The power of the sun and it’s impact on metabolic health

Taking a walk in the fresh air or simply sitting in the sun during your lunch break. Both sound quite banal, but can contribute significantly to our health and even help control blood sugar levels. How this can be? Sunlight is not only beautiful and warming, but it is also much needed by our bodies. Namely, UV light allows vitamin D to be produced in the skin. And this nutrient is needed by our body for important metabolic processes.

Vitamin D — an important nutrient

Vitamin D is a remarkable and important nutrient in many respects. Unlike the other vitamins and minerals, we only consume 20% through food. The body can produce the other 80% itself through metabolic reactions in the skin.However, something very specific is needed for this: UV radiation from the sun. The precursors produced in the body can thus be converted into active vitamin D3 — known as cacitriol — via various steps. Calcitriol is a hormone that, among other things, has a great influence on our bone health, the immune system and also on blood sugar.

How the sun affects our blood sugar

A deficiency of vitamin D can negatively affect the functions of our cells. The pancreas is particularly affected. Insulin is produced in the cells of the pancreas, which is particularly important in connection with type 2 diabetes.

If we have a vitamin D deficiency, the cells of the pancreas can produce significantly less insulin. This means that a deficiency promotes the development of insulin deficiency and insulin resistance in the long term, which in turn leads to the development of type 2 diabetes in the long term. This connection means that sufficient sunlight can ultimately help prevent insulin resistance from developing and keep our blood glucose levels within a non-diabetic range.

In addition, a deficiency of vitamin D causes a deficiency of the enzyme LPL (lipoprotein lipase). This enzyme plays an important role in fat metabolism: if we have a deficiency of LPL, this leads to higher levels of the harmful triglycerides. So in addition to blood glucose levels, fat levels also deteriorate.

A scientific study with type 2 diabetics showed the relevance of vitamin D in connection with the disease: after the participants had regularly taken vitamin D supplements for 18 months, the functional performance of the cells of the pancreas improved. The cells were thus able to produce more insulin again, which reduced insulin resistance. In addition, fat levels in the blood also improved. The levels of the health-promoting HDL cholesterol increased over time, while the harmful LDL cholesterol decreased.

In addition to poorer sugar and fat levels, however, diabetes also leads to another danger: bone loss is increased, leading to a higher risk of osteoporosis and bone fractures. Here, too, vitamin D plays a central role: this nutrient is in fact needed so that calcium can be deposited in the bones and the bones become more stable. If we have a vitamin D deficiency in combination with diabetes, this is therefore doubly bad for our bones.

Prevent deficiency specifically

We maintain: a vitamin D deficiency should definitely be compensated for in order to promote health. Signs of a deficiency can be hair loss, a higher susceptibility to infections or muscle weakness and pain.

We can absorb vitamin D2 through food. Good sources of vitamin D2 are:9

- Fish (e.g. herring, salmon, mackerel)

- Chicken egg / yolk

- Mushrooms (e.g. mushrooms, chanterelles, shiitake).

However, the intake of vitamin D2 from food is by far not sufficient to cover the daily requirement. The decisive factor here is the body’s own production of vitamin D3 through sunlight. For this purpose, it is a good idea to take a walk in the sun from time to time or to sit outside in the sun during the lunch break.

But what if all this is not enough to compensate for the deficiency? After all, a vitamin D deficiency can be caused by geographic location or season alone. The less sunshine there is, the more likely a deficiency is. For example, if you are in Sweden in the winter, a deficiency is much more likely than in Italy in the summer. But certain diseases such as chronic inflammatory bowel disease, celiac disease and renal insufficiency can also promote a vitamin D deficiency.

In winter or in regions where there is generally little sunshine, it can therefore make sense to take vitamin D supplements. However, caution is advised here: Vitamin D can be toxic in too high concentrations and dangerously increase calcium levels. It is therefore best to have your vitamin D level determined by a doctor and only then take specific preparations.

Combine positive factors

Various studies show how important sunlight and vitamin D are for our health. But that’s not all: exercise and sport in the sunshine and fresh air naturally have many other health benefits. Because in addition to the body’s own production of vitamin D, exercise also helps to lower blood sugar, fat levels and blood pressure. This also reduces the risk of various diseases.

In addition, stress can also be effectively reduced and you get a good mood for free. But be careful: in order not to increase the risk of skin cancer, one should of course not go unprotected into the sun.

