Monday, August 12, 2013

Should I eat breakfast?

If you were born in the United States in the late 1960s  or after, and watched Saturday morning cartoons, chances are you saw a public service announcement like this one:
If you didn't watch TV but attended public school, you probably still had "nutrition units" that reminded you that breakfast was the most important meal of the day.  All well and good, as there is research to indicate that children in school do perform better when they eat something for breakfast (Link).  Children are also obviously at a stage where good nutrition is crucial to growth and future health, and it makes sense that to get everything that they need that they are probably better off spreading their intake throughout the day.  But what about adults, especially those who are, um, trying to shed some of their growth, so to speak?  That question might be on your mind if you have seen some of the reports that come out in the news lately, some of them conflicting.

The first news report to catch my attention came out a few weeks ago: Skipping Breakfast Might Do a Dieter Good, Scientists say.  The statement from that article that jumped out at me the most was this one:
"It’s common belief that people who skip breakfast overeat later in the day. But that’s “based on a myth, not on hard data,” Levitsky said by phone. It’s hard to measure what people eat because memories are faulty and people don’t do a great job at estimating amounts."
I too was guilty of believing that myth, and admit that I "preached" it to many of my patients for longer than I care to admit.  But fortunately I had enough people who were willing to admit that they sometimes did better with skipping breakfast that I decided it was time to look at the data (I know I need to have my assumptions challenged on a regular basis, I am probably not alone either).  Some people really do wind up consuming less (and isn't that the goal?) if they cut out that meal, and some people find themselves less hungry during the day if that first meal is skipped.

Of course, along comes another study like this one, as reported on the Wall Street Journal: Bigger Meals Earlier Can Help Weight Loss.  This small, short term study indicated that people who ate a higher calorie breakfast lost more weight.  So what do we do with this?

First of all recognize that the second study was too short to determine long term benefits, and what really makes a "good" eating plan is one that we can sustain, so we can't really recomend a change of practice until we have more studies and more information.  Second, remember that in the first study people ate what they wanted during the day (although what they ate was measured), and in the second study the meals were planned out for them, and comparing eating "ad lib" to a series of planned meals isn't exactly a fair comparison either (although at least both studies contained measurements!).  Third, there are plenty of obese people with type 2 diabetes and pre-diabetes out there, and having that amount of carbohydrate to start out your day isn't going to be so good for your blood glucose control the rest of the day either.

So, it looks like skipping breakfast might be a viable option for some, but not so good for others.   Based on what we do know, here are some things for you to take into account when considering your breakfast habits.

1) What happens to me when I skip breakfast?  Do I have any hard data to support my overeating?  If not, keep a food diary for a week or longer.  Keep track of how hungry you are when you do eat.  If you are miserable by the time lunch comes around, this might not be for you.

2) If you are "starving" when you wake up, think about what how what you are eating and drinking the day before affects you.  If your carbohydrate intake is excessive, you might be elevating your levels of circulating insulin in your body, triggering hunger that day and the next day.  You might have to have an eating overhall before you think about skipping a meal.

3) Some medications need to be taken with food or you might have nausea/vomiting/diarrhea, which is not the most pleasant way to lose weight.  Sometimes you might be able to switch the timing of your medicine to later in the day, but you will need to ask your physician first.

4) If  you have Type 2 diabetes and take certain medications or certain kinds of insulin, you might need to eat three times per day to avoid low blood glucose.  Now, keep in mind, if you are having to eat constantly just to avoid low blood glucose, you likely need less medication or insulin, so get in touch with your physician ASAP to help adjust it.   If you have Type 1 diabetes, or have Type 2 that requires insulin, you can also ask for a more flexible insulin regimen that can be tailored to your eating schedule or ask about insulin pump therapy.

5) Are you already having trouble meeting your protein needs, etc, with just two meals?  Then you might need to spread your food intake over three meals.

6) Do you have any health conditions that effect your digestive system (IBS, etc)?  If so, your body might absorb nutrients better if you spread your intake out over three meals.

Take home message--skipping breakfast is still not recommended for children and teenagers, but it might be an option for overweight adults.

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