Comparison of a High-Carbohydrate Diet with a High-Monounsaturated-Fat Diet in Patients with Non-Insulin-Dependent Diabetes Mellitus

Abstract

We compared a high-carbohydrate diet with a high-fat diet (specifically, a diet high in monounsaturated fatty acids) for effects on glycemic control and plasma lipoproteins in 10 patients with non-insulin-dependent diabetes mellitus (NIDDM) receiving insulin therapy. The patients were randomly assigned to receive first one diet and then the other, each for 28 days, in a metabolic ward. In the high-carbohydrate diet, 25 percent of the energy was in the form of fat and 60 percent in the form of carbohydrates (47 percent of the total energy was in the form of complex carbohydrates); the high-monounsaturated-fat diet was 50 percent fat (33 percent of the total energy in the form of monounsaturated fatty acids) and 35 percent carbohydrates. The two diets had the same amounts of simple carbohydrates and fiber. As compared with the high-carbohydrate diet, the high-monounsaturated-fat diet resulted in lower mean plasma glucose levels and reduced insulin requirements, lower levels of plasma triglycerides and very-low-density lipoprotein cholesterol (lower by 25 and 35 percent, respectively; P less than 0.01), and higher levels of high-density lipoprotein (HDL) cholesterol (higher by 13 percent; P less than 0.005). Levels of total cholesterol and low-density lipoprotein (LDL) cholesterol did not differ significantly in patients on the two diets. These preliminary results suggest that partial replacement of complex carbohydrates with monounsaturated fatty acids in the diets of patients with NIDDM does not increase the level of LDL cholesterol and may improve glycemic control and the levels of plasma triglycerides and HDL cholesterol.

Diets high and low in glycemic index versus high monounsaturated fat diets: effects on glucose and lipid metabolism in NIDDM

“…The small increments in HDL cholesterol on a highmonounsaturated fat diet have been reported by some investigators (Garg et al, 1988;Coulston et al, 1989) although we did not observe a statistically signi®cant reduction in triacylglycerol concentration as they also described. However, a number of other studies, most of which were conducted in outpatients, have failed to show any changes in plasma lipids (Bonanome et al, 1991;Rasmussen et al, 1993;Walker et al, 1995).…”

“…In contrast, studies done under metabolic ward conditions with insulin using type 2 patients (Garg et al, 1988), and studies using outpatients (Garg et al 1994, Campbell et al, 1994Walker et al, 1995) have found signi®cant reductions in concentrations of plasma glucose, insulin, triacylglycerol and VLDL cholesterol, and elevated HDL cholesterol concentrations after four weeks on a high-mono diet. A recent meta-analysis (Garg et al, 1998) has con®rmed that high monounsaturated fat diets reduce plasma triacylglycerol by 19% and modestly increase HDL cholesterol compared with high CHO diets.…”

“…On the other hand, high-mono diets have been shown to improve glycemic control without causing detrimental changes in triacylglycerol and HDL cholesterol concentrations when compared to high-CHO, low-fat diets of similar ®bre content (Campbell et al, 1994;Garg et al, 1988;Rasmussen et al, 1993). When the glycemic index could be estimated from the data these high-CHO diets have been generally high-GI and the carbohydrate in the high mono diet has also been high-GI.…”

Effects of hazelnut-enriched diet on plasma cholesterol and lipoprotein profiles in hypercholesterolemic adult men

“…In patients with established diabetes, high-fat diets increased fasting and postprandial glucose and insulin concentrations. However, it was reported by Garg et al (1988) that the high-MUFA diets resulted in improvements in glycemia. In the present study, no significant differences were observed in fasting glucose concentration in the group of hazelnut-enriched diet compared to others.…”

The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic

“…Omega 3 PUFA have wide-ranging cardiovascular protective capacities including lowering of plasma VLDL cholesterol and triacylglycerol (TG) concentrations (Connor & Connor, 1997). Consequently, it is entirely possible to consume relatively high-fat diets that do not necessarily produce a plasma lipid profile that promotes CVD (Garg et al, 1988;Nelson et al, 1995) given sufficient MUFA, PUFA (Gardner & Kraemer, 1995;Mensink & Katan, 1992) and an appropriate o-6=o-3 PUFA ratio (Connor & Connor, 1997) relative to the hypercholesterolemic fatty acids.…”