Blood Glucose Management Resources

Wolever, T.M.S., Campbell, J.E., Au-Yeung, F., Dioum, E.H.M., . . . Chu, Y. (2023). Chia seeds (Salvia hispanica L.), incorporated into cookies, reduce postprandial glycaemic variability but have little or no effect on subjective appetite. Journal of Functional Foods, 109, 105806. doi:10.1016/j.jff.2023.105806

Abstract:

Chia seeds are gaining interest as a potential functional food. We compared the subjective hunger, fullness and glycaemic responses elicited by 30 g cookies containing 0, 3, 5 or 7 g chia seed (CS0, CS3, CS5 or CS7; 140–150 kcal, 7–8 g fat, 4 g protein, 0–2 g dietary-fibre, 16 g available-carbohydrate) using a randomized, double-blind, cross-over design. Overnight-fasted heathy adults (24 male, 22 female) consumed test-cookies with endpoints measured before and intermittently for 3 h after eating. Total areas under the curve (tAUC0-3 h) for hunger were similar among treatments (p = 0.49) but fullness differed (p = 0.019) with tAUC0-3 h after CS3 > CS7 (mean ± SEM) (140 ± 9 vs 122 ± 10 mm × h, p < 0.025), but neither different from CS0 (127 ± 10 mm × h). Mean incremental glucose AUC0-2 h after CS3, CS5 and CS7, respectively, were 22%, 23% and 30% less than CS0 (p < 0.05). Thus, although chia seeds reduced glycaemic responses, we were unable to demonstrate a significant effect on hunger or fullness versus control.

Noronha, J. C., Zurbau, A., & Wolever, T. M. S. (2022). The importance of molecular weight in determining the minimum dose of oat β-glucan required to reduce the glycemic response in healthy subjects without diabetes: A systematic review and meta-regression analysis. European Journal of Clinical Nutrition, 77, 308–315. doi:10.1038/s41430-022-01176-5

Abstract:

To determine the minimum amount of oat β-glucan (OBG) required to reduce glycaemic responses (MinDose), we conducted a systematic review and meta-regression analysis of acute, crossover, single-meal feeding trials that examined the effects of adding OBG or oat bran to a carbohydrate-containing test-meal versus a control test-meal containing an equivalent amount of available-carbohydrate (avCHO) from the same or similar source. Medline, Embase, and Cochrane Library were searched up to 18 August 2021. The primary outcome was glucose incremental-area-under-the-curve (iAUC). Secondary outcomes included insulin iAUC, and glucose and insulin incremental peak-rise (iPeak). Two independent reviewers extracted data. Results were expressed as ratio-of-means (RoM) with 95% confidence intervals (CIs). Linear associations were assessed by random effects meta-regression. MinDose was defined as the dose at which the upper 95% CI of the regression line cut the line of no effect (i.e., RoM = 1). Fifty-nine comparisons (n = 340) were included; 57 in healthy subjects without diabetes and two in subjects with diabetes; 24 high-MW (>1000 kg/mol), 22 medium-MW (300–1,000 kg/mol), and 13 low-MW (<300 kg/mol). In healthy subjects without diabetes the associations between OBG dose and glucose iAUC and iPeak were linear (non-linear p value >0.05). MinDoses for glucose iAUC for high-MW, medium-MW and low-MW OBG, respectively, were estimated to be 0.2 g, 2.2 g and 3.2 g per 30 g avCHO; MinDoses for glucose iPeak were less than those for iAUC. Insufficient data were available to assess MinDose for insulin, however, there was no evidence of a disproportionate increase in insulin. More high-quality trials are needed to establish MinDose in individuals with diabetes.

Xu, D., Fu, L., Pan, D., Chu, Y., . . . Sun, G. (2022). Role of probiotics/synbiotic supplementation in glycemic control: A critical umbrella review of meta-analyses of randomized controlled trials. Critical Reviews in Food Science and Nutrition. doi:10.1080/10408398.2022.2117783

Abstract:

The evidence regarding the beneficial effects of probiotics/synbiotic supplementation have been revealed by several meta-analyses, however some of these studies have fielded inconsistent results and a conclusion has yet to be reached. Therefore, the aim of present umbrella meta-analyses was to assess relevant evidence and elucidate the efficacy of probiotics/synbiotic supplementation in glycemic control. A comprehensive search in four databases (Cochrane library, PubMed, Web of science and Scopus) was performed to collect relevant studies up to August 2022, the pooled effects were measured with the use of random/fix-effect model depends on the heterogeneity. A total of 47 eligible meta-analyses involving 47,720 participants were identified to evaluate the pooled effects. The overall results showed that probiotics/synbiotic supplementation delivered significant decreases in fast plasma glucose (ES = −0.408, 95% CI: −0.518, −0.298; P < 0.001; I² = 82.996, P < 0.001), fast plasma insulin (ES = −1.165, 95% CI: −1.454, −0.876; P < 0.001; I² = 89.629, P < 0.001), homeostasis model assessment of insulin resistance (ES = −0.539, 95% CI: −0.624, −0.454; P < 0.001; I² = 56.716, P < 0.001), and glycosylated hemoglobin (ES = −0.186, 95% CI: −0.270, −0.102; P < 0.001; I² = 59.647, P = 0.001). Subgroup analysis showed that patients with impaired glucose homeostasis might benefit the most from probiotics/synbiotic supplementation. In conclusion, current umbrella meta-analysis strongly supporting the beneficial health effects of probiotics/synbiotic supplementation in glycemic control.

