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The breakfast hype

Special to The Times

SHELLEY RATTET of Framingham, Mass., has lost about 25 pounds these past few months. It was the first time the 55-year-old clinical psychologist had lost weight in 10 years.

One of the changes she made: Making sure that she ate a good breakfast.

Mark Mattson, a neuroscientist at the National Institute on Aging, disdains the morning repast. He hasn’t eaten breakfast in 20 years, ever since he started running early in the mornings.

He says he’s skinny and healthy and never felt better.

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Whatever you do, don’t skip breakfast.

Breakfast: It’s the most important meal of the day.

Such pronouncements carry almost the aura of nutritional religion: carved in stone, not to be questioned. But a few nutritionists and scientists are questioning this conventional wisdom.

They’re not challenging the practice of sending children off to school with some oat bran or eggs in their belly. They acknowledge the many studies reporting that children who eat breakfast get more of the nutrients they need and pay more attention in class.

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They do say, however, that the case for breakfast’s benefits is far from airtight -- especially for adults, many of whom, if anything, could stand skipping a meal.

“For adults, I think the evidence is mixed,” says Marion Nestle, professor of nutrition, food studies and public health at New York University who hasn’t eaten breakfast in years because she is just not hungry in the morning.

“I am well aware that everyone says breakfast is the most important meal of the day, but I am not convinced,” Nestle wrote in her book, “What to Eat.” (She later received many e-mails from readers telling her that they were relieved to hear it.) “What you eat -- and how much -- matters more to your health than when you eat.”

A few scientists go further than this. They say it may be more healthful for adults to skip breakfast, as long as they eat carefully the rest of the day.

“No clear evidence shows that the skipping of breakfast or lunch (or both) is unhealthy, and animal data suggest quite the opposite,” wrote Mattson, possibly the ultimate anti-breakfast iconoclast, last year in the medical journal the Lancet. Advice to eat smaller and more frequent meals, he wrote, “is given despite the lack of clear scientific evidence to justify it.”

Mattson admits that he hasn’t proven his case yet. His studies are still preliminary.

But already, his findings have attracted a cadre of followers who started to skip breakfast once they heard of his results. Meanwhile, a diet plan that involves breakfast skipping -- the Warrior Diet -- is attracting followers in the U.S. and worldwide.

These aren’t the only ones forgoing the morning repast, of course. Surveys show that about one-third of all people in the U.S. and Europe skip breakfast, primarily because they say they don’t have enough time in the morning or because they want to lose weight -- and what better way to do so than miss a meal?

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Most nutritionists and health experts maintain that this is unwise. Breakfast skippers, they say, risk skimping on important nutrients. They also tend to binge later on, actually increasing their risk of gaining weight.

“There isn’t any downside to eating a healthy breakfast,” says registered dietitian Joan Salge Blake, a clinical assistant professor at Boston University who specializes in weight management. “Currently, Americans, on average, fall short on their daily servings of whole grains, fruits and dairy foods. Eating breakfast is an excellent way to add these foods to the diet.”

Breaking the ‘fast’

Wherever and whenever the concept was first invented, breakfast today is enjoyed by cultures around the world: coffee with French bread and butter and jam in Algeria; soup and rice porridge in Thailand and Vietnam; stuffed steamed buns and soy milk in northern China; a heart-stopping plate of bacon, eggs, sausages and fried bread in the British Isles.

Breakfast cereals are relatively modern additions, debuting after the invention of “granula” by Dr. James Jackson in 1863, and cornflakes by Dr. John Harvey Kellogg in 1902.

It makes sense that the body would want to refuel after many hours of fasting, says Susan Bowerman, a registered dietitian and assistant director at the UCLA Center for Human Nutrition. In the morning, blood glucose level is generally low. “Since the brain’s primary source of fuel is glucose,” Bowerman says, “it seems logical that fueling up in the morning ... would make sense.”

Refueling is not the only benefit, however. “Many of the foods that people consume at breakfast are things they may not consume the rest of the day,” such as dairy products, fruits and whole grains, Bowerman says.

Foods generally served at breakfast are good sources of calcium (from milk, yogurt and cheese), fibers (from whole fruits, whole wheat bread and cereal), iron (from fortified breakfast cereals or whole grain breads), and vitamin C or A (from orange juice and fortified milk, respectively).

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“If you skip that meal, you will make up for those calories later in the day,” Salge Blake says. “But are you going to be reaching for high fiber cereal or nonfat milk that’s rich in vitamin D and calcium? Probably not.”

