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Glycemic Response to Pasta: Effect of Surface Area, Degree of Cooking, and Protein Enrichment

July 1986
Diabetes Care 9(4):401-4

DOI:10.2337/diacare.9.4.401

Source
PubMed

Authors:

Thomas Wolever

INQUIS Clinical Research, Ltd

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To see whether food form, the degree of cooking, or protein enrichment affected the glycemic response to pasta, we gave test-meal breakfasts to 13 diabetic patients. Macaroni had a significantly greater glycemic index (GI) (68 +/- 8) than spaghetti (45 +/- 6, P less than .01); the GI of star pastina was intermediate (54 +/- 6). The GI of spaghetti was not significantly affected by cooking for 5 or 15 min (45 +/- 6 and 46 +/- 5, respectively), or by protein enrichment (38 +/- 4). The GI of spaghetti was similar in 11 non-insulin-dependent and 6 insulin-dependent diabetic patients (49 +/- 7 compared with 57 +/- 8). We conclude that different types of pasta may produce different glycemic responses but that these are not necessarily related to differences in cooking or surface area.

Test-meal constituents, cooking methods, and mean ± SE glycemic indices

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lycemic

Response to Pasta: Effect of

Surface

Area, Degree of Cooking, and

Protein

Enrichment

M. S.

WOLEVER, BM, MSc,

D. J. A.

JENKINS, DM,

KALMUSKY, RPDt,

GIORDANO, RPDt,

GIUDICI, RPDt,

JENKINS, RPDt,

L. U.

THOMPSON, PhD,

G. S.

WONG, MD, AND

R. G.

JOSSE,

see whether food form, the degree of

cooking,

or protein enrichment affected the glycemic response

pasta, we gave test-meal breakfasts to 13 diabetic patients. Macaroni had a significantly greater

glycemic

index (GI) (68 ± 8) than spaghetti (45 ± 6, P < .01); the GI of star pastina was intermediate

(54

± 6). The GI of spaghetti was not significantly affected by cooking for 5 or 15 min (45 ± 6 and

± 5, respectively), or by protein enrichment (38 ± 4). The GI of spaghetti was similar in 11 non-

insulin-dependent

and 6 insulin-dependent diabetic patients (49 ± 7 compared with 57 ± 8). We

conclude

that different types of pasta may produce different glycemic responses but that these are not

necessarily

related to differences in cooking or surface area,

DIABETES

CARE

1986;

9=401-404.

here is much interest in the glycemic responses to

carbohydrate foods in diabetic patients.1"8 Many

factors affect the glycemic response to meals: im-

portant among these are the food form,69 particle

size,

protein content of the meal,12 and the degree of

cooking.713 Pasta is a popular starchy food, which, in the

form of spaghetti, has been shown to have a low glycemic

response, ~60% that of bread.4'6 However, there are many

different types of pasta available, and each type may have

potentially different metabolic effects because of different sur-

face areas and protein contents. In addition, the traditional

Italian method of cooking pasta

different from that in North

America; the Italians prefer their pasta relatively under-

cooked, or "al dente." We have therefore investigated the

effect on the glycemic response in diabetic patients of five

different forms of pasta: "overcooked" spaghetti, "under-

cooked" spaghetti, macaroni, star pastina (small pasta stars),

and protein-enriched spaghetti.

METHODS

Seventeen diabetic patients who had no evidence of gastro-

paresis were studied. Six were classified as insulin dependent

(IDDM: fasting C peptide <0.6 ng/ml with no postprandial

rise) and 11 as non-insulin dependent (NIDDM). Charac-

teristics of the IDDM and NIDDM subjects, respectively,

were

follows:

age, 50 ± 6 and 70 ±

yr; ideal body weight,

107 ± 5 and 129 ± 10%; duration of diabetes, 19 ± 4 and

10 ± 2 yr; mean fasting blood glucose, 8.7 ± 0.8 and

7.2 ± 0.5 mmol/L; and mean HbAlc, 8.2 ± 0.7 and

6.7 ± 0.4%. The IDDM patients took a mean of

± 5 U

of insulin per day. Seven of the NIDDM patients were treated

with insulin (mean 28 ± 11 U/day), three with oral hypo-

glycemic agents, and one with diet only. Fasting fingerprick

capillary blood samples were obtained (Autolet lancets, Owen

Mumford, Woodstock, Oxford, UK). Five minutes after the

patients took their usual insulin or other diabetes medications

(if any), a test meal was given. Fingerprick blood samples

were obtained every 30 min for 3 h after the start of each

meal for measurement of whole blood glucose with an au-

tomatic analyzer (Model 27, Yellow Springs Instruments, Yel-

low Springs, OH).

