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Starches last for better blood glucose

Advice for blood sugar regulation ranges from "eat a balanced diet" to "beware carbs!". Macros and foods aside, could switching up the order in which you eat the same foods impact blood sugar?

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

Introduction

What do you eat first during a meal? Most people probably don’t give this question much thought, especially when surrounded with a variety of delicious foods to eat. However, how you answer could have a notable impact on your health.

In Study Deep Dives #10v1’s “Carbs-protein or protein-carbs … does food order matter?”, we discussed a study investigating the effect of food order on postprandial blood sugar responses in people with type 2 diabetes. On two separate occasions, the participants visited a research lab and consumed the same exact meal, but in different ways. On one visit, the starches and sugars (carbohydrates) were consumed first, followed by the meat and fibrous vegetables (protein, fat, and fiber). On the other visit, the order was reversed. Consuming the protein, fat, and fiber first led to significantly lower post-meal blood glucose and insulin levels compared to eating the carbohydrates first.

The above study was the first to document improvements in blood glucose and insulin by manipulating food order in Americans consuming a Western-like meal. Previous research from Japan[1] has shown similar findings both in the immediate post-meal timeframe as well as over the long-term. For instance, one study in Japanese patients with type 2 diabetes showed that receiving instructions to eat fibrous vegetables before starchy carbohydrates and sugars was more effective than basing meals around the traditional diabetic exchange list for reducing HbA1c at 12- and 24-month follow-ups.

Only a handful of studies have been published investigating the impact of food order on health outcomes in participants with type 2 diabetes. The existing studies mostly examined advice to eat vegetables before carbohydrates, and none of the studies attempted to control calories (at least to some degree) over the course of months. The current study tested a strategy of providing instructions to consume carbohydrate-containing foods after high-protein and high-fat foods, to see if it helped with glycemic benefits in patients with type 2 diabetes when compared to receiving standard weight loss advice.

A small number of trials have shown that consuming high-carbohydrate foods such as grains and fruits after consuming high-protein and high-fiber foods such as meats and most vegetables leads to more favorable glycemic outcomes in participants with type 2 diabetes, compared to consuming these foods in the reverse order. The current study sought to test whether these benefits would be observed over two months, when compared to a prescribed diet consisting of the same number of calories.

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