Karen White

Effects of High vs Low Glycemic Index of Dietary Carbohydrate on Cardiovascular Disease Risk Factors and Insulin Sensitivity: The OmniCarb Randomized Clinical Trial

IMPORTANCE Foods that have similar carbohydrate content can differ in the amount they raise blood glucose. The effects of this property, called the glycemic index, on risk factors for cardiovascular disease and diabetes are not well understood. OBJECTIVE To determine the effect of glycemic index and amount of total dietary carbohydrate on risk factors for cardiovascular disease and diabetes. DESIGN, SETTING, AND PARTICIPANTS Randomized crossover-controlled feeding trial conducted in research units in academic medical centers, in which 163 overweight adults (systolic blood pressure, 120-159 mm Hg) were given 4 complete diets that contained all of their meals, snacks, and calorie-containing beverages, each for 5 weeks, and completed at least 2 study diets. The first participant was enrolled April 1, 2008; the last participant finished December 22, 2010. For any pair of the 4 diets, there were 135 to 150 participants contributing at least 1 primary outcome measure. INTERVENTIONS (1) A high-glycemic index (65% on the glucose scale), high-carbohydrate diet (58% energy); (2) a low-glycemic index (40%), high-carbohydrate diet; (3) a high-glycemic index, low-carbohydrate diet (40% energy); and (4) a low-glycemic index, low-carbohydrate diet. Each diet was based on a healthful DASH-type diet. MAIN OUTCOMES AND MEASURES The 5 primary outcomes were insulin sensitivity, determined from the areas under the curves of glucose and insulin levels during an oral glucose tolerance test; levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides; and systolic blood pressure. RESULTS At high dietary carbohydrate content, the low- compared with high-glycemic index level decreased insulin sensitivity from 8.9 to 7.1 units (-20%, P = .002); increased LDL cholesterol from 139 to 147 mg/dL (6%, P ≤ .001); and did not affect levels of HDL cholesterol, triglycerides, or blood pressure. At low carbohydrate content, the low- compared with high-glycemic index level did not affect the outcomes except for decreasing triglycerides from 91 to 86 mg/dL (-5%, P = .02). In the primary diet contrast, the low-glycemic index, low-carbohydrate diet, compared with the high-glycemic index, high-carbohydrate diet, did not affect insulin sensitivity, systolic blood pressure, LDL cholesterol, or HDL cholesterol but did lower triglycerides from 111 to 86 mg/dL (-23%, P ≤ .001). CONCLUSIONS AND RELEVANCE In this 5-week controlled feeding study, diets with low glycemic index of dietary carbohydrate, compared with high glycemic index of dietary carbohydrate, did not result in improvements in insulin sensitivity, lipid levels, or systolic blood pressure. In the context of an overall DASH-type diet, using glycemic index to select specific foods may not improve cardiovascular risk factors or insulin resistance. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00608049.