Wolever, T. M. S., Jenkins, A., L., Campbell, J. E., Ezatagha, A., . . . Chu, Y. (2022). Decreasing the RAG:SAG ratio of granola cereal predictably reduces postprandial glucose and insulin responses: A report of four randomised trials in healthy adults. Journal of Nutritional Science, 11, e21. doi:10.1017/jns.2022.22

Abstract:

Dietary starch contains rapidly (RAG) and slowly available glucose (SAG). To establish the relationships between the RAG:SAG ratio and postprandial glucose, insulin and hunger, we measured postprandial responses elicited by test meals varying in the RAG:SAG ratio in n 160 healthy adults, each of whom participated in one of four randomised cross-over studies (n 40 each): a pilot trial comparing six chews (RAG:SAG ratio 2·4–42·7) and three studies comparing a test granola (TG1-3, RAG:SAG ratio 4·5–5·2) with a control granola (CG1–3, RAG:SAG ratio 54·8–69·3). Within studies, test meals were matched for fat, protein and available carbohydrate. Blood glucose, serum insulin and subjective hunger were measured for 3 h. Data were subjected to repeated-measures analysis of variance (ANOVA). The relationships between the RAG:SAG ratio and postprandial end points were determined by regression analysis. In the pilot trial, 0–2 h glucose incremental areas under the curve (iAUC0–2; primary end point) varied across the six chews (P = 0·014) with each 50 % reduction in the RAG:SAG ratio reducing relative glucose response by 4·0 %. TGs1-3 elicited significantly lower glucose iAUC0–2 than CGs1–3 by 17, 18 and 17 %, respectively (similar to the 15 % reduction predicted by the pilot trial). The combined means ± SEM (n 120) for TC and CG were glucose iAUC0–2, 98 ± 4 v. 118 ± 4 mmol × min/l (P < 0·001), and insulin iAUC0–2, 153 ± 9 v. 184 ± 11 nmol × h/l (P < 0·001), respectively. Neither postprandial hunger nor glucose or hunger increments 2 h after eating differed significantly between TG and CG. We concluded that TGs with RAG:SAG ratios <5·5 predictably reduced glycaemic and insulinaemic responses compared with CGs with RAG:SAG ratios >54. However, compared with CG, TG did not reduce postprandial hunger or delay the return of glucose or hunger to baseline.

Zhouyao, H., Malunga, L. N., Chu, Y., Eck, P., . . . Thandapilly, S. J. (2022). The inhibition of intestinal glucose absorption by oat-derived avenanthramides. Journal of Food Biochemistry, 46(10), e14324. doi:10.1111/jfbc.14324

Abstract:

Avenanthramides are phenolic compounds unique to oats and may contribute to health-promoting properties associated with oat consumption. This study used Xenopus laevis oocytes expressing the glucose transporters, glucose transporter 2 (GLUT2) or sodium–glucose transport protein 1 (SGLT1) and human Caco-2 cells models to investigate the effect of oat avenanthramides on human intestinal glucose transporters. The presence of avenanthramide reduced the glucose uptake in a dose-dependent manner in Caco-2 cells. Glucose uptake in oocytes expressing either GLUT2 or SGLT1 was nullified by oat avenanthramide. There was no significant difference between the inhibition potencies of avenanthramides C and B. Thus, our results suggest that avenanthramides may contribute to the antidiabetic properties of oats.

Musa-Veloso, K., Noori, D., Venditti, C., Poon, T., . . . Chu, Y. (2021). A systematic review and meta-analysis of randomized controlled trials on the effects of oats and oat processing on postprandial blood glucose and insulin responses. The Journal of Nutrition, 151(2), 341-351. doi:10.1093/jn/nxaa349

Abstract:

Background

Oats are a whole grain cereal with potentially favorable effects on the postprandial glycemic response; however, the effects of oat processing on these glycemic benefits are not well understood.

Objectives

The study objective was to determine the effects of differently processed oats on the postprandial blood glucose and insulin responses relative to refined grains.

Methods

Eleven electronic databases were systematically searched to identify studies published up to and including May 2019. Randomized controlled trials comparing the postprandial blood glucose and insulin responses to oats compared with any refined grain were included, so long as the available carbohydrate content of the test meals was similar. Pooled effect sizes were computed using the difference in incremental area under the curves for blood glucose and insulin following the consumption of oats compared with the refined grain control.

Results

Ten publications were included, with intact oat kernels studied in 3 comparisons, thick oat flakes (>0.6 mm) in 7 comparisons, and thin/quick/instant oat flakes (≤0.6 mm) in 6 comparisons. Compared with the consumption of the refined grain control, the consumption of intact oat kernels was associated with significant reductions in postprandial blood glucose (−45.5 mmol x min/L; 95% CI: −80.1, −10.9 mmol x min/L; P = 0.010) and insulin (−4.5 nmol x min/L; 95% CI: −7.1, −1.8 nmol x min/L; P = 0.001) responses; the consumption of thick oat flakes was associated with significant reductions in postprandial blood glucose (−30.6 mmol x min/L; 95% CI: −40.4, −20.9 mmol x min/L; P < 0.001) and insulin (−3.9 nmol x min/L; 95% CI: −5.3, −2.5 nmol x min/L; P < 0.001) responses; but, the consumption of thin/quick/instant oat flakes was not associated with any effects on the postprandial blood glucose and insulin responses.

Conclusions

A disruption in the structural integrity of the oat kernel is likely associated with a loss in the glycemic benefits of oats.

