Diabetes Self-Management Blog

People with Type 2 diabetes are often advised to eat a calorie-controlled diet broken down into five or six small meals over the course of the day. But now a small new study from researchers in the Czech Republic suggests that eating those calories in two large meals each day may be better for controlling blood glucose levels and weight. Roughly 600,000 people in the Czech Republic and 25 million people in the United States have Type 2 diabetes.

Studies in animals have indicated that reducing the frequency of meals may extend lifespan and reduce the risk of chronic diseases, and observational trials in humans have suggested that eating more than three times a day may play a role in overweight and obesity. To clarify the relationship between eating frequency and glucose control and weight in people with Type 2 diabetes, researchers recruited 54 people (29 men and 25 women) to test the effects of two dietary regimens. The participants were all between 30 and 70 years old, overweight or obese, and being treated with oral diabetes medicines; their A1C levels (a measure of glucose control over the previous 2–3 months) ranged from 6% to 11.8%.

The study subjects were randomly assigned to one of two meal plans, one consisting of six small meals a day and the other consisting of two large meals (breakfast and lunch) a day. Both diets had the same nutrient and calorie content (on average, about 1700 calories a day — roughly 500 calories less than the daily recommended amount). All of the participants followed their assigned diet for 12 weeks, then switched to the alternate diet. Various health markers, including liver fat content, beta-cell function (the function of the insulin-producing cells of the pancreas), and insulin sensitivity, were measured during the course of the study.

At the conclusion of the study period, the researchers found that weight, liver fat content, fasting plasma glucose, and C-peptide levels (an indicator of insulin production) had decreased in both groups, but to a greater extent in those following the two-meal regimen. Additionally, levels of fasting plasma glucagon (a hormone that promotes glucose secretion by the liver) had fallen in those eating two meals a day but increased in those eating six meals a day.

“Mostly it has been recommended for people with Type 2 diabetes to eat five or six small meals a day, but in Western societies at least, it turns out that snacks are not healthy, they are high in sugar and fat. So a regimen of frequent eating hasn’t resulted in better control,” noted lead study author Hana Kahleová, MD.

In an interview with Medscape Medical News, the researchers suggested that the practical takeaway of the findings is that “three meals a day is enough; breakfast should be the largest meal of the day, and dinner may be light.”

“The old saying, ‘Eat breakfast like a king, lunch like a prince, and [dinner] like a pauper’ may indeed hold true,” observed Kahleová.

Because the trial involved only 54 people, larger, longer-term studies are needed to confirm the findings, the researchers note.

For more information, read the article “Breakfast Like a King: 2 Large Meals Benefit Diabetes” or see the study in the journal Diabetologia. And to learn more about maintaining blood glucose control, read “Managing Your Blood Glucose Ups and Downs” by pharmacist Stacy Griffin and certified diabetes educator Diane Ballard.

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Comments
  1. This finding is very disturbing. Not that IO don’t believe its validity but it throws everything that was told to me so far, out the window. I am all for the free distribution of information but having two totally opposite views on something that is a matter of life and death, literally, is very disturbing and upsetting.

    Posted by Mel |
  2. Hi Mel,

    Thank you for your comment. We do want to reiterate that this was a small study and that further research is required to determine whether its findings hold up. If you have a management routine that’s working for you, that’s fantastic and you should stick with it! And if your routine is not keeping your blood glucose levels well controlled, your doctor or diabetes educator should be your first point of contact for determining where changes might need to be made.

    Best,
    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  3. Dianne:

    Comments like this while well meant ignore some
    more serious issues.

    If your liver is working and signalling reasonably
    on the insulin in the blood: one can get away with very tight low glycemic diets and thoughts like 2 meals a day.

    My cgms data was most clear that for me with leaky liver and sloppy signalling, steps proposed here end up with sloppy and excess glucose swings due to liver bad performance.

    The study on small sample size jumps/leaps to conclusions that this is a universal approach many can safely implement! Au Contraire and drop that nonsense!

    Posted by jim snell |
  4. Thank for the information - this was indeed very helpful. It is very difficult to find time to eat five to six times each day, especially when you work or attend meetings on a regular basis. I find that eating two large healthy meals does help me to control my blood glucose better because I am more active during the day and need to take it easy and de-stress after a long day. The small study seems to reiterate what I have learned on my own. The same regimen does not work for every person, so it’s good to have an alternative that does work. Thanks again!

    Posted by Sonja |
  5. Eggs and coffee were staples for me. Then OH NO!! they’re bad for you. Now they good again. Pasta was good for you. Now it’s not. Americans weren’t obese until they started chowing on the carbs.The flip flopping on health happens all the time. Get used to it. That’s why I do what feels best. I also know that smoking benefits schizophrenics. Life and death — I still do what I think is best. Life’s too short to take all the screeching seriously.

