Dietary fiber in management of diabetes

Current evidence suggests that high-fiber diets, especially of the soluble variety, and soluble fiber supplements may offer some improvement in carbohydrate metabolism, lower total cholesterol and low-density lipoprotein (LDL) cholesterol, and have other beneficial effects in patients with non-insulin-dependent diabetes mellitus (NIDDM). Diets enriched with wheat bran and guar gum induce 10-20% reductions in serum cholesterol and LDL in both normo- and hypercholesterolemic subjects and have the ability to blunt the hypertriglyceridemic effects of diets high in carbohydrate and low in fiber. In insulin-dependent diabetes mellitus (IDDM) the situation is less clear, but a decrement of the circadian glucose profile has been shown. Americans, in general, consume too little fiber. With the need to restrict fat and reduce protein, an increase in carbohydrates is mandatory. A practical goal would be to establish the present level of fiber intake (15-30 g/day) and to gradually increase it. An intake of up to 40 g of fiber per day or 25 g/1000 kcal of food intake appears beneficial; in many individuals on weight-reducing diets higher levels may be unacceptable because of gastrointestinal side effects. The level of maximum benefit has not been determined. Fiber supplementation appears beneficial only if given with a diet comprising approximately half of the calories as carbohydrate. Foods should be selected with moderate to high amounts of dietary fiber from a wide variety of choices to include both soluble and insoluble types of fiber. Insufficient data are available on the long-term safety of high-fiber supplements. People at risk for deficiencies, such as postmenopausal women, the elderly, or growing children, may require supplements of calcium and trace minerals. People with upper gastrointestinal dysfunction are at risk of bezoar formation and cautioned against a diet high in fiber of the leafy vegetable type. Careful attention must be paid to insulin dose because hypoglycemia can result if there is a radical change in fiber intake and insulin dose is not reduced appropriately. Care must be exercised in the use of "novel" fibers, including the wood celluloses, because little is known of their safety and efficacy.