GUIDE TO THE LOW GLYCEMIC DIET Nutritional Information for People with Diabetes

GUIDE TO THE LOW GLYCEMIC DIET Nutritional Information for People with Diabetes Making healthy choices!

Gary Russell, President of FIFTY 50 with Johanna Burani (left), Registered Dietitian, Certified Diabetes Educator, and co-author of The Glucose Revolution Life Plan, and Pat Gawdun (right), Vice President of FIFTY 50 and also a Registered Dietitian. My Glycemic Index Story Several years ago, I heard about a new way to help control diabetes through diet. It s called the Low Glycemic Diet. I learned it is widely used in Europe, Australia, and Canada. I thought I d give it a try. It works! The amount of insulin needed was reduced, my blood sugars were better controlled, and even my hemoglobin A1c, which was always pretty good, was improved. Best of all, I did not need to make a major adjustment to my lifestyle to follow the Low Glycemic Diet. Over the past 20 years, researchers have taken a closer look at carbohydrate foods and how they affect blood glucose. It turns out that carbohydrates, all of which were thought to have the same effect on blood sugar, were actually very different. Some increase blood sugar quickly and dramatically. Others produce a slower rise. There are now numerous clinical studies that prove foods with a low glycemic index (those that produce less of a rise in blood glucose) can better manage diabetes and help people lose weight at the same time. Following the Low Glycemic Diet is simply a matter of being better informed about the carbohydrate choices you make each day. And even simple changes in your diet can have a profound effect. I urge you to learn more about the glycemic index and see what a low glycemic diet can do for you. We ve developed this Guide to the Low Glycemic Diet to get you started. 2 Gary Russell President Disclaimer: The information provided in this guide is intended for general educational purposes only. You should consult your physician or other qualified health care professional for guidance concerning your own specific dietary needs. The Glycemic Index works within a prescribed meal plan specifying overall caloric and carbohydrate intake. Individuals should receive their daily caloric needs, nutrient recommendations, and dietary supervision from their doctor or dietitian.

INTRODUCTION Because you have diabetes, you know how important it is to control your blood sugar levels.* You also know that the foods you eat affect your sugar levels. You may do your very best to follow the dietary advice of your doctor or dietitian to keep those levels under control. But even when you carefully follow this advice, you may still be frustrated by high blood sugar readings. taking care of my diabetes The answer to improved blood sugar control might be in this booklet. It s all about the glycemic index, or for short. The is an approach to categorizing carbohydrates that helps you make better choices choices that can improve daily blood sugar levels as well as overall health. The can help you: Have better control of your blood sugar levels Feel less hungry Lose weight Improve your cholesterol levels The can also help you feel better because you ll avoid dramatic swings in your blood sugar level. Correctly using the will provide you with a steady and consistent level of energy the amount of energy you need when you need it. And once you ve read this booklet, you ll see that it s easy, too. * Some people use the term blood glucose, and others use the term blood sugar. Both terms refer to exactly the same thing the amount of glucose (the kind of sugar the body uses as its food) that s present in your blood. 3

THE GLYCEMIC INDEX What is the glycemic index ()? The glycemic index ( ) is a scoring system that ranks foods based on their effect on blood sugar levels. The covers only carbohydrates most of the foods you eat such as fruits and juices, potatoes, rice, pasta, breads, cereals, etc, that contain sugars, starches, and different types of fiber. That s because foods that are high in carbohydrates have the greatest impact on your blood sugar. Other foods such as fats and proteins, have little effect on blood sugar. When you eat carbohydrates, they are broken down in the mouth, stomach, and intestine to smaller units that the body can use for fuel. These units are a sugar called glucose. Glucose supplies power to every cell in the body. Without it, you wouldn t be alive. But when people have diabetes, glucose may not get into the cells easily and can build up in the blood. If blood glucose levels get too high, people with diabetes have symptoms such as fatigue, hunger, thirst, frequent urination, and weight loss. If blood glucose levels remain too high for a long period of time (years), people with diabetes can develop very serious complications affecting the eyes, kidneys, peripheral nerves, and heart. That s why doctors, diabetes educators, and dietitians believe it s very important to keep blood glucose levels under control. Here s where the comes in. Whenever you eat foods that contain carbohydrates, they are completely digested, releasing glucose into the bloodstream. Scientists have learned, though, that different carbohydrate foods cause blood glucose levels to rise at different rates. Some foods cause glucose levels to rise quickly after you eat them. The result is a virtual gush of glucose into the bloodstream. Other carbohydrate foods cause glucose levels to rise more slowly a trickle, so to speak. The is a system that separates the gusher foods from the trickler foods. By eating less of the gushers and more of the tricklers, you can keep your after-meal blood glucose levels more in check. 4