Zurbau, A., Noronha, J. C., Khan, T. A., Sievenpiper, J. L., & Wolever, T. (2021). The effect of oat β-glucan on postprandial blood glucose and insulin responses: A systematic review and meta-analysis. European Journal of Clinical Nutrition, 75,1540–1554. doi:10.1038/s41430-021-00875-9

Abstract:

To determine the effect of oat β‑glucan (OBG) on acute glucose and insulin responses and identify significant effect modifiers we searched the MEDLINE, EMBASE, and Cochrane databases through October 27, 2020 for acute, crossover, controlled feeding trials investigating the effect of adding OBG (concentrate or oat-bran) to carbohydrate-containing test-meals compared to comparable or different carbohydrate-matched control-meals in humans regardless of health status. The primary outcome was glucose incremental area-under-the-curve (iAUC). Secondary outcomes were insulin iAUC, and glucose and insulin incremental peak-rise (iPeak). Two reviewers extracted the data and assessed risk-of-bias and certainty-of-evidence (GRADE). Data were pooled using generic inverse-variance with random-effects model and expressed as ratio-of-means with [95% CIs]. We included 103 trial comparisons (N = 538). OBG reduced glucose iAUC and iPeak by 23% (0.77 [0.74, 0.81]) and 28% (0.72 [0.64, 0.76]) and insulin by 22% (0.78 [0.72, 0.85]) and 24% (0.76 [0.65, 0.88]), respectively. Dose, molecular-weight, and comparator were significant effect modifiers of glucose iAUC and iPeak. Significant linear dose-response relationships were observed for all outcomes. OBG molecular-weight >300 kg/mol significantly reduced glucose iAUC and iPeak, whereas molecular-weight <300 kg/mol did not. Reductions in glucose iAUC (27 vs 20%, p = 0.03) and iPeak (39 vs 25%, p < 0.01) were significantly larger with different vs comparable control-meals. Outcomes were similar in participants with and without diabetes. All outcomes had high certainty-of-evidence. In conclusion, current evidence indicates that adding OBG to carbohydrate-containing meals reduces glycaemic and insulinaemic responses. However, the magnitude of glucose reduction depends on OBG dose, molecular-weight, and the comparator.

Guzman, G., Xiao, D., Liska, D., Mah, E., . . . Edirisinghe, I. (2021). Addition of orange pomace attenuates the acute glycemic response to orange juice in healthy adults. The Journal of Nutrition, 151(6), 1436. doi:10.1093/jn/nxab017

Abstract:

Background Fiber is an important part of a healthy diet and is known to attenuate postprandial glycemia. Orange pomace (OP) is a by-product of orange juice (OJ) production and is a rich source of fiber. Objective Two separate studies determined the impact of added OP to 100% OJ on postprandial glycemic response compared with sugar-matched OJ or whole orange fruit (WOF). Methods Study 1 included 17 adults [65% female, age 39.3 ± 3.1 y, and BMI (in kg/m²) 24.6 ± 0.7], and study 2 included 45 different adults (47% female, age 25.1 ± 4.3 y, and BMI 22.5 ± 1.6). Studies were conducted at separate locations using a randomized, 3-arm, crossover design to test the glycemic response to sugar-matched OJ, OJ with 5 g fiber from OP (OPF), or WOF. The primary outcomes were 2-h glucose incremental area under the curve (iAUC) in study 1, analyzed by repeated measures ANOVA, and maximum glucose concentration (C_max) in study 2, analyzed using PROC MIXED (ANCOVA). Glucose and insulin concentrations were measured at fasting and multiple time points over 2 h after test product consumption (study 1, serum; study 2, plasma). Results In study 1, glucose iAUC was not significantly lower in OPF compared to the OJ or WOF (825 ± 132 compared with 920 ± 132 and 760 ± 132 mg · min · dL⁻¹, respectively, P = 0.57 for both). In study 2, glucose iAUC was significantly lower in WOF compared with OPF and OJ (689 ± 70.7 compared with 892 ± 70.7 and 974 ± 70.7 mg · min · dL⁻¹, P = 0.02 and 0.001, respectively). Data from both studies indicated OPF reduced C_max compared with OJ and that the reductions were comparable to WOF (study 1: OPF, 115 ± 4.06 compared with OJ, 124 ± 4.06 and WOF, 114 ± 4.06 mg · dL⁻¹, P = 0.002 and 0.75, respectively; study 2: OPF, 128 ± 1.92 compared with OJ, 136 ± 1.92 and WOF, 125 ± 1.92 mg · dL⁻¹, P = 0.001 and 0.28, respectively). Conclusion Data from both studies demonstrated no significant effect of OPF on postprandial iAUC compared with OJ. However, adding OP into OJ attenuates the postprandial glucose C_max, and the responses were comparable to WOF in healthy adults.

Rebello, C. J., Johnson, W. D., Pan, Y., Larrivee, S., . . . Greenway, F. L. (2020). A snack formulated with ingredients to slow carbohydrate digestion and absorption reduces the glycemic response in humans: A randomized controlled trial. Journal of Medicinal Food, 23(1), 21-28. doi:10.1089/jmf.2019.0097

Abstract:

This study compared the effect of a snack with ingredients to slow carbohydrate digestion (Test-snack) on postprandial blood glucose and insulin concentrations and subjective appetite ratings. We hypothesized that Test-snack would lower glucose and insulin responses and reduce appetite compared with a Control-snack. Overweight or obese subjects (n = 17) completed a randomized crossover study. Glucose, insulin, and appetite ratings were measured before consuming each snack or white bread (Bread) and over a period of 4 h. Subjects received Test-snack, Control-snack, or Bread in random order at least a week apart. The a priori primary outcome was the glucose response, and the secondary outcomes were appetite ratings and insulin responses. Mixed effects statistical models were used to perform analysis of variance in terms of the area under curve (AUC) and at specific time points. The 2-h AUC for glucose was significantly lower with Test-snack compared to Control-snack and Bread (AUC and 95% confidence intervals: Test = 2186.43 [1783.36–2589.51]; Control = 3293.75 [2893.97–3693.54]; Bread = 2800.28 [2405.79–3194.77] mg/dL · min). Four-hour AUC for glucose, and insulin, followed a similar pattern except that Test-snack did not differ from Bread. The glucose concentrations peaked at 45 min under all three conditions, but Test-snack elicited a lower response than Control-snack and Bread (P < .01). Test increased fullness and satisfaction and reduced hunger and prospective intake compared to Bread (P < .02), but was not significantly different from Control-snack. Ingredients that slow carbohydrate digestion in a snack reduce the postprandial glucose and insulin responses compared to a product without these ingredients.

