My doctoral research at the Institute of Cellular Medicine of Newcastle University focuses on the field of clinical nutrition in type 2 diabetes. In particular, I am interested in the potential of whey protein as a nutritional strategy to improve postprandial (after eating) glucose control of individuals with type 2 diabetes. Improving post-prandial glycaemia could plays a pivotal role in improving overall blood glucose control. In this post, I will explain how, and explore the clinical potential of therapeutic whey protein use for diabetes management.
Rising tide of diabetes
Type 2 diabetes is a progressive metabolic disorder which is initiated by a host of both non-modifiable (e.g., genetics, age, ethnicity) and modifiable (e.g., physical activity, eating habits, body fatness) factors. Presently, around 425 million people worldwide have some form of diabetes, and about 90% of them have type 2 diabetes. This imposes an enormous strain on public health care services at both economic and logistical levels. Disturbingly, incidence rates are projected to soar further over the next 20 years, taxing global health care systems even more. Efforts to mitigate the growing problem focus largely on factors that we have control over such as diet and lifestyle.
Battle for control
A large amount of research has been aimed at understanding the mechanisms behind type 2 diabetes and on developing strategies to stymie disease progression. Within this body of work, the period after eating due to its effect on general metabolic health and its influence on blood glucose control is of strong clinical interest. Diabetes, after all, is characterised by repeated periods of high-blood glucose, particularly after eating (“post-prandial hyperglycaemia”), which is associated with metabolic and hormonal disturbances.
Food on demand
In non-diabetic individuals, blood glucose concentrations remain stable around a narrow range, which represents the periods before and after eating, and longer-term between meals. However, with type 2 diabetes, individuals experience large fluctuations in their blood glucose throughout the day. It is possible that modern day eating habits exaggerate this dysfunction, where people often consume food prior to experiencing a state of physical hunger (metabolic hunger) and many “graze” on food throughout their day. This behaviour can often be problematic for individuals who have an impaired glucose tolerance, causing repeated fluctuations in blood glucose levels throughout the day. Such fluctuations in blood glucose have actually been shown to be more damaging than sustained high blood glucose levels. As such, a host of dietary and lifestyle interventions are targeted at improving postprandial glucose control.
However, a large amount of individuals are unable to achieve target glucose control with diet and lifestyle interventions alone meaning there is a heavy reliance on drug therapies, which, aside to their cost, are often associated with unwanted side effects. It is essential to establish further dietary and lifestyle therapies. A key tool in this may be to utilize foods and patterns that accommodate patient needs and preferences.
Whey protein as a treatment lever
We all want to be able to enjoy our food. Therefore, nutritional strategies that maintain a level of enjoyment while offering metabolic benefit are essential. A growing body of evidence, including work conducted at Newcastle University and other institutions, demonstrates that whey protein could be a functional food for the management of type 2 diabetes. Specifically, it has been suggested that when whey protein is consumed prior to or with a meal, blood glucose concentrations do not rise as high when compared to when whey is not consumed.
So, why whey protein?
Whey protein has been shown to regulate blood glucose levels via several mechanisms:
- Firstly, whey protein is rich in branched-chain amino acids (BCAAs) and is rapidly digested compared to other proteins meaning that amino acids appear in the blood stream shortly after being consumed. Particularly, whey protein is rich in the BCAAs leucine, valine, and isoleucine, which are known to stimulate insulin secretion. In fact, in individuals with type 2 diabetes, consuming whey protein before a meal it has improved pancreatic β-cell function resulting in a restored insulin response compared to when whey was not consumed before the meal.
- Secondly, in type 2 diabetes, the pancreas’ ability to release insulin in response to carbohydrates is diminished, its ability to secrete insulin in response to protein is maintained. Whey protein’s easy digestibility and amino acid profile makes it a very favourable, functional protein when compared with other protein sources.
- Thirdly, whey protein is also able to stimulate the release of various gut peptides, particularly GLP-1, influencing insulin secretion, slowing down digestion and reducing appetite. Whey protein’s effect on gastric emptying is actually thought to play a major role in reducing postprandial glucose concentrations.
Collectively, whey protein is painting quite a promising picture for blood glucose management.
Over the last decade, a lot of promising research using whey protein as a management tool for diabetes has been conducted, greatly informing both the scientific and medical communities about the potential of whey protein for glucose regulation. The task now is to translate the discoveries that have been previously made into viable dietary options for people with diabetes, where there are still some questions that we need to answer. Going forward, we need to address different doses of whey protein and assess its clinical application using “real-world” scenarios.
These are exciting times for whey protein research! Watch this space.
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