Bibliography:

[1] Szymczak-Pajor I, Drzewoski J, Sliwinska A. The Molecular Mechanisms by Which Vitamin D Prevents Insulin Resistance and Associated Disorders. Int J Mol Sci 2020; 21(18):6644. doi: 10.3390/ijms21186644

[2] Huang Y, Li X, Wang M et al. Lipoprotein lipase links vitamin D, insulin resistance, and type 2 diabetes: a cross-sectional epidemiological study. Cardiovasc Diabetol 2013; 12:17. doi: 10.1186/1475–2840–12–17

[3] McGill AT, Stewart JM, Lithander FE et al. Relationships of low serum vitamin D3 with anthropometry and markers of the metabolic syndrome and diabetes in overweight and obesity. Nutr J 2008; 7:4. doi: 10.1186/1475–2891–7–4

[4] Li X, Liu Y, Zheng Y et al. The Effect of Vitamin D Supplementation on Glycemic Control in Type 2 Diabetes Patients: A Systematic Review and Meta-Analysis. Nutrients 2018; 10(3):375. doi: 10.3390/nu10030375

[5] Al-Daghri NM, Alkharfy KM, Al-Othman A, et al. Vitamin D supplementation as an adjuvant therapy for patients with T2DM: an 18-month prospective interventional study. Cardiovascular diabetol. 2012; 11:85. doi: 10.1186/1475–2840–11–85

[6] Rathinavelu S, Guidry-Elizondo C, Banu J. Molecular modulation of osteoblasts and osteoclasts in type 2 diabetes. J Diabetes Res 2018; 2018:6354787. doi: 10.1155/2018/6354787

[7] Zhang J, Li Y, Lai D et al. Vitamin D Status Is Negatively Related to Insulin Resistance and Bone Turnover in Chinese Non-Osteoporosis Patients With Type 2 Diabetes: A Retrospective Cross-Section Research. Front Public Health 2022; 9:727132. doi: 10.3389/fpubh.2021.727132

[8] Kennel KA, Drake MT, Hurley DL. Vitamin D deficiency in adults: when to test and how to treat. Mayo Clin Proc 2010; 85(8):752–7. doi: 10.4065/mcp.2010.0138

[9] Holick FM, Binkley NC, Bischoff-Ferrari HA et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96(7):1911–30. doi: 10.1210/jc.2011–0385

[10] Sahota O. Understanding vitamin D deficiency. Ageing 2014; 43(5):589–91. doi: 10.1093/ageing/afu104

[11] Marcinowska-Suchowierska E, Kupisz-Urbanska M, Łukaszkiewicz J et al. Vitamin D Toxicity-A Clinical Perspective. Front Endocrinol (Lausanne) 2018; 9:550. doi: 10.3389/fendo.2018.00550

Plant-based diet can lower blood sugar naturally

Vegetarian, vegan, Mediterranean or macrobiotic — plant-based eating styles are becoming increasingly popular. But how much evidence is behind this trend?

What exactly a plant-based diet means is interpreted differently. Some mean an exclusively vegan diet, i.e. all animal products such as meat, fish, eggs, milk, cheese and other dairy products, as well as gelatin, honey and animal rennet are consistently omitted. Often however also a predominantly vegetable — e.g. vegetarian, Mediterranean or macrobiotic — nutrition is included. In any case, one thing is certain: the largest portion of the diet consists of fruits, vegetables, legumes such as lentils or beans, nuts, vegetable oils and alternatives to common grains such as couscous, bulgur, quinoa, buckwheat or amaranth. Meat substitutes such as soy, tofu, tempeh or seitan are also becoming increasingly popular.

Does a plant-based diet have benefits for me?

The benefits of a plant-based diet over an omnivorous (“all-eating”) diet are now well supported by scientific studies. For example, studies have shown that switching from an omnivorous to a vegetarian or vegan diet can lead to weight loss and increased insulin sensitivity. Increased insulin sensitivity allows more glucose to be absorbed from the blood into the cells. This is particularly important to avoid permanently elevated blood glucose levels and thus reduce the risk of type 2 diabetes [1, 2, 3]. A plant-based diet can also offer advantages for diabetics who have already been diagnosed: since a vegan diet in particular is typically very low in unhealthy fats, this can contribute to weight reduction compared to the diet generally recommended for diabetics. Blood glucose levels and blood fat levels such as the harmful LDL cholesterol or triglycerides can be lowered [4].

