The present invention relates to a method for reducing the postprandial glycemic excursion to carbohydrates by feeding supplemental fructose prior to the carbohydrate challenge. The unit does of fructose required to blunt the postprandial glycemic excursion is from about 2 grams to about 30 grams fructose. The fructose source is consumed from about 10 to about 90 minutes before a meal.

Description of the Invention

TECHNICAL FIELD

The present invention relates to a method for reducing the postprandial glycemic excursion by feeding supplemental fructose prior to the carbohydrate challenge and to its use in the dietary management of diabetics.

INTRODUCTION

The control of blood glucose in people with diabetes mellitus is of paramount importance for the long-term management of this disease. While intensive treatment with insulin or oral glucose-lowering agents is of great benefit, they are associated with an increased risk of hypoglycemia and weight gain. The concomitant use of diet as adjunctive therapy for the management of blood glucose further enhances the quality of life and reduces the risk of hypoglycemia and weight gain in people with diabetes. Furthermore, nutritional management should be the first mode of treatment for people with insulin resistance or early stage type 2 diabetes mellitus as well as a preventative therapy for high-risk populations (e.g., obese and first degree relatives of people with type 2 diabetes mellitus).

American Diabetes Association (ADA) guidelines emphasize individualization of diet strategies. The purpose is to achieve optimal glycemic and metabolic control by varying the proportion of calories provided by the macronutrients. The proportion selected depends on goals for glycemic control, dietary preferences and response to the diet.

The ADA currently recommends a diet in which protein is the same as that for the general population and accounts for 10% to 20% of total calories. With protein contributing 10% to 20% of the total calories, 80% to 90% of the total calories remain to be distributed between carbohydrate and fat. The carbohydrate/fat mix is individualized according to dietary preference, treatment goals, metabolic control and the presence of other medical conditions. However, the ADA does make a recommendation for the various types of fat in the diet. Specifically, saturated fat should contribute less than 10% of total calories, and polyunsaturated fat contributing no more than 10% of total calories. The remainder of fat calories should come from monounsaturated fat and the daily intake of cholesterol should be limited to less than 300 mg. The recommendation for fiber intake is the same as for the general public with approximately 20 to 35 g/day of dietary fiber from a variety of food sources. The micro nutrient requirements of otherwise healthy persons with diabetes mellitus will likely be met by consuming the amounts suggested by the Reference Daily Intakes (RDIs). Individuals considered at risk for micronutrient deficiencies should be evaluated to determine if supplementation is necessary. Because fructose and sucrose intake have been shown to cause hypertriacylglycerolemia and hypercholesterolemia in rats and humans, nutritional recommendations have been made to avoid supplementation of simple sugars to the diabetic diet.

Products designed as nutritionals for the person with diabetes are commercially available and typically include fructose as a sweetener. These nutritional products are typically liquids or in a solid form such as nutritional bars and baked goods.

Glucerna.RTM. (Ross Products Division of Abbott Laboratories, Columbus Ohio) is a liquid nutritional with fiber for patients with abnormal glucose tolerance. Sodium and calcium caseinates make up 16.7% of total calories as protein; maltodextrin, soy polysaccharide and fructose make up 34.3% of total calories as carbohydrate; and high oleic safflower oil and canola oil make up 49% of total calories as fat. Soy polysaccharide contributes 14.1 g/1000 ml of total dietary fiber. The RDI for vitamins and minerals is delivered in 1422 kcals. The product also contains the ultra trace minerals selenium, chromium and molybdenum and the conditionally essential nutrients carnitine and taurine.

Resource.RTM. Diabetic (Sandoz Nutrition Corporation, Berne, Switzerland) is a complete liquid formula with fiber specifically designed for persons with type 1 and type 2 diabetes and for persons with stress-induced hyperglycemia. Sodium and calcium caseinates, and soy protein isolate make up 24% of total calories as protein; hydrolyzed corn starch and fructose make up 36% of total calories as carbohydrate; and high oleic sunflower oil and soybean oil make up 40% of total calories as fat. Partially hydrolyzed guar gum contributes 3.0 g/8 fl. oz. of total dietary fiber. The RDI for vitamins and minerals is delivered in 2000 kcals. The product also contains the ultra trace minerals selenium, chromium and molybdenum and the conditionally essential nutrients carnitine and taurine.

Ensure.RTM. Glucerna.RTM. Shake (Ross Products Division of Abbott Laboratories, Columbus Ohio) is an oral supplement specifically designed for people with diabetes. Sodium and calcium caseinates and soy protein isolate make up 18% of total calories as protein; maltodextrin, fructose, maltitol, soy polysaccharide and FOS make up 47% of total calories as carbohydrate; and high oleic safflower oil and canola oil make up 35% of total calories as fat. Soy polysaccharide and fructooligosaccharides (FOS) contribute 3.0 g/8 fl. oz. of total dietary fiber. At least 25% of the DV for 24 key vitamins and minerals are delivered in 8 fl. oz. The product also contains the ultra trace minerals selenium, chromium and molybdenum.

