The day starts early at our farm and raising two boys means a bigger effort in the morning to get everyone ready for the day ahead. So, how bad is it to short-change breakfast?
We asked a medical doctor to review the scientific literature and tell us what science has to say about the (un)importance of breakfast. Farmers should eat a big breakfast, we know, but how about people of all walks of life and all ages?
Here’s what she had to say – and oh, yeah, we should be making more out of breakfast!
P.S. We did not ask her to investigate the importance of eating maple syrup at every breakfast because we all know that it’s important. 😊
By Michele Repo B.Sc. (Human Nutrition), MD
THE SCIENCE OF BREAKFAST: WHAT DO THE EXPERTS SAY?
There are more than a few schools of thought when it comes to breakfast. We’ve all heard the adage, “Make sure you have a good breakfast.” and probably also know a few people who report that they’re “just not breakfast people.” So, is it different strokes for different folks or does science tell us that one approach is better than the other?
Breakfast: To eat or not to eat?
Let’s start with children, the group of people who are arguably the most likely to be lectured about the value of breakfast. What does science tell us about the value of breakfast to the young ones in our life? Firstly, science doesn’t always tell us the same thing. Research study A may directly contradict research study B. Still, there are significant trends in the scientific literature when it comes to children and the first meal of the day. For example:
- Weight management: Multiple studies have shown an association between skipping breakfast and children being overweight and/or obese 1,2,3.
- Cognitive Function: There is some evidence that eating breakfast is associated with improved attention, executive function, memory, standardized test results and school performance in children 4,5,6. When eaten “nearly every day,” breakfast was also associated with higher IQ in kindergarten children
- Physical Health: In a study of 2000 children (Ho, 2015), daily breakfast was associated with lower blood pressure and reduced risk of metabolic syndrome (a condition that includes, amongst other things, high blood pressure, high blood sugar, and abdominal obesity).
- Athletic Performance: In a study of over 250 school aged children, eating breakfast was associated with better aerobic fitness and stronger leg muscles – both which come in handy for young athletes 8.
It may seem obvious that children with their developing minds and bodies, would benefit from morning fuel. But what about adults, who aren’t experiencing the same growth spurts or brain development as their younger counterparts? Does breakfast have anything to offer them? Here’s a sampling of relevant research:
- Weight management: A multi-year study in the USA found that eating breakfast was associated with lower BMI and smaller waist circumference in adults 9. However, par for the course, other researchers in the field have found no such association 10, 11.
- Cognitive Function: A small study of 10 adults demonstrated that skipping breakfast reduced executive function significantly 12. A broader review of the literature found a “small but robust” improvement in memory associated with eating breakfast 13.
- Physical Health: In a study of Japanese adults (aged 45-74), the more frequent the breakfast eating, the lower the risk of stroke. In this study, three days of breakfast didn’t offer the same protection as seven days 14. In a study of younger adults (aged 21-39), those who regularly skipped breakfast had a greater risk of high blood pressure, higher levels of “bad” cholesterol and abdominal obesity. In contrast, the authors reported that the breakfast eaters had a better "cardiometabolic profile."15
- Athletic Performance: In a study of 10 adults used to eating breakfast, missing that meal reduced their exercise performance later in the day 16.
It’s safe to say that there is a fair chunk of evidence that eating breakfast is associated with good things for both children and adults. However, it’s important to point out that there is also a sizeable amount of published research demonstrating that breakfast either doesn’t provide any benefit or, worse, can result in detrimental effects such as weight gain 17, an outcome not terribly popular with most people.
Will anything do or, can I just grab a double glazed and call it a morning?
Okay, so the scientific literature is a mixed bag when it comes to breakfast. Despite this, some people will embrace breakfast as part of their daily routine, whether they chose to do so based on habit, preference and/or their reading of the science. For those people, the natural next question is, “Will any breakfast do or does it have to be, ‘healthy’ or ‘complete’?”
