The number of persons with diabetes — estimated at 20 million with nearly a third undiagnosed — is growing at an accelerated rate. The number of “prediabetics” (persons with elevated glucose levels not yet to the level of active diabetes) is estimated at 5 to 7 million and also increasing. These numbers are expected to double by mid-century.
If the numbers are correct, and most experts agree they are, the population of persons with diabetes will continue to increase exponentially. Manufacturers of food products for this important demographic, although long aware of this, still find themselves working full speed to keep up.
Taken together with the population of persons having impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), this is a market segment food manufacturers ignore to their peril.
Discussions of diabetes focus on carbohydrate metabolism. Carbohydrates exist in a few basic forms — simple and complex — but infinite variety. Simple carbohydrates consist of one or two sugar units. Glucose is the sugar in blood.
Two glucose units linked together compose maltose, the sugar of sprouted grain. Glucose linked to fructose is sucrose, the sugar in sugar cane that we extract and refine for table sugar. Complex carbohydrates, the starches of grains, beans, and potatoes, are chains of glucose links, either straight or branched.
The difficulty is that these chains, which break up during digestion, may be changed by processing before consumption. When starch granules are heated in a moist environment, the granules swell and break apart.
When starches are processed under the high temperatures and dry conditions characteristic of baking and frying, they break down into smaller chains and are handled by the body more as sugar. The addition of acids and enzymes further trigger the breakdown of starch to sugars, either when processed into syrups and sweeteners, or during digestion.
Foods containing complex carbohydrates are best prepared by steaming or boiling (where temperatures don’t exceed 212˚F). This keeps the complex carbohydrates from breaking into small chains before being consumed.
Fiber, also a carbohydrate, is associated with reduced diabetic symptoms (when fiber content of the diet is high). Kathleen Ellwood, of the Center for Food Safety and Applied Nutrition, confirmed the FDA is studying petitions recommending nondigestible fiber be removed from the carbohydrate portion of the nutritional label, making it clearer for persons with diabetes that fiber does not raise blood sugar levels.
Sugars require insulin to aid their entrance into muscle or fat cells. Normally the insulin is produced by specialized pancreatic cells. In type I diabetes, these cells are damaged and insulin must be taken either orally, by injection or through a small automatic pump. Measuring the proper amount of insulin needed makes the difference between regulated and uncontrolled diabetes with all its dangerous side effects, including kidney failure, blindness, and amputation.
In type II diabetes, the muscle and fat cells are resistant to the effects of insulin. This form of diabetes can generally be controlled by diet and exercise, without the necessity of added insulin.
Persons with diabetes must be able to accurately gauge their food intake to keep their blood glucose regulated. Those who successfully manage their condition with diet and exercise are must be aware of the content, component amounts and types of foods they eat. This demands accuracy in label statements.
Controlling Blood Glucose
Controlling blood sugar in diabetes involves monitoring the types and amounts of food eaten. This holds true even for persons taking insulin on a regular schedule or via automatic pump. Monitoring the glycemic index of foods is another system used by persons with diabetes to control blood glucose. Glycemic index is a rating system based on the concept that different carbohydrates raise blood glucose by different amounts.
The GI system was developed by Jennie Brand-Miller, PhD, of the University of Sydney, Australia. According to Brand-Miller, GI helps consumers tell how a food will affect blood sugar. Foods with a high index are believed to raise blood sugar and should be eaten in small amounts. A GI of 70 or greater is high, a GI of 56 to 69 intermediate and a GI of 55 or less low. (To learn more about the glycemic index, check out “GI Blues” on the Wellness Foods web channel at www.foodprocessing.com.)
During deliberations, the 2005 Dietary Guidelines Advisory Committee (DGAC) evaluated the utility of the glycemic index, which they defined as the overall health significance of glycemic response to carbohydrates and the contribution of “added sugars” to human health.
The committee did not find GI to be a useful tool for the average American, primarily because it is only one factor among many describing the nutritional value of a food and may eclipse other values such as fat, fiber or energy content.
Another system of monitoring is Glycemic Load, which adds the information about the quantity of carbohydrate to information about the response to a specific carb. If a food has a high GI, but there isn’t a lot of that particular food in a mix, the glycemic load is relatively low. A GL of 20 or more is high, a GL of 11 to 19 is intermediate, and a GL of 10 or less is low.
Carb counting is another, more basic method of monitoring carb intake. Based on the total amount of carbohydrates consumed in a meal, grams of carbs are converted to insulin units using a relatively simple algorithm. Because most U.S. foods are labeled for total carbs, using the carb counting method is fairly simple.
Foods That Count
While nutritionists debate the best way to manage blood glucose, the market is stirring. The current trend is toward GI- and glycemic load-oriented products, according to Lynn Dornblaser, director of consulting services for the Mintel Group, Chicago.