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DJ Jenkins and AL Jenkins
Department of Nutritional Sciences, University of
Toronto, Ontario, Canada.
The current nutrition recommendations of
the American Diabetes Association (ADA)
represent a thoughtful synthesis of much current data. They depart
from tradition by not advocating specific figures for total
fat and carbohydrate intake. Rather, since many issues
are still topics of scientific debate, they endorse
the principle of individualization and set guidelines
accordingly. One topic that may be worthy of further debate is
the principle of "spreading the nutrient load," or lengthening
the absorption time. This principle covers the effects
of altered meal frequency, viscous
dietary fibers, low-glycemic index foods, and
inhibitors of carbohydrate absorption. In its simplest
form it is illustrated by studies of altered meal frequency
("nibbling versus gorging"). Reducing the size and
increasing the frequency of meals has been shown acutely to result
in lower mean blood glucose and insulin levels over the
day in type II diabetes and to result
in reduced 24-h urinary C-peptide losses. In the longer
term in nondiabetic subjects, total and low-density lipoprotein
cholesterol levels are reduced, together with fasting apolipoprotein
B and serum uric acid levels, as additional risk factors
for coronary heart disease. These and other physiological
effects make slowing carbohydrate absorption ("lente
carbohydrate") a potentially useful therapeutic modality.
However, of the possible ways of slowing absorption, only
alteration in meal frequency was of general interest in
the current ADA nutrition recommendations. Nevertheless,
the effects of slowing carbohydrate absorption by various
means may have beneficial metabolic effects in diabetes
and may support the use of ethnic foods in diets compatible
with further modifications identified more favorably in the
current nutrition recommendations (e.g., increased use of
monounsaturated fat).
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