Showing posts with label blood glucose. Show all posts
Showing posts with label blood glucose. Show all posts

Tuesday, May 16, 2023

Chrononutrition: Food timing, circadian fasting...

 

Chrononutrition: Food Timing, Circadian Fasting, and Resetting the Body’s Internal Clock

Circadian cycles are part of the body’s internal clock, and disruption to these biological rhythms may result in adverse health outcomes. Aligning meal timing with the body’s circadian cycle for optimal glucose and insulin responsiveness may be effective for improving metabolic health. In the field of chrononutrition, time-restricted feeding has been prominent in research, studied for its benefits on metabolic health and as a means for realigning and supporting the body’s internal clock. How do circadian considerations potentially benefit personalized health interventions for chronic disease treatment or prevention?


Timing influences human physiology. Circadian cycles are a property of the body’s internal clock, and disruption to these biological rhythms may result in adverse health outcomes. The field of chronobiology is dynamic and continues to elucidate the associations between circadian rhythms and health implications, from neurodegenerative risks to metabolic dysfunctions.1,2 Chrononutrition is the focused study of the relationship between food, metabolism, meal timing, and the circadian system. Is there metabolic benefit when aligning lifestyle behaviors such as food timing with the body’s internal clock? How do circadian considerations influence personalized health interventions for chronic disease prevention or treatment?

Aligning Food Timing With Circadian Rhythms

Most cells and tissues of the body show molecular clock activity and express cellular clock genes that contribute to tissue and system function. In metabolic processes, circadian-related components modulate the activation and expression of hormones, enzymes, and signaling pathways.3,4 Aligning meal timing with the body’s circadian cycle for optimal glucose and insulin responsiveness, as well as with hormones such as cortisol and leptin that are also affected by circadian oscillations,3 may be effective for improving metabolic health. A 2023 meta-analysis of nine RCTs (n=485 total participants) compared higher energy consumption earlier in the day with higher consumption later in the day on weight loss and metabolic parameters.5 Researchers reported a significantly greater weight loss in groups with higher energy intakes earlier compared to groups with high energy intake later in the day. In addition, significantly greater reductions in LDL cholesterol, fasting glucose, and insulin resistance (measured by HOMA-IR) were reported in groups with earlier energy intakes compared with later intakes.5

Both glucose tolerance and insulin sensitivity have been shown to be lower in the evening than in the morning,6which may contribute to an increased risk of metabolic dysfunctions for those who habitually eat meals during the evening hours. A 2020 meta-analysis (n=10 acute postprandial studies) investigated whether acute glucose and insulin responses after night-time meals (8 pm–4 am) differed from the responses after day-time meals (7 am–4 pm) in healthy adults.7 Results indicated that after an identical meal, the postprandial glucose and insulin responses were both significantly lower in the day compared to the night.7 Interestingly, specific to carbohydrate intake, a 2022 systematic review of eight randomized clinical trials (n=116 healthy adults) indicated that consumption of carbohydrates at night also led to higher postprandial glycemic values than morning consumption; however, no significant difference between morning and night carbohydrate consumption was found for postprandial insulin values.8

TIME-RESTRICTED FEEDING & CIRCADIAN REALIGNMENT

As the field of chrononutrition continues to expand and develop, time-restricted feeding (TRF) has been prominent in research, studied for its benefits on metabolic health and as a means for realigning and supporting the body’s circadian clock.9,10 As a form of circadian fasting, TRF is a dietary pattern that optimizes circadian elements by consuming food and beverage within a shortened window of time during the day, extending a person’s nightly fast to 12 hours or more. A 2022 systematic review of 22 TRF-related randomized controlled trials suggested that among adults with overweight/obesity, TRF may lead to improved insulin resistance and glycemic responsiveness throughout the day.11 Of note, most of the reviewed studies assessed the effects of a 16-hour fast/8-hour feeding regimen (day-time feeding window variable), with only one included study comparing the early TRF (eating between 6 am and 3 pm) with the mid-day TRF (eating between 11 am and 8 pm).11

