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Eggs or Flakes? Not 30% vs. 25% protein! A brief reminder of the fact that the stuff you eat is still food.

I am not quite sure when or why this happened, but I know that more and more people are thinking in terms of "macros" instead of foods. What I do know, though, is that the recent publication of studies from the Pennington Biomedical Research Center at the Louisiana State University System (Bayham. 2014) and an ostensibly unrelated study that was conducted by researchers from the Alimentary Pharmabiotic Centre, Biosciences Institute in Cork and scientists working at the local university and the University of Pittsburgh School of Medicine (Patterson. 2014) confirms - once again (!) - how futile this ignorant approach to nutrition actually is.

Eggs vs. cereals - not the best example, but...

In that, I am well aware that the "battle" between an egg- and a cereal-based breakfast in the Patterson study is not exactly a good model of whats currently going on in the health and fitness community. With cereals being labeled as "the devil" (its always nice to be "anti", isnt it?), no one would after all consider having ...

• One-and-a-half cup of Special K® RTE cereal, 200 ml Silk® original soymilk, one slice of Natural Grain “Wheat n’ Fiber”® bread, 13 g of butter, and 10 g of sugar-free strawberry jam (CG)

... for breakfast. In view of the fact that the same can be said for the calorie- and mocronutrient matched "high quality protein" breakfast, i.e.

• Two scrambled eggs, 120 mL skim milk, two slices of Holsum® thin white  bread, 5 g of butter, and 18 g of Smuckers® strawberry jam

... I still believe that the consequences of "breaking the fast" (learn why I am calling breakfast thus in "Breakfast or Breaking the Fast" | read more) with eggs vs. Special K are still relevant to the previously introduced context. And if you know that the acetylated form of ghrelin and PYY are "satiety hormones", it does not take a rocket scientists to interpret the data in Figure 1.

Figure 1: Level(s) of "satiety hormones" after the different breakfasts (Bayham. 2014)

What is difficult to tell, though, is whether the increased satiety after the egg breakfast would actually lead to a reduced intake at the subsequent meal.

• On an individual basis, i.e. on just one of the two eating occasions, the higher levels of acetylated ghrelin and PYY did not suppress the 20 healthy overweight or obese subjects energy intake during the subsequent lunch
• For day 1 and day 7, together, on the other hand, the 64kcal the egg eaters consumed less than the cereal eaters did reach statistical significance.

If we throw overboard all the things we (believe) we know about the fallacy of calorie counting, this would translate into a ~448kcal difference for one week and a whopping difference of 23,360kcal for a year, which should shed ~3.3kg of body fat a year.
Whether or not similar concrete weight loss vs. gain effects can be achieved with different types of fat is nothing study #2 in todays science mash-up here at the SuppVersity could answer. What it can tell you though, is that protein and obviously carbohydrates, where even Mr. Average Joe thinks in terms of "low GI" = good and "high GI" = bad carbs, these days, is by no means the only food component, where unspecifically counting macros is not going to cut it (or get you cut, if thats what you want to achieve).

This is not just about fish oil

"Of course, the bad omega-6s" ... I know that this is what youre thinking right now, but lets be honest, isnt that a bit narrow-minded?  It sure is and still, the results Ellaine Petterson and her Irish and American colleagues present in their most recent paper demonstrate quite clearly that the ingestion of fish and flax seed oil has pretty unique effects that go beyond its ability to increase the tissue concentrations of DHA to levels way beyond what youd see in low fat or high fat diets with palm, olive or safflower oil powered high fat diets.
In addition it lead to an increase in the relative abundance of bifidobacteria, a gut tenant that has been linked to all sorts of beneficial health effects, but has recently been outshadowed by various strains of lactobacilli (0.95% vs. more than 2% in all other groups), which - and this is an important information - were the lowest in the rodents who were kept on diets with 45% of the energy from fish and flaxseed oils.

Whether or not, the negative effects of fish oil on the lactobacillacea count in the guts of the lab animals is also partly responsible for the more or less disappointing effects the fish and flax seed diet had on the body composition (Figure 2) of the wild-type C57BL/6J male mice (21 d old) in the study at hand is questionable.

