The Order You Eat Matters: A Simple Strategy For Better Sugar Control By Dr. Fayaz Shawl

(MENAFN- Mid-East Info) By Dr. Fayaz Shawl, MD, FACC, FACP, FSCAI
Clinical Professor of Medicine, George Washington University
Interventional Cardiologist practising in the United States and Dubai
Founder, The Fayaz Shawl Philanthropic Foundation Borderless Finance. AI-Native.

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For many families in the UAE, Emirati and expatriate alike, a meal brings together rice, khubz, grilled meat, salads and dishes shared across generations. Advice about diabetes should make room for these familiar foods. The aim is to help people enjoy them in portions and combinations that support better health.
What we eat and how much we eat remain central to diabetes care. The order in which we eat may also help. A practical meal sequence is to begin with vegetables, either alone or with a modest serving of plain unsweetened yoghurt or labneh, then eat protein foods such as grilled chicken, fish, eggs, lentils or chickpeas, and finish with a modest portion of rice or bread at the end of the meal. Do not eat the rice or bread first.
Why the order may help
During digestion, starch in rice, bread and pasta is broken down into glucose. In diabetes, the body has difficulty keeping this glucose within a healthy range. A large portion of carbohydrate can therefore produce a substantial rise in blood sugar.
Small clinical studies have found that eating vegetables and protein before carbohydrate can reduce the immediate rise in blood glucose in people with type 2 diabetes. This is a useful additional strategy, but the evidence is stronger for short-term meal responses than for lasting improvements in diabetes or prevention of its complications.
Foods interact during digestion. Fibre, protein and fat can influence how quickly a meal leaves the stomach and how rapidly glucose reaches the bloodstream. Eating vegetables first does not create a barrier that makes a large serving of rice harmless. Portion size still matters.
A small serving of nuts before the meal
One option is a small serving of unsalted walnuts and almonds, taken 20–30 minutes before a meal with a glass of water. About 10 almonds and 4 walnut halves, roughly 20 grams in total, is a practical portion rather than a prescribed dose. Count these nuts within your daily food intake, replacing other calories rather than adding them before every meal. Avoid nuts if you have a nut allergy.
In my clinical experience with continuous glucose monitors (CGMs), I have noticed smaller glucose spikes when nuts are taken before meals. This is an observation, not a controlled study; meal size, food choices and activity also influence the result.
A small randomised study in Asian Indians with prediabetes found benefits from 20 grams of almonds taken 30 minutes before meals. The walnut-and-almond combination and a 20-minute interval were not tested in that study. Nuts provide fibre, protein and unsaturated fats, which may influence digestion and fullness. Water supports hydration and may help you feel full sooner, but it has not been shown to lower glucose further. Anyone prescribed a fluid restriction should stay within it.
Start with vegetables
Begin with a green salad, fattoush with little or no fried bread, tabbouleh, cucumber and tomato, grilled vegetables, okra or spinach. Cooked vegetables are suitable; there is no need to insist on raw food. Prepare them with moderate amounts of oil and salt. Give vegetables a generous place on the plate.
When it suits the meal, eat a modest serving of plain unsweetened yoghurt or labneh with the vegetables, for example a spoonful with salad or a yoghurt-and-cucumber salad (khiyar bi laban). In my CGM observations, combining plain yoghurt with non-starchy vegetables at the start of the meal was associated with a smaller post-meal glucose rise. Plain yoghurt generally causes only a small rise in blood sugar and adds protein, and strained varieties such as labneh and Greek yoghurt contain more protein than regular yoghurt. The vegetable-and-yoghurt combination has not been tested in a controlled trial. Treat it as an observation, not a proven treatment, and avoid flavoured yoghurts, sweetened laban, honey and date syrup.
Follow with protein, lentils or chickpeas
Next, eat some grilled fish such as sea bream or hammour, skinless chicken, lean lamb or beef, eggs, or lentils and chickpeas. If plain yoghurt or labneh was not taken with the vegetables, it can accompany this part of the meal. Yoghurt does not have to be eaten before meat, and it is not compulsory at every meal. People with lactose intolerance or dairy allergy need an alternative.
Lentils, chickpeas and foul (fava beans) are valuable sources of protein and fibre, but they also contain carbohydrate, as does hummus. Plain yoghurt contains natural milk sugar. Neither should be treated as a food that has no effect on blood glucose. Keep fried foods such as falafel and samboosa, and creamy sauces, occasional.
Then add a small portion of rice or bread
After vegetables and protein, add a smaller serving of rice, whole-wheat khubz or bulgur at the end of the meal, not at the beginning. These can be eaten with the vegetables or protein remaining on your plate. There is no need to turn the meal into a rigid ritual or wait a set number of minutes between foods.
