Does Eating Protein Before Meals Help With Postmeal Peaks?

 A recent study has shown that eating whey protein before meals lowers the postprandial blood glucose (BG) peaks. Here is the research paper.

The study subjects consumed 15 g of whey protein in a beverage 10 minutes before eating the meal. They found that this procedure reduced the prevalence of daily hyperglycemia by 8% thus increasing the time spent in daytime euglycemia (normal BG levels) by 9%. Nighttime BG levels were not affected.

 Now, this study concerned only whey protein, in a beverage, but there's no reason to think that other proteins would have different effects. And it's something you could easily try yourself.

Eat some protein about 10 minutes before the rest of your meal and see if it has any effect. 

For some people, starting the meal with the protein is normal, although they don't usually wait 10 minutes to eat the rest of the meal. And in social situations, this might be difficult. "What, you don't like my vegetables and salad?"

But if you're eating alone or with family or friends who understand what you 're doing, you could try this. It's easy to do, and who knows, it might help your postmeal BG levels. 

Sticking to a low-carb diet would probably have a bigger effect than starting a meal with protein, but everything helps.

Gut and Brain Conversations

 Your gut and your brain are in constant communication. This is not really surprising, as essentially everything in your body is connected, as I've noted before. But some connections are stronger than others.

Your gut contains zillions (really scientific term) of bacteria, which are not only helping you to digest what you eat but are also releasing what to them are waste products but may be active compounds that will get into your circulation and affect your physiology.

In other words, you should be kind to your gut bacteria as much as you can because if you are, they will help you. This means if you have killer bacteria in your gut, it makes sense to take an antibiotic that will kill these bacteria. Then it makes sense to repopulate your gut with good bacteria, for example, by eating foods like yogurt that contain a lot of microorganisms.

But it doesn't make sense to take antibiotics when you don't need them, for example for a viral infection that isn't affected by antibiotics.

This recent research shows that your gut bacteria can affect your appetite, which is very relevant to type 2 diabetes. If you have a ravenous appetite it's difficult to limit what you eat, and limiting what you eat along with getting exercise is the best way to control type 2 diabetes. 

Not everyone can do this if the disease has progressed with time either before or after you were diagnosed, and then drugs, including insulin, may be necessary. But it doesn't hurt to try.

I used to have a huge appetite. Someone once remarked that they'd never seen anyone so small eat so much. But with time, I don't know if mostly because of increased age or habit, my appetite has decreased so I now find the portions you get in restaurants to be too large. As I can't stand to waste food (some ancestors were Scottish) I now, when I go out, carry my own doggy bag, a plastic thing with dividers that fits inside a purselike bag. I can put the extra food in that and avoid juggling those big Styrofoam containers restaurants usually give you with leftovers. And walking down the street, I don't let everyone know that I'm carrying food. 

Dogs aren't fooled, however.

Short- and Long-Term Effects

Sometimes the short-term (acute) effects of some stimulus are different from the long-term (chronic) effects. One well-known example of this is the effect of free fatty acids on insulin release. In the short term, they stimulate insulin release, but in the long term they inhibit it.

Now it has been found that the effects of prednisone depend on how often you take it.  Daily prednisone promotes obesity, but weekly prednisone promotes increased lean body mass. The researchers also found that the weekly prednisone caused an increase in adiponectin, a hormone that protects against insulin resistance.

And another study shows that ceramide, a lipid, reduces stress in cells in the short term, but in long-term metabolic diseases like diabetes, the ceramide may kill the cells. 

What this means is that when you read about some study, notice how long the study lasted. If a new drug reduces blood glucose levels after a week or a month, will that effect last 6 months or a year or even longer? The same holds for some nondrug treatment.

The body is constantly adapting to its environment, including drugs as well as diet and exercise patterns and stress. Research papers don't always control for that, and such control would sometimes be difficult. For instance, researchers can't really measure how much stress the subjects have had during the course of the study, or if the subjects have started getting groceries from a different place, maybe a farmers market instead of a grocery store or vice versa as the seasons change.

But it's good to be aware of the possible effects of time.

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Snail Insulin

Can marine snails lead to better insulins for human use? Could be.

It seems that the cone snail uses a type of insulin as a weapon. It drops the blood sugar of the fish they hunt so quickly that the fish become paralyzed. And a new insulin for humans has been based on the cone snail insulin. It's not yet commercially available.

Of course, there are already relatively fast acting insulins like Humalog, Novolog, and Apidra, but they take about 15 minutes to start working. The goal with the snail-type insulin would be to have it start working even sooner.

Human insulin tends to associate into hexamers, and then it has to dissociate from these clusters. The snail insulin doesn't form these clusters, so it can act much faster.

The full text has more details, but it's behind a paywall for those without institutional access.

