The Effects of Carbohydrate Timing on the Human Body

Melissa Trost and Kaydee Shaw

Nestle Foundation
April 18, 2016

April 18, 2016

Nestle Foundation
P.O. Box 581
Lausanne, Switzerland

Nestle Foundation Grant Committee,

We are writing you in regards to your pilot grant (PG) program and the opportunity to receive funds
towards our study. We wish to conduct a pilot study regarding the effects of carbohydrate timing on the
human body. There is a great need for this pilot study due to lack of research concerning carbohydrate
timing as well as common misconceptions about carbohydrates. We are aiming to study whether the
distribution timing of 60% of recommended daily carbohydrate intake in the a.m. vs p.m. can influence
body weight, body fat %, and blood lipid levels. Conducting this study would allow us to carry on
research to draw greater conclusions among a bigger sample size. We aim to make this a small pilot study
to test out our hypothesis and study design while still obtaining results that can impact science as we
know it today. Results from this study can be published and further made into a larger scale study and
changes can be made according to results.
We are asking for $2,000 from your foundation in order to carry out our study in combination with $5,000
institutional funds. Funds from your contributions from your foundation will help fund our all-inclusive
research retreat for our participants. This retreat will include all participants meals as well as housing and
medical testing for body weight, body fat %, and blood lipid markers.
We would greatly appreciate any funding from your foundation and we look forward to carrying out our
study in your name. This funding will allow us to change research and knowledge on carbohydrates.
Sincerely,
Kaydee Shaw and Melissa Trost
ABSTRACT

Our pilot study is designed with the intention of discovering the role of carbohydrate timing within
metabolism as it affects weight loss, body fat percentage, and blood lipid values. Specifically, we are
aiming at looking at the affects that the timing of consumption of carbohydrates has on the body. We can
conclude based on results of any body fat % change if the metabolic pathway of de novo lipogenesis has
occurred or not. This is a topic in nutrition and health today that is very controversial. There are many
misconceptions about carbohydrates and there are many contrasting research articles and findings
concerning the timing of consumption of them and how it affects body weight and body fat storage. We
will be performing a randomized control trial with 20 men and women (10 men, 10 women) of all
ethnicities and socioeconomic statuses. All participants of our study will reside in a fully controlled
retreat facility over the course of 6 weeks with both their diet and physical activity monitored and
accounted for. Half of the participants will be consuming 60% of their daily carbohydrate needs at dinner
(7:00 pm) and half of the participants will be consuming 60% of their daily carbohydrate needs at
breakfast (7:00 am). On the first day of weeks 1, 3, and 6, all participants will have certain biomarkers
tested. We will be using a BodPod machine to collect body weight and body fat percent and an Alere
Cholestech LDX Analyzer to collect blood lipid levels. On the first day of weeks 2, 3, 4, 5, and 6 we will
give each participant a questionnaire, which will ask questions concerning the adequacy and overall
adaptivity of their diets thus far.
Results from this study could potentially be useful in furthering current research already done on
carbohydrates. There is not enough current research that explains how the timing of consumption of this
macronutrient affects the body. Therefore, it is essential that additional and extensive research be done on
this topic so that we can gain a greater understanding and eventually be able to nutritionally counsel
individuals who may struggle with weight loss.

