Glycaemic Index (GI) and Glycaemic Load (GL): What Does it Mean?

Carbohydrate (CHO) is the major source of energy fuel in the average human diet, supplying approximately half of the caloric intake. Food carbohydrates (CHO) consist of mono-, oligo-, and polysaccharides, the latter is composed of starch and non-starch polysaccharides (Nils-Georg Asp 1996, p.9). Monosaccharides (glucose, galactose and fructose) are structurally the simplest form of CHOs, in that they cannot be reduced to smaller units (Gropper et al. 2005, p.72). Glucose and fructose are the principle dietary monosacarrides derived mainly from fruit, berries and sweetened drinks (Nils-Georg Asp 1996, p.10). Disaccharides, the most abundant of the oligosaccharides, are comprised of two monosaccharide monomers linked together by a glycosidic bridge. The most nutritionally significant disaccharides are sucrose (glucose + fructose), lactose (glucose + galactose), and maltose (glucose + glucose) (Holum 1998, p.535). Nutritionally, both mono- and disaccharides, owing to their low molecular weight, are referred to as simple sugars. Sucrose and fructose are the most abundant disaccharides, with sucrose furnishing nearly one-third of total dietary CHO intake in an average diet (Gropper 2005, p.73). Dietary polysaccharides are high molecular weight, long-chain glucose polymers, often referred to as complex carbohydrates. They represent approximately two-third of CHO intake in the average human diet. Dietary polysaccharides are derived from plants and either yield to digestion, classified as starch, or are resistant, non-starch polysaccharides (NSP). Their digestibility is determined by the bonds that link the glucose monomers together (Holum 1998, p.538, Nils-Georg Asp 1996, p.10). In the human diet, the most important nutritional component of CHO in all forms is the glucose. Glucose is the bodys preferred source for synthesising ATP the bodys energy currency and is the main source of energy for all cells (Tratora et al. 2000, p.874). Glucose is also the most common CHO found in the blood and is therefore often referred to as blood sugar (Holum 1998, p.520). Before the introduction of the GI, absorption rates of CHOs into the blood (glycemic response) were thought to be directly related to the molecules chemical structure: simple or complex. The assumption was that the simple sugars, because of their smaller molecular weight, would be digested and absorbed into the blood stream quickly, producing a rapid increase in blood glucose concentration. Conversely, the larger, complex starches were thought to digest and absorb more slowly and therefore would cause a more gradual release of glucose into the blood stream (BrandMiller et al. 2007, pp.6-7). In the early 1980s however, this concept was challenged by Jenkins et al. (1981) with their introduction of the glycemic index (GI). Jenkins et al. (1981) proposed the concept of GI as a classification of the blood glucose-raising potential of carbohydrate foods. (Ludwig et al. 2002, p.264S; Frost & Dornhorst 2005, p.413). GI is defined as the incremental rise in blood glucose (area under the curve) following a test food, expressed as the percentage of the corresponding area following a carbohydrate equivalent load of a reference product, usually glucose (Englyst et al. 2007, p.S19). Glucose is used as the reference food because it produces the greatest effect on blood glucose levels (Brand-Miller et al. 2007, p. 12). A food with a higher GI will cause a higher rises in blood glucose levels than a food

