"Stomaching" the food we eat-The imponderables!

We all know that food serves the twin purpose of satisfying our hunger and delivering the nutrients we need for growth and well being. Out of the three basic necessities of life, viz food, shelter and clothing the first one is most important as without food along with air and water no life can sustain in this planet. Most human beings take it for granted that when food is consumed the gastrointestinal ( GI )system automatically process these foods into usable nutrients required for the well being. But rarely any thought is given as to how complex is the GI system and what problems can arise if the normal process of digestion and absorption is hindered or adversely affected due to a host of reasons, many of them not still well known. Only people with disorders like allergies, intolerances, Crohn's disease, Celiac disease, Irritable bowel syndrome etc know what sufferings they have to endure as the present day treatment regimes are not considered absolutely satisfactory. Explosive growth of that industry sector manufacturing gluten free foods bears out the fact that all foods cannot agree with all the people. The so called well being food industry is rolling in money because the products being made by it commands a good following by those with one or the other real or imaginary problem with the foods they eat. Recent evolution of the concept of adverse effect of FODMAPS, a group of carbohydrates present in many foods, is further complicating the picture vis-a-vis tolerance of some of the foods by the GI system. Whether this is really a significant issue will emerge soon requiring attention at the hands of health pundits sooner or later. 

Take the case of Gluten-free foods which are made and marketed through out world mainly to cater to the needs of those consumers who experience disorders like Irritable Bowel Syndrome (IBS) and Celiac disease. These foods are designed based on the presumption that gluten is primarily responsible for the discomfort experienced by the patients. However over the years many consumers who do not have this disorder, rightly or wrongly, seemed to have started a feeling that gluten is a villainous food component and avoiding the same can improve their quality of life.The result was the beginning of a booming industry that caught the fancy of the consumer creating a huge market. Whether it is ethical for this industry to make a fast buck exploiting the misconception that is gaining traction during the last one decade is a difficult issue to answer because the industry is after all giving to the consumer what he wants on a platter. What may not be justified is the massive marketing blitz singing the virtues of gluten free foods attracting more and more consumers of normal health into the fold of IBS patients. The global business for gluten free foods is reported to be worth $ 3 billion which is predicted to reach about $ 5 billion within 5 years. Interestingly Europe leads in marketing these foods, more than 50% of business generated in this region. But in terms of growth, USA is on a fast galloping growth phase out pacing Europe in the near future though no one knows what is contributing to this peculiar phenomenon.

Though no reliable statistics can be cited for the extent of people affected by intestinal disorders like IBS and Celiac disease, some estimates claim that 10-15% of global population is affected. But among those patronizing gluten free foods more than 70% are not suffering from this affliction. That means the size of the current market does not reflect the ground reality vis-a-vis gluten induced GI disorders. While gluten free food market is fast growing, there is another interesting development that gives further hope to the well being industry to expand the market several fold. Based on the findings in Australia that besides gluten, there is a range of food constituents present naturally in most foods which can also create GI related disorders. These are collectively called FODMAPS, the acronym for Fermentable, Oligo-, Di--Mono-saccharides and polyols and it has been scientifically shown that reducing the levels of FODMAPS containing foods in the diet dramatically provides relief to those suffering from such GI related disorders. What does this mean to the food industry? A sign that demand for specially designed food products containing no or low levels of FODMAPS is bound to grow dramatically in the coming years.

Though Gluten cornered all the attention over many years as a causative factor for GI disorders, there have been many observations in the past that consumption of some carbohydrates does not go well with many consumers and among them a few short-chain carbohydrates that include lactose, fructose and sorbitol, fructans and galacto oligosaccharides caused IBS-like symptoms. What was more significant was that such studies also showed dramatic improvements among the affected people when there was dietary restriction to exclude short-chain carbohydrates in the diet. These carbohydrates induced symptoms similar to that caused by Gluten in the small intestine. These short-chain carbohydrates, being small molecules are either poorly absorbed or not absorbed at all and are capable of dragging water into the intestine through osmosis Further  they are easily fermented by colonic bacteria that reside in the large intestine generating gases like hydrogen, carbon dioxide and methane. Such a situation causes an expansion in volume of intestinal contents, which stretches the intestinal wall and stimulates nerves in the gut. that triggers the sensations of pain and discomfort, commonly experienced by those affected by IBS. The FODMAP concept maintains that a collective reduction in the dietary intake of all indigestible or slowly absorbed, short-chain carbohydrates would minimise stretching of the intestinal wall which in turn may reduce stimulation of the gut's nervous system and provide the best chance of reducing symptom generation in people with IBS. Later the collective term FODMAPS was evolved for designating indigestible or slowly absorbed, short-chain carbohydrates. 

