Effect of low fat-high carbohydrate diets in hypertensive patients with non-insulin-dependent diabetes mellitus

Effects of variations in dietary fat and carbohydrate content on various aspects of glucose, insulin, and lipoprotein metabolism were evaluated in 11 patients with hypertension, who also had non-insulin-dependent diabetes mellitus (NIDDM). All of these patients were being treated with sulfonylureas, thiazides, and beta-adrenergic receptor antagonists. The comparison diets contained either 40 or 60% of total calories as carbohydrate, with reciprocal changes in fat content from 40 to 20%. The diets were consumed in a random order for 15 days in a crossover experimental design. The ratio of polyunsaturated to saturated fat and total cholesterol intake were held constant in the two diets. Plasma glucose and insulin concentrations were significantly (P less than .001) elevated throughout the day when patients consumed the 60% carbohydrate diet. Fasting plasma total and very-low-density lipoprotein (VLDL) and triglyceride (TG) concentrations increased by 30% (P less than .001) after 15 days on the 60% carbohydrate diet. Total plasma cholesterol concentrations were similar on both diets, as were low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol concentrations.     

Metabolic effects of added dietary sucrose in individuals with noninsulin-dependent diabetes mellitus (NIDDM)

This study addresses the metabolic effects of sucrose in the diets of 11 individuals with noninsulin-dependent diabetes mellitus (NIDDM). Each of two dietary periods were 15 days in length, and contained 50% of the calories as carbohydrate, 30% as fat, and 20% as protein. The only variable between the two periods was the percentage of total calories as sucrose, 16% v 1%. Fasting blood samples were analyzed for plasma glucose and insulin as well as total plasma VLDL-, LDL- and HDL-cholesterol and triglyceride concentrations. In addition, postprandial blood samples were obtained for the measurement of plasma glucose, insulin and triglyceride concentrations. Fasting plasma glucose, insulin, and day-long insulin concentrations were similar between the two diets. However, the addition of sucrose in amounts comparable to those typically consumed by the general population resulted in significantly elevated day-long glucose (P less than 0.05) and triglyceride (P less than 0.05) responses, as well as elevated fasting total plasma cholesterol (P less than 0.001), triglyceride (P less than 0.05), VLDL-cholesterol (P less than 0.01), and VLDL-triglyceride (P less than 0.05) concentrations. LDL-cholesterol and HDL-cholesterol concentrations were unchanged during the added sucrose diet. It is clear that the consumption of diets containing moderate amounts of sucrose resulted in changes to plasma lipid and postprandial glucose concentrations that have been identified as risk factors for coronary artery disease. Therefore, it seems prudent at this time to advise patients with NIDDM to avoid added dietary sucrose.     

Urinary albumin excretion rate and 24-h ambulatory blood pressure in NIDDM with microalbuminuria: effects of a monounsaturated-enriched diet

Summary Previous studies have shown that unsaturated fat-enriched diets may have a beneficial effect on blood pressure in non-insulin-dependent diabetic (NIDDM) patients, whereas little is known about the effects on albuminuria. In a 3-week cross-over design we compared the effects of a currently recommended high-carbohydrate diet (50% carbohydrate, 30% fat [10% monounsaturated fat]) vs a diet rich in monounsaturated fat (30% carbohydrate, 50% fat [30% monounsaturated fat]) on urinary albumin excretion rate, 24-h ambulatory blood pressure and metabolic control in ten NIDDM patients with persistent microalbuminuria. The 24-h ambulatory blood pressure was similar before and after both the high-carbohydrate diet (mean±SD: 145/78±25/10 vs 143/79±19/10 mmHg (NS) and the monounsaturated fat diet: 140/78±16/8 vs 143/79±15/8 mmHg (NS). No changes were observed in day or night-time blood pressures. Urinary albumin excretion rate was unaffected after 3 weeks' treatment by the diets: from (geometric mean ×/÷ tolerance factor) 32.4×/÷2.1 to 36.0×/÷1.9 g/min (NS) vs from 34.2×/÷1.9 to 32.1×/÷2.1 g/min (NS). Fasting plasma glucose, serum fructosamine and HbA_1c as well as lipid and lipoprotein concentrations were stable during both diets. Compared to the high-carbohydrate diet a reduction in the LDL/HDL cholesterol ratio was observed during the monounsaturated fat diet (p<0.03). In conclusion, compared to a high-carbohydrate diet, 3 weeks' treatment with a monounsaturated fat diet did not affect the levels of 24-h ambulatory blood pressure or albuminuria in microalbuminuric NIDDM patients. Moreover, glycaemic control and lipoprotein levels were unchanged, although a potential beneficial effect on the LDL/HDL-cholesterol ratio was noted. Monounsaturated fat represents an alternative in the diets of NIDDM patients especially when caloric intake is not a concern.Abbreviations UAE Urinary albumin excretion rate - NIDDM non-insulin-dependent diabetes mellitus - MUFA monounsaturated fatty acids - PUFA polyunsaturated fatty acids - ANOVA analysis of variance - CHO carbohydrate - CI confidence interval     

