03 Issues & Trends
Cereal Foods World, Vol. 63, No. 4
Print To PDF
Counterpoint: Glycemic Index and Glycemic Load Add Complexity and Have Marginal Value for Helping Consumers Choose Quality Carbohydrates
Julie M. Jones1
St. Catherine University, St. Paul, MN, U.S.A.
1 St. Catherine University, 2004 Randolph Ave, St. Paul, MN 55105, U.S.A. Tel: +1.651.690.6000; E-mail: firstname.lastname@example.org
Glycemic index (GI) and glycemic load (GL) were proposed in the 1980s as ways to measure carbohydrate quality. Despite extensive research, findings published in the literature are inconsistent with respect to most health outcomes. In addition, GI values published in tables and on food packaging may not characterize the glycemic response of a food as eaten, especially when it is eaten as part of a meal. Further, these values do not consider variability introduced by any number of factors, such as variety, ripeness, degree and mode of cooking or processing, presence of other foods or ingredients, temperature of food when eaten, amount eaten, etc. The use of GI as a touchstone in food selection, diet planning, and other applications is concerning due to its wide variability and limited precision and accuracy. With standard deviations that are equal to class boundaries for medium-GI foods, designation of foods as high, medium, or low GI is prone to error. This discussion identifies some of the limitations surrounding the measure and its use and outlines the weak evidence for many health outcomes. Further, the assignment of GI values to food intake data collected in dietary surveys by food frequency and other vehicles is questioned. It is unclear whether GI and GL can help consumers determine carbohydrate quality and guide them to make food choices that may reduce their risk of associated chronic diseases. Although a group of noted scientists has met and published a consensus on carbohydrate quality, their findings are not aligned with those of other recognized health-promotion organizations, such as the American Diabetes Association or the Academy of Nutrition and Dietetics Evidence Analysis Library. Thus, their conclusion that GI and GL are measures of carbohydrate quality is not substantiated by the state of the research at this point in time, making the publication of a consensus on the subject premature.
Trying to reach content?
View Full Article
if you don't have access, become a member
- Jenkins, D. J., Wolever, T. M., Taylor, R. H., Barker, H., Fielden, H., Baldwin, J. M., Bowling, A. C., Newman, H. C., Jenkins, A. L., and Goff, D. V. Glycemic index of foods: A physiological basis for carbohydrate exchange. Am. J. Clin. Nutr. 34:362, 1981.
- Augustin, L. S., Kendall, C. W., Jenkins, D. J., Willett, W. C., Astrup, A., et al. Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC). Nutr. Metab. Cardiovasc. Dis. 25:795, 2015.
- Foster-Powell, K., Holt, S. A., and Brand-Miller, J. C. International table of glycemic index and glycemic load values: 2002. Am. J. Clin. Nutr. 76:5, 2002.
- Atkinson, F. S., Foster-Powell, K., and Brand-Miller, J. C. International tables of glycemic index and glycemic load values: 2008. Diabetes Care 31:2281, 2008.
- Pi-Sunyer, F. X. Glycemic index and disease. Am. J. Clin. Nutr. 76:290s, 2002.
- Eleazu, C. O. The concept of low glycemic index and glycemic load foods as panacea for type 2 diabetes mellitus: Prospects, challenges and solutions. Afr. Health Sci. 16:468, 2016.
- Jones, J. M. Glycemic index: The state of the science, part 2—Roles in weight, weight loss, and satiety. Nutr. Today 48:7, 2013.
- Jenkins, D. J., Kendall, C. W., Augustin, L. S., Franceschi, S., Hamidi, M., Marchie, A., Jenkins, A. L., and Axelsen, M. Glycemic index: Overview of implications in health and disease. Am. J. Clin. Nutr. 76:266S, 2002.
- DeVries, J. W. Glycemic index: The analytical perspective. Cereal Foods World 52:45, 2007.
- Aziz, A., Dumais, L., and Barber, J. Health Canada’s evaluation of the use of glycemic index claims on food labels. Am. J. Clin. Nutr. 98:269, 2013.
- FAO. Methods of food analysis. In: Food Energy—Methods of Analysis and Conversion Factors. Rep. Tech. Workshop, Rome, 3–6 December 2002. Published online at www.fao.org/docrep/006/Y5022E/y5022e03.htm. FAO, Rome, 2003.
- McCleary, B. V. Determination of total dietary fibre and available carbohydrates: A rapid integrated procedure that simulates in vivo digestion. Starch 67:860, 2015.
- Niwano, Y., Adachi, T., Kashimura, J., Sakata, T., Sasaki, H., Sekine, K., Yamamoto, S., Yonekubo, A., and Kimura, S. Is glycemic index of food a feasible predictor of appetite, hunger, and satiety? J. Nutr. Sci. Vitaminol. (Tokyo) 55:201, 2009.