Figure 2: Body composition analysis at the end of the study (Patterson. 2014)

Its not impossible, though. A brief glance at the insulin levels and leptin levels in Figure 3 reveals that neither of them looks anyway close to what someone whos religiously taking his fish oil caps on a daily basis would be expecting. In the end, it is thus not really that surprising that only the palm oil diet group ended up with an inferior lean-to-fat mass ratio of 1.17 (vs. 1.33 in the omega-3 group).

Figure 3: Changes (%) in relevant metabolic markers in response to the different diets (Patterson. 2014)

The results of the study at hand, i.e. the effects on body composition (Figure 2), as well as blood glucose and lipid metabolism (Figure 3) are thus clearly not in line with the ubiquitously placated message that "fish oil is good for you" - a message, the indoctrinated average supplement junkie will still discern from the abstract of the study:

"[...] Ingestion of the HF-flaxseed/fish oil diet for 16 weeks led to significantly increased tissue concentrations of EPA, docosapentaenoic acid and DHA compared with ingestion of all the other diets (P< 0·05); furthermore, the diet significantly increased the intestinal population of Bifidobacterium at the genus level compared with the LF-high-maize starch diet (P< 0·05). These data indicate that both the quantity and quality of fat have an impact on host physiology with further downstream alterations to the intestinal microbiota population, with a HF diet supplemented with flaxseed/fish oil positively shaping the host microbial ecosystem." (Petterson. 2014).

Neither the "loss" of lactobacilli, nor the - if anything - negative effects of the high omega-3 diet on the lean-to-fat-mass ratio and the amount of insulin thats floating around in the rodents blood are mentioned in said abstract.

Fat = Diabetes - A FAT Mistake?

If you go take a look at the actual study data, we are thus left with the question, whether the purported benefits of having high amounts of omega-3 fatty acids in our cells (see red info box a couple of paragraphs above) are real enough (or really enough - whatever you prefer) to discard the fact that the study at hand would actually suggest that olive and not fish + flaxseed oil should be your go-to source of dietary fat on a high fat diet.

Moreover, if we abandon any paradigmatic believes, we would even have to concede that - within the current context, i.e. a rodent study and a diet with protein contents of only 19.2% (low fat) and 23% (high fat), the low fat mix of 1.25% of palm, 1.25% olive, 1.25% safflower oil, 0.625% fish and 0.625% flaxseed oil the rodents in the starch and sucrose groups received is superior to any of the high fat variants.

You may say that this is "rodent shit" (and it is, because this is what the scientists analyzed to access the SFCA metabolism of the mice) and a mere coincidence, but wouldnt you agree that this oil mix looks a little too much like the mixture youd get on a low-to-moderate fat diet with olive oil as a staple for everything, where you add oils, palm and safflower oil from processed foods on your cheat days and fish oil / omega-3s from your once or twice a week serving of salmon... ?
References: 

• Bayham, Brooke E., et al. "A Randomized Trial to Manipulate the Quality Instead of Quantity of Dietary Proteins to Influence the Markers of Satiety." Journal of Diabetes and its Complications (2014).
• Filaire, Edith, et al. "Effect of 6 Weeks of n-3 fatty-acid supplementation on oxidative stress in Judo athletes." International journal of sport nutrition 20.6 (2010): 496.
• Danthiir, Vanessa, et al. "Cognitive Performance in Older Adults Is Inversely Associated with Fish Consumption but Not Erythrocyte Membrane n–3 Fatty Acids." The Journal of nutrition (2014): jn-113.
• Patterson, E., et al. "Impact of dietary fatty acids on metabolic activity and host intestinal microbiota composition in C57BL/6J mice." The British journal of nutrition (2014): 1-13.

Believe it or not, but the question "low or high carb for breakfast" is non-sense, because there is no general answer. It depends on who is asking and what he is going to spend the rest of his day.

Before we can start reviewing the contemporary literature, we will have to define the term "breakfast" as the first meal in the day which is eaten in the AM. This definition differs from the "literal" one, Ive used in a previous article with the title "Circadian Rhythmicity - "Breakfast" or "Breaking the Fast"? Fasting as Zeitgeber & All About King, Prince & Pauper" (read it) and is thus in line with the mainstream idea of standing up, showering and... yes, you got it: having breakfast.