INTRODUCTION

We aim to discover the role of carbohydrate timing within metabolism as it effects weight loss, body fat
percentage, and blood lipid values. When distributing carbohydrates over the time of day we are able to
uncover the utilization of glucose within the body and see if de novo lipogenesis has occurred. This
allows us to make inferences based on whether or not carbohydrates should be consumed in the morning
versus in the evening, and in what amounts. We will be asking: Does the distribution of consumption of
60% of daily carbohydrate needs at dinner (7pm) vs. breakfast (7am) result in weight, body fat, and blood
lipid level increase in a randomized sample of 20 men and women in the U.S. in a 6 week randomized
control trial performed at a fully controlled retreat facility? By measuring body weight, body fat
percentage, as well as blood lipid markers, we are able to see the effects of carbohydrate timing
throughout the day on the body as an outcome over 6 weeks. Implications of this study will include the
ability to counsel individual on carbohydrate timing in regards to weight loss and overall blood lipid
improvement. This will allow populations to become healthier by not changing carbohydrate intake
amount but by changing the timing of their intake of carbohydrates. This randomized control trial will
allow us to continue carbohydrate research to discover the implications of carbohydrates on our diet when
looking at weight loss and overall health improvement.
LITERATURE REVIEW
INTRODUCTION
Carbohydrates are an integral part of a healthy and balanced diet. Along with other nutrients, they
facilitate energy into our cells for utilization and ultimately for survival. They provide the body with its
main source of fuel, carbohydrates can often be associated with weight gain (Wang, Patterson, Ang,
Emond, Shetty, & Arab 2014). On the other hand however, carbohydrates have been linked to weight loss
(Sofer, Eliraz, Madar & Frozy 2015). Exploring the timing in which high carbohydrate meals are
consumed may provide understanding of the critical function of this macronutrient in metabolism and
weight fluctuation. Carbohydrate timing differs from culture to culture and throughout history. The timing
of consumption can influence energy regulation and in time, obesity (Wang et al 2014). Weight and

overall health struggles lead us to consider key components encompassing carbohydrate research: the role
of carbohydrates at breakfast vs. dinner, low carbohydrates diets vs. high carbohydrate diets, and the
specific timing of the consumption of carbohydrates, all of which may have a significant impact on an
individuals biomarkers.

BREAKFAST VS. DINNER

BREAKFAST
The inclusion of breakfast into ones diet on a daily basis reduces obesity, blood glucose levels, and the
tendency to overeat (Schlundy, Hill, Sbrocco, Pope, & Sharp 1992; Keim, Loan, Horn, Barbieri &
Mayclin 1997). Many Americans choose to skip breakfast with reasoning to reduce overall caloric intake
for the day (Schlundy et al 1992). From reviewing previous studies conducted in obese women, we can
conclude that the intake of breakfast on a daily basis along with two other meals (lunch and dinner) (Kein
et al 1997) compared to the intake of two larger meals a day provided greater nutrient density as well as
overall diet adequacy (Bandin, Scheer, Luquw, Avila, Zamora, Madria, Gomeez & Garulet 2014). In a
twelve-week study, those consuming a high calorie breakfast lost significantly more weight than those
consuming a high calorie dinner (Wang et al 2014). The inclusion of breakfast reduced snacking impulses
throughout the day, as well as greater weight loss (Keim et al 1997).
DINNER
Obesity is accompanied by a reported decrease in satiety and higher levels of hunger caused primarily by
a low caloric intake at dinner (Schlundy et al 1997). Carbohydrates included at dinner improve satiety as
well as various anthropometric measures (Schlundy et al 1997). Greater weight loss and overall body fat
percentage has been shown in groups who eat high carbohydrate dinners (Sofer et al 2015). Individuals
who did not eat a high carbohydrate dinner had a reported increase in hunger levels and a greater urge to
overeat (Sofer et al 2015), and statistically significant decrease in triglycerides and total cholesterol was

identified in groups who ate high carbohydrate dinners (Sofer et al 2015). On the contrary, in the
Energetics Study preformed at UCLA, subjects who consumed

33% of their daily total calories in

the evening (after 5:00 p.m.) resulted in a 2x higher risk to become obese (Wang et al 2014).
Breakfast and dinner have been beneficial to health, however further research is needed on the importance
of these two meals, regarding the effect that the carbohydrate content may have on the body.

