HUN3800

Literature review paper

Effects of dietary fiber on glucose control in patients with type 2 diabetes

Hollon Livermore

N01064664

10/28/2016
 Introduction

Per the 2006-2007 American Diabetes Association Nutrition Recommendations,

the recommended amount of fiber to intake to help prevent diabetes is 14 grams of fiber

per 1000 kcals every day. 1 A high fiber diet consist most of fruits, vegetables, legumes,

nuts/seeds, whole grains, brans, and whole wheats that are rich in soluble and/or

insoluble fibers. 1 Some examples of these types of foods would be: apples, corn, celery,

beans and lentils, almonds, sunflower seeds, whole grain breads, bran cereals, and

whole wheat pastas. 2 Essentially, dietary fiber consists of non-digestible carbohydrates

and lignin that are intrinsic and intact in plants. 2

Dietary fiber decreases the risk for type 2 diabetes, cardiovascular disease, and

colon cancer by reducing the digestion and absorption of macronutrients and

decreasing the contact time of carcinogens within the intestinal lumen. 3 Many other

health benefits have been found in other studies pertaining to other diseases, but in this

case what is being analyzed is how the dietary fiber helps in stabilizing blood sugar

control in type 2 diabetic patients.

Furthermore, one point that will be discussed is how dietary fiber can control the

homeostasis of blood glucose levels by talking about and explaining how glycemic index

contributes to the control. Further discussed with be how insulin resistance and insulin

sensitivity are important in type 2 diabetic patients blood sugar homeostasis. Some

important factors and contributions will be explained as well. Also, how different

populations can differ by different diets and intake of different fibers based on where

they are geographically. Lastly, explain what soluble fibers are and how they can

contribute to the control of blood sugar levels will be also be discussed.

 Glycemic Index

To start, the glycemic index of a certain food can have a big impact on the

homeostasis of the blood glucose levels in type 2 diabetic patients. Glycemic index is a

way of categorizing carbohydrates by the way the food affects the blood sugar level. 2

Many dietary fibers have carbohydrates in them, but some have a lower glycemic index

than others. Low glycemic loads and high fiber diets are found to reduce the risk of

diabetes. 4 The higher the glycemic index is, the more the blood sugar level is going to

spike and then shoot back down. What is trying to be avoided in these cases is having a

higher glycemic index intake, because you do not want the spike in the blood sugar. 4

The goal is to intake a lower glycemic level food so it can metabolism slower and not

cause a large increase in the blood glucose level, thus maintaining homeostasis and

increasing satiety. 4

Satiety can be important in the diet because if you stay full longer, you will not

eat as much food. Food in any form can increase blood sugar levels if you are type 2

diabetic with insulin resistance, therefore not eating as much food can help maintain

homeostasis within the blood, and possibly help with weight loss because you feel fuller,

longer. 4

In the study by Jenkins, it talks about how legumes, including beans, chickpeas,

and lentils are among the lowest glycemic index foods and have been recommended in

national diabetes mellitus guidelines. 5 The study showed that the low glycemic index

legume diet and the high wheat fiber diet that the study group had ingested for 3 months

had improved their hemoglobin A1C levels. 5

 Insulin Resistance and Sensitivity

A patient who had type 2 diabetes is usually a result from insulin resistance or a

lack of sensitivity to insulin. 2 Insulin is a hormone that is released from the pancreas

during the fed state to maintain homeostasis of glucose control. 2 In a type 2 diabetic

patient, the cells are not responding to the high demand of insulin, therefore insulin

cannot allow glucose into the cell to be taken out of the blood stream and absorbed. 2

