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“When you wake up in the morning, Pooh," said Piglet at last, "what's the first thing you say to yourself?"
"What's for breakfast?" said Pooh. "What do you say, Piglet?"
"I say, I wonder what's going to happen exciting today?" said Piglet.
Pooh nodded thoughtfully. "It's the same thing," he said.
― A.A. Milne
From Dr. Taylor: Winnie the Pooh may have been onto something, according to a recent study published in the Journal of the American College of Cardiology. Breakfast is an exciting event if you consider that it could improve your chances of leading a longer life.
After conducting an observational study of 6,550 adults ages 40 to 75, researchers from the University of Iowa concluded that skipping breakfast increases the risk of death from cardiovascular disease, while eating breakfast promotes heart health.
Cardiovascular disease has long been the leading cause of death in the United States and across the world. We know that common risk factors—cholesterol levels, diabetes, weight—are influenced by what we eat. But researchers recognized that we didn’t know as much about the heart-health effects of how we eat, such as whether we eat breakfast. They decided to look into it.
The Researcher’s Approach: Who Was in the Study?
To begin their research, they pulled data from the highly regarded and ongoing National Health and Nutrition Examination Survey (NHANES), which has nearly 40,000 participants. The researchers included participants from Phase III of the study who were between the ages of 40 and 75, had no history of cardiovascular disease or cancer, and whose underlying cause of death was part of the study data.
This type of study is called “observational,” meaning that the researchers observed and analyzed data from a sample population to determine if there were conclusions that could be applied to the general population. While it was not a randomized controlled study, considered the gold standard in research, the observations are worth considering.
Among their cohort (with a mean age of 53 years), 59 percent ate breakfast every day, 25 percent ate breakfast some days, and 16 percent never or rarely ate breakfast. After adjusting the data for a range of factors including age, gender, race/ethnicity, and body mass index, those who never ate breakfast had a significantly increased risk of death from cardiovascular disease, particularly stroke.
A Few Questions: The Why and What About Breakfast and Heart Health
These study results raised some clear questions for many:
- Is this study definitive?
- Why does breakfast make a difference for our hearts?
- Does it matter what we eat at breakfast?
In answer to the first question, no, this is not a definitive study, but it does show an association between skipping breakfast and cardiovascular-related death. Since most of us want to live the best lifestyle we can, these results give us all something to think about if we tend to skip breakfast. And I must admit, I often do.
Regarding question two about how breakfast makes a difference for our hearts, researchers suggest that skipping breakfast can lead to harmful cardiovascular effects in several ways.
- First, if you don’t “break the fast” when you wake up in the morning, you may feel hungrier later on, leading to overeating and insulin resistance. When your body is insulin resistant, you need more insulin to keep your blood sugar at a normal level. Ongoing insulin resistance can lead to Type 2 diabetes—a heart disease risk factor. On the other hand, the researchers said eating breakfast can help you regulate your appetite and improve your body’s sensitivity to insulin.
- Second, skipping breakfast can lead to elevated blood pressure in the morning—another heart disease risk factor—while eating breakfast can actually help lower blood pressure.
- Third, skipping breakfast may increase cholesterol levels, clearly linked to heart disease.
- Fourth, skipping breakfast may be a red flag for overall unhealthy food and lifestyle choices.
Finally, regarding the last question, researchers did not have access to information about what the study participants ate for breakfast. However, together with my colleague, Andrea Goergen, a dietitian with our Bariatric Program, we offer some healthy suggestions below.
Heart-Smart Breakfasts: Ideas and Tips
From Andrea Goergen: I must admit that I actually enjoy eating breakfast, but I totally understand that everyone is different. Some of my patients aren’t hungry in the morning, others are just too busy to sit down for a meal, while others skip breakfast because they mistakenly think it will help them lose weight. I do appreciate all of these situations, and I have some suggestions if any of these reasons sound familiar to you.
First, what is breakfast? In 2016, the Academy of Nutrition and Dietetics proposed the following guidelines:
- Breakfast should provide between 15 and 25 percent of your total recommended daily calories.
- You should eat it within two to three hours of waking.
- The meal should Include at least three of the following food groups: lean protein, fruits and/or vegetables, whole grains, and low-fat or non-fat dairy. A balanced combination of these food groups can jump-start your metabolism and provide enough fiber and energy to fill you up and keep you satisfied until lunch.
Quick-Fix Ideas for a Heart-Healthy Breakfast
- Low-fat Greek yogurt with raspberries and almonds.
- Oatmeal made with 1 percent milk, blueberries and walnuts. (You can use an instant oatmeal packet but avoid those with added sugar.)
- Whole-grain cereal with 1 percent milk and strawberries.
- Whole grain waffle or English muffin with peanut butter and a banana. (This is easy to eat on the go as well.)
Another option if your mornings are busy is to prepare some foods in advance. A healthy frittata with potatoes, green onions, asparagus (or other vegetable), and low-fat cheese is an excellent breakfast choice. It can be made on the weekend and you can heat individual portions in the microwave or toaster oven throughout the week. Yogurt bowls and smoothies can also be made in advance. Or try overnight oats or slow-cooker oatmeal to have a hot, nutritious breakfast ready for you early in the morning.
Also don’t forget that you don’t have to eat “breakfast” foods for breakfast. Try your leftovers from dinner, such as chicken with green beans and quinoa, salmon with roasted potatoes and broccoli, or red beans and brown rice with spinach.
Healthy Choices when You Have More Time
- A two-egg omelet with low-fat cheese, spinach, onions, tomatoes, and a slice of whole wheat toast.
- Two eggs with black beans, low-fat cheese, onions, and peppers over brown rice or on a whole wheat tortilla.
- A breakfast burrito with eggs, salmon, low-fat cheese, and a squeeze of lemon together with a fruit bowl. (These can also be made ahead, frozen, then thawed overnight and warmed in the morning.)
Not Hungry? Try Drinking Your Breakfast
Some of my patients who are not hungry when they wake up find that drinking their breakfast is easier. If you experience this lack of hunger, too, try preparing a smoothie with low-fat Greek yogurt, berries, and spinach, or try one with strawberries and peanut butter or peanut butter powder.
From Dr. Taylor and Andrea: If you already eat breakfast every day and want to ensure you’re making the best choices for your heart, we hope you find these ideas helpful. If you don’t eat breakfast regularly, we hope you take some wisdom from Pooh and begin to view this meal as an exciting opportunity to make your heart happier and healthier.