In a nutshell, the is a number scale that ranges from 1 to over 100. Think of it as an automobile s speedometer. When you drive, the higher the speedometer reading, the faster you re traveling. When you eat, the higher the of your food, the faster your blood sugar level will rise; the lower the of your food, the more slowly your blood sugar level will rise. Food Rating FOOD RATING SYSTEM High (gushers) More than 70 Intermediate 55 to 70 Low (tricklers) Less than 55 How is the measured? The of carbohydrate food is determined by careful scientific testing. All s are ranked in comparison with a reference food, pure glucose. Glucose is what s known as a simple sugar. If you were to eat glucose, your body would not have to break it down. Instead, it would go directly into your bloodstream. The of glucose has been set at 100. In order to calculate a food s, volunteers eat a carefully measured amount of a test food containing 50 grams of carbohydrates. Over the next 2 hours, blood samples are taken to measure how high the volunteers blood glucose rises. They are tested again, in the same way, only this time the volunteers consume 50 grams of glucose (the reference food). The total rise in blood glucose levels for the test food and glucose are noted and the test food is then expressed as a percentage of the rise from glucose. For example, a hard roll has a of 71; this means that when you eat a hard roll, the rise in blood sugar is 71% as great compared to the rise in blood sugar when eating a similar amount of glucose. Since the of pumpernickel is only 41, you can lower the rise in blood sugar if you eat pumpernickel bread instead 5

of a hard roll. That s how the diet works. The following graph shows the rise in blood sugar from two common sweeteners, table sugar and fructose. So far, scientists have measured the s of more than 2,000 common food products. Some popular examples are listed on pages 24-29. COMPARATIVE BLOOD GLUCOSE RESPONSE FOLLOWING CONSUMPTION OF TABLE SUGAR OR FRUCTOSE Table Sugar Fructose 1 Hour 2 Hours Table sugar creates a high-glycemic effect that is, a fast peak (high) followed by a trough (low) in blood glucose levels compared to an equivalent amount of a sweetener like fructose, whose low-glycemic effect causes blood glucose levels to rise more slowly. Energy and insulin levels remain more constant when blood glucose levels rise more gradually without the peak and trough effect seen with high-glycemic foods. Who supports the? Scientific support for the is wide ranging. Since the concept was first developed in 1981 by researchers at the University of Toronto, extensive research from around the globe has confirmed its usefulness. Numerous studies on the have appeared in medical and nutrition journals. What s more, the is now an important part of diabetes control and is endorsed by diabetes associations in such countries as Australia, New Zealand, Canada, Great Britain, France, and throughout Europe. TEST YOUR CARBOHYDRATE CHOICES This might be a good time to find out how your carbohydrate choices rate on the glycemic index. Do you prefer gushers ( more than 70)? Or are tricklers ( less than 55) more to your taste? Place a check mark next to your preferred foods in each of the categories on the next page. Then find your favorites in the listing that begins on page 24. 6

Which breakfast cereals are you most likely to eat? All-Bran Raisin bran Corn flakes Special K Oatmeal (instant) Shredded wheat Oatmeal (old-fashioned) good food Which bread do you prefer? 100% stone-ground whole-wheat bread Bagel French bread Kaiser roll English muffin White bread Which are your favorite fruits or juices? Apple Apple juice Grapefruit Orange juice Pineapple Watermelon Which kind of potatoes do you prefer? French fries Sweet potatoes Mashed (from scratch) Mashed (Instant) Which would you eat as a snack? Chocolate bar Graham crackers Ice cream Pizza Popcorn Pretzels 7

