Sweeteners and metabolic disorders

  • N. Finer


It is only recently that man has been exposed to a significant intake of sweetness in the diet. The pattern of sweetener use is rapidly changing; use of sucrose from cane and beet is giving way to corn-derived syrups (which contain fructose as well as sucrose), new nutritive sweeteners such as sorbitol and xylitol, and a rapidly growing use of intense, non-nutritive (or artificial) sweeteners such as saccharin and aspartame. This chapter considers the metabolic fate of this variety of sweet-tasting dietary components, how they may affect health, and the problems they pose for individuals already suffering from certain metabolic diseases such as diabetes mellitus and phenylketonuria.


Blood Glucose Level Uric Acid Level Glycogen Storage Disease Gastric Inhibitory Polypeptide Glycaemic Index 
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  1. Abraira C. and Derler J. (1988) Large variations of sucrose in constant carbohydrate diets in Type II diabetes. Am. J. Med. 84, 193–200.CrossRefGoogle Scholar
  2. Akerblom, H.K., Siltanen, I. and Kallio, A.K. (1972) Does dietary fructose affect the control of diabetes in children? Acta Med. Scand. 542 (Suppl.), 197–202.Google Scholar
  3. American Diabetes Association (1979) Principles of nutrition and dietary recommendations for individuals with diabetes mellitus. Diabetes 28, 1027.Google Scholar
  4. Anderson J.W., Herman R.H. and Zakim D. (1973) Effect of high glucose and sucrose diets on the glucose tolerance of normal men. Am. J. Clin. Nutr. 26, 600–607.Google Scholar
  5. Arvidsson-Lenner, R. (1976) Studies of glycemia and glycosuria in diabetics after breakfast meals of different composition. Am. J. Clin. Nutr. 29, 716–725.Google Scholar
  6. Arvidsson-Lenner, R. (1976) Specially designed sweeteners and food for diabetics—a real need. Am. J. Clin. Nutr. 29, 726–733.Google Scholar
  7. Bantle, J.P. (1989) Clinical aspects of sucrose metabolism. Diabetes Care 12 (Suppl. 1), 56–61.CrossRefGoogle Scholar
  8. Bantle, J.P., Laine, D.C., Castle, G.W., Thomas, J.W., Hoogwerf, B.J. and Goetz, F.C. (1983) Postprandial glucose and insulin responses to meals containing different carbohydrates in normal and diabetic subjects. N. Engl. J. Med. 309, 7–12.CrossRefGoogle Scholar
  9. Bantle, J.P., Laine, D.C. and Thomas, J.W. (1986) Metabolic effects of dietary fructose and sucrose in types I and II diabetic subjects. J. Am. Med. Assoc. 256, 3241–3246.CrossRefGoogle Scholar
  10. Beaugerie, L. (1987) Contribution à l’étude du transport intestinal du sorbitol chez l’homme, Thesis, Hôpital St Lazare, Paris.Google Scholar
  11. Bennett, P.H., Rushforth, H.B. Miller, M. and LeCompte, P.M. (1976) Epidemiologic studies of diabetes in the Pima Indians. Rec. Prog. Horm. Res. 32, 333–376.Google Scholar
  12. Blayo, A., Fontvieille, A.M., Acosta, M., Bruzzo, F., Tchobroutsky, G. and Slama, G. (1988) Metabolic effects of a one year daily intake of granulated sucrose or fructose by diabetic patients. Diabetologia, 472A.Google Scholar
  13. Bossetti, B.M., Kocher, L.M., Moranz, J.F. and Falko, J.M. (1984) The effects of physiologic amounts of simple sugars on lipoprotein, glucose and insulin levels in normal subjects. Diabetes Care 7, 308–312.CrossRefGoogle Scholar
