Three regular meals a day is best in T2DM

 

CHICAGO – Spreading calories out over three regular meals a day, instead of six small ones, helps patients with type 2 diabetes lose weight and better control their blood glucose, especially when breakfast is the main meal of the day, according to Israeli investigators.

Too often, obese type 2 patients end up on a treadmill of ever-increasing insulin doses that lead, in turn, to more weight gain and still more insulin, plus greater risk of diabetic complications. “To break this vicious cycle, we need to better control diabetes with less insulin,” said lead investigator Daniela Jakubowicz, MD, an endocrinologist at the Wolfson Medical Center at Tel Aviv University.

The team had a hunch that meal-timing would help, so they randomized 19 obese, uncontrolled type 2 patients to three meals a day, and 18 to six meals. The overall calories were the same in each arm: 1,500-1,800 per day.

 

Those in the three-meal (3m) group took 50% of their calories at breakfast, mostly from carbohydrates and protein, and consumed by 9:30 a.m. One-third of their calories were consumed at lunch, and the final 17% at dinner, where carbohydrates were not allowed. Between-meal snacking on vegetables was allowed. The six-meal (6m) group took 20%, 25%, and 25% of their calories at breakfast, lunch, and dinner, plus three snacks each consisting of 10% of their daily caloric intake. The study included a few more men than women, and insulin was titrated biweekly in the two groups as needed.

The groups were statistically identical at baseline, with a mean age of about 70 years, a 20-year or so history of type 2 diabetes, and a mean body mass index (BMI) of just under 33 kg/m². However, at the end of 3 months, the 3m group was doing much better.They had lost a mean of 5.4 kg at that point and reduced their BMI by a mean of 1.9 kg/m² and their HbA1c 1.2%. The 6m group, meanwhile, gained a mean of 0.26 kg, increased their BMI 0.1 kg/m², and dropped their HbA1c only 0.2%. Both groups started with a mean HbA1c of around 8%.

Hunger and craving scores improved in the 3m group, as well, and their total daily insulin dose dropped 27 units from a baseline of 74 units; 6m subjects went up 5 units/day, from a baseline of 71 units. The findings were all statistically significant.

In short, the 3m is “more effective than the traditional diet with six small meals evenly distributed along the day, for weight loss, overall glycemia, HbA1c, appetite, and for the reduction of insulin requirements. Therefore, the three-meal schedule with a high-energy breakfast “should be a strategy to improve diabetes control and outcome,” Dr. Jakubowicz said at the annual meeting of the Endocrine Society.

 

The findings caught the attention of her audience. One endocrinologist said that “patients always ask me about doing six small meals a day.”

Most of the mean blood glucose reduction found in the 3m group happened after only 14 days on the diet, suggesting an improvement in hepatic insulin sensitivity. There was no correlation between glucose levels and weight; the beneficial effects of the 3m diet appeared independent of weight loss.
Those benefits instead might attributable to effects on “clock genes,” which control the circadian oscillation of gene expression. The investigators are looking into the matter further. Two meals per day also has been shown to help in type 2, but the investigators preferred the three-meal approach because it’s more in line with how people actually live.

The funding source was not reported. Dr. Jakubowicz, author of “The Big Breakfast Diet” (Workman Publishing Co., 2009), had no other disclosures. The other investigators had no disclosures.

aotto@frontlinemedcom.com

SOURCE: Jakubowicz D et al. ENDO 2018, Abstract OR05-2.

 

CHICAGO – Spreading calories out over three regular meals a day, instead of six small ones, helps patients with type 2 diabetes lose weight and better control their blood glucose, especially when breakfast is the main meal of the day, according to Israeli investigators.

Too often, obese type 2 patients end up on a treadmill of ever-increasing insulin doses that lead, in turn, to more weight gain and still more insulin, plus greater risk of diabetic complications. “To break this vicious cycle, we need to better control diabetes with less insulin,” said lead investigator Daniela Jakubowicz, MD, an endocrinologist at the Wolfson Medical Center at Tel Aviv University.

The team had a hunch that meal-timing would help, so they randomized 19 obese, uncontrolled type 2 patients to three meals a day, and 18 to six meals. The overall calories were the same in each arm: 1,500-1,800 per day.

 

Those in the three-meal (3m) group took 50% of their calories at breakfast, mostly from carbohydrates and protein, and consumed by 9:30 a.m. One-third of their calories were consumed at lunch, and the final 17% at dinner, where carbohydrates were not allowed. Between-meal snacking on vegetables was allowed. The six-meal (6m) group took 20%, 25%, and 25% of their calories at breakfast, lunch, and dinner, plus three snacks each consisting of 10% of their daily caloric intake. The study included a few more men than women, and insulin was titrated biweekly in the two groups as needed.

The groups were statistically identical at baseline, with a mean age of about 70 years, a 20-year or so history of type 2 diabetes, and a mean body mass index (BMI) of just under 33 kg/m². However, at the end of 3 months, the 3m group was doing much better.They had lost a mean of 5.4 kg at that point and reduced their BMI by a mean of 1.9 kg/m² and their HbA1c 1.2%. The 6m group, meanwhile, gained a mean of 0.26 kg, increased their BMI 0.1 kg/m², and dropped their HbA1c only 0.2%. Both groups started with a mean HbA1c of around 8%.

