Breakfast is a Dangerous Meal: Why You Should Ditch Your Morning Meal For Health and Wellbeing. Terence Kealey
Three articles appear in this issue of the Journal that challenge a long-held belief of both nutrition scientists and the lay public: breakfast is the most important meal of the day. Of course this is true, if you are selling breakfast cereals. Putting profits aside, the consumption of breakfast is currently part of 1) most weight-reduction procedures and 2) school breakfast programs designed to improve cognitive/school performance. The publication of these articles may give us reason to examine the veracity of these ideas.6
This is not a paragraph that needs translating into ordinary English. Nor does the last paragraph of the editorial need translating:
Myths abound in nutrition. Many, like the consumption of breakfast, are driven by powerful commercial interests. In the current environment in which the major nutritional problem we face is the increasing prevalence of obesity, we, as nutrition scientists, must consider the possible harm we are doing by perpetuating myths such as the value of consuming breakfast.
Recent (welcome) developments: Allison and Levitsky are not the only scientists to have challenged Harvard’s approach to epidemiology. Here are four recent Times headlines:
Daily yoghurt may cut risk of diabetes7
Daily bowl of porridge is key to longer life8
Eat a few peanuts a day to slash risk of early death9
Biggest-ever study proves berries and grapes help weight loss10
All four studies came from Harvard or Harvard collaborators, and though each paper invariably contained formal warnings that the findings were only associations, the tone of the papers nonetheless justified The Times’s cheerleading headlines.
But The Times also collated some robust responses:
‘It could be that those eating yoghurt were more likely to lead a healthy lifestyle’ (Alastair Rankin, the director of Diabetes UK, 14 November 2014)
‘People with a higher intake of whole grains also tend to have a healthier overall lifestyle and diet’ (Victoria Taylor, senior dietician at the British Heart Foundation, 6 January 2015)
‘We know that in this study peanut eaters were leaner, ate more fruits and vegetables … were less likely to have high blood pressure or diabetes … these factors combined are a more powerful influence on mortality than a nibble of peanuts daily’ (Catherine Collins, the senior dietician at St George’s Hospital, London, 11 June 2015)
‘This type of study cannot prove a cause-and-effect … individuals who eat more high-flavonoid foods have other habits which lead them to put on less weight’ (Professor Sattar of the University of Glasgow, 26 January 2016).
We seem to be witnessing a healthy tendency in dietary epidemiology by which those researchers who are prone to believing in linear or causative relationships, including over breakfast, are being increasingly challenged by those who acknowledge correlation. And some people now worry that Harvard is insufficiently concerned with publishing the facts as they fall out of the observations; rather, people worry, Harvard is too concerned about the consistency of its public health messages.11
And this scepticism is now spilling over, publicly, into breakfast. The US government’s 2010–2015 Dietary Guidelines for Americans stated that ‘not eating breakfast has been associated with excess body weight,’12 which was a strong anti-skipping nudge, yet in a story in the Washington Post of 10 August 2015 entitled ‘The science of skipping breakfast: How government nutritionists may have gotten it wrong’, the journalist Peter Whoriskey argued that the nudge was not based on science but on speculation. In Whoriskey’s damning sentence: ‘A closer look at the way the government nutritionists adopted the breakfast warning for the Dietary Guidelines shows how loose scientific guesses – possibly right, possibly wrong – can be elevated into hard-and-fast federal nutrition rules that are broadcast throughout the United States.’
As Whoriskey pointed out, the epidemiological studies that recommend breakfast are only observational, and he quoted S. Stanley Young, the former director of bioinformatics at the National Institute of Statistical Sciences, who said, ‘Wow. Is this really science? Every observational study could be challenged.’13
Blood glucose and breakfast: the unhealthy majority
In Chapter 1 I reported how both Professor Christiansen and I had found that blood glucose levels rose disproportionately after breakfast in type 2 diabetics, and that – because raised levels of blood glucose are dangerous – breakfast was in consequence an unusually dangerous meal for those patients. Simultaneous discovery is a feature in sciencefn1 (famously, Charles Darwin had to rush his Origin of Species into print in 1859 after Alfred Russel Wallace had had the same insight into evolution by natural selection) so, equally, this type 2 diabetic breakfast discovery has been made independently by at least four other research groups.
Rather than force the reader to plough through all the papers, I’ve collated them in the box on the next page.
Blood glucose levels after breakfast in type 2 diabetes
in 2009 Dr Raj Peter and his colleagues from the Diabetes Research Unit, Penarth, UK, studied forty-nine patients with type 2 diabetes. Though he fed them the same meals at breakfast, lunch and dinner, breakfast increased their circulating blood glucose levels by 35 per cent more than did lunch or dinner. Dr Peter thus confirmed that, for type 2 diabetics, lunch and dinner were the most important meals of the day; breakfast was dangerous1
in a study on 248 patients with type 2 diabetes, a Montpelier/Swansea research collaboration gave their subjects only half as many calories at breakfast than at lunch or dinner, yet ‘the highest peak glucose value … was observed in the post-breakfast period’.2 And we are not talking small differences: breakfast, though containing only half as much food as either lunch or dinner, drove blood glucose levels 40 per cent higher from baseline
and in 2013 Dr Hans Guldbrand and his colleagues from the department of medicine in Linkoping, Sweden, found that if type 2 diabetics skipped breakfast and, instead, bundled it into a large lunch, their post-lunch blood glucose levels were no higher than if they had eaten only a normal lunch, thus confirming that lunch was, for type 2 diabetics, a safer meal than breakfast3
finally, in 1996, Dr Guenther Boden and his colleagues from the Temple University School of Medicine, Philadelphia, on studying six type 2 diabetics,