  14. Brunzell, J.D. (1978) Use of fructose, sorbitol, or xylitol as a sweetener in diabetes mellitus. Diabetes Care 1, 223–230.CrossRefGoogle Scholar
  15. Bunn, H.F. and Higgins, P.J. (1981) Reaction of monosaccharides with proteins: possible evolutionary significance. Science 213, 222–224.CrossRefGoogle Scholar
  16. Caballero, B., Mahon, B.E., Rohr, F.J., Levy, H.L. and Wurtman, R.J. (1986) Plasma amino acid levels after single-dose aspartame consumption in phenylketonuria, mild hyperphenylalaninaemia, and heterozygous state for phenylketonuria. J. Paediatr. 109, 668–671.CrossRefGoogle Scholar
  17. Committee for a Study on Saccharin and Food Safety Policy (1978) Saccharin: Technical Assessment of Risks and Benefits. Assembly of Life Sciences/Institute of Medicine/National Research Council/National Academy of Sciences, Washington, DC.Google Scholar
  18. Coniston, A.M. Hollenbeck, C.B., Swislocki, A.L.M., Chen, Y.-Di and Reaven, G.M. (1987)Google Scholar
  19. Deleterious effects of high carbohydrate sucrose-containing diets in patients with non-insulindependent diabetes mellitus. Am. J. Med. 82, 213–220.Google Scholar
  20. Court, J.M. (1976) Diet in the management of diabetes: why have special foods? Med. J. Aust. 1, 841–843.Google Scholar
  21. Crapo, P.A. (1988) Use of alternative sweeteners in diabetic diet. Diabetes Care 11, 174–182CrossRefGoogle Scholar
  22. Crapo, P.A. and Kolterman, O.G. (1984) The metabolic effects of two-week fructose feeding in normal subjects. Am J. Clin. Nutr. 39, 525–534.Google Scholar
  23. Erkelens, D.W., Stofkooper, A., Van den Bogaard, E. and Van der Snoek, B.E. (1985) Glycaemic effect of mono-, di-and polysaccharides in a mixed meal in diabetic patients. Neth. J. Med. 28, 157–163.Google Scholar
  24. Farber, S.A. (1990) The price of sweetness. Technol. Rev. January, 46–50.Google Scholar
  25. Felber, J.P. Renold, A. and Zahno, G.R. (1959) The comparative metabolism of glucose, fructose and sorbitol in normal subjects and disease states. Med. Prob. Paediatr. 4, 482–487.Google Scholar
  26. Fernandes, J. L. (1975) Hepatic glycogen storage disease. In The Treatment of Metabolic Disease, ed. D.N. Raine, MTP Press, Lancaster, p. 115.Google Scholar
  27. Fernstrom, J.D., Fernstrom, M.H. and Grubb, P.E. Effects of aspartame ingestion on the carbohydrate-induced rise in tryptophan hydroxylation rate in rat brain. Am. J. Clin. Nutr. 44, 195–205Google Scholar
  28. Filer, L.J. Jr. and Stegink, L.D. (1988) Effect of aspartame on plasma phenylalanine concentration in humans. In Dietary Phenylalanine and Brain Function, eds. R.J. Wurtman and E. Ritter Walker, Boston, p. 18.Google Scholar
  29. Filer, L.J. Jr. and Stegink, L.D. (1989) Aspartame metabolism in normal adults, phenylketonuric heterozygotes and diabetic subjects. Diabetes Care 12, 67–74.CrossRefGoogle Scholar
  30. Foiling, A. (1934) Uber Ausscheidung von Phenylbrenztraubensaure in den Harn als Stoffweschselanomalie in Verbindung mit Imbezillatat. Z. Physiol. Chem. 227, 169–176.CrossRefGoogle Scholar
  31. Food and Drug Administration (1984) Food additives permitted for direct addition to food for human consumption; aspartame (denial of request for hearing). Federal Register 49, 6672–6682.Google Scholar