Phosphorus Content of Popular Beverages

Carbonated drinks Coke 37.5 6 0.2 Cherry Coke 33.8 6 0 Dr. Pepper 25.9 6 0.2 Diet Dr. Pepper 27.1 6 0.5 Pepsi 31.2 6 0.7 Diet Pepsi 24.1 6 0.3 AMP Energy 30.9 6 0.8 Fruit-Flavored Drinks Crystal Light, Classic Orange 100.5 6 16.0 Crystal Light, Raspberry Ice 2.4 6 0.1 Crystal Light, Fruit Punch 10.9 6 0.5 Tang, Orange 91.1 6 5.0 Kool-Aid, Tropical Punch 2.7 6 0.3 Kool-Aid, Black Cherry 2.4 6 0.1 Kool-Aid, Grape 4.7 6 0.6 Hawaiian Punch, Fruit Juicy Red 77.4 6 0.3 Sunny-D, Tangy Original 68.8 6 0 Sunny-D, Smooth 69.0 6 0.5 Coffee Drinks Starbucks Doubleshot Energy, Mocha 131.2 6 0.2 Starbucks Doubleshot Energy, Vanilla 130.2 6 1.5 Iced Teas Gold Peak Iced Tea, Sweet Tea 6.7 6 0.2 Gold Peak Iced Tea, Lemon 2.5 6 0.2 Lipton Brisk Iced Tea, Sweet Tea 105.2 6 0.8 Lipton Brisk Iced Tea, Lemon 56.9 6 0.5 Lipton Brisk Iced Tea, Raspberry 83.6 6 3.8 Lemonade Crystal Light, Raspberry Lemonade 8.0 6 0.7 Country Time, Lemonade 15.8 6 0.0 Country Time, Pink Lemonade 14.1 6 0.2 Kool-Aid, Pink Lemonade 7.3 6 0.1 Flavored Waters Vitamin Water, Power C Dragonfruit 1.0 6 0 Vitamin Water, Revive Fruit Punch 261.4 6 1.7 Vitamin Water, Focus Kiwi Strawberry 0.9 6 0 Vitamin Water, Essential Orange-Orange 63.4 6 0.7 Vitamin Water, Defense Raspberry Apple 1.5 6 0.1 Vitamin Water Zero, Squeezed Lemonade 86.2 6 1.2 Vitamin Water Zero, Rise Orange 97.7 6 1.7 Mio Fit, Arctic Grape 12.4 6 2.1 Mio Fit, Berry Blast 14.4 6 1.6 SoBe Lifewater, Blood Orange Mango 43.9 6 0.5 Aquafina Flavor Splash, Mixed Berry 56.3 6 0.7 Propel Zero, Berry 54.9 6 0.3 Sports Drinks Gatorade, Frost Glacier Freeze (powder) 20.9 6 3.2 Gatorade, Orange (powder) 21.0 6 4.4 Powerade Zero, Fruit Punch 18.0 6 0.2 Powerade Zero, Orange 18.6 6 0.1 Powerade, Fruit Punch 18.7 6 0.2 Powerade, Orange 18.9 6 0.1

A Dietary Intervention in Urban African Americans: Results of the "Five Plus Nuts and Beans" Randomized Trial.

INTRODUCTION Unhealthy diets, often low in potassium, likely contribute to racial disparities in blood pressure. We tested the effectiveness of providing weekly dietary advice, assistance with selection of higher potassium grocery items, and a

Effects of Lowering Glycemic Index of Dietary Carbohydrate on Plasma Uric Acid Levels: The OmniCarb Randomized Clinical Trial

30 per week food allowance on blood pressure and other outcomes in African American adults with hypertension. DESIGN We conducted an 8-week RCT with two parallel arms between May 2012 and November 2013. SETTING/PARTICIPANTS We randomized 123 African Americans with controlled hypertension from an urban primary care clinic in Baltimore, Maryland, and implemented the trial in partnership with a community supermarket and the Baltimore City Health Department. Mean (SD) age was 58.6 (9.5) years; 71% were female; blood pressure was 131.3 (14.7)/77.2 (10.5) mmHg; BMI was 34.5 (8.2); and 28% had diabetes. INTERVENTION Participants randomized to the active intervention group (Dietary Approaches to Stop Hypertension [DASH]-Plus) received coach-directed dietary advice and assistance with weekly online ordering and purchasing of high-potassium foods (

A pilot feeding study for adults with asthma: The healthy eating better breathing trial

30/week) delivered by a community supermarket to a neighborhood library. Participants in the control group received a printed DASH diet brochure along with a debit account of equivalent value to that of the DASH-Plus group. MAIN OUTCOME MEASURES The primary outcome was blood pressure change. Analyses were conducted in January to October 2014. RESULTS Compared with the control group, the DASH-Plus group increased self-reported consumption of fruits and vegetables (mean=1.4, 95% CI=0.7, 2.1 servings/day); estimated intake of potassium (mean=0.4, 95% CI=0.1, 0.7 grams/day); and urine potassium excretion (mean=19%, 95% CI=1%, 38%). There was no significant effect on blood pressure. CONCLUSIONS A program providing dietary advice, assistance with grocery ordering, and

Physical Function Following a Long-Term Lifestyle Intervention among Middle Aged and Older Adults with Type 2 Diabetes: the Look AHEAD Study

30/week of high-potassium foods in African American patients with controlled hypertension in a community-based clinic did not reduce BP. However, the intervention increased consumption of fruits, vegetables, and urinary excretion of potassium.

