bBefore the pandemic, Barbara Senich, a retiree from Chapel Hill, NC, was diagnosed with prediabetes, meaning the sugar levels in her blood put her at risk for developing type 2 diabetes. The source of that blood sugar level was sweet foods, grains and other carbohydrates. She says she thought about it every 30 seconds, which led to constant snacking.
Today, she has reduced her cravings and blood sugar levels in part by changing the way she eats. But Senich didn’t leave out the carbs. She changed the order she has them in.
Researchers have recently discovered that eating certain foods such as non-starchy vegetables for Carbohydrates can result in lower, healthier blood sugar levels, compared to carbohydrates first. Especially at breakfast, these vegetarian starters also suppress the hormones that cause hunger during the day.
Carbohydrates are not necessarily bad. They are the main source of energy for the nervous system and provide fiber that aids digestion and lowers cholesterol levels. Although carbohydrates are found in some unhealthy foods (think French fries), they are also plentiful in healthy options like whole fruits, lentils and beans that nourish the brain and muscles. Some high-carb foods can raise blood sugar levels, also called glucose, higher than the ideal range, especially if eaten alone and in excess. If these spikes occur frequently over the years, our cells stop responding to insulin, the hormone that normally signals cells to take up glucose for energy expenditure. This problem, called insulin resistance, causes sugar to build up in the blood – a defining feature of diabetes.
About 1 in 3 Americans, or 98 million, have prediabetes – and more than 80% are unaware of it. Many will develop type 2 diabetes, potentially leading to nerve damage, vision loss and shortened lives.
But by changing the order in which you eat foods, it is possible to eat your carbs and also maintain healthy blood sugar levels. It’s free and “doesn’t require superhuman willpower,” says Senich.
Why it works
When we eat vegetables first, their fiber sets a filter in the intestines. Once the carbohydrates hit the scene, the filter slows them down, like sand catching flood water, so the glucose enters the bloodstream in just a trickle instead of a trickle. Our cells need less insulin to absorb these droplets, which puts less strain on the pancreas. “The body of research strongly supports the idea that food sequencing reduces glucose spikes after a meal,” says Dr. Alpana Shukla, associate professor of research at Weill Cornell Medicine, who studies food order.
The strategy could yield the biggest benefits in people with prediabetes and diabetes, simply because they have higher glucose levels to begin with. But those with normal blood sugar levels also see benefits. In one study, when healthy people left rice for last, their glucose spikes were significantly lower than when they ate rice before meat and vegetables. Over time, more stable glucose could help prevent serious illness.
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Another plus for everyone is that if you eat vegetables first, you tend to eat more of them, compared to filling up on carbs before eating vegetables. Many Americans are vitamin deficient and on average we consume 10 to 15 grams of fiber per day, while our ancestors consumed about 100 grams. Adjusting the order often results in a preference for foods that are richer in nutrients, says Shukla, which is good whether you have health problems or want to prevent them.
How to eat vegetarian entrees
Try eating a vegetable 10 minutes before you eat your carbs, although you’ll still see some benefit without taking a break before carbs, says Shukla. Noosheen Hashemi, founder and CEO of health research company January AI, keeps her blood sugar levels healthy by carrying vegetables like broccoli, fennel or peppers in her bag to restaurants in anticipation of high-carb dishes. “I carry vegetables,” she says. (TIME owner Marc Benioff is an investor in January’s AI.)
It is not necessary to eat the vegetables themselves to reap the benefits. Combining vegetables and protein before carbs results in 46% lower glucose spikes, compared to carbs first, in people with prediabetes. According to Shukla, this combination may work slightly better than vegetables alone.
Another benefit: a feeling of fullness for three hours after a meal, because starters with vegetables and proteins suppress the hormone ghrelin that causes hunger. We may therefore consume fewer calories. When people eat the same meal in reverse order, with carbohydrates first, this ghrelin hormone rises much higher after three hours.
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Eating carbohydrates last releases another hormone, GLP-1, which slows the rate at which your stomach sends food to the intestines, further relieving pressure on our insulin systems. This effect of GLP-1 forms the basis for the successful weight loss drugs, such as Ozempic, which are becoming increasingly popular. “You can harness and boost your own GLP-1 through this intervention,” says Shukla.