  32. Forfar, J.O. and Arneil, G.C. (1984) Textbook of Paediatrics, Churchill Livingstone, Edinburgh.Google Scholar
  33. Fox, I.H. and Kelly, W.N. (1972) Studies on the mechanism of fructose-induced hyperuricaemia in man. Metab. Clin. Exp. 23, 713–721.CrossRefGoogle Scholar
  34. Francis, D. (1987) Diets for Sick Children, Blackwell Scientific, Oxford.Google Scholar
  35. Froesch, E.R. (1976) Disorders of fructose metabolism. Clin. Endocrinol. Metab. 5, 599–611.CrossRefGoogle Scholar
  36. Gabbay, K.H. (1973) The sorbitol pathway and the complications of diabetes. N. Engl. J. Med. 288, 831–836.CrossRefGoogle Scholar
  37. Garattini, S., Caccia, S. Romano, M. et al. (1988) Studies on the susceptibility to convulsions in animals receiving abuse doses of aspartame. In Dietary Phenylalanine and Brain Function, eds. R.J. Wurtman and E. Ritter-Walker, Birkhauser, Boston.Google Scholar
  38. Garcia, M. McNamara, P. Gordon, T. and Kannel, W.B. (1974) Morbidity and mortality in diabetics in the Framingham population. Diabetes 23, 105–111.Google Scholar
  39. Geekie, M., Eaton, J., Simpson, H. and Mann, J.I. (1981) Will diabetics accept an increase in dietary carbohydrate? Diabetologia 21, 507–510.Google Scholar
  40. Glinsmann, W.H., Irausquinn, H. and Park, Y. (1986) Evaluation of Health Aspects of Sugars Contained in Carbohydrate Sweeteners. Report of Sugars Task Force, US Food and Drug Administration, Washington, DC.Google Scholar
  41. Gonen, B. and Rubenstein, A.H. (1978) Haemoglobin Al and diabetes mellitus. Diabetologia 15, 1–8.CrossRefGoogle Scholar
  42. Hallfrisch, J., Ellwood, K., Michaelis, O.E. IV, Reiser, S., and Prather, E.S. (1984) Plasma fructose, uric acid, and inorganic phosphorus responses of hyperinsulinemic men fed fructose. J. Am. Coll. Nutr. 5, 61–68.Google Scholar
  43. Harper, A.E. Phenylalanine metabolism. In Aspartame: Physiology and Biochemistry, eds. L.D. Stegink and L.J. Filer Jr, Marcel Dekker, New York, p. 77.Google Scholar
  44. Heybach, J.P. and Allen, S.S. Resources for inferential estimates of aspartame intake in the United States. In Dietary Phenylalanine and Brain Function, eds. R.J. Wurtman and E. Ritter-Walker, Birkhauser, Boston, p. 361.Google Scholar
  45. Hollenbeck, C.B., Coulston, A.M. and Reaven, G.M. (1989) Effects of sucrose on carbohydrate and lipid metabolism in NIDDM patients. Diabetes Care 12, 62–66.CrossRefGoogle Scholar
  46. Holzel, A., Schwartz, V. and Sutcliffe, K.W. (1959) Defective lactose absorption causing diarrhoea. Lancet i, 1126.Google Scholar
  47. Horwitz, D.L. (1984) Aspartame use by persons with diabetes. In Aspartame. Physiology and Biochemistry, eds. L.D. Stegink and L.J. Filer, Marcel Dekker, New York, p. 633.Google Scholar
  48. Huijing, F. (1968) Enzymes of glycogen metabolism in leucocytes in relation to glycogen storage disease. In Control of Glycogen Metabolism, Universitetsforlager, Oslo, p. 115.Google Scholar
  49. Jellish, S., Emanuele, M.A. and Abraira, C. (1984) High sucrose carbohydrate diets vs sucrose restricted diets in overt hypertriglyceridemic diabetics. Am. J. Med. 77, 1015–1022.CrossRefGoogle Scholar
  50. Jenkins, D J A., Wolever, T.M.S. and Jenkins, A.L. (1988) Starchy foods and glycemic index. Diabetes Care 11, 149–159.CrossRefGoogle Scholar