Test

meals.

Test-meal constituents and cooking methods

are shown in Table 1. White flour and the uncooked spaghetti

were analyzed for nutrient14 and dietary fiber content.15 Mac-

aroni and star pastina were assumed to have the same com-

position as the spaghetti from the same manufacturer.

Each test meal contained 50 g available carbohydrate from

white bread or pasta. For palatability, all the test meals were

served with 32 g cheddar cheese plus 100 g cooked tomato.

Each subject also took at least three test meals of white bread

only (mean 5.6 ± 0.7, range 3-12).

The test meals were consumed in random order. Four of

the IDDM subjects were unable to complete all the tests and

were given only the 5-min spaghetti test meal. Because no

significant difference in the glycemic response to spaghetti

DIABETES

CARE, VOL. 9 NO. 4, JULY-AUGUST 1986

401

GLYCEMIC RESPONSE TO PASTA/T. M. S. WOLEVER AND ASSOCIATES

TABLE 1

Test-meal constituents, cooking methods, and mean ± SE glycemic indices

FoodDry wt

(g)Cooking methodGlycemic index'

White bread

White bread + C + Tt

5-min spaghetti§ + C + T

15-min spaghetti§ + C + T

Macaroni§ + C + T

Star pastina§ + C + T

Spaghetti|| + C + T

(protein-enriched)

67.0t

67.

66.0

66.3

Baked in diet kitchen

Boiled, 180 ml water, 5 min

Boiled, 300 ml water, 15 min;

frozen, reheated before test

Boiled, 180 ml water, 5 min

Boiled, 180 ml water, 7 min

100A

99 ± 4A

45 ± 6B

46 ± 6B

64 ± 8C

54 ± 6BC

38±4

Excess water from cooking was consumed with the test meals.

'Means not sharing the same letter superscript are significantly different (P < .01).

tWeight of flour. $C = 32 g mild cheddar cheese, T = 100 g cooked tomato. §Lancia-Bravo Foods Ltd., Toronto, Canada; ||Catelli Plus, Catelli Ltd.,

Montreal, Canada.

was found between IDDM and NIDDM subjects, the results

of 2 IDDM subjects who completed all the test meals were

pooled with the results of the 11 NIDDM subjects.

The study was approved by the human experimentation

ethics committee of the University of Toronto.

Data

analysis.

The glycemic indices (GIs) of the test meals

were calculated using the three white bread tests taken closest

to the date of each test meal, which has been shown to

minimize the variability of GI calculations.16 Results are ex-

pressed as means ± SE. The dimensions of uncooked pasta

were measured and the surface areas calculated by appropriate

formulas. Incremental areas under the blood glucose response

-O White bread

-#-

White bread plus cheese and tomato

60 120

Time (min)180

FIG. I. Mean ± SE blood glucose responses of 13 diabetic patients

(I I NIDDM and 2 IDDM) who took meals of white bread containing

50 g available carbohydrate or same amount of white bread with 32 g

cheddar cheese plus 100 g cooked tomato.

curves were calculated geometrically using the blood glucose

increments.17 Any area beneath the fasting blood glucose

level was ignored. After demonstration of significant heter-

ogeneity by two-way analysis of variance,18 the means were

compared using Fisher's test (if F > 10) or Tukey's test (if

F < 10). The significance of the differences for the six IDDM

patients who tested spaghetti and bread was assessed by Stu-

dent's t test for paired data.

RESULTS

Effect of added cheese and tomato. The effect on the glycemic

response of adding cheese and tomato to bread was negligible

(Fig. 1, Table 1). Therefore, no adjustment for added cheese

and tomato was made to the GI of the pasta meals.

