
1 cup quinoa, rinsed and cooked
1 cup halved red cherry tomatoes
1 cup halved yellow cherry tomatoes
½ cup pitted black olives
½ cup walnut halves
4 large leaves radicchio, roughly torn
2 handfuls torn pale inner leaves of curly endive or rocket
Sea salt flakes and ground pepper to taste (optional)
⅓ cup extra virgin olive oil
1 tablespoon red wine vinegar

To make the marinated zucchini, wash, trim and cut the zucchini lengthways into 8 mm (⅜ in) thick slices. Working in batches, heat 2 tablespoons of the olive oil in a sturdy non-stick pan over medium-high heat. Arrange the zucchini in a single layer in the pan and cook about 3 minutes each side until well browned. Remove from the pan, arrange in a shallow dish and sprinkle lightly with salt and pepper. Warm the garlic, vinegar and sugar in a small pan and pour over the zucchini. Scatter with mint and parsley, toss lightly and leave at room temperature for 1 hour before serving. • Put the barley, quinoa, tomatoes, olives, walnuts, radicchio and curly endive into a large bowl with salt and pepper to taste. Whisk the oil and vinegar together until emulsified, pour over salad and toss lightly. Serve the salad topped with marinated zucchini.

Per serve 
1590kJ/380 calories; 5g protein; 31g fat (includes 4g saturated fat; saturated : unsaturated fat ratio 0.15); 18g available carbs (includes 5.5g sugars and 12.5g starches); 5g fibre; 150mg sodium; 410mg potassium; sodium : potassium ratio 0.37

REVERSING DIABETES 
The latest research into type 2 diabetes shows that for some people it's possible to put diabetes into remission and for others they can prevent or at least delay the complications of diabetes. Reversing Diabetes published by Murdoch Books explores what these findings mean for you. Drawing on over 20 years of clinical experience as an Accredited Practising Dietitian, including nearly 16 years at Diabetes Australia, Dr Alan Barclay combines the highest quality evidence about the nutritional management and prevention of diabetes into one easy-to-read book with 70 delicious recipes.

REVERSING DIABETES

TOMATO, MOZZARELLA AND OLIVE QUINOA PIZZAS 
Quinoa has a light, nutty texture with a slight crunch and will give the pizza bases a lovely crisp texture. Serves 4 • Preparation 20 minutes + 1 hour resting • Cooking 1 hour

TOMATO, MOZZARELLA AND OLIVE QUINOA PIZZAS

¼ cup quinoa, rinsed
2 teaspoons instant dried yeast
1 cup wholemeal plain flour
½ cup stone-ground plain flour semolina, for sprinkling
140g (5oz) artichoke hearts in brine, rinsed and halved
100g (3½oz) reduced-fat grated mozzarella cheese
⅓ cup black olives, halved
1 handful basil leaves
200g (7oz) baby English spinach leaves
250g (9oz) baby roma tomatoes, halved
1 small Lebanese (short) cucumber, thinly sliced
2 tablespoons balsamic vinegar

Tomato sauce 
2 teaspoons olive oil
1 brown onion, finely chopped
2 garlic cloves, crushed
500g (1lb 2oz) ripe tomatoes, finely chopped

Put the quinoa and ½ cup water in a saucepan and bring to the boil. Reduce the heat, cover and simmer for 10–12 minutes or until all the liquid has evaporated. Transfer to a bowl to cool. • Stir the yeast into 185ml (6fl oz/¾ cup) tepid water until the yeast has dissolved. Combine the quinoa and flours in a large bowl. Make a well in the centre, add the yeast mixture and mix to a soft dough. Turn the dough out onto a lightly floured surface and knead for 10 minutes or until smooth and elastic. Return the dough to the lightly oiled bowl, cover with a tea towel (dish towel) and rest in a warm place for 1 hour or until doubled in size.

To make the sauce, heat the oil in a saucepan over medium heat. Cook the onion, stirring, for 4 minutes or until softened. Add the garlic and stir for 1 minute. Add the tomatoes, reduce the heat to low, cover and simmer, stirring occasionally, for 15 minutes or until the sauce has thickened. Remove the lid and cook for 5 minutes or until reduced by two-thirds. Set aside to cool, then purée using a stick blender.

Preheat the oven to 220°C (425°F). Sprinkle two large baking trays with semolina. Divide the dough into four portions and roll each on a lightly floured surface into a 20cm (8inch) round, about 5mm (¼inch) thick. Place on the prepared trays. • Spread the tomato sauce over the bases, then top with the artichokes, mozzarella and olives. Bake the pizzas for 18–20 minutes or until crisp and golden. Top with the basil leaves and cut into wedges. • Drizzle the spinach, tomatoes and cucumber with the vinegar and serve with the pizzas

Per serve
1790kJ/ 426 calories; 21g protein; 9.5g fat (includes 3g saturated fat; saturated : unsaturated fat ratio 0.46); 58g available carbs (includes 10g sugars and 48g starches); 11g fibre; 270mg sodium; 1150mg potassium; sodium : potassium ratio 0.23

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1 March 2018

GI News - March 2018

GI News

GI News is published by the University of Sydney, School of Life and Environmental Sciences and the Charles Perkins Centre. Our goal is to help people choose the high-quality carbs that are digested at a rate that our bodies can comfortably accommodate and to share the latest scientific findings on food and diet with a particular focus on carbohydrates, dietary fibres, blood glucose and the glycemic index.