Large variations of sucrose in constant carbohydrate diets in type II diabetes

Several studies show that sucrose does not aggravate hyperglycemia in type II diabetes mellitus, but sucrose is still restricted in dietary recommendations. Since sucrose in high carbohydrate diets elevates fasting triglyceride levels, the effects of sucrose were evaluated in diets with fixed carbohydrate levels. Eighteen diabetic volunteers receiving no medication were given weight maintenance diets with 50 percent carbohydrate, 35 percent fat, 15 percent protein, and 120 g of sucrose for 10 days as inpatients. They were then randomly assigned diets of similar composition with either 220 g of sucrose (high sucrose diet) or less than 3 g of sucrose daily (complex carbohydrate [CHO] diet) for one additional month. There were no differences in fasting, one-, two-, and three-hour post-lunch serum glucose levels; 24-hour glycosuria; glycohemoglobin levels; fasting and postprandial serum triglyceride levels, or fasting high-density lipoprotein-cholesterol levels. Twelve patients with preexisting higher triglyceridemia had similar trends, but the postprandial triglyceride levels were lower in the high sucrose diet group of this subset (p less than 0.05 in the third week). Postprandial serum insulin levels declined in the second week on the complex CHO diet. More than 75-fold difference in sucrose intake with constant carbohydrate and fat did not affect glycemic or triglyceridemic control in type II diabetic patients. The reported high sucrose-carbohydrate-induced rise in fasting triglyceridemia was not present when a diet high in sucrose was given without changing total carbohydrate.     

Effect of the Mediterranean diet on fasting concentrations of activated factor VII in healthy persons

INTRODUCTION AND OBJECTIVES: Many clinical and epidemiologic studies suggest that activated factor VII may be involved in the pathogenesis of coronary heart disease. Our objective was to determine the effect of a Mediterranean diet on plasma levels of activated factor VII in comparison to a low-fat diet and a diet rich in saturated fat. PATIENTS AND METHOD: The study population comprised 16 healthy normolipemic men who consumed 3 different diets in consecutive 28-day periods. The first diet was rich in saturated fat (38% calories as fat, 20% saturated fat), the second was a low-fat, high-carbohydrate diet (28% calories as fat, 10% saturated fat), and the third was enriched in monounsaturated fatty acids (38% calories as fat, 22% monounsaturated fat). At the end of each period, plasma concentrations of total cholesterol, HDL cholesterol, LDL cholesterol, total triglycerides, apolipoprotein A-I, apolipoprotein B, and glucose were measured. Activated factor VII was determined with a coagulation assay. RESULTS: The diet rich in saturated fat was associated with a significant increase in total cholesterol, LDL cholesterol, apolipoprotein AI, and apolipoprotein B in comparison to the other 2 diets. There were no significant differences between the carbohydrate-rich diet and the Mediterranean diet in any of the lipid parameters. The Mediterranean diet decreased plasma levels of factor VIIa in comparison to the diet rich in saturated fat (34.6+/-15.3 mU/mL vs 101.5+/-19.2 mU/mL; P<.05). CONCLUSIONS: In comparison to the diet rich in saturated fat or the high-carbohydrates diet, the Mediterranean diet decreased plasma concentrations of activated factor VII in healthy young men. This phenomenon may constitute another protective mechanism of the Mediterranean diet in reducing cardiovascular risk.     