Effect

type

of pasta. The mean glycemic responses to the

pasta meals were significantly lower than those to the bread

meals (Fig. 2, Table 1). The GI of spaghetti was significantly

lower than that of macaroni (P < .01). The glycemic re-

sponses to star pastina and protein-enriched spaghetti were

not significantly different from those to regular spaghetti (Fig.

Table 1).

Effect of

cooking.

Cooking spaghetti for 5 or 15 min had

virtually no impact on the mean glycemic response (Fig. 2)

orGI (Table 1).

Comparison of IDDM with NIDDM subjects. IDDM and

NIDDM subjects responded similarly to spaghetti cooked for

5 min, or "al dente" (Fig. 3). The GIs for spaghetti in IDDM

(57 ± 8, N = 6) and NIDDM (49 ± 7, N = 11) patients

were not significantly different.

DISCUSSION

he results confirm the low GI of pasta.6 In addition,

they indicate that differences exist in the glycemic

response to different forms of pasta; these differ-

ences are not necessarily related to the surface area,

the degree of cooking, or protein enrichment.

Surface area has been ascribed an important role in deter-

402DIABETES CARE, VOL. 9 NO. 4, JULY-AUGUST 1986

GLYCEMIC RESPONSE TO PASTA/T. M. S. WOLEVER AND ASSOCIATES

O-White Bread

-A- Star Pastina

Macaroni

Spaghetti

-O White Bread -#- Enriched Spaghetti

Spaghetti -Q- 15min Spaghetti

60 120

Time (min)180

FIG.

Mean

± SE

blood glucose responses

of 13

diabetic patients

(11 N/DDM and

IDDM) who took meals of white

bread,

macaroni,

star pastina,

5-min

("aldente")

spaghetti,

15-min {overcooked) spaghetti,

or protein-enriched

spaghetti.

For each time, means not sharing same letter

are significantly different

(P < .01).

mining the rate of digestion of starch, which, in turn, is

related to the glycemic response.19 Increasing the surface area

by grinding rice, for example, has been associated with an

increased rate of enzymatic hydrolysis and enhanced glycemic

and endocrine responses.1011 Although the surface areas of

the 66-g portions of uncooked spaghetti, macaroni, and star

pastina were quite different

(0.11,

0.091,

and 0.14 m2, re-

spectively), they did not relate to the glycemic response. This

was probably because the surface areas would have been in-

creased to different extents by chewing.

Starch produces a greater glycemic response when cooked

than when consumed raw,713 presumably because cooking

increases the degree of starch gelatinization and its suscep-

tibility to enzymatic digestion. In this study, the difference

between cooking spaghetti for 5 or 15 min was not reflected

in a different glycemic response, despite the fact that the

"overcooked" spaghetti was frozen and reheated as well as

cooked for a longer period of time and was, therefore, much

softer than the 5-min spaghetti. Nevertheless, our "over-

cooked" spaghetti may not have been overcooked enough to

see the true effect of the very-overcooked pasta that is some-

times eaten in North America (e.g., canned pasta).

The addition of protein to meals has been found to increase

insulin secretion and reduce the glycemic response12 only

when relatively large amounts of protein (30-50 g protein/

carbohydrate) are used. The lack of effect of added cheese

and tomato (containing 9.1 g protein) or of protein-enriched

spaghetti (2.3 g more protein than the portion of regular

o-White bread

-•- Aldente spaghetti

IDDM

60 120

Time (min)180

FIG.

Mean

SE blood glucose responses of 6 IDDM subjects (top

panel) and JJ NIDDM

subjects

(bottom panel) who took meab of

white bread or "al dente" spaghetti.

DIABETES CARE, VOL. 9 NO. 4, JULY-AUGUST 1986403

GLYCEMIC RESPONSE TO PASTA/T. M. S. WOLEVER AND ASSOCIATES

spaghetti) on the glycemic response was probably due to the

small amounts of protein added.

We conclude that pasta has a significantly lower GI than

bread. However, different types of pasta have different gly-

cemic responses that are not necessarily related to surface

area, the degree of cooking, or protein enrichment.

