I am always grateful to my Israeli colleagues to provide innovative evidence to collaborate what i observe in my clinical practice among the Indigenous people.
Abstract
OBJECTIVE To compare the clinical effects of a personalized postprandial-targeting (PPT) diet versus a Mediterranean (MED) diet on glycemic control and metabolic health in prediabetes.
RESEARCH DESIGN AND METHODS We randomly assigned adults with prediabetes (n = 225) to follow a MED diet or a PPT diet for a 6-month dietary intervention and additional 6-month follow-up. The PPT diet relies on a machine learning algorithm that integrates clinical and microbiome features to predict personal postprandial glucose responses. During the intervention, all participants were connected to continuous glucose monitoring (CGM) and self-reported dietary intake using a smartphone application.
RESULTS Among 225 participants randomized (58.7% women, mean ± SD age 50 ± 7 years, BMI 31.3 ± 5.8 kg/m2, HbA1c, 5.9 ± 0.2% [41 ± 2.4 mmol/mol], fasting plasma glucose 114 ± 12 mg/dL [6.33 ± 0.67 mmol/L]), 200 (89%) completed the 6-month intervention. A total of 177 participants also contributed 12-month follow-up data. Both interventions reduced the daily time with glucose levels >140 mg/dL (7.8 mmol/L) and HbA1c levels, but reductions were significantly greater in PPT compared with MED. The mean 6-month change in “time above 140” was −0.3 ± 0.8 h/day and −1.3 ± 1.5 h/day for MED and PPT, respectively (95% CI between-group difference −1.29 to −0.66, P < 0.001). The mean 6-month change in HbA1c was −0.08 ± 0.19% (−0.9 ± 2.1 mmol/mol) and −0.16 ± 0.24% (−1.7 ± 2.6 mmol/mol) for MED and PPT, respectively (95% CI between-group difference −0.14 to −0.02, P = 0.007). The significant between-group differences were maintained at 12-month follow-up. No significant differences were noted between the groups in a CGM-measured oral glucose tolerance test.
CONCLUSIONS In this clinical trial in prediabetes, a PPT diet improved glycemic control significantly more than a MED diet as measured by daily time of glucose levels >140 mg/dL (7.8 mmol/L) and HbA1c. These findings may have implications for dietary advice in clinical practice.
Ben-Yacov O, Godneva A, Rein M, et al. Personalized Postprandial Glucose Response-Targeting Diet Versus Mediterranean Diet for Glycemic Control in Prediabetes. Diabetes Care. 2021 Jul 23. pii: dc21-0162. doi: 10.2337/dc21-0162. (Original study)
What makes the blood sugar goes up after you eat ?
I have my own theories. I work exclusively with Indigenous people so it is easy to make observations (being an anthropologist helps as unlike Medical Doctors, anthropologists tend to be more qualitative)
I give you an example
A primary care provider made the diagnosis of Type 2 Diabetes on an Indigenous person. The blood sugar was in the range of 200 mg/dl range. She was not obese. But her nutrition was the General American Diet (which probably caused her Diabetes?)
Three of us work together : The Diabetes Educator who is also a certified Physical Education Teacher and indigenous herself ; the Nutritionist who is a Professor of Nutrition at a University nearby and open minded and with years of experience working with Indigenous people and my work has been exclusively with Indigenous people.
Six weeks ago, the Nurse Practitioner in the Clinic informed us that a 61 year old Indigenous person has been diagnosed with Type 2 Diabetes.
First Lifestyle history with emphasis on NUTRITION or lack of it.
In a country where majority of the people consume ultra processed food, a history of that consumption makes up the huge chunk of Lifestyle and the ability to manipulate it.
Results Ultra-processed foods comprised 57.9% of energy intake, and contributed 89.7% of the energy intake from added sugars. The content of added sugars in ultra-processed foods (21.1% of calories) was eightfold higher than in processed foods (2.4%) and fivefold higher than in unprocessed or minimally processed foods and processed culinary ingredients grouped together (3.7%). Both in unadjusted and adjusted models, each increase of 5 percentage points in proportional energy intake from ultra-processed foods increased the proportional energy intake from added sugars by 1 percentage point. Consumption of added sugars increased linearly across quintiles of ultra-processed food consumption: from 7.5% of total energy in the lowest quintile to 19.5% in the highest. A total of 82.1% of Americans in the highest quintile exceeded the recommended limit of 10% energy from added sugars, compared with 26.4% in the lowest.
Conclusions Decreasing the consumption of ultra-processed foods could be an effective way of reducing the excessive intake of added sugars in the USA.
Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. thanks to Dr Carlos Augusto Monteiro, USP, Brasil.
As expected, our patient's caloric intake was predominantly prepared by others, in take-out restaurants and fast food restaurants.
Education about Malnutrition and Ill health.
Assess the willingness of the patient for a change in Nutrition. This patient was very willing as she had seen the consequences of uncontrolled diabetes in her tribe.
Continuous Glucose Monitoring. We use Libre 14 days, and with the promise that she would check the machine often and send the results to me.
What is important here is her willingness to make changes to her nutrition.
Within one week her average blood sugar came down from 200 mg/dl to 150 mg/dl. The Primary Care Provider had begun her on two medications and I stopped one and within the next two months, the other medication was also stopped.
Because of the CGM we were able to find out many peculiarities of the effects of Food on her Blood Sugar.
This is what the two ERAN s (Siegel and Elianav) in Israel do with their algorithm , in which Microbiome of each patient is included.
In a way we were doing a hit and miss Microbiome examination of our own .
In this patient, any Bread or bread products increased the Blood sugar
But whole grain Pita, did not. (I joked that she must be my sister, as the same thing happens to be when I eat Pita or the other types of bread. but I do know my microbiome)
On the way over to the clinic one day, she stopped at STARBUCKS and had one of those mixed drinks and her Blood sugar went up by more than 60 mg/dl
One thing to note was the lack of postprandial excursions of blood sugar.
She is now off all medications, and her Blood sugar remains around 100 mg/dl. No change in exercise, typr or intensity or time.
Has she reversed her Diabetes ?
In my opinion, Yes
We now have people trying to reverse their diabetes, and in general the "fresh" they are in the diagnosis, the faster they reverse their Diabetes.
Yet another patient, his story is so astonishing that it deserves to be in the Publications for patients on Diabetes. ( I attend ONLY to Indigenous patients, aunque estoy un medico sin fronteras, bien que je sois un médecin sans frontières)