    Posted by Martha |
  6. Wait until tomorrow and another study will come out. I eat three meals a day (breakfast, dinner andsupper) and if I ate just 2
    meals a day my blood sugar would really be out of wack and then I would question when to take meds.
    Seems all the articles in this issue are very questionable. I’m not going to start experimenting when I know what works for me. This is just so depressing to someone as old as I am.

    Posted by Ferne |
  7. I don’t know what kind of diabetes yall have but with mine, carbs are the enemy…period. The ADA says eat them. They couldn’t be more wrong. They must be in cahoots with the drug companies.

    I have no idea what planet the doctors or the ADA are from but when I got diabetes, I realized that I needed to test after every single food I ate to see what it did to ME not anyone else. I went through thousands of test strips and my doctor thought I was nuts. He said I should just test a few times a day. Really? Yeah, right. No. That’s just stupid advice. How on earth will I know what’s bad for me if I don’t see what it does to ME? I had to fire that man. He can screw up someone else.

    FORGET about what everyone else says!!! Test and see what’s good for YOU!!! TEST all the time!!! You have to take control of your diabetes. Listen to your body!!! TEST!! It’s the only thing that will tell you the truth!!!

    Posted by Tia |
  8. Sorry but that would not work for me. Things forever changing some one ideas or thoughts…geeze what is next? One meal a day. LOL. 5 meals work for me

    Posted by pat |
  9. wow - wonderful excellent excellent comments and response. I agree with those who echo the comment about “not another damm study!.

    Posted by jim snell |
  10. I’d like to see a study that compares people who claim to be morning people and those who claim to be night people. I am a night-owl, and am very rarely hungry in the morning, so for me to eat like a king in the morning would make me feel awful, unless I’ve been up for at least an hour or two. I am hungry in the evening, however, which according to some is the worst time to eat. I have a very difficult time fighting my true nature. I hoot with laughter at the folks who claim that you can reset your inner clock so you become a morning person–that’s a joke. I’d love to see a morning person adjust their inner clock so they’ll be able to stay up until 2 or 3 a.m. and sleep until 9 or 10 a.m. Two meals a day works just fine for me, but I’m not everyone, nor would I presume to tell everyone they have to be like me.

    Posted by Sally |
  11. Sally,

    I worked for 28 years on a night/evening schedule and loved it. From my teens onward I had considered myself a night person. I usually went to bed around 3am and woke at 11am. For the last 4 years I’ve been working 9-5. I’ve adjusted and now can rarely sleep past 7am and am asleep around 11:30pm. I’m sure that if it were required I would be able to readjust to that night schedule. My blood sugar numbers have been more consistent since the move to days (I was diagnosed about 4 months before the move to days, so there were still probably significant adjustments happening due to the diagnosis being so recent). Eating on a consistent schedule has helped to make that happen. It took me several months to acclimate to the schedule change, but overall it’s been good for me. I’m not sure I’d have believed anyone if they told me, say a few months before the schedule change, that I’d adapt to it so well in a reasonable amount of time.

    Posted by Murph |
  12. Personally, I believe there has to be more than one way to resolve a problem. While eating/grazing during the day may be great for some people…the two large meals a day may be the optimal way to go. I have, since childhood, been ravenous upon arising in the morning and can eat everything that is not nailed down until about 2 pm and require very little after that to keep me feeling comfortable. It is something I have just returned to since using the prescribed diet regimen by the diabetes educator is causing me to gain weight, although my A1C was staying in the good range.

    I find it exciting that there are potential solutions “out there” for those of us with the disease and it is quite possible like clothing - not always does “one size fit all”. Perhaps its is true with eating for health.

    Posted by Starla |
  13. Never mind this walking around the edge of the issue of 2 meals versus more; what about this latest comment in Wall Street Journal:

    Well, here we go with Wall Street Book Review today June 5, 2014 on a book by Nina Teicholz titled The Big Fat Surprise. The lead states The Worst Diet in US History..

    Regarding this low fat diets and crusade about saturated fats was preventing heart disease! ” What was left, as Ms Teicholz adumbrates, was a monstrous thought: What if the crusade against cholesterol had fed the spread of obesity by encouraging a population to retreat from the very foods that would have satiated its hunger more efficiently than the hallowed grains and fruits and vegetables of the great dietary pyramid? What if the low fat mantra had driven a population into feeling constantly hungry?
    What if you were better off eating meat, eggs, and dairy rather than a diet bloated in carbs and vegetable oils?”

    And my question is – why the explosion in type 2 disease since the 1960′s and no success treating it cheaply, easily, and simply. Most type 2 diabetics -30 years myself, finally got their mess under control by following a low carb diet , booting and controlling the grains and their products tightly,, with some dietary fats as well as using the Mediterranean diet approach?

    Posted by jim snell |

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