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BENEFICIAL EFFECTS OF HIGH
DIETARY FIBER INTAKE IN
PATIENTS
Manisha
Chandalia, M.D., Abhimanyu Garg, M.D., Dieter Lutjohann, Ph.D., Klaus Von Bergmann, M.D.,
Scott M. Grundy, M.D., Ph.D., and Linda J. Brinkley, R.D.
N Engl J Med
2000;342:1392-8
Background
The effect of increasing the intake of dietary fiber
on glycemic control in patients with type 2 diabetes mellitus is controversial.
Methods
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 of the high-fiber diet, as compared with 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 per cent confidence interval, 1 to 24 mg per deciliter [0.1 to 1.3 mmol per
liter]; P=0.04) and mean daily urinary glucose excretion was 1.3 g lower (median
difference, 0.23 g; 95 percent confidence interval, 0.03 to 1.83; 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 per cent (P=0.02), triglyceride
concentrations by 10.2 percent (P=0.021), and very-low-density lipoprotein cholesterol
concentrations by 12.5 percent (P=0.01).
Conclusions
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.
©2000, Massachusetts Medical Society