Manipulating the sequence of food ingestion improves glycemic control in type 2 diabetic patients under free-living conditions

Abstract

Lipid and protein ingested before carbohydrate reduce postprandial hyperglycemia. We tested feasibility, safety and clinical efficacy of manipulating the sequence of nutrient ingestion in patients with type 2 diabetes (T2D). After a 4-week run-in, 17 T2D patients were randomized to either a control diet (CD) or to an experimental diet (ED) allowing the consumption of high-carbohydrate foods only after high-protein and high-fat foods at each main meal (lunch+dinner). Both diets were accurately followed and neutral on arterial blood pressure, plasma lipids and indices of hepatic and kidney function. After 8 weeks, in spite of a similar reduction of body weight (ED −1.9 95% confidence interval (−3.4/−0.4)kg, P<0.03; CD −2.0 (−3.6/−0.5)kg, P<0.02) and waist circumference (ED −2.9 (−4.3/−1.5)cm, P<0.002; CD −3.3 (−5.9/−0.7)cm, P<0.02), the ED only was associated with significant reductions of HbA1c (−0.3 (−0.50/−0.02)%, P<0.04), fasting plasma glucose (−1.0 (−1.8/−0.3)mmol l−1, P<0.01), postprandial glucose excursions (lunch −1.8 (−3.2/−0.4)mmol l−1, P<0.01; dinner: −1.0 (−1.9/−0.1)mmol l−1, P<0.04) and other indices of glucose variability (s.d.: −0.5 (−0.7/−0.2)mmol l−1, P<0.02; Coefficient of variation: −6.6 (−10.4/−2.7)%, P<0.02). When compared with the CD, the ED was associated with lower post-lunch glucose excursions (P<0.02) and lower glucose coefficients of variation (P<0.05). Manipulating the sequence of nutrient ingestion might reveal a rapid, feasible, economic and safe strategy for optimizing glucose control in T2D.

The impact of food order on postprandial glycaemic excursions in prediabetes

“…The key components of standard nutritional counselling include reducing calorie intake and glycaemic load. Sequential nutrient ingestion is a novel strategy to attenuate the glycaemic effect of a meal researched by our group and others in patients with type 2 diabetes . In a previous crossover study of metformin‐treated subjects with type 2 diabetes, we showed that ingestion of protein plus vegetables before carbohydrate led to lower postprandial glucose excursions over 180 minutes, compared with eating the same foods in the reverse order .…”

The influence of food order on postprandial glucose levels in children with type 1 diabetes

“…Furthermore, the order of intake of macronutrients—and therefore, food order—seems to influence postprandial glycemia in patients with type 2 diabetes . Shukla et al found significantly lower blood glucose levels after 30, 60, and 120 minutes in 11 adults with type 2 diabetes when vegetables and protein were consumed prior to carbohydrates compared to the reverse order …”

Reducing the glycemic impact of carbohydrates on foods and meals: Strategies for the food industry and consumers with special focus on Asia

“…Studies have shown that co‐ingestion of coconut oil (Tan et al., ), butter, olive oil, or grapeseed oil (Henry, Lightowler, Newens, & Pata, ), and rapeseed oil (Hätönen et al., ) reduced the GI of rice porridge, bread, and mashed potatoes, respectively. A food high in both protein and fat, such as cheese, has shown to greatly reduce and sustain low glycemic levels when ingested as a preload (Tricò et al., ). Protein is more effective at attenuating glycemic response than fat alone, but shows a synergistic reduction when taken in combination (Hätönen et al., ).…”

“…Protein is insulinogenic, that is, it stimulates production of insulin (Bornet, 1987), which lowers postprandial blood glucose by transporting glucose out of the bloodstream. Preloading with protein or high-protein beverages such as soymilk (Sun, Tan, Han, Leow, & Henry, 2017), soy protein isolate (Kashima et al, 2016), dairy milk (Sun et al, 2017), and whey protein and meat/cheese/fish (Tricò, Filice, Trifirò, & Natali, 2016) has been shown to increase insulin secretion prior to ingestion of the main carbohydrate meal, which lowered glycemic response compared to a blank (water) preload. In terms of satiety, consumption of preloads containing whey protein decreased subsequent meal energy intake as compared to an isocaloric nonprotein preload (Astbury, Stevenson, Morris, Taylor, & Macdonald, 2010).…”