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Glycemic Index

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Carbohydrates Glycemic Index (carbsGI) are is a measure of how much a key energy source for runnersfood raises blood glucose (blood sugar). The way carbs are used depends on the state you are in. If you are in A food with a higher Glycemic Index raises the middle of exercise, these carbs tend to be used directly for energyblood sugar more than a food with a lower Glycemic Index. If you The Glycemic Index value is based on a comparison with a reference food, normally either white bread or glucose. High Glycemic Index foods are at recovering from exerciselinked to a wide variety of health problems, these carbs will go into quick access storage (but there is evidence that different people may have widely differing Glycemic Indexes for the same food.[[Glycogen]])File:Glycemic Index Fellrnr. If your [[Glycogen]] stores are full, then the carbs will tend to be stored as fatpng|none|thumb|500px|A graph of blood glucose (sugar) for high and low glycemic index foods.]]=Calculating the Glycemic Index=Some carbs are easily digested, with The Glycemic Index is calculated by measuring blood glucose periodically after the consumption of the fuel becoming ready for use quicklyfood. These 'quick carbs' Typically the measurements are great in taken just before consuming the middle of a runfood, then at 15, 30, 45, 60, 90, as the [[Muscle|muscles]] (and brain) will start to burn them120 minutes<ref name="Brand-MillerStockmann2008"/>. If you are at restThese measurements provide a blood glucose curve, these quick carbs can raise and the blood sugar levels quickly, causing a 'blood sugar spike'. The body reacts by producing insulin, which can overcompensate for area between the spike curve and result in a 'blood sugar crash'. Neither the spike nor baseline measurement taken just before consuming the crash food is good for youthe "incremental Area Under the Curve" (iUAC). The iUAC is compared with the iUAC for a reference food and the value given as a percentage. So what carbs are 'easily digested'? In some literature, quickly digested carbs are considered 'simple' and slow digesting carbs are 'complex', but this is not a useful division. a Glycemic Index of 50 means that the food raises the blood sugar by 50% of the reference food. Generally the portion of test food consumed contains 50 grams of carbohydrate. (The difference between simple and complex iAUC is based on sometimes called the chemistry of the carb molecule - small molecules like sugar are 'simple' and big molecules like starch (bread, etcPost Prandial Glycemic Response or PPGC.) are 'complex'[[File:Glycemic Index Spike Fellrnr. This division into simple and complex is unfortunately crap (biochemistry term meaning 'not useful')png|none|thumb|500px| A graph showing a low GI food that has a higher peak blood glucose than a high GI food.]] The digestion of carbs is Most Glycemic Index examples show two foods, with the high G.I. food having a sophisticated system that does not follow this simple division. Some simple carbs higher peak blood glucose and a greater incremental Area Under the Curve ([[Fructose]]iAUC) are very slow to digest. However, whereas some complex carbs ([[Maltodextrin]]) are very easy to digest. The actual measure of digestibility of carbs this is normally called 'not always the case, and Glycemic Index' (GI)is based only on the iAUC, which is how much so a food that rapidly spikes the blood sugar rises when glucose and then the level drops quickly can have a lower iAUC than a food is eaten [1]that keeps the blood glucose at a moderate level for longer. For instance, white bread (a This means that Glycemic Index alone may not tell us as much as we'complex' carb, GI 70) has d like.=Glycemic Index and Health=High blood glucose levels are linked to many health problems. * High Glycemic Index foods may be associated with obesity<ref name="Roberts2009"/><ref name="Brand-Miller-2002"/><ref name="Ludwig-1999"/> which constitutes a higher GI than table sugar (a 'simple' carbmajor health risk<ref name="MastersReither2013"/>.* Lower Glycemic Index foods are considered critical to preventing metabolic syndrome, GI 60). This as it is because highly refined flour in bread is more easily digested than table sugar the high Glycemic Index foods that are risk factors, not carbohydrates as a whole <ref name="Riccardi-2000"/>. * Elevated blood glucose after consuming food (which Postprandial Hyperglycemia) is half [[Fructose]])an independent risk factor for heart disease and high blood pressure <ref name="Chiasson-2003"/>.* Postprandial Hyperglycemia is associated with an increased risk of stroke and heart attacks<ref name="Stettler-2006"/>.Understanding * Postprandial Hyperglycemia is associated with the GI risk of food is important to health. Spikes in death in both diabetics and the overall population, independent of age, blood sugar has been linked to Diabetespressure, cholesterol, body mass index, heart disease and weight gainsmoking habit <ref name="Khaw-2001"/>. As a runner, high GI food is great for taking in * Lower Glycemic Index foods may improve HDL (Healthy) Cholesterol levels<ref name="Ford-2001"/><ref name="Frost-1999"/>.