Formulation of low FODMAP diet was originally developed by scientists in Australia and tested as to know whether low FODMAP diet really improved symptom control in patients with IBS. It is this pioneering work  which established the mechanism by which the diet exerted its effect. This led to efforts to evolve methodologies for measuring the FODMAPS content in foods and create a data base for foods that are consumed regularly. It is tribute to these scientists that a comprehensive and accurate database now exists describing the FODMAP content of a vast array of foods. There is now a better understanding about the mechanism by which the diet works and there is sound evidence indicating that a low FODMAP diet improves symptom control in approximately three out of every four people with IBS and other other Functional Gastric Intestinal Disorders (FGID). To day it is more or less agreed that the basis of many functional gastrointestinal disorders (FGIDs) is distension of the intestinal lumen. Such luminal distension may induce pain, a sensation of bloating, abdominal distension and motility disorders. Therapeutic approaches seek to reduce factors that lead to distension, particularly of the distal small and proximal large intestine. Food substances that can induce distension are those that are poorly absorbed in the proximal small intestine, osmotically active, and fermented by intestinal bacteria with hydrogen. 

An important question that may trouble many consumers is whether poor absorption of most FODMAP carbohydrates present in many foods can affect every body including normal healthy persons. A pertinent question that can be explained away in an understandable language.  Any FODMAPs that are not absorbed in the small intestine pass into the large intestine, where bacteria ferment them. The resultant production of gas potentially results in bloating and flatulence. Fortunately most individuals do not suffer significant symptoms but some may suffer the symptoms of IBS depending on their constitution and other biological variations. Fructose
malabsorption and lactose intolerance may produce IBS symptoms through the same mechanism but, unlike with other FODMAPs, poor absorption is found only in a minority of people. Many who 

benefit from a low FODMAP diet need not restrict fructose or lactose. It is possible to distinguish these two conditions by breath testing for the presence of hydrogen hydrogen and methane breath which will help to build into the diet only reasonable restrictions. Some of the significant sources of FODMAPS include wheat, rye, barley, onion, garlic, jerusalem  & globe artichokes, asparagus, beetroot, chicory, dandelion leaves, leek, broccoli, brussel sprouts, cabbage, fennel etc. Pulses and beans are rich in galactans while some some fruits like apples, apricots, avocado, blackberries, cherries, lychees, nectarines peaches, pears, prunes, water melon have significant concentrations of polyols. Isomalt, maltitol, mannitol, sorbitol and xylitol gets into the food when they are used as functional processing adjuncts by the industry. If such a large portfolio of foods is out of bounds for some people vulnerable to GI system malfunctioning, it is difficult to imagine how their quality of life is affected. May be this is the price humans pay for the progress of civilization as we see to it day. Ultimately the one going to be benefited is the well being food industry and the pharma sector! 

