CrossFit | The Story of Breakfast, Part 1

The Story of Breakfast, Part 1

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ByTerence Kealey, MD, Ph.D.January 26, 2020
Found in:Health

On May 24, 2010, my wife drove me to our family doctor’s office and told me not to emerge without a diagnosis. Over the previous two or so months, I’d started to feel increasingly thirsty, and I’d not only started to drink water all day but I’d also started to pee all day. And all night. I was losing weight, my muscles were wasting away in a strange crackling ache, and I felt tired all the time. I even woke in the mornings feeling tired.

Since I am a doctor and a metabolic biochemist, I did what any doctor and metabolic biochemist would have done under those circumstances: I ignored the symptoms in the hope they’d go away. But my wife, who didn’t know better, drove me to the doctor’s office with orders not to emerge without a diagnosis.

Everybody reading this will have guessed my diagnosis, of course, and indeed my urine was full of sugar, as was my fasting blood (350 mg/dL; normal fasting range below 100), while my HbA1c was 13.3% (normal range below 5.7%). Once diagnosed, however, I was prescribed the usual drugs, to which my blood sugar levels responded appropriately, and all seemed well — until I was sent to the dietitians.

In those dark days, back in May 2010, Type 2 diabetics like me were given three pieces of dietary advice:

  • We were told to eat frequently, at least five times a day. Breakfast was a particularly important meal.
  • We were told to eat carbohydrates and avoid fat. Sugar was also to be avoided, but complex carbohydrates like porridge (oatmeal) or brown bread or potatoes or brown rice were very healthful.
  • Alcohol was to be avoided.

I shall not address the whole gamut of this advice, for CrossFit has been in the forefront of exposing much of it, but I shall tell the story of breakfast; for after my condition had settled down, and after I’d adopted my newly recommended diabetic diet, I soon — thanks to my glucometer — made a dismaying observation. Well, two observations actually.

First, I was waking with quite high blood glucose levels of around 135 mg/dL. Those levels, I was to discover, were typical of Type 2 diabetics. But when I ate the breakfast I’d been recommended (porridge, aka oatmeal, without sugar or milk), my blood sugar levels rapidly spiked to over 200 mg/dL, which could only damage me. In short, the advice I’d been given was bizarre, for I was being told to eat carbohydrates on top of a high baseline blood sugar level. Even worse, I was being told to eat carbohydrates in the morning, which is the time of maximal insulin and glucose resistance.

We wake in the mornings because blood levels of cortisol spike. This spike wakes us up, but it also makes us insulin- and glucose-resistant. And since Type 2 diabetes can be described as a condition of insulin and glucose resistance, the advice I’d received to eat carbohydrates at a time of maximal insulin and glucose resistance can really be described only as weird. Were the doctors and dietitians actually conspiring against their patients?

Breakfast has a recorded history of over 3,000 years. The ancient Greeks ate breakfast (in both the Iliad and the Odyssey, Odysseus eats breakfast) as did the Romans, and from the surviving records we know that, in classical times, people breakfasted on bread, cheese, olives, nuts, raisins and polenta porridge. During the medieval period in Europe, though, members of the upper classes stopped eating breakfast. The peasants, needing to fuel their work in the fields, ate on rising in the mornings, so, to highlight their freedom from manual labor, smart people in that era of feudal class divisions would ostentatiously not eat until lunchtime. Today’s fashion for time-restricted eating (eating only lunch and dinner) has, therefore, a long and posh pedigree.

Breakfast made its social revival only after the breakdown of the feudal system, during the 16th and 17th centuries, when even smart people needed to engage with markets, which was hungry work. But as, during the 20th century, life became increasingly sedentary for people, they tended to revert to the old aristocratic pattern of eating less in the mornings. By the 1920s, the average American breakfast amounted to little more than a cup of coffee and perhaps a roll or a glass of orange juice, which concerned the cereal, bacon, and egg companies.

Breakfast has, over the millennia, generally been a light meal because many (not all, but many) people are simply not hungry in the mornings (in book 19 of the Iliad, Achilles, a breakfast-skipper, wants to attack Troy first thing in the morning; it’s Odysseus who insists on breakfasting first). This lack of morning hunger is probably an evolutionary defense against eating when insulin and glucose resistant, but whatever the reason, it has obviously impacted negatively on investors in the food industry, who have done everything they can to overcome it.

