When it comes to keeping blood sugar under control, both in the case of prediabetes and in the case of full-blown type 2 diabetes, we should not only look at what we eat but above all in what order we do it. Small adjustments to the order in which we consume fiber, protein and carbohydrates, in fact, can lead to great benefits. This emerges from two scientific studies performed by the same group of scientists at the prestigious Weill Cornell Medical College in New York and published a few years apart from each other (Shukla et al, Diabetes care, 2015 - Shukla et al, Diabetes Obes Metab, 2018).
The fight against overweight, obesity and diabetes
Overweight and obesity are constantly growing conditions in the world. This data is worrying because overweight and obesity are often accompanied by conditions in which the insulin produced is either not sufficient or not effective in keeping blood sugar under control, which thus begins to increase. In the United States alone, it is estimated that 37% of the population over the age of 20 and even one in two adults over the age of 50 have prediabetes, meaning that their blood sugar has risen but is not yet high enough to a diagnosis of diabetes. Prediabetes is the antechamber of type 2 diabetes and, like the full-blown disease, it can cause damage to health, especially at the level of the heart and blood vessels. Hence the importance of keeping blood sugar under control and avoiding situations in which there are excessive increases in blood sugar. The main intervention, in these cases, concerns the lifestyle, with an increase in physical activity and changes to the diet, preferring whole foods with a low glycemic index. However, there is also another intervention, which at present is often not taken into consideration and which instead has proven to be very effective in reducing the glycemic response, changing the order in which we consume different foods. But let's try to understand better.
Vegetables and fibers at the beginning of the meal reduce blood sugar, the study
The first research was conducted in 2015 on a small sample of 11 people diagnosed with type 2 diabetes. The volunteers, after an overnight fast, consumed all the same type of meal, made up of carbohydrates, and in particular ciabatta bread and fruit juice, followed 15 minutes later by proteins, namely grilled chicken breast, and finally vegetables, raw and cooked. One week later, the volunteers were asked to eat this same meal again, after a night of fasting, but in reverse order. In particular, the vegetables were consumed first, then the chicken breast and finally the carbohydrates. Study participants had blood sugar measured before, immediately after the meal, and 30, 60, and 120 minutes after the meal. Well, what emerged was that consuming a carbohydrate-containing meal starting with vegetables and protein reduced postprandial blood glucose levels by 28% half an hour after the meal and even by almost 37% an hour later, compared to blood sugar levels measured when the meal started with carbohydrates. The increase in blood glucose from fasting value was 73% lower when vegetables were served first and the insulin released was also significantly lower, indicating that eating salad and vegetables first led to an improvement in insulin sensitivity.
Confirmation of the results even in the case of prediabetes
These results were confirmed by the study carried out a few years later on a sample of 15 volunteers with prediabetes. The procedure was identical and, also in this case, after a night of fasting, the volunteers were asked to consume a meal starting with carbohydrates, bread and fruit juice, followed 15 minutes later by proteins, i.e. grilled chicken, and finally salad. A week later the order was reversed by asking volunteers to start with vegetables, followed by protein and finally carbohydrates. What emerged is that the best way to keep blood sugar under control was to consume vegetables as a first course. In fact, the postprandial blood glucose increase was more than 40% lower than when the meal started with carbohydrates.
The two studies show that lifestyle can do a lot to keep blood sugar under control and that the order in which we consume the different foods in a meal is also essential. Good advice, whether we find ourselves having to control blood sugar or not, as a form of prevention, is therefore to start meals that contain carbohydrates with a salad, since the fibers contained help slow down the absorption of sugars. In short, for us this is a small change in lifestyle but for our health the benefits are huge.