A High-Fiber Diet Decreases Postabsorptive Protein Turnover but Does Not Alter Insulin Sensitivity in Men with Type 1 Diabetes Mellitus.

ABSTRACT

BACKGROUND: High-fiber diets (HFDs) are recommended in the diet of persons with diabetes, yet such diets can impair macronutrient digestion and/or absorption, modify insulin sensitivity, and reset metabolism. OBJECTIVES: We studied the effects of a HFD on the kinetics of whole-body protein, a macronutrient that could be affected by dietary fiber, in type 1 diabetes mellitus (T1DM), under both basal-low insulinemic and hyperinsulinemic conditions. METHODS: Eight men with T1DM (body mass index range 21.8-27.8 kg/m2) were studied twice - before and after the addition of guar gum (∼15 g/d) to their usual diet for ∼4 mo. Whole-body protein degradation (i.e., the rate of appearance [Ra] of endogenous leucine), leucine disposal to protein synthesis (PS), deamination, and reamination, were determined before and after the HFD, both in the postabsorptive state and following a euglycemic, hyperinsulinemic, hyperaminoacidemic clamp, using isotope dilution methods. RESULTS: After the HFD, mean values (± SEs) for postabsorptive leucine Ra decreased by ∼20% from 2.52 (0.15) to 2.03 (0.16) µmol x kg-1 x min-1, P < 0.049, after vs. before the HFD respectively. PS also decreased, by ∼25% from 2.03 (0.15) to 1.57 (0.15), P < 0.045. Leucine concentration (P = 0.1) and reamination (P = 0.095) decreased moderately, whereas deamination was unchanged. Following the clamp, plasma amino acid concentrations (P < 0.001), leucine deamination (+ ∼50%, P < 0.00002), reamination (+ ∼30%, P < 0.0007), and PS (+ ∼35%, P < 0.00001) were all increased compared with postabsorptive state values, whereas endogenous leucine Ra was suppressed (by 15%, P < 0.00001, and by 25%, P < 0.001, with the primary or the reciprocal pool models, respectively). No significant differences in these insulin effects before compared with after the HFD were observed. Metabolic control (glycated hemoglobin), daily insulin requirement, and insulin-mediated glucose disposal were unchanged after the HFD. CONCLUSIONS: A HFD downregulates postabsorptive protein turnover in men with T1DM, by decreasing both protein degradation and synthesis, possibly due to a subtle decrease and/or delay in amino acid absorption. It does not significantly affect the insulin (and amino acid sensitivity) to protein turnover, glucose disposal, and metabolic control.