Postprandial Glucose Spikes Research Articles

Potential of GLP-1 Analogs in Managing Hyperphagia and Obesity in Prader-Willi Syndrome: A Review of Efficacy and Safety

Introduction: Prader-Willi Syndrome (PWS) is a genetic disorder marked by hyperphagia, obesity, developmental delays, and behavioral challenges. Traditional treatments like dietary control and growth hormone therapy often fail to effectively manage these symptoms. Recently, glucagon-like peptide-1 (GLP-1) analogs have shown potential in treating PWS. This review assesses the efficacy, safety and mechanisms of GLP-1 analogs in PWS treatment. They improve glycemic control, cardiovascular health, and appetite regulation, contributing to better weight management and overall health in PWS patients. These analogs enhance insulin secretion, inhibit glucagon release, and slow gastric emptying, helping to reduce postprandial glucose spikes and caloric intake. Results: Several small-scale studies and case reports have shown mixed results regarding the effectiveness of GLP-1 analogs in reducing BMI and hyperphagia in PWS patients. Although the studies demonstrated varied outcomes in terms of BMI reduction, all of them reported improvement in satiety or appetite levels.Conclusions: Overall, GLP-1 analogs hold promise for addressing hyperphagia, obesity, and glycemic control in PWS patients, improving their overall health and quality of life. Continued research and long-term studies are essential to establish these benefits and optimize treatment strategies.

Comparison of feature learning methods for non-invasive interstitial glucose prediction using wearable sensors in healthy cohorts: a pilot study

BackgroundAlterations in glucose metabolism, especially the postprandial glucose response (PPGR), are crucial contributors to metabolic dysfunction, which underlies the pathogenesis of metabolic syndrome (MetSyn). Personalized low-glycemic diets (PLGD) have shown promise in reducing postprandial glucose spikes. However, current methods such as invasive continuous glucose monitoring (CGM) or multi-omics data integration to assess PPGR come with limitations, including cost and invasiveness, hindering widespread adoption in primary disease prevention. Our aim is to assess machine-learning algorithms for predicting individual PPGR using non-invasive wearable data, thereby circumventing the limitations associated with existing approaches. By identifying the most accurate model, we seek to provide a more accessible and efficient method for managing glucose metabolism. MethodsThis data-driven analysis utilized the experimental dataset from the SENSE (”Systemische Ernährungsmedizin”) study. Healthy participants used an Empatica E4 wristband and Abbott Freestyle Libre 3 CGM for ten days. Blood volume pulse (BVP), electrodermal activity (EDA), heart rate (HR), skin temperature (TEMP), and the corresponding CGM values were measured. Subsequently, four data-driven deep learning (DL) model-convolutional neural network (CNN), lightweight transformer (LTF), long short-term memory with attention (LSTM-A), and Bi-directional LSTM (BiLSTM)-were implemented and compared to determine the potential of DL in predicting interstitial glucose levels without involving food and activity logs. ResultsThe proposed BiLSTM achieved the best interstitial glucose prediction performance, with an average root mean squared error (RMSE) of 13.42 mg/dL, an average mean absolute percentage error (MAPE) of 0.12, and only 3.01% values falling within area D in Clarke error grid analysis (CEGA), incorporating the leave-one-out cross-validation (LOOCV) strategy for a five-minute prediction horizon. ConclusionThe findings of this study may demonstrate the feasibility of transferring knowledge gained from invasive glucose monitoring devices to non-invasive approaches. Furthermore, it emphasizes the promising prospects of combining deep learning with wearable technologies to predict glucose levels in healthy individuals.

