15/55/30: Are All High Carb Diets The Same?

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In the following study from the NEJM, both diets used the 15/55/30 ratio. But, one had 50 grams of fiber in it (25 grams of it insoluble) and more unrefined foods and the other had only 24 grams of fiber and more refined foods. . The 24 gram fiber diet was the ADA diet, which is the same as the AHA diet and the same as the Typical American diet. It is the same one that was criticized in the study posted by Al and also by Tony in saying we can use that as a good reason to criticize ALL high carb diets (> 55% carb).. However, the test diet, with the same ratios and ratio of carb, had dramatically different results. You can read about the composition and the ratios and the differences in the full text. No supplemental fiber was used, all fiber came from whole foods. http://content.nejm.org/cgi/content/full/342/19/1392 So, again, let us not be so quick to condemn and criticize and high carb (or low fat) diets, without being careful to look closer and futher of the compostiion of what is contributing to the high carb (or low fat) diet. And lets not lump all high carb diets together just because the overall ratio of carb may be the same. This would be as futile as saying all 30% fat diets are the same and deserve the same criticism (or praise). Let us use the same dedication to the details in evaluating the carbohydrate content of diets (good or bad) as we do in evaluating the fat content of diets. The source of carbs, the degree of refinement, the type of refinement, the amount of fiber, the type of fibers, the ratio of the fibers, the ratio of fiber to total carb, the ratio of fiber to total

calorie, are all very important points to consider when looking at the carb content of a diet and not just the total percentage of carb in the diet.ThanksJeff NEJM Volume 342:1392-1398 May 11, 2000 Number 19 Beneficial Effects of High Dietary Fiber Intake in Patients with Type 2 Diabetes Mellitus Manisha Chandalia, M.D., Abhimanyu Garg, M.D., Dieter Lutjohann, Ph.D., Klaus von Bergmann, M.D., M. Grundy, M.D., Ph.D., and J. Brinkley, R.D. ABSTRACT Background The effect of increasing the intake of dietary fiber on glycemic control in patients with type 2 diabetes mellitus is controversial. Methods In a randomized, crossover study, we assigned 13 patients with type 2 diabetes mellitus to follow two diets, each for six weeks: a diet containing moderate amounts of fiber (total, 24 g; 8 g of

soluble fiber and 16 g of insoluble fiber), as recommended by the American Diabetes Association (ADA), and a high-fiber diet (total, 50 g; 25 g of soluble fiber and 25 g of insoluble fiber) containing foods not fortified with fiber (unfortified foods). Both diets, prepared in a research kitchen, had the same macronutrient and energy content. We compared the effects of the two diets on glycemic control and plasma lipid concentrations. Results Compliance with the diets was excellent. During the sixth week of the high-fiber diet, as compared with the sixth week of the ADA diet, mean daily preprandial plasma glucose concentrations were 13 mg per deciliter (0.7 mmol per liter) lower (95 percent confidence interval, 1 to 24 mg per deciliter [0.1 to 1.3 mmol per liter]; P=0.04) and mean daily urinary glucose excretion was 1.3 g lower (median difference, 0.23 g; 95 percent confidence interval, 0.03 to 1.83; P=0.008). The high-fiber diet also lowered

the area under the curve for 24-hour plasma glucose and insulin concentrations, which were measured every two hours, by 10 percent (P=0.02) and 12 percent (P=0.05), respectively. The high-fiber diet reduced plasma total cholesterol concentrations by 6.7 percent (P=0.02), triglyceride concentrations by 10.2 percent (P=0.02), and very-low-density lipoprotein cholesterol concentrations by 12.5 percent (P=0.01). Conclusions A high intake of dietary fiber, particularly of the soluble type, above the level recommended by the ADA, improves glycemic control, decreases hyperinsulinemia, and lowers plasma lipid concentrations in patients with type 2 diabetes.