New Dietary Guidelines From the American Diabetes Association

The new Dietary Guidelines from the American Diabetes Association (ADA) provide no support for the use of the glycemic index in the management of diabetes. However, it should be made clear to the ADA’s membership that the ADA’s position is at odds with recent reviews and recommendations from authorities that have evaluated the same evidence. Specifically:

1) The United Nations World Health Organization and the Food and Agriculture Organization recommend in their 1997 expert consultation report on Carbohydrates in Human Nutrition that when looking at carbohydrate-containing foods, the glycemic index should “be used to compare foods of similar composition within food groups” (1).

2) The European Association for the Study of Diabetes Nutrition Group recommend in their 1999 revision of guidelines for the management of patients with diabetes that: “Foods with a low glycemic index (e.g., legumes, oats, pasta, parboiled rice, certain raw fruits) should be substituted when possible for those with a high glycemic index since they may help to improve glycemic control and lipid levels” (2).

3) The Dietary Guidelines for Older Australians (1999) specifically recommend the consumption of lower glycemic index cereal-based foods: “Eat plenty of cereals, breads and pastas-preferably high-fiber foods and those with a lower glycemic index” (3).

4) Recommendations for the use of glycemic index in meal planning are also outlined by Diabetes Australia (http://www.diabetesaustralia.com.au), the Juvenile Diabetes Research Foundation Australia (http://jdrf.org.au), and the International Diabetes Institute in Melbourne (http://www.diabetes.com.au).

In Australia, people with diabetes have benefited from the general acknowledgment among health professionals that the glycemic index is one tool among many that can be used in diabetes management. The glycemic index is already familiar to many consumers. We recently conducted a random telephone survey of Australian grocery buyers and found that nearly 30% of respondents were aware of the glycemic index, and after the glycemic index was explained, 71% stated they would be likely to use the glycemic index in food purchase decisions. A member survey by Diabetes Australia in 2000 found that two in three respondents would like to see the glycemic index stated in nutrition panels.

This awareness has stimulated the introduction of a glycemic index symbol program for food labels. The program is run by a nonprofit company formed as a partnership between Diabetes Australia, the Juvenile Diabetes Research Foundation, and the University of Sydney. The aim is to promote consumer awareness and understanding of glycemic index as an important guide for food purchase decisions. Carbohydrate-containing foods that have been properly glycemic index tested (tested in vivo according to published methodology) are licensed to carry an easily recognizable symbol on their labels. Foods must meet several nutrition criteria for their food group. The license fees are used to fund educational activities about the glycemic index and to support the research and education undertaken by our member organizations.