While perhaps counterintuitive, a big breakfast rich in protein and fat was found more effective in lowering blood sugar levels and blood pressure among type 2 diabetics than diet programs focused on small breakfasts.
Researchers from the Hebrew University of Jerusalem recently presented their findings at the European Association for the Study of Diabetes annual meeting in Barcelona on Wednesday. To carry out the study, the team split 59 people with type 2 diabetes into two groups, one eating a big breakfast and the other a small one, and found that the group eating a smaller breakfast tended to overindulge throughout the day.
"As the study progressed, we found that hunger scores increased significantly in the small breakfast group while satiety scores increased in the big breakfast group," study co-author Dr. Hadas Rabinovitz said in a news release from the association. "In addition, the big breakfast group reported a reduced urge to eat and a less preoccupation with food, while the small breakfast group had increased preoccupation with food and a greater urge to eat over time."
Setting Yourself Up For Success
This finding may seem patently obvious: people who eat more are less hungry. What makes the study noteworthy is the profound domino effect produced by enlarging one’s breakfast. Even though people often consider themselves in control of their own diets, managing temptations at the outset — in the mornings — has been shown far more effective at reducing daily consumption than concerted efforts throughout the day.
Diabetes is the leading cause of kidney failure, nontraumatic lower-limb amputations, and new cases of blindness among adults in the U.S., according to the Centers for Disease Control and Prevention. The disease arises when blood glucose levels, through a mixture of diet and genetics, reach a critically high threshold and eventually cause the pancreas to stop producing the hormone insulin, ultimately causing sugar to build up in the blood.
Blood glucose spikes are considered more dangerous than consistently high levels, as the heart must work harder to pump blood throughout the body.
One recent study from Tel Aviv University showed that participants who ate a breakfast of 700 calories, lunch of 500, and dinner of 200 enjoyed greater weight loss and lower glucose and triglyceride levels than the other group, whose caloric intake was reversed for each meal. The breakfast and dinner meal were the same for both groups.
Where both studies find common ground is in the participants’ reduced levels of ghrelin, also known as the “hunger hormone.” Ghrelin is produced in the stomach and opposes the hormone leptin, which signals to a person’s brain that he or she is full. It makes sense, then, that ghrelin levels would be lower in subjects who consumed a big breakfast than those who ate a smaller one. More critical differences were found in what comprised the breakfast, researchers noted.
The high-protein, high-fat content of the large breakfast wound up reducing blood pressure and blood sugar levels among participants, the team found, due mostly to the absence of carbohydrates. All carbs, whether they’re sugary fruits or starchy grains, are digested very quickly. This can create problems for diabetics who struggle with high blood glucose levels.
"We know when you eat carbohydrates, they can elevate blood sugar within 15 minutes to an hour," said Vandana Sheth, a spokeswoman for the Academy of Nutrition and Dietetics. "Protein takes longer to convert into glucose, as long as three hours, and not all of it goes to glucose. Some of it is used to repair muscle, for example. So it's not a direct effect — 100 percent of the carbs you eat convert to glucose, while only a portion of protein you eat converts to glucose."
Small, But Hopeful
The latest study saw one-third of big breakfast subjects, whose meal comprised roughly one-third their daily caloric intake, reduce their blood pressure medication over the 13-week study. Small breakfast subjects, whose first meal made up 12.5 percent of their total caloric intake, actually had to increase their medication in certain cases — up to 17 percent of the time.
While the study is admittedly small, both in breadth and duration, its findings have even skeptical researchers impressed.
"It's a virtually benign manipulation of the meal pattern," said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center, who also wondered why certain trial patients dropped out early. "I want to give it to my nutritionist to see what she thinks, and we may end up using it with several of our patients."