Carbohydrate and lipid metabolism in patients with non-insulin-dependent diabetes mellitus: effects of a low-fat, high-carbohydrate diet vs a diet high in monounsaturated fatty acids

Abstract

Nineteen patients affected by non-insulin dependent diabetes mellitus (NIDDM), in good glycemic control (fasting plasma glucose 7.2 +/- 0.3 mmol/L, glycosylated hemoglobin 6.3 +/- 0.2%), underwent three isocaloric dietary phases. In phases 1 and 3 the diet was rich in complex carbohydrates (Carbo) whereas in phase 2 it was rich in monounsaturated fatty acids (Mono). Plasma glucose concentrations were 7.1 +/- 0.3 and 7.2 +/- 0.3 mmol/L for the two Carbo phases and 7.5 +/- 0.4 mmol/L for the Mono phase (NS). Plasma total cholesterol values for the Carbo phases were 6.2 +/- 0.2 and 6.4 +/- 0.2 mmol/L, respectively, and 6.5 +/- 0.2 mmol/L on the Mono phase (NS). Similarly, no significant changes were noticed for plasma triglycerides and high-density-lipoprotein (HDL) cholesterol. Thus, both diets were well-tolerated and did not alter glucose homeostasis or worsen plasma lipid concentrations. Consequently, these results suggest that a wider dietary choice can be made available to NIDDM patients without producing unwanted side effects.

Diets high and low in glycemic index versus high monounsaturated fat diets: effects on glucose and lipid metabolism in NIDDM

“…Our ®ndings for the high-mono high-GI diet were consistent with one long-term study that showed a highmono diet did not alter glucose or lipid metabolism in freeliving NIDDM patients compared to a high-CHO, low-®bre diet (Bonanome et al, 1991). In contrast, studies done under metabolic ward conditions with insulin using type 2 patients (Garg et al, 1988), and studies using outpatients (Garg et al 1994, Campbell et al, 1994Walker et al, 1995) have found signi®cant reductions in concentrations of plasma glucose, insulin, triacylglycerol and VLDL cholesterol, and elevated HDL cholesterol concentrations after four weeks on a high-mono diet.…”

“…However, a number of other studies, most of which were conducted in outpatients, have failed to show any changes in plasma lipids (Bonanome et al, 1991;Rasmussen et al, 1993;Walker et al, 1995). The differences in HDL cholesterol on the three diets may relate to the small and non signi®cant differences in fasting glucose which were seen after adjustment for diet order as well as the increase in fat on the high-monounsaturated fat diet.…”

“…This may also explain our failure to observe changes in plasma triacylglycerol with dietary modi®cation as there were no changes in overall glycemic control. Previous dietary trials, similar in design to this one, have examined more homogeneous and better controlled populations of NIDDM patients (Bonanome et al, 1991;Campbell et al, 1994;Walker et al, 1995) which may be a factor related to the observed improvements in glucose and lipid metabolism. Our results may suggest that when study populations differ widely in their glycemic or lipid control, the small effects of short term dietary change may be masked.…”

What is an optimal diet? Relationship of macronutrient intake to obesity, glucose tolerance, lipoprotein cholesterol levels and the metabolic syndrome in the Whitehall II study

“…24 However, many isocaloric substitution diets do not distinguish between the two, or examine only one type of unsaturate. 16,21,25 Interestingly, in our population very little bene®t appeared to be gained by high intake of monounsaturates. For normoglycaemics, at least, polyunsaturates appear to be the more bene®cial fat substituent for saturated fat.…”

Comparison of the effects of a monounsaturated fat diet and a high carbohydrate diet on cardiovascular risk factors in first degree relatives to type-2 diabetic subjects

“…The cornerstone in the treatment of Type-2 DM is dietary intervention, and in several years the prescribed diet has been rich in carbohydrate whereas interest in metabolic effects of different fatty acids has come later. However, several studies have displayed bene®cial metabolic effects of dietary monounsaturated fatty acids (MUFA) in Type-2 DM (Garg et al, 1988;Bonanome et al, 1991;Garg et al, 1992aGarg et al, , 1992bRasmussen et al, 1993;Thomsen et al, 1995a;Lerman-Garber et al, 1994a, 1994bNielsen et al, 1995). Interestingly, we recently showed bene®cial effects of MUFA diets on the diurnal blood pressure and von Willebrand Factor (vWF) in normotensive Type-2 DM subjects without proteinuria, both compared with a diet rich in carbohydrate (Rasmussen et al, 1994) and a diet rich in polyunsaturated fatty acids (Thomsen et al, 1995a(Thomsen et al, , 1995b.…”