Ensure.RTM.Glucerna.RTM. Snack Bars (Ross Products Division of Abbott Laboratories, Columbus Ohio) are complete, balanced nutritional bars designed specifically for people with diabetes. Soy protein, rice protein, corn protein and milk and cocoa (from the coating) make up 17% of total calories as protein; high fructose corn syrup, honey, microencapsulated guar gum, rice starch, maltodextrin, soy polysaccharide, glycerin, microcrystalline cellulose, fructooligosaccharides (FOS) and maltitol (from the coating) make up 57% of total calories as carbohydrate; and partially hydrogenated soy and cottonseed oils, high oleic safflower oil and canola oil make up 26% of total calories as fat. Microencapsulated guar gum, soy polysaccharide, microcrystalline cellulose, FOS and resistance starch contribute 4 g total dietary fiber per 1.34 oz bar. One bar provides at least 15% of the DV for 24 key vitamins and minerals. The product also contains the ultra trace minerals selenium, chromium and molybdenum and the conditionally essential nutrient m-inositol.

Choice Dm.RTM. Bar (Mead Johnson & Company, Evansville, Ind.) is a nutritional bar with fiber, antioxidants and 24 essential vitamins and minerals for people with diabetes. Calcium caseinate, soy protein isolate, whey protein concentrate, toasted soybeans, soy nuggets (soy protein isolate, rice flour, malt, salt) and peanut butter make up 17.1% of total calories as protein; lactose, fructose, sugar, dextrose, honey, maltodextrin, rice syrup, sorbitol and peanut flour make up 54.3% of total calories as carbohydrate; and palm kernel oil and canola oil make up 28.9% of total calories as fat.

Typically, the commercial nutritionals are designed as meal replacements and include all the macro and micronutrients required of a meal replacement. These nutritionals typically utilize multiple sources of carbohydrate that are absorbed at different rates to control the glycemic response to the nutritional. While the nutritionals are handy for a busy schedule when it is not practical to prepare a meal, many diabetics prefer to eat "normal" food and do not want to routinely consume their entire meal out of a can. There is clearly a need for an easy method to blunt the glycemic response of a meal composed of "normal" food.

SUMMARY OF THE INVENTION

The nutritive sweetener, fructose, in itself is a dietary carbohydrate source with a low postprandial glycemic excursion. Because of its reduced glycemic response, fructose is an ideal carbohydrate for use in the dietary control of postprandial glycemia in people with diabetes mellitus. However, because fructose intake levels greater than 17% of total Kcal have been shown to cause hypertriacylglycerolemia and hypercholesterolemia in rats and humans, dietary recommendations for the diabetic have been made to avoid high intakes of simple carbohydrates, especially fructose.

The inventors discovered that low amounts of supplemental fructose when given along with a meal glucose tolerance test had no effect on the postprandial glycemic response. However, when a low dose of fructose was given prior to the meal tolerance test, fructose reduced the postprandial glycemic response.

The present invention relates to a method for reducing the postprandial glycemic excursion to carbohydrates by feeding supplemental fructose prior to the carbohydrate challenge. The unit does of fructose required to blunt the postprandial glycemic excursion is from about 2 grams to about 30 grams fructose, preferably from about 5 to about 15 grams of fructose, more preferably about 10 grams of fructose. The fructose source is consumed from about 10 to about 90 minutes before a meal, preferably from about 15 to about 75 minutes before a meal, more preferably from about 30 to about 60 minutes before a meal.

The source of fructose may be any food grade fructose source such as sucrose, maltitol, high fructose corn syrup, honey, fruit, fruit juice, liquid fructose, powder fructose and crystalline fructose.

The fructose dose may be in any suitable form such as a tablet, caplet, lozenge, powder, crystal, fruit, syrup, candy and liquid.

The method may be used for nutritional management of persons with diabetes, for people with insulin resistance as well as a preventative therapy for high-risk populations (e.g., obese and first degree relatives of people with type 2 diabetes mellitus).

DETAILED DESCRIPTION OF THE INVENTION

The present invention relates to a method of feeding fructose to a person prior to a carbohydrate challenge, which significantly reduces the postprandial glycemic excursion to that challenge. As described in Example I, the inventors surprising discovered that 10 g supplemental fructose when given with a meal glucose tolerance test (50 g carbohydrate from instant mashed potatoes) had no effect on the postprandial glycemic response. However, when 10 g of fructose were given 30 or 60 minutes before the meal tolerance test, fructose reduced the postprandial glycemic response.

