“When we have veggies first, their fiber sets up a filter in the intestines. Once the carbs arrive on the scene, the filter slows them down, like sand catching floodwater, so the glucose enters the bloodstream at a mere trickle instead of a gush. Less insulin is needed for our cells to absorb these drips, putting less strain on the pancreas. “The totality of the research strongly supports the notion that food sequencing does reduce glucose spikes after a meal,” says Dr. Alpana Shukla, an associate professor of research at Weill Cornell Medicine who studies food order”
“It’s not necessary to eat the vegetables by themselves to get the benefits. Combining veggies and protein before carbs results in 46% lower glucose peaks, compared to carbs-first, in people with prediabetes. This combo may work slightly better than veggies alone, according to Shukla.”
“Patients swear by food order to support their obesity care,” says Dr. Katherine Saunders, an obesity medicine physician at Weill Cornell Medicine and co-founder of Intellihealth, partly because they can still have carbs. “The best diet is one that doesn’t feel like a diet.””
A twist in the carb/protein/fats balancing act. I was aware that it’s generally recommended to pair carbs with protein, as well as to fill up on fiber. But it’s new advice to me to strive to eat fiber before carbs or ideally fiber + protein first. Later the article also discusses a protein starter as a similar strategy.
After reading the article for yourself, what are your thoughts? One easy conclusion seems to be to bypass the bread basket before a meal (they’ve pretty much gone out of fashion anyway).
This is a subject I have looked into. There is a great evidence-based YouTube channel hosted by Dr Gil Carvahlo: Nutrition made simple. The article you linked to does not appear to link to the underlying papers which makes the article difficult to interpret. I have seen some analyses of papers on food order research.
Most of these papers are reporting tiny investigations, 35 participants was a larger panel.
It is important to distinguish effects seen in pre-diabetic and diabetic populations from normally functioning metabolic systems. Something that may be important in one population may not hold for the other.
It is also important to distinguish the size of the effect from its statistical reliability. Some dietary effects {or drug effects or anything} can be highly statistically reliable but theeffect remains so small as to be negligible.
My take on the area is that it is one of those things that in a food lab shows more effect that it really makes in real life. I try and do it. Especially the veggies at the start of a meal. But I think the benefit is from making me feel fuller and hence eat less calorie-dense foods at the end.
The huge issue in any food study is that losing weight makes everything look better metabolically and coronary-wise, so anything that helps you lose weight is a good thing. Anything that helps you maintain a healthy weight is a good thing. So an eating pattern that slows down your food intake in and of itself is probably a good thing.
I also am convinced by the evidence that there is great benefit in eating complex carbs containing high fiber, and replacing refined with poly and momo saturated fats are both risk reducing. And making these switches in the diet can lead to a lot of weight loss. I have lost 40# since switching to this kind of eating pattern with not a lot of effort. The eating pattern supported good choices.
Also, on my health and weight loss journey, I fixed a long history of sleep apnea {I am now CPAP-free after being on one for over a year} and I work out regularly with a combo of general activity and weekly resistance training.
The article cites a very smalll, underpowered academic study where again, like many, many times before, “big” general conclusions are drawn out of it. Many academic food related studies have the problem that they rely on small sample size and are often driven to get the next round of funding and so they are aimed to generate “interesting” data. Many people in academia avoid useful larger studies as they cost more but more importantly are likely to not show the “desired” effect.
@ChristinaM I have to thank you for reminding me about this. I’ve been trying to work it back into practice ever since you posted.
The sequencing advice has existed in diabetes treatment for a long time, but perhaps not publicized outside the sphere (like GI / GL, insulin resistancxe, etc took a while to make it out from there and into broader weight management).
A close friend who’s an endocrinologist has shared these kinds of tidbits over the years — essentially, to coat your stomach before the carbs hit to ameliorate the glucose spike. When her patients want ice cream, she tells them to eat Haagen Dazs, because the fat content is so hig, it dampens the impact of the sugar. Extend the fat buffer to other carbs too.
Of late, I’ve seen more lay information about sequencing out there using more easily available (these days) glucose monitor data. The IG account Glucose Goddess does interesting visuals on different foods and sequencing based on data from her glucose monitor.
It makes sense, but I don’t always remember to implement it, nor is it always possible. Eating your carbs last is harder when it’s a meal where the carbs go with everything else (eg in indian or other asian food — it would be strange to eat the veg and protein first, and save the bread / noodles / rice for later, when they are meant to be eaten together). But I view all the information as useful building blocks. Add refrigerating rice, pasta, potatoes to increase resistant starch, complex carbs to the mix too.
(A lot of this research is guided out of the same labs / folks – Louis Aronne is one of the better-known co-authors. He and David Ludwig of Always Hungry fame have also been working on research to reverse the commonly held belief that obesity is a cause, rather that it is symptom.)
I’m a T2 (or possibly T1.5), on insulin and with a CGM. I’ve heard the food sequencing stuff for a few years now and have sporadically tried it. As Saragama notes, it is sometimes tough when you commonly eat foods where the carbs, protein, etc. are all mixed together. I keep celery pieces in the fridge to snack on before meals sometimes or eat a piece of cheese. But despite RDs and my endo touting/mentioning food sequencing, I am not convinced it makes much of a difference for most people in the long term.
I liked the focus in the video of longer term implications of avoiding the spikes - what is the impact on HbA1C? That is the most important value for me and my docs.
Yes, for sure, because they are naturally coursed as starter + main.
But it’s also got me thinking about about how Indian meals are traditionally eaten as combinations (not dissimilar to the “triangle” approach described in the article about Japanese eating in the other thread) – as a thali, where veg, legumes, salad, carbs, and yogurt are all eaten in combinations rather than standalone, and that must have something to do with absorption and spikes too.
My mom used to serve us a vegetable soup every evening as a tide-over about a half hour before dinner. My grandmother would set out a big plate of “salad” (sliced raw veggies like carrots, cucumber, tomatoes, and radishes) so everyone could snack on them instead of bothering her while she finished dinner. My SIL makes everyone a bowl of salad (lettuce++) to start dinner, no matter what cuisine we are eating. Any of these would solve my own “problem” if I stocked the ingredients and had the foresight to do it, lol.
I’m liking the vote of confidence you and @tcamp are giving here because
… there was no way I was going to watch a YouTube without knowing it was going to be worth my while
Those picographs are pretty compelling and I confess I haven’t done enough analysis of my own data to generate such things. Again, most of my medical providers have touted food sequencing but OTOH one of them in particular (an NP), has convinced me that high-ish spikes are not the problem as long as I return to baseline in 3 or so hours. That a much bigger issue is going too low which then prompts a ricochet effect. That, of course, isn’t related to food sequencing. Also, I take short acting insulin before some meals, depending on starting BG and what I’m eating so that would skew results.
What works best for me is reduced carbs, carbs that are whole grain, portion control, no/minimal processed foods, and exercise after each meal. Following that protocol is what results in optimal HbA1C values for me.
