Different starchy foods produce different glycemic responses when fed individually, and there is evidence that this also applies in the context of the mixed meal. Methods of processing, and other factors unrelated to the nutrient composition of foods may also have major effects on the glycemic response. The reason for differences in glycemic response appears to relate to the rate at which the foods are digested and the many factors influencing this. The glycemic index (GI) is a system of classification in which the glycemic responses of foods are indexed against a standard (white bread). This allows the results of different investigators to be pooled. GI values also depend upon a number of nonfood-related variables. The method of calculation of the glycemic response area is most important, but the method of blood sampling and length of time of studies also may have effects. Variability of glycemic responses arises from day-to-day variation in the same subject and variation between different subjects. There is less variability between the GI values of different subjects than there is within the same subject from day to day. Therefore, the mean GI values of foods are independent of the glucose tolerance status of the subjects being tested. Potentially clinically useful starchy foods producing relatively flat glycemic responses have been identified, including legumes, pasta, barley, bulgur, parboiled rice and whole grain breads such as pumpernickel. Specific incorporation of these foods into diets have been associated with reduced blood glucose, insulin, and lipid levels. Low-GI foods may influence amino acid metabolism although the implications of these are unknown. In addition, low GI foods increase colonic fermentation. The physiologic and metabolic implications of this relate to increased bacterial urea utilization, and to the production and absorption of short chain fatty acids in the colon. The application of the GI to therapeutic diets should be in the context of the overall nutrient composition of the diet. High-fat or high-sugar foods may have a low GI, but it may not be prudent to recommend these foods solely on the basis of the GI. It is therefore suggested that the most appropriate use of the GI is to rank the glycemic effects of starchy foods which would already have been chosen for possible inclusion in the diet on the basis of their nutritional attributes, i.e. low-fat, unrefined carbohydrate.