Publisher:
Professor Jennie Brand-Miller, AM, PhD, FAIFST, FNSA
Editor: Philippa Sandall
Scientific Editor/Managing Editor: Alan Barclay, PhD, APD AN
Contact GI News: glycemic.index@gmail.com

Sydney University Glycemic Index Research Service
Manager: Fiona Atkinson, PhD, APD AN
Contact: sugirs.manager@sydney.edu.au

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FOOD FOR THOUGHT

ANYTHING TO DECLARE? 
Dr Sharma

Conflict of interest is about much more than money says Dr Arya Sharma. In a blog post in Obesity Notes (a shortened version reprinted here with permission) he highlights the conflicts and potential biases nutrition researchers should not hesitate to acknowledge and disclose that John Ionnadis and John Trepanowski raise in JAMA.

First, the authors focus on nutrition research for good reasons. They say: “The totality of an individual’s diet has important effects on health, [while] most nutrients and foods individually have ambiguously tiny (or nonexistent) effects. Substantial reliance on observational data for which causal inference is notoriously difficult also limits the clarifying ability of nutrition science. When the data are not clear, opinions and conflicts of interest both financial and nonfinancial may influence research articles, editorials, guidelines, and laws. Therefore, disclosure policies are an important safeguard to help identify potential bias.”

While the potential for financial conflict in relationship to the food industry is well recognised and there are now well-established disclosure norms, other conflicts, of which there are many, are not routinely acknowledged, let alone, disclosed. For one, there are significant financial conflicts that have nothing to do with taking money from industry. For example: “Many nutrition scientists and experts write books about their opinions and diet preferences. Given the interest of the public in this topic, books about nutrition, diets, and weight loss often appear on best-selling lists, even though most offer little to no evidence to support their frequently bold claims.”

DIET BOOKS

Furthermore: “Financial conflicts of interest can also appear in unexpected places. For example, many not-for-profit nutrition initiatives require considerable donor money to stay solvent. Public visibility through the scientific literature and its reverberation through press releases, other media coverage, and social media magnification can be critical in this regard.”

But conflicts can get even more complicated when they start reflecting researchers’ own personal views and biases: “Allegiance bias and preference for favorite theories are prevalent across science and can affect any field of study. It is almost unavoidable that a scientist eventually will form some opinion that goes beyond the data, and they should. Scientists are likely to defend their work, their own discoveries, and the theories that they proposed or espoused.” While that is certainly true for any area of research, nutrition scientists face an additional challenge.

“Every day they must make numerous choices about what to eat while not allowing those choices to affect their research. Most of them also have been exposed to various dietary norms from their family, culture, or religion. These norms can sometimes be intertwined with core values, absolutist metaphysical beliefs, or both. For instance, could an author who is strongly adherent to some religion conclude that a diet-related prescription of his or her religion is so unhealthy as not to be worthwhile?”

The authors propose that nutrition researchers: “disclose their advocacy or activist work as well as their dietary preferences if any are relevant to what is presented and discussed in their articles. This is even more important for dietary preferences that are specific, circumscribed, and adhered to strongly. For example, readers should know if an author is strongly adherent to a vegan diet, the Atkins diet, a gluten-free diet, a high animal protein diet, specific brands of supplements, and so forth if these dietary choices are discussed in an article. The types of articles in which relevant disclosure should be expected include original research, reviews, and opinion pieces (such as editorials).” Although the article focuses on nutrition research, the authors acknowledge that similar biases may exist in other areas of research.

In my own experience, ideological biases (although well-intended) are pervasive through much of the research and publications on topics ranging from physical activity to public health, where I often see strong recommendations made based on evidence that is not even remotely as robust or rigorous as the evidence that comes from, say a large randomised clinical trials of a new prescription drug.

I certainly agree with the authors’ recommendation that: “As a general rule, if an author’s living example could be reasonably expected to influence how some readers perceive an article, disclosure should be encouraged. Authors who have strong beliefs and make highly committed choices for diet or other behaviors should not hesitate to disclose them. Doing so may help everyone understand who is promoting what and why.”

Dr Arya M. Sharma, MD/PhD, FRCPC is Professor of Medicine & Chair in Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Clinical Co-Chair of the Alberta Health Services Obesity Program.

Read more:
• John Ionnadis and John Trepanowski: Disclosures in Nutrition Research: Why It Is Different.
• Dr Arya Sharma: Conflict Disclosures in Nutrition Research

WHAT’S NEW?

MEDITERRANEAN DIET AND DEPRESSION 
A new trial from Deakin University shows improving diet quality helps treat major depression. “We’ve known for some time that there is a clear association between the quality of people’s diets and their risk for depression,” says Professor Felice Jacka, president of the International Society for Nutritional Psychiatry Research. “This is the case across countries, cultures and age groups, with healthy diets associated with reduced risk, and unhealthy diets associated with increased risk for depression. However, this is the first randomised controlled trial to directly test whether improving diet quality can actually treat clinical depression.”

