Glycemic index and glycemic load: measurement issues and their effect on diet-disease relationships

Glycemic index (GI) describes the blood glucose response after consumption of a carbohydrate containing test food relative to a carbohydrate containing reference food, typically glucose or white bread. GI was originally designed for people with diabetes as a guide to food selection, advice being given to select foods with a low GI. The amount of food consumed is a major determinant of postprandial hyperglycemia, and the concept of glycemic load (GL) takes account of the GI of a food and the amount eaten. More recent recommendations regarding the potential of low GI and GL diets to reduce the risk of chronic diseases and to treat conditions other than diabetes, should be interpreted in the light of the individual variation in blood glucose levels and other methodological issues relating to measurement of GI and GL. Several factors explain the large inter- and intra-individual variation in glycemic response to foods. More reliable measurements of GI and GL of individual foods than are currently available can be obtained by studying, under standard conditions, a larger number of subjects than has typically been the case in the past. Meta-analyses suggest that foods with a low GI or GL may confer benefit in terms of glycemic control in diabetes and lipid management. However, low GI and GL foods can be energy dense and contain substantial amounts of sugars or undesirable fats that contribute to a diminished glycemic response. Therefore, functionality in terms of a low glycemic response alone does not necessarily justify a health claim. Most studies, which have demonstrated health benefits of low GI or GL involved naturally occurring and minimally processed carbohydrate containing cereals, vegetables and fruit. These foods have qualities other than their immediate impact on postprandial glycemia as a basis to recommend their consumption. When the GI or GL concepts are used to guide food choice, this should be done in the context of other nutritional indicators and when values have been reliably measured in a large group of individuals.