This article clearly outlines the major differences  between The recommendations from the American Diabetes Association and what can be found on this site. The quotes in the blue boxes are directly from the American Diabetes Association as of 3/31/2007 and are unedited.

these quotes show how they still do not support The Low Glycemic concepts for diabetic control, seem to promote unhealthy diabetic choices and do not cite or support recent research into alternative options for glucose control. Is it any wonder the diabetic epidemic is out of control when the most trusted American Source for diabetic information is debunking one of the most effective strategies for glucose control and casting doubt on other effective strategies? 

For this article I will focus on just three differences that that make me question the motives of those offering the advice. After each quote from the American Diabetes website I will offer my comments.

Does cinnamon improve glucose and lipids of people with type 2 diabetes?

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A few recent studies have suggested that cinnamon improves blood glucose, triglyceride, total cholesterol, HDL cholesterol, and LDL cholesterol levels in people with type 2 diabetes.  These studies involved just a few people and were short in duration, and do not yet provide enough evidence that cinnamon can play a useful role in treating diabetes.

The quantities of cinnamon involved were much larger than traditionally used in cooking and seasoning. The studies are interesting, however, and may point the way to further research.

Read more on the cinnamon study.  http://www.diabetes.org/cinnamon.jsp

This is just a short quote to get us started. The primary study cane from The USDA ARS. The much larger amounts referred to by the ADA is only 1/4 teaspoon per day. Maybe the ADA considers that an excessive amount of cinnamon but I find it vary easy to add to my food each day. Perhaps the ADA considers the USDA study inconclusive but it is good enough for me and my meter shows good results. Here is what the study was about and the conclusion.

 OBJECTIVE—The objective of this study was to determine whether cinnamon improves blood glucose, triglyceride, total cholesterol, HDL cholesterol, and LDL cholesterol levels in people with type 2 diabetes.

RESEARCH DESIGN AND METHODS—A total of 60 people with type 2 diabetes, 30 men and 30 women aged 52.2 ± 6.32 years, were divided randomly into six groups. Groups 1, 2, and 3 consumed 1, 3, or 6 g of cinnamon daily, respectively, and groups 4, 5, and 6 were given placebo capsules corresponding to the number of capsules consumed for the three levels of cinnamon. The cinnamon was consumed for 40 days followed by a 20-day washout period.

RESULTS—After 40 days, all three levels of cinnamon reduced the mean fasting serum glucose (18–29%), triglyceride (23–30%), LDL cholesterol (7–27%), and total cholesterol (12–26%) levels; no significant changes were noted in the placebo groups. Changes in HDL cholesterol were not significant.

CONCLUSIONS—The results of this study demonstrate that intake of 1, 3, or 6 g of cinnamon per day reduces serum glucose, triglyceride, LDL cholesterol, and total cholesterol in people with type 2 diabetes and suggest that the inclusion of cinnamon in the diet of people with type 2 diabetes will reduce risk factors associated with diabetes and cardiovascular diseases.

This is just getting us stated. Click the read more link below for the full article.

The Glycemic Index debate: Does the type of carbohydrate really matter?

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by Janine Freeman, RD, CDE

As the low-carbohydrate-diet fad slowly loses steam, another may be moving in to take its place: the glycemic index fad.

The glycemic index (GI) ranks carbohydrate foods based on how they affect the body's blood glucose levels. "High GI" foods such as corn flakes, instant potatoes, and white bread greatly affect blood glucose levels. "Low GI" foods such as oatmeal, most fruits and vegetables, legumes, and nuts produce less of an effect. Recently, some weight loss diets have popularized the concept of the glycemic index, linking low GI foods to weight loss and high GI foods to weight gain.

The usefulness of the glycemic index in the treatment of diabetes has been controversial since its creation some 25 years ago. It's easy to understand why. The idea of classifying foods into groups -- those that greatly affect blood glucose and those that do not -- sounds very appealing to people with diabetes. It seems like it could make meal planning easier and improve after-meal blood glucose levels.