with a lower GI, if the carbohydrate content is equal (Frost & Dornhorst 2005, p.413); Nils-Georg Asp (1996) notes that although insulin response to foods is not used to define glycemic index, they are highly correlated. The work conducted by Jenkins et al. (1981) illustrated that the effect of a carbohydrate source on blood sugar was determined by much more than its chemical composition. The glycemic response to CHO depends on several factors, these include: the nature of the CHO, its source, its mode of preparation, the physical form in which its eaten, the presence of other nutrients (lipids, proteins) and fibres and the time of day that it is consumed (Bornet et al. 1997, pp.210-213; Wolever & Bolognesi 1996, p. 383). The nature of the CHO, or the physical state of the starch in the food, is highly influential in determining its GI value. Polysaccharides exist in two forms: starch, which is digestible by humans, and non-starch, which is resistant to digestion. The most commonly digestible polysaccharide in plants is starch, which is a mixture of two types of polymers of -glucose, amylose and amylopectin. The amylose polymer is comprised of glucose units joined in a linear succession of 1-4 glycosidic bonds and arranged in a coiled configuration. This configuration renders amylose less water soluble and therefore more resistant to hydrolysis in the gut. Amylopectin in contrast has both 1-4 and 1-6 linkages in a highly branched conformation, which yields more readily to hydrolysis in the gut. Natural starches are generally composed of 10-20% amylose and 80-90% amylopectin. The ratio of amylose to amylopectin influences the rate of digestibility of a CHO and therefore its GI value (Holum 1998, p.538). A CHO with a high amylopcectin to amylose ratio will have a higher GI value (Pi-Sunyer 2002, p291S). Researchers have also found that the time of day may influence glycaemic responses to foods; glycaemic response appears to be more dramatic the first meal of the day. A lunchtime instance of that same food appears to produce a lower-GI response (Wolever & Bolognesi 1996, p. 383). Looking at some of the highest GI foods listed in the International table of GI and GL values: 2002 (Foster-Powell et al.2002, pp. 9-52), the factors that influence GI can be elucidated more clearly when discussing some of the major high-carbohydrate foods individually. Rice is an example of a food with high GI, as it has a high amylopectin to amylose ratio and is easily digestible; however, the GI range varies from 37-103 across the types of rice examined. Rice varieties produced in different countries have and inherent botanical differences which may effect the starch composition (Foster-Powell et al. 2002, p.7). For instance, Bangladeshi rice variety BR16, Doongara white rice, and white basmati rice have low to medium GIs of 37, 50 and 58 respectively (ibid, p.23); however jasmine rice has a GI of 109, eliciting a quicker glycemic response than glucose (GI 100). Jasmine rice has a very high amylopectin to amylose ratio. According to Pi-Sunyer (2002, p291S) the starch in jasmine rice leaves the stomach very quickly and is digested equally as fast. Bangladeshi rice in contrast has higher amylose content (26%), which accounts for its low GI value (Foster-Powell et al. 2002, p.23). In addition to the amylopectin:amylose ratio, the method of preparation can effect GI. In its uncooked form, the starch in the rice is stored in compact granules, which is very difficult to digest. The application of heat and moisture affects the starch granules by disrupting their crystalline structure, causing the granules to swell and burst free from this structure, while gelatinization of this matrix also occurs. In this freed state, the starch molecules with their greater surface area are very accessible to digestive enzymes and can be digested and absorbed quickly, which in turn raises the GI value of the rice (Pi-Sunyer 2002, p291S). The GI of that same rice can then be lowered by simply allowing it to cool. As the rice starch cools and undergoes further gelatinization, a crystallinity to the gel can occur, called retrogradation of the starch. This retrograde starch complex is insoluble and resistant to digestion, the presence of this complex slows down digestion and absorption of the starch, decreasing the rate and quantity of glucose absorbed (Brand-Miller 2007, p.20). The gelatinization process is also responsible for the relatively low GI value (30-60) of pasta.