Wolever, T. M. S., Tosh, S. M., Spruill, S. E., Jenkins, A. L., . . . Steinert, R. E. (2020). Increasing oat β-glucan viscosity in a breakfast meal slows gastric emptying and reduces glycemic and insulinemic responses but has no effect on appetite, food intake, or plasma ghrelin and PYY responses in healthy humans: A randomized, placebo-controlled, crossover trial. American Journal of Clinical Nutrition, 111(2), 319-328. doi:10.1093/ajcn/nqz285

Abstract:

Background: The viscosity of oat β-glucan (OBG) determines its effect on serum cholesterol and glycemic responses, but whether OBG viscosity affects gastric emptying, appetite, and ad libitum food intake is unknown. Objectives: We aimed to determine the effect of altering the amount or molecular weight (MW) and, hence, viscosity of OBG in a breakfast meal on the primary endpoint of food intake at a subsequent meal. Methods: Overnight-fasted males (n = 16) and nonpregnant females (n = 12) without diabetes, aged 18–60 y, with BMI 20.0–30.0 kg/m² who were unrestrained eaters participated in a double-blind, randomized, crossover study at a contract research organization. Participants consumed, in random order, breakfast meals equivalent in weight, energy, and macronutrients consisting of white-bread, butter, jam, and 2% milk plus hot cereal [Cream of Rice (CR), or instant-oatmeal plus either 3 g oat-bran (2gOBG), 10 g oat-bran (4gOBG), or 10 g oat-bran plus β-glucanase (4gloMW) to reduce OBG MW and viscosity compared with 4gOBG]. Gastric emptying, subjective appetite, and glucose, insulin, ghrelin, and peptide tyrosine tyrosine (PYY) responses were assessed for 3 h and then subjects were offered an ad libitum lunch (water and pizza). Results: Pizza intakes (n = 28) after CR, 2gOBG, 4gOBG, and 4gloMW (mean ± SEM: 887 ± 64, 831 ± 61, 834 ± 78, and 847 ± 68 kcal, respectively) were similar (nonsignificant). Compared with CR, 4gOBG significantly reduced glucose (78 ± 10 compared with 135 ± 15 mmol × min/L) and insulin (14.0 ± 1.6 compared with 26.8 ± 3.5 nmol × min/L) incremental area-under-the-curve and delayed gastric-emptying half-time (geometric mean: 285; 95% CI: 184, 442, compared with geometric mean: 105; 95% CI: 95, 117 min), effects not seen after 4gloMW. Subjective appetite, PYY, and ghrelin responses after 2gOBG, 4gOBG, and 4gloMW were similar to those after CR. Conclusions: The results demonstrate that OBG viscosity determines its effect on postprandial glucose, insulin, and gastric emptying. However, we were unable to demonstrate a significant effect of OBG on appetite or food intake, regardless of its viscosity.

Huang, Y., Park, E., Replogle, R., Boileau, T., . . . Edirisinghe, I. (2019). Enzyme-treated orange pomace alters acute glycemic response to orange juice. Nutrition and Diabetes, 9, 24. doi:10.1038/s41387-019-0091-z

Abstract:

The goal of the present study was to determine the impact of the addition of enzyme-treated orange pomace to orange juice on postprandial glycemic response. Ten healthy subjects (aged 27.9 ± 7.7 years, body mass index 22.1 ± 1.1 kg m−2) participated in a randomized, 2-arm, cross-over clinical trial to test the glycemic response to 100% orange juice (OJ) or 100% orange juice with 5 g of enzyme-treated orange pomace fiber (OPF). Blood samples were collected and glucose and insulin concentrations were measured at fasting (0 min) and every 15 min for 2 h after consuming the study juice products. Analysis of the 2 h incremental area under the curve (iAUC0–2h) indicated a significant reduction in blood glucose after ingesting the OPF juice compared to the OJ, p = 0.02. Peak glucose concentrations were also lowered after the OPF juice compared to the OJ, p < 0.05. No significant difference was observed in insulin responses between treatments, p > 0.05. Overall, this study demonstrated that adding 5 g of fiber from orange pomace into a serving of OJ attenuated the postprandial glucose response.

Dong, H., Rendeiro, C., Kristek, A., Sargent, L. J., . . . Lovegrove, J. A. (2016). Addition of orange pomace to orange juice attenuates the increases in peak glucose and insulin concentrations after sequential meal ingestion in men with elevated cardiometabolic risk. The Journal of Nutrition, 146(6), 1197-1203. doi:10.3945/jn.115.226001

Abstract:

Background: Prospective cohort studies show that higher dietary fiber intake is associated with reduced cardiovascular disease risk, yet the impact on postprandial glucose and insulin responses is unclear. Objective: This study aims to evaluate the effects of orange beverages with differing fiber concentrations on postprandial glycemic responses (secondary outcome measure) after a sequential breakfast and lunch challenge in men with increased cardiometabolic risk. Methods: Thirty-six men (aged 30–65 y; body mass index 25–30 kg/m²: fasting triacylglycerol or total cholesterol concentrations: 0.8–2.2 or 6.0–8.0 mmol/L, respectively) were provided with a high-fat mixed breakfast and were randomly assigned to consume 240 mL Tropicana (PepsiCo, Inc.) pure premium orange juice without pulp (OJ), OJ with 5.5 g added orange pomace fiber (OPF), juice made from lightly blended whole orange, or an isocaloric sugar-matched control (Control) on 4 occasions separated by 2 wk. A medium-fat mixed lunch was provided at 330 min. Blood samples were collected before breakfast and on 11 subsequent occasions for 420 min (3 time points postlunch) to determine postprandial glucose, insulin, lipid, and inflammatory biomarker responses. Repeated-measures ANOVA was used for data analysis. Results: OPF significantly (P < 0.05) reduced the maximal change in glucose concentrations (1.9 ± 0.21 mmol/L) reached after breakfast compared with other treatments (2.3–2.4 mmol/L) and after lunch (3.0 ± 0.05 mmol/L) compared with OJ (3.6 ± 0.05 mmol/L). The maximal change in insulin concentration (313 ± 25 pmol/L) was also lower compared with Control (387 ± 30 pmol/L) and OJ (418 ± 39 pmol/L) after breakfast. OPF significantly delayed the time to reach the peak glucose concentration compared with Control and OJ, and of insulin compared with Control after breakfast. Conclusion: OPF consumed with breakfast may lower postprandial glycemic and insulinemic responses to typical meal ingestion in men with increased cardiometabolic risk.

