Nutrition Principles and Diabetes: A role for “lente carbohydrate”?

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).