Effect of modifying the rate of digestion of a food on the blood glucose, amino acid, and endocrine responses in patients with cirrhosis.

To see whether foods with slower rates of digestion may benefit the metabolic abnormalities seen in cirrhosis, the same food, processed in two different ways, was fed to seven patients with cirrhosis. The breakfast of lentils processed by prolonged heating, to produce more rapid in vitro digestion, resulted in a significantly higher incremental rise in large neutral amino acid levels at 60 min (p less than 0.02) and a tendency for a more rapid rise in total amino acid concentrations by comparison with conventionally cooked lentils with slower in vitro digestion rates. After more rapidly digested lentils, incremental levels of branched-chain amino acids were also higher at 60 min (67 +/- 9, p less than 0.001) despite a greater overall insulin response. Comparable incremental amino acid areas after both meals suggested that the total amount of amino acids absorbed was not influenced by processing. Greater blood glucose, insulin, and gastric inhibitory polypeptide responses were seen after the more processed meal with no significant differences in pancreatic glucagon, entroglucagon, or neurotensin levels. Processing a food to alter the rate of digestion may therefore be used to manipulate amino acid, glucose, and endocrine responses in cirrhosis.