Breakfast: Still the Most Important Meal of the Day

It can be challenging to help patients make substantive lifestyle changes during brief office visits. A good place to begin is at the beginning—with breakfast. Helping patients understand that starting the day right can have a major impact on their weight and health is a relatively simple step that can pay big rewards.

Scientific findings on the benefits of a healthy breakfast have been piling up for years. The Physician’s Health Study found that those who ate two servings of high-fiber cereal for breakfast per week reduced their risk of heart failure by almost 20%.¹

Eating breakfast regularly also appears to help improve lipid profiles. In one study, women who did not eat breakfast had higher levels of total and LDL cholesterol. Those who did not consume breakfast also showed marked blunting in their insulin response.²

By the time we wake up, most of us have gone at least twelve hours since our last meal. Skipping breakfast extends this fast even longer, and by lunch it has been up to eighteen hours since our last feeding. By mid-morning, we are starving, and the donut we know we shouldn’t eat becomes irresistibly appealing.

We now have excellent research that shows that these extended periods of starvation slow our metabolism; since there’s not enough energy coming in, our bodies work to preserve the calories we have stored, making it harder to lose weight.

What we eat for breakfast also has an effect on how easy it is to lose weight. In one study, participants who ate cereals, quick breads, or muffins for breakfast had a lower Body Mass Index (BMI) than those who ate meat and eggs. The study also found that eating whole grain and cooked cereals for breakfast produced better results than did ready-to-eat cereals or muffins.³ There is also recent evidence that whole grain rye porridge is more effective than whole grain breads at producing satiety.⁴

Other studies have shown that breakfast skippers tend to have a higher BMI. At the same time breakfast eaters with a lower BMI are likely to consume meals more regularly throughout the day. Similarly, those eating early in the day are less likely to snack later on and to snack more sensibly when they do snack.⁵

The best part of all this research is that it gives us a simple piece of tried-and-true advice that we can pass on to our patients: Make time for a healthy breakfast. Indeed, with a little planning, grabbing a bowl of high fiber cereal, a few pieces of whole grain toast, or a muffin or quick bread can be far faster and less expensive than stopping at a fast food joint for a (less-healthy) sausage biscuit.

Pairing the carbohydrates with some protein is important to ensure satiety until lunch—cereal with milk or yogurt, whole grain breads with an egg, reduced-fat cheese or peanut butter, or even some quality granola and yogurt. Breakfast can be an excellent time for a serving of fruit as well.

Many of my patients still believe that dietary cholesterol—eggs and shrimp in particular—has an effect on their cholesterol levels. It is important to reassure them that for most people, this simply isn't the case.⁶

A 1999 review of two large studies showed no evidence of a link between egg consumption and cardiovascular disease. The researchers' conclusion stated, "These findings suggest that consumption of up to one egg per day is unlikely to have substantial overall impact on the risk of CHD [coronary heart disease] or stroke among healthy men and women."⁷ The researchers did find, however, that consumption of eggs by diabetics might lead to a higher risk of cardiovascular disease. And another study showed that those who ate two or more eggs daily increased their risk of heart failure by 64%.⁸

Good Breakfast Options

1. Have some carbohydrates (cereal) and protein (milk or yogurt) with a piece of fruit

2. Breads should be served with a protein. Select a bread choice, a topping or spread, and one item from the protein list.

Cereal

Amount per serving

Oatmeal

1/4 cup (before cooking)

Cream of Wheat

1/4 cup (before cooking

Cheerios (Multi-grain is best!)

1 cup (30 grams)

Bite-size Shredded Wheat or Shredded Wheat and Bran

1 cup (52 grams)

Raisin Bran (Check for added sugar content, especially high fructose corn syrup)

1 cup

Total Whole Grain

1 cup

Total Raisin Bran

1 cup

Kashi Cinnamon Harvest

1 cup

Kashi GoLEAN

1 cup (53 grams)

Breads

Amount

Whole Wheat Toast (the higher the fiber content the better)

1 slice

Bagel (whole grain if possible)

1/2 large bagel

Whole wheat English Muffin

1 whole muffin

Whole grain muffin or quick bread

1

Whole Grain Frozen Waffle

1

Toppings and Spreads for Breads

Choose one only

Amount

Take Control Light Spread

2 tsp.

Promise Spread Light

2 tsp.

Smart Balance Light Spread

2 tsp.

Preserves or Jam

2 tsp.

Reduced-fat Cream Cheese (“light” cream cheese is best for spreading)

2 tsp.

Take Control Light Spread and

Syrup or honey

2 tsp. and

1 tbsp.

Protein

Amount

Large Egg (cooked in as little fat as possible)

1

Peanut Butter

2 tbsp.

Reduced-fat cheese

1/2 ounce

2%, 1% or Skim Milk

1/2 cup

Non-fat Yogurt (with no added sugar)

1 cup

References

1. Djoussé L, Gaziano JM. Breakfast cereals and risk of heart failure in the physicians’ health study. Arch Intern Med. 2007;167(19):2080-2085.

2. Farshchi HR, Taylor MA, Macdonald IA. Deleterious effects of omitting breakfast on insulin sensitivity and fasting lipid profiles in healthy lean women. Am J Clin Nutr. 2005;81(2):388-396.

3. Cho S, Dietrich M, Brown CJ, Clark CA, Block G. The effect of breakfast type on total daily energy intake and body mass index: results from the Third National Health and Nutrition Examination Survey (NHANES III). J Am Coll Nutr. 2003;22(4):296-302.

4. Isaksson H, Tillander I, Andersson R, et al. Whole grain rye breakfast—sustained satiety during three weeks of regular consumption [published online ahead of print October 28, 2011]. Physiol Behav. Accessed November 21, 2011.

5. Schlundt DG, Hill JO, Sbrocco T, et al. The role of breakfast in the treatment of obesity: a randomized clinical trial. Am J Clin Nutr. 1992;55(3):645-651.

6. Oh SY, Miller LT. Effect of dietary egg on variability of plasma cholesterol levels and lipoprotein cholesterol. Am J Clin Nutr. 1985;42(3):421-431.

7. Hu FB, Stampfer MJ, Rimm, EB, et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA. 1999;285(15):1387-1394.

8. Djoussé L, Gaziano JM. Egg consumption and risk of heart failure in the Physicians' Health Study. Circulation. 2008;117(4):512-516.

Timothy Harlan, MD, is currently medical director and assistant professor of medicine at Tulane University School of Medicine. He writes extensively on diet and health on his website, DrGourmet.com, an easy-to-use resource to navigate complex nutrition and wellness info translated for the American kitchen. He is the author of Just Tell Me What to Eat!