  51. Jenkins, D.J.A., Wolever, T.M.S., Leeds, A.R. etal. Dietary fibres, fibre analogues and glucose tolerance: importance of viscosity. Br. Med. J. 1, 1392–1394.Google Scholar
  52. Jenkins, D.J.A., Wolever, T.M.S., Taylor, R.H. et al. (1981) Glycemic index of foods: a physiological basis for carbohydrate exchange. Am. J. Clin. Nutr. 34, 362–366.Google Scholar
  53. Joslin, E.P. (1928) Treatment of Diabetes Mellitus, Lea and Febiger, Philadelphia. Koch, R., Shaw, K.N.F., Williamson, M. and Haber, M. Use of aspartame in phenylketonuric heterozygous adults. J. Toxicol. Environ. Health 2, 453–457.Google Scholar
  54. Kreisberg, R.A. and Wood, B.C. (1983) Drug and chemical-induced metabolic acidosis. Clin. Endocrinol. Metab. 12, 391–411.CrossRefGoogle Scholar
  55. Leiter, L.A., Ryan-Harschman, M. and Anderson, G.H. (1988) Effects of phenylalanine and aspartame on mealtime food intake and behavior in adult males. In Dietary Phenylalanine and Brain Function, eds. R.J. Wurtman and E. Ritter-Walker, Birkhauser, Boston, p. 296.Google Scholar
  56. Leon, S.A., Hunninghake, D.B., Bell, C., Rassin, D.K. and Tephly, T.R. (1989) Safety of long-term large doses of aspartame. Arch. Intern. Med. 149, 2318–2324.CrossRefGoogle Scholar
  57. Lieberman, H.R., Caballero, B., Emde, G.G. and Bernstein, J.M. (1988) The effects of aspartame on human mood, performance and plasma amino acids. In Dietary Phenylalanine and Brain Function, eds. R.J. Wurtman and E. Ritter-Walker, Birkhauser, Boston, p. 198.Google Scholar
  58. Lindquist, B. and Meeuwisse, G.W. (1962) Chronic diarrhoea caused by monosaccharide malabsorption. Acta Paediatr. 51, 674.CrossRefGoogle Scholar
  59. Macdonald, I. (1972) Relationship between dietary carbohydrates and fats in their influence on serum lipid levels. Clin. Sci. 43: 265.Google Scholar
  60. Macdonald, I. Keyser, A. and Pacy, D. (1978) Some effects, in man, of varying the load of glucose, sucrose, fructose, or sorbitol on various metabolites in blood. Am. J. Clin. Nutr. 311305–1311.Google Scholar
  61. Maenpaa, P.H., Raivio, K.O. and Kekomaki, M.P. (1968) Liver adenine nucleotides: fructoseinduced depletion and its effect on protein synthesis. Science 161, 1252–1254.CrossRefGoogle Scholar
  62. Matthews, D.M. (1984) Absortion of peptides, amino acids and their methylated derivatives. In Aspartame Physiology and biochemistry, eds. L.D. Stegink and L.J. Filer Jr, Marcel Dekker, New York, p. 29.Google Scholar
  63. Mazur, R.H., Schlatter, J.M. and Goldkamp, A.H. (1969) Structure-taste relationships of some dipepetides. J. Am. Chem. Soc. 91, 2684.CrossRefGoogle Scholar
  64. McIntyre, N., Holdsworth, D. and Turner, D.S. (1964) New interpretation of oral glucose tolerance. Lancet ii, 20–21.Google Scholar
  65. Mehnert, H. (1978) Advantages and disadvantages of artificial sweeteners and sugar substitutes. In Health and Sugar Substitutes. Proceedings of ERGOB Conference, Karger, Basel, p. 262.Google Scholar
  66. Morgan, L.M., Flatt, P.R. and Marks, V. (1988) Nutrient regulation of the entero-insular axis. Nutr. Res. Rev. 1, 79–97.CrossRefGoogle Scholar
  67. Moskovitz, E. (1937) Der Einfluss vegetabiler Nahrugsmittel auf den Blutzucker bei Diabetikern. Z. Klin. Med. 131, 648–659.Google Scholar
