Research paper
Ludwig DS. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA. 2002 May 8;287(18):2414-2423. doi:10.1001/jama.287.18.2414. PMID: 11988062.
Why we cite it
Review article in JAMA (10 pages) examining the physiological mechanisms by which high-glycemic-index foods contribute to obesity, diabetes, and cardiovascular disease. Central contribution is the detailed description of the three-phase postprandial cascade: (1) rapid glucose absorption from high-GI foods produces hyperglycaemia and an exaggerated insulin-to-glucagon ratio; (2) the insulin overshoot drives blood glucose below preprandial levels (reactive hypoglycaemia) while suppressing free fatty acids; (3) counterregulatory hormones (glucagon, adrenaline, cortisol, growth hormone) restore euglycaemia but cause a marked rebound in free fatty acids. This hormonal rollercoaster promotes fat storage in the fed state and stimulates appetite in the post-absorptive state, potentially driving overeating and weight gain. Relevant to companion 386 (the-insulin-response) as the mechanistic framework connecting food choices to insulin dynamics and downstream metabolic consequences.
About the author
David S. Ludwig, MD, PhD, is Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard T.H. Chan School of Public Health. MD and PhD from Stanford University. Paediatric endocrinologist at Boston Children’s Hospital. Co-director of the New Balance Foundation Obesity Prevention Center. Over 250 peer-reviewed publications; ~65,000 citations on Google Scholar. Contributing Writer for JAMA; Associate Editor at the American Journal of Clinical Nutrition. Founder of the Optimal Weight for Life (OWL) programme, one of the oldest and largest multidisciplinary clinics for overweight children in the US. Over 20 years of NIH funding; raised over $50 million in philanthropic support. Major contributor to the “carbohydrate-insulin model” of obesity. E.V. McCollum Award (American Society for Nutrition, 2008), Oded Bar-Or Award (The Obesity Society, 2015), Samuel J. Fomon Nutrition Award (American Academy of Pediatrics, 2019). New York Times #1 bestselling author (Always Hungry?, 2016).