CHECK YOUR BLOOD SUGAR TO FIND OUT HOW HIGH- AND LOW- FOODS AFFECT YOU. You can see for yourself how the glycemic index works. Try this: 1. Test your blood sugar right before a meal and record the results. 2. Eat a meal containing 2 or 3 servings of high glycemic index foods. 3. Between 90-120 minutes after you start eating, test your blood sugar and record the results. Determine your increase in blood sugar for the meal (subtract your pre-meal number from your 90-120 minute number). 4. The following day, substitute equal amounts of low- foods for the higher foods in the same meal as the day before. 5. Check your blood sugar in the same way before the meal and between 90-120 minutes after you start eating the low- meal and record both results. Determine your increase in blood sugar for the meal (subtract your pre-meal number from your 90-120 minute number). 6. Now compare these two numbers to see how the high- and low- foods affected your blood sugars. LOW- MEALS/HIGH- MEALS Like many people, you might find you rely far too heavily on gushers for your carbohydrate needs. Look at the sample meals shown below. You ll see examples of high- meals and low- makeovers These simple meal makeovers are healthier alternatives that provide all the nutrition you need without causing that aftermeal gush of blood sugar. 8 BREAKFAST High- Corn flakes with skim milk English muffin with jelly Coffee (regular)

Low- makeover ` Old-fashioned oatmeal with skim milk and peaches 100% stone-ground wholewheat toast with FIFTY 50 Sugar Free Fruit Spread Coffee (decaf) LUNCH High- starting the day off right Turkey sandwich on white bread with lettuce and tomato Watermelon Ice tea (regular, sweetened) Low- makeover Turkey sandwich on 100% stone-ground whole-wheat bread with lettuce and tomato Apple Ice tea (decaf, diet) eating my favorite lunch DINNER High- Broiled chicken breast Mashed potatoes (instant) Steamed green beans French bread Low- makeover Broiled chicken breast Converted rice Steamed green beans Salad with vinaigrette dressing dinner and a movie 9

WHY AFTER-MEAL BLOOD SUGAR LEVELS MATTER Hemoglobin A1c is a measure of the average level of glucose in the blood over 3 months. Research has shown you can achieve normal A1c control but still be at risk of complications caused by abnormally high blood glucose levels. If you eat high- foods, your after-meal blood sugar will spike and then drop severely. Because A1c averages highs and lows, it will not reflect after-meal spikes that can damage tissue in your eyes, kidneys, and blood vessels. You may think you are in good control, but you re not. It is also important for people at risk of developing diabetes to avoid high- foods. Here s why: A spike in your blood sugar sends a signal to your pancreas to release insulin, which helps the sugar leave the bloodstream and enter the body s cells, where it can be used later for fuel. High levels of insulin are associated with weight gain, high cholesterol levels, and high blood pressure. The high levels can also lead to insulin resistance, a component of the most common form of diabetes (type 2 diabetes). By using the when you select your foods, you can help keep your insulin levels from rising too high, too quickly. When you eat low- foods, your blood sugar levels rise gradually. And, in response, your pancreas releases insulin gradually. By reducing after-meal blood sugar gushes, you also reduce after-meal insulin gushes and the health problems they can cause. FACTORS THAT AFFECT THE OF FOOD Many factors come into play in determining the of the foods we eat. Anything that makes it easier for our bodies to convert food to blood sugar increases the and blood sugar levels. As important as it is for our cells to have glucose, it s the rapid gush of glucose into the bloodstream that we generally want to avoid. 10

Starch. Starch is a important source of carbohydrate in our diet. Examples of starchy foods include breads, cereals, rice, pasta, and potatoes. There are two kinds of starch in food and, yes, you guessed right, one is quickly digested, and the other breaks down more slowly. Thus, the of a starchy food depends on which is the predominant kind of starch in that particular food. Thanks to the researchers, we can make our choices directly from the list. Cooking. As a general rule, cooked foods have higher s than uncooked foods. One of the reasons is because cooking causes starches to swell, which makes them easier to digest. The amount of cooking time can affect the, too. When pasta is cooked only until it s al dente (firm), it has a low ; when pasta is overcooked and becomes soft and mushy, it has a higher. Processing. Much of the food we eat today is highly processed, including our staple grains wheat, corn, and oats which are finely ground into powdery flours that produce many wonderful-tasting breads, cookies, breakfast cereals, and baked goods. And many processed foods have higher S than the unprocessed version. For example, old-fashioned oatmeal made from rolled oats has a of 49, while Quaker 1-minute oats has a of 66 which raises the blood sugar level 35% higher and faster. This means the more processed 1-minute oats will raise your blood sugar level higher and faster than the old-fashioned oats. Acids. The more acidity there is in food, the more slowly it is emptied from the stomach, and, in turn, the more slowly it is digested and turned into blood sugar. Foods that are acidic, such as oranges and sourdough bread, have low s. Adding acid to a meal, in the form of vinegar (as in many salad dressings) or lemon juice, can help lower the of a meal. In fact, research has shown that adding in as little as 4 teaspoons of vinegar in a vinaigrette dressing at an average meal can lower blood sugar by 30%. 11

