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The diabetic diet, dietary carbohydrate and differences in digestibility

Conclusion

The last decade has seen much interest in the physiological response to carbohydrate foods. Interest in dietary fibre emphasised the possible influence of events within the gastrointestinal tract on carbohydrate metabolism. Links have been established between digestibility and the glycaemic response to foods. However, the influence of food factors on these processes is ill understood. Nevertheless food form, certain types of fibre, other anti-nutrients and the nature of the starch-protein interaction may be major determinants. Genetic differences in the responses of different individuals to the same food remain to be explored. For example, the protein, gliadin, may act as a lectin [97] in susceptible individuals to the extent of causing villous atrophy (coeliac disease) and so severely limiting absorption. Coeliac disease and Type 1 diabetes are linked both in occurrence [98] and in the frequency with which sufferers share the same tissue antigens (HLA-B8 and DW3) [99–102]. Less dramatic alterations in absorptive capacity may be seen in subclinical coeliac disease or with other anti-nutrients. These, therefore, represent other ways in which food can modify the glycaemic response. Perhaps in those with impaired carbohydrate metabolism a mildly reduced absorptive capacity could be beneficial.

In view of the present state of knowledge, the decisions of the American and Canadian Diabetes Associations and the British Diabetic Association to increase carbohydrate intake [1–3] may be seen as a worthwhile move to encourage not so much gastronomic licence, but, some would say, more frugal living. The frugality might be lightened by inclusion of new foods and preservation of certain ethnic dishes. Indeed choice for the diabetic may ultimately be greatly enhanced as indicated by two recently published diet guides [103, 104]. The advice was not intended to be thrust on all with a sweep of the pen but it will give support to those willing to prescribe, and those willing to accept, such diets. In addition, it has provided a tremendous impetus to further activity for those working in this field. For those unable to take the diets, continued exploration along these lines may result in new pharmaceutical approaches to the management of diabetes.

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Jenkins, D.J.A., Taylor, R.H. & Wolever, T.M.S. The diabetic diet, dietary carbohydrate and differences in digestibility. Diabetologia 23, 477–484 (1982). https://doi.org/10.1007/BF00254294

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Keywords

  • Carbohydrate Metabolism
  • Absorptive Capacity
  • Coeliac Disease
  • Carbohydrate Intake
  • Dietary Carbohydrate