Dietary Fiber in the Management of Diabetes

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Abstract
It generally is accepted that a diet high in fiber, particularly soluble fiber, is useful in the management of the plasma glucose concentration in individuals with diabetes. This is one of the reasons several national diabetes associations have recommended that diabetic individuals ingest a diet high in fiber-containing foods. However, more recent data obtained in carefully controlled studies with more definitive end points, indicate this may not be the case. It has been shown clearly that addition of water-soluble, gel-forming fiber in the form of guar gum and perhaps gum tragacanth to an ingested glucose solution or to a mixed meal will reduce the expected rise in glucose concentration. This has been demonstrated in both normal subjects and subjects with IDDM and NIDDM. However, it is only observed when large amounts of fiber are added. The fiber also must be mixed with the administered glucose or food. Other less viscous soluble fiber sources such as the pectins and psyllium powder are not effective. In long-term, well-controlled trials, guar gum, pectin, beet fiber, or cereal bran fiber ingested with meals has been of little or no value in controlling the plasma glucose concentration in individuals with NIDDM. Several studies have been conducted in which a high-carbohydrate diet has been reported to reduce the plasma glucose concentration. In these diets, foods with a high fiber content have been emphasized. In general, they were not well controlled, and several confounding variables such as weight loss, decreased food energy intake, different food sources with potential for differences in starch digestibility, and decreased dietary fat content were present. Thus, it has not been possible to determine if dietary fiber was playing a significant role. The results of studies in which specific, defined fibers have been added to the diet would suggest that the naturally occurring fiber in foods is likely to play only a minor role.

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