The researchers recruited adults with a major depressive disorder and randomly assigned them to receive over a three-month period either social support (helpful for people with depression), or support from a clinical dietitian. The dietary group were given information and help to improve their diet especially on increasing vegetables, fruits, wholegrains, legumes, fish, lean red meats, olive oil and nuts, and reducing sweets, refined cereals, fried food, fast-food, processed meats and sugary drinks.

Participants in the dietary intervention group had a much greater reduction in their depressive symptoms over the three-month period, compared to those in the social support group. At the end of the trial, a third of those in the dietary support group met criteria for remission of major depression, compared to 8 percent of those in the social support group. “These results were not explained by changes in physical activity or body weight, but were closely related to the extent of dietary change,” says Jacka. “Those who adhered more closely to the dietary program experienced the greatest benefit to their depression symptoms. Importantly, depression also increases the risk of and, in turn, is also increased by common physical illnesses such as obesity, type 2 diabetes and heart disease. Successfully improving the quality of patients’ diets would also benefit these illnesses.”

Read more:

WHAT TO EAT WHEN YOU’RE EXPECTING? 
Pregnant women tend to be overwhelmed with unsolicited advice on a whole range of topics including “eat this, don’t eat that” dietary advice. Recently, a slew of fad diet books promoting low carb diets has cranked up the confusion about what to eat when you are expecting several notches by suggesting that by “reducing the intake of carbohydrates, [people] could significantly improve their health and well-being”. To set the record straight, a pregnant woman absolutely needs nutrient-rich sources of carbohydrate (what we call “good carbs”) in the right amounts to ensure she is meeting her own nutritional needs as well as her baby’s.

Prof Clare Collins and University of Newcastle researchers tackled six questions they are endlessly asked about eating carbs during pregnancy in a recent piece in The Conversation. They are now recruiting pregnant women in Australia (12–22 weeks gestation) to take part in an online survey to learn more about their nutrition knowledge and eating habits. The survey takes about 20–25 minutes and participants go into the draw to win one of four $100 gift cards. You can find out more about the survey and sign up to take part HERE.

Read more:
Six common questions about eating carbs during pregnancy answered

CHOOSING THE RIGHT DRINKS
Diabetes is a disease that develops when the body either stops producing the hormone insulin (type 1) or when the insulin it produces is not working properly (type 2). Insulin sensitivity describes how sensitive the body is to the effects of insulin, which is why it’s a key risk marker for diabetes. Someone who is insulin sensitive will require smaller amounts of insulin to lower blood glucose levels than someone who has low sensitivity to insulin.

A recent randomized controlled trial compared three everyday beverage choices on insulin sensitivity: semi-skimmed milk (recommended in dietary guidelines) with sugar-sweetened and “artificially” (intensely) sweetened soft drinks. Water was the non-calorie control. While the researchers hypothesized that drinking milk would improve insulin sensitivity and risk markers of cardiovascular disease in people who were overweight and obese, that’s not what they found. After 6 months’ intake of milk, or sugar-sweetened or intensely sweetened soft drinks, or water, there was no difference in risk markers for type 2 diabetes in the participants who remained weight stable throughout, suggesting the results were also independent of body weight.

Read more
FEED THE BIRDS 
In February, we wrote about how a dog can prompt you to be more active, help calm jagged nerves, and reduce feelings of isolation and loneliness. Interacting with birds is also good for us, mentally and physically, and people like to do this is by feeding the birds in their garden, “a habit that’s natural and extremely popular around the world,” says Prof Daryl Jones.

Feeding Birds

[Bird feeding] is a really important topic, says Jones, “because of the potential impact we’re having. We’re genuinely changing the shape of the wildlife community that lives in the city with us. These things we must not shy away from – if you are hosting people coming to your place to feed, you don’t allow them to go away sick. You are really, really, careful about how nutrient wise the food is and how clean the plate is. The same goes for birds.

As for a diet of bread and sugar or honey, traditional lorikeet fare in Australia, “that’s not a good idea at all,” says Jones, “as it can become very easily tainted with bacteria and fungi and make the birds ill. Probably the most important suggestion for bird feeders is to avoid mince and bread altogether; the mince is sticky, fatty and has too little calcium; far better is dry or tinned pet food. And bread is terrible for any animal apart from humans.”

Commenting on backyard bird feeding, Grainne Cleary, a researcher at Deakin University who led the Australian bird feeding and watering study, says “we need to understand its effect and provide guidelines to those who regularly feed birds in their backyards or urban settings.” She adds that making healthy food for birds more available on supermarket shelves, rather than just an ordinary cockatiel mix, will drastically improve bird health.

Darryl’s golden rules:

Cleanliness. Sweep up any left overs and spray feeder dish with a mix of water and vinegar. Dry and then add new feed. Daily.
Provide a snack. Not a meal. A little bit of healthy, appropriate food goes a long, long, way.
Never feed birds away from your home. Feeding bread to the ducks and swans at the park is a definite no-no.
Enjoy – because really, you're feeding the birds for yourself, not for their benefit.