ACKNOWLEDGMENTS:

T.M.S. W. received a Fellowship from the

Kellogg's Company, Battle Creek, Michigan. These studies

were supported by the Natural Sciences and Engineering Re-

search Council of Canada.

From the Department of Nutritional Sciences, Faculty of Med-

icine (T.M.S.W., D.J.A.J., J.K., C.G., S.G., A.L.J., L.U.I.); and

the Division of Endocrinology and Metabolism, St. Michael's Hos-

pital (T.M.S.W., D.J.A.J., G.S.W., R.G.J.), University of Toronto,

Toronto, Ontario M5S 1A8, Canada.

Address reprint requests to Dr. Thomas M. S. Wolever at the

above address.

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Nov 2020

Anne-Esther Breyton

L’hyperglycémie chronique est impliquée dans le développement de complications associées au DT2 et la variabilité glycémique (VG) apparait comme une composante à part entière de l'homéostasie du glucose. Les mesures hygiéno-diététiques, en première ligne dans la prise en charge du DT2, passent entre autres par une modification de l’alimentation, dans laquelle les glucides occupent une place prépondérante. Au-delà de la quantité, la qualité des glucides a été mise en avant comme ayant un impact déterminant sur les excursions glycémiques. Notamment, la digestibilité des produits à base d’amidon pourrait alors avoir un impact sur le contrôle glycémique chez les patients atteints de DT2. Mais il y a aujourd’hui un réel besoin d’apporter une caractérisation des produits plus complète sur cet aspect et de mener des études de faisabilité et d’efficacité de tels régimes modulant la digestibilité de l’amidon. Mes travaux de thèse montrent qu’il est possible de concevoir un régime riche en amidon lentement digestible (SDS), grâce à des choix de produits amylacés disponibles dans le commerce, des conseils de cuisson et des recommandations adaptées. Pour la première fois, nous avons montré que le contrôle de la digestibilité de l'amidon de produits amylacés avec des instructions de cuisson appropriées dans une population atteinte de DT2 augmentait la consommation de contenu en SDS dans un contexte de vie réelle et que ce type de régime était bien accepté dans telle population. De plus, nous avons montré que l’augmentation du rapport SDS/glucides était associée à une amélioration du contrôle glycémique postprandial et qu’il existait une corrélation linéaire inverse entre les paramètres de VG et la teneur en SDS. La mise en œuvre d’un régime riche en amidon lentement digestible dans une population atteinte de DT2, a montré une différence significative sur le profil de variabilité glycémique, mais également sur les excursions glycémiques postprandiales, évalués par le CGMS, en comparaison avec un régime pauvre en amidon lentement digestible. Ce type de régime a également permis aux patients d’atteindre des cibles glycémiques postprandiales plus appropriées. Grâce à un travail de revue de la littérature, nous avons mis en évidence que la déviation standard (SD), le coefficient de variation (CV), l’amplitude moyenne des excursions glycémiques (MAGE) et la moyenne glycémique (MBG) étaient les paramètres de VG les plus étudiés en termes de relation avec les paramètres de diagnostic du DT2 et les complications liées au DT2 et qu’ils montraient des relations fortes, en particulier avec l’HbA1c. Dans les études interventionnelles, nous avons pu voir que la SD, le MAGE et le temps dans la cible (TIR) étaient les paramètres les plus utilisés comme critères d’évaluation, montrant des améliorations significatives suite aux interventions pharmacologiques ou nutritionnelles, souvent en lien avec des paramètres de contrôle glycémique comme l’HbA1c, la glycémie à jeun ou en postprandial. La VG apparaît donc comme une composante clé de la dysglycémie du DT2. Au-delà de son utilisation par le patient comme support du contrôle glycémique, le CGMS apparait comme un outil pertinent en recherche clinique pour évaluer l’efficacité des interventions même si à ce jour, il reste encore très peu utilisé pour les interventions nutritionnelles. Des études plus approfondies seront cependant nécessaires pour confirmer l'impact bénéfique de telles interventions alimentaires à long terme. Nous avons conçu une étude à plus grande échelle pour étudier l'impact à long terme d’un régime riche en SDS sur la variabilité et le contrôle glycémiques (CGMS) et les complications et comorbidités associées chez le patient atteint de DT2. La modulation de la digestibilité de l'amidon dans l'alimentation pourrait alors être utilisée comme un outil nutritionnel simple et approprié pour améliorer l'homéostasie glucidique au quotidien dans le DT2.

PROFIL GLUCIDIQUE ET INDEX GLYCEMIQUE DU DOCKOUNOU : UN GATEAU TRADITIONNEL A BASE DE BANANE PLANTAIN SENESCENTE

Article

Full-text available

Nov 2021

Des données récentes recueillies à partir de l'optimisation de la fabrication du gâteau dockounou ont montré qu'un dockounou optimisé pourrait être un excellent moyen de valorisation de la banane plantain trop mûre. Mais, à ce jour, il existe peu de données scientifiques sur les propriétés glycémiques de cet aliment, qui est intégré dans les habitudes alimentaires urbaines. Nous avons donc déterminé l'index glycémique et la charge glycémique d’un dockounou traditionnel et le dockounou optimisé. En outre, nous avons réalisé leur profilage glucidique, dont la présence dans ces mets n’a été que peu étudiée. Dans l'ensemble, il n'y a pas eu de variations considérables dans leur composition nutritionnelle, à l'exception des cendres et des glucides. Les valeurs suivantes ont été obtenues pour les composantes glucidiques (g/100 g): amidon (32,4-33,7); saccharose (4,1- 8,8); glucose (20,1-20,7); fructose (21,1-22,6); fibres solubles (2,5-2,5) et fibres insolubles (6,9-6,9). L’index glycémique et la charge glycémique étaient respectivement de 79 et 20,4 pour le dockounou optimisé et respectivement de 81 et 21,3 pour le dockounou traditionnel. Ces résultats confirment bien que ces aliments sont une bonne source de glucides, notamment de la fraction glucose. Cependant, les niveaux élevés d'index glycémique et de charge glycémique impliquent une consommation avec modération.

Pasta Structure Affects Mastication, Bolus Properties, and Postprandial Glucose and Insulin Metabolism in Healthy Adults

Article

Full-text available

Oct 2021
J NUTR

Background: Structure and protein-starch interactions in pasta products may be responsible for lower postprandial glycemic responses compared with other cereal foods. Objective: We tested the effect on postprandial glucose metabolism induced by two pasta products, couscous and bread, through their structural changes during mastication and simulated gastric digestion. Methods: Two randomized controlled trials (n = 30/trial) in healthy normal weight adults (23.9 and 23.0 kg/m2) evaluated postprandial glucose metabolism modulation to 50g of available carbohydrate portions of durum wheat semolina spaghetti, penne, couscous, and bread. A mastication trial involving 26 normal weight adults was conducted to investigate mastication processes and changes in particle size distribution and microstructure (light microscopy) of boluses after mastication and in vitro gastric digestion. Results: Both pasta products resulted in lower areas under the 2h-curve for blood glucose (-40% for spaghetti and -22% for penne vs couscous; -41% for spaghetti and -30% for penne vs bread), compared with the other grain products (P < 0.05). Pasta products required more chews (spaghetti: 34 ± 18; penne: 38 ± 20; bread: 27 ± 13; couscous: 24 ± 17) and longer oral processing (spaghetti: 21 ± 13 s; penne: 23 ± 14 s; bread: 18 ± 9 s; couscous: 14 ± 10 s) than bread or couscous (P < 0.01). Pastas contained more large particles (46-67% of total particle area) compared to bread (0-30%) and couscous (1%) after mastication and in vitro gastric digestion. After in vitro gastric digestion, pasta samples still contained large areas of non-hydrolyzed starch embedded within the protein network, protein in bread and couscous was almost entirely digested, and starch was hydrolyzed. Conclusions: Preservation of the pasta structure during mastication and gastric digestion explains slower starch hydrolysis and, consequently, lower postprandial glycemia compared to bread or couscous prepared from the same durum wheat semolina flour in healthy adults. Postprandial in vivo trials were registered at clinicaltrials.gov as NCT03098017 & NCT03104686.Clinical Trial Registry: NCT03098017 & NCT03104686 www.clinicaltrials.gov.

