ADVANCED NUTRITION (HFS4352)

GLYCEMIC INDEX
Mohd Razif Shahril, PhD
School of Nutrition & Dietetics
Faculty of Medicine and Health Sciences
Universiti Sultan Zainal Abidin

KNOWLEDGE FOR THE BENEFIT OF HUMANITY

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Outline
• What is Glycemix Index (GI)?
• Glycemix Index Determination Protocol
• Factors Influencing GI
• Benefits of Low GI Diet
• Take home message

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What is Glycemix Index (GI)
• A scale that ranks carbohydrate by how much they
raise blood glucose levels compared to a reference
food.
– Developed by Jenkins et al. 1981. Am J Clin Nutr.
34(3):362-366.
• References on GI
– Brand-Miller et al. 2006. The New Glucose
Revolution. 3rd ed. New York, NY: Marlowe & Co.
– Written by experts on GI
– Atkinson et al. 2008. Diabetes Care 31(12):2281-
2283
– Most comprehensive table of the GI of foods that has been
assembled to date

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What is Glycemix Index (GI)

Rapidly digested or absorbed

carbohydrates

Slowly digested or absorbed

carbohydrates

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What does the GI value mean?
• The glycemic index (GI) is expressed as a ratio
comparing the blood glucose increase caused by a test
food to that of a reference food (usually glucose) for 2
hours following ingestion.

Area Under the Curve for Test Food

× 100 = GI
Area Under the Curve for Reference Food

GLYCEMIC INDEX VALUE

Low GI 0 – 55
Moderate GI 56 – 69
High GI ≥ 70

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Glycemic Load (GL)?
• The glycemic load (GL) takes into account the amount of
carbohydrate (CHO) in a common serving in addition to
its glycemic index (GI)

GL = (GI of CHO × grams of CHO per serving) ÷ 100

– Example: Carrots (peeled, boiled) have a GI of 47

and 5 g CHO per serving
The GL of carrots is: (47 × 5) ÷ 100 = 2.4

GLYCEMIC LOAD VALUE

Low GL 0 – 10
Moderate GL 11 – 19
High GL ≥ 20 6
GI Determination Protocol
Test food response
25 g or 50 g CHO of compared to Repeat among 8 to
test food reference food 10 volunteers
(glucose)

1st hour – Blood

Calculate Area
taken every 15 GI value
Under Curve (AUC)
minutes

2nd hour – Blood Glucose response

take every 30 value plotted in
minutes graph

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GI Determination Protocol

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Factors Influencing GI
Type of starch

Physical entrapment

Viscosity of fibre

Sugar content

Fat and protein content

Acid content

Food processing

Cooking 9
[1] Type of starch

Amylose Amylopectin
Absorbs less water Absorbs more water
Molecules form tight clumps Molecules are more open
Slower rate of digestion Faster rate of digestion

LOWER GI HIGHER GI

E.g. Kidney beans (28) Eg. Russet potato (85)

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[1] Type of starch

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[2] Physical entrapment
• 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)

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[2] Physical entrapment

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[3] Viscosity of fibre
• Viscous, soluble fibers transform intestinal
contents into gel-like matter that slows down
enzymatic activity on starch.
• High soluble fibre = lower GI
• Lower GI
– Apple (40)
– Rolled oats (51)
• Higher GI
– Whole wheat bread (73)
– Cheerios (74)

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[4] Sugar content

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[4] Sugar content
sugar sucrose glucose + fructose
(GI 60) (GI 100) (GI 19)

starch maltose glucose + glucose

(GI 105) (GI 100) (GI 100)

• Lower GI
– Frosted Flakes (55)
– Raisin Bran (61)
• Higher GI
– Golden Grahams (71)
– Rice Krispies (82)
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[5] Fat and protein content
• Fat and protein slow down gastric emptying, and
thus, slows down digestion of starch.
• High fat and protein foods have lower GI
• Lower GI
– Peanut M&M’s (33)
– Potato chips (54)
– Special K (69)
• Higher GI
– Jelly beans (78)
– Baked potato (85)
– Corn Flakes (92)

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[6] Acid content
• Acid slows down gastric emptying, and thus,
slows down the digestion of starch.
• Foods with higher acid content = lower GI
• Lower GI
– Sourdough wheat bread (54)
• Higher GI
– Wonder white bread (73)