Whole-wheat khubz still contains carbohydrate, as do brown rice and cooled rice. None of them allows unlimited portions. Your appropriate serving depends on your activity, medicines, nutritional needs and blood glucose response.
Cook, cool and reheat rice when you can
A practical option is to cook rice in advance, cool it promptly, refrigerate it for about 24 hours, and then reheat only the portion needed. During cooling, some of the cooked starch changes into resistant starch, which the body digests less readily. A small clinical study found that white rice refrigerated for 24 hours at 4°C and then reheated produced a lower post-meal glucose response than freshly cooked rice.
The evidence is limited and not completely uniform, so the effect cannot be guaranteed for every person or every variety of rice. Cooling and reheating do not remove the carbohydrate and do not make a large serving harmless. The most important steps remain a smaller portion, eating rice after vegetables and protein, and checking your own response when glucose monitoring is available.
Food safety matters. Put cooked rice into shallow containers and refrigerate it within two hours, or within one hour on a hot day or in a warm kitchen; keep the refrigerator at 4°C or below. Use it within about 24 hours, reheating only the portion you need until it is steaming hot throughout (74°C), and eat it promptly. Discard cooked rice that has been left at room temperature for longer than two hours (one hour in hot conditions).
Putting the advice into an everyday UAE meal
For a meal of chicken machboos with salad and yoghurt, start with the salad, with a spoonful of plain yoghurt if you like. Have the chicken next, then eat a modest portion of the rice alongside the remaining chicken and salad.
For a family meal of grilled hammour, fattoush and rice, or a lentil and vegetable curry with chapati, begin with the salad or vegetables, follow with the fish or lentils, and then add a small portion of rice or one chapati. Avoid making rice the largest part of the meal.
Breakfast breads, karak and coffee
Breakfast in the UAE often centres on bread: khubz, regag, manakish, khameer, chebab, paratha and croissants. These are not nutritionally identical: some are simple refined-flour breads, while others are closer to pastries because they contain generous butter, ghee, milk, sugar or date syrup. Recipes and sizes vary between bakeries and homes, so judge a bread by its ingredients, its portion size and your own glucose response rather than by its name alone.
Why these breads deserve special attention. Most khubz, regag, manakish, paratha and croissants are made mainly from refined white flour. Milling removes much of the grain's fibre and structure, so the starch is digested rapidly. Eating the bread by itself, especially at breakfast after an overnight fast, can produce a substantial glucose rise. Za'atar or sesame on top may add flavour, but they do not cancel the carbohydrate load of the flour.
Plainer refined-flour breads: limit closely
Khubz (Arabic bread). A large round of khubz can contain as much starch as two or three slices of bread, and several pieces are often eaten at one meal. Limit it closely while glucose is high; if later included, choose half a piece of whole-wheat khubz, eaten after protein.
Regag. A very thin Emirati bread, often cooked with oil, egg or cheese. Because it is thin, several pieces can seem modest even though the starch adds up quickly. Count every piece.
Manakish. A flatbread topped with za'atar and olive oil, or with cheese. The topping does not offset the flour. Choose a small piece with eggs or vegetables rather than a whole manakish, and only after control improves.
Rich and sweet breads and breakfast dishes: avoid while diabetes is uncontrolled
Paratha. A layered flatbread made with refined flour and generous ghee or oil, popular across the UAE's South Asian communities. The fat may delay the glucose peak without removing it. Avoid it while diabetes is uncontrolled and choose a plain chapati instead; after control improves, keep it occasional.
Croissants and pastries. Rich, layered pastries made with refined flour and repeated layers of butter, sometimes filled with chocolate, cheese or sweet cream. The glucose rise may be delayed and prolonged. Avoid them while diabetes is uncontrolled; after control improves, treat them as occasional pastries, not everyday breads.
Chebab and balaleet. Chebab are Emirati pancakes usually served with date syrup, and balaleet is sweetened vermicelli topped with egg. Both combine refined starch with added sugar, making them among the least suitable choices. After control improves, keep them to a very small taste at an occasional celebration.
Khameer. A soft Emirati bread of refined flour, often lightly sweetened and flavoured with cardamom or saffron. It combines refined starch with added sweetness; keep portions small and infrequent even after control improves.
Guidance while diabetes remains uncontrolled
When HbA1c is 7% or higher, or daily readings remain above your agreed target, the safest practical approach is to avoid the rich and sweet breads (paratha, croissants, pastries, chebab, balaleet and khameer) and to pause or tightly limit khubz, regag and manakish. HbA1c below 7% is a commonly recommended goal for many nonpregnant adults, but it is not a universal definition of control. Age, risk of low blood sugar, pregnancy, kidney disease, other illnesses and treatment burden may require a different target set by your doctor.
