Eating your food in the "right" order
Death to hacks
I have been asked a lot lately about whether I recommend “meal/macro sequencing” (eating non-glycaemic foods - protein, non-starch veges or fat - before the carbohydrate).
My answers are below.
If you are trying to manage your energy intake, eating veges and protein first can be a good way of doing this.
This is simply because you might get full up more and quicker; and in terms of nutrition vs kcal you get more bang for your buck. Don’t worry at all about doing this with fat: just drizzle some healthy oil over your veges or whatever and you’re good.
If you have type 2 diabetes*, it is a meaningfully effective way of managing your blood glucose.
Changing the meal order (having protein/and or veges first) can lower post-prandial glucose by a good 4mmol/L over at least 2 hours (see figure below). Also, post-prandial glucose in diabetes can reach harmful levels, so yes unequivocally there is benefit from reducing it.
If you’re wondering why I’ve put the subtitle of this post as “death to hacks”, here’s the third, and read on.
If you don’t have pre-diabetes/diabetes and you’re not trying to manage your weight, just enjoy your meal in whatever way you want.
It’s not that meal ordering doesn’t also lower your glucose, it’s just that 1) your glucose doesn’t reach a level shown to cause harm, and 2) the magnitude of effect is much much smaller than it is in type 2 diabetes. In addition, what probably happens is that insulin remains elevated for slightly longer when you eat meat/veges first. Again, I doubt that this tiny increase in insulin exposure makes any difference either. But even if the reduction in glucose were marginally beneficial (which I don’t think it would be), I would imagine that marginal benefit would be negated by the [probably irrelevant] marginal harm of extended exposure of the tissues to insulin…. In other words, it doesn’t make any difference in terms of the metabolic response to meals so don’t waste your time thinking about it.
But there’s another reason. I worry people are being compelled to pay wildly disproportionate attention to normal biological processes; are worrying about little things that are probably irrelevant to health in the wider scheme of things; and the endless protocols and monitoring and HACKING are actively making their lives less pleasant.
I saw a great post by a personal trainer called Stephen Keane** on instagram the other day which said:
I’ve looked after renal and gastro patients as a dietitian, and I cannot tell you the effect it has on their quality of life to have to micromanage their food intake. What they wouldn't give to be able to order whatever they want, and simply enjoy the pleasure and taste of food. Many people with type 1 diabetes will tell you how burdensome it is having to pay attention to their glucose all the time.
Of course, people might read this and think, “well if a person feels anxious measuring things then of course they shouldn't engage in these hacks and tips”.
But that's not really fair. Because they're not operating in a vacuum.
PhDs are telling them eating carbohydrate causes diabetes. MDs are telling them that they're eating the wrong kind of vegetables***.
MDs are telling them to boost their NAD to extend their lifespan. PhDs are telling them to eat protein to boost GLP-1. MDs telling them that too much protein impairs autophagy.
RDs are telling them their probiotic is BACKED BY SCIENCE. Also did you know modern life is so bad “everyone would benefit from taking a probiotic”.
PhDs are extolling the benefits of metagenomic analysis of the microbiome.
Oh, and HAVE YOU THOUGHT ABOUT THE TRACE NUTRIENTS YOU NEED TO PREVENT COGNITIVE DECLINE?
They’re being told that glucose spikes cause iNfLaMaTiOn.
MDs are warning them about the type of oats they should buy to avoid TOXINS.
Wait, you don’t fast 16 hours a day!? Do you know what that’s doing to your EPITHELIUM???.
MDs are warning people that supermarket bread has “diacetyl tartaric acid esters of mono- and diglycerides of fatty acids” in it which is a CHEMICAL.
It’s really unfair. And all these people are trying to sell you something, whether it’s a book, a supplement, a CGM. Or honestly they just like the attention of being “a guru” who knows something that normal idiot doctors don’t.
We know the bog-standard stuff that matters for health, and I won’t bore you by writing it here. All this other stuff - at best - will have a marginal, likely negligible impact on your biological health.
There’s a lot of wiggle room in the diet for “not so perfect” and even downright unhealthy foods without any meaningful detrimental impact on health. You can actually have a reasonable amount of sucrose in the diet without any observable effect on any meaningful health marker.
So if you’re worried about eating foods in the right order in case of glucose spikes let me leave you with this:
People drone on about the gloriously healthy Italian diet of extra virgin olive oil, legumes, and polyphenols but forget that they eat fucking biscuits for breakfast as well.
*I would not recommend it yet in type 1 diabetes, as the pancreas and other glucoregulatory mechanisms respond very differently compared to prediabetes/type 2 diabetes.
**It’s not surprising to me that people who see clients/patients realise they’re whole, complete humans, and not just a collection of biological processes needing to be “optimised”.
***YOU EAT LETTUCE YOU ABSOLUTE MUPPET!?
Disclaimer
As a dietitian, and not a medical doctor, I am not qualified to diagnose any health conditions.
I learned that frequent and big glucose spike (by eating frequent and too much high GI foods (sugar, refined carbohydrates) will cause insulin resistance, and eventually diabetic.
And lower postprandial blood glucose is good.
For example, this study says:
"Diets based on foods that produce lower postprandial blood glucose responses (i.e. LGI foods) reduce the risk of developing diabetes , CVD and certain cancers, while improving insulin sensitivity, blood glucose control and blood lipid profiles"
Please see:.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494382/
But you say we don't need to care about postprandial glucose spike (for non-diabetics).
So, we can eat as much sugar and refined carbohydrates as we want (it will cause big glucose spike, but it is ok)?
We don't need to care about GI (brown bread is not better than white bread for metabolic health, and to prevent diabetic)?
And what is GI for?
It is only useful to diabetics; not to non-diabetics?
100% this. I can absolutely confirm that my n=1 type 1 experience is looking on with utter bemusement at the people out there voluntarily tracking and “managing” blood glucose for “fun”.
Imagine doing a whole extra full time job on top of your actual full time job/life etc when you don’t have to!