Skipping breakfast does NOT cause heart attacks

Repeat after me: Association Does Not Equal Causation.

A study reported this week led directly to these Main Stream Media headlines:

  • Skipping Breakfast Tied to Heart Attack
  • Why is Skipping Breakfast So Bad For Our Heart Health?
  • Skipping Breakfast Could Double Risk for Heart Disease

There are plenty more where those came from.  All completely missing the actual point of the study.  The study authors didn’t even leap to those conclusions.

The study was done in Spain.  Middle aged adults provided information about diet patterns, particularly breakfast habits.  Heart disease risk was assessed with blood vessel scans and other tests.  When risk was compared to breakfast habits, skipping the morning meal entirely was associated with increased incidence of atherosclerosis.  Eating a light breakfast (less than 20% of daily calories) was also associated with some increase in artery plaque compared to breakfast eaters.

However, the authors did not then declare that breakfast prevents heart disease, which would be a ridiculous claim.  Rather they concluded that skipping it was part of a dietary pattern that was associated with higher incidence of atherosclerosis.  They called it a “social-business eating pattern.”  Characteristics include:

  1. skipping breakfast or eating very little
  2. overall unhealthy food choices
  3. busy schedule
  4. frequent dining out
  5. male gender
  6. smoking
  7. more red meat

The breakfast skippers were also more obese, and I’m going to leap to the conclusion that they were also less physically active.

If you get your nutrition news from headlines, such as the ones above, you might conclude that adding breakfast to an unhealthy lifestyle will prevent heart disease.  Unfortunately that’s not likely to help at all.

The study had a calorie cut-off point of 20% of daily calories for a substantial morning meal.  For a middle-aged woman, that might be a minimum of 300-400 calories, not really a huge amount.  For an adult man, it could be 500.  Of course what you choose is also important, and the study didn’t look at that aspect of breakfast.  If your 500 calorie breakfast is 2 donuts and a large sugar-sweetened latte, not so wonderful.  A Poptart and a diet soft drink?  No, just no.  If your 400 calorie breakfast is 2 scrambled eggs, glass of orange juice and a piece of whole grain toast, that’s better.  Here are some other ideas in that calorie ball park:

  • medium burrito with egg, potato, salsa and sprinkling of cheese
  • oatmeal topped with dried fruit, walnuts and vanilla Greek style yogurt
  • cold cereal, milk, juice, sliced banana
  • bowl of yogurt with fresh fruit and toast
  • 1/2 bagel, 1-1/2 oz smoked salmon, 2 TB cream cheese

So you see, you don’t have to eat a lot, but you do have to make decent choices.  Protein is especially important at breakfast.  Older adults need to have signifiant protein at all meals to maintain muscle mass, and protein helps dieters control appetite.

One more thing: it’s interesting that, bacon and sausage aside, breakfasts are mostly vegetarian affairs.  Sometimes they’re vegan by default.  Aside from smoked salmon, everything on the list is vegetarian.  If you don’t want salmon, substitute melted cheese on the bagel and perhaps add avocado or tomato slices.  Vegans can substitute soy milk for cereal, and nut butter for salmon on a bagel or toast.  A burrito can be made with refried beans instead of eggs.  Instead of a bowl of yogurt, vegans could make a fruit smoothie and add soy protein.

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