Fiber. Soluble fibers, such as those found in apples, rolled oats, and beans and other legumes, tend to slow digestion, resulting in a low. Including kidney beans or chickpeas in a salad or adding an apple as the dessert to a meal will lower that meal s overall and thus produce a slower and more subtle rise in after-meal blood sugar levels. Fats. Although we all should limit the amount of fat we eat, fatty foods slow the rate of stomach emptying and, thus, digestion. Keep in mind, though, one should never go overboard in terms of fats, because too much fat in the diet will increase the risk of heart disease and stroke. Experts agree that daily fat consumption should fall between 20% and 35% of total caloric intake. The heart-healthiest fats are the monounsaturated and polyunsaturated fats, which are liquid at room temperature. They re found in most vegetable oils and the fats found in nuts, olives and fatty fish. Sugar. There are several kinds of sugars in the foods we eat. Some were put there by Mother Nature; examples include fructose (fruit sugar) and lactose (milk sugar). These natural sugars have low s and will not cause a spike in blood sugar levels. Other sugars, such as sucrose (ordinary table sugar), will spike your blood sugar levels. For example, FIFTY 50 Fructose has a of only 19, compared with a of 68 for ordinary table sugar (sucrose). The take-home message is: all sugars are not equal. MAKING SMART CARBOHYDRATE CHOICES Here s a handy table that will help you make healthier food choices. For a low- lifestyle, choose alternatives from the column labeled Tricklers. Try to avoid foods from the column labeled Gushers. healthy whole grains and vegetables 12

TRICKLERS BEVERAGES Soy millk Apple juice (unsweetened) GUSHERS Soft drinks Sports drinks BREADS 100% stoned-ground Bagels (white flour) whole wheat or multigrain made with whole- English muffins grain flour Matzoh (white flour) Cracked or sprouted whole wheat White breads, muffins, rolls, and baguettes Dark, heavy, coarse breads with intact whole Whole-wheat bread (less grains, seeds, nuts, than 100% whole wheat) flaxseed, oats, or oat bran Pumpernickel Rye Sourdough Whole-wheat pita bread Whole-wheat tortilla CANDY, SNACKS AND CRACKERS FIFTY 50 Chocolate Bars Jelly beans FIFTY 50 Hard Candies Life Savers Corn chips Popcorn Fruit leather Pretzels Nutella Rice cakes Nuts (cashews, peanuts) Saltines Whole-grain crackers Water crackers CEREALS All-Bran Bran or wheat flakes Bran Buds Cheerios Fiber One Corn flakes/chex /Pops Muesli Instant or quick-cooking oatmeal (or other instant Oatmeal (old-fashioned) hot cereal) FIFTY 50 Hearty Cut Oatmeal Puffed wheat or rice Rice Krispies /Chex 13

TRICKLERS COOKIES AND DESSERTS FIFTY 50 cookies and wafers (different varieties) Oatmeal cookies Social Tea biscuits Sponge cake Angel food cake Doughnuts PopTarts DAIRY PRODUCTS All milk Instant pudding Cooked puddings and Tofutti custards Light (artificially or fructose-sweetened) or plain yogurt Ice cream FRUIT PRESERVES AND SYRUPS FIFTY 50 Fruit Spreads High-fructose corn syrup FIFTY 50 Syrup Pancake syrup Jellies and Preserves FRUITS GUSHERS Apples Apricots Berries Cherries Citrus fruits Grapes Nectarines Peaches Pears Plums Prunes Strawberries Dates Watermelon beautiful and delicious 14