A method for evaluating the risks of glucose dysregulation in daily life by continuous measurement of glucose excursions under reduced glycemic load: a pilot study

Introduction: Continuous glucose monitoring is essential for the management of patients with metabolic syndromes in their daily lives. However, how metabolic risks are accessed using time-series glucose excursion data for healthy individuals remains unclear.Methods: Thus, this study aimed to present a method for evaluating the risks of glucose dysregulation by analyzing glucose responses under reduced glycemic load using a phytochemical alpha-glucosidase inhibitor. A 14-day pilot trial with healthy adult participants was conducted to demonstrate the validity of the method.Results and Discussion: The results showed that ultradian glucose spike packets with lower heights dominantly appeared under reduced glycemic load, replacing postprandial single-lobe glucose spikes with higher heights. Furthermore, the frequency dominance of ultradian spike packets contributed to the reduction of overall mean glucose excursions during the test period under reduced glycemic load. Based on the time-delay model, it was indicated that glycemic load reduction recovers regular glucose–insulin coupling accompanying ultradian oscillations, thereby contributing to the maintenance of glucose homeostasis. The findings of this study indicate that the frequency ratio between pulsatile spike packets and single-lobe spikes could be a marker for evaluating glucose regulation/dysregulation in healthy adults.

Inhibition of human starch digesting enzymes and intestinal glucose transport by walnut polyphenols

One approach to controlling type 2 diabetes (T2D) is to lower postprandialglucose spikesby slowing down the digestion of carbohydrates and the absorption of glucose in the small intestine. The consumption of walnuts is associated with a reduced risk of chronic diseases such as T2D, suggested to be partly due to the high content of (poly)phenols. This study evaluated, for the first time, the inhibitory effect of a (poly)phenol-rich walnut extract on human carbohydrate digesting enzymes (salivary and pancreatic α-amylases, brush border sucrase-isomaltase) and on glucose transport across fully differentiated human intestinal Caco-2/TC7 monolayers. The walnut extract was rich in multiple (poly)phenols (70 % w/w) as analysed by Folin-Ciocalteau and by LCMS. It exhibited potent inhibition of both human salivary (IC50: 32.2 ± 2.5 µg walnut (poly)phenols (WP)/mL) and pancreatic (IC50: 56.7 ± 1.7 µg WP/mL) α-amylases, with weaker effects on human sucrase (IC50: 990 ± 20 µg WP/mL), maltase (IC50: 1300 ± 80 µg WP/mL), and isomaltase (IC25: 830 ± 60 µg WP/mL) activities. Selected individual walnut (poly)phenols inhibited human salivary α-amylase in the order: 1,3,4,6-tetragalloylglucose > ellagic acid pentoside > 1,2,6-tri-O-galloyl-β-D-glucopyranose, with no inhibition by ellagic acid, gallic acid and 4-O-methylgallic acid. The (poly)phenol-rich walnut extract also attenuated (up to 59 %) the transfer of 2-deoxy-D-glucose across differentiated Caco-2/TC7 cell monolayers. This is the first report on the effect of (poly)phenol-rich extracts from any commonly-consumed nut kernel on any human starch-digesting enzyme, and suggests a mechanism through which walnut consumption may lower postprandial glucose spikes and contribute to their proposed health benefits.

Manipulation of Post-Prandial Hyperglycaemia in Type 2 Diabetes: An Update for Practitioners.

This review paper explores post-prandial glycemia in type 2 diabetes. Post-prandial glycemia is defined as the period of blood glucose excursion from immediately after the ingestion of food or drink to 4 to 6 hours after the end of the meal. Post-prandial hyperglycemia is an independent risk factor for cardiovascular disease with glucose "excursions" being more strongly associated with markers of oxidative stress than the fasting or pre-prandial glucose level. High blood glucose is a major promoter of enhanced free radical production and is associated with the onset and progression of type 2 diabetes. Oxidative stress impairs insulin action creating a vicious cycle where repeated post-prandial glucose spikes are key drivers in the pathogenesis of the vascular complications of type 2 diabetes, both microvascular and macrovascular. Some authors suggest post-prandial hyperglycemia is the major cause of death in type 2 diabetes. Proper management of post-prandial hyperglycemia could yield up to a 35% cut in overall cardiovascular events, and a 64% cut in myocardial infarction. The benefits of managing post-prandial hyperglycemia are similar in magnitude to those seen in type 2 diabetes patients receiving secondary prevention with statins - prevention which today is regarded as fundamental by all practitioners. Given all the evidence surrounding the impact of post-prandial glycemia on overall outcome, it is imperative that any considered strategy for the management of type 2 diabetes should include optimum dietary, pharma, and lifestyle interventions that address glucose excursion. Achieving a low post-prandial glucose response is key to prevention and progression of type 2 diabetes and cardiometabolic diseases. Further, such therapeutic interventions should be sustainable and must benefit patients in the short and long term with the minimum of intrusion and side effects. This paper reviews the current literature around dietary manipulation of post-prandial hyperglycemia, including novel approaches. A great deal of further work is required to optimize and standardize the dietary management of post-prandial glycemia in type 2 diabetes, including consideration of novel approaches that show great promise.