  68. Nasrallah, S.M. and Iber, F.L. (1969) Mannitol absorption and metabolism in man. Am. J. Med. Sci. 258, 80–88.CrossRefGoogle Scholar
  69. Nathan, D.M., Godine, G.E., Gauthier-Kelly, C., Kawahara, D. and Grinvalsky, D. (1984) Ice cream in the diet of insulin-dependent diabetic patients. J. Am. Med. Assoc. 251, 2825–2827.CrossRefGoogle Scholar
  70. Nikkila, E.A. (1974) Influence of dietary fructose and sucrose on serum triglycerides in hypertriglyceridaemia and diabetes. In Sugars in Nutrition. eds. H.L. Sipple and K.W. McNutt, Academic Press, New York, p. 439.Google Scholar
  71. Nutrition Sub-Committee of the British Diabetic Association’s Medical Advisory Committee (1982) Dietary recommendations for the 1980s—a policy statement by the British Diabetic Association. Hum. Nutr. Appl. Nutr. 36A, 378–386.Google Scholar
  72. Opperman, J.A., Muldoon, E. and Ramney, R.E. (1973) Metabolism of aspartame in monkeys. J. Nutr. 103, 1454–1459.Google Scholar
  73. Panel on Diet in Relation to Cardiovascular Disease (1984) Reports on Health and Social Subjects. No 28: Diet and Cardiovascular Disease, HMSO, London.Google Scholar
  74. Panel on Dietary Sugars Committee on Medical Aspects of Food Policy (1989) Report on Health and Social Subjects. No.28: Dietary Sugars and Human Disease, HMSO, London.Google Scholar
  75. Pardridge, W.M. (1977) Kinetics of competitive inhibition of neutral amino acid transport across the blood-brain barrier. J. Neurochem. 28, 103–108.CrossRefGoogle Scholar
  76. Pardridge, W.M. (1988) Phenylalanine transport at the blood-brain barrier. In Dietary Phenylalanine and Brain Function, eds. R.J. Wurtman and E. Ritter-Walker, Birkhauser, Boston, p. 55.Google Scholar
  77. Pelkonnen, R., Aro, A. and Nikkila, E.A. (1972) Metabolic effects of dietary fructose in insulin-dependent diabetes of adults. Acta Med. Scand. 542 (Suppl.), 187–193.Google Scholar
  78. Peterson, D.B., Lambert, J., Gerring, S. et al. (1986) Sucrose in the diet of diabetic patients—just another carbohydrate? Diabetologia 29, 216–220.CrossRefGoogle Scholar
  79. Ranney, R.E., Opperman, J.A., Muldoon. E. and McMahon, F.G. (1976) The comparative metabolism of aspartame in experimental animals and man. J. Toxicol. Environ. Health 2, 441–451.CrossRefGoogle Scholar
  80. Ravich, W.J., Bayless, T.M. and Thomas, M. (1983) Fructose: incomplete intestinal absorption in humans. Gastroenterology 84, 26–29.Google Scholar
  81. Reiser, S., Handler, H.B., Gardner, L.B., Hallfrisch, J.G., Michaelis, O.E. IV, and Prather, E.S. (1979) Isocaloric exchange of dietary starch and sucrose in human. II. Effect on fasting blood insulin, glucose and glucagon and on insulin and glucose response to a sucrose load. Am. J. Clin. Nutr. 32, 2206–2216.Google Scholar
  82. Rennhard, H.H. and Bianchine, J.R. (1976) Metabolism and caloric utilization of orally administered maltitol-C14 in rat and man. J. Agric. Food Chem. 24, 287–291.CrossRefGoogle Scholar
  83. Reynolds, W.A., Butler, V. and Lenikey-Johnston, N. (1976) Hypothalamic morphology following ingestion of aspartame or MSG in the neonatal rodent and primate: a preliminary report. J. Toxicol. Environ. Health 2, 471–480.CrossRefGoogle Scholar
