Modulating Glucose Tolerance With Dietary Tyrosine

Not Applicable

Completed

• Conditions: Glucose Tolerance
• Interventions: Dietary Supplement: Tyrosine (TYR) Supplementation

• Registration Number: NCT03872557
• Lead Sponsor: Columbia University

Brief Summary

Metabolic or Bariatric surgery is an effective treatment for type 2 diabetes mellitus (T2DM) diabetes associated with obesity. There remain some questions about the biochemical mechanism that drive how these surgeries work to reverse hyperglycemia. In the proposed human studies, the investigators will test the hypothesis that the amino acid tyrosine is a key metabolite in regulating blood sugar levels and that manipulation of the amount tyrosine supplied by nutrition is able to achieve some of the metabolic benefits seen in the early post-surgical period following bariatric surgery. The central hypothesis is that that the tyrosine content of the meal challenge affects post-prandial intestinal and plasma dopamine and levodopa and L-3,4-dihydroxyphenylalanine (L-DOPA) levels, which, in turn, impact β-cell insulin secretion and glucose excursions. The investigators now propose to characterize the possible effects of manipulating dopamine and L-DOPA levels in the gut and plasma on glucose tolerance, insulin secretion, and insulin sensitivity in healthy volunteers with a range of body mass indexes (BMIs).

Detailed Description

Several biochemical mechanisms explaining how Roux-en-Y Gastric Bypass (RYGB) provides an effective treatment for obesity associated type 2 diabetes mellitus (T2DM) and improves hyperglycemia independently of weight loss have been proposed. Two are of particular interest; a) the hindgut hypothesis suggesting that nutrient delivery to the distal intestine drives the production of "incretins" which enhance insulin secretion (e.g. glucagon-like peptide-1 (GLP-1)), and b) the foregut hypothesis, positing that foregut bypass reduces the secretion of factors (i.e. anti-incretins) that normally defend against hypoglycemia. The investigators have been actively investigating this topic and have developed a hypothesis based on past studies that they wish to test in a limited human clinical study. In addition, preclinical data suggest that there exists a gut-to-beta cell pathway, responsive to nutritional tyrosine, regulating insulin secretion, and this pathway provides a mechanism for the early postoperative improvements in hyperglycemia observed in RYGB.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study First Submitted: 2019-03-11
• Study First Submitted QC: 2019-03-11
• Study First Posted: 2019-03-13
• Study Start: 2019-08-07
• Primary Completion: 2020-01-24
• Study Completion: 2020-01-24
• Status Verified: 2021-04
• Last Update Submitted: 2021-04-30
• Last Update Posted: 2021-05-05

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 10

Inclusion Criteria

Not provided

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Exclusion Criteria

1. Any diabetes medication within previous three (3) months.
2. Fasting plasma Glucose (FPG) >126 mg/dl or HbA1c > 6.4%
3. Current use (or within 6 months) of antipsychotic, anti-anxiety, or antidepressant medications (e.g. monoamine oxidase (MAO) inhibitors, 5-Hydroxytryptophan (5HT) inhibitors, tricyclic antidepressants, L-DOPA), reserpine, β-2-receptor agonists (e.g., terbutaline), steroids, weight loss medication, anticoagulant medication, over-the-counter nutritional supplements other than standard vitamin and mineral supplements
4. History of Phenylketonuria or other inherited disorders of amino acid metabolism.
5. History of movement disorder such as Parkinson's disease or Huntington's disease
6. Cardiovascular, renal, pulmonary, gastrointestinal, migraines or other medical conditions deemed significant by investigators
7. History of/ or psychiatric illness such as major depression, bipolar disease, anxiety or schizophrenia.
8. History of bariatric surgery with the exception of gastric band if the band has been removed
9. Female of child-bearing age, currently pregnant, breastfeeding or not using a form of birth control.
10. Previous or current use of cocaine, methamphetamine, ecstasy (3-4 methylenedioxymethamphetamine (MDMA))
11. Current daily intake of caffeine >500 mg/day (>4-5 cups of coffee; >10 12-oz cans of soda)
12. Consumption of more than 1 alcoholic drink per day or smoking more than 5 cigarettes/day.
13. Systolic Blood Pressure (SBP) > 150 mmHg; Diastolic Blood Pressure (DBP) > 100 mmHg.
14. Recent history (in the past three months) of more than a 3% gain or loss in body wt.
15. Difficulty in swallowing capsules.
16. Concurrent use of antacids or proton pump inhibitors (e.g.,Prilosec Prevacid, dexilant, Aciphex, Protonix, Nexium, Vimovo, Zegerid)

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Tyrosine (TYR) depletion, then oral TYR	Tyrosine (TYR) Supplementation	TYR supplementation: Subjects will be directed to avoid consumption of L-DOPA and TYR enriched foods for 48 hours before oral glucose tolerance test (OGTT). On the evening prior to OGTT, subjects will substitute normal meal and snack for three prepackaged tyrosine-phenylalanine-free liquid meals. Visit 2. Placement of intravenous catheter for the collection of serial blood samples and an OGTT with supplementation with oral tyrosine supplement. To supplement the OGTT with Tyrosine, the contents of four (4) L-Tyrosine 500 mg capsule are given 45 minutes before the oral glucose solution is administered. The capsules are to be administered with less than eight ounces of water to minimize dilution of gastric acidity.

Primary Outcome Measures

Name	Time	Method
Plasma insulin concentration	Up to 120 minutes from baseline	Plasma insulin concentration versus time profile following glucose challenge define glucose tolerance
Plasma dopamine concentration	Up to 120 minutes from baseline	Plasma dopamine concentration versus time profile following glucose challenge may affect glucose tolerance
Plasma glucagon concentration	Up to 120 minutes from baseline	Plasma glucagon concentration versus time profile following glucose challenge impacts glucose tolerance
Whole blood glucose level	Up to 120 minutes from baseline	Glucose concentration versus time profile following glucose challenge define glucose tolerance
Plasma L-DOPA concentration	Up to 120 minutes from baseline	Plasma L-DOPA concentration versus time profile following glucose challenge may affect glucose tolerance
Plasma GLP-1 concentration	Up to 120 minutes from baseline	Plasma GLP-1 concentration versus time profile following glucose challenge impacts glucose tolerance
L-tyrosine concentration	Up to 120 minutes from baseline	Plasma L-tyrosine concentration versus time profile following glucose challenge may affect glucose tolerance

Trial Locations

Locations (1)

Columbia University Irving Medical Center; 🇺🇸 New York, New York, United States