Science appears to support this concern. A number of studies find nutrient shortfalls in adult breakfast skippers, says Gail Rampersaud, a registered dietitian at the University of Florida in Gainesville. One study reported this year of almost 16,000 adults 20 years or older found (based on the subjects’ own reports of what they ate) that those who don’t eat breakfast get fewer micronutrients, including folic acid, vitamin C, calcium, magnesium, iron, potassium and fiber.

Another 1998 study of 504 young adults in Bogalusa, La., reported that breakfast skippers were less likely to meet two-thirds of the recommended dietary intake for many vitamins and minerals, including vitamins D and C, and calcium.

Research also suggests that skipping breakfast could backfire on anyone who’s doing it to stay, or become, slim. “The preponderance of studies suggest that breakfast skipping is associated with greater risk of being overweight,” says Michael Murphy, a child psychologist at Massachusetts General Hospital and an associate professor at Harvard Medical School.

For example, a 2003 study of more than 10,000 Finnish adolescents and parents showed that both adults and adolescent skippers are significantly more likely to become overweight or obese. Another, 2002 study of 499 adults found a four-fold increased risk of obesity for those who reported skipping breakfast 25% of the time.

And a 2003 study of more than 16,000 U.S. adults reported that, on average, breakfast skippers had higher body mass indexes than people eating cereal or bread for breakfast.

The reason could be that people who skip breakfast make up for that calorie shortfall later -- with a vengeance. John de Castro, a psychologist formerly at the University of Texas at El Paso, analyzed seven-day food diaries from about 900 adults and found that people who consume most of their calories later in the day tend to eat more on that day. And a 2003 study of more than 1,200 Swedish adolescents found that breakfast skippers were more likely to get their energy from snack food.

“If people skip breakfast, they will hunt around in the office, and the food they sometimes choose will be more energy dense and not nutrient dense,” says Salge Blake, who advises obese clients to introduce breakfast into their diets.

This tip resonates with Shelley Rattet, who is one of Salge Blake’s clients.

“I didn’t eat breakfast because I was trying to lose weight,” Rattet recalls. “But at night I was starving, so I ate whatever tasted good, for example, potato chips, a piece of cake or popcorn.”

Breakfast may help prevent chronic disease, says Dr. Walter Willett, chair of the department of nutrition at the Harvard School of Public Health. That’s because more frequent smaller meals (including breakfast) are less likely to produce high peaks of glucose and insulin in the blood, which in the long-run can damage the pancreas and increase diabetes risk.

“Spreading out caloric intake, rather than having a few large meals, leads to a better metabolic profile,” Willett says.

And breakfast fuels the brain, helping it perform better, says David Benton, a professor in the department of psychology at Swansea University in Wales. In a 1998 study of 137 women and 47 men, Benton found that students who routinely skipped breakfast (including on the morning of a test) recalled fewer words than people who had had breakfast. Their performance improved when they were given a glucose drink.

Shaky science

Given this mound of pro-breakfast data, what could there be to challenge?

Breakfast skeptics point out that the results of studies that support eating breakfast are mixed, and often not solid enough to draw definitive conclusions.

Many who think breakfast is healthful are quick to acknowledge the shortfalls in the science as well.

To start with, some studies don’t find a clear relationship between skipping breakfast and obesity. For example, a 12-week clinical trial published in 1992, in which 52 obese women received a reduced-calorie diet, did not find a significant difference in weight loss between a group who skipped breakfast and a group who ate three meals a day.

And even in cases in which effects are observed, studies often depend on data that may be unreliable, such as self-reported diets. “I am not always sure that what people report is what they actually do,” says David Levitsky, professor of nutrition and psychology at Cornell University.

Cause and effect is also hard to prove, making it possible that the relationship between body weight and breakfast is spurious.

For example, a 2005 study by Ruth Striegel-Moore, a professor of psychology at Wesleyan University, followed about 2,400 adolescent girls for nine years. She found that girls who ate breakfast more consistently had a lower body mass index.

But the association between skipping breakfast and being overweight went away when the researchers accounted for other factors that differed among the girls, such as overall energy intake, physical activity levels and parental education.

“My personal view is that breakfast skipping probably doesn’t cause health-compromising behavior,” says Dr. Anna Keski-Rahkonen, an epidemiologist at the University of Helsinki, Finland, author of the study of Finnish adolescents and their parents. “It’s probably really a good indicator of a more unhealthy lifestyle.”

