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> Glycemic spikes on the other hand are linked to increased insulin resistance, heightened risk of diabetes, cardiovascular disease and so on. How exactly are

> Glycemic spikes on the other hand are linked to increased insulin resistance, heightened risk of diabetes, cardiovascular disease and so on. How exactly are they linked? Is it the size of the spike, the length, the frequency? Does it matter at all if you don't overeat? What evidence exists to support it? For instance, the plain white rice causes a huge glycemic spike but somehow it's the US facing both obesity and type-2 diabetes wave, not Vietnam. I agree that linking glycemic spikes with insulin resistance is "logical" but without hard evidence it's worthless and it doesn't seem to agree with the reality I see.

Etheryte 1y ago
The risks related to glycemic spikes are a widely accepted fact in the medical community, it's not even remotely close to being a controversial opinion. See [0], [1] and [2] for a start, but really, there's a very wide body of research on this matter along with ample evidence. [0] https://cardiab.biomedcentral.com/articles/10.1186/s12933-020-01085-6 https://cardiab.biomedcentral.com/articles/10.1186/s12933-02... [1] https://diabetesjournals.org/care/article/38/12/2354/29088/Long-term-Glycemic-Variability-and-Risk-of-Adverse https://diabetesjournals.org/care/article/38/12/2354/29088/L... [2] https://www.sciencedirect.com/science/article/pii/S0261561424000566 https://www.sciencedirect.com/science/article/pii/S026156142...
- alexey-salmin 1y ago
  No, not really. There's an established correlation between glycemic spikes and health risks which the papers you reference confirm. But correlation is not causation, and I haven't seen any evidence that reducing spikes have positive long-term consequences for general population (not diabetics). Would be interesting to see a controlled test if it ever happened. In the absence of data my guess is that glycemic spikes simply share common root causes with health risks: overeating, junk food etc. I say this because there's plenty of meals like white rice that cause glycemic spikes but not the health issues. And at the same time e.g fructose has low GI but seems to be linked to obesity and type 2 diabetes. In the same way sunglasses correlate with sweating but removing the sunglasses won't make you sweat any less.
  - dinfinity 1y ago
    The key problems of glycemic spikes: 1. The excess glucose is turned into fat. This is a causal link with obesity. 2. To turn the excess glucose into fat, insuline spikes (there is also an insulin index, which can be different than the glycemic index). This is a causal link with developing diabetes (the insulin insensitivity variant). 3. The associated glycemic crash (which is very significant) causes a desire to eat more, especially more quickly digestible food. Again, a causal link with obesity. In a relatively nutrient-poor environment the effects make complete sense: Get as much of the cheap energy providing stuff as possible and store the energy for later. In the Western world it leads to issues.
    - alexey-salmin 1y ago
      I'm aware of this theory and it sounds very logical, but essentially it's hand-waving that is not backed by controlled trials or observational data [1][2] What's described above is not necessarily a "problem", it's normal functioning of human body. If there are issues in the "Western world" I would look elsewhere. The theory about "nutrient-poor environments" doesn't really fit the case of France which is consuming 3x more bread per capita than US while having 4x less obese people. [1] https://pubmed.ncbi.nlm.nih.gov/34352885/ https://pubmed.ncbi.nlm.nih.gov/34352885/ [2] https://jn.nutrition.org/article/S0022-3166(22)01097-5/fulltext https://jn.nutrition.org/article/S0022-3166(22)01097-5/fullt...
      - dataangel 1y ago
        The type of bread matters. Fiber dampens the spike.
      - dinfinity 1y ago
        If you wear a glucose monitor and experiment a little, you'll find that the composition and timing of meals matter a lot. Eat high glycemic index stuff on its own: big spike, big crash. Eat it with slowly digesting stuff: hardly a spike. It makes sense if you mentally trace how the food you ate will be moving through your digestive system. French people eat lots of bread, but it's not like American white 'bread' and it is often eaten together with plenty of cheese, olives, butter, etc. From your linked study: "Dietary carbohydrate content may not fully represent glycemic response, because other aspects of the diet, such as fat content and cooking methods, can also influence glycemic response." Said otherwise: glycemic index != glycemic response. > The theory about "nutrient-poor environments" doesn't really fit the case of France which is consuming 3x more bread per capita than US while having 4x less obese people. I think you're misinterpreting. The nutrient-rich French (or American) environment doesn't cause glycemic spikes, but those spikes are problematic when they occur due to that environment. If there were only a very limited source of food in the US, the spikes wouldn't be as problematic (with regard to obesity, not insulin insensitivity).

