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Eating breakfast is cereally good for your health

We all know that eating breakfast is good for you, but recent research found that nearly half of young people aged 16-24 miss breakfast at least twice a week, which could be fuelling the rising UK obesity rates in the under-25s.(1) Sarah Schenker gives some practical advice on how to get a healthy start to the day

Sarah Schenker
BSc SRD PhD
Dietitian
British Nutrition Foundation
London

The belief that breakfast is the most important meal of the day has become part of conventional wisdom. So is the old cliché true? Breakfast certainly is a very important meal and the advice not to skip breakfast is included as one of the eight tips for eating well by the Food Standards Agency (see Resources). Not only does breakfast provide energy to start a new day, but a healthy breakfast is linked to many health benefits, including weight control and improved mental performance.(2)
Studies show that eating a healthy breakfast can help to (see Resources):(2)

  • Achieve a more nutritionally complete diet, higher in nutrients, vitamins and minerals.
  • Improve concentration and performance in the classroom or the work place.
  • Provide strength and endurance to engage in physical activity.
  • Lower cholesterol levels.
  • Help with weight control.

Breaking the fast
Breakfast typically follows the longest period of fasting
during the 24-hour daily cycle. Therefore skipping breakfast will lead to reductions in energy and nutrient levels throughout the morning. Overnight the body's metabolism changes from an anabolic state (often referred to as well fed) to a catabolic state (starvation mode) and as such the body draws on its energy reserves to keep itself going. The brain is the biggest user of glucose in the body, which is supplied by the breakdown of carbohydrate, fat and protein stores. This continues until you literally break the fast, ie, eat breakfast. While some may view the breakdown of fat stores as desirable, during this catabolic phase the body does not exclusively break down fat and carbohydrate stores, in fact protein muscle stores are also broken down, which can ultimately decrease lean muscle mass and consequently decrease metabolic rate (which is proportional to muscle mass).(3)
Eating a mixed breakfast soon after waking provides available energy for the day ahead and is said to kickstart the body's metabolism. On waking it is natural to have a slightly low blood sugar level as the body tries to spare available glucose. Skipping breakfast can therefore lead to feelings of sluggishness and fatigue until something is eaten (by which time hunger pangs occur). Additionally it is normal to wake up slightly dehydrated as the body loses fluid overnight, which is expelled first thing in the morning, and skipping breakfast may limit the amount of fluid that is taken, leaving the body not fully hydrated, maybe not dehydrated enough to feel thirsty but enough to affect concentration levels.(4)

Breakfast and cognitive performance
Eating breakfast is important for everyone, but is especially so for children and adolescents. Children who eat breakfast perform better in the classroom and on the playground, with better concentration, problem-solving skills, and eye-hand coordination.(5) The majority of studies investigating the effects of eating breakfast on mental ability and academic achievement have been conducted in school-aged children, but the results have implications for adults too.
Studies have shown that eating breakfast can improve performance on cognitive tasks. For example, one study demonstrated not eating breakfast impaired the problem-solving abilities of well-nourished nine to 11-year-old children. When tested in the late morning, the children made significantly more errors on a task when they had not eaten breakfast. Similarly, another study found that the same-age children made significantly more errors on a test, and did more poorly on an attention task, when they had not had breakfast.(6,7)
There have also been a few studies in adults. Benton and Sargent reported that university students who did not eat breakfast did more poorly on memory tests than students who consumed a morning meal.(8) Smith et al, using a similar group of subjects, found that not eating breakfast impaired performance on free recall and recognition memory tasks, but did not alter performance on sustained attention tasks.(9)