The effects of high-carbohydrate and high-fat diets on the serum lipid and lipoprotein concentrations of endurance athletes

We examined the effects of high-carbohydrate and high-fat diets on the serum lipid levels of distance runners. For seven days before each study, subjects consumed a diet containing 15% protein, 32% fat, and 53% carbohydrate. During 14-day experimental periods, a control group (n = 10) continued the same diet while two other groups consumed 69% of their calories as either carbohydrate (n = 13) or fat (n = 14). High-density lipoprotein (HDL)-cholesterol decreased 9% during the high-carbohydrate diet because of a 26% fall in the HDL2 fraction (1.063 to 1.125 g/mL). These changes were not accompanied by changes in the levels of apolipoproteins (apo) A-I or A-II. Total and low-density lipoprotein (LDL)-cholesterol initially decreased but subsequently exceeded pre-diet values while triglyceride concentrations increased 30% to 50%. Postheparin lipoprotein lipase activity (LPLA) fell 20%. Despite these dietary effects, HDL and HDL2 cholesterol concentrations in the athletes remained above values typical of sedentary men. The high-fat diet produced different effects on the serum lipids and lipoprotein levels of the athletes. HDL levels changed little during the study although HDL-cholesterol and apo A-I on the last diet day were both slightly above initial values. The high-fat diet provided 111 g of saturated fat per day but had surprisingly little effect on total and LDL-cholesterol whereas serum triglycerides fell by 10% to 20%. Postheparin LPLA increased 30% with fat feeding and the changes in LPLA correlated with alterations in triglyceride levels (r = -0.53, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

The effect of sucrose content in high and low carbohydrate diets on plasma glucose, insulin, and lipid responses in hypertriglyceridemic humans

To further understand the effect of high carbohydrate (CHO)-low fat diets and the role of variations in dietary sucrose on CHO and lipid metabolism, 10 patients with hypertriglyceridemia were fed 2 isocaloric, typical American diets, containing 40% and 60% CHO, for 15 days in random sequence. Each patient was their own control, and they were divided into 2 groups of 5 patients each. In one group, sucrose was held constant at 13% of total calories (40-13% and 60-13%), whereas the sucrose content was 9% of the total calories on a 40% CHO diet (40-9%), and 15% of total calories on a 60% CHO diet (60-15%) in the other group. Fasting and postprandial blood samples were analyzed for plasma glucose, insulin, cholesterol (Chol), and triglycerides (TG), as well as for Chol and TG in chylomicrons, very low density, low density, and high density lipoproteins (HDL). Fasting plasma TG levels were significantly increased in both groups on the 60% CHO diet, primarily due to increases in very low density-TG concentration. The magnitude of the elevation was attenuated when sucrose content was kept constant. Postprandial TG responses were qualitatively similar. There were no significant changes in plasma Chol concentrations, except for a modest fall in plasma HDL-Chol level after the 60-13% diet period (P less than 0.05). No significant differences were found in fasting plasma glucose or insulin concentration. However, postprandial glucose and insulin responses were increased on both high CHO diets. The results of these studies demonstrate that high CHO-low fat diets, in general, tend to elevate plasma glucose, insulin, and TG concentrations and reduce HDL-Chol concentration in patients with endogenous hypertriglyceridemia. In addition, these data illustrate the important role that small variations in dietary sucrose can play in modulation of CHO and lipid metabolism.     

Effects of monounsaturated fatty acids v complex carbohydrates on serum lipoproteins and apoproteins in healthy men and women

