Breakfast is a Dangerous Meal: Why You Should Ditch Your Morning Meal For Health and Wellbeing

PART ONE

1

My diagnosis

On 24 May 2010 my wife drove me to our family doctor’s surgery and told me not to emerge without a diagnosis. Over the previous two or so months I had started to feel increasingly thirsty, and I had not only started to drink water all day but I had also started to pee all day. And all night. I was losing weight, my muscles were wasting away with a strange ‘crackling’ ache, and I felt tired all the time. I even woke in the morning feeling tired. Clearly, my wife said, I had developed diabetes, and she was irritated by my assurances that if we ignored the symptoms they might go away. So it was she who made the appointment to see our doctor, and it was she who drove us to the surgery to ensure I kept it.

I told my doctor what was happening and, echoing my wife, he said it sounded a bit like diabetes. I was forced to agree. So he performed a spot urine test, and there it was – glucose in my urine (‘sugar in the water,’ as he put it). I was diabetic. He then sent a blood sample to the lab, which shortly revealed a fasting blood glucose level of 19.3 mmol/l (normal range 3.9 to 5.5) and an HbA1c of 13.3 per cent (normal range 4 to 5.9; see later). I was very diabetic indeed. Type 2.

My story should thereafter have been routine. Thanks to a good wife and a good doctor a correct diagnosis had been made, and I was surely on the road to recovery. But I was then told to eat breakfast.

The authorities: Diabetes UK is the major diabetic charity in Britain. It was founded in 1934 as the Diabetic Association by H.G. Wells, the author, and by Dr R.D. Lawrence, a prominent physician, both of whom were diabetic. In 2013 its membership exceeded 300,000 people and its income was £38.8 million.1 It is universally respected, both for its research and for its support for patients. Here is some dietary advice from its Eating Well With Type 2 Diabetes:

Eat three meals a day [in bold in the publication]. Avoid skipping meals and space out your breakfast, lunch and evening meal over the day. This will not only help control your appetite but will also help control your blood glucose levels.2

And in case we don’t get the message, Diabetes UK and the NHS have combined to reiterate, in red in the joint publication:

Don’t skip breakfast.3

The American Diabetes Association (ADA) is another impressive body. It has a membership of 441,000 and an annual turnover of $222 million,4 and it recommends an even more generous frequency of eating, suggesting that diabetics eat: ‘breakfast, lunch, dinner, and two snacks’.5

The diabetic charities certainly believe in frequent meals, and equally they believe in breakfast. So when, on diagnosing my diabetes, my doctor recommended I eat three meals a day including breakfast – as well as frequent snacks – he was only following the internationally agreed guidelines.

My glucometer: I might never have discovered how bizarre was that advice and those guidelines if our family doctor hadn’t also given me a personal glucose meter or glucometer. This is a hand-held device, not much larger than a mobile phone, that allows people to monitor their fingerprick blood glucose levels several times a day. Because it provides the patient with direct access to the mysteries of their own disease, the glucometer is the diabetic equivalent of the ninety-five theses Martin Luther reportedly hammered into the church door in Wittenberg: it allows the patient to bypass the doctor, the NHS and the diabetes charities as directly as Luther once bypassed the pope, so patients can test the official advice against their own blood glucose levels.

On using my glucometer I soon made an unexpected discovery. I found that my blood glucose levels were dismayingly high first thing in the morning, but – even worse – they would rise much further, indeed hazardously, if I ate breakfast. I didn’t feel ill with those elevated levels (glucose in high concentrations is a silent killer), but over time they would be killing me.

Yet if I skipped breakfast, my blood glucose levels would fall to normal over the morning. After lunch and dinner, of course, they would rise again, but noticeably less than after breakfast. Since high blood glucose levels are unsafe, I had discovered that, as a type 2 diabetic, breakfast was the most dangerous meal of my day. On reviewing the research journals, moreover, I found I hadn’t been the first person to make that discovery. One of the pioneers was Professor Jens Christiansen from the department of medicine at the University of Aarhus in Denmark.

Professor Christiansen’s experiment: Figure 1.1 shows the typical twenty-four-hour blood glucose profile of a group of healthy young people who eat three meals a day.6

As you can see, blood glucose levels between meals normally run at around 4–5 mmol/l. Within an hour of eating, however, those levels rise to well over 6. Yet within six hours of eating, those levels fall back to around 4–5.fn1

To see what happens in type 2 diabetes, Professor Christiansen and his colleagues monitored the blood glucose levels of thirteen adult patients. On some days he asked his thirteen patients to skip breakfast, whereas on others he asked them to eat it. To ensure that all other conditions were unchanged, he asked his patients on breakfast-free days to compensate by eating more for lunch and dinner, so their daily energy intake was the same. Figure 1.2A shows his patients’ blood glucose levels on the days they ate breakfast.7

FIGURE 1.1

Glucose levels in healthy people who eat three typical meals a day.

21 healthy subjects eating typical meals were studied and their results averaged. The arrows indicate that breakfast was served at 7.30, lunch at 12.15 and dinner at 18.00. The results are from interstitial fluid, which is similar to blood plasma and serum. (Less energy was ingested at breakfast than at the other two meals.)