Beyond the positive effects of a plant-based diet on body weight and blood glucose levels, it is also well documented that a plant-based diet reduces numerous risk factors for heart attack, stroke, or atherosclerosis [4, 5]. Blood pressure can also be lowered by switching from an omnivorous to a vegetarian or vegan diet, which in turn significantly reduces the risk of heart attack, stroke, atherosclerosis, or kidney damage.

Whether a strictly vegan diet is more suitable than, for example, a Mediterranean or vegetarian diet, is much debated scientifically. Recent studies also show positive effects on cardiovascular risk factors with the consumption of dairy products or moderate meat consumption [6].

Less fat, sugar and a lower glycemic index

One of the main advantages of plant-based diets is based on the fact that plant foods — especially vegetables or salad — have a low energy density. This means that you can eat a high volume of these foods without having taken in many calories. One study showed that a vegan diet can reduce body weight even when strict portion sizes have not been established. This effect is due to the low-calorie and low-fat characteristics of vegan versus omnivorous diets [7]. Weight loss, in turn, is fundamentally associated with improved blood glucose levels and improved insulin sensitivity [7].

However, weight loss is far from the only factor contributing to the blood sugar-lowering effect in the plant-based diet:

The glycemic index describes how strongly carbohydrate-containing foods cause blood sugar levels to rise. The glycemic index of plant-based[GK1] [GK2] foods is often lower, which is why blood sugar levels rise less. Studies have shown that a diet with a high glycemic index is associated with a 40% increased risk of type 2 diabetes [8] and that reducing the glycemic index — as in the plant-based diet — can also reduce long-term blood glucose [9].

The low-fat diet also leads to less fat being stored in the tissues and muscles. This not only makes you lose weight, but also improves insulin sensitivity, which in turn is beneficial for blood glucose levels [7].

Meat and other animal products also contain many saturated fatty acids. These promote inflammation and have a negative effect on blood sugar levels. In contrast, fats from vegetable oils such as olive oil have a higher proportion of polyunsaturated fatty acids, which have an anti-inflammatory and anti-oxidant effect and are beneficial for blood glucose and blood lipid levels [10].

Dietary fiber is more than just ballast

In the plant-based diet, the intake of dietary fiber is also significantly increased. High fiber content is found especially in whole grains, vegetables, lettuce and lentils. Contrary to their name, however, dietary fibers are much more than just ballast: they can lower blood sugar levels via various pathways.

First, fiber slows gastric emptying, which also slows or reduces glucose uptake in the intestines and keeps blood glucose levels constant after eating instead of skyrocketing.

Since dietary fiber cannot be metabolized in the small intestine, it enters the large intestine, where it is fermented by millions of bacteria — the “Million Friends. This causes the dietary fiber to break down into short-chain fatty acids, which are then absorbed by the intestine and have positive effects on the metabolism. The short-chain fatty acid propionate is particularly important here, as propionate suppresses the production of endogenous glucose in the liver. In addition, the short-chain fatty acids lead to an increased release of satiety hormones and insulin. The higher concentration of satiety hormones means that people feel full faster and eat less overall. The increased insulin secretion means that more glucose can be absorbed from the blood into the cells and the blood glucose level therefore rises less sharply [7, 10].

Vitamins, minerals and polyphenols also influence blood sugar levels

Some vitamins, minerals or secondary plant substances such as the so-called polyphenols can also have an influence on blood sugar levels.

For example, the so-called heme iron — iron that we ingest from animal foods — has pro-oxidant properties and leads to the formation of radicals in the body. These radicals can, among other things, negatively affect the function of the β-cells in the pancreas. The β-cells are needed for the secretion of insulin. Thus, if the β-cells no longer function properly, less insulin can be secreted and the blood glucose level remains permanently elevated. In contrast to animal heme iron, non-heme iron ingested from plant foods is associated with a lower risk of type 2 diabetes [7, 10].

Vitamin K, which is needed for blood formation, also has a positive effect on blood sugar levels. Green vegetables such as spinach, broccoli, kale and lettuce have a particularly high vitamin K content. Other important vitamins with a positive influence on blood sugar levels are, for example, vitamin C and vitamin E, which achieve their effect through their anti-oxidative properties.

In addition, a plant-based diet also increases the intake of secondary plant compounds such as polyphenols. Polyphenols can counteract type 2 diabetes as well as elevated blood glucose levels via various mechanisms. For example, certain polyphenols can reduce the absorption of glucose in the intestine, while others promote the uptake of glucose from the blood into the cells. Both contribute to a reduction in blood glucose levels [10].