Read more: 
Australian Bird Feeding and Watering Study 
Urban Bird Feeding: Connecting People with Nature
To feed or not to feed
Bird Feeding Takes Wing in U.S., With Summer Meals, Designer Seed 
• Darryl Jones: The Birds at My Table. Why We Feed Wild Birds and Why It Matters (publishing March 2018)

PERSPECTIVES WITH DR ALAN BARCLAY

SOCIAL DRINKING 

Many factors influence what, when, and how much we drink, including taste, cultural background, religious beliefs, budget, health, and social occasion ... Drinking lubricates most social functions. It’s one of life’s pleasures. So, let’s look at some of the more popular options.

A round of drinks

Water Plain water is the best drink to quench your thirst: it is the most refreshing, provides zero kilojoules, plus a few minerals. However, it doesn’t seem to work so well socially – few people pop down to the pub for a couple of rounds of water.

Mineral water (with ice and a slice of lemon) is socially more acceptable. Plain mineral water (still or sparkling) contains relatively small amounts of sodium, potassium, magnesium and calcium. Fruit flavoured varieties are increasingly popular and available in sugar sweetened or intensely sweetened (“diet”) varieties. Sugar sweetened versions provide around 400kJ (100 calories) and 24g of carbohydrate (sugars) per cup (250ml); intensely sweetened varieties provide some 12kJ (3 calories) and 0.5g of carbohydrate (sugars) per cup. If you are watching your weight or blood glucose levels, plain or intensely sweetened options are your best options.

Tea/coffee A cuppa with family or friends is a popular social activity in most parts of the world. Black tea or coffee provides very little energy (around 13kJ or 3 calories) or carbohydrate (less than 1g) per cup. Adding milk or sugar increases both of course, with a cup of unsweetened white tea or coffee providing about 75kJ (18 calories) and around 2g of carbohydrate; and a cup of sweetened (2 level teaspoons of sugar) white tea or coffee about 235kJ (55 calories) and around 10g of carbohydrate – enough to raise blood glucose levels in most people with diabetes if the sugar is sucrose (GI=65).

However, if you sweeten your tea or coffee with an intense sweetener like aspartame, saccharin, sucralose or stevia, you don’t appreciably increase its energy or carbohydrate content, and so it won’t adversely affect blood glucose levels or body weight.

Low joule/calorie or “diet” soft drinks Unlike water, tea or coffee, these soft drinks probably shouldn’t be consumed daily, but they are still good choices when socialising as an alternative to alcohol. Carbonated beverages have a low pH (they are acidic), and in theory, frequent consumption may increase the risk of developing tooth decay which is a serious health issue for many people. However, they have no effect on blood glucose levels and provide very few kilojoules (around 5kJ or 1 calorie per cup). There is good evidence that substituting regular soft drinks with diet varieties will help people to lose weight.

Fruit juices and fruit drinks People enjoy these soft options at social gatherings. They are a source of calories, vitamin C, dietary fibre and carbohydrate. On average, they provide approximately 400kJ (95 calories) per cup, and are an important source of vitamin C providing on average 113mg per cup, which is more than twice the RDI (45mg per day). Most fruit juice contains a small amount of dietary fibre, but higher fibre varieties are becoming increasingly common.

Fruit juices and drinks have a low pH and are a source of fermentable carbohydrate for cariogenic bacteria. Frequent consumption may therefore increase the risk of developing tooth decay. On average, fruit juices and drinks provide 22g of carbohydrate per cup. All fruit juices made from low GI fruit and most fruit drinks have a low GI, however a 250ml serve of most varieties has a medium glycemic load.

Sugar sweetened soft drinks Save these for special occasions. Like fruit juices and drinks, they have a low pH and are a source of fermentable carbohydrate for cariogenic bacteria, and consumption is associated with increased risk of tooth decay. On average, a small glass (250ml) of sugar sweetened soft drink provides around 440kJ, 27g of carbohydrate (around 2 exchanges), and most varieties have a medium glycemic index, and a medium–high glycemic load, and consequently they will raise blood glucose levels in people with diabetes.

Hard drinks For many people, social occasions include the enjoyment of alcoholic beverages in moderation. We have discussed them in detail in previous issues of GI News (See “Cheers” in Read More).

The bottom line Plain water is unquestionably the best option for quenching thirst, but it’s rarely the first choice when drinking socially with family, friends and colleagues. There’s an increasingly large variety of beverages out there so choose wisely for your health and enjoyment.

Read more:

Dr Alan Barclay  
Alan Barclay, PhD is a consultant dietitian. He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of  The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).

Contact: You can follow him on Twitter.

KEEPING IT GREEN – EATING FOR BODY AND PLANET

MEAT-LESS

Meat-less movement 

‘Meatless Monday’ is not new. It was started by the US government during World War 1 to reduce consumption of key foods to win the war (interestingly they also had ‘wheatless Wednesday’). It was revived as a health awareness campaign in 2003 to address excessive meat intake in the USA. Since then it has gone from strength to strength. People are seeing the environmental benefits of eating meat-free (or less meat) and not just on Mondays. Eating less meat is a growing global movement. According to Google Trends, interest in ‘vegetarian recipes’ has more than doubled over the past 5 years worldwide. And for those not quite ready to quit meat completely there is now a new category of eaters called ‘flexitarians’ who eat mostly vegetarian foods but have the occasional meaty meal.

The true cost of meat 

There are some costs that are not included in the ticket price of food – the costs to the environment. According to the IPCC, not only are more resources required to produce livestock compared to plant foods, but their manure produces greenhouse gases too - an environmental double whammy. In countries where there are more cattle and sheep, these animals were the greatest agricultural contributor of greenhouse gases.

