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[ADA2015]指数创始人GI Jennie:钟爱低血糖指数食物的理由
——澳大利亚悉尼大学医学院Jennie Brand-Miller教授现场访谈
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作者:Brand-Miller 2015/6/17 11:06:00    加入收藏
内容概要:Jennie Brand-Miller,澳大利亚悉尼大学医学院人类营养学家。她开创了评估人体碳水化合物吸收程度的方法,即通常所说的血糖指数(GI,glycemic index),并获得国际认可,人们称她为GI Jennie。她的突破性发现是并非所有的碳水化合物都是“平等”的,GI描述了这种差异。Brand-Miller认为低GI饮食使血糖和胰岛素水平产生较小的波动,从而能够减少糖尿病和心血管风险,并减轻体重。她的研究兴趣涵盖了与碳水化合物相关的各个方面,如低GI饮食对妊娠女性及其后代的影响。
  <International Diabetes>: So, Professor Brand-Miller, so talking about the pathogenesis, what is the benefit of low glycemic index food for patients with type 2 diabetes or patients with high diabetes risk?
 
  Dr. Brand-Miller: Alright, so if we’re talking first about the people who already have a diagnosis of type 2 diabetes then low glycemic index foods can help reduce the risk of complications. And the mechanism there is that by choosing starchy foods that are slowly digested, slowly digested and absorbed that you lower their postprandial glucose response and that means that you’re giving the beta cell less challenge. It helps the beta cells’ health by reducing the demand for insulin. So that means that you maintain better beta cell function and by doing that you reduce the risk of oxidative stress in all the cells. So all the cells that are susceptible to glycemic stress including the eyes, the kidneys, and the nerves and the cells that line the blood vessels, the endothelial cells, less oxidative stress means that they are more likely to reduce – people are more likely to reduce their risk of complications. Alright? So for people that’ve not yet have diabetes but have risk factors, so they might be pre-diabetic, the same thing holds, that you are helping to reduce oxidative stress by reducing postprandial glycaemia. And that has all these important health effects for the beta cells. It means that your beta cells are more likely to be multiplying at a rate which is more balanced with the rate at which the cells are undergoing apoptosis. So beta cell mass is better maintained and in the long run that means less postprandial glycaemia.
 

   《国际糖尿病》:Brand-Miller教授,对2型糖尿病患者或是糖尿病风险较高的患者而言,低血糖指数食物有何益处?

 
  Brand-Miller教授:首先,对已经确诊2型糖尿病的患者而言,低血糖指数食物有助于降低并发症发生风险。其机制主要是通过选择可被缓慢消化及吸收的淀粉类食物来降低2型糖尿病患者的餐后血糖反应,从而减少对β细胞的负担,通过减少机体对胰岛素的需求使β细胞变得健康。这就意味着,低血糖指数食物有助于保持更好的β细胞功能,降低所有细胞中的氧化应激风险。而对血糖应激易感的所有细胞(包括眼、肾脏、神经、血管内皮细胞)中氧化应激水平越低,患者并发症的风险就更容易降低。
 
  对仅伴有危险因素但尚未发生糖尿病的糖尿病高危患者(如糖尿病前期患者)而言,低血糖指数食物也同样具有上述益处,可通过降低餐后血糖减轻氧化应激,从而对β细胞发生重要的有益效应。这就意味着,应用低血糖指数食物时,人体的β细胞容易以与凋亡速度相平衡的速度来进行增殖,从而能够更好地维持β细胞的数量。从长远来看,更有助于降低餐后血糖。
 
  <International Diabetes>: Thank you. So, now my question would be can low glycemic index food decrease cardiovascular risk?
 
  Dr. Brand-Miller: Alright, I think they can. I think low GI foods help the endothelial cells which line the blood vessels. That means that there’s less dysfunction of those cells because they’re exposed to less glucose stress, less glucose oxidative stress. But some meta-analyses have also shown that low GI diets reduce LDL cholesterol and they reduce CRP, C - reactive protein, which is a measure of low-grade chronic inflammation. So we’ve got several mechanisms that are operating there that reduce cardiovascular risk.
 
  《国际糖尿病》:低血糖指数食物能否降低心血管风险?
 
  Brand-Miller教授:我认为,低血糖指数食物可以降低心血管风险。其对血管中的内皮细胞有益,可减少血管内皮细胞的葡萄糖应激及葡萄糖氧化应激,从而减轻血管内皮细胞功能障碍。此外,有些荟萃分析显示,低血糖指数食物可降低LDL-C以及慢性低度炎症标志物C反应蛋白(CRP)的水平。因此,我们已经得知低血糖指数食物可通过上述几种机制发挥降低心血管风险之作用。
 
 
  <International Diabetes>: Sure, thank you. So, next question would be for population with high carbohydrate diet as the main diet, such as China, what would be your suggestion to their health intervention?
 
  Dr. Brand-Miller: Yes, well for people with diabetes I would suggest that they might decrease carbohydrate intake modestly, alright? Not drastically. Just by a little bit. And replace the calories with protein foods, so I would recommend a modest increase in protein, which means, you know, it might come up to, say, 100 grams a day of protein and that means eating maybe 300, 400 grams of protein foods a day. And that can come from a range of protein foods like eggs, dairy products, it could be lean red meat, it could be chicken or fish. Alright? And a mixture of those I think is good. But also modestly reducing carbohydrate intake and being very choosy about the type of carbohydrate foods. So I would try to choose low glycemic index carbohydrate foods. Some rice have a low glycemic index, and noodles, rice noodles have a lower glycemic index than the most common rice in China. So I think China’s food industry should be actively breeding low glycemic index rice for their population.
  《国际糖尿病》:对以高碳水化合物饮食为主要饮食的人群如中国人群而言,您对其健康干预有何建议?
 
