FIBER, the alleged preventer of everything from colon cancer to high blood pressure, may also save the eyes and arteries of diabetics who include more of it in their diets.
Diabetes has confused medical specialists for decades. Through the years many dietary solutions have been offered for those who lack insulin, the hormone that facilitates the movement of blood sugar across cell membranes so that it can be used for energy.
The latest method of dietary regulation of blood sugar comes from Dr. James Anderson, a medical professor at the University of Kentucky. More than a decade of experiments involving diabetics and high-fiber diets has convinced him that high-fiber diets can reduce or eliminate a diabetic's need for insulin and stabilize blood glucose levels.
This translates into potentially fewer health complications for the diabetic.
While fiber appears in plenty of foods from bean sprouts to bran muffins, Americans tend to avoid it. We eat refined flours, fatty foods and lots of sugar. Even many hospital dietitians who have no qualms about offering us Jell-O or Cream of Wheat don't do the high-fiber duty.
"It's not practical," says Pat Wise, a dietitian at Holy Cross Hospital. Fifty grams of dietary fiber (Anderson recommends 35 to 50 gms.) amount to a sizeable hill of beans, and it's difficult to convert to the diet from normal eating habits. While she supports the high-fiber theory, she says Holy Cross outpatient diabetes classes don't include the specific information about fiber.
"It's not practical to take insulin twice a day," counters Anderson, formulator of the diet.
"We're all pressing for the high-fiber diet," says Providence Hospital dietitian Madonna Heckman. But, she says, it involves "an immense amount of food" and "takes so much time to prepare."
The American Dietetic Association, according to a spokesman, has not taken a position on the diet. The American Diabetic Association, while recommending a high-carbohydrate diet (50 to 60 percent of the calories should come from complex carbohydrates) comparable to Anderson's, does not stress high fiber per se.
"It's pretty motivating to get off insulin," says Beverly Sieling in response to remarks about the diet's cumbersome qualities. A research dietitian at the Veterans Administration hospital in Lexington, Ky., she has spent the last four years helping Anderson draw up the schedules for this high-fiber diet. One patient has remained off insulin for eight years. In other studies, high-fiber diets seem to control the rising insulin needs of pregnant diabetic women, whose requirements increase an average of 50 percent.
The improvement comes from a low-fat, high-carbohydrate, high-fiber regime. High-fat diets inhibit the ability of the cells to recognize insulin, even when it's there. This condition, traditionally corrected with medicine, can be helped when a patient limits the use of butter, mayonnaise, fatty meats, olives, nuts, salad dressing and other fatty foods.
And the high fiber content slows absorption, which regulates the amount of sugar in the blood, lowers the amount of fat in the blood and makes the patient feel less hungry.
" The diabetic feels better on this diet," says Sieling laconically.
The diet calls for menu overhauls. Sieling says that average Americans eat about 10 ounces of meat each day; this diet calls for 5. American diets are 40 to 45 percent fat; Anderson calls for 11 percent. The carbohydrate content of the typical diet is 40 percent; Anderson's hospital patients eat 70 percent of their calories as carbohydrates and he recommends that all his patients have a diet that is over half carbohydrates.
The regimen gives more than pause to patients. Many get what health professionals euphemistically call "flatulence."
"That's true, they will" get gas, Sieling concedes. But if they switch gradually, from white bread to whole wheat, from fruit juice to whole fruit, "it's not that much of a problem." When it's a choice between insulin injections and a little gastrointestinal irregularity, between fighting infection or disease and feeling well, her patients usually maintain the proper priorities.
One Washington attorney, who began the diet a couple of years ago "trying to beat insulin," says, "I do it because it's a whole lot easier than the diabetic diet" with which a patient must carefully measure portions and monitor eating intervals.
"I'm just very busy, I don't have time to worry about the diet ." So he avoids meat, limits fatty milk products, eats whole grains and bran, lots of salads and pieces of fruit to sustain him throughout the day.
All this is consistent with the high-fiber/high-carbohydrate diet goals. In addition, the diet that Anderson developed stresses:
* Choose food that's as close to its natural state as possible -- brown rice instead of white, whole-wheat flour instead of white, oranges instead of orange juice.