V.H.POTTY
http://vhpotty.blogspot.com
http://foodtechupdates.blogspot.com

Glycemic Index of foods- its relevance and reliability under a cloud

Diabetes is by now considered a debilitating disease which many viewing it as a silent killer. While educated people with some basic knowledge about the etiology of this affliction understand how the food we eat affects the blood glucose level and the adverse effect high glucose levels can have on different health parameters. It is sad to see millions of people suffering from diabetes, not very much aware of the consequences of eating high carbohydrate foods, that too based on highly refined ones, on the dynamics of glucose generation within the body and fall prey to serious ailments affecting eyes, heart, kidneys, limbs etc destroying the quality of their life. According to available reports there are more than 422 million people suffering from this disorder which is fast becoming a top killer among all the diseases. In India itself number of people afflicted by diabetes is placed around 62 million and if experts are to be believed, India may become the world capital of diabetes soon, if not checked effectively. Once diabetes is diagnosed appropriate diet and disciplined eating habits can provide substantial benefits along with correct drugs in right dosage. Inability of the body to assimilate sugar at a rate that will prevent undue build up in the blood, due to insulin insufficiency or insulin insensitivity has to be recognized and such build up can be "managed" only by a diet predominant in whole grains with particular emphasis on pulses, vegetables, meat, fish and nuts with low rate glucose release when consumed.

It is not that information is lacking regarding the type of foods that can be eaten moderately and the quantity that can be safe but often the logistical difficulties in adhering to a strict diet regimen besides often conflicting nature of such information, make it impractical to follow the guidelines of the physicians. Against such a situation the evolution of the concepts of Glycemic Index (GI) and glycemic load (GL) during early eighties provided a reasonably reliable guide to the ability of different foods consumed regularly to generate glucose in the body. Thus high GI, medium GI and low GI foods were developed or conceptualized that will safeguard against undue glucose spikes in the blood after consumption. But if recent reports by a group of scientists from the US are to be believed, GI is not as reliable as it was thought to be pushing millions of diabetics as well as the food industry developing products with low GI into a new era of uncertainty. What are the implications of the results of this study? 

Traditionally blood glucose levels, estimated after a 12 hour fasting  and 2 hours after ingesting a normal breakfast provided a reasonable clue as whether a person is diabetic or not. While a glucose level of 100 mg per 100 ml after fasting and 150 mg/100 ml 2 hours after breakfast are considered normal. Though there are slight variations in diabetic assessment technique essentially all of them highlight the ability of the body cells to assimilate free glucose from the blood for hundreds of biological functions. While high levels of blood glucose are supposed to cause hyperglycemic conditions considered dangerous, especially it it continues for long time, low levels of glucose cause hypoglycemic symptoms such as giddiness and over all weakness. Though these values are more or less accepted universally, monitoring blood glucose levels frequently, especially in the home environment is fraught with some logistical problems. Estimating glucose in a pathological laboratory may take at least a couple of hours but there are home gadgets based on mild pricking and drawing a tiny drop of blood on to a glucose oxidase enzyme strip that provides digital readings of glucose levels in a matter of a few seconds. Many people buy these gadgets for testing of glucose as and when they feel symptoms of hyper or hypo glycemia. A non-invasive system without the necessity of puncturing the skin is still in the realm of development and may take some time before becoming a common tool.

What is GI? Using a standard material like sugar for testing glucose transfer to blood from the food ingested is measured as a percentage of the time taken for the sugar to manifest in the blood, GI is expressed usually as a definitive number. Easily assimilable and fast appearance of glucose from the ingested sugar sources usually have high GI numbers while those foods which do not release glucose easily  have low GI values. Generally whole grains and pulses are slow glucose releasers and hence have low GI values. Most food products based on sugar and refined cereal flours have high GI values indicating that they cause glucose spikes in blood considered highly undesirable. Similarly processed foods containing high levels of retrograded starch and uncooked foods also have relatively lower GI values. Since a diabetic wants to avoid rapid rise in blood sugar levels, his choice is always foods with low GI numbers. Food industry also strives to evolve food products with less and less GI numbers to attract diabetes affected consumers and incidentally such tailor made foods also command higher prices.

