Glycative Stress Research
Online edition : ISSN 2188-3610
Print edition : ISSN 2188-3602
Received : January 20, 2018
Accepted : February 14, 2018
Published online : March 31, 2018

Original article

Effect of yogurt on postprandial blood glucose after steamed rice intake
Masayuki Yagi 1), Yasuyo Kishimura 2), Fuka Okuda 1), Mari Ogura 1), Kaori Ishizaki 1),
Wakako Takabe 1), Yoshikazu Yonei 1)
1) Anti-Aging Medical Research Center and Glycation Stress Research Center, Graduate School of Life and Medical Sciences,
Doshisha University, Kyoto, Japan
2) Japan Diet Laboratory, Tokyo, Japan

Abstract

Purpose: A continuous hyperglycemic state increases glycative stress. Therefore, even if the fasting blood glucose level iswithin the reference level, an acute postprandial hyperglycemic state leads to glycative stress. The purpose of this research
was to verify the effects of yogurt on the blood glucose level after eating steamed rice.
Method: The subjects were 20 healthy males and females (aged 35.8 ± 6.6) and written consent was obtained fromall participants. The eating orders of the test food sets were: (A) eating steamed rice only as a control food, (C) eating
steamed rice before eating yogurt and (D) eating yogurt before eating steamed rice. The changes in blood glucose
levels based on eating order were then verified. For the purpose of comparison of the inhibiting effects on postprandial
hyperglycemic state based on these eating orders, another eating order of vegetable salad before eating steamed rice (B)was prepared. On the day of the test, after blood glucose level was measured at fasting time, the subjects ate the test
foods within a 10 minute time frame. Then, 15, 30, 45, 60, 90 and 120 minutes after they started eating the test food(s),they measured their own blood glucose level using a self-monitoring blood glucose (SMBG) device by puncturing theirown fingertip. The evaluations of glycative stress were conducted using rising blood glucose levels, maximum blood
glucose level change (ΔCmax) and the area under the incremental blood glucose curve (iAUC).
Results: There were no adverse events and no subjects who fell under the exclusion criteria. Therefore, all subjects wereregarded as effective analysis subjects. ΔCmax was smaller in (B) (p < 0.05) and (D) (p < 0.01) than in (A). iAUC was
smaller in (C) and (D) than in (A) (p < 0.05). ΔBlood glucose levels were lower in (B) and (D) ( p < 0.05) when eating
vegetable salad or yogurt before eating steamed rice than that of (A) after 30 minutes and 45 minutes, and lower only in (D)after 15 minutes and 90 minutes (p < 0.05). When comparing the eating orders of steamed rice and yogurt, Δblood glucose
levels (C) and (D) (p < 0.05) were lower than that of (A) after 30 minutes and 90 minutes, and lower in (D) than that of (A)after 15 minutes and 45 minutes (p < 0.05).
Conclusion: The habit to eat yogurt together with steamed rice inhibited postprandial blood hyperglycemic states. Eating
yogurt before steamed rice greatly inhibited postprandial hyperglycemic state and its effect was more than equal to eating
vegetable salad before eating steamed rice, which had been reported. Adding yogurt to the meal possibly contributes to theprevention of the progression of aging and diseases.

KEY WORDS: glycative stress, yogurt, protein, lactic acid

Introduction

Reducing sugars including glucose and aldehyde
substances generated by the metabolism of alcohol and lipids
react with protein and form advanced glycation end products(AGEs) in vivo. The transformation of protein to AGEs isoften accompanied by cross-link formation, inflammation
and browning which cause physical, physiological and visualdamage to various tissues and cells. Therefore, the concept

of comprehensively integrating biological stress caused by
reducing sugars and aldehyde substances and the effects of thegeneration of AGEs of protein is called glycative stress 1, 2).
Long-term hyperglycemia enhances glycative stress.
Therefore, even if fasting blood glucose levels are within thereference level, an acute postprandial hyperglycemic stateleads to glycative stress. It is an age-related risk factor andbecomes a factor for the progression of skin aging, diabetic