* Limit fat and oil intake by eating foods without adding butter or margarine, by making salad dressings with yogurt and cottage cheese rather than mayonnaise.
* Anderson restricts his patients to 4 to 5 ounces of meat each day. That's one chicken breast, or one hamburger.
* Learn to eat the skins on apples, potatoes, carrots, tomatoes and other produce.
* Cereals are separate from breads in this diet. Among the cereals recommended are All Bran, Chex, Corn Flakes, Grape-Nuts, Puffed Wheat, Shredded Wheat and other whole-grain and bran cereals, both quick and those that require cooking, but without additional sugar.
* Foods included in the bread group include whole-grain sliced breads, whole-wheat pasta, popcorn, whole-grain rolls and muffins.
* The type of fiber in dried beans is useful in lowering blood cholesterol, according to Anderson. In addition, beans provide a lot of the protein.
* Three or four vegetables should be consumed at dinner.
Because the diet is a relatively new treatment, it still seems difficult to many. But Anderson says that diabetics are accustomed to exchange-lists of food; that adding one or two more choices isn't as confusing as it might seem to nondiabetics.
On the other hand, says dietitian Wise, "We have lots of people who eat mashed potatoes and white bread, and this is a very big deal to them." It's easier with a few suggestions, however. SPICY PUMPKIN (4 to 6 servings) 3 tablespoons vegetable oil 2 medium onions, chopped 1 clove garlic, minced 1/2 teaspoon ground cumin 1/2 teaspoon ground red pepper 1 cup bulgur (whole wheat berries) 1 cup cooked garbanzo beans (chick peas) 2 pounds fresh pumpkin, peeled and cut into chunks, or 2 cups pumpkin puree 1 green pepper, seed and chopped 1/2 cup minced fresh parsley
Heat oil in large skillet. Add onions and garlic and stir several minutes over medium heat. Add cumin and red pepper and stir over medium heat for 2 minutes. Add bulgur, garbanzo beans, pumpkin, pepper and parsley along with 2 cups of water. Cover and lower heat. Simmer for 30 minutes.
Note: If using pureed pumpkin, cook the bulgur and green pepper in water and add remaining ingredients to heat through. BEAN SALAD (12 servings) 1 pound cooked garbanzo beans 1 pound cooked kidney beans 1 pound cooked green beans 1 pound cooked waxed beans 1 tablespoon sugar or substitute, or to taste 1/2 cup white vinegar 1/2 cup olive oil 1/2 teaspoon salt 1/4 teaspoon freshly ground pepper 1/2 teaspoon dry mustard 1/2 teaspoon dried basil 1 small red onion, sliced and separated into rings 3 tablespoons chopped parsley
In a large bowl, mix together the four different beans (if using canned beans, drain them well). In a small bowl, combine sugar or substitute and vinegar. Stir in oil, salt, pepper, mustard and basil. Pour vinegar mixture over beans. Mix thoroughly. Cover and chill several hours. To serve, add onion and parsley, tossing lightly. From "Vegetable Cookery" by Lou Siebert Pappas BEANS AND PASTA (3 servings) 3 cups canned plum tomatoes, drained and chopped 1 cup tomato sauce 1/2 teaspoon basil 1/2 teaspoon oregano 1/4 teaspoon freshly ground pepper 1 large clove garlic, minced 6 ounces whole-wheat pasta shells, twists or other chunky pasta shape 1 cup low-fat cottage cheese 1 1/2 cups cooked kidney beans, or roughly chopped fava beans 14 ounces canned artichoke hearts (packed in water), quartered 2 ounces grated sharp cheese (about 1/2 cup)
Combine tomatoes, tomato sauce, herbs, pepper and garlic and simmer over medium heat, stirring occasionally. Meanwhile, boil a large pot of water. Add pasta shells and cook about 5 minutes; they should not be cooked through. Drain well and stir with cottage cheese. Add kidney beans and quartered artichoke hearts to tomato mixture. Spread half the mixture in the bottom of a loaf pan. Top with pasta mixture and add remaining tomato mixture. Sprinkle with grated cheese and bake casserole for 20 to 25 minutes at 350 degrees.