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To the Editor: Dr Ludwig reviewed the glycemic index and its possible role in the establishment and maintenance of insulin resistance.¹ However, in the section addressing the mechanisms by which a high–glycemic index diet may precipitate cardiovascular disease, he did not address the cardiovascular effects of counterregulatory hormones and fatty acids. Such substances may be related to chronically increased autonomic tone,² which has many of the same long-term consequences as insulin resistance.

Ludwig notes that consumption of a meal with a high glycemic index results in a postprandial surge of counterregulatory hormones and free fatty acids that "resembles a state of fasting normally reached only after many hours without food." In contrast to insulin, which is vasodilatory, all the counterregulatory hormones (glucocorticoids, catecholamines, glucagon, and growth hormone) increase cardiovascular tone. There is recent evidence that fatty acids do so, as well.³ Thus, this response itself may confer increased risk for . . . [Full Text of this Article]

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The Glycemic Index: Physiological Mechanisms Relating to Obesity, Diabetes, and Cardiovascular Disease
David S. Ludwig
JAMA. 2002;287(18):2414-2423.
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