Effect of apple cider vinegar on delayed gastric emptying in patients with type 1 diabetes mellitus: a pilot study

Joanna Hlebowicz, Gassan Darwiche, Ola Björgell, Lars-Olof Almér, Joanna Hlebowicz, Gassan Darwiche, Ola Björgell, Lars-Olof Almér

Abstract

Background: Previous studies on healthy people show that vinegar delays gastric emptying and lowers postprandial blood glucose and insulin levels. The aim of this study was to investigate the effect of apple cider vinegar on delayed gastric emptying rate on diabetes mellitus patients.

Methods: Ten patients with type 1 diabetes and diabetic gastroparesis, including one patient who had undergone vagotomy, were included and completed the investigator blinded crossover trial. The gastric emptying rate (GER) was measured using standardized real-time ultrasonography. The GER was calculated as the percentage change in the antral cross-sectional area 15 and 90 minutes after ingestion of 300 g rice pudding and 200 ml water (GER1), or 300 g rice pudding and 200 ml water with 30 ml apple cider vinegar (GER2). The subjects drank 200 ml water daily before breakfast one week before the measurement of GER1. The same subjects drank 200 ml water with 30 ml vinegar daily before breakfast for two weeks before the measurement of GER2.

Results: The median values of GER1 and GER2 were 27% and 17%, respectively. The effect of vinegar on the rate of gastric emptying was statistically significant (p < 0.05).

Conclusion: This study shows that vinegar affects insulin-dependent diabetes mellitus patients with diabetic gastroparesis by reducing the gastric emptying rate even further, and this might be a disadvantage regarding to their glycaemic control.

Trial registration number: ISRCTN33841495.

Figures

Figure 1
Figure 1
Gastric emptying of a rice pudding meal ingested with and without apple cider vinegar, expressed as the gastric emptying rate (GER), in ten type 1 diabetics with clinically diagnosed diabetic gastroparesis. The median (Md), minimum (Min), and maximum (Max) values and the values of the first (q1) and the third (q3) quartiles are shown. Values of p

