Nuts as a Replacement for Carbohydrates in the Diabetic Diet
Nuts as a Replacement for Carbohydrates in the Diabetic Diet
Objective—Fat intake, especially monounsaturated fatty acid (MUFA), has been liberalized in diabetic diets to preserve HDL cholesterol and improve glycemic control, yet the exact sources have not been clearly defined. Therefore, we assessed the effect of mixed nut consumption as a source of vegetable fat on serum lipids and HbA1c in type 2 diabetes.
Research Design And Methods—A total of 117 type 2 diabetic subjects were randomized to one of three treatments for 3 months. Supplements were provided at 475 kcal per 2,000-kcal diet as mixed nuts (75 g/day), muffins, or half portions of both. The primary outcome was change in HbA1c.
Results—The relative increase in MUFAs was 8.7% energy on the full-nut dose compared with muffins. Using an intention-to-treat analysis (n = 117), full-nut dose (mean intake 73 g/day) reduced HbA1c (−0.21% absolute HbA1c units, 95% CI −0.30 to −0.11, P < 0.001) with no change after half-nut dose or muffin. Full-nut dose was significantly different from half-nut dose (P = 0.004) and muffin (P = 0.001), but no difference was seen between half-nut dose and muffins. LDL cholesterol also decreased significantly after full-nut dose compared with muffin. The LDL cholesterol reduction after half-nut dose was intermediate and not significantly different from the other treatments. Apolipoprotein (apo) B and the apoB:apoA1 ratio behaved similarly. Nut intake related negatively to changes in HbA1c (r = −0.20, P = 0.033) and LDL cholesterol (r = −0.24, P = 0.011).
Conclusions—Two ounces of nuts daily as a replacement for carbohydrate foods improved both glycemic control and serum lipids in type 2 diabetes.
Replacement of carbohydrate by healthy fat, such as monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs), has been increasingly recognized as a possible therapeutic strategy in the treatment of diabetes as concerns emerge over the impact of refined carbohydrate foods in increasing postprandial glycemia and reducing HDL cholesterol. At the same time, increased proportions of fat and protein in the diet, especially of plant origin, may confer metabolic benefits and reduce the risk of developing coronary heart disease (CHD) and diabetes. However, there is little guidance on the optimal foods with which to increase the fat and protein intakes, and fear persists that increasing the proportion of fat in the diet will increase body weight. Nevertheless, use of nuts to increase fat intake has not resulted in weight gain, and habitual nut consumption lowers LDL cholesterol. Furthermore, nut intake has been associated with reduced CHD risk, a major cause of death in diabetes. Despite these potential advantages of nuts, few studies have been undertaken in diabetes, and none have demonstrated advantages in glycemic control.
Therefore, we have carried out a study specifically to test the effect on glycemic control and serum lipids of substituting nuts as a source of fat and vegetable protein to replace carbohydrate foods (muffins) in the diets of patients with type 2 diabetes.
Abstract and Introduction
Abstract
Objective—Fat intake, especially monounsaturated fatty acid (MUFA), has been liberalized in diabetic diets to preserve HDL cholesterol and improve glycemic control, yet the exact sources have not been clearly defined. Therefore, we assessed the effect of mixed nut consumption as a source of vegetable fat on serum lipids and HbA1c in type 2 diabetes.
Research Design And Methods—A total of 117 type 2 diabetic subjects were randomized to one of three treatments for 3 months. Supplements were provided at 475 kcal per 2,000-kcal diet as mixed nuts (75 g/day), muffins, or half portions of both. The primary outcome was change in HbA1c.
Results—The relative increase in MUFAs was 8.7% energy on the full-nut dose compared with muffins. Using an intention-to-treat analysis (n = 117), full-nut dose (mean intake 73 g/day) reduced HbA1c (−0.21% absolute HbA1c units, 95% CI −0.30 to −0.11, P < 0.001) with no change after half-nut dose or muffin. Full-nut dose was significantly different from half-nut dose (P = 0.004) and muffin (P = 0.001), but no difference was seen between half-nut dose and muffins. LDL cholesterol also decreased significantly after full-nut dose compared with muffin. The LDL cholesterol reduction after half-nut dose was intermediate and not significantly different from the other treatments. Apolipoprotein (apo) B and the apoB:apoA1 ratio behaved similarly. Nut intake related negatively to changes in HbA1c (r = −0.20, P = 0.033) and LDL cholesterol (r = −0.24, P = 0.011).
Conclusions—Two ounces of nuts daily as a replacement for carbohydrate foods improved both glycemic control and serum lipids in type 2 diabetes.
Introduction
Replacement of carbohydrate by healthy fat, such as monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs), has been increasingly recognized as a possible therapeutic strategy in the treatment of diabetes as concerns emerge over the impact of refined carbohydrate foods in increasing postprandial glycemia and reducing HDL cholesterol. At the same time, increased proportions of fat and protein in the diet, especially of plant origin, may confer metabolic benefits and reduce the risk of developing coronary heart disease (CHD) and diabetes. However, there is little guidance on the optimal foods with which to increase the fat and protein intakes, and fear persists that increasing the proportion of fat in the diet will increase body weight. Nevertheless, use of nuts to increase fat intake has not resulted in weight gain, and habitual nut consumption lowers LDL cholesterol. Furthermore, nut intake has been associated with reduced CHD risk, a major cause of death in diabetes. Despite these potential advantages of nuts, few studies have been undertaken in diabetes, and none have demonstrated advantages in glycemic control.
Therefore, we have carried out a study specifically to test the effect on glycemic control and serum lipids of substituting nuts as a source of fat and vegetable protein to replace carbohydrate foods (muffins) in the diets of patients with type 2 diabetes.
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