6) CONTROLLING WEIGHT
h) Timing of Meals
The bottom line on timing of meals for most but not all people with type 2 diabetes is to avoid eating more than once in any three hour period and to have one 11 to 12 hour period per day where no food is consumed (preferably while you sleep and either in the evening or in the morning). Beyond this rule, a person should simply do whatever works best with their body. Just as with carbohydrate control and a diet for losing weight, no one formula will work when it comes to timing of the food intake, everyone with type 2 diabetes is different.
Clear research into the timing and number of meals that is "best" for a person with type 2 diabetes is lacking. A person with diabetes wants to maintain a low blood glucose level of 80 to 110 (70 to 90 is preferred and is "normal' for a thin young healthy physically fit person). Research suggests that if a person with type 2 diabetes eats one or two hours after they have eaten another snack, their limited insulin response can get really out of whack and their blood glucose levels will start getting out of control. Eating every 3 hours should be the minimum time between eating, with 4 and 5 hours a goal. It is a valid point, especially if the person with diabetes is a continual snacker, eating constantly. The one constant of overweight individuals is that they get hungry frequently and they then eat frequently. If a person eats every four hours with a 12 hour fast every day, then they will eat only three meals a day with no snacks.
One person with diabetes did lose weight by eating very small portions of refined carbohydrates every two hours. But when asked what their blood glucose levels were they couldn't tell me as they hadn't even purchased a meter or educated themselves about blood glucose. My experience is that they probably had relatively constant but also relatively high blood glucose levels, not a healthy state for an individual with type 2 diabetes. Losing weight is important but let's not bury our head in the sand when the subject of blood sugar levels comes up. If the "three very small meals and three very small snacks" plan seems to be the best way a person has to satisfy their food cravings, we definitely recommend that the blood sugar be measured one and a half hours after eating each of these small meals and snacks. If the level keeps coming up more than 140, this might not be the ideal plan.
As a person with diabetes trying to lose weight they sometimes simply have to accept the fact that they will be hungry some part of the day. A person with diabetes must learn to ignore hunger pangs if they ate only one or two hours before. They should try drinking water to help the hunger pangs. They can eat SMALL AMOUNTS if they get really hungry, trying to maintain at least three hours between food inputs, trying to include some protein in the snack or meal, always eating it very slowly and never eating more than 20 to 40 grams of carbohydrate per meal. Some experts advise that, if someone doesn't get hungry, don't force themselves to eat. Other experts recommend religiously eating every four hours. There is just no meaningful statistically significant research we could find which backs up either position. No matter which way a person goes, it is very important, to track carbohydrates and calories and stop when the daily goal is reached.
Research has clearly shown that eating breakfast is beneficial to losing weight. The theory behind the "always eat breakfast" weight lose rule is that people respond poorly to being very hungry. And people without diabetes get very hungry in the morning. Unfortunately if any person is hungry it indicates their blood glucose is low, a desirable state for a person with type 2 diabetes. But some people respond to being overly hungry with overeating, and that is very bad for a person with type 2 diabetes. Now, if the morning meal of a person with type 2 diabetes is eaten without regard to the quantity of food or the amount of carbohydrates, the person with type 2 diabetes will simply eat too much. Because the person with type 2 diabetes has eaten too much carbohydrate at breakfast they can get a rebound effect where their blood glucose will go up too fast and too high. In individuals who still produce insulin, this leads to delayed overproduction of insulin and a rapid drop in blood glucose. This starts a rapid cycle of eating - satiation - hunger - eating - satiation - hunger - eating - satiation - hunger -…the hypoglycemic cycling. This cycle results in eating way too much over the span of a day. The ideal breakfast for anyone with diabetes is low in saturated fats, low in refined carbohydrates, and high in fiber. I.e. old fashioned oatmeal, beans or vegetables. We don't recommend eating only protein for breakfast as this will initiate an insulin output from the pancreas of most people with type 2 diabetes. This insulin output will have no blood sugar to feed on and will give a person low blood sugar and make them hungry again. This can start hypoglycemic cycling and result in weight gain. Protein should always be eaten with some carbohydrates at the main meal.
Research in the UK by Farshchi et al has shown a low glycemic breakfast to be beneficial both to dieting and to blood lipid chemistry.
"In a randomized crossover trial, 10 women [ ± SD body mass index (BMI; in kg/m2): 23.2 ± 1.4] underwent two 14-d eat breakfast or omit breakfast interventions separated by a 2-wk interval. In the eat breakfast period, subjects consumed breakfast cereal with 2%-fat milk before 0800 and a chocolate-covered cookie between 1030 and 1100. In the omit breakfast period, subjects consumed the cookie between 1030 and 1100 and the cereal and milk between 1200 and 1330. Subjects then consumed 4 additional meals with content similar to usual at predetermined times later in the day and recorded food intake on 3 days during each period. Fasting and posttest meal glucose, lipid, and insulin concentrations and resting energy expenditure were measured before and after each period.
