New York Times
December 19, 2008
Recommended Diet for Diabetics May Need Changing, Study Suggests
By RONI CARYN RABIN

People with Type 2 diabetes on a high-fiber diet kept their blood
sugar under better control when they ate foods like beans and nuts
instead of the recommended whole-grain diet, researchers have found.

Beans and nuts are among foods that only modestly increase blood
glucose levels; scientists describe these foods as having a low
glycemic index. The new study, which lasted six months, is one of the
largest and longest to assess the impact of foods with a low-glycemic
index, researchers said.

Participants on the low-glycemic diet also saw significant
improvements in cholesterol after six months, with increases in HDL,
the so-called "good" cholesterol associated with a reduced risk of
heart disease, the study found.

"That's an important issue today, because there's a double whammy for
people who are diabetic," said Dr. David J. A. Jenkins, lead author of
the report and a professor of nutritional sciences at the University
of Toronto. "If they're men, they have twice the risk of heart
disease, and if they're women, they have four times the risk. If you
can hit the heart disease to which they're particularly vulnerable,
you may have something useful."

"Pharmaceuticals used to control Type 2 diabetes have not shown the
expected benefits in terms of reducing cardiovascular disease," he
added.

The study was published on Tuesday in the Journal of the American
Medical Association.

Some 210 patients with Type 2 diabetes were randomly assigned to a
low-glycemic diet or a high-cereal, high-fiber diet.

The high-cereal high fiber diet emphasized "brown foods" such as
whole-grain bread and breakfast cereal, brown rice and potatoes with
the skin on. The low-glycemic diet included beans, peas, lentils,
pasta, quickly boiled rice and certain breads, like pumpernickel and
rye, as well as oatmeal and oat bran cereals.

Both diets are low in saturated fat and trans fat. Both groups were
told to limit their consumption of white flour and to eat five
servings of vegetables and three servings of fruit each day.

Participants on the low-glycemic diet saw their hemoglobin A1C levels
— a measure of blood glucose levels over recent months — reduced
slightly, by 0.5 percent on average, but experienced significant
improvements in HDL, which increased by 1.7 milligrams per deciliter
of blood on average. Those on the high-cereal diet saw smaller
reductions in hemoglobin A1C and slight drops in HDL.

Dietitians who work with people who have Type 2 diabetes said earlier
studies had not demonstrated the benefits of low-glycemic index foods
as clearly as this report.

"We've been telling people to eat whole grains for a long time," said
Emmy Suhl, a nutrition and diabetes educator at the Joslin Diabetes
Center in Boston. "What this study shows is that it's not enough to
have whole grains. It's these very specific low-glycemic carbohydrates
that do a much better job."

But, she said, following such a diet is complicated, since the
glycemic index of a food can change depending on how it is prepared
and served.

"People tell us again and again that diet is the hardest part of
diabetes management," she added..