By David Katz, M.D. HuffPost
Personally, I have long thought that whatever the particular merits of breakfast, hieratic zeal as the main course was in fact a rather dubious way to start the day. So it is that I welcomed a new study that purportedly was about debunking breakfast, but was really about debunking dogma for breakfast.
The study in question, just published in the American Journal of Clinical Nutrition, is noteworthy for a couple of reasons. The research team was led by none other than Dr. David Allison, famous for confronting the popular myths and folklore of public health nutrition. Dr. Allison was all but burned in effigy in the documentary Fed Up because of his involvement with industry-funded research. That is a worthy topic in its own right, one Dr. Allison has addressed, and one to which I will turn my attention in a subsequent column. For now, we may simply note that Dr. Allison can be a bit controversial, but is generally recognized among professionals, both by those prone to agree and those prone to disagree with him, as one of the smartest people in the business.
In this case, Dr. Allison and his research team devoted those aptitudes to the design of a rather elegant study addressing the time-honored question: Is it critical to eat breakfast if interested in losing weight?
Consider the trial elements we would need to answer that question reliably. An obvious start would be a group of overweight or obese adults interested in weight loss. The study enrolled just such a group of slightly over 300 people, at five participating medical centers in two countries. We would want study involvement limited to people who were active during the day, and out of bed at some reasonable time in the morning -- a study of breakfast among night-shift workers would be obviously distorted. Here, too, the study did just what we would hope.
We should want to know something about the habitual approach to breakfast among study participants, and ideally account for that in the study design. The study did that, too -- stratifying subjects on the basis of their pre-study breakfast routine. In other words, study participants who routinely ate breakfast and those who routinely skipped it were randomized in equal proportions to the different interventions.
As for those interventions, we would obviously want to compare two comparable weight-loss programs that differed only with regard to advice about breakfast, one involving having it every day, the other involving skipping it. To know that the weight-loss program itself was responsible for weight loss, we might like those two groups compared to a control group that didn't get any advice about breakfast at all. The study satisfied all of these criteria as well, randomizing subjects to one of three such groups.
The control group received a pamphlet about good nutrition developed by the USDA, general advice about weight loss, and no instructions regarding breakfast per se. The breakfast group received the same pamphlet and weight-loss guidance along with instructions to have breakfast before 10 a.m. every day. The "no breakfast" group received identical weight-loss guidance and materials, along with instructions not to eat anything before 11a.m. Study participants knew which group they were in, of course, but the researchers gathering and analyzing the data did not -- so the study was both randomized, and "single-blinded."
Dr. Allison is, among other things, an accomplished biostatistician, so the study data were parsed and presented with noteworthy erudition, but we may spare ourselves those details and cut to the chase. Weight loss was a modest half to one kilogram on average (predictable, given the very moderate intensity of the intervention) over the study span of four months, and virtually identical in all three groups. It was also statistically identical between those who historically ate and those who historically skipped breakfast prior to the study, with insignificantly more weight loss observed among the historical breakfast skippers. The researchers specifically looked for an interaction between breakfast habits at baseline, and weight loss in response to study assignment, and found none.
There's more to the article, but we can let it go at that. Limitations include the relatively short duration, the very modest nature of the weight-loss intervention, the very modest weight loss overall, and no particular attention to the details of breakfast choice. But none of these obviates the basic takeaway message: other things being equal, breakfast consumption before 10 a.m. had no direct implications for weight control.
I rather like the public health implications of breakfast for a number of reasons. In our culture, fiber intake tends to be well below recommended levels, and well-chosen whole grain cereals -- such as oatmeal -- can help redress that. Breakfast is also a great opportunity for fruit and nut consumption, and for those so inclined, dairy as well -- providing often needed vitamin D and calcium, along with high-quality protein. My own daily breakfast is nicely representative: mixed berries and other fruits, walnuts, organic plain non-fat Greek yogurt, and whole grain cereal (typically one of my favorite Nature's Path* varieties).
But fan though I may be, I have also recognized that the seemingly inviolate importance of breakfast to health and weight was largely based on very limited research conducted mostly among poor school children who skipped breakfast involuntarily and came to school hungry. No great surprise that the distraction of an empty, grumbling stomach does not a good student make.
I have also been resistant to the notion that breakfast had to be at any very specific time, never finding any clear evidence to the contrary. I often write first thing in the morning, and then fit in a late morning workout -- and have my "breakfast" afterward. I consider it breakfast both because it is comprised of traditional breakfast foods as noted, and because it is my first meal of the day and thus the one that "breaks" my overnight "fast." But I often have it after 11 a.m., and thus would qualify under the study terms as a breakfast "skipper." I was never convinced that a decree had ever been issued by the gods of nutrition that eating at 9:52 a.m. was fundamentally different from eating at 11:03 a.m. Breaking our fast has to happen, of course, but I see no reason why we can't do it when so inclined.
There are still potential perils in "skipping" breakfast, however. In my experience, some people trying to lose weight convert to a pattern of not eating for long hours, and then eating at the end of the day. This approach may work for some, but it clearly backfires for others -- producing an overwhelming appetite that induces unrestrained, end-of-day binges. This is obviously different than eating a late breakfast at lunchtime because that's when you first get hungry.
I remain a proponent of breakfast, comprised of well-chosen, highly nutritious, fiber-rich and satiating foods. But of course, in a culture that runs on Dunkin', and where multi-colored marshmallows are "part of a complete breakfast," a great deal of devilry may reside in the details of dietary choice. This study did not delve into the particulars of breakfast composition, but other work has suggested how important it can be.
Whatever the merits of breakfast, there are none to the propagation of dogma unsupported by reliable evidence. Yet just such misguided zeal suffuses prevailing opinions about diet. Dr. Allison and colleagues haven't necessarily debunked the value of breakfast -- but they have helped to take dogma about it off the menu. That's wholesome.