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The Metabolic Response of Subjects with Type 2 Diabetes to a High-Protein, Weight-Maintenance Diet

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 reported that a weight-maintaining diet in which the percentage of total food energy as protein was increased from 15–30% resulted in a decrease in postprandial glucose and glycohemoglobin in people with untreated type 2 diabetes without a significant change in insulin. Protein was substituted for carbohydrate in the diet. The fat content remained unchanged. In this publication, we present data on other hormones and metabolites that were considered to potentially be affected by substitution of protein for carbohydrate in the diet.

The mean fasting plasma GH and total IGF-I concentrations were elevated on the 30% protein diet. The urinary free cortisol also was increased. However, the urinary aldosterone was unchanged. Although urinary pH was decreased, calcium excretion was not significantly increased. The plasma postprandial -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.

This work is supported by grants from the American Diabetes Association and the Minnesota Beef Council, NE Beef Council, CO Beef Council, and Merit Review Funds from the Medical Research Service, Department of Veterans Affairs. A.S. is a Fellow in Endocrinology. K.J. is a Graduate Student.

Abbreviation: STDU, Special Diagnostic and Treatment Unit.

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