A Novel Approach for Managing One's Glucose Levels

Authored By: Kersten Sykes

Art By: Stefanie Chen

When you are staring down at the plate, rather than just thinking about what you are eating, have you ever thought about when? That doesn't necessarily mean the time of day, but rather the order in which those different foods are being eaten. Research by Glazier (2024) has shown that the order in which certain macronutrients, such as carbohydrates, fiber, and proteins are consumed can significantly impact one’s postprandial glycemic levels, helping in some cases to reduce those infamous glucose and insulin spikes [1]. Foods high in fiber, typically fruits and vegetables, can delay gastric emptying and in some cases shift acidity levels within the stomach inhibiting the enzymes that process carbohydrates and sugars. Both of these interactions slow the release and amount of sugar that enters the bloodstream, helping reduce postprandial glycemic levels.

This phenomenon was initially observed in 2010 by researchers within the Department of Clinical Nutrition at Osaka Prefecture University [2]. Imai (2010) found that when participants with type 2 diabetes consumed a serving of vegetables (cabbage and tomatoes) prior to a serving of carbohydrates (white rice), they were able to significantly reduce their postprandial glycemic levels compared to eating the same meal in the reverse order. These results sparked a slew of research over the next decade about how food order could be optimized to reduce postprandial hyperglycemia. That is, an unhealthy spike in glucose after eating. One study by Alpana et. al (2015) published by the American Diabetes Association further developed the idea by adding the macronutrient protein into the mix [3]. The study consisted of a crossover design in which participants received both treatments one week apart from each other. The first treatment examined how glucose levels were affected when carbohydrates were consumed before protein and vegetables, while the second treatment reversed this order. The results showed that in the treatment where vegetables and protein were consumed first, postprandial glycemic levels were reduced by 28.6% after 30 minutes and 36.7% after 60 minutes. 

According to Mishra et. al (2023) the reason behind these staggering results comes down to how certain foods can impact the digestion and absorption of nutrients within the GI tract [4]. Typically, vegetables are higher in fiber than grains and other forms of carbohydrates. When consumed, the fiber present can delay gastric emptying, meaning that food is sitting in the stomach longer and the sugars within it cannot be absorbed by the small intestine all at once. This delay helps reduce abrupt spikes in blood sugar. Additionally, certain fruits and vegetables that are more acidic can lower the intestinal pH levels resulting in the inhibition of key enzymes like amylase. These enzymes break down complex sugars into their absorbable form, glucose; when this activity ceases, so does the rise of glucose in the bloodstream.

So, why is it so imperative that we avoid these spikes? In the short term,  it won't hurt to eat a large bowl of carb-heavy pasta or a sugary dessert. However, when these spikes occur after every meal there is a risk of developing hyperglycemia. Those with sustained hyperglycemia are at further the risk of developing insulin resistance (i.e. type two diabetes). Once a person develops this condition, controlling one’s glucose levels becomes even more of a priority. If left unchecked, the effects of glucose fluctuations can snowball and cause more serious and life threatening chronic diseases like cardiovascular disease and dementia [5,6].

From a clinical perspective, one of the best approaches for treating type 2 diabetes and other chronic conditions is to change a person’s behavioral patterns, specifically their diet. However, adapting to a new diet often proves a difficult task for patients, even when faced with these health risks [2]. Could it be possible for them to adapt to eating their meals in a certain order? Convincing patients to focus on eating veggies first before a meal may be an easier approach to help those who are looking to manage their glucose levels. 

Although there is strong evidence surrounding the health benefits of consuming fiber and protein before carbohydrates, practice by itself will not prevent and cure all chronic conditions.In conclusion, consuming vegetables and proteins before carbohydrates can be a simple yet effective strategy to manage postprandial glycemic levels. This approach, combined with other healthy lifestyle changes, can help individuals, especially those with type 2 diabetes, lead healthier lives. In reality, there are a variety of lifestyle factors beyond just nutrition and dietary patterns that play a role in determining a person's health. Despite this, eating vegetables is a great first step for patients who are looking to control their glucose levels and ultimately lead healthier lives.

References:

1. Glazier, E., Ko, E. (2024, April 22). Eating in Certain Order Helps Control Blood Glucose. UCLA Health. https://www.uclahealth.org/news/article/eating-certain-order-helps-control-blood-glucose

2. Imai, S., Kajiyama S. (2010) Eating Order Diet Reduced Postprandial Glucose and Glycated Hemoglobin Levels in Japanese Patients with Type 2 Diabetes. J Rehabil Health Sci 2010;8:1-7

3. Alpana P. Shukla, Radu G. Iliescu, Catherine E. Thomas, Louis J. Aronne. (2015). Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels. Diabetes Care 1 July 2015; 38 (7): e98–e99. https://doi.org/10.2337/dc15-0429

4. Mishra S, McLaughlin A, Monro J. (2023). Food Order and Timing Effects on Glycaemic and Satiety Responses to Partial Fruit-for-Cereal Carbohydrate Exchange: A Randomized Cross-Over Human Intervention Study. Nutrients. 2023; 15(14):3269. https://doi.org/10.3390/nu15143269 

5. Crane, P., et. al. (2013) Glucose Levels and Risk of Dementia. New England Journal of Medicine, vol. 369, no. 6, 8 Aug. 2013, pp. 540–548, https://doi.org/10.1056/nejmoa1215740. 

6. Blaak, E. E., Antoine, J. M., Benton, D., Björck, I., Bozzetto, L., Brouns, F., Diamant, M., Dye, L., Hulshof, T., Holst, J. J., Lamport, D. J., Laville, M., Lawton, C. L., Meheust, A., Nilson, A., Normand, S., Rivellese, A. A., Theis, S., Torekov, S. S., & Vinoy, S. (2012). Impact of postprandial glycaemia on health and prevention of disease. Obesity reviews : an official journal of the International Association for the Study of Obesity, 13(10), 923–984. https://doi.org/10.1111/j.1467-789X.2012.01011.