LOW CARBOHYDRATES VS. HIGH CARBOHYDRATES

LOW CARBOHYDRATES
A low carbohydrate diet provides the greatest amount of short-term weight loss (Faster, Wyatt, Hill,
Makris, & Rosenbaum 2010). A low carbohydrate diet can improve lipid panels over a two-year period,
although weight loss was the primary outcome in this randomized study (Foster et al 2010). Although a
low carbohydrate diet may prove to be beneficial in the short-term, it may not be healthy because
according to the Academy of Nutrition and Dietetics, carbohydrates need to make up 45-60% of ones
daily caloric intake (AND 2015).
HIGH CARBOHYDRATE
Little research regarding the effects of carbohydrate rich diets pertaining to health biomarkers such as
lipid panels and overall weight change has been conducted. However, a study done with Pima Indians
showed that a high carbohydrate diet (65% of daily calories) reduced total cholesterol after a seven-week
period (Abbott, Swinburn, Ruotolo, Hara, Patti, Harper, Grundy, & Howard 1990). An impaired
mechanism in the rate of change from VLDL to IDL, was caused by the high carbohydrate diet (Abbott et
al 1990). Due to the impairment of this conversion, VLDL taken up by the liver was increased (Abbott et
al 1990). Further research needs to be done to understand the direct effects of a high carbohydrate diet in
a more diverse population spanning over a longer period of time.

SPECIFIC TIMING OF THE CONSUMPTION OF CARBOHYDRATES

Leptin is the hormone responsible for hunger and satiety, and at its lowest secretion levels during the day
(from 8:00 a.m. to 4:00 p.m.) versus the time in which secretion levels are at its peak (from 5:00 p.m. to
1:00 a.m.) (Sofer et al 2010). This implies that one may feel fuller faster from the time of 5:00 p.m. to
1:00 a.m. due to the increase of leptin in adipose tissue, and its release to the brain causing satiety cues to
be answered (Sofer et al 2010). This was seen in a study done by Sofer et al which resulted in greater
weight loss in participants who concentrated their carbohydrate consumption during the hours in which
leptin secretion was at its highest. When food is consumed at the wrong time it leads to weight gain,
although no extra calories were consumed (Bandin et al 2014). Carbohydrate timing also has been proven
to be useful in the refeeding after exercise showing that immediate consumption post exercise improves
insulin action as well as the utilization of carbohydrates (Steohens, Sautter, Holtz, Sharoff, Chipkin, &
Braun 2007). Eating late at night will lead to weight gain (Bandin et al 2014) The weight gain is due to
less utilization of the carbohydrates consumed during this late eating period (Bandin et al 2014).
Carbohydrate timing effect on the body also could be due to the rate of gastric empting being slower after
late meals versus morning meals (Garaulet, Gomez & Abellan 2014). A high fat diet has been shown to
disrupt circadian expression of metabolic factors and obesity, however timing of this diet can prevent
obesity (Gaurelt, Gomez, & Abellan 2014). Carbohydrate metabolism could be greatly influenced
revealing the impact of timing of carbohydrate metabolism. Therefore, the purpose of our study is to
attempt to unlock the key to understanding the critical role of this macronutrient in metabolism and
weight fluctuation.

PURPOSE

To discover the role of carbohydrate timing within metabolism as it effects weight loss, body fat
percentage, and blood lipid values.
OBJECTIVES
i.

To discover if carbohydrate distribution timing effects weight loss, body fat percentage, and

ii.

blood lipid values.

To discover if a diet composed of 60% carbohydrates effects weight loss, body fat percentage,

iii.

and blood lipid values.

To identify whether age, weight, or starting blood lipid values play a role in the utilization of
carbohydrates for energy.

