Tuesday, September 13, 2011

Goji Berry

Tuesday, September 13, 2011

Goji (Lycium spp.) 

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies.
Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s).
Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms
• Barbary wolfberry, betaine, boxthorn, carotenoids, Chinese boxthorn, Chinese matrimony vine,
Chinese wolfberry, Di Gu Pi, Digupi, dried wolfberries, fructus Lycii, fructus Lycii berry, fructus Lycium barbarum L., goji berry, goji juice, gou qi (Chinese), gou qi zi (Chinese), gouqi (Chinese), gouqizi (Chinese), Kei Tze, L. exsertum, L. fremontii, lutein, Lycii berries, Lycii chinense, Lycii fructus, Lycii fruit, Lycium, Lycium barbarum, Lycium barbarum polysaccharides (LBP), Lycium californicum, Lycium chilense, Lycium chinense, Lycium europaeum, Lycium halimifolium, Lycium nodosum, Lycium parishii, Lycium ruthenicum, Lycium shawii, Lycium vulgare, matrimony vine, Ning Xia Gou Qi (Chinese), polysaccharides, scopoletin, Solanaceae (family), Tibetan goji berry, wolfberry, wolfberry fruit, zeaxanthin.

• The dried ripe fruits of Lycium barbarum and Lycium chinense, commonly called goji berry or
wolfberry, have been consumed for medicinal purposes and as a functional food in China and
throughout Asia for at least 2,000 years. Traditionally, goji berry has been used for its antiaging properties, vision-enhancing and immune system-enhancing effects, and support of kidney and liver function, and as a treatment for respiratory diseases. Goji berries contain significant quantities of lutein and zeaxanthin, which are antioxidant carotenoid pigments. The leaves, roots, and root bark of Lycium species have also been used medicinally.
• China is the world's main supplier of commercially grown goji berries. In the 21st Century, goji
berries and juice have become increasingly popular "superfoods" in the Western world.
• Although not well-studied in humans, Lycium barbarum polysaccharides (LBP) have
demonstrated anticancer, antidiabetic, anti-infertility, antioxidant, blood pressure-lowering,
cholesterol-lowering, and immune-stimulating properties. More human clinical studies are needed
to investigate goji's potential therapeutic effects.

Scientific Evidence Uses 
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Preliminary evidence suggests that a traditional Chinese medicine, "Invigorating Kidney," which
contains seven herbs, including goji, may improve airway flow in asthmatics. More research is
required to determine the effects of goji alone, as well as in combination with other herbs.

Polysaccharides from goji may have immune-stimulating effects. In human research, cancer patients receiving goji plus immune system-stimulating biological drugs improved more than patients receiving the drugs only. Additional research is needed before firm conclusions can be made.

Goji berries contain high concentrations of antioxidants. Goji-containing dietary supplements are marketed as vision-improving agents. High-quality human clinical studies are required before goji's effect on vision can be evaluated.

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

• Acne, age-related nerve damage, aging, alcoholism, Alzheimer's disease, anemia, antiaging,
antifungal, anti-inflammatory, antimicrobial, antioxidant, antioxidant (free radical scavenging,
hypoxia), antitumor, arthritis, athletic performance, attention-deficit hyperactivity disorder (ADHD), autism, chemotherapy adverse effects, chronic fatigue syndrome, cough, depression, diabetes, dizziness, erectile dysfunction, fatigue, fever, food uses, gastrointestinal reflux disease (acid reflux), heart muscle injury, high blood pressure (hypertension), hypoglycemic agent (lowers blood sugar), immune function, immune suppression, immune system enhancement, immune system stimulant, immunomodulation, improving circulation, infertility, irritability, kidney protection, leukemia, lipid-lowering effects, liver protection, liver toxicity (protection), low blood platelets, male infertility, muscle strength, neurodegeneration,neurologic disorders, neuroprotection, nosebleeds, oral hygiene, osteoporosis, ovulation disorders, periodontal disease, radioprotection, radiosensitization, respiratory disease, restless legs syndrome, sexual dysfunction, sweating, thirst, tinnitus (ringing in the ears), tonic, type 2 diabetes, well-being, wheezing.

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

• A dose of 6-15 grams of Lycium berries taken by mouth daily has been suggested. Three to four
ounces of goji juice has been taken by mouth. A typical dose is one or more cups of tea daily,
with its strength based on the condition being treated.
Children (under 18 years old)
• There is no safe or effective dose for goji in children.