What can we do? 

There is no doubt meat is nutritious, including red meat. Red meat is a great source of protein, iron and vitamin B12. However, some of us eat more than we need. To minimise your environmental impact, you need to eat ‘just enough’ meat to meet (pardon the pun) your nutritional requirements. For example, the Australian Dietary Guidelines recommended up to 455g cooked lean red meat per week. Ordering a 500g steak at a restaurant is a week’s worth of red meat on its own. Cooking 500g of raw red meat at a meal is enough for a family of 4. If this doesn’t seem enough, add some plant protein like legumes and plenty of vegetables and some wholegrains to fill the plate.

Enjoy variety 

Meat is part of the ‘meat and alternatives’ food group that includes red meat, white meat, fish, eggs and plant-based alternatives like pulses, legumes, nuts and seeds. Aim for 2-3 ‘serves’ of a variety of options from this group per day, where one serve is: 65g of cooked red meat (100g raw); 80g cooked poultry (100g raw); 100g cooked fish (115g raw); 2 eggs; 1 cup (150g) cooked legumes (lentils, chickpeas, black beans); 170g tofu; or 30g of nuts or seeds.

Eating just enough meat, in a nutshell 

  • Make meat a side player rather than the main event – aim for ¼ of the plate as meat, half the plate as vegetables, and a quarter as grains (or starchy vegetable). 
  • Vary your meat choices - smaller animals such as poultry and (sustainable) fish have a smaller footprint. And don’t forget eggs – they offer perfect protein at a smaller environmental cost. 
  • Replace some of your meat with plant proteins: try adding lentils to your spaghetti Bolognese, burgers, meatloaf or casseroles; or chickpeas or tofu and nuts to curries, soups and salads. 

Thanks to Rachel Ananin AKA TheSeasonalDietitian.com for her assistance with this article.

 Nicole Senior    
Nicole Senior is an Accredited Nutritionist, author, consultant, cook, food enthusiast and mother who strives to make sense of nutrition science and delights in making healthy food delicious.   Contact: You can follow her on Twitter, Facebook, Pinterest, Instagram or check out her website.

GOOD CARBS FOOD FACTS A TO Z


BEANS
Beans are packed with good things for good health including slow-digesting carbs, fibre (including the sticky ones that lower cholesterol), vitamins and minerals. But what makes them really stand out from the plant food crowd is their protein – typically 7–10 grams per half cup cooked dried beans.

Roasted Beetroot and White Bean Salad
Picture: Roasted Beetroot and White Bean Salad from The Low GI Vegetarian Cookbook (Hachette Australia)

Renowned for farts and jokes, the main culprits in beans are the large indigestible sugars (raffinose, stachyose and verbascose) which zip through the digestive system and arrive in the large bowel intact where the resident healthy bacteria enthusiastically ferment them and feast. That embarrassing gas is a natural outcome. Eating small amounts regularly helps your body acclimatize. And rinsing beans several times before soaking and cooking helps wash them away (the indigestible sugars are water soluble). Our word is “bean” and the Roman’s was “faba” – but they actually have a common ancestor, the Indo-European bhabh or bhabha which means “swollen” or “swelling”. Whoever had naming rights was spot on – beans are generous providers, swelling up in the cooking pot so that one cup of dried beans gives us two or three cups to serve. It’s no wonder they have made themselves at home in kitchens around the world in classic dishes, family favourites and vegetarian fare. Not only do they bulk things out, they thicken, add texture and colour, absorb flavours, make great partners, and are nourishing, frugal extenders making a little go a very long way.

Chia nutrition facts
 Source: The Good Carbs Cookbook

IN THE GI NEWS KITCHEN

STICKS, SEEDS, PODS AND LEAVES 
Kate contributed the recipes to Ian Hemphill’s best-selling Spice and Herb Bible. You will find more of her recipes on the Herbies spices website. Or you can follow her on Instagram (@herbieskitchen).

Kate

Kate uses Herbies spices and blends in her cooking, but you can substitute with what you have on hand in your pantry.

BLACK LIME and BEAN SALAD

This quick salad is wonderfully enhanced by the zing of black lime powder. It makes a perfect packed lunch that will keep you going all afternoon. Prep: 5 mins Cook time: 5 mins Serves: 4
BLACK LIME and BEAN SALAD

2 x 400g (14oz) cans of 3-bean mix, drained
1 x 400g (14oz) can of unsweetened corn kernels, drained
15 green beans, trimmed and cut into 3cm/1½in pieces (or 1 cup defrosted frozen green beans)
1 avocado, cut into 2cm/¾in cubes
2 tbsp olive oil
1 tbsp lime juice
3 tsp Herbie's Spices
Black Lime Powder
½ cup coriander leaves, roughly chopped

If using fresh beans, blanch for 2 minutes in boiling water, then drain and add to the serving bowl with 3-bean mix and corn kernels. • Whisk together olive oil, lime juice and black lime powder. • Stir dressing through salad with avocado and coriander and serve.

