Diabetics, carbohydrate intake

The ADA does not recommend low-carbohydrate diets in diabetes management. Although carbohydrates are a primary contributor to post-meal glucose levels, they are also an important source of energy, water-soluble vitamins, minerals, and fiber. Thus, the ADA recommends that carbohydrate intake consists of 45% to 65% of total calories. 

For many years, and still, controlling available carbohydrate intake has been a cornerstone of diabetes management. However, in many foods available carbohydrate, measured as carbohydrate available in food analysis, is not quite the same as carbohydrate that is available in the gut in food as normally consumed. Glycemic response depends not only on the amount of potentially available carbohydrate consumed, but also on how rapidly it is digested, absorbed, and disposed of in the body, and that depends on a myriad of factors including food structure and the influence of other food components that vary in importance from food to food. 

Type 2 diabetes may be Hrst treated by increasing physical activity, decreasing carbohydrate intake and weight loss insuhn sensitivity can be restored with only moderate weight loss. 

Low HDL is a strong independent risk predictor of CHD. The ATP 111 redefined low HDL cholesterol as less than 40 mg/dL but specified no goal for HDL cholesterol raising. Low HDL may be a consequence of insulin resistance, physical inactivity, type 2 diabetes, cigarette smoking, very high carbohydrate intake, and certain drugs (see Table 21-5). 

Ketosis, abnormally high levels of blood ketone bodies, is a situation that arises under some pathological conditions, such as starvation, a diet that is extremely low in carbohydrates (as with the high-protein liquid diets), or uncontrolled diabetes mellitus. The carbohydrate intake of a diabetic is normal, but the carbohydrates cannot get into the cell to be used as fuel. Thus diabetes amounts to starvation in the midst of plenty. In diabetes the very high concentration of ketone acids in the blood leads to ketoacidosis. The ketone acids are relatively strong acids and therefore readily dissociate to release H+. Under these conditions the blood pH becomes acidic, which can lead to death. 

The results of studies where the cereal fiber content of the diabetic diet were raised have been variable. Their interpretation is also difficult because in many cases the carbohydrate intakes were also raised (2,29,30). It has been suggested that the higher carbohydrate intake may have contributed to the improved diabetic state, (31-34) however this... 

Another disadvantage is supposed to be the caloric value that diabetics have to take into account. However, with the increased use of blood glucose monitors and relatively simple insulin delivery devices it has become easier to match the carbohydrate intake to the blood sugar level, especially for patients with type I diabetes. Apart from that the contribution of sugar through medicines is small and it is actually not necessary to develop special sugar-free medicines for diabetics. 

Conn (1940) showed that reduction of dietary carbohydrate in normal subjects and diabetics causes profound impairment of glucose tolerance, which reverts to normal when carbohydrate intake is increased again. His main purpose was to preach caution in the interpretation of glucose tolerance tests unless the previous diet had been standardized for several days and contained a sufficient quantity of carbohydrate. Amazingly, this simple point has been overlooked by physicians prescribing dietary treatment for their diabetics. There were a few reports of benefit from an increase in available carbohydrate intake (Kempner et al, 1958 Ernest et al., 1962), but it is only in the last 10 yr that any real interest in this effect has been shown. Even then, results were overshadowed by preoccupation with fiber, so that the possible benefits of increased intake of available carbohydrate have received much less attention. 

Shifting the metabolic machinery of the body to excessive utilization of fats instead of carbohydrates or a balance of fats and carbohydrates results In the buildup of ketone bodies— acetoacetate, beta-hydroxybutyrate, and acetone—in the blood and their appearance in the urine. This condition is referred to as ketosis, and outwardly noted by the sweetish, acetone odor of the breath. Three circumstances can cause ketosis (1) high dietary intake of fat but low carbohydrate intake as in ketogenic diets (2) diminished carbohydrate breakdown and high mobilization of fats as in starvation or (3) disorders in carbohydrate metabolism as in diabetes melli-tus. Unless ketosis goes unchecked and results in acidosis, it is a normal metabolic adjustment. 

Seed oil of interest for GLA content as a prostaglandin precursor, especially for PGEi prostaglandins help regulate metabolic functions. Normal synthesis of GLA from linoleic acid via 5-6-desaturase may be blocked or diminished in mammalian systems as the result of aging, diabetes, excessive carbohydrate intake, or fasting. Seeds of Oenothera biennis... 

In uncontrolled diabetes, the concentration of blood glucose exceeds the ability of the kidney to reabsorb glucose, and glucose appears in the urine. High levels of glucose increase the osmotic pressure in the blood, which leads to an increase in urine output. Symptoms of diabetes include frequent urination and excessive thirst. Treatment for diabetes includes diet changes to limit carbohydrate intake and may require medication such as a daily injection of insulin or pills taken by mouth. 

Every patient with diabetes requires some form of dietary assessment, and often therapy. This is important to allocate the relative amounts of energy derived from carbohydrate, protein and fat of total recommended daily calories in proportion to the patient s body weight and height and daily requirements, while avoiding atherogenic diets. Diets with high carbohydrate content (50-60%), low fat (30-35%) and adequate protein (10-15%) is recommended. Fibre-rich foods are preferable. The use of non-nutritive sweeteners (saccharin, aspartame, ace-sulfame K and sucralose) are acceptable. Alcohol intake should be assessed since excess consumption... 

A calorie intake of 1,800-2,500 kcal/day (ca. 30 kcal/ kg BW/day) is guaranteed by the adequate administration of fats (70-140 g) and carbohydrates (280-325 g). Consideration should be given to the fact that cirrhotic patients show a resistance to insulin and a glucose intolerance, with a tendency to develop a diabetic metabolic condition. For this reason, it might well be necessary to administer insulin. Carbohydrates reduce the plasma levels of ammonia and free tryptophan. 

The proportions of carbohydrates (4.0-5.0), fats (1.0-2.0) and proteins (0.8-1.5) (each in g/kg BW/day) in patients with chronic liver disease correspond to those of an ordinary diet the basic calorie requirement is 35 kcal/kg BW/day. From the metabolic viewpoint, and in the case of diabetes, daily food intake should be divided into 3 main meals and 2 snacks. As a prophylactic measure, it is advisable to restrict the use of common salt to 7-8 g (because of the very high NaCl content in the usual diet). Moreover, a preponderance of lacto-vegetarian proteins over proteins derived from meat and fish (with their higher production of ammonia) is... 

Interest in the rise in plasma glucose levels following consumption of different starchy foods arose because of health concerns for diabetes. Certain diabetics require a specific schedule of energy intake throughout the day. These patients require a constant supply of carbohydrate but must avoid drastic increases or fluctuations in the concentration of plasma glucose. Consequently, their nutritional treatment includes instructions to avoid rapidly absorbed sugars (mono-and disaccharides) and to consume the more slowly absorbed starches. 

Carbohydrates are of major interest in ferod science. The monosaccharides and Starches present in natural and processed foods have a marked effect on their color, texture, consistency, and pa la lability. l,actose, the major carbohydrate of milk, can limit its acceptability as a food for those with lactose intolerance. Slowly digestible carbohydrates are used in the diets of certain diabetics, who must eliminate or restrict their intake of foods containing rapidly absorbed carbohydrates such as candies, honey syrup, and jam. 

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