So, during the 1920s, the Beech-Nut Packing Company (a bacon producer) paid the leading PR operative of the day, Edward Bernays (Sigmund Freud’s nephew and the author of the 1928 book Propaganda, which was Joseph Goebbels’ bible), to mobilize 4,500 doctors to endorse big breakfasts (a later film by Bernays describing his persuading the doctors to endorse breakfast is still available on the web). But Bernays was pushing at an open door, because everybody “knew” breakfast was the most important meal of the day. And everybody “knew” we should breakfast like kings, lunch like princes, and dine like paupers.

The “discovery” that breakfast was the most important meal of the day was made in 1847 by Dr. William Robertson, who practiced medicine in Buxton, in the U.K., and who wrote in his Treatise on Diet and Regimen: “Breakfast should always be an important, if not the most important, meal of the day.” Why? Well, because “breakfast is very properly made to consist of a considerable proportion of liquids, to supply the loss of the fluids of the body during the hours of sleep.” Eh?

Robertson, you see, was a water physician, and Buxton was a water spa town, and Robertson believed Buxton waters could cure a host of diseases, including the terrible problem of night-time dehydration. This was a belief not far removed from Hippocrates’ belief in the four humors; or, to put it less politely, it’s garbage.

It is to Adelle Davis (1904-1974), an American dietitian, that we owe the mantra that we should eat breakfast like a king, lunch like a prince, and dine like a pauper. Why? Well Davis, who was no more scientific than Robertson, had been told that our blood sugar levels fall in the mornings unless we eat breakfast. Actually, nothing could be more healthful in the Western world today than falling blood sugar levels, for over half of all older people are pre-diabetic or Type 2 diabetic. But Davis supposed (with precisely zero evidence) that falling blood sugar levels were a problem, to which breakfast was the solution. We now, therefore, know the evidence Davis invoked to justify breakfast actually shows the opposite: To be healthy in a world of rampant Type 2 diabetes and pre-diabetes, we should skip breakfast and rejoice in our blood sugar levels falling gently yet safely over the morning.


Terence Kealey was born in London, where he also went to medical school (Bart’s Hospital Medical School, University of London; in the U.K., most medical students start at the age of 18.) But he soon realized he wanted to do research, so after his house year (internship) he went to Oxford to do his D.Phil. (Ph.D.) in metabolism, where his supervisor (advisor) was Philip Randle. After some years at Oxford, he moved to Cambridge, where he lectured for many years in clinical biochemistry. He then moved as vice chancellor (president) to the University of Buckingham, which is the only university in the U.K. not to be funded directly by the state. After many years there, he moved to the Cato Institute in Washington, D.C., and though he has recently returned to the U.K., he remains an adjunct scholar at Cato.

His research focused on the cell physiology of human skin (his group, for example, was the first to grow hair follicles, including human hair follicles, in vitro), but when, 10 years ago, he developed Type 2 diabetes, he resurrected his earlier training in biochemistry and medicine to show that the conventional clinical advice of the day for Type 2 diabetics was bizarre. In 2016 he published Breakfast Is a Dangerous Meal (4th Estate, London).

Comments on The Story of Breakfast, Part 1

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lea ale
February 24th, 2020 at 4:32 pm
Commented on: The Story of Breakfast, Part 1

Thank you very much for that. Maybe the best breakfast (we say petit déjeuner in french) has to be a mix of the best nutriments we have to eat all time with more proteins like it s said here

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Marcos Rivera
January 29th, 2020 at 9:29 pm
Commented on: The Story of Breakfast, Part 1

Good read. Appreciate the humor, "Doing what all good doctors do..." Often times we find it difficult to practice what we preach so some humility shows the human element.


But what came of you? Guess that is in part II?

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Terence Kealey
January 29th, 2020 at 11:44 pm

Thanks Marcos, the answer is this: thanks to my glocometer (the use of which, can you imagine!!!, was not recommended for type 2 diabetics in the British national health service 10 years ago) I rapidly discovered that skipping breakfast and avoiding carbohydrates but enjoying some wine with supper (alcohol inhibits glucose release from the liver) put my blood levels happily in the pre-diabetic range. I'd essentially reversed my condition (& I think that if I worked at my desk less, and concentrated on my diet more, and take even more exercise, I could do even better--but my doctors are v happy with and for me, and I take only metformin and a statin).

not bad for someone who was told on diagnosis I'd be on insulin in 6 months!

