Improve Postprandial Glucose With “Anti-Inflammatory” Diet

Markers of inflammation and cardiovascular health show improvement with the improvement of postprandial glucose and lipid profiles.

"The highly processed, calorie-dense, nutrient-depleted diet favored in the current American culture frequently leads to exaggerated supraphysiological post-prandial spikes in blood glucose and lipids," write James H. O’Keefe, MD, from the Mid America Heart Institute and University of Missouri–Kansas City, and colleagues. "This state, called post-prandial dysmetabolism, induces immediate oxidant stress, which increases in direct proportion to the increases in glucose and triglycerides after a meal. The transient increase in free radicals acutely triggers atherogenic changes including inflammation, endothelial dysfunction, hypercoagulability, and sympathetic hyperactivity."

Even in individuals without diabetes, postprandial dysmetabolism independently predicts future cardiovascular events. Dietary improvements are associated with dramatic and immediate benefits in postprandial dysmetabolism.

To attenuate the increase in glucose, triglycerides, and inflammation after a meal, the review authors recommend a diet rich in minimally processed, high-fiber, plant-based foods, including vegetables and fruits, whole grains, legumes, and nuts. Other dietary interventions that can significantly ameliorate postprandial dysmetabolism include intake of lean protein, vinegar, fish oil, tea, and cinnamon. Additional benefits may result from calorie restriction, weight loss, exercise, and low-dose to moderate-dose alcohol.

Specific recommendations to improve postprandial glucose and triglycerides are as follows:

· Select high-fiber carbohydrates with low glycemic index, including vegetables, fruits, whole grains, legumes, and nuts.

· At all 3 meals, consume lean protein.

· Eat approximately 1 handful of nuts daily (using a closed fist), consumed with vegetables, grains, berries, or other fruits.
· Eat salad daily, consisting of leafy greens with dressing of vinegar and virgin olive oil.

· Avoid highly processed foods and beverages, particularly those containing sugar, high-fructose corn syrup, white flour, or trans fats.

· Limit portion sizes to modest quantities.

· Maintain normal weight and avoid overweight or obesity. Waist circumference should be less than one half of height in inches.

· Perform physical activity for at least 30 minutes or more daily, of at least moderate intensity.

· For those with no history of substance abuse, consuming 1 alcoholic beverage before or with an evening meal may be considered.

"Experimental and epidemiological studies indicate that eating patterns, such as the traditional Mediterranean or Okinawan diets, that incorporate these types of foods and beverages reduce inflammation and cardiovascular risk," the review authors write. "This anti-inflammatory diet should be considered for the primary and secondary prevention of coronary artery disease and diabetes."

Practice Tools:

· There is a linear relationship between impaired glucose tolerance and mortality, and a fatty meal can lead to immediate increases in serum triglyceride levels. However, reducing triglyceride levels can reduce the risk for coronary artery disease by as much as 40%.

· The current review recommends foods with a low glycemic index such as vegetables and fruits. Other recommended foods include nuts, cinnamon, vinegar, egg whites, and whey protein.
J Am Coll Cardiol. 2008;51:249-255.

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