It is almost a decade and a half since GI became a standard parameter for assessing suitability of different foods for consumption by diabetic affected people and no one has so far contested the relevance or reliability of GI to assess the glucose release and absorption by the blood. Of course from time to time there were informed criticism regarding the reliability of GI concept, in the absence of a better alternative, GI was still widely adopted by nutritionists and medical community as a practical tool. Though GI is widely used by physicians and dietitians for advising their clients regarding the best foods they must consume to control diabetes, periodic checking of fasting sugar and postprandial sugar levels still gives an idea about the extent of control of the food regimen by a diabetic patient.  Of course this traditional practice of glucose monitoring in the morning can at best give a picture about the glucose dynamics in the blood during pre-lunch period.  What about the situation in the post lunch period? Though many diabetics use home gadgets to monitor the blood glucose level as many times as they wish, it is not practical to do this often due to the physical discomfort involved in skin puncturing. The concept of glycosylated haemoglobin (HbA1c) measurement in the blood once in 2-3 months provides a reliable means of knowing about the history of food eating during that period. While a value of less than 6 is considered normal, any value beyond that can be an indicator of onset of diabetes. Values beyond 7 must be taken seriously to exercise better control of the diet by including more and more of low GI foods in their diet. 

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One can realize how far the world has gone in adopting GI as a useful tool to manage diets. It is this edifice which is sought to be destroyed by the findings of a group of scientists in the US who claim that GI is not as dependable as it is thought to be, because of inconsistent values of GI noted for the same food in different people. While minor variations up to 5% can be ignored because of experimental error that may creep in in different laboratories, variations as big as 20% cannot be attributed to lab error. If their results are true the commonly consumed white bread can show GI values ranging from 47 to 77! This means white bread can be a low GI food for some, medium GI food for some body else and a high GI food for some others. How ludicrous it is? But if the results of the American scientists are validated, it is going to open a Pandora's Box with unimaginable consequences. Low GI foods have values 35-55, medium ones 57-67 and high GI category with GI 70-103. More shocking is that same food with a certain standard GI value gave widely different values in the same person when determined on different occasions according to these scientists! What can one make out of these observations and what impact it will have on various stakeholders of the diabetic disease?.

It is unfortunate that the new studies have come at a time when some consensus is emerging about the need for the food industry to include in the label information regarding the GI value of the contents within the packet. Will this be the pretext for the manufacturers to resist pressure from the consumer community to publish GI data on the label? That should not be allowed to happen at any cost unless more studies are organized to validate the new findings. Even if GI values show variations under different conditions, by and large they seem to remain same most of the time. Similarly it does not matter that GI response varies from person to person since most data applied to day is based on majority response. Till a new and better alternative energies, it may be fool hardy to ignore it for the time being. Diabetics are better advised to base their diet on low GI foods and best way to manage diabetes could be to adopt diets based on foods undergoing minimum processing.

The million dollar question is whether hundreds of scientist working on GI of foods have gone wrong some where? What can be the scientific explanation for this shocking anomaly? A larger question is if there are such wide metabolic and physiological variations amongst human beings, what relevance studies using humans as subjects can have in generalizing the results of such studies to be applicable to entire humanity? This question assumes more significance when human studies are undertaken while testing drugs for various ailments and diseases. It is urgent that the questions raised by the Tuft university scientists are further examined by a few independent groups under international collaboration to arrive at a consensus. If Gi tool is to be thrown out of the window what other alternatives we have to assess appropriateness and soundness of foods for consumption by diabetic population? No body disagrees with the universal consensus that fruits, vegetables, whole cereals, pulses and foods rich in retrograded starch must constitute the core part of any diet but to make them palatable appropriate products have to be evolved acceptable to the targeted consumers.  .     

V.H.POTTY
http://vhpotty.blogspot.com
http://foodtechupdates.blogspot.com

Fat is no more a dirty word for health conscious consumers? Another twist to "fat saga"!

Every American child from its early development stage has been fed on a food myth that butter and cheese are not good for their health and the food industry in western countries found an opportunity to cash on this understanding of the consumers, churning out thousands of food products with no fat or low fat. Saturated fat was a still dirtier word because of the repeated claims by many studies that they contribute to heart disease by raising bad cholesterol level in the blood. Healthy plant oils like Palmolein and Coconut oil became a permanent item in the"no buy" list of most families since they are rich in saturated fats! What a paradox? To day both these oils are becoming popular for the very opposite reason that they are healthy! It is true that all animal fats do contain cholesterol but that is no reason to shun them indiscriminately without realizing their good qualities. It is a good development that at least some scientists of modern generation are asking hard questions as to whether dietary guidelines formulated a generation ago were authenticated by exacting scientific studies that to day are mandatory before arriving at such far reaching conclusions. 