When that reversal first happened, 10 years ago, my doctor was outraged because, he said, only 1% of patients achieved that, yet I'd done all the things he'd told me not to do. "doesn't that make you think?" I asked.

"No" he said, "these are the NICE guidelines." [National Institute of Clinical Excellence or something like that] which I found a bit discombobulating.

anyway, my story is now commonplace as people increasingly go carbohydrate-free, but then it seemed pioneering.

btw, when my glucose levels stray, a few days of vegan diet correct that. But most of the time I can be carnivorous if I wish.

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jr Wild
January 28th, 2020 at 2:24 pm
Commented on: The Story of Breakfast, Part 1

Interesting story, looking forward to continuation.

Another puzzling stydy on breakfast

Jacobowicz et.all www.ncbi.nlm.nih.gov/pubmed/23512957


Overweight people ate same (restricted) calories of 1400 kcal either beakfast -emphasized or dinner -emphasized. So 700-500-200 kcal was delivering good results + weight loss, in comparison to 2-5-7 with heavy dinner.


All measures glucose, insulin, HOMA-ir, triglyserades improved within the heavy breakfast group.


The group concluded: breakfast -heavy eating style is supposedly good for metabolic syndrome or obesity therapy.


Can't get my head around this. Eating "against nature" or at least against insulin resistence is good? The storage form in the evening really stores the dinner energy? As designed for hunter-garherers?


Writing this as a recent (2y) breakfast skipper, not just hungry any more. No willpower exercised nor needed.

JR

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Terence Kealey
January 28th, 2020 at 11:36 pm

Thank you. I've written about this group and their studies before (Breakfast is a Dangerous Meal, 2016, 4th Estate, UK, pp 91-95). What they've done in this particular study is to put their subjects on a weight-loss diet, which raises free fatty acid levels (which they did not measure or report in this study, unless I've stupidly overlooked them.) When free fatty acid levels are raised, breakfast remains a dangerous meal but dinner becomes even more dangerous. But that is only a temporary phenomenon while subjects are fasting and losing weight. But when subjects revert to stable weights, then dinner also reverts to being safe.

It's a shame I think that these authors did not measure circulating free fatty acid levels, because that would have made it so much easier to understand what is going on. It's also a shame I think that these authors attribute so much to circadian rhythms when a much simpler explanation--FFAs--are there to be found.

So the rule remains: for day-to-day life, breakfast should be avoided (unless you're one of those people who absolutely needs it and if you're slim and fit and free of blood sugar problems).

But if you're losing weight, then dinner will become temporarily an even more dangerous meal than breakfast, so then and then alone should dinner be the meal to avoid.

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jr Wild
May 14th, 2020 at 8:42 pm

Hope you are still there, prof. Kealey.

Read your book and checked those three jakubowicz studies. Soon I settled with pictures only. The text and logic is fishy.


They focus primarily on glucose reactions, while feeding td2 people (or pre D) with min 46% carbs. They are happy when the insulin reaction is greater! They seem to think lipolysis is a bad thing (using lipogenesis as a term). Similarily, they like bigger glp1 reaction. Like they get everything upside down, and repeat the same bs with the same team, over and over.


Not anymore so confused, thanks for guidance.

JR

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Emily Jenkins
January 28th, 2020 at 7:38 am
Commented on: The Story of Breakfast, Part 1

Thanks for this article. I’m curious about this recommendation of skipping breakfast as a blanket statement to combat trends we are seeing in the US. Dr. Kealey, do you think some individuals will thrive on eating breakfast? Say, modern day “laborers”. I would like to know to what extent you are reaching with this recommendation. Thank you.

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Terence Kealey
January 28th, 2020 at 10:54 pm

Thank you. I think my point is this: to thine own self be true. The curse of 'breakfast is the most important meal of the day' and 'breakfast like a king, lunch like a prince and dine like a pauper' is that it encourages people to eat breakfast when they're not hungry, out of a sense of metabolic 'duty.' So if you're not hungry in the morning, then don't eat breakfast! But if you are, then of course you must (though a person can still go easy on the carbs.) And if you're a 'labourer' and function better with breakfast then--again--do; but--again--don't eat just because someone says you should: eat only if you're hungry.