Ames, N., Malunga, L. N., Mollard, R., Johnson, J., . . . Thandapilly, S. J. (2021). Effect of processing on oat β-glucan viscosity, postprandial glycemic response and subjective measures of appetite. Food & Function, 12(8), 3672–3679. doi:10.1039/d0fo03283b

Abstract:

Oat has procured its acclaim as a health promoting food partially due to its positive effect on glucose control. It has been demonstrated that oat β-glucan can interfere with postprandial glucose response. A large majority of this action is attributed to the increase in viscosity due to the β-glucan content in oat foods. While it is known that an increase in viscosity due to higher molecular weight of β-glucan can improve its glycemic effects, it is not known if an increase in viscosity attained by processing variables can further enhance the positive effect of oat on glucose control. In the current study we have examined the effect of kilning, tempering, microwaving, cooking, soaking and flaking on oat β-glucan viscosity. An acute randomized crossover clinical trial was also conducted to test oatmeal products containing low, medium and high β-glucan viscosity for their effect on postprandial glycemic response. Results from the processing experiments demonstrate that kilned samples, when tempered to 25% moisture and microwaved for 2 minutes, can produce much higher final viscosity compared to other samples with similar β-glucan content, molecular weight and solubility. However, results from the clinical trial show that the increase in the viscosity of the oat β-glucan attained through processing in this study did not have any effect on postprandial glucose control.

Wolever, T. M. S., Jenkins, A. L., Yang, J., Nisbet, M., . . . Pan, Y. (2019). An optimized, slowly digested savory cluster reduced postprandial glucose and insulin responses in healthy human subjects. Current Developments in Nutrition, 3(3), nzz006. doi:10.1093/cdn/nzz006

Abstract:

Background: Slowly digested carbohydrates are perceived as beneficial by some consumers, and various regulatory bodies have published specific criteria defining lower postprandial glycemic response. We developed an optimized savory cluster snack containing slowly digested starch. Objective: We compared the glucose and insulin responses elicited by the optimized (test-) cluster, a control-cluster, and an available-carbohydrate-matched portion of white bread in healthy individuals. The primary outcome was blood-glucose peak rise. We tested healthy individuals (n = 25) on 3 occasions using a randomized crossover design. On each occasion, the participants provided fasting blood samples and then consumed 1 serving of test-cluster, control-cluster, or white bread. We then measured the participants’ blood-glucose and serum-insulin concentrations over the next 4 h. Results: The test-cluster elicited a significantly lower blood-glucose peak rise (mean ± SEM: 1.24 ± 0.09 mmol/L) and incremental area under the curve (iAUC; 67 ± 8 mmol × min/L) than the control-cluster (2.27 ± 0.13 mmol/L and 117 ± 10 mmol × min/L, respectively) and white bread (2.27 ± 0.16 mmol/L and 114 ± 9 mmol × min/L, respectively). The serum-insulin peak rise and iAUC elicited by the test-cluster (128 ± 13 pmol/L and 6.10 ± 0.73 nmol × min/L, respectively) and white bread (141 ± 20 pmol/L and 6.47 ± 1.11 nmol × min/L, respectively) were significantly lower than those elicited by the control-cluster (205 ± 26 pmol/L and 9.60 ± 1.31 nmol × min/L, respectively). Conclusion: The test-cluster elicited lower glucose and insulin responses than the control-cluster. The results support the hypothesis that the carbohydrates in the test-cluster are digested and absorbed slowly in vivo.

Wolever, T. M. S., Jones, P. J. H., Jenkins, A. L., Mollard, R. C., . . . Chu, Y. F. (2019). Glycaemic and insulinaemic impact of oats soaked overnight in milk vs. cream of rice with and without sugar, nuts, and seeds: A randomized, controlled trial. European Journal of Clinical Nutrition, 73(1), 86-93. doi:10.1038/s41430-018-0329-1

Abstract:

Background/Objectives: Soaking oats overnight in milk renders them ready to eat the next morning, however, it is unknown whether oats prepared this way will retain its relatively low glycaemic and insulinaemic impact. Therefore, we compared the glycaemic, insulinaemic and subjective hunger responses elicited by oats soaked overnight in 110 g skim-milk (ONO) vs. cooked cream of rice cereal (CR), both with and without inclusions. Subjects/Methods: The project was performed at two research centers (Toronto, Winnipeg) as two separate studies each using a randomized, cross-over design with similar methods. The glycaemic and insulinaemic responses of overnight-fasted participants without diabetes (males:females: Toronto, 24:16; Winnipeg, 20:20) were measured for 3 h after consuming CR and ONO fed alone (Toronto) or with added sugar, nuts, and seeds (CRsns and ONOsns) (Winnipeg). Participants rated subjective hunger using visual analog scales. Data were analyzed by paired t-test. The primary endpoint was 0–2 h incremental area under the curve (iAUC) for glucose. Results: Mean glucose iAUC was 33% less, after ONO than CR (mean difference was 39 (51–27) mmol × min/l, p < 0.0001) and 24% less, after ONOsns than CRsns (mean difference was 43 (65–21) mmol × min/l, p = 0.0003). Serum-insulin iAUC was 33% less, after ONO than CR (mean difference 57 (81–40) pmol × hl, p < 0.0001) and 32% less, after ONOsns than CRsns (966 (1360–572) pmol × h/l, p < 0.0001). In both Toronto and Winnipeg, subjective hunger ratings were similar across the two treatments. Conclusions: Oats prepared by soaking overnight in skimmed milk without and with inclusions retain their relatively low glycaemic and insulinaemic impact.

