Breakfast and Diabetes: What’s the connection?

Recent evidence suggests that breakfast skipping raises the risk of developing type-2 diabetes by a third and those who are overweight are more susceptible.

Breakfast, a must for diabetics!

It is well established that starting the day with a wholesome breakfast can benefit everyone. Breakfast is necessary for diabetics and it can have real benefits.

Is diabetes prevention and management important in India?

International Diabetes Federation’s (IDF) diabetes atlas 2017 projects 72.9 million people to be having diabetes in India. By 2045, it is projected that India will have 134.3 million people with diabetes. But the matter of concern is that those with undetected diabetes in India are 4.2 million or 57.9% of persons in the age group of 20-79 years. In addition, prevalence of impaired glucose tolerance (a risk factor for diabetes) in 20-79 years is 24 million.¹

Breakfast leads to better blood glucose

In a study, 22 people who controlled their T2D with diet alone or diet plus metformin were studied on two different days. On one, they ate three identical meals for breakfast, lunch, and dinner. On the other, they ate only lunch and dinner. On the days they skipped breakfast, their peak blood glucose was 36.8 percent higher after lunch and 26.6 percent higher after dinner than on the days they ate breakfast.²Another research highlighted that high-energy intake breakfast of around 700 kcals (vs a low energy breakfast of 200 kcals) decreased the overall high blood sugar (hyperglycaemia) in T2D patients over the entire day. It has been established that better management of blood sugar has been associated with preventing complications of diabetes.³

Breakfast skipping increases the risk of diabetes

Earlier studies in 2015, have established a link between breakfast skipping and significantly increased risk of T2D.^4,5 A 2019 meta-analysis suggests that those who miss their breakfast are on an average 33% more likely at risk of type-2 diabetes and the risk increases to 55% for those missing 4-5 days in a week.⁶

Regular breakfast consumption is potentially important for the prevention of T2D. A 2017 study tested 17 healthy adults on three separate days: once when they skipped breakfast, once when they had three regular meals and once when they skipped dinner. Breakfast skipping led to higher glucose concentrations after lunch than dinner skipping.⁷

What should a good breakfast look like?

The key to a healthy morning meal is to choose a variety of foods so that you will get a balance of carbohydrate, protein, fat and other nutrients like vitamins and minerals along with the much-needed fibre that helps manage the blood sugar levels. Here are some options to consider:

• Whole grains. Go with whole grains: oatmeal, muesli with no added sugar, wheat flakes with added bran, whole-wheat daliya/chapatti/khakhra/paratha/ bread, whole grain millet (ragi, jowar, bajra) preparations. Whole grains are a good source of carbohydrates (including fibre), vitamins and minerals

• Dairy. Use nonfat or low-fat milk instead of whole milk. If you don’t drink milk, try non-dairy milk alternatives like soy, almond, coconut milk etc. Choose plain rather than sweetened versions.

• Fruits and vegetables. Fresh fruit is great addition to any breakfast given that they provide fibre, vitamins and minerals. However, limit fruit juice. Vegetables (like carrot, French beans, capsicum, leafy greens like palak, methi etc.) can be added to all the traditional breakfast foods - add them to poha, upma, idli, chila, paratha, omelet or scrambled eggs etc.

• Lean protein. Protein foods may help control hunger, manage blood sugar and maintain lean body mass, so include protein at breakfast. Sources of protein include low fat milk/curd/yoghurt/paneer/cottage cheese, eggs, tofu, whole pulses like moong, channa, vatana, rajma, chawli etc. and split pulses, which are all the dals.

• Healthy fat. Fat can help you feel full but it is important to choose wisely. Go for nuts and seeds, nut butters, avocados etc. in small to moderate amounts.

Breakfast doesn’t have to consist of traditional or commonly consumed breakfast foods. It can also include dinner left overs like vegetable and roti, rajma-chawal or seasoned leftover with vegetables etc. It is important to eat something in the morning (“break the fast”) to kick-start one’s metabolism and give a head start to help manage one’s blood sugars for the rest of the day.

Diabetic friendly breakfast ideas^#

• Oats porridge with fruit and nuts

• Muesli (no added sugar) with milk; fruit and flax seeds

• Wheat flakes with added bran with milk, fruit and nuts

• Dalia porridge with milk with a bowl of fruits

• Wheat and soya flour vegetable or paneer paratha with curds

• Khakhra / thepla with methi and curds

• Vegetable upma (from semolina, oats, quinoa) / poha / wheat or jowar daliya with curd / buttermilk along with a fruit

• Oats / ragi idli / dosa / uttapam with sambhar (with vegetables) and channa dal/poodi chutney

• Egg omelette with vegetables, whole wheat toast and fruit and nut smoothie

• Whole grain/ Mutigrain bread sandwich with stuffing of tomato, cucumber, capsicum, paneer; fruit and a glass of toned milk

• Methi / palak missi roti with curds and fruit

• Oats / quinoa smoothie with fruit, seeds and nuts

• Besan (channa dal) / moong dal chila with vegetables and curd / buttermilk

• Sprouts dhokla / muthia with vegetable and buttermilk

• Dalia or oats upma with vegetables and sprouts

^#Consult your doctor / dietitian before making changes in your diet.

Madhavi Trivedi
Head of Nutrition and Scientific Affairs with Kellogg India Private Limited

References:

1. International Diabetes Federation. Facts and Figures. Available at: https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html

2. Jakubowicz D et al. High-energy breakfast with low-energy dinner decreases overall daily hyperglycaemia in type 2 diabetic patients: a randomised clinical trial Diabetologia. 2015; 58(5):912-9.

3. Jakubowicz, D et al. Fasting Until Noon Triggers Increased Postprandial Hyperglycemia and Impaired Insulin Response After Lunch and Dinner in Individuals With Type 2 Diabetes: A Randomized Clinical Trial. Diabetes Care 2015 Oct; 38(10): 1820-1826.

4. Bi H, et al. Breakfast skipping and the risk of type 2 diabetes: a meta-analysis of observational studies. Public Health Nutr. 2015 Nov; 18(16):3013-9.

5. Uemura, M, et al. Breakfast Skipping is Positively Associated With Incidence of Type 2 Diabetes Mellitus: Evidence From the Aichi Workers’ Cohort Study. J Epidemiol. 2015; 25(5): 351–358.

6. Ballon A, Neuenschwander M, Schlesinger S. Breakfast Skipping Is Associated with Increased Risk of Type 2 Diabetes among Adults: A Systematic Review and Meta-Analysis of Prospective Cohort Studies, The Journal of Nutrition, Volume 149, Issue 1, January 2019, Pages 106–113, https://doi.org/10.1093/jn/nxy194

7. Nas. A, et al. Impact of breakfast skipping compared with dinner skipping on regulation of energy balance and metabolic risk. Am J Clin Nutr 2017; 105:1351–61.

Disclaimer:

The views and opinions expressed by the author in this blog are purely those of the author and do not represent those of Kellogg India. Kellogg India is not responsible for ensuring the accuracy or completeness of the information provided in the blog. The information is being presented on “as is” basis and is not medical advice and is not meant to act as substitute for medical advice. Kellogg India is not responsible for any consequences arising from use of or reliance on the information. This blog is brought to you by Kellogg India as part of the nutrition awareness initiative of Kellogg India.