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.
As someone who’s at the frustrating intersection of fascinated and clueless, what are the implications of a blood sugar spike and are they bad? Is the problem the absolute amount of blood sugar or is it the sudden change in blood sugar levels? And what is the general takeaway or advice from this study?
A lot of questions there, but I would be really grateful for any insights. It’s something I know I should know plenty more about.
I'm not an expert but as someone who finds benefit from low-carbing my understanding is: if you raise sugar levels then you raise insulin levels, and at some point if your insulin is chronically raised you lose some sensitivity to the hormone (similar to how you can get tolerant to caffeine from drinking too much coffee etc), and being 'insulin resistant' can lead to many health issues.
The implication is mostly straightforward in abstract: the body has a limited ability to manage blood sugar, and when it's imbalanced other symptoms develop. In the short term this may just mean finishing a meal and being unable to focus for the next hour, longer term it might develop into something more impactful like diabetes. The specific pathways of this response and how they lead to specific symptoms are what isn't known by the science.
But it's analogous to most everything else about the body: we can't concentrate a lot of strong signals like temperature changes or physical exertion into a short timeframe and expect to stay in homeostasis. If you overdo it, that's when the problems start.
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.
> 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.
I would assume the chicken slows down your stomach's digestion/emptying (resulting in slower intake of the carbohydrates/sugars of the fries). Whether it's healthy to eat 10 chicken wings on an empty stomach is another question.
> Basically just distract your liver and you won’t get a massive spike in blood glucose levels.
I'm not sure if that is the best/correct advise. I would advise: eat more fiber.
> I would assume the chicken slows down your stomach's digestion/emptying (resulting in slower intake of the carbohydrates/sugars of the fries).
I believe this is correct according to Levels.
> Whether it's healthy to eat 10 chicken wings on an empty stomach is another question.
Why do you say that? I think as long as you're not eating wings tossed in a sugary sauce or corn starch, and they're cooked in a good fat like beef tallow, avocado oil, olive oil, etc. they're a perfectly healthy food. There's an ounce or less of meat really, so it's not some crazy amount of protein you're taking in at once.
> I'm not sure if that is the best/correct advise. I would advise: eat more fiber.
I agree with you about eating more fiber. I believe that's the key to improved gut health, and getting a more sustained level energy from your food. I didn't mean to imply that distracting your liver is "healthy," but I do think that's what's going on in some of these situations.
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.
> 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.
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.
Yes, and if you look at evidence of how people ate in history, this was not always true. This is the modern way of doing things. I guess we eventually figured it out.
Yes bread is served first. But I always thought bread was to be consumed with the rest of the courses.
I think the butter thing came later. People got impatient waiting so they started serving butter with the bread so that you can get a bite while waiting.
But the original purpose of bread was to be an extra carb along your starter or main depending on what you're having.
I always thought it had more to do with the sweetness of dessert will make you lose your appetite, desire, or reduce the taste of the less sweet foods you eat first.
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.
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.
Saw another study mentioned in comments that had 24 hour glucose levels and there are definitely higher spikes for carb first for both T2 diabetics and people with a normal glucose response. One thing to note is that protein/veggies first didn't spike as much, but the glucose levels were also much slower to return to baseline. So I would call it a win, but not an absolute for T2 diabetics. It was a total win for people not glucose impaired.
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.