HUN 3800 Nutrition Science Research and Ethics

Literature Review Paper

Fiber Versus Pharmaceuticals for maintaining

healthy blood glucose levels in Type II Diabetics
Candace H. Gilbert
N01050037

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Fiber versus pharmaceuticals for maintaining

healthy blood glucose levels with type II diabetes

Introduction
Diabetes is one of the most common metabolic diseases in the world
today with a prevalence of an estimated 285-366 million people 1, 2. This
already expatiated rate of occurrence is expected to explode in the next 15
years to include 430-552 million people and some studies predict in the next
25 years that the population effected by this disease will double 1, 2, 3. The
majority of these cases, 90-95% are type II diabetes5.
Type II diabetes mellitus is a disease characterized by a defect in
glucose metabolism and includes insulin resistance and declining pancreatic
-cell mass; a decline in insulin secretion is also observed4, 5, 6. The increase
of type II diabetes is mirrored by an increase of obesity which in turn can
lead to insulin resistance, further perpetuating this disesase4,5.
There are two approaches to maintaining a healthy fasting glucose
level: food and pharmaceuticals. Because obesity is so closely linked to
T2DM, a healthy diet is a logical approach to make when addressing the
issues of chronic disease associated with an unhealthy body weight. Fiber is
an important consideration when applying this method as it has a direct
effect not only on weight control but on fasting glucose levels as well.
Glucose depressors and insulin boosters are other tactics that can be used to
circumvent the negative effects of T2DM.

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Fiber
Dietary fiber is a natural component of plants and consist generally of
the polysaccharides that make up the cell walls and structure of the plant.
Categorized at one time to differentiate between physiological impacts, the
terms soluble and insoluble are still used in labeling though there is an
increasing amount of evidence that shows it is more the viscosity and
fermenability that determines the function of fiber in the body. Examples of
dietary fiber include whole grains, legumes, fruits, and vegetables, as well as
oat and wheat bran, cellulose, fructan, oligosaccharides, inulin, lignin and
some resistant starches among others7.
Functional fiber is fiber found naturally in plants or is manufactured
and broken down before being added to manufactured foods to supplement
the fiber content. It can be found in commercially produced carbohydrates,
indigestible dextrin, polydextrose, animal carbohydrates as well as gums and
pectin and resistant starches7.
The Daily Reference Intakes were developed as guidelines because an
Estimated Average Requirement was unavailable for a Recommended
Dietary Allowance. The numbers obtained for the Adequate Intake were
determined by the amount of fiber that needed to be consumed to protect
against coronary heart disease; reduced risk of diabetes lends support to this
number. Consuming fiber in these amounts is also thought to provide some
relief of the symptoms of constipation and diverticulitis, and also lower blood
lipid and glucose levels.

The recommended 14g/ 1000kcal or 25g/ day for

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woman and 38g/ day for men is not being met by Western populations which
average half this amount7.
It is suggested that fiber contributes to a healthy weight by decreasing
the small intestines ability to absorb nutrients. Fiber rich foods also take
longer to chew and digest providing for a quicker feeling of satiety and
maintains more balanced energy.

Big Pharma
Drugs come in a variety of classes, broken down by how they achieve
desired results based on how they are metabolized by the body. The
majority of glucose dampening medications target adipose and skeletal
muscle tissue, liver, small intestine, or pancreas and work by tempering
endogenous insulin to control the tissues utilization of glucose. Another
class is called insulin secretagogues and like the name sounds, they work to
release more insulin. Sulfonylureas and meglitinides are two of this class of
drug1.
Thiazolidinediones, or glitazones, are insulin sensitizers. Yet another
type of diabetes drug is an incretin-based therapiy and include dipeptidyl
peptidase-4 inhibitors or DPP-41. This drug works two-fold to stimulate
glucose-dependent insulin while decreasing glucagon secretion. Biguanides,
of which Metformin is a member, impede hepatic glucose release by
impeding gluconeogenesis and may improve insulin sensitivity. Metformin is

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the go to drug of choice for first line pharmaceutical intervention and as an
insulin sensitizer it causes the reduction of insulin resistance and plasma
fasting insulin levels1, 5. A new class of drug is the sodium-glucose
cotransporter 2 inhibitors or SGLT2 for short, and is quite unique in its
function. SGLT2 inhibitors work to block the reabsorption of glucose by the
kidney and excrete it out in the urine1.

Studies
A randomized clinical trial to examine the effect of soluble fiber intake
in lipid and glucose levels in healthy subjects between the ages of 18-70 was
conducted to study the effects of two diets with different degrees fiber
content over the span of 3 months. Fifty-three healthy subjects were put into
two groups, group 1 received 10.4 g of fiber and the group 2 was given 30.5
g of fiber daily, all other factors being equal. Assessments of weight and
nutrition intake were made at baseline and 3 months. Fasting blood samples
were taken and tested for total cholesterol, triglyceride s and other lipids,
LDL and HDL cholesterol levels as well as glucose and insulin. Group 2,
showed significant change form baseline in the LDL-cholesterol and glucose
blood levels8.
In the second study examined, the long-term effects of fiber on
glycosylated hemoglobin A1c levels and glycemic control status was
conducted in two cross-sectional surveys conducted in 2006 and 2011.

