In early adolescence I stopped eating breakfast. I just did not feel well after eating in the morning. In fact, most of the times I felt awful. There were times when I tried to eat breakfast again, for example when I was in good company or in a hotel before being out a whole a day in a foreign city. I also felt it necessary before a walk in the mountains. But it was always a mistake. Breakfast is no good for me. This is totally in opposite to most medical advice. Am I an exception to an important rule?
During the decades in general medicine I came across many people feeling like me. We do not only violate the common sense about breakfast. We are also fine with one meal a day or may be a second one. We have problems with the rule to eat every three to four hours, an idea still common among dietologists. Out of personal experience but also by studying the principles of human robustness I have severe doubts about this rule and many others.
Starting medical school in the early 70ies, there was still the idea that a newborn has to be breastfed or fed every 4 hours. Mothers woke their babies up from sleep in order to feed them. But, more often, they carried around their hungry, crying babies until the hour for feeding had come. With this practice mothers failed to breastfeed their children and it probably laid the ground for quite a few eating disorders. So much stress and despair because of a rule that did not make any sense, in the first place.
Does the still prevailing rule to eat every three to four hours make more sense? It is often argued that a continuous stream of nutrition coming in from the intestines would be good for health, just like a car needs continuously fuel. Firstly, such machine models are doubtful for the living. Secondly, there is enough stored energy to climb mountains or to do hard work in a time when food is lacking if this does not last for weeks.
One might argue that this fasting stress might be not so good for our health. But the opposite is true. Not eating for an extended amount of time activates the immune system,[1] reduces the resistance to insulin,[2] and has many other positive effects.[3] Not to eat for a certain amount of time is today called intermittent fasting. One might not eat for one or two days a week. This is called 2/5 fasting. Another strategy is not to eat for several hours a day. The 8/16-rule says that we should only eat during a time frame of 8-10 hours and to stay continuously without food for 14-16 hours.
Of course, also this rule is wrong, although it fits perfectly to my way of living. I belong to the lion style eaters. We need one big meal a day and it is a luxury to have a smaller second one. We cannot eat every 3-4 hours. We feel bad and it makes us fat. We eat a lot when we eat. In contrast to us are the chicken style eaters. They need quite often a little amount of food and have difficulties in staying without food for an extended time. For them the 8/16 rule is totally wrong.
This is important to understand: all rules are but rules. They might be true for one person, but not applicable to someone else. This difference cannot be solved by statistics which is the pride of most medical scientists. Statistics are hints and always meaningless for an individual. Moreover, most published research findings are false,[4] especially in the field of nutrition.[5] Nutrition is a complex field and it is nearly impossible to come to clear answers.
What about breakfast then? Breakfast has become a kind of battlefield in medicine where traditional opinions (mostly of the chicken style) clash with the opinion of lion style eaters. Some scientists regard breakfast as superfluous.[6] Others insist that breakfast has many health benefits. For example, skipping breakfast is associated with more cardiovascular disease[7] or weight gain.[8] Yet, we should not take all this research toο seriously.
What we should take seriously are the results of another study. It investigated in how far breakfast influences the school performance of the children.[9] Although the study did not come to a clear conclusion, it raises an important issue: the quality of breakfast. Too often breakfast is full of sugar, consists of white bread with sweetened cacao spread (like Nutella) and drinking chocolate. It has, as it is called, a high glycemic index. This leads some time later, during school hours, to a reactive hypoglycemia. This hypoglycemia does not only disturb school performance,[10] it impedes the function of the immune system[11] and has other negative impacts on the health of the child.
Cereal bars and many other cereals are not better off. They mostly have a lot of added sugar. Industrial fruit yoghurt contains up to 20% sugar.[12] Thus, it makes no difference whether a child eats cornflakes with sugar or sugar with cornflakes. The glycemic index is far too high.
Such a breakfast has no health benefit. Cutting sugar is a major step in improving the health of a child.[13] The alternative with toast, margarine and slice of turkey is only slightly better.
Breakfast seems to be a difficult affair. Or as a science journalist put it: Childrens’ “food shouldn’t be this hard. After a few hundred thousand years of raising children, humans ought to have this part down. Yet we still get it wrong.”[14]
This is especially true when parents try to feed a child which is not actually hungry in the morning. They try to feed it, because they think it is important for the child to eat.
The idea that we need a rich breakfast goes back to a media campaign in the USA during the 1920ies. Edward Bernays, the initiator of the media campaign, is regarded as one of the most influential people of the last century. He not only convinced the world that it is important to eat a rich breakfast. He also convinced women that smoking is an expression of independence.[15] We should be aware that a lot of our knowledge is but the result of advertisement.
Skipping breakfast might be good for a child when it is not hungry. It will eat better and with more quality later. Skipping breakfast is also recommended before workout as it is beneficial for health and promotes weight loss.[16] Parents should not be afraid that their children run out of fuel.