Unfortunately, it's not that simple. Here are a few reasons why.

• The GI of a food varies substantially depending on the kind of food, its ripeness, the length of time it was stored, how it was cooked, its variety (potatoes from Australia, for example, have a much higher GI than potatoes from the United States), and how it was processed.



• The GI of a food varies from person to person and even in a single individual from day to day, depending on blood glucose levels, insulin resistance, and other factors.



• The GI of a food might be one value when it is eaten alone and another when it is eaten with other foods as part of a complete meal.



• The GI value is based on a portion that contains 50 grams of carbohydrate, which is rarely the amount typically eaten.



• Most GI values reflect the blood glucose response to food for only 2 hours, whereas glucose levels after eating some foods remain elevated for up to 4 hours or longer in people with diabetes.

Figuring out which foods are "high GI" and "low GI" can be complicated, too, because it depends on which base reference is used to determine the GI -- white bread or glucose. And believe it or not, many high-fat foods, such as candy bars and pizza, have a low GI. If food manufacturers begin lowering the GI of processed foods by adding high-fat ingredients or high-fructose corn syrup (which has a low GI), we'll have the same dilemma we had when low-carb products began inundating the market: junk foods that have been altered and labeled as healthy.

Some studies show small improvements in A1Cs among people who are attentive to the glycemic index. But reducing calories, weight loss, and basic carbohydrate counting have been shown to be more effective in improving A1Cs among people with type 2 diabetes than basing diet decisions on the GI.

I don't suggest eliminating "high GI" foods in favor of "low GI" foods to gain better blood glucose levels for two reasons. First, there is not enough evidence yet to show that such an action actually will improve your blood glucose levels; and second, choosing foods based solely on GI will compromise healthy eating.

I suggest basing your food choices on a nutritionally balanced diet, while controlling total carbohydrates, as a first measure. Then, if you find that your after-meal blood glucose is much higher after eating certain foods, you can either choose to eat smaller portions of those foods or adjust your mealtime diabetes medication.

This guest editorial was taken from the September 2005 issue of Diabetes Forecast.

Quoted from  The American Diabetes Association website 3/31/2007

Now lets analyze what was said. The ADA and Janine Freeman, RD, CDE seem to want to cast doubt on the effectiveness of the glycemic index and as is often the case grains of truth are used with a spin.

Her first point "The GI of a food varies substantially depending on the kind of food, its ripeness, the length of time it was stored, how it was cooked, its variety (potatoes from Australia, for example, have a much higher GI than potatoes from the United States), and how it was processed." is true. All of these factors affect the GI of the food.

Understanding why these factors change and how to incorporate them into your plan will make a big difference. Overcooking some foods like pasta will raise the glycemic index. Over ripe fruits contain more sugar (fructose) and are higher GI. Learning to recognize the high glycemic foods and avoid them will show on your glucometer. She refers to potatoes, which can have GI values higher than table sugar. Some potatoes such as new potatoes can have a lower GI. Refrigerating the potatoes overnight and using them in a potato salad can further lower their GI value. Rice is another great example. White rice can have an extremely high GI value while Uncle Ben's Converted rice or brown rice can have a much lower GI. Yes it will take some education on the part of the diabetes patient but the result is well worth the effort.

Point 2 "The GI of a food varies from person to person and even in a single individual from day to day, depending on blood glucose levels, insulin resistance, and other factors." I have not noticed a large difference from day to day but I will give her the benefit of doubt and assume there may be some truth in her accretion. It is still our responsibility to monitor our daily glucose readings and make adjustments if we see a pattern of a food having a negative impact.

Her third point "The GI of a food might be one value when it is eaten alone and another when it is eaten with other foods as part of a complete meal." Is clearly understood by anyone who has done even a basic study of the glycemic index. Of course the GI is changed according to the content of the whole meal. Fats and proteins added to a carbohydrate will lower the GI of the carbohydrate. Why she even made such a weak argument other than trying to muddy the water belies the weakness of her remarks.