Per serve 
2000kJ/480 calories; 17g protein; 20g fat (includes 3.5g saturated fat; saturated : unsaturated fat ratio 0.21); 47g available carbs (includes 9g sugars and 38g starches); 17g fibre; 815mg sodium; 840mg potassium; sodium : potassium ratio 0.97

CHRISSY FREER’S FOOD WITH ADDED LIFE 
As a qualified nutritionist, Chrissy’s philosophy is simple: limit the amount of processed food in your diet and focus on whole foods. “By returning to eating whole foods, that is foods in their most natural state, we allow our bodies to benefit from all the available nutrients that food can provide.” Steer clear of food fads and miracle cures, if it sounds too good to be true then it probably is!

CHRISSY FREER

SALMON WITH WHITE BEAN MASH 

This delicious meal will be on the table in 25 minutes. It’s rich in the good omega-3 fats and cholesterol-fighting legumes. Recipe and photo (Steve Brown) courtesy www.taste.com.au. Serves 4.
SALMON WITH WHITE BEAN MASH

1 tbsp olive oil
2 garlic cloves, crushed
1 tsp ground cumin
1 tsp finely grated lemon rind
2 x 400g (14oz) cans cannellini beans, rinsed, drained
1 tbsp fresh lemon juice
1 cup fresh continental parsley leaves
1 small red onion, halved, thinly sliced
1 tbsp baby capers, rinsed, drained
olive oil spray 4
(about 125g/4oz each) skinless salmon fillets
steamed green round beans, to serve

Heat the oil in a medium saucepan over medium heat. Add the garlic, cumin and lemon rind and cook, stirring, for 30 seconds or until aromatic. Add the cannellini beans and lemon juice, and cook for 2 minutes. Use a fork to coarsely crush. Set aside and cover to keep warm. • Combine the parsley, onion and capers in a small bowl. • Heat a large non-stick frying pan over medium-high heat. Spray with oil. Cook the salmon for 3-4 minutes each side for medium or until cooked to your liking. • Divide the bean mixture among serving plates. Top with the salmon and the parsley mixture. Serve with green beans.

Per serve 
2250kJ/ 540 calories; 41g protein; 25g fat (includes 5g saturated fat; saturated : unsaturated fat ratio 0.25); 27g available carbs (includes 6g sugars and 21g starches); 16g fibre; 690mg sodium; 1300mg potassium; sodium : potassium ratio 0.53

COPYRIGHT AND PERMISSION

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Nutritional analysis To analyse Australian foods, beverages, processed products and recipes, we use FoodWorks which contains the AusNut and Nuttab databases. If necessary, this is supplemented with data from www.calorieking.com.au or http://ndb.nal.usda.gov/ndb/search.

Disclaimer GI News endeavours to check the veracity of news stories cited in this free e-newsletter by referring to the primary source, but cannot be held responsible for inaccuracies in the articles so published. GI News provides links to other World Wide Web sites as a convenience to users, but cannot be held responsible for the content or availability of these sites. All recipes that are included within GI News have been analysed however they have not been tested for their glycemic index properties by an accredited laboratory according to the ISO standards.

© ®™ The University of Sydney, Australia

1 February 2018

GI News - February 2018

GI News

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Publisher:
Professor Jennie Brand-Miller, AM, PhD, FAIFST, FNSA
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FOOD FOR THOUGHT

DOGS AND HEART HEALTH
Dog owners know how much warmth and comfort their canine companions add to their lives. A growing body of research shows they can do more than that. The Harvard Medical School Health Report, Get Healthy, Get a Dog, discusses how having a dog can prompt you to be more active, help calm jagged nerves, and reduce feelings of isolation and loneliness. Just petting a dog can lower blood pressure and heart rate (while having a positive effect on the dog as well). A new Swedish epidemiological study in Scientific Reports finds it may cut your risk of death from cardiovascular disease.

Cardiovascular disease (CVD) is the leading cause of death worldwide, accounting for 45% of all deaths. Having diabetes means that you are more likely to develop heart disease and have a greater chance of a heart attack or a stroke. As well as a combination of healthy low GI eating, regular physical activity and appropriate medication (and quitting smoking, if you do), there’s a growing body of evidence suggesting having a dog can be good for your heart.

Swedish scientists, who used national registries of more than 3.4 million Swedes aged 40 to 80, found that dog ownership had a dramatic effect on people who live alone, cutting the risk of death from cardiovascular disease by 36%. In households with more people under the same roof, dogs had less of a positive impact, but still lowered deaths from heart disease by 15%. (Just over 13% of those in the study had dogs.) “If you have a dog you neutralise the effects of living alone” said Tove Fall, professor of epidemiology at Uppsala University.

The researchers analysed the effects of different breeds and found that owners of dogs originally bred for hunting, such as terriers, retrievers, and scent hounds, had the lowest risk of cardiovascular disease. People who buy hunting dogs may be more physically active in the first place, because the dogs require so much exercise. The relationship may work both ways though, with livelier dogs effectively demanding that their owners do not slip into an overly-sedentary lifestyle.

“These kinds of epidemiological studies look for associations in large populations but do not provide answers on whether and how dogs could protect from cardiovascular disease. We know that dog owners in general have a higher level of physical activity, which could be one explanation to the observed results. Other explanations include an increased well-being and social contacts or effects of the dog on the bacterial microbiome in the owner. My impression is that this has to do with social support,” said Fall. One key question is whether dogs protect humans against heart disease by reducing blood pressure or through some other effect.

