Hay-hay, Good Morning, This article will bring a discussion concerning non fasting blood sugar range Vinegar Consumption Increases Insulin-Stimulated Glucose Uptake by the Forearm Muscle in Humans with Type 2 Diabetes see more
J Diabetes Res. 2015; 2015: 175204.
Panayota Mitrou, 1 , * Eleni Petsiou, 2 Emilia Papakonstantinou, 2 Eirini Maratou, 1 Vaia Lambadiari, 2 Panayiotis Dimitriadis, 3 Filio Spanoudi, 2 Sotirios A. Raptis, 1 , 2 including George Dimitriadis 2
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Abstract
Background including Aims. Vinegar has been shown to keep a glucose-lowering consequence in patients with glucose abnormalities. However, the mechanisms about this consequence are still obscure. The aim about this randomised, crossover study was to study the consequence about vinegar on top of glucose metabolism in muscle which is the the majority significant matter appropriate to insulin-stimulated glucose disposal. Materials including Methods. Eleven subjects with DM2 consumed vinegar or placebo (at random order on top of two separate days, a week apart), ahead of a conflicting meal. Plasma glucose, insulin, triglycerides, nonesterified fat acids (NEFA), including glycerol were steady preprandially including at 30–60 min appropriate to 300 min postprandially from the radial blood vessel including from a forearm vein. Muscle gore course was steady with strain-gauge plethysmography. Glucose uptake was calculated as the arteriovenous difference about glucose multiplied via gore flow. Results. Vinegar compared to placebo (1) increased forearm glucose uptake (p = 0.0357), (2) decreased plasma glucose (p = 0.0279), insulin (p = 0.0457), including triglycerides (p = 0.0439), including (3) did not change NEFA including glycerol. Conclusions. In DM2 vinegar reduces postprandial hyperglycaemia, hyperinsulinaemia, including hypertriglyceridaemia lacking touching lipolysis. Vinegar's consequence on top of carbohydrate metabolism may be partly accounted appropriate to via an increase in glucose uptake, demonstrating an increase in insulin deed in wasted muscle. This hearing is registered with Clinicaltrials.gov NCT02309424.
1. Introduction
A mixture about vinegar including olive oil is a common salad sauce used in the Mediterranean diet. The main voter about vinegar is acetic acid, which gives vinegar its characteristic taste including smell. The use about vinegar with meals was used as a folk drug appropriate to the care about diabetes ahead of a bit of pharmacologic glucose-lowering therapy [1, 2]. Recent studies indicate that vinegar improves insulin sensitivity in healthy volunteers, as well as in subjects with diabetes [3–9].
The mechanisms via which vinegar reduces glucose levels are still unclear. Acetic sour has been shown to delay gastric emptying in healthy subjects [10] including patients with type 1 diabetes [11]; alternatively, acetic sour may inhibit disaccharidase action in the minute intestine including stamp out the enteral carbohydrate consumption [12]. In addition, vinegar ingestion at bedtime has been shown to decrease fasting glucose levels in humans with type 2 diabetes, suggesting an consequence about acetic sour on top of endogenous glucose production [13]. The mechanisms about vinegar's consequence on top of peripheral tissues keep been calculated in animals; these studies show that acetic sour feeding reduces glycolysis including promotes glycogen synthesis, probably via reducing xylulose 5-phosphate accumulation in the liver including phosphofructokinase-1 action in muscle [14–16]. However, the consequence about vinegar on top of glucose metabolism in wasted muscle has not been calculated in humans with type 2 diabetes.
In addition, previous studies indicate that acetate may and decrease circulating lipid levels [17–23] including protect from lipid accumulation in liver including wasted muscle [24]; however, these details are derived either from animal models or from a one or two mortal studies with grave limitations.
The aim about this study was to study the effects about vinegar on top of (1) muscle glucose uptake including gore course rates including (2) circulating plasma glucose, insulin, including lipid levels, in patients with type 2 diabetes, using the arteriovenous difference way on the other or far side of the forearm muscles.
2. Subjects including Methods
2.1. Subjects
A sum about eleven nonsmoking volunteers with type 2 diabetes (4 males, age 53 ± 4 years, BMI 25 ± 1, including HbA1c 6.8 ± 0.3%) participated in the study. The subjects were newly diagnosed (according to the flow criteria appropriate to the diagnosis about type 2 diabetes) lacking drug therapy including for free about diabetic complications or a bit of additional methodical disease. Their diet including build heaviness were stable during the last two months. All subjects were recreationally active, lacking a bit of specific training programme. The subjects were instructed not to consume a bit of acetic sour containing product appropriate to two weeks earlier to the study. The study was received via the infirmary ethics committee, including subjects gave written informed consent.