The Effect of the Timing of Banana Intake on Postprandial Glucose Spike: Randomized Parallel-Group Comparison Study

Objective: To elucidate the effects of the timing of banana intake on postprandial glucose spike and glucose metabolism. Methods: This randomized parallel-group comparison study was designed to randomize 54 adults aged 41- 60 years into three groups. The first group consumed 120 g of banana at breakfast daily for 2 weeks, the second group consumed 120 g of banana after dinner daily for 2 weeks, and the third consumed no banana or banana-containing food for 2 weeks. The participants in each group wore a continuous glucose monitor on their arms for 2 weeks to measure their blood glucose trend. Body composition and serum biomarkers were evaluated before and after intervention. Results: There were 16 participants in the banana-at-breakfast group, 16 in the banana-after-dinner group, and 15 in the control group. We defined a postprandial blood glucose increase of >140 mg/dL as a “glucose spike.” When comparing the glucose spike incidence ratio (incidence of glucose spikes divided by number of times measured), the point estimate of the incidence ratio of banana-at-breakfast group at dinner compared with breakfast was 1.55 (point estimate. 95% confidence interval: 1.09- 2.20), that of banana-after dinner group 1.83 (point estimate. 95% confidence interval: 1.28-2.61), and control group 2.03 (point estimate. 95% confidence interval: 1.36-3.04). In addition, the banana-afterdinner and control groups showed a higher incidence ratio, compared with the banana-at-breakfast group. Glycoalbumin decreased significantly in the banana-at- breakfast group compared with the other groups. Conclusions: The results showed that glucose spikes were less generated when consuming bananas at breakfast than when consuming them after dinner or not consuming them at all. The level of glycoalbumin, an index for average blood glucose, was lower in the banana-at-breakfast group than in the banana-after-dinner and control groups within 2 weeks. Clinical Trial Registry: UMIN 000050025

Uncovering personalized glucose responses and circadian rhythms from multiple wearable biosensors with Bayesian dynamical modeling

Wearable biosensors and smartphone applications can measure physiological variables over multiple days in free-living conditions. We measure food and drink ingestion, glucose dynamics, physical activity, heart rate (HR), and heart rate variability (HRV) in 25 healthy participants over 14days. We develop a Bayesian inference framework to learn personal parameters that quantify circadian rhythms and physiological responses to external stressors. Modeling the effects of ingestion events on glucose levels reveals that slower glucose decay kinetics elicit larger postprandial glucose spikes, and we uncover a circadian baseline rhythm for glucose with high amplitudes in some individuals. Physical activity and circadian rhythms explain as much as 40%-65% of the HR variance, whereas the variance explained for HRV is more heterogeneous across individuals. A more complex model incorporating activity, HR, and HRV explains up to 15% of additional glucose variability, highlighting the relevance of integrating multiple biosensors to better predict glucose dynamics.

The Effects of Elexacaftor, Tezacaftor, and Ivacaftor (ETI) on Blood Glucose in Patients With Cystic Fibrosis: A Systematic Review.

