"Skipping breakfast could cause dangerous spikes"

Phlogiston

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http://www.diabetes.co.uk/news/2015/jul/skipping-breakfast-with-type-2-diabetes-could-cause-dangerous-spikes-in-blood-glucose-levels-93716047.html?utm_source=Communicator&utm_medium=Email&utm_content=Untitled20&utm_campaign=Should+I+eat+breakfast?&utm_dispatch ID=3447174&utm_email name=DCUK+-+4/8+-+T2

This article featured in one of the diabetes uk e-mails that I received today. Looks plausible enough, even if accompanied by a picture of the sort of high carb breakfasts I've had to give up on. Then I read the summary of the paper. Mrs P nearly called the ambulance as my blood pressure rose (note - hyperbole!).
The key bits.

The study involved 22 participants, each of whom had type 2 diabetes. The average age of the study group was 56.9 years old. Every participant ate the same diet for two days, which consisted of a balanced meal of milk, tuna, bread, and a chocolate bar. On the second day, however, the participants did not eat breakfast.

"We theorised that the omission of breakfast would not be healthy, but it was surprising to see such a high degree of deterioration of glucose metabolism only because the participants did not eat breakfast.

"For type 2 diabetic individuals, the omission of breakfast is associated with a significant increase in all-day blood sugar spikes and of HbA1c, which represents average blood glucose levels over the preceding three months."

The researchers observed huge blood glucose peaks of 14.9 following lunch, and 16.6 after dinner. After an identical lunch and dinner with breakfast on the first day, the participants peaked at 10.7 after lunch, and 11.9 after dinner.

The study argues that including breakfast as part of your daily diet is more important than the specific foods you eat. Following a low-carb diet - or any other diet for that matter - will apparently have little effect on blood glucose levels if breakfast is skipped.


The study had a small sample size.
Why was the duration of the experiment so short?
How can they call meals with no vegetables balanced meals?
Why are they feeding diabetics bread and chocolate?
Why did they only do the test over two days?
Are blood peaks of 10.7 and 11.9 good? (only compared to 14.9 and 16.6)
Did they test the skipping of breakfast on a low carb diet?
How can they draw conclusions about the benefits or otherwise of a low carb diet if they only test their victims on a high carb low micronutrient diet that may diabetics would consider unsuitable? If I ate this diet, I would expect to get ill.
Why is Diabetes UK publicising this unscientific stuff that would score low marks in a GCSE science exam, let alone a university assignment?
The strapline should be "You get spikes if you eat bread and chocolate - but you get even bigger spikes if you skip breakfast"
 
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uart

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Why did they only do the test over two days?

Agreed. It seems like the study could have been better designed.

For example, we don't know what changes (to the subjects) were happening over time due to the change in diet. At a very minimum I think the study should be repeated with the breakfast being skipped on DAY 1 instead of DAY 2 and see if that alters the result. Or at least have this variable randomized so that some subjects skipped breakfast on day one and others on day two.
 
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NoCrbs4Me

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A very silly study that doesn't add any new understanding, just misinformation. I think the word "balanced" should be banned from being used to describe a diet or meal. It's completely meaningless. In what possible way is a meal of "milk, tuna, bread, and a chocolate bar" balanced?
 
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Robbity

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I read this and couldn't believe my eyes when i saw what their balanced meal consisted of.

If I skip breakfast I'll occasionally have a liver dump and stay a bit high much of the day, but it couldn't by any means be called a dangerous spike, and I believe it's far lower than a breakfast of "milk, tuna, bread, and a chocolate bar" would ever be likely to cause me.

I think it's probably the worst load of utter tosh and codswallop that I've ever come across masquerading as serious "research"! Lord help us all if this is the sort of work being done on diabetes.

Robbity
 
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Bluetit1802

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Whatever the rights and wrongs of the study, I have just discovered exactly the opposite to their findings.

For a long time I have moaned that my morning levels (from after breakfast onwards) have been my highest of the day. Despite fasting levels of mid 5's and a breakfast of about 6 carbs - a very few berries and Greek yogurt with flaxseed, I always spiked to the 7's after an hour, back to 6's at 2 hours but stayed in the 6's for 3 or more hours, only seeing mid 5's again before lunch. I assumed this was some sort of liver dump to help get me going. My morning walk never helped. I never really thought it was the food as there were so few carbs and a lot of fat and protein.

Fed up with this scenario, yesterday I abandoned breakfast. I just had a decaf coffee with double cream. I was surprised this saw me through till lunch, but it did. Result - mid 5's from fasting all the way through the morning. No rises or spikes. My afternoon levels and evening levels were also noticeably lower with well tried and tested meals for lunch and dinner.

I repeated it again today. Exact same results.

My experiment, sample n=1, shows that breakfast raises my levels and keeps them up. No breakfast, and my levels stay low.

