Some years back a study was done comparing how one ate the same meal made a difference is your metabolism. Now a more specific evaluation on one of the components of that metabolism was evaluated and found to be affected in no surprise. I thought, though, this gave me an opportunity to review the earlier information, because it’s just SO important for everyone to understand.
You go into a nice Italian restaurant, and they have great bread. You love the bread, but you figure you’re watching your diet, so you’ll only have the bread – no oil or butter. WRONG!! Literally, the worst thing you can do. Why?
Restaurants know from years of experience, giving bread before the meal MAKES PEOPLE ORDER MORE FOOD. Turns out that the carbohydrate load minutes before consuming any other macronutrient (think protein, fat, carbs) will drive up your blood sugar to astronomical heights, and thus driving up insulin levels, and that elevation will persist for hours. This combination leads to “overeating”. You’re priming the pump for pre-diabetes.
If start the meal with bread AND butter or olive oil, that fat will actually work in your favor to slow the carbohydrate absorption, blunt your sugar elevation, blunt your insulin response, which results in 40% lower levels and a far lower chance of driving that pre-diabetes story.
Now, of course, if you eat all the bread, all the food, and the dessert, all bets are off! But if you want to have a piece of that delicious bread, do yourself a favor – dip it in some olive oil, or if they have really good, yellow butter (like Kerry Gold), go for it!
Now THAT’S A CRAZY STORY! (but true 😉)
FROM DIABETES CARE / BY ALPANA P. SHUKLA, ELIZABETH MAUER, LEON I. IGEL, WANDA TRUONG, ANTHONY CASPER, REKHA B. KUMAR, KATHERINE H. SAUNDERS, LOUIS J. ARONNE
Data suggest that the temporal sequence of carbohydrate ingestion during a meal has a significant impact on postprandial glucose 1-3), insulin, and glucagon-like peptide 1 (GLP-1) excursions (4) in type 2 diabetes, while the effects on ghrelin suppression and satiety have not been reported.
The study design and methods have previously been described in detail (4). Briefly, using a crossover design, 16 subjects with overweight/obesity and metformin-treated type 2 diabetes were assigned to consume the same meal on 3 days in random order:
Carbohydrate-first meal: carbohydrate (bread and orange juice), followed 10 min later by protein (chicken) and vegetables
Carbohydrate-last meal: protein and vegetables, followed 10 min later by carbohydrate
Sandwich: all meal components together, each half consumed over 10 min with a 10-min interval in between
Blood was sampled for glucose, insulin, active GLP-1, and total ghrelin measurements at baseline (just before meal ingestion) and at 30-min intervals up to 180 min. Participants rated their hunger and fullness levels using a visual analog scale (VAS) at the same time points.
Baseline glucose, insulin, GLP-1, and ghrelin concentrations, as well as hunger and satiety scores, were similar in the three meal conditions. At 180 min, ghrelin levels remained suppressed following the carbohydrate-last meal order, while the carbohydrate-first meal led to a rebound in ghrelin to preprandial levels (percent ghrelin change from baseline to 180 min −11.45 ± 3.86% vs. 4.13 ± 4.38%; P = 0.003) (Fig. 1). Decremental areas under the curve for 0–180 min were similar in the three meal conditions. There was an inverse correlation between percent change in ghrelin and percent change in glucose from baseline when assessing all participants in the three meal conditions at the evaluated time points (r = −0.204; P < 0.001). We did not observe a significant effect of food order on subjective VAS appetite measures.
Ghrelin percent change from baseline following carbohydrate-first (carbs first), carbohydrate-last (carbs last), and sandwich meal orders. Values are mean ± SEM, n = 16. ¥Statistically significant difference (P = 0.003, linear mixed-effects model) between carbs first and carbs last at 180 min.
We have previously demonstrated that the carbohydrate-last meal pattern reduces postprandial glucose excursions compared with other meal patterns. Controlling for carbohydrate amount, this meal pattern stimulates lower insulin and higher GLP-1 response compared with the carbohydrate-first pattern (4). Taken together with our new findings on ghrelin suppression, this suggests that macronutrient order during a meal modifies the pattern of postprandial insulin and gut hormone secretion that could potentially impact satiety and weight regulation. However, similar to observations in previous studies that have investigated gut hormone excursions to isocaloric meal interventions (5,6), these disparate hormonal responses did not translate into any significant differences in hunger/satiety scores reported by participants in the three meal conditions. This result may reflect both the subjective nature of the VAS tool and the complexity of appetite regulation; ghrelin is the only known orexigenic peptide, whereas GLP-1 is one of several anorexigenic signaling gut hormones. Further study with an extended observation period, assessment of other gut hormones using meals with different macronutrient composition, and more objective measures of satiety is needed.
In conclusion, to our knowledge, this is the first study to demonstrate that manipulation of macronutrient order can impact gut hormone excursions. Its clinical implications for satiety and weight management require further study.