Copyright

4th Estate

An imprint of HarperCollinsPublishers

1 London Bridge Street

London SE1 9GF

www.4thEstate.co.uk

First published in Great Britain by 4th Estate in 2016

Copyright © Terence Kealey 2016

Diagrams redrawn by Martin Brown

Cover image © Keenan

The right of Terence Kealey to be identified as the author of this work has been asserted by him in accordance with the Copyright, Design and Patents Act 1988

This book contains advice and information relating to health care. It should be used to supplement rather than replace the advice of your doctor or another trained health professional. If you know or suspect you have a health problem, it is recommended that you seek your GP’s advice before embarking on any medical programme or treatment. This publisher and the author accept no liability for any medical outcomes that may occur as a result of applying the methods suggested in this book.

A catalogue record for this book is available from the British Library.

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Source ISBN: 9780008172367

Ebook Edition © December 2016 ISBN: 9780008172350

Version: 2017-04-27

Dedication

To my wife, Sally

Contents

Cover

Title Page

Copyright

Dedication

Prologue

Preface

PART ONE: My Story, Episode

1. My diagnosis

PART TWO: The Dubious Advocates of Breakfast

2. The glorification of breakfast

3. Breakfast in an age of commercial science

PART THREE: Breakfast Myths

4. Myth No. 1: Breakfast cereals are healthy

5. Myth No. 2: Breakfast is good for the brain

6. Myth No. 3: Breakfast is slimming

PART FOUR: The Breakfast Paradox

7. Yo-yo dieting

8. Chaotic lives

9. Five breakfast sagas

PART FIVE: Breakfast Wars

10. The Harvard and Cambridge challenges

11. The heroic breakfast guerrillas

PART SIX: Misleading Experiments

12. Blood glucose and breakfast: the unhealthy majority

13. Blood glucose and breakfast: the healthy minority

14. Why have the scientists claimed breakfast to be safe?

PART SEVEN: How Breakfast Kills Us

15. The fat saga

PART EIGHT: Insulin, the Great Traitor

16. The carbohydratisation of the English-speaking breakfast

17. Nothing about breakfast makes sense except in the light of insulin

18. Diabesity, the big new disease

19. Insulin-resistance, the modern plague

20. Definitions

21. The dawn phenomenon

22. The biochemists have been warning us for nearly a century that breakfast is dangerous

PART NINE: Skipping Breakfast: Personal Stories

23. My story, episode 2

PART TEN: How Insulin Kills Us

24. What a modern plague looks like: the metabolic syndrome

25. Can we reverse the metabolic syndrome?

26. The new fasting diets

27. Type 3 diabetes (and other consequences of the metabolic syndrome)

PART ELEVEN: If You Must Eat Breakfast, What Must You Eat?

28. So, what to eat?

29. And if you must eat breakfast?

Envoi

Afterword

Footnotes

References

Illustration Credits

Index

Acknowledgements

About the Author

About the Publisher

Prologue

I was contracted to submit the first draft of this manuscript to my publishers on 31 January 2016. The day before, on 30 January, The Times trailed on its front page an article by Angela Epstein, a health journalist, entitled ‘Eight great weight-loss myths’. Skipping breakfast was myth number four:

A recent study by Louisiana State University found that a 250-calorie serving of oatmeal [porridge] for breakfast resulted in reduced calorie intake at lunch.

Some people like to do the crossword, but my morning hobby is to find the catch in claims that breakfast is good for me, so where was this article’s catch? I had twenty-four hours in which to uncover it.

It wasn’t hard to locate the study, which had just been published in the Journal of the American College of Nutrition, where I discovered that it had actually come jointly from Louisiana State University and PepsiCo (which owns the Quaker Oats Company).¹ That is obviously a different provenance than from Louisiana State University alone.

The study showed, moreover, that, compared with a breakfast of Honey Nut Cheerios, a bowl of Quaker Instant Oatmeal slightly reduced the amount eaten subsequently at lunch; but the study did not compare subjects who ate a bowl of Quaker Instant Oatmeal with those who’d actually skipped breakfast, because no subjects were asked to skip it. Why not?

Well, it so happens that, contrary to what most people believe, eating breakfast significantly increases your total intake of calories: though eating breakfast may reduce your calorie intake at lunch, the calories you consume at breakfast will greatly exceed the ones they displace at lunch. So a fuller Times report of the study in the Journal of the American College of Nutrition might have read:

A recent study by Louisiana State University that was funded by – and performed jointly with – PepsiCo (which owns the Quaker Oats Company) found that a 250-calorie serving of oatmeal for breakfast resulted in a slightly reduced calorie intake at lunch compared with an equivalent serving of Honey Nut Cheerios. Eating any cereal, however, greatly increases the total daily calorie intake, and only if breakfast were actually skipped would the total calorie intake have fallen.

That little story summarises this book.

Preface

Every morning Providence provides us with a precious gift, the gift of fasting. Overnight we digest the food we’ve eaten the day before, and by morning our metabolism has transitioned from feeding to fasting mode.