HYPOTHESIS
We hypothesize that between the a.m. and p.m. group there will be no significant changes (p=0.05) on
values of weight, body fat percentage, and blood lipid values.
METHODS
Study is an analytical prospective pilot study.
Participants will be chosen based on volunteer basis. All ethnicities, SES, religion and gender will be
accepted. Exclusion criteria includes: age <18-50>, chronic diseases including metabolic syndrome, as
well as any food allergies and intolerances. All participants will be in a health retreat setting. All aspect of
diet and activity will be controlled, accounted for, and considered. Upon entry into our retreat facility,
participants will be instructed to arrive in the morning between 6 a.m. and 8 a.m. fasted for their
preliminary testing on site for one day approx. 3 hours. Participants will be instructed to arrive in one
communal location for testing. Participants will wait until their name is called for testing. Once called,
participants will go through the BodPod first, then following with blood lipid testing. All testing will be
done by trained staff. Data from preliminary testing will be immediately recorded into an electronic
spread sheet via iPad devices with specialized programming by the tester. Once blood lipid levels are

taken, participants will be free to go. Study will begin the following day. Data from preliminary testing
will then be analyzed and arranged to ensure control and experimental groups have similar participant
populations with coding for participants to ensure no bias. We will consider age, weight, and total
cholesterol in determining groups. Control and experimental groups will then be assigned double blind
and with coding numbers instead of names. Participants will be called and told to arrive at set location
depending on whether they are control or experiment. Participants are not allowed to contact each other.
Participants will arrive at 6 a.m. the following day to get room assignments as well as a debriefing on
what type of meals to expect. Study will carry on for 2 weeks and 6 days. On the first day of the 3 rd week,
participants will be individually called down at 7 a.m., 3 at a time to do testing until all testing is
complete. There will be 1 testing station, with the a.m. group being tested first followed by the p.m.
group. A trained staff member will accompany each station. Once participants have completed testing
they are handed a questionnaire and asked to fill it out. Once filled out, participants are free to go back
into the unit. Once again data will be immediately entered into an iPad program to ensure no data is lost.
Total testing time should take no longer than 45 min. Repeat testing procedure for week 4 and 6.
DATA ANALYSIS
All comparisons between control and experimental groups will be analyzed using a paired t-test. This test
will be performed to compare all values of total cholesterol, HDL, LDL, triglycerides, and body fat
percentage at weeks 1, 3 and 6 between participants own values. We will be using a paired t-test because
we are comparing one groups values against each other, which is dependent. A p-value of 0.05 will be
used due to human variability. All comparisons within one group will be analyzed using a standard t-test.
This test will be performed not only for averages, but also for values taken at week 1, 3, and 6 for all lab
values to compare the a.m. group vs. the p.m. group to determine effectiveness of this specific diet.

Data analyzed will be:

Control group starting weights vs ending weights

Experimental group starting weights vs ending weights

Control group starting body fat% vs ending body fat %
Experimental group starting body fat % vs ending body fat %
Control group staring total cholesterol vs ending total cholesterol
Experimental group starting cholesterol vs ending cholesterol
Control group starting weight vs experimental group starting weight
Control group starting body fat % vs experimental group starting body fat %
Control group starting total cholesterol vs experimental group staring cholesterol
Control group ending weight vs experimental group ending weight
Control group ending body fat % vs experimental group ending body fat %
Control group ending total cholesterol vs experimental group ending cholesterol.
EXPECTED RESULTS
We expect results to be non-significant (p<0.05). Based on previous research, low carbohydrate diets have
proven successful as well as high carbohydrate diets. We expect participants to lose weight if they are
consuming less calories than they normally would, despite recommended daily amount. We expect
participants to gain weight if they are consuming more calories than they normally would, despite
recommended daily amounts. We can conclude based on weight gain or loss as well as body fat % change
if de novo lipogenesis has occurred or not. Basal metabolic rate will be accounted for with BodPod
results and estimate calories will be given based off of that amount. We believe our hypothesis will be
supported due to the science of calories in vs. calories out.
LIMITATIONS
Due to our study being a pilot study, limitations should be considered. The first limitation is the
population size. Doing our study with 20 participants allows us to test our methods and study design as
well as detect if there is any statistical significance between control and experimental groups. The study
will be carried out in a research unit retreat where all food given by the kitchen will be accounted for.
Activity will be accounted for with BodPod calculations as normal activity levels. Participants will be

asked to take advantage of the retreats pool and gym to carry out normal daily activity. But, with this we
cannot control actual activity levels for every single participants. From participant selection, BMI will not
be considered. Actual participants may have varying BMIs. This must be accounted for when looking at
weight loss or weight gain, as well as body fat % and total cholesterol.