Light and blood glucose levels

Can the level of light in your bedroom affect your blood glucose (BG) levels? These researchers say yes. 

The study was in only 20 people, so the results would have to be confirmed with more subjects, but it is suggestive. The full text is here. Moderate light exposure is considered to be 100 lux, and "dimly lit" is considered less than 3 lux. This gives some examples of different levels of light.

Most people do turn the lights off, or at least way down, when they sleep, but not everyone has that option. In a crowded home without a lot of spare rooms, one person might need light to study, or someone might want to watch TV when someone else wanted to sleep in that room. Or maybe your bed partner just likes to read in bed before going to sleep. Or maybe you live in an urban environment where outdoor lighting is bright.

Whatever, knowing that light could affect your BG levels might inspire you to keep the light levels as low as possible when you sleep. Our ancestors had only moonlight to sleep in, and even a full moon gives off only 0.1 lux.

So make sure your bedroom is as dark as possible. Well, at least when you're sleeping there.

Modifying the Gut through Diet

 Our gut is apparently modified by what we eat. This makes a lot of sense. If we usually eat a lot of some food and the body ramps up the enzymes that digest that food, then we should get more energy from that food, and until relatively recently, getting as much energy from our food as posible was the body's goal. It's only in the recent past that most of us have too much food available so that obesity and not starvation is the problem.

Here is a study showing that if you eat a lot of food, your gut expands so you can digest more food. It had previously been shown that cold does the same, which makes sense because you need to burn more calories to stay warm when it's cold. The interesting thing is that this process seems to be reversible, meaning that if you limit your food intake for a bit, your gut may change its structure again (reducing the number of absorptive villi and hence surface area) so that it absorbs fewer calories.

Interestingly, fructose seems to do the same thing, increasing the villus length: "the increase in villus length was associated with increased nutrient absorption, weight gain and fat accumulation in the animals" wrote the authors of this study. They note that this makes sense evolutionarily because fruit, which contains a lot of fructose ("fruit sugar"), is most available in the fall, when animals want to fatten up so they can survive the lean times of winter.

Eating a peach is not likely to fatten you up, but overeating fructose by drinking a lot of high-fructose corn syrup--sweetened sodas could.

The abstract of the paper can be found here. Note that the authors suggest that fructose also promotes tumor growth.

Of course, if you have diabetes, any sugars like glucose, sucrose, or fructose are not a great idea.

New Hormone Complex Affecting Diabetes

Sometimes it seems as if a new factor that affects diabetes is announced every week. The latest one is called fabkin, which sounds to me like a detergent or a new diet craze. And fabkin is not one factor but a complex of of several. The name comes from fatty-acid-binding protein 4 (FABP4), which forms a functional hormone complex with two kinases, adenosine kinase (ADK) and nucleoside diphosphate kinase (NDPK) to regulate extracellular ATP and ADP levels.

It's postulated that fabkin affects beta cells, blunting their effects. The interesting thing is that using antibodies to neutralize fabkin improves beta cell function in both type 2 and type 1 diabetes. In fact, it has been suggested that neutralizing fabkin could "spell the end of diabetes."

This is an exaggeration, although of course anything is possible. A lot more research needs to be done before fabkin wipes out diabetes.

But it's another factor to keep an eye on.

 

 

The Demise of NuSI

 I don't know how many people have been following this, but NuSI (the Nutrition Science Initiative) was founded in 2011 with the goal of improving the quality of nutrition research, which would allow clarification of which diet was best for weight loss.

Gary Taubes, author of Good Calories and Bad Calories as well as many articles in various media supporting low-carb diets for weight loss, and Peter Attia, a physician interested in longevity, were the founders, and thanks to the John Arnold Foundation, they were able to throw a lot of money at studying the issue. They completed a few studies, but the results were not earth shaking.

 Unfortunately, like so much these days, the organization soon became embroiled in controversy and science politics, and Taubes has just announced its dissolution. 

This won't have much effect on most of us patients. What we want to do is find an eating plan that controls our blood glucose levels and lets us lose weight if we need to, or maintain our weight if we don't need to lose. Diet politics is of less importance to us.

If I were a physician prescribing diets to patients, I'd want to know the results of big controlled trials on many people, so I could first prescribe a diet with the greatest chance of succeeding and then if that didn't work, prescribe something else. But I'm not. So although it's too bad, the demise of NuSI doesn't have much effect on people like me. 

The success of any diet depends on many factors. No diet works well if the subject doesn't follow it, and different people have different tastes. A diet of 100% sea slugs might work 100% of the time, but how many people would be willing to eat nothing but sea slugs? A more reasonable diet might work most of the time if people adhered to it, but even then adherence would vary.

So although the demise of NuSI is sad, it won't have a huge effect on most of us patients. We'll just keep plugging away with the knowledge we have now.

 

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