Meal sequencing (Veg first, Carbs last)

Floraidh said:

Hi, I am new here. Hopefully, I can post and keep to the guidelines.

I am not diabetic but my OH is. He was diagnosed in 2016 and until last August I didn't get involved unless he asked for my opinion. Due to detiorating health he wanted me to come along to his appointments. He started using Libre 2 a couple of months ago so that gives a much clearer picture of his numbers. He is also sulphite intolerant which means we avoid things like almond flour which might have been a lower carb option.

I recently found information on a couple of small studies that looked at the order that we eat our food and the impact that would have on blood sugars for those with T2D.

The suggested order is

Veg 1st
Protein/Fats 2nd
Carbs 3rd

I suggested that this might be worth a try to see if this would help to stabilise his bg numbers. They always spiked after breakfast and after our evening meal.

His breakfast is
Oat bran porridge 25g with blueberries and milk followed by mushroom and egg

Dinner is usually meat or fish with veg and 2 precooked potatoes

By simply changing the order of eating.
He went from peaking at 15 to peaking around 8.5/9 and for the very 1st time staying 100% within range for a 24 hour period.

Before posting, I searched this site for any other posts relating to this but couldn't find any. Maybe the info is there under another heading.

I hope this might be helpful to others struggling with diet and stabilising bg numbers.

Best wishes
Flora

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I believe the French eat like that. start with crudite, then the meat course followed by dessert (pastiseries). In england we did similar starting with soup, then main course of meat +2 veg, then pudding (although in previous times the pudding was savoury, and went second hence Yorkshire pudding which was a course on its own.

By in - range, what range does your OH consider his target? Normally when we test we look to find a rise of no more than 2 mmol/l at the 2hr after eating , and a return to the baseline starting value by 4 hours. My target range that I use is between 5 and 8 mmol/l to hopefully avoid complications. But everybody has differences in what they consider 'in range' to mean to them.

Is he still using a Libre? Is he on medication other than insulin? You mention low carb, but the meals you described are not exactly low carb. Oatmeal, bran and potatoes are very glucogenic (regardless of GI value they still turn to sugar) But as an insulin user he should be able to cope with them but fixed dose may be problematic, whereas for me they would spike me.

This has recently been popularised on Instagram by the self-styled "Glucose Goddess", and I she even wrote a book, based on her experiences with wearing a CGM. It's not just the order of eating, but also starting the meal with vinegar (as a drink or salad), never eating "naked" carbs and more that I don't remember (as I eat low carb anyway). The book was still interesting, with the caveat of check your own responses!

Larissima said:

This has recently been popularised on Instagram by the self-styled "Glucose Goddess", and I she even wrote a book, based on her experiences with wearing a CGM. It's not just the order of eating, but also starting the meal with vinegar (as a drink or salad), never eating "naked" carbs and more that I don't remember (as I eat low carb anyway). The book was still interesting, with the caveat of check your own responses!

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Actually this is one of those very rare occasions when I agree with a Guru. The science stacks up. the practice holds water, and floats my boat.

The French got it right. Starting with a light carb load means that for non diabetics, the carb rush is unhindered by fat and protein, and is often assisted by vinegar, and hence kick starts the pancreas First Response insulin release. Then the heavy duty protein and fat load gets handled as it should and fills us up to ring the saiety bell. finally the sweeties and goodies are kept till last anf being mostly satiated, this naturally reduces our demand intake and reduces the glycemic load from all that sugar by portion control.

Sadly for diabetics, especially T2D, our first response curve is usually pathetic or non existant. And for insulin deficient folk, the insulin release is probably quite weak if T2D, and non existant in T1 et al. But for those on insulin treatment this procedure may be helpful even though the pancreas is not so effective.

Also, the kickstart effect if active will release energy needed for digestion so pays the piper up front rather than waiting for the glucose to get into the bloodstream and ending up being stored instead of being used. But again Insulin resistance will reduce this benefit.

I always wondered why restaurants menu had starters. I thought it was just to give the punters something to do while chef worked his **** off preparing the main course. Shane that prawn cocktail has a high protein and fat content (not always true since many restaurants hold the prawns it seems)

So I think that this procedure may help those usng insulin, but will probably have minimal benefit for most T2D.

Floraidh said:

He's been told by his DN to keep between 6 and 9. Having previously been eating a fairly high carb diet, his current intake is low for him although not "low carb". I have never managed to persuade him to go low carb. Having a stroke which affected his judgement and decision making i don't think he would be able to manage a low carb diet without very intensive support.
He is still using the libre 2 which is very helpful to see where the spikes are. As to meds he is taking metform 2000mg per day and sitagliptin 100mg. He is on fixed insulin doses twice per day although this has reduced from 56ml to 48ml in the last week due to frequent overnight lows. The alarms are great until they wake you every night of the week. He is also taking Victoza - he started on the 2nd of March, and hopefully this will help with his weight loss journey. He has managed to shed 10lbs since mid February.

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Slowly, slowly catchee monkey. Low carb by stealth. Who does the shopping? And the cooking? I ended up doing both for my family, and we all benefitted from Low Carb (LCHF not keto) My wife and I both lost about 8 stones in about 4 months, and my fusspot daughter actually found she liked the menu. So there may be a pathway there to tread.

Because he is on insulin, he is able to tolerate a higher level of carbs than I can, but the fixed dose insulin may be difficult to manage since LCHF is typically a high protein and high fat type of diet, and this delays the metabolism so spikes occur at different times that are not so predictable.

Changing the eating order to one like wot the French use is not ridiculous, and it sounds like your experiment shows it helps to even out the spikes. I suggest you research starters and crudite (accent acute) to simply get the juices flowing up front.