Breakfast and weight control
Many studies, in both adults and children, have shown that breakfast eaters tend to weigh less than breakfast skippers.(10) One theory suggests that eating a healthy breakfast can reduce hunger throughout the day, and help people make better food choices at other meals. While you may come across patients who think that they can "save calories" by skipping breakfast, it is worth explaining to them that this is not an effective strategy. Typically, hunger gets the best of breakfast-skippers, and they eat more at lunch and throughout the day. They are also more likely to be in a situation where they are not able to make a healthy choice once hunger strikes. For example, at work there is likely to be limited or no access to fruit or cereal, in which case they will have to rely instead on the office vending machine for sweets and crisps.
Another theory behind the breakfast-weight control link implies that eating breakfast is part of a healthy lifestyle that includes making wise food choices and balancing energy intake with activity. This in turn has linked the consumption of breakfast with improved health, lower cholesterol levels, lower blood pressure and lower risk of obesity-linked conditions such as diabetes, heart disease and cancer. In the US, the National Weight Control Registry follows the progress of successful weight losers, all of whom have lost at least 30 pounds and kept it off for at least one year. Some 80% of the people in the Registry regularly eat breakfast (and also follow a calorie-controlled, low-fat diet). It is important to note that most studies linking breakfast to weight control/loss looked at a healthy breakfast containing protein and/or wholegrains - not meals high in fat and calories.

The composition of breakfast
While it is acknowledged that eating something for breakfast is better than eating nothing, it has been suggested that the composition of breakfast may be important in maintaining the feeling of fullness until lunchtime. Stubbs, et al compared the effect of isoenergetically-dense, high-protein, high-fat or high-carbohydrate breakfasts on subjective hunger, fullness and appetite, macronutrient balance and ad libitum energy intake throughout the day.(11) Subjective hunger was significantly greater during the hours between breakfast and lunch after the high-fat breakfast compared with the high-carbohydrate and high-protein meals, although the high-protein meal suppressed hunger to a greater extent than the other two over 24 hours. However, mean ad libitum lunch intakes were similar after each breakfast.
Protein blunts hunger more than either carbohydrate (even low GI) or fat, and is the most satiating of the energy-providing nutrients. The results of a recent study by Vander Wal et al showed that a traditional breakfast of eggs may be one of the best ways to provide morning protein.(12) The researchers compared weight loss in women who ate either two eggs or a bagel for breakfast. 
The two breakfast meals were identical in energy and volume. Compared with the bagel eaters, overweight women who ate two eggs for breakfast five times a week for eight weeks as part of a low-fat, reduced-calorie diet, lost 65% more weight, reduced waist circumference by 83%, reported higher energy levels, and had no significant difference in their blood cholesterol or triglyceride levels.
Further studies, as yet unpublished, substantiate protein's ability to satisfy hunger. The researchers claim that when people eat eggs at breakfast, they experienced greater satiety, reduce perceived cravings and subsequent short-term energy intake, compared to those who ate a primarily carbohydrate meal like a bagel.(13)
Another study by Leidy et al found that women who added a little lean protein to their breakfast (in the form of a slice of Canadian bacon added to an egg sandwich made with an English muffin) felt less hunger during the next four hours than those who ate a breakfast without protein.(14) All the participants lost about 18 pounds over the course of the study, but the group eating more protein - about 30% of total calories - kept more lean muscle than the group who ate the same number of calories but less protein. This has been explained by the fact that lean muscle mass is more metabolically active, and thus helps with weight management.

Breakfast cereal and weight control
Many studies have also shown that when breakfast cereal is consumed as part of an overall healthy lifestyle, it can play a role in maintaining a healthy body weight. Analysis of data from the Health Professionals Follow-Up Study of more than 17,000 men, found that those who frequently ate breakfast cereal - both refined grain and wholegrain types - consistently weighed less than those who rarely or never ate breakfast cereal.(15)
Another study by Song et al evaluated the diets of adults and found that breakfasts of ready-to-eat cereal were associated with lower BMIs in women than other, higher-fat breakfast meals.(16)