As a PS, it isn't the berries and yogurt with flaxseed either, because I had these at lunch time as a pudding, and had similar results to the same lunch without the pudding. I also have berries and cream or yogurt at other times, with no material effect. My conclusion is that my body does not appreciate even a small amount of carbs plus protein in the morning.
 
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gillyhill

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I read this and couldn't believe my eyes when i saw what their balanced meal consisted of.

If I skip breakfast I'll occasionally have a liver dump and stay a bit high much of the day, but it couldn't by any means be called a dangerous spike, and I believe it's far lower than a breakfast of "milk, tuna, bread, and a chocolate bar" would ever be likely to cause me.

I think it's probably the worst load of utter tosh and codswallop that I've ever come across masquerading as serious "research"! Lord help us all if this is the sort of work being done on diabetes.

Robbity
I just read the email and thought it was somebody's idea of a joke. I'm the same as you Robbity. Readings might be slightly higher but never dangerously so.
They are getting their '15 minutes of fame' and trying to scaremonger at same time. Wonder how much they were paid for it and by who?
 
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phoenix

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Have a look at the second meal effect. This is a very well researched phenomena in that an earlier meal decreases the expected glucose rise in a subsequent meal. (they have used lots of permutations of meals and there are several theories about the type of meal and foods and mechanisms that are responsible for the effect. )
Here's a piece of research from Prof Taylors lab here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699724/
a whole review here http://www.omicsonline.org/the-seco...ce-on-glycemia-2161-0509.1000108.php?aid=4874
This study shows a continuation of the effect though to the third meal. To be honest I am surprised that they say it hasn't been done before.
. They don't use the word balanced for the meal when they describe the research in more detail.on Medscape
full paper behind pay wall) They use the term 'standard' ie each meal contained exactly the same amount of calories/ fat/carbs/protein/fibre .It was a higher percentage carb diet at 58% but they weren't investigating what sort of foods produced the best second meal effect (lots of studies and discussion on that already see review)
.http://www.medscape.com/viewarticle/849018

@ photognut why the link to an article knocking DUK when this is a piece of research reported on Diabetes.co.uk (and many places elsewhere) It was a piece of research from Israel with nothing to do with DUK.
 
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NeilG

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How does this approach fit in with a short period weight loss diet such as that followed in the Newcastle experiment? May be this study is only relevant to a long term diet but I agree with the comments that the authors of the work do not seem to know what a balanced diabetic meal is and that the length of the experiment was far too short. I am interested in some of the comments on "liver dump". Has anyone any sound references to studies into this?
 

phoenix

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How does this approach fit in with a short period weight loss diet such as that followed in the Newcastle experiment? May be this study is only relevant to a long term diet but I agree with the comments that the authors of the work do not seem to know what a balanced diabetic meal is and that the length of the experiment was far too short. I am interested in some of the comments on "liver dump". Has anyone any sound references to studies into this?
Not a lot. These sort of studies are more to do with the underlying mechanisms . They really aren't diet trials and so people are asking them to be something that they aren't. (probably not helped by the press office of the university who try to get publicity for the paper)

However this trial did note that "Skipping breakfast also led to higher levels of glucagon and free fatty acids and to reduced levels of intact GLP-1 after lunch and dinner, whereas eating breakfast resulted in the reverse, Jakubowicz and colleagues report"

Higher levels of glucagon mean that your liver will be releasing more glucose .
I'm never really sure how much is 'dump' and how much is the gradual accumulation of glucose from uncontrolled glucagon release over a period of time during the night .Type 1s take a basal insulin to try to control it, and for example I increase the basal rate on my pump between 3.30am and 7.30 am. There are certainly various hormones that act to increase glucose release in preparation for the mornings search for food.

When you break your fast, you eat, you release insulin (or in my case inject it) and this insulin suppresses glucagon and hence hepatic (liver) glucose production/release. Don't eat and it just carries on.

One very well respected researcher has proposed that diabetes is as much about about dysregulation of glucagon as insulin " the insulinocentric view of metabolic homeostasis is incomplete and that glucagon is indeed a key regulator of normal fuel metabolism"
Not easy but his paper explains his hypothesis and there is a more general you tube video somewhere from him http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248306/

Of course people who low carb try not to eat large amounts of protein because that is a material the liver can use to create glucose ( actually, it will use whatever it can get hold of including muscle protein and more controversially fatty acids http://blog.cholesterol-and-health.com/2012/01/we-really-can-make-glucose-from-fatty.html )
 
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Brunneria

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One very well respected researcher has proposed that diabetes is as much about about dysregulation of glucagon as insulin " the insulinocentric view of metabolic homeostasis is incomplete and that glucagon is indeed a key regulator of normal fuel metabolism"
Not easy but his paper explains his hypothesis and there is a more general you tube video somewhere from him http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248306/

Fascinating. Thank you.

I have often speculated that my reactive hypoglycaemia was/is more to do with dysfunctional glucagon than insulin issues.