Arabic coffee and plain tea are usually not the main glucose problem. The larger carbohydrate load usually comes from the bread, the dates served alongside, and sweetened drinks. Karak chai, sweetened mint tea, flavoured coffee drinks, sweetened laban, fresh fruit juices and Ramadan drinks such as Jallab, Vimto and Qamar al-Din can contain as much sugar as a dessert. Sugar in a drink is absorbed quickly, because there is little fibre, protein or fat to slow it. Adding sugar, or eating the bread with honey, date syrup, jam or sweet spreads, increases the glucose burden further. Dates are nutritious but rich in natural sugar: three or four on an empty stomach can cause a sharp rise, so limit them to one or two, eaten after a few nuts or at the end of a meal.
How to reintroduce a small portion after control improves
1.Do not eat the bread first on an empty stomach. Begin with protein, such as a boiled egg, shakshuka, a vegetable omelette made with little oil, labneh or white cheese.
2.Add plain yoghurt or labneh if desired. Plain unsweetened yoghurt or labneh can accompany the meal. It may make the meal more filling, but it does not make an unlimited bread portion safe.
3.Choose one bread and keep the portion visibly small. Because khubz, manakish and pastries vary greatly in size, half of one or one small piece is more sensible than automatically eating the whole thing. Do not combine bread with another large starch serving at the same meal.
4.Avoid sweet and fatty accompaniments. Do not add honey, date syrup, jam, sugar or butter.
5.Measure your own response. Use a CGM when available, or check before the meal and about two hours after starting it, according to your doctor's monitoring plan. A high-fat bread may cause a delayed rise, so the CGM trace over several hours can tell you more than a single early reading.
6.Walk after the meal when medically appropriate. See the walking advice below. Walking supports the plan; it does not make up for a large portion.
A practical breakfast example. Start with eggs, shakshuka or another protein food and, if desired, plain labneh with cucumber and tomato. If your glucose has reached its target, follow with half a small whole-wheat khubz or a small piece of za'atar manakish, with Arabic coffee or unsweetened tea. Enjoy one date rather than a handful, and avoid a second piece of bread simply because breakfast continues. Review your CGM response to decide whether the portion was right for you.
Eid, weddings and buffets
At Eid gatherings, weddings and hotel buffets, large platters of machboos, ouzi and biryani often arrive with bread, and it is natural to begin with rice and keep returning to it. For someone with diabetes, both the first bites and the total amount of rice and bread deserve attention. The serving order can remain traditional while you choose a different eating order: vegetables first, protein and plain yoghurt next, and rice last.
Rice and bread are central to many meals in the UAE and often take up the largest part of the plate. Repeated large portions of white rice and bread can therefore be an important, changeable contributor to high post-meal glucose and poor diabetes control. They are not the only cause of diabetes (weight, activity, heredity, medicines and the rest of the diet also matter), but their quantity and timing deserve special attention.
This suggested sequence applies general diabetes nutrition principles to Eid, wedding and buffet meals; it has not been tested as a specific plan. Menus and recipes vary between families, hotels and caterers.
What to eat and in what order
1.Vegetables first. Begin with fattoush, asking the kitchen to hold the fried bread, tabbouleh made mostly with parsley, a green salad, grilled vegetables or a vegetable dish such as okra. Take these before the rice and bread when possible. Potatoes, hummus eaten with bread and fried samboosa should count as starch, not as the vegetable starter.
2.Plain yoghurt and a modest protein portion next. Have some plain yoghurt or labneh, followed by a small portion of shish taouk, a mixed grill skewer, grilled fish or seafood, or lean lamb kofta. Choose pieces with less visible fat and little sauce. These foods can be eaten together; there is no required pause between them.
3.Eat rice last, in a small planned portion. After the vegetables, yoghurt and protein, take a small serving of machboos, biryani or rice with the remaining food, or one small piece of bread. Set your portion aside so you can judge the quantity, rather than taking fresh rice with every course. Do not assume that food left out at room temperature, especially in hot weather, is safe to eat or reheat.
4.Finish without another carbohydrate course. Choose water or Arabic coffee without sugar. If having dessert, take a small taste of luqaimat, kunafa, baklava or Umm Ali within your carbohydrate allowance rather than a full serving. These combine refined pastry or dough, butter or ghee and sugar syrup, so keep them for rare occasions, and enjoy one or two dates rather than a handful.
If vegetables are unavailable, start with a little plain yoghurt and a modest portion of the least fatty protein available, then add the small rice portion. If you take insulin at mealtime, do not delay eating while waiting for a preferred dish.
Eid and buffet dos and don'ts
Do choose a few dishes to enjoy in small portions. You do not need a serving of every dish on the buffet. Limit rich gravies and creamy sauces; creamy dips are not the same as plain yoghurt.
