Summary
To clarify the separate influences of digestible carbohydrate and of dietary fibre on blood glucose control and serum lipoproteins, 14 diabetic patients (six Type 1 and eight Type 2) were submitted to three weight-maintaining diets for 10 days each: (1) low carbohydrate/low fibre diet with 42% carbohydrate and 20g fibre; (2) high carbohydrate/low fibre diet (carbohydrate 53%, fibre 16g); (3) high carbohydrate/ high fibre diet (carbohydrate 53%, fibre 54 g). In comparison with the low carbohydrate/low fibre diet, the 2-h post-prandial blood glucose and the daily blood glucose profile decreased significantly on the high carbohydrate/high fibre diet, without significant changes during the high carbohydrate/low fibre diet. The diet-induced modifications of blood glucose control were similar in both types of diabetic patients (twoway analysis of variance: F=5.86, p<0.02 for dietary treatment and F=2.09, NS for type of diabetes). Total and lowdensity lipoprotein cholesterol were also decreased after the high carbohydrate/high fibre diet in comparison with the low carbohydrate/low fibre diet (p<0.001 for both), while they were not significantly modified after the high carbohydrate/ low fibre diet. Again the modifications of low density lipoprotein cholesterol induced by diet were similar in both types of diabetic patients (F=10.02, p<0.005 for dietary treatment and F=0.14 for type of diabetes, NS). High-density lipoprotein cholesterol was lower after the two test diets than after the low carbohydrate/low fibre diet. However statistical significance was found only for the high carbohydrate/high fibre diet (p<0.005). In conclusion: (1) a simple increase of digestible carbohydrate without a parallel increase of dietary fibre does not help in improving the metabolic control of diabetic patients; (2) the hypoglycaemic and hypolipidaemic effects of high carbohydrate/high-fibre diets are due principally to dietary fibre.
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References
American Diabetes Association (1979) Principles of nutrition and dietary recommendations for individuals with diabetes. Diabetes Care 2: 520–523
British Diabetic Association (1982) Dietary recommendations for diabetics for the 1980's. Hum Nutr Appl Nutr 36 A: 378–394
Special Report Committee (1981) Guidelines for the nutritional management of diabetes mellitus: A special report from the Canadian Diabetes Association. J Can Dietet Assoc 42: 110–118
Reaven GM (1980) How high the carbohydrate? Diabetologia 19: 409–413
Brunzell JD, Lerner RL, Hazzard WR, Porte D Jr, Bierman EL (1971) Improved glucose tolerance with high carbohydrate feeding in mild diabetes. N Engl J Med 284: 521–524
Brunzell JD, Lerner RL, Porte D Jr, Bierman EL (1979) Effect of a fat free high carbohydrate diet on diabetic subjects with fasting hyperglycemia. Diabetes 23: 138–142
Weiser RL, Seeman A, Herrera G, Assal GP, Soeldner JS, Gleason RE (1974) High and low carbohydrate diets in diabetes mellitus: study of effects on diabetic control, insulin secretion and blood lipids. Ann Intern Med 8: 332–341
Kjehm TG, Anderson JW, Ward K (1976) Beneficial effects of a high carbohydrate, high fibre diet on hyperglycemic diabetic men. Am J Clin Nutr 29: 895–899
Rivellese A, Riccardi G, Giacco A, Pacioni D, Genovese S, Mat tioli PL, Mancini M (1980) Effect of dietary fibre on glucose control and serum lipoproteins in diabetic patients. Lancet 2: 447–450
Rivellese A, Riccardi G, Giacco A, Pacioni D, Genovese S, Mattioli PL, Mancini M (1981) A fibre rich diet for the treatment of diabetes. In: Howard AN, McLean Baird I (eds) Recent advances in clinical nutrition I. J Libbey, London, pp 99–100
