Nuts as a replacement for carbohydrates in the diabetic diet

David J A Jenkins, Cyril W C Kendall, Monica S Banach, Korbua Srichaikul, Edward Vidgen, Sandy Mitchell, Tina Parker, Stephanie Nishi, Balachandran Bashyam, Russell de Souza, Christopher Ireland, Robert G Josse, David J A Jenkins, Cyril W C Kendall, Monica S Banach, Korbua Srichaikul, Edward Vidgen, Sandy Mitchell, Tina Parker, Stephanie Nishi, Balachandran Bashyam, Russell de Souza, Christopher Ireland, Robert G Josse

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 HbA(1c) 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 HbA(1c).

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 HbA(1c) (-0.21% absolute HbA(1c) 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 HbA(1c) (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.

Trial registration: ClinicalTrials.gov NCT00410722.

Figures

Figure 1
Figure 1
Mean HbA1c measurements in participants with type 2 diabetes consuming full-nut dose, half-nut dose, or muffins.

References

    1. Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002;25:148–198
    1. Halton TL, Willett WC, Liu S, et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med 2006;355:1991–2002
    1. Jenkins DJ, Wong JM, Kendall CW, et al. The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med 2009;169:1046–1054
    1. Sabaté J, Oda K, Ros E. Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials. Arch Intern Med 2010;170:821–827
    1. Fraser GE, Sabaté J, Beeson WL, Strahan TM. A possible protective effect of nut consumption on risk of coronary heart disease: The Adventist Health Study. Arch Intern Med 1992;152:1416–1424
    1. Hu FB, Stampfer MJ. Nut consumption and risk of coronary heart disease: a review of epidemiologic evidence. Curr Atheroscler Rep 1999;1:204–209
    1. Tapsell LC, Gillen LJ, Patch CS, et al. Including walnuts in a low-fat/modified-fat diet improves HDL cholesterol-to-total cholesterol ratios in patients with type 2 diabetes. Diabetes Care 2004;27:2777–2783
    1. Lovejoy JC, Most MM, Lefevre M, Greenway FL, Rood JC. Effect of diets enriched in almonds on insulin action and serum lipids in adults with normal glucose tolerance or type 2 diabetes. Am J Clin Nutr 2002;76:1000–1006
    1. Scott LW, Balasubramanyam A, Kimball KT, Aherns AK, Fordis CM, Jr, Ballantyne CM. Long-term, randomized clinical trial of two diets in the metabolic syndrome and type 2 diabetes. Diabetes Care 2003;26:2481–2482
    1. Ma Y, Njike VY, Millet J, et al. Effects of walnut consumption on endothelial function in type 2 diabetic subjects: a randomized controlled crossover trial. Diabetes Care 2010;33:227–232
    1. Jentzsch AM, Bachmann H, Fürst P, Biesalski HK. Improved analysis of malondialdehyde in human body fluids. Free Radic Biol Med 1996;20:251–256
    1. Jenkins DJ, Chiavaroli L, Wong JM, et al. Adding monounsaturated fatty acids to a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia. CMAJ 2010;182:1961–1967
    1. Hu ML. Measurement of protein thiol groups and glutathione in plasma. Methods Enzymol 1994;233:380–385
    1. Atkinson FS, Foster-Powell K, Brand-Miller JC. International tables of glycemic index and glycemic load values: 2008. Diabetes Care 2008;31:2281–2283
    1. Coniff RF, Shapiro JA, Seaton TB, Hoogwerf BJ, Hunt JA. A double-blind placebo-controlled trial evaluating the safety and efficacy of acarbose for the treatment of patients with insulin-requiring type II diabetes. Diabetes Care 1995;18:928–932
    1. SAS Institute Inc. 2008. SAS/STAT 9.2 User’s Guide Cary, NC, SAS Institute Inc.
    1. Garg A, Bantle JP, Henry RR, et al. Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus. JAMA 1994;271:1421–1428
    1. Franz MJ, Horton ES, Sr, Bantle JP, et al. Nutrition principles for the management of diabetes and related complications. Diabetes Care 1994;17:490–518
    1. Vessby B, Uusitupa M, Hermansen K, et al. Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: The KANWU Study. Diabetologia 2001;44:312–319
    1. American Heart Association AHA Committee Report. Diet and coronary heart disease. Circulation 1978;58:762A–766A
    1. Anderson JW, Randles KM, Kendall CW, Jenkins DJ. Carbohydrate and fiber recommendations for individuals with diabetes: a quantitative assessment and meta-analysis of the evidence. J Am Coll Nutr 2004;23:5–17
    1. Sabaté J. Nut consumption and body weight. Am J Clin Nutr 2003;78(Suppl.):647S–650S
    1. U.S. Food and Drug Administration. Guidance for industry: diabetes mellitus: developing drugs and therapeutic biologics for treatment and prevention. Released 13 February 2008. Accessed 18 November 2010
    1. Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358:2560–2572
    1. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 2005;293:43–53

Source: PubMed

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