More than 80% of people don't know that they have prediabetes. The number of people with type 2 diabetes is increasing today. But the number of people with prediabetes—the population in which diabetes can be prevented if acted on early—beats the former. [1] We need effective evidence-based strategies to reverse prediabetes today.
Lifestyle modifications are the key to reversing prediabetes. Among these lifestyle changes, intermittent fasting is a commonly recommended strategy by some experts. This is because studies have shown that it can improve insulin sensitivity in people with prediabetes. [2]
But more recent studies show that skipping breakfast can raise your risk of developing diabetes. [3] The connecting dot is that most people who do intermittent fasting skip breakfast and directly have lunch. This leaves us with the question of whether we should fast or not to prevent prediabetes from progressing to diabetes.
In this article, we are going to analyze the reason for this controversy, the basic physiology, and the actual expert recommendations on what to follow to reverse prediabetes.
Prediabetes is a condition where your blood sugar is higher than the normal range but not high enough to satisfy the criteria to be diagnosed with diabetes. It occurs when our body becomes resistant to insulin. [4]
The signs and symptoms are due to insulin resistance and are similar to those of diabetes, like increased thirst and appetite, frequent urination, tiredness, frequent infections, and the presence of darkened skin in the creases and folds of the armpits and neck.
The signs of insulin resistance, like skin tags in the neck, a larger waistline, flabby arms, and fat in the back of the neck, can be seen in the early stages. [4,5]
Fasting blood glucose of 100 to 125 mg/dL (5.6 to 6.9 mmol/L)
2-hour blood glucose of 140 to 199 mg/dL (7.8 to 11.0 mmol/L) after a 75-gram glucose load
HbA1c of 5.7% to 6.4%.
Now let’s dive into whether intermittent fasting or eating breakfast is good for prediabetes.
Three important underlying mechanisms to be aware of to understand the connection between the timing of your meals and blood glucose levels:
Your body’s internal biological clock, the circadian rhythm, plays a role in regulating blood glucose levels by optimizing hormone and enzyme activity. External factors like the light-dark cycle and mealtimes have an impact on this rhythm.
The timing and amount of insulin released after a meal depend on the time and type of food intake.
The rise of blood glucose levels after a meal depends on the composition and timing of food intake.
Also, research [7] shows that insulin sensitivity is higher in the morning. This means that the body can process glucose efficiently earlier in the day.
People in prediabetic states are insulin-resistant.
When they practice intermittent fasting, their blood glucose levels will come down. This reduces the insulin requirements and thus insulin levels drop. The stored glucose and fat are then broken down for energy by hormones like glucagon and cortisol. This allows the insulin-secreting cells of the pancreas to rest, thereby improving insulin sensitivity. Thus, the body, which was resistant to insulin’s actions to control blood glucose, can now manage glucose levels efficiently.
Intermittent fasting, by improving insulin sensitivity, promoting weight loss, and reducing inflammation, can prevent prediabetes from progressing to type 2 diabetes. [2] Some studies show that IF can reverse prediabetic state. [11]
A study published in 2015 emphasized the importance of breakfast for diabetic patients. Their study found that skipping breakfast increased the blood glucose and HbA1C levels in diabetic patients, resulting in huge glucose spikes throughout the day. [9]
Also, a more recent study conducted in Barcelona, done in a larger population of over 1 lakh participants, shows that eating breakfast after 9 a.m. can increase the risk of developing diabetes by 59% compared in people who eat their breakfast before 8 a.m. [3]
The exact reason for this abnormal glucose level due to skipping breakfast is yet to be studied further. However, possible reasons [8] that the researchers theorized are:
The body’s central circadian rhythm responders in the brain respond to the light/dark cycle. The body’s peripheral circadian rhythm responders in the pancreas, liver, and other organs respond to meal timing and other factors. When it’s morning and the brain sees the light, it activates the central circadian clock. Now your pancreas is waiting to activate the peripheral circadian clock through the breakfast meal that it has been trained to assimilate for so long. But when you skip breakfast and eat a huge afternoon meal, the pancreas gets confused by the disconnect between the central and peripheral circadian clocks. And it forgets to secrete the needed amount of insulin, thus resulting in a glucose spike.
The second mechanism is that during fasting, the body burns fat as a source of energy. During this process, substances called free fatty acids (FFA) are released. These FFAs affect the actions of insulin, thus not letting it do the job of regulating glucose levels.
Thus, studies show that there is a significant chance of developing type 2 diabetes if we skip breakfast. In patients with prediabetes, who are already resistant to insulin, these mechanisms triggered by skipping breakfast can accelerate the risk even further.
To reap the benefits of fasting while maintaining blood glucose levels, we need to focus on eating at the right time in addition to the right food. The points to follow are:
Have an early breakfast: Breakfast is an important meal to set the circadian rhythm of the body. Aim to have a protein-rich breakfast before 9 a.m. Avoid high-sugar breakfast so that your pancreas can start its work with ease. Having more protein can help with this.
Have an early dinner: The same Barcelona study [3] found that having a late dinner after 10 p.m. increases the risk of diabetes. Having an early dinner before 7 pm can be in line with the normal circadian rhythm. You can fast after this dinner until morning for a period of 12 to 14 hours. This period of fasting is beneficial, especially for people with prediabetes, to maintain blood glucose levels while promoting weight loss.