Fasting is a wonderfully healthy state. When we fast, our insulin levels fall, as do our blood sugar, triglyceride and cholesterol levels. Most usefully, when we fast, we lose weight. But what do too many of us do on waking? We break that lovely gift of fasting – we literally breakfast – and we eat, so courting type 2 diabetes, obesity, heart disease, strokes, hypertension, dementia and cancers of the liver, breast, pancreas and uterus.

Breakfast damages us in at least four different ways. First, it increases (not decreases) the number of calories we consume. Second, it provokes hunger pangs later in the day. Third, it aggravates the metabolic syndrome, which is the mass killer of our day, which – fourth – is further aggravated by the fact that breakfast is generally a carbohydrate-laden meal.

Breakfast may be the most important meal of the day, but only if we skip it.

PART ONE

My Story, Episode 1

1

My diagnosis

On 24 May 2010 my wife drove me to our family doctor’s surgery and told me not to emerge without a diagnosis. Over the previous two or so months I had started to feel increasingly thirsty, and I had not only started to drink water all day but I had also started to pee all day. And all night. I was losing weight, my muscles were wasting away with a strange ‘crackling’ ache, and I felt tired all the time. I even woke in the morning feeling tired. Clearly, my wife said, I had developed diabetes, and she was irritated by my assurances that if we ignored the symptoms they might go away. So it was she who made the appointment to see our doctor, and it was she who drove us to the surgery to ensure I kept it.

I told my doctor what was happening and, echoing my wife, he said it sounded a bit like diabetes. I was forced to agree. So he performed a spot urine test, and there it was – glucose in my urine (‘sugar in the water,’ as he put it). I was diabetic. He then sent a blood sample to the lab, which shortly revealed a fasting blood glucose level of 19.3 mmol/l (normal range 3.9 to 5.5) and an HbA1c of 13.3 per cent (normal range 4 to 5.9; see later). I was very diabetic indeed. Type 2.

My story should thereafter have been routine. Thanks to a good wife and a good doctor a correct diagnosis had been made, and I was surely on the road to recovery. But I was then told to eat breakfast.

The authorities: Diabetes UK is the major diabetic charity in Britain. It was founded in 1934 as the Diabetic Association by H.G. Wells, the author, and by Dr R.D. Lawrence, a prominent physician, both of whom were diabetic. In 2013 its membership exceeded 300,000 people and its income was £38.8 million.¹ It is universally respected, both for its research and for its support for patients. Here is some dietary advice from its Eating Well With Type 2 Diabetes:

Eat three meals a day [in bold in the publication]. Avoid skipping meals and space out your breakfast, lunch and evening meal over the day. This will not only help control your appetite but will also help control your blood glucose levels.²

And in case we don’t get the message, Diabetes UK and the NHS have combined to reiterate, in red in the joint publication:

Don’t skip breakfast.³

The American Diabetes Association (ADA) is another impressive body. It has a membership of 441,000 and an annual turnover of $222 million,⁴ and it recommends an even more generous frequency of eating, suggesting that diabetics eat: ‘breakfast, lunch, dinner, and two snacks’.⁵

The diabetic charities certainly believe in frequent meals, and equally they believe in breakfast. So when, on diagnosing my diabetes, my doctor recommended I eat three meals a day including breakfast – as well as frequent snacks – he was only following the internationally agreed guidelines.

My glucometer: I might never have discovered how bizarre was that advice and those guidelines if our family doctor hadn’t also given me a personal glucose meter or glucometer. This is a hand-held device, not much larger than a mobile phone, that allows people to monitor their fingerprick blood glucose levels several times a day. Because it provides the patient with direct access to the mysteries of their own disease, the glucometer is the diabetic equivalent of the ninety-five theses Martin Luther reportedly hammered into the church door in Wittenberg: it allows the patient to bypass the doctor, the NHS and the diabetes charities as directly as Luther once bypassed the pope, so patients can test the official advice against their own blood glucose levels.

On using my glucometer I soon made an unexpected discovery. I found that my blood glucose levels were dismayingly high first thing in the morning, but – even worse – they would rise much further, indeed hazardously, if I ate breakfast. I didn’t feel ill with those elevated levels (glucose in high concentrations is a silent killer), but over time they would be killing me.

Yet if I skipped breakfast, my blood glucose levels would fall to normal over the morning. After lunch and dinner, of course, they would rise again, but noticeably less than after breakfast. Since high blood glucose levels are unsafe, I had discovered that, as a type 2 diabetic, breakfast was the most dangerous meal of my day. On reviewing the research journals, moreover, I found I hadn’t been the first person to make that discovery. One of the pioneers was Professor Jens Christiansen from the department of medicine at the University of Aarhus in Denmark.

