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Beginning with Breakfast Elizabeth Shepard, MD

Updated: Nov 14, 2019

Breakfast is often called the most important meal of the day. But do we really need to eat breakfast? We all know someone who says they just aren’t hungry in the morning, or they feel nauseated, or they don’t have time to eat. What might be the consequences of not eating breakfast?    The word breakfast literally means to break the fast. For most people, breakfast takes place eight to 12 hours following the last meal, after a night of sleep. Eating breakfast when we go from darkness into light is tied to the body’s biological rhythms, which affect the hormones that control food intake and metabolism. However, more people skip breakfast than any other meal of the day. School/work performance The conventional wisdom is that eating breakfast helps kids to do better in school by feeding the brain and satisfying hunger. This was one of the rationales for creating the National School Breakfast Program. Scientific evidence has been mixed as to the benefits of breakfast on school achievement in children, but it leans toward supporting breakfast for tasks requiring attention and cognition. It is difficult to isolate the direct effects of breakfast on cognitive performance from all the other factors that influence school performance but, at a minimum, eating breakfast in the morning probably helps kids to focus on school work instead of hunger. Also, consuming adequate food and fluids helps to prevent headaches at school. In adults, eating breakfast has beneficial effects on memory, particularly delayed recall.

Weight and metabolism Population studies of adults indicate that eating breakfast is associated with long-term prevention of weight gain and maintenance of weight loss in those who were previously obese. Skipping breakfast is associated with a higher risk of obesity and diabetes in adults and children, as well as atherosclerotic disease in adults. In other words, breakfast is good for our metabolic health. The reasons for this are complex and likely related to the chronological cycles, or circadian rhythms, we go through every day with light, darkness and sleep. Eating that is shifted towards the night hours leads to a greater glycemic response, or a spike in blood sugar through hyperinsulinemia (high insulin in the blood). The risk of gaining excess weight increases when we eat at night and when we spread out our eating over a long number of hours, even if the total daily caloric intake is not greater than eating several meals over a shorter interval.

Exercise Everyone knows that athletes need fuel for performance. Likewise, children and adults doing physical activity such as walking or cycling to school or work or participating in PE or exercise probably benefit from eating before physical activity. Studies show that children and adults who eat breakfast are more active during the day. Eating immediately before exercise can lead to nausea, so it’s best to wait at least 30 to 60 minutes after eating to do any moderate to vigorous physical activity.

Nutrition Breakfast provides several important nutrients that benefit health:

  • Fiber: Breakfast cereals can be a good source of fiber. Fiber helps with maintaining a healthy gut flora (bacteria and other microorganisms that live in the gut), producing normal stools and regulating glucose metabolism. If choosing to eat cereal, the key is to select options without sugar or white flour as the primary ingredients. Fruit combined with cereal provides even more fiber. For people under 20, the minimum recommended intake is age in years + five grams/per day. The recommendations for adults are 25 grams/day for women and 38 grams/day for men. Whole grains provide fiber as well as B vitamins, including folate. Fruit is an important source of fiber as well as vitamin C.

  • Protein: Protein offers a long-lasting sense of fullness (satiety) by suppressing the production of ghrelin, the hunger hormone—think of ghrelin causing your growling stomach. Protein also helps to build strong muscles.

  • Calcium and vitamin D: Milk or yogurt with breakfast helps to fulfill the body’s daily need for calcium and vitamin D and helps to build strong bones in children and adolescents. Yogurt additionally provides probiotics, or healthy bacteria, to populate the gut.

Examples of healthy breakfast foods:

  • Eggs—pasteurized or cooked to at least 160 degrees (due to the risk of Salmonella food poisoning from raw eggs)

  • Dry cereal with milk—look for at least three grams of fiber per serving and avoid added sugars, including cane sugar, high fructose corn syrup, honey and agave, as one of the first three ingredients. The American Heart Association recommends no more than 25 grams (six teaspoons) per day of added sugars for women and children and no more than 36 grams (nine teaspoons) per day for men.

  • Homemade granola with nuts and dried fruit

  • Hot cereal such as oatmeal

  • Pancakes or waffles made with whole grain flour (whole wheat flour, buckwheat, or other)

  • Seasonal fruit, such as blueberries, strawberries or blackberries, or frozen fruit any time of year

  • A breakfast burrito with black beans or pinto beans and avocado

  • A yogurt-and-fruit smoothie

  • A whole-grain bagel with fish 

Use caution with these foods and beverages:

  • Juice is a highly concentrated source of calories that lacks the fiber of whole fruit and can cause spikes in blood sugar. The American Academy of Pediatrics currently recommends no more than four to six ounces of juice per day for children four to six years old and eight ounces per day for children seven to 18 years old.