Cystic fibrosis (CF) is an autosomal recessive genetic disorder resulting from defects in the cystic fibrosis transmembrane conductance regulator (CFTR) protein, which in turn results in a multi-systemic disorder. There are numerous known CF alleles associated with different mutations of the CFTR gene, with the most common CF allele being a three-base-pair deletion known as ΔF508. One common manifestation of CF is glycemic dysregulation associated with decreased insulin secretion, often progressing into a distinct form of diabetes known as cystic fibrosis-related diabetes (CFRD). In the past decade, a class of drugs known as CFTR modulators has entered clinical practice. These drugs interact with the CFTR protein to restore its function, with different modulators (or combinations of modulators) suitable for patients with different CFTR mutations. Previous research has established that the modulator ivacaftor is effective in decreasing blood glucose and sometimes resolving CFRD in patients with certain CFTR mutations (class III mutations). However, early modulator therapies for individuals with the common ΔF508 mutation (e.g., a combination of the modulators lumacaftor and ivacaftor) have largely proven ineffective in improving glucose regulation. More recently, a combination therapy of three modulators, namely elexacaftor, tezacaftor, and ivacaftor (ETI), has entered clinical practice for patients with the ΔF508 mutation. However, it is not clear whether this therapy is effective in treating dysglycemia. We searched for studies of any design that examined the effects of ETI on measures of blood glucose. All available studies were observational studies comparing patients before and after initiating ETI therapy. Measures of daily-life blood glucose (those obtained with continuous glucose monitoring systems or by measuring glycated hemoglobin (HbA1c)) and post-prandial glucose spikes from oral glucose tolerance tests showed significant improvements in at least some studies. The majority of studies showed significant improvements from pre- to post-ETI in one or more blood glucose measures. While the interpretation of this evidence is complicated by the lack of randomized controlled trials, it appears that ETI therapy is associated with improved glucose regulation for at least some patients with the ΔF508 mutation.

The efficacy and tolerability of intermittent prandial acarbose to reduce glucose spikes in healthy individuals

Acarbose is an α-glucosidase inhibitor that slows the digestion of carbohydrates and can prevent sharp increases in blood sugar levels after meals (spikes). Excessive postprandial blood glucose spikes have been associated with chronic conditions, increase all-cause mortality, and may contribute to aging. Therefore, the prevention of glucose spikes may contribute to the preservation of human healthspan. Indeed, acarbose has been associated with increased lifespan in animal models. However, its tolerability profile has limited acarbose use in healthy individuals. We hypothesized that using low-dose acarbose right before the occasional high-carbohydrate meal may prevent glucose spikes in healthy individuals. We performed a prospective clinical study to evaluate the tolerability and efficacy of acarbose in healthy individuals. Participants were randomized into two arms, each performing two control tests and two treatment tests. Continuous glucose monitor (CGM) measurements were collected for 2 h after high carbohydrate meals with or without pre-meal 50 mg acarbose intake. Tolerability was assessed using questionnaires. Twelve patients had evaluable results. Acarbose pretreatment resulted in reductions in CGM glucose measurements, with a significant decrease in glucose levels at the start, after 15 min, and at peak glucose levels. Few participants reported acarbose adverse events, and these included flatulence, bloating, nausea, abdominal pain, and stomach aches. No statistical difference in tolerability was detected between periods with and without acarbose. In conclusion, treatment with 50 mg of acarbose before meals was found to be well tolerated and efficacious in blunting the postprandial glucose spike by over 17% in healthy individuals.

Distribution and function of glucagon-like peptide 1 (GLP-1) in the digestive tract of mammals and the clinical use of its analogues

Recently, interest in glucagon-like peptide-1 (GLP-1) and other peptides derived from preproglucagon has increased significantly. GLP-1 is a 30-amino acid peptide hormone produced in L-type enteroendocrine cells as a response to food intake. GLP-1 is rapidly metabolized and inactivated by the dipeptidyl peptidase IV enzyme before the hormone leaves the intestine, which increases the likelihood that GLP-1 action is transmitted through sensory neurons in the intestine and liver through the GLP-1 receptor. The main actions of GLP-1 are to stimulate insulin secretion (i.e. act as incretin hormone) and inhibit glucagon secretion, thus contributing to the reduction of postprandial glucose spikes. GLP-1 also inhibits motility and gastrointestinal secretion, and therefore acts as part of the „small bowel brake” mechanism. GLP-1 also appears to be a physiological regulator of appetite and food intake. Because of these effects, GLP-1 or GLP-1 receptor agonists are now increasingly used to treat type 2 diabetes. Reduced GLP-1 secretion may contribute to the development of obesity, and excessive secretion may be responsible for postprandial reactive hypoglycemia. The use of GLP-1 agonists opens up new possibilities for the treatment of type 2 diabetes and other metabolic diseases. In the last two decades, many interesting studies covering both the physiological and pathophysiological role of GLP-1 have been published, and our understanding of GLP-1 has broadened significantly. In this review article, we have tried to describe our current understanding of how GLP-1 works as both a peripheral hormone and as a central neurotransmitter in health and disease. We focused on its biological effects on the body and the potential clinical application in relation to current research.

