Many of you reacted to the words of Jessie Inchauspé on Europe 1 on May 10, 2022. According to her, “A meal can have a completely different impact on glucose depending on the order in which you eat the food.” .
Despite the presence of scientific studies on this subject, the opinions of specialists on the question diverge and the answer does not seem so clear-cut.
What do the studies say?
We contacted Jessie Inchauspé to first ask her about the studies she was referring to in her interview on Europe 1. In her response, the holder of a master’s degree in science (biochemistry) cites five studies: HERE, HERE, HERE , HERE and HERE. She also invites us to visit this page of her site which lists other studies.
Clearly, the studies cited conclude that the order in which we eat foods during a meal impacts the level of glucose (sugar) in the blood. According to the authors, lipids and proteins ingested before carbohydrates significantly improve glucose tolerance, mainly by delaying gastric emptying and increasing insulin secretion. In other words, blood sugar improvement can be achieved by optimizing the timing of carbohydrate ingestion during a meal.
The limits of the studies
Among the studies cited, some come back more than others, especially on nutrition sites (HERE HERE or HERE) which sell the merits of this method of feeding: those of Pr Alpana P. Shukla. However, the studies of the professor of the Weill Cornell Medical College of New York relate essentially to subjects suffering from type 2 diabetes (under metformin – antihyperglycemic), obesity or prediabetes.
We therefore contacted Prof. Alpana P. Shukla to ask her if the results of her studies could also be applied to a healthy population in general. She replies:We conducted another study in people who were overweight/obese and at high risk of developing diabetes (i.e. prediabetes). We found that the food order/meal sequence also had a very significant effect on glucose levels in this population. We have not studied perfectly healthy people, it is likely that there will be an effect, although less significant” .
We submitted the professor’s response to Jessie Inchauspé who told us: “As we know the underlying mechanism, we know that this will reduce the glucose peak of everyone, diabetic or not. As in diabetics/prediabetics the peaks are larger, the effect will indeed be more marked” .
We also note that during certain studies, intakes of lipids/proteins/carbohydrates are each spaced out by 15 minutes on average, which does not really correspond to the eating habits of a Western population. To find out more, we contacted Laurent Buhler, dietician-nutritionist and holder of a DU “Reading of Clinical Trials”. The dietician has many reservations about these studies. According to him :
- The sample is restricted
- The context is “artificial” in the sense that there is a full 10 minute delay between the two food intakes, which does not necessarily correspond to how people eat their meals in real life (although the authors consider their protocol as applicable on a daily basis – which remains to be validated).
- “Artificial” context also because it is quite rare that we choose to eat starchy foods as a starter and then wait 10 minutes for the rest of the meal; at the limit, it can apply to the restaurant where you nibble bread while waiting for your dish. (A counter-example could be the Italian culture in which the meal is sometimes started with a pasta dish – is the prevalence of diabetes and obesity higher in Italy?)
- The authors indicate that they observed a great variability in insulin responses (“However, the insulin response, albeit lower, was not significantly different between these meal conditions, likely due to limitations of sample size and greater heterogeneity in insulin secretory patterns in individuals with prediabetess.”) – Given the expected variability of glycemic and insulin responses, the choice of the duration over which the AUC is measured is also important. A difference is observed up to 180 minutes, would this still be the case at 240 minutes?
- As in the other study, we do not have clinical criteria because this would require a much longer study (at least 3 months to observe a reliable variation in HbA1C for example and even more for criteria such as retinopathy, neuropathy, micro -angiopathy)
- Are these elements of interest to the general population? For what benefit? Given that we don’t know, is it legitimate to say so on a prime time radio station?
For Laurent Buhler, advising what almost everyone already does (starter, main course, dessert) is not really “revolutionary” . “It is not the difference in carbohydrate response, which is expected relative to the protocol of the studies, which is problematic, it is the fact of announcing that vsThis difference in response will have a significant effect on long-term health” .
However, in her email, Jessie Inchauspé maintains her words by declaring to us: “Avoiding glucose peaks and troughs reduces cravings, hunger, insulin levels, and this leads to weight loss in most people. A meal eaten in the correct order will reduce the peak, which will reduce the dip, which will reduce hunger before the next meal (https://www.nature.com/articles/s42255-021-00383-x)” .
Affirmation : The order in which we eat foods affects our level of glucose.
Verdict : Partially true. The studies that prove that the order in which we eat foods have an impact on our glucose level concern a specific population and have been carried out on a limited number of people under very specific conditions. The effects on a healthy population are not as marked as for a population with diabetes, for example. Moreover, the subject does not seem to be unanimous among some specialists.
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