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Abstract

This perspective examines the utility of the glycemic index (GI) as a carbohydrate quality indicator to improve Dietary Guidelines for Americans (DGA) adherence and diet quality. Achieving affordable, high-quality dietary patterns can address multiple nutrition and health priorities. Carbohydrate-containing foods make important energy, macronutrient, micronutrient, phytochemical, and bioactive contributions to dietary patterns, thus improving carbohydrate food quality may improve diet quality. Following DGA guidance helps meet nutrient needs, achieve good health, and reduce risk for diet-related non-communicable diseases in healthy people, yet adherence by Americans is low. A simple indicator that identifies high-quality carbohydrate foods and improves food choice may improve DGA adherence, but there is no consensus on a definition. The GI is a measure of the ability of the available carbohydrate in a food to increase blood glucose. The GI is well established in research literature and popular resources, and some have called for including the GI on food labels and in food-based dietary guidelines. The GI has increased understanding about physiological responses to carbohydrate-containing foods, yet its role in food-based dietary guidance and diet quality is unresolved. A one-dimensional indicator like the GI runs the risk of being interpreted to mean foods are “good” or “bad,” and it does not characterize the multiple contributions of carbohydrate-containing foods to diet quality, including nutrient density, a core concept in the DGA. New ways to define and communicate carbohydrate food quality shown to help improve adherence to high-quality dietary patterns such as described in the DGA would benefit public health.

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References

  1. Nicholls J (2022) Perspective: The Glycemic Index Falls Short as a Carbohydrate Food Quality Indicator to Improve Diet Quality. Front. Nutr. 9:896333. doi: 10.3389/fnut.2022.896333
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Abstract

The objective of this study was to determine the effect of white potato cooking methods on subjective appetite, short-term food intake (FI), and glycemic response in healthy older adults. Using a within-subject, repeated-measures design, 20 participants (age: 70.4 ± 0.6 y) completed, in random order, five treatment conditions: three potato treatments (baked potatoes, mashed potatoes, and French fries), an isocaloric control treatment (white bread), or a fasting condition (meal skipping). Subjective appetite and glycemic response were measured for 120 min using visual analogue scales and capillary blood samples, respectively. Lunch FI was measured with an ad libitum pizza meal at 120 min. Change from baseline subjective appetite (p < 0.001) and lunch FI (p < 0.001) were lower after all test treatments compared with meal skipping (p < 0.001), but did not differ among test treatments. Cumulative FI (test treatment + lunch FI) did not differ among treatment conditions. Blood glucose concentrations were higher after all test treatments compared with meal skipping (p < 0.001), but were not different from each other. In healthy older adults, white potatoes suppressed subjective appetite and lunch FI compared with meal skipping, suggesting white potatoes do not bypass regulatory control mechanisms of FI.

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References

  1. Bellissimo N, Amalraj R, Lee JJ, Brett NR, Totosy de Zepetnek JO, Proteau S, Rousseau D. Effect of White Potatoes on Subjective Appetite, Food Intake, and Glycemic Response in Healthy Older Adults. Nutrients. 2020 Aug 27;12(9):2606. doi: 10.3390/nu12092606. PMID: 32867083; PMCID: PMC7551271.
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Abstract

Plant foods are universally promoted for their links to improved human health, yet carbohydrate-containing foods are often maligned based on isolated, reductionist methods that fail to assess carbohydrate foods as a matrix of nutrients and food components. Currently accepted positive carbohydrate quality indices include plant food, whole-grain content, and dietary fiber, while negative health outcomes are linked to high intakes of added sugar and high glycemic index. More recently, negative health aspects have been linked to ultra-processed foods, which are often high in carbohydrates. Yet, carbohydrate staples such as grains and dairy products are both enriched and fortified, resulting in these carbohydrate foods containing important nutrients of concern such as dietary fiber, potassium, vitamin D, and calcium. This Perspective analyzes carbohydrate metrics used in dietary guidance and labeling and finds limitations in accepted indices included in standardized quality carbohydrate definitions and also proposes additional indices to benefit both human and environmental health. As nutrition recommendations shift away from a single-nutrient focus to a more holistic dietary pattern approach that is flexible and adaptable for each individual, it is necessary to determine the quality components that make up these patterns. This review concludes that current approaches that demonize staple carbohydrate foods do little to promote the recommended patterns of foods known to improve health status and reduce disease risk.