Imagine the population of the US at 220 million in 1983 when the above dietary guidelines were imposed and that in the UK at 56 million, started the shift from normal diet to low fat diet believing the norms as absolute truth. These guidelines restricted consumption of fat to 30% of the total dietary calories and that from saturated fat to 10% of daily calorie intake. Unfortunately there was no improvement in the general health status of the people consequent to the new paradigm introduced in these countries. On the contrary there was dramatic decline of health when measured in terms of CVD, obesity, diabetes and other diseases! This is not to argue that new dietary guidelines caused this slump but it has something to do with the changes in the diet of consumers, who replaced the fat with carbohydrates from refined grain flours and sugar-rich products to meet their overall calorie needs!. It is now more or less agreed that white sugar, fructose sugars and high gycemic index (GI) carbohydrates of refined grain flours are the real culprits in damaging the health of millions of Americans, Europeans and populations in other wealthy countries.

A curious fact brought out recently by a group of scientists from the US and Scotland is that because of taking a premature decision on fat consumption then, world is facing the present health crisis. Butter is a very common food adjunct used world over for centuries and by casting aspersion on its health credentials, a whole generation of population has been shunning it ever since the guidelines were issued in 1977. Same is true with cheese and other dairy products also. Even to day there is a sustained attack on milk consumption in the US and the dairy industry in that country is struggling with declining demand, with the per capita consumption continuously falling during the last few years, from 78 liters per person in the year 2000 to less than 70 liters in 2009 and further anticipated to decline by 3% in 2020!. What was the result of this presumed mistake? The obesity epidemic, heart disease, blood pressure, kidney ailments, cancer cases have devastated the people with no hope of coming out of this crisis. Possibly consumers, in order to meet their energy requirements started depending more and more on carbohydrates in stead of fat. Added to this another folly was committed by consuming carbohydrate foods mostly based on refined floors, white sugar and high fructose corn syrup (HFCS)! Further damage was done by decreasing consumption of fruits and vegetables which are considered the most health friendly foods in this planet! Is this not a right recipe for disaster?

It is too often forgotten that food cannot be considered in a fragmented format in terms of fat, carbohydrate, protein, fiber and other nutrients but should be looked at holistically through the every day diet people consume. If this is an accepted fact, then man will be well off if a mixed diet containing whole grains, healthy fats, proteins from lean meats or legumes, milk, fruits and vegetables are consumed regularly without over eating. There is a feeling now among scientists that the food market of to day is dangerously weighted against healthy foods and the consumers are not realizing the bitter truth that tastier the food more unhealthy it can be! This ground reality is being exploited by the industry in making market place foods highly tasty and mouth watering! Probably this situation may continue unless concrete action is thought of, to improve the "food environment" in the market place with more choices of healthy foods being made available while shrinking the portfolio of unhealthy foods! How this can be achieved is some thing the stakeholders in this triangle viz industry, government and the consumers, must sit together and take appropriate decisions.

V.H.POTTY

http://vhpotty.blogspot.com
http://foodtechupdates.blogspot.com

'LAB' TO HELP DIABETICS?

Chinese scientists have made a splash in the international circuit recently by claiming the development of a technology to make low carbohydrate juice products from vegetables like carrot using lactic acid fermentation and further claiming that these products are good for diabetic people. What is not clear in this claim is whether they have found a new strain of microorganism that will 'eat up' complex carbohydrates like starch present in many vegetables. Use of Lactic Acid Bacteria (LAB) in many traditional vegetable products is ancient dating back to centuries and many traditional foods in Asian and African continents are based on this fermentation. Professor Steinkraus, an internationally acclaimed and highly knowledgeable microbiologist, has brought out an epic book on the fermented foods which is virtually an encyclopedia on the subject. It is difficult to understand what is new in the present findings reported by Chinese scientists. Lack of any substantial data on their study makes it difficult to come to any meaningful conclusion.

