Mechanisms of action of a carbohydrate-reduced, high-protein diet in reducing the risk of postprandial hypoglycemia after Roux-en-Y gastric bypass surgery
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Mechanisms of action of a carbohydrate-reduced, high-protein diet in reducing the risk of postprandial hypoglycemia after Roux-en-Y gastric bypass surgery. / Kandel, Daniel; Bojsen-Møller, Kirstine Nyvold; Svane, Maria Saur; Samkani, Amirsalar; Astrup, Arne; Holst, Jens Juul; Madsbad, Sten; Krarup, Thure.
In: American Journal of Clinical Nutrition, Vol. 110, No. 2, 2019, p. 296-304.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Mechanisms of action of a carbohydrate-reduced, high-protein diet in reducing the risk of postprandial hypoglycemia after Roux-en-Y gastric bypass surgery
AU - Kandel, Daniel
AU - Bojsen-Møller, Kirstine Nyvold
AU - Svane, Maria Saur
AU - Samkani, Amirsalar
AU - Astrup, Arne
AU - Holst, Jens Juul
AU - Madsbad, Sten
AU - Krarup, Thure
N1 - CURIS 2019 NEXS 021
PY - 2019
Y1 - 2019
N2 - Background: Postprandial hypoglycemia is a risk after Roux-en-Y gastric bypass (RYGB).Objectives: We speculated that a carbohydrate-reduced, high-protein (CRHP) diet might reduce the risk of hypoglycemia and therefore compared the acute effects of a conventionally recommended (CR) diet and CRHP diet [55/30 energy percent (E%) carbohydrate and 15/30 E% protein, respectively] in RYGB patients.Methods: Ten individuals (2 males, 8 females, mean ± SD age 47 ± 7 y; stable body mass index 31 ± 6 kg/m2; 6 ± 3 y post-RYGB) with recurrent postprandial hypoglycemia documented by plasma glucose (PG) ≤3.4 mmol/L were examined on 2 d with isoenergetic CRHP or CR diets comprising a breakfast and subsequent lunch meal.Results: Peak PG was significantly reduced on the CRHP diet after breakfast and lunch by 11% and 31% compared with the CR diet. Nadir PG increased significantly on CRHP (by 13% and 9%). Insulin secretion was reduced, and glucagon secretion increased on the CRHP diet after both meals. Glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide secretion were lower after lunch but unaltered after breakfast on CRHP; β-cell function and insulin clearance were unchanged.Conclusions: The CRHP diet lowered glucose excursions and reduced insulin secretion and incretin hormone responses, but enhanced glucagon responses compared with the CR diet. Taken together, the results may explain the decreased glucose variability and lower risk of postprandial hypoglycemia. This study was registered at clinicaltrials.gov as NCT02665715.
AB - Background: Postprandial hypoglycemia is a risk after Roux-en-Y gastric bypass (RYGB).Objectives: We speculated that a carbohydrate-reduced, high-protein (CRHP) diet might reduce the risk of hypoglycemia and therefore compared the acute effects of a conventionally recommended (CR) diet and CRHP diet [55/30 energy percent (E%) carbohydrate and 15/30 E% protein, respectively] in RYGB patients.Methods: Ten individuals (2 males, 8 females, mean ± SD age 47 ± 7 y; stable body mass index 31 ± 6 kg/m2; 6 ± 3 y post-RYGB) with recurrent postprandial hypoglycemia documented by plasma glucose (PG) ≤3.4 mmol/L were examined on 2 d with isoenergetic CRHP or CR diets comprising a breakfast and subsequent lunch meal.Results: Peak PG was significantly reduced on the CRHP diet after breakfast and lunch by 11% and 31% compared with the CR diet. Nadir PG increased significantly on CRHP (by 13% and 9%). Insulin secretion was reduced, and glucagon secretion increased on the CRHP diet after both meals. Glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide secretion were lower after lunch but unaltered after breakfast on CRHP; β-cell function and insulin clearance were unchanged.Conclusions: The CRHP diet lowered glucose excursions and reduced insulin secretion and incretin hormone responses, but enhanced glucagon responses compared with the CR diet. Taken together, the results may explain the decreased glucose variability and lower risk of postprandial hypoglycemia. This study was registered at clinicaltrials.gov as NCT02665715.
KW - Faculty of Science
KW - Low carbohydrate diet
KW - Postprandial hypoglycemia
KW - Roux-en-Y gastric bypass
KW - Obesity
KW - Insulin secretion
U2 - 10.1093/ajcn/nqy310
DO - 10.1093/ajcn/nqy310
M3 - Journal article
C2 - 30624666
VL - 110
SP - 296
EP - 304
JO - American Journal of Clinical Nutrition
JF - American Journal of Clinical Nutrition
SN - 0002-9165
IS - 2
ER -
ID: 211855566