Effect of Protein Ingestion on the Glucose and Insulin Response to a Standardized Oral Glucose Load

Article

Full-text available

Sep 1984
DIABETES CARE

Type II diabetic subjects were given 50 g protein, 50 g glucose, or 50 g glucose with 50 g protein as a single meal in random sequence. The plasma glucose and insulin response was determined over the subsequent 5 h. The plasma glucose area above the baseline following a glucose meal was reduced 34% when protein was given with the glucose. When protein was given alone, the glucose concentration remained stable for 2 h and then declined. The insulin area following glucose was only modestly greater than with a protein meal (97 +/- 35, 83 +/- 19 microU X h/ml, respectively). When glucose was given with protein, the mean insulin area was considerably greater than when glucose or protein was given alone (247 +/- 33 microU X h/ml). When various amounts of protein were given with 50 g glucose, the insulin area response was essentially first order. Subsequently, subjects were given 50 g glucose or 50 g glucose with 50 g protein as two meals 4 h apart in random sequence. The insulin areas were not significantly different for each meal but were higher when protein + glucose was given. After the second glucose meal the plasma glucose area was 33% less than after the first meal. Following the second glucose + protein meal the plasma glucose area was markedly reduced, being only 7% as large as after the first meal. These data indicate that protein given with glucose will increase insulin secretion and reduce the plasma glucose rise in at least some type II diabetic persons.

Depletion and disruption of dietary fibre. Effects on satiety, plasma-glucose, and serum-insulin

Article

Nov 1977

Ten normal subjects ingested test meals based on apples, each containing 60 g available carbohydrate. Fibre-free juice could be consumed eleven times faster than intact apples and four times faster than fibre-disrupted purée. Satiety was assessed numerically. With the rate of ingestion equalised, juice was significantly less satisfying than purée, and purée than apples. Plasma-glucose rose to similar levels after all three meals. However, there was a striking rebound fall after juice, and to a lesser extent after purée, which was not seen after apples. Serum-insulin rose to higher levels after juice and purée than after apples. The removal of fibre from food, and also its physical disruption, can result in faster and easier ingestion, decreased satiety, and disturbed glucose homoeostasis which is probably due to inappropriate insulin release. These effects favour overnutrition and, if often repeated, might lead to diabetes mellitus.

Determination of Total Dietary Fiber in Foods and Food Products: Collaborative Study

Article

Nov 1983
J Assoc Offic Anal Chem

A collaborative study was conducted to determine the total dietary fiber (TDF) content of food and food products, using a combination of enzymatic and gravimetric procedures. The method was basically the same as published earlier (J. Assoc. Off. Anal. Chem. (1984) 67, 1044-1052), with changes in the concentration of alcohol and buffers, time of incubation, sample preparation, and some explanatory notes, all with the intent of decreasing the coefficient of variation (CV) of the method. Duplicate blind samples of soy isolate, white wheat flour, rye bread, potatoes, rice, wheat bran, oats, corn bran, and whole wheat flour were analyzed by 9 collaborators. TDF was calculated as the weight of the residue minus the weight of protein and ash. CV values of the data from all laboratories for 7 of the samples ranged from 1.56 to 9.80%. The rice and soy isolate samples had CV values of 53.71% and 66.25%, respectively; however, each sample contained only about 1% TDF. The enzymatic-gravimetric method for determining TDF has been adopted official first action.

The use of the glycemie Index in predicting the blood glucose response to mixed meals

Article

Feb 1986

There has been much interest in the use of the glycemic index (GI). A recent study reporting plasma glucose responses to mixed meals containing fat and protein concluded that the results were totally disparate from what would have been expected from published GI values of the foods fed. However, this conclusion was based upon an inappropriate assessment of the data using absolute rather than incremental blood glucose response areas. The present report demonstrates how data may be analyzed to make use of the GI values of individual foods to predict the GI of mixed meals (r = 0.987; p less than 0.02). It is concluded that the GI concept applies well to mixed meals containing fat and protein.