References

    1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–1053. doi: 10.2337/diacare.27.5.1047.
    1. Horowitz M, Harding PE, Maddox AF, Wishart JM, Akkermans LM, Chatterton BE, Shearman DJ. Gastric and oesophageal emptying in patients with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia. 1989;32:151–159. doi: 10.1007/BF00265086.
    1. Horowitz M, Maddox AF, Wishart JM, Harding PE, Chatterton BE, Shearman DJ. Relationships between oesophageal transit and solid and liquid gastric emptying in diabetes mellitus. Eur J Nucl Med. 1991;18:229–234. doi: 10.1007/BF00186645.
    1. Keshavarzian A, Iber FL, Vaeth J. Gastric emptying in patients with insulin-requiring diabetes mellitus. Am J Gastroenterol. 1987;82:29–35.
    1. Wegener M, Börsch G, Schaffstein J, Luerweg C, Leverkus F. Gastrointestinal transit disorders in patients with insulin-treated diabetes mellitus. Dig Dis. 1990;8:23–36.
    1. Lyrenås EB, Olsson EH, Arvidsson UC, Orn TJ, Spjuth JH. Prevalence and determinants of solid and liquid gastric emptying in unstable type I diabetes. Relationship to postprandial blood glucose concentrations. Diabetes Care. 1997;20:413–418. doi: 10.2337/diacare.20.3.413.
    1. Attvall S, Abrahamsson H, Schvarcz E, Berne C. Gastric emptying is important for the patients with diabetes. Lakartidningen. 1995;92 4166, 4169, 4171–4162.
    1. Maleki D, Locke GR, 3rd, Camilleri M, Zinsmeister AR, Yawn BP, Leibson C, Melton LJ., 3rd Gastrointestinal tract symptoms among persons with diabetes mellitus in the community. Arch Intern Med. 2000;160:2808–2816. doi: 10.1001/archinte.160.18.2808.
    1. Jones KL, Russo A, Stevens JE, Wishart JM, Berry MK, Horowitz M. Predictors of delayed gastric emptying in diabetes. Diabetes Care. 2001;24:1264–1269. doi: 10.2337/diacare.24.7.1264.
    1. Kong MF, Horowitz M. Diabetic gastroparesis. Diabet Med. 2005;22:13–18. doi: 10.1111/j.1464-5491.2005.1761e.x.
    1. Lysy J, Israeli E, Strauss-Liviatan N, Goldin E. Relationship between hypoglycaemia and gastric emptying abnormalities in insulin-treated diabetic patients. Neurogastroenterol Motil. 2006;18:430–440. doi: 10.1111/j.1365-2982.2006.00800.x.
    1. Bytzer P, Talley NJ, Leemon M, Young LJ, Jones MP, Horowitz M. Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults. Arch Intern Med. 2001;161:1989–1996. doi: 10.1001/archinte.161.16.1989.
    1. Jones KL, Horowitz M, Wishart JM, Maddox AF, Harding EH, Chatterton BE. Relationships between gastric emptying, intragastric meal distribution and blood glucose concentrations in diabetes mellitus. J Nucl Med. 1995;36:2220–2228.
    1. Brighenti F, Castellani G, Benini L, Casiraghi MC, Leopardi E, Crovetti R, Testolin G. Effect of neutralized and native vinegar on blood glucose and acetate responses to a mixed meal in healthy subjects. Eur J Clin Nutr. 1995;49:242–247.
    1. Liljeberg H, Björck I. Delayed gastric emptying rate may explain improved glycaemia in healthy subjects to a starchy meal with added vinegar. Eur J Clin Nutr. 1998;52:368–371. doi: 10.1038/sj.ejcn.1600572.
    1. Leeman M, Ostman E, Björck I. Vinegar dressing and cold storage of potatoes lowers postprandial glycaemic and insulinaemic responses in healthy subjects. Eur J Clin Nutr. 2005;59:1266–1271. doi: 10.1038/sj.ejcn.1602238.
    1. Ostman E, Granfeldt Y, Persson L, Björck I. Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. Eur J Clin Nutr. 2005;59:983–988. doi: 10.1038/sj.ejcn.1602197.
    1. Johnston CS, Kim CM, Buller AJ. Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care. 2004;27:281–282. doi: 10.2337/diacare.27.1.281.
    1. McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PW, Jacques PF. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care. 2004;27:538–546. doi: 10.2337/diacare.27.2.538.
    1. Darwiche G, Almer LO, Björgell O, Cederholm C, Nilsson P. Measurement of gastric emptying by standardized real-time ultrasonography in healthy subjects and diabetic patients. J Ultrasound Med. 1999;18:673–682.
    1. Darwiche G, Björgell O, Thorsson O, Almer LO. Correlation between simultaneous scintigraphic and ultrasonographic measurement of gastric emptying in patients with type 1 diabetes mellitus. J Ultrasound Med. 2003;22:459–466.
    1. Liljeberg HG, Lönner CH, Björck IM. Sourdough fermentation or addition of organic acids or corresponding salts to bread improves nutritional properties of starch in healthy humans. J Nutr. 1995;125:1503–1511.
    1. Schvarcz E, Palmér M, Aman J, Berne C. Hypoglycemia increases the gastric emptying rate in healthy subjects. Diabetes Care. 1995;18:674–676. doi: 10.2337/diacare.18.5.674.
    1. Schvarcz E, Palmer M, Aman J, Lindkvist B, Beckman KW. Hypoglycaemia increases the gastric emptying rate in patients with type 1 diabetes mellitus. Diabet Med. 1993;10:660–663.
    1. Fraser RJ, Horowitz M, Maddox AF, Harding PE, Chatterton BE, Dent J. Hyperglycaemia slows gastric emptying in type 1 (insulin-dependent) diabetes mellitus. Diabetologia. 1990;33:675–680. doi: 10.1007/BF00400569.
    1. Schvarcz E, Palmér M, Aman J, Horowitz M, Strindsberg M, Berne C. Physiological hyperglycemia slows gastric emptying in normal subjects and patients with insulin-dependent diabetes mellitus. Gastroenterology. 1997;113:60–66. doi: 10.1016/S0016-5085(97)70080-5.
    1. Rawlins MD, Henderson DB, Hijab AR. Pharmacokinetics of paracetamol (acetaminophen) after intravenous and oral administration. Eur J Clin Pharmacol. 1977;11:283–286. doi: 10.1007/BF00607678.
    1. Sanaka M, Kuyama Y, Yamanaka M. Guide for judicious use of the paracetamol absorption techniques in a study of gastric emptying rate of liquids. J Gastroenterol. 1998;33:785–791. doi: 10.1007/s005350050177.
    1. Fushimi T, Tayama K, Fukaya M, Kitakoshi K, Nakai N, Tsukamoto Y, Sato Y. Acetic acid feeding enhances glycogen repletion in liver and skeletal muscle of rats. J Nutr. 2001;131:1973–1977.
    1. Ogawa N, Satsu H, Watanabe H, Fukaya M, Tsukamoto Y, Miyamoto Y, Shimizu M. Acetic acid suppresses the increase in disaccharidase activity that occurs during culture of caco-2 cells. J Nutr. 2000;130:507–513.
    1. Lin HC, Doty JE, Reedy TJ, Meyer JH. Inhibition of gastric emptying by acids depends on pH, titratable acidity, and length of intestine exposed to acid. Am J Physiol. 1990;259:G1025–1030.
    1. Meyer KA, Kushi LH, Jacobs DR, Jr, Slavin J, Sellers TA, Folsom AR. Carbohydrates, dietary fibre, and incident type 2 diabetes in older women. Am J Clin Nutr. 2000;71:921–930.
    1. Janket SJ, Manson JE, Sesso H, Buring JE, Liu S. A prospective study of sugar intake and risk of type 2 diabetes in women. Diabetes Care. 2003;26:1008–1015. doi: 10.2337/diacare.26.4.1008.
    1. Salmerón J, Ascherio A, Rimm EB, Colditz GA, Spiegelman D, Jenkins DJ, Stampfer MJ, Wing AL, Willett WC. Dietary fibre, glycemic load, and risk of NIDDM in men. Diabetes Care. 1997;20:545–550. doi: 10.2337/diacare.20.4.545.
    1. Colditz GA, Manson JE, Stampfer MJ, Rosner B, Willett WC, Speizer FE. Diet and risk of clinical diabetes in women. Am J Clin Nutr. 1992;55:1018–1023.
    1. Salmerón J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC. Dietary fibre, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. Jama. 1997;277:472–477. doi: 10.1001/jama.277.6.472.
    1. Lundgren H, Bengtsson C, Blohmé G, Isaksson B, Lapidus L, Lenner RA, Saaek A, Winter E. Dietary habits and incidence of noninsulin-dependent diabetes mellitus in a population study of women in Gothenburg, Sweden. Am J Clin Nutr. 1989;49:708–712.
    1. Sheard NF, Clark NG, Brand-Miller JC, Franz MJ, Pi-Sunver FX, Mayer-Davis E, Kulkarni K, Geil P. Dietary carbohydrate (amount and type) in the prevention and management of diabetes: a statement by the american diabetes association. Diabetes Care. 2004;27:2266–2271. doi: 10.2337/diacare.27.9.2266.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться