Food Order Has Significant Impact on Glucose and Insulin Levels (2015)

Title should be edited to include the date (2015), I wondered why it was being announced as something we didn't already know.

A study I read had two groups each eating a bowl of white rice (a high glycemic load food), except one group ate an apple fifteen minutes before the rice. Each group ate the same serving of rice, so the apple group was getting more carbs, more sugar, more calories. They found the apple group experienced less of a blood sugar spike from the rice. This changed the way I think about food and diet maybe more than anything other single food study.

I wore a glucose monitor through the levels health program for a couple of months. I’m not diabetic, just curious. They present the idea of eating your protein and fat before carbs in a meal as a “challenge” to see how it’s different from eating the same meal with the carbs first. It’s not the most scientific result, but multiple times I ate 10 chicken wings then ate an order of French fries after the wings with zero increase in my blood glucose levels.

Taking a shot of apple cider vinegar also helped blunt the glucose spike. Alcohol also blunts a glucose spike. Basically just distract your liver and you won’t get a massive spike in blood glucose levels.

I kinda figured this out something like this for myself by trial and error. I'm hypoglycemic not diabetic. If I have simple carbs first thing in the day I'll get a bump in energy then crash for most of the day, even if I ate proteins right afterward. It's especially bad if I start hungry and have the carbs with coffee. Don't know what's going on with insulin or whatnot but order definitely matters.

I have first hand experience this ,as I was recently diagnosed with reactive hypoglycaemia[1]. The recommended treatment was eating protein and vegetables before carbohydrates, along with daily 12 hour fasting, and within week my symptoms were gone. It's apparently an intestinal issue, where it over-reacts to the presence of carbs when the stomach is empty, and is fairly common in people who have had bariatric surgery.

[1] https://en.wikipedia.org/wiki/Reactive_hypoglycemia

> They worked with 11 patients, all of who had obesity and type 2 diabetes and take an oral drug that helps control glucose levels, called metformin.

This is such a tiny and specific sample compared to the unqualified claim they make in the title. Unfortunately, this level of rigor seems to be par for the course in the world of nutrition.

Didn't know about this ordering/sequencing thing, but as far as combining types of foods -- this effect can be seen in graphs from continuous glucose monitors -- I vaguely knew that you can reduce the impact of carbs by mixing in meat etc, but it's enlightening to see it visually.

Eg. here: https://neo.life/2019/01/personalized-health-advice-every-60...

Would be good to have insulin monitoring be as easy as glucose monitoring at home..

PS. I remember at a social event someone with diabetes eating ice cream a bit before the meal--I wonder if it was related (just to reduce the impact) or if there was some other insulin/glucose management technique going on there.

Since most deserts are full of sugar their order in the meal now makes sense.

I’ll try to explain what is going on. It’s not magic, and it’s not all conclusively beneficial.

Fructose acts on the pancreas to increase insulin, but converts to glycogen directly at first pass of the liver and gets stored there. The glucose from the rice then gets deposited faster to adipose tissue because of the insulin, which shows up as lower levels of blood glucose.

Fructose alone can cause hypoglycemia with this effect. Too much glycogen from fructose turns into non-alcoholic fatty liver disease. But glycogen feels great to the brain, which is why we drink HFCS. There are also some reasons why high blood glucose is bad, like decreased insulin sensitivity, and cell damage in sensitive tissues like the retina.

The clear-cut benefit of the apple is the insoluble fiber, which slows absorption and gets metabolized by colon bacteria to capric acid, giving satiety for hours afterward. It’s possible that what I describe with the fructose is also good, if the glycogen stores are depleted prior to eating, and the adipose tissue is sensitive enough to grehlin/GH to release fatty acids throughout the day, and of course, the person maintains the proper energy balance.

Energy balance always wins. Study after study tries to find a way around it, and it never works. Beyond basic macro and micro requirements, there’s very little effect of changing anything else. But those things might make you feel better, which makes energy balance goals easier to achieve.

It's primarily the fiber. Even a couple of hours after the fact, having consumed fiber first will lower glycemic response from simple carbs.

I've been doing this for years by starting with meat/veggies and only then with carbs. Feel a lot better this way.

Apparently my family knew this in the 1960s, as we always ate dinner before dessert.

Wouldn’t you need more than 12 patients to conduct such experiments?

I wish they would have tested further out than 120 minutes in case part of the effect was not digesting the carbs until later (vs just lowering spikes). One of the books I read on blood sugar talked about some hard to digest pasta that will take 3-5 before the glucose spikes up from it.

(HN mods: From 2015)