Large breakfast, small dinner tied to better diabetes blood sugar

Big breakfasts and small dinners might be a healthier way to eat for people with type 2 diabetes, according to a small new study.

Diabetics in the study who ate big breakfasts and small dinners had fewer episodes of high blood sugar than those who ate small breakfasts and large dinners, researchers found.

Blood sugar—also known as blood glucose—is controlled by the body’s internal clock, with larger blood sugar peaks after evening meals, Dr. Daniela Jakubowicz told Reuters Health in an email.

People with type 2 diabetes often time their meals in opposition to their internal clock, said Jakubowicz, a researcher at Tel Aviv University’s Wolfson Medical Center in Israel.

“They frequently skip breakfast while eating a high-calorie dinner,” she said, adding that skipping breakfast is linked to obesity and poor blood sugar control.

The new study involved eight men and ten women with type 2 diabetes, ages 30 to 70, who were being treated with either the diabetes drug metformin and dietary advice or diet advice alone.

Type 2 is the most common form of diabetes and is often linked to obesity. In type 2 diabetes, the body's cells are resistant to the hormone insulin, or the body doesn't make enough of it. Insulin gives blood sugar access to the body's cells to be used as fuel.

The participants were randomly assigned to follow a meal plan that consisted of either a 700-calorie breakfast and 200-calorie dinner or a 200-calorie breakfast and a 700-calorie dinner. Both diets included a 600-calorie lunch.

After following the assigned meal plans for six days at home, the participants spent a day at the clinic, where blood tests were taken. They repeated the experiment two weeks later with the other diet plan.

The study team found that post-meal glucose levels were 20 percent lower, and levels of insulin were 20 percent higher, when the participants consumed the large breakfasts and small dinners, according to the results in Diabetologia.

“Our study demonstrated that a large breakfast and reduced dinner is a beneficial alternative for the management of glucose balance during the day and should be considered as a therapeutic strategy in type 2 diabetes,” Jakubowicz said.

Jakubowicz said longer studies are needed to see if the benefits would continue over time.

The new results support the advice to eat like a king at breakfast, a prince at lunch and a pauper at dinner, said Anna Taylor in an email to Reuters Health.

“Select your calories with care, however; what you eat, how you eat, and when you eat all play an important role in your nutrition as well as your health,” said Taylor, a registered dietitian at the Cleveland Clinic in Ohio. She wasn’t involved in the study.

She added that it’s important for people to keep in mind that the study’s participants took few medications and had no major complications.

The results might therefore not apply to other groups with diabetes, Taylor said.

She said that people with diabetes who take insulin should speak to their endocrinologists before experimenting with drastic dietary adjustments. — Reuters

Certain diabetics more likely to benefit from blood pressure meds

People with type 2 diabetes who get treatment for high blood pressure live longer and have a lower risk of heart disease, according to a new review.

But to the researchers’ surprise, diabetics with only slightly high blood pressure - higher than the healthy range but not quite in the hypertension range - didn’t get as much benefit from treatment.

“Everything else being equal,” the patients with type 2 diabetes most likely to benefit from blood pressure lowering are those whose blood pressure is higher, said coauthor Professor Kazem Rahimi of The George Institute United Kingdom and The University of Oxford, in email to Reuters Health.

The review included 40 trials from 1966 to 2014 on blood pressure lowering treatments in more than 100,000 people with type 2 diabetes. The treatments included diuretics (sometimes called “water pills”), ACE inhibitors, and other drugs.

A healthy blood pressure reading is 120/80 millimeters (mm) of Mercury (Hg).

Readings above 120/80 but below 140/90 indicate “pre-hypertension.” Blood pressure above 140/90 mm Hg can be diagnosed as hypertension.

According to the new review, with every decrease of 10 mm Hg in the first number – the systolic blood pressure - the risk of dying during the study decreased by about 10 percent, and the risk of an acute heart problem, heart disease, stroke and diabetic retinopathy also went down.

Lowering blood pressure appeared to carry the most benefit for people whose initial systolic readings were higher than 140 mm Hg, the authors write in JAMA.

“The study calls for more individualized treatment decisions when it comes to controlling blood pressure in people with type 2 diabetes, in particular for diabetics with lower baseline blood pressure levels,” Rahimi said.

Blood pressure medications did decrease the risk of other problems like stroke, diabetic eye disease and excess protein in the urine, even for people with relatively lower blood pressures, he said.

But diuretics can cause an increase in blood sugar for people with diabetes. Other side effects of blood pressure medications include impotence, potassium deficiency, skin rash or kidney damage.

