This was a very small study, but unlike many other “breakfast” studies, it prescribed specific breakfasts, and more to the point, they’re not bowls of ultra-processed carbs, but rather high protein options with a breakdown of 340 calories made up of 30g of protein, 36g of carbohydrates, and 9g fat.
What the authors were interested in were the differences, in the same individuals, of having a high protein breakfast vs. skipping breakfast (first meal at noon), on hunger, fullness, desire to eat, prospective food consumption (PFC) and related hormones, food cue–stimulated functional magnetic resonance imaging (fMRI) brain scans, ad libitum evening food intake, sleep quantity and sleep quality.
The participants were healthy young men and women without obesity and each arm of the experiment lasted for 7 days with a 3 day washout period in between.
The results saw breakfast eaters see their hunger, desire to eat, PFC, and ghrelin levels decrease on breakfast days versus skipping days, while their fullness and related hormones increased.
What didn’t differ however was total energy consumed, this despite the fact that when they ate breakfast, participants on average consumed 30% fewer carb based evening snacks. There was also no real impact on sleep or sleep markers.
What was great about this study was that it didn’t just look at next meal consumption, but rather the impact of breakfast on whole days, something my clinical experience has been screaming for years was necessary. That said, at least in this short study, it didn’t seem to matter, at least not to total daily energy intake.
So does this mean you shouldn’t skip breakfast? Not exactly, but it does suggest that eating a high protein breakfast, though it won’t make you eat fewer calories, it may leave you feeling fuller and decrease evening processed food snacking.
And so once again, the answer is personal and not particularly complicated. If breakfast helps you to eat less, eat better, or feel better, then yes, you should eat it, and if it doesn’t, don’t.
Surrey, BC – Justin Trudeau, Leader of the Liberal Party of Canada, will deliver remarks to supporters at a Liberal fundraising event in Surrey on September 4, 2018. The Liberal Party of Canada has committed to the strongest standards in federal politics for openness and transparency, and is challenging other parties to do the same. […]
Molly Galbraith, on her Facebook page, in light of recent events, discusses rape culture in the fitness industry.
Julia Belluz, in Vox, takes on nutritional epidemiology and what amount of alcohol is safe to drink.
Jason Lusk, on his blog, with his take on how the hierarchies of food needs fuel dietary fads and nutritionism.
Gene editing breakthrough fixes muscular dystrophy in dogs
We need to fight wildfire with fire – but we need to understand it first
Zika spread like wildfire and then it fizzled – why?
Giant prehistoric cave bears mated with brown bears
One of Russia’s missiles is missing – is this an undisclosed nuclear disaster?
An online game lets you practice generating fake news (repeat)
The other day a GP tweeted at me that there was “no role for pharmacology” in the treatment of obesity along with an #LCHF hashtag. I can only presume she believes low-carb high-fat diets are the global panacea that everyone needs, and that those not adopting and succeeding with them are personal failures.
And hers isn’t an isolated viewpoint, nor is it one that’s relegated only to the #LCHF crowd as I’ve heard from other non-LCHF hashtagged physicians that forks and feet are what’s required, not medications or surgery.
But those viewpoints tend only to be extended to obesity, not to any of the literally dozens of other chronic, non-communicable diseases, that lifestyle may prevent or treat, and so yes, while useless truisms like eating less and exercising more would help people to lose weight, and while #LCHF would help some too, it’s bias that has obesity as the sole medical condition that people feel comfortable proclaiming that medication (or surgery) has no role in treatment.
Clinically useless truisms aside, obesity is complicated, and moreover we have yet to discover a non-surgical, reproducible, sustainable, and uniformly effective plan for the management of obesity. And while there’s no argument about the fact that in a ideal world everyone would take it upon themselves to live the healthiest lives possible, there are two problems with that argument. Firstly, not everyone is interested or able to change their lifestyles, and secondly, statistically speaking, the majority of even those who are interested and successful with lifestyle change will ultimately regress.
Is it lazy to want to improve your quality and/or quantity of life? Because for many that’s what the treatment of obesity would do, and that’s true for pharmacologically assisted weight loss and surgical weight loss too. And yes, sure, it’d be lovely if everyone had the very real luxuries of possessing the health, time, money, and inclination to regularly and genuinely exercise, cook, and life broadly healthful lives everyday, forevermore, but except in the minds of those filled with dripping I can do it and so should you lifestyle sanctimony, that’s simply not the case for a large percentage of our real life population.
