1. Glycemic and Insulinemic Response of Staple Indian Foods Kasturi Sen Ray, Pooja Singhania and Neha Paharia University Dept of Food Science and Nutrition SNDT Women ’ s University Mumbai, India Quality Assessment of Selected Carbohydrate Rich Food for Normal and Diabetic subjects

2. In diabetic condition, the metabolism of CHO is completely deranged.- Dietary management focuses on maintaining the postprandial blood sugar levels close to normal.- Life long dietary management requires careful selection of the quality and quantity of CHO.

3. There are food restrictions and taboos controlling the food intake in these subjects. Many of them are misleading

4. Glycemic Index (GI) was traditionally used to assess Glycemic Quality of the food on Equi-carbohydrate basis. - CHO Area under 2 hr bl. Gluc. curve of 50 g CHO from test food glucose Area under 2 hr bl. Gluc. Curve of 50 g glucose in water GI = X 100

5. -Amount of food - providing 50g of available CHO would vary tremendously in different food. Therefore comparison becomes difficult and impractical.

6. Watermelon: A high GI of 72, a low GL of only 7.21. Water melon have 92% water, bread has 37%. Based on GI, watermelon is not a suitable food for people with diabetes. Bread, not even sweet in taste, have much more starch density and therefore higher glycemic impact.

7. We do not consume CHO in isolation, rather whole food along with co-nutrients - influencing the glycemic and insulinemic responses of food. GI cannot reliably predict mixed meal responses. The quantity of food consumed varies from person to person GI is an absolute value. So people consume low GI food freely.

8.  To overcome the limitations of GI, Glycemic index food (GI food ) has been introduced.  GI food determines the glycemic impact of foods on Equi- quantity basis (Monro, J.A, 2003). CHO AU 2 hr bl. Gluc. curve after 50 g available CHO from test food glucose AU 2 hr bl. Gluc. curve after 50 g glucose in water GI = X 100 Area under 2 hr bl. Glu. response curve after 50 g test food GI Food = X 100 Area under 2 hr bl. Glu. response curve after 50 gm Std. food

9. GI is based on Food Science point of view Glycemic index food is a functional classification based on Physiological impact of food

10. To determine the suitability of food for diabetic subject, we have selected few food items, tested for their physiological impact using GI food method. Rice, Whole wheat Chapatti Mango which are usually modified by the doctors and dietitians for subjects with diabetes.

11. Rice: Chapatti:. Mango : Classified as high GI product [GI: 60-110] Commonly restricted for a person with diabetes Unleavened Indian flat bread made from whole wheat flour, low GI Value (GI = 45.1). Commonly advised and favorably consumed by Indians for its higher nutrient density Strictly restricted for a person with diabetes due to its high free sugar content. Average GI of 51. An excellent source of soluble fibre, antioxidants like vitamin C and A and Beta carotene, a good source of vitamin B6 and other Phytonutirents of immense health benefits.

12. Materials and Method Inclusion criterion of the subject: The maturity onset diabetic subject [ n=8,] Age group of 45- 65yrs, Without any co-morbidity, Blood HbA1c level < 8, Comparatively stable sugar level with hypoglycemic medicine,  Age and BMI matched clinically healthy adults as normal group [n = 6]

13. Study design: Blood was collected in fasting state and at 30, 60, 90 and 120 min post consumption of foods (Standard and test) with 100ml water, on different occasions. Blood glucose and insulin was assessed following the double blind system. Starch and moisture content of the food were analyzed. The Incremental Area Under the Curve (IAUC) of Glycemic and Insulinemic response for each food sample was calculated.

14. Result and discussion

15. - Proximate Composition of standard and test food Food Product Starch wwb g % Total sol. Sugars (g%) Total CHO (g %) Protein (g %) Fat (g %) Moisture (g %) W. Bread (Britannia) 33.97 ±0.7 3.94 41.68 8.311.71 ± 0.9 37.26±3 Boiled Rice (Surti Kolam) 20.47 ±0.4 -20.477.33 ±0.6 1.35 ±0.9 75.15±1 Chapatti (whole wheat) 39.34 ±3.5 -39.3410.35 ±1.0 2.5 ± 1.0 27.16 ±5 Mango Variety: Alphanso 3.45 ±5.2 2023.831.01-74.09

16. Average delta glycemic impact of rice and wheat chapatti (n = 8/group) Normal Diabetic : C max for rice was achieved by 30m followed by gradual decline to baseline. Equi-quantity Chapatti and bread c max at 60m and continue to stay elevated even at the end of 120 min. Normal: Bl. Glucose for all the product came down below baseline within 120m.

17. Relative Insulinemic Impact of rice and Wheat chapatti Foods which trigger lower insulin secretion will be beneficial in diabetic condition. The insulin response to rice is lowest followed by chapatti and bread.

18. Dose Response The quantity of food consumed per meal varies from person to person,affecting the blood glucose and insulin levels. When the quantity changes, the GI Value does not change although it may result hyperglycemic effect. GI food Value is dose sensitive as well.

19. Average IAUC of Rice and Chapatti individuals Diabetic o Diabetic: When dose is increased, insulin is not increasing proportionately and therefore blood glucose is increasing more. o Normal: The glycemic response to wheat chapatti is only 6% higher than rice, however, the insulin response for the same is 34% higher than rice. o It indicate the higher insulinemic impact of wheat starch in comparison with rice starch.

20. GI food is expressed in terms of Glycemic Bread Equivalent [GBE] GBE is “ weight of bread that would induce the same glycemic response as a given amount of test food”. Glycemic Bread Equivalent works like currency

21. Common serving sizes Food 50g/HH measure 50g/GBEHH measure / Serving Amount (g) / Serving GBE /serving Bread3 ¼ slices50 2 slices31 Wheat Chapatti 1½ medium442 medium6073 Rice1/4 cup111 cup13026 (Sen Ray & Singhania (2015) High moisture containing foods e.g. boiled rice (1 cup) can be safely consumed in their regular serving size without posing risk of postprandial hyperglycemia. whereas, the normal serving size of Chapatti (2 medium) may produce prolonged hyperglycemia even greater than that induced by same amounts of bread

22. GBE of rice is 20 means that 100g rice produces same glycemic responses as 20g bread

23. Even within a particular food group (cereals) Glycemic and insulin response varies a lot in both diabetic and normal individuals.

24. Mango exerts a lower glycemic response than white bread in terms of both Cmax as well as AUC in diabetic and normal individuals. The IAUC of mango was seen to be 3 times lower than standard food bread, in both the groups and this difference is significant. Glycemic Impact of Mango

25. Mango Fruits Sugars naturally present in food have a lower glycemic impact than refined starchy carbohydrate foods, e.g. Bread [Wolever and Brand Miller, 1995]. Fruits mainly contain simple sugars such as sucrose, glucose and fructose In fruits, the starch present in form of resistant starch RS1 or RS2 as intact encapsulated and not available to the digestive enzymes. RS3 is found in only cooked food items and absent in fresh fruits.

26. Conclusion Wheat products – Wheat Chapatti and bread, not sweet in taste, having higher glycemic impact and high demand for insulin, may not be a preferred choice for Diabetic person. Rice, commonly restricted in diabetic individuals due to its high glycemic index- is a better option as a carbohydrate source for diabetic person. The lower insulinemic impact of rice may help in reducing the stress on the pancreas, particularly beneficial in management of diabetes and people with insulin resistance.

27. GBE can be used to predict response to common serving / any measures consumed. Having same unit in gm, can be included in the Food Exchange table

28. Thank you