As an endocrinologist in a busy hospital, I treat patients with type 1 and type 2 diabetes. Type 2 diabetes typically develops after years of the so-called ‘metabolic syndrome’ – a constellation of risk markers that include increased waist circumference, high blood pressure, high blood glucose levels, and elevated blood lipids such as cholesterol and triglycerides. So although my focus with patients is diabetes, I’m always aware that the cluster of risk factors carries a broader risk, not least of which is cardiovascular disease including heart attacks and stroke.
Tackling this syndrome is therefore a pressing concern. Along with my team of researchers, I’m investigating how functional foods could address components of the metabolic syndrome and, therefore, the chronic health problems that come with it.
We know, of course, that physical activity and weight loss can do wonders to correct the metabolic syndrome. But in today’s world many patients find it very difficult to alter their risk factors. They are left primarily with prescription medicines as treatment, but they, like me, would welcome effective food supplements as an alternative.
I’ve therefore been conducting a broad-ranging search for functional foods that really work, and several show promise. These include bioactive compounds in coffee, seaweed, the herb stevia and dietary fibre. I’m also particularly interested in the constituents of milk, and have looked at the effects of whey protein, casein and medium chain fatty acids.
Whey protein and blood lipids
One of the most interesting and promising milk components is whey protein. This year I co-authored a publication looking at the effect of treating pre-diabetic people with a combination of whey protein and dietary fibre. These subjects had the typical metabolic syndrome indicators but had not yet developed type 2 diabetes – in other words, they had pre-diabetes.
After twelve weeks we looked at the change in each subject’s metabolic health indicators. One result stood out: people who had consumed whey protein hydrolysate twice daily had significantly reduced levels of triglycerides in their plasma, both before and after a meal. This is an encouraging finding given that plasma triglycerides are essentially fat circulating in the bloodstream, and high levels are strongly linked with cardiovascular disease. They are part of the dyslipidaemia that is an element of the metabolic syndrome.
Our big surprise
A big surprise to us was that this effect was only significant in subjects who concurrently consumed a low-fibre diet (around 10 grams of wheat-based fibre per day). In those who combined the whey protein with a high-fibre diet (30 grams per day), the triglyceride reduction wasn’t nearly as pronounced. This surprised us because it is known that wheat fibre has the potential to improve blood lipids.
In addition to the low and high fibre intervention groups that ingested whey protein, we had two other groups: people who consumed the starch maltodextrin (as a control for the whey protein) in combination with the same low or high fibre foods. These people showed no significant changes in their metabolic health indicators at the end of the twelve weeks.
Under the hood
In order to determine just how whey protein might be used as a functional food, we had to tease out the causes of the change we found. For a start, we considered why the high fibre might have counteracted the benefits of whey. The most likely reason is that the fibre was in a highly processed, enzyme-treated form, and we speculate that this may have caused the loss of important bioactive compounds in the fibre.
When it came to elucidating how whey protein exerted its positive effect, we turned to the raft of metabolic measures that we took. We found that the subjects in the low-fibre-plus-whey-protein group not only had lower triglyceride levels, but a lower plasma level of the protein named apolipoprotein-B 48. This indicates lower absorption of dietary fat from the intestine and less release of unhealthy lipids from the liver. We found a similar result in a 2015 study using whey protein.
The future for whey protein and the metabolic syndrome is, I believe, in testing it in people who have lost control of their blood glucose and therefore developed fully-fledged type 2 diabetes. In particular, we need to test dietary supplements with whey protein in longer term studies, ideally for six months.
We also need to investigate how to optimise whey protein for patients. Could we get benefits with lower doses of perhaps 15 grams daily, as opposed to the 60 grams we used in this study? Should it be taken with a meal or shortly beforehand? After all, several researchers have noted that what’s consumed with whey protein can alter its effect, and our recent study certainly confirmed that. And from a purely practical point of view, would patients find it most convenient as a powder or a pre-mixed drink?
My team continues to seek funding for nutritional studies because we are convinced that diet and functional foods have a powerful beneficial impact on the metabolic syndrome. I know that my patients would like a more natural supplement instead of medication. Effective functional foods would reduce drug and health system costs, and the risk of side effects, not to mention the long-term health conditions that patients suffer as a result of the metabolic syndrome.
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