Carbohydrate intolerance is common in patients with cirrhosis. The aim of the present study was to determine whether the beneficial metabolic effects of low glycemic index diets observed in noncirrhotic diabetics also occurred in patients with cirrhosis. Therefore, for one day, five patients with cirrhosis were fed diets in which low glycemic index foods were substituted, replacing those which produced higher blood glucose rises. Reduction in the estimated glycemic impact of the diet by approximately 30% reduced the mean incremental blood glucose level over the day by 40 +/- 5% (p less than 0.001). Measurement at breakfast of amino acid, insulin, and gastric inhibitory polypeptide profiles confirmed a reduction of similar magnitude. No change was seen in pancreatic glucagon, whereas enteroglucagon levels tended to be higher. In view of these findings and the possible long-term benefits of chronic reduction of hyperinsulinism and alteration in amino acid metabolism, this approach to dietary management of cirrhosis warrants further consideration.