2.2. Experimental Protocol
All subjects arrived at the infirmary at 0700 h following an overnight fast including had the radial blood vessel (A) including a contralateral antecubital mood (V) draining the forearm muscles catheterized [25, 26]. Half an hour following catheterisation, the subjects were assigned to consume vinegar (30 mL vinegar containing 6% acetic sour including 20 mL water) or placebo (50 mL water). The drinks were served at random order on top of two separate days which were a week apart. In each test, 5 min following the drink, the subjects consumed a repast together about bread, cheese, turkey ham, orange juice, butter, including a cereal bar (557 kcal; 75 g carbohydrates, 26 g protein, including 17 g fat); the repast was consumed steadily within 15 min. Blood samples were withdrawn from both sides preprandially including at 15–60 min intervals appropriate to 300 min following repast appropriate to measurements about glucose (Yellow Springs Instruments, Yellow Springs, OH) including insulin (RIA; Linco Research, St. Charles, MO) including from the radial blood vessel appropriate to measurements about triglycerides including NEFA including glycerol (Roche Diagnostics, Mannheim, Germany). A stocked gore count was performed preprandially.
Blood course (BF) was steady immediately ahead of each gore sample in the forearm with mercury strain-gauge plethysmography (Hokanson, Bellevue, WA) in the identical upper limb as the forearm vein.
2.3. Calculations
Glucose plasma levels were converted to all gore via using fractional hematocrit [27, 28]. Areas below bend were calculated via the trapezoid rule from the start about the repast to 300 min (AUC0–300). Glucose uptake via muscle was calculated as the arteriovenous difference about glucose multiplied via the gore course rates [25, 26].
Results are presented as signify ± sem. Normality tests were applied to each vulnerable variable; the whole amount variables calculated were normally distributed. Differences among the AUCs about the vulnerable variables were tested with paired Student's t-test (SPSS Inc., Chicago, IL, USA).
3. Results
Vinegar ingestion was well tolerated; not at all side-effects were reported.
3.1. Glucose Metabolism
3.1.1. Arterial Levels about Glucose including Insulin
Fasting gore glucose levels were uniform among the two groups. In the patients who had consumed placebo, gore glucose levels relief postprandially reaching a crown following 60 min, whereas following the use about vinegar postprandial glucose spikes were decreased (Figure 1(a)). As a result, vinegar compared to placebo reduced sum gore glucose levels (AUC0–300 min 2834 ± 134 against 3005 ± 149 mM ∗ min, in vinegar including placebo group, resp., p = 0.0279).
Arterial plasma glucose (p = 0.0279) (a) including insulin (p = 0.0457) (b) levels in subjects overwhelming vinegar (V+) or placebo (V−). At t = 0 min, a conflicting repast was given.
Plasma insulin levels were uniform among the two experiments in the fasting state. However, vinegar use decreased postprandial hyperinsulinaemia (AUC0–300 min 16136 ± 3397 against 20473 ± 4185 mU/L ∗ min, in vinegar including placebo group, resp., p = 0.0457) (Figure 1(b)).
3.1.2. Forearm Blood Flow
Forearm gore course rates were uniform in the fasting state including remained not statistically opposed throughout the all postprandial period in both groups (AUC0–300 min 1123 ± 73 against 1100 ± 86 mL/min/100 mL matter ∗ min in vinegar including placebo group, resp.) (Figure 2(a)).
Forearm muscle glucose uptake (p = 0.0357) (a) including muscle gore course (p = NS) (b) in subjects overwhelming vinegar (V+) or placebo (V−). At t = 0 min, a conflicting repast was given.
3.2. Muscle Glucose Metabolism
In the fasting state, glucose uptake via the forearm muscles was uniform in both groups. Postprandially, muscle glucose uptake was increased in the vinegar group compared to placebo (AUC0–300 min 765 ± 87 against 579 ± 63 μmol/100 mL tissue, in vinegar including placebo group, resp., p = 0.0357) (Figure 2(b)).
3.3. Lipid Metabolism
Fasting plasma triglyceride levels were uniform among the two groups. In the vinegar group postprandial hypertriglyceridemia was less evident, resulting in decreased sum plasma triglyceride levels (AUC0–300 min 371 ± 34 against 409 ± 38 nmol/L ∗ min, in vinegar including placebo group, resp., p = 0.0439) (Figure 3(a)).