The effects of a high-carbohydrate, high-fiber diet and an olive-oil-rich diet on the distribution of cholesterol over the various lipoproteins, on serum apolipoproteins, and on the composition of HDL2 and HDL3 were studied under strict dietary control. Forty-eight healthy subjects first consumed a high-saturated-fat diet [proportion of energy, en%] (saturated fat 20 en%, total fat 38 en%) for 17 days. For the next 36 days, 24 subjects consumed a diet high in complex carbohydrates (monounsaturated fat 9 en%, total fat 22 en%) and the other 24 consumed a high-fat, olive-oil-rich diet (monounsaturated fat 24 en%, total fat 41 en%). The amounts of protein (12% to 14 en%), polyunsaturated fat (4 to 5 en%), and cholesterol (31 to 35 mg/MJ) were similar in all three diets. Serum cholesterol levels fell by 0.44 mmol/L in subjects consuming the carbohydrate diet and by 0.52 mmol/L for those receiving the olive-oil-rich diet. VLDL-cholesterol levels rose by 0.08 mmol/L in the carbohydrate group and fell by 0.08 mmol/L in the olive oil group (P less than .05 for difference between test diets). HDL2 and LDL cholesterol levels fell to the same extent on both diets. HDL3 cholesterol fell by 0.09 mmol/L on the high-carbohydrate diet and increased by 0.01 mmol/L on the olive oil diet (P less than .05). There was no change in the composition of HDL3, suggesting that the fall was due to a decrease in the total number of circulating particles.(ABSTRACT TRUNCATED AT 250 WORDS)     

Short-term energy balance in patients with infections: carbohydrate-based versus fat-based diets.

The effects of a carbohydrate-based diet (50% carbohydrate calories, 30% fat calories, 20% protein calories) versus a fat-based diet (28% carbohydrate calories, 55% fat calories, 17% protein calories) on oxidation rates of carbohydrate, fat, and protein were assessed in 12 patients with infections by indirect calorimetry and estimation of urea nitrogen production rate. The diets were given continuously for 18 hours in a randomized cross-over study on 2 consecutive days. Energy supply (kcal/d) was adjusted individually to meet the energy expenditure measured on the preceding day after an overnight fast and was 1,647 +/- 129 (SEM) for the carbohydrate-based diet and 1,655 +/- 131 for the fat-based diet. Oxidation rates (kcal/d) for carbohydrate (carbohydrate-based diet, 525 +/- 70; fat-based diet, 363 +/- 84) were different between the diets (P less than .05), whereas no difference could be found for fat (carbohydrate-based diet, 820 +/- 117; fat-based diet, 968 +/- 136) and protein (carbohydrate-based diet, 252 +/- 29; fat-based diet, 236 +/- 23). However, during carbohydrate-based feeding, carbohydrate balance (288 +/- 93 kcal/d) and fat balance (-327 +/- 107 kcal/d) were significantly different from zero (P less than .05), indicating continuous oxidation of endogenous fat and storage of administered glucose. During the fat-based diet, carbohydrate and fat balances were not different from zero. A correlation between energy and substrate balances was not seen during either diet.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of a low-fat diet on plasma lipoprotein levels

Lowering the intake of fat to decrease serum cholesterol levels has unknown effects on the proportion of cholesterol in low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Twenty normolipidemic nonvegetarians were given dietary instruction and supervision in a low-fat, semivegetarian diet for three months. Mean consumption of total fat, saturated fat, and cholesterol decreased, whereas intake of carbohydrate increased significantly on a low-fat diet. Plasma LDL levels decreased by 18% and HDL levels by 7% from prestudy baseline levels. The LDL/HDL ratio declined by 11%. Plasma triglyceride levels and body weight were unchanged. In individual subjects, the decrements in consumption of saturated fat and the increments in ingestion of polyunsaturated fat were each significantly correlated with decreases in LDL. One year after the subjects had returned to a self-selected diet, levels of dietary saturated fat and cholesterol and the plasma LDL/HDL ratio remained significantly below prestudy levels. This study and others suggest that a low-fat, high-carbohydrate diet favorably affects the plasma LDL/HDL proportion by decreasing LDL on a percentage basis 2 1/2 to three times more than it decreases HDL.     

High amount of dietary carbohydrate does not cause an adaptational increase of stimulated human pancreatic amylase secretion

In order to investigate whether the human pancreas is capable of adapting to a diet with high-carbohydrate, low-fat, and normal protein content, 10 healthy volunteers were given a defined elemental diet (60% of calories as carbohydrates, 22% as fat, and 18% as protein) for 7 d. For the next 7 d they received an elemental diet with a further increased carbohydrate content (76% of calories) and a decreased fat content (10% of calories). A complete secretin-pancreozymin test was carried out at the end of the first wk and at d 14. The results show that an increase in dietary carbohydrate does not provoke an adaptational response of stimulated secretion rates of amylase, trypsin, and chymotrypsin in humans, as expected from animal experiments.     

