Hi SELF Family,

You've probably heard the food order advice for blood sugar: vegetables and protein first, and the rice, roti, or bread last. If your meals look like most of the world's, with rice under a curry, beside dal, or tossed through a stir-fry, that advice can sound like it was written for someone else. Nobody wants to finish dinner with a bowl of plain rice.

A viewer made that point on this week's video: in much of Asia, rice is eaten with the meat and vegetables, never on its own, and many dishes cook all three together. It's a fair objection, and the research answers it. One part of the trick has to change, and the rest can stay the way you eat now.

Order matters because your stomach lets food into your intestine a little at a time, and the sugar from rice reaches your blood only once it gets there. Protein eaten first makes the stomach empty more slowly, and the fiber in vegetables slows how fast the sugar is absorbed.

A team in New York tested the mixed version. In a study published in BMJ Open Diabetes Research & Care, 16 adults with type 2 diabetes ate the same meal of chicken, salad, bread, and orange juice on three days. With the bread and juice first, their blood sugar rose about 75 mg/dL at its peak. Eaten together as a sandwich, it rose about 58. With the bread and juice last, it rose about 35. Mixing everything together landed in between.

The same team then tested a shortcut in 15 adults with prediabetes, meaning blood sugar above normal but below the diabetes range. A1C, a blood test of your average blood sugar over about three months, reads normal below 5.7 percent, prediabetes from 5.7 to 6.4, and diabetes at 6.5 or higher. The shortcut was vegetables first, then the protein and carbs together. The results, published in Diabetes, Obesity and Metabolism, showed it cut the blood sugar peak by a little over 40 percent compared with carbs first, about as much as the full order did.

Keep the rice with the meal, and move the vegetables to the front.

There's a longer-term reason to make the vegetables count. A 2-year trial in Japan, published in the Asia Pacific Journal of Clinical Nutrition, randomly assigned 101 adults with type 2 diabetes to one of two plans. One was simple: vegetables before carbohydrates at every meal, green vegetables every day, less fruit, and chewing each bite 20 times. The other was a traditional portion-counting meal plan. A1C fell in both groups, but further with the simple plan: from 8.3 to 6.8 percent, against 8.2 to 7.3 percent with the meal plan. Two months in, the simple-plan group was eating about twice the green vegetables they started with, and less fruit. Both groups were eating less carbohydrate.

The simple plan changed what was on the plate, and the lower A1C came with that change.

If you tried food order and gave it up because plain rice at the end of dinner felt wrong, you weren't the problem. You were handed the strictest version of the trick.

Before your curry and rice, stir-fry, or dal and roti, eat a real serving of non-starchy vegetables, such as a side salad or stir-fried greens. For scale, the salad in the 16-person New York study was about 6 ounces of lettuce, tomato, and cucumber. Then eat your dish the way you always do.

Two cautions come with this. Food order changes how fast a meal's sugar arrives, not how much: in the New York tests, the meal was identical in every order, so it doesn't make room for a bigger bowl. And if you take insulin with meals, your dose and timing were matched to how you eat now, so work out the timing with your doctor before you change the order.

The video covers the full plate, including dal and roti, whether you need to pause between courses, and why protein first shouldn't mean more protein if you have kidney disease. Watch This Rice Trick Beat a Diabetes Diet for 2 Years.

Hit reply and tell me the dish you eat with rice, roti, or bread most often, and what would make it hard to start that meal with vegetables.

With gratitude,

Dr. Sean

From SELF Principle

The research behind this letter

1. Shukla AP, Andono J, Touhamy SH, Casper A, Iliescu RG, Mauer E, Shan Zhu Y, Ludwig DS, Aronne LJ. Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes. BMJ Open Diabetes Research & Care. 2017;5(1):e000440.

2. Shukla AP, Dickison M, Coughlin N, Karan A, Mauer E, Truong W, Casper A, Emiliano AB, Kumar RB, Saunders KH, Igel LI, Aronne LJ. The impact of food order on postprandial glycaemic excursions in prediabetes. Diabetes, Obesity and Metabolism. 2019;21(2):377-381.

3. Imai S, Matsuda M, Hasegawa G, Fukui M, Obayashi H, Ozasa N, Kajiyama S. A simple meal plan of 'eating vegetables before carbohydrate' was more effective for achieving glycemic control than an exchange-based meal plan in Japanese patients with type 2 diabetes. Asia Pacific Journal of Clinical Nutrition. 2011;20(2):161-168.

This content is for educational purposes only and is not medical advice. Always consult your healthcare provider for individual care. The views expressed are Dr. Hashmi's own and do not represent his employer.