Ordering food can be especially useful at breakfast. After not eating at night, your mealtime glucose may rise higher than it would at lunch or dinner, says Shukla. Start breakfast with a vegetarian omelet, she suggests. Mix lots of veggies with the egg protein before finishing with your carb, a piece of multigrain toast.
“We know that ordering meals throughout the day has an impact,” says Sarah Berry, associate professor of food science at King’s College London and chief scientist at science and personalized nutrition company ZOE. Unhealthy glucose levels after lunch are partly determined by whether glucose peaks at breakfast, Berry has found, and high-carb cereals and bagels dominate our personal breakfast menus.
For best results, visualize half your plate covered with vegetables, 25% with protein, and 25% with carbohydrates, says Shukla. But a smaller starter can also help regulate blood sugar levels, she adds.
“It’s not all or nothing,” said Senich, the North Carolinian. She makes sure baby carrots are always within reach, and knows that having a dozen or so is better than just eating carbs.
As always, it’s good to aim for carbohydrates that are unprocessed, complex and high in fiber.
Try a protein appetizer
Another option that has been shown to smooth out glucose spikes: a protein primer without vegetables. Consuming protein on its own, prior to carbohydrates, can prevent glucose spikes and increase fullness. Before eating oatmeal, Senich makes sure to eat sugar-free Greek yogurt or nuts, both good sources of protein. An “almond appetizer” reduces post-meal glucose levels by 15%.
Joe Sapone, the founder of a consulting firm from Atlantic Highlands, N.J., says food sequencing helped him lose 120 pounds, along with medications. “I’ve gotten into the habit of eating protein first,” he says. He is a fan of whey protein shakes. “I’m Italian, so food is religion,” says Sapone. “I definitely want pasta and bread.” However, after the shakes, less hunger translates into smaller portions.
“Whey is king,” says Daniel West, a professor at Newcastle University who focuses on nutrition and insulin, because it is packed with amino acids that “prime the system” for carbohydrates. Just 15 grams of whey before a meal can improve daily glucose levels by 10%. Other research shows sustained benefits for 12 weeks.
Hashemi prefers pea protein shakes, another evidence-backed option, says West.
Fruit with a relatively low sugar content may also have some benefit as a pre-loader. Because of the high fiber content in some whole fruits, such as strawberries, eating them before other types of carbohydrates may increase GLP-1 hormone and help suppress appetite, compared to eating the whole fruit last, some studies have found. found it. This effect could support weight loss, but research is mixed on whether consuming fruit first helps control blood sugar levels. “Preloading with non-starchy vegetables or protein-rich foods is better because they contain very little sugar or carbohydrates,” says Shukla.
Prepare for success
If you’re busy, keep vegetarian entrees within reach. Preparation is key. “At the store, I make sure I buy easy-to-grab vegetables,” such as cucumbers, Senich says. While cooking carbs, she eats chopped peppers.
Sapone, who has type 2 diabetes, prepares nearly a week’s worth of healthy food in advance and places it at eye level in his refrigerator. He loads up on carrots at his beach club, just in case the pretzels tempt him. “I’m not a very disciplined person,” he says, but he is “happy” ordering food. He is not alone in this. “Patients swear by food ordering to support their obesity care,” says Dr. Katherine Saunders, physician of obesity medicine at Weill Cornell Medicine and co-founder of Intellihealth, in part because they can still get carbohydrates. “The best diet is one that doesn’t feel like a diet.”
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Sapone’s enthusiasm was reinforced by his own data. He likes to use a continuous glucose monitor to track how carbs on their own raise his glucose levels, and how preloads help. In addition to his weight and average blood glucose dropping, his cholesterol has also dropped.
Through technology companies like January AI, people can track how food ordering and other factors affect glucose, even without using a continuous glucose monitor. Take a photo of your meal and January AI’s algorithm predicts the post-meal effect based on demographics such as your age, body mass index and disease state.
Food sequencing is not a panacea. For obesity and diabetes, it is most effective if patients also take medications under the supervision of specialists, as in the cases of Sapone and Senich. Further improvements in glucose management come from getting a good night’s sleep, eating more slowly, and regular exercise.
And keep in mind that most studies on vegetarian starters focus on their immediate effects. More research is needed on the long-term results. “We have so many tools in the toolbox,” Berry says. “Meal ordering is just one of those tools.”