Results: Reported energy intake was significantly lower in the eating breakfast period (P = 0.001), and resting energy expenditure did not differ significantly between the 2 periods. Omitting breakfast was associated with significantly higher fasting total and LDL cholesterol than was eating breakfast (3.14 and 3.43 mmol/L and 1.55 and 1.82 mmol/L, respectively; P = 0.001). The area under the curve of insulin response to the test meal was significantly lower after eating breakfast than after omitting breakfast (P < 0.01).
Conclusion: Omitting breakfast impairs fasting lipids and postprandial (after meal) insulin sensitivity and could lead to weight gain if the observed higher energy intake was sustained."
From a Berkeley study:
"This analysis provides evidence that skipping breakfast is not an effective way to manage weight. Eating cereal (ready-to-eat or cooked cereal) or quick breads for breakfast is associated with significantly lower body mass index compared to skipping breakfast or eating meats and/or eggs for breakfast."
Personally I find that eating vegetables and/or beans for breakfast gives me the best control. It gives me blood sugars which won't spike (like cereal) and insulin which won't spike (like protein). It might seem a little unusual to eat a bag of steamable mixed vegetables for breakfast but in China they eat fish soup for breakfast. So what? There is a lot of research showing that individuals who eat a breakfast lose weight faster than people who don't eat a breakfast. But the research subjects did not have type 2 diabetes. Again it is individualized, some people lose weight a lot faster if they skip breakfast and just drink coffee until noon. Then at noon they can eat a very controlled meal, where the carbohydrates are less than 30 grams (for instance tuna fish or 3 ounces of 55% fiber cereal). This is one of those things that are individualized responses, so try it both ways for a few weeks and see what happens. A lot depends on just how well disciplined a person is and whether or not a person is willing to feel hungry for a good portion of the day. It also obviously depends on what a person's pancreatic response is to glucose in the blood, how much insulin their pancreas can produce and how delayed is its response. If someone has type 2 diabetes and has the "dawn phenomenon", where blood sugar rises in the morning, then one might consider holding off on breakfast until the blood sugar comes down.
Another "rule" which is backed up by research is to never eat before bedtime. But then some individuals cannot go to sleep on an empty stomach and do just fine eating nothing till the mid afternoon and eating their major meal just before they go to bed, then waiting 12 hours before eating again. As we keep emphasizing, every individual with type 2 diabetes is different. Another interesting line of research keeps showing that people who sleep 5 to 6 hours per night will lose weight if they increase the amount of sleep to 8 hours per night. Supposedly this is because the person has more energy during the day and burns off more calories. An alternative theory is that chronic sleep deprivation can increase the levels of the hormone cortisol, the hormone ghrelin, appetite, and weight gain. Another theory is that chronic sleep deprivation increases the level of stress in an individual which is a known factor which increases appetite. Most experts recommend seven to nine hours. Irregardless of the mechanism, it is clearly important for anyone with type 2 diabetes to get at least seven hours of sleep per night.
One endocrinologist quoted by David Mendoza asked nine questions (my answers are in brackets):
1. Do you eat out on weekdays? [No]
2. Do you watch TV while eating? [No]
3. Do you skip breakfast? [Yes]
4. Do you eat processed foods at home? [Yes]
5. Do you drink sodas? [No]
6. Do you have an erratic sleep schedule? [Yes]
7. Do you have an erratic meal schedule? [Yes]
8. Do you do comfort/stress eating? [No]
9. Do you not eat mixed meals? [Yes]
Then, she suggests, we eliminate one of them that we do for the next five weeks
10. A tenth question might be, do you eat anything after dinner? [Yes]
I tried this. #1, #2, #5 and #8 I don't do anyhow, so I started eating on a regular schedule (#7) which included vegetables for breakfast (#3) with no processed food (#4). I lost 20 pounds, not bad.......
Insulin production is actually begun before the glucose level in the blood begins to rise. Insulin production appears to begin when an individual chews food (this varies considerably between individuals). When a person thinks about or chews a small amount of food and spits it out, their insulin level typically will rise about ten minutes later, if their pancreas is producing insulin. This is an interesting point that is often overlooked. If one eats very slowly, with a small amount of food eaten fifteen minutes before the main meal, the insulin response can be timed to coincide with the glucose absorption. So a person with diabetes who still produces insulin should eat the initial portion of their meals very slowly.
Ingestion of protein has been shown to raise insulin production rate without raising the blood glucose level. So a small amount of protein eaten fifteen minutes before every meal is very beneficial to individuals who are not injecting insulin (i.e. their pancreas still produces insulin). By the same token, if a person with type 2 diabetes eats some protein and doesn't eat a small amount of carbohydrate within half an hour, it is conceivable that a case of the "shakes" and hypoglycemia (too low of blood glucose) could result, especially if the person with diabetes is exercising. Eating only protein before a heavy duty work out is not a good idea for a person with type 2 diabetes. It is possible to become very disoriented and wobbly, to the point of being a danger if you are driving. If the individual with type 2 diabetes is on insulin, unconsciousness, coma and death can result.
Current Chapter: 6) CONTROLLING WEIGHT
a) Introduction
b) What is "Overweight"
c) The Endless Cycles of an Overweight Person with Type 2 Diabetes
d) Food and Diet
e) Food "Rules"
f) USDA Food Pyramid
g) Adaptive Human Body
h) Timing of Meals
i) Serving Size
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