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The Emerging Field of Chrononutrition in Type 2 Diabetes

Jun 23, 2020
 
Editor: Steve Freed, R.PH., CDE

Author: Kenya Henderson, 2021 PharmD. Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences

 While managing diabetes, when you eat is just as important as what you eat, according to chrononutrition.  

Chrononutrition is the timing of when a person eats. It specifies coordinating food intake with the body’s daily rhythms. The timing of eating is just as important as what and how many times a person eats a day. The 24-hour daily rhythms are known as the circadian clock, located in the suprachiasmatic nuclei (S.C.N.). Chrononutrition is influenced by a person’s chronotype, and each individual has a different chronotype. For instance, a person with evening chronotypes means they eat food later during the day, and a person with morning chronotypes means they eat food in the morning. The time of day you choose to eat has a significant influence on postprandial glucose, consequently affecting those with type 2 diabetes. Previous research and studies show that eating early in the day has more significant benefits on postprandial glycemia than eating in the evening. Also, the order in which you eat food, changing meals by consuming more protein at night, and choosing to eat low glycemic index (G.I.) foods in the morning rather than at night, are all good strategies to improve glycemic control.  

Dietary interventions have always been the cornerstone of diabetes prevention. Therefore, diabetes management should focus more on the quality of nutrients consumed and when they are consumed. Due to insomnia and most job occupations and lifestyles, plenty of people’s lives are not aligned with their circadian clock, which affects food intake, weight regulation, and glucose metabolism. Meal timing and dietary components such as chrononutrition play a vital role in regulating circadian clocks to reduce the risk of developing type 2 diabetes.  

In many of today’s lifestyles, individuals skip breakfast and have a late-night eating pattern. Late-night eating causes circadian misalignment, which negatively impacts glucose control. A 16-year follow-up cohort study showed that there was a 21% increased risk of developing type 2 diabetes in U.S. men who skipped breakfast versus those who consumed breakfast. Those who have evening chronotypes or that choose to eat later in the day are more likely to skip breakfast the following day. Another cross-sectional study by Sakai et al. strongly supported this evidence, showing the association between eating late at night and skipping breakfast the next morning with poor glycemic control in those with type 2 diabetes.  

Meal composition has a significant influence on glucose metabolism, just as much as the timing of meal ingestion. One study showed a 2-fold higher incidence of type 2 diabetes when most of a person’s calories were consumed during dinner. Therefore, consuming a high caloric diet in the morning is better than consuming it at night. Low glycemic index (G.I.) foods are also beneficial. In a four-way randomized study by Morgan et al., the effect of low glycemic index meals and high glycemic meals given in the morning or evening was evaluated. Postprandial glucose response in the evening was higher even after the low G.I. meal, which shows that no matter when you decide to eat the low G.I. meal, it is still less capable of glucose control. There was a recent study that determined the timing of low G.I. meals in the morning (0800 h), evening (2000h), and midnight (0000 h). The low G.I. meals consumed in the evening and at midnight resulted in higher insulin levels than the morning meals. So, these meals improved glycemic control in the morning but provided little control at night. 

Another strategy in preventing the development of type 2 diabetes is consuming more protein than fats at night. A diet high in protein showed a significant difference in glucose response. Increasing the amount of protein in a meal is entirely linked to a reduction of postprandial glucose at night. Since this has been shown, more people who work at night or have the evening or night chronotypes can impose this strategy, reducing the risk of hyperglycemia. 

The order in which you eat food plays an essential role in postprandial glucose also. The ordered sequence should include the consumption of vegetables, meat, and lastly, rice/starches. Further studies should be done on how the sequence of eating components has an impact on modulating glycemic response. In conclusion, there is still more information that needs to be learned in this new, emerging field of chrononutrition. Based on this review, the choice of food does not dictate a glycemic response. Still, the timing and order of food presentation within and between meals could significantly influence postprandial glycemia.  

Practice Pearls:  

  • Eating meals during the day, rather than in the evening, should be highly considered in those with type 2 diabetes.  
  • The time you eat during the day is just as important as focusing on the nutritional value of a meal alone.  
  • The order in which you eat food, and consuming more proteins, especially in those individuals who have night chronotypes, influences glycemic response.  

 

“Chrono-Nutrition: When You Eat Is as Important as What You Eat.” Deanna Minich, www.deannaminich.com/chrono-nutrition-why-when-you-eat-is-as-important-as-what-you-eat/. 

Henry, C.J., Kaur, B. & Quek, R.Y.C. Chrononutrition in the management of diabetes. Nutr. Diabetes 10, 6, (2020). https://doi.org/10.1038/s41387-020-0109-6 

Kenya Henderson, 2021 PharmD. Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences 

 

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