Hunger and craving scores improved in the 3m group, as well, and their total daily insulin dose dropped 27 units from a baseline of 74 units; 6m subjects went up 5 units/day, from a baseline of 71 units. The findings were all statistically significant.

In short, the 3m is “more effective than the traditional diet with six small meals evenly distributed along the day, for weight loss, overall glycemia, HbA1c, appetite, and for the reduction of insulin requirements. Therefore, the three-meal schedule with a high-energy breakfast “should be a strategy to improve diabetes control and outcome,” Dr. Jakubowicz said at the annual meeting of the Endocrine Society.

 

The findings caught the attention of her audience. One endocrinologist said that “patients always ask me about doing six small meals a day.”

Most of the mean blood glucose reduction found in the 3m group happened after only 14 days on the diet, suggesting an improvement in hepatic insulin sensitivity. There was no correlation between glucose levels and weight; the beneficial effects of the 3m diet appeared independent of weight loss.
Those benefits instead might attributable to effects on “clock genes,” which control the circadian oscillation of gene expression. The investigators are looking into the matter further. Two meals per day also has been shown to help in type 2, but the investigators preferred the three-meal approach because it’s more in line with how people actually live.

The funding source was not reported. Dr. Jakubowicz, author of “The Big Breakfast Diet” (Workman Publishing Co., 2009), had no other disclosures. The other investigators had no disclosures.

aotto@frontlinemedcom.com

SOURCE: Jakubowicz D et al. ENDO 2018, Abstract OR05-2.

 

CHICAGO – Spreading calories out over three regular meals a day, instead of six small ones, helps patients with type 2 diabetes lose weight and better control their blood glucose, especially when breakfast is the main meal of the day, according to Israeli investigators.

Too often, obese type 2 patients end up on a treadmill of ever-increasing insulin doses that lead, in turn, to more weight gain and still more insulin, plus greater risk of diabetic complications. “To break this vicious cycle, we need to better control diabetes with less insulin,” said lead investigator Daniela Jakubowicz, MD, an endocrinologist at the Wolfson Medical Center at Tel Aviv University.

The team had a hunch that meal-timing would help, so they randomized 19 obese, uncontrolled type 2 patients to three meals a day, and 18 to six meals. The overall calories were the same in each arm: 1,500-1,800 per day.

 

Those in the three-meal (3m) group took 50% of their calories at breakfast, mostly from carbohydrates and protein, and consumed by 9:30 a.m. One-third of their calories were consumed at lunch, and the final 17% at dinner, where carbohydrates were not allowed. Between-meal snacking on vegetables was allowed. The six-meal (6m) group took 20%, 25%, and 25% of their calories at breakfast, lunch, and dinner, plus three snacks each consisting of 10% of their daily caloric intake. The study included a few more men than women, and insulin was titrated biweekly in the two groups as needed.

The groups were statistically identical at baseline, with a mean age of about 70 years, a 20-year or so history of type 2 diabetes, and a mean body mass index (BMI) of just under 33 kg/m². However, at the end of 3 months, the 3m group was doing much better.They had lost a mean of 5.4 kg at that point and reduced their BMI by a mean of 1.9 kg/m² and their HbA1c 1.2%. The 6m group, meanwhile, gained a mean of 0.26 kg, increased their BMI 0.1 kg/m², and dropped their HbA1c only 0.2%. Both groups started with a mean HbA1c of around 8%.

Hunger and craving scores improved in the 3m group, as well, and their total daily insulin dose dropped 27 units from a baseline of 74 units; 6m subjects went up 5 units/day, from a baseline of 71 units. The findings were all statistically significant.

In short, the 3m is “more effective than the traditional diet with six small meals evenly distributed along the day, for weight loss, overall glycemia, HbA1c, appetite, and for the reduction of insulin requirements. Therefore, the three-meal schedule with a high-energy breakfast “should be a strategy to improve diabetes control and outcome,” Dr. Jakubowicz said at the annual meeting of the Endocrine Society.

 

The findings caught the attention of her audience. One endocrinologist said that “patients always ask me about doing six small meals a day.”

Most of the mean blood glucose reduction found in the 3m group happened after only 14 days on the diet, suggesting an improvement in hepatic insulin sensitivity. There was no correlation between glucose levels and weight; the beneficial effects of the 3m diet appeared independent of weight loss.
Those benefits instead might attributable to effects on “clock genes,” which control the circadian oscillation of gene expression. The investigators are looking into the matter further. Two meals per day also has been shown to help in type 2, but the investigators preferred the three-meal approach because it’s more in line with how people actually live.

The funding source was not reported. Dr. Jakubowicz, author of “The Big Breakfast Diet” (Workman Publishing Co., 2009), had no other disclosures. The other investigators had no disclosures.

aotto@frontlinemedcom.com

SOURCE: Jakubowicz D et al. ENDO 2018, Abstract OR05-2.