TRICKLERS JUICES Unsweetened juices apple, grapefruit, orange, tomato LEGUMES AND BEANS Baked beans Black beans Black-eyed peas Butter beans Cannellini beans Chickpeas Kidney beans Lentils Mung beans Pinto beans Soy beans Split peas PASTA AND GRAINS Barley Basmati rice Brown rice Buckwheat Bulgur Corn Pasta cooked al dente Tortellini Uncle Ben s Converted Long-Grain Rice (not instant) Wild rice VEGETABLES All green leafy vegetables All non-starchy vegetables (except beets) Carrots Corn New potatoes Peas Sweet potatoes Yams GUSHERS Sweetened juices and juice drinks Fava beans healthy and tasty Aborio rice Glutinous rice (sticky Chinese rice) Jasmine rice Short-grain, instant, or quick-cooking rice Baked and mashed potatoes Beets Parsnips Pumpkin Rutabaga 15

PERFORM THIS EXERCISE: DESIGN YOUR In the spaces provided below, jot down some of the high- foods in your current diet. Then substitute 1 or 2 low- alternatives for each; use the list on the previous pages and the one beginning on page 24 BEVERAGES MY HIGH- FOODS BREADS CEREALS COOKIES AND DESSERTS CRACKERS AND SNACKS DAIRY PRODUCTS FRUIT PRESERVES AND SYRUPS FRUITS JUICES LEGUMES AND BEANS PASTA AND GRAINS VEGETABLES 16

LOW- DIET Write these choices in the boxes below. If you are unsure about the s of some of the foods you eat, ask your dietitian or diabetes educator for help. Be sure to put your new low- diet into practice! BEVERAGES MY LOW- FOODS BREADS CEREALS COOKIES AND DESSERTS CRACKERS AND SNACKS DAIRY PRODUCTS FRUIT PRESERVES AND SYRUPS FRUITS JUICES LEGUMES AND BEANS PASTA AND GRAINS VEGETABLES 17

MENU SUGGESTIONS Here are some tasty and healthful meal suggestions to help get you on your way to better health. Healthy Breakfast Ideas 100% stone-ground whole-wheat toast with FIFTY 50 Peanut Butter and FIFTY 50 Fruit Spread Light yogurt with fresh fruit and low-fat granola or bran buds FIFTY 50 Hearty Cut Oatmeal with dried apricots (cooked in fat-free milk) Low- cold cereal (see list of foods) with skim milk Whole-wheat pita bread stuffed with scrambled egg Sourdough French toast with FIFTY 50 Maple Syrup and fruit Bran muffin with FIFTY 50 Strawberry Spread Buckwheat pancakes with FIFTY 50 Maple Syrup and fruit Multi-grain waffles with natural applesauce Pumpernickel toast with melted low-fat cheese Rye toast and egg-white Western omelet and fruit A low- breakfast includes whole-grain breads or toasts, cereals rated as tricklers, and lots of fresh fruits. Avoid syrups other than the ones listed above, and stay away from instant hot cereals; they re gushers. Healthy Lunch Ideas Homemade or canned soups made with low- ingredients vegetable, lentil, black bean, split pea, minestrone, or barley (don t be afraid to add extra vegetables to make it extra chunky) Sandwiches made with lean meats on whole-grain wheat, rye, pumpernickel or pita bread, along with baby carrots and fruit salad 18

Pasta salad with vinaigrette dressing and assorted fresh vegetables and reduced-fat cheese Mixed salad with grilled chicken and vinaigrette dressing (Be sure to toss in some beans!) FIFTY 50 Peanut Butter and FIFTY 50 Fruit Spread on low- bread and a salad Light yogurt with fruit and whole-grain muffin with spreadable light cheese At lunch time, steer clear of processed white bread and rolls. Instead, make a sandwich using whole-grain pumpernickel or rye bread. Try salads made with lots of varied fresh vegetables and vinaigrette dressing. Canned tuna or salmon is also a good protein addition. Healthy Dinner Tips Pasta, grains, rice, beans, or whole-grain breads Fresh vegetables and salads Lean meats, chicken, and fish Substitute beans, peas, or lentils for protein sources if you prefer Limit intake of high- starches baked or instant mashed potatoes, instant rice, boxed stuffing mixes, processed white breads Base your meal on a low- carbohydrate, with generous amounts of non-starchy vegetables and plenty of fresh salads. Eat lean meats, poultry, and fish. End your balanced meal with a serving of fresh fruit or one of the healthy snacks and desserts listed below. Snacks and Desserts No-sugar-added cocoa FIFTY 50 Fructose Sweetened Cookies Fresh or dried fruits (see list) Light yogurt with fruit Nuts (small serving) FIFTY 50 Sugar-Free Chocolate Bar (small serving) 19

