Blood Sugar Secrets: Why Breakfast Holds The Key To Control

No one wants to face the life-altering consequences of a heart attack, stroke, diabetes, or kidney failure, and yet it seems so complex and confusing.

This article will simplify the challenge by limiting the parameter that will be measured to one thing – postprandial blood sugar (PPG).

The first part will present a study showing why PPG is crucial to preventing many common conditions that contribute to the most common causes of chronic disease and death. Much research has since confirmed the results with many other diseases.

The Critical Role of Postprandial Glucose

Postprandial glucose is more than just a temporary spike in blood sugar after meals.

It’s a significant contributor to HbA1C levels and a powerful predictor of both cardiovascular disease (CVD) and other complications.

Glycosylated hemoglobin or HbA1c measures the three-month average of a person’s blood sugar.

Studies have shown that hyperglycemia after meals is linked to:

Small Vessel or Microvascular complications:

- Retinopathy causing blindness
- Neuropathy of the fingers and toes
- Kidney dysfunction leading to failure and dialysis

Large Vessel or Macrovascular complications:

- Coronary artery diseases like heart attacks and angina pectoris
- Strokes
- Peripheral arterial disease – a disease of blood vessels supplying the arms and legs
- Diseases of the aorta, like aortic aneurysms and aortic dissection

A review article from Clinical Diabetes emphasizes that PPG correlates more strongly with cardiovascular outcomes than fasting glucose.[1]

For example, the Honolulu Heart Program demonstrated that elevated PPG increased the risk of coronary heart disease even in individuals without diabetes!

Similarly, the DECODE study highlighted PPG as a superior predictor of mortality compared to FPG. Equally significant is that it revealed that individuals with high PPG often go undiagnosed if only Fasting Blood Sugar is tested.

PPG’s Connection to Cardiovascular Risk

PPG plays a significant role in driving oxidative stress, endothelial dysfunction, and carotid artery thickening—all of which contribute to cardiovascular events.

In fact, diabetes-related CVD accounts for up to 80% of deaths in individuals with type 2 diabetes.

Monitoring PPG can provide an early warning system. It allows patients and healthcare providers to do something before long-term damage occurs.

PPG Guidelines

Most treatment guidelines now include specific PPG targets alongside A1C and FPG targets.

Organization	A1C Target	Fasting Plasma Glucose (FPG)	Postprandial Glucose (PPG)
American Diabetes Association (ADA)	<7.0%	80–130 mg/dL	<180 mg/dL
European Association for the Study of Diabetes	<7.0%	80–130 mg/dL	<180 mg/dL
International Diabetes Federation (IDF)	<7.0%	115 mg/dL	<160 mg/dL
American Association of Clinical Endocrinology (AACE)	<7.0%	110 mg/dL	≤140 mg/dL

The PPG targets above are rarely discussed with patients, and PPG measurements are rarely taken. The best measure is from the AACE, which is ≤140 mg/dL at two hours.

Based on other study results not yet included in the recommendations, I recommend the 155 mg/dl cut-off at one hour postprandial.

The Breakfast Effect for Whole-Day Sugar Control

A randomized clinical trial published in Diabetes Care explored the impact of skipping breakfast on glucose control.

Researchers compared two meal patterns in individuals with type 2 diabetes:

One including breakfast, lunch, and dinner (Yes Breakfast or YesB),
The second involved skipping breakfast while consuming lunch and dinner (No Breakfast or NoB). The findings were striking:

Higher Blood Sugar Spikes After Lunch and Dinner:

- On the day without breakfast, post-meal blood sugar levels were 36.8% higher after lunch and 26.6% higher after dinner than on days without breakfast.

Breakfast Lowers Postprandial Glucose All Day — Comparison Of Blood Sugar Readings On Days With And Without Breakfast. The Lower Numbers Show The Days With Breakfast. From Jakubowcz Et Al.

Delayed Insulin Response:

- Skipping breakfast caused a 30-minute delay in insulin secretion after lunch and dinner, prolonging blood sugar spikes.

Reduced Hormonal Regulation:

- Glucagon-like peptide-1 (GLP-1) levels, which help control blood sugar, were significantly lower after lunch and dinner on the No Breakfast days.

