Low GI carbs. Can sugars play a role? The example of Palatinose (isomaltulose)

Transcription

1 Low GI carbs Can sugars play a role? The example of Palatinose (isomaltulose) Silke Ullmann, MPH, Registered Dietitian Manager Nutrition Communication 17004p-SUN_Low GI carbs_fdin

2 Outline Why is GI relevant to our health? Importance of blood sugar management Evidence for high and low GI diets Introducing Palatinose A unique carbohydrate with slow release properties Evidence on blood glucose response and diabetes risk Evidence in sports Can low GI play a role in sports nutrition? 2

3 Why is GI relevant to our health? Importance of blood sugar management 3

4 The diabetes wave Diabetes mellitus continues to dramatically increase Diabetes mellitus 2015: 415m people (8.8% population) 2040: 642m people (10.4% population) Impaired glucose tolerance (IGT) 2015: 318m people (6.7% population) 2040: 481m people (7.8% population) m m m m m m m m m m m m m m overweight 1.9 bn 39% obese 600 m 13% all numbers refer to adult population Overweight and obesity Overweight: 1.9bn people (39% population) Obese: 600m people (13% population) International Diabetes Federation, IDF Diabetes Atlas 7th Edition 2015; World Health Organization (2015) Fact Sheet N. 311, (13Apr2016) Note: all numbers refer to adult population; worldwide 4

5 Risk factors for Non-Communicable Diseases Diet plays a key role Most risk factors are preventable! The diet plays a major role! Raised blood glucose is the No 3 mortality risk factor worldwide! World Health Statistics

6 Carbohydrates need more attention Carbohydrate quality influences metabolism Change in blood glucose Carbohydrates represent the largest group of nutrients and main source of energy, directly affect blood glucose levels, trigger insulin release, determine the metabolic profile Carbohydrate quality plays a key role breakfast snack lunch snack dinner With high glycemic diet With low glycemic diet 08:00 24:00 Time of day (hours) 6

7 Evidence for high and low GI diets 7

8 Evidence for high and low GI diets piling up over past 30 years 8

9 Health benefits of reduced glycaemia: Outcome of a Scientific Consensus Summit 2013 Glycaemic Index, Glycaemic Load and Glycaemic Response: An International Scientific Consensus Summit June 6-7, Stresa (Milan), Italy Scientific Consensus Committee Chairs: David J.A. Jenkins (University of Toronto) Walter C. Willett (Harvard School of Public Health) Members: Additional 18 key academics of the GI and GL research field The scientific consensus statement says that Reducing postprandial glycaemic response is recognised as beneficial physiological effect There is convincing evidence that diets low in GI/GL improve glycaemic control in people with type 2 and type 1 diabetes reduce the risk of type 2 diabetes reduce the risk of coronary heart disease There is probable evidence that diets low in GI/GL reduce total body fat mass and support body weight management Full text and corresponding references of final document available at : SUMMIT.aspx 9

10 Positive EFSA opinions Reduced glycaemic response as health benefit EFSA recognise "reduced glycaemic response" as health benefit for the general population Corresponding claims have been approved for several food ingredients a.o., e.g. Sugar replacement with - low glycaemic sugars like isomaltulose - polyols like isomalt and/or intense sweeteners - non-digestible carbohydrates, like inulin and oligofructose Replacement of digestible starch by resistant starch Addition of viscous soluble fibres like pectins, arabinoxylan, HPMC Enrichment with slowly digestible starch by processing EFSA Journal 2011;9(4):2076 EFSA Journal (2014) 12(1):3513; 10

11 Carbohydrates and Health Scientific Advisory Committee on Nutrition 2015 Health/disease outcomes Glycaemic Index Key findings / conclusions Evidence Glycaemic Load Cardiovascular disease events No association + Association + Blood pressureprospective cohort studies indicate - Systolic No effect - Diastolic No effect No effect Effect Fasting blood lipids - Total cholesterol Limited evidence from Effect cohort studies ++ and RCT suggests No effect - LDL-cholesterol There may also be Effect other adverse ++ health effects No effect - Triacyglycerol No effect ++ Effect Type 2 diabetes mellitus Association +++ Association +++ Fasting blood glucose No effect ++ No effect + Fasting insulin No effect ++ No effect + Evidence Diets with a higher GI or GL are associated with greater risk of T2DM However, higher and lower GI / GL diets will, in most cases, differ in many ways other than the carbohydrate fraction and therefore study results are difficult to interpret as it is not possible to exclude confounding by other dietary variables Insulin sensitivity/resistance No effect ++ No effect + (e.g. dietary fibre, protein or fat content, cooking methods, food processing, and storage) limited; ++ moderate; +++ adequate SACN (2015) Carohydrates and Health, Belfast RCT: randomised controlled trial 11