Contact Address: Professor Masayuki Yagi, PhD
Anti-Aging Medical Research Center,
Graduate School of Life and Medical Sciences, Doshisha University
1- 3 Tatara Miyakodani, Kyotanabe, Kyoto, 610 - 0321 Japan
PPhone/Fax: + 81-774-65-6394 Email: myagi@mail.doshisha.ac. jp
Co-authors: Kishimura Y, ykishimu@ybb.ne. jp ; Okuda F, bmo2071@mail4.doshisha.ac. jp ;Ogura M, mogura@dwc.doshisha.ac. jp; Ishizaki K, ishizaki@antiaging-com.co. jp;
Takabe W, wtakabe@mail.doshisha.ac. jp; Yonei Y, yyonei@mail.doshisha.ac. jp_ 68 _

Glycative Stress Research 2018; 5 (1): 068 - 074(c) Society for Glycative Stress ResearchGlycative Stress Researchcomplications, osteoporosis and cognitive impairment(dementia). As a means to alleviate glycative stress, thereis the inhibition of postprandial hyperglycemic states, theinhibition of glycation reaction and the decomposition andexcretion AGEs 3).
It has been reported that eating vegetable salad 4, 5) andvinegar 6) before eating steamed rice can inhibit a postprandial
hyperglycemic state. We have studied the effects of the kindsof carbohydrates as stable food and others eaten together on
postprandial hyperglycemic states and, as a result, reported
that for the purpose of inhibiting a postprandial hyperglycemic
state, the following eating styles are recommended: Eat
grapefruit before eating bread 7), add dietary fibers to udon
noodles 8), eat udon noodles or steamed rice together with side
dishes such as eggs, vegetable salad, mabo nasu (eggplantstir-fry recipe) 9) and gyudon (boiled beef and onions) toppings 10)
rather than eating noodles or steamed rice only.
In order to verify the effects of yogurt on hyperglycemic
state after eating steamed rice in this research, the glucose
level transitions were investigated in the cases of eating
steamed rice only as a reference diet, eating steamed rice
before eating yogurt and eating yogurt before eating steamed
rice. For the purpose of comparison of inhibiting actions
on postprandial hyperglycemic states, the case of eating
vegetable salad before eating steamed rice was verified as apositive control.

Methods
Subjects

The subjects met the following inclusion criteria: those
who are fully informed of the purpose and contents of theresearch, and have the ability to understand and agree withit, applied to participate in this research of their own will andsubmitted consent in writing, healthy Japanese aged 20 years
or older and younger than 50 years old and whose body massindex (BMI) is 30 or less, those who have had no abnormal
glucose tolerance for the past a year based on physicalcheckup, those who are not taking blood pressure lowering
medication and those who eat yogurt less than twice a week.
The subjects did not fall under the following exclusion
criteria: those who have food and other allergies to these test
foods, those who participated in other tests during the monthprior to the start of this research, those who are scheduled
to participate in another test after they consent to participate
in this research, those who are breastfeeding or those whoare scheduled to be pregnant or desire to become pregnant
during the period of research.
The number of subjects was calculated by two-tailed
test, at effect size = 0.8, significance level = 0.05 and power= 0.8, using G*Power 3, version 3.1. 9. 2 as power analysis
software 11). As a result, the number of subjects satisfying
scientific rationality was determined to be 15, so the numberof subjects was decided to be 20 by adding extra number (10males and 10 females).

Test Items and Their Contents

For the purpose of inspection of the participant’s
backgrounds, the subjects wrote down their own age, healthhistory and the presence of any food allergy on the survey
form by themselves. They collected their blood by puncturing

their own fingertip using a medical lancet and measured
their own blood glucose level using an instrument for SMBG
device (Medisafefit, Terumo Corporation, Shibuya-ku,
Tokyo, Japan).

