Sunday, January 04, 2009

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Low-glycemic-index diet beats high-cereal-fiber diet for glycemic control in diabetics

December 16, 2008

Toronto, ON - Eating a diet rich in low-glycemic foods, such pumpernickel and flaxseed breads, beans, peas, lentils, and nuts, provides greater improvements in glycemic control in diabetic patients compared with a diet rich in cereal fibers, a new study has shown. After six months of eating foods with a low-glycemic index, patients lowered glycosylated hemoglobin A1c (HbA1c) levels and raised HDL-cholesterol levels significantly more than those eating the high-cereal-fiber diet, report researchers.

"There's nothing fancy here," lead investigator Dr David Jenkins (University of Toronto, ON) told heartwire. "Slowly released carbohydrates seem to have a benefit in terms of metabolism in these diabetic patients. If you release carbohydrates into the digestive track slowly, it gets absorbed slowly, and over time the tissues become insulinized, taking up the glucose without much of it appearing in the blood or as a rise in blood sugar."

The study is published in the December 17, 2008 issue of the Journal of the American Medical Association.A nondrug option for patients
In an interview with heartwire, Jenkins said that diabetic patients are typically advised to follow a similar low-fat diet that patients with heart disease follow. Although it is recommended they reduce calories from carbohydrates, many diabetic patients have been influenced by the Atkins diet, reducing their calories from carbohydrates from the recommended 50% to approximately 40%, said Jenkins.

In this study, the researchers studied the effects of a low-glycemic-index diet on diabetes control and cardiovascular risk factors in 210 individuals with diabetes treated with antihyperglycemic medications. Previous studies have suggested the dietary strategy could improve diabetes control, as well as improve various cardiovascular risk factors, such as raising HDL cholesterol and lowering triglyceride and CRP levels.

Patients randomized to the low-glycemic-index diet consumed pumpernickel, rye, and flaxseed breads, large-flake oatmeal or oat-bran cereal, fruits such as apples and pears, pasta, beans, peas, lentils, and nuts. Among those randomized to the high-cereal-fiber diet, participants consumed whole-grain breads and breakfast cereals, brown rice, potatoes with skins, and fruits such as cantaloupe and mango, as well as crackers. Caloric intake did not differ between the two treatment arms.

After six months, HbA1c levels were significantly better in individuals assigned to the low-glycemic-index diet compared with those who consumed the high-cereal-fiber diet. HDL-cholesterol levels were also significantly improved. LDL-cholesterol and triglyceride levels were not significantly altered with the dietary strategy.

Jenkins pointed out that a diet based on a low glycemic index differs from a low-glycemic diet. The Atkins diet, an example of a low-glycemic diet, involves the restriction of carbohydrates. A low-glycemic-index diet, on the other hand, does not restrict the consumption of carbohydrates but rather restricts foods that overwhelm the insulin secretion mechanisms and cause spikes in blood glucose levels.

The reduction in HbA1c was modest, said Jenkins, but the diet "is another tool in the toolkit for clinicians" and should help those not wishing to prescribe too many antihyperglycemic medications or who do not wish to significantly increase the dose of existing drugs. Investigators did not observe any appreciable hypoglycemic occurrences, something that is difficult to avoid with medications, said Jenkins.

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