12 Blood glucose response and health The relevance of insulin as key regulator Direct correlation between insulin and blood glucose level High-glycaemic carbohydrates lead to higher insulin levels than low-glycaemic carbohydrates What matters from a physiological point of view is the blood glucose response and insulin release König 2008 at the 1st European BENEO Scientific Symposium, 11 April, Brussels 12

13 Blood sugar management matters to all age groups! 13

14 The carbohydrate classification into Sugars = "bad carbs" Consumer language ʺsimple carbohydratesʺ Food chemical classification mono- & disaccharides Others = "good carbs" Consumer language ʺcomplex carbohydratesʺ Food chemical classification oligo- & polysaccharides with longer chain length Examples: glucose, fructose, maltose, sucrose, HFCS, galactose, lactose Examples: Maltodextrin, starch (amylose, amylopectin), fibres 14

15 does not always reflect physiological properties Glycaemic Index (GI) values of sugars Blood glucose curves of foods providing 50 g of mostly "complex carbohydrates" Foster-Powell et al (2002) Am J Clin Nutr 76(2002):5 56 Atkinson et al (2008) Diabetes Care 31(12): Jenkins et al (1981) Am J Clin Nutr 34,

16 Introducing Palatinose A unique carbohydrate with slow release properties 16

17 Introducing Palatinose A unique innovative carbohydrate Palatinose is a slow release carbohydrate: It supplies the body with the full carbohydrate energy in a slower, more balanced way and over a longer period of time than conventional carbohydrates. Like sucrose composed of glucose and fructose A natural constituent of honey Produced via rearrangement of sucrose 17

18 Digestibility is key Palatinose in the small intestine Palatinose is a fully digestible slow release" carbohydrate Small intestine Slow yet complete digestion by human enzymes and subsequent absorption Slow glucose release (low glycaemic) Full calories (4 kcal/g) Large intestine Not relevant (fully digestible carbohydrate!) 18

19 Palatinose The stronger linkage makes all the difference Blood glucose Palatinose Slow and sustained energy Higher level of fat burning Low blood glucose response Kind to teeth sugar Time after consumption 19

20 Evidence on blood glucose response and diabetes risk 20

21 Palatinose makes the difference It is a low glycaemic carbohydrate Plasma insulin change (m m ol/l) Plasma glucose change (m m ol/l) GI (%) 5 Blood glucose GI Sucrose Palatinose TM Time (m in) 0 Glucose Sucrose Isomaltulose Insulin Sucrose Palatinose TM The lower blood glucose response is associated with a lower insulin release Time (m in) 10 healthy volunteers (18-24 years, BMI kg/m 2 ), intake 50g in 250ml water in fasting conditions. Sydney University s Glycaemic Index Research Service (SUGiRS) (2002) Sponsor: BENEO 21

22 Low glycaemic properties confirmed in over 30 human trials with Palatinose Consistent findings with Palatinose LOWER blood glucose response LOWER insulin response 22

23 Low glycaemic properties of Palatinose Confirmation in healthy and diabetic conditions Number of relevant human intervention studies with Palatinose : >20 23

24 Palatinose The better sugar for people with diabetes! Study of the German Institute of Human Nutrition (DIfE) confirms: Palatinose lowers the blood glucose response and insulin in people with diabetes mellitus, linked with a better incretin response. Press Release ( Till Budde/DIfE) Blood glucose and serum insulin concentrations in type 2 diabetics after intake of 50g Palatinose or sucrose. Values are mean ± SEM. *p>0.05, ** p<0.01 and ***p<0.001 Keyhani-Nejad et al. (2016) Diabetes Care 39(3):e38-e39. doi: /dc

25 Palatinose has a different incretin response "Footprints" of its slow release The incretines GIP and GLP-1 are gut hormones, which stimulate glucose-dependent insulin secretion Upper small intestine GIP release from K cells Stimulated by monosaccharides Palatinose : GIP Lower small intestine GLP-1 release from L cells Palatinose : GLP-1 Palatinose digestion and absorption occurs along the entire small intestine. References a) Healthy adults Maeda et al (2013) J Diabetes Investig 4 (3) b) Diabetes mellitus Ang and Linn (2014) Am J Clin Nutr 100: (data shown here) Keyhani-Nejad et al (2016) Diabetes Care 39(3):e38-e39. 25

26 Palatinose makes a difference long term Benefits on body composition & body weight % Body Weight Body composition Indications from various animal and first human studies Palatinose causes less fat accumulation in adipose tissue ( belly fat ) with benefits on body composition in the liver with potential in the prevention of non-alcoholic fatty liver and insulin resistance* Body Weight Change over 12 weeks Sucrose Body weight Results from long-term studies on body weight management Palatinose may be more effective in promoting weight loss in a weight-loss diet than sucrose Palatinose TM Time Carbohydrate-rich meal replacement formula with Palatinose and fibre is effective in promoting weight loss * first animal study 26