Professor Christiansen’s experiment: Figure 1.1 shows the typical twenty-four-hour blood glucose profile of a group of healthy young people who eat three meals a day.⁶

As you can see, blood glucose levels between meals normally run at around 4–5 mmol/l. Within an hour of eating, however, those levels rise to well over 6. Yet within six hours of eating, those levels fall back to around 4–5.fn1

To see what happens in type 2 diabetes, Professor Christiansen and his colleagues monitored the blood glucose levels of thirteen adult patients. On some days he asked his thirteen patients to skip breakfast, whereas on others he asked them to eat it. To ensure that all other conditions were unchanged, he asked his patients on breakfast-free days to compensate by eating more for lunch and dinner, so their daily energy intake was the same. Figure 1.2A shows his patients’ blood glucose levels on the days they ate breakfast.⁷

FIGURE 1.1
Glucose levels in healthy people who eat three typical meals a day.

21 healthy subjects eating typical meals were studied and their results averaged. The arrows indicate that breakfast was served at 7.30, lunch at 12.15 and dinner at 18.00. The results are from interstitial fluid, which is similar to blood plasma and serum. (Less energy was ingested at breakfast than at the other two meals.)

As you can see, these diabetics start their days in a hazardous state: their overnight fasting blood glucose levels are not much short of 7.0 mmol/l. But look what happens after breakfast. When patients are fed a full breakfast of about 600 calories (between a quarter and a third of a day’s intake of energy) their blood glucose levels spike at around 10.5. These come down within four hours, but that spike will have done the patients no good because spikes in blood glucose levels will double a person’s chances of dying from heart attacks and strokes.⁸

Moreover, Professor Christiansen also showed that, over the rest of the day, the breakfast eaters’ blood glucose levels remain volatile; and such volatility not only adds a further risk of the two cardiovascular diseases of heart attacks and strokes, it also increases the risk of developing a gamut of diabetic complications including blindness, renal failure and the need for limb amputations.⁹

FIGURE 1.2A
Plasma glucose levels in type 2 diabetics who eat breakfast.

13 patients were studied on four occasions, and their results averaged. The arrows indicate that breakfast was served at 8.00, lunch at 12.00, a snack at 15.00, dinner at 18.00 and supper at 20.00.

Now look at Figure 1.2B. On the days the diabetics ate no breakfast, they enjoyed mornings of beautifully falling blood glucose levels. On those days they ate bigger lunches and dinners, so their post-lunch and post-dinner rises were higher than on the days they did eat breakfast, but those rises were gentler and therefore safer than the post-breakfast spikes they had thus avoided. (These subjects also ate two snacks a day, but that doesn’t change this analysis.)

FIGURE 1.2B
Plasma glucose levels in type 2 diabetics who do not eat breakfast.

13 patients were studied on four occasions, and their results averaged. Lunch was served at 12.00, a snack at 15.00, dinner at 18.00 and supper at 20.00.

Professor Christiansen’s data and my own experience with my glucometer are, therefore, comparable, and Professor Christiansen has confirmed my unexpected finding that, for type 2 diabetics at least, breakfast is a dangerous meal. As readers of Professor Christiansen’s paper will discover, he was equally surprised by the finding, and like me he concluded that type 2 diabetics should skip breakfast.

So, why was I told to eat breakfast?

Box 1: Glucometers and type 2 diabetes

Normally doctors won’t give glucometers to patients with type 2 diabetes (only type 1s get them). Here is the recommendation from NICE (the National Institute for Health and Care Excellence) which is the quango that advises doctors on how to treat their patients: ‘Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes.’¹⁰

NICE gives this advice because of research that suggests that self-monitoring does not benefit type 2 diabetics,¹¹ but I don’t trust that research. Consider slimming and self-weighing. It makes sense that people who weigh themselves regularly would eat less and would lose more weight than people who do not weigh themselves, and although some researchers disagree,¹² most researchers find exactly that.¹³ Equally, people who use fitness trackers to monitor their own exercise would be expected to walk more every day, which is what researchers find.¹⁴ Correspondingly, I would expect diabetics who monitor their own blood glucose levels also to improve their control.

As would Diabetes UK, and though it may be unsound on breakfast, it is a superb patients’ advocate, and it is shocked that type 2s are not routinely given glucometers. Diabetes UK admits that patients who self-monitor will ‘commonly’ fail to act on the results of their glucometer readings (thus rendering the blood tests futile), but that failure, it explains, arises only because of patients’ ‘lack of education in how to interpret them’. That lack of education, moreover, has not been helped by ‘a lack of interest in the results from health care professionals’. Consequently, Diabetes UK says, the self-monitoring of blood glucose levels has failed only because ‘the professionals expect the patients to self-manage’ while the ‘patients expect the health care professionals to use the results.’¹⁵

But I am not only a researcher who has specialised in the biochemistry of glucose and fats, I am also a medical doctor, so I needed no education in interpreting blood glucose levels, and I was grateful for the glucometer my doctor proffered, which allowed me to take control of my diabetes and which also allowed me to discover that the conventional advice was simply wrong. Yet even for non-biochemists and non-doctors the necessary level of education is actually modest, and it should be extended to all patients with type 2 diabetes, so that they too can optimise their diets. It was thanks to his pioneering use of the personal glucometer that the great Dr Bernstein streaked decades ahead of the curve in advocating low-carbohydrate diets for type 1 diabetics,¹⁶ and now we need a Dr Bernstein for type 2s.

