Breakfast is a Dangerous Meal: Why You Should Ditch Your Morning Meal For Health and Wellbeing

The choice is black or white, but the consequences may be life or premature death.

And though I totally respect the Cambridge scientists’ data, I do regret one set of facts they seem to have omitted: they appear to have excluded from their analysis all the subjects who died or fell ill over the 3.7 years they monitored them. But it is a principle in epidemiology that the most important potential end-point of an investigation is not a proxy measurement (such as obesity) but the end-point itself, namely death. The team might still have those data, and it would be good to see them published. Do they show if breakfast kills or cures?

Why were Dr Farshchi’s subjects anomalous?

Why were Dr Farshchi’s breakfast eaters eating less, overall, than the breakfast skippers? Or, to rephrase the question, why were the breakfast skippers eating more, overall, than the breakfast eaters?

Well, Dr Farshchi studied only ten women, whom we have to conclude were simply unrepresentative of the wider population. Different people can respond dramatically differently to the same food. Consider blood glucose. In 2015 two Israeli scientists published a comprehensive study on no fewer than 800 people, finding that ‘people eating identical meals present high variability in post-meal blood glucose responses.’

Consider bread. There is a ninefold difference between different people’s blood sugar responses to breakfast bread, with some people registering only a pimple on the graph while others register a huge rise. Some people, remarkably, register higher levels of blood glucose after eating bread than after eating the equivalent amount of glucose itself. In some people, moreover, bananas raise blood glucose levels worryingly but cookies are completely safe, yet for other people the exact reverse is true. And for some people tomatoes are dangerous.

These variabilities should not have been surprising: in a classic experiment from 1990, a Quebec study isolated twelve pairs of young male twins, and for four months overfed all twenty-four men by 1,000 calories a day, almost as if they were geese on a pâté de fois gras production line. On average, the men gained 8.1 kg (18 pounds or 1¼ stones) but the range was considerable, from 4.3 kg to 13.3 kg.

Intriguingly, though, each twin gained almost the same amount of weight as their fellow twin; i.e. different people’s metabolisms are very different indeed, and the differences are largely genetic.

People, in short, have inherited very different responses to food, so nutritional studies on only ten people will inevitably be overwhelmed by individuals’ quirks. Indeed, a later breakfast experiment by Dr Farshchi’s colleagues in Nottingham on twelve men found that the ‘combined energy intake [breakfast and lunch] did not differ between the breakfast and no-breakfast trials’,

i.e., when those Nottingham scientists repeated their own experiment on twelve men, they got different results from when they’d performed it on ten women – with both sets of findings being at variance with previous studies. To get a solid breakfast finding, therefore, it may not be necessary to study 800 folk the way Segal and Elinav did, but equally we must view findings on ten or twelve subjects as only preliminary and potentially misleading, not definitive.

It was scrupulously honest of Dr Farshchi to admit to the anomalous nature of his experiment, but it is nonetheless depressing that his paper has been cited over 200 times (including by the Harvard scientists), and though I’ve not checked every paper that has cited it, every one I have checked has cited it to confirm a breakfast hypothesis that the data in the paper actually disprove. Dismaying.

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The heroic breakfast guerrillas (#ulink_44ee6cd1-491c-5d69-9031-dc6f8ff8079b)

It takes courage to flout the dominant paradigm, so let me here signpost the work of a small group of brave resisters.

David Allison: In 2013 David Allison and his colleagues from the University of Alabama at Birmingham reviewed ninety-two studies known to have reported on skipping breakfast. Their review had a dramatic title, ‘Belief beyond the evidence: Using the proposed effect of breakfast on obesity to show 2 practices that distort scientific evidence’, but their review lived up to the billing, showing that breakfast researchers regularly misrepresent not only their own results but also those of other researchers. So, for example, Allison reported that no fewer than 62 per cent of the papers he surveyed cited just one particular study in a ‘misleading’ fashion. Allison concluded that: ‘The scientific record is distorted by research lacking probative value and biased research reporting.’

This conclusion was challenged by researchers from Harvard University’s School of Public Health, who argued that Allison had not disproved the suggestion that breakfast skipping caused obesity;

to which Allison responded by saying he was not trying to disprove it, he was showing that no one had actually established the causation in the first place.

In 2014, moreover, in a randomised controlled trial, Allison divided obese or overweight adults into three weight-loss groups, who either

ate breakfast every day

ate no breakfasts

ate however they wanted.

And after sixteen weeks there was no difference in weight between the three groups.

In so doing Allison replicated a 1992 study from Nashville, Tennessee, which reported that when moderately obese women were put on identical weight-reduction diets, differing only in the provision or otherwise of breakfast (the breakfast skippers ate more at lunch and dinner to compensate for the skipped calories) there was no difference in the rate of weight loss.

David Levitsky: It’s not only southerners who are seceding from the dominant paradigm. On 1 August 2014 David Levitsky of Cornell University, NY, wrote an editorial for the American Journal of Clinical Nutrition declaring war on breakfast. It was Levitsky who, with Carly Pacanowski, had shown (above) that breakfast does not induce satiety – rather, it increases food consumption – so Levitsky has been a pioneer in exploding breakfast myths. This is how he opened his editorial:

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.

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 (#litres_trial_promo)

Daily bowl of porridge is key to longer life8 (#litres_trial_promo)

Eat a few peanuts a day to slash risk of early death9 (#litres_trial_promo)

Biggest-ever study proves berries and grapes help weight loss10 (#litres_trial_promo)

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 TheTimes’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.

And this scepticism is now spilling over, publicly, into breakfast. The US government’s 2010–2015Dietary Guidelines for Americans stated that ‘not eating breakfast has been associated with excess body weight,’

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.’

PART SIX (#ulink_52b99315-398e-56b9-b643-c9c88cdba9d3)

Misleading Experiments (#ulink_52b99315-398e-56b9-b643-c9c88cdba9d3)

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Blood glucose and breakfast: the unhealthy majority (#ulink_24e49eb6-f6cb-54ec-84c0-7645f4aae668)

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 science

(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