  84. Roberts, H.J. (1990) Aspartame (NutraSweet): is it safe? The Charles Press, Philadelphia.Google Scholar
  85. Salminen, S., Salminen, E. and Marks, V. (1982) The effects of xylitol on the secretion of insulin and gastric inhibitory polypeptide in man and rats. Diabetologia 22, 480–482.CrossRefGoogle Scholar
  86. Secchi, A., Pontirolli, A.E., Cammelli, L., Bizzi, A., Cini, M. and Pozza, G. (1986) Effects of oral administration of maltitol on plasma glucose, plasma sorbitol, and serum insulin levels in man. Klin. Wochenschr. 64, 265–269.CrossRefGoogle Scholar
  87. Sestoft, L. and Fleron, P. (1974) Determination of the kinetic constants of fructose transport and phosphorylation in the perfused rat liver. Biochim. Biophys. Acta 354, 27–38.Google Scholar
  88. Simpson, R.W., Mann, J.I., Eaton, J., Carter, R.D. and Hockaday, T.D.R. (1979a) Highcarbohydrate diets and insulin-dependent diabetics. Br. Med. J. 2, 523–525.CrossRefGoogle Scholar
  89. Simpson, R.W., Mann, J.I., Eaton, J., Moore, R.A., Carter, R. and Hockaday, T.D.R. (19796) Improved glucose control in maturity-onset diabetes treated with high-carbohydrate-modified fat diet. Br. Med. J. 1, 1753–1756.Google Scholar
  90. Skyler, J.S. (1979) Complications of diabetes mellitus: relationship to metabolic dysfunction. Diabetes Care 2, 499–509.Google Scholar
  91. Slama, G., Haardt, M.J., Jean-Joseph, P. et al. (1984) Sucrose taken during mixed meal has no additional hyperglycaemic action over isocaloric amounts of starch in well-controlled diabetics. Lancet 122–125.Google Scholar
  92. Steel, J.M., Mitchell, D. and Prescott, R.L. (1983) Comparison of the glycaemic effect of fructose, sucrose and starch-containing mid-morning snacks in insulin-dependent diabetics. Hum. Nutr. Appl. Nutr. 37A, 3–8.Google Scholar
  93. Stegink, L.D. (1984) Aspartame metabolism in humans-acute dosing studies. In: Aspartame: Physiology and Biochemistry, eds. L.D. Stegink and L.J. Filer Jr, Marcel Dekker, New York.Google Scholar
  94. Stegink, L.D. (1987) The aspartame story: a model for the clinical testing of a food additive. Am. J. Clin. Nutr. 46, 204–215.Google Scholar
  95. Stegink, L.D., Brummell, M.C., McMartin, K.E. et al. (1981) Blood methanol concentrations in normal adult subjects administered abuse doses of aspartame. J. Toxicol. Environ. Health 7, 218–290.Google Scholar
  96. Stegink, L.D., Filer, L.J. and Baker, G.L. (1987) Plasma amino acid concentrations in normal adults ingesting aspartame and monosodium-L-glutamate as part of a soup/beverage meal. Metabolism 36, 1073–1079.CrossRefGoogle Scholar
  97. Stegink, L.D., Filer, L.J., Baker, G.L. and McDonnell, J.E. (1979) Effect of aspartame loading upon plasma and erythrocyte amino acid levels in phenylketonuric heterozygotes and normal subject. J. Nutr. 609, 708–717.Google Scholar
  98. Stegink, L.D., Filer, L.J. Jr and Baker, G.L. (1981) Plasma and erythrocyte concentrations of free amino acids in adult humans administered abuse doses of aspartame. J. Toxicol. Environ Health 7, 291–305.CrossRefGoogle Scholar
  99. Stegink, L.D., Filer, L.J. Jr and Baker, G.L. (1988) Repeated ingestion of aspartame-sweetened beverage: effect on plasma amino-acid concentration in normal adults. Metabolism 37, 246–251.CrossRefGoogle Scholar
