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Title:
The Clinical Impact of Fiber Supplementation for
the Reduction of Postprandial Blood Glucose and Risk
Reduction of Complications from Diabetes
Author:
Freed, SH; Joffe, DJ
Source:
Diabetes In Control, Issue 15 (1) : 12-18 2000 Aug
Abstract:
OBJECTIVE:
The prevalence of diabetes has increased dramatically in
recent years1.
However, the role of dietary fiber in blood glucose
regulation remains unclear.
The purpose of this work was to investigate
the acute effects of supplementing the diet with soluble
fiber in regards to it’s glucose and
cholesterol lowering thereby reducing the HbA1c and
therefore the complications from diabetes.
By reducing the HbA1c (Average Blood Glucose) 1%,
the DCCT2
study showed Type 1 diabetics could reduce the
complications of Retinopathy
by 38%, Nephropathy by 28% Neuropathy by 35%.
The UKPDS3
showed that by reducing the HbA1c in Type 2 diabetics by
0.9% you could reduce any diabetic end point by 12%,
reduce any Microvascular end point by 25%, reduce MI by
16%, reduce Retinopathy by 21% and reduce microalbuminurea
at 12 years by 34%.
The UKPDS
also showed that Postprandial (blood glucose 1-2 hours
after eating) glucose is a better indicator of glycemic
control than fasting glucose levels4.
Treatment of
postprandial hyperglycemia is critical to achieving
optimal outcomes in type 2 diabetes5.
The New
England JM6
5/2000 showed that a high intake of dietary fiber 50
gms particularly of the soluble type, improves
glycemic control, decreases hyperinsulinemia, and lowers
plasma lipid concentrations in patients with type 2
diabetes.
METHODS:
After 30 days of monitoring fasting and postprandial blood
glucose, a base HbA1c (9.2%), cholesterol screen-total
cholesterol (210), Triglycerides (299), HDL (35), weight
(208lbs.)and blood pressure(145/82), Average Postprandial
blood glucose(250mg/dl.), average fasting blood glucose
(150mg/dl.) were taken.
Fifteen patients (7male/8 female), average age 65,
were given 10grams of soluble fiber to be added to their
diet of 15-20 grams.
Fiber consisted of Guar Gum, Gum Arabic, Locust
Bean Gum, Pectin, Oat Fiber (Source of Beta Glucans), and
Stevia dispersed in Calcium Carbonate.
Five grams were taken twice daily 5-10 minutes
prior to eating for 90 days.
They continued to monitor fasting and postprandial
blood glucose through the study period.
At the conclusion of the 90 day period,
their levels were measured.
RESULTS:
Compliance with the fiber diet and supplementation was
excellent. During the 12 weeks of the
high-fiber diet and supplementation, mean daily
preprandial plasma glucose concentrations were 17 percent
lower (95 percent confidence interval).
The high-fiber diet and supplementation also
lowered the area under the curve for 2-hour plasma glucose
concentrations, by 36 percent. The high-fiber diet and
supplementation reduced plasma total cholesterol
concentrations by 12 percent, triglyceride concentrations
by 42 percent, raised high-density lipoprotein cholesterol
concentrations by 6 percent, reduced body weight by an
average of 6 pounds, lowered blood pressure from 145/82 to
131/77 and lowered HbA1c from 9.2% to 7.8%(1.4 decrease).
CONCLUSIONS:
A high intake of dietary fiber, particularly of the
soluble type, above the level recommended by the ADA
(25-30grm.), improves glycemic control, decreases
hyperinsulinemia, and lowers plasma lipid concentrations
in patients with type 2 diabetes. Reducing postprandial
blood glucose significantly caused a decrease of HbA1c by
1.4%, therefore reducing the complications from diabetes. 2-5-6
1-Beckles
GLA et al. Diabetes Care. 1998;21:1432-1438.American
Diabetes Association. Diabetes Care. 1998;21(Suppl
1).Colwell JA. Ann Intern Med.
1996;124(1pt2):131-135.Abraira C et al. Diabetes Care.
1992;15:1560-1571.Klein R et al. Am J Epidemiol.
1987;126:415-428.Cowie CC et al. Diabetes in America. 2nd
ed.
vol.
44, November ol. 44, November, 1995.
2- The New England Journal of
Medicine -- September 30, 1993 -- Vol. 329, No. 14-DCCT
research group, Diabetes 95;44:969-983;
3- Hawaii Med J 2000
Jul;59(7):295-8, 313; BMJ. 2000 Aug 12;321(7258):405-12.
4. Harris
et al. Diabetes Care. 1994.
5-
De
Veciana et al. N Engl J Med. 1995;333:1239
6-
NEJM May 11, 2000 - Vol. 342, No. 19; Klein, R, Diabetes
Care. 1996:18:258-268
Source
Information. Can J Physiol Pharmacol June 1988; J Am Coll
Nutr Aug 1996; Jama 1999;282; Am J Clin Nut 1993;58:513-8;
Ann Intern Med April 1978; Va Med Nov 1979; Vopr
Pitan 1994; Am Fam Physician Apr. 1989; Am J Clin Nutr Nov
1991; Can J Physiol Pharmacol June 1988
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