Sugar-free Jell-O (add some fruit) Sugar-free pudding in FIFTY 50 Pie Crust Low-fat ice cream with fresh fruit Whole-wheat pita chips or baked tortilla chips Natural applesauce with light whipped topping You can have dessert! By choosing snacks with a low or low-fat desserts, you can help prevent some of the symptoms and complications associated with gusher foods. Eating Out To some people, the thought of eating out and of maintaining a low- diet might seem like a contradiction in terms. It s not! Although you might not have as much control over what you eat when you re out of the house, restaurants today offer a growing variety of healthy and delicious low- foods. Many menus feature grilled seafood, fresh vegetables, pastas, and fruits; choices such as these are healthy also, because they re low in fat. And with the growing popularity of ethnic foods, healthy choices are even broader. Here are some tips: Chinese food. Authentic Chinese food features plenty of vegetables and is low in fat a good, low- option. Limit your intake of starchy, Asian-style sticky white rice, though, which has a high. A low- alternative would be oriental noodles (egg, rice or mung bean). Try to stay away from deep-fried foods, also not so much from a standpoint, but because they re very high in fat. Mexican food. Most Mexican restaurants in the United States serve high-starch, high-fat foods (including chips), that are denser in calories than they are in nutrients. If possible, stick with grilled seafood and chicken dishes, black beans, and entrees such as fajitas. Limit the sour cream. Italian food. Pasta dishes, seafood dishes, and meat dishes are nutritionally sound choices, as long as they re not overloaded with cheese. Thin-crust pizza with vegetable toppings is a good choice. And 20

remember, those bread calories eaten while waiting for the meal to arrive still count! Ask for semolina bread if it s available. Japanese food. Practically anything in an authentic Japanese restaurant works into a low- meal plan, even sushi (it s prepared with vinegar). Canned lychees, however, have a high. Thai food. Thai dishes typically include small amounts of meat, seafood, or tofu with vegetables and spicy sauce. All are good choices from a standpoint. Indian food. Indian cuisine is generally friendly to a low- diet. It features legumes, chicken, fish, vegetables, and yogurt. Just be aware of the high-fat fried foods and heavy, butter-based sauces. Fast food. Fast-food restaurants can spell trouble for low- diets. Hamburgers and other fast-food sandwiches are served on processed breads and rolls having high s. Most fast foods are also very high in fat and sodium. As a general rule, try to avoid fast foods. If you can t avoid fast-food restaurants, find one that offers salads on the menu. STOCKING YOUR LOW- PANTRY To simplify the planning and preparing of low- meals, make sure you always have the right ingredients at hand. Limit the high- foods that you buy and keep your pantry stocked with lots of healthy staples. Here are some pointers: Grain-based foods Foods made from grain products (especially unprocessed grain products) are great for a low- lifestyle. Stock your pantry with healthy and delicious pasta products. Uncle Ben s Converted Long Grain Rice should be another pantry staple. Avoid quickcooking or instant starches. Legumes Canned and dried beans, peas, and legumes are good sources of protein and are also low- carbohydrate foods (except fava beans, which have a high ). Keep them on hand to add to soups, side dishes, salads, and main courses. 21