* Elevated blood glucose and insulin are associated with cancers of the middle of exercise or directly after. At other times, it's best to avoid high GI foods. The web site [http:colon<ref name="McKeown-Eyssen-1994"/><ref name="Giovannucci-1995"/><ref name="LimburgStolzenberg-Solomon2006"/>, breast<ref name="Baglietto-2007"/ http:>, and prostrate<ref name="Lima-2009"/><ref name="Hsing-2003"/www.nutritiondata><ref name="HsingChua2001"/>.com] has a lot of nutritional information on many foods, and includes a It'glycemic load', which can s been suggested that the high mortality rate from most cancers in obese subjects may be useful in choosing due to elevated insulin<ref name="Boyd-2003"/>* Diets with Lower Glycemic Index foods. The site [http:may help manage Impaired Glucose Tolerance (IGT)<ref name="WoleverMehling2007"/>* IGT is a risk factor for Type 2 Diabetes, with estimates that 70% of those with IGT will eventually develop Diabetes<ref name="Nathan-2007"/>, with 5-10% succumbing each year<ref name="Bansal2015"/] has a database of GI values for food>One * IGT is also linked with metabolic syndrome, which is the cluster of health problems including obesity, high blood pressure, non-alcoholic fatty liver disease, elevated triglycerides, and cardiovascular disease<ref name="Grundy-2012"/>. (Note that while glucose lowering drugs may help prevent the factors limiting the use conversion of GI in food labeling is that it has IGT to be experimentally tested; Diabetes, but it can't be measured based on s unclear if they will help prevent some of the food due to the complexities health complications of the human bodydiabetes<ref name="Grundy-2012"/>. For instance sourdough bread has )* IGT is a lower GI than equivalent regular bread because risk factor for liver cirrhosis<ref name="Nishida-2006"/> and survival rates for those with liver cirrhosis<ref name="García-Compeán2014"/>.=Individuality and the acidity in Glycemic Index=Most metrics around foods are based on relatively simple, objective measures of the sourdough bread slows digestionfood itself. Another example: In contrast, the difference between white and most whole wheat bread Glycemic Index is not significant. Swapping high GI foods for low GI foods can be a very useful part measure of how the human body reacts to a [[Weight Loss]] program. A given number food, rather than just an attribute of calories of a high GI the food will not keep us satiated as long as low GIin isolation. That means that eating a low GI food will stave off hunger for longer, causing us to eat less overall. [[File:Studies have shown large variability in the Glycemic Index Simplemeasured for given foods between individuals as well as large variability for repeated tests on the same individuals<ref name="Vrolix-2010"/><ref name="Vega-López-2007"/>. A 2015 study attempted to understand and model the individual Glycemic Index responses<ref name="ZeeviKorem2015"/>.png|none|thumb|500px|A graph of blood sugar for high and low glycemic index foods.]This study used continuous glucose monitoring of 800 subjects for a week, with the subjects recording their food intake, sleep, and exercise electronically. This provided a remarkable 1.5 million glucose measurements over 5,435 person/days. The study found a number of things:* A higher Glycemic Response (iAUC) was related to obesity (greater BMI), higher [ HbA1c ] (an indicator of average blood glucose over time), fasting blood glucose, and age. This tends to confirm the importance of Glycemic Index, but underlines the individual variability.* Unlike earlier studies, this study indicates that the glycemic response has a lower variability for a given individual.* Glycemic Index is normalized to the Glycemic Response for a standardized meal, which makes it a relative rather than absolute measure. This study did evaluate the absolute Glycemic Response, and found large variability for the standardized meals. Even [[Fructose]], which has lower variability, still has a few individuals with a surprisingly high absolute Glycemic Response (see below).<br/>[[File:ZeeviF3 E H.jpg|none|thumb|400px| High levels of variability in absolute Glycemic Response for standardized meals.]]* Even when the Glycemic Responses are normalized to that of glucose, there are still remarkably high levels of variability. The diagram below shows that white bread, which is typically reported as having a Glycemic Index of around 71 has some individuals with extremely low Glycemic Index responses, and some that are much higher. Even fructose has some individuals with an indicated Glycemic Index of over 100, when the literature indicates it is generally around 19.<br/>[[File:ZeeviF3 I K.jpg|none|thumb|400px| The variability when three standardized meals are normalized to the individuals Glycemic Response for glucose.]]* This individual variability is a nicely shown in the blood glucose responses shown below. These graphs show the responses of two individuals to glucose and bread. Each test was repeated, giving two lines for each participant's response to each of the two foods. You can see that each participant had reasonably similar responses each time they ate each of the foods. However, the top participant had a much higher Glycemic Response to glucose than a bread, this is what would be expected from the published Glycemic Index values. However, the participant in the lower graph has an inverted response, with higher glycemic response to bread than glucose.<br/>[[File:ZeeviF2 E.jpg|none|thumb|300px| The blood glucose responses to the standardized meals of glucose and bread for two individuals.]]* The graphs below show two individuals Glycemic Response to bananas and cookies. Here you can see the individuals had opposite responses to the two foods. Personally, I am a little cautious in interpreting this data as the bananas and cookies were not standardized. It's possible that the top participant had an extremely ripe banana, and a high fat cookie, while the lower participant had an unripe banana, and a low fat cookie.