Let’s start the answer with a look at what the experts in the field consider to be a “healthy” or “complete” breakfast. Not surprisingly, there isn’t yet a consensus when it comes to defining those terms. One approach to take is simply to assign breakfast it’s fair share of the daily macro and micro-nutrient requirements. In other words, if breakfast is one of five eating episodes during the day (for those who take the three meals and two snack route), then including approximately 20% of your daily energy and nutrient needs at breakfast seems intuitive. Equally intuitive would be a breakfast not steeped in saturated fat, sugar, and sodium. But, if you’re looking for something more specific, then the Breakfast Quality Index (BQI) proposed by researchers out of Brazil might be of interest 18. When assuming five meals/snacks per day, this indicator allows a breakfast to earn “quality” points based on meeting the following criteria:
- The breakfast includes cereal, fruit/vegetable, and dairy.
- Calories equal 15 to 25% of daily intake.
- Calcium equal to at least 20% of daily requirement.
- Free sugar (i.e., added sugar plus sugar from honey, syrup and fruit juice) equals less than 2% of total daily calories.
- At least 5 grams of fiber.
- Sodium is less than 400 mg.
- Saturated fat content equals less than 2% of total daily calories
As would be expected, these criteria are research based. For example, when it comes to the fiber criteria, a study of 70,000 women found that high fiber carbohydrates for breakfast offer more protection against developing type II diabetes than low fiber carbohydrates 19. An earlier study found the same association in men 20. When it comes to added sugar, the benefits of breakfast to mental performance may be better when the meal causes a “lower postprandial glycemic response.” 21 What does that mean? Put simply, foods that cause less of a spike in your blood sugar (i.e., generally those that contain less free sugar) may be better for your brain performance. And again, in keeping with the BQI, German researchers found that men eating breakfast which included processed foods, complete with higher saturated fat and salt content, had larger waists and worse blood sugar control than the men who ate breakfasts made up of cereal, fruit, and vegetables 22.
But remember, breakfast doesn’t have to be complicated. Even a bowl of ready-to-eat (RTE) breakfast cereal may be of benefit. If cereal is your breakfast-of-choice and you want to optimize potential health benefits, try opting for the high fiber, low sugar, whole grain variety rather than a bowl of brightly colored sugary treats 23. Still have a hankering for your favorite childhood cereal, refined grains and all? Well, take heart. A study of over 17,000 male physicians demonstrated that both whole grain and refined cereals are associated with lower BMI and less weight gain over 8-13 years 24. If you want more specifics when it comes to eating RTE cereals for breakfast, a 2016 meta-analysis of 64 studies found that eating this food at least five times a week offers some advantages including 25:
- Significantly greater chance of having a diet that includes enough vitamin A, calcium, folate, vitamin B6, magnesium, and zinc.
- Potential for improved hypertension and type 2 diabetes if eating whole grain RTE cereal.
- Potential for lower levels of “bad” (LDL) cholesterol if eating RTE containing soluble fiber.
The disadvantage to grabbing a bowl of cereal as you rush through your morning routine? Not unexpectedly, the sugar content of many RTE cereals gets in the way of winning the prize for “best-breakfast-food-ever.”
Ahh, but before we finish discussing “healthy” and “complete” breakfasts, the fly in the ointment is once again the lack of agreement between different studies. In reviewing the research, Phillipou 26 reported that the evidence is inconclusive when it comes to whether a “healthier” or “more complete” breakfast is the best choice. So, what to do? One option is to wait until scientists reach something resembling a consensus. Another option is to acknowledge the lack of agreement in the research community while still (logically?) putting your money on getting more health benefits from whole grains, healthy fats and phytonutrients found in fruits and vegetables, than from the chocolate croissant calling your name.
Was grandma (or grandpa) right? Is a hot breakfast better than a cold one?