One in 10 Americans has diabetes today, most often type 2, the adult-onset kind, according to the Centers for Disease Control and Prevention. Two out of three people with diabetes have high blood pressure or take medication to lower it, according to the American Diabetes Association.

“People with a blood pressure of 140 or higher are likely to enjoy the greatest benefit from blood pressure lowering, and for most, the benefits of taking blood pressure medication are likely to outweigh the potential side effects,” Rahimi said. “In people with systolic blood pressure below 140 mm Hg, treatment recommendation requires more careful assessment of the patient’s likely absolute net benefit.”

Based on one U.S. trial in 2010, blood pressure goals have been relaxed for people with diabetes, which may have been an overreaction, according to Dr. Bryan Williams of University College London, who wrote an accompanying editorial in the journal.

Before that trial, most guidelines recommended that people with diabetes keep their blood pressure below 130/80 mm Hg. Afterward, some guidelines were relaxed to 140/90 mm Hg.

Rahimi’s study “shows that the current BP goals are not low enough to optimally reduce the risk of stroke, for example,” Williams told Reuters Health by email.

“Certainly BP should be lowered to below 140/90 mm Hg and I would suggest it would be appropriate to go lower than 130/80 if the patient will tolerate it and this is more likely to be tolerated better in younger people,” he said.

“There is no magical threshold above which blood pressure suddenly becomes harmful and below which it becomes benign,” Williams said. “The thresholds are designed to simplify trials and guidance but in reality the risk relationship is continuous with no obvious threshold.” — Reuters

Too little sleep linked to heart disease risk

NEW YORK - In a large US study, people who tended to get less than six hours of sleep nightly were more likely to have high blood pressure, high cholesterol, diabetes, and to be obese.

The research is the first to look at differences in risk between racial and ethnic groups, and also finds the strongest effect among Black and Hispanic Americans.

"This is important, since racial minorities are generally at increased risk of cardiovascular disease, diabetes and obesity," Michael A. Grandner said. "And if they also tend to have more sleep difficulties, that could be making things worse."

Grandner led the study at the Center for Sleep and Circadian Neurobiology at the University of Pennsylvania in Philadelphia.

Using nationwide survey data from 2008, researchers divided results from more than 5,000 respondents representing the US population into three groups. Very short sleepers got less than five hours per night, short sleepers got between five and six hours and long sleepers got more than nine hours.

Very short and short sleep were both linked to poor health, Grandner's team reports in the journal Sleep Medicine.

Very short sleepers were twice as likely to have high blood pressure and high cholesterol, compared to people who slept around seven to eight hours. Very short sleepers were also 75 percent more likely to have diabetes and 50 percent more likely to be obese.

Short sleepers were about 20 percent more likely than normal sleepers to report high blood pressure and obesity.

Blacks were most likely to report sleeping less than five hours and very short sleep was most strongly linked to obesity among Blacks.

Short sleep was strongly linked to high blood pressure among Blacks, Whites and non-Mexican Hispanics, while people of Asian descent had the strongest link between short sleep and high cholesterol.

Long sleepers did not appear to experience any negative health effects once researchers adjusted for other factors.

There is no consensus on what the ideal minimum amount of sleep should be for good health, Kristen L. Knutson said.

Knutson studies sleep and heart health in different populations at the University of Chicago Department of Medicine. She was not involved in the new study.

There's no set number for sleep, in part "because there is likely to be some variability in how much sleep different people need," Knutson said. "Still, the majority of large studies have found that people who say they sleep between seven and eight hours are the healthiest."

Recommendations vary by age, with younger people generally needing more sleep than older people.

"Like most aspects of health, too little is bad for you and too much is also likely bad for you," Grandner said.

"It is hard to say that short sleep is worse than long—it's just that we currently have a better idea of why short sleep is detrimental to health," he said.

Quantity of sleep isn't the only important factor though, Grandner said. Insomnia, sleep apnea and waking frequently during the night may be related to heart disease, diabetes and obesity, he said.

"These data do suggest that short sleep, whatever the cause, is associated with important negative health outcomes," Knutson said.

Sleep and health are likely linked in a two-way relationship, Grandner said. Less sleep may negatively impact health, and certain health conditions like obesity might make sleep more difficult.

"Lack of sleep limits your body's ability to keep itself healthy, increasing risk for disease, which puts stress on the body, making sleep harder," he said. "It is likely a cycle like this." — Reuters

source: gmanetwork.com