The

second survey was a repeat of the first survey using the same participants.

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The participants were taken from communities in and around Shanghai,
China and met the WHO diagnostic criteria for T2DM. Initially the study
started with 934 participants however, the second phase dropped to 508
patients, the 426 remaining patients were unable to participate for a variety
of reasons.
Interviews were taken as well as body measurements and blood
samples were collected after an overnight fast >10 hours. HbA1c was
measured using ion-exchange chromatography and quality assessment of
assays were performed. The results demonstrated an association between
higher dietary fiber intake and improved glycemic control.

Conclusion
Both the studies done on the effectiveness of fiber and those preformed on
drugs to lower the blood glucose levels showed viable improvements though
the drug regimens proved to be a better and more consistent formula for
achieving these goals.
Recommendations
There are no negative consequences to added fiber in the diet so long
as the increase is done incrementally and no unpleasant side effects become
apparent. A healthy diet is always safe to recommend with the exception of
certain food allergies and insomuch as intolerances are not present. This
approach could be very beneficial in eliminating the need for further
treatment and may reverse symptoms of type II diabetes if addressed within

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early onset of disease. Further research is needed to find a positive
causation in the effects of fiber and lowered blood glucose levels however
there is a definite correlation between a diet high in fiber and more regulated
glucose levels.
Likewise, drug intervention therapy also has a strong, necessary
presence in the control of type II diabetes and should not be discounted.
There is strong evidence that mono-therapies have a place in the control of
this disease yet often times and with progression, a multi-oral approach
would be more proactive in controlling the symptoms effects of this disease.
More studies will need to be done as far as long term effects of these
therapies and the combined use and application of available drugs. The
good news is that new advancements are coming about with frequency and
control is more able to be achieved. However it is the eradication of disease
or at the very least an abrupt lessening of occurrence that needs mostly to
be addressed.

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References:
1. Dardi, I, Kouvatsos, et al. SGLT2 inhibitors. Biochem Pharmacol.
2015. Available at: http://dx.doi.org/10.1016/j.bcp.2015.09.005.
2. Brockman, D, Chen, X, Gallaher, D. Consumption of a high -glucan
barley flour improves glucose control and fatty liver and increases muscle
acylcarnitines in the Zucker diabetic fatty rat. <i>European Journal of
Nutrition</i>. 2013;52(7):17431753 11p. doi:10.1007/s00394-012-0478-2.
3. Corrao, G, Romio, S, Zambon, A, Merlino, L, Bosi, E, Scavini, M.
Multiple outcomes associated with the use of metformin and sulphonylureas
in type 2 diabetes: a population-based cohort study in Italy. <i>European
Journal of Clinical Pharmacology</i>. 2011;67(3):289299 11p.
doi:10.1007/s00228-010-0939-6.
4. Rave, K, Roggen, K, Dellweg, S, Heise, T, Dieck, HT. Improvement of
insulin resistance after diet with a whole-grain based dietary product: results
of a randomized, controlled cross-over study in obese subjects with elevated
fasting blood glucose. <i>BJN British Journal of Nutrition</i>. 2007;98(05).
doi:10.1017/s0007114507749267.
5. Hashemitabar, M, Bahramzadeh, S, Saremy, S, Nejaddehbashi, F.
Glucose plus metformin compared with glucose alone on -cell function in
mouse pancreatic islets. <i>Biomedical Reports</i>. 2015;3(5):721725.
doi:10.3892/br.2015.476.
6. Yang, L, Shu, L, Jiang, J, et al. Long-term effect of dietary fibre intake
on glycosylated haemoglobin A1c level and glycaemic control status among
Chinese patients with type 2 diabetes mellitus. <i>Public Health
Nutrition</i>. 2014;17(8):18581864 7p. doi:10.1017/S1368980013002000.

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7. Position of the American Dietetic Association: Health Implications of
Dietary Fiber. <i>Journal of the American Dietetic Association</i>.
2008;108(10):17161731. doi:10.1016/j.jada.2008.08.007.
8. Rokka, S, Ketoja, E, Jrvenp, E, Tahvonen, R. The glycaemic and
C-peptide responses of foods rich in dietary fibre from oat, buckwheat and
lingonberry. <i>International Journal of Food Sciences &amp; Nutrition</i>.
2013;64(5):528534 7p. doi:10.3109/09637486.2013.763914.
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2015;6(3):163168. doi:10.4103/2229-3485.159942.
10. Gupta, S, Khajuria, V, Tandon, VR, Mahajan, A, Gillani, ZH.
Comparative evaluation of efficacy and safety of combination of metforminvidagliptin versus metfromin-glimepiride in most frequently used doses in
patients of type 2 diabetes mellitus with inadequately controlled metformin
monotherapy-A randomised... <i>Perspectives in Clinical Research</i>.
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