- Wolever, T. M., Brand-Miller, J. C., Abernethy, J., Astrup, A., Atkinson, F., et al. Measuring the glycemic index of foods: Interlaboratory study. Am. J. Clin. Nutr. 87:247s, 2008.
- Matthan, N. R., Ausman, L. M., Meng, H., Tighiouart, H., and Lichtenstein, A. H. Estimating the reliability of glycemic index values and potential sources of methodological and biological variability. Am. J. Clin. Nutr. 104:1004, 2016.
- Monro, J. A., Wallace, A., Mishra, S., Eady, S., Willis, J. A., Scott, R. S., and Hedderley, D. Relative glycaemic impact of customarily consumed portions of eighty-three foods measured by digesting in vitro and adjusting for food mass and apparent glucose disposal. Br. J. Nutr. 104:407, 2010.
- Korach-André, M., Roth, H., Barnoud, D., Péan, M., Péronnet, F., and Leverve, X. Glucose appearance in the peripheral circulation and liver glucose output in men after a large 13C starch meal. Am. J. Clin. Nutr. 80:881, 2004.
- Venn, B. J., and Green, T. J. Glycemic index and glycemic load: Measurement issues and their effect on diet-disease relationships. Eur. J. Clin. Nutr. 61(Suppl. 1):S122, 2007.
- Laine, D. C., Thomas, W., Levitt, M. D., and Bantle, J. P. Comparison of predictive capabilities of diabetic exchange lists and glycemic index of foods. Diabetes Care 10:387, 1987.
- Nuttall, F. Q., and Gannon, M. C. Plasma glucose and insulin response to macronutrients in nondiabetic and NIDDM subjects. Diabetes Care 14:824, 1991.
- Jones, J. M. Glycemic index: The state of the science, part 1—The measure and its variability. Nutr. Today 47:207, 2012.
- Shafaeizadeh, S., Muhardi, L., Henry, C. J., van de Heijning, B. J. M., and van der Beek, E. M. Macronutrient composition and food form affect glucose and insulin responses in humans. Nutrients. DOI: 10.3390/nu10020188. 2018.
- Tian, J., Chen, J., Ye, X., and Chen, S. Health benefits of the potato affected by domestic cooking: A review. Food Chem. 202:165, 2016.
- Thompson, M. E., and Noel, M. B. Issues in nutrition: Carbohydrates. FP Essent. 452:26, 2017.
- Bonnema, A. L., Altschwager, D. K., Thomas, W., and Slavin, J. L. The effects of the combination of egg and fiber on appetite, glycemic response and food intake in normal weight adults—A randomized, controlled, crossover trial. Int. J. Food Sci. Nutr. 67:723, 2016.
- Mackie, A. R., Bajka, B. H., Rigby, N. M., Wilde, P. J., Alves-Pereira, F., Mosleth, E. F., Rieder, A., Kirkhus, B., and Salt, L. J. Oatmeal particle size alters glycemic index but not as a function of gastric emptying rate. Am. J. Physiol. Gastrointest. Liver Physiol. 313:G239, 2017.
- Kendall, C. W., Esfahani. A., Truan, J., Srichaikul, K., and Jenkins, D. J. Health benefits of nuts in prevention and management of diabetes. Asia Pac. J. Clin. Nutr. 19:110, 2010.
- Kendall, C. W., Esfahani. A., Josse, A. R., Augustin, L. S., Vidgen, E., and Jenkins, D. J. The glycemic effect of nut-enriched meals in healthy and diabetic subjects. Nutr. Metab. Cardiovasc. Dis. 21(Suppl. 1):S34, 2011.
- Hettiaratchi, U. P., Ekanayake, S., and Welihinda, J. Glycaemic indices of three Sri Lankan wheat bread varieties and a bread-lentil meal. Int. J. Food Sci. Nutr. 60(Suppl. 4):21, 2009.
- Gunathilaka, M. D., and Ekanayake, S. Effect of different cooking methods on glycaemic index of Indian and Pakistani basmati rice varieties. Ceylon Med. J. 60:57, 2015.
- Hettiaratchi, U. P., Ekanayake, S., and Welihinda, J. Sri Lankan rice mixed meals: Effect on glycaemic index and contribution to daily dietary fibre requirement. Malays. J. Nutr. 17:97, 2011.
- Widanagamage, R. D., Ekanayake, S., and Welihinda, J. Carbohydrate-rich foods: Glycaemic indices and the effect of constituent macronutrients. Int. J. Food Sci. Nutr. 60(Suppl. 4):215, 2009.
- Meng, H., Matthan, N. R., Ausman, L. M., and Lichtenstein, A. H. Effect of macronutrients and fiber on postprandial glycemic responses and meal glycemic index and glycemic load value determinations. Am. J. Clin. Nutr. 105:842, 2017.