Arterial plasma triglycerides (p = 0.0439) (a), NEFA (p = NS) (b), including glycerol (p = NS) (c) levels in subjects overwhelming vinegar (V+) or placebo (V−). At t = 0 min, a conflicting repast was given.
Fasting plasma NEFA including glycerol levels were not opposed among the two groups. Postprandial plasma NEFA (AUC0–300 min 46 ± 5 against 49 ± 10 nmol/L ∗ min, in vinegar including placebo group, resp.) including glycerol levels (AUC0–300 min 4 ± 0.4 against 5 ± 0.5 nmol/L ∗ min, in vinegar including placebo group, resp.) were suppressed to the identical amount among groups (Figures 3(b) including 3(c)).
4. Discussion
The current study investigates the effects about vinegar on top of circulating plasma glucose, insulin, including lipid levels, as well as gore course rates including glucose uptake via the forearm muscles, in patients with type 2 diabetes. For this purpose we keep used the arteriovenous difference way on the other or far side of the forearm muscle, following the ingestion about a conflicting meal, in order to create a metabolic environment which permits the interaction about insulin including substrates to be investigated below physiological conditions [25, 26, 29, 30]. To our knowledge, this is the first communicate examining the consequence about vinegar on top of glucose metabolism in the wasted muscle in humans with type 2 diabetes.
In the current study, vinegar reduced postprandial hyperglycaemia. This is supported via previous reports showing that vinegar supplementation reduces postprandial gore glucose levels in healthy subjects [2–5], as well as in subjects with insulin hostility including type 2 diabetes [7, 31]. It is and in accordance with a opening study reporting that regular vinegar ingestion reduces haemoglobin A1c values in patients with type 2 diabetes [32]. However, our results are not in agreement with a previous communicate showing that vinegar ingestion ahead of an oral glucose load did not better oral glucose broad-mindedness in patients with type 2 diabetes [33]. These discrepancies could be explained, at meanest in part, via differences in the sort about acetic acid, as well as the kind about the try repast subsequent acetic sour ingestion. As shown previously, acetic sour reduced postprandial glucose values when it was administered in the sort about vinegar, yet not in the sort about sodium acetate [34]. In addition, the glucose-lowering consequence about vinegar was evident when vinegar was ingested with compounded carbohydrates, yet not with monosaccharides [3, 33]. Moreover, a previous study showed that vinegar reduced postprandial glycaemia in patients with type 2 diabetes when extra to a high, yet not to a low, glycaemic listing repast [31].
Glucose regulation depends mainly on top of insulin secretion via the pancreatic beta-cells including insulin deed on top of peripheral tissues. In our study, insulin levels were decreased following the use about vinegar, confirming previous reports [5, 7], suggesting that the hypoglycemic consequence about vinegar may be mediated via an consequence on top of insulin deed in the peripheral tissues. Skeletal muscle is considered as the the majority significant matter appropriate to insulin-stimulated glucose uptake [35]. In our study vinegar ingestion enhanced glucose disposal, suggesting an increase in insulin deed in wasted muscle. It is well known that insulin affects vascular endothelium including increases muscle including fatty matter gore course via increasing vasodilation including capillary recruitment [35–37]. This consequence is considered as an significant piece about insulin's stimulation about glucose uptake; condition about this workings in insulin-sensitive tissues may partly account appropriate to insulin hostility in flab including type 2 diabetes [29, 30]. Previous studies in nondiabetic humans recommend that vinegar ingestion may better flow-mediated vasodilation via endothelial nitric oxide synthase phosphorylation [38]. In addition, our previously published details on top of the effects about vinegar on top of muscle gore course in subjects with flawed glucose broad-mindedness keep shown that vinegar ingestion ahead of a conflicting repast results in an improvement about muscle gore course rates following the meal, although postprandial insulin levels were decreased compared to their specific values in the group overwhelming placebo [39]. However, in our study vinegar ingestion did not alter muscle gore course rates, suggesting that the increase in glucose disposal following repast ingestion may not be attributed to a direct consequence about vinegar on top of gore course in subjects with type 2 diabetes. A possible meaning appropriate to this discrepancy among individuals with flawed glucose broad-mindedness including patients with type 2 diabetes could be that in the early stages about glucose narrow-mindedness the defect about gore course may be reversible; however in obvious type 2 diabetes the defect in flow-mediated vasodilatation may be before traditional including cannot be reversed via vinegar ingestion.