Protocol for Testing

As previously reported 8-11), the test was conducted inaccordance with the unified protocol by the Japan Glycemic
Index (GI) Study Group 12) in this research.
The subjects should live as usual except for the following
restrictions during the test period: Refrain from hard exercise
the day before the test and do not eat anything after 8:00 pm;
avoid excessive drinking and eating and staying up late atnight; abstain from taking any new drugs, including those forgeneral medical use, quasi-drugs, supplements, health foods
and foods for specified health uses that might affect theresults of the test during the test period; and when visiting
doctor during the period, report it immediately to the person
in charge (Healthcare Systems Co., Ltd., Chiyoda-ku, Tokyo,
Japan).
On the day of test, the participants do not eat breakfast.
They participate in the test beginning between 7:00am
and 9:00am. Before they eat the test foods, they sterilize afingertip thoroughly with alcohol and dry it. After puncturing
it using a lancet, they measure their own blood glucose level(any fingertip will do). They eat the control food and test
food in 5-10 minutes from start, chew each bite more than
30 times and swallow. They abstain from smoking and areallowed to do mild standing or sitting tasks.
Blood tests are conducted before eating test food (1sttime), 15 minutes after start (2nd time), 30 minutes (3rd time)after start, 45 minutes after start (4th time), 60 minutes after
start (5th time), 90 minutes after start (6th time) and 120
minutes after start (7th time). The test is conducted in a day
or more after the previous test and the number of tests are
four during the test period. The test is not carried out during
menstruation.

Test foods

Nutrient components of the test foods used in thisresearch are shown in Table 1. The nutrient components were
calculated using the information shown in the nutrient facts
label of foods used in this research. Commercially available
packed steamed rice, yogurt (plain yogurt) and salad wereused. Packed steamed rice was “Sato no gohan,” Koshihikari,
small serving 150 g (Sato Kogyo Co., Ltd., Niigata, Japan),yogurt was “ Meiji Bulgaria Yogurt LB81, Plain” (Meiji
Holdings Co., Ltd, Chuo-ku, Tokyo, Japan) and vegetablesalad was “a mixed salad of onion and lettuce which canbe used without washing” (Aeon Co., Ltd., Chiba, Japan).
Vegetable salad was eaten without dressing.
The intake amounts of test foods were determinedin accordance with the unified protocol by the Japan
Glycemic Index (GI) Study Group so that the total amountof carbohydrate becomes 49.9 ± 0.4 g (mean ± standard
deviation [SD]) as follows.
(A) Steamed rice 150 g (carbohydrate 49.7 g)(B) Vegetable salad 101 g and steamed rice 138 g(carbohydrate 49.7 g)(C, D) Yoghurt 200 g and steamed rice 120 g(carbohydrate 50.4 g)_ 69 _

Yogurt and Postprandial Blood Glucose

Results

For the method of consumption, each test food set waseaten within 10 minutes after the start of test. However, in thecases from (B) to (D), (B) vegetable salad 101 g, (C) steamed
rice 120 g or (D) yoghurt 200 g was eaten first during thefirst five minutes before eating the second item.

No adverse events concerning this test was reported (datahave not been published).

Selection of Safety Analysis Subjects

Evaluation of Effectiveness of Subjects

Safety analysis subjects were those who had experienced
eating these foods even once.

Selection of Effective Analysis Subjects

Effective analysis subjects were those who completed all
determined test schedules and test contents excluding thosefalling under the following exclusion criteria: those whose
behavior clearly degraded the credibility of test results, those
who were clearly proven to have fallen under the exclusion
criteria and those who were unable to abide by restrictions
after the start of test.

Statistical Analysis

The evaluation and analysis of the safety of the test
targeted the safety analysis subjects group. The symptoms,
degrees and frequencies of the adverse events and side effects
were totaled and evaluated.
The effectiveness analysis of the test targeted theeffective analysis subjects group. The blood glucose levels
obtained by subtracting the blood glucose levels before thefirst intake of test foods (1st time, value at 0 minute) fromthe levels over time after eating test foods were defined as
Δblood glucose levels and the maximum blood glucose levelchange from the start of test to 120 minutes was defined as
ΔCmax. Blood glucose incremental area under curve (iAUC)
was calculated in accordance with the unified protocol by theJapanese Glycemic Index (GI) Study Group.
IMB SPSS Statistics 24 (IBM Japan, Minato-ku, Tokyo,
Japan) was used for statistical analysis. A Friedman test was
conducted for the comparison of the test results between thegroups and a risk rate of less than 5% by two-sided test was
regarded as a significant difference.