22 Canned and Jarred Foods Lots of canned and jarred foods are both delicious and have low s; it s a good idea to keep them well stocked. Great choices found in cans include: Tuna (preferably in water) Salmon (preferably in water) Sardines (preferably in water) Tomatoes and tomato paste Corn Fruits (not packed in syrup) New white potatoes Vegetables (asparagus, carrots, green beans mushrooms, etc.) Marinated vegetables packed in jars are great as snacks and side dishes. An added benefit is the vinegar they contain, which helps lower the of the foods you eat along with them. Here are some examples: Sun-dried tomatoes Artichoke hearts Olives Capers Marinated vegetables Roasted peppers Pickles love your vegetables Oils and Vinegars Many people use oils in the preparation of their foods. Vegetable oils are mostly unsaturated and heart healthy (exceptions: palm, palm kernel, and coconut). But because oils are fats, the amount consumed should be limited: aim for no more than one tablespoon per meal, per person. Good choices include: Extra-virgin olive oil Canola oil Sunflower oil Sesame oil Peanut oil

There are many types of vinegar available, also. All vinegars are acidic; therefore, when you include some vinegar in a meal, it helps lower the of the meal. Keep a variety of vinegars on hand to enhance the different flavors in your healthy salads. Snacks Make sure you have plenty of fruits and vegetables on hand. Also, stock dried nuts and FIFTY 50 Low Glycemic Fructose Sweetened Cookies. Just remember to stay within your calorie and fat limits. CONCLUSIONS SECRETS TO SUCCESS In conclusion, the glycemic index is a wonderful, user-friendly health tool. A low- diet can help you avoid after-meal gushes in blood glucose and in insulin. By putting a low- diet into practice, you can have better control of your blood glucose levels, feel less hungry, lose weight, improve your cholesterol levels, and provide yourself with a consistent and steady energy level throughout the day. Improved cholesterol levels can reduce your risk of heart attack and stroke. Improving your health with the glycemic index is simple. All you have to do is use the lists in this booklet and those in other sources listed on pages 30 and 31. Check the s of foods you normally eat. Then do this: Determine which high- foods you eat frequently Replace high- foods with low- foods; reduce the quantity and/or frequency of high- foods Make sure your diet consists of balanced meals and snacks based on your prescribed meal plan and calorie level Enjoy your meals - enjoy good health! 23

LISTING Glycemic index values of some popular foods are listed below. BEANS AND PEAS Low Intermediate High (less thn 55) (55 to 70) (more than 70) Baked beans 48 Black-eyed peas, canned 42 Chana dal (Indian Bean) 8 Chickpeas, canned 42 Chickpeas, dried 28 Kidney beans, boiled 28 Kidney beans, canned 52 Lentils 29 Lima beans (frozen) 32 Yellow split peas 32 BREADS Low Intermediate High 100% stone-ground whole wheat 53 Bagel 72 Bread stuffing 74 Croissant 67 French baguette 95 Hamburger bun 61 Kaiser roll 73 Pita, whole wheat 57 Pumpernickel 41 Rye 58 Sourdough 54 Taco shell 68 White 70 Whole wheat 69 BREAKFAST/BAKERY Low Intermediate High Angel food cake 67 Blueberry muffin 59 Bran muffin 60 Carrot muffin 62 Doughnut 76 Pancakes 67 Pastry pie crust 59 Pound cake 54 24

BREAKFAST/BAKERY Low Intermediate High (less thn 55) (55 to 70) (more than 70) Scones 92 Sponge cake 46 Waffles 76 BREAKFAST CEREALS Low Intermediate High All-Bran 38 Bran Buds 47 Bran flakes 74 Cheerios 74 Corn Chex 83 Corn flakes 92 Cream of Wheat, cooked 66 Cream of Wheat, instant 74 Grapenuts 71 Muesli, toasted 43 Multi-Bran Chex 58 Oat bran, raw 55 Oatmeal (old-fashioned) 49 Puffed wheat 67 Quick (1-minute) oats 66 Raisin Bran 61 Rice Krispies 82 Shredded Wheat 75 Special K 69 COOKIES Low Intermediate High FIFTY 50 Butter 36 Chocolate Chip 44 FIFTY 50 Chocolate Chip 34 FIFTY 50 Coconut 45 FIFTY 50 Hearty Oatmeal 30 FIFTY 50 Vanilla Creme Filled Wafers 41 Oatmeal 55 Shortbread 64 25

