Can The Order in Which You Eat Your Food Help Prevent Diabetes? New Study Suggests Yes

According to the Centers for Disease Control and Prevention (CDC), about 96 million U.S. adults—that’s over 1 in 3—have prediabetes, a condition where blood sugar levels are higher than normal, but not high enough to meet the criteria for a type 2 diabetes diagnosis.

What’s the big deal about prediabetes? According to a new study published on October 20, 2023, in Nutrients, prediabetes was shown to be associated with chronic diseases, including cardiovascular disease, non-alcoholic fatty liver disease, neuropathy, chronic kidney disease, cancer and dementia.

The good news is that lifestyle changes, including modifications to your eating pattern and increasing physical activity, have been shown to help lower the risk of prediabetes becoming type 2 diabetes—and ultimately overall disease risk.

While there is evidence that a variety of eating patterns can help reduce the risk of type 2 diabetes, these researchers wanted to test a specific eating pattern where participants ate protein and non-starchy vegetables first and saved carbohydrate-rich foods for last. They were also trying to replicate other studies—including ones they had previously done—that suggested that eating certain nutrients in a specific order could influence blood glucose levels and weight loss. Most importantly, they wanted to see how this worked in real life and if it was sustainable.

How Was the Study Conducted?

For the study, researchers randomly split participants with prediabetes into two groups. One group, the C group, received standard nutrition counseling only. The second group, the FO group, received standard nutrition counseling plus counseling that instructed them to eat protein and non-starchy vegetables first and carbohydrate-rich foods last at each meal.

All participants received an oral glucose tolerance test at the beginning of their study period and again at the end of the 16-week study period. Their level of physical activity was also assessed at the beginning and again at the end, and they were asked not to increase their activity during the study period.

For the standard nutrition counseling, which both groups received, a registered dietitian reviewed each participant’s baseline food diary and counseled them on the tenets of a healthy, varied diet based on the USDA’s MyPlate framework.

The FO group received additional counseling, instructing them to eat protein and non-starchy vegetables first at each meal, followed by carbohydrates. They were also instructed as to which foods fell under each category and how to deal with combination foods, like sandwiches (they were told to eat a green salad first). Both groups kept food diaries for the 16 weeks.

What Did the Study Find?

It’s important to note that some of the participants’ 16-week study period was prior to the COVID-19 pandemic and others fell during the beginning of it. For this reason, all of the counseling went from in-person to telephone and video sessions.

The researchers hypothesized that the FO groups would exhibit better glucose tolerance test results and HbA1c (a 90-day average of blood sugar levels) at the end of the 16 weeks. What they actually found were no major differences between the two groups in these two areas. With that said, both groups were trending lower, meaning that their blood sugar test results were lower than at baseline, and had the study been longer, they may have continued in that direction.

They also hypothesized that the FO group would have greater weight loss than the C group. This is where it gets a bit tricky. The people in the FO group prior to the pandemic did, indeed, lose more weight compared to the C group—an average of six pounds compared to one pound over the 16 weeks. However, the participants in the FO group whose study period fell during the pandemic had less weight loss compared to those whose study period fell prior to the pandemic—and they also has about the same amount of weight loss as those in the C group.

The researchers feel that the change from in-person sessions to remote sessions had a negative impact on some of the results. It could also have been the stress during that time, as we know that stress can influence our hunger and satiety hormones, encouraging us to eat more.

Interestingly, if we compare the pre-pandemic groups, the C group reduced their overall intake of calories but didn’t experience much weight loss. The FO group didn’t reduce their overall calorie intake and did have greater weight loss. They also increased their vegetable intake and stated that it was a modification they could continue because it felt easy to do.