- Dodd, H., Williams, S., Brown, R., and Venn, B. Calculating meal glycemic index by using measured and published food values compared with directly measured meal glycemic index. Am. J. Clin. Nutr. 94:992, 2011.
- Wolever, T. M., Jenkins, D. J., Ocana, A. M., Rao, V. A., and Collier, G. R. Second-meal effect: Low-glycemic-index foods eaten at dinner improve subsequent breakfast glycemic response. Am. J. Clin. Nutr. 48:1041, 1988.
- Chen, M. J., Jovanovic, A., and Taylor, R. Utilizing the second-meal effect in type 2 diabetes: Practical use of a soya-yogurt snack. Diabetes Care 33:2552, 2010.
- Brandon, E. F., Bakker, M. I., Kramer, E., Bouwmeester, H., Zuidema, T., and Alewijn, M. Bioaccessibility of vitamin A, vitamin C and folic acid from dietary supplements, fortified food and infant formula. Int. J. Food Sci. Nutr. 65:426, 2014.
- Ye, Y., Wu, Y., Xu, J., Ding, K., Shan, X., and Xia, D. Association between dietary carbohydrate intake, glycemic index and glycemic load, and risk of gastric cancer. Eur. J. Nutr. 56:1169, 2017.
- Aune, D., Chan, D. S., Lau, R., Vieira, R., Greenwood, D. C., Kampman, E., and Norat, T. Carbohydrates, glycemic index, glycemic load, and colorectal cancer risk: A systematic review and meta-analysis of cohort studies. Cancer Causes Control 23:521, 2012.
- Mulholland, H. G., Murray, L. J., Cardwell, C. R., and Cantwell, M. M. Glycemic index, glycemic load, and risk of digestive tract neoplasms: A systematic review and meta-analysis. Am. J. Clin. Nutr. 89:568, 2009.
- U.S. Department of Agriculture, Agricultural Research Service. Question 4: What is the relationship between glycemic index or glycemic load and body weight, type 2 diabetes, cardiovascular disease, and cancer? Page 298 in: Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010. Published online at www.cnpp.usda.gov/sites/default/files/dietary_guidelines_for_americans/2010DGACReport-camera-ready-Jan11-11.pdf. USDA ARS, Washington, DC, 2010.
- Nagle, C. M., Olsen, C. M., Ibiebele, T. I., Spurdle, A. B., Webb, P. M., Australian National Endometrial Cancer Study Group, and Australian Ovarian Cancer Study Group. Glycemic index, glycemic load and endometrial cancer risk: Results from the Australian National Endometrial Cancer Study and an updated systematic review and meta-analysis. Eur. J. Nutr. 52:705, 2013.
- Schlesinger, S., Chan, D. S. M., Vingeliene, S., Vieira, A. R., Abar, L., Polemiti, E., Stevens, C. A. T., Greenwood, D. C., Aune, D., and Norat, T. Carbohydrates, glycemic index, glycemic load, and breast cancer risk: A systematic review and dose-response meta-analysis of prospective studies. Nutr. Rev. 75:420, 2017.
- Schwingshackl, L., Hobl, L. P., and Hoffmann, G. Effects of low glycaemic index/low glycaemic load vs. high glycaemic index/high glycaemic load diets on overweight/obesity and associated risk factors in children and adolescents: A systematic review and meta-analysis. Nutr. J. 14:87, 2015.
- Gaesser, G. A. Carbohydrate quantity and quality in relation to body mass index. J. Am. Diet. Assoc. 107:1768, 2007.
- Larsen, T. M., Dalskov, S.-M., van Baak, M., Jebb, S. A., Papadaki, A., et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. N. Engl. J. Med. 363:2102, 2010.
- Clifton, P. Assessing the evidence for weight loss strategies in people with and without type 2 diabetes. World J. Diabetes 8:440, 2017.
- Ørjasæter Elvsaas, I.-K., Juvet, L. K., Giske, L., and Fure, B. Effectiveness of interventions for overweight or obesity in children and adolescents: Report from the Norwegian Institute of Public Health No. 2016-13. Knowledge Centre for the Health Services at the Norwegian Institute of Public Health. Available online at www.fhi.no/en/publ/2016/effekt-av-tiltak-for-barn-og-unge-med-overvekt-eller-fedme. (In Norwegian with English summary). NIPH, Oslo, 2016.
- Raynor, H. A., and Champagne, C. M. Position of the Academy of Nutrition and Dietetics: Interventions for the treatment of overweight and obesity in adults. J. Acad. Nutr. Diet. 116:129, 2016.
- Academy of Nutrition and Dietetics. Adult weight management (AWM) low glycemic index diets. Available online at www.andeal.org/template.cfm?template=guide_summary&key=626. Evidence Analysis Library. The Academy, Chicago, 2018.