Effects of Lowering Glycemic Index of Dietary Carbohydrate on Plasma Uric Acid: The OmniCarb Randomized Clinical Trial: TRIAL OF GLYCEMIC INDEX, CARBOHYDRATE INTAKE, and URIC ACID

The effects of carbohydrates on plasma uric acid levels are a subject of controversy. We determined the individual and combined effects of carbohydrate quality (the glycemic index) and quantity (the proportion of total daily energy [percentage of carbohydrates]) on uric acid levels.

Use of online recruitment strategies in a randomized trial of cancer survivors

Rationale Evidence from observational studies and to a lesser extent clinical trials suggest that a healthy diet may improve symptoms and lung function in patients with asthma. We conducted a pilot study to determine the feasibility of conducting a larger scale dietary trial and to provide preliminary evidence on the impact of a healthy diet on asthma outcomes. Methods In a randomized, two period cross-over trial, participants with asthma received a 4-week dietary intervention followed by a usual diet (or vice versa), separated by a 4-week washout. The dietary intervention was a healthy diet rich in unsaturated fat. During the dietary intervention, participants ate three meals per week on site at the Johns Hopkins ProHealth Research Center. All remaining meals and snacks were provided for participants to consume off-site. During the control diet, participants were instructed to continue their usual dietary intake. Relevant biomarkers and asthma clinical outcomes were assessed at 0, 2, and 4 weeks after starting each arm of the study. Results Eleven participants were randomized, and seven completed the full study protocol. Among these seven participants, average age was 42 years, six were female, and six were African American. Participant self-report of dietary intake revealed significant increases in fruit, vegetable, and omega-3 fatty acid intake with the dietary intervention compared to usual diet. Serum carotenoids (eg. lutein and beta-cryptoxanthin) increased in the intervention versus control. Total cholesterol decreased in the intervention versus control diet. There was no consistent effect on asthma outcomes. Conclusions The findings suggest that a feeding trial in participants with asthma is feasible. Larger trials are needed to definitively assess the potential benefits of dietary interventions on pulmonary symptoms and function in patients with asthma.

Effects of a DASH Diet Intervention on Serum Uric Acid in African Americans with Hypertension

Background Lifestyle interventions have been shown to improve physical function over the short term; however, whether these benefits are sustainable is unknown. The long-term effects of an intensive lifestyle intervention (ILI) on physical function were assessed using a randomized post-test design in the Look AHEAD trial. Methods Overweight and obese (body mass index ≥ 25 kg/m2) middle-aged and older adults (aged 45-76 years at enrollment) with type 2 diabetes enrolled in Look AHEAD, a trial evaluating an ILI designed to achieve weight loss through caloric restriction and increased physical activity compared to diabetes support and education (DSE), underwent standardized assessments of performance-based physical function including a 4- and 400-m walk, lower extremity physical performance (expanded Short Physical Performance Battery, SPPBexp), and grip strength approximately 11 years postrandomization and 1.5 years after the intervention was stopped (n = 3,783). Results Individuals randomized to ILI had lower odds of slow gait speed (<0.8 m/s) compared to those randomized to DSE (adjusted OR [95% CI]: 0.84 [0.71 to 0.99]). Individuals randomized to ILI also had faster gait speed over 4- and 400-m (adjusted mean difference [95% CI]: 0.019 [0.007 to 0.031] m/s, p = .002, and 0.023 [0.012 to 0.034] m/sec, p < .0001, respectively) and higher SPPBexp scores (0.037 [0.011 to 0.063], p = .005) compared to those randomized to DSE. The intervention effect was slightly larger for SPPBexp scores among older versus younger participants (0.081 [0.038 to 0.124] vs 0.013 [-0.021 to 0.047], p = .01). Conclusions An intensive lifestyle intervention has modest but significant long-term benefits on physical function in overweight and obese middle-aged and older adults with type 2 diabetes. ClinicalTrials.gov Identifier NCT00017953.

Evaluation of robenidine analog NCL195 as a novel broad-spectrum antibacterial agent

The effects of carbohydrates on plasma uric acid levels are a subject of controversy. We determined the individual and combined effects of carbohydrate quality (the glycemic index) and quantity (the proportion of total daily energy [percentage of carbohydrates]) on uric acid levels.