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Letters |

Dietary Fiber and Weight Gain—Reply

David S. Ludwig, MD, PhD; Mark A. Pereira, PhD; David R. Jacobs, Jr, PhD
JAMA. 2000;283(14):1821-1822. doi:10.1001/jama.283.14.1821.
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In Reply: Mr McCarty raises an interesting point regarding the effect of dietary protein on body weight. Our study suggests that diets low in fiber may increase the risk of obesity and heart disease by raising insulin levels. McCarty notes that protein potentiates the insulin response to carbohydrate and may therefore promote weight gain. In support of this supposition, we did find that protein consumption was modestly associated with body weight and several cardiovascular disease risk factors. However, recent findings from the Nurses' Health Study suggest that dietary protein actually may protect against ischemic heart disease.1 The effects of protein on hyperinsulinemia-related health outcomes could be influenced by several factors: protein source (animal proteins have a higher lysine-to-arginine ratio than vegetable proteins and, for this reason, stimulate more insulin secretion2), dietary patterns (increased secretion of insulin would be expected if dietary protein replaced fat or low-glycemic-index carbohydrate, but not if protein replaced high-glycemic-index carbohydrate; eg, postprandial insulin levels were lower after consumption of high-protein foods vs equicaloric portions of many high-carbohydrate foods3), and noninsulin-mediated actions (protein may be more satiating than the other macronutrients,4 possibly because of effects on glucagon secretion).

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