<br/>[[File:ZeeviF2 G.jpg |none|thumb|300px| The blood glucose response to anonymous and cookies in two individuals.]]* While the study found large variability, it also found that the average Glycemic Response generally corresponded well to the published figures.<br/>[[File:ZeeviF2 F.jpg|none|thumb|300px| The average Glycemic Response in absolute terms to various foods.]]The research team used the data from the 800 participants to create a computer model to predict the Glycemic Response of a further hundred subjects. This computer model was able to predict the Glycemic Response surprisingly well (r=0.70 for those into statistics.) Analysis of the computer model revealed a number of factors that tend to predict the glycemic response.* As expected, the carbohydrate content of a meal is strongly related to the Glycemic Response. However, the model did reveal some subjects that seemed relatively insensitive to the overall carbohydrate content. It appears that about 5% of subjects had a Glycemic Response that was as high as the rest of the subjects, but wasn't related to the overall carbohydrate content. Below you can see the relationship of participant 49 whose glycemic response is broadly proportional to the carbohydrate response compared with participant 145 whose glycemic response appears unrelated to the overall carbohydrate content. <br/>[[File:ZeeviF4 B.jpg|none|thumb|300px| The glycemic response of two individuals to meals with varying levels of carbohydrate.]]* The study also found the expected relationship between glycemic response and fat content. However, there were also individuals where the relationship between fat content glycemic response was not seen.* The level of Fiber in a meal was linked to higher glycemic responses. While this seems counterintuitive, I suspect it's because meals that are high in fiber are often also high in carbohydrates, and finely ground whole wheat products often exhibit similar glycemic index is to those using white wheat flour. Higher fiber intake over a 24-hour period was related to lower glycemic responses.* There were also indications that higher sodium levels, longer times since the last sleep and the subjects' cholesterol levels were also linked to higher glycemic responses.* The study analyzed the digestive bacteria from stool samples, and found 21 beneficial strains and 28 non-beneficial strains of bacteria.All this suggests that while the published Glycemic Index values are a useful rough guide to the health implications of various foods, they don't show the whole picture. It is possible to measure your own glycemic response, and I have some recommended [[Blood Glucose| Blood Glucose Meters]]. While it is impractical to perform this type of test on a wide variety of foods, I've measured my own glycemic response to a few of the meals that I eat most commonly. This measurement must be performed first thing in the morning on an empty stomach. Simply measure your fasting blood glucose, consumer the meal, then check your blood glucose over the next two hours. Measuring at 15, 30, 45, 60, 90, and 120 minutes will give you a standardized curve, but you could probably get away with far fewer measurements to get an approximation. You could normalize your values to a standardized meal, but I simply used an absolute value so that I could confirm what I was eating was not creating a health problem for me.=How Exercise Changes Glycemic Index=I found no studies that looked at how exercise changes the Glycemic Index of foods. The evidence available from looking at diabetic subjects suggests that exercise will lower the Glycemic Index of food consumed post exercise, and the effects of the exercise might last for up to 24 hours. * A study showed that 30 minutes of cycling was 15 minutes after eating white bread reduced the Glycemic Index by about a third<ref name="RasmussenLauszus1994"/>. However, this study was on type-1 Diabetics and the subjects had a constant infusion of insulin. * Another study found that 45-60 minutes of exercise reduced their blood glucose level for the following 24 hours<ref name="Van Dijk-2013"/>.* Studies of type-2 diabetics suggest that exercise generally lowers blood glucose (as measured by [ HA1c])<ref name="Boulé-2001"/><ref name="SnowlingHopkins2006"/>.=Simple and Complex Carbohydrates=At one time, it was believed that "simple carbohydrates" had high Glycemic Index, while "complex carbohydrates" had lower Glycemic Indexes<ref name="ND"/>. The difference between simple and complex carbohydrates is based on the chemistry of the carbohydrate molecule, with small molecules like sugar considered "simple" and big molecules like bread considered "complex". This division into simple and complex is unfortunately crap (biochemistry term meaning 'not useful'). The digestion of carbs is a sophisticated system that does not follow this simple division. Some simple carbs (Fructose) are very slow to digest, whereas some complex carbs (maltodextrin) are very easy to digest. For instance, white bread (a "complex" carb, GI 70) has a higher Glycemic Index than table sugar (a 'simple' carb, GI 60). This is because highly refined flour in bread is more easily digested than table sugar (which is half fructose).=References=<references><ref name="SnowlingHopkins2006">N. J. Snowling, W. G. 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