17004p-SUN_Low GI carbs_FDIN 20170307

Low GI carbs

Can sugars play a role?

The example of Palatinose™ (isomaltulose)

Silke Ullmann, MPH, Registered Dietitian

Manager Nutrition Communication

© 2017 BENEO

Outline

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• Why is GI relevant to our health?

• Importance of blood sugar management

• Evidence for high and low GI diets

• Introducing Palatinose™

• A unique carbohydrate with slow release properties

• Evidence on blood glucose response and diabetes risk

• Evidence in sports

• Can low GI play a role in sports nutrition?

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Why is GI relevant to our health?

Importance of blood sugar management

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© 2017 BENEO

The diabetes waveDiabetes mellitus continues to dramatically increase

International Diabetes Federation, IDF Diabetes Atlas 7th Edition 2015; http://www.diabetesatlas.org/

World Health Organization (2015) Fact Sheet N. 311, http://www.who.int/mediacentre/factsheets/fs311/en; http://www.who.int/diabetes/globa-report (13Apr2016)

Note: all numbers refer to adult population; worldwide

2015 44.3 m2040 60.5 m

2015 59.8 m2040 71.1 m

2015153.2 m2040214.8 m

201514.2 m204034.2 m

201535.4 m204072.1 m

201578.3 m2040140.2 m

2015 29.6 m2040 48.8 m

overweight

1.9 bn39%

obese600 m13%

Diabetes mellitus2015: 415m people (8.8% population)

2040: 642m people (10.4% population)

Impaired glucose tolerance (IGT)2015: 318m people (6.7% population)

2040: 481m people (7.8% population)

Overweight and obesity Overweight: 1.9bn people (39% population)

Obese: 600m people (13% population)all numbers refer to adult population

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Risk factors for Non-Communicable Diseases

Diet plays a key role

World Health Statistics 2012. http://www.who.int/nmh/publications/ncd_report_chapter1.pdf

Most risk factors are preventable!

The diet plays a major role!

Raised blood glucose is the No 3

mortality risk factor worldwide!

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Carbohydrates need more attention

Carbohydrate quality influences metabolism

Carbohydrates

• represent the largest group of nutrients

• and main source of energy,

• directly affect blood glucose levels,

• trigger insulin release,

• determine the metabolic profile

Carbohydrate quality plays a key role

breakfast snack lunch snack dinner

With high

glycemic diet

With low

glycemic diet

Cha

ng

e in

blo

od

glu

co

se

Time of day (hours)08:00 24:00

6

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Evidence for high and low GI diets

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Evidence for high and low GI diets

piling up over past 30 years

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Health benefits of reduced glycaemia:

Outcome of a Scientific Consensus Summit 2013

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The scientific consensus statement says that

• Reducing postprandial glycaemic response is recognised as

• beneficial physiological effect

• There is convincing evidence that diets low in GI/GL

• improve glycaemic control in people with type 2 and type 1 diabetes

• reduce the risk of type 2 diabetes

• reduce the risk of coronary heart disease

• There is probable evidence that diets low in GI/GL

• reduce total body fat mass and support body weight management

Full text and corresponding references of final document available at :

http://www.nutrition-foundation.it/notizie/GLYCAEMIC-INDEX--GLYCAEMIC-LOAD-AND-GLYCAEMIC-RESPONSE--AN-INTERNATIONAL-SCIENTIFIC-CONSENSUS-

SUMMIT.aspx

Glycaemic Index, Glycaemic Load and Glycaemic Response: An International Scientific Consensus Summit

June 6-7, 2013 - Stresa (Milan), Italy

Scientific Consensus Committee

Chairs:

• David J.A. Jenkins (University of Toronto)

• Walter C. Willett (Harvard School of Public Health)

Members:

Additional 18 key academics of the GI and GL research field

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• EFSA recognise "reduced glycaemic response" as health benefit for

the general population

• Corresponding claims have been approved for several food ingredients a.o., e.g.

