Is whey the way to go with diabetes?

In the English children’s rhyme Little Miss Muffet had curds and whey, but it was the whey that helped keep her type 2 diabetes (T2D) in check. While various studies have shown that whey protein supplementation prior to a meal reduces postprandial glycemia in people with diabetes, it’s been unclear whether premeal supplementation could be practical and effective when used on a daily basis, according to Kieran Smith, a PhD student at the Population of Health Sciences Institute, Newcastle University. He was coauthor of a study investigating use of a novel, premeal beverage containing a low dose of whey protein for daily use in people with T2D. Findings were published in BMJ Open Diabetes Research & Care. Read: Type 2 diabetes may accelerate brain aging and cognitive decline It found that thrice daily mealtime supplementation could reduce daily hyperglycemic exposure, and increased the time spent in euglycemia as measured by continuous glucose monitoring. Generally, whey protein for this use are unpalatable, powdered supplements which require dilution and mixing with flavoring immediately before they are consumed. The solutions people need to drink tend to be large in volume, cumbersome and, well, unappealing. “Premeal interventions need to be compatible with contemporary living,” Dr. Smith said. What does whey protein do? When taken immediately before eating, it stimulates the early and sustained release of insulin and several gut peptides, including glucagon-like peptide 1 (GLP-1), and delays gastric emptying, and in this way reduces the glycemic response to a meal, the study said. Researchers worked with a food company to develop something easier and tastier for people to try—individual packets each containing about three ounces of a premixed, flavoured whey protein supplement. The researchers called these “shots.” “Our pre-meal shots were not as viscous as Pepto Bismol. They were similar to a yogurt type drink,” Dr. Smith told the Medical Post by email. They came in two flavours: cocoa-cappuccino and strawberry. The study had a randomized, placebo-controlled, single-blind crossover design. All participants were required to have an HbA1c (glycated hemoglobin) of less than80 mmol/mol (9.5%) and have a body mass index of 40 kg/m2 or less. People with a history of gastrointestinal disease or who took medications known to affect gastrointestinal function or appetite were not included in the study. A total of 18 insulin naive individuals with T2D were included. They had a mean age of 50 years; a mean HbA1c of 7.4%; and had an average duration of diabetes of six years. The primary outcome was the time spent in hyperglycemia (defined as above 10 mmol/L) during a seven-day free-living period. In a counterbalanced order, patients randomly consumed either the active whey protein shot (these contained about 15g of protein) or a protein-depleted placebo shot 10 min before breakfast, lunch, and dinner over a seven-day free-living period. Participants were instructed to make no changes to their habitual dietary or physical activity patterns. Glucose control was measured in a blinded fashion with continuous glucose monitoring and determined by the percentage of time spent above range (over 10 mmol/L), in euglycemic range (3.9 to 10.0 mmol/L), below range (less than 3.9 mmol/L) and mean glucose concentrations. Measurements automatically occurred every fifth minute for a total of 288 values per day, and recorded over the seven-day period. Results showed that during the week when patients were using the placebo, they spent an average of 38.1% of each 24-hour period with their blood glucose above 10.0 mmol/L. The prevalence of daily hyperglycemia (over 10.0 mmol/L) was reduced by 8.3% when using the active whey protein shots. This resulted in 117 minutes less per 24 hours spent in hyperglycemia. “For the first time, we demonstrate that daily hyperglycemia can be significantly reduced by the provision of a low dose of whey protein ingested prior to each main meal over seven days of free-living. This enabled patients to achieve two hours more per day spent within euglycemia, without increasing the risk of hypoglycemia,” the study said. Patient’s Glucose Management Indicator (GMI), an estimate of overall glycemic control, was reduced by an average of −2.9 mmol/mol when using the thrice daily shots, compared to the placebo. This indicated improved glycemic control and a reduction in hyperglycemia. Indeed, relative to the placebo, mean 24-hour glucose concentrations were −0.6 mmol/L lower following use of the premeal shots. “There were no adverse effects to the whey or placebo shots. That is, there was no gut discomfort or nausea. There were no differences in physical activity levels during the two treatment periods, nor were there any changes to patient medication,” Dr. Smith said. The use of such shots could be an effective sole or adjunctive therapy for the treatment of hyperglycemia, the study said. “This a unique study with interesting findings, but also some significant limitations. More research is required to ensure results are applicable to larger cohorts of diverse people living with type 2 diabetes,” said Ann Besner, a registered dietitian and senior manager of Patient Knowledge and Connection at Diabetes Canada. She was not a part of the study. She added that Diabetes Canada’s Clinical Practice Guidelines recommend the inclusion of protein as part of a healthy, balanced diet for people living with diabetes in the amount of 15% to 20% of total daily energy. “Protein can come from a variety of animal and plant-based sources, including whey, if desired,” she said.

Is whey the way to go with diabetes?

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