Ungelatinized starch granules become entrapped in the gluten protein network of the dough, making the starch less accessible to digestive processes (ibid. p.23). The particle size of a food is another factor that influences gelatinization and GI value of a CHO. Processing of grains by milling them not only disrupts the outer germ layer and starch granules but also reduces particle size. This leaves the resulting grain product more susceptible to hydrolysis and digestion, therefore increasing its GI value. An example of this is bread. Breads have a GI range of 27, course barley kernel bread, to 95, a French baguette. The GI value is highly reflective of the milling process the flour underwent before it was baked (Nils-Georg 1996, p.11). The course milling process of the course barley kernel flour renders a larger particle starch product with much of the germ in tact; the combination of the two factors slows hydrolysis and digestion. The fine milling process involved in the manufacture of French bread results in a very small particle starch product with no germ layer in tact, rendering the product very accessible to hydrolysis and digestion. Fermentation, in which lactic acid and propionic acid are produced by the natural fermentation of starch and sugars by yeast can also affect GI, as is seen across varieties of sourdough bread, which have a lower GI (48-57) than most other breads (Foster-Powell et al. 2002, p.16; Brand-Miller 2007, p.28). Potatoes generally sit in the high-medium to high GI range. Their GI values are also greatly affected by cooking methods, such as mashing, baking, and boiling. Uncooked potatoes are resistant to hydrolysis, but when cooked the starch granules gelatinize and become readily digestible, when cooled, as with rice, gelatinization occurs which lowers the GI value (Pi-Sunyer 2002, p291S). The addition of fat to the cooking process also lowers the GI value due to the fact that fat slows the rate at which the stomach empties; thereby holding up digestion (Brand-Miller 2007, p.26). Fibre also affects carbohydrate tolerance. A high CHO breakfast cereal like Kelloggs AllBran, made from wheat bran, has a low GI (mean 42). This is likely due to the fact that the bran layer of the wheat containing insoluble fibre, acts as a physical barrier, delaying access to starch by water and digestive enzymes (Brand-Miller 2007, p.190). Legumes have a similar amount of CHO to All Bran with a low GI range, but it is the presence of soluble fibre that exerts an influence over the GI value. Soluble fibres thicken the mixture of food entering the digestive tract, delaying gastric empting and slowing intestinal absorption, which in turn slows release of glucose in to the bloodstream (Bornet et al. 1997, 213). Sweetened condensed milk has 136g of available CHO in a 250g serving, yet it has only a medium GI value (GI=61). This is due to presence of both sucrose (fructose + glucose) and lactose (glucose + galactose) in the product. According to research conducted by Cohen et al.( 1972, p137), fructose, comprising half of the sucrose disaccharide, gives a very low glycaemic response as does lactose. In addition, the presence of milk proteins curd in the stomach and slow the rate of emptying and subsequently absorption (Brand-Miller 2007, p.196). Both the quantity and quality (ie, nature or source) of carbohydrate influence the glycaemic response. By definition, the GI compares equal quantities of carbohydrate and provides a measure of carbohydrate quality but not quantity (Foster-Powell et al. 2002, p. 8). In 1997 the concept of glycaemic load (GL) was introduced by researchers at Harvard University to quantify how much a serving of food will raise blood glucose (Foster-Powell et al. 2002, p. 8). The GL of a typical serving of food is the product of the amount of available carbohydrate in that serving and the GI of the food. The higher the GL, the greater the expected elevation in blood glucose and in the insulinogenic effect of the food. A small amount of a high-GI food may raise blood glucose equally as much as a large amount of a low-GI food; therefore, the more CHO consumed, the

higher blood glucose rises. The higher the GI food consumed, the higher the resultant rise in blood glucose (Salmeron et al 1997, p.472). Some foods contain very little CHO that their GI value is insignificant, as is the case with many vegetables. Carrots for example have a GI of 41 and provide approximately 6 grams of CHO in a serving. Honey on the other hand, also has a low GI value (35) but contains a much higher proportion of CHO per serving (1 Tbsp. = 18g CHO). When comparing these foods in equal proportions, these two foods would be classified as low GI foods but carrots would have a much lower GL than the honey (Brand-Miller 2007, pp. 16-17). GI only applies to high CHO foods. Foods such as meat and eggs are high in protein but have no CHO and therefore their GI=0. Butter is high in fat but has no CHO and thus no GI value. A balanced diet requires the presence of all three macronutrients: fat, protein and CHO, so keeping too low a GL diet would imply that the diet is too heavily weighted in fat and protein. The long-term consumption of a diet with a relatively high GL (adjusted for total energy) is associated with an increased risk of type 2 diabetes and coronary heart disease. A diet with a lower glycaemic load can be achieved by choosing foods with a low glycaemic index or by reducing the quantities of carbohydrate consumed, or both.(Daly M.E., 2004, p.736).

