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April 15, 2009

Low–Glycemic Index vs High–Cereal Fiber Diet in Type 2 Diabetes—Reply

JAMA. 2009;301(15):1538-1539. doi:10.1001/jama.2009.484

In Reply: Drs Weickert and Pfeiffer raise important issues concerning the value of nonviscous (insoluble) wheat fiber in the prevention and treatment of type 2 diabetes and the potentially important role of other measures in addition to HbA1C and fasting blood glucose to provide a complete picture of changes in glycemic health. Our assessment of the literature and our own studies suggest that wheat fiber supplementation, such as wheat bran, has little effect on routine measures of blood glucose control in short-term studies (≤3 months)1 and no effect on serum lipids in the short-term.2 However, we agree that very significant benefits in diabetes incidence and heart disease have been seen for those who choose the higher fiber or “whole-wheat” option as cereal foods in longer-term cohort studies.3-5 The reasons for this inconsistency between short-term trials with markers of glycemic control compared with long-term studies with disease end points require further exploration.