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

• Avoid in those with known allergy or hypersensitivity to goji berries, root bark, roots, leaves, goji components, or members of the Solanaceae family.
• Avoid in those with known allergy or hypersensitivity to sulfites or in those with asthma, as
undeclared sulfites have been detected in two separate dried goji berry products.

Side Effects and Warnings
• Anecdotally, high doses of goji berry extract may cause alertness at bedtime and interfere with sleep, as well as cause nausea and vomiting.
• Goji may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or those taking drugs, such as warfarin (Coumadin®), that may increase the risk of bleeding. Dosing adjustments may be necessary.
• Goji may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
• Use cautiously in patients with low blood pressure or in those taking drugs, herbs, or supplements that lower blood pressure.
• Use caution in combination with radiation therapy, as the Lycium barbarum polysaccharide may
enhance the effects of radiation.
• Avoid in asthma patients and in patients with sulfite sensitivities. The New York Department of Agriculture detected the presence of undeclared sulfites, a food additive, in two dried goji berry products from China.
• Avoid in patients who are allergic or hypersensitive to goji, any of its constituents, or members of the Solanaceae family.
• Avoid in pregnant or breastfeeding women as goji may stimulate the uterus.
Pregnancy and Breastfeeding
• Avoid in pregnant or breastfeeding women. Goji may stimulate the uterus.

Most herbs and supplements have not been thoroughly tested for interactions with other herbs,
supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs
• Goji may increase the risk of bleeding when taken with drugs that increase the risk of bleeding.
Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or
heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory
drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
• Goji may lower blood sugar levels. Caution is advised when using medications that may also
lower blood sugar. Patients taking insulin or drugs for diabetes by mouth should be monitored
closely by a qualified healthcare professional, including a pharmacist. Medication adjustments
may be necessary.
• Goji may lower blood pressure. Caution is advised in patients who are taking blood pressuring-
lowering drugs.
• Goji may interfere with the way the body processes certain drugs using the liver's cytochrome
P450 enzyme system. As a result, the levels of these drugs may be increased in the blood, and
may cause increased effects or potentially serious adverse reactions. Patients using any
medications should check the package insert, and speak with a qualified healthcare professional,
including a pharmacist, about possible interactions.
• Goji may also interact with antibiotics, anticancer agents, antidepressant agents (including
monoamine oxidase inhibitors (MAOIs)), antifungals, antivirals, cholesterol-lowering and
triglyceride-lowering drugs, drugs affecting the heart and blood vessels, drugs that are toxic to the liver, hormonal agents (including male sexual hormones), immunosuppressants, insulin,
interleukins, and osteoporosis drugs.

Interactions with Herbs and Dietary Supplements 
• Goji may increase the risk of bleeding when taken with herbs and supplements that are believed
to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of
Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may
theoretically increase the risk of bleeding, although this has not been proven in most cases.
• Goji may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need
• Goji may lower blood pressure. Caution is advised in patients who are taking blood pressuring-
lowering herbs or supplements.
• Goji may interfere with the way the body processes certain herbs or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements
possibly have on the P450 system.
• Goji may also interact with antibacterials, anticancer agents, antidepressant agents (including monoamine oxidase inhibitors (MAOIs)), antifungals, antivirals, cholesterol-lowering and triglyceride-lowering agents, herbs affecting the heart, herbs that affect the immune system, herbs toxic to the liver, hormonal herbs and supplements, iron, iron-containing foods,
osteoporosis agents, vitamin C, vitamin C-containing foods, zeaxanthin, zinc, and zinc-containing foods.