As to the 50-gram portion used to determine GI, 50 grams sounds like a lot more than ½ a cup. Lets use cooked medium grain white rice as an example.

100 grams = 130 calories.

1 cup = 180 grams = 241.8 calories

So 50 grams of white rice = .5377 cup or 130.016 calories (slightly more than ½ cup)

She makes 50 grams sound like an unusual amount but I think it is fairly common.

Her accretion that "basic carbohydrate counting have been shown to be more effective in improving A1Cs among people with type 2 diabetes than basing diet decisions on the GI."  Yes, the GI is not the only criteria for planning a healthy diet but an important one. She further claims that," Some studies show small improvements in A1Cs among people who are attentive to the glycemic index. Over two years ago when I was diagnosed I had a very high A1C. While following the ADA guidelines religiously I had great difficulty getting my daily glucose readings under 250 mg/dl, which would have resulted in a rather high A1C. By including low GI in my management plan I was able to quickly lower my A1C to 5.2 (a very respectable result) in less than 90 days.

The ADA even suggest sugar can be added to a diabetic diet.

One has to wonder why the association that is supposed to be the recognized world leader for diabetes advice will offer such questionable advice and seem to recommend foods that have such high glycemic values.

The ADA's website even features supposedly safe ways for diabetics to consume sugar on its "Sweeteners and Desserts" page. "If you have diabetes, that doesn’t mean you can’t eat sweets. People with diabetes can eat desserts, use sweeteners, and still keep their blood glucose (sugar) levels in their target range," the site reads. "In the past, people with diabetes were warned to avoid sugar. Experts believed eating sugar would rapidly increase blood glucose, resulting in levels that were too high. Some people even thought eating sugar caused diabetes, an idea that we know now isn’t true. Research has shown that sugar has the same effect on blood glucose levels as other carbohydrates."

Khan's statements denying that sugar can cause diabetes came in the same week that the Journal of Pediatrics published a study blaming much of childhood obesity and type 2 diabetes on over-consumption of sugary sodas. The study found that sugared sodas contribute about 20 teaspoons of sugar per day to the diets of American teenagers.

Although he did not state that sugar is connected to diabetes, Khan did admit that weight is connected to diabetes. Khan said that calories (not sugar) are connected to the disease, and that weight is simply a measure of calories in and calories out. According to Khan, whether those calories come from sugar, fat or protein is unimportant. If more calories go in than come out, obesity will occur, which can lead to the onset of type 2 diabetes.

"If you have diabetes, that doesn't mean you can't eat sweets. People with diabetes can eat desserts, use sweeteners, and still keep their blood glucose (sugar) levels in their target range. These options are available for sweetening your foods:

As you read the following quote from the ADA pay attention to what they say about sugar and also notice the foods mentioned as carbs.

"The key to keeping your blood glucose on target is to substitute small portions of sweets for other carb-containing foods in your meals and snacks.  Carb-containing foods include bread, tortillas, rice, crackers, cereal, fruit, juice, milk, yogurt, potatoes, corn, and peas." ADA Quote.

Some of the foods they say to substitute sweets are foods that should not be included anyway. Bread made from highly refined flours especially white bread  are very high glycemic as are tortillas, white rice, crackers (also unacceptable levels of trans fats), most boxed or bagged breakfast cereals, juice, potatoes and corn.

With strong research telling us to avoid such foods why are they being suggested by the ADA? Is the advice tainted by special interest? The ADA board of directors and the major contributors may offer a clue. Pharmaceutical companies and food manufacturers (some that produce candy and sugared drinks) are among the biggest financial contributors. Pharmaceutical company executives are on the ADA board of directors. The ADA says they in no way influence the work of the ADA but one has to wonder in light of the advice given.

One also has to wonder why they seem to endorse sweeteners that are questionable such as Saccharin (Sweet N Low, Sugar Twin) aspartame which have been under suspicion for some time.

