Annchen Weidemann | Dietician Cape Town

Insulin index of foods

Annchen Weidemann, Dietician, Cape Town

March 16 2018

Potatoes had a significantly higher insulin score than any other carbohydrate-rich food. Whole meal bread and white bread had similar scores, as did white and brown pasta.

Among the bakery products, there appeared to be little difference between the test foods, and all tended to be high. Amongst the snack foods, jelly beans had the highest insulin score, despite the fact that they contained as much total carbohydrate as the four fruits tested. Again, this might be due to the fact that jelly beans are manufactured mainly from glucose, with a small content of fructose.

As previously observed, protein and fat added with carbohydrate increase the insulin response in comparison to the insulinogenic effect of the nutrients separately. This may partly explain the high insulin score found with baked beans. Other discrepancies between GI and insulin responses were also found in the porridge/cereal group of foods tested.

There is evidence to create concern that high carbohydrate diets may increase triglyceride concentrations and reduce HDL concentrations. Furthermore, the utility of GI in conditions other than treatment for diabetes and prevention of cardiovascular disease has been unproven, and there appears to be no evidence of the utility of using GI as a strategy for weight loss in overweight polycystic ovarian syndrome (PCOS).

PART TWO:

Who succeeds in maintaining weight loss?

This interesting review article by Elfhag and Rossner appeared in Obesity Reviews in 2005. It caught my interest since one of the largest stumbling blocks in implementation of a weight loss treatment regime is failure in maintenance or “drop out”. It would also seem that “drop out” with weight loss regimes is higher in certain patient groups compared to others. The above authors cite the following factors for consideration in weight loss maintenance:

Weight loss goals:

Many studies have confirmed that goals set for weight loss are commonly unrealistic. Men seem to be more realistic in their approach to weight loss than women. Subjects who are successful in weight maintenance seem to be the ones who achieved their desired weight loss. The debatable question remains whether the amount of initial weight loss, compared to achieving the set weight goal plays the larger role in long-term positive outcome. Patients with insulin-resistant conditions have shown a drop-out rate of almost 40 % as opposed to non – insulin resistant, weight matched controls.

Weight loss patterns:

It still remains unclear how the early weight loss response predict the long-term outcome. This complexity is illustrated in a study using orlistat (Xenical). Weight loss of > 5% over 12 weeks was a good indicator of 2-year success, compared to a loss of > 10 % after 6 months which could not be related significantly to the 2-year outcome. The longer the patient maintains the weight loss, the better the chances of continuation of a lower body weight.

Dietary intake:

Although weight loss maintenance is related to lower caloric intake and reduced portion sizes, weight loss and maintenance is closely associated with reduced frequency of snacks. A regular rhythm of meals has been identified as helpful in helping long-term weight loss and maintenance.

Self-monitoring:

Although self-monitoring should be done regularly to observe oneself, the weight regainers seem to be those that become less vigilant over self-monitoring over time. Professional help and regular follow-up is crucial in most cases, and not seen as an unnecessary expense. Expertise dietary therapy, involving detailed history taking and tailored advice has been shown to prove successful for reduction in weight and BMI over 3 visits within 3 months.

Other factors:

The authors write very interestingly about life events, social support, motivation and attitudes, etc.

The successful weight maintainer:

This ideal patient starts losing weight early in the weight-loss regime, and reaches the weight goal within the set time. He/she leads an active life, with more leisure activities and less TV watching. Self-monitoring behaviour continues and binge-eating is not an overriding factor. Portions are kept to a lower level, meal rhythm is regular and food choices do not include junk food. Snacking is reduced. In summary, the ideal weight maintainer has more emotional stability and able to cope with stressful life events.

PART THREE:

Message from the author:

I would like to remind each and every doctor out there to be on the lookout for early symptoms of the very progressive metabolic syndrome. In brief, the international criteria for diagnosis are:

• Waist circumference (WC) > 100 cm in males; > 85 cm in females or BMI ≥ 25 kg/m2
• Triglycerides ≥ 1.7 mmol/l
• HDL cholesterol ≤ 1.0 mmol/l in males; ≤ 1.3 mmol/l in females
• Blood pressure ≥ 135 / 85 mmHg or on anti-hypertensive medication
• Fasting plasma glucose ≥ 6.1 mmol/l.
Please look for the other symptoms when you have found one or two. The long-term consequences cause desperate discomfort and detract from the quality of the patient’s life.

I understand too well that they don’t take your advice early on, and usually wait until it’s critical before they follow advice to change their lifestyle. It’s only in their best interest that they understand the importance.

As a delightful patient said to me “…I have worked all my life to buy the best shoes, and worked my whole life to drive this car, and now I can’t get into either without help…”

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