So yes, medications for those who want and need them. Same with surgery. And also varied dietary approaches and behavioural strategies. Because my job as a physician is to provide people with enough information about their options for them to make their own informed decisions, it’s not to be a myopic, biased, patient-blaming, blowhard, dietligious, zealot
Mississauga, ON – Justin Trudeau, Leader of the Liberal Party of Canada, will deliver remarks to supporters at a Liberal fundraising event in Mississauga on August 30, 2018. The Liberal Party of Canada has committed to the strongest standards in federal politics for openness and transparency, and is challenging other parties to do the same. […]
Ever wonder if you’re biased against people with obesity?
Have you ever stood in line behind someone with obesity at the supermarket and judged them on the basis of the items they were pulling out of their cart? Or behind someone with obesity at a fast food place and judged them on the basis of their order?
Now ask yourself if you have, or would have, similarly judged a thin person pulling out those same items or making that same order.
And it’s worth noting, there’s no good answer here.
If you answered, no, you wouldn’t have judged a thin person similarly, well that reflects weight bias.
And if you answered, yes, you’d be judging them the same way, well that reflects you judging people on the basis of things that are none of your business.
Everyone’s life is complicated, and moreover, food plays roles far beyond fuel and serves as comfort, as celebration, is one of life’s most seminal pleasures, and it’s not for anyone to judge anyone else on the basis of their choices therein.
Oh boy, allergy elimination diets are a breeze! Said no one ever. It’s been challenging to think of recipes when many of the foods and ingredients I love are also ones I should avoid for a bit before gradually reintroducing. So when I came up with these flatbreads, I was seriously overjoyed! There’s always a […]
John Ioannidis, in JAMA, on the incredibly flawed foundations of nutritional research and dietary recommendations. Given subscribers here are likely interested in nutrition, I believe this to be an important enough read that I don’t want to recommend you read anything else.
The Conservatives’ disintegration is, in an odd, backhanded way, a tribute to Stephen Harper. There never really was a united “Conservative Party of Canada”; conceived in exile and consummated in the back room, it was always an uneasy patchwork…
It is a fairly common practice for fertility clinics to deny treatments to women with obesity. The rationale presented usually references the increased risks posed to both mom and fetus consequent to mom’s obesity.
And indeed, there are increased risks in pregnancy in women with obesity including of gestational diabetes, preeclampsia, prolonged first stage of labour, increased instrumental deliveries, shoulder dystocia, macrosomia (big babies), congenital anomalies, and C-Sections.
But here’s the thing, there are plenty of pre-existing conditions that women seeking fertility treatments have that confer comparably increased risks, and yet those women are not denied access to treatment, instead they are counselled about those risks, informed consent is obtained, and treatment is provided.
Couple the above with the fact that there simply are no gold standard non-surgical means by which women with obesity can ensure they’ll lose weight, and that denying fertility treatment to women has been shown to negatively affect self-esteem, social isolation, anxiety, and depression, and I can’t help but wonder whether there are grounds for a lawsuit? Grounds that have been made that much stronger by the recent publication of the Canadian Fertility and Andrology Society’s recommendations on obesity and reproduction which spell out all of the above (minus the legal question), and which are well worth a read by women with obesity seeking fertility treatments.
It’s okay to give yourself a break. This is something I’ve been reminded of over and over again since the beginning of the year. In a recent newsletter, I shared my struggles with injury and overtraining and opened up about why I decided to take a big old exercise break starting in January 2018. It […]
Two new studies are bound to disappoint those who still want to believe water makes a difference in weight management.
The first of these studies, Increasing water intake influences hunger and food preference, but does not reliably suppress energy intake in adults, asked participants to drink 500, 1000, 1500, or 2000ml of water in the morning before an all you can eat lunch buffet to see if doing so reduced how much people ate. The researchers found that even drinking 2L of water before lunch didn’t reduce how many calories were consumed at the buffet.
The second, Complementary and compensatory dietary changes associated with consumption or omission of plain water by US adults, compared the self-reported dietary intake patterns (which you should know aren’t generally thought to be be reliable) of individuals who had days recorded with and without water intake to see if there were a difference in calories reportedly consumed. There wasn’t.
As to how pervasive the belief that water is a key player in weight management, you might be surprised by how many people I meet in my office who believe water drinking makes or breaks an effort, though when you consider the fact that 63.4% of adults in a recent US survey of weight loss practices cited water drinking as one of theirs, maybe it shouldn’t be all that shocking.
In my mind the only thing that’s surprising is that I would have thought it to be fairly self-evident, that water drinking was an incredibly minor player at best, because if drinking 8 or more glasses of water a day contributed even moderately to successful weight management, we’d see a great many more success stories walking around.
[That said, if you replace all your regularly consumed caloric beverages with water, well that might lend a hand.]
I have not written a post for many months as I have been on quite an adventure. I would like to share the details of that adventure with family and friends. Many of my posts will be personal and reveal some secrets. Stay tuned. Just wanted you to know …
Robert O’Conner, in Medium, with his expert thoughts on glycophosphate (RoundUp) and cancer.