Synchronizing lifestyle habits such as food timing with circadian biological rhythms has been studied in a range of health areas, including the management of non-alcoholic fatty liver disease,12,13 the reduction of blood pressure,14inflammation,15 reduced cognitive decline,16 and cancer risk.17 Evaluating the feasibility of this therapeutic nutritional approach continues to evolve. A recent pilot study tested the feasibility of implementing TRF in adults with overweight and obesity through a smartphone intervention.18 Fifty participants with a normal eating duration of 14 hours or more were enrolled. After the 90-day TRF trial, the average adherence to logging meal activities and to reducing eating windows was 64% and 47% respectively.18 Of note, 16 of the TRF participants reduced their eating window from an average of 16 hours to approximately 12 hours. In addition, decreases in body weight, waist circumference, and systolic blood pressure were reported.18

Chronotype & Personalized Nutrition

It is important to note that some patients may not be suitable candidates for therapeutic fasting treatments due to preexisting conditions. However, for some patients, TRF interventions that optimize circadian elements by encouraging energy intake earlier in the day and increasing the fasting window have the potential to improve metabolic outcomes.

As research develops, determining the optimal time period for TRF interventions (early TRF versus mid-day TRF) may be clarified. Ultimately, ideal eating times and habits could be associated with a patient’s chronotype. Genetic variations in clock genes contribute to varied circadian inclinations among individuals and may impact best sleep and meal schedules for any given person. Specific chronotypes, for example, an “early-bird” or “night-owl,” describes not only at what time a person is naturally inclined to sleep and to be awake but may also influence appetite and physical activity.19,20 Studies continue to investigate the impact of chronotype on disease development,21 and chrononutrition trials are beginning to explore chronotype influences on interventions for improved metabolic health.22

As part of a personalized, lifestyle-based approach, nutritional therapies tailored to the individual patient are crucial for effectiveness and sustainability. Circadian rhythms are just one component to consider when creating and implementing dietary interventions. A variety of factors such as potential underlying nutrient deficiencies, presentation of disease symptoms, food sensitivities, accessibility, and personal preferences may all shape personalized treatments. IFM’s suite of therapeutic food plans are all available for modification based on an individual’s health needs. Learn more about food plan personalization within the IFM framework and creating effective and sustainable nutrition-based strategies to promote health through the online course Therapeutic Food Plans: A Component of Personalized Nutrition.

Source: <https://www.ifm.org/news-insights/chrononutrition-food-timing-circadian-fasting-and-the-bodys-internal-clock/?utm_campaign=Newsletter&utm_medium=email&_hsmi=251085985&_hsenc=p2ANqtz-8T_k3YJCFivLIRpT-UCW4IK1x8vKKGfijKRnr4-astzNGhHDqTj9WiCepB_vUcJE-ZK70SXU68vmHZtY9rEmT8JsGpZA&utm_content=251085983&utm_source=hs_email>

References:

