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May 20th, 2019

If you have read any recent reporting on breakfast skipping and heart disease risk, please read on. The silliness of the modern news media latching on to a published scientific study without thinking through the reality of the published result or reading the entire study is exemplified in the recently published study linking heart disease to those people that skip breakfast.

Dr. Rong and colleagues looked at the large NHANES3 data set and looked for a link between breakfast consumption and heart disease. This is like asking, did the NHANES study population stub their toe on days when the sky was blue.

If the data set showed that this occurred then we must infer that blue skies equal stubbed toes. There are so many other variables that could account for a stubbed toe. Clearly this is a ridiculous assumption. This is essentially what the breakfast heart disease study seems to be when you drill down into the data.

When you really look at the study, you realize very quickly that the non breakfast consuming group and the breakfast consuming groups were seriously different groups owing to the difference in outcomes.

Directly from the study: "As shown in Table 1, participants who never consumed breakfast were more likely to be non-Hispanic black, former smokers, heavy drinkers, unmarried, physically inactive, and with less family income, lower
total energy intake, and poorer dietary quality, when compared with those who regularly ate breakfast. As shown in Table 2, participants who never consumed breakfast were more likely to have obesity, and higher total blood cholesterol level than those who consumed breakfast regularly."

Even directly in the results section of the study we see that what the study really showed was that non breakfast eaters had poorer lifestyle habits which are the real risk factors for heart disease and mortality. They use statistical manipulations to try and prove associative causality which does not work.

You may ask, why did I devote my time to this article? The answer is based on the fact that we as consumers of news media trust that the information is vetted when provided to us. This is often far from the truth in the nutritional space.

Over the years, I have tried to provide everyone with vetted and scientifically sound information for consumption and learning. I have probably read more about heart disease than any other topic save for the microbiome. It is often very frustrating when these types of blanket statements, "breakfast is equal to less heart disease", end up in the public cybersphere altering behavior potentially to the detriment of us.

If we really look at the historical evidence related to food ingestion, timing and associations, we would soon realize that the meal type choice, host genetics and associated lifestyle behaviors drive coronary artery disease. Fasting is scientifically looking very good for longevity and health. Consuming minimally processed foods, mostly vegetables and fruits, is the route to less heart disease. At this point, I see no evidence to offer you that eating breakfast is beneficial over not eating it.

I personally do not eat breakfast as I compress my meal time into a 6-8 hour window in the afternoon. However, that being said, I could easily see eating breakfast and lunch and not dinner to achieve the same effect.

We all need to do what works for our body. The real issue with health is not breakfast to be or not to be, but truly avoiding the lifestyle factors that promote disease:

1) Sedentary behavior
2) Chronic mental stress
3) Highly processed refined foods
4) Excessive trans/saturated fat consumption (likely genetic susceptibility related)
5) Chemical exposure - smoker, alcohol, factory worker, polluted air/water, toxic creams and much more
6) Chronic unremitting viral infections
7) Poverty

PS: for a deeper dive read Peter Attia's email on this same topic.

Dr. M

Rong Journal of the American College of Cardiology Article
Full Text of Article
Peter Attia Email