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
1. Benzie IF, Chung WY, Wang J, et al. Enhanced bioavailability of zeaxanthin in a milk-based formulation of wolfberry (Gou Qi Zi; Fructus barbarum L.). Br J Nutr 2006;96(1):154-160. View Abstract
2. Breithaupt DE, Weller P, Wolters M, et al. Comparison of plasma responses in human subjects after the ingestion of 3R,3R'-zeaxanthin dipalmitate from wolfberry (Lycium barbarum) and non-esterified 3R,3R'- zeaxanthin using chiral high-performance liquid chromatography. Br J Nutr 2004;91(5):707-713. View Abstract
3. Cao GW, Yang WG, Du, P. [Observation of the effects of LAK/IL-2 therapy combining with Lycium barbarum polysaccharides in the treatment of 75 cancer patients]. Zhonghua Zhong Liu Za Zhi 1994;16(6):428-431. View Abstract
4. Cheng CY, Chung WY, Szeto YT, et al. Fasting plasma zeaxanthin response to Fructus barbarum L. (wolfberry; Kei Tze) in a food-based human supplementation trial. Br J Nutr 2005;93(1):123-130. View Abstract
5. Fu JX. [Measurement of MEFV in 66 cases of asthma in the convalescent stage and after treatment with Chinese herbs]. Zhong Xi Yi Jie He Za Zhi 1989;9(11):658-9, 644. View Abstract
6. Gan L, Hua Zhang S, Liang Yang X, et al. Immunomodulation and antitumor activity by a polysaccharide- protein complex from Lycium barbarum. Int Immunopharmacol 2004;4(4):563-569. View Abstract
7. Gan L, Zhang SH, Liu Q, et al. A polysaccharide-protein complex from Lycium barbarum upregulates cytokine expression in human peripheral blood mononuclear cells. Eur J Pharmacol 2003;471(3):217-222. View Abstract
8. Gong H, Shen P, Jin L, et al. Therapeutic effects of Lycium barbarum polysaccharide (LBP) on irradiation or chemotherapy-induced myelosuppressive mice. Cancer Biother Radiopharm 2005;20(2):155-162. View Abstract
9. Kim HP, Kim SY, Lee EJ, et al. Zeaxanthin dipalmitate from Lycium chinense has hepatoprotective activity. Res Commun Mol Pathol Pharmacol 1997;97(3):301-314. View Abstract
10. Lee DG, Jung HJ, Woo ER. Antimicrobial property of (+)-lyoniresinol-3alpha-O-beta-D-glucopyranoside isolated from the root bark of Lycium chinense Miller against human pathogenic microorganisms. Arch Pharm Res 2005;28(9):1031-1036. View Abstract
11. Luo Q, Li Z, Huang X, et al. Lycium barbarum polysaccharides: Protective effects against heat-induced damage of rat testes and H2O2-induced DNA damage in mouse testicular cells and beneficial effect on sexual behavior and reproductive function of hemicastrated rats. Life Sci 2006;79(7):613-621. View Abstract
12. Luo Q, Cai Y, Yan J, et al. Hypoglycemic and hypolipidemic effects and antioxidant activity of fruit extracts from Lycium barbarum. Life Sci 2004;76(2):137-149. View Abstract
13. Wu H, Guo H, Zhao R. Effect of Lycium barbarum polysaccharide on the improvement of antioxidant ability and DNA damage in NIDDM rats. Yakugaku Zasshi 2006;126(5):365-371. View Abstract
14. Yu MS, Leung SK, Lai SW, et al. Neuroprotective effects of anti-aging oriental medicine Lycium barbarum against beta-amyloid peptide neurotoxicity. Exp Gerontol 2005;40(8-9):716-727. View Abstract
15. Zhao R, Li Q, Xiao B. Effect of Lycium barbarum polysaccharide on the improvement of insulin resistance in NIDDM rats. Yakugaku Zasshi 2005;125(12):981-988. View Abstract
Natural Standard Monograph (www.naturalstandard.com)
Copyright © 2011 Natural Standard Inc. Commercial distribution or reproduction prohibited..

Wednesday, July 6, 2011

PMS - B Vitamin-rich food

SourceAm J Clin Nutr, February 23, 2011;[Epub ahead of print]

Research: Thiamine, riboflavin, niacin, vitamin B-6, folate and vitamin B-12 are required to synthesize neurotransmitters that are potentially involved in the pathophysiology of premenstrual syndrome (PMS). In this study, researchers set out to evaluate whether B vitamin intake—from food sources and supplements—is associated with the initial development of PMS. They conducted a case-control study nested within the Nurses’ Health Study II cohort among participants who were free of PMS at baseline (1991). After 10 years of follow up, 1057 women were confirmed as cases and 1968 were confirmed as controls. Dietary information was collected in 1991, 1995 and 1999 by using food-frequency questionnaires.

Results: Intakes of thiamine and riboflavin from food sources were each inversely associated with incident PMS. For example, women in the highest quintile of riboflavin intake 2-4 years before the diagnosis year had a 35% lower risk of developing PMS than did those in the lowest quintile. However, there were no significant associations between incident PMS and dietary intakes of niacin, vitamin B-6, folate, and vitamin B-12. Additionally, intake of B vitamins from supplements was not associated with a lower risk of PMS.

Prostate Cancer - Vitamin E, Soy and Selenium

Source:J Clin Oncol, May 2, 2011. [Epub ahead of print].

Research: High-grade prostatic intraepithelial neoplasia (HGPIN) is a putative precursor of invasive prostate cancer (PCa) and preclinical evidence suggests vitamin E, selenium and soy protein may prevent the progression of HGPIN to PCa. This hypothesis was tested among 300 men in a randomized phase III double-blind study of daily soy (40 grams), vitamin E (800 IUs) and selenium (200 μg) consumption versus placebo. Treatment was administered daily for 3 years. Follow-up prostate biopsies occurred at 6, 12, 24 and 36 months post-randomization.