  Brand-Miller教授:对糖尿病患者,我建议其适度而非大幅度减少碳水化合物的摄入量,采用蛋白质食物替代减少的碳水化合物来提供热量,适度增加蛋白质摄入量。这就意味着,每天需要摄入100 g蛋白质,每天需要食用300~400 g含蛋白质的食物。就蛋白质的来源而言,可以选择鸡蛋、奶制品、瘦肉、鸡肉或鱼。我自己认为,最好能食用多种来源的蛋白质。当然,这类人群的饮食还应适度减少碳水化合物的摄入量,选择适宜类型的碳水化合物食品。我一般建议尽量选择血糖指数较低的碳水化合物食物。与中国最常见的大米饭相比,有些米饭的血糖指数更低。
 
 
  <International Diabetes>: So, Professor Brand-Miller, I want you explain about what is low glycemic index food?
 
  Dr. Brand-Miller: Okay. So a low glycemic index food is a food that contains carbohydrates that are slowly digested and absorbed and reduce postprandial glycaemia because they’re slowly digested and absorbed. Okay?
 
  <International Diabetes>:  Okay, great.
 
  Dr. Brand-Miller: Alright, so we – what we do is, to make things easy, the glycemic index has a scale from zero to one hundred and we rate or rank carbohydrate foods on that scale. So high glycemic index foods have a GI value above 70, whereas low glycemic index foods have a GI below 55. Okay?
 
  《国际糖尿病》:能否请您介绍一下什么是低血糖指数食物?
 
  Brand-Miller教授:低血糖指数食物指的是含有消化吸收较为缓慢的碳水化合物的食物。因其可被缓慢消化及吸收,故可降低餐后血糖。我们所需要做的就是让一切变得简单。血糖指数的数值可从0到100,我们可以对含有碳水化合物的食物根据其血糖指数进行排序。血糖指数>70的食物就是高血糖指数食物,血糖指数<55的食物就是低血糖指数食物。
 
  <International Diabetes>: Thank you.  So for the nutritional therapy of diabetes, comparing controlling the total energy and adjusting the composition of dietary nutrition, which one is more important?
 
  Dr. Brand-Miller: Okay. Well I would say weight loss is important in the beginning. But not a lot of weight loss, maybe five percent of body weight. So reducing energy, to start with, is important. And I think it can be really any diet. Alright? And perhaps the milkshake diets might be helpful in doing so to lose, say, between five and ten percent of body weight. Alright? But the challenge is to maintain that weight loss and that’s where diet composition becomes more important. You want to keep that weight loss off for life, alright? You don’t want to regain it. So then I think your diet should be modestly higher in protein and modestly lower in carbohydrates, and choose the lower glycemic index carbohydrate foods.
 
 
  《国际糖尿病》:就糖尿病的营养治疗而言,控制总能量摄入与调整膳食营养组成何者更重要?
 
  Brand-Miller教授:我认为开始的时候减重非常重要。但是,并不一定要使体重减轻得非常多,减重达到5%就可以。而要想实现减重就需要从减少能量摄入开始,减少能量摄入是非常重要的。我认为,任何饮食都是可以的。但是,目前我们所面临的挑战是如何维持减重效果。而对维持减重效果而言,调整膳食营养组成就显得更加重要。人们肯定想一生保持减重效果,不愿意让体重反弹。要想做到这一点,我认为其饮食就需要适当地增加蛋白质的含量,适度减少碳水化合物含量,并尽可能地选择食用低血糖指数的食物。
 
  <International Diabetes>: Thank you very much. So the question next would be should diabetes patients with obesity be given a different recommendation on the composition of dietary nutrients with diabetes patients whose not obese?
 
  Dr. Brand-Miller: Well if they don’t need to lose weight then, obviously, someone who’s already a good healthy weight should just choose a slightly higher protein, lower GI diet. That combination is really helpful. So they don’t have incremental weight gain creep, alright? If they already have obesity, alright? Then it’s – the most critical thing is they reduce their by a small amount. They don’t have to half their weight. They just have to lose about five kilograms or ten kilograms of body weight, alright? That’s the most important thing for obese people.
 
  <International Diabetes>: Okay, thank you very much.
 
  《国际糖尿病》:与不合并肥胖的糖尿病患者相比,合并肥胖的糖尿病患者之膳食营养组成的推荐是否有所差异?
 
  Brand-Miller教授:对不需要减重、只需要维持健康体重的糖尿病患者而言,他们只需选择蛋白质含量稍高的低血糖指数饮食即可。只要做到这一点,他们就可以维持健康体重,体重不会进一步增加。对已合并肥胖的糖尿病患者而言,最紧要的是减轻体重。就减轻体重而言,无需将其体重“减半”,只需少量减轻即可。一般来说,只需要减轻5kg或10 kg即可。对合并肥胖的糖尿病患者而言,这一点是非常重要的。
 
 

 

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