Breakfast: The Best Time to Test PPG

Findings from Diabetes Technology and Therapeutics further validate breakfast as the optimal time to monitor PPG.

This study found that breakfast PPG peaks are more consistent and reliable than those after lunch or dinner. Key insights include:

Predictable Peaks:

Blood sugar peaks about 90 minutes after breakfast, with less day-to-day variation than other meals.

Strong Correlation with HbA1C:

Breakfast PPG has a robust link to long-term glucose control.

Actionable Trends:

Monitoring PPG after breakfast provides clearer data for adjusting treatments or lifestyle interventions.
Use the PPG data to make continuous improvements of the blood sugar using this technique – Applying The OODA Loop For Better Health

How Does Eating Breakfast Control Whole-Day Blood Sugar?

1. Prepares Insulin Response:

Eating breakfast helps “prime” the pancreas, enabling a more efficient insulin response throughout the day.
Skipping breakfast disrupts this rhythm, leading to blood sugar spikes later.

2. Reduced Oxidative Stress:

Stabilizing glucose levels after breakfast minimizes oxidative damage, a key driver of diabetes complications.

3. Improved Hormonal Balance:

Breakfast helps maintain GLP-1 levels, which regulate blood sugar and appetite.

Recommendations for Breakfast and PPG Testing

When to Test:

Measure blood sugar approximately 90 minutes after breakfast to capture the PPG peak.

What is An Acceptable 90-minute blood sugar?

The postprandial targets listed in the table above are typically based on measurements taken 1 to 2 hours after the beginning of a meal.

Since blood glucose levels often peak around 90 minutes after a meal, aiming for PPG values within these ranges is reasonable.

Studies have indicated that:

1-Hour Postprandial Glucose: Levels around 154.8 mg/dL are associated with increased risks.
2-Hour Postprandial Glucose: 140 mg/dL levels are also linked to heightened risks.
Between the one-hour and two-hour blood sugars, the one-hour period is a more reliable predictor of future diseases.

While specific data for 90-minute PPG levels are limited, aiming for a glucose level between the 1-hour (154.8 mg/dL) and 2-hour (140 mg/dl) values is advisable.

Therefore, maintaining a 90-minute PPG level below 150 mg/dL may benefit cardiovascular health and reduce the risk of developing type 2 diabetes.

What to Eat:

- Choose low-glycemic, high-fiber foods like oatmeal, eggs, or whole-grain toast.
- Include protein and healthy fats to slow glucose absorption.
- Articles On How To Lower Postprandial Sugar
- 102 Easy Ways to Lower Post-Prandial Blood Sugar Without Meds

Breakfast Help Lower Blood Sugar All Day — A Healthy Breakfast With Eggs, Whole-Grain Toast, Avocado, And A Side Of Fruit

Be Consistent:

Establish a regular breakfast routine to maintain metabolic balance and improve daily glucose control.

Conclusion

Breakfast offers a unique window into the dynamics of blood sugar regulation, making it the best time to test postprandial glucose.

By incorporating PPG monitoring and prioritizing a healthy breakfast, individuals with type 2 diabetes can gain valuable insights, reduce the risk of complications, and improve overall metabolic health.

Whether you’re managing diabetes or striving for better wellness, breakfast truly is the most important meal of the day.

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Related:

References:

Hershon KS, Hirsch BR, Odugbesan O. Importance of Postprandial Glucose in Relation to A1C and Cardiovascular Disease. Clin Diabetes. 2019 Jul;37(3):250-259. doi: 10.2337/cd18-0040. PMID: 31371856; PMCID: PMC6640888.
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):1820-6. doi: 10.2337/dc15-0761. Epub 2015 Jul 28. PMID: 26220945.
Cichosz SL, et al. Assessment of postprandial glucose excursions throughout the day in newly diagnosed type 2 diabetes. Diabetes Technol Ther. 2013 Jan;15(1):78-83. doi: 10.1089/dia.2012.0199. Epub 2012 Nov 23. PMID: 23176177.

DrJesseSantiano.com does not provide medical advice, diagnosis, or treatment

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