Results: For all patients, the median age was 63 years. The median baseline prostate-specific antigen (PSA; n = 302) was 5.41 ug/L; total testosterone (n = 291) was 13.4 nmol/L. Invasive PCa developed among 26% of patients. Gleason score distribution was similar in both groups, with 83.5% of cancers graded Gleason sum of 6. Baseline age, weight, PSA and testosterone did not predict for development of PCa. The supplement was well tolerated with flatulence reported more frequently (27% vs. 17%) among men receiving micronutrients. According to researchers, this trial does not support the hypothesis that combination vitamin E, selenium and soy prevents progression from HGPIN to PCa.

Olive Oil and Stroke

Source: Neurology, June 15, 2011;[Epub ahead of print].

Research: Among participants from the Three-City Study with no history of stroke at baseline, researchers examined the association between olive oil consumption (main sample, n=7625) or plasma oleic acid (secondary sample, n=1245) and incidence of stroke (median follow-up 5.25 years), ascertained according to a diagnosis validated by an expert committee.

Results: In the main sample, 148 incident strokes occurred. After adjustment for socio-demographic and dietary variables, physical activity, body mass index, and risk factors for stroke, a lower incidence for stroke with higher olive oil use was observed. Compared to those who never used olive oil, those with intensive use had a 41% lower risk of stroke. In the secondary sample, 27 incident strokes occurred. After full adjustment, higher plasma oleic acid was associated with lower stroke incidence. Compared to those in the first tertile, participants in the third tertile of plasma oleic acid had a 73% reduction of stroke risk.

Wednesday, April 13, 2011

Broccoli sprouts: Cancer

Resource: Nutr Cancer, February 2011;63(2):196-201.

Research: Sulforaphane (SF) is a chemopreventive isothiocyanate (ITC) derived from the myrosinase-catalyzed hydrolysis of glucoraphanin, a thioglucoside present in broccoli. Broccoli supplements often contain glucoraphanin but lack myrosinase, putting in question their ability to provide dietary SF. This study compared the relative absorption of SF from air-dried broccoli sprouts rich in myrosinase and a glucoraphanin-rich broccoli powder lacking myrosinase, individually and in combination. Subjects (n = 4) each consumed 4 meals consisting of dry cereal and yogurt with 2 g sprouts, 2 g powder, both or neither. Blood and urine were analyzed for SF metabolites.

Results: The 24-hour urinary SF recovery was 74%, 49% and 19% of the dose ingested from broccoli sprouts, combination and broccoli powder meals, respectively. Urinary and plasma ITC appearance was delayed from the broccoli powder compared to the sprouts and combination. A liver function panel indicated no toxicity from any treatment at 24 hours. These data indicate a delayed appearance in plasma and urine of SF from the broccoli powder relative to SF from myrosinase-rich sprouts. Combining broccoli sprouts with the broccoli powder enhanced SF absorption from broccoli powder, offering the potential for development of foods that modify the health impact of broccoli products.

Wednesday, March 2, 2011

Types of Functional Foods

There are three different types of functional foods. First, there are those products that are inherently healthy. This includes products that do not add any bioactives, but intrinsically contain nutritional compounds that have scientific data to support functionality. For instance, Welch’s grape juice sales increased 33% following the release of clinical data supporting antioxidant activity and cardiovascular benefits; Gardenburger sales increased 25% in the two months following the FDA approved health claim for soy; cranberry juice sales increased 20% after the results of a 1994 Harvard study demonstrated health benefits; and General Mill’s Cheerios sales jumped 11% after being marketed for a heart health benefit.

The second category of functional foods includes those which add a researched bioactive compound to provide a health benefit. The classic example here is Tropicana Pure Premium orange juice, which reformulated its line with added calcium, growing sales 173% and building a new category. This class of functional foods addressed the reintroduction of orphaned phytonutrients.

Finally, engineered functional foods are those formulated specifically to deliver a desired functional benefit. Whether you knock back a Red Bull for an energy lift, a PowerBar for sports performance benefit, or a Gatorade to replenish electrolytes, these products are based on scientific research to deliver to the consumer a desired benefit.