The downfall to this is glucose is left in the bloodstream and homeostasis of the blood

glucose level is not maintained. 2 In some serious cases of type 2 diabetes, patients

cannot obtain glucose homeostasis in the blood stream, therefore they start on an

exogenous insulin to obtain optimum glucose levels in the blood. 2 In this case the

patient is essentially replacing the insulin that is supposed to be being released form the

pancreas, and utilizing that insulin to bring the glucose into the cell so it can be

transported out of the blood stream to undergo more metabolic pathways that are

required for storage or utilization. 2

In a study performed by Ziegler, about nutritional modifications that included an

increase in dietary fiber, patients with type 2 diabetes were found to differentially

improve whole body insulin sensitivity and secretion and improve oxidative glucose

utilization in the blood stream. 6 Therefore, this study shows how fiber can help insulin

be more proficient in getting glucose into the cells so it can be transported out of the

bloodstream so you do not get a surplus of sugar in the blood, resulting in high blood

sugar levels. 6

Hemoglobin A1C is a test that is used to conclude if a patients blood glucose

levels have been running high or low over a period of two to three months. 7 This is often
a test a medical professional will request if suspected to have some signs or symptoms

of diabetes, which is the basis a doctor or health care professional can diagnose a

patient with diabetes on. 7 If your hemoglobin A1C comes back high, that means that

your average blood glucose levels have been running too high, which is considered

anything 8% or above. 7 Pre-diabetes patients are considered to have a hemoglobin

A1C of anything between 5.7%-6.4%. 7 A normal hemoglobin A1C is 5.7% or below, for

a person who does not have diabetes. 7 This test is performed twice a year for patients

who have type 2 diabetes and are not taking insulin and blood glucose levels are in

targeted range per your health care professional. 7 All though, if exogenous insulin is

being injected in a type 2 diabetic patient, and blood sugar control is not adequate, 4

hemoglobin A1C test should be performed a year. 7

Population and Diet Differences

A Mediterranean diet is a type of diet that is typically high is fibrous foods. In a

meta-analysis of ten prospective studies and 136,846 participants total, showed that

people who maintained a Mediterranean diet were associated with a 23% reduced risk

of developing type 2 diabetes. 8 Also found in this analysis of these studies was that the

Mediterranean diet can be a very advantageous choice in diet for type 2 diabetic

patients if they can make a diet plan based off needs and availability in their local area.
8 There is no absolute diet plan that is said to be the exact diet to lower the risk of type 2

diabetes, but the Mediterranean diet is a beneficial one and has shown to reduce the

risk of type 2 diabetes. 8

Some countries may have different availability of certain foods depending on

their agriculture or even their government. Culture is also a big impact of type of food
that are taken in or even how it's cooked no matter where in the county a person may

be. For example, in a study performed based on a Mexican style diet with different

glycemic indexes on people with type 2 diabetes, metabolic parameter was shown to

improve in a 6-week treatment period. 9 The study showed that the experimental group

that was consuming a lower glycemic index of food were also consuming more dietary

fiber verses the experimental group that was consuming higher glycemic index foods. 9

Also, the low glycemic index group had lower hemoglobin A1C levels and body mass

index than the high glycemic index group. 9 Therefore, the lower the glycemic index

was, the more fiber was consumed in this category, and the better the maintenance of

the blood glucose levels were. 9

Soluble Fibers

In general, soluble dietary fibers have a greater water holding capacity and are

more viscous and fermentable in comparison to insoluble dietary fibers. 2 In the study

performed by Chunye Chen, a total of 117 patients with type 2 diabetes between the

ages of 40 and 70 were evaluated. There were 2 groups in the study, the experimental

group was assessed with a dietary intake of 10mg to 20mg of soluble dietary fiber a

day. 10 The second, control group was assessed by the American Dietetic Association

daily recommended amount of soluble dietary fiber. The current institute of medicine

(IOM) daily recommended about of daily fiber is 14gram of fiber for every 1000 kcals

consumed, whether this is soluble or insoluble or even a combination of both. 2 This

study showed that patients who increased their soluble dietary fiber intake showed a

great improvement in insulin sensitivity, reduce systemic inflammation, lower

postprandial and overall glucose levels, and hemoglobin A1C levels decreased. 10 The
general statement this study was trying to show was that the recommended daily intake

of soluble dietary fiber needs to be increased because of all the pronounced benefits it

has on the body, especially in type 2 diabetic patients. 10

Soluble fibers have a high viscosity, meaning they have a higher ability to bind to

water rather than insoluble fiber that have a low viscosity. 11 In a random control trail

study performed by Abutair about psyllium (a soluble fiber) and how it improves

glycemic response and weight loss in type 2 diabetic patients, the viscosity of soluble