Tove Fall

“It may be that dog owners like to be outdoors more, or are more organised, or more empathic,” Fall said. “There might also be differences between owners and non-owners already before buying a dog, which could have influenced our results, such as those people choosing to get a dog tending to be more active and of better health.”

A recent article in The Conversation, Can pets create health in humans? says: “A study known as the “blue zone” study has focused on factors affecting longevity for over a decade. Nine factors have been identified as increasing lifespan in the communities studied, and many of these factors are increased by pets.” They include natural everyday movement, having a sense of purpose, regular destressing activities, belonging and commitment.

The bottom line from Harvard Health: Don't add a dog to your life if you're not ready or able to take care of one, and prepared to make sure it gets enough exercise. The potential benefits for your heart health are a plus.

Read more:

WHAT’S NEW?

MISTAKEN BELIEFS ABOUT PET NUTRITION AND OBESITY 

  • Obesity in pets is at epidemic proportions. 
  • Obesity and overweight are an important health issue for more than half of our furry friends. 
Domestic cat

Obesity continues to be the greatest health threat to dogs and cats. It is a disease that kills millions of pets prematurely, can cause complications in almost every system in the body with conditions ranging from diabetes to osteoarthritis, creates immeasurable pain and suffering, and costs pet owners tens of millions of dollars in avoidable medical costs.

“Pet owners and vets both agree that good nutrition can extend a pet’s life. But they differ sharply on what constitutes good nutrition. Pet owners are far more likely to think corn and other grains are problematic” writes Ted Kyle in ConscienHealth. “Many think that food labelled organic and raw diets are better. And yet, none of this is supported by good evidence. In fact, no standards exist for pet foods that claim to be organic. Or “holistic”. Or for “treats”, (the pet industry’s fastest growing segment).”

All the little extras that your dog gets everyday can add up to a lot of extra calories and unbalance the diet if you’re not careful say the veterinarians at Tufts who recommend no more than 10% of calories come from foods that are not your dog’s main pet food. Experienced dog owners tend to use them only as a training tool when teaching a dog to walk on a lead, or sit etc. – a reward for good behaviour and carrying out a command.

A report in Vet Record finds that most commercially available dog treats often exceed the recommended daily energy allowance for treats. Researchers led by Giada Morelli at the University of Padua, compared the nutrient composition of different categories of treats to see if the daily intake recommendations on the label were in accordance with WSAVA guidelines. They analysed 32 popular dog treats available in pet shops and supermarkets (five biscuits, ten tender treats, three meat-based strips, five rawhides [dry bovine skin], twelve chewable sticks and six dental care sticks).

Three out of four treats contained between four to nine ingredients, and the ingredients were not precisely described. For example, biscuits and dental sticks had ‘cereals’ listed as the first ingredient, while tenders, meat strips, rawhides and chewable sticks had ‘meat and animal derivatives’ listed first. Almost half mentioned ‘sugars’ on the label's ingredient list and all contained varying amounts of minerals. The most calorically dense treats were biscuits, whereas the least calorically dense were dental sticks. When caloric density was expressed as kcal/treat, rawhides were the most energy-dense products, followed by chewable sticks and dental sticks.

Read more: 
WEIGHT LOSS FOR DOGS
Researchers from the University of Liverpool's Small Animal Teaching Hospital and Royal Canin have recently completed the largest ever international weight loss trial in dogs, involving 340 veterinary practices in 27 countries across the world. All dogs received a specially-formulated high-protein high-fibre weight loss diet for a period of a three months, and the amount of weight loss was determined. In addition, owners were asked to score levels of activity, quality of life, and food-seeking behaviour throughout the trial.

The majority of dogs enrolled in the study lost weight, with the average being 11% of their starting body weight. However, differences were noted between intact and neutered dogs, with neutered dogs losing less on average. Owners also reported improvements in activity and quality of life during the study whilst, despite being on a diet, their food-seeking behaviour became less pronounced.

“While the short-term duration of the study meant that many dogs did not reach their target weight, the fact that owners observed improved activity and quality of life suggests real benefits to wellbeing,” said Professor Alex German. A spokesperson for Royal Canin added: “In addition to improvements in quality of life and activity, owners believed that their dogs begged less as the study progressed, findings that can hopefully assure pet owners that returning their pet to a healthy body condition is beneficial and worthwhile.”

Read more: 

REIMAGINING OBESITY IN 2018 
The recent JAMA theme issue on obesity includes a range of articles on its prevention and management. Edward Livingston notes in an accompanying editorial that: “The approach to the prevention and treatment of obesity needs to be reimagined. The relentless increase in the rate of obesity suggests that the strategies used to date for prevention are simply not working … From a population perspective, the increase in obesity over the past 4 decades has coincided with reductions in home cooking, greater reliance on preparing meals from packaged foods, the rise of fast foods and eating in restaurants, and a reduction in physical activity. There are excess calories in almost everything people eat in the modern era. Because of this, selecting one particular food type, like SSBs [sugar sweetened beverages], for targeted reductions is not likely to influence obesity at the population level. Rather, there is a need to consider the entire food supply and gradually encourage people to be more aware of how many calories they ingest from all sources and encourage them to select foods resulting in fewer calories eaten on a daily basis. Perhaps tax policy could be used to encourage these behaviors, with taxes based on the calorie content of foods. Revenue generated from these taxes could be used to subsidize healthy foods to make them more affordable.”