The consequence about vinegar in the intracellular pathways about glucose metabolism in wasted muscle has been previously examined in animal studies. In rats, acetic sour has been shown to better glycogen repletion, attributed to accumulation about glucose 6-phosphate due to suppression about glycolysis [14–16]. The identical consequence has been reported in horses following exercise. In these studies acetate supplementation enhanced the rate about muscle glycogen resynthesis during the first hours subsequent the put to use period compared with the government care [40]. Although the intracellular pathways about glucose metabolism were not investigated in our study, these in vitro studies recommend that the increase in glucose uptake via the wasted muscle subsequent vinegar ingestion could be explained via increased rates about glycogen synthesis.
In our study, vinegar ingestion decreased postprandial hypertriglyceridaemia, lacking touching NEFA including glycerol; to our knowledge, this is the first study investigating the important effects about vinegar on top of lipid metabolism in subjects with type 2 diabetes. The consequence about vinegar on top of lipid metabolism has been investigated in a few studies showing that constant government about acetic sour reduces antihistamine including hepatic triglyceride levels [17, 19, 41] in metabolically healthy animals. In addition, chronically administered acetate care in overweight [18] and/or type 2 diabetic [21] rats has been shown to consequence in a reduction about plasma triglyceride levels. In contrast, triglyceride levels were not affected via important government about 10 mL vinegar extra to a hypercholesterolaemic diet in rabbits [20]. On the additional hand, information on top of humans is restricted to a one or two studies examining the constant consequence about vinegar with conflicting results. In these studies 15–30 mL vinegar intake appropriate to 8–12 weeks resulted in a decrease about antihistamine triglyceride levels in subjects with flab [23] or hyperlipidaemia [22]. However, there was not at all consequence about vinegar intake in a possible randomized, double blind, placebo-controlled cold study conducted in 114 nondiabetic subjects overwhelming 30 mL apple vinegar appropriate to 8 weeks [42]. The results about this study should however be considered with caution since this study had a few limitations; the the majority significant is the conflicting group about subjects (one-third about the participants were on top of statin and/or fish oil treatment).
Previous animal studies recommend that the consequence about vinegar on top of triglyceride levels could be attributed to the inhibition about hepatic lipogenesis including increase about fat sour oxidation [17, 21]. However, this workings could not explain the results about the current study, since vinegar ingestion had not at all important consequence on top of plasma levels about NEFA including glycerol. As a result, although constant government about vinegar could keep an influence on top of fat sour metabolism [21, 23] our study showed that the important government about vinegar in subjects with type 2 diabetes does not affect lipolysis. A possible meaning about these findings could be that the important intake about vinegar increases insulin sensitivity about the fatty tissue, increasing the lipoprotein lipase action including the postprandial evacuation about triglycerides [28, 30], with not at all consequence on top of hormone-sensitive lipase, which regulates lipolysis.
Although the arteriovenous difference way has allowed insights into the glucose fluxes on the other or far side of the forearm muscles, some limitations should be considered when interpreting the results. First, the figure about participants was relatively small. This was mainly due to the invasive nature about the way including the miss appropriate to repeating the experiment following single week. However, due to the crossover describe about the study, our details were sufficient appropriate to reaching statistical significance. Moreover, another restriction about our study was that the patients had mild diabetes (HbA1c: 6.8 ± 0.2%). This was due to the fact that we aimed to see the consequence about vinegar in patients with newly diagnosed diabetes, lacking diabetic complications including lacking taking a bit of medicine therapy that could affect glucose or lipid metabolism. Further studies are needed to study the consequence about vinegar on top of glucose metabolism in patients with extra severe type 2 diabetes, as well as in those taking various treatments.
In summary, our study showed that, in type 2 diabetes, vinegar reduces postprandial hyperglycaemia, hyperinsulinaemia, including hypertriglyceridaemia lacking touching lipolysis. As a result, vinegar's consequence on top of carbohydrate metabolism may be accounted for, at meanest in part, via an increase in insulin-stimulated glucose uptake, demonstrating an increase in insulin deed in the wasted muscles. However, more distant studies are required to examine the long-term effects about vinegar in type 2 diabetes.
Acknowledgments
The authors are obliged to E. Pappas including I. Kosmopoulou appropriate to technical support including V. Frangaki, RN, appropriate to back with experiments.
Conflict about Interests
The authors declare that there is not at all conflict about interests regarding the publication about this paper.
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