Ethical Standard

This research was conducted in compliance with the
ethical principles based upon the Declaration of Helsinki(Additional commentary in 2004 General Assembly Tokyo,
Japan) and Personal Information Protection Law and inreference to “Standards for the Implementation of Clinical
Trials (GCP)), an ordinance of the Ministry of Health, Labourand Welfare No. 28 of March 27, 1997), as well as “Ethical
Guidelines for Epidemiology Research” by the Ministry of
Education, Culture, Sports, Science and Technology and theMinistry of Health, Labour and Welfare.
Healthcare Systems Co., Ltd. held an ethical review
committee, where the morality and appropriateness of thistest were discussed and it was approved (Approval Number:#1701). This test was conducted after being registered in the
open database (UMIN) run by National University Hospital
Council of Japan (Test ID: #000028061).

Evaluation of Safety

Because there were not any subjects falling under the
exclusion criteria, all 20 subjects were effective analysis
subjects: 10 males and 10 females; aged 35.8 ± 6.6 (mean ±SD) (male 35.7 ± 6.7, female 35.8 ± 6.9); height 165.3 ± 8.0
cm (male 171.5 ± 5.1, female 159.1 ± 5.), body weight 59.6 ±12.5 kg (male 69.4 ± 9.0, female 49.9 ± 6.0) and BMI 21.7 ±
3.4 (male 23.7 ± 3.5, female 19.6 ± 1.7).

Evaluation of EffectivenessBlood glucose level transition after test food intake isshown in Table 2. ΔCmax and iAUC are shown in Fig. 1, 2.
Compared with the case of eating steamed rice only (A),ΔCmax was significantly lower in the case of eating steamed
rice before eating yogurt (C) and in the case of eating yogurt
before eating steamed rice (D) (p < 0.01). Similarly, ΔCmax
was lower in the case of eating vegetable salad before eating
steamed rice (B) was lower than the case of (A) (p < 0.05).
iAUC was smaller in (C) and (D) than that in (A) (p <0.01). Similarly, it tended to be smaller in (B) than in (A).
ΔBlood glucose level changes (glucose values obtainedby subtracting the blood glucose level before the first intakeof test foods [1st time, value at 0 minutes]) are shown in
Table 3.
Fig. 3 shows Δblood glucose levels in the cases of eating
vegetable salad (B) or Yogurt (D) before eating steamed
rice. Compared with (A), Δblood glucose levels of (D) werelower (p < 0.05) after 15 minutes, those of (B) and (D) werelower (p < 0.01) after 30 minutes and those of (B) and (D)were lower (p < 0.01) and (p < 0.05), respectively, after 45
minutes. ΔBlood glucose level of (D) was lower (p < 0.05)
than that of (B) after 90 minutes.
Fig. 4 shows Δblood glucose levels in the cases of
eating steamed rice before eating yogurt (C) and eating
yogurt before eating steamed rice (D). Compared with (A),Δblood glucose level in (D) was lower (p < 0.05) after 15
minutes, (C) and (D) were lower (p < 0.05) and (p < 0.01),
respectively, after 30 minutes, (D) was lower (p < 0.05) after
45 minutes and those of (C) and (D) were lower (p < 0.05)
after 90 minutes.

Discussion

Inhibitory Effects of Yogurt on Postprandial
hyperglycemic state

For the purpose of verifying the effect of yogurt onblood glucose levels after eating steamed rice, the changes inblood glucose level caused by eating only steamed rice as acontrol food and eating yogurt and steamed rice in different
eating orders were compared with those caused by eating
vegetable salad before eating steamed rice. The effects on
blood glucose were then verified.

_ 70 _Glycative Stress Research

Table 1. Nutrition facts of test meal.

Test food

Unit (g)Energy (kcal)

Protein (g)Fat (g)Carbohydrate (g)Sugar (g)Fiber (g)

150

216

3.2

0.5

4 9. 7

-

-

100

22

0.6

0.1

-

4. 0

1. 4

Steamed rice 1)
Yogurt 2)
Vegetable salad 3)( no dressing )

100

62

3.4

3.0

-

5. 3

-

1) Sato no gohan, Kodawari Koshihikari, small serve 150 g (Sato Kogyo Co., Ltd.).
2) Meiji Bulgaria Yogurt LB81, plain (Meiji Holdings Co., Ltd.).
3) The mixed salad of the onion and lettuce which can be used without washing (Aeon Co., Ltd.).

Table 2. Blood glucose level transition after intake of the test meal.