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WHAT’S THE DIFFERENCE OF HIGH AND LOW GI DIETS (IN MICE AND RATS)?
A systematic review and meta-analysis in Nutrients shows that male mice and rats fed high GI diets increased their body weight, body adiposity, and fasting insulin levels compared to those on low GI diets. While slowing carbohydrate digestion and absorption might be key to beneficial health effects, the low GI diets were also typically high in fibre including resistant starch which may exert mechanisms on metabolism independent of effects on postprandial glycaemia. However, the authors were not able to analyse the metabolic effect of dietary fibre as fibre content was typically not quantified in the original reporting articles, with only two paper specifying fibre content.

What about female mice and rats? “There are too few studies in female animals to be confident of effects,” report the authors calling for future experiments to include females given that the maternal nutritional environment is critical for the development of chronic diseases later in life.

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PERSPECTIVES WITH DR ALAN BARCLAY

DO HIGH CARB DIETS INCREASE THE RISK OF DIABETES? 
High carbohydrate diets, and as a consequence foods and drinks high in carbohydrate, are the current dietary villains. Book store shelves are lined with the latest low-carb fad diet books. Similarly, our supermarket shelves are becoming increasingly stocked with food and drinks that proudly declare that they are low, or at least lower, in carbohydrate, on their food labels and associated marketing materials. Fad diets are great for business.

The theory behind the fad is that consumption of carbohydrate (starches and sugars) increases blood glucose and insulin levels, ultimately increasing insulin resistance, and therefore making it harder for our bodies to utilise fat (from our diets as well as what’s stored in our fat cells). Consequently, they make us get fatter. Because carbohydrate has the most profound effect on blood glucose and insulin levels, many people also think that reducing carbohydrate consumption may correspondingly reduce the risk of developing type 2 diabetes. However, as explained previously in GI News, proteins in food can also increase insulin secretion and fats can increase insulin requirements by increasing insulin resistance. Unfortunately, both foods and human physiology are much more complicated than what is portrayed in the latest fad diets.

Excess weight – particularly carried around the middle (central obesity) – is a well-established risk factor for type 2 diabetes, and randomised controlled trials conducted around the globe have proven conclusively that losing at least 7% of initial body weight will prevent its development in people with pre-diabetes (elevated fasting blood glucose or impaired glucose tolerance).

One of the best examples of this can be found in the Diabetes Prevention Program, which was a large (more than 3000 people), multi-centre randomised controlled clinical trial, which commenced in the USA in the mid-1990s. Participants were over 25, had a BMI over 24 kg/m2, and had pre-diabetes. They were randomly assigned to one of three groups: (1) placebo; (2) metformin; or (3) intense lifestyle.

Low saturated fat meal

People assigned to the intense lifestyle group were encouraged to achieve and maintain over 7% weight loss (based on their initial body weight) and were counselled to follow a reduced-energy (calorie/kilojoule), low-fat (also low in saturated fat) diet and to engage in more than 150 minutes of moderate-intensity physical activity each week. After an average of 2 years and 9 months, people in the lifestyle group had a 58% (3 out of 5) decrease in risk of developing type 2 diabetes, and due to these outstanding results, the trial was discontinued. Careful analysis of the data demonstrated that weight loss through reduced energy intake and increased physical activity was the main driver of their reduced diabetes risk.

Participants’ dietary intake was estimated at the beginning of the study (baseline) and 1 year later using a validated food frequency questionnaire. At baseline, body weight was inversely associated with total carbohydrate consumption and positively associated with total and saturated fat consumption. In other words, diets higher in total and saturated fat and lower in carbohydrate were associated with increased body weight. Similarly, weight loss at 1 year was strongly associated with increased carbohydrate consumption – in particular from foods that were naturally high in dietary fibre like fruits, vegetables and legumes. Weight loss was also associated with decreases in total and saturated fat consumption.

There are several potential reasons why increasing carbohydrate from fruits, vegetables and legumes are associated with weight loss:

  • High carbohydrate and high fibre foods generally have a lower energy density (Calories or kilojoules per gram of food), but are very filling. 
  • The dietary fibres stimulate the production of short-chain fatty acids in the colon, which may alter energy metabolism in our liver, muscles and fat tissues. 
  • Soluble dietary fibres from these foods slow down the passage of the carbohydrate from the stomach and intestine and slow their absorption into the blood. 
  • The carbohydrate and fibre provide important fuel for the microbiome, which in turn effects energy balance. 
The authors overall conclusion was: “Given the widespread public perception that carbohydrates are detrimental in increasing diabetes risk and the increasing prominence of low-carbohydrate diets for weight loss, the current findings are critical to the development of evidence-based recommendations for optimal dietary approaches to prevent diabetes.”

Based on the best available evidence, dietary patterns that encourage the regular consumption of quality carbohydrates do not increase the risk of developing type 2 diabetes. Quite the contrary.

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Dr Alan Barclay  
Alan Barclay, PhD is a consultant dietitian. He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of  The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).

Contact: You can follow him on Twitter.