Bariatric Times

P O T L I G H T o n N U T R I T I O N S S UPPLEMENT TO BARIATRIC TIMES VOLUME 12, NUMBER 10 • OCTOBER 2015 • SUPPLEMENT C The Value of Nutritional Management of Glucose Response Post-bariatric Surgery Weight Regain: Type 2 Diabetes Relapse Risks Recent studies indicate that bariatric surgery has a significant resolution rate for type 2 diabetes (T2DM) in more than 75 percent of patients treated; 1 however, patients frequently fail to maintain their weight loss long term. Weight regain poses a significant risk for T2DM relapse in these patients if proper nutrition and lifestyle changes are not upheld. In these instances, it may be necessary to medically intervene. When indicators of patient nonadherence are evident, a medical food could be prescribed to help establish dietary support for the management of glucose response. Instances of T2DM relapse are becoming increasingly common—indicating a major unmet need for a practical, easy- to-use method to promote patient adherence and mitigate the active return of T2DM symptoms. Functional Medicine Research Center ® Study on Glycemic Response Ultra Glucose Control ® (UGC [Metagenics, Inc., Aliso Viejo, California]) is a medical food formulated to provide clinicians and patients with an effective dietary tool to facilitate blood glucose control. In a double-blind, randomized, crossover evaluation study performed at the Functional Medicine Research Center (FMRC, the clinical research arm of Metagenics, Inc.), UGC was assessed against commercially available medical therapy products. 2 The primary aim of the study was to compare glycemic response in 24 otherwise healthy subjects who were overweight or obese and pre-diabetic following the ingestion of UGC and three other commercially available products: a nutritional shake mix (NSM), a ready-to-drink medical food (RTD), and flavored instant oatmeal (OAT). Subjects were required to have an overnight fast and consume the study products in the morning. T he pharmacokinetic parameters used to determine differences in glycemic response to the four study products were incremental area-under- the-curve (iAUC) for blood glucose, peak blood glucose (C max ), and time to peak blood glucose (T m ax ). iAUC represents a measure of the total blood glucose during the response above the baseline blood glucose; C max is the maximum concentration reached during the response; and T m ax is the time at which the maximal response occurred. The terminal slope of a glucose response is a representation of how quickly glucose is removed from the blood. After an initial screening visit for baseline laboratory tests and a health history survey, subjects were randomly assigned to receive each of the four food products at different visits, at which participants ingested a single portion of a study product. Blood samples were collected by finger-stick at 30, 60, 90, 120, and 180 minutes after sample ingestion to determine blood glucose. Findings: UGC Significantly Reduced Glycemic Response UGC was associated with reduced postprandial glycemic response in otherwise healthy subjects who were overweight or obese and pre-diabetic. The results demonstrated a more controlled glycemic response for UGC compared to the pattern observed for OAT and suggested that participants who consumed UGC were less likely to experience hypoglycemia. Differences in several measures of glycemic response to UGC, NSM, and RTD suggested that UGC had a modest but positive effect on glucose metabolism relative to the other foods. (Study subjects also rated UGC as similarly palatable as OAT, a standard American breakfast food.) Differences in the composition of the study foods likely contributed to differing glycemic responses (Table 1). Possible factors influencing these differing responses include macronutrient ratio, the presence of branched-chain amino acids, 4 fiber c ontent, 5 a mount and type of carbohydrate, 6 and the amount and type of protein. 6 Ultra Glucose Control—An Evidence- based Formulation Over the last two decades, experts have attempted to counter the erroneous notion that high- carbohydrate diets promote weight loss and health. Nutrition research has provided evidence-based information related to glycemic response that was employed in creating UGC (Table 2). First, UGC has a macronutrient ratio that is beneficial to glycemic control: 40 percent carbohydrate, 30 percent fat, and 30 percent protein, as recommended by guidelines by clinical centers. 1,7 Evidence does not support the idea that high-fat diets are associated with insulin resistance or increased incidence of diabetes. 3 In fact, clinical care guidelines from the American Diabetes Association do not place an upper limit on the amount of unsaturated dietary fat. Secondly, specific foods or specific qualities of foods influence glycemic homeostasis. Studies have shown that increasing the proportion of dietary monounsaturated fats (MUFAs) provides beneficial effects related to insulin sensitivity and levels of triglycerides and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol— suggesting a benefit for both glucose and lipid metabolism. 11 Overall, higher intake of MUFAs increased glycemic control. It is for this reason that UGC incorporates plant-based fat that is high in MUFAs while minimizing saturated fat content. Similarly, the carbohydrate and protein content of UGC was based on research that demonstrated the benefits of specific characteristics. For example, the amylopectin-enriched carbohydrate in UGC is designed to provide sustained release, and the protein base, derived from pea and rice, is low in allergenicity. Supported by: by John Troup, PhD Dr. Troup is Chief Science Officer Metagenics and Bariatric Advantage

• BT_4A.pdf
• BT_4B.pdf