SUMMARY
In summary, we look forward to carrying out this study within the next 1-2 years. Upon approval of
funding from Nestle, we will begin preliminary work immediately. Involving 20 participants of many
SES, religions, and BMIs will allow us to draw greater conclusions from our results to apply them
towards a greater population. Upon analyzing results we can then draw conclusion about the metabolism
of carbohydrates and weight gain. We can conclude from our study whether de novo lipogenesis has
occurred and if so to what extent. Research on de novo lipogenesis is slim, so this will impact all future
studies on carbohydrates. Once our study has been completed and results are analyzed, we can then use
the information to plan a bigger study under the same Nestle Foundation funding. This will allow us to
test on a bigger, more varied population and allow for less statistical errors. We can use this study to draw
conclusions as well as test previous findings from pilot study.

APPENDICIES
BUDGET
A. PERSONNEL COSTS (TOTAL = $1,500)
a. 2 technicians which are trained to perform Cholestech analysis as well as Bodpod tests
b. 1 technician will be responsible for taking a blood sample for the Cholestech machine
and 1 will be responsible for running the Bodpod test. They will be responsible for
directly entering information into iPad soft wear provided.

c. Technicians will work 4, 8 hour days. Day 1 will be initial testing for all participants,
while following days will be testing in their assigned a.m. or p.m. group on weeks 1, 3,
and 6.
d. Technicians will be payed $10 an hour.
e. We will contract a foodservice provider to prepare meals on site. They will work full time
days at minimum wage (approx. $8/hr). Approx. 5 kitchen staff.

B. PROFESSIONAL AND TECHNICAL SERVICES AND CONTRACTS (TOTAL = $500)

a. Contract to use iPad software which will link to computer software

C. Equipment (Total = $2,500)

a. Equipment to be rented for the duration of the trial (6 wks.):
-Cholestech LDX Analyzer (1)
-Bodpod (1)
-iPads (2)
-Retreat facility (1)
-Kitchen and kitchen equipment
-Computers (2)
b. Cholestech and Bodpod will be used to measure biomarkers and anthropometric data
essential to trial outcome measurement. IPads will be used to collect this data upon
measurement to decrease human error and possible loss of data by technicians. The
metabolic unit facility will be used to house 100 participants for the full duration of the
trial. This allows maximum control over diet to increase data validity. Kitchen and
equipment will be needed to prepare participants meals by contracted kitchen staff.

D. Supplies (Total = $500)

a. Supplies to be used include:

-Copying paper/ink- $50
-Cholestech lancet and test strips- $200
-Internet usage- $250

E. Other Expenses (Total = $2,000)

a. List other costs along with a description of their relationship with the research project.
i. Indirect Costs.
No administrative overhead costs.

ii. In-kind contributions are gifts of goods or services instead of cash.

1. Along with housing, food, and multiple laboratory exams, participants
will be given a $100 visa gift card upon completion of the 6 week trial.

BUDGET TOTAL:

$7,000

Amount to be covered by Nestle Foundation: $2,000

INFORMED CONSENT
Date:
Patient name:
You are being asked to take part in a research study concerning how the timing of carbohydrate
consumption affects the human body in terms of body weight, body fat percentage, and blood lipid levels.
Please read this form carefully and ask any questions you may have before agreeing to take part in the
study.

The purpose of this study is to compare and contrast how consuming 60% of ones daily recommended
carbohydrates in the a.m. vs. the p.m. affects the overall biomarkers listed above.