The amount of fructose required to blunt the postprandial glycemic excursion is from about 2 grams to about 30 grams, preferably from about 5 to about 15 grams of fructose, more preferably about 10 grams of fructose.

Any fructose source suitable for human consumption may be utilized in the instant invention. Examples of typical fructose sources include sucrose, maltitol, high fructose corn syrup, honey, fruit, fruit juice, liquid fructose, powder fructose and crystalline fructose. Examples of suitable fruit and fruit juices include apple, grape, orange, grapefruit, pear and watermelon.

Fructose is found in fruits and honey. More typically, commercially available fructose is produced by well known enzymatic conversion of saccharides to fructose. The fructose content of various sources is listed in Table 1 (see Original Patent).

Commercial high fructose corn syrup is available with various levels of fructose. The high fructose corn syrup profiles listed in Table 1 represent typical commercially available high fructose corn syrup, with fructose levels at 42% and 55% of the corn syrup, respectively. Typical values for fructose sources of different fruit may be found in Human Nutrition Information Service (1987) Sugar content of selected foods: Individual and total sugars. (Home Economics Research Report no. 48, USDA, Washington, D.C.) Examples of appropriate fruits include a raw apple (31/4 inch diameter) which typically contains 10.5 gm fructose and 4.6 gm of sucrose; a Bartlett pear (21/2 inch diameter) typically contains 10.6 mg fructose and 3 gm of sucrose; and grape juice reconstituted frozen concentrate (8 fl. oz.) typically contains 11 gm of fructose. One knowledgeable in the art would be able to select the appropriate type and amount of fruit or fruit juice to serve as a source of fructose.

Any reference in this application to a quantity of fructose should be understood as referring to the actual fructose content within the carbohydrate source. For example, 100 gm of the honey in Table 1 would provide 49 gm of fructose. One skilled in the art can readily calculate how much of a carbohydrate source is required to deliver the desired amount of fructose.

Fructose may be indirectly provided by feeding maltitol or sucrose to the subject. Sucrose is hydrolyzed and absorbed in the small intestine as glucose and fructose. Maltitol (glucose alpha-1,4 sorbitol) is hydrolyzed and absorbed in the small intestine as glucose and sorbitol. Sorbitol is dehydrogenated (via sorbitol dehydrogenase) in the liver to fructose. Sorbitol alone is not a suitable indirect source of fructose, because it is malabsorbed from the small intestine.

Commercial sources for fructose are readily available and known to one practicing the art. For example, various high fructose corn syrups are available from Cargil in Minneapolis, Minn. Liquid and powder fructose is available from A. E. Staley in Decatur, Ill. Honey, fruit and fruit juices are available from the local grocery stores.

Because the fructose is consumed prior to a meal, individual unit dose size packages are preferred over bulk packaging. Suitable dosage forms typically include tablet, caplet, lozenge, powder, crystal, fruit, syrup, candy and liquid. Examples of preferred dosage forms typically include crystalline fructose packaged in a sachet, fructose chewable tablets packaged in a roll, individually wrapped hard candies, an 8 fl. oz bottle of grape juice and one medium raw apple.

Typically, from about 1 to about 10 fructose doses are consumed prior to the meal, preferably from about 1 to about 5, more preferably from about 1 to 2 fructose doses are consumed prior to the meal. One knowledgeable in the art would be able to produce acceptable dosage forms by well known manufacturing procedures in the food and confectionery industry.

As noted above, the fructose dose is consumed from about 10 to about 90 minutes before a meal, preferably from about 15 to about 75 minutes before a meal, more preferably from about 30 to about 60 minutes before a meal.

A diabetic would typically practice the method of the invention 30 minutes prior to a meal, by consuming 2 hard candies that contain 5 gm of fructose each.

Numerous types of containers are readily available and know to one practicing the art. Convenience is the primary criteria for selecting the appropriate container depending on the dosage form. Examples of container types typically include packets or sachets which are typically manufactured of paper, foil and plastic film, and foil and plastic film coated paper; blister packs which are typically manufactured of paper, foil, plastic, plastic film; rolls or tubes which are typically manufactured of paper, foil, plastic, plastic film; ampoules which may be manufactured of plastic, reinforced paper and glass; and individual wrappers which are typically manufactured of paper, foil, plastic film.
 

Claim 1 of 12 Claims

1. A method for blunting the postprandial glycemic response to a meal, said method comprising feeding a diabetic individual from about 2 grams to about 30 grams of a source of supplemental fructose from about 10 minutes to about 90 minutes prior to a meal, wherein the source of supplemental fructose is selected from the group consisting of liquid fructose, powder fructose and crystalline fructose, in a dosage form selected from the group consisting of sachet, tablet, caplet, lozenge, powder, syrup, and liquid.

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