MedBound Times approached Aarshbhi Gupta, a clinical nutritionist and diabetes expert at Sugar.fit, to shed light on the impact of fasting and skipping breakfast on sugar levels.
In my experience, I have noticed that a fasting gap of 14 hours is really effective for managing fasting blood sugar. 14 hours must be the natural time, for which I recommend having the earliest dinner followed by a protein-rich diet for dinner and breakfast, which simultaneously helps. This will not lead to the event of skipping breakfast for the patient. The key is to have an early dinner, which is a major challenge for our Indian community.Aarshbhi Gupta, M.Sc.Food Science and Nutrition, Diabetes expert and Clinical Nutritionist, Sugar.Fit
Eat according to your hunger cues: This is the basic one. It is not that intermittent fasting is bad. But, as a prediabetic, it is okay to break your fast with a healthy meal or snack if you are hungry. Nutritionist Munmun Ganeriwal advises in her book Yuktahaar to eat according to your hunger cues to maintain healthy body weight and inner ecosystem. [10] In the Barcelona study [3], they also found that having small, frequent meals about five times a day can lower the risk of diabetes. People who like to practice fasting can do this in their eating window before starting their fast.
Prediabetes is rising in incidence, and we need to regulate our blood sugars now more than ever. One of the methods commonly recommended to reverse prediabetes is intermittent fasting. Intermittent fasting is beneficial in terms of promoting insulin sensitivity and controlling blood sugars. But skipping breakfast has also been shown to have the opposite effect on blood sugar. This can make it pointless to practice fasting to prevent diabetes. So, by embracing a better approach, you can reap the goodness of fasting while enjoying a healthy breakfast. Having an early dinner and an early breakfast can help regulate blood sugars and protect you from diabetes.
References:
India Today. “Over 100 million people have diabetes in India, Goa has the highest number: ICMR,” June 9, 2023. https://www.indiatoday.in/health/story/over-100-million-people-have-diabetes-in-india-goa-has-the-highest-number-icmr-2390784-2023-06-09. (Cited on 07/08/2024)
Ojo TK, Joshua OO, Ogedegbe OJ, Oluwole O, Ademidun A, Jesuyajolu D. Role of Intermittent Fasting in the Management of Prediabetes and Type 2 Diabetes Mellitus. Cureus. 2022;14(9):e28800. Published 2022 Sep 5. doi:10.7759/cureus.28800 (Cited on 07/08/2024)
ScienceDaily. “An early breakfast may reduce the risk of developing type 2 diabetes,” July 23, 2023. https://www.sciencedaily.com/releases/2023/07/230718105633.htm. (Cited on 07/08/2024)
WebMD. “Prediabetes: Causes, Symptoms, and Treatment,” February 5, 2024. https://www.webmd.com/diabetes/what-is-prediabetes. (Cited on 07/08/2024)
Booth, Stephanie. “Insulin Resistance – What You Need to Know.” WebMD, April 22, 2024. https://www.webmd.com/diabetes/insulin-resistance-syndrome. (Cited on 07/08/2024)
“Standards of Care in Diabetes—2023 Abridged for Primary Care Providers.” Clinical Diabetes 41, no. 1 (December 12, 2022): 4–31. https://doi.org/10.2337/cd23-as01. (Cited on 07/08/2024)
Lucidi, Paola, Gabriele Perriello, Francesca Porcellati, Simone Pampanelli, Michelantonio De Fano, Andrea Tura, Geremia B. Bolli, and Carmine G. Fanelli. “Diurnal Cycling of Insulin Sensitivity in Type 2 Diabetes: Evidence for Deviation From Physiology at an Early Stage.” Diabetes 72, no. 10 (July 13, 2023): 1364–73. https://doi.org/10.2337/db22-0721. (Cited on 07/08/2024)
Miyamura K, Nawa N, Isumi A, Doi S, Ochi M, Fujiwara T. Association between skipping breakfast and prediabetes among adolescence in Japan: Results from A-CHILD study. Front Endocrinol (Lausanne). 2023;14:1051592. Published 2023 Feb 22. doi:10.3389/fendo.2023.1051592 (Cited on 07/08/2024)
Diabetes. “Skipping breakfast with type 2 diabetes could cause dangerous spikes in blood glucose levels,” May 16, 2019. https://www.diabetes.co.uk/news/2015/jul/skipping-breakfast-with-type-2-diabetes-could-cause-dangerous-spikes-in-blood-glucose-levels-93716047.html. (Cited on 07/08/2024)
Ganeriwal, Munmun. Yuktahaar. Penguin Random House India Private Limited, 2021. http://books.google.ie/books?id=T_5REAAAQBAJ&dq=book+yuktahaar+by+munmun+ganeriwal&hl=&cd=1&source=gbs_api. (Cited on 07/08/2024)
Society, Endocrine. “Intermittent fasting may reverse type 2 diabetes.” Endocrine Society, January 18, 2023. https://www.endocrine.org/news-and-advocacy/news-room/2022/intermittent-fasting-may-reverse-type-2-diabetes. (Cited on 07/08/2024)
By Dr. Shanjitha J Hussain