Wolever, T. M. S., Johnson, J., Jenkins, A. L., Campbell, J. C., . . . Chu, Y. (2019). Impact of oat processing on glycaemic and insulinaemic responses in healthy humans: A randomised clinical trial. British Journal of Nutrition, 121(11), 1264-1270. doi:10.1017/S0007114519000370

Abstract:

Oats can be processed in a variety of ways ranging from minimally processed such as steel-cut oats (SCO), to mildly processed such as large-flake oats (old fashioned oats, OFO), moderately processed such as instant oats (IO) or highly processed in ready-to-eat oat cereals such as Honey Nut Cheerios (HNC). Although processing is believed to increase glycaemic and insulinaemic responses, the effect of oat processing in these respects is unclear. Thus, we compared the glycaemic and insulinaemic responses elicited by 628 kJ portions of SCO, OFO, IO and HNC and a portion of Cream of Rice cereal (CR) containing the same amount of available-carbohydrate (23 g) as the oatmeals. Healthy males (n 18) and females (n 12) completed this randomised, cross-over trial. Blood was taken fasting and at intervals for 3 h following test-meal consumption. Glucose and insulin peak-rises and incremental AUC (iAUC) were subjected to repeated-measures ANOVA using Tukey’s test (two-sided P<0·05) to compare individual means. Glucose peak-rise (primary endpoint, mean (SEM) mmol/l) after OFO, 2·19 (SEM 0·11), was significantly less than after CR, 2·61 (SEM 0·13); and glucose peak-rise after SCO, 1·93 (SEM 0·13), was significantly less than after CR, HNC, 2·49 (SEM 0·13) and IO 2·47 (SEM 0·13). Glucose iAUC was significantly lower after SCO than CR and HNC. Insulin peak rise was similar among the test meals, but insulin iAUC was significantly less after SCO than IO. Thus, the results show that oat processing affects glycaemic and insulinaemic responses with lower responses associated with less processing.

Wolever, T. M. S., Jenkins, A. L., Prudence, K., Johnson, J., . . . Steinert, R. E. (2018). Effect of adding oat bran to instant oatmeal on glycaemic response in humans - A study to establish the minimum effective dose of oat β-glucan. Food and Function, 9(3), 1692-1700. doi:10.1039/c7fo01768e

Abstract:

Reducing the glycaemic response to carbohydrate-containing foods may have desirable physiological effects for many people. Here, we aimed to determine the minimum amount of oat β-glucan from oat-bran which, when added to instant-oatmeal, would reduce the glycaemic response by 20% compared to a β-glucan-free cereal. Therefore, the glycaemic responses elicited by one serving (27 g) instant-oatmeal plus 247 g 2% milk (IO, 28 g available-carbohydrate, 1.2 g β-glucan) or IO plus 0.2, 0.4, 0.8 or 1.6 g oat β-glucan (OBG) from oat-bran, or an available-carbohydrate matched portion of cream of rice (CR) plus milk were measured over 2 h in n = 40 subjects using a randomized, cross-over design. The primary endpoint was incremental area under the curve (iAUC). The secondary endpoint was glucose peak-rise. The results showed that grams OBG consumed were significantly correlated with mean iAUC (p = 0.009) and with mean glucose peak-rise (p = 0.002). Each gram of OBG reduced iAUC by 7% and peak-rise by 15%. Thus, to achieve a ≥20% reduction in iAUC relative to CR, 1.6 g OBG had to be added to IO (74 ± 7 vs. 93 ± 6 mmol min L−1, p < 0.05), but, to achieve a 20% reduction in peak-rise, only 0.4 g OBG was required (2.00 ± 0.1 vs. 2.40 ± 0.1 mmol, p < 0.05). We conclude that adding OBG to IO flattened postprandial glycaemic responses in a dose-dependent fashion; 1.6 g OBG was required to reduce iAUC by ≥20% versus CR, but a 20% reduction in peak-rise required only 0.4 g. The greater effect of OGB on peak-rise than iAUC presumably reflects the way viscous dietary fibres modulate glucose absorption kinetics.

Moser, S., Aragon, I., Furrer, A., Van Klinken, J. W., . . . Ferruzzi, M. G. (2018). Potato phenolics impact starch digestion and glucose transport in model systems but translation to phenolic rich potato chips results in only modest modification of glycemic response in humans. Nutrition Research, 52, 57-70. doi:10.1016/j.nutres.2018.02.001

Abstract

Beneficial effects of some phenolic compounds in modulation of carbohydrate digestion and glycemic response have been reported, however effects of phenolics from processed potato products on these endpoints are not well known. The aims of this study were to characterize phenolic profiles of fresh potatoes (purple, red, or white fleshed; 2 varieties each) and chips, and to examine the potential for potato phenolic extracts (PPE) to modulate starch digestion and intestinal glucose transport in model systems. Following in vitro assessment, a pilot clinical study (n=11) assessed differences in glycemic response and gastric emptying between chips from pigmented and white potatoes. We hypothesized that phenolics from pigmented potato chips would be recovered through processing and result in a reduced acute glycemic response in humans relative to chips made from white potatoes. PPEs were rich in anthocyanins (~98, 11 and ND mg/100 g dw) and chlorogenic acids (~519, 425 and 157 mg/100 g dw) for purple, red and white varieties respectively. While no significant effects were observed on starch digestion by α-amylase and the α-glucosidases, PPEs significantly (p<0.05) decreased the rate of glucose transport, measured following transport of 1,2,3,4,5,6,6-d7 -glucose (d7-glu) across Caco-2 human intestinal cell monolayers, by 4.5-83.9%. Consistent with in vitro results, consumption of purple potato chips modestly but significantly (p<0.05) decreased blood glucose at 30 and 60 minutes post consumption compared to white chips without impacting gastric emptying. These results suggest that potato phenolics may play a modest role in modulation of glycemic response and these effects may result in subtle differences between consumer products.

