Skipping breakfast can be a great idea; however, research on intermittent fasting is not impressive
An August 2017 Annual Review of Nutrition article is entitled: “Metabolic Effects of Intermittent Fasting.”
An excerpt reads:
The potential effects of prolonged nightly fasting on energy intake, sleep, physical activity, and circadian activity rhythm may act in concert to reduce the risks of cardiometabolic disease and cancer.
A Sept. 28, 2020 New York Times article is entitled:” A Potential Downside of Intermittent Fasting: A rigorous three-month study found that people lost little weight, and much of that may have been from muscle.”
Intermittent fasting is a trendy weight loss strategy. But a new study found that a popular form of intermittent fasting called time-restricted eating produced minimal weight loss and one potential downside: muscle loss.
The new research, published in JAMA Internal Medicine, is one of the most rigorous studies to examine time-restricted eating, which involves fasting for 12 or more hours a day. Many followers of the diet, which has been popularized in best-selling diet books and touted by celebrities, routinely skip breakfast and eat all their meals between roughly noon and 8 p.m., resulting in a daily 16-hour fast.
Research over the years has suggested that the practice spurs weight loss and improves metabolic health, although much of the data has come from animal experiments or small studies of relatively short duration in humans. Experts say the diet works because it allows people the freedom to eat what they want so long as they do it in a narrow window of time, which leads them to consume fewer calories over all.
A Sept. 28, 2020 CNBC article is entitled: “Intermittent fasting doesn’t help you lose weight, UCSF study suggests.”
An excerpt reads:
A 12-week UCSF study of 116 overweight people found no statistically significant difference in weight loss between people who restricted their eating to a specific eight-hour period every day and those who didn’t.
A March 5, 2021 Atlantic article is entitled: “There’s No Real Reason to Eat 3 Meals a Day: Your weird pandemic eating habits are probably fine.”
An excerpt reads:
You can probably see the fault lines already. Of course vanishing commutes, remote schooling, and the flexibility to make a sandwich during a conference call would change how people eat. The three-meal-a-day axiom was created to bend human life around the necessity of leaving the home to work elsewhere for the whole day, and now people are bending once again, around a whole new set of challenges. Our old eating schedules are no more natural than sitting in a cubicle for 10 hours a day.
Research published years ago often suggested red wine good for your heart. More recently I’ve been following research indicating the optimum amount of wine is none at all.
Such changes in research over the years is highlighted at a post entitled:
Kindly Presbyterian couple registered themselves as alcoholics, thereby ensuring crucial liquor supply for Tyrone Guthrie and fellow theatrical luminaries, as they rehearsed Stratford Festival’s opening performances, in 1953
Earlier claims about the supposed health benefits of chocolate have also been revised.
Over the years, I’ve also been following a meme that says that you have to have a big breakfast every day.
Study of the evidence indicates that if you know what you’re doing, it may be to your benefit to say goodbye to the big breakfast.
I’ve recently been reading many short stories by Alice Munro. As with studies by Erving Goffman, I have minimal interest in reading reviews of Alice Munro’s work. What interests me above all is reading the short stories themselves. I have an interest in reading the original texts of Alice Munro and Erving Goffman.
That said, the cottage industries that have grown up around the texts by the above-noted writers are of value, to the extent that readers are prompted to read the original works.
Both authors are fine observers; they describe things in a manner that is compelling. As well, Alice Munro often pivots to reveal a stance totally unexpected as a story nears its ending. It occurs to me that stories about breakfast have also given rise, over the years, to unexpected transformations.
Do we need a big breakfast?
A Feb. 1, 2019 Global News article is entitled: “You’ve been told breakfast is the most important meal of the day. Is it?”
The article notes that, “Contrary to the belief that breakfast helps kick-start your metabolism, research just published in the BMJ found that eating the morning meal may not be the best strategy for weight loss. In fact, researchers concluded that skipping breakfast likely doesn’t lead to weight gain, either.”
The Global News article refers to a Jan. 30, 2019 BMJ article entitled: “Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials.”
An excerpt reads:
Conclusion: This study suggests that the addition of breakfast might not be a good strategy for weight loss, regardless of established breakfast habit. Caution is needed when recommending breakfast for weight loss in adults, as it could have the opposite effect. Further randomised controlled trials of high quality are needed to examine the role of breakfast eating in the approach to weight management.
