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Carb-Loading at Breakfast Makes Dieting Easier Long-Term

Posted: Wednesday, June 25, 2008

Loading up on protein and carbohydrates at breakfast may help obese patients with metabolic syndrome stick to a low-calorie, low-carbohydrate diet the rest of the day, researchers found. 

Such a breakfast was associated with five-fold greater weight loss than was achieved on a low-carb, low-calorie diet alone, reported Daniela Jakubowicz, M.D., of the Hospital de Clinicas in Caracas, Venezuela, at the Endocrine Society meeting.

These 32-week findings from a randomized clinical trial suggested that it's not enough to simply reduce food intake and increase exercise for effective long-term weight loss, Dr. Jakubowicz said.

Although restrictive, low-carb diets are among the most effective for short-term weight loss, though maintenance is dismal with a success rate of only 5% after two years, she said.

Diets for obese patients with insulin resistance -- common in obesity -- need to address appetite and carbohydrate cravings, she said.� To test this, she and her colleagues randomized 94 obese, physically inactive women with metabolic syndrome to two diets low in fat and total calories.

 
The low-carb diet allowed 1,085 calories a day with 17 grams of carbohydrates, 51 grams of protein, and 78 grams of fat. Breakfast for members of this group was to be 290 calories with 7 grams of carbohydrates and 12 grams of protein.
The modified form of this diet allowed 1,240 calories a day with less total fat (46 grams) but more carbs (97 grams) and protein (93 grams). The main feature was a 610-calorie "big breakfast" accounting for about half of the daily carbohydrates (58 grams), protein (47 grams), and fat (22 grams).

During the first 16-week weight-loss phase, the big-breakfast group lost about the same amount of weight as the low-carb group (10.6 kg versus 12.6) with no significant difference between groups.

During the following 16-week maintenance phase, though, the groups' experience diverged. The big-breakfast group continued losing weight and reached an average 21.3% weight loss by the end of the trial (18.1 kg below baseline).

The low-carb group, on the other hand, regained much of the weight lost to end at just 4.5% below baseline (4.3 kg). The protein- and carbohydrate-heavy breakfast appeared to regulate hunger cues, the researchers said.

Visual analog scale scores after breakfast for the two groups were improved with the big-breakfast diet compared with the low carb diet for the following:

  • Hunger (P=0.018)
  • Feeling of still being able to eat a lot more food (P=0.001)
  • Fullness (P=0.001)
  • Satiety (P=0.07)

    The difference in fullness extended beyond lunch and through 11 p.m. (P=0.001).

A hearty breakfast also appeared to reduce cravings overall and for sweets, carbohydrates and starches, and fast food, whereas the low carbohydrate diet alone increased cravings compared with baseline (between group differences all P=0.001).

Dr. Jakubowicz commented that, �Although eating a big breakfast may be inconvenient for some patients, the same results would not likely have been achieved by a larger meal at a different time of day.� �In the morning, the body is primed with hormones like adrenaline and cortisol and ready with the "machinery" to convert protein to energy, she said. The carbohydrates and protein also give a greater sense of satiety in the morning, she added.

Practice Pearls:

  • Explain to interested patients that the study suggested that a big breakfast may have an impact on weight loss by mediating hunger and cravings
  • Note that this study was published as an abstract and presented as a poster at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal

Source: Diabetes In Control: ENDO 2008: Jakubowicz D, et al "Effect of diet with high carbohydrate and protein breakfast on weight loss and appetite in obese women with metabolic syndrome" ENDO meeting 2008; Abstract P3-220.

 
 
 
 
 
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