Meal sequencing, which means the deliberate order in which foods are eaten, has gained popularity in recent years. On social media, for example, many people report more stable blood sugar levels, weight loss, and general health benefits, particularly for people with type 2 diabetes. But can these effects be substantiated scientifically? Researchers at the German Diabetes Center (DDZ) took a closer look in a systematic review. Their conclusion: The order in which foods are eaten can influence the short-term course of blood sugar and insulin levels after a meal. However, the evidence for this is limited so far, as is the evidence for an improvement in long-term values.
Eating the components of a meal in a specific order is the principle of meal sequencing. For example, foods with a low glycemic index, especially vegetables or salad, are eaten first, followed by carbohydrate-rich foods with a higher glycemic index, such as bread, rice, potatoes, or pasta. This sequence is intended to flatten the rise in blood sugar after eating and, according to voices from the health and nutrition field, could therefore also be of interest in the context of type 2 diabetes.
The presumed mechanism behind the principle of eating vegetables before carbohydrates can be explained by the dietary fiber contained in vegetables. When fiber reaches the gastrointestinal tract first, it can slow the absorption of glucose, a simple sugar found in carbohydrates. To examine how well this assumption can be supported scientifically, researchers at the German Diabetes Center (DDZ) conducted a systematic review, evaluating 18 randomized controlled trials in adults that met the team’s strict selection and quality criteria.
Result: A specific eating order initially lessens the rise in blood sugar immediately after the meal
The results show that blood sugar initially rises less at 30 and 60 minutes after eating when vegetables are consumed before carbohydrates. However, after about 120 minutes, the individuals who do not follow this order actually have lower blood sugar levels again than those who eat according to the principle of meal sequencing. Insulin levels also initially run lower but rise more steeply later on, which could indicate that the body secretes more insulin at a later stage to compensate for the delayed rise in blood sugar. “The results show that the order of foods can influence the metabolic response to a meal in the short term. However, the effect does not manifest as a lasting reduction in blood sugar levels. Rather, the time course of blood sugar and insulin levels may change,” explains Katharina Kampmann-Gongoll, nutrition scientist at the Institute for Biometrics and Epidemiology at the DDZ.
There are also initial indications of a possible effect on fasting blood sugar and long-term blood sugar (HbA1c), also known as the “blood sugar memory.” In people with type 2 diabetes, both values decreased more in the group that ate vegetables before carbohydrates than in the comparison group. However, this finding is based on a single study of people with type 2 diabetes, and that study also has methodological limitations. In addition, for long-term blood sugar, the amount of vegetables was not identical between the groups, so it cannot be determined with certainty whether the observed change was actually due to the order of foods or to the higher overall vegetable intake.
Limited significance of the results – especially for people with type 2 diabetes
No general recommendation for meal sequencing can be derived from the results, especially not for people with type 2 diabetes, emphasizes Dr. Alexander Lang, postdoctoral researcher at the Institute for Biometrics and Epidemiology: “The studies often had few participants and tested different types of vegetables in different sequences. Moreover, most of the studies were conducted in Japan, frequently with young, healthy individuals. Because the blood sugar response to a meal can vary between population groups, the findings cannot readily be transferred to other groups, such as older people or people with prediabetes and type 2 diabetes.”
Professor Michael Roden, Scientific Director and Spokesman for the Board of the DDZ as well as Director of the Department of Endocrinology and Diabetology at Düsseldorf University Hospital, points to the relevance of other dietary factors that have a scientifically established influence on blood sugar levels and thus on the course of type 2 diabetes: “In addition to the quality of foods and the composition of meals, appropriate calorie intake is also important – as is calorie reduction in cases of overweight.” To be able to derive practice-oriented recommendations in the future, the researchers believe studies would be helpful that use uniform measurement methods and include more people with prediabetes and type 2 diabetes as well as from different population groups.
Original publication:
Title: Effect of eating vegetables before carbohydrates on glucose, insulin and glycemic control – A systematic review and meta-analysis of randomized controlled trials
Authors: Kampmann-Gongoll, K., Schlesinger, S., Noreik, M., Kuss, O., Lang, A.
Journal: Clinical Nutrition
DOI: www.doi.org/10.1016/j.clnu.2026.106775
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