diabetes two meals per day
May 17, 2014

Two Meals More Effective For Treating, Controlling Type 2 Diabetics

April Flowers for redOrbit.com - Your Universe Online

The prevailing wisdom for those with Type 2 diabetes is to eat three to six small meals a day in order to keep blood glucose (BG) levels even, instead of spiking as it does with fewer, or more irregular, meals. A new study from the Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic, however, reveals that two large meals breakfast and lunch (with the same calorie count as the six smaller meals) are better for controlling weight and BG.

Type 2 diabetes, formerly known as adult onset diabetes, occurs when the body is unable to process insulin, the hormone that controls the amount of sugar in the bloodstream. At first, a Type 2 diabetic’s pancreas develops insulin resistance and creates too much insulin, then eventually quits making the hormone completely. The American Diabetes Association reports that over time, especially if left untreated, Type 2 diabetes can damage the eyes, kidneys, nerves or heart.

The research team, led by Dr. Hana Kahleová, recruited 29 men and 25 women for the study. All were treated with oral diabetes medications, between the ages of 30 and 70 years with a Body Mass Index (BMI) of 27-50 putting them in the overweight to obese category, according to the National Heart Lung and Blood Institute. The participants also had a Hemoglobin A1c (HbA1c) of 6-11 percent. The HbA1c test reveals the average level of a patient's BG over the previous 3 months, and allows a doctor to see how well the diabetes is being controlled.

The study subjects were put in one of two groups of 27 each, both of which were on a restricted calorie diet containing 500 calories less than the recommended daily amount. In the first group, they were given six small meals a day. The second group was given two large meals each day, breakfast and lunch. The crossover study had each group follow one of the plans for 12 weeks, then follow the second plan for a subsequent 12 weeks.

In both groups, the diets had the same macronutrient and calorie content. The researchers used a variety of methods and mathematical modeling to track liver fat content, insulin sensitivity and pancreatic beta cell function (the cells that produce insulin).

Dr. Kahleová said the results were "very pleasing," according to BBC News.

She told BBC's Pippa Stephens, "The patients were really afraid they would get hungry in the evening but feelings of hunger were lower as the patients ate until they were satisfied. But when they ate six times a day the meals were not leaving them feeling satisfied. It was quite surprising."

Although the researchers found that body weight decreased under both plans, the decrease was sharper for the group eating two meals (8.1 pounds) than for the group eating six meals a day (5.1 pounds). The same was true for fasting plasma glucose and C-peptide levels. For fasting glucagon, the hormone that converts glycogen to glucose, the two-meal group saw a decrease while the six-meal group increased. Both groups saw an increase in oral glucose insulin sensitivity (OGIS), although more for the two-meal group. The research team observed no adverse effects for either group.

The authors said, "Eating only breakfast and lunch reduced body weight, liver fat content, fasting plasma glucose, C-peptide and glucagon, and increased OGIS, more than the same caloric restriction split into six meals. These results suggest that, for type 2 diabetic patients on a calorie-restricted diet, eating larger breakfasts and lunches may be more beneficial than six smaller meals during the day."

"Novel therapeutic strategies should incorporate not only the energy and macronutrient content but also the frequency and timing of food. Further larger scale, long-term studies are essential before offering recommendations in terms of meal frequency."

Dr. Kahleova said that the findings have implications for those without diabetes who were trying to lose weight as well.

The study adds to existing evidence that eating fewer, larger meals a day could be more effective at managing the condition, Dr. Richard Elliot, research communications officer at Diabetes UK, told Stephens. "However, larger studies over longer periods of time will be needed to back up these findings before we would make changes to the dietary advice given to people with type 2 diabetes."

Elliot notes that to effectively manage Type 2 diabetes, it is vital for the patient to eat a healthy, balanced diet, continue being active, and maintain a healthy weight.

The findings were published in a recent issue of Diabetologia.