Test food0 min

15 min30 min45 min60 min90 min

120 minA
B
C
D

92.3 ± 7.8

103.4 ± 12.3

131.3 ± 20.4

139.6 ± 13.2

135.4 ± 17.3

123.3 ± 20.0

112.9 ± 14.1

107.6 ± 11.4

126.1 ± 23.8

95.5 ± 7.6

100.9 ± 9.3

95.1 ± 7.0

97.4 ± 7.0

96.9 ± 8.6

114.9 ± 14.7

123.4 ± 16.8

111.0 ± 12.4

125.4 ± 16.6

129.2 ± 16.0

125.7 ± 14.8

123.4 ± 15.4

122.7 ± 14.0

120.1 ± 12.3

113.5 ± 10.8

110.7 ± 7.1

110.3 ± 17.3

124.5 ± 14.2

105.4 ± 15.5

Data are expressed as mean ± SD, unit; mg/dL, n = 20. A; steamed rice, B; vegetable salad (no dressing) before steamed rice, C; steamed rice before
yogurt, D; yogurt before steamed rice.SD, standard deviation.

＊＊

80

iAUC (mg/dL・min)

60
ΔCmax (mg/dL)

＊＊

5,000

＊

40

20

4,000
3,000
2,000
1,000

0

0

A

B

C

D

A

B

C

D

Test foodFig. 1. The amount of maximum blood glucose levelchange (ΔCmax) after ingesting test meal.

Data are expressed as mean ± 95% CI, n = 20. ** p < 0.01,* p < 0.05 by Friedman test. A; steamed rice, B; vegetablesalad (no dressing) before steamed rice, C; steamed rice before
yogurt, D; yogurt before steamed rice. CI, confidence interval.

Fig. 2. The area under curve blood glucose level change(iAUC) after ingesting test meal.

Data are expressed as mean ± 95% C I, n = 20. ** p < 0.01
by Friedman test. A; steamed rice, B; vegetable salad (nodressing) before steamed rice, C; steamed rice before yogurt,
D; yogurt before steamed rice.

Table 3. The amount of blood glucose level change (Δblood glucose) after ingesting test meal.

Test food

15 min30 min45 minA
B
C
D

11.1 ± 10.6 (5.0)

39.0 ± 19.4 (9.1)

47.3 ± 14.0 (6.6)

10.7 ± 8.8 (4.1)

29.2 ± 23.0 (10.8)* 32.3 ± 14.9 (7.0)

5.4 ± 7.7 (3.6)

60 min43.1 ± 20.5 (9.6) 31.0 ± 21.0 (9.8)

19.4 ± 15.4 (7.2)** 27.9 ± 17.2 (8.0)** 30.2 ± 15.2 (7.1)

2.3 ± 5.3 (2.5)* 16.0 ± 11.2 (5.2)** 30.4 ± 15.0 (7.0)*

90 min27.2 ± 11.9 (5.6)

26.5 ± 14.0 (6.6) 13.4 ± 14.0 (6.6)*#

120 min20.7 ± 15.9 (7.4)

24.6 ± 14.0 (6.5)

8.5 ± 11.4 (5.4)##

29.5 ± 15.5 (7.3) 18.4 ± 11.8 (5.5)*# 15.7 ± 9.1 (4.2)

Data are expressed as mean ± SD, parenthesis indicate 95 % CI, unit; mg/dL, n = 20. *p < 0.05, ** p < 0.01 vs A, #p < 0.05, ## p < 0.01 vs B by Friedman test.
A; steamed rice, B; vegetable salad (no dressing) before steamed rice, C; steamed rice before yogurt, D; yogurt before steamed rice. SD, standard deviation; CI,
confidence interval.

_ 71 _

Yogurt and Postprandial Blood Glucose

60

A
B

ΔBlood glucose (mg/dL)

50

D

40

＊

30

＊＊

20

＊＊
＊＊

＊#

10

＊

0
0

15

30

45

60

90

120

Postprandial time (min)Fig. 3. Fluctuation of the blood glucose level at the time of ingesting vegetable salad or yogurt ahead of rice.

Data are expressed as mean ± 95% CI, n = 20. * p < 0.05, ** p < 0.01 vs A, # p < 0.05 vs B by Friedman test. A; steamed
rice, B; vegetable salad (undressed) before steamed rice, D; yogurt before steamed rice. CI, confidence interval.

