Slower Eating Increases Satiety, Reduces Hunger in Type 2 Diabetes Patients

Slowing down the pace of eating increases feelings of fullness and decreases hunger among overweight and obese people with type 2 diabetes (T2DM), according to a study conducted in Greece and published online in July in BMJ Open Diabetes Research & Care.

“The message for clinical practice is that, apart from focusing on our T2DM patients' adherence to a hypocaloric, low glycemic index diet, and an increase in physical activity, we may get better results by also urging them to eat at a slower pace,” commented author Alexander Kokkinos, Assistant Professor of Internal Medicine in the Department of Propaedeutic Medicine, Athens University Medical School, Athens, Greece.

“The accumulating evidence-both epidemiological and experimental-regarding the effect of fast eating on overconsumption has become quite convincing,” Kokkinos added. He also pointed out that many studies link rapid eating to increased body weight, insulin resistance, and T2DM.

Researchers looked at 20 participants with T2DM and BMI above 25 kg/m². All were well controlled on metformin with HbA1c <7%.  In the crossover design, each participant had two meal sessions during which they ate a slow- or rapid-spaced meal of 300 mL (675 kcal) of ice cream. Rapid spaced meals were divided into two equal portions eaten 5 minutes apart. Slow spaced meals were divided into 7 portions eaten at 5 minute intervals over 30 minutes. Participants rated feelings of fullness and hunger using visual analog scales (VAS).  Blood levels of glucose, insulin, PYY, GLP-1, and ghrelin were also analyzed at baseline and at 30 minute intervals up to 180 minutes after meal completion.

VAS ratings of fullness were significantly higher at the 90-, 120-, 150-, and 180-minute time points and hunger ratings were lower at 90’, 150’, and 180’ for the 30-minute meal. The area under the curve (AUC) for fullness was higher after the 30-minute than after the 50-minute meal (11 943.7±541.2 vs 10 901.0±568.8 mm min, p=0.003) whereas the hunger AUC was lower (4442.9±328 vs 4966.7±347.5 mm min, p=0.012).

Typically, levels of the peptide ghrelin, which increases hunger, drop immediately after eating a meal.  Levels of peptide YY (PYY) and GLP-1, which both decrease hunger and increase satiety, usually increase.

In contrast, gut hormone responses among study participants were unaffected by rapid versus slow spaced eating. Glucose, insulin, PYY, GLP-1, and ghrelin responses were pretty much the same for both rates of consumption.    

A similar study by the same investigators² in which participants were slightly overweight but did not have T2DM found that slow-spaced eating versus rapid consumption increased feelings of satiety and reduced hunger, and also raised  GLP-1 and PYY levels.²

The difference between the studies may be related to the fact that patients with T2DM in the current study were “quite a lot more overweight” than the healthy subjects in the previous study, according to Kokkinos. Also, incretin secretion in patients with T2DM is known to be impaired and could have affected the results.

“The results regarding hunger and satiety [in the second study] were much more robust, and became apparent after the first few sessions,” Kokkinos explained. “Hunger and satiety perception is very complex and influenced by numerous factors, including neurohormonal, cognitive, hedonic, and reward circuits, among others. It is quite possible that slow spaced eating enhances satiety not only through its effect on gut peptides, but also on these factors as well.

“There is no doubt that the twin epidemics of obesity and diabetes are driven by a decrease in physical activity and an increase in the consumption of readily available, energy-rich, highly palatable foods,”  Kokkinos emphasized. 

Kokkinos believes that interventions targeting “fast-eating” could improve the situation. Some devices are already available that mechanically slow down food consumption, such as the Mandometer and the Hapifork.  

“The effectiveness [of such devices] regarding body weight remains to be seen,” Kokkinos concluded.  “However, a more simple approach just might be a return to basics: reinstate the custom of eating as a family, use meals as a means for social interaction and conversation, and take the time to savor and enjoy your food.”

References:

• Angelopoulos T, Kokkinos A, Liaskos C, et al.  The effect of slow paced eating on hunger and satiety in overweight and obese patients with type 2 diabetes mellitus. BMJ Open Diab Res Care. 2014 2: e000013. doi: 10.1136/bmjdrc-2013-000013
• Kokkinos A, le Roux CW, Alexiadou K, et al.  Eating slowly increases the postprandial response of the anorexigenic gut hormones, peptide YY and glucagon-like peptide-1. J Clin Endocrinol Metab.2010;95:333-337.