Musa-Veloso, K., Poon, T., Harkness, L. S., O'Shea, M., & Chu, Y. (2018). The effects of whole-grain compared with refined wheat, rice, and rye on the postprandial blood glucose response: A systematic review and meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition, 108(4), 759-774. doi:10.1093/ajcn/nqy112

Abstract:

Background: Whole grains are often referred to collectively, despite differences in their composition, physical structure, processing, and potential health benefits. Objective: The aim of this study was to compare the postprandial blood glucose response of whole-grain with refined wheat, rice, or rye, while controlling for the food delivery matrix and the processing of the grain (e.g., grinding, germination). Design: Eleven electronic databases were systematically searched to identify studies published up to and including November 2017. Randomized controlled trials comparing the effects of whole-grain wheat, rice, or rye with those of each grain's refined counterpart on postprandial blood glucose area under the curve (AUC) were included. Pooled effect sizes were computed by using the difference in the blood glucose AUC after the consumption of the whole compared with the refined grain. Results: Twenty publications were included, with 10, 14, and 5 strata (or active-control comparisons) on whole-grain wheat, rice, and rye, respectively. The consumption of ground (wholemeal) wheat, compared with white wheat, was not associated with a significant reduction in blood glucose AUC (−6.7 mmol/L ⋅ min; 95% CI: −25.1, 11.7 mmol/L ⋅ min; P = 0.477). The consumption of wholemeal rye, compared with endosperm rye, was not associated with a significant reduction in blood glucose AUC (−5.5 mmol/L ⋅ min; 95% CI: −24.8, 13.8 mmol/L ⋅ min; P = 0.576). The consumption of intact (whole-grain) rice, compared with white rice, was associated with a significant reduction in blood glucose AUC (−40.5 mmol/L ⋅ min; 95% CI: −59.6, −21.3 mmol/L ⋅ min; P < 0.001). Conclusions: Compared with white rice, whole-grain rice significantly attenuates the postprandial blood glucose response. In most of the studies on wheat and rye, the postprandial blood glucose responses to foods formulated with wholemeal compared with refined flours were compared. Whether reductions in the blood glucose AUC can be achieved with whole-grain (as opposed to wholemeal) wheat and rye requires further investigation.

Chen, C. O., Rasmussen, H., Kamil, A., Du, P., & Blumberg, J. B. (2017). Orange pomace improves postprandial glycemic responses: An acute, randomized, placebo-controlled, double-blind, crossover trial in overweight men. Nutrients, 9(2), 130. doi:10.3390/nu9020130

Abstract:

Orange pomace (OP), a fiber-rich byproduct of juice production, has the potential for being formulated into a variety of food products. We hypothesized that OP would diminish postprandial glycemic responses to a high carbohydrate/fat breakfast and lunch. We conducted an acute, randomized, placebo-controlled, double blind, crossover trial with 34 overweight men who consumed either a 255 g placebo (PLA), a low (35% OP (LOP)), or a high (77% (HOP)) dose OP beverage with breakfast. Blood was collected at 0, 10, 20, 30, and 45 min and at 1, 1.5, 2, 3, 4, 5, 5.5, 6, 6.5, 7, and 8 h. Lunch was consumed after the 5.5-h blood draw. OP delayed the time (T_max1) to the maximum concentration (C_max1) of serum glucose during the 2-h period post breakfast by ≥36% from 33 (PLA) to 45 (HOP) and 47 (LOP) min (p = 0.055 and 0.013, respectively). OP decreased post-breakfast insulin C_max1 by ≥10% and LOP delayed the T_max1 by 14 min, compared to PLA at 46 min (p ≤ 0.05). HOP reduced the first 2-h insulin area under concentration time curve (AUC) by 23% compared to PLA. Thus, OP diminishes postprandial glycemic responses to a high carbohydrate/fat breakfast and the second meal in overweight men.

Wolever, T. M. S., van Klinken, B. J., Spruill, S. E., Jenkins, A. L., . . . Harkness, L. (2016). Effect of serving size and addition of sugar on the glycemic response elicited by oatmeal: A randomized, cross-over study. Clinical Nutrition ESPEN, 16, 48-54. doi:10.1016/j.clnesp.2016.07.003

Abstract:

Background & aims We aimed to determine the impact of serving size and addition of sucrose on the glycemic response elicited by oatmeal. Methods We studied 38 healthy subjects (mean ± SD age 40 ± 12 yr, BMI 26.4 ± 3.6 kg/m²) on 8 separate days using a randomized, cross-over design. Capillary blood-glucose responses over 2hr after consuming 30, 40 and 60 g Classic Quaker Quick Oats (18, 24 and 36 g available-carbohydrate [avCHO], respectively) and 30 g Oats plus 9 g sucrose (27 g avCHO) were compared with those after avCHO-matched servings of Cream of Rice cereal (Control) (22, 29, 44 and 33 g cereal, respectively). Blood-glucose incremental area under the curve (iAUC), peak-rise, rate-of-decline, time-to-peak and time-to-baseline were calculated. Results As serving size increased, iAUC, peak-rise, rate-of-decline and time-to-baseline increased significantly for both cereals, but the rate of increase was significantly greater for Control than for Oats. Time-to-peak increased significantly with serving size only for Oats. Compared to avCHO-matched servings of Control, mean (95%CI) iAUC, peak-rise and rate-of-decline, respectively were 22 (16, 27)%, 22 (19, 26)% and 23 (18, 27)% lower after consuming Oats without sucrose and 26 (18, 34)%, 14 (9, 20)% and 16 (9, 24)% lower after consuming Oats plus sucrose. Conclusions Oatmeal elicited a significantly lower glycemic response than avCHO-matched servings of Cream of Rice, even when sucrose was added to the oatmeal. Measures of glycemic response tended to increase with increased serving size; although the pattern of change varied between cereal types. These results suggest that oatmeal may be a good choice for minimizing postprandial glycemia.