Nutrient deficiencies must be specifically prevented

Particularly with a strictly vegan, but also with a vegetarian diet is, in addition to the already mentioned positive effects, but also caution is required: some vitamins and minerals such as vitamin B2, vitamin B12, vitamin D, calcium, zinc, iron or iodine are found especially in animal products in larger quantities. If one decides for a vegan or vegetarian nutrition, one should absolutely pay attention to prevent a nutrient deficiency. To this end, it is important to have the vitamin status checked at regular intervals and to include the right plant-based foods in the diet [11].

Control blood sugar with MillionFriends

With MillionFriends, you can have your blood glucose level checked for 14 days. By keeping a food diary at the same time and continuously measuring your blood glucose level via a blood glucose sensor, it is possible to determine which nutrity type you belong to at the end. This will tell you which foods are particularly beneficial for you personally in order to keep your blood glucose level constant.

Why not also try vegetarian or vegan dishes and discover which dishes keep your blood sugar levels stable. In this way, you will learn how you can support your health sustainably through nutrition.

Bibliography

[1] Barnard, N.D., Scialli, A.R., Turner-McGrievy, G. et al. (2005). The effects of a low-fat, plant-based dietary intervention on body weight, metabolism, and insulin sensitivity. Am J Med. 118(9):991–7. doi: 10.1016/j.amjmed.2005.03.039

[2] Pischke, C.R., Weidner, G., Elliot-Eller, M. et al. (2006). Comparison of coronary risk factors and quality of life in coronary artery disease patients with versus without diabetes mellitus. Am J Cardiol. 97(9):1267–73. doi: 10.1016/j.amjcard.2005.11.051

[3] Liese, A.D., Nichols, M., Sun, X. et al (2009). Adherence to the DASH Diet is inversely associated with incidence of type 2 diabetes: the insulin resistance atherosclerosis study. Diabetes Care. 32: 1434–1436. 10.2337/dc09–0228.

[4] Benatar J.R., Stewart, R.A.H. (2018). Cardiometabolic risk factors in vegans; A meta-analysis of observational studies. PloS One. 13(12):e0209086. doi: 10.1371/journal.pone.0209086

[5] Appel, L.J., Moore, T.J., Obarzanek, E. et al. (1997). A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 336: 1117–1124. 10.1056/NEJM199704173361601.

[6] Deghan, M., Mente, A., Rangarajan, S. et al. (2018). Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet. 392(10161):2288–2297. doi: 10.1016/S0140–6736(18)31812–9

[7] Barnard, N.D., Katcher, H.I., Jenkins, D.J.A. et al. (2009). Vegetarian and vegan diets in type 2 diabetes management. Nutr Rev. 67(5):255–63. doi: 10.1111/j.1753–4887.2009.00198.x

[8] Barclay, A.W., Petocz, P., McMillan-Price J. et al. (2008). Glycemic index, glycemic load, and chronic disease risk-ameta-analysis of observational studies. Am J Clin Nutr. 87(3):627–37. doi: 10.1093/ajcn/87.3.627

[9] Zafar, M.I., Mills, K.E., Zheng, J. et al. (2019). Low-glycemic index diets as an intervention for diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 110(4):891–902. doi: 10.1093/ajcn/nqz149

[10] — Salas-Salvadó, J., Becerra-Tomás, N., Papandreou, C. et al. (2019). Dietary Patterns Emphasizing the Consumption of Plant Foods in the Management of Type 2 Diabetes: A Narrative Review. Adv Nutr. 10(Suppl_4):S320-S331. doi: 10.1093/advances/nmy102

[11] Bakaloudi, D.R., Halloran, A., Rippin, H.L. et al. (2021). Intake and adequacy of the vegan diet. A systematic review of the evidence. Clin Nutr. 40(5):3503–3521. doi: 10.1016/j.clnu.2020.11.035

French Paradox — promote health with red wine?

Have you ever heard that red wine is good for the heart and therefore has health-promoting effects? This phenomenon is based on the observation that French people — despite their high consumption of red wine and saturated fats — live longer on average and have fewer heart attacks among them than is the case with Germans or Americans. Since alcohol and saturated fat are generally considered harmful to health, a longer life span and lower risk of heart attack is the opposite of what one would expect. Therefore, this phenomenon is also known as the “French Paradox”.

But how much evidence is actually behind this phenomenon, or does the French Paradox not exist in the end?