Etheryte 1y ago

The risks related to glycemic spikes are a widely accepted fact in the medical community, it's not even remotely close to being a controversial opinion. See [0], [1] and [2] for a start, but really, there's a very wide body of research on this matter along with ample evidence. [0] https://cardiab.biomedcentral.com/articles/10.1186/s12933-020-01085-6 https://cardiab.biomedcentral.com/articles/10.1186/s12933-02... [1] https://diabetesjournals.org/care/article/38/12/2354/29088/Long-term-Glycemic-Variability-and-Risk-of-Adverse https://diabetesjournals.org/care/article/38/12/2354/29088/L... [2] https://www.sciencedirect.com/science/article/pii/S0261561424000566 https://www.sciencedirect.com/science/article/pii/S026156142...

alexey-salmin 1y ago
No, not really. There's an established correlation between glycemic spikes and health risks which the papers you reference confirm. But correlation is not causation, and I haven't seen any evidence that reducing spikes have positive long-term consequences for general population (not diabetics). Would be interesting to see a controlled test if it ever happened. In the absence of data my guess is that glycemic spikes simply share common root causes with health risks: overeating, junk food etc. I say this because there's plenty of meals like white rice that cause glycemic spikes but not the health issues. And at the same time e.g fructose has low GI but seems to be linked to obesity and type 2 diabetes. In the same way sunglasses correlate with sweating but removing the sunglasses won't make you sweat any less.
- dinfinity 1y ago
  The key problems of glycemic spikes: 1. The excess glucose is turned into fat. This is a causal link with obesity. 2. To turn the excess glucose into fat, insuline spikes (there is also an insulin index, which can be different than the glycemic index). This is a causal link with developing diabetes (the insulin insensitivity variant). 3. The associated glycemic crash (which is very significant) causes a desire to eat more, especially more quickly digestible food. Again, a causal link with obesity. In a relatively nutrient-poor environment the effects make complete sense: Get as much of the cheap energy providing stuff as possible and store the energy for later. In the Western world it leads to issues.
  - alexey-salmin 1y ago
    I'm aware of this theory and it sounds very logical, but essentially it's hand-waving that is not backed by controlled trials or observational data [1][2] What's described above is not necessarily a "problem", it's normal functioning of human body. If there are issues in the "Western world" I would look elsewhere. The theory about "nutrient-poor environments" doesn't really fit the case of France which is consuming 3x more bread per capita than US while having 4x less obese people. [1] https://pubmed.ncbi.nlm.nih.gov/34352885/ https://pubmed.ncbi.nlm.nih.gov/34352885/ [2] https://jn.nutrition.org/article/S0022-3166(22)01097-5/fulltext https://jn.nutrition.org/article/S0022-3166(22)01097-5/fullt...
    - dataangel 1y ago
      The type of bread matters. Fiber dampens the spike.
    - dinfinity 1y ago
      If you wear a glucose monitor and experiment a little, you'll find that the composition and timing of meals matter a lot. Eat high glycemic index stuff on its own: big spike, big crash. Eat it with slowly digesting stuff: hardly a spike. It makes sense if you mentally trace how the food you ate will be moving through your digestive system. French people eat lots of bread, but it's not like American white 'bread' and it is often eaten together with plenty of cheese, olives, butter, etc. From your linked study: "Dietary carbohydrate content may not fully represent glycemic response, because other aspects of the diet, such as fat content and cooking methods, can also influence glycemic response." Said otherwise: glycemic index != glycemic response. > The theory about "nutrient-poor environments" doesn't really fit the case of France which is consuming 3x more bread per capita than US while having 4x less obese people. I think you're misinterpreting. The nutrient-rich French (or American) environment doesn't cause glycemic spikes, but those spikes are problematic when they occur due to that environment. If there were only a very limited source of food in the US, the spikes wouldn't be as problematic (with regard to obesity, not insulin insensitivity).