Glucometers and their strips can be bought at any pharmacy – no prescriptions are necessary – so if you have type 2, and if you do not have a glucometer, let me urge you to buy your own; and in the meanwhile, for want of anything better, let this book be your education. (The real cost of blood glucose measurements comes, incidentally, not from the purchase of the glucometer but from the test strips. I use roughly sixty strips a month, which costs me about £25 a month, which is cheap at the price.)

PART TWO

The Dubious Advocates of Breakfast

2

The glorification of breakfast

Early one morning, some 3,000 years ago, a Greek army idled while two of its generals argued. As Homer recounts in Book 19 of The Iliad, Achilles wanted to attack Troy at dawn, but Odysseus urged him not to send his men ‘to fight the Trojans fasting, for the battle will be long and furious, so first get your men to eat bread and wine by the ships’.¹

Odysseus won the argument, and breakfast was duly served to the troops. Achilles refused his portion but, fortunately, the goddess Athena ‘dropped nectar and ambrosia into Achilles, so hunger wouldn’t weaken him’. Greek soldiers believed in breakfast, as apparently did everybody in Homeric Greece, and Book 16 of The Odyssey opens with ‘Back at the hut, Odysseus and the noble swineherd had lit a dawn fire and were making breakfast.’²

By the classical era in Greece, around 500 bc (bce), breakfast seems to have consisted of barley bread or pancakes, sometimes dipped in wine, sometimes complemented by figs or olives. The Romans ate a similar breakfast, around dawn, of bread, cheese, olives, salad, nuts, raisins and perhaps cold meat. The Roman army, though, fed its soldiers a hot breakfast of porridge, similar to polenta, made from roasted spelt wheat or barley that was then pounded and cooked in boiling water.

In their patterns of eating the Greeks and Romans were apparently not unusual, and Heather Anderson opened her 2013 book Breakfast: A History with: ‘Throughout history, most people partook of a simple breakfast … ample written record supports the notion that ancient Romans had a three-meals-a-day (plus afternoon snack) routine similar to that of today’s United States and Europe.’³

But that routine was not imperishable, and it appears that for a thousand years after the fall of the Roman Empire breakfast was skipped in polite Europe. Thus Charlemagne (748–814) was described as being typical in not eating breakfast,⁴ while 700 years later a King of France, Francis I (1494–1547), was still saying that people should ‘rise at five, dine at nine, sup at five, and couch at nine’,⁵ and a generation after that the priest William Harrison was reporting in his 1577 Description of England that ‘the nobility, gentry and students do ordinarily go to dinner at 11 and to supper at 5,’⁶ which was reiterated as late as 1602 by Dr Edmund Hollings, the Renaissance dietician.⁷ So, what happened to breakfast after the fall of the Roman Empire?

The Church was one of the things that happened. The clerics disapproved of breakfast as self-indulgent, and, inspired by biblical passages such as Ecclesiastes 10:16, ‘Woe to thee, O land, when … thy princes eat in the morning,’ a writer such as Thomas Aquinas could write in his Summa Theologica (1265–74) that breakfast represented praepropere or the sin of eating too soon, which was a form of gluttony. Breakfast in medieval Europe was largely, therefore, restricted to children, the elderly, the sick – and to working men: it appears that labourers, needing to fuel their labours, would eat in the morning.

Which was the other thing that happened to breakfast after the fall of the Roman Empire, namely the hierarchy of the feudal system. If working men needed to eat breakfast, then grandees were keen not only to skip it but also to be seen to skip it. Medieval aristocrats, therefore, apparently ate breakfast only when they had to exert themselves, perhaps if travelling or going on pilgrimage, whereupon their spiritual advisers discovered that John 21:12 (‘Jesus said to them, “Come and have breakfast,”’ English Standard Version) did actually license the practice. So in 1255 Henry III of England ordered 6 tuns of wine (2,112 gallons) for his court’s breakfasts while on pilgrimage.⁸

Only with the displacement of feudalism by markets was breakfast revived as a regular meal for the socially respectable, and in his popular article ‘How the Tudors Invented Breakfast’ Dr Ian Mortimer argued that as the market economy spread, and as people thus worked longer and harder, so those people increasingly demanded three meals a day including breakfast.⁹ By 1589, therefore, Thomas Cogan, the Manchester physician and schoolmaster, could write in his Haven of Health that it was unhealthy to skip breakfast because to ‘suffer hunger long filleth the stomack with ill humors’.¹⁰