fibers play a large role on how the fiber is also helping maintain homeostasis on blood

sugar control. 11 The study talks about how the viscosity of soluble fiber helps food

move through the digestion and absorption processes much slower, because the

viscous solution turns into a gel-like substance and is thick. 11 This can also help with

the feeling of being fuller, longer, also called satiety. 11 The feeling of satiety can help

with overeating because if you feel full longer, you are less likely to overeat and over

indulge on foods that are not necessary. 11 When you eating food, it inhibits the release

of insulin so glucose can enter the cells to leave the bloodstream to maintain

homeostasis of blood sugar. 2 Thus, not eating as much food or over indulging on foods

would not only help with weight loss, but also help in the maintenance of blood glucose

control, which is shown in the study by how the hemoglobin A1C levels had improved

significantly in their studies and glucose metabolism in general. 11

Conclusion

Conclusively, there are many reasons and mostly healthy beneficial reason

dietary fiber recommended daily intakes should be increased. Glucose control being

uncontrolled can be a very detrimental effect, long term or short term. All of these
studies and analysis have shown how important dietary fiber can be on health and

especially on glucose maintenance. Therefore, the position of these studies as whole

would be to increase the dietary fiber requirements because of all the benefits to health

that have been found are too overwhelming to be overlooked. If our population is not

educated on these findings then the increase of type 2 diabetic patients is going to

steadily go up, as it has been over the years. Not only the studies researched in this

paper show pronounced benefits in health, but there are also many other peer reviewed

studies that show the same benefits or more benefits to increase dietary fiber. There

should not be much more research that needs to be performed to convince or show how

important it can be to simply increase the recommended values or at least start

educating the population on how important the increase of dietary fiber can be to a

single persons overall health.

Applications

One way we can implicate how important it is to increase dietary fiber is to

educate the patients. A dietician is a person who is a food and nutrition expert who can

translate the science of nutrition into practical solution of living a healthier lifestyle. 12 A

dietician can have a huge impact on people that need help with their diet or are going to

a doctor to get help with other health implications. Meal planning is a big role in a

dieticians everyday work schedule. 12 This is one area where the impact can be and

dietitians can help educate patients how important dietary fiber is to the diet and how

many healthy impacts it has on diet and even metabolic processes in our bodies. With

the increasing rate of type 2 diabetes and how many people are being diagnosed with

type two diabetes in hospitals, the education a dietician can give to a patient is very
important and everlasting. Also, when a person is first diagnosed with something like

diabetes, it is mostly about your diet intake. Therefore, it is not an easy adjustment,

considering it will affect that persons everyday lifestyle and choices.

Secondly, we need to educate the educators and dietitians so they understand

the importance of dietary fiber in our diet. One of the first people you will see in a

hospital after being diagnosed with diabetes by a health care professional before you

are discharged, is usually a certified diabetes educator (CDE) or a registered dietician.

13 That is where the education is delivered to the patient so they can understand and

ask questions on what they are supposed to do upon discharge. Typically, a diet plan is

talked about during the meeting and what foods are good for a diabetic patient to eat

and what foods are to be avoided. The CDE or dietician needs to be properly educated

before educating the patient.

A certified diabetes educator is a health professional who possesses

comprehensive knowledge and experience in pre-diabetes, diabetes prevention, and

diabetes management. 13 The CDE educates and supports people affected by diabetes

to understand and manage the condition. 13 A CDE promotes self-management to

achieve individualized behavioral and treatment goals that optimize health outcomes. 13

Certified diabetes educators usually get their certification after becoming a registered

nurse, registered pharmacist, or even a resisted dietitian. Therefore, nurses and

pharmacist need to also be informed of the impacts of dietary fiber so they can influence

the positive impacts on their patients for a healthier outcome. To become a certified

diabetes educator, you need to check for eligibility and then take the examination.

These educators are in very high need.

 Furthermore, dietary fiber intake doesnt just help with the homeostasis of blood

glucose control, but also helps with things like prevention of coronary artery disease and

cardiovascular disease. 1 Education of all the health benefits would not only help

diabetic patients that are more likely to get these problems, but also people without

diabetes, therefore the total population would benefit.

 References

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