Should you decide to participate, you will be attending an all-inclusive health and wellness retreat for a
total of six weeks. You will be placed into either a control group or an experimental group based upon
your preliminary test results. You will be named by a number code as to eliminate any sort of bias at any
given time. Once placed in a group, you will be given a room assignment and will be informed on what
type of meals to expect for the next six weeks. On the first day of weeks one, three, and six, your weight
and body fat percentage will be tested by a BodPod machine. On these same days, your blood lipid levels
will also be tested via the Alere Cholestech LDX Analyzer machine. Total testing time should take no
longer than forty-five minutes. In addition to testing your biomarkers, you will also be given a brief
questionnaire on the first day of weeks two, three, four, five, and six. These questionnaires will collect the
details concerning the adequacy and overall adaptivity of your diet thus far. The questionnaires will be
the same for each week.

Risks of the study may include hunger or satiety discomfort as you will be on a strict diet regimen.
However, the amount of food provided to you will be based off of a 2,000 calorie diet and will provide you
with all of the essential RDAs of nutrients. Benefits of this study include compensation of $100.00, meals
and living quarters fully paid for, as well as nutrition counseling based upon the tests that you will
undergo.

The records and results of this study will be kept confidential. In any report that we make public, we will
not include any information that will make it possible to identify you. Research records will be kept in a
locked file that only the research team will have access to.

Taking part in this study is completely voluntary, and you may choose to withdraw from the study at any
time and for whatever reason.

The researchers conducting this study are Melissa Trost and Kaydee Shaw. Please ask any questions you
have now. If you have questions or concerns later, you may contact Melissa Trost at
tros2258@vandals.uidaho.edu or contact Kaydee Shaw at shaw2226@vandals.uidaho.edu.

You will be given a copy of this form to keep for your records.

Statement of Consent:
I have read the above information, and have received answers to any questions I asked. I consent to take
part in this study.

Your Signature:____________________ Date:__________________

Your Name (printed):_______________________________________

SURVEY TO BE USED

Follow-Up Questionnaire on Carbohydrate Timing Study

Please circle one of the following options. Thank you for you participation.
1. How hungry are you immediately upon waking in the morning?
I am a little bit

I am

I am not

hungry, but I

moderately

hungry at all /

could go

hungry and

My stomach is
I am hungry

I am really

and will need

hungry and I

food soon

need food now!

