Type 2 diabetics less depressed, hungry on 2 meals a day

By Anne Harding

Eating two large, fiber-rich meals a day as part of a calorie-restricted diet - rather than six smaller meals spread throughout the day - helps people with type 2 diabetes feel less hungry and less depressed, according to a secondary analysis of a crossover trial comparing both meal schedules.

"These results suggest that for long-term adherence to a hypocaloric diet rich in fiber, eating large breakfasts and lunches may be more beneficial than the usual snacking model," Dr. Hana Kahleova of the Institute for Clinical and Experimental Medicine in Prague, Czech Republic, told Reuters Health by email. "However, further large-scale, long-term studies are needed before offering clear recommendations."

In the original trial (http://1.usa.gov/1IowgEC), in 54 patients, each person spent 12 weeks eating six meals a day, and 12 weeks eating only breakfast and lunch daily. Both meal regimens reduced energy intake by about 500 calories a day - but body weight, hepatic fat content, fasting plasma glucose, C-peptide levels, and glucagon all showed a significantly greater decrease with two meals daily vs six meals. The study also showed a greater increase in oral glucose sensitivity in patients on the two-meal regimen.

In the new findings, published April 1 as a Letter to the Editor in the European Journal of Clinical Nutrition, the researchers looked at quality of life, depressive symptoms, and eating behavior in the study participants.

With both meal schedules, patients had improvements in quality of life and decreases in depressive symptoms. However, the decrease in depressive symptoms was significantly greater when study participants followed the two-meal-a-day plan; they also felt significantly less hungry. Disinhibition also decreased when people ate twice a day.

"One probable explanation of this finding is that larger meals impart the sense of fullness and satiety and inhibit ghrelin, making periods of fasting more bearable than being hungry all the day long, from eating more smaller meals without getting full," Dr. Kahleova and her colleagues write.

In order to follow a two-meal-a-day plan successfully, Dr. Kahleova added, "it is necessary to eat at least 30-40 g fiber per day to avoid large excursions in blood sugar and feelings of hunger."

Dr. Margaret Powers of the International Diabetes Center at Park Nicollet in Minneapolis, Minnesota, who is also president-elect of healthcare and education for the American Diabetes Association, reviewed the new study for Reuters Health.

"I think it's fascinating research," Dr. Powers said in a telephone interview. "I certainly agree that we need more research to really understand this, but I think there's a lot of dynamics when people are eating that we don't clearly understand."

By looking at the effect of eating patterns on patients' depressive symptoms, Dr. Powers said, the new research is starting to take into account the "big emotional component to eating."

The most important eating strategy for people with type 2 diabetes is to have a meal plan, Dr. Powers adds. "It's really important that doctors emphasize that the right food plan needs to be found for each individual person, and it isn't a magic number," she said.

Working out this plan involves first looking at how a person eats now and distributes their carbohydrate intake across the day, Dr. Powers said, and checking this against his or her blood glucose levels. People should plan out when they eat, how often they eat, and how much carbohydrates they will have at each meal or snack in order to keep a steady blood glucose level.

Sometimes, she added, people will get hungry in the afternoon because they are using too much insulin. Instead of eating to keep up with their medication, and gaining weight, according to Dr. Powers, patients should be adjusting their medication to their eating plan.

The Ministry of Health supported this research. The authors declared no conflicts of interest.

SOURCE: http://bit.ly/1H2oiPW

Eur J Clin Nutr 2015.

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