For patients with diabetes, it is better to eat a single large meal than several smaller meals throughout the day, according to a new study from Linkoping University in Sweden.

The study, which was published on 27 November 2013 in the open-access journal PLOS ONE, compared the levels of  blood glucose, blood lipids and different hormones after patients with type 2 diabetes ate meals with three different macronutrient compositions. The diets were a low-fat diet, a low-carbohydrate diet and a Mediterranean diet. All three diets were tested in a randomised order by 21 patients. During each test day, blood samples were collected at six time points.

The low-fat diet had a nutrient composition that has traditionally been recommended in the Nordic countries, with about 55 per cent of the total energy from carbohydrates. The low-carbohydrate diet had a relatively low content of carbohydrate; approximately 20 per cent of the energy was from carbohydrates and about 50 per cent of the total came from fat.

The Mediterranean diet was composed of only a cup of black coffee for breakfast, and with all the caloric content accumulated to one large lunch. Additionally, the Mediterranean meal included energy from 150ml (women) to 200ml (men) of French red wine to ingest with the lunch. The food in the Mediterranean diet had an energy content from carbohydrates that was intermediate between the low-fat and the low-carbohydrate meals. Sources of fat were mainly olives and fatty fish.

“We found that the low-carbohydrate diet increased blood glucose levels much less than the low-fat diet, but that the levels of triglycerides tended to be high compared to the low-fat diet,” said Dr Hans Guldbrand, who, together with Professor Fredrick Nystrom, was the principal investigator of the study.

“It is very interesting that the Mediterranean diet, without breakfast and with a massive lunch with wine, did not induce higher blood glucose levels than the low-fat diet lunch, despite such a large single meal,” said Professor Nystrom. “This suggests that it is favourable to have a large meal instead of several smaller meals when you have diabetes, and it is surprising how often one today refers to the usefulness of the so-called Mediterranean diet, but forgets that it also traditionally meant the absence of a breakfast,” he said.

“Our results give reason to reconsider both nutritional composition and meal arrangements for patients with diabetes,” Professor Nystrom said.

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