A Jan. 30, 2019 BMJ opinion article is entitled: “Tim Spector: Breakfast—the most important meal of the day?:
An excerpt for the above-noted BMJ opinion article reads:
Despite these flaws in the science and the steady increase in opposing evidence from randomised controlled trials, the idea that skipping meals is unhealthy has prevailed for decades. Not skipping breakfast is still part of current NHS recommendations by Public Health England and one of its eight key healthy diet messages, part of the United States Department of Agriculture diet guidelines for Americans, and the current Australian Guidelines for Nutrition. Another common argument by the pro-breakfast lobby is that as well as reducing obesity, breakfast is essential for the mental wellbeing of children, even if they are generally well nourished. Again the evidence is weak, largely observational, and likely biased in the same way as for adults.
Evidence is also accumulating that restricting eating times and increasing fasting intervals can help certain people to lose weight. Some of these recent developments that seem counterintuitive to traditional thinking make sense in the context of the importance of the gut microbiome on human health and metabolism. The community of 100 trillion gut microbes have a circadian rhythm and vary in composition and function in fasting and fed states. Although this is a young discipline, some data suggest that microbial communities could benefit from short periods of fasting. They, similar to us, might need to rest and recuperate, which could be important for gut health in humans.
Around a third of people in developed countries regularly skip breakfast, whereas many others (including myself) enjoy it. This does not mean that all overweight people would benefit from skipping breakfast. Some people are programmed to prefer eating food earlier in the day and others later, which might suit our unique personal metabolism. No “one size fits all,” and prescriptive slow moving diet guidelines filled with erroneous information look increasingly counterproductive and detract from important health messages. While waiting for guidelines to change, no harm can be done in trying out your own personal experiments in skipping breakfast.
University of Iowa study claims skipping breakfast associated with higher risk of cardiovascular death
I see the following article as an outlier. Its does not convince me. That said, the study is of interest.
An April 22, 2019 Iowa Now article is entitled: “UI study: Skipping breakfast associated with higher risk of cardiovascular death.”
An excerpt reads:
Eating breakfast every day has always been considered an important part of a healthy lifestyle, but a new study from the University of Iowa shows just how important it is.
The study, by Wei Bao, assistant professor of epidemiology in the University of Iowa College of Public Health, finds that people who never ate breakfast had an 87 percent higher risk of death caused by cardiovascular disease than people who ate breakfast every day. Published in the Journal of the American College of Cardiology, it supports the benefits of eating a daily breakfast in promoting heart health.
Bao says health care providers and dietary experts have known for years the importance of eating breakfast every day. The early-morning calories jumpstart the body’s metabolism and give people the energy and nutrients needed to start the day. But despite evidence that suggests skipping breakfast leads to increased risk of obesity, high blood pressure, type 2 diabetes, and other health complications, fewer people report they are making the meal a part of their daily routine.
The article refers to an April 16, 2019 Journal of the American College of Cardiology article entitled: “Association of Skipping Breakfast With Cardiovascular and All-Cause Mortality.”
I’ve omitted a link as I prefer not to link to insecure sites. But you can find it via a browser search.
A Dec. 25, 2019 USA Today article is entitled: “Goodbye, stressful diets? Intermittent fasting offers health benefits, study says. But it’s not for everybody.”
An excerpt reads:
Trading holiday feasts for intermittent fasting could yield health benefits from lower cholesterol to reduced stress, according to a new study.
The dieting method requires patience, researchers wrote in a review published Thursday in the New England Journal of Medicine, but doctors can help patients reach the scientifically-proven benefits or warn at-risk groups to avoid it.
While intermittent fasting diets vary, the practices of alternating between certain periods of eating and not eating fall into two categories, said co-author Mark Mattson, a neuroscience professor at the Johns Hopkins School of Medicine. One restricts eating to six to eight hours per day and another limits people to one moderate-sized meal two days each week.
The eating patterns can increase resistance to stress and improve blood sugar regulation, while decreasing blood pressure, blood lipid levels and resting heart rates, Mattson wrote. Multiple studies on humans and animals have reported those results, he said, bringing legitimacy to the practice.
It may be noted that the link at the final paragraph (above) refers to recent research about blood pressure that is of much interest; however, the link does not have a direct connection to research findings related to intermittent fasting. Instead the link, which demonstrates a measure of inattentiveness by USA Today, is concerned with research reported in an Oct. 22, 2019 European Heart Journal article indicating that bedtime is the optimal time to take blood pressure medications.
That said, the Dec. 25, 2019 USA Today article does refer to a Dec. 26, 2019 New England Journal article (see below) which outlines research indicating that intermittent fasting improves multiple indicators of heart health including blood pressure, resting heart rate, and markers of systemic inflammation and oxidative stress associated with atherosclerosis.
