Effects of dietary fiber on glucose metabolism in diabetic patients

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Effects of dietary fiber on glucose and lipoprotein metabolism

in diabetic patients

 

G Riccardi and AA Rivellese

Institute of Internal Medicine and Metabolic Diseases,

Second Medical School, University of Naples, Italy.

 

 

 

Dietary recommendations for the treatment of diabetic patients

issued by national and international diabetes associations

consistently emphasize

the need to increase carbohydrate consumption.

 

However, these recommendations have been questioned on the basis of

growing evidence that, in both insulin-dependent and

non-insulin-dependent diabetic patients, a high-carbohydrate diet

does

not offer any advantage in terms of blood glucose and plasma lipid

concentrations compared with a high-fat (mainly unsaturated) diet.

 

It has been shown repeatedly that a high-carbohydrate diet increases

plasma insulin and triglyceride levels and can deteriorate blood

glucose control in the postprandial period.

 

However, much of the controversy between advocates and detractors of

dietary carbohydrate can be settled

by taking into account dietary *fiber*.

 

Several studies have shown that the adverse metabolic effects of

high-carbohydrate diets are neutralized when fiber and carbohydrate

are

increased *simultaneously* in the diet for diabetic patients.

 

In particular, these studies demonstrated that a high-

carbohydrate/high-fiber diet significantly improves blood glucose

control and reduces plasma cholesterol levels

in diabetic patients--

compared with a low-carbohydrate/low-fiber diet.

 

In addition, a high-carbohydrate/high-fiber diet does not increase

plasma insulin and triglyceride concentrations,

 

despite the higher consumption of carbohydrates.

 

Unfortunately, dietary fiber represents a heterogenous category, and

there is still much to understand as to which foods should be

preferred

to maximize the metabolic effects of fiber.

 

There are indications that only " water-soluble " fiber is active on

plasma

glucose and lipoprotein metabolism in humans.

 

Therefore, in practice, the consumption of legumes, vegetables, and

fruits--

rich in water-soluble fiber--should be particularly encouraged.

 

The mechanisms by which dietary fiber exerts its hypoglycemic and

hypolipidemic activities are unknown.

 

However, the ability of dietary *fiber* to retard food digestion and

nutrient absorption certainly has an important " influence " on lipid

and

carbohydrate metabolism.

 

The beneficial effects of high-fiber foods are also exerted by some

foods not particularly rich in fiber.

 

The fiber content and physical form of the food can influence the

accessibility of nutrients by

digestive enzymes, thus delaying digestion and absorption.

 

The identification of these foods with a low-glycemic response would

help enlarge the list of foods particularly suitable for diabetic

patients.

 

In conclusion,

a diet low in cholesterol and saturated fat should be recommended to

all diabetic patients to prevent cardiovascular disease.

 

A balanced increase in consumption of fiber-rich foods and

unsaturated

fat is the most rational way to replace foods rich in saturated fat

and cholesterol in the diabetic diet.

 

 

 

http://care.diabetesjournals.org/cgi/content/abstract/14/12/1115?

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