Abstract
As years progress, we are found more often in a postprandial than a postabsorptive state. Chrononutrition is an integral part of metabolism, pancreatic function, and hormone secretion. Eating most calories and carbohydrates at lunch time and early afternoon, avoiding late evening dinner, and keeping consistent number of daily meals and relative times of eating occasions seem to play a pivotal role for postprandial glycemia and insulin sensitivity. Sequence of meals and nutrients also play a significant role, as foods of low density such as vegetables, salads, or soups consumed first, followed by protein and then by starchy foods lead to ameliorated glycemic and insulin responses. There are several dietary schemes available, such as intermittent fasting regimes, which may improve glycemic and insulin responses. Weight loss is important for the treatment of insulin resistance, and it can be achieved by many approaches, such as low-fat, low-carbohydrate, Mediterranean-style diets, etc. Lifestyle interventions with small weight loss (7–10%), 150 min of weekly moderate intensity exercise and behavioral therapy approach can be highly effective in preventing and treating type 2 diabetes. Similarly, decreasing carbohydrates in meals also improves significantly glycemic and insulin responses, but the extent of this reduction should be individualized, patient-centered, and monitored. Alternative foods or ingredients, such as vinegar, yogurt, whey protein, peanuts and tree nuts should also be considered in ameliorating postprandial hyperglycemia and insulin resistance. This review aims to describe the available evidence about the effects of diet, chrononutrition, alternative dietary interventions and exercise on postprandial glycemia and insulin resistance.
Highlights
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We have shown in a series of studies that foods and characteristics are able to reduce glucose excursions and overall postprandial glycemic responses [293,294,295], indicating the need for more clinical trials investigating the effects of functional foods on postprandial glycemia and insulin resistance (IR)
A recent minireview suggested that matured products, fermented dairy products, and whey-based products, and the addition of prebiotics and/or plant-derived products have a higher ability to regulate postprandial glycemia due to their probiotic strains with higher proteolytic and exopolysaccharides-forming abilities leading to inhibition of digestive enzymes, such as the a-amylase (1,4-alpha-Dglucan-glucanohydrolase), the enzyme that hydrolyses polysaccharides to glucose and maltose oligosaccharides, and the α-glucosidases, membrane bound enzymes located in the epithelium of the brush borders of the small intestine, that hydrolyze the oligosaccharides at the non-reducing links releasing the bound α-glucose, increasing the blood glucose levels [409]
Summary
“Let food be thy medicine, and let medicine be thy food”, the famous quote by Greek physician Hippocrates stands well the test of time. The eating pace of consuming a meal has been implicated in modulating postprandial hyperglycemia; for example, eating fast has been associated with higher glycemic excursions in healthy women [82] Another important strategy to consider is the consumption of foods and meals that induce a lower GL and delay gastric emptying, leading to decreased insulin requirements and postprandial glucose excursions and may reduce hunger and desire to eat [31]. Such foods and meals typically contain high fiber, soluble fiber, low amounts of absorbable carbohydrates, low amounts of total carbohydrates, and are high in proteins [31,46,75]. The type, total amount, other macronutrients consumed in parallel, physiological organic function, the GI/GL of carbohydrate containing foods, the extent to glucose excursions and fluctuations, and the time of day that the majority of carbohydrates is consumed, will be determinant factors of postprandial glucose and insulin increases and amelioration or not of IR
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