  • 1) Leng Y, Musiek ES, Hu K, Cappuccio FP, Yaffe K. Association between circadian rhythms and neurodegenerative diseases. Lancet Neurol. 2019;18(3):307-318. doi:1016/S1474-4422(18)30461-7
  • 2) Chaput JP, McHill AW, Cox RC, et al. The role of insufficient sleep and circadian misalignment in obesity. Nat Rev Endocrinol. 2023;19(2):82-97. doi:1038/s41574-022-00747-7
  • 3) Serin Y, Acar Tek N. Effect of circadian rhythm on metabolic processes and the regulation of energy balance. Ann Nutr Metab. 2019;74(4):322-330. doi:1159/000500071
  • 4) Flanagan A, Bechtold DA, Pot GK, Johnston JD. Chrono-nutrition: From molecular and neuronal mechanisms to human epidemiology and timed feeding patterns. J Neurochem. 2021;157(1):53-72. doi:1111/jnc.15246
  • 5) Young IE, Poobalan A, Steinbeck K, O’Connor HT, Parker HM. Distribution of energy intake across the day and weight loss: a systematic review and meta-analysis. Obes Rev. 2023;24(3):e13537. doi:1111/obr.13537
  • 6) Mason IC, Qian J, Adler GK, Scheer FAJL. Impact of circadian disruption on glucose metabolism: implications for type 2 diabetes. Diabetologia. 2020;63(3):462-472. doi:1007/s00125-019-05059-6
  • 7) Leung GKW, Huggins CE, Ware RS, Bonham MP. Time of day difference in postprandial glucose and insulin responses: systematic review and meta-analysis of acute postprandial studies. Chronobiol Int. 2020;37(3):311-326. doi:1080/07420528.2019.1683856
  • 8) de Almeida RS, Marot LP, Latorraca COC, Oliveira RÁ, Crispim CA. Is evening carbohydrate intake in healthy individuals associated with higher postprandial glycemia and insulinemia when compared to morning intake? A systematic review and meta-analysis of randomized crossover studies. J Am Nutr Assoc. Published online March 1, 2022. doi:1080/07315724.2022.2043199
  • 9) Adafer R, Messaadi W, Meddahi M, et al. Food timing, circadian rhythm and chrononutrition: a systematic review of time-restricted eating’s effects on human health. Nutrients. 2020;12(12):3770. doi:3390/nu12123770
  •  10) Zeb F, Wu X, Fatima S, et al. Time-restricted feeding regulates molecular mechanisms with involvement of circadian rhythm to prevent metabolic diseases. Nutrition. 2021;89:111244. doi:1016/j.nut.2021.111244
  •  11) Tsitsou S, Zacharodimos N, Poulia KA, Karatzi K, Dimitriadis G, Papakonstantinou E. Effects of time-restricted feeding and Ramadan fasting on body weight, body composition, glucose responses, and insulin resistance: a systematic review of randomized controlled trials. Nutrients. 2022;14(22):4778. doi:3390/nu14224778
  •  12) Perez-Diaz-Del-Campo N, Castelnuovo G, Caviglia GP, Armandi A, Rosso C, Bugianesi E. Role of circadian clock on the pathogenesis and lifestyle management in non-alcoholic fatty liver disease. Nutrients. 2022;14(23):5053. doi:3390/nu14235053
  • 13) Kord-Varkaneh H, Salehi-Sahlabadi A, Tinsley GM, Santos HO, Hekmatdoost A. Effects of time-restricted feeding (16/8) combined with a low-sugar diet on the management of non-alcoholic fatty liver disease: a randomized controlled trial. Nutrition. 2023;105:111847. doi:1016/j.nut.2022.111847
  •  14) Xie Z, He Z, Ye Y, Mao Y. Effects of time-restricted feeding with different feeding windows on metabolic health: a systematic review of human studies. Nutrition. 2022;102:111764. doi:1016/j.nut.2022.111764
  •  15) Ramos-Lopez O, Martinez-Urbistondo D, Vargas-Nuñez JA, Martinez JA. The role of nutrition on meta-inflammation: insights and potential targets in communicable and chronic disease management. Curr Obes Rep. 2022;11(4):305-335. doi:1007/s13679-022-00490-0
  •  16) Currenti W, Godos J, Castellano S, et al. Association between time restricted feeding and cognitive status in older Italian adults. Nutrients. 2021;13(1):191. doi:3390/nu13010191
  •  17) Palomar-Cros A, Espinosa A, Straif K, et al. The association of nighttime fasting duration and prostate cancer risk: results from the Multicase-Control (MCC) study in Spain. Nutrients. 2021;13(8):2662. doi:3390/nu13082662
  •  18)Prasad M, Fine K, Gee A, et al. A smartphone intervention to promote time restricted eating reduces body weight and blood pressure in adults with overweight and obesity: a pilot study. Nutrients. 2021;13(7):2148. doi:3390/nu13072148
  •  19) Beaulieu K, Oustric P, Alkahtani S, et al. Impact of meal timing and chronotype on food reward and appetite control in young adults. Nutrients. 2020;12(5):1506. doi:3390/nu12051506
  •  20) Sempere-Rubio N, Aguas M, Faubel R. Association between chronotype, physical activity and sedentary behaviour: a systematic review. Int J Environ Res Public Health. 2022;19(15):9646. doi:3390/ijerph19159646
  •  21) Barrea L, Vetrani C, Altieri B, et al. The importance of being a ‘lark’ in post-menopausal women with obesity: a ploy to prevent type 2 diabetes mellitus? Nutrients. 2021;13(11):3762. doi:3390/nu13113762
  •  22) Mazri FH, Manaf ZA, Shahar S, Mat Ludin AF, Abdul Basir SM. Development and evaluation of integrated chrono-nutrition weight reduction program among overweight/obese with morning and evening chronotypes. Int J Environ Res Public Health. 2022;19(8):4469. doi:3390/ijerph19084469
  • Monday, August 29, 2022

    Are Artificial Sweeteners Really Harmless???

     

    Are Artificial Sweeteners Really Harmless?

    Medscape Medical News - August 19, 2022

    New research discounts the long-held notion that aspartame and other nonnutritive sweeteners (NNS) have no effect on the human body.
    In a study, researchers found that these sugar substitutes are not metabolically inert and can alter the gut microbiome in a way that can influence blood glucose levels.
    The study was published online August 19,20-22 in the journal Cell.