Jenswell AS, Thomas BJ, Brown AM (1975) Survey of dietary policy and management in British diabetic clinics. Br Med J 2: 7–11
Fidanza F, Versiglione N (1982) Tabelle di composizione degli alimenti. Idelson, Napoli
Southgate DAT (1969) Determination of carbohydrates in foods. II. Unavailable carbohydrates. J Sci Food Agric 20: 331–335
Hjelm M (1966) Enzymatic determination of hexoses in blood and urine Scand. J Clin Lab Invest 18: (Suppl 192): 85–89
Klose S, Hagen A, Greif H (1975) Methode de dosage colorimétrique du cholestérol par voie entièrement enzymatique adaptée à tous les types de auto-analyseur. In: Biologie prospective, 111. Colloque de Pont-à-Mousson. L'Expansion Scientifique Française, Paris, pp 505–537
Wahlefeld AN (1974) Triglycerides determination after enzymatic hydrolysis. In: Bergmeyer HV (ed) Methods of enzymatic analysis, Academic Press, New York
Carlson K (1973) Lipoprotein fractionation. J Clin Path 26 (Suppl 5): 32
Snedecor GW, Cochran WH (1967) Statistical Methods. Ames Iowa USA
Simpson HCR, Simpson RW, Lousley S, Carter RD, Gekh M, Hockaday JDR, Mann JI (1981) A high carbohydrate leguminous fibre diet improves all aspects of diabetic control. Lancet 2: 1–5
Anderson JW, Kyllen W (1979) High carbohydrate-high fiber diets for insulin treated men with diabets mellitus. Am J Clin Nutr 2: 2312–2321
Report of a WHO Expert Committee (1982) Prevention of coronary heart disease. Technical Report series 678. WHO, Geneva
Rivellese A, Riccardi G, Giacco A, Postiglione A, Mastranzo P, Mattioli PL (1983) Reduction of risk factors for atherosclerosis in diabetic patients treated with a high fiber diet. Prev Med 12: 128–132
Simpson HCR, Carter RD, Lousley S, Mann JI (1982) Digestible carbohydrate — an independent effect on diabetic control in Type 2 (non-insulin-dependent) diabetic patients? Diabetologia 23: 235–239
Riccardi G, Rivellese A, Romano G, Giacco R, Mancini M (1984) The influence of dietary fibre on serum lipoproteins in diabetic and hyperlipidaemic patients In: Carlson LA, Olsson AC (eds) Treatment of hyperlipoproteinaemia. Raven Press, New York (in press)
Jenkins DJA, Reynolds D, Slavin B, Leeds AR, Jenkins AL, Jepson EM (1980) Dietary fiber and blood lipids: treatment of hypercholesterolemia with guar crispbread. Am J Clin Nutr 33: 575–581
Taskinen M, Nikkilä EA, Ollus A (1983) Serum lipids and lipoproteins in insulin-dependent diabetic subjects during high-carbohydrate, high-fiber diet. Diabetes Care 6: 224–230
Greenfield M, Koltermann O, Olefsky J, Reaven GM (1980) Mechanism of hypertriglyceridaemia in diabetic patients with fasting hyperglycaemia. Diabetologia 18: 441–446
Farquhar JW, Frank A, Gross RC, Reaven GM (1966) Glucose, insulin and triglyceride responses to high and low carbohydrate diets in man. J Clin Invest 45: 1641–1656
Rivellese A, Riccardi G, Farinaro E, Capaldo B, Mancini M (1978) Relationship between insulin response to intravenous glucose and VLDL triglycerides in a healthy population. Diabetes and obesity. In: Vague J, Vague Ph (eds) Proceedings of the Vth International Meeting of Endocrinology. Excerpta Medica, Amsterdam, Oxford, pp 303–306
Olefsky MJ, Farquhar JW, Reaven GM (1974) Reappraisal of the role of insulin in hypertriglyceridemia. Am J Med 57: 552–560
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Riccardi, G., Rivellese, A., Pacioni, D. et al. Separate influence of dietary carbohydrate and fibre on the metabolic control in diabetes. Diabetologia 26, 116–121 (1984). https://doi.org/10.1007/BF00281117
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DOI: https://doi.org/10.1007/BF00281117