The acute effect of prolonged walking and dietary changes on plasma lipoprotein concentrations and high-density lipoprotein subfractions

The effect of diet on exercise-induced changes in the plasma concentrations of lipoproteins was examined in six healthy male subjects during walks of 37 km on each of four successive days. With a high-carbohydrate diet (85% of the calories as carbohydrate) there was an increase (P less than .05) in the concentration of very-low-density lipoprotein (VLDL)-cholesterol and VLDL-triglyceride and a decrease (P less than .01) in the concentration of high density lipoprotein (HDL)-cholesterol, due mainly to a decrease in HDL3-cholesterol (P less than .01), and HDL-protein (P less than .001). In contrast, a high-fat diet (75% fat) produced a decrease (P less than .01) in the concentration of VLDL-cholesterol and VLDL-triglyceride with increases (P less than .01) in HDL-protein concentration and in HDL-cholesterol concentrations that arose largely from an increase (P less than .001) in HDL2-cholesterol. Gradient gel electrophoretic analysis showed an increase (P less than .01) in the relative concentration of HDL2b (subspecies of diameter 10.57 nm) with a decrease (P less than .01) in the concentration of HDL2a (9.16 nm) plus HDL3a (8.44 nm) with the high-fat diet, but no significant or consistent change with the high-carbohydrate diet. There was no change in the level of the apolipoprotein E-rich HDL subfraction with either diet. Plasma lecithin:cholesterol acyltransferase activity decreased (P less than .05) with the high-fat diet but not with the high-carbohydrate diet. Thus, diet can strongly influence the changes that occur in plasma lipoprotein concentrations during prolonged low-intensity exercise.     

The effects of a high-carbohydrate low-fat cholesterol-restricted diet on plasma lipid, lipoprotein, and apoprotein concentrations in insulin-dependent (type I) diabetes mellitus

Six women with well-defined insulin-dependent diabetes mellitus (IDDM) were studied for 4 weeks during a control diet containing 45% of the calories as carbohydrate, 40% fat (P/S ratio 0.14), 15% protein, and 580 mg of cholesterol, and for 6 weeks during a high-carbohydrate low-fat cholesterol-restricted diet with 65% carbohydrate, 20% fat (P/S ratio 1.40), 15% protein, and 62 mg cholesterol. All subjects completed both dietary periods in a crossover experimental design. Individual menus were subject-selected from a calculated exchange list containing conventional food items consistent with current American dietary patterns. The diets were well-tolerated by all subjects. Total plasma cholesterol decreased from 201 to 156 mg/100 mL (P less than 0.05) during the cholesterol-restricted diet, while total plasma triglyceride (TG) increased from 96 to 115 mg/100 mL (P less than 0.01). During this same period, very low-density lipoprotein cholesterol (VLDL-C) and VLDL-TG increased from 17 to 21 mg/100 mL (P less than 0.05) and from 59 to 76 mg/100 mL (P less than 0.001), respectively, while low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) decreased from 126 to 90 mg/100 mL (P less than 0.05) and from 50 to 39 mg/100 mL (P less than 0.05), respectively. LDL-C/HDL-C and total-C/HDL-C ratios were lower but not significantly different, and LDL-TG and HDL-TG were unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of a high carbohydrate diet on the content of apolipoproteins C-II, C-III and E in human plasma high density lipoprotein subfractions

