Big Breakfast Beats Traditional 6-Meal Diabetes Diet

When you eat matters most when it comes to diet planning for people with type 2 diabetes.

It's all in the timing, according to researchers from Tel Aviv University who propose shifting the way you eat so you’re having the biggest meal of the day at breakfast and fewer calories for dinner,1 during a presentation at ENDO 2018, the 100th annual meeting of the Endocrine Society in Chicago, Illinois.

“When you eat matters much more than what you eat,” says Daniela Jakubowicz, MD, professor of medicine and a pediatric endocrinologist at the Wolfson Medical Center at Tel Aviv University in Israel, in sharing results of a study about the benefit of a high energy breakfast in people with type 2 diabetes who need insulin to help manage their blood sugar.

Move Calories to Earlier in the Day to Lose Weight

By flipping the amount of food you eat to earlier in the day—having 50% of your calories at breakfast, about 30% of your daily intake at lunch, and just 20% of your calories at dinner (some protein and vegetables but no starch)—participants have the ability to dramatically lessen the need for insulin and lose weight, in comparison to the typical diabetes-type diet in which food is consumed throughout the day.1

 

“We know that people who eat in the evening have a tendency to gain weight, which may be because of the natural rise in glucose that occurs throughout the day and is highest in the evening,”2 says Dr. Jakubowicz, based on earlier research. “Since this scenario typically leads to a need for more insulin, which in turn prompts weight to climb, the result is a vicious cycle of more insulin and increasing weight.”

The good news, say these researchers, is that it matters very little what you eat if you are stuck in this cycle, and the way out may be to shift the timing of your meals so you're having a high energy breakfast and consuming most of your calories by about 3 pm. This is far different than the usual way most people eat—having the biggest meal in the evening when the body is already winding down.2

“This is a useful, non-pharmacologic treatment for anyone who requires insulin to manage their type 2 diabetes,” she tells EndocrineWeb, “Focusing on your meal schedule with tight restrictions on time but not on the composition of your diet will reduce feelings of hunger, lessen your need for insulin, and eliminate carbohydrate cravings.”

Eat During the Most Active Daytime Hours  

Dr. Jakubowicz and her team studied 29 men and women, with an average age of 69 years, who had obesity and type 2 diabetes requiring insulin. Over three months, they were randomly assigned to follow a meal plan with the same number of calories (~1800 calories), but the timing varied:

  • Bdiet—3 meals daily with calories distributed as follows: a large breakfast (50% ); lunch (30% ), and dinner (20% of calories, no starches; some protein and lots of vegetables)
  • 6Mdiet—6 eating occasions (a traditional diabetes-type diet) with breakfast (20% of calories), lunch (25%), dinner (25%), and 3 snacks (10% each).

Here’s what might you expect by adopting a change in the way you time your meals to reflect an eating style similar to the Bdiet group:1

  • Significantly less need for insulin (20.5 units less daily vs. 2.2 units more in the 6Mdiet group), in as little as 2 weeks
  • Weight loss of ~11 pounds (versus 3-pound weight gain in the 6Mdiet group)
  • Drop in fasting glucose levels more than twice a much as the 6Mdiet group
  • Decrease in mean glucose levels during sleep 

“To reduce your need for insulin, improve your glucose control, and even see your weight drop, you will want to be prepared to make this an almost everyday routine,” senior study author, Zohar Landau, MD, a pediatric endocrinologist at Wolfson Medical Center told EndocrineWeb, “and, by making this change, you will see a drop in your [insulin] medication, your body weight, and you will have better glucose control.”

A diet with the same level of calories but a change in meal timing and frequency has a pivotal role to help patients improve their type 2 diabetes,says Dr. Jakubowicz.

Obesity Experts Weighs In

From this study, while maintaining the same caloric intake, in this case 1600 calories a day, the differences for patients who consumed most of their calories earlier in the day was significant, says J. Michael Gonzalez-Campoy, MD, PhD, FACE,  medical director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology in Eagan, Minnesota.

"Clearly, there is a lesson here," Dr. Mike tells EndocrineWeb," For people with obesity and type 2 diabetes mellitus, there is more to it than total daily caloric intake to optimize the meal plan.  This is strong encouragement to do away with snacking, and to plan three good meals a day with the biggest one early in the day."

Now we need to understand why stacking most calories earlier in the day seems to make such as difference. "Why this observation holds true needs to be addressed," he says.

The authors had no financial disclosures.

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