"Breakfast is the Most Important Meal of the Day" takes another hit (2016)



Good article in The Atlantic documenting how we wound up with “Breakfast is the most important meal of the day,” and what has happened to our health as a result. The health harm flows (no surprise here) from the fact that the slogan comes from the breakfast cereal company (Grape Nuts) and breakfast cereals were heavily marketed as the savoir food to help us be “healthy.”

Peter Attia followed up with an email detailing the critical flaws in the arguments put forward today to insist that the slogan is correct. I’ll paste that in below, but The Atlantic article is another indication that the facade that protects “nutritional science” is crumbling.

Greetings -

Nota bene : I was pretty pissed off when I wrote this, but don’t let my annoyance detract from the message. Bad science is an abomination. Incompetent news reporting on bad science is worse.

You’ve probably heard that breakfast is the most important meal of the day. “What is less commonly mentioned,” writes Alex Mayyasi in The Atlantic , “is the origin of this ode to breakfast: a 1944 marketing campaign launched by General Foods, the manufacturer of Grape Nuts, to sell more cereal.”

Seventy-five years later, here’s the latest report from the April issue of the Journal of the American College of Cardiolog y: “Taken together, these studies [showing a positive association between skipping breakfast and CVD and CVD risk factors] as well as our findings underscore the importance of eating breakfast as a simple way to promote cardiovascular health and prevent cardiovascular morbidity and mortality.”
What were the findings? Let’s look at a few newspapers:

  • “Want to Lower Your Risk for Heart Disease? Eat Breakfast Every Morning” (Healthline)
  • “Eating breakfast? Skipping a morning meal has higher risk of heart-related death, study says” (USA TODAY)
  • “Study: Skipping breakfast increases risk of heart disease mortality by 87 percent (FOX)”

(You may notice that all three headlines imply causality.)

Looks like General Foods was right. Time to reach for the Lucky Charms? Perhaps it’s time to put on our critical thinking cap instead. The actual study, and the media coverage of it, is a part of the Groundhog Day that is observational epidemiology (for more on the limitations of this type of research, check out Studying Studies: Part II). This was a prospective cohort study pulling data from NHANES III, looking at people who reportedly eat breakfast every day to people who never eat breakfast, and then following up with them (about 19 years later on average), tallying up the deaths from CVD and deaths from all causes.

One question to ask about the population studied is: was eating breakfast or not eating breakfast the only difference between these two groups? In other words, were there any confounding factors (for more on confounding, see Studying Studies: Part IV)? The authors reported that, “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.” Not only that, “participants who never consumed breakfast were more likely to have obesity, and higher total blood cholesterol level than those who consumed breakfast regularly.” They also had a higher reported incidence of diabetes and dyslipidemia. Read that again, please.

While the study used statistical models to “adjust for” many of these potential confounders, it’s extremely difficult (actually, it’s impossible) to accurately and appropriately adjust for what amounts to fundamentally different people. The healthy user bias (or the inverse, an unhealthy user bias) is virtually impossible to tease out of these studies (the healthy user bias is covered in more depth in Studying Studies: Part I). Not only that, you never really know what you’re not looking for. This is typically referred to as residual confounding in the literature, where other factors may be playing a role that go unmeasured by the investigators.

I haven’t even yet mentioned the misleading nature of reporting relative risk — in this case, an associated 87% (reported in the study as a hazard ratio of 1.87) — without reporting absolute risk. The question you should always ask is, 87% greater than what ? To get an idea of the associated absolute risk, the number of CVD deaths in the “every day” breakfast group were 415 out of a total of 3,862 people over 16.7 years (that’s an unadjusted rate of 10.7%) while the numbers for the “never” breakfast folks were 41 CVD deaths out of a total of 336 people over 16.7 years (unadjusted rate of 12.2%). That’s an absolute difference of 1.5% over almost 17 years (annually, this is an absolute difference of 0.09%). Granted, this is before adjustment of the myriad confounders (including the biggest “risk factor” for CVD death, age , in which the “never” breakfast group was younger on average at baseline), but it gives you an idea that we’re looking at small differences even over the course of a couple of decades. This looks a lot difference on paper than an associated 87% increased risk of CVD death. (For more on absolute risk and relative risk, see Studying Studies: Part I.)

There’s more:

  • What were the participants actually eating for breakfast? We don’t know. The investigators didn’t have information about what foods and beverages they consumed.
  • Did participants change their breakfast eating (or abstaining) habits over the course of almost 20 years? We don’t know. Information on breakfast eating was only collected at baseline.
  • Could there be errors in the classification of the causes of death in the participants? It’s possible.
  • What constitutes skipping breakfast? Was it the timing of the first meal of the day? We don’t know. Participants were asked, “How often do you eat breakfast?” but there was no definition of what that means, exactly.

