The Metabolic Response of Subjects with Type 2 Diabetes to a High-Protein, Weight-Maintenance Diet
Frank Q. Nuttall,
Mary C. Gannon,
Asad Saeed,
Kelly Jordan and
Heidi Hoover
Metabolic Research Laboratory and the Section of Endocrinology, Metabolism, and Nutrition (F.Q.N., M.C.G., A.S., K.J., H.H.), Department of Veterans Affairs Medical Center and the Departments of Medicine (F.Q.N., M.C.G.) and Food Science and Nutrition (M.C.G.), University of Minnesota, Minneapolis, Minnesota 55417
Address all correspondence and requests for reprints to: Frank Q. Nuttall, M.D., Ph.D., Chief, Endocrinology, Metabolism & Nutrition Section, One Veterans Drive (111G), Department of Veterans Affairs Medical Center, Minneapolis, Minnesota 55417.
In a randomized, crossover 5-wk study design, we recently reportedthat a weight-maintaining diet in which the percentage of totalfood energy as protein was increased from 15–30% resultedin a decrease in postprandial glucose and glycohemoglobin inpeople with untreated type 2 diabetes without a significantchange in insulin. Protein was substituted for carbohydratein the diet. The fat content remained unchanged. In this publication,we present data on other hormones and metabolites that wereconsidered to potentially be affected by substitution of proteinfor carbohydrate in the diet.
The mean fasting plasma GH and total IGF-I concentrations wereelevated on the 30% protein diet. The urinary free cortisolalso was increased. However, the urinary aldosterone was unchanged.Although urinary pH was decreased, calcium excretion was notsignificantly increased. The plasma postprandial -amino nitrogenconcentrations were increased, but the 24-h integrated concentrationwas unchanged, indicating an accelerated amino acid removalrate. The plasma urea nitrogen was increased as expected. Theurea production rate also was increased such that a new steady-statefasting value was present. The calculated urea production rateaccounted for 97% of the protein ingested on the 15% proteindiet, but only 80% on the 30% protein diet, suggesting net nitrogenretention on the high-protein diet. In conclusion, an increasein dietary protein results in a number of metabolic adaptationsin addition to reducing the circulating glucose concentration.Serum TSH, total T3, free T4, B12, folate, homocysteine, uricacid, and creatinine concentrations were unchanged.
This work is supported by grants from the American DiabetesAssociation and the Minnesota Beef Council, NE Beef Council,CO Beef Council, and Merit Review Funds from the Medical ResearchService, Department of Veterans Affairs. A.S. is a Fellow inEndocrinology. K.J. is a Graduate Student.
Abbreviation: STDU, Special Diagnostic and Treatment Unit.
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-amino nitrogen concentrations were increased, but the 24-h integrated concentration was unchanged, indicating an accelerated amino acid removal rate. The plasma urea nitrogen was increased as expected. The urea production rate also was increased such that a new steady-state fasting value was present. The calculated urea production rate accounted for 97% of the protein ingested on the 15% protein diet, but only 80% on the 30% protein diet, suggesting net nitrogen retention on the high-protein diet. In conclusion, an increase in dietary protein results in a number of metabolic adaptations in addition to reducing the circulating glucose concentration. Serum TSH, total T3, free T4, B12, folate, homocysteine, uric acid, and creatinine concentrations were unchanged. 