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References

  1. Schulz, Joanne Slavin, Perspective: Defining Carbohydrate Quality for Human Health and Environmental Sustainability, Advances in Nutrition, 2021; nmab050.
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Abstract

Guidelines for reducing postprandial blood glucose concentrations include avoiding high glycemic index (GI) foods, such as white potatoes. However, GI testing is often undertaken in the morning with foods consumed in isolation by non-clinical cohorts. We investigated the impact of potato preparation and consumption as part of a mixed-evening meal on postprandial and nocturnal glycemic responses, and postprandial insulin response, in individuals with Type 2 Diabetes Mellitus (T2DM).  In a randomized, cross-over design, 24 males and females (age 58.3 ± 9.3 y; BMI: 31.7 ± 6.8 kg/m2) with T2DM (diet or metformin controlled) completed four experimental trials after consuming a standardized breakfast (25% daily energy intake (EI)) and lunch (35% EI). Dinner (40% EI) was consumed at 1800 h being either: 1) boiled potato (BOIL); 2) roasted potato (ROAST); 3) boiled potato cooled for 24 h (COOLED); or 4) basmati rice (CONTROL). Each meal contained 50% carbohydrate, 30% fat and 20% protein. Blood samples were collected prior to, immediately post meal and at 30-min intervals for a further 120 min. A continuous glucose monitor was worn to assess nocturnal interstitial glucose concentrations. No differences were detected in postprandial venous glucose area under the curve (iAUC) between CONTROL and all three potato conditions. Postprandial insulin iAUC was greater following COOLED compared to CONTROL (P = 0.003; 95% CI: 18.9-111.72 miU/mL). No significant differences between CONTROL and BOIL or ROAST were detected for postprandial insulin concentrations. All potato meals resulted in lower nocturnal glucose AUC than CONTROL (P < 0.001; 95% CI 4.15-15.67 mmol/L x h). Compared to an isoenergetic rice meal, boiled, roasted or boiled then cooled potato-based meals were not associated with unfavourable postprandial glucose responses or nocturnal glycemic control, and can be considered suitable for individuals with T2DM when consumed as part of a mixed-evening meal.

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References

  1. Devlin BL, Parr EB, Radford BE, Hawley JA. Lower nocturnal blood glucose response to a potato-based mixed evening meal compared to rice in individuals with type 2 diabetes. Clin Nutr. 2020. doi: 10.1016/j.clnu.2020.09.049.
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Abstract

The terms “high- and low-quality carbohydrate” are often ascribed to individual foods as a means of describing the healthfulness of the food in question, without any empirical definition of what constitutes high or low quality. This article summarizes the views of experts on the concept of carbohydrate quality and the numerous factors that should be considered when assessing the quality of a carbohydrate-containing food or meal.

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References

  1. Kanter, M. (2019). High Quality Carbohydrates: A Concept in Search of a Definition. Nutrition Today. doi:10.1097/NT.0000000000000377
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Abstract

(1) High-fat (HF) diet leads to gut microbiota dysbiosis which is associated with systemic inflammation. Bacterial-driven inflammation is sufficient to alter vagally mediated satiety and induce hyperphagia. Promoting bacterial fermentation improves gastrointestinal (GI) epithelial barrier function and reduces inflammation. Resistant starch escape digestion and can be fermented by bacteria in the distal gut. Therefore, we hypothesized that potato RS supplementation in HF-fed rats would lead to compositional changes in microbiota composition associated with improved inflammatory status and vagal signaling. (2) Male Wistar rats (n = 8/group) were fed a low-fat chow (LF, 13% fat), HF (45% fat), or an isocaloric HF supplemented with 12% potato RS (HFRS) diet. (3) The HFRS-fed rats consumed significantly less energy than HF animals throughout the experiment. Systemic inflammation and glucose homeostasis were improved in the HFRS compared to HF rats. Cholecystokinin-induced satiety was abolished in HF-fed rats and restored in HFRS rats. HF feeding led to a significant decrease in positive c fiber staining in the brainstem which was averted by RS supplementation. (4) The RS supplementation prevented dysbiosis and systemic inflammation. Additionally, microbiota manipulation via dietary potato RS prevented HF-diet-induced reorganization of vagal afferent fibers, loss in CCK-induced satiety, and hyperphagia.

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References

  1. Klingbeil, E.A., Cawthon, C., Kirkland, R., de La Serre, C.B. (2019) Potato-Resistant Starch Supplementation Improves Microbiota Dysbiosis, Inflammation, and Gut-Brain Signaling in High Fat-Fed Rats. Nutrients. doi:10.3390/nu11112710
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Abstract