    Gut Reaction? 

    Several years ago, a team led by Eran Elinav, MD, PhD, an immunologist and microbiome researcher at the Weizmann Institute of Science, Rehovot, Israel, observed that NNS affect the microbiome of mice in ways that could affect glycemic responses.
    They have now confirmed this observation in a randomized controlled trial with 120 healthy adults.
    Before the study, all participants strictly avoided NNS. During the trial, some remained NNS-free, while others used saccharin, sucralose, aspartame, or stevia daily for 2 weeks in doses lower than the acceptable daily intake.
    Each NNS "significantly and distinctly" altered stool and oral microbiome, and two of the sweeteners (saccharin and sucralose) significantly impaired glucose tolerance, the researchers report.
    "Importantly, by performing extensive fecal transplantation of human microbiomes into germ-free mice, we demonstrate a causal and individualized link between NNS-altered microbiomes and glucose intolerance developing in non-NNS-consuming recipient mice," they say.
    They note that the effects of these sweeteners will likely vary from person to person because of the unique composition of an individual's microbiome.
    "We need to raise awareness of the fact that NNS are not inert to the human body as we originally believed. With that said, the clinical health implications of the changes they may elicit in humans remain unknown and merit future long-term studies," Elinav said in a news release.
    For now, Elinav says it's his personal view that "drinking only water seems to be the best solution.”

    Weighing the Evidence 

    Several experts weighed in on the results in a statement from the UK nonprofit organization, Science Media Centre.
    Duane Mellor, PhD, RD, RNutr, registered dietitian and senior teaching fellow, Aston University, Birmingham, United Kingdom, notes that the study does not show a link between all NNS and higher blood glucose levels in the long term (only after a glucose tolerance test).
    "It did suggest, though, that some individuals who do not normally consume sweeteners may not tolerate glucose as well after consuming six sachets of either saccharin or sucralose mixed with glucose per day," Mellor says.
    Kim Barrett, PhD, distinguished professor of physiology and membrane biology, University of California, Davis, School of Medicine, concurs, saying, "this well-designed study indicates the potential for NNS to have adverse effects in at least some individuals."
    The study also does not provide any information about how people who normally consume sweeteners or people with either type 1 or type 2 diabetes respond to NNS.
    "Therefore, for some people, it is likely to be a better option and more sustainable approach to use sweeteners as a 'stepping stone,' allowing them to reduce the amount of added sugar in foods and drinks, to reduce their sugar intake, and still enjoy what they eat and drink, on the way to reducing both added sugar and sweeteners in their diet," Mellor suggests.
    Kevin McConway, PhD, with the Open University, Milton Keynes, United Kingdom, says it's "important to understand that the research is not saying that these sweeteners are worse for us, in heath terms, than sugar.
    "But exactly what the health consequences of all this, if any, might be is a subject for future research," McConway adds.
    Kathy Redfern, PhD, lecturer in human nutrition, University of Plymouth, UK, agrees.
    "We still have a lot to learn about the human microbiome, and although this study suggests two of the sweeteners tested in this study (sucralose and saccharin) significantly affected glucose tolerance, these deviations were small," she says.
    The International Sweeteners Association also weighs in, saying, "No conclusions about the effects of low/no calorie sweeteners on glucose control or overall health can be extrapolated from this study for the general population or for people who typically consume sweeteners, including people living with diabetes."
    They add that "a recent review of the literature concluded that there is clear evidence that changes in the diet unrelated to low/no calorie sweeteners consumption are likely the major determinants of change in gut microbiota."
    Nevertheless, Redfern says the results "warrant further investigation to assess how small changes in glucose tolerance in response to NNS consumption may influence longer term glucose tolerance and risk for metabolic complications, such as type 2 diabetes."
    The study had no specific funding. Elinav is a scientific founder of DayTwo and BiomX, a paid consultant to Hello Inside and Aposense, and a member of the scientific advisory board of Cell. Mellor has provided consultancy to the International Sweetener Agency and has worked on projects funded by the Food Standards Agency that investigated the health effects of aspartame. Barrett, McConway, and Redfern report no relevant financial relationships. 
    Cell. Published online August 19, 2022. <https://www.cell.com/cell/fulltext/S0092-8674(22)00919-9>