Sweeteners & Desserts

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If you have diabetes, that doesn't mean you can't eat sweets. People with diabetes can eat desserts, use sweeteners, and still keep their blood glucose (sugar) levels in their target range. These options are available for sweetening your foods:

• Sugar and other sweeteners with calories including honey, brown sugar, molasses, fructose, cane sugar, and confectioners sugar
• Reduced-calorie sweeteners including erythritol, hydrogenated starch hydrolysates, isomalt, lactitol, maltitol, mannitol, sorbitol, and xylitol
• Low-calorie sweeteners such as ascelfume potassium, aspartame, saccharin and sucralose

Sugar and Other Sweeteners with Calories

 

In the past, people with diabetes were warned to completely avoid sugar. Experts thought that eating sugar would rapidly increase blood glucose, resulting in levels that were too high. Some people even thought that eating sugar caused diabetes, an idea that we now know isn't true.

Research has shown that the total amount of carbohydrate affects blood glucose levels the most. But, the type of carbohydrate (e.g. sugar vs. starch) can also affect blood glucose levels. Learn more about the types of carbohydrate and the glycemic index.

Now experts agree you can eat foods with sugar as long as you work them into your meal plan as you would any other carb-containing food. The same guidelines apply to other sweeteners with calories, including brown sugar, honey, and molasses.

Of course, most sweets and desserts don't provide the important vitamins and minerals found in more healthful foods, so you’ll want to make sure you’re still getting the nutrients you need.  Many sweets, in addition to having carbs, are also high in fat and calories.

If you like sweets, but also want to lose weight, you can try these tips:

• Satisfy your sweet tooth with fresh or dried fruit
  

• Eat a small serving of your favorite dessert, instead of something ordinary
  

• When you are eating out, split desserts with a friend or family member
  

• Cut back on the amounts of sugar and fat in your recipe favorites
  

• Try new recipes for lower-calorie sweets
  

• Choose lower-calorie, lower-fat versions of your favorite desserts
  

• Use a low-calorie sweetener instead of sugar for your coffee or tea

How can I have sweets and still keep my blood glucose on target?

The key to keeping your blood glucose on target is to substitute small portions of sweets for other carb-containing foods in your meals and snacks.  Carb-containing foods include bread, tortillas, rice, crackers, cereal, fruit, juice, milk, yogurt, potatoes, corn, and peas.  For many people, having about 45 to 60 grams at meals is about right.  Serving sizes make a difference.  To include sweets in your meal, you can cut back on the other carb foods at the same meal.

For example, you’d like to have cookies with your lunch.  Your lunch is a turkey sandwich with two slices of bread.  Your first step is to identify the carb foods in your meal.  Bread is a carb.  You decide to swap two slices of bread for two slices of low-calorie bread and have the cookies -- it’s an even trade.  Your total amount of carbohydrate remains the same for the meal.

What to Check in the Nutrition Facts

You can also use the Nutrition Facts Label on foods to guide you.  The first thing to check is the serving size.  The second is the total carbohydrate.  The total carbohydrate tells you how much carbohydrate is in one serving of the food.

What else can I learn from food labels?

Foods labeled as sugar-free, no sugar added, reduced sugar, and dietetic still contain carbohydrate.  To check the amount of sugars (listed as “Sugars” under “Total Carbohydrate”) in the Nutrition Facts Label, keep in mind that it includes both added sugars and naturally occurring sugars, such as the natural sugar in raisins.  It is more helpful to check the total carbohydrate because it gives a better picture of all the carbohydrate in a single food. 

Reduced Calorie Sweeteners – Sugar Alcohols

Sugar alcohols are one type of reduced-calorie sweetener and are used in sugar-free candies, chewing gum, and desserts.  They provide about half the calories of sugars and other carbohydrates.  Isomalt, maltitol, mannitol, sorbitol, and xylitol are examples of sugar alcohols.  Even though they are called sugar alcohols, they do not contain alcohol.  Sometimes sugar alcohols can cause diarrhea, especially in children.  Many people think that foods with sugar alcohols are “free foods.”  This is not true!

