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The impact of dietary protein restriction on insulin secretion and action

Published online by Cambridge University Press:  28 February 2007

Mark J. Holness
Mark J. Holness*
Affiliation:
Molecular and Cellular Biology, Division of Biomedical Sciences, St Bartholomew’s and the Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, Mile End Road, London E1 4NS, UK
*
Corresponding Author: Dr Mark J. Holness, fax +44 (0)181 981 8836, email [email protected]
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Abstract

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The goal of this review is to develop the hypothesis, and review the evidence, that protein restriction, through synergistic effects on multiple organ systems predisposes to loss of normal regulation of fuel homeostasis that plays the central role in the development of type 2 (non-insulin-dependent) diabetes mellitus. The ability of insulin to regulate glucose production and disposal varies between individuals. These differences, together with the various compensatory mechanisms that are invoked to attempt to normalize fuel homeostasis, are of fundamental importance in the development and clinical course of type 2 diabetes mellitus. Protein deprivation impacts on both insulin secretion and insulin action. These effects may persist even when a diet containing adequate protein is presented subsequently. Data are presented that suggest that protein restriction results in an impaired ability of pancreatic β-cells to compensate adequately for the defect in insulin action in insulin-resistant individuals. This persistent impairment of insulin secretion resulting from protein restriction predisposes to loss of glucoregulatory control and impaired insulin action after the subsequent imposition of a diabetogenic challenge. This inability to maintain the degree of compensatory hyperinsulinaemia necessary to prevent loss of glucose tolerance may have relevance to the increased incidence of diabetes on changing from a nutritionally-poor diet to a Western diet, and to the hypothesis that some cases of type 2 diabetes in adulthood may be related to poor early nutrition.

Keywords

Protein restrictionFetal programmingNon-insulin-dependent diabetes mellitusInsulin resistance
Type
Sir David Cuthbertson Medal Lecture
Information
Proceedings of the Nutrition Society , Volume 58 , Issue 3 , August 1999 , pp. 647 - 653
Copyright
Copyright © The Nutrition Society 1999

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