  100. Stern, S.B., Bleicher, S.J., Flores, A., Gambos, B., Recitas, D. and Shu J. (1976) Administration of aspartame in non-insulin-dependent; diabetics. J. Toxicol. Environ. Health 2, 429–439.CrossRefGoogle Scholar
  101. Sykes, S., Morgan, L.M., English, J. and Marks, V. (1980) Evidence for preferential stimulation of gastric inhibitory polypeptide secretion in the rat by actively transported carbohydrates. J. Endocrinol. 85 201–207.CrossRefGoogle Scholar
  102. Tchoubroutsky, G. (1978) Relation of diabetic control to development of microvascular complications. Diabetologia 15, 143–152.CrossRefGoogle Scholar
  103. Tephly, T.R. and McMartin, K.E. (1984) Methanol metabolism and toxicity. In Aspartame: Physiology and Biochemistry, eds. L.D. Stegink and L.J. Filer Jr, Marcel Dekker, New York, P. 111.Google Scholar
  104. Thompson, R.G., Hayford, J.T. and Danney, M.M. (1978) Glucose and insulin responses to diet. Diabetes 27, 1020–1026.Google Scholar
  105. Turner, J.L. and Bierman, E.L., Brunzell J.D. and Chait, A. (1979) Effect of dietary fructose on triglyceride transport and glucoregulatory hormones in hypertriglyceridemic men. Am. J. Clin. Nutr. 32, 1043–1050.Google Scholar
  106. Vorster, H.H., van Tonder, E., Kotze, J.P. and Walker, A.R.P. (1987) Effects of graded sucrose additions on taste preference, acceptability, glycemic index, and insulin response to butter beans. Am. J. Clin. Nutr. 45, 575–579.Google Scholar
  107. Watts, R.W.E. (1987) Inborn errors of amino acid and organic acid metabolism. In Oxford Textbook of Medicine, eds. D.J. Weatherall, J.G.G. Ledingham and D.A. Warren, Oxford University Press, p. 9. 11.Google Scholar
  108. West, K.M. (1973) Diet therapy of diabetes: an analysis of failure. Ann. Intern. Med. 79, 425–434.CrossRefGoogle Scholar
  109. Weyers, H.A., Van de Kramer, J.H., Dicke, W.J. and Ijsseling, J. (1961) Diarrhoea caused by deficiency of sugar-splitting enzymes. Acta Paediatr. 50, 55.CrossRefGoogle Scholar
  110. Weyman-Daum, M., Fort, P., Recker, B., Lanes, R. and Lifshitz, F. (1987) Glycemic response in children with insulin-dependent diabetes mellitus after high-or low-glycemicindex breakfast. Am. J. Clin. Nutr. 46, 798–803.Google Scholar
  111. Wursch, P. (1989) Starch in human nutrition. World Rev. Nutr. Diet 60, 199–256.Google Scholar
  112. Wursch, P. and Anantharaman, G (1989) Aspects of the energy value assessment of the polyols. In Progress in Sweeteners, ed. T.H. Grenby, Elsevier Applied Science, London, p. 241.Google Scholar
  113. Wurtman, R.J. (1983) Neurochemical changes following high-dose aspartame with dietary carbohydrates. N. Engl. J. Med. 309, 429–430.CrossRefGoogle Scholar
  114. Wurtman, R.J. (1985) Aspartame: possible effect on seizure susceptibility. Lancet ii, 1060. Wurtman, R.J. and Ritter-Walker, E. (1988) Dietary phenylalamine and brain function, Birkhauser, Boston.Google Scholar
  115. Yudkin, J. (1964) Dietary fat and dietary sugar in relation to ischaemic heart disease and diabetes. Lancet ii, 4–5.Google Scholar
  116. Zimmett, P. and Whitehouse, S. (1978) Bimodality of fasting and two-hour glucose tolerance distributions in a Micronesian population. Diabetes 27, 793–799.CrossRefGoogle Scholar

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