17004p-SUN_Low GI carbs_FDIN 20170307
Low GI carbs
Can sugars play a role?
The example of Palatinose™ (isomaltulose)
Silke Ullmann, MPH, Registered Dietitian
Manager Nutrition Communication
© 2017 BENEO
Outline
2
• 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?
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Why is GI relevant to our health?
Importance of blood sugar management
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The diabetes waveDiabetes mellitus continues to dramatically increase
International Diabetes Federation, IDF Diabetes Atlas 7th Edition 2015; http://www.diabetesatlas.org/
World Health Organization (2015) Fact Sheet N. 311, http://www.who.int/mediacentre/factsheets/fs311/en; http://www.who.int/diabetes/globa-report (13Apr2016)
Note: all numbers refer to adult population; worldwide
2015 44.3 m2040 60.5 m
2015 59.8 m2040 71.1 m
2015153.2 m2040214.8 m
201514.2 m204034.2 m
201535.4 m204072.1 m
201578.3 m2040140.2 m
2015 29.6 m2040 48.8 m
overweight
1.9 bn39%
obese600 m13%
Diabetes mellitus2015: 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)
Overweight and obesity Overweight: 1.9bn people (39% population)
Obese: 600m people (13% population)all numbers refer to adult population
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Risk factors for Non-Communicable Diseases
Diet plays a key role
World Health Statistics 2012. http://www.who.int/nmh/publications/ncd_report_chapter1.pdf
Most risk factors are preventable!
The diet plays a major role!
Raised blood glucose is the No 3
mortality risk factor worldwide!
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Carbohydrates need more attention
Carbohydrate quality influences metabolism
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
Cha
ng
e in
blo
od
glu
co
se
Time of day (hours)08:00 24:00
6
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Evidence for high and low GI diets
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Evidence for high and low GI diets
piling up over past 30 years
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Health benefits of reduced glycaemia:
Outcome of a Scientific Consensus Summit 2013
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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 :
http://www.nutrition-foundation.it/notizie/GLYCAEMIC-INDEX--GLYCAEMIC-LOAD-AND-GLYCAEMIC-RESPONSE--AN-INTERNATIONAL-SCIENTIFIC-CONSENSUS-
SUMMIT.aspx
Glycaemic Index, Glycaemic Load and Glycaemic Response: An International Scientific Consensus Summit
June 6-7, 2013 - 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
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• 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
Positive EFSA opinions
Reduced glycaemic response as health benefit
EFSA Journal 2011;9(4):2076
EFSA Journal (2014) 12(1):3513; http://www.efsa.europa.eu/en/efsajournal/doc/3513.pdf 10
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Carbohydrates and Health
Scientific Advisory Committee on Nutrition 2015
+ limited; ++ moderate; +++ adequate
SACN (2015) Carohydrates and Health, Belfast
RCT: randomised controlled trial
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Health/disease outcomes Glycaemic
Index
Evidence Glycaemic
Load
Evidence
Cardiovascular disease events No association + Association +
Blood pressure
- Systolic
- Diastolic
No effect
No effect
++
++
No effect
Effect
+
+
Fasting blood lipids
- Total cholesterol
- LDL-cholesterol
- Triacyglycerol
Effect
Effect
No effect
++
++
++
No effect
No effect
Effect
+
+
+
Type 2 diabetes mellitus Association +++ Association +++
Fasting blood glucose No effect ++ No effect +
Fasting insulin No effect ++ No effect +
Insulin sensitivity/resistance No effect ++ No effect +
Key findings / conclusions
Prospective cohort studies indicate
Diets with a higher GI or GL are associated with greater risk of T2DM
Limited evidence from cohort studies and RCT suggests
There may also be other adverse health effects
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
(e.g. dietary fibre, protein or fat content, cooking methods, food processing,
and storage)
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Blood glucose response and health
The relevance of insulin as key regulator
König 2008 at the 1st European BENEO Scientific Symposium, 11 April, Brussels 12
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
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Blood sugar management matters
to all age groups!
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The carbohydrate classification into …
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Sugars
= "bad carbs"
ʺsimple carbohydratesʺ
mono- & disaccharides
Food chemical classification
Consumer language
Others
= "good carbs"
ʺcomplex carbohydratesʺ
oligo- & polysaccharides
with longer chain
length
Food chemical classification
Consumer language
Examples: glucose, fructose, maltose,
sucrose, HFCS, galactose, lactose
Examples: Maltodextrin, starch
(amylose, amylopectin), fibres
© 2017 BENEO
… does not always reflect physiological properties
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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):2281–2283
Jenkins et al (1981) Am J Clin Nutr 34, 362-366
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Introducing Palatinose™
A unique carbohydrate with
slow release properties
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© 2017 BENEO
Introducing Palatinose™
A unique innovative carbohydrate
• Like sucrose composed of glucose and fructose
• A natural constituent of honey
• Produced via rearrangement of sucrose
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.
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Digestibility is key
Palatinose™ in the small intestine
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!)