If you google "breakfast" and "obesity" youre served a colorful potpourri of "pro breakfast" articles which will inform you about "facts" like "Eating a big breakfast fights obesity and disease" (ScienceDaily), or "Breakfast Combats Obesity and Diabetes in Young People" (medscape).
Could all these "experts" be wrong? For the obedient average Joe this sounds crazy. Like one of those theories from your average Internet conspiracy theorist, but if you look at the actual evidence you have to admit:"A definitive conclusion can be made concerning the role of breakfast skipping in weight change." (McCrory. 2014)

The reasons for our cluelessness are manifold

There is for example a very good reason I anteceded this article with a definition of "breakfast". The latter is after all something you wont find in the average study, which could therefore consider eating a donut at 11am in as much as "breakfast", as it would discard having a protein shake immediately after you wake up as "not breakfast".

If we look at the actual "average Joe" (according to US National survey data), were getting into even more trouble. This guy was eating 2.76 meals in 1971–75, while he is now up to 2.96 in 1999–2002 (Kant. 2007).

In other words: Americans eat more frequently these days, but are still fatter

Obviously frequency alone doesnt tell us whether one of those "almost three" meals was actually the holy breakfast. I mean, if it wasnt its obvious the Americans became fatter and fatter - right (sarcasm)? The data we are interested in, is thus not the total number of meal (if you want to know more about that, take a look at "Many Small Meals Suck!" | go for it!). The data we are interested in is the data in Figure 1, the number of non-obedient US citizens who dont listen to the well-meant advice from the USDA and simply skip one of their holy meals.

Figure 1: Prevalence of skipping meals (breakfast, lunch, dinner) and snacking in the US, 2009–10 (McCory. 2014).

As McCorey highlights in a recent review (2014), their number rose. This seems to be a contradiction. I mean, if the number of meal skippers increases, shouldnt the number of meal (on average) decrease, when it in fact rose from 11% to 18%? Well, it should, if it was not for the snackers and grazers who either skip breakfast and snack all-day or are over-obediently grazin on 20+ small meals per day.

Figure 2: Prevalence of breakfast skipping among US men and women (USDA)

Whats interesting, is that we will find that the was a decrease in breakfast skippin from 2002 to 2009, of which I am pretty sure that it was (at least partly) mediated by headlines like the ones I quoted in the introduction to this article (USDA)

USDA shows a slight decrease in the prevalence of breakfast skippingin both men and women by about 4%. If not having breakfast was the root cause of the obesity epidemic, the average American should thus have lost a few pounds over the past decade - right?

Right! This should be the case if breakfast was the mythical "lean-maker" the "experts" want us to believe. The figures, i.e. the constantly increasing rate of obesity, dont disprove that (those who dont eat breakfast could simply gain even more weight), but they certainly put another "?" behind the statement that having breakfast has anti-obesogenic effects.

23% of males and 20% of females skip lunch!

Apropos "?", I am missing one, here! One behind the consequences of skipping lunch. With all the upheaval about skipping breakfast, people seem to have forgotten that lunch, not breakfast, was the most commonly skipped meal among most age groups in 2009–10. In most age groups, 23% of males and 20% of females are skipping this important (?) meal... and are - you bet - having an unhealthy snack later in the afternoon.
Anyway! This is the breakfast skipping research summary and no afford to dig up the two or three studies that dealt with skipping lunch explicitly. Lets thus, just for the time being, assume breakfast does in fact keep you lean. How on earth would eating some extra-food do that, when we all agree that the root cause of the obesity epidemic is after all the ravenousness of the average Westerner and the ways in which his / her diet multiplies these effects...oh, I guess the latter will lead us right to one of the answer to our question.

Proposed reasons for the anti-obesity effects of breakfast

I am not sure if I will be able to list all of them, but the following list of explanations that have been brought forward to explain the cross-sectionally observed negative association between body weight and breakfast eating is probably pretty comprehensive:

• skipping breakfast leads to lower satiety than if breakfast had been eaten, thus 
• overeating will ensue later in the day, which
• over time would result in weight gain

What? Yeah, in the end, this is all the "breakfastpromoters" have to tell you: Its an overcompensation for the energy missed at breakfast they blame the alleged fattening effects of not having breakfast on. As McCroy points out, in whats probably the most recent peer-reviewed analysis of the contemporary evidence, one could easily imagine another scenario

"in which breakfast skipping could result in no weight change over time, if breakfast skipping does not lead to overeating (i.e., if there is perfect compensation for the missed meal), or to weight loss if there is lack of compensation." (McCrory. 2014)

In his review McCory provides an enlightening overview of each of these possible scenarios, I dont want to keep from you. The“control” in this imaginary case study is a habitual breakfast eater with energy needs of 2000kcal/day, whose energy intake distribution across breakfast, lunch, snacks and dinner is 2000 kcal/day and therefore who is maintaining body weight.