• Sugar replacement with - low glycaemic sugars like isomaltulose

- polyols like isomalt and/or intense sweeteners

- non-digestible carbohydrates, like inulin and oligofructose

• Replacement of digestible starch by resistant starch

• Addition of viscous soluble fibres like pectins, arabinoxylan, HPMC

• Enrichment with slowly digestible starch by processing

Positive EFSA opinions

Reduced glycaemic response as health benefit

EFSA Journal 2011;9(4):2076

EFSA Journal (2014) 12(1):3513; http://www.efsa.europa.eu/en/efsajournal/doc/3513.pdf 10

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Carbohydrates and Health

Scientific Advisory Committee on Nutrition 2015

+ limited; ++ moderate; +++ adequate

SACN (2015) Carohydrates and Health, Belfast

RCT: randomised controlled trial

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Health/disease outcomes Glycaemic

Index

Evidence Glycaemic

Load

Evidence

Cardiovascular disease events No association + Association +

Blood pressure

- Systolic

- Diastolic

No effect

No effect

++

++

No effect

Effect

+

+

Fasting blood lipids

- Total cholesterol

- LDL-cholesterol

- Triacyglycerol

Effect

Effect

No effect

++

++

++

No effect

No effect

Effect

+

+

+

Type 2 diabetes mellitus Association +++ Association +++

Fasting blood glucose No effect ++ No effect +

Fasting insulin No effect ++ No effect +

Insulin sensitivity/resistance No effect ++ No effect +

Key findings / conclusions

Prospective cohort studies indicate

Diets with a higher GI or GL are associated with greater risk of T2DM

Limited evidence from cohort studies and RCT suggests

There may also be other adverse health effects

However, higher and lower GI / GL diets will, in most cases,

differ in many ways other than the carbohydrate fraction and

therefore study results are difficult to interpret as it is not possible

to exclude confounding by other dietary variables

(e.g. dietary fibre, protein or fat content, cooking methods, food processing,

and storage)

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Blood glucose response and health

The relevance of insulin as key regulator

König 2008 at the 1st European BENEO Scientific Symposium, 11 April, Brussels 12

Direct correlation between insulin and blood glucose level

High-glycaemic carbohydrates lead to higher insulin levels

than low-glycaemic carbohydrates

What matters from a physiological point of view is

the blood glucose response and insulin release

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Blood sugar management matters

to all age groups!

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The carbohydrate classification into …

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Sugars

= "bad carbs"

ʺsimple carbohydratesʺ

mono- & disaccharides

Food chemical classification

Consumer language

Others

= "good carbs"

ʺcomplex carbohydratesʺ

oligo- & polysaccharides

with longer chain

length

Food chemical classification

Consumer language

Examples: glucose, fructose, maltose,

sucrose, HFCS, galactose, lactose

Examples: Maltodextrin, starch

(amylose, amylopectin), fibres

© 2017 BENEO

… does not always reflect physiological properties

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Glycaemic Index (GI)

values of sugars

Blood glucose curves of foods providing

50 g of mostly "complex carbohydrates"

Foster-Powell et al (2002) Am J Clin Nutr 76(2002):5–56

Atkinson et al (2008) Diabetes Care 31(12):2281–2283

Jenkins et al (1981) Am J Clin Nutr 34, 362-366

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Introducing Palatinose™

A unique carbohydrate with

slow release properties

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© 2017 BENEO

Introducing Palatinose™

A unique innovative carbohydrate

• Like sucrose composed of glucose and fructose

• A natural constituent of honey

• Produced via rearrangement of sucrose

Palatinose™ is a “slow release” carbohydrate:

It supplies the body with the full carbohydrate energy

in a slower, more balanced way and over a longer period of

time than conventional carbohydrates.

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Digestibility is key

Palatinose™ in the small intestine

Small intestine

• Slow yet complete digestion by human

enzymes and subsequent absorption

• Slow glucose release (low glycaemic)

• Full calories (4 kcal/g)

Large intestine

• Not relevant (fully digestible

carbohydrate!)

Palatinose™ is a fully digestible

“slow release" carbohydrate

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© 2017 BENEO

Palatinose™

The stronger linkage makes all the difference

Slow andsustained

energy

Low blood glucose

response

Higher level of fat

burning

Palatinose™

Kind toteeth

Blo

od g

lucose

Time after consumption

sugar

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© 2017 BENEO

Evidence on blood glucose

response and diabetes risk

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Palatinose™ makes the difference

It is a low glycaemic carbohydrate

10 healthy volunteers (18-24 years, BMI 19-24 kg/m2),

intake 50g in 250ml water in fasting conditions.

