Head of Department, Professor University of Copenhagen
• There is evidence that the “gluco-static concept” is an important regulator of satiation and determinant of spontaneous energy intake during meals. With increasing insulin resistance and failure to compensate with enhanced postprandial insulin secretion, the satiating effects of carbohydrates are attenuated due to reduced glucose uptake in the brain, and possibly in other tissues.
• Carbohydrate-rich diets are thus effective in normoglycemic obese individuals, but type 2 diabetics lose more weight on carbohydrate-restricted diets rich in protein and fat.
• Responsiveness in pre-diabetic obese to high-fibre diets seems also to depend on microbiota, e.g. the ratio of Prevotella to bacteroides, which suggests that the production of short-chain fatty acids such as butyrate by certain bacteria may stimulate satiety, potentially through an insulin sensitizing mechanism.