Breakfast in England: Margaret Lane, the author of Jane Austen and Food, has chronicled how, for the rich, breakfast then evolved: ‘Breakfast in Jane Austen’s era [she lived between 1775 and 1817] was very different from the cold meat, coarse bread and ale of earlier ages, or the abundance of eggs, kidneys, bacon and so forth under which Victorian sideboards groaned. Rather it was an elegant light meal of toast and rolls, with tea, coffee or chocolate to drink.’¹¹

But Austen’s era was still socially divided, and to reinforce their superiority the grander classes ate their breakfasts late: ‘The planned excursion from Barton Park to Whitwell in Sense and Sensibility begins with the whole party assembling at Barton Park for breakfast at ten … Jane frequently wrote letters before breakfast. In London she even went shopping.’¹² Dissolute members of the aristocracy might breakfast even later. Roger Carbury in Anthony Trollope’s 1875 novel The Way We Live Now, ‘would come at twelve as Felix generally breakfasted at that hour’.¹³

The late breakfasts, though, pressed up against dinner, which was then eaten in the middle of the day and which was then – as it had been for a thousand years – the biggest meal of the day, so that meal gradually got pushed back. Eventually, as the prosperous classes increasingly enjoyed an evening social life facilitated by candle and other artificial lights, their dinner moved so late as to become an evening meal, largely displacing supper, which was reduced to a bedtime snack. But the lateness of dinner then created a midday gap, which had to be filled by a new meal, which was sometimes called ‘nuncheon’ after ‘noonshine’ (in Sense and Sensibility Willoughby takes nuncheon in an inn) but which became corrupted to ‘luncheon’ (in Pride and Prejudice Lydia and Kitty order luncheon in an inn).

Recapitulating its origins in a snack, this new meal was initially only a cold spread, but as Anthony Trollope captured in The Way We Live Now, it grew: ‘There were two dinner parties every day, one at two o’clock called lunch, and the other at eight.’¹⁴ The confusions around the new meal were reflected in 1847 by a fashionable physician, Dr William Robertson, in his Treatise on Diet and Regimen: ‘that anomalous meal, luncheon, becomes necessary or desirable if the dinner cannot be taken about five hours after the breakfast. If a man … cannot dine before five in the evening, he should eat luncheon.’¹⁵

The working classes, though, continued to eat their dinner in the middle of the day, and some parts of the north of England and Scotland still describe the midday meal as dinner and the evening meal as tea or high tea. To this day many schools describe the ladies who serve lunch as ‘dinner ladies’.

Breakfast in America: Heather Anderson reports that, initially, the Americans and Britons shared a common breakfast culture:

By the middle of the 18th century, England and America alike were basking in the glow of breakfast’s budding golden age; matitudinal feasts of mutton chops, bacon, eggs, corn cakes, and muffins – even pies – were favourites of American Founding fathers Benjamin Franklin and Thomas Jefferson … Franklin’s only complaint was that his co-workers drank too much beer in the morning … In well-to-do English households, most days began with porridge, followed by bacon and eggs … Soon the Victorian era witnessed the birth of Britain’s greatest (perhaps only) culinary achievement: the Full Breakfast.fn1

But as American meals and waistlines expanded, so a reaction developed, and during the 1830s the Popular Health Movement arose to advocate a frugal, near-vegetarian diet. In 1863, to help meet the demand for a more modest lifestyle, Dr James Caleb Jackson (1811–95), a New York physician, invented Granula, which consisted of nuggets of bran-rich Graham flour (a type of wholemeal flour). The first wholegrain breakfast cereal had arrived.

In the same year, 1863, and emerging in part from the same Popular Health Movement, the Seventh-day Adventist Church was established at Battle Creek, Michigan. The Adventists’ theology lies outside the purlieus of this book but its health message is relevant because it promotes a vegetarian, alcohol- and caffeine-free lifestyle. In 1866 the Church opened a sanatorium, also at Battle Creek, where its vegetarian teachings were harnessed to cure as well as to prevent disease. Its therapies were holistic, employing nutrition, enemas and exercise; and it was at the sanatorium, in 1894, that its most famous superintendent, Dr John Kellogg (1854–1943), invented cornflakes. Dr Jackson’s Granula had not been very convenient (it needed to be soaked overnight) but cornflakes were very convenient indeed, and with his brother, Will, John Kellogg created the cereal company we know today.

Some of the beliefs of those Popular Health Movement pioneers are now easy to mock. In his 1877 Plain Facts for Old and Young John Kellogg advocated some robust measures against masturbation:

To prevent erection the prepuce or foreskin is drawn forward over the glans, and the needle to which the wire is attached is passed through from one side to another. After drawing the wire through, the ends are twisted together and cut off close. It is now impossible for an erection to occur … In females the author has found the application of pure carbolic acid [phenol] to the clitoris an excellent means of allaying the abnormal excitement.¹⁶

And in his 1893 Ladies’ Guide in Health and Disease John Kellogg indeed recommended clitorectomy for nymphomania. An early example of FGM in the western world. Yet John’s views on masturbation were not an isolated idiosyncrasy, because they seemingly linked to his views on breakfast: he apparently trusted that the low levels of cornflake nutrition would inhibit early morning masturbation. Meat, he believed, fuelled lust: ‘Flesh, condiments, eggs, tea, chocolate and all stimulants have a powerful influence directly on the reproductive organs. They increase the local supply of blood; and through nervous sympathy with the brain, the passions are aroused.’¹⁷ But cornflakes would leave a person energetically deprived.¹⁸

Although he never explicitly marketed cornflakes as an energy-depleting anti-masturbatory tool, John Kellogg nonetheless conceived breakfast cereals – which are now sold as nutritionally valuable – to be nutritionally poor. The history of breakfast is littered with these ironies because, until recently, opinions emerged out of beliefs, not out of empirical evidence.