Functional foods are not a panacea and are therefore bound to be abused, just as dietary supplements have been. In other words, in controlled dosing, such as pills, one can specify the amount of certain bioactive compounds such as vitamin A. But when these compounds are in a food product, it is a bit more difficult to manage the dosing, especially when a good tasting snack product is involved. Maybe one just wasn’t enough and soon the consumer is doubling or tripling the amount of vitamin A, possibly reaching a potentially toxic level. Remember General Mill’s Cheerios? Well, FDA recently claimed that Cheerios were being marketed as a drug, since the company promoted cholesterol reduction of 4% in six weeks.

Another valid concern is the encouragement of additional caloric intake. Functional foods “delude people into thinking that [they] are healthy,” says author and New York University food scientist Marion Nestle. And many of the foods marketed as functional are not particularly “healthy” aside from the bioactives involved.

Considering more than half of households are using food or beverages to treat or manage specific health issues, it is important to recognize the burden that must be carried by companies marketing these products. If consumers are eating medicine like it’s food, they could get too much of a good thing. And the consumption of additional calories simply feeds a real health pandemic: obesity. So it is very important that manufacturers think very carefully about what they are formulating and how they are marketing these functional food products. The key take away is this: functional food success will be defined by wellness, not disease treatment.

Tuesday, March 1, 2011

Diabete Mellitus

Diabete Mellitus e uma condição na qual o corpo não metaboliza o açúcar devidamente. O sintoma mais proeminente e a sede e a frequencia urinaria; complicações da diabete frequentemente inclui cegueira, doenças cardiacas, problemas renais e de circulação nas extremidades do corpo. No caso de diabete Mellitus o pâncreas nao produz a quantidade suficiente de insulina, um hormônio que controla o nível de sangue. O resultado e hiperglicemia (excesso de açúcar no sangue).

O caso mais comum de diabete e quando começa na fase adulta - e produzida a quantidade adequada de insulina mas sua utilização nas células do corpo e simplesmente bloqueada pelos efeitos de uma dieta rica em gorduras (açúcar refinado e outros tipos de açúcar que mais tarde se convertem em gordura). Quando uma dieta em baixa gordura como grãos integrais, vegetais e legumes e seguida por algumas semanas, aproximadamente 80% dos diabéticos podem parar de tomar insulina e pílulas para diabete e os 20% restantes podem reduzir suas medicação.

O nível elevado de gordura que normalmente causa a diabete também causa a estagnação do fígado, uma condição de excesso que cause desequilíbrio entre o Baco e o Pâncreas através do ciclo dos Cinco Elementos destrutivos, desta forma fazendo a secreção pancreática (insulina) menos efetiva.

A solução obvia e o menor consumo de comida, especialmente comidas que estressam o fígado e enfraquecem o Baco-Pancreas. Embora se possa limitar a ingestão de gorduras (carne, ovos, queijo, manteiga,, excesso de óleo, nozes e sementes) e evitar comidas refinadas (massas, qualquer uso da farinha branca, açúcar, gorduras sintéticas - como margarina, ingredientes químicos e tóxicos que encontramos escondidos nas comidas preparadas), e comidas muito doces, salgadas e condimentadas. Evitar comer tarde da noite, dando preferência para freqüentes mas pequenas quantidades que ajudam a estimular a produção de insulina.

Cromo, zinco e manganês são fatores que controlam o nível de sangue. estes minerais são removidos no processo de refinamento do açúcar, farinha, sal e outros produtos processados. Nos farelos dos cereais integrais ainda encontramos este minerais presentes. Os farelos são também uma fonte rica em silício, um mineral que aumenta as funções do pâncreas .
De modo a maximizar a absorção dos minerais podemos empregar a clorofila, o maior catalisador do reino vegetal que aumenta a utilização de todos os nutrientes nos humanos, favorecendo desta maneira no tratamento da diabetes. A clorofila catalisa a renovação das células, o que em longo termo favorece ao diabética na reconstrução do pâncreas que se encontra danificado. Uma vez que a diabete geralmente envolve acidez sanguinea, uma intoxicação generalizada e varias inflamações, a alcalinização, desintoxicação e os efeitos anti inflamatório da clorofila são desta forma úteis. Mesmo extrato puro de clorofila são efetivos no tratamento da diabete embora os alimento com teor elevado – especialmente o trigo e a cevada, a espirulina, e a clorela – contem extra minerais, enzimas e outros nutrientes.

A pratica mais básica para aumentar a assimilação dos nutrientes e uma boa mastigação, especialmente em carboidratos complexos, a digestão começa ai com a saliva e o mastigar que e essencial para a completa dissolução do alimento favorecendo a absorção dos outros nutrientes. Se sentindo satisfeito o diabético tende a comer sem excesso e evita as grandes refeições.