Reducing glycemic excursions is a main target in treating T2D to lower HbA1c and cardiovascular risk. Diurnal glycemic variations are controlled by clock genes (CG), which are significantly influenced by meal timing. A diet that aligns with circadian clock genes, consisting of a high-energy-protein breakfast and a low-carbohydrate (CH) dinner (Bdiet), upregulates clock-gene mRNA expression, reduces body weight, HbA1c, overall (diurnal and nocturnal) glycemia, and appetite scores as compared to a reverse schedule or a diet with six meals, with energy and CH evenly distributed throughout the day. In addition to meal timing in Bdiet, the source of proteins—whether from milk or soy—may also contribute to metabolic benefits. Milk and dairy proteins exert an insulinotropic effect, reducing overall glycemia, inflammation, and risk of T2D. We compared, in a randomly assigned crossover study in 20 T2D patients, the outcomes of a four-week B diet schedule (2000±200 kcal; B:L:D 50:33:17%) either containing milk and dairy proteins (YesMdiet) or an isocaloric B diet with non-dairy sources of protein, i.e., soy (NoMdiet).

Conclusions: YesMdiet was more effective than NoMdiet in reducing overall glycemia, mean daily glucose levels, CGM-HbA1c, postprandial glucose after breakfast, lunch, and dinner (p<0.0001), and VAS scores for hunger, desire to eat, and desire for sweets (p<0.0001). Alongside the known insulinotropic effect of milk proteins, YesMdiet significantly upregulated clock-gene mRNA expression, particularly PER1. This may enhance β-cell secretion, muscle and hepatic insulin sensitivity, and appetite scores, leading to improved daily glucose metabolism in T2D.

Professor Daniela Jakubowicz, MD, has completed his specialization in Endocrinology at Columbia University, New York, and has achieved her affiliation as Professor of Medicine at Virginia Commonwealth University, USA. Since 2009 is working at the Endocrinology and Diabetes Unit at the Wolfson Medical Center. Tel Aviv University, Israel, and Tel Aviv Medical Center. Most of Prof. Daniela Jakubowicz, MD's, clinical experience and her multiple research publications and manuscripts are focused on the effect of meal timing on circadian rhythms, clock gene expression in obesity, metabolic syndrome, polycystic ovary and T2D