Published: Sep 26, 2013
By Ed Susman , Contributing Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

BARCELONA — A breakfast rich in protein — and lighter meals at night — appears to make sense for Type 2 diabetes patients trying to maintain glycemic control, researchers suggested here.

In a press briefing, Daniela Jakubowicz, MD, professor of medicine at Tel Aviv University, Israel, reported that patients in her small study who were randomly assigned a big breakfast strategy achieved in 3 months a reduction in HBA1c of 0.46%, compared with a 0.146% in the small-breakfast group (P=0.047).

Average fasting glucose decreased 14.51 mg/dL in the big breakfast group and decreased 4.91 mg/dL in the small breakfast group (P=0.011), she said at the annual meeting of the European Association for the Study of Diabetes.

Jakubowicz, the author of the 2009 book, “The Big Breakfast Diet“, and colleagues screened 150 patients to identify 80 eligible patients, but due to transportation difficulties or lack of interest in participating in the trial, the team eventually assigned 29 individuals to the big-breakfast diet and 30 individuals to the small-breakfast diet. By the end of the 3-month trial, 23 individuals in each group had completed the program. There were 9 men and 14 women in the big-breakfast group and 6 men and 17 women in the small-breakfast group.

Patients in the big-breakfast group were instructed to consume 33% of their daily calories in their morning meal — that included up to 30% protein, up to 37% fat, and the rest in carbohydrates. Patients in the small-breakfast group were instructed to consume 12.5% of their daily calories at breakfast — with up to 70% in the form of carbohydrates.

Among the other results:

• By the end of the study, both groups had lost weight, an average of 2.43 kg in the big-breakfast group and an average of 1.86 kg in the small-breakfast group (P=0.35), a non-significant difference.
• Systolic blood pressure declined 9.58 mmHg in the big-breakfast group and 2.43 mmHg in the small-breakfast group (P=0.04).

“A simple dietary manipulation of the big breakfast diet rich in protein and fat appears to confer metabolic benefits compared to a conventional low-calorie diet in individuals with Type 2 diabetes,” Jakubowicz said.

Briefing moderator Andreas Pfeiffer, MD, professor of internal medicine, endocrinology and diabetology at the Charite University Hospital, Berlin, told MedPage Today, “What is important when you are a diabetic is how much insulin you need for the food that you eat, and clearly carbohydrates require the most insulin — and insulin is what is lacking in diabetes. Foods that are low in carbohydrates and high in good fat — which are plant fats — and protein usually do much better for glycemic control in diabetics than foods without.”

“In this study the Type 2 diabetics on the big breakfast had low carbohydrates and high fat and high protein, and they appeared to have better glycemic control,” Pfeiffer said. “Their argument was that you should eat in the morning a big breakfast and this is what many people are saying because it will reduce your craving for food.”

The large breakfast idea is not unique, he suggested. “There are a number of studies which are going in the same direction and which appear to reinforce and support that view,” he said. “So having a good breakfast in the morning and then a second meal in the afternoon and a little [meal] in the evening appears to be a good scheme.”

Pfeiffer cautioned, however, that the diet plan may not be ideal for everyone. “Having low carbohydrates certainly has advantages for diabetics who have no kidney problems,” he said. “High protein and kidney problems may be another topic.”

Full Story:  http://www.medpagetoday.com/MeetingCoverage/EASDEndo/41880