John was an intellectual who took ideas seriously. His views on masturbation were then orthodox, as were his views on eugenics (he was in favour) and constipation (he was against), but his brother, Will, was not an intellectual and – to promote their palatability – he put sugar into cornflakes, which John opposed. John lost that fight but it was sincerely fought.

One of their contemporaries, Dr Dewey of Meadville, Pennsylvania, went even further, and in his 1900 book The No-Breakfast Plan and the Fasting Cure he advocated skipping breakfast altogether: Dewey wrote that patients who skipped breakfast seemed to make better and faster cures from illnesses than did breakfast eaters.

The revival of breakfast: By the 1920s Dr Dewey seemed to be winning the argument: breakfast in America was apparently declining into little more than a snack. This was a concern to the Beech-Nut Packing Company, which was raising lots of pigs but which was finding too few buyers for its bacon, and it therefore commissioned Edward Bernays to rescue its market.

Bernays, one of the fathers of PR, was the nephew of Sigmund Freud, whose techniques he exploited on behalf of powerful clients, which included American Tobacco (for whom he helped break the taboo against women smoking in public) and the United Fruit Company (for whom he helped engineer the coup that removed the democratically elected president of Guatemala, Jacobo Arbenz Guzman). Bernays, famously, influenced Goebbels, which is no surprise since in his 1928 book Propaganda he’d written:

The conscious and intelligent manipulation of the organised habits and opinions of the masses is an important element in democratic society. Those who manipulate this unseen mechanism of society constitute an invisible government which is the true ruling power of our country … We are governed, our minds are molded, our tastes formed, our ideas suggested, largely by men we have never heard of.¹⁹

One opinion of the masses that Bernays resolved to manipulate was their commitment to a ‘very light breakfast of coffee, with maybe a roll and orange juice’, which he sought to replace ‘with a heavy breakfast’; and in a film (still available as a video on the web)²⁰ Bernays explained how he mobilised 4,500 doctors to publicly support Beech-Nut’s faith in heavy breakfasts.fn2 In the words of Dr Kaori O’Connor, a social anthropologist at University College London and the author of the 2013 book The English Breakfast: The Biography of an English Meal: ‘the idea that [breakfast] is healthy in its own right was laid on a plate for us by marketing companies. And, by and large, we’ve gobbled it up.’²¹

The breakfast mantras: It was in 1847, in the fourth edition of his Treatise on Diet and Regimen, that Dr William Robertson, who practised medicine in Buxton, Derbyshire, UK, wrote that ‘Breakfast should always be an important, if not the most important, meal of the day.’²² As I have already noted, Dr Robertson was a prominent physician, so it behoves us to ask: what research led him to coin that momentous phrase? Which careful observations, which controlled experiments, underpinned that weighty idiom? Well, this is what he wrote: ‘Breakfast is very properly made to consist of a considerable proportion of liquids, to supply the loss of the fluids of the body during the hours of sleep.’

Eh? It is true we lose water through our lungs and sweat glands as we sleep, but why was Dr Robertson so fixated on that? Well, Dr Robertson was a water physician: he practised in Buxton, which was a spa town whose waters were believed to cure myriad diseases, so of course Dr Robertson believed that water lay at the heart of health and illness. But that belief – which is barely more advanced than Hippocrates’ belief in the four humours – is an absurdity. Yet Dr Robertson was no one-trick pony, and he also believed that ‘the nervous system is restored by sleep to its fullest power and activity,’ and that we should therefore eat early ‘before the nervous system has become expended by its mental and physical labours’, which is a further absurdity.

The other great breakfast mantra is, of course, Adelle Davis’s injunction to ‘Eat breakfast like a king, lunch like a prince, and dinner like a pauper.’²³ Adelle Davis (1904–74) was the most popular nutritionist in America of her day, and though she was a controversial figure who was regularly accused of misusing science to promote dietary fads, she sold over 10 million copies of books with titles such as Let’s Eat Right to Keep Fit (1954). As to her famous mantra, let us ask: what was the thinking behind it? Did it emerge from the systematic scientific study of a problem that is still urgent today, or did it emerge out of a health scare that has since been discredited?

