High Carbohydrate‐High Fibre Diets in Poorly Controlled Diabetes

Abstract

Fifteen non-insulin-dependent diabetic patients with persistently elevated blood glucoses despite high doses of oral hypoglycaemic agents, were randomly allocated to a high carbohydrate-high fibre diet (HC) or a reinforced low carbohydrate diet (LC). After six weeks the diets were reversed for a similar period. Immediately preceding the study and at the end of each dietary period 24-h biochemical profiles were performed. In the 11 patients who completed the study, fasting and preprandial glucose, percentage glycosylated haemoglobin, VLDL cholesterol and mean 24-h triglycerides were significantly lower on HC than on LC or during the initial profile on their usual diet. There was no significant difference in any of the measurements on LC compared with the usual diet. Previous studies of high carbohydrate-high fibre diets in diabetes have been carried out in relatively well-controlled patients. These data show that poorly controlled non-insulin-dependent patients have an even more striking response.

Dietary fibre and diabetes revisited

“…The early studies were criticised on the grounds that we could not distinguish between the beneficial effects of carbohydrates per se and dietary fibre, but later studies in which carbohydrate alone was increased left little doubt that in order to achieve improved glycaemic control and reduced LDL without any increase in VLDL and triglycerides or reduction in HDL it was essential to increase dietary fibre, especially soluble fibre (Simpson et al, 1982). We were also able to show that it was possible to achieve beneficial effects with more acceptable amounts of dietary fibre than had been used in our earlier studies (Lousley et al, 1984). Other groups publishing at around the same time or shortly afterwards produced broadly comparable results (Rivellese et al, 1980;Riccardi et al, 1984).…”

“…Our studies clearly showed improved glycaemic control and reduced total and LDL cholesterol on a diet relatively low in fat and in which readily obtainable fibre-rich foods accounted for the increased intake of carbohydrate (Simpson et al, 1979a;Simpson et al, 1979b;Simpson et al, 1981;Lousley et al, 1984). The improvement was particularly striking when foods rich in soluble fibre were encouraged (Simpson et al, 1981).…”

“…In fact such observations were not entirely new, similar observations having been made many years earlier by Kempner using his rice diet (Kempner et al, 1958). Inspired by the work of Anderson and also by the studies of Stone and Connor (1963), who drew attention to the potential of the low carbohydrate -high fat diet, then in widespread use, to increase cardiovascular risk, our own group in Oxford, England embarked on a series of carefully controlled studies which helped to further understand the role of dietary fibre (Simpson et al, 1979a;Simpson et al, 1979b;Simpson et al, 1981;Simpson et al, 1982;Lousley et al, 1984;Geekie et al, 1986;Mann, 1984). Each of the studies involved a crossover design in which patients with type 1 and type 2 diabetes were randomised to receive advice regarding the standard diabetic diet of the time, relatively low in carbohydrate and dietary fibre, or an experimental high carbohydrate diet.…”

Absolute risk of cardiovascular disease events, and blood pressure‐ and lipid‐lowering therapy in Australia

“…497,586 (1+) Compared with diets that are low in carbohydrate, low in fi bre and high in unsaturated fatty acids, they improve glycaemic parameters, total cholesterol and LDL-C levels while triglycerides remain unchanged. 575,578,580,587,588 (1+) The results are most signifi cant when the dietary interventions include a large proportion of low glycaemic index foods, such as dried peas and beans (legumes) or viscous non-starch polysaccharide (soluble fi bre). 580,584,585,589 When high carbohydrate diets (>55% of energy) of average fi bre content (24 -35 g/day) are compared with lower carbohydrate diets rich in monounsaturated fatty acids but with equivalent fi bre, both diets lower LDL-C but the diets rich in monunsaturated fatty acids may lower triglyceride and VLDL-C levels more effectively in the short-term but without any difference in HbA1c.…”

Importance of low carbohydrate diets in diabetes management

“…94 For example, high carbohydrate diets in T2DM initially showed significant benefits on glucose metabolism and lipid profiles contrary to the data reported above. 95 However, the focus of the high carbohydrate diet was a high fiber intake, which has not been consistently repeated in later studies. The acute effect of dietary fiber is seen in combination with a low glycemic index meal in a recent study in people with T2DM where improvements in postprandial glucose and insulin responses were most prominent in the meals high in fiber and low in glycemic index.…”