A Low Glycemic Index Diet for Prevention of Glucose Intolerance During Bed Rest

Study Overview
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Brief Summary
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Recovery from surgery, injury or illness might require periods of bed rest in-hospital or at home. Bed rest may be needed for recovery but also has negative consequences. Prolonged bed rest reduces the ability of muscle to take up sugar from the blood, and increases blood levels of sugar and fat which may actually delay recovery. Bone starts breaking down when there is very little skeletal stimulation or 'stress' that typically occurs with walking. Bed rest stiffens arteries which may increase blood pressure. Different diets may influence the extent of harmful effects to muscle, bone and arteries during bed rest. This study compares a diet with increased plant sources (i.e. lentils, chickpeas, beans and peas) to a typical hospital diet (mostly animal sources and foods high in refined sugar) on blood, arteries, muscle and bone during bed rest. The investigators will test six healthy adults before, during and after two periods of 4-day bed rest, one when they eat a typical hospital diet, one with a diet containing more plant sources. The investigators will learn more about the effects of diet during bed rest and be able to make recommendations about diets to help ensure healthy recovery for individuals requiring bed rest.

Detailed Description
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Many medical conditions and interventions require periods of bed rest in order to maximize recovery and restore optimal physical function. Unfortunately, muscle becomes glucose intolerant, bone starts to break down, and arteries become stiffer during sustained periods of chronic inactivity, such as bed rest. Elevation of blood glucose during hospital stays results in increased morbidity, mortality, length of stay and costs. Components of the typical Western diet (refined carbohydrates and protein from animal sources common in hospital foods) induce glucose intolerance, bone catabolism, and arterial stiffening; plant-based proteins may not have the same negative impact. Pulses (i.e. low fat legumes: lentils, chickpeas, beans, peas) contain carbohydrate with a low glycemic index, and do not substantially increase blood glucose levels. At the same time, they are high in protein, but do not contain the same sulphur-containing amino acid profile as animal proteins that induce bone resorption. Pulses are, therefore, a potential 'super food' to mitigate many of the negative impacts associated with required bed rest following medical illness. The study purpose is to determine the effects of a pulse-based diet compared to a Western diet of typical hospital foods on glucose tolerance, bone catabolism, and arterial stiffening during bed rest. The investigators hypothesize that a pulse-based diet will be superior to a typical Western diet for preventing glucose intolerance, bone catabolism, and arterial stiffening during sustained bed rest. Six healthy adults will take part in a cross-over study where they will be randomized to four days of bed rest while on a pulse-based or Western diet, have a one month wash-out and then cross-over before another four days of bed rest with the other diet. Immediately before and after bed rest (i.e. the first morning after the last night of bed rest), oral glucose tolerance tests will be conducted to assess glucose tolerance and insulin sensitivity (i.e. markers used to assess diabetes risk). At the same time points, fasting blood samples will be collected for lipid assessments. Urine will be collected for assessment of bone catabolism (via measures of N-telopeptides: a by-product of collagen from bone which appears in the urine when bone is breaking down). Blood pressure will be evaluated every two hours during bed rest days from 9am to 9pm. Arterial stiffness (measured by the gold-standard technique of pulse wave velocity using applanation tonometry) and beat-by-beat blood pressure will be used to assess blood vessel function before and after four days of bed rest. This study will inform improved hospital diets and nutritional habits of patients to prevent or offset negative health implications during periods of bed rest that may be required either in-hospital, long-term care or at home as part of standard medical care.

Official Title
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A Low Glycemic Index Diet for Prevention of Glucose Intolerance During Bed Rest

Conditions
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Glucose Intolerance

Intervention / Treatment
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* Dietary Supplement: Low glycemic index, pulse-based diet
* Dietary Supplement: Moderate glycemic index hospital diet


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Healthy Exclusion Criteria: Diabetic Vegetarian Food allergies

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Low glycemic index diet<br>Low glycemic index pulse-based diet (i.e. beans, peas, lentils, chickpeas) | Dietary Supplement: Low glycemic index, pulse-based diet<br>* Diet that includes pulses (i.e. meals that contain chickpeas, lentils, beans, or peas)<br>|
| Active Comparator: Regular hospital diet<br>Moderate glycemic index diet based on hospital menus | Dietary Supplement: Moderate glycemic index hospital diet<br>* Diet that is derived from a regular hospital menu for patients<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Glucose area under the curve | glucose area under the curve from 2-hour oral glucose tolerance test | Change from baseline to 4 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Insulin area under the curve | Insulin area under the curve from 2-hour oral glucose tolerance test | Change from baseline to 4 days | 
| Fasting glucose | Fasting glucose from serum | Change from baseline to 4 days | 
| Fasting insulin | Fasting Insulin from serum | Change from baseline to 4 days | 
| Fasting cholesterol | Fasting cholesterol from serum | Change from baseline to 4 days | 
| Fasting LDL-cholesterol | Fasting LDL-cholesterol from serum | Change from baseline to 4 days | 
| Fasting triglycerides | Fasting triglycerides from serum | Change from baseline to 4 days | 
| Fasting HDL-cholesterol | Fasting HDL-cholesterol from serum | Change from baseline to 4 days | 
| Bone resorption | Urinary n-telopeptides | Change from baseline to 4 days | 
| Lean tissue mass | Lean tissue mass from dual energy X-ray absorptiometry scans | Change from baseline to 4 days | 
| Fat mass | Fat mass from dual energy X-ray absorptiometry scans | Change from baseline to 4 days | 
| Systolic Blood pressure | Beat-by-beat blood pressure measurement | Change from baseline to 1, 2, 3, and 4 days | 
| Arterial stiffness | Arterial stiffness assessed by tonometry | Change from baseline to 1, 2, 3, and 4 days | 
| Diastolic blood pressure | Beat-by-beat blood pressure measurement | Change from baseline to 1, 2, 3, and 4 days |