Conclusion
All of this demonstrates how important it is to persuade patients to stop the bad habit of skipping breakfast and encourage them to choose healthier foods. A healthy breakfast meal should contain a variety of foods, including fruits and/or vegetables, wholegrains, low-fat dairy foods and lean protein.
Some quick and healthy choices include:

  • A low-fat cheese and tomato omelette and a piece of wholemeal toast.
  • A wholemeal English muffin with low-fat cheese and slice of lean ham with sliced tomato.
  • Smoked salmon on a wholegrain bagel with low-fat soft cheese.
  • Oatmeal made with semi- or skimmed milk, raisins and nuts, with fruit juice.
  • Wholegrain cereal with fresh fruit and semi-skimmed milk.

For those who think they don't have time to eat breakfast, some quick and healthy choices include:

  • A smoothie made with fruit and low-fat yoghurt.
  • A low-fat yoghurt or fromage frais and a piece of fresh fruit.
  • A carton of fruit juice and a breakfast bar.
  • A banana and a probiotic drink.
  • A skinny latte and a low-fat fruit scone or muffin.

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References

  1. Nursing in Practice online. Skipped breakfast fuelling obesity rates. 31 March 2008. Available from: /article_9618
  2. Ramersaud GC, Pereira MA, Girard BL, Adams J, Metzl JD. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc 2005;105:743-60.
  3. Johnstone AM. Fasting - the ultimate diet? Obes Rev 2007;8:211-22.
  4. Lieberman HR . Hydration and cognition: a critical review and recommendations for further reseach. J Am Coll Nutr 2007;26:555S-61.
  5. Kleinman RE, Hall S, Green H, et al. Diet, breakfast, and academic performance in children. Ann Nutr Metab 2002;46 Suppl 1:24-30.
  6. Crepinsek MK, Singh A, Bernstein LS, McLaughlin JE. Dietary effects of universal-free school breakfast: findings from the evaluation of the school breakfast program pilot project. J Am Diet Assoc 2006;106:1796-803.
  7. Murphy JM, Pagano ME, Nachmani J. The relationship of school breakfast to psychosocial and academic functioning: cross-sectional and longitudinal observations in an inner-city school sample. Arch Pediatr Adolesc Med 1998;152:899-907.
  8. Benton D, Sargent J. Breakfast, blood glucose and memory. Biol Psychol 1992;33:207-10.
  9. Smith AP, Clark R, Gallagher J. Breakfast cereal and caffeinated coffee: effects on working memory, attention, mood, and cardiovascular function. Physiol Behav 1999;67:9-17.
  10. Stubbs RJ, van Wyk MC, Johnstone AM, Harbron CG. Breakfasts high in protein, fat or carbohydrate: effect on within-day appetite and energy balance. Eur J Clin Nutr 1996;50:409-17.
  11. de la Hunty A, Ashwell M. Are people who regularly eat breakfast cereals slimmer than those who don't? A systematic review of the evidence. Nutr Bull 2007;32:118-28.
  12. Vander Wal JS, Marth JM, Khosla P, Jen KL, Dhurandhar NV. Short-term effect of eggs on satiety in overweight and obese subjects. J Am Coll Nutr 2005;24:510-5.
  13. Dhurandhar NV. Egg breakfast enhances weight loss' conference. Experimental Biology. Department of Infection and Obesity. LSU's Pennington Biomedical Research Center. 2007.
  14. Leidy HJ, Carnell NS, Mattes RD, Campbell WW. Higher protein intake preserves lean mass and satiety with weight loss in pre-obese and obese women. Obesity 2007;15:421-9.
  15. van der Heijden AA, Hu FB, Rimm EB, van Dam RM. A prospective study of breakfast consumption and weight gain among US men. Obesity 2007;15:2463-9.
  16. Song WO, Chun OK, Obayashi S. Is consumption of breakfast associated with body mass index in US adults? J Am Diet Assoc 2005;105:1373-82.

Resource
EatWell - Nutrition Consultancy
W: www.eatwell.co.uk