The lower blood glucose response

is associated with a lower insulin release

Sucrose

PalatinoseTM

30 60 90 1200

1

-1

2

3

4

5

-2

Time (m in)

Pla

sm

a g

lucose c

hange (

m m

ol/L)

Sucrose

PalatinoseTM

30 60 90 1200

50

-50

100

150

200

250

Time (m in)

Pla

sm

a in

sulin

change (

m m

ol/L)

Glucose IsomaltuloseSucrose0

20

40

60

80

100100

68

32GI

(%)

Blood glucose

Insulin

GI

Sydney University’s Glycaemic Index Research Service (SUGiRS) (2002)

Sponsor: BENEO 21

© 2017 BENEO

Low glycaemic properties confirmedin over 30 human trials with Palatinose™

Consistent findings with Palatinose™

• LOWER blood glucose response

• LOWER insulin response

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Low glycaemic properties of Palatinose™

Confirmation in healthy and diabetic conditions

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✓

✓

✓

Number of relevant human

intervention studies with Palatinose™:

>20

© 2017 BENEO

Palatinose™

The better sugar for people with diabetes!

Keyhani-Nejad et al. (2016) Diabetes Care 39(3):e38-e39. doi: 10.2337/dc15-1891

Blood glucose and serum insulin concentrations in type 2 diabetics after intake of 50g Palatinose™ or sucrose.

Values are mean ± SEM. *p>0.05, ** p<0.01 and ***p<0.001

(© Till Budde/DIfE)

Study of the German Institute of

Human Nutrition (DIfE) confirms:

Palatinose™ lowers the

blood glucose response and insulin

in people with diabetes mellitus,

linked with a better incretin response.

Press Release

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© 2017 BENEO

Palatinose™ has a different incretin response

"Footprints" of its slow release

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The incretines GIP and GLP-1 are gut hormones, which

stimulate glucose-dependent insulin secretion

Palatinose™ digestion and absorption occurs

along the entire small intestine.

Lower small intestine

• GLP-1 release from L cells

• Palatinose™: GLP-1

Upper small intestine

• GIP release from K cells

• Stimulated by

monosaccharides

• Palatinose™: GIP

References

a) Healthy adults

Maeda et al (2013) J Diabetes Investig 4 (3) 281-6.

b) Diabetes mellitus

Ang and Linn (2014) Am J Clin Nutr 100:1059–68. (data shown here)

Keyhani-Nejad et al (2016) Diabetes Care 39(3):e38-e39.

© 2017 BENEO

Body composition

• Palatinose™ causes less fat accumulation

• in adipose tissue (“belly fat”)

with benefits on body composition

• in the liver with potential in the prevention of

non-alcoholic fatty liver and insulin resistance*

Body weight

• Palatinose™ may be more effective in promoting

weight loss in a weight-loss diet than sucrose

• Carbohydrate-rich meal replacement formula with

Palatinose™ and fibre is effective in promoting weight loss

Body Weight Change over 12 weeks

Time

% B

ody

Weig

ht

Sucrose

PalatinoseTM

* first animal study

Results from long-term studies on body weight management

Indications from various animal and first human studies

Palatinose™ makes a difference – long term

Benefits on body composition & body weight

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© 2017 BENEO

Long-term studies

Benefits of Palatinose™ vs. high GI carbohydrates

• Weight management and body composition

• Less abdominal fat

• Supportive effect on body weight loss

• Blood glucose control

• Reductions in fasting blood glucose

• Improving effects on insulin resistance in persons with

poor insulin sensitivity

• Reductions in fasting plasma triglycerides

• Prevention of non-alcoholic fatty liver and insulin resistance,

independent of obesity*

• Cardiovascular risk

• No detrimental effects on blood lipids (incl. cholesterol)

and cardiovascular risk markers

• Emerging science proposes a beneficial effect on arterial stiffness

* Animal data

© 2017 BENEO

Evidence in sports

Can low GI play a role in sports nutrition?

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© 2017 BENEO

Low GI carbs in sports? It depends!

