I have read that drinking too much sweetened soda and fruit punch, but not fruit juice, raises the likelihood of developing diabetes. Fruit juices are still a basic sugar (fructose) and are quantity-restricted on diabetic diets.

If there is evidence that their consumption does not carry the same risk as the other drinks listed, I would love to get back to enjoying at least one glass of orange juice. — Wayne Tamberelli, PA-C, Roanoke Rapids, N.C.

The amount of sugar in the diet does not cause diabetes. Type 2 diabetes is caused by a combination of genetic predisposition, environmental exposures, and overall imbalance of caloric intake and expenditure. Avoiding fruit juice throughout life will not prevent the development of diabetes. All individuals should be encouraged to maintain a balanced diet and to exercise to prevent diabetes, heart disease, cancer and a number of chronic diseases.

Once a patient has developed diabetes, it is advisable to restrict all sources of natural sugars and carbohydrates to <50% of caloric intake. Patients should be encouraged to increase fiber intake, especially whole grains, legumes, vegetables and fruits. The overall caloric intake is what matters most. For additional information on meal planning and exchanges, refer to the American Diabetes Association website (www.diabetes.org).

Another way to look at intake is with the glycemic index, which is a measure of how quickly a carbohydrate is digested and metabolized, thereby releasing glucose into the bloodstream. Foods with a high glycemic index will result in a rapid rise in blood glucose.

Glycemic indices above 50 are considered high (e.g., honey 91, table sugar 64). Orange juice is in the 53-to-58 range, depending on the source. Fresh fruits, such as apples (38), are lower. — Claire Babcock O’Connell, MPH, PA-C (178-2)

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