What’s more likely: reported skipping breakfast was a marker for a lifestyle and environment that may have predisposed these people to a higher risk of CVD death or that skipping breakfast itself causes CVD death?

Go ahead and skip all the breakfasts you want. And please forward this to the next 10 people who tell you it’s unhealthy to do so.

  • (Pissed off) Peter


In Jordan B. Peterson’s book 12 Rules For Life, An antidote to chaos (2018)
the author notes the importance of a low carb breakfast for people suffering anxiety or depression. It is linked to the psychological effects of insulin.

He writes about it in Rule#1, p.18. It is second in importance as fundamental therapy to correcting circadian rhythm and getting good sleep.

I was wondering if there was a thread on the forum that may mention the importance of breakfast. Especially for specific groups of people.

(Full Metal Keto) #3

I don’t think there’s anything wrong with skipping breakfast. However I like breakfast a lot, I choose an early eating window over a later one. I feel I use the food energy better throughout the day, rather than eating more before my most sedentary period of the day. The evening and sleep time. I eat at about 8-9am and 3-5 pm depending on the day’s activity. We all thrive on different schedules or have commitments that dictate when our eating time is. But for me breakfast is the most important meal of the day, but it’s KETO breakfast. Eggs, meat, cheese, fat and sometimes some vegetables in there. Pretty much a huge fat and protein load early in the day and a lighter dinner. :cowboy_hat_face:

(Michael - Don't expect miracles and you won't be disappointed.) #4

AND THEY DID NOT EAT GRAPE NUTS FLAKES!!! So that pretty much makes it conclusive. Just like everyone who DOES NOT EAT ALL BRAN is constipated!!! :astonished:

(Full Metal Keto) #5

Yes, the slogan definitely came from folks like General Mills, Kellog’s, and Post. Pushing their corn and wheat. In this case breakfast was best skipped! :cowboy_hat_face:


@KNHVT I appreciate all the links to how to read a scientific paper. Great stuff! Totally agree that poorly designed experiments interpreted with bias and relative risk statistics, then media grabbed and amplified into misleading click bait headlines is infuriating.

“The Man” has taken a general truism… that at some stage an over night (or longer) fast will finish when foods are available and a person feels hungry. And then they do that tricky thought sculpting (marketing) of a general truth to suit their product sales needs. So we end up having cereal grain food products pushed on to us with heaped spoonfuls of equivocation that sort of resembles science.

The core tenet remains unshakable that eventually the fast needs to be broken. In that we have the difficulty to separate the marketing, wishful thinking, health hypotheses and agendas underlaid, from what is basically true.

Thank goodness for “all day breakfast”. And it usually is a cooked fast break form.

I think this topic highlights that eating is not just about food. The more we are mindful about our eating habits and behaviours, the closer we can get to finding the healthiest way for each family group. I don’t think it is a totally scalable idea to national population size as industrial food-like substance manufacturers would seek us to believe.
Interesting to hear Robb Wolf mention that when linking intermittent fasting to circadian rhythm studies that there may be benefit to loading calories earlier in the day. I think Sachin Panda may be the scientist with that data?

(Marius the butter craving dude) #7

Blockquote Ads like these were key to the rise of cereal, a product launched by men like John Harvey Kellogg, a deeply religious doctor who believed that cereal would both improve Americans’ health and keep them from masturbating and desiring sex. (Only half of his message made it into the ads.)

This thing goes way more further in time, and it ties in with veganism and the adventist church…

Also Breakfast is actualy a new concept not more than 100 years ago. My grandparents would not eat anything in the morning when going to work in the fields…The notion that it is the most important is strange… If you eat nutritional dense foods and you eat meats than no healthy human should feel like starving in the morning, or not having energy…

(Michael - Don't expect miracles and you won't be disappointed.) #8

(Full Metal Keto) #9

You may not believe that breakfast is the most important meal of the day, simply because you believe it was a slogan promoted by grain farming aggregates, but eating windows make a lot of difference with how your body deals with glucose and your insulin response to that. Dr. Fung explains this in detail and advocates breakfast and early eating over later eating windows, the difference is dramatic.



(Karen) #10

Dr. Boz also suggests an early morning shift for two meals for ladies of a certain age who are plateaued. She suggests having your last meal before 2pm