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United States [6]. In 1987-1988, fructose intake had increased to 39g per day, accounting for ~9% of energy intake [7] and in 1988-1994, it had further increased to 55 g per day, accounting for ~10% of energy intake [8]. Approximately one third of fructose came from fruits, vegetables and other natural sources and two thirds were added to beverages and foods in the diet. A similar trend toward substantial caloric sweetener and fructose consumption is occurring worldwide [9].

There has long been interest in the metabolic effects of fructose, particularly in people with diabetes. Studies in diabetic subjects done in the 1970s and 1980s demonstrated that fructose-containing test meals produced smaller postprandial increases in plasma glucose than test meals containing isocaloric amounts of sucrose, glucose and starch [10-12]. Jenkins et al. [13] greatly expanded our knowledge about the differences in response to dietary carbohydrates with the development of the glycemic index of foods. Glycemic index was defined as the increase in plasma glucose area from 0 to 120 min after ingestion of 50 g of available carbohydrate from a test food compared to 50 g of carbohydrate from a reference food such as glucose. The glycemic indices of carbohydrate-containing foods vary substantially, with fructose having a particularly low glycemic index (table 2).

In an effort to further evaluate the potential for fructose to lower postprandial plasma glucose, we developed five test meals containing different carbohydrates and fed the meals to healthy and diabetic volunteers [14]. The meals contained nearly identical amounts of carbohydrate, protein and fat but a different test carbohydrate which accounted for 24 or 25% of total calories. The test carbohydrates were glucose, fructose, sucrose, potato starch and wheat starch. Plasma glucose and serum insulin were measured before and at intervals for 240 min after the meals. In healthy volunteers, type-1 diabetic volunteers and type-2 diabetic volunteers, the fructose meal produced the smallest postprandial increment in plasma glucose and the smallest increment in postprandial glucose area (fig. 1). The fructose meals also produced the smallest increment in serum insulin in healthy and type-2 diabetic volunteers but the differences among meals were not significant.

Table 2. Glycemic indices of selected carbohydrate-containing foods

[from 13]

Food

Glycemic index

Food

Glycemic index

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