Andrew Kniss, in his blog, with his expert thoughts on glycophosphate and cancer.
Lynn Johnson, in National Geographic, with an incredible story about Katie Stubblefield’s face and life.
Health Canada’s latest neonic ban is good news for insects, says ecologist
Tracking wide scale animal migrations from space
Zombie gene in elephants comes back to life to kill cancer cells
Bee pheromones may be useful as an elephant repellant
Earth simply cannot make enough food to feed everyone a North American diet
Moon’s orbit around the Earth would change its hypothetical tides
This morning The Calgary Herald published a column by Licia Corbella, entitled “Family of jailed Saudi blogger angry over Trudeau”. In it Corbella criticized government’s twitter diplomacy efforts in the Raif Badawi case, directly quoting members of the man’s family. As you will note by clicking through the link above, that column is now gone. Mr. Badawi’s wife, in a series of tweets early this afternoon, called the story “fake news”. Those tweets are also gone, as is all reference to the story in Ms. Corbella’s twitter feed. I contacted The Herald and asked if they had yanked the piece, and they responded as below:
The column has been removed at the request of Ensaf Haidar (wife of imprisoned blogger Raif Badawi) due to the sensitive nature of the family’s situation.
— Calgary Herald (@calgaryherald) August 14, 2018
So there appears to have been a severe cock-up on the journalism front by Ms. Corbella, the precise details of which remain obscure. It wouldn’t be the first time.
The study’s pre-registered primary outcome measure, as recorded in ClinicalTrials.gov, was change in baseline fat mass at 16 weeks.
Secondary outcome measures (as recorded) were changes in baseline appetite at 16 weeks (assessed with visual analog scales and an eating behavior questionnaire), and objective appetite measures including a weighed breakfast buffet, weighted 3-day food records, and serum satiety hormone levels.
(Not preregistered as an outcome of interest? Body weight change or BMIz score.)
Outcome wise, here’s a snapshot of the study’s abstract:
Reading through the study, here’s what I found as outcomes:
The authors’ conclusions about a prebiotic supplement that was shown to markedly increase hunger hormone levels, that didn’t decrease 3 day food diary energy intake, that didn’t change all-you-can-eat breakfast buffet energy intake (unless you arbitrarily after the fact divided up the kids into those aged 7-10 and 11-12), and where the study’s registered primary outcome wasn’t mentioned in the study itself sure look differently than what you might expect, with their concluding sentence being,
“This simple dietary change has the potential to help with appetite regulation in children with obesity“
I also found it surprising that the study was free to read, and given the incredibly unexciting findings, it’s more difficult to imagine the authors paying for its open access. Easier to imagine the company that makes the prebiotic that a randomized controlled trial published in an impactful journal explicitly concluded, “has the potential to help with appetite regulation in children with obesity” (even though it didn’t), paying the extra fees as open access articles generally gather more citations.
As to what Beneo, the manufacturer of the prebiotic used in this study had to say, I found these quotes in an article published on the trade-zine Nutraingredients at the time of the study’s publication,
“Beneo regards this research of highest importance“,
and despite the study not even remotely coming to this conclusion also added,
“The intake of 8g of prebiotic inulin (Orafti Synergy 1) in a glass of water prior to dinner is a simple dietary intervention that supports children in their weight management efforts. The results show that they were naturally eating less (YF: no they didn’t) than the control group having maltodextrin“
And you can bet your bottom dollar, it’s studies and conclusions like this one that supplement companies use to suggest great benefits to their products, and it’s also studies like this one where I wish the journal employed open peer review as I can’t fathom how this one got through as is.
Lastly, while the authors didn’t report any conflicts of interest with this particular study, the supplements and placebos were provided by Beneo, and it was noted that one of the authors had previously enjoyed funding from Beneo. Unfortunately there is no mention as to who paid for this study’s open access.
[Dear remaining readers: apologies for neglecting this blog of late—pressing assignments, alas. Stay tuned for more in a while. Until then, join me in abominating this dreadful spectacle of politically-correct historical erasure. Down the memory hole. Right out of…
Pilots are much more likely to pass flight maneuvers when carbon dioxide concentrations are low.
Children with finger lengths signalling they were exposed to higher levels of testosterone in the womb showed lower voice pitches in infancy as well as adulthood.
Birds often evolve larger brains on they reach islands, scientists confirm.
Wildfires, record heat, droughts – scientists are parsing through the extreme weather events to determine what exactly is caused by climate change.
Fireflies mostly only glow at night because that’s when the males are trying to get the attention of female fireflies, according to entomologist Dr. Sandy Smith.
Facing warmer temperatures, wolf spiders are changing up what’s for dinner, and in doing so, lessening the effects of climate change in their ecosystem.