Palatinose™ is a fully digestible
“slow release" carbohydrate
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Palatinose™
The stronger linkage makes all the difference
Slow andsustained
energy
Low blood glucose
response
Higher level of fat
burning
Palatinose™
Kind toteeth
Blo
od g
lucose
Time after consumption
sugar
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Evidence on blood glucose
response and diabetes risk
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Palatinose™ makes the difference
It is a low glycaemic carbohydrate
10 healthy volunteers (18-24 years, BMI 19-24 kg/m2),
intake 50g in 250ml water in fasting conditions.
The lower blood glucose response
is associated with a lower insulin release
Sucrose
PalatinoseTM
30 60 90 1200
1
-1
2
3
4
5
-2
Time (m in)
Pla
sm
a g
lucose c
hange (
m m
ol/L)
Sucrose
PalatinoseTM
30 60 90 1200
50
-50
100
150
200
250
Time (m in)
Pla
sm
a in
sulin
change (
m m
ol/L)
Glucose IsomaltuloseSucrose0
20
40
60
80
100100
68
32GI
(%)
Blood glucose
Insulin
GI
Sydney University’s Glycaemic Index Research Service (SUGiRS) (2002)
Sponsor: BENEO 21
© 2017 BENEO
Low glycaemic properties confirmedin over 30 human trials with Palatinose™
Consistent findings with Palatinose™
• LOWER blood glucose response
• LOWER insulin response
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Low glycaemic properties of Palatinose™
Confirmation in healthy and diabetic conditions
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✓
✓
✓
Number of relevant human
intervention studies with Palatinose™:
>20
© 2017 BENEO
Palatinose™
The better sugar for people with diabetes!
Keyhani-Nejad et al. (2016) Diabetes Care 39(3):e38-e39. doi: 10.2337/dc15-1891
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
(© Till Budde/DIfE)
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
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© 2017 BENEO
Palatinose™ has a different incretin response
"Footprints" of its slow release
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The incretines GIP and GLP-1 are gut hormones, which
stimulate glucose-dependent insulin secretion
Palatinose™ digestion and absorption occurs
along the entire small intestine.
Lower small intestine
• GLP-1 release from L cells
• Palatinose™: GLP-1
Upper small intestine
• GIP release from K cells
• Stimulated by
monosaccharides
• Palatinose™: GIP
References
a) Healthy adults
Maeda et al (2013) J Diabetes Investig 4 (3) 281-6.
b) Diabetes mellitus
Ang and Linn (2014) Am J Clin Nutr 100:1059–68. (data shown here)
Keyhani-Nejad et al (2016) Diabetes Care 39(3):e38-e39.
© 2017 BENEO
Body composition
• 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
• Palatinose™ may be more effective in promoting
weight loss in a weight-loss diet than sucrose
• Carbohydrate-rich meal replacement formula with
Palatinose™ and fibre is effective in promoting weight loss
Body Weight Change over 12 weeks
Time
% B
ody
Weig
ht
Sucrose
PalatinoseTM
* first animal study
Results from long-term studies on body weight management
Indications from various animal and first human studies
Palatinose™ makes a difference – long term
Benefits on body composition & body weight
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© 2017 BENEO
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
© 2017 BENEO
Evidence in sports
Can low GI play a role in sports nutrition?
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© 2017 BENEO
Low GI carbs in sports? It depends!
Situations where Palatinose™ can be beneficial
RCT: randomised controlled trial29
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
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
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
Endurance training
Endurance activity prior to a sprint
Physical activity
& weight management
Physical activity
& diabetes mellitus
ow/ob: overweight/obese
T1DM: type 1 diabetes mellitus
© 2017 BENEO
Rate of energy supply determines fuel partitioning
Palatinose™ promotes fat burning
Carb. oxidation
Fat oxidation
Insulin
Blood glucose
Benefits of Palatinose™
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Slow and sustained release
Lower blood glucose response
Less insulin release
Lower carbohydrate oxidation
Higher fat oxidation in energy gain
Traditional carbohydrates
© 2017 BENEO
Palatinose™ promotes fat oxidation
Palatinose™ and its more balanced glucose supply
allows a higher fat oxidation in energy metabolism
than conventional high glycaemic carbohydrates
PalatinoseTM studies (BENEO) Further published studies 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)
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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
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© 2017 BENEO
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 (VO2max > 55 ml/kg)
• Consumption of a beverage with 75g Palatinose™ or maltodextrin before exercise
33Koenig D et al (2016) Nutrients 8, 390-400.
Sponsor: BENEO
Pre-run Endurance exercise
60-65% VO2max
-45‘ 0‘ 45‘15‘ 30‘ 60‘ 75‘ 90‘
Intake of 750 ml drink with 10% (75g) Palatinose™ or maltodextrin
Time Trial Test
(6.5 kJ/kg bw)
end-30‘ -15‘
© 2017 BENEO
Endurance performance
Results from the time trial
König D et al (2016) Nutrients 8, 390-400.
Sponsor: BENEO
31.08 min
30.05 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
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© 2017 BENEO
• 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
Conclusion
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