To begin with most vegetables are low in carbohydrates including sugars and their consumption is recommended because of this reason. Besides they are rich in dietary fiber, several vitamins and essential minerals. The carbohydrate content in most of the vegetables vary from 2.5% in bitter gourd to 9.7% in carrot but is high in some like Peas (14.4%) potato (22.1%), Yam (18.4%), Breadfruit (15.8%) and Plantain (14%). There are many vegetables grown in India with low carbohydrate content like bottle gourd (2.5%), brinjal (4%), squash (3.4%), okra (6.4%), snake gourd (3.3%), pumpkin (4.6%), ridge gourd (3.4%), spinach (4.3%), radish (3.4%), and tomato (4.7%). More over the glycemic index (GI) of of most of the vegetables is very low because whatever little carbohydrates present in them, are encased in so much cellulosic material that they cause practically no rise in blood sugar even if consumed in large quantities. Only some like Potato ( GI 80+), Peas (GI 48), Corn (GI 53) and Carrot (GI 47) are considered having some what higher GI values. Vegetables are rich sources of dietary fiber, both soluble as well as insoluble and many of them contain 2-6% fiber, considered vital for good health. If this is so where is the need to reduce the carbohydrate involving costly technological intervention which will also remove the beneficial dietary fiber and other nutrients in the process? Nonetheless LAB fermentation process does not involve heating of the raw material and there fore the products may contain some health protecting phytonutrients like isothiocyanates in significant quantities generated by live enzymes like myrosinase.

If the purpose is to make drinkable juice products, use of pectinase can serve the same purpose faster. Subjecting vegetable pulps to LAB fermentation is time consuming and cumbersome and the products will have a distinct acidic taste which has to be adjusted to suit the palates of the consumers that calls for significant dilution. Again addition of salt or sugar may be necessary to make the product palatable especially to young age consumers. A 3/4 cup juice is supposed to be equivalent to one serving of vegetables and if 5 servings are to be made, almost 4 cups of juice will have to be consumed requiring at least 4 g of salt to make them palatable! It is true that health freaks are already consuming such juices from many vegetables and herbs but their number and quantities consumed are rather limited raising a question regarding the commercial viability of these LAB fermented vegetable juices.

LAB group consists of homofermentors and heterofermentors, converting sugar to lactic acid and CO2 or a mixture of lactic acid, acetic acid, ethyl alcohol and CO2 respectively. These include Lactobacillus acidophilus, L.bulgaricus, L.plantarum, L.caret, L.pentoaceticus, L.brevis and L.thermophilus. Streptococcus and Leuconostoc species also produce lactic acid but much less than that produced by Lactobacillus species. They are all microaerophilic organisms requiring no oxygen for their growth and metabolism. Traditional sauerkraut fermentation of cabbage brought about by Leuconostoc mesenteroides is a classical example of lactic acid preserved vegetable, consumed widely by Europeans. There are typical traditional fermented products in many countries, almost all of them preserved by lactic acid fermentation in presence of salt. Kimchi of Korea, Gundruk of Nepal, Kocho of Ethiopia, Pak-gard-dong, Hum-dong, Hua-chai po and Naw-mai-dong of Thailand, Hum choy and Tai-tan-tsoi of China, Tempoyak of Malaysia, dozens of pickles from mango, lime, gooseberry etc in India, are all LAB mediated preserved foods that have stood the test of time for centuries.

The critical substrate for LAB is sugar and only in case of vegetables that contain small concentration of sugar can initiate fermentation. The role of the salt is primarily to bring out the juice and subsequent liberation of sugar for further action by the microbes. During LAB action glucose is broken down mainly to lactic acid and lactate which enters the blood when pickles are consumed is converted to pyruvate in the liver for deriving energy through the Kreb's Cycle. Excess accumulation of lactate in the blood can end up as glucose through the pyruvate route. Though lactic acid fermentation does bring down carbohydrate load, it does not guarantee against rise in blood sugar in the blood under certain conditions. While LAB fermented vegetable juice products can be a separate category of newly developed beverages which should stand scrutiny of the consumer for its acceptability, claiming it to be a panacea for diabetic people is some what far-fetched!

V.H.POTTY
http://vhpotty.blogspot.com/