An astonishing number of us are pre-diabetic or diabetic, and there's no doubt that if we can lower weights across the population (& skipping breakfast is such an easy way to do so) we'd be healthier as a population.

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Emily Jenkins
February 6th, 2020 at 1:15 pm

Thank you for clarifying. I think it is important to note that skipping breakfast can be a useful "hack" for a certain population but does not mean that you must skip in order to be healthy. Thanks again, I'm looking forward to reading Part 2!

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Mick Reynolds
January 27th, 2020 at 11:47 pm
Commented on: The Story of Breakfast, Part 1

I've got diabetes, for which I'm taking pills (metformin), and slow and fast acting insulin, in addition to working out at 6am most mornings (go CrossFit !nconceivable). When I wake up, my blood sugars are usually on the rise, after being stable overnight. I compensate with some insulin before working out, but many mornings my blood sugar is higher after the workout than it was before, with no carb intake. What gives?

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Terence Kealey
January 28th, 2020 at 10:45 pm

Yup, you're right to be puzzled. Most people tend to go hypo after exercise, for reasons that are obvious, but some people tend to go hyper as glucagon and adrenaline kick in and drive glucose out of the liver. All anyone can do is to recognise that everyone is different and to determine what functions for them. But working out remains a very good idea!

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Embriette Hyde
January 27th, 2020 at 11:05 pm
Commented on: The Story of Breakfast, Part 1

Thank you for this enjoyable, interesting article. I learned a few things I hadn't known before! But one thing I can say is that I've personally benefited from skipping breakfast. I used to struggle with low blood sugar unless I ate every three hours. I've been intermittent fasting for over a year now, and never suffer from shakiness, headaches, or anything else I used to experience from low blood sugar. I haven't actually measured my numbers, but based on how I feel I think it's safe to say that my blood sugar has stabilized. I even feel better working out fasted -- as if I were lighter, less weighed down.

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Terence Kealey
January 28th, 2020 at 10:38 pm

This is really good news, and I think some people really do get a hypo dip after their blood sugar levels rise so high after breakfast. You wld seem to be one of those people

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Derrick Antoniak
January 27th, 2020 at 7:07 pm
Commented on: The Story of Breakfast, Part 1

Interesting read. However, in May 2010 I had just finished my 2nd year of medical school, and none of the dietary recommendations given to you match what I had learned of metabolism and nutrition to that point.

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Mary Dan Eades
January 27th, 2020 at 10:35 pm

Derrick ~ As a physician who graduated 40 years ago, I can attest that we got a good grounding in biochemistry, however, we got (precisely) 3 hours (by which I do not mean credit hours, but rather actual hours on the clock) of 'nutrition'. And that amounted to a single lecture on how to write orders for 'low cholesterol diet', 'low fat diet', 'bland diet', 'low residue diet' etc etc. We, who were interested in the topic, were forced to dig out our own nutritional education over the intervening years as autodidacts, and I, for one, would love to know what they are teaching med students nowadays in nutrition. Would you mind expanding a bit on what they're teaching you now? Your comment that what you're learning doesn't at all jibe with what Dr. Kealey's initial diabetic treatment was, makes curious about what's being taught now. Would you comment further? Thanks!

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Terence Kealey
January 28th, 2020 at 10:36 pm

Thank you Derrick. What were you then taught? In those days people were still taught that type 2 diabetes was invariably progressive, but we now know a low-calorie and/or a low carbohydrate diet can in many cases reverse it. But I agree with Dr Eades that physicians were simply not then taught a nutritional science that made sense or which was even based on biochemistry, so I'd be grateful for your comments.

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Emmanuel Chibuikem
January 27th, 2020 at 3:05 pm
Commented on: The Story of Breakfast, Part 1

i love the way you analyzed the reasons why we have these conceptions.

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Terence Kealey
January 28th, 2020 at 11:37 pm

Thank you Candice, Amedeo and Emmanuel

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Amedeo Alessio Cerea
January 27th, 2020 at 9:13 am
Commented on: The Story of Breakfast, Part 1

Pure truth

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Candice Theron
January 27th, 2020 at 7:21 am
Commented on: The Story of Breakfast, Part 1

Excellent article, I enjoyed reading about the history behind these assumptions and myths.

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