The most important meal of the day is breakfast.
That's what my mother always said, especially to my younger brother, who insisted on starting the day with just a Coke.
A recent article published in the Journal of the American College of Cardiology brought this to mind, as skipping breakfast has now been associated with an increased chance of developing premature atherosclerotic disease. This new study examined three kinds of breakfasts:
High energy, providing more than 20 percent of the day's calories
Low energy, with 5 percent to 20 percent of the day's calories
Skipping breakfast entirely, which includes my brother's plan of ingesting calories without any actual nutrition.
This finding came as part of a larger trial called PESA (Progression of Early Subclinical Atherosclerosis), which follows more than 4,000 middle-aged Spaniards to see what factors cause premature heart disease.
The conclusion: Not only is skipping breakfast bad for you, resulting in earlier heart disease, but it also may be a marker of a future unhealthy lifestyle.
Other studies have shown that men who skipped breakfast had a 27 percent increase in coronary heart disease and as much as a 36 percent increased risk of stroke. People who skip breakfast eat meals later in the day that are less nutritionally balanced than the meals breakfast eaters consume, too.
Because as many as three in 10 American adults skip breakfast, this is important news. Just as important: The adverse effects of skipping breakfast begin in early childhood.
Skipping other meals is probably no better than skipping breakfast, for much the same reason: You just get too hungry to make good choices when you do eat. Intermittent fasting is now popular for weight loss and can be effective, at least, in the short run. Research to date has shown no difference compared with other weight loss regimens; there is no evidence that it is harmful, but remember, it is a fad. Making a real lifestyle change and restricting sugar is a far healthier approach.
Beware of ‘health’ marketing
These studies did not address what kind of breakfast choices both children and adults make. But all the research on the perils of too much sugar suggest that a breakfast full of the sweet stuff may be as bad for you as skipping breakfast entirely.
We learned as children to be cuckoo for Cocoa Puffs (with 13 grams — more than a tablespoon — of added sugar per cup), that Lucky Charms (also 13 grams) are magically delicious, and Raisin Bran (a whopping 18 grams) has two scoops of raisins. In reality, cereal marketers have been playing Trix (13 grams) on us.
Read the nutrition labels on the side of the box before you buy. The type may be small, but it's clear.
Original Cheerios has a single gram of sugar per serving. Honey Nut Cheerios has 10.5 grams per cup. And as for the healthy-sounding Cheerios Protein, there's more than four teaspoons (17 grams) of added sugar per serving, and just four more grams of protein than original Cheerios. That's hardly a boost, considering that an adult man requires an average of 56 grams of protein a day.
Another popular breakfast choice is doughnuts. Introduced by the Dutch as sweet dough fried in pork fat, their day-starting popularity took off once marketers paired them with coffee. A Krispy Kreme original doughnut has 10 grams of sugar, and a chocolate-filled one has 23 grams of sugar and 350 calories.
But nobody thinks doughnuts are healthy. Yogurt has a positive health reputation like few other foods — one it deserves only if it's unsweetened. Yoplait Mountain Blueberry has 18 grams of sugar, and YoCrunch strawberry low-fat yogurt with granola has 25 grams.
Orange juice is not part of a low-sugar breakfast. A 12-ounce serving has 33 grams of sugar, not much better than my brother was doing with his morning cola. True, it's "natural sugar," but without the fiber you get by eating a whole orange, the juice makes your blood sugar spike like Kool-Aid would.
So what's good for breakfast? Try whole fruit, whole-wheat toast spread with some ripe avocado, protein-rich cottage cheese or even a light smear of peanut butter. Plain yogurt flavored with fresh fruit is another healthy alternative.
The bottom line: Sometimes we all have to make choices. I think I will continue to eat my Quaker Oatmeal Squares every morning, despite containing disappointing amounts of sugar (9 grams per serving), as I have come to really enjoy it. But, I will try to add more fruit and eat less of the cereal.
David Becker, M.D., is a runner and a board-certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. He has been in practice for 25 years.
On the breakfast menu
Here are some good breakfasts to try, courtesy of registered dietitian Patti Morris:
Breakfast #1: Oatmeal
1 cup steel cut oats = 170 calories, 5 grams of fiber, 7 grams protein, 29 grams of carbohydrates
½ cup blueberries = 45 calories, 2 grams of fiber, 10 grams of carbohydrates
3 tablespoons almonds = 120 calories, 3 grams of fiber, 3 grams of protein, 2 grams of carbohydrates
8 ounces skim milk = 90 calories, 8 grams of protein, 12 grams of carbohydrates
Total = 344 calories, 10 grams of fiber, 18 grams of protein, 53 grams of carbohydrates
Breakfast #2: Yogurt parfait
8 ounces fat-free Greek yogurt = 130 calories, 23 grams of protein, 9 grams of carbohydrates
½ cup strawberries = 25 calories, 2 grams of fiber, 6 grams of carbohydrates
¼ cup walnuts = 200 calories, 5 grams of protein, 2 grams of fiber, 1 grams of carbohydrates
Total = 355 calories, 4 grams of fiber, 28 grams of protein, 16 grams of carbohydrates
Breakfast #3: Egg sandwich
1 whole egg and 3 egg whites, scrambled = 140 calories, 17 grams protein, 5 grams of fat, 0 grams of carbohydrates
½ avocado = 160 calories, 15 grams of heart healthy fat, 6 grams of fiber, 8 grams of carbohydrates
Whole-wheat sandwich thin= 100 calories, 4 grams of protein, 5 grams of fiber, 22 grams of carbohydrates
Total = 400 calories, 21 grams of protein, 20 grams of fat, 11 grams of fiber, 30 grams of carbohydrates