CRACKERS Low Intermediate High (less thn 55) (55 to 70) (more than 70) Graham crackers 74 Kavli crisp bread 71 Melba toast 70 Rice cakes 82 Ryvita crisp bread 69 Stoned Wheat Thins 67 Soda crackers (saltines) 74 Water crackers 78 DAIRY FOODS Low Intermediate High Ice cream, premium, French vanilla 38 Milk, skim 32 Milk, whole 31 Yogurt, low-fat, with fruit, artificially sweetened 14 Yogurt, low-fat, w/fruit & sugar 33 DINNERS/MEAL REPLACEMENTS Low Intermediate High Fish stick fingers 38 Cheese tortellini 50 Macaroni & cheese, packaged 64 Meat ravioli 39 Pizza 60 FRUITS Low Intermediate High Apple 38 Apricots, canned in light syrup 64 Apricots, dried 30 Apricots, fresh 57 Banana 52 Cantaloupe 65 Cherries 22 Dates, dried 103 Figs, dried 61 Fruit cocktail, in natural juice 55 Grapefruit 25 Grapes, green 46 26

FRUITS Low Intermediate High (less thn 55) (55 to 70) (more than 70) Kiwi 58 Mango 51 Orange, navel 42 Papaya 56 Peach, canned in juice 38 Peach, fresh 42 Pear, canned in natural juice 43 Pear, fresh 38 Pineapple, fresh 66 Plum 39 Prunes 29 Raisins 56 Strawberries 40 Watermelon 72 GRAINS Low Intermediate High Barley, pearled 25 Buckwheat 54 Cornmeal 68 Couscous 65 JUICES Low Intermediate High Apple 40 Cranberry juice cocktail 52 Grapefruit 48 Orange, unsweetened 53 Pineapple 46 Tomato 38 PASTA Low Intermediate High Capellini 45 Fetuccini, egg 32 Linguine, thick 46 Macaroni 47 Rice vermicelli 58 Spaghetti, white 38 Spaghetti, whole wheat 37 Spiral pasta 43 Star pastina 38 27

POTATOES Low Intermediate High (less thn 55) (55 to 70) (more than 70) Baked 85 Canned 65 French fries 75 Instant, mashed 86 New, unpeeled 62 Red skinned, boiled 88 Sweet 44 White skinned, mashed 70 Yam 37 RICE Low Intermediate High Aborio 69 Basmati 58 Brown 55 Converted, white, long grain 44 Glutinous, sticky 98 Instant, white 87 Long-grain white 56 Short-grain white 72 Wild 57 SNACKS Low Intermediate High Cashews 22 Corn chips 42 FIFTY 50 Milk Chocolate Bar 31 Hummus 6 Jelly beans 78 Kudos Whole Grain Bar, chocolate chip 62 Milk chocolate 42 Peanuts 15 Popcorn 72 Pretzels 83 Potato chips 57 Walnuts 15 28

SOUPS Low Intermediate High (less thn 55) (55 to 70) (more than 70) Black bean 64 Lentil 44 Minestrone 39 Pea 66 Tomato 38 SWEETENERS Low Intermediate High FIFTY 50 Low Calorie Fruit Spread 6 FIFTY 50 Maple Flavored Syrup 19 FIFTY 50 Fructose 19 Honey 55 Smucker s Jam, strawberry 74 Marmalade, orange 48 Pancake syrup (maple) 76 Sucrose 68 VEGETABLES Low Intermediate High Beets 64 Broccoli 10 Cabbage 10 Carrots 49 Corn, canned 46 Green peas 48 Lettuce 10 Mushrooms 10 Onions 10 Parsnips 97 Pumpkin 75 Red peppers 10 Tomatoes 10 29

FOR MORE INFORMATION To learn more about the, the benefits of a low- diet, and how to make the work for you, look for these books or visit these Internet sites: Books The New Glucose Revolution for Diabetes By Brand-Miller, Foster-Powell, Colagiuri and Barclay. 2007 The New Glucose Revolution Shopper s Guide to Values 2010 By Brand-Miller and Foster-Powell. 2010 Good Carbs, Bad Carbs - Lose Weight and Enjoy Optimum Health and Vitality by Eating the Right Carbs By Burani. 2004 30

Information on the Internet FIFTY 50 Foods/Glycemic Index http://www.fifty50.com University of Sydney, Australia http://www.glycemicindex.com/ Glycemic Index Related Information http://www.mendosa.com 31