Figure 3: Theoretical models illustrating different types of breakfast skippers vs. a habitual breakfast eater (McCrory. 2014).

There are potentially three types of habitual breakfast skippers: those with perfect compensation and maintain body weight, those who overcompensate and gain weight, and those who undercompensate and lose weight over time. In his consecutive review, in which McCrory considered only studies in adults (?18 years on average) and focusing primarily on experimental studies (short-term acute feeding trials or longer-term feeding trials) and longitudinal studies (prospective or retrospective, with the outcome of body weight change), the scientists from the Purdue University draws the following conclusions:

• Acute feeding studies on breakfast skipping effects on energy intake and appetite later in the day show equivocal results.
• Longer-term (2–3 weeks) randomized controlled trials do not show effects of breakfast skipping on weight change.
• In prospective studies with 3.7–10 years follow-up, individuals who consume breakfast more frequently gain less weight.

McCrory also points out that the lack of standardization is a major obstacle that makes it difficult, if not impossible to compare the results from different labs / different experimental setups.
References:

• Brown, Andrew W., Michelle M. Bohan Brown, and David B. Allison. "Belief beyond the evidence: using the proposed effect of breakfast on obesity to show 2 practices that distort scientific evidence." The American journal of clinical nutrition 98.5 (2013): 1298-1308.
• Kant, Ashima K., and Barry I. Graubard. "Secular trends in the association of socio-economic position with self-reported dietary attributes and biomarkers in the US population: National Health and Nutrition Examination Survey (NHANES) 1971–1975 to NHANES 1999–2002." Public health nutrition 10.02 (2007): 158-167.
• McCrory, Megan A. "Meal skipping and variables related to energy balance in adults: A brief review, with emphasis on the breakfast meal." Physiology & Behavior (2014).

It always hits the (already) big ones.

A recent study that was conducted by a group of researchers from the Roehampton University, and the Universities of Northampton and Hull in London took an interesting and totally overdue approach to dispel the myths that revolve around the anti-obesity effects of breakfast. In the said study, a team of researchers recruited 37 participants who were assigned to one out of four groups on the basis of their body mass index (BMI) - normal weight BMI <25 kg/m² | or overweight/obese BMI > 25 kg/m² | habitual breakfast eaters | habitual breakfast omitters.

Subsequently, even the latter, i.e. the breakfast eaters were requested  to  eat  breakfast  for  an  entire  week. The BREAKFAST week was followed by a one week wash-out and an entire  week during which the subjects had to omit breakfast.
Over the course of the whole study period, all subjects hat do keep detailed 7-day food diaries, reporting what was consumed and the timing of consumption were completed for each breakfast condition.

Figure 1: Lean (left) and overweight (right) subjects react very different to breakfast skipping (Reeves. 2014)

As the data in Figure 1 already reveals, the total energy intake was significantly higher during the breakfast than the no breakfast week. But just as the scientists say, the present study did also reveal a "significant effects of timing on energy intakes": More energy was consumed during the afternoon in the no breakfast week compared to the breakfast week.

Timing and body weight, both make a difference!

In general, overweight participants consumed greater amounts of  energy than normal weight  participants (surprise ;-) in the early evening - the effect was even more pronounced for those of them who were regular breakfast omitters and thus used to feasting in the afternoon / evening.

Overall, this sounds as if having breakfast regularly was a very good idea, but unlike some people want to make you believe, the total energy intake does count. The same is yet also true for the amount of sugar, which skyrocketed in the overweight subjects in the no breakfast week. Running around on empty and being unable to tap into their affluent energy depots on the hips and around the waist, the insulin resistant (dont tell me about "healthy obesity!") overweight part of the study participants gravitated towards readily available energy intake.
References:

• Reeves, Sue, et al. "Experimental manipulation of breakfast in normal and overweight/obese participants is associated with changes to nutrient and energy intake consumption patterns." Physiology & Behavior | Available online 24 May 2014.