The case for a low carbohydrate breakfast

‘In Wilson’s scale of evaluations, breakfast rated just after life itself and ahead of the chance of immortality.’

Robert Heinlein, By His Bootstraps

Breakfast is the most important meal of the day. This old adage has nothing to do with science. It was created by Adventists Jackson and Kellogg to sell more breakfast cereal in the 19th century. Later the bacon industry jumped on the bandwagon, which cemented the myth. I wish I would have known about this when I was a kid, so I could have told my mum to stop forcing toast on me.

For type 1 diabetics, breakfast matters. “It’s the most difficult meal to control for my patients”, my endocrinologist said at our last appointment. “Many people are more insulin resistant in the mornings, which makes dosing for carbohydrates difficult.” This comes from the dawn phenomenon, or feet on the floor. Whilst the dawn phenomenon happens in the hours before rising, feet on the floor happens after you get out of bed. The reason is most likely the same; a surge of hormones released in the early morning to wake you up. These hormones (glucagon, cortisol, epinephrine and growth hormone) tell the liver to dump glucose into your blood. So how do you counter this? Some people inject a small dose of insulin immediately upon waking. Having breakfast is also a good idea, to help convince the liver it’s not starving.

What you eat is important. Typical breakfast foods such as toast, cereal and porridge are rich in carbohydrates. A bowl of porridge or some cereal with milk easily has 60-70g of carbohydrates . This will often spike your blood sugar if you’re diabetic. The first few months with diabetes I ate 30-40g of carbs for breakfast. The result was hit and miss. Sometimes I’d get lucky and not spike, but a lot of the time my blood sugar would hit 10 mmol/l (180 mg/dl). Matching carbohydrate to insulin and nailing the timing felt like a real guessing game. My seemingly healthy breakfast wasn’t doing my blood sugar any favors.

I decided to cut out the fruits and the whole-grain, and increase the fat. Now I have two eggs and 40g of cheese every morning, and a little bit of whatever plant happens to be in the fridge. I also have coffee with double cream. The nutritional content is 35g fat, 25g protein and less than 5g carbohydrate. Cheese and eggs are brilliant breakfast foods for diabetics. They are very nutritious with roughly equal parts protein and fat, and almost no carbohydrates. If you’re worried about eating too much fat, mozzarella and feta cheese are on the lower side.

Whether a diet high in animal fat is good for you is a controversial topic. The science is inconclusive and there’s a myriad of information. One thing that I find amazing is how filling fat is. When I used to eat a lot of carbohydrates I would soon be hungry again. My typical breakfast before diabetes was crumpets and fruit. These days I often skip lunch and eat only two meals a day without feeling deprived.

Eating the same things every day means I take the same insulin dose. This saves me from making decisions or doing math in the morning. I have feet on the floor, so I inject 3u of regular insulin as soon as I get out of bed, then go to make breakfast. If I don’t inject insulin or eat something, my blood sugar will keep rising until I feed the liver. The other day I tried skipping breakfast, and I went from waking up at 4 mmol/l to 8 mmol/l within an hour of being up. I didn’t even have coffee. Here’s another interesting thing – on mornings when I’m going to work I have to take an extra 1u of insulin not to go high. My guess is that cortisol levels are higher when I’m at work, than when I’m lounging around in bed with a book.

To sum up what I want to say: low carbohydrate diets were around a hundred years before insulin. Dosing insulin for large amounts of carbohydrates as a type 1 diabetic is difficult. This is especially true in the mornings when insulin sensitivity is poor for many people. I dose twice as much insulin in the morning, as I do at other times. Eating a low to no carbohydrate breakfast might help you off to a better start of the day. When I spike my blood sugar at breakfast, I’m often struggling to get back into range by lunch.

Please note that insulin dosing is individual so your dose will not be the same as mine. You only dose for protein if you’re eating very few carbohydrates, or a lot of protein. If you’re on fixed insulin doses you always need to talk to your doctor before lowering the amount of carbohydrates in your diet.