27 Long-term studies Benefits of Palatinose vs. high GI carbohydrates Weight management and body composition Less abdominal fat Supportive effect on body weight loss Blood glucose control Reductions in fasting blood glucose Improving effects on insulin resistance in persons with poor insulin sensitivity Reductions in fasting plasma triglycerides Prevention of non-alcoholic fatty liver and insulin resistance, independent of obesity* Cardiovascular risk No detrimental effects on blood lipids (incl. cholesterol) and cardiovascular risk markers Emerging science proposes a beneficial effect on arterial stiffness * Animal data

28 Evidence in sports Can low GI play a role in sports nutrition? 28

29 Low GI carbs in sports? It depends! Situations where Palatinose can be beneficial Increase body s fat oxidation capacity Consistent evidence from several RCT: Palatinose promotes fat oxidation in energy metabolism vs. high GI carbs "Training effect" Fuel management for endurance Recently published study suggests benefit of Palatinose vs. high GI Potential glycogen sparing Endurance training Physical activity & diabetes mellitus Physical activity & weight management Endurance activity prior to a sprint Stabilise blood sugar levels along physical activity in T1DM Series of 5 studies in T1DM: Palatinose allows more stable blood sugar levels and less hypoglycemic episodes (vs. high GI) Stabilise blood sugar levels RCT: randomised controlled trial T1DM: type 1 diabetes mellitus ow/ob: overweight/obese Physical activity to support weight management strategies Study in ow/ob men: Palatinose allows higher fat oxidation during rest and physical activity vs. high GI Maintain fat burning rate 29

30 Rate of energy supply determines fuel partitioning Palatinose promotes fat burning Traditional carbohydrates Benefits of Palatinose Blood glucose Slow and sustained release Lower blood glucose response Insulin Carb. oxidation Fat oxidation Less insulin release Lower carbohydrate oxidation Higher fat oxidation in energy gain 30

31 Palatinose promotes fat oxidation Palatinose and its more balanced glucose supply allows a higher fat oxidation in energy metabolism than conventional high glycaemic carbohydrates Effect of Palatinose on fat oxidation confirmed in different populations: at rest and during physical activity trained endurance athletes and moderately active people normal weight and overweight people normal and impaired glucose tolerance (IGT) Palatinose TM studies (BENEO) Further published studies 31

32 Palatinose in sports Series of sports studies with Palatinose In comparison with maltodextrin or sugar In trained athletes or recreational sports Taken before, during and after exercise Key findings for Palatinose More steady glucose supply Sufficient carbohydrate energy for high intensity endurance performance Improved metabolic profile: less fluctuations, higher level of fat oxidation ( training effect ) No gastrointestinal distress 32

33 Study Design Palatinose and Performance Purpose Effect of Palatinose (low GI) vs. maltodextrin (high GI) on substrate use during endurance exercise and subsequent time trial performance Study Design 2-arm cross-over design, randomised, double-blind, placebo controlled N = 20 male endurance athletes (VO 2 max > 55 ml/kg) Consumption of a beverage with 75g Palatinose or maltodextrin before exercise Pre-run Endurance exercise 60-65% VO 2 max Time Trial Test (6.5 kj/kg bw) end Intake of 750 ml drink with 10% (75g) Palatinose or maltodextrin Koenig D et al (2016) Nutrients 8, Sponsor: BENEO 33

34 Endurance performance Results from the time trial min min Finish line Palatinose improved cycling performance (vs. maltodextrin): Faster time to finish time trial Higher power output in the time trial finish Palatinose provided glucose more steadily with positive influence on fuel use in preceding endurance exercise (vs. maltodextrin) More stable and sustained blood glucose profile Higher fat oxidation rates Proposed mechanism: Lower carbohydrate oxidation could have allowed to spare glycogen sources for the final time trial performance König D et al (2016) Nutrients 8, Sponsor: BENEO 34

35 Conclusion Evidence and acceptance is piling up that the blood glucose response to foods matters to health and disease prevention Focus on GI/GL or simple vs. complex carbs has limitations to convey the message The slow release carbohydrate Palatinose, when replacing high GI carbs, can contribute to bring a low glycaemic diet into practice More steady glucose supply Lower blood glucose and insulin response Improved metabolic profile Benefits for blood sugar management, diabetes risk and metabolic health Additionally, in sports nutrition and physical activity, Palatinose can offer advantages over high GI carbohydrate in different situations 35

36