In July of this year (2013) there was a barrage of articles and reblogs about a study done on breakfast and exasperation of health conditions. Here is the study: “Prospective study of breakfast and incident coronary heart…”
The interpretation is sort of our classic oversimplification and very linear (which is a single thing creates a single outcome) view of the evidence. “Skipping Meals Leads to Heart Attacks”.
The “why” of skipping breakfast leading to a greater risk of heart attacks is guessed by the researchers that because these individuals eat only two meals they are eating more calories in a short time-span creating excessive load. it’s not a bad theory, eating a lot of calories can be stressful to the system, similar to sex or exercise. But the problem with the guess that it’s like a quick burst of exercise creating heart attack risk, is that we within the same study they already contradict this assertion. Those stating they only eat 2 meals a day have a reduced risk heart attack. Does that mean they cancel each other out, or that those eating only two meals a day can handle the “exercise” of a larger meal? That’s what is called a systems approach. We have to look at the system to make our interpretation of the evidence.
The ultimate bottomline: “Don’t Skip Breakfast” which is the advice and interpretation from the lead researcher of this study, Dr. Leah E. Cahill, could and should really be in my opinion “Don’t Let Food or Lack of cause you excessive or unmanaged stress”.
Excessive calories are problematic, but directly problematic because of the high sugar-fat content. Skipping breakfast, especially if it’s forced or in the name of time, may be problematic because when the system is starving and goes into crazy “must have food” mode, it’s going to go for even higher calorie options. We know this from the studies on HPA reactivity in response to a meal being withheld and common sense and experience. If we skip a meal and get too hungry we go for whatever is quickest and tastiest.
Researchers discuss this as “meal anticipatory” mechanisms. If we think of heart dysfunction as a metabolic dysfunction from foods we could see this as multifold stress mechanism. When under stress the action of the heart and subsquent arterial actions are altered. If we look for causes we look for stress supervisors being overwhelmed, in trouble and trying to regain control. So. For some skipping a meal, like they do in alternate-day fasting may be beneficial when adapted to because it gives the system more time to not be eating and to be doing other things. Hence we see benefits. But when one skips a meal and is then “starving” by lunch or midafternoon, the system is in an emergency state. And in those emergency states the body wants higher calorie, quicker forms of energy, foods. The problem with these foods of course is that in the processed forms of high fat-sugar combinations, this causes the system more stress. So the load of the meal (calories) can be stressful as can the load of fat-sugar in isolation. We see evidence to this effect that polyphenols (like from olive oil) attenuate the stress of a high fat-sugar meal. So the better quality the meal the better this would be. The calorie load stress is much like an exertion stress from exercise or sex, it could trigger a heart attack, but it’s not really something we could see in isolation as creating the problem. Long term constant stress on top of stresses on top of stresses (without resources and recovery) are clearly problems. Skipping breakfast isn’t good or bad in and of itself but doing it to restrain yourself or if you are in a hurry and then pound a crappy lunch, this is going to cause you metabolic distress.
But this is why we must look at these things in the context of stress mechanisms. Why does skipping breakfast create heart issues? Because it creates excessive stress. Eating the second meal under stress makes for bad choices, those bad choices exasperate the stressed situation. Who’s it going to effect the most? Those under social stress are predisposed to react to stress in that particular manner. Chaos. Stress. So much sense (and sense of evidence). The problem is our current medical model thinks everything is linear. So they think they can give linear advice, like “don’t skip breakfast” or “eat healthier”, it’s not that those pieces of advice are untrue, it’s that those pieces of advice are inadequate because we are using linear logic in a nonlinear dynamic. A nonlinear dynamic depends on the system and really how that system handles stress and what it considers stressful. It makes it so any blanketed advice is wrong and the evidence needs to be worked in a nonlinear way, not a linear “cause-effect” give a piece of advice manner.
So we know that for those that skip the first meal, I would hypothesize that it depends on their cortisol levels and it would depend if skipping that meal made them “starving” later. Like the researchers guessed that it would be too many calories in too short of time. But again this would depend on the state of the system and the quality of the meal. Too much fat and sugar would definitely cause a strain on the system. And we tend to crave higher fat-sugar combinations when we’ve gone too long without eating and we’ve created a stress reaction.
