Large differences exist in the degree to which different starch containing foods affect the blood glucose levels of both normal volunteers and diabetics. These differences appear to relate to the digestibility of the starch and the factors determining this, including: the interaction of starch with fiber, antinutrients (eg, phytate) and protein in the food, together with the nature of the starch itself and its physical form (eg, raw or cooked, ground or whole). In this respect legumes exemplify a class of foods, high in fiber, protein and antinutrients, with a starch which is digested slowly in vitro. They also produce relatively small blood glucose rises after consumption by both normals and diabetics and in the longterm result in improved diabetic control. Identification of more such foods and further understanding of factors determining starch digestibility will allow greater therapeutic use of diet in the management of diabetics and disorders of carbohydrate metabolism.

Summary. Recently diabetic patients have been encouraged to increase their carbohydrate intake, but exact details of which foods to use are lacking. To determine whether sufficiently large differences existed to justify more specific dietary advice, we compared the glycaemic responses to 50 g carbohydrate portions of different foods, taken as breakfast test meals by groups of five to seven diabetic patients. Two-to threefold differences were seen amongst the 15 foods tested. The glycaemic responses for spaghetti, 'All-bran', rice and beans were significantly below those for bread, while 'Cornflakes' were above. Factors predicted to influence this were without effect, including: substituting wholemeal for white bread, increasing substantially the simple sugars (using 'All-bran' or bananas instead of wholemeal bread) and doubling meal protein by adding cottage cheese to bread. Paired comparisons of the glycaemic response to the five legumes with those of the seven other starchy foods (breads, spaghetti, rice, Cornflakes, oatmeal porridge and potatoes) showed that the mean peak rise in blood glucose concentration and mean area under the glucose curve after beans were 23 and 28% lower, respectively, than the mean for the other foods (p < 0.001). Such results suggest a potentially valuable role for dried leguminous seeds in carbohydrate exchanges for individuals with impaired carbohydrate tolerance. These large differences in the blood glucose response to different food cannot at present be predicted directly from tables of chemical composition. Nevertheless, physiological testing may both aid in understanding the factors responsible and help selection of the appropriate carbohydrate foods for the diabetic diet.Key words: Glycaemic index, leguminous seeds, low blood glucose rise, diabetes, diabetic diet, fat, sugars, protein.To lessen the risk to the diabetic of carciovascular disease, current dietary guidelines of the American [1] and Canadian [2] Diabetes Associations and the British Diabetic Association [3] have recommended increasing complex carbohydrate and fibre intakes, while reducing fat consumption. Exactly how this should be achieved is not known and there are fears that increased intake of specific foods, or carbohydrates in general, may worsen diabetic control [4]. However, in the context of high fibre diets this does not appear to be the case [5]. Indeed studies using purified fibre and high-fibre, high-carbohydrate diets have been associated with improved diabetic control [9][10][11][12][13][14][15]. Nevertheless, the carbohydrate foods of greatest potential use to the diabetic have not as yet been defined and it has now been acknowledged that information on the glycaemic effect of individual foods and meals is urgently needed [3].We have therefore compared the effect of taking 50 g carbohydrate portions of 15 different foods on the blood glucose responses of diabetic patients. We wished to determine whether large differences existed which favoured the use of particular foods. It was also important to s...

To test the effect of processing on digestibility and the glycemic response to a leguminous seed, a group of eight healthy volunteers took a series of breakfast test meals containing either lentils which had been processed in four different ways or the same amount of carbohydrate as white bread. Lentils, boiled for 20 min, resulted in a flattened blood glucose response by comparison with bread. This was unaltered by blending the lentils to a paste or boiling them for an additional 40 minutes. However the blood glucose response was significantly enhanced by drying the boiled blended lentils for 12 h at 250 degrees F. In vitro digestion with human saliva showed the rate of sugars released from the food related positively to the blood glucose rise. Breath hydrogen studies indicated that carbohydrate malabsorption was too small to account for differences in the blood glucose response. These results emphasize the importance of processing in determining digestibility and hence the glycemic response to a food.

To determine the effect on blood glucose of removal of protein from wheat products, healthy volunteers took test meals of white bread made from either regular or gluten-free flour. After bread made from gluten-free flour, the blood-glucose rise was significantly greater. This corresponded with a significantly more rapid rate of digestion in vitro and reduced starch malabsorption in vivo as judged by breath-H2 measurements. Addition of gluten to the gluten-free bread mix did not reverse these effects. Factors associated with unprocessed wheat flour, such as the natural starch-protein interaction, may therefore be important in wheat products in reducing both their rate of absorption and glycemic response. They may have implications in the dietary management both of diabetes and of diseases where small intestinal absorptive capacity is impaired.

A significant relationship was found between the rate of release of the sugars; glucose, maltose, and maltotriose from amylitic digestion of 10 foods tested in vitro (expressed as the digestibility index) and the blood glucose response to 50-g carbohydrate portions of the same foods eaten by diabetics (expressed as the glycemic index), (r = 0.815, n = 10, p greater than 0.01). The glycemic index related to both the palatability of the foods (r = 0.731, p less than 0.05) and their frequency of use (r = 0.698, p less than 0.05). However, in this group of motivated diabetics food use was not related directly to palatability, but rather to health belief (r = 0.689, p less than 0.05). The results suggest that carbohydrate foods of potential use to the diabetic may be identified by their in vitro digestion characteristics but to a large extent their acceptance will depend on health belief and possibly ease of preparation.