Big Breakfast or No Breakfast for Type 2 Diabetes

2013-12-23 07:03
Breakfast and type 2 diabetes

People with type 2 diabetes who have been keeping up with the research on the importance of breakfast may be confused right now. That’s because a new study says a big breakfast may be beneficial for weight and glycemic control, although previous recent research suggested no breakfast may be the way to go.

Which study is right? As the saying goes, the devil’s in the details.

Big breakfast study
First let’s look at the new study and what the investigators discovered about a big breakfast versus a small breakfast. Fifty-nine overweight or obese adults (21 men) with type 2 diabetes participated in the randomized, controlled trial.

Read about breakfast and weight gain

During a three-month period, half of the participants ate a big breakfast every day. That meal was high in protein and fat and provided 33 percent of the daily calorie intake.

The other group ate a high-carbohydrate breakfast that provided 12.5 percent of their daily caloric intake. Body weight, glycemic control, and metabolic factors were measured and recorded for all of the participants.

At the end of the three months, here’s what the investigators discovered:

  • Weight loss between the two groups was similar
  • Individuals who ate a big breakfast showed a greater decline in hemoglobin A1c (HbA1c) levels; that is 4.62% vs 1.46%
  • Big breakfast eaters also had a greater decline in systolic blood pressure when compared with the small breakfast eaters; that is, 9.58 mmHg vs 2.43 mmHg
  • The need for antidiabetes medication declined in 31 percent of the big breakfast eaters compared with 0 percent in the other group
  • An increase in antidiabetes medication was seen in 16.7 percent of small breakfast eaters compared with 3.4% in the big breakfast group
  • Participants in the big breakfast group had greater improvements in fasting glucose levels than did those in the small breakfast group

Read about a healthy breakfast

Based on the findings of this small study, the authors concluded that making this simple dietary change of “enriching breakfast with energy as protein and fat appears to confer metabolic benefits and might be a useful alternative” for managing type 2 diabetes. They also emphasized that “further research is required to confirm and clarify the mechanisms by which this relatively simple diet approach enhances satiety, leads to better glycemic outcomes compared to a more conventional dietary approach.”

What about no breakfast?
You may remember another study published recently in Diabetologia that involved comparing three dietary approaches:

  • Low-fat diet in which individuals consumed 45 to 56 percent of calories from carbs at breakfast and lunch combined
  • Low-carb diet in which they ate 16 to 24 percent of calories from carbs at breakfast and lunch combined
  • A Mediterranean diet with no breakfast and 32 to 35 percent of calories from carbs consumed at lunch only, with the same amount of calories as the other two eating plans

Read about type 2 diabetes and nuts

In this study, which included only 19 participants, the researchers found that skipping breakfast resulted in a significant rise in insulin levels following lunch and that this increase “was large enough to keep glucose excursions to be similar as during the low-fat diet containing much less calories at this single meal.” They then suggested that their findings indicated “that it is favorable to have a large meal instead of several smaller meals when you have diabetes.”

So what’s the answer: should you eat a big breakfast, small breakfast, or no breakfast if you have type 2 diabetes?

And the answer is…
It depends on the individual. As the latter study’s lead investigator, Professor Fredrik Nystrom, explained, their findings “give reason to reconsider both nutritional composition and meal arrangements for patients with diabetes.”

What works for one person may not be beneficial for another because no two people with type 2 diabetes are alike. Numerous factors such as body weight, level of exercise, physical limitations, use of diabetes medications, presence of other health problems, stress management, and dietary habits must be taken into consideration.

Read about diabetes educators

In other words, you need to talk with a diabetes professional about your personal goals, your current management program, and what changes you can make to meet those goals. Modifying your eating habits, including breakfast, may or may not be something that will improve your blood glucose levels and overall control of type 2 diabetes.

References
Rabinovitz HR et al. Big breakfast rich in protein and fat improves glycemic control in type 2 diabetes. Obesity (Silver Spring) 2013 Oct 20. Epub ahead of print
Rossi M et al Mediterranean diet and glycaemic load in relation to incidence of type 2 diabetes: results from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC). Diabetologia 2013 Nov; 56(11): 2405-13

Image: Morguefile

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