Nuts as a Replacement for Carbohydrates in the Diabetic Diet

  1. Robert G. Josse, MB, BS1,2,3,4
  1. 1Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital Toronto, Toronto, Ontario, Canada
  2. 2Division of Endocrinology and Metabolism, St. Michael’s Hospital Toronto, Toronto, Ontario, Canada
  3. 3Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  1. Corresponding author: David J.A. Jenkins, cyril.kendall{at}


OBJECTIVE Fat intake, especially monounsaturated fatty acid (MUFA), has been liberalized in diabetic diets to preserve HDL cholesterol and improve glycemic control, yet the exact sources have not been clearly defined. Therefore, we assessed the effect of mixed nut consumption as a source of vegetable fat on serum lipids and HbA1c in type 2 diabetes.

RESEARCH DESIGN AND METHODS A total of 117 type 2 diabetic subjects were randomized to one of three treatments for 3 months. Supplements were provided at 475 kcal per 2,000-kcal diet as mixed nuts (75 g/day), muffins, or half portions of both. The primary outcome was change in HbA1c.

RESULTS The relative increase in MUFAs was 8.7% energy on the full-nut dose compared with muffins. Using an intention-to-treat analysis (n = 117), full-nut dose (mean intake 73 g/day) reduced HbA1c (−0.21% absolute HbA1c units, 95% CI −0.30 to −0.11, P < 0.001) with no change after half-nut dose or muffin. Full-nut dose was significantly different from half-nut dose (P = 0.004) and muffin (P = 0.001), but no difference was seen between half-nut dose and muffins. LDL cholesterol also decreased significantly after full-nut dose compared with muffin. The LDL cholesterol reduction after half-nut dose was intermediate and not significantly different from the other treatments. Apolipoprotein (apo) B and the apoB:apoA1 ratio behaved similarly. Nut intake related negatively to changes in HbA1c (r = −0.20, P = 0.033) and LDL cholesterol (r = −0.24, P = 0.011).

CONCLUSIONS Two ounces of nuts daily as a replacement for carbohydrate foods improved both glycemic control and serum lipids in type 2 diabetes.


  • Received February 18, 2011.
  • Accepted May 4, 2011.

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