Prediction of the Relative Blood Glucose Response of Mixed Meals Using the White Bread Glycemic Index

Article

Sep 1985
DIABETES CARE

Unexpected plasma glucose responses to different mixed meals fed to normal and diabetic volunteers have recently been reported. We have therefore examined in normal volunteers the effect of mixing carbohydrate foods of different glycemic indices (GIs) without the addition of fat and protein. The observed GI of the mixed meal was within 2% of the expected value. In studies in the literature where fat and protein were added to mixed meals, the observed blood glucose responses also related significantly to the meal GIs calculated from the individual foods. Addition of fat and protein in the quantities used did not obscure this relationship. Studies to determine sources of error in comparing glycemic responses showed that type II diabetic patients displayed the least within-individual variation, and type I diabetic patients the most. Expression of results as the GI rather than as absolute glycemic response areas reduced by 50% the between-subject variation. The mean GI values of rice tested in type I and type II patients were similar (82 +/- 22 compared with 74 +/- 19) and the reproducibility 22 mo later in the same group of subjects was excellent (81 +/- 15 compared with 83 +/- 15). However, the lack of precise GI values for all foods fed in the test meals indicates a need for GI values to be derived for a wider range of individual foodstuffs. The GI approach to classifying foods according to physiologic effect may play a useful role in planning meals and diets in which specific blood glucose profiles are required.

Glycemic Response to Wheat Products: Reduced Response to Pasta but No Effect of Fiber

Article

Mar 1983
DIABETES CARE

The blood glucose response to feeding 50-g carbohydrate portions of white and wholemeal bread and white spaghetti was studied in a group of nine diabetic subjects. Blood glucose rises after white and wholemeal bread were identical, but the response after spaghetti was markedly reduced. These results emphasize that food form rather than fiber may be important in determining the glycemic response and that pasta may be a useful source of carbohydrate in the diabetic diet.

Postprandial Glucose and Insulin Responses to Meals Containing Different Carbohydrates in Normal and Diabetic Subjects

Article

Aug 1983

To examine whether the form of dietary carbohydrate influences glucose and insulin responses, we studied the glucose and insulin responses to five meals--each containing a different form of carbohydrate but all with nearly identical amounts of total carbohydrate, protein, and fat--in 10 healthy subjects, 12 patients with Type I diabetes, and 10 patients with Type II diabetes. The test carbohydrates were glucose, fructose, sucrose, potato starch, and wheat starch. In all three groups, the meal containing sucrose as the test carbohydrate did not produce significantly greater peak increments in the plasma concentration of glucose or greater increments in the area under the plasma glucose-response curves than did meals containing potato, wheat, or glucose as test carbohydrates. Urinary excretion of glucose in patients with diabetes was not significantly greater after the sucrose meal. The meal containing fructose as the test carbohydrate produced the smallest increments in plasma glucose levels, but the differences were not always statistically significant. In healthy subjects and patients with Type II diabetes, peak serum concentrations of insulin were not significantly different in response to the five test carbohydrates. Our data do not support the view that dietary sucrose, when consumed as part of a meal, aggravates postprandial hyperglycemia.

Tihe Glycemic Effect of Different Meals Approximately Isocaloric and Similar in Protein, Carbohydrate, and Fat Content as Calculated Using the ADA Exchange Lists

Article

Sep 1983
DIABETES CARE

The effect on plasma glucose concentration of four different, approximately isocaloric breakfasts designed using the American Diabetes Association food exchange lists was studied in eight type II diabetic patients. The meals were estimated to contain similar amounts of carbohydrate, protein, and fat and were given in random order. The plasma glucose responses to the different meals were similar except for one meal. This meal resulted in a greater glucose increase but the latter could be explained by the substitution of banana for orange juice in the meal. Banana contains starch as well as fructose and glucose, whereas orange juice contains glucose, fructose, and sucrose. In regard to the postmeal glucose response, these data indicate that the ADA food exchange list is useful in meal planning, at least for breakfast.

The relationship between glycemic response, digestibility, and factors influencing the dietary habits of diabetics

Article

Jan 1985

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.

The glycaemic index of foods tested in diabetic patients: A new basis for carbohydrate exchange favouring the use of legumes

Article

May 1983

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 less than 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 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.