Repeated glucose spikes and insulin resistance synergistically deteriorate endothelial function and bardoxolone methyl ameliorates endothelial dysfunction.

BackgroundBoth insulin resistance and postprandial glucose spikes are known for their potential to induce vascular endothelial dysfunction in individuals with metabolic syndrome. However, these factors are inextricable, and therefore, their relative contributions to inducing endothelial dysfunction remain elusive. In this study, we aimed to disentangle the effects of these factors and clarify whether bardoxolone methyl (CDDO-Me), a novel nuclear factor erythroid 2-related factor 2 (Nrf2) activator, protects against glucose spike-induced endothelial dysfunction.MethodsWe induced glucose spikes twice daily for a duration of 1 week to rats fed a standard/control diet (CD) and Western-type diet (WTD). Endothelium-dependent relaxation (EDR) was evaluated using isolated thoracic aortas. Gene expression and dihydroethidium (DHE)-fluorescence studies were carried out; the effect of CDDO-Me on aortic endothelial dysfunction in vivo was also evaluated.ResultsNeither WTD-induced insulin resistance nor pure glucose spikes significantly deteriorated EDR. However, under high-glucose (20 mM) conditions, the EDR of thoracic aortas of WTD-fed rats subjected to glucose spikes was significantly impaired. In this group of rats, we observed significantly enhanced DHE fluorescence as a marker of reactive oxygen species, upregulation of an oxidative stress-related gene (NOX2), and downregulation of an antioxidant gene (SOD2) in the thoracic aortas. As expected, treatment of the thoracic aorta of this group of rats with antioxidant agents significantly improved EDR. We also noted that pretreatment of aortas from the same group with CDDO-Me attenuated endothelial dysfunction, accompanied by a correction of the redox imbalance, as observed in gene expression and DHE fluorescence studies.ConclusionsFor the first time, we showed that insulin resistance and glucose spikes exert a synergistic effect on aortic endothelial dysfunction. Furthermore, our study reveals that CDDO-Me ameliorates endothelial dysfunction caused by glucose spikes in a rat model of metabolic syndrome.

Modulating the digestibility of cassava starch by esterification with phenolic acids

This study applied ferulic acid, sinapic acid, and p-coumaric acid to synthesise esters with cassava starch and investigated their digestibility, GI and starch structure alterations. Starch after esterification contained less rapidly digestible starch (as low as 44.59%) and more resistant starch. Sinapic acid starch ester (SASE) had the lowest hydrolysis rate, which was 61.04% in this study. The GI of ferulic acid, p-coumaric acid, and sinapic acid starch esters were 53.5, 58.4, and 47.1, respectively. They were all significantly decreased compared with native cassava starch (81.5) (P < 0.05). The steric hindrance of phenolic acid moiety and increased hydrophobicity led to the reduced digestibility of starch esters. All these results indicated that phenolic acid starch esters could help to reduce postprandial blood glucose spikes, and therefore became a potential tool for diabetes management.

Prevention of Postprandial Hyperglycemia by Ophthalmic Nanoparticles Based on Protamine Zinc Insulin in the Rabbit.