Resistant starch (RS) has been shown to improve postprandial glycemia and insulin sensitivity in adults with metabolic syndrome. RS is found naturally in potatoes, where the amount varies based on cooking method and serving temperature. Thirty females with a mean BMI of 32.8 ± 3.7 kg/m2, fasting glucose of 110.5 mg/dL, and insulin of 10.3 µIU/L, completed this randomized, crossover study. A quantity of 250 g of boiled (low RS) and baked then chilled (high RS) russet potatoes were consumed on two separate occasions. Glycemic (glucose and insulin) and incretin response, subjective satiety, and dietary intake were measured. Results showed that the chilled potato elicited significant reductions at 15 and 30 min in glucose (4.8% and 9.2%), insulin (25.8% and 22.6%), and glucose-dependent insulinotropic peptide (GIP) (41.1% and 37.6%), respectively. The area under the curve for insulin and GIP were significantly lower after the chilled potato, but no differences were seen in glucose, glucagon-like peptide-1, and peptide YY, or overall subjective satiety. A higher carbohydrate and glycemic index but lower fat diet was consumed 48-hours following the chilled potato than the boiled potato. This study demonstrates that consuming chilled potatoes higher in RS can positively impact the glycemic response in females with elevated fasting glucose and insulin.

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References

  1. Patterson MA, Fong JN, Maiya M, Kung S, Sarkissian A, Nashef N, Wang W. Chilled Potatoes Decrease Postprandial Glucose, Insulin, and Glucose-dependent Insulinotropic Peptide Compared to Boiled Potatoes in Females with Elevated Fasting Glucose and Insulin. Nutrients. 2019; 11(9):2066, doi:10.3390/nu11092066.
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Abstract

The objective of this review is to discuss the effect of white vegetable consumption on glycemia, satiety, and food intake. White vegetables is a term used to refer to vegetables that are white or near white in color and include potatoes, cauliflowers, turnips, onions, parsnips, white corn, kohlrabi, and mushrooms (technically fungi but generally considered a vegetable). They vary greatly in their contribution to the energy and nutrient content of the diet and glycemia and satiety. As with other foods, the glycemic effect of many white vegetables has been measured. The results illustrate that interpretation of the semiquantitative comparative ratings of white vegetables as derived by the glycemic index must be context dependent. As illustrated by using the potato as an example, the glycemic index of white vegetables can be misleading if not interpreted in the context of the overall contribution that the white vegetable makes to the carbohydrate and nutrient composition of the diet and their functionality in satiety and metabolic control within usual meals. It is concluded that application of the glycemic index in isolation to judge the role of white vegetables in the diet and, specifically in the case of potato as consumed in ad libitum meals, has led to premature and possibly counterproductive dietary guidance.

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References

  1. G. Harvey Anderson, Chesarahmia Dojo Soeandy, Christopher E. Smith, White Vegetables: Glycemia and Satiety, Advances in Nutrition, Volume 4, Issue 3, May 2013, Pages 356S–367S, https://doi.org/10.3945/an.112.003509
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Abstract

Potatoes are rich in phenolic compounds which have been reported to impact starch digestion and intestinal glucose transport in model systems through phenolic-starch interactions. While these effects are well documented for pigmented potatoes and in model systems, the relevance of phenolics to the glycemic properties of processed colorless potato-based foods under naturalistic conditions remains unclear. This study assessed impacts of processing on phenolic concentrations, resistant starch content and glycemic properties of Russet Burbank and Shepody potatoes. Product forms included French fries, shredded (hash browns) and diced (home fries) produced through commercial processing as well as parallel in-home techniques. Commercial products had significantly higher concentrations of resistant starch (p < 0.05, 1.48-6.57 vs. 1.23-2.22 g/100 fresh weight, FW) and resistant starch/total starch ratio (5.42-18.3 % vs. 3.58-7.62 %) compared to freshly prepared counterparts, while statistically lower total caffeoylquinic acid content (2.94-10.9 vs. 11.5-25.2 mg/100 FW). Glucose release and intestinal transport assessed using an in vitro digestion/Caco-2 cell monolayers model demonstrated a reduction in d7-glucose intestinal transport from commercially processed products relative to fresh prepared counterparts (p < 0.05, 31.3-61.2 % vs. 79.3-110 % at 60 min). Commercial Russet Burbank potato products including French fries, home fries and hash browns were then selected for clinical assessment of glycemic response and appetite rating by 23 participants (11 male and 12 female). The three products presented a subtle but discernable ascending trend (French fry ≥ home fry ≥ hash browns) for incremental area under the curve (IAUC, 95.2 ± 12 vs. 105 ± 10 vs. 107 ± 14 mM•min, p < 0.05) at 2 h post breakfast and for appetite rating (45.2 ± 6.3 vs. 52.4 ± 4.1 vs. 57.7 ± 7.2 for hunger) at 4 h post breakfast with no significant difference from the control (whole wheat pancake). These results suggest that potato phenolics have only a modest influence on acute glycemic responses.

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References

  1. Li M, George J, Hunter S, Hamaker BR, Mattes R, Ferruzzi MG. Potato product form impacts in vitro starch digestibility and glucose transport but only modestly impacts 24h blood glucose response in humans. Food Funct. 2019; 10:1846-1855. doi:10.1039/C8FO02530D.
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