Skipping Breakfast: Bad Idea for People With Type 2 Diabetes

With commentary by Daniela Jakubowicz, MD, professor, Diabetes Unit, E. Wolfson Medical Center, Tel Aviv University and Tel Aviv Medical Center.

Breakfast, often called the most important meal of the day, may be especially crucial if you have type 2 diabetes, new research suggests.

"It is quite remarkable that, in our study in type 2 diabetes individuals, the omission of breakfast was associated with a significant increase in all-day blood sugar spikes," says Daniela Jakubowicz, M.D., a professor in the diabetes unit at the E. Wolfson Medical Center, Tel Aviv University and Tel Aviv Medical Center.

egg white omletteSkipping breakfast increased blood sugar levels after both lunch and dinner, she found. In the study, she evaluated 22 patients with type 2 diabetes who had been diagnosed about 8 years earlier. Their average age was about 57. Ten managed their condition with diet, and the other 12 controlled their blood sugar by both diet and metformin. Their average body mass index or BMI was 28, considered overweight but not obese.

Evaluations were done on two different days. On one, the men and women ate lunch and dinner at specific times. On another day, they ate all three meals, again at specific times. The meals were the same—milk, tuna, bread and a chocolate breakfast bar. The researchers measured blood sugar levels after meals.

The rise in blood sugar levels was surprising, Dr. Jakubowicz says. The study is published in October in Diabetes Care and was published earlier online. "We found that participants experienced extraordinary glucose peaks of 268 mg/dl after lunch and 298 mg/dl after dinner on days they skipped breakfast," she says, "versus only 192 mg/dl, and 215 mg/dl after eating an identical lunch and dinner on days they ate breakfast." They measured after meals up to 3 hours after starting to eat. (According to the American Diabetes Association, those practicing tight control of their disease should aim for a blood sugar of less than 180 mg/dl 1-2 hours after eating.)

Put another way, on a day when the men and women skipped breakfast, lunchtime blood sugar levels were 37 percent higher then on the day they ate breakfast and they were 27 percent higher at dinner time.

"This means that reducing the amount of starch and sugars in lunch and dinner [in attempts to better control blood sugar] will have no effect on reducing elevated glucose levels if diabetic individuals also skip breakfast," she says.

Her bottom line? Even if you don't overeat at lunch and dinner after skipping breakfast, skipping the first meal of the day can cause ''major damage to the beta cell function."

While many researchers have studied the value of breakfast, this new study is valuable because if focused on those with diabetes, says Minisha Sood, MD, director of inpatient diabetes at Lenox Hill Hospital, New York. She reviewed the findings. The new study also looks at the entire day and the effect of skipping breakfast, which gives a more realistic view of the impact, Dr. Sood says.

She tells those with type 2 diabetes to eat breakfast and make it ''a balanced meal consisting of a reasonable ratio of lean protein, carbs and fat."  For instance? Try an egg white frittata sautéed in extra virgin olive oil with vegetables and a slice of multigrain toast, she says.

The new study findings may seem to conflict with other recent research finding that a fasting mimicking diet or FMD may slow aging and reduce the risk of chronic diseases, including diabetes. In one study, those who followed the FMD reduced their fasting blood sugar by more than 11 percent.

However, the fasting diet is not suggested for those on diabetes medications or on insulin. And that knocks out many people with type 2 diabetes, Dr. Sood says. "The vast majority are on medications," she said. "Probably 80 percent [are]."

Bottom line, according to the author of the new research? "In light of our study, we highly recommend that those with type 2 diabetes not skip breakfast," Dr. Jakubowicz says, ''because it causes major damage to the beta cell function and leads to high sugar levels, even if they don't overeat at lunch and dinner."

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