Resveratrol — a special ingredient

At some point, the theory arose that the longer life expectancy and lower risk of heart attack can be attributed to the high consumption of red wine. This is because red wine has a special ingredient: resveratrol.

Resveratrol is a secondary plant compound that gives grapes their red color. Many studies investigated its effects and found various positive, health-promoting properties. Resveratrol is strongly anti-oxidant, which means it can scavenge harmful radicals in the cells and thus helps to maintain our health [1]. In addition, resveratrol also has anti-inflammatory, cardioprotective (meaning it protects the heart), anti-hypertensive, and anti-cancer effects [1, 2]. And resveratrol also has a positive effect on blood glucose and lipid levels: it can promote insulin sensitivity and the uptake of glucose from the blood into cells, which lowers blood glucose levels [2, 3]. In addition, more insulin is released from the cells of the pancreas, which in turn helps to lower blood glucose levels [3]. The storage of fat in the body’s fat deposits is reduced, which may help resveratrol aid in weight loss [2]. Recent studies also show that resveratrol can positively influence the composition of the gut microbiome — our Million Friends. This could also have positive effects on blood sugar and cholesterol levels [1, 4].

Of course, this sounds really great at first. But these results also have a catch: the studies that investigated the positive properties of resveratrol were conducted almost exclusively on animals. Due to differences in metabolism, however, data from animal studies cannot be directly transferred to humans. There are only a few studies that examined the effects of resveratrol in humans. And these results suggest that the health-promoting effects in humans are significantly lower or even absent [2, 4]. So a lot of scientific work is still needed here to shed light on this.

The Hormesis Effect: More Does Not Equal Better

The fact is that we do not consume resveratrol as a single substance, but in a mixture with numerous other substances, each of which has its own effects. And red wine also contains a substance that is harmful to health: alcohol.

Alcohol is not only the most commonly consumed psychoactive drug in Germany, but also massively damages the liver, can lead to liver cirrhosis and liver cancer, negatively affects the nervous system, and is carcinogenic [5, 6, 7].

It is not without reason that alcohol has been classified by the World Health Organization (WHO) as a class 1 human carcinogen. This means that there is sufficient scientific evidence that alcohol is carcinogenic [8].

But how can it be then that according to the “French Paradox” the consumption of red wine prolongs life, has a cardioprotective effect and even lowers blood sugar levels? The quantity is decisive! Red wine and resveratrol show a so-called hormesis effect. This means that the effect depends on the dose. In low concentrations, resveratrol shows a health-promoting effect. However, if one increases the dose, the properties are rather detrimental and harmful to health [9].

Scientific studies have shown that low to moderate alcohol consumption — especially in the form of red wine — can reduce the risk of type 2 diabetes [10, 11]. This positive effect is also associated with improved insulin sensitivity [12]. Health-promoting HDL cholesterol can also be increased and inflammatory markers in the body lowered by low to moderate alcohol consumption [12]. At the same time, however, studies show that higher alcohol consumption does not achieve any positive effects [13]. So more does not equal better.

What exactly does “moderate” alcohol consumption mean? The WHO specifies a maximum of 24 g of ethanol per day for men and a maximum of 12 g of ethanol per day for women for low-risk (not to be confused with risk-free!) alcohol consumption. In addition, there should be at least 2 completely alcohol-free days per week. 12 g of ethanol corresponds to one standard glass of the respective alcoholic beverage [8, 12]. Anyone who drinks more than this amount is clearly harming the body.

Benefit or risk — which outweighs the other?

So how much evidence is actually behind the French Paradox? The fact that French people live longer and have fewer heart attacks is not necessarily due to their consumption of red wine. It could also be that people in France have a different diet overall than those in Germany or the USA, for example. In fact, the Mediterranean diet is more widespread in France. In this diet, the proportion of vegetables, fruit, whole grains, fish and high-quality oils is significantly higher, while at the same time the consumption of convenience foods, simple sugars or deep-fried foods is lower. The health-promoting effects of the Mediterranean diet have been demonstrated in various studies [14, 15, 16].

It is possible that red wine — when consumed in small quantities — can have health-promoting and cardioprotective effects. Whether this is really the case has not been conclusively clarified. It is therefore possible that the French Paradox is more of a myth than a reality.