Tips for Carb Counting and Sugar Alcohols Sugar alcohols don’t raise blood glucose as much as the same amount of other carbohydrates.  To figure out the amount of other carbohydrate you should count for a food with sugar alcohols, follow these tips: Subtract half of the sugar alcohol grams from the total carbohydrate Count the remaining grams For Example: Serving Size: 1 bar Total carbohydrate 15 grams  --  Sugar alcohol 6 grams One bar counts as 12 grams carbohydrate (15 – 3 = 12)

Low Calorie Sweeteners

Don't throw away your low-calorie sweeteners just because sugar is safer than you thought. Low-calorie sweeteners are "free foods." They make food taste sweet, and have no calories and do not raise blood glucose levels. They do not count as a carbohydrate, a fat, or any other exchange. They can be added to your meal plan instead of substituted.

The Food & Drug Administration (FDA) has approved the use of these low-calorie sweeteners. The American Diabetes Association accepts the FDA's conclusion that these sweeteners are safe and can be part of a healthy diet.

Saccharin (Sweet N Low, Sugar Twin)
Saccharin can be used in both hot and cold foods to make them sweeter.  You may recall that some studies giving very large quantities of saccharine to rats raised concerns that saccharin could cause cancer, but many studies and years of use have shown saccharin to be safe in the quantities used by consumers.

Aspartame (NutraSweet, Equal)
Aspartame is another low-calorie sweetener. Because high temperatures can decrease its sweetness, check the manufacturer's Web site or call their toll-free number for guidelines when using aspartame in recipes. 

Acesulfame potassium (Sweet One, Swiss Sweet, Sunett)
Another low-calorie sweetener on the market is acesulfame potassium, also called acesulfame-K. This sweetener is heat stable and can be used in baking and cooking.

Sucralose (SPLENDA)
Sucralose is the newest low-calorie sweetener on the market. Sucralose is not affected by heat and retains its sweetness in hot beverages, baked goods, and processed foods.

If you like to cook, you know that sugar does more in hot foods, especially baked goods like cookies and cakes, than just add sweetness.  It also affects the way the foods cook and the final texture.  Substituting a low-calorie sweetener may affect the texture and taste.  Many people use a combination of sugar and a low-calorie sweetener to reduce overall calories and sugar while still producing acceptable results.

All of these low-calorie sweeteners may help people who are overweight or have diabetes to reduce calories and stick to a healthy meal plan. In addition, these sweeteners are useful for reducing calories and carbohydrates when used instead of sugar in coffee, tea, cereal, and on fruit.

Are low-calorie sweeteners safe?

The low-calorie sweeteners in the United States all underwent extensive testing before they were approved.  Results showed that low-calorie sweeteners are safe for everyone, including children and pregnant women.  However, people with a rare condition called phenylketonuria (PKU) should limit their intake of aspartame, one type of low-calorie sweetener.

What are the advantages and disadvantages of reduced-calorie or low-calorie sweeteners?

Foods with low- or reduced-calorie sweeteners can have fewer calories than foods made with sugar and other caloric sweeteners.  That can help if you’re trying to lose weight or even prevent weight gain.  However, some sugar-free foods or products that use low-calorie sweeteners actually have more calories than, and may have more fat than, the sugar sweetened versions. 

When you’re considering foods with low- or reduced-calorie sweeteners, always check the Nutrition Facts on the label.  By comparing the calories in the sugar-free version to the regular version, you’ll see whether you’re really getting fewer calories.  You’ll also want to compare the fat content of the labels.  Some people choose the regular version of a food and cut back on the serving size instead of buying the sugar-free version.  Consider price as well.  Sometimes sugar-free versions cost more.

Low-calorie sweeteners are useful for adding extra flavor or sweetness to your food, with few if any extra calories.  You can experiment with your own recipes to include reduced- and low-calorie sweeteners.

http://www.diabetes.org/nutrition-and-recipes/nutrition/sweeteners.jsp