Do limit fried foods such as falafel and samboosa, fatty lamb and visible fat. These may have little carbohydrate yet still be rich in saturated fat and calories. A low early glucose reading does not make a rich meal heart-healthy, and a fatty meal can also cause a later glucose rise.
Don't treat a dish as a vegetable serving just because of its name. Fattoush with plenty of fried bread, fried aubergine and vegetable samboosa can be rich in fat or starch. Choose plainer vegetables when available.
Don't keep returning to the rice platter or bread basket, add fruit juice, soft drinks or sweetened laban, or treat an after-meal walk as permission to overeat. Continue your prescribed treatment, and if you use insulin, follow your agreed meal-timing and glucose-monitoring plan during a long Eid or wedding meal.
Hosts can help by serving salad, vegetables and plain yoghurt early, offering smaller rice portions and providing water or unsweetened drinks. Guests can then enjoy the celebration with choices that fit their health needs.
Eating out: let AI or a quick search help
Restaurant meals are often larger and richer than home cooking. Before you order, whether at a restaurant or through a delivery app, give an AI assistant on your phone the name of the restaurant and ask, for example:“I have type 2 diabetes. What should I order at [restaurant name] to avoid a large blood sugar spike?” You can also search a dish online with the question“Is [dish] good for diabetes?” Many chain restaurants post nutrition information, including carbohydrate content, on their websites.
Treat these answers as a helpful starting point rather than medical advice: AI tools can make mistakes, and menus and portion sizes change. If you use a CGM, check afterwards which choices caused the smallest glucose rise, and keep a note of the dishes that work best for you at your favourite restaurants in Dubai and across the UAE. At the table, apply the same order: start with a salad or vegetables, choose a protein-based main dish, skip or limit the bread basket, ask for sauces and dressings on the side, and take part of a large portion home.
Make the whole meal count
A useful starting point is to fill about half the plate with non-starchy vegetables, one quarter with protein, and one quarter with carbohydrate foods. When lentils or chickpeas supply the protein, remember their carbohydrate content when deciding how much rice or bread to add. Choose water or unsweetened drinks.
If you are physically able, begin a gentle 10- to 15-minute walk within 10–15 minutes of finishing your meal. Walking soon after eating helps reduce the post-meal glucose rise because active muscles take up glucose. A short walk after dinner is especially useful, and in the summer heat, walking indoors or in an air-conditioned mall works too. Treat this as a practical target, not a strict deadline, and adapt the pace and timing to your mobility, comfort and health.
Keep treatment individual
Meal order supports treatment; it does not replace it. Do not stop diabetes medicines because you have changed your diet. Eating less rice and bread can lower glucose quickly in people taking insulin or sulfonylureas such as glimepiride or gliclazide. Anyone taking these medicines should discuss substantial changes in carbohydrate intake or meal timing with their doctor before making them. If you plan to fast during Ramadan, see your doctor six to eight weeks beforehand to review your medicines. For some people, such as those who have recently had severe hypoglycaemia or diabetic ketoacidosis, guidelines advise against fasting altogether. At iftar, break the fast with water and one or two dates, in keeping with tradition, rather than a handful, then eat vegetables and protein before rice or bread.
Families can make these habits easier by serving vegetables generously and offering smaller first portions of rice and bread. Familiar dishes can remain at the table. Begin with vegetables, include nourishing protein foods, keep starch portions sensible, and build habits that you can maintain every day.
Sources
Food order and post-meal glucose: Shukla et al., Diabetes Care, 2015
Pre-meal almonds in prediabetes: Gulati et al., European Journal of Clinical Nutrition, 2023
Cooled and reheated rice: Sonia et al., Asia Pacific Journal of Clinical Nutrition, 2015
Walking after meals: Reynolds et al., Diabetologia, 2016
Yoghurt and glycaemic index: Wolever, Journal of Nutrition, 2017
Carbohydrates and individualised A1C targets: American Diabetes Association
Diabetes meal planning: CDC and NIDDK; refined grains: Harvard T.H. Chan School of Public Health
Leftovers and food safety: USDA Food Safety and Inspection Service
Disclaimer: My observations come from continuous glucose monitors, sensor patches worn on the arm that send readings to a mobile phone. Glucose may fall substantially after this dietary sequence; individual responses vary, and this is not a controlled trial. Patients taking insulin or medicines that can cause low blood sugar must coordinate with their treating physician about dose adjustment. During the early dietary change, monitor glucose frequently and do additional finger-stick tests, especially at bedtime, when the sensor shows a low or rapidly falling value, or when symptoms do not match the sensor reading. Do not change medication without guidance from your treating doctor.

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