As Madelyn states in her article “Skipping breakfast and heart disease: Not so simple” states it’s about the quality of the meals as well. Madelyn reduces her oversimplified advice to eat breakfast but make sure it’s “healthy”. And by the definition of a low fat and good nutrition. But low fat isn’t always essential for heart-health, a nice piece of stinky cheese and oily fish may be in order for some, those are certainly not low fat! Always eat a breakfast every day that is low-fat and “healthy” is also too over-simplified. Over at NPR reporting on the topic, so-and-so gets closer because she herself is a breakfast skipper, she simply has no appetite in the morning and waits to eat till mid-morning. She feels it’s no good to force yourself and I’d certainly see her point of view. What it boils down to is what and how the meal is creating stress, both eating a meal that slows us down first thing in the morning. But avoiding meals to only put yourself into an excessive stress mode later in the day. It’s stress all around. How do we control stress? It’s a complicated story, but it comes down to putting the evidence first in the correct framework, a nonlinear one. It’s going to give us better answers. Should we have fish and cheese for breakfast? Bacon and eggs? Bisquit and coffee? Green tea and granola? Fruit and yogurt? Or skip it all together (for a later midmeal). The answer is going to be “it depends on your system”. We can find patterns and associations, but there will never be a blanketed “Eat this and Not that” for everyone. That’s linear thinking and when it comes to stress and our health, it is inadequate and misleading.
REFERENCES AND FURTHER READING:
- Dairy delights: Eating butter and cheese ‘doesn’t increase risk of heart attacks’ Read more: http://www.dailymail.co.uk/health/article-1388971/Dairy-delights-Eating-butter-cheese-doesnt-increase-risk-heart-attacks.html#ixzz2ZuA83LcZ
- Skipping Breakfast and Heart Disease: Not so Simple. http://www.nbcnews.com/health/skipping-breakfast-heart-disease-not-so-simple-6C10710530
- Why Skipping Breakfast Might Raise Risk Of Heart Disease. by Allison Aubrey. July 23, 2013 http://www.npr.org/blogs/thesalt/2013/07/23/204567839/SKIPPING-BREAKFAST-IS-RISKY
- The impact of religious fasting on human health. Trepanowski JF, Bloomer RJ. Nutr J. 2010 Nov 22;9:57. doi: 10.1186/1475-2891-9-57.
- The implications of Ramadan fasting for human health and well-being. Alkandari JR, Maughan RJ, Roky R, Aziz AR, Karli U.J Sports Sci. 2012;30 Suppl 1:S9-19. doi: 10.1080/02640414.2012.698298. LINK
- NRF2 and the Phase II Response in Acute Stress Resistance Induced by Dietary Restriction. Hine CM, Mitchell JR.J Clin Exp Pathol. 2012 Jun 19;S4(4). pii: 7329. LINK
- Fish Oil in Primary and Secondary Cardiovascular Prevention. Surya M. Artham, MD, Carl J. Lavie, MD, Richard V. Milani, MD, Rishi G. Anand, MD, James H. O’Keefe, MD, and Hector O. Ventura, MD. Ochsner J. 2008 Summer; 8(2): 49–60. LINK
- The Diet-Heart Myth: Cholesterol and Saturated Fat Are Not the Enemy. http://chriskresser.com/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy
- Food anticipation and subsequent food withdrawal increase serum cortisol in healthy men. Ott V, Friedrich M, Prilop S, Lehnert H, Jauch-Chara K, Born J, Hallschmid M. Physiol Behav. 2011 Jul 6;103(5):594-9. doi: 10.1016/j.physbeh.2011.04.020. Epub 2011 Apr 28. LINK
- Meal anticipation potentiates postprandial ghrelin suppression in humans. Ott V, Friedrich M, Zemlin J, Lehnert H, Schultes B, Born J, Hallschmid M. Psychoneuroendocrinology. 2012 Jul;37(7):1096-100. doi: 10.1016/j.psyneuen.2011.10.007. LINK
- High HPA-axis activation disrupts the link between liking and wanting with liking and wanting related brain signaling. Born JM, Martens MJ, Rutters F, Lemmens SG, Goebel R, Westerterp-Plantenga MS. JournalPhysiol Behav. 2012 Jan 18;105(2):321-4. doi: 10.1016/j.physbeh.2011.08.015. LINK
- Low Calorie Dieting Increases Cortisol. Janet Tomiyama, Ph.D., Traci Mann, Ph.D., Danielle Vinas, B.A., Jeffrey M. Hunger, B.A., Jill DeJager, MPH., RD,Shelley E. Taylor, Ph.D.Psychosom Med. 2010 May; 72(4): 357–364. LINK
- Diet Choice, cortisol reactivity, and emotional feeding in socially housed rhesus monkeys. Marilyn Arce, Vasiliki Michopoulos, Kathryn N. Shepard, Quynh-Chau Ha, and Mark E. Wilson. Physiol Behav. 2010 November 2; 101(4): 446–455. LINK
- Does consuming breakfast influence activity levels? An experiment into the effect of breakfast consumption on eating habits and energy expenditure. Halsey LG, Huber JW, Low T, Ibeawuchi C, Woodruff P, Reeves S. Public Health Nutr. 2012 Feb;15(2):238-45. doi: 10.1017/S136898001100111X. Epub 2011 Jun 23.