As well, we can say that research about the optional time of day to take blood pressure medication does have an indirect link to research about intermittent fasting, given that circadian rhythm is of relevance, with regard to each of these research topics.
New England Journal of Medicine
The USA Today article refers to a Dec. 26, 2019 New England Journal of Medicine review article entitled: “Effects of Intermittent Fasting on Health, Aging, and Disease.”
The article speaks of the option (among other options) of fasting, say, 16 to 18 hours a day (including not eating breakfast), and packing all of one’s eating within six to eight hours, with no snacks. Tea (with nothing added) or black coffee during the fasting portion does not break such a form of fasting, according to research overviews I have read.
It is also worth noting that eating of plenty of fruits and vegetables and very low amounts of sugar and processed foods tends to be emphasized in research studies related to health benefits of intermittent fasting.
An excerpt from the above-noted review article reads:
Preclinical studies consistently show the robust disease-modifying efficacy of intermittent fasting in animal models on a wide range of chronic disorders, including obesity, diabetes, cardiovascular disease, cancers, and neurodegenerative brain diseases.3,7-10 Periodic flipping of the metabolic switch not only provides the ketones that are necessary to fuel cells during the fasting period but also elicits highly orchestrated systemic and cellular responses that carry over into the fed state to bolster mental and physical performance, as well as disease resistance.11,12
Here, we review studies in animals and humans that have shown how intermittent fasting affects general health indicators and slows or reverses aging and disease processes. First, we describe the most commonly studied intermittent-fasting regimens and the metabolic and cellular responses to intermittent fasting. We then present and discuss findings from preclinical studies and more recent clinical studies that tested intermittent-fasting regimens in healthy persons and in patients with metabolic disorders (obesity, insulin resistance, hypertension, or a combination of these disorders). Finally, we provide practical information on how intermittent-fasting regimens can be prescribed and implemented. The practice of long-term fasting (from many days to weeks) is not discussed here, and we refer interested readers to the European clinical experience with such fasting protocols.13
An additional excerpt reads:
In contrast to people today, our human ancestors did not consume three regularly spaced, large meals, plus snacks, every day, nor did they live a sedentary life. Instead, they were occupied with acquiring food in ecologic niches in which food sources were sparsely distributed. Over time, Homo sapiens underwent evolutionary changes that supported adaptation to such environments, including brain changes that allowed creativity, imagination, and language and physical changes that enabled species members to cover large distances on their own muscle power to stalk prey.6
A third excerpt reads:
Despite the evidence for the health benefits of intermittent fasting and its applicability to many diseases, there are impediments to the widespread adoption of these eating patterns in the community and by patients. First, a diet of three meals with snacks every day is so ingrained in our culture that a change in this eating pattern will rarely be contemplated by patients or doctors. The abundance of food and extensive marketing in developed nations are also major hurdles to be overcome.
The Cochrane Collective has put together a protocol which will guide systematic review of the topic at hand; the protocol is entitled: “Intermittent fasting for the prevention of cardiovascular disease.”
An excerpt reads:
Why it is important to do this review
Intermittent fasting is becoming more popular for health and fitness and in October 2016, the search term “diet fasting intermittent alternate day” received 210,000 searches (Patterson 2017). Intermittent fasting was also in the top 10 diet searches on diet on Google trends in the USA in 2018 (Google trends 2018). The popularity of intermittent fasting makes us question whether there is a potential benefit of it as a lifestyle intervention in preventing or reducing the burden of CVD. The majority of existing human studies are cross‐sectional and observational studies which focus on the benefits of religious fasting such as Ramadan fasting. The existing trials report inconsistent results on the benefit of intermittent fasting. Moreover, the comparisons between intermittent fasting and calorie restriction diets are not conclusive. Finally, each trial has addressed a limited number of cardiovascular risk factors and therefore a comprehensive review is needed.
This review aims to bring together all the relevant RCTs in a single systematic review, reporting the effects of intermittent fasting in humans and providing a comprehensive report on the impact of intermittent fasting on CVD.
I have been following the work of the Cochrane Collective for many years. I first learned about it when reading about the history of evidence-based practice in the health sciences.
Evidence Based Medicine
An earlier post is entitled:
An excerpt reads:
On that day, he read his first randomized clinical trial and discovered the power of evidence, an epiphany that changed his life and, eventually, the practice of medicine in the Western world. He also apologized to his patient and told him to walk around as much as he liked.