Postprandial hyperglycemia, a so-called blood glucose spike, is associated with enhanced risks of diabetes mellitus (DM) and its complications. In this study, we attempted to design nanoparticles (NPs) of protamine zinc insulin (PZI) by the bead mill method, and prepare ophthalmic formulations based on the PZI-NPs with (nPZI/P) or without polyacrylic acid (nPZI). In addition, we investigated whether the instillation of the newly developed nPZI and nPZI/P can prevent postprandial hyperglycemia in a rabbit model involving the oral glucose tolerance test (OGTT). The particle size of PZI was decreased by the bead mill to a range for both nPZI and nPZI/P of 80–550 nm with no observable aggregation for 6 d. Neither nPZI nor nPZI/P caused any noticeable corneal toxicity. The plasma INS levels in rabbits instilled with nPZI were significantly higher than in rabbits instilled with INS suspensions (commercially available formulations, CA-INS), and the plasma INS levels were further enhanced with the amount of polyacrylic acid in the nPZI/P. In addition, the rapid rise in plasma glucose levels in OGTT-treated rabbits was prevented by a single instillation of nPZI/P, which was significantly more effective at attenuating postprandial hyperglycemia (blood glucose spike) in comparison with nPZI. In conclusion, we designed nPZI/P, and show that a single instillation before OGTT attenuates the rapid enhancement of plasma glucose levels. These findings suggest a better management strategy for the postprandial blood glucose spike, which is an important target of DM therapy.

Postprandial Glucose Spikes, an Important Contributor to Cardiovascular Disease in Diabetes?

Clinical trials investigating whether glucose lowering treatment reduces the risk of CVD in diabetes have thus far yielded mixed results. However, this doesn't rule out the possibility of hyperglycemia playing a major causal role in promoting CVD or elevating CVD risk. In fact, lowering glucose appears to promote some beneficial long-term effects, and continuous glucose monitoring devices have revealed that postprandial spikes of hyperglycemia occur frequently, and may be an important determinant of CVD risk. It is proposed that these short, intermittent bursts of hyperglycemia may have detrimental effects on several organ systems including the vasculature and the hematopoietic system collectively contributing to the state of elevated CVD risk in diabetes. In this review, we summarize the potential mechanisms through which hyperglycemic spikes may increase atherosclerosis and how new and emerging interventions may combat this.

Effect of High-Protein High-Fibre Supplement on Glycaemic Control in Overweight and Obese Indian Adults with Type 2 Diabetes Mellitus: A 24-Week, Randomized, Controlled Trial

Background: Foods rich in protein, dietary fibre and low in glycaemic index could potentially improve glycaemic control and help in management of type 2 diabetes mellitus (T2DM) in overweight/obese participants. In this study, the effect of high-protein high-fibre (HPHF) nutritional supplement in addition to standard medical care for glycaemic control was evaluated. Methods: In this open-label, parallel-arm, randomised study, 100 overweight/obese participants with T2DM (aged 30-65 years) were randomised (1:1) to either intervention group (25 g HPHF nutritional supplement [twice daily]+standard care of T2DM) or a control group (standard care of T2DM), for 6 months. Primary endpoint included change from baseline in 24��?hour glycaemic response at weeks 12 and 24. Results: Of 320 participants screened, 100 participants were randomised to either the intervention group (n=50) or the control group (n=50). In the intervention group; the mean (SE) daily incremental area under curve (IAUC) from baseline to week 24 was significantly lower ��?23.0 mg-15min/dL (57.2) compared to control group 168.0 mg-15min/ dL (39.0), p=0.008. The intervention group showed significant reduction in glycosylated haemoglobin (HbA1c) (p=0.03) and fasting blood sugar (p=0.01) level at the end of week 24 compared to the control group. Conclusions: Twice-daily consumption of HPHF nutritional supplement (25 g each) significantly improved glycaemic control, reduced the average 24-hour glycaemic response and postprandial glucose spikes. Inclusion of HPHF supplement would be a useful effective aid to glycaemic control in overweight/obese participants with T2DM.

MON-599 Post-Bariatric Hypoglycemia: A Clinical Vignette on an Increasingly Recognized Disease