60

A
C
D

ΔBlood glucose (mg/dL)

50

40

30
＊

＊

＊

20

＊
＊＊
＊

10

＊

0
0

15

30

45

60

90

120

Postprandial time (min)Fig. 4. Fluctuation of the blood glucose level at the time of changing thesequence of ingesting yogurt and rice.

Data are expressed as mean ± 95% CI, n = 20. * p < 0.05, ** p < 0.01 vs A by Friedman test. A; steamed rice, C; steamed
rice before yogurt, D; yogurt before steamed rice.

_ 72 _Glycative Stress Research

ΔCmax was smaller in (B) and (D) than in (A). iAUC
was smaller at the time when eating yogurt in (C) and(D) than in (A). ΔBlood glucose levels by measuring time
when eating vegetable salad (B) or yogurt (D) before eating
steamed rice were smaller in both (B) and (D) than in (A)after 30 minutes and 45 minutes; however, that of (D) only
was smaller after 15 minutes and 90 minutes. Therefore,
it was verified that the diet of eating vegetable salad or
yogurt before eating steamed rice inhibited postprandial
hyperglycemic state to a greater extent than eating steamed
rice only.
It has been reported that the diet of eating vegetablesalad before eating steamed rice inhibits postprandial
hyperglycemic state 4, 5). There are some examples of clinicalexperiments on the effect of yogurt to inhibit hyperglycemia
using animals including rats and mice 13, 14) as well as humanclinical tests 15).
It was reported that the amino acids included in milk
whey promote the secretion of incretin which causes aninhibitory action on postprandial hyperglycemic states 16). It is
known that lactic acid has the effect of promoting the gelationof digesta in digestive organs 17), and the inhibitory action ondigestion rate by the gastrin secretion inhibition is known 18).
Furthermore, mono carboxylic acid, including lactic acid,promotes the generation of energy in mitochondria in muscle
tissues through monocarboxylate transporter (MC T )existing on cell membranes 19). According to the results of aninvestigation into 19 kinds of commercially available plain
yogurt, the amount of protein in yogurt was 3- 4 g/100 g(shown on the nutrient facts label) and the amount of lactic
acid was 90 -900 mg/100 g (data is not shown). It has beenreported that a plasma concentration of lactic acid rises
30 minutes after eating yogurt and it is maintained for thefollowing three hours 20). Therefore, it is possible that the
inhibitory effect on postprandial hyperglycemic state at thetime when eating yogurt and steamed rice together is causedby secretion of incretin promoted by amino acids associatedwith the digestion of milk protein in yogurt, the delay ofdigestion rate by lactic acid in the stomach, promotion of thegelation of digesta in digestive organs and the promotion ofcarbohydrate metabolism caused by absorbed lactic acid.
Meanwhile, in this research, iAUC was further decreasedby eating yogurt rather than eating vegetable salad. In a
preceding research on a vegetable salad eating experiment,
olive oil and vinegar were used as dressing and eaten together
with a vegetable salad 4, 5). It has been reported that vinegar
and olive oil have an inhibitory action on postprandial
hyperglycemic states 21). It was also reported that the inhibitory
action of dressing on postprandial hyperglycemic states differ
based on different compositions 22). It is possible that because
no dressing was used for the vegetable salad in this research,
the inhibitory action of vegetable salad on postprandial
hyperglycemic state was weaker.

Eating Order of Yogurt and Steamed Rice
The effects of eating orders of both (C) and (D)were smaller than (A) after 30 minutes and 90 minutes,
disregarding eating order. However, the effect of eating
yogurt before steamed rice (D) was small after 15 minutes
and after 45 minutes. The difference in Δblood glucose
after 15 minutes is possibly caused by the time allocation
for carbohydrate intake in 10 minutes. However, because
the time when both (C) and (D) become ΔCmax was after
45 minutes, the diet of eating yogurt before steamed rice