The effect of isocaloric high and low carbohydrate (Carb) diets on the structure and apoprotein composition of plasma high density lipoproteins (HDL) was assessed in four healthy men. The high Carb diet contained 65% calories as Carb and 15% as fat; the low Carb was 15% and 65%, respectively, with protein fixed at 20% of calories in each case. Cholesterol was 400 mg/day and the P/S ratio of the fat was 0.4. Each diet was sequentially consumed for periods of 3 weeks. At the end of each 3-week study period, plasma HDL2 and HDL3 were isolated by zonal ultracentrifugation and their apoprotein and lipid compositions were determined. Compared to the low Carb diet, the high Carb diet was associated with an increase in the size of HDL2 (116.0 +/- 1.8 vs. 109.1 +/- 1.8 A) and in the content (mean weight % +/- SEM) of apoE (2.81 +/- 0.71 vs. 1.79 +/- 0.49, P less than 0.01) and of apoC-II (1.73 +/- 0.09 vs. 1.11 +/- 0.12, P less than 0.01). HDL2 apoC-III content was not significantly different on the two diets (6.49 +/- 0.50 vs. 7.42 +/- 1.21). On the two diets, HDL3 size and HDL3 apoE content were not significantly changed. HDL3 apoC-II and apoC-III, however, were higher on the high Carb diet, P less than 0.05. The ratio (by weight) of HDL2 apoE/HDL2 apoC-II + C-III increased on the high Carb diet compared to the low Carb diet (0.344 +/- 0.058 vs. 0.228 +/- 0.053, P less than 0.01). We suggest that the increased amount of apolipoprotein E in HDL2 may influence its rate of catabolic clearance and may account for the well-known decrease in plasma HDL-cholesterol in subjects on high Carb diets.     

Perspectives: A Practical Approach to the Dietary Treatment of Hypertriglyceridemia

Reducing high plasma triglyceride (TG) levels is an important step in the treatment and prevention of coronary artery disease. The rise in plasma TGs seen after subjects consume low-fat, high-carbohydrate diets for a period of time may be due to the simple form of carbohydrate provided and/or prevention of weight loss in these studies. Ad libitum low-fat, high-carbohydrate intake often results in weight loss and decreases in plasma TGs. Replacing dietary carbohydrate with monounsaturated fat lowers serum TG levels and maintains serum high-density lipoprotein levels but fails to result in weight loss. Low fat, high complex carbohydrate intake reduces incidence rates of coronary artery disease. On the basis of the evidence, a lowfat, high-complex carbohydrate diet combined with limited alcohol and sugar intake is recommended for the treatment of hypertriglyceridemia.     

Plasma glucose, insulin and lipid responses to high-carbohydrate low-fat diets in normal humans

Two levels of dietary carbohydrate (40% and 60% of calories) were incorporated into typical U.S. diets and fed for 10 days each to 11 healthy volunteers. Fasting blood samples were drawn on days 8, 9, and 10 of each dietary period and analyzed for glucose, insulin, cholesterol, triglyceride (TG) and high density lipoprotein (HDL)-cholesterol concentrations. In addition, plasma glucose, insulin and TG concentrations were determined before, and for 3 hr after the noon meal on days 8 and 10. No differences were observed in fasting plasma glucose, insulin or cholesterol concentrations. However, fasting plasma TG levels were significantly elevated on the 60% carbohydrate diet, and HDL-cholesterol concentrations were significantly decreased. Furthermore, the plasma insulin and triglyceride responses to the meal tolerance test during the 60% carbohydrate dietary period were significantly elevated. These results indicate that high-carbohydrate diets lead to changes in insulin, TG, and HDL-cholesterol concentrations which have been associated with an increase in incidence of coronary artery disease.     

Effects of the glycemic index of foods on serum concentrations of high-density lipoprotein cholesterol and triglycerides

The role of carbohydrates in cardiovascular disease prevention has garnered increasing attention due to accumulating evidence showing deleterious effects of low-fat, high-carbohydrate diets on serum triglycerides and high-density lipoprotein (HDL) cholesterol. Researchers argue that classifying carbohydrates based on their capacity for increasing blood glucose (termed the glycemic index [GI]) is a useful tool for elucidating the effects of carbohydrate-rich foods on glucose and lipid metabolism. Several epidemiologic reports show that lower dietary GI is associated with lower serum triglycerides and higher HDL cholesterol. Results from intervention studies show that substituting low-GI for high-GI foods in a low-fat, high-carbohydrate diet lowers serum triglycerides by 15% to 25%. The available evidence to date suggests that the glycemic index of foods will be an important factor in future dietary prevention research.     