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[7] Food processing
• Highly processed foods require less digestive
processing.
• Processed foods = higher GI
• Lower GI
– Old fashioned, rolled oats (51)
• Higher GI
– Quick, 1-minute oats (66)

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[8] Cooking
• Cooking swells starch molecules and softens
foods, which speeds up the rate of digestion.
• Overly cooked foods = Higher GI
• Lower GI
– Al dente spaghetti – boiled 10 to 15 minutes (44)
• Higher GI
– Over-cooked spaghetti – boiled 20 minutes (64)

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Low/High GI Meals/ Snacks

GI = 60 GL = 48 GI = 42 GL = 31

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Low/High GI Meals/ Snacks

GI = 85 GL = 48 GI = 39 GL = 22

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Low/High GI Meals/ Snacks

GI = 83 GL = 19 GI = 14 GL = 1

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Low/High GI Meals/ Snacks

GI = 80 GL = 32 GI = 61 GL = 12

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Low/High GI Meals/ Snacks

GI = 57 GL = 31 GI = 32 GL = 16

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GI Symbol

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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 compared to
high GI diet.
• 0.43% points in HbA1c over &
above reduction compared to
high GI diet

Brand-Miller et al. Diabetes Care. 2003; 26; 2263.

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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

GI HbA1c
Lowest quartile 58-78 6.04
Highest quartile 86-112 6.60

Buyken et al. Am J Clin Nutr. 2001; 73; 578.

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Benefits of Low GI Diet
Low GI diet improves lipid levels
NHANES III, 1988-1994
13,907 American adults, 20+ y

GI HDL-C
Lowest quintile 52.51
Highest quintile 49.42

Ford & Liu. Arch Intern Med. 2001; 161; 572-576.

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Benefits of Low GI Diet
Low GI diet improves lipid levels
23 obese young adults, 18-35 y, BMI > 27, 12 mos. duration

GL Tot. LDL HDL TG

chol.
Ad libitum low GL diet 53 -8.5 -9.7 12.2 -37.2
Low calorie, low fat diet 77 -6.2 -7.4 1.1 -19.1

Ebbling et al. Am J Clin Nutr. 2005; 81; 981.

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Benefits of Low GI Diet
Low GI diet aids in weight control
Nurses’ Health Study, 1984-1996
74,091 women, 38-63 y

Calculated odds ratios (lowest > highest quintiles)

BMI (≥30) Major weight gain
n = 6,400 (≥25kg) n = 657
Whole grains -19% -23%
Refined grains +18% +26%
Dietary fiber -34% -49%

Lin et al. Am J Clin Nutr. 2003; 78; 923.

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Benefits of Low GI Diet
Low GI diet aids in weight control
Post low GI MNT counseling, 21 subjects, 21-89 y, 3-36 mos.
75%
pre LGI-MNT
post LGI-MNT

50%
% of Subjects

25%

0%
< 18.5 18.5 - 24.9 25.0 - 29.9 30.0 - 34.9 35.0 - 44.9 45.0 +
BMI

Burani & Longo. Diabetes Educ. 2006; 32; 83.

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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

Relative risk of CHD

GL highest quintile 1.98
GI highest quintile 1.31

Lin et al. Am J Clin Nutr. 2000; 71; 1455-1461.

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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

Relative risk
CHO intake (all subjects) 2.05 for hemorrhagic stroke
CHO intake (BMI ≥ 25) 2.13 for total stroke
3.84 for hemorrhagic stroke
GL intake (BMI ≥ 25) 1.61 for total stroke
cereal fiber (all subjects) 0.66 for total stroke
0.51 for hemorrhagic stroke
Oh et al. Am J Epid. 2005; 161; 161-169.
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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

Relative risk
GI 1.37
GL 1.47
cereal fiber 0.72
GL cereal fiber 2.50

Salmeron et al. JAMA. 1997; 277; 472.

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Take home message
• Eat high-fiber breakfast cereals (oats, bran, barley)
OR add berries, nuts, flaxseed and cinnamon to
high GI cereals.
• Choose dense, whole grain and sourdough breads
and crackers OR add a heart-healthy protein and/or
condiment to high GI breads and crackers.
• Include 5-9 servings of fruits and vegetables every
day.
• Replace white potatoes with yams or sweet potatoes
OR consume smaller portion of high GI potatoes.
• Eat less refined sugars and convenience foods
(soda, sweets, desserts, etc.) OR combine nuts,
fruit, yogurt, ice cream with commercial sweets –
watch portion sizes.
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Thank You

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