How Many Meals Should People With Diabetes Eat Every Day? (Hint: It’s Not 3)

If you have type 2 diabetes or prediabetes, you need a diabetes meal plan. And it might be time to rethink breakfast, lunch, and dinner.

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You’ve been told all your life to eat three square meals a day. But is that the best meal plan for people with diabetes? That’s the question researchers set out to answer in a study published in 2018 in Diabetes & Metabolism.

They enlisted 47 obese adults and divided them into three groups. The participants in two of the groups had prediabetes (meaning they had higher-than-normal blood sugar levels, but not high enough to be diagnosed with type 2 diabetes), while those in the third group had full-blown type 2. Each group was asked to follow a weight-maintaining diet—consumed in either a three-meal or six-meal plan—for 12 weeks. Then they swapped over to the other plan for another 12 weeks.

At the end of the 24-week period, the participants who ate smaller, more frequent meals had better results: Even though they ate the same number of calories, their average blood sugar levels were lower and they showed signs that their bodies could use glucose better. Among those with prediabetes, it took longer for blood sugar to spike after they ate.

And while neither of the plans helped the volunteers lose weight on average, all three groups reported reduced hunger levels on the six-meal plan, as compared to when they were following the three-meal approach.

The pros of eating more often

“Smaller, more frequent meals helps stabilize blood glucose and avoids the larger swings in blood glucose that many people see from eating only two to three meals a day,” explains Melinda Maryniuk, RDN, a certified diabetes care and education specialist, and owner of Diabetes & Nutrition Consultants in Boston. “Subjects in this study also reported less hunger when they ate more frequent smaller, meals—and that can also be helpful.”

If you don’t have diabetes and aren’t at risk for the disease, but are merely looking to shed pounds, you might not want to jump onboard the six-meal plan. Research, including a study published in 2017 in The Journal of Nutrition, found that healthy adults didn’t lose more weight when eating six meals per day as opposed to  three.

…and the cons

If you have prediabetes and are considering the six-meal regimen as a way to prevent type 2, Maryniuk offers a few caveats. “Since the overall goal for people with prediabetes is to minimize chronic hyperglycemia (high blood glucose), this strategy can help,” she says. “However, other strategies—such as modest weight loss and exercising 150 minutes per week—can also help. You have to know yourself. For some people, aiming to eat six small meals a day could actually increase the amount of food they eat, as it’s easy for ‘small meals’ to quickly turn into medium-size or large meals. For some folks, the better strategy is limiting overall exposure to food, and that will limit overall intake.”   

You should also consider your lifestyle, she says. If the rest of your family is eating three square meals a day, it can be difficult to eat smaller amounts at the traditional meal times while they eat larger portions. Eating frequent small meals can also be harder if you tend to eat out a lot.

“Think about your usual eating patterns and who you eat with,” suggests Maryniuk. “Is this something that your partner is willing to do with you? That can make it easier.” If so, she adds, “try it for a month and see how it goes. There are many different eating styles that can be helpful. This is one way—not the only way.”

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Sources
  • Diabetes & Metabolism, "Effects of 6 vs 3 eucaloric meal patterns on glycaemic control and satiety in people with impaired glucose tolerance or overt type 2 diabetes: A randomized trial"
  • Melinda Maryniuk, RDN, CDCES, a registered dietitian nutritionist, certified diabetes care and education specialist, and owner of Diabetes & Nutrition Consultants in Boston
  • The Journal of Nutrition, "Meal Frequency and Timing Are Associated with Changes in Body Mass Index in Adventist Health Study 2"