An excerpt reads:
A global team of influential researchers, clinicians, regulators, and citizen advocates suggest how we can start to build an evidence base for healthcare that is free of commercial influences
We all want to base our healthcare decisions on trustworthy evidence. Yet the landmark 2009 Institute of Medicine report identified widespread financial conflicts of interest across medical research, education, and practice.1 It highlighted that extensive industry influence may be jeopardising “the integrity of scientific investigations, the objectivity of medical education, the quality of patient care, and the public’s trust in medicine.”1
A classic case of how commercial interests have influenced medical decision making (among other things in relation to opioids) is outlined at a post entitled:
Similarly, the relationship between the alcohol industry and an earlier research narrative, which claimed to link red wine to cardiovascular health, has been a topic of discussion over the years.
As well, over the years a number of observers have pointed toward a relationship between the chocolate industry and an earlier narrative, which claimed to link dark chocolate with cardiovascular health.
With regard to the general topic of evidence, and what it may or may not be good for, a September 2004 Social Science & Medicine article is entitled: “The problem of evidence-based medicine: directions for social science.”
The article underlines that Evidence Based Practice is not as cut and dried as it is sometimes presented to be. The abstract for the article (I’ve broken a longer text into shorter paragraphs) reads:
Evidence-based medicine (EBM) is arguably the most important contemporary initiative committed to reshaping biomedical reason and practice. The move to establish scientific research as a fundamental ground of medical decision making has met with an enthusiastic reception within academic medicine, but has also generated considerable controversy.
EBM and the broader forms of evidence-based decision making it has occasioned raise provocative questions about the relation of scientific knowledge to social action across a variety of domains. Social science inquiry about EBM has not yet reached the scale one might expect, given the breadth and significance of the phenomenon.
This paper contributes reflections, critique and analysis aimed at helping to build a more robust social science investigation of EBM. The paper begins with a “diagnostics” of the existing social science literature on EBM, emphasizing the possibilities and limitations of its two central organizing analytic perspectives: political economy and humanism.
We further explore emerging trends in the literature including a turn to original empirical investigation and the embrace of “newer” theoretical resources such as postmodern critique. We argue for the need to move the social inquiry of EBM beyond concerns about rationalization and the potential erasure of the patient and, to this end, suggest new avenues of exploration. The latter include analysis of clinical epidemiology and clinical reason as the discursive preconditions of EBM, the role of the patient as a site for the production of evidence, and the textually mediated character of EBM.
Cohort study of Tsimane in Bolivian Amazon
An March 17, 2017 Lancet article is entitled: “Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study.”
An excerpt reads:
Despite a high infectious inflammatory burden, the Tsimane, a forager-horticulturalist population of the Bolivian Amazon with few coronary artery disease risk factors, have the lowest reported levels of coronary artery disease of any population recorded to date. These findings suggest that coronary atherosclerosis can be avoided in most people by achieving a lifetime with very low LDL, low blood pressure, low glucose, normal body-mass index, no smoking, and plenty of physical activity. The relative contributions of each are still to be determined.
With reference to the above-noted research, a March 17, 2019 CBC article is entitled: “Amazon men in their 80s have the arteries of Americans in their 50s: Lancet study shows diet low on processed carbs, sugar, cholesterol, while active living boosts heart health.”
An excerpt reads:
Kaplan said undertaking the study involved fostering a special relationship with the Tsimane over decades.
“They trust us that we really do care about their best interests. Our arrangement with the tribal council is that we provide medical assistance regardless of whether you’re involved in our study.”
Nearly nine in 10 Tsimane had no risk of heart disease (596 of 705 people, or 85 per cent), 13 per cent had low risk and three per cent had moderate or high risk, according to the Lancet study.
Among those 75 or older, nearly two-thirds (31 of 48, or 65 per cent) had almost no risk and eight per cent had moderate or high risk — the lowest recorded levels of coronary artery disease of any population, the researchers said.
A June 27, 2019 CNN article is entitled: “Life lessons from the native tribe with the healthiest hearts in the world.”
An excerpt reads:
As you might also imagine, the food there is not processed or refined, lacking any added sugars or salts. All-natural carbs are the mainstay of the healthy-hearted Tsimane, along with around 15% fat and 15% protein. Additionally, the diet provides twice as much fiber as the standard American diet, according to an article in the Lancet medical journal. Their diet has lots of micronutrients, such as selenium, potassium and magnesium, coming from their farmed food. Spending time with the Tsimane, I also learned from talking to them and from my own observations that intermittent fasting was part of the culture, not because it is fashionable but because of food scarcity.
I have highlighted additional studies, related to the Tsimane in the Bolivian Amazon, at a post entitled: