CAN SKIPPING BREAKFAST (OR FASTING) HARM YOUR HEART?
On average we make over 200 decisions a day on what to eat and when to eat. We live in environments providing an abundance of calories of diverse sources but we are often rushing, particularly in the morning. Not only do we have to decide whether we have time to cook steel cut oats versus grabbing a Danish and a latte on the way to work, we also have to consider the benefit or harm of skipping meals or adding periods of fasting to our health plan. Can skipping breakfast as a planned fasting practice be a healthy option (technically, skipping breakfast is not fasting but rather time restricted feeding or TRF; fasting is often defined as >30 hours without food unless it is the fasting modified diet described below)? Or does it harm the body not to get 3 square meals a day?
NEW BREAKFAST DATA FROM SPAIN
Headlines appeared in the last few weeks announcing that skipping breakfast might promote more rapid atherosclerosis (hardening or aging of arteries). What was that all about? A research study was published in a prominent cardiology journal reporting that a group of citizens in Spain who answered a survey that they routinely skipped breakfast had more atherosclerosis detected on ultrasounds of their carotid and femoral arteries than those reporting they ate breakfast. Interestingly, the amount of silent heart artery aging found on CT scans in these apparently healthy people was 18% overall and not statistically higher in breakfast skippers (maybe skipping breakfast protected the heart in these relatively unhealthy subjects?). Let’s look a bit behind the headlines before you fry up a few eggs, sausage links and toast on before leaving for work.
Prior observational studies have reported that skipping breakfast may be a sign of poor health habits that impact arteries like higher cholesterol and blood sugar levels, higher blood pressure, more smoking and more animal rich diets. The new study in the headlines of Spanish bank employees found similar associations. The 118 employees who skipped breakfast (out of over 4,000 total) reported smoking twice as often, drank more soda and alcohol, weighed more, and had worse lab results. When heart disease was considered in this group, the picture of an overall stressed bank worker grabbing a coffee and a cigarette while running out the door appeared to deserve the blame, not the choice of eating breakfast or not. It appears that people without a solid health plan who have a multitude of poor health habits often skip breakfast and eat poorly the rest of the day. It is odd that only 3% of the bank research group indicated skipping breakfast, a habit in my clinic reported by 20–30% of patients. Also, dinner in Spain often starts at 8 or 9 PM so the gap until breakfast is shorter than typical in the USA.
PRIOR DATA FOR HEART DISEASE AND DIABETES
The Intermountain Heart Collaborative Study evaluated if patients with a routine religious fasting pattern (1 time per month for 24 hours) had health issues. An analysis of this group found that patients who fasted routinely had a reduced risk for coronary artery disease by 35% compared with individuals who did not fast routinely. In the same study, comparing routine fasters and non-fasters, the risk of developing Type 2 diabetes was reduced by half by fasting regularly.
SKIPPING BREAKFAST AND CALORIE INTAKE: NEW DATA
A recent study of 40 teenagers was just published where girls either skipped breakfast or were given a standardized breakfast. Overall, those girls skipping breakfast ate 350 less calories in a day compared to breakfast eaters. If continued, that would result in the loss of 3 pounds a month. When you have a health plan, skipping breakfast and eating healthy the rest of the day may favor weight loss.
WHAT OTHER STUDIES SHOW FASTING IS GOOD FOR THE HEART?
The newest and most convincing data on fasting and risks for heart disease come from the work of Valter Longo Ph.D. at USC. The protocol, called a fasting mimicking diet, involves reduced calories overall and a low calorie breakfast 5 days in a row once a month. The prepared whole food is low in sugar and protein, higher in whole food fats, and is plant based. Human studies show that subjects lose weight from visceral (belly) fat and sustain the weight loss even 6 months after completing 3 months of the plan. The subjects demonstrated lower blood pressure, inflammation, lower markers of cancer risk (IGF-1) and higher levels of stem cells in the blood performing reparative functions.
DOES EATING LATE AT NIGHT AFFECT THE HEART?
There is evidence for heart patients that late night eating may be harmful. In the Health Professional Follow-Up Study, nighttime eating was defined as eating after going to bed. Men with nighttime eating had an increased risk of heart disease 1.5 greater than compared with men who did not eat during the night.
TAKE HOME MESSAGES
Planned fasting and planned skipping of breakfast, or adding in a scientifically proven program of a fasting mimicking diet 5 days a month, may help reduce the obesity, heart and diabetes epidemic now reaching 40% of US adults and 20% of US kids. As the adage goes, if you fail to plan your fasting and meals, you are planning to fail.
Specifically, it is wise to plan your meals and your diet like you plan your vacation, leaving nothing to chance. Do not outsource your meals to vending machines, fast food choices, or skipping on the run while grabbing junk food, whatever time of day. If you eat breakfast, plan ahead with a fruit and vegetable smoothie, overnight oats, chia pudding. If you eat 3 meals a day, find simple solutions that are easy and plant based like bean soups, lentil loafs, and large salads to increase nutrients and fiber during the day. Packs snacks like fruit, carrot sticks and hummus, walnuts and some dried fruit. Pack water in glass bottles to avoid soda. Consider 2 meals a day or a fasting mimicking program 5 days a month. You will be on your way to a flat belly and a strong heart.