About the Author:

Jeanette Lilly Blanks Medical Herbalist/Naturopath Jeanette Lilly Blanks, a UK (NIMH) and Australian (NHAA) registered herbalist and naturopath, received her BSc (Hons) from the University of Westminster, College of Biosciences in 2005 followed by post-graduate studies in Nutrition Medicine at RMIT in Australia and Sports Nutrition though the International Olympic Committee. Since 2005, she has maintained practices in London, Singapore, and Hong Kong. She works with a wide range of medical conditions including: childrens ailments, women and mens reproductive health, allergies, arthritis, digestive disorders, skin complaints, anxiety, insomnia, adrenal fatigue, detoxification, and weight management. Within a naturopathic framework, she employs a variety of therapeutics including herbal and nutritional medicine, Bach flower remedies, dietary therapy, and lifestyle counselling, to address the root cause of disorder and bring the body back into balance. All ages, infant to elderly, can benefit from naturopathic healthcare.

References:
Bornet F.R.J., Billaux M. S., Messing B.,1997. Glycaemic index concept and metabolic diseases. International Journal of Biological Macromolecules, 21(Issues 1-2), pp. 207-219. Brand-Miller J., Wolever T.M.S., Foster-Powell K., Colagiuri S., 2007. The New Glucose Revolution, 3rd ed. New York: Marlowe & Company.

Cohen A.M., Briller S., Shafrir E., 1972. Effect of longterm sucrose feeding on the activity of some enzymes regulating glycolysis, lipogenesis and gluconeogenesis in rat liver and adipose tissue. Biochimica et Biophysica Acta, 279(1): pp. 129-138. Daly M.E., 2004. Extending the use of the glycaemic index: beyond diabetes? Lancet, 364(9436):736-7. Englyst K.N., Liu S., Englyst H.N., 2007 Nutritional characterization and measurement of dietary carbohydrates. European Journal of Clinical Nutrition, 61 (Suppl 1), pp. S19-39 Foster-Powell K., Holt S.H.A., Brand-Miller J.C., 2002. International table of glycemic index and load. American Journal of Clinical Nutrition, 76(1), pp.5-56. Frost G. & Dornhorst A., 2005. Glycemic Index. Encyclopedia of Human Nutrition 2nd ed., Elsevier Ltd, pp. 390-398. Gropper, S.S., Smith J.L., Groff J.L., 2005. Advanced Nutrition and Human Metabolism 4th ed., USA: Thomson Wadsworth. Holum J.R.,1998. Fundamentals of General, Organic, and Biological Chemistry 6th ed. New York: John Wiley & Sons, Inc. Ludwig D.S., Eckel R.H., 2002. The glycemic index at 20y. American Journal of Clinical Nutrition, 76(suppl), pp.264S-5S. Jenkins D.J.A., Wolever T.M.S., Taylor R.H., Barker H., Fielden H., Baldwin J.M., Bowling A.C., Newman H.C., Jenkins A.L. and Goff D.V., 1981. Glycemic index of foods: a physiological basis for carbohydrate exchange. American Journal of Clinical Nutrition, 34, pp362-366. Mann J. and Truswell A.S., 2002. Essentials of Human Nutrtition 2nd ed., Oxford: Oxford University Press. Nils-Georg Asp, 1996. Dietary carbohydrates: classification by chemistry and physiology. Food Chemistry, 57(1), pp.9-14. Pi-Sunyer 2002 Glycemic index and disease. American Journal of Clinical Nutrition, 76 (Suppl):290S-8S. Salmeron J, Manson JE, Stampfer MJ, Colditz G.A., Wing A.L. & Willett W.C., 1997. Dietary fiber, glycemic load, and risk on non-insulin-dependent diabetes mellitus in women. JAMA, 277, pp.472 477. Tratora G.J., Grabowski S.R., 2000. The Principles of Anatomy and Physiology 9th ed. New York: John Wiley & Sons, Inc. Wolever, T.M.S. and Bolognesi C., 1996. Time of day ifluences relative glycaemic effect of foods. Nutrtition Research, 16(3), pp.381-384.