[1] Becker, T., Loch, G., Beyer, M. et al. (2010): FOXO-dependent regulation of innate immune homeostasis. Nature 463, 369–373 (2010) doi:10.1038/nature08698
[2] Furmli S, Elmasry, Ramos M, Fung J (2017): Therapeutic use of intermittent fasting for people with type 2 diabetes as a Rn alternative to insulin, BMJ Case Reports, 2018; bcr-2017-221854 DOI: 10.1136/bcr-2017-221854
[3] NIH/National Institute on Aging. (2018, September 6): Longer daily fasting times improve health and longevity in mice: Benefits seen regardless of calorie intake, diet composition in new study, ScienceDaily. Retrieved September 7, 2018 from www.sciencedaily.com/releases/2018/09/180906123305.htm
Wilkinson et al. (2019): Ten-Hour Time-Restricted Eating Reduces Weight, Blood Pressure, and Atherogenic Lipids in Patientswith Metabolic Syndrome, Cell Metabolism, https://doi.org/10.1016/j.cmet.2019.11.004
[4] Ioannidis JPA (2005): Why Most Published Research Findings Are False, PLoS Med. 2005 Aug; 2(8): e124., Published online 2005 Aug 30. doi: 10.1371/journal.pmed.0020124, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/pdf/pmed.0020124.pdf
[5] Ioannidis JPA (2018): The Challenge of Reforming Nutritional Epidemiologic Research. JAMA. 2018;320(10):969–970. doi:https://doi.org/10.1001/jama.2018.11025
[6] Chowdhury EA, Richardson JD, Holman GD, Tsintzas K, Thompson D, Betts JA (2016): The causal role of breakfast in energy balance and health: a randomized controlled trial in obese adults, Am J Clin Nutr. 2016 Mar;103(3):747-56. doi: 10.3945/ajcn.115.122044
Betts JA, Chowdhury EA, Gonzalez JT, Richardson JD, Tsintzas K, Thompson D (2016): Is breakfast the most important meal of the day?, Proc Nutr Soc. 2016 Nov;75(4):464-474
[7] Rong S, Snetselaar LG, Xu G, et al. Association of skipping breakfast with cardiovascular and all-cause mortality. J Am Coll Cardiol. 2019;73:2025-2032.
[8] Kahleova H, Lloren JI, Mashchak A, Hill M, Fraser GE (2017): Meal Frequency and Timing Are Associated with Changes in Body Mass Index in Adventist Health Study 2, J Nutr. 2017 Sep;147(9):1722-1728. doi: 10.3945/jn.116.244749
[9] Edefonti V, Bravi F, Ferraroni M (2017): Breakfast and behavior in morning tasks: Facts or fads?, J Affect Disord. 2017 Dec 15;224:16-26. doi: 10.1016/j.jad.2016.12.028
[10] Swedish Research Council. “Right Breakfast Bread Keeps Blood Sugar In Check All Day.” ScienceDaily. ScienceDaily, 11 September 2007, www.sciencedaily.com/releases/2007/09/070905095324.htm
[11] Owczarek D, Rodacki T, Domagała-Rodacka R, Cibor D, Mach T (2016): Diet and nutritional factors in inflammatory bowel diseases, World J Gastroenterol. 2016 Jan 21;22(3):895-905. doi: 10.3748/wjg.v22.i3.895
[12] foodwatch Marktstudie (2019): Zuckergehalt in Frühstücksflocken und Joghurts für Kinder, https://www.foodwatch.org/fileadmin/-DE/Themen/Kinderernaehrung/Marktstudie_Kinderlebensmittel.pdf
[13] Lustig, R.H., Mulligan, K., Noworolski, S.M., Tai, V.W., Wen, M.J., Erkin‐Cakmak, A., Gugliucci, A. and Schwarz, J.‐M. (2016), Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome. Obesity, 24: 453-460. doi:10.1002/oby.21371
[14] Bilger B (2019): Can Babies Learn to Love Vegetables?, The New Yorker November 25, 2019
https://www.newyorker.com/magazine/2019/11/25/can-babies-learn-to-love-vegetables
[15] Wikipedia contributors. (2019, December 4). Edward Bernays. In Wikipedia, The Free Encyclopedia. Retrieved 11:23, December 6, 2019, from https://en.wikipedia.org/w/index.php?title=Edward_Bernays&oldid=929302002
Held L (2009): High-Protein Diet Could Be Harmful, Monitor on Psychology Vol 40, No. 11: 32
https://www.apa.org/monitor/2009/12/consumer
[16] Edinburgh RM, Hengist A, Smith HA, Travers RL, Betts JA, Thompson D, Walhin JP, Wallis GA, Hamilton DL, Stevenson EJ, Tipton KD, Gonzalez JT (2019): Skipping Breakfast Before Exercise Creates a More Negative 24-hour Energy Balance: A Randomized Controlled Trial in Healthy Physically Active Young Men, J Nutr. 2019 Aug 1;149(8):1326-1334. doi: 10.1093/jn/nxz018.
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