As you can see, these diabetics start their days in a hazardous state: their overnight fasting blood glucose levels are not much short of 7.0 mmol/l. But look what happens after breakfast. When patients are fed a full breakfast of about 600 calories (between a quarter and a third of a day’s intake of energy) their blood glucose levels spike at around 10.5. These come down within four hours, but that spike will have done the patients no good because spikes in blood glucose levels will double a person’s chances of dying from heart attacks and strokes.8

Moreover, Professor Christiansen also showed that, over the rest of the day, the breakfast eaters’ blood glucose levels remain volatile; and such volatility not only adds a further risk of the two cardiovascular diseases of heart attacks and strokes, it also increases the risk of developing a gamut of diabetic complications including blindness, renal failure and the need for limb amputations.9

FIGURE 1.2A

Plasma glucose levels in type 2 diabetics who eat breakfast.

13 patients were studied on four occasions, and their results averaged. The arrows indicate that breakfast was served at 8.00, lunch at 12.00, a snack at 15.00, dinner at 18.00 and supper at 20.00.

Now look at Figure 1.2B. On the days the diabetics ate no breakfast, they enjoyed mornings of beautifully falling blood glucose levels. On those days they ate bigger lunches and dinners, so their post-lunch and post-dinner rises were higher than on the days they did eat breakfast, but those rises were gentler and therefore safer than the post-breakfast spikes they had thus avoided. (These subjects also ate two snacks a day, but that doesn’t change this analysis.)

FIGURE 1.2B

Plasma glucose levels in type 2 diabetics who do not eat breakfast.

13 patients were studied on four occasions, and their results averaged. Lunch was served at 12.00, a snack at 15.00, dinner at 18.00 and supper at 20.00.

Professor Christiansen’s data and my own experience with my glucometer are, therefore, comparable, and Professor Christiansen has confirmed my unexpected finding that, for type 2 diabetics at least, breakfast is a dangerous meal. As readers of Professor Christiansen’s paper will discover, he was equally surprised by the finding, and like me he concluded that type 2 diabetics should skip breakfast.

So, why was I told to eat breakfast?

Box 1: Glucometers and type 2 diabetes

Normally doctors won’t give glucometers to patients with type 2 diabetes (only type 1s get them). Here is the recommendation from NICE (the National Institute for Health and Care Excellence) which is the quango that advises doctors on how to treat their patients: ‘Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes.’10

NICE gives this advice because of research that suggests that self-monitoring does not benefit type 2 diabetics,11 but I don’t trust that research. Consider slimming and self-weighing. It makes sense that people who weigh themselves regularly would eat less and would lose more weight than people who do not weigh themselves, and although some researchers disagree,12 most researchers find exactly that.13 Equally, people who use fitness trackers to monitor their own exercise would be expected to walk more every day, which is what researchers find.14 Correspondingly, I would expect diabetics who monitor their own blood glucose levels also to improve their control.

As would Diabetes UK, and though it may be unsound on breakfast, it is a superb patients’ advocate, and it is shocked that type 2s are not routinely given glucometers. Diabetes UK admits that patients who self-monitor will ‘commonly’ fail to act on the results of their glucometer readings (thus rendering the blood tests futile), but that failure, it explains, arises only because of patients’ ‘lack of education in how to interpret them’. That lack of education, moreover, has not been helped by ‘a lack of interest in the results from health care professionals’. Consequently, Diabetes UK says, the self-monitoring of blood glucose levels has failed only because ‘the professionals expect the patients to self-manage’ while the ‘patients expect the health care professionals to use the results.’15

But I am not only a researcher who has specialised in the biochemistry of glucose and fats, I am also a medical doctor, so I needed no education in interpreting blood glucose levels, and I was grateful for the glucometer my doctor proffered, which allowed me to take control of my diabetes and which also allowed me to discover that the conventional advice was simply wrong. Yet even for non-biochemists and non-doctors the necessary level of education is actually modest, and it should be extended to all patients with type 2 diabetes, so that they too can optimise their diets. It was thanks to his pioneering use of the personal glucometer that the great Dr Bernstein streaked decades ahead of the curve in advocating low-carbohydrate diets for type 1 diabetics,16 and now we need a Dr Bernstein for type 2s.

Glucometers and their strips can be bought at any pharmacy – no prescriptions are necessary – so if you have type 2, and if you do not have a glucometer, let me urge you to buy your own; and in the meanwhile, for want of anything better, let this book be your education. (The real cost of blood glucose measurements comes, incidentally, not from the purchase of the glucometer but from the test strips. I use roughly sixty strips a month, which costs me about £25 a month, which is cheap at the price.)

PART TWO

2

The glorification of breakfast

Early one morning, some 3,000 years ago, a Greek army idled while two of its generals argued. As Homer recounts in Book 19 of The Iliad, Achilles wanted to attack Troy at dawn, but Odysseus urged him not to send his men ‘to fight the Trojans fasting, for the battle will be long and furious, so first get your men to eat bread and wine by the ships’.1

Odysseus won the argument, and breakfast was duly served to the troops. Achilles refused his portion but, fortunately, the goddess Athena ‘dropped nectar and ambrosia into Achilles, so hunger wouldn’t weaken him’. Greek soldiers believed in breakfast, as apparently did everybody in Homeric Greece, and Book 16 of The Odyssey opens with ‘Back at the hut, Odysseus and the noble swineherd had lit a dawn fire and were making breakfast.’2

By the classical era in Greece, around 500 bc (bce), breakfast seems to have consisted of barley bread or pancakes, sometimes dipped in wine, sometimes complemented by figs or olives. The Romans ate a similar breakfast, around dawn, of bread, cheese, olives, salad, nuts, raisins and perhaps cold meat. The Roman army, though, fed its soldiers a hot breakfast of porridge, similar to polenta, made from roasted spelt wheat or barley that was then pounded and cooked in boiling water.