The evidence for dietary carbohydrate management for diabetics is clear
Advisory on dietary carbohydrate has been an integral part of clinical practice guideline for secondary intervention of diabetes (MOH, 2014). Management of carbohydrate quantity and quality in clinical setting reliably reduces elevated blood glucose. A recent 2016 American Diabetes Association position paper stated consumption of carbohydrate-rich processed foods as one of the reasons for hyperglycaemia among diabetic patients.
The effects of carbohydrate portioning and substitution from refined to unrefined sources are immediate and well documented (Feinman et al., 2004, Ley, 2014; AlEssa, 2015). These clinical improvements are supported by established principles in carbohydrate biochemistry and physiology.
The health benefits to diabetic individuals, when refined carbohydrates are replaced by whole grains in the diet are further supported by a series of evidence-based research (Sun et al. 2010, Ye et al. 2012, Aune et al. 2013 and Wang et al. 2013). Individuals with diabetes are encouraged to replace refined carbohydrates and added sugars with whole grains, legumes, vegetables, and fruits. The consumption of sugar –sweetened beverages and “low-fat” or “non-fat” products with high amounts of refined grains and added sugars should be discouraged (ADA, 2016)
The carbohydrate strategy – an urgency to move from secondary management to primary prevention at the population level
Similarly, in the context of primary setting, evidence from both epidemiological & randomised control trials, is emerging that there is a dose-response relationship between levels of consumption of refined carbohydrate foods (white rice, noodles, white breads), and risk of developing type 2 diabetes (Chanson-Rolle, 2015). On average, every additional serving (250g plate) of white rice increases the risk of type 2 diabetes by >11% (Hu et al., 2012). Randomised control trials have similarly shown that substituting brown rice for white rice can lower the risk of type 2 diabetes. (Hsu et al., 2008; Panlasigui & Thompson, 2006).