Post-war, America went through a strange panic over low blood sugar levels, and a charity called the Hypoglycemia Foundation claimed that ‘There is probably no illness today which causes so much widespread suffering, so much inefficiency and loss of time, so many accidents, so many family breakups and so many suicides as hypoglycemia.’²⁴

The media followed suit, and a magazine such as Family Circle could in June 1965 assert that ‘millions among us … suffer unknowingly from low blood sugar’ while Town and Country could state in June 1971 that ‘ten million Americans have hypoglycaemia.’ Respected professionals fed the national anxiety, and a psychiatrist wrote that

‘about half of the people I see for psychiatric problems have abnormal blood sugar … the incidence in schizophrenia is high and in neuroses even higher.’²⁵

Adelle Davis herself asserted that ‘irritability resulting from low blood sugar can be a factor in divorces.’²⁶

It is rare for a bizarre new idea to emerge without someone, somewhere, profiting from it, and it appears that the hypoglycaemia scare coincided with the discovery that adrenal extracts – which were expensive and therefore profitable to administer – could ‘cure’ hypoglycaemia; but the respectable authorities rallied against the charlatans, and in 1973 the American Medical Association, the American Diabetes Association and the Endocrine Society published a joint statement saying that few Americans suffer from low blood sugar levels, which in any case were not dangerous:

Statement on Hypoglycemia

Recent publicity in the popular press has led the public to believe that the occurrence of hypoglycemia is high in this country and that many of the symptoms that affect the American population are not recognised as being caused by this condition. These claims are not supported by the medical evidence.²⁷

Adelle Davis, therefore, coined her great aphorism to address a non-problem: she knew that the blood sugar levels of breakfast skippers fell gently during the mornings,²⁸ and since raised blood sugar levels are one of the great killers of our time, so the same data that inspired Davis’s mantra should now inspire its revision: Eat breakfast like a pauper.

We see, therefore, that the two popular breakfast mantras were coined to address the non-problems of night-time dehydration, night-time starvation, brain fatigue and rampant hypoglycaemia, yet those mantras remain so potent that many people today believe they have a metabolic duty to eat breakfast. In a world where millions of people overeat, their pushing themselves to eat a meal they might otherwise skip is not a trivial matter.

The Mediterranean breakfast: Judging by the longevities of the people who eat it, the Mediterranean diet is healthier than that of northern Europe or North America, and in his 2003 book Food in Early Modern Europe Ken Alabala, professor of history at the University of the Pacific, California, notes that in southern Europe breakfast never really developed: ‘In countries where the evening meal was larger, breakfast did not become important. In southern Europe it is still not a proper meal, but merely coffee and perhaps a piece of bread or pastry. In England and the north [of Europe] the pattern was quite different.’²⁹

As a group of senior Italian nutritionists wrote in 2009: ‘Every morning, most [Italian] adults just drink a cup of coffee or a cappuccino.’³⁰

Yet as the World Health Organization, the United Nations and the CIA have all confirmed, the Italians live longer than either the British or the Americans.³¹ That doesn’t, of course, prove that breakfast is bad for you, but it does weaken the suggestion that good health is impossible without it.

Overview: When, in Tudor times, the European aristocracy ceased to skip breakfast, certain wise contemporaries expressed alarm. In 1542 the celebrated physician Andrew Boorde wrote in his Dietary of Health that ‘A labourer may eat three times a day but two meals a day are adequate for a rest man.’³²

Why? Because, Boorde said, ‘repletion shortens a man’s life.’³³ Equally, in his Naturall and Artificial Directions for Health of 1602,³⁴ the scholar William Vaughan advised us to:

‘eat three meals a day until you come to the age of 40 years,’³⁵

which was echoed by Sir John Harington (1560–1612):

‘feed only twice a day when you are at man’s age.’³⁶

As we’ll discover, breakfast is dangerous because it is eaten when the body is most insulin-resistant, and, as we’ll also discover, the people who are most at risk of insulin-resistance are those who are over 45 years old and physically inactive. We might do worse than recapitulate the sixteenth-century wisdom of Dr Boorde and others.

Our best guide to breakfast may be Franz Kafka, who in his 1915 book Metamorphosis described how ‘for Gregor’s father, breakfast was the most important meal of the day.’³⁷ This description is often invoked by pro-breakfast scientists,³⁸ but their confidence is misplaced because the full quote is: ‘The washing up from breakfast lay on the table; there was so much of it because, for Gregor’s father, breakfast was the most important meal of the day, and he would stretch it out for several hours as he sat reading a number of different newspapers.’ Kafka is actually telling us that Gregor’s father is a jerk, who won’t work to support his family but who will nonetheless lash out at Gregor, the family breadwinner.

And with that image of breakfast as the meal of moral degenerates, I shall end this review of its history.

3

Breakfast in an age of commercial science

An article published in 1917 in Good Health, the self-proclaimed ‘oldest health magazine in the world’, reiterated that ‘breakfast is the most important meal of the day,’¹ and Good Health was edited by Dr John Kellogg. So here’s the worry. Type the popular mantras into Google today, and you discover that many of the studies asserting them are supported and funded by the manufacturers of breakfast cereals.