was considered to possibly increase the inhibitory action
on the postprandial hyperglycemic state. This phenomenon
is considered to be similar to the diet of eating grapefruits
before eating bread 7) and that of taking vinegar 6) and avinegar drink 23) before eating steamed rice can inhibit a
postprandial hyperglycemic state.
It has already been reported that in order to inhibit a
postprandial hyperglycemic state, it is recommended to
add dietary fibers to udon noodles 8) and eat udon noodles
or steamed rice together with side dishes such as egg,
vegetable salad, mabo nasu 9) and gyudon topping 10), rather
than eating noodles or steamed rice only. However, eating
yogurt after eating steamed rice shows a greater inhibitory
effect on postprandial hyperglycemia state than eating
noodles or steamed rice only. Therefore, as far as yogurt isconcerned, the difference in effect based ondifferent eatingorder is possibly small. The reason is considered to be thatthe time difference of eating order was only five minutes
and the lactic acid in yogurt was promptly absorbed andthe concentration of lactic acid in the blood is maintained.
As a result, the carbohydrate metabolism was promoted andcontinued through MCT.

Inhibition on Glycative Stress by Inhibition of
Postprandial Hyperglycemic State

A postprandial hyperglycemic state leads to excess
secretion of insulin 24). Therefore, the repetition of extreme
postprandial hyperglycemic states is involved in causing
insulin resistance. It has been reported that responding toa rise in postprandial blood glucose, the concentrations of
3-deoxyglucosone, glyoxal and methylglyoxal, which areglycation reaction intermediates in blood 25), increased. It
is known that methylglyoxal in blood damages vascularendothelial cells 26). Therefore, the inhibition of a postprandial
hyperglycemic state prevents damage to tissues and organs
caused by the injuries of small blood vessels. The continued
dietary guidance for 1-2. 5 years to eat vegetables before
staple foods has led to the decrease of HbA1c in patients withdiabetes and the prevention of the progression of diabetic
complications 27). There is a result of a meta-analysis that the
dietary habit of eating a portion of yogurt everyday reduces
the risk of type 2 diabetes 28). Therefore, the dietary habit
to continuously eat yogurt together with a meal possibly
alleviates glycative stress by inhibiting a postprandial
hyperglycemic state and contributes to the prevention of
aging and the progression of age-related diseases.

Conclusion

The dietary habit of eating yogurt together with a meal
inhibited postprandial hyperglycemic states and eating yogurt
before eating steamed rice contributed to the inhibitory action
to a greater extent. This diet exhibits the same inhibitory
action or more as that of eating a vegetable salad before
eating steamed rice, which has been reported. It is possiblethat eating yogurt together with a meal contributes to theprevention of progression of aging and age-related diseases.

Declaration of Conflict of Interest

This research received support from Ez Es Company
Ltd. (Tokyo, Japan).