The scientific literature doesn’t seem to have dedicated many resources to the question of hot versus cold breakfasts. But if “hot” is a proxy for whole grain porridge and “cold” is a proxy for a bowl of a typical cold cereal, there may be a difference. In a study of 48 adults, either eating a breakfast of oatmeal porridge or cold cereal, it was the former group that experienced more satiation, reduced hunger and ate less at lunch compared to the cold cereal group 27. The oatmeal was higher in fiber and protein, and lower in sugar but contained the same number of calories as the bowl of cereal. Knowing that, one can speculate that porridge offers some advantages not because it is hot but because of its nutritional content. In keeping with that theory, a study of adults found that having (warm) rye porridge for breakfast kept hunger at bay longer than your standard piece of (warm) white toast 28. Same temperature, different results. (As a bonus, the higher fiber content of the rye porridge may also improve cholesterol levels and digestive function).
Daily or will occasionally do?
You might next ask, “Who has time for breakfast every day of the week? Can’t I just settle on a few days and save myself time, effort and expense?” Your call, of course, but if you’re hoping to accrue as many benefits from your breakfast as possible, it may be that eating that meal seven days a week is the best option. In a study of 40,000 nurses, eating breakfast every day was associated with a lower rate of type 2 diabetes than eating breakfast 0 to 6 times per week 29. The possibility that daily breakfast offers more health benefits than eating it less frequently is also supported by the Japanese stroke study mentioned previously 14 and at least one study of school performance and metabolic health in children 5.
Just remember - associations are not causations:
As already acknowledged, just as there are plenty of studies demonstrating that eating breakfast is associated with significant benefits, there are also plenty of studies which found no such thing. Further, even when an association is evident, it is very important to remember that just because A is associated with B doesn’t mean A causes B. In other words, breakfast can be associated with benefits without being responsible for said benefits. For example, maybe people who make breakfast part of their daily routine also tend to make exercise a regular part of their daily routine. If that’s true, then physical activity, rather than eating breakfast, may deserve the credit for reducing BMI, waist circumference and the risk of type 2 diabetes. And that's why as recently as 2017 it has been argued that the role breakfast plays in optimizing cognitive function, physical performance, weight, and physical health has yet to be fully established 30.
It’s up to you how much evidence is enough to justify taking a good, hard look at your breakfast habits and consider making some changes. Only you know whether the possibility of benefits is enough to justify the certainty of the effort required to make breakfast a regular part of your daily routine. If the evidence threshold has been reached, and you’re so inclined, you can always conduct your own experiment. Maybe try a daily breakfast (as “complete” and “healthy” as you can tolerate) and keep track. Does your blood pressure improve? Your ability to think clearly for the first 3 hours of the work day? If your family is joining in, do your kids seem to be more focused? More energetic? Just remember, that breakfast may not always result in short term benefits. So, a week of porridge might not be the answer to the 10 pounds you’ve been trying to lose for the last five years. But six weeks of warm oatmeal just might make a positive difference to your total cholesterol and waist circumference 31.
A parting thought: Go the route of a food scientist, not the food police.
Some words to the wise for anyone considering becoming a breakfast evangelist. Nobody likes the food police. If you decide that breakfast is the way to go, consider becoming a scientific ambassador for the meal and not an individual who sentences your partner, or your kids to a morning bowl of unrequested and unwanted oatmeal. If you go the route of “you must eat breakfast or else…,” you may win the short term-battle but lose the war, as power struggles over food are nobody’s friend. By all means, be a proud supporter of breakfast, but lead by example not by edict. Whether the example you provide is hot cereal, scrambled eggs or a smoothie full of yogurt and berries, doesn’t really matter. What matters is that breakfast in your house is about positives, not punishment.
The science of breakfast continues to unfold and with it, our understanding of what that meal can offer our mind and body. For now, with many questions still lacking definitive, once-and-for-all, answers, it’s likely that the combination of science, common sense, and personal preference will be the guiding force for breakfast done right. It’s a reasonable starting point that hopefully will segue into an increasingly scientifically informed morning meal.
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