Synopsis of research study by Dr Anoop Misra and Dr Seema Gulati on how “Eating Almonds Before Meals Improved Blood Sugar Levels in Some People with Prediabetes”
Two new research studies showed that a simple addition of almonds to the diet may help reduce the burden of di abetes. More specifically, a handful of almonds eaten 30 minutes before breakfast, lunch and dinner for three m onths reversed prediabetes to normal blood sugar levels in nearly one-quarter of the people studied – improve ments as potent as taking prescription diabetes medication.[1],[2] Diabetes researchers described this reversal fr om prediabetes to normal blood glucose regulation as “the holy grail of medicine.”
As you’re probably aware, prediabetes is an ever-growing concern globally. Nearly 70% of people with prediab etes will develop diabetes in their lifetimes. This means, targeted nutrition strategies have never been more es sential.
These two new studies containing almonds—one longer term lasting three months and the other shorter term la sting three days—offer what could be a groundbreaking treatment. In both studies, that treatment was about a handful of almonds (20 g/0.7 oz) 30 minutes before breakfast, lunch and dinner. Control participants avoided all nuts.
In the shorter-term study, researchers found that indicators for hyperglycemia (blood glucose, serum insulin, C-peptide and oral glucose tolerance test results) were lower for the almond group versus the control group, most notably an 18% decrease in hyperglycemia levels after the meal, indicating improved regulation of glycemic resp onses among the almond consumers.
In the longer-term study, participants consuming almonds had statistically significant reductions in body weight, body mass index and waist circumference. Similarly, reductions were seen for fasting glucose, postprandial ins ulin, hemoglobin A1c and other cardiometabolic measures.
The press release below provides much more information for easy reference.
Eating Almonds Before Meals Improved Blood Sugar Levels in Some People with Prediabetes
Two new studies among Asian Indians with prediabetes and overweight/obesity showed that snacking on almonds before meals improved blood sugar control; nearly one-quarter reversed prediabetes in 12 weeks
India, March 21, 2023 – Two new research studies[3]–[4] with almonds, one conducted over three days and the ot her over three months, demonstrated benefits to blood sugar control for Asian Indians with prediabetes and ov erweight/obesity – and the three-month almond intervention broke new ground, reversing prediabetes, or gluc ose intolerance, to normal blood sugar levels in nearly one quarter (23.3%) of the people studied.
In both studies, 60 people ate 20 g (0.7 oz) of almonds, around a small handful, 30 minutes before breakfast, lu nch, and dinner throughout the study durations. Researchers expressed their enthusiasm for these almond stu dies and the first-of-its-kind statistically significant reduction in measures of prediabetes by calling the reversal of prediabetes through diet “the holy grail of medicine.” Better glucose control over time through dietary stra te gies like including almonds could help stave off diabetes progression. Nearly 70% of individuals with prediabetes will develop diabetes within their lifetime.
Both studies were randomized controlled trials funded by the Almond Board of California. The researchers hy pothesized that the almond snack before major meals, known as “preloading,” would reduce glucose and insulin fluctuations after meals and reduce overall hyperglycemia compared to the control diet. The findings complem ent the breadth of research on different populations on how almonds support healthy blood sugar as part of a balanced diet.
“Results from our studies indicate almonds might be a key differentiator in helping regulate blood glucose levels as part of a dietary strategy. These results showcase that the simple addition of a small portion of almonds befor e each meal can quickly and drastically improve glycemic control in Asian Indians in India with prediabetes in jus t three days. Eating 20 g of almonds 30 minutes before an oral glucose load showed a significant decrease in blo od sugar and hormones. Almonds’ nutritional makeup of fiber, monounsaturated fats, zinc, and magnesium work together to help provide better glycemic control and reduce hunger,” said lead author Dr. Anoop Misra, Profes so r and Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology (New Delhi). “Our outcomes provide a promising dietary strategy for reducing prediabetes progression and returning people to normal glucose regulation.”
His collaborators agree. “In view of the increasing prevalence of diabetes, dietary strategies like consuming alm onds 30 minutes before major meals offers a good option to decrease the spike in blood glucose levels after me als,” said Dr. Seema Gulati, head, Nutrition Research Group, National Diabetes, Obesity, and Cholesterol Found ation. 
The longer-term study:
This three-month longer-term study was with overweight or obese Asian Indian adults who had prediabetes. Par ticipants were random ized into either the almond treatment group or into the control grou p, and both were pro vided with diet and exercise counseling as well as home-use glucometers to measure their glucose levels, which we re recorded in diaries along with dietary intake and exercise.
Study measures comprised a variety of anthropometrics: body weight; circumferences of waists, hips, and arms; skinfolds of customary locations of the body; and body fat estimates. Biochemical measures included insulin, blo od sugar, hemoglobin A1c, C-peptide, glucagon, proinsulin, high sensitivity C-reactive protein, tumor necrosis factor alpha, and lipids.
Eating 20 g (0.7 oz) almonds ahead of breakfast, lunch, and dinner, for three months resulted in first-of-its kind statistically significant reductions for the treatment group in body weight, body mass index, waist circumferen ce, skinfold tests for shoulder and hip areas, as well as improved handgrip strength. Similarly, reductions were se en for fasting glucose, postprandial insulin, hemoglobin A1c, proinsulin, total cholesterol, LDL-cholesterol, and very low-density lipoprotein. Importantly, no changes occurred with beneficial HDL-cholesterol, meaning this cardioprotective lipid was maintained despite other observed biochemical alterations.