Wolever, T. M. S., Van Klinken, B. J., Bordenave, N., Kaczmarczyk, M., . . . Harkness, L. (2016). Reformulating cereal bars: High resistant starch reduces in vitro digestibility but not in vivo glucose or insulin response; whey protein reduces glucose but disproportionately increases insulin. American Journal of Clinical Nutrition, 104(4), 995-1003. doi:10.3945/ajcn.116.132431

Abstract:

Background: Resistant starch (RS) and whey protein are thought to be effective nutrients for reducing glycemic responses. Objective: We aimed to determine the effect of varying the sucrose, RS, and whey protein content of cereal bars on glucose and insulin responses. Design: Twelve healthy subjects [mean ± SD age: 36 ± 12 y; mean ± SD body mass index (in kg/m²): 24.9 ± 2.7] consumed 40 g available-carbohydrate (avCHO) portions of 5 whole-grain cereal bars that contained varying amounts of RS and whey protein concentrate [WPC; 70% protein; RS:WPC, %wt:wt: 15:0 (Bar15/0); 15:0, low in sucrose (Bar15/0LS); 15:5 (Bar15/5); 10:5 (Bar10/5); and 10:10 (Bar10/10)] and 2 portion sizes of a control bar low in whole grains, protein, and RS [control 1 contained 40 g avCHO (Control1); control 2 contained total carbohydrate equal to Bar15/0LS (Control2)] on separate days by using a randomized crossover design. Glucose and insulin responses in vivo and carbohydrate digestibility in vitro were measured over 3 h. Results: Incremental area under the curve (iAUC) over 0–3 h for glucose (min × mmol/L) differed significantly between treatments (P < 0.001) [Bar15/0LS (mean ± SEM), 169 ± 14; Control2, 164 ± 20; Bar15/0, 144 ± 15; Control1, 140 ± 17; Bar10/5, 117 ± 12; Bar15/5, 116 ± 9; and Bar10/10, 100 ± 9; Tukey’s least significant difference = 42, P < 0.05], but insulin iAUC did not differ significantly. Higher protein content was associated with a lower glucose iAUC (P = 0.028) and a higher insulin-to-glucose iAUC ratio (P = 0.002) All 5 RS-containing bars were digested in vitro ∼30% more slowly than the control bars (P < 0.05); however, in vivo responses were not related to digestibility in vitro. Glucose and insulin responses elicited by high-RS, whey protein–free bars were similar to those elicited from control bars. Conclusions: The inclusion of RS in cereal bar formulations did not reduce glycemic responses despite slower starch digestion in vitro. Thus, caution is required when extrapolating in vitro starch digestibility to in vivo glycemic response. The inclusion of whey protein in cereal bar formulations to reduce glycemic response requires caution because this may be associated with a disproportionate increase in insulin as judged by an increased insulin-to-glucose iAUC ratio. 

Tosh, S. M., & Chu, Y. (2015). Systematic review of the effect of processing of whole-grain oat cereals on glycaemic response. British Journal of Nutrition, 114(8), 1256-1262. doi:10.1017/S0007114515002895

Abstract:

Whole-grain oats have been identified as a type of food that blunts blood glucose increase after a meal. However, processing of oats changes the physical characteristics of the grain, which may influence human glycaemic response. Therefore, the effect of different processes on acute postprandial glycaemic response, quantified using glycaemic index (GI) measurements, was investigated in a systematic review. A review of the literature identified twenty publications containing fifty-six individual tests. An additional seventeen unpublished tests were found in an online database. Of the seventy-two measurements included in the review, two were for steel-cut oats, eleven for large-flake oats, seven for quick-cooking (small flake) oats, nine for instant oatmeal and twenty-eight for muesli or granola. One granola measurement was identified as an outlier and was removed from the statistical analysis. In all, fifteen clinical tests were reported for rolled oat porridge that did not specify the type of oats used, and thus the effect of processing could not be assessed. Steel-cut oats (GI=55 (SE 2·5)), large-flake oats (GI=53 (SE 2·0)) and muesli and granola (GI=56 (SE 1·7)) elicited low to medium glycaemic response. Quick-cooking oats and instant oatmeal produced significantly higher glycaemic response (GI=71 (SE 2·7) and 75 (SE 2·8), respectively) than did muesli and granola or large-flake oatmeal porridge. The analysis establishes that differences in processing protocols and cooking practices modify the glycaemic response to foods made with whole-grain oats. Smaller particle size and increased starch gelatinisation appear to increase the glycaemic response.

Bordenave, N., Kock, L. B., Abernathy, M., Parcon, J. C., . . . Kasturi, P. (2015). Toward a more standardised and accurate evaluation of glycemic response to foods: Recommendations for portion size calculation. Food Chemistry, 167, 229-235. doi:10.1016/j.foodchem.2014.06.124

Abstract:

This study aimed at evaluating the adequacy of calculation methods for portions to be provided to subjects in clinical trials evaluating glycemic response to foods. Portion sizes were calculated for 140 food samples, based on Nutrition Facts labels (current practice) and actual available carbohydrate content (current recommendation), and compared against the amount of monosaccharides yielded by the digestive breakdown of their actual available carbohydrate content (basis for glycemic response to food). The current practice can result in significant under- or over-feeding of carbohydrates in 10% of tested cases, as compared to the targeted reference dosage. The method currently recommended can result in significantly inadequate yields of monosaccharides in 24% of tested cases. The current and recommended calculation methods do not seem adequate for a standardised evaluation of glycemic response to foods. It is thus recommended to account for the amount of absorbable monosaccharides of foods for portion size calculation.