High-carbohydrate, high-fibre diets for diabetics

Effect of soluble fibers on plasma lipids, glucose tolerance and mineral balance

Fibers are broadly classified as soluble and insoluble based on their physical or analytical properties. Two human studies have been carried out in this laboratory utilizing soluble gums. The first compared a low fiber diet to the diet with an average of 19.5 g of added fiber per day from cellulose, an insoluble fiber, or carboxymethylcellulose gum, karaya gum or locust bean gum, all soluble fibers. Plasma cholesterol levels but not triglycerides were significantly lower when the soluble gums were consumed for 4 weeks each. Glucose and insulin response curves after a standard glucose tolerance test were not significantly different between the 5 diets. Adding refined fibers to the basal diet did not significantly affect apparent mineral balance of calcium, magnesium, manganese, iron, copper or zinc, with the exception of a negative manganese balance after carboxymethylcellulose. The second study added an average of 31.7 g of guar gum per day to the diets of non-insulin dependent diabetic individuals for 6 months. Lipid levels observed at the beginning of the study were not reduced in either group, placebo or guar gum supplemented. Consumption of guar gum significantly reduced the C-peptide but not the glucose response curve. The number of insulin receptors increased while affinity remained the same. Apparent mineral balance was not affected by the consumption of guar gum for 6 months. The combined results of these studies indicates that soluble refined gums may have therapeutic value in reducing cholesterol and improving glucose metabolism without adversely affecting most mineral balances.

Effect of guar gum on gastric emptying in growing pigs

1. Simple gastric cannulas were surgically fitted to four pigs, initially of 30 kg live weight, to examine the effects of guar gum on gastric emptying. 2. Four semi-purified high-fat diets based on starch, casein, soya-bean oil and tallow were given to each pig. They contained 0 (control), 20, 40 or 60 g powdered guar gum/kg diet. The meals as fed contained 257 g dry matter (DM)/kg. 3. The contents of the stomach were evacuated, with rinsing, before feeding or 0.5, 1, 2 or 4 h after feeding. 4. The mean pH of the digesta was unaffected by guar gum until 4 h after feeding when the value increased as the amount of guar gum in the diet rose. 5. The only significant effects of guar gum on the emptying of digesta and its components (compared with the control diet) were to reduce the rate of emptying of (a) digesta 1 h after feeding (60 g/kg diet) and 4 h after feeding (40 and 60 g/kg diets), (b) dry matter and glucose 1 h after feeding (60 g/kg diet), (c) nitrogen 1 h after feeding (60 g/kg diet) and 4 h after feeding (40 and 60 g/kg diets). 6. When expressed on a half-time (T50) basis, the emptying of digesta and N (but not of DM and glucose) were significantly slower for diets containing 40 and 60 g guar gum/kg than for the control diet. 7. The apparent viscosity of the gastric digesta ranged between 0.5 and 23.7% of the values for the diets as consumed. 8. It was concluded that the effects of guar gum on gastric emptying of high-solid meals were small, and that this was unlikely to be an important aspect of the mechanism by which guar gum reduces postprandial blood glucose concentrations.

Effect of various types of dietary fibre on gastric emptying in growing pigs

1. Five pigs initially of 40-50 kg live weight were fitted with simple gastric cannulas which permitted complete evacuation and sampling of gastric digesta once daily. 2. The effects of addition of four types of dietary fibre (wheat bran (WB; 40 g/kg), sodium carboxymethylcellulose (CMC; 40 g/kg), high-methoxy citrus pectin (Pe; 40 g/kg) and granulated guar gum (G; 40 g/kg] on gastric emptying of a semi-purified diet during 4 h following a meal were measured. 3. Each of the test diets and the control diet (C) were given to each pig for 1 week using a 5 x 5 Latin-square arrangement. Digesta were collected before and 0.5, 1, 2 or 4 h after feeding on the last 5 d of each week. 4. The mean gastric pH was not significantly affected by diet except 2 h after feeding (CMC higher than C) and 4 h (Pe, G and CMC higher than C). 5. Compared with diet C, the rate of gastric emptying of digesta was significantly slower for diet G, 1, 2 and 4 h after feeding, and 2 and 4 h after feeding for diet CMC. 6. The rates of gastric emptying of digesta components were not significantly reduced by dietary fibre except for dry matter (DM) (diet CMC 2 h and diet B 4 h after feeding), total nitrogen (TN) (diet G 2 h after feeding) and total glucose (diet Pe 2 h after feeding). 7. There were no significant effects of diet on trichloroacetic-acid-soluble N:TN. 8. When gastric emptying was expressed in terms of half-time (T50) values, significant increases (compared with diet C) were found for digesta (diets G and CMC), DM (diet WB) and TN (diet G). 9. The apparent viscosity of the gastric digesta was significantly higher when diets Pe, G, and CMC were given than diets C or WB. Diets Pe and CMC were very viscous in the meal before ingestion, but diet G was not; its high viscosity developed after it had reached the stomach. 10. It is concluded that although those types of dietary fibre which increased meal or gastric viscosity reduced the rate of gastric emptying of digesta, this effect was confined to the liquid phase, because DM, total glucose and TN emptying were largely unaffected. The hypothesis that a reduced rate of gastric emptying may be an important determinant of the decreased rates of glucose absorption observed when such sources of dietary fibre are eaten is not supported by the results presented.

Glycaemic effects of bread and marmalade in insulin-dependent diabetes

The glycaemic responses of 12 C-peptide negative insulin-dependent diabetics were studied following four breakfasts with different carbohydrate sources. Total energy content of the meals was the usual for each subject, carbohydrate supplying 55% and fat 32%. The meals comprised: wholemeal bread with margarine; white bread with margarine; marmalade made with sucrose, and cheddar cheese; and marmalade (22% of total energy) on wholemeal bread with margarine. The study demonstrated powerfully that there were no statistically significant or clinically relevant differences between the meals in post-prandial glucose peak elevation, or in incremental area under the blood glucose curve to 120 mins. On these grounds, sucrose, in amounts considered acceptable to the general population, need not be prohibited from diabetic diets.