growling for food

but I am not
Full

without food

want to eat
uncomfortable yet

for a while

soon

2. How hungry are you immediately before going to bed at night?

I am
I am so hungry
I am not really

moderately

hungry, but I

hungry and

am not feeling

would be

full either

happy eating

I am not

I am very
I am hungry

hungry at all /

that I am
hungry and I

and want to eat

Full

uncomfortable
would like

a small snack

and won't be able

another meal
to sleep until I eat

something

3. How would you describe your energy levels at 8:00 am?

I have no

I have a

I have a

moderate

moderate

amount of

amount of

I have so much

I have little
I have a high

energy that I

energy and am energy but can

energy but not energy and feel level of energy am bouncing off
very tired

still function
as much as I

better than I

usually do

usually do

the walls

4. How would you describe your energy levels at 2:00 pm?

I have no

I have a

I have a

moderate

moderate

amount of

amount of

I have so much

I have little
energy at all

I have a high

energy that I

energy but can

and am very

energy but not energy and feel level of energy am bouncing off
still function

tired

as much as I

better than I

usually do

usually do

the walls

5. How would you describe your energy levels at 8:00 pm?

I have no

I have a

I have a

moderate

moderate

amount of

amount of

I have so much

I have little
I have a high

energy that I

energy and am energy but can

energy but not energy and feel level of energy am bouncing off
very tired

still function
as much as I

better than I

usually do

usually do

6. How were your satiety/fullness levels after breakfast?

the walls

I was
I was not

I was a little bit

satiated at all

satiated

I was satiated

I was so satiated
I was very

moderately

and

that I was
satiated

satiated

comfortable

uncomfortable

7. How were your satiety/fullness levels after lunch?

I was
I was not

I was a little bit

satiated at all

satiated

I was satiated

I was so satiated
I was very

moderately

and

that I was
satiated

satiated

comfortable

uncomfortable

8. How were your satiety/fullness levels after dinner?

I was
I was not

I was a little bit

satiated at all

satiated

I was satiated

I was so satiated
I was very

moderately

and

that I was
satiated

satiated

comfortable

uncomfortable

9. Rate your overall satisfaction of the meals you were provided with (variety, taste, accessibility, etc.)
Very poor

Poor

Okay

Good

Very good

Excellent

10. How would you describe your overall well-being throughout this study?
Okay
Very poor

(sometimes

Good (mostly

happy,

happy, decent

Excellent (never
Very good

(depressed,

Poor (unhappy,

felt better, very

(happy, energy

miserable,

semi-hungry,

sometimes sad,

energy levels,

high energy
levels high,

hungry, low

little energy)

energy levels

not hungry

varied, hunger

often)

levels, never
rarely hungry)

energy)

levels varied)

went hungry)

REFRENCES
1. Abbott, Swinburn, Ruotolo, Hara, Patti, Harper, Grundy, & Howard (1990). Effect of a highcarbohydrate, low-saturated-fat diet on apolipoprotein B and triglyceride metabolism in Pima
Indians. The Journal of Clinical Investigation. 88(2): 642-650. doi: 10.1172/JCI114756
2. Bandin, Scheer, Luque, Avila, Zamora, Madris, Gomeez-Abellah & Garulet (2014). Meal timing
affects glucose tolerance, substrate oxidation and circadian-related variables: A randomized, cross
3.

over trial. International Journal of Obesity. 39, 828-853.

Foster, Wyatt, Hill, Makris, & Rosenbaum (2010). Weight and metabolic outcomes after 2 years on
a low-carbohydrate versus low-fat diet: a randomized trial. Annals of Internal Medicine 153: 147

157.
4. Garaulet, Gomez-Abellan (2014). Timing of Food Intake and obesity: A novel association. Journal
of Physiology and Behavior. 134: 44-50.
5. Keim, Van Loan, Horn, Barbieri & Mayclin, (1997). Weight loss in greater with consumption of
large morning meals and fat-free mass is preserved with large evening meals in women on a
controlled weight reduction regimen. American Society of Nutritional Sciences. 127: 75-82.
6. Schlundy, Hill, Sbrocco Pope, & Sharp, T (1992). The role of breakfast in the treatment of obesity: a
randomized control trial. American Journal of Clinical Nutrition. 55:645-51.
7. Sofer, Eliraz, Madar & Froy (2015). Metabolic effects of obesity: a review. World Journal of
Diabetes. 1, 76-88.
8. Softer, Eliraz, Madar, & Froy (2015). Concentrating carbohydrates before sleep improves feeding
regulation and metabolic inflammatory parameters in mice. Journal of Molecular and Cellular
Endocrinology. 414 (2015) 29-41. doi: 10.1016.06.032
9. Stephens, Sautter, Holtz, Sharoff, Chipkin, & Braun (2007). Effect of timing of energy and
carbohydrate replacement on post-exercise insulin action. Applied Physiology and Nutrition
Metabolism. 32(6):1139-47.
10. Stubbs, Prentice, & James (1997), Carbohydrates and Energy Balance. Annals of the New York
Academy of Sciences 819: 4469. doi: 10.1111/j.1749-6632.1997.tb51798.x

11. Wang, Patterson, Ang, Emond, Shetty & Arab (2014) Timing of energy intake during the day is
associated with risk of obesity in adults. Journal of Human Nutrition and Dietetics. (Suppl. 2) 255262 doi: 10.1111/jhn.12141