These substantial metabolic improvements led to nearly one-fourth (23.3%) of the prediabetes study participa nts returning to normal blood glucose regulation. These findings are meaningful for global public health given t he prevalence of diabetes, the troubling rates of progression from prediabetes to diabetes, and are specifically relevant to Asian Indians in India who are disproportionately impacted because of their greater tendency to p rogress from prediabetes to diabetes.
Researchers think the nutrients in almonds may play a role in the observed health benefits from this study. “The natural combination of monounsaturated fatty acids and soluble fiber could be responsible for the positive me tabolic outcomes,” Dr. Misra said. “Almonds may slow stomach emptying, which could help people ingest less fo od and fewer calories to promote weight management, which is important in helping reverse the course of pre diabetes back to normal blood sugar regulation.”
While the results are extremely promising, the researchers noted some limitations, including the relatively small sample size and limited period of intervention. They also noted that the study included Asian Indians who had w ell-controlled prediabetes, and the researchers cannot extrapolate the same impact of a premeal load of almon ds in participants with type 2 diabetes. Including participants with poorly controlled metabolic states as well as those with diabetes could be useful.
The short-term study:
- Part 1: One Day Oral Glucose Tolerance Testing (OGTT): Participants were first divided into two groups of 30. The first group consumed a 20 g (0.7 oz) portion of almonds. The second group received no almonds and both groups were given an OGTT.
- Part 2: Three-Day Blood Glucose Monitoring: Using a continuous glucose monitoring system (CGMS), researchers compared the glycemic effects of preloading three meals a day (breakfast, lunch, dinner) with 20 g (0.7 oz) of almonds for three consecutive days in 60 participants, with the participants who received no preloading of almonds.
Upon conclusion of the short-term study, researchers found that indicators for hyperglycemia, such as blood glu cose, serum insulin, glucagon, and C-peptide (only OGTT results) were lower for the almond group versus the co ntrol group. There was an 18.05% decrease in PPBG levels, indicating improved regulation of glycemic responses among the almond consumers.
Results from the continual glucose monitoring system showed statistically significant improvement in glucose variability over the first 24 hours in the almond group, indicating appropriate glucose control. Specifically, PPHG levels were lowered by 10.07% in the almond group compared to control. Additionally, treatment with premeal almond loading significantly improved several indicators that reflect daily glycemic control compared to the con trol group: lower mean 24-hour blood glucose concentration, less time spent above an elevated blood glucose le vel of 140 mg/dL, lower peak 24-hour glucose levels, decreased post-prandial blood glucose levels, lower min im um glucose levels at night, and lower overall hyperglycemia.
Limitations of the short-term study include a limited period of intervention with a smaller sample size compr is ing people with prediabetes. Also, nutritional intervention studies can trigger behavioral changes in both groups as the participants are made aware of their risk during the recruitment process and were given dietary instruc ti on prior to the study. Further research is needed to investigate the effects of almond preloading consumptionon the same measures in different ethnicities and in individuals with diabetes and normal body weights to be able t o provide broader recommendations.
In summary, with both studies, Dr. Misra and colleagues found that study participants who ate 20g (0.7oz) of alm onds 30 minutes before a meal showed significant improvements in glycemic control compared to not eating alm onds before meals over three months. Almonds can be part of a nutritious dietary solution offering good poten ti al for the reversal of prediabetes to normal glucose regulation in some Asian Indians and therefore potentially prevent or delay the development of diabetes in people with prediabetes.
A one-ounce (28 g) serving of almonds provides 4 g (14% DV) fiber and 15 essential nutrients, including: 77 mg (20% DV) magnesium, 210 mg (4% DV) potassium, and 7.27 mg (50% DV) vitamin E, making them a perfect nutr ient-rich snack for those with impaired glucose tolerance or type 2 diabetes.
[1] Gulati, S., Misra, A., Tiwari, R., Sharma, M., Pandey, R. M., Upadhyay, A. D., & Sati, H. C. (In press 2023). Premeal almond load decreases postprandial glycaemia, adiposity and reversed prediabetes to normoglycemia: A randomized controlled trial. Clinical Nutrition ESPEN, 54, 12-22. https://doi.org/10.1016/j.clnesp.2022.12.028
[2] Gulati, S., Misra, A., Tiwari, R., Sharma, M., Pandey, R. M., Upadhyay, A. D., & Sati, H. C. (2023). Beneficial effec ts of premeal almond load on glucose profile on oral glucose tolerance and continuous glucose monitoring: rando mized crossover trials in Asian Indians with prediabetes. European Journal of Clinical Nutrition. https://doi.org/10.1038/s41430-023-01263-1
[3] Gulati, S., Misra, A., Tiwari, R., Sharma, M., Pandey, R. M., Upadhyay, A. D., & Sati, H. C. (2023). Beneficial effe cts of premeal almond load on glucose profile on oral glucose tolerance and continuous glucose monitoring: randomized crossover trials in Asian Indians with prediabetes. European Journal of Clinical Nutrition. https://doi.org/10.1038/s41430-023-01263-1
[4] Gulati, S., Misra, A., Tiwari, R., Sharma, M., Pandey, R. M., Upadhyay, A. D., & Sati, H. C. (In press 2023). Preme al almond load decreases postprandial glycaemia, adiposity and reversed prediabetes to normoglycemia: a ran domized controlled trial. Clinical Nutrition ESPEN, 54, 12-22. https://doi.org/10.1016/j.clnesp.2022.12.028