But since the positive properties of resveratrol have been shown in various (animal) studies, a question naturally arises here: if resveratrol in particular is responsible for the health-promoting effect of red wine, couldn’t one simply drink grape juice or eat red grapes? The answer is quite simple: yes, you can. Because resveratrol is not only found in red wine. Resveratrol is also found in the skin of red grapes, grape juice, peanuts, mulberries, cranberries, and legumes [1, 2]. And the good thing is that the harmful aspects of alcohol are not present in the anti-alcoholic alternatives.

In the end, everyone must now decide for themselves whether the benefits or risks of consuming red wine outweigh the risks.

Bibliography

[1] Carrera-Quintanar L, López Roa RI, Quintero-Fabián S et al. Phytochemicals That Influence Gut Microbiota as Prophylactics and for the Treatment of Obesity and Inflammatory Diseases. Mediators Inflamm 2018; 2018:9734845.doi: 10.1155/2018/9734845

[2] Chaplin A, Carpéné C, Mercader J. Resveratrol, metabolic syndrome, and gut microbiota. Nutrients 2018; 10(11):1651. doi: 10.3390/nu10111651

[3] Huang DD, Shi G, Jiang Y et al. A review on the potential of resveratrol in prevention and therapy of diabetes and diabetic complications. Biomed Pharmacother 2020; 125:109767.doi: 10.1016/j.biopha.2019.109767

[4] Fernández-Quintela A, Carpéné C, Fernández M et al. Anti-obesity effects of resveratrol: comparison between animal models and humans. J Physiol Biochem 2016; 73(3):417–429. doi: 10.1007/s13105–016–0544-y

[5] Varela-Rey M, Woohoo A, Martinez-Chantar ML et al. Alcohol, DNA methylation, and cancer. Alcohol Res 2013; 35(1):25–35.

[6] Lackner C, Tiniakos D. Fibrosis and alcohol-related liver disease. J Hepatol 2019; 70(2):294–304. doi: 10.1016/j.jhep.2018.12.003

[7] De la Monte SM, Kril JJ. Human alcohol-related neuropathology. Acta Neuropathol 2014; 127(1):71–90. doi: 10.1007/s00401–013–1233–3

[8] World Health Organization/ International Agency for Research on Cancer. Agents Classified by the IARC Monographs, Volumes 1–130. On the Internet: https://monographs.iarc.who.int/list-of-classifications

[9] Calabrese EJ, Mattson MP, Calabrese V. Dose response biology: the case of resveratrol. Hum Exp Tol 2010; 29(12):1034–7. doi: 10.1177/0960327110383641

[10] Koppes LL, Dekker JM, Hendriks HF et al. Moderate alcohol consumption lowers the risk of type 2 diabetes: a meta-analysis of prospective observational studies. Diabetes Care 2005; 28:719–25. doi: 10.2337/diacare.28.3.719

[11] Baliunas DO, Taylor BJ, Irving H et al. Alcohol as a risk factor for type 2 diabetes: A systematic review and meta-analysis. Diabetes Care 2009; 32:2123–32. doi: 10.2337/dc09–0227

[12] Chiva-Blanch G, Arranz S, Lamuela-Raventos RM et al. Effects of wine, alcohol and polyphenols on cardiovascular disease risk factors: evidences from human studies. Alcohol Alcohol 2013; 48(3):270–7.doi: 10.1093/alcalc/agt007

[13] Mekary RA, Rimm EB, Giovannucci E et al. Joint association of glycemic load and alcohol intake with type 2 diabetes incidence in women. Am J Clin Nutr 2011; 94:1525–32. doi: 10.3945/ajcn.111.023754

[14] Davis C, Bryan J, Hodgson J et al. Definition of the Mediterranean Diet; a Literature Review. Nutrients 2015; 7(11):9139–53. doi: 10.3390/nu7115459

[15] Gantenbein KV, Kanaka-Gantenbein C. Mediterranean Diet as an Antioxidant: The Impact on Metabolic Health and Overall Wellbeing. Nutrients 2021; 13(6):1951. doi: 10.3390/nu13061951

[16] Nani A, Murtaza B, Khan AS et al. Antioxidant and anti-inflammatory potential of polyphenols Contained in Mediterranean Diet in Obesity: Molecular Mechanisms. Molecules 2021; 26(4):985. doi: 10.3390/molecules26040985

[GK1]No, meat and dairy products have a lower GI. Glycemic index and glycemic load — Nutritional therapeutic value — FETeV (fet-ev.eu)

[GK2]For low GI you need to omit the carbohydrate cereals