- Izadi, V., Haghighatdoost, F., Moosavian, P., and Azadbakht, L. Effect of low-energy-dense diet rich in multiple functional foods on weight-loss maintenance, inflammation, and cardiovascular risk factors: A randomized controlled trial. J. Am. Coll. Nutr. 37:399, 2018.
- Barazzoni, R., Deutz, N. E. P., Biolo, G., Bischoff, S., Boirie, Y., et al. Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group. Clin. Nutr. 36:355, 2017.
- Juanola-Falgarona, M., Salas-Salvadó, J., Ibarrola-Jurado, N., Rabassa-Soler, A., Díaz-López, A., Guasch-Ferré, M., Hernández-Alonso, P., Balanza, R., and Bulló, M. Effect of the glycemic index of the diet on weight loss, modulation of satiety, inflammation, and other metabolic risk factors: A randomized controlled trial. Am. J. Clin. Nutr. 100:27, 2014.
- Schultes, B., Panknin, A. K., Hallschmid, M., Jauch-Chara, K., Wilms, B., de Courbière, F., Lehnert, H., and Schmid, S. M. Glycemic increase induced by intravenous glucose infusion fails to affect hunger, appetite, or satiety following breakfast in healthy men. Appetite 105:562, 2016.
- Munsters, M. J., Geraedts, M. C., and Saris, W. H. Effects of different protein and glycemic index diets on metabolic profiles and substrate partitioning in lean healthy males. Appl. Physiol. Nutr. Metab. 38:1107, 2013.
- Sun, F.-H., Li, C., Zhang, Y.-J., Wong, S. H.-S., and Wang, L. Effect of glycemic index of breakfast on energy intake at subsequent meal among healthy people: A meta-analysis. Nutrients. DOI: 10.3390/nu8010037. 2016.
- Greenwood, D. C., Threapleton, D. E., Evans, C. E., Cleghorn, C. L., Nykjaer, C., Woodhead, C., and Burley, V. J. Glycemic index, glycemic load, carbohydrates, and type 2 diabetes: Systematic review and dose-response meta-analysis of prospective studies. Diabetes Care 36:4166, 2013.
- Farvid, M. S., Homayouni, F., Shokoohi, M., Fallah, A., and Farvid, M. S. Glycemic index, glycemic load and their association with glycemic control among patients with type 2 diabetes. Eur. J. Clin. Nutr. 68:459, 2014.
- Goff, L. M., Cowland, D. E., Hooper, L., and Frost, G. S. Low glycaemic index diets and blood lipids: A systematic review and meta-analysis of randomised controlled trials. Nutr. Metab. Cardiovasc. Dis. 23:1, 2013.
- Fleming, P., and Godwin, M. Low-glycaemic index diets in the management of blood lipids: A systematic review and meta-analysis. Fam. Pract. 30:485, 2013.
- Miller, M., Stone, N. J., Ballantyne, C., Bittner, V., Criqui, M. H., et al. Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation 123:2292, 2011.
- Wolever, T. M., Gibbs, A. L., Mehling, C., Chiasson, J. L., Connelly, P. W., et al. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: No effect on glycated hemoglobin but reduction in C-reactive protein. Am. J. Clin. Nutr. 87:114, 2008.
- American Diabetes Association. Understanding carbohydrates: Glycemic index and diabetes. Published online at www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/glycemic-index-and-diabetes.html. The Association, Arlington, VA, 2014.
- American Heart Association. Glycemic index and diabetes. Published online at www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Glycemic-Index-and-Diabetes_UCM_457070_Article.jsp#.WzpZDNJKiUk. The Association, Dallas, 2017.
- Academy of Nutrition and Dietetics. Diabetes (type 2) Prevention: Glycemic index/glycemic load and prevention of type 2 diabetes. Available online at www.andeal.org/topic.cfm?menu1⁄45344 &cat1⁄45210. Evidence Analysis Library. The Academy, Chicago, 2018.
- Kohn, J. B. What do I tell my clients who want to follow a low glycemic index diet? J. Acad. Nutr. Diet. 117:164, 2017.
- EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific opinion on the substantiation of health claims related to carbohydrates that induce low/reduced glycaemic responses (ID 474, 475, 483, 484) and carbohydrates with a low glycaemic index (ID 480, 481, 482, 1300) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA J. 8(2):1491, 2010.
- Ojo, O., Ojo, O. O., Adebowale, F., and Wang, X.-H. The effect of dietary glycaemic index on glycaemia in patients with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Nutrients. DOI: 10.3390/nu10030373. 2018.
- Wang, Q., Xia, W., Zhao, Z., and Zhang, H. Effects comparison between low glycemic index diets and high glycemic index diets on HbA1c and fructosamine for patients with diabetes: A systematic review and meta-analysis. Prim. Care Diabetes 9:362, 2015.