From Wednesday's Globe and Mail
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If eating breakfast isn’t part of your regular schedule, consider rethinking your morning routine. Eating breakfast – versus skipping it – has been linked with a healthier weight, improved memory, lower cholesterol and a more nutritious diet. But there’s another reason to eat breakfast every day, particularly if you’re male.
According to a new study published online last week, men who routinely missed breakfast had a significantly greater risk of developing type 2 diabetes. And men who ate only once or twice a day were also at increased risk for the disease.
More than 2.4 million Canadians have diabetes, the vast majority, 90 per cent, having type 2 diabetes, a condition in which the body’s pancreas does not secrete enough insulin – the hormone that removes sugar from the bloodstream – or body cells are resistant to the action of insulin. As a result, excess sugar (glucose) remains in the blood.
Risk factors for type 2 diabetes include obesity (especially abdominal obesity), inactivity, impaired fasting glucose (pre-diabetes), family history and increasing age.
The study, from Harvard School of Public Health, followed 51,529 healthy men, aged 40 to 75, for 16 years. Dietary questionnaires were completed at the start of the study and then every four years thereafter.
Compared to breakfast eaters, men who skipped the meal were 21 per cent more likely to be diagnosed with type 2 diabetes over the 16-year period, even after accounting for body weight.
Worse, men who skipped breakfast and followed a western-style diet – characterized by a higher intake of red meat, processed meat, refined grains, sweets and desserts – had an even greater risk of diabetes.
Men were also asked the times of day they usually ate – breakfast, between breakfast and lunch, lunch, between lunch and dinner, and so on. Participants could report eating one to eight times per day.
Eating three main meals per day, including breakfast, was the optimal pattern for protection against type 2 diabetes. Men who ate only once or twice per day – rather than three square meals – had a 25 per cent greater risk of developing type 2 diabetes. Eating four or more times per day also increased diabetes risk.
Men who ate more than three times a day had a higher body mass index. This suggests that eating more frequently boosted body weight, which in turn, increased diabetes risk.
Eating breakfast can reduce type 2 diabetes risk through its effect on body weight. Several studies have associated breakfast skipping with a higher body mass index.
An earlier report from this Harvard study found that men who ate breakfast daily gained less weight over a 10-year period than their peers who skipped the meal.
Breakfast helps control appetite and blood-sugar levels. Studies show skipping breakfast results in increased levels of ghrelin, an appetite-related hormone, which can cause hunger and overeating.
The type of breakfast you eat may also play a role. Some– but not all – research has shown eating a breakfast made up of low-glycemic foods – foods that cause blood sugar to rise gradually rather than quickly – improves insulin and blood-sugar levels in the morning.
The fact that not all studies have found such improvement from eating a high- versus low-glycemic meal suggests that eating breakfast itself has favourable effects on metabolism, over and above the role of breakfast quality.
The finding that eating more often than three times per day increased diabetes risk might seem surprising, given advice we hear from health professionals, myself included, to eat every three hours to fuel the body and ward off hunger.
The explanation likely revolves around calories. In this study, men who ate more than three times per day tended to have a higher body mass index. Large portion sizes and poor quality of snacks – think cookies, sugary muffins, potato chips, and so on – can boost calorie intake during the day.
Even if a snack isn’t overly caloric, if it delivers refined carbohydrates and/or sugar, it can leave you feeling dissatisfied and hungry, causing you to keep on nibbling.
In my opinion, the take-home message from this study is to make time for breakfast. These findings add to considerable evidence that eating soon after you wake up is beneficial for a healthy metabolism and a healthy body weight.
Choose low-glycemic carbs
A breakfast based on quickly digested carbohydrates such as white bread, refined and sugary cereals, muffins and pastries causes a rapid spike in blood sugar and insulin, which can trigger hunger and inhibit the breakdown of body fat.
Low-glycemic carbohydrates release sugar more slowly into the bloodstream and don’t produce an outpouring of insulin. They include grainy breads, steel-cut and large-flake oats, bran cereal, oat bran, apples, citrus fruit, grapes, pears, nuts, milk, yogurt and soy beverages.
Include fibre
Breakfast should include at least five grams of fibre, preferably more. A fibre-rich breakfast has been shown to slow the rise in blood sugar after eating and improve how the body uses insulin.
To increase fibre at breakfast, choose 100-per-cent whole-grain breads, breakfast cereals with at least five grams of fibre per serving, and eat whole fruit instead of drinking juice.
Mix one-half cup of 100-per-cent bran cereal with another whole-grain cereal. Ground flaxseed, chia seeds, oat bran and raw wheat bran also add fibre at breakfast.
Add protein
To put the brakes on your appetite throughout the morning, include at least one protein-rich food at breakfast such as yogurt, milk, part-skim cheese, cottage cheese, soy beverage, egg whites, turkey and salmon.
Start small
If you can’t face food in the morning, start gradually. Try fruit and yogurt, a breakfast smoothie or a slice of grainy toast with nut butter. Over time, you’ll wake up hungry for breakfast.
Leslie Beck, a Toronto-based dietitian, is the national director of nutrition for Body Science Centers, medical clinics focusing on healthy aging (www.BSC5.com).
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