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2. The role of carbohydrate in human health: a case for new products Functional Foods Melton Mowbray

3. Complex nature of the relationship between food and health

4. Disease Risk and Body Mass

5. Obesity – Past and Future

6. The problem we are faced with • An ever increasing rate of obesity • 1000 deaths a week are directly related to obesity • It will soon become the most common preventable cause of cancer • Type 2 diabetes • CHD rates remain high

7. Massive changes in life style

8. Massive changes in the life style • Energy expenditure down • Access to cheap calories energy dense calories • Public health looking into a bottomless precipice • If we go on as we are in the few generations time will be the first where children die before parents

9. Role of carbohydrates

10. Carbohydrate is a complex groupwith complex absorption

11. Carbohydrate: The complex group Class Free sugars Short-chain CHO Starch Fibre (non-starch polysaccharides) Components Mono & disaccharides Sugar alcohols Oligosaccharides Insulin Rapidly digestible starch Slowly digestible starch Insoluble Soluble Comments Sorbitol Large bowel effects, stimulate bacterial growth Probiotic Amylose Amylopectin Little metabolic effect Metabolic effect

12. Dietary fibre (non-starch polysaccharides)

13. Problems with definitions • Physiological definition does not help chemical analysis • Does not help interpretation of scientific work (dietary fibre v whole grain) • Does not help public understanding • Does not help labelling of produces

14. What is Glycaemic Index Incremental area under the blood glucose response curve for food X 100 Corresponding area after equi- carbohydrate portion of glucose

16. Glycaemic index FOOD White bread Wholemeal bred Brown rice White rice Boiled potato Pasta Yam Green banana Sucrose Baked beans Chickpeas GI 100 100 81 81 98 65 74 65 83 70 60

17. Second meal effects

18. Epidemiological evidence

20. Overall view of GI and diabetes

21. Review of glycaemic index and lipids (Ludwig 2002)

23. Insulin Resistance • Insulin sensitivity = insulin stimulated glucose disposal • Insulin resistance = abnormal carbohydrate + lipid metabolism • Insulin Resistance Syndrome(Reaven, 1988)

24. The Insulin Resistance Syndrome Insulin Resistance  Triglycerides Hyperinsulinaemia  HDL- chol Glucose intolerance  B.P. Small, dense LDL  Uric acid  PAI-1 Coronary Heart Disease

25. Insulin Resistance “Relative inability of insulin to stimulate glucose disposal” Insulin sensitive Insulin resistant GENES ENVIRONMENT   RISK CHD AND TYPE II DIABETES

26. Possible model of insulin resistance

30. Effect of a HGI and LGI diet on glucose day profiles in middle aged men

31. Post prandial metabolism

32. Obesity evidence • 16 single-day studies in humans, 15 found lower satiety, increased hunger, or higher voluntary food intake after consumption of high- compared with low-glycemic index meals • obese children were given high-glycemic index instant oatmeal or low-glycemic index steel-cut oats with identical energy and macronutrient content at breakfast and lunch, and ad libitum energy consumption was monitored throughout the afternoon. Energy intake was 53% higher after the high- compared with the low-glycemic index meals • Slabber et al found significantly more weight loss in obese hyperinsulinemic women after 12 weeks of consuming an energy-restricted low-compared with high-glycemic index diet • Bouche et al found lower adiposity by DXA scan in 11 obese men after 5 weeks on an energy- and nutrient-controlled low- compared with high-glycemic index diet

33. The Gut Hormones Gastrin Ghrelin Pancreatic Polypeptide Secretin CCK GIP Motilin GLP1 GLP2 Oxyntomodulin Neurotensin PYY GLP1 Oxyntomodulin PYY

34. PERIPHERAL SIGNALS REGULATING APPETITE HYPOTHALAMUS PYY3-36 GHRELIN LEPTIN

35. Can food release gut peptides The big challenge

36. Nutrient Release of Gut hormones • Consistency of food makes a difference to peptide realise • Gasrtic emptying (Frost etal 2000) • Products of fermentation make a difference • Ileo break • Effect gastric emptying (Frost etal 2003) • Adding propionic acid increases GLP-1 release, lows gastric emptying and decreases hunger (Frost 2003)

37. Evidance of effect of Low GI diets and gut hormones • Evidence from a number of short term studies • Holt etal 1992 CCK • Juntunen etal 2002 GLP-1 and GIP (wholegrains) • Tappy etal 1986 GIP

38. Effect of GI on postprandial metabolism Gut peptides Gut peptides Gut peptides

39. Glycaemic index FOOD White bread Wholemeal bred Brown rice White rice Boiled potato Pasta Yam Green banana Sucrose Baked beans Chickpeas GI 100 100 81 81 98 65 74 65 83 70 60

40. Problems of intake in whole grains • Benefit is seen at 2-3 servings a day • Consumption in a lot of Western countries is less then 1 serving a day • Scandinavians consume more whole grain. Norway has 4x US intake • Main sources are limited to wholemeal bread, rye bread and whole grain cereal

42. Problem of who eats high fibre/wholegrain foods • US and UK • Older • High socio-economic group • Less likely to smoke • Do more exercise • Part of a healthy middle class lifestyle • Many chronic diseases are associated with low income, smoking, lack of exercise and are rooted in the young

43. Need a new raft of products • Need to compete with commonly consumed foods • Need to be seen as products with added value • Ongoing research collaboration with Holgrain and RHM is trying to do this with with bread • Is it possible to product a low GI white bread which will compete in the market place

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