A low-carbohydrate/high-fat diet improves glucoregulation in type 2 diabetes mellitus by reducing postabsorptive glycogenolysis

The aim of this study was to examine the mechanisms by which dietary carbohydrate and fat modulate fasting glycemia. We compared the effects of an eucaloric high-carbohydrate (89% carbohydrate) and high-fat (89% fat) diet on fasting glucose metabolism and insulin sensitivity in seven obese patients with type 2 diabetes using stable isotopes and euglycemic hyperinsulinemic clamps. At basal insulin levels glucose concentrations were 148 +/- 11 and 123 +/- 11 mg/dl (8.2 +/- 0.6 and 6.8 +/- 0.6 mmol/liter) on the high-carbohydrate and high-fat diet, respectively (P < 0.001), with insulin concentrations of 12 +/- 2 and 10 +/- 1 microIU/ml (82 +/- 11 and 66 +/- 10 pmol/liter) (P = 0.08). Glucose production was higher on the high-carbohydrate diet (1.88 +/- 0.06 vs. 1.55 +/- 0.05 mg/kg.min (10.44 +/- 0.33 vs. 8.61 +/- 0.28 micromol/kg.min) (P < 0.001) because of higher glycogenolysis. Gluconeogenic rates were not different between the diets. During the use of hyperinsulinemic euglycemic clamps, insulin-mediated suppression of glucose production and stimulation of glucose disposal were not different between the diets. Free fatty concentrations were suppressed by 89 and 62% (P < 0.0001) on the high-carbohydrate and high-fat diet, respectively. We conclude that short-term variations in dietary carbohydrate to fat ratios affect basal glucose metabolism in people with type 2 diabetes merely through modulation of the rate of glycogenolysis, without affecting insulin sensitivity of glucose metabolism.     

Are diets associated with different rates of human interdigestive and postprandial pancreatic enzyme secretion?

To determine if diets are associated with different rates of interdigestive and postprandial enzyme secretion and how quickly enzyme secretion is modulated by nutrients, 27 healthy humans were randomly selected to follow one of five diets. The calorie proportions of carbohydrate, fat, and protein in each diet was assigned by a mixture design. After the subjects followed a diet for 2 weeks, they were intubated with an oroduodenal tube, and enzyme outputs were measured during the interdigestive period and after eating a meal identical to meals eaten during the previous 2 weeks. For the next 24 hours subjects either followed the same diet or a diet that contained the same amount of fat, but the percent of carbohydrate and protein was changed by 30%. Then interdigestive and postprandial pancreatic enzyme outputs were remeasured. After 2 weeks, diets containing the most carbohydrate (50%-80%) were associated with the lowest interdigestive and postprandial amylase and lipase (P less than 0.05) and trypsin outputs (P less than or equal to 0.05). In contrast, diets containing the most fat (40%) were associated with the highest interdigestive and postprandial outputs of amylase (P less than 0.05) and trypsin (P less than 0.05). Maintaining or altering diets for 24 hours did not change interdigestive pancreatic enzyme outputs, but postprandial amylase output was significantly increased (P less than 0.05) by increasing protein and decreasing carbohydrate content of the diets by 30% for 24 hours. We conclude that diets containing a high proportion of calories as carbohydrate for 2 weeks are associated with lower interdigestive and postprandial pancreatic secretion than diets that have a high fat content. In response to diets, changes in postprandial pancreatic enzyme secretion occur within 24 hours whereas changes in interdigestive secretion (no nutrients in the lumen) occur after 24 hours.     

Implementation of low-protein diets for treatment of persons with early diabetic nephropathy

Low-protein diets are being increasingly used as a treatment for early nephropathy associated with diabetes. Recent research studies have shown a decrease in proteinuria while serum albumin levels and weight have been maintained. A level of 0.6 g protein/kg ideal body weight has been suggested. In structuring these diets, fat should be restricted to approximately 30% of calories, with the remainder supplied as carbohydrate calories after the protein content has been calculated. In some persons, simple sugars need to be included to avoid excessive amounts of high-bulk, high-fiber carbohydrate foods. Insulin and oral agent dosages may need adjustment to compensate for increased glucose levels. Self-monitoring of glucose levels can provide valuable feedback for medication adjustment. Intensive dietary education is needed with these patients, as the diet is sometimes radically different from diets previously used. A hypothetical patient is described and diet calculations provided using the ADA Exchange Lists with accompanying menus.