Indeed, the committee of scientists who advised the government in crafting its 2005 dietary guidelines concluded that there’s insufficient evidence to say breakfast helps people manage their body weight, says Dr. Carlos Camargo, an associate professor of epidemiology at the Harvard School of Public Health, who served on that committee. (The committee did conclude, however, that there was nothing wrong with eating breakfast -- it wouldn’t make you fatter -- and that skipping it could lower the nutritional quality of the diet.)

Case for skipping

A few researchers would go further than saying breakfast is no great shakes. They’d say avoiding it may even be healthy.

Take dieting.

“If you look at the first change that dieters make in their habits, it’s [dropping] breakfast,” Levitsky says. He thinks they are on the right track. “They know more than the scientists,” he says.

Unconvinced by the skip-breakfast-get-fat connection, Levitsky set out to test it in his lab. In a still unpublished study, he had undergraduate students eat well-defined meals under controlled conditions -- including an all-you-can-eat breakfast some days and no breakfast on others. Both groups could eat as much as they wanted for the rest of the day.

The skippers, Levitsky found, ate about 150 more calories at lunch -- but no extra calories for the rest of the day. As a result, they ate 450 fewer calories.

“If you skip breakfast twice a week, that’s about 1000 calories less,” Levitsky says -- enough, over time, to make a significant difference in one’s weight.

Mattson, of the National Institute on Aging, has done similar research, except he asked people to skip not only breakfast, but lunch as well. In a still unpublished study, he enrolled 20 normal-weight adult men and women, then instructed half of them to skip all meals except dinner. They were told to try to eat the same amount of calories.

None of the people on one meal a day ate more than those on three meals, he says. At the end of two months, those who were on one meal a day hadn’t gained, or lost, any weight -- although he suspects that they would have lost weight, if left to their own devices, because they found it difficult to eat all their allotted calories.

They also had more muscle compared with fat, showed signs of boosted immune responses, and didn’t have higher blood insulin levels, as some scientists fear could result. But they did have higher cholesterol levels.

Mattson has also conducted “intermittent fasting” studies, as he terms them, on rodents. He’s reported that animals deprived of food every other day have lower blood pressure and heart rate, lower insulin levels and an improved removal of glucose from the blood -- all good things.

He would be the first to admit that neither his human or animal studies are quite analogous to just skipping one’s morning meal. But, he adds, “My own gut feeling is that when the inter-meal interval is increased -- whether through intermittent fasting or skipping breakfast -- that will result in qualitatively similar beneficial effects.”

Rodent studies are also invoked by another scientist in support of skipping breakfast. Tamas Horvath, a veterinarian and neuroscientist at Yale University, says he has evidence from mice that hunger makes them smarter. He notes that both hungry mice and hungry people have higher blood levels of a hormone called ghrelin, which is released from an empty stomach, signaling hunger to the body. In a study published this year, he found that mice engineered to lack the ghrelin gene took longer to learn how to avoid electric shocks in a maze-running task.

“It has been known for hundreds of years that for an animal to perform, you need to food deprive them,” Horvath says. “Who invented breakfast? It was a social thing. Most animals don’t have breakfast, lunch and dinner.”

In exploring the breakfast issue, some scientists have even experimented on themselves. For Seth Roberts, a professor of psychology at UC Berkeley, years of self experimentation, changing one thing at a time and meticulously recording the effects, showed him that he tended to wake up several hours before breakfast. The effect, called “anticipatory activity,” has been known in animals for decades, he says.

So he cut out breakfast. And now he sleeps much better.

“People get it exactly wrong,” he says. “Breakfast is the most important meal to avoid.”

Pro-breakfast researchers and dietitians are not too impressed by such findings. They note that animal studies may not apply to human beings, and as-yet-unpublished trials on people have not yet passed the test of critical peer review.

The case against breakfast is “based on bad science and spurious assumptions,” says Murphy of Harvard.

“Don’t throw out breakfast because of a few animal studies,” he says. “Even for adults, the evidence is strong.”

Many breakfast advocates also say there’s a need for better studies -- such as formal clinical trials -- to study the role of breakfast in promoting good health. But this doesn’t mean, they add, that the data for the traditional morning meal aren’t pretty persuasive already.

“I totally agree that we need more research,” say Striegel-Moore of Wesleyan. “But if pinned to the wall, I would say that breakfast skipping is bad. Is the evidence bulletproof? No. It’s like climate change. We haven’t experimentally manipulated the Earth, but we have got a lot of evidence.”

It is not clear that major, federal money will ever be thrown at settling the breakfast dilemma. In the meantime, anyone who wants to skip it but is worried about those shortfalls in vitamins and minerals can take a handy tip from Mattson.

“Eat breakfast at lunch,” he says.


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