Breakfast is a Dangerous Meal: Why You Should Ditch Your Morning Meal For Health and Wellbeing. Terence Kealey
in 2003 from the Massachusetts Medical School.1 That survey confirmed that people who ate breakfast were slim, but the researchers warned that their ‘findings cannot be considered causal’ because most of their subjects were ‘white middle class members of a health maintenance organization … [who] were highly motivated … in their own health’. And what in 2003 did members of health maintenance organisations know? They knew that breakfast was the most important meal of the day! Most of the survey’s subjects were, therefore, complying with medical advice to eat breakfast, but they were also complying with the advice of not overeating during the course of the day.
Normally, of course, people do well to comply with medical advice, but such compliance can sometimes be dangerous. Consider vitamin D deficiency. A Swedish medical team has monitored a cohort of some 30,000 healthy women, of whom some 2,500 died from natural causes over twenty years. To minimise their risks of developing malignant melanoma, many of the women had avoided exposure to the sun. Such women had thus become vitamin D deficient and, as a consequence, their overall death rate from all disease … doubled. In the words of the paper: ‘the mortality rate amongst avoiders of sun exposure was approximately twofold higher compared with the highest sun exposure group … the effect was presumably attributable to cancer, heart disease and cerebrovascular disease.’2
Compliance dangers are perennial because medical science advances perennially, and such advances invariably take doctors and patients into unknown territory, where the law of unintended consequences can apply. And one important compliance danger is breakfast. Your doctor may assure you that breakfast is the most important meal of the day, but that self-same doctor would once have assured you that babies have to be laid to sleep on their tummies (see below).
Cot deaths and neonatal blindness: compliance dangers
When our first child was born, in 1991, the world was still in the grip of the epidemic of cot deaths that had, unexpectedly, erupted some years earlier. To minimise the risks to our child, my wife and I were told to lay her to sleep on her tummy. But when our second child was born, in 1993, we were told to lay him on his back. It transpired that more than half of cot deaths before 1992 had occurred because babies had been laid to sleep on their tummies; and they were sleeping on their tummies because studies had shown that sick babies in intensive care units did better on their tummies. Fair enough. But that observation was then extrapolated, without proper testing, to healthy babies at home; and those do worse on their tummies, so their death rates rose.3
Perhaps the best-known example of compliance danger is provided by Stevie Wonder, whose blindness was caused by his having been given, as a sick baby, 100 per cent oxygen to breathe. Routinely giving 100 per cent oxygen to sick babies – regardless of their illness and regardless of their actual need for extra oxygen – was once conventional until doctors realised that the contemporary epidemic of infant blindness was being caused by the excessive oxygen that, by stimulating the uncontrolled growth of certain cells in the eyes, was destroying the babies’ vision.
We can go on multiplying the recent examples of doctors being wrong (I’m not talking leeches here, I’m talking about modern doctors). Consider hormone replacement therapy (HRT) for the menopause. For half a century this was lauded by doctors, and for years ‘it was considered malpractice if you did not prescribe HRT for menopausal women.’4 Only with the publication of the two Women’s Health Initiatives in 1992 did the breast cancer story emerge, and HRT is now prescribed with circumspection.5
These stories are relevant to breakfast because they confirm that modern doctors can sometimes be wrong in their advice, advice over breakfast not excluded.
2. People under-report their food intake: Another breakfast confounder is that obese people tend to under-report their food intake, so the association between obesity and breakfast skipping may be simply a reporting artefact: obese people may be eating breakfast, and thus getting fat, but they may be reporting themselves as not eating breakfast.6
I have no doubt that large people, like most people actually, under-report their eating, though large people may be particularly extreme under-reporters. In the days when, as a young doctor, I ran metabolic clinics, I would be astonished by the vehemence with which some overweight and obese patients denied the obvious fact that they ate excessively. I remember one very large lady who denied eating between meals, whose daughter approached me discreetly to say that her mother ate biscuits all day, claiming ‘they didn’t count.’
3. Breakfast skipping is not properly defined: In 2008 a philosopher, Peter Vranas of the University of Wisconsin, noted that different research groups were using up to twenty-four different definitions of breakfast skipping. These ranged from never consuming a calorie before midday, to never consuming one before 10.00 a.m., to consuming a light drink of milk or fruit juice on occasion or regularly, to eating a full breakfast but only at weekends, etc., etc. And Vranas found … well, let the title of his paper speak for itself: ‘Breakfast skipping and body mass index among adolescents in Greece: whether an association exists depends on how breakfast skipping is defined’.7
This was an alarming finding because it suggested that different research groups had published different conclusions based solely on different definitions of breakfast skipping.
Vranas has shown, in short, that much of the epidemiological literature may have been distorted by loose definitions. We probably need more philosophers in this area.
4. ‘Kick-starting’ metabolism: On eating a meal, a person’s metabolic rate increases as they consume energy in digesting the food (which is why some people feel hot or sweaty during or after a meal). So a number of researchers have suggested that if (if!) the eating of breakfast is slimming, perhaps that is because eating breakfast stimulates metabolism all day long, thus burning calories all day long. That suggestion is echoed commercially: easyJet’s on-board magazine Bistro & Boutique for March 2015 carried a claim from the CEO of Moma, a porridge company, saying that breakfast ‘kick starts your metabolism’.8
But in 2014 a research team led by James Betts from the University of Bath, UK, performed the most comprehensive study to date.9 Studying a group of subjects over six weeks, half of whom ate breakfast and half of whom did not, Betts first confirmed that breakfast satiety is a myth: when his subjects ate breakfast they consumed 539 extra calories overall during the day (i.e. skippers consumed 539 fewer calories overall). But then he found that, after six weeks of daily breakfast, ‘contrary to popular belief there was no … increased resting metabolism’: i.e. he’d exploded the myth that breakfast kick-started metabolism. Dr Betts went on to tell the Daily Mail:
The belief that breakfast is ‘the most important meal of the day’ is so widespread that many people are surprised to learn that there is a lack of scientific evidence showing whether or how breakfast may directly cause changes in our health. It is certainly true that people who regularly eat breakfast tend to be slimmer and healthier but these individuals also typically follow most other recommendations for a healthy lifestyle, so have more balanced diets and take more physical exercise.10
Indeed, in a similar study on obese people, Betts concluded that: ‘In view of the public perception that breakfast consumption facilitates weight management, it is paradoxical that 10 of the 11 individuals in the breakfast group gained weight.’11
As Betts told the Independent on 24 March 2016, breakfast ‘is not going to make you lose weight’ so there’s no need to hypothesise a mythical metabolic kick-start to account for a mythical weight loss. There’s no if.
And Betts himself – a man who knows more about breakfast than most of us – generally skips it.
5. Breakfast skippers are owls, not larks: A recent study