_ 73 _

Yogurt and Postprandial Blood Glucose

Reference1) Ichihashi M, Yagi M, Nomoto K, et al. Glycation stressand photo-aging in skin. Anti-Aging Med. 2011; 8: 23-29.
2) Yagi M, Yonei Y. Glycative stress and anti-aging: 1. Whatis glycative stress? Glycative Stress Res. 2016; 3: 152-155.
3) Yagi M, Ishizaki K. The evaluation method of thefunctional food and cosmetics, which focused on theglycative stress. Fragrance Journal. 2016; 44: 56-64. (inJapanese)
4) Kanamoto I, Inoue Y, Moriguchi T, et al. Effect ofdifferences in low glycemic index food intake sequence on
plasma glucose profile. J Japan Dia Soc. 2010; 53: 96-101.
(in Japanese)5) Imai S, Matsuda M, et al. Crossover study of the effectof “Vegetables Before Carbohydrates” on reducing
postprandial glucose and insulin in Japanese subjects with
type 2 diabetes mellitus. J Japan Diab Soc. 2010; 53: 112115. (in Japanese)
6) Endo M, Matsuoka T. The efficacy of vinegar on the
suppression of postprandial glucose elevation. J Japan
Diab Soc. 2011; 54: 192-199.
7) Ogura M, Yagi M, Nomoto K, et al. Effect of grapefruit
intake on postprandial plasma glucose. Anti-Aging Med.
2011; 8: 60-68.
8) Matsushima M, Yagi M, Hamada U, et al. Effects ofchoice of staple food and the addition of dietary fiber onchanges in postprandial blood glucose level. Glycative
Stress Res. 2014; 1: 46-52.
9) Matsushima M, Yagi M, Hamada U, et al. Prevention of
postprandial hyperglycemia by the combination of a staple
food and a side dish. Glycative Stress Res. 2014; 1: 53-59.
10) Kawabata A, Yagi M, Ogura M, et al. Postprandial blood
glucose level after intake of a bowl of rice topped withbeef. Glycative Stress Res. 2015; 2: 67-71.
11) Faul F, Erdfelder E, Lang AG. G*Power 3: A flexible
statistical power analysis program for the social,
behavioral, and biomedical sciences. Behavior Research
Methods. 2007; 39: 175-191.
12) Japanese Association of the Study for Glycemic Index.
Unified protocol (unified procedure). (in Japanese)
http://www.gikenkyukai.com/protocol.html
13) Tabuchi M, Morita H, He F, et al. Effect of administrationof Lactobacillus rhamnosus GG on postprandial blood
glucose level in rats. Milk Science. 2005; 54: 17-21. (inJapanese)
14) Yun SI, Park HO, Kang JH. Effect of Lactobacillus gasseri
BNR17 on bloodglucose levels and body weight in amouse model of type 2 diabetes. J Appl Microbiol. 2009;
107: 1681-1686.
15) Östman EM, Liljeberg Elmståhl HG, Björck IM.
Inconsistency between glycemic and insulinemic
responses to regular and fermented milk products. Am J
Clin Nutr. 2001; 74: 96-100.
16) Gunnerud1 U, Holst JJ, Östman E, et al. The glycemic,
insulinemic and plasma amino acid responses to equicarbohydrate milk meals, a pilot-study of bovine andhuman milk. Nutr J. 2012; 11: 83.
17) Östman EM, Nilsson M, Liljeberg Elmståhl HGM, et al.
On the effect of lactic acid on blood glucose and insulin
responses to cereal products: Mechanistic studies inhealthy subjects and in vitro. Journal of Cereal Science.
2002; 36: 339-346.

18) Ebihara K. Effect of lactic acid on postprandial plasma-

glucose and -insulin responses in rats administeredglucose solution. Nutrition Research. 1996; 16: 1575-1585.
19) Kitaoka Y, Hoshino D, Hatta H, Monocarboxylatetransporter and lactate metabolism. J Phys Fitness Sports
Med. 2012; 1: 247-252.
20) de Vrese M, Barth CA, Postprandial plasma D-lactate
concentrations after yogurt ingestion. Z Ernahrungswiss.
1991; 30: 131-137.
21) Bozzetto L, Alderisio A, Giorgini M, et al. Extra-virgin
olive oil reduces glycemic response to a high-glycemic
index meal in patients with type 1 diabetes: A randomized
controlled trial. Diabetes Care. 2016; 39: 518-524.
22) Kawakita K, Kimoto S, Takenoyama S, et al. The effects
of changing the order of eating salad and rice in ameal on postprandial plasma glucose and triglyceride
levels: Differences among salad dressings. Bulletin of
Minamikyushu University. A, Natural science. 2017; 47A:
11-18. (in Japanese)23) Yagi M, Shimode A, Yasui K, et al. Effect of a vinegar
beverage containing indigestible dextrin and a mixed
herbal extract on postprandial blood glucose levels: A
single-dose study. Glycative Stress Res. 2014; 1: 8-13.
24) Lautt WW. Postprandial insulin resistance as an early
predictor of cardiovascular risk. Ther Clin Risk Manag.
2007; 3: 761-770.
25) Maessen DE, Hanssen NM, Scheijen JL, et al. Post-glucose
load plasma α-dicarbonyl concentrations are increased inindividuals with impaired glucose metabolism and type2 diabetes: The CODAM study. Diabetes Care. 2015; 38:
913-920.
26) Takahashi K, Tatsunami R, Tampo Y. Methylglyoxalinduced apoptosis of endothelial cells. Yakugaku Zasshi.
2008; 128: 1443-1448. (in Japanese)27) Imai S, Fukui M, Kajiyama S. Effect of eating vegetables
before carbohydrates on glucose excursions in patientswith type 2 diabetes. J Clin Biochem Nutr. 2014; 54: 7-11.
28) Chen M, Sun Q, Giovannucci E, et al. Dairy consumption
and risk of type 2 diabetes: 3 cohorts of US adults and an
updated meta-analysis. BMC Med. 2014; 12: 215.

_ 74 _