Beneficial effects of high dietary fiber intake
in patients with type 2 diabetes mellitus.
N Engl J Med. 2000 May 11;342(19):1392-8.
N Engl J Med. 2000 May 11;342(19):1440-1.
Chandalia M, Garg A, Lutjohann D, von Bergmann K, Grundy SM, Brinkley
Department of Internal Medicine, University of Texas Southwestern Medical
Center, Dallas 75390, USA.
The effect of increasing the intake of dietary fiber on glycemic control
in patients with type 2 diabetes mellitus is controversial.
In a randomized, crossover study, we assigned 13 patients with type
2 diabetes mellitus to follow two diets, each for six weeks: a diet
containing moderate amounts of fiber (total, 24 g; 8 g of soluble fiber
and 16 g of insoluble fiber), as recommended by the American Diabetes
Association (ADA), and a high-fiber diet (total, 50 g; 25 g of soluble
fiber and 25 g of insoluble fiber), containing foods not fortified with
fiber (unfortified foods). Both diets, prepared in a research kitchen,
had the same macronutrient and energy content. We compared the effects
of the two diets on glycemic control and plasma lipid concentrations.
RESULTS: Compliance with the diets was excellent. During the sixth week,
the high-fiber diet, as compared with the the sixth week of the ADA
diet, mean daily preprandial plasma glucose concentrations were 13 mg
per deciliter [0.7 mmol per liter] lower (95 percent confidence interval,
1 to 24 mg per deciliter [0.1 to 1.3 mmol per liter]; P=0.04) and mean
median difference, daily urinary glucose excretion 1.3 g (0.23; 95 percent
confidence interval, 0.03 to 1.83 g; P= 0.008). The high-fiber diet
also lowered the area under the curve for 24-hour plasma glucose and
insulin concentrations, which were measured every two hours, by 10 percent
(P=0.02) and 12 percent (P=0.05), respectively. The high-fiber diet
reduced plasma total cholesterol concentrations by 6.7 percent (P=0.02),
triglyceride concentrations by 10.2 percent (P=0.02), and very-low-density
lipoprotein cholesterol concentrations by 12.5 percent (P=0.01).
A high intake of dietary fiber, particularly of the soluble type, above
the level recommended by the ADA, improves glycemic control, decreases
hyperinsulinemia, and lowers plasma lipid concentrations in patients
with type 2 diabetes.
Randomized Controlled Trial