No need to eat breakfast if you have type 2 diabetes, according to Swedish research. (Photo: Colourbox)

Diabetes advice: Go Mediterranean and skip breakfast

Swedish research offers unusual recommendations for diabetes patients: Skip breakfast and tuck into a large Mediterranean-style lunch instead.

While breakfast is commonly believed to be a crucial meal, breakfast might now be off the table – at least if you’ve got type 2 diabetes. Research from University has shown how skipping breakfast and indulging in a large Mediterranean-type lunch is just as beneficial for glucose levels as a low-fat diet.

The study explored how three different diets with the same total caloric intake – low-fat, low-carbohydrate and the so-called Mediterranean diet, respectively – affected the glucose levels, blood-lipids and certain hormones of 21 participants.

A cup of coffee for breakfast

The findings show that the Mediterranean diet, which consists of one cup of black coffee for breakfast followed by a large lunch of fish, olive oil and an optional glass of wine, did not lead to higher glucose levels than the low-fat diet.

”The large Mediterranean-style lunch meal induced similar postprandial (ie ‘after-meal’) glucose elevations as the low-fat meal despite almost double the amount of calories, due to a pronounced insulin increase,” the researchers concluded.

Fredrik Nyström. (Photo: Linköping University)

"This suggests that one meal is preferable to several lighter ones for people with diabetes," says Fredrik Nyström, Professor of Internal Medicine at Linköping University.

"It is odd how often a Mediterranean diet is recommended without noting that it usually excludes breakfast."

Avoiding the cortisol peak

“Traditional meal distributions in countries such as Greece, Portugal and Italy do not provide much calories, sometimes none at all, for breakfast. Instead, a large proportion of the calories are consumed at lunch, or in the evening,” the report points out.

Skipping breakfast can be a metabolic advantage since cortisol (which reduces the body's sensitivity to insulin) is at its peak release in the morning. If the main intake of calories is delayed till later in the day, the impact of insulin on glucose levels will be more pronounced.

Low-fat, low-carb and Mediterranean diets

As well as the Mediterranean diet, the study also looked at a low-fat diet providing (as recommended) 45-56 percent of the energy content from carbohydrates, and a low-carb diet consisting of more fat and less carbohydrates (16-25 energy percent).

The participants tested the three diets on three consecutive days, but in different order. A series of lab tests each day monitored their reaction to the diets.

"We found that a low-carb diet led to lower glucose levels compared to a low-fat diet, but somewhat higher levels of triglycerides," says co-author and doctor Hans Gulbrand.

Increased release of insulin

Even though the Mediterranean-style lunch contained almost twice as many calories as the low-fat lunch, it did not result in higher glucose levels – due to the increased release of insulin.

The researchers concluded that skipping breakfast and eating a big Mediterranean-style lunch thus might offer metabolic advantages to people with type 2 diabetes.

"Our findings merit a review of current dietary recommendations for diabetes patients, both when it comes to nutritional content and the structure of meals throughout the day,”  Nyström said.

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