Situations where Palatinose™ can be beneficial

RCT: randomised controlled trial29

Increase body‘s fat oxidation capacity

Consistent evidence from several RCT:

Palatinose™ promotes fat oxidation

in energy metabolism vs. high GI carbs

"Training effect"

Fuel management for endurance

Recently published study suggests

benefit of Palatinose™ vs. high GI

Potential glycogen sparing

Stabilise blood sugar levels

along physical activity in T1DM

Series of 5 studies in T1DM: Palatinose™

allows more stable blood sugar levels and

less hypoglycemic episodes (vs. high GI)

Stabilise blood sugar levels

Physical activity to support weight

management strategies

Study in ow/ob men: Palatinose™ allows

higher fat oxidation during rest and

physical activity vs. high GI

Maintain fat burning rate

Endurance training

Endurance activity prior to a sprint

Physical activity

& weight management

Physical activity

& diabetes mellitus

ow/ob: overweight/obese

T1DM: type 1 diabetes mellitus

© 2017 BENEO

Rate of energy supply determines fuel partitioning

Palatinose™ promotes fat burning

Carb. oxidation

Fat oxidation

Insulin

Blood glucose

Benefits of Palatinose™

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Slow and sustained release

Lower blood glucose response

Less insulin release

Lower carbohydrate oxidation

Higher fat oxidation in energy gain

Traditional carbohydrates

© 2017 BENEO

Palatinose™ promotes fat oxidation

Palatinose™ and its more balanced glucose supply

allows a higher fat oxidation in energy metabolism

than conventional high glycaemic carbohydrates

PalatinoseTM studies (BENEO) Further published studies Effect of Palatinose™ on fat oxidation

confirmed in different populations:

• at rest and during physical activity

• trained endurance athletes and

moderately active people

• normal weight and overweight people

• normal and impaired glucose tolerance

(IGT)

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© 2017 BENEO

Palatinose™ in sports

Series of sports studies with Palatinose™

• In comparison with maltodextrin or sugar

• In trained athletes or recreational sports

• Taken before, during and after exercise

Key findings for Palatinose™

More steady glucose supply

Sufficient carbohydrate energy

for high intensity endurance performance

Improved metabolic profile:

less fluctuations, higher level of fat oxidation

(“training effect”)

No gastrointestinal distress

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© 2017 BENEO

Study Design

Palatinose™ and Performance

Purpose

Effect of Palatinose™ (low GI) vs. maltodextrin

(high GI) on substrate use during endurance

exercise and subsequent time trial performance

Study Design

• 2-arm cross-over design, randomised, double-blind, placebo controlled

• N = 20 male endurance athletes (VO2max > 55 ml/kg)

• Consumption of a beverage with 75g Palatinose™ or maltodextrin before exercise

33Koenig D et al (2016) Nutrients 8, 390-400.

Sponsor: BENEO

Pre-run Endurance exercise

60-65% VO2max

-45‘ 0‘ 45‘15‘ 30‘ 60‘ 75‘ 90‘

Intake of 750 ml drink with 10% (75g) Palatinose™ or maltodextrin

Time Trial Test

(6.5 kJ/kg bw)

end-30‘ -15‘

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Endurance performance

Results from the time trial

König D et al (2016) Nutrients 8, 390-400.

Sponsor: BENEO

31.08 min

30.05 min

Finish line

• Palatinose™ improved cycling

performance (vs. maltodextrin):

• Faster time to finish time trial

• Higher power output in the time

trial finish

• Palatinose™ provided glucose

more steadily with positive

influence on fuel use in preceding

endurance exercise (vs.

maltodextrin)

• More stable and sustained

blood glucose profile

• Higher fat oxidation rates

Proposed mechanism:

Lower carbohydrate oxidation could have allowed to spare

glycogen sources for the final time trial performance

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© 2017 BENEO

• Evidence and acceptance is piling up that the blood glucose response

to foods matters to health and disease prevention

• Focus on GI/GL or simple vs. complex carbs has

limitations to convey the message

• The slow release carbohydrate Palatinose™,

when replacing high GI carbs, can contribute

to bring a low glycaemic diet into practice

• More steady glucose supply

• Lower blood glucose and insulin response

• Improved metabolic profile

Benefits for blood sugar management, diabetes risk and metabolic

health

• Additionally, in sports nutrition and physical activity, Palatinose™ can

offer advantages over high GI carbohydrate in different situations

Conclusion

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silke.ullmann@beneo.com