  • Bacon and sausage: Processed meats are high in saturated fat and nitrites and add to the long-term risk for heart disease and colon cancer.

  • Caffeine in coffee, tea and energy drinks: Excess caffeine can cause jitteriness, heart arrhythmias and elevated blood pressure. The recommended limit for adults is no more than 400 mg per day (an eight-ounce cup of coffee averages between 100-150 mg of caffeine). For children, there is no need to drink caffeinated beverages, but a safe limit should be no more than 2.5 mg per kg per day.

How to set yourself up for a successful start to your day

  1. Plan ahead. Have something ready to go such as yogurt, cereal, fruit or a waffle to pop in the toaster. Put oatmeal in a slow cooker and set it to be ready in the morning. Save leisurely breakfasts with the family for weekends.

  2. Wake up early enough to eat breakfast. Change your sleep cycle to go to bed a little earlier and wake up a little earlier each day. Even a change of 10 minutes gives you enough time to eat breakfast. If it’s hard for you or your child to wake up in the morning, look for signs of sleep apnea, such as snoring, gasping or daytime sleepiness and talk to a doctor about a sleep study.

  3. If you experience nausea in the morning or you are simply not hungry, try not to eat too late at night and avoid excessively fatty foods that delay gastric emptying. Be mindful of the symptoms of gastroesophageal reflux, including bloating, nausea and burning in the chest. Talk to a doctor if these symptoms occur.

  4. Improvise. If you can’t make it work to eat breakfast first thing in the morning, then plan for a mid-morning snack.

In summary, breakfast is an integral part of starting the day off on the right foot. It provides fuel for schoolwork and physical activity, contributes to the day’s nutrition and helps to prevent chronic disease. Eating even a small amount of breakfast is likely to have both short- and long-term benefits for health.


Resources

  • Adolphus, K., Lawton, C.L., Champ, C.L. & Dye, L. "The effects of breakfast and breakfast composition on cognition in children and adolescents: A Systematic Review." Adv Nutr. 2016 May 16; 7(3):590S-612S.

  • Blondin, S.A., Anzman-Frasca, S., Djang, H.C. & Economos C.D. "Breakfast consumption and adiposity among children and adolescents: an updated review of the literature." Pediatr Obes. 2016 Oct; 11(5):333-48.

  • Clayton, D.J., Barutcu, A., Machin, C., Stensel D.J. & James L.J. "Effect of Breakfast Omission on Energy Intake and Evening Exercise Performance." Med Sci Sports Exerc. 2015 Dec; 47(12):2645-52.

  • Galioto, R. & Spitznagel, MB. "The Effects of Breakfast and Breakfast Composition on Cognition in Adults." Adv Nutr. 2016 May 16;7(3):576S-89S.

  • Jakubowicz, D. et al. "Influences of breakfast on clock gene expression and postprandial glycemia in healthy Individuals and individuals with diabetes: A randomized clinical trial." Diabetes Care. 2017 Nov; 40(11):1573-1579.

  • Kuehn, BM. "Resetting the circadian clock might boost metabolic health." JAMA. 2017; 317(13):1303-1305.

  • Maki, K.C., Phillips-Eakley, A.K. & Smith, K.N. "The effects of breakfast consumption and composition on metabolic wellness with a focus on carbohydrate metabolism." Adv Nutr. 2016 May 16; 7(3):613S-21S.

  • Wang, S. et al. "School breakfast and body mass index: a longitudinal observational study of middle school students." Pediatr Obes. 2017 Jun; 12(3):213-220. 

  • Wyatt, H.R et al. "Long-term weight loss and breakfast in subjects in the National Weight Control Registry." Obesity Research. 2002 Feb; 10(2): 78-82.


Elizabeth Shepard, MD


Elizabeth Shepard is a general pediatrician and specialist in obesity and nutrition in the Division of General Pediatrics at Stanford University School of Medicine. She is passionate about the role of food and nutrition in promoting good health and about the natural environment and its relationship to children’s health. Elizabeth did her residency in Pediatrics, followed by fellowship training in General Academic Pediatrics and Pediatric Gastroenterology and Nutrition. She is a board-certified Physician Nutrition Specialist and a board-certified Diplomate in Obesity Medicine. She does much of her food shopping at local farmers' markets and loves heading out on trails on the weekend whenever possible. She also enjoys teaching the next generation of physicians about nutrition and health.  

elizabeth.shepard@stanford.edu

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