Introduction: Previously referred to as late dumping syndrome, post-bariatric hypoglycemia (PBH) is thought to represent at least 1% of all hospitalizations for hypoglycemia and 10% of all clinically recognized hypoglycemia cases. However, through the advent of CGM and more strict criteria over the last decade these numbers are likely an underestimate. As obesity continues to remain prevalent and with rising bariatric centers to help deal with this epidemic, endocrinologists will play an increasing role in managing PBH patients.Clinical Case: A 39-year female with a PMH of hypothyroidism and bariatric surgery (BS) in 2009 presented to our ER for a seizure. She has been having seizures nearly every 2 weeks for one year. Neurology started her on Keppra; however, no etiology was identified. EMS had documented a blood glucose of 40 mg/dL; the patient was given an amp of D50 with resolution of neuroglycopenic symptoms. TSH and cortisol levels were within normal range. A sulfonylurea panel in the ED was negative. The patient states the symptoms can occur while fasting but also mainly post-prandial. A 72-hr fast was conducted with the patient nadir POC glucose of 77. Subsequently, the patient had a mixed meal tolerance performed and after 2 hours had a seizure and was found to have a BG of 50 mg/dL with an insulin level of 49 uIU/mL and a c-peptide of 18.8 ng/mL. The patient was diagnosed with PBH, and was discharged with a CGM, started on acarbose and was seen by nutrition to discuss dietary modifications. She is now seen in our clinic with control of her symptoms with the addition of diazoxide.Conclusion: Altered anatomy after bariatric surgery, particularly after gastric bypass and sleeve gastrectomy is thought to play a major role in developing PBH. By bypassing normal anatomy, gastric emptying is increased 2–3 x, which leads to a higher and more rapid appearance of glucose in the distal foregut. This subsequently leads to an amplified incretin response leading to a hyperinsulinemic response in patients who have had bariatric surgery; however, for unclear reasons some patients develop an even more amplified hyperinsulinemic response that leads to subsequent hypoglycemia. History of neuroglycopenic symptoms 1–3 hours after eating in a patient who had a gastric bypass > 6–12 months and with relief of symptoms with carbohydrates should raise an endocrinologist’s suspicion of PBH. Fasting hypoglycemia is an atypical feature that should raise one’s suspicion of a broader differential. Altered nutrition habits is the cornerstone of therapy with which the primary aim is to reduce post-prandial glucose spikes in these patients after they eat carbohydrates. These spikes in turn lead to hyperinsulinism leading to subsequent hypoglycemia. Primary diet modifications include controlled carbohydrate consumption of less than 30g per meal, avoiding high glycemic carbs, and always taking in ample fat and proteins with every meal.

The effect of viscous soluble dietary fiber on nutrient digestion and metabolic responses Ⅰ: In vitro digestion process

The consumption of viscous soluble dietary fibers (VSDF) as thickening agents for beverages and fluid foods has increased with their ability to modulate postprandial glycaemic response due to increasing digesta viscosity. The present study was designed to establish appropriate VSDF viscosity that can beneficially modulate nutrient digestion and attenuate glucose release and absorption. The effects of xanthan (XG), guar gum (GG) and locust bean gum (LBG) on the digestibility of starch and protein in beverages with initial low viscosity (300 mPa s, 30 s−1) and high viscosity (1500 mPa s, 30 s−1) were investigated using the proposed Infogest simulated digestion model. Moreover, the effects of dilution, physiological pH and enzymatic activities on viscosity decrease of three gums during digestion were evaluated. The results showed that at the end of intestinal digestion, XG showed the highest viscosity at low and high viscosity followed by GG and LBG, respectively. During the intestinal digestion process, three gums have little effects on protein and starch digestion at low viscosity. However, all the gums significantly reduced nutrient digestion at higher viscosity, and XG exhibited the best performance in reducing the amount of glucose and free amino acid released. The digestion rates of protein and starch showed a linear relationship with the viscosity of the system. Similarly, the amount of glucose diffused as a function of time was most significantly (p < 0.05) decreased by XG followed by GG. At low and high initial viscosities, dilution of the gastrointestinal contents was the most important source of viscosity reduction for all gums, and XG was the most resistant to dilution and recorded the least viscosity drop. These observations suggested that XG with high viscosity may serve as a useful food ingredient to attenuate postprandial glucose spikes in human.

Spent coffee (Coffea arabica L.) grounds promote satiety and attenuate energy intake: A pilot study.

