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people with diabetes. While dental caries are still associated with high sucrose consumption in non-industrialised countries, refined starch is also implicated (39). The use of fluoridated water supplies and toothpastes in Western countries has dramatically reduced the problem of tooth decay and made sugar intake less important.

Conclusion

People with diabetes have long suffered from the widespread belief that normal everyday pleasures such as chocolate are to be eaten sparingly or not at all. It can be concluded that the majority of chocolate products give glycemic and insulin responses that are lower than those shown for white or wholemeal bread. Some products, however, stimulate disproportionately more insulin relative to the level of glycemia and may be undesirable in large amounts in the diet of people with insulin resistance syndrome (i.e. individuals who are overweight, hypertensive, with impaired glucose tolerance or NIDDM).

Although the subjects studied were often normal non-diabetic individuals, the findings are likely to apply to individuals with diabetes. Hence, chocolate products should not be blamed for high blood sugar levels, nor should they be recommended for the treatment of clinical hypoglycemia (low blood sugar) in insulin-dependent diabetes. Chocolate products are usually very energy-dense foods and should therefore play a small but nonetheless pleasurable and guilt-free role (e.g. one daily 'indulgence') in the diet of people with type 2 diabetes. Active individuals with type 1 diabetes can afford to include more generous amounts of chocolate as long as blood glucose and lipid control remain within desirable levels.

References

  1. American Diabetes Association (1988) Report of the American Diabetes Association's Task Force on Nutrition. Diabetes Care 11, 127128.
  2. American Diabetes Association (1994) Nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care 17, 519522.
  3. FAO/WHO (1998) Joint FAO/WHO Expert Consultation. Carbohydrates in Human Nutrition. Paper 66, 1418 April 1997, FAO Food and Nutrition. FAO, Rome.
  4. Jenkins, D.J.A., Wolever, T.M.S. and Taylor, R.H. (1981) Glycemic index of foods: a physiological basis for carbohydrate exchange. Am. J. Clin. Nutr. 34, 362366
  5. Brand Miller, J., Pang, E. and Broomhead, L. (1995) The glycaemic index of foods containing sugars: comparison of foods with naturally occurring versus added sugars. Br. J. Nutr. 73, 613623.
  6. Waldron, S., Swift, P.G.F., Raymond, N.T. and Botha, J.L. (1997) A survey of the dietary management of children's diabetes. Diabetic Med. 14, 698702.
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