We evaluated the effects of acute intake of biscuits (B) containing either spent coffee grounds (SCG), (added with fructooligosaccharides; SC-FOS) or SCG antioxidant dietary fiber (SCF), on satiety, energy intake as well as gastrointestinal tolerance of healthy overweight volunteers. The addition of SCG and SCF to the biscuits (SC-FOS-B and SCF-B) increased their protein (11.4% and 12.2%), and total dietary fiber (8.4% and 11.8%) contents. TheSCF-B significantly increased satiety perception, impacting ad libitum energy intake compared to the traditional biscuits recipe (TB; no added fiber). Moreover, SC-FOS-B and SCF-B decreased (no-observed-adverse effect) the most frequently reported symptoms by the participants, demonstrating that doses up to 5g of SCF (per biscuit portion; 45g) are well tolerated. The use of SCF and SCG as functional ingredients represents a sustainable strategy for the coffee industry and also potentiates the reduction of overweight, one of the leading health problems among the population. PRACTICAL APPLICATIONS: The addition of SCF or SCG as food ingredients increases protein and the dietary fiber content of traditional biscuits. SCF can slow gastric emptying, modulate appetite and thus body weight. SCF attenuates carbohydrate digestion blunting post-prandial blood glucose spikes reducing the risk of type 2 diabetes. SCF can be used as a functional ingredient to formulate foods with health benefits.

Acarbose improves health and lifespan in aging HET3 mice.

To follow‐up on our previous report that acarbose (ACA), a drug that blocks postprandial glucose spikes, increases mouse lifespan, we studied ACA at three doses: 400, 1,000 (the original dose), and 2,500 ppm, using genetically heterogeneous mice at three sites. Each dose led to a significant change (by log‐rank test) in both sexes, with larger effects in males, consistent with the original report. There were no significant differences among the three doses. The two higher doses produced 16% or 17% increases in median longevity of males, but only 4% or 5% increases in females. Age at the 90th percentile was increased significantly (8%–11%) in males at each dose, but was significantly increased (3%) in females only at 1,000 ppm. The sex effect on longevity is not explained simply by weight or fat mass, which were reduced by ACA more in females than in males. ACA at 1,000 ppm reduced lung tumors in males, diminished liver degeneration in both sexes and glomerulosclerosis in females, reduced blood glucose responses to refeeding in males, and improved rotarod performance in aging females, but not males. Three other interventions were also tested: ursolic acid, 2‐(2‐hydroxyphenyl) benzothiazole (HBX), and INT‐767; none of these affected lifespan at the doses tested. The acarbose results confirm and extend our original report, prompt further attention to the effects of transient periods of high blood glucose on aging and the diseases of aging, including cancer, and should motivate studies of acarbose and other glucose‐control drugs in humans.

Glycemic Index and Response of a Plant Based Nutritional Supplement and Its Subjective Satiety Following Its Use in Indian Adults

Background: Diet plays a vital role in managing diabetes. Foods with a low glycemic index provide lower postprandial glucose spikes and induce satiety. The objective of this study was to assess the Glycemic index (GI) without milk and Glycemic response (GR) with milk of two different flavours of a plant-based supplement which is high in protein and fibre, along with a subjective assessment of satiety. Methods: Fifteen overweight/obese subjects aged 18 - 45 years were recruited. After overnight fasting, blood samples were drawn at 5 mins before food consumption (-5), 0, 15, 30, 45, 60, 90 and 120 minutes. Participants underwent 3 days of reference food testing and 1 day of test food in random order with 2 days of wash-out period. The GI was assessed using a validated protocol recognized by FAO/WHO, as well as the guidelines by the International Dietary Carbohydrate Task Force for GI Methodology. The satiety index was measured using the Visual Analog Scale (VAS). The dietary intake of the subjects was measured by 24-hour dietary recall. The Incremental Area Under the Curve (IAUC) was calculated using the trapezoid rule. Results: Both the flavours of the supplement had low GI & GR. The GI and GR of Flavour 1 were 27.3 ± 4.8 & 16.4 ± 2.6 (Mean ± SEM) respectively. For Flavour 2 the GI and GR were 36.7 ± 4.4 & 25.7 ± 2.3 (Mean ± SEM). For Flavour 1, 60% and for flavour 2 66.7% of subjects reported feeling hungry only after 3 hours, showing good satiety. Conclusion: The plant-based high fibre high protein supplement in both flavours showed a low glycemic index and hence may be useful to include in the diets to reduce the postprandial glycemic response and could improve satiety.