As a simple experiment, on 24 October 2015 I typed ‘breakfast’ into Google Scholar and downloaded the first ten papers that were medical or biological and which were fully accessible online. Of those ten papers, would you like to guess how many were funded, at least in part, by Kellogg, General Mills, Nestlé or some other food company? The answer is given in the footnote.fn1

Breakfast is big business: global breakfast cereal sales are expected to reach $43.2 billion annually by 2019, up from $32.5 billion in 2012, and the North American market alone was worth $13.9 billion in 2012. But that North American market is now mature, which is why manufacturers now target the emerging world.² Of course they do: the breakfast cereal business is a great business; the raw product (grain or rice) is cheap but the final product on the supermarket shelves is not so cheap.

The fast food breakfast market is also big and growing. Dominated by McDonald’s, it was worth $31.7 billion in 2012 in North America, and between 2007 and 2012 its sales increased by 4.8 per cent annually.³ Fast food = meat = protein, and that message is now so strong that Kellogg’s has entered that market, to sell Kellogg’s Special K Flatbread Breakfast Sandwich Sausage, Egg and Cheese.⁴ These sandwiches, which are designed to be microwaved at home, look to English eyes like hamburgers. They are so small as to each deliver only 240 calories, but each sandwich also delivers 820 mg sodium (over 2 g of actual salt) which is a third of the daily recommended intake, and as most people would eat two Flatbread Sandwiches for breakfast, they will not only have consumed a gratuitous meal, they will also have consumed two-thirds of their daily allowance for salt before leaving the house in the morning.⁵ Still, the packet boasts a pretty photograph of two slices of orange placed alongside the Kellogg’s Special K Flatbread Breakfast Sandwich Sausage, Egg and Cheese.

Research funded by companies tends to produce results that are favourable to those companies: there will rarely be actual dishonesty on the part of the scientists, but nonetheless a bias can creep into the published findings. Consider the pharmaceutical industry. There is a class of drugs known as ‘calcium-channel antagonists’ that are prescribed for heart disease, and over the years at least seventy clinical studies on these drugs have been published by university professors and practising doctors. Some of those studies were funded by the manufacturers, while others were funded by independent sources including charities, government research agencies and hospitals, and in 1998 a group of investigators from the University of Toronto found: ‘A strong association between scientists’ opinions about safety and their financial relationships with the manufacturers. Supportive scientists were much more likely than critical scientists to have financial associations with the manufacturers.’⁶

University professors and practising doctors, therefore, publish findings that support their sources of research money. Repeated surveys of scientists’ publications have confirmed this finding, which is why journals now require the authors of papers to list their sources of research income and consultancies. Yet such listings can still leave the reader adrift: does an industrial association negate a researcher’s work, or can they be trusted anyway?

The food and drinks companies will also manipulate publication. David Ludwig is a hero in the battle against obesity. He is a professor of paediatrics at Harvard and an author of the 2007 book Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World. He is also an author of a study that found that research papers that have been funded, at least in part, by the drinks manufacturers are four to eight times more likely to report good news about commercial drinks than those that were funded independently. No research paper, moreover, that was funded wholly by the drinks manufacturers reported any bad news.fn2 Since so many papers on drinks are funded by the manufacturers, Ludwig concluded that the whole field of study has been biased.⁷

So we have to be careful: breakfast studies have been infused by industrially funded science, and we may be at the same stage in their development as cigarette studies were before 1950, when Richard Doll and Bradford Hill discovered the link between smoking and lung cancer. Before 1950, and even for a time afterwards, that field was dominated by academic papers, sponsored by the tobacco companies, that proclaimed the health benefits of cigarettes and which then supported the subsequent advertising (‘More doctors smoke Camels than any other cigarette’, ‘L&M Filters are just what the doctor ordered’, ‘Reach for a Lucky instead of a sweet’).

Industrial money gets into surprising places. Even the great charities accept commercial funding: so Diabetes UK charges companies between £10,000 and £25,000 p.a. for using the Diabetes UK logo and name, while in 2013 at least twelve companies gave the American Diabetes Association more than $500,000. The charities do invaluable work, so they need support, and though it is perhaps a shame they solicit money from industry, they are nonetheless sensible of the risks and they implement scrupulous ethical policies. Which can be very effective. In 2013, for example, Dr Heather Leidy and her colleagues from the University of Missouri published a paper with a convoluted title: ‘Beneficial effects of a higher-protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese, “breakfast skipping,” late-adolescent girls’.⁸

And though Dr Leidy acknowledged that her study was supported by the beef and egg producer associations, she also wrote that they ‘were not involved in the design, implementation, analysis or interpretation of data’, and I believe her because Dr Leidy had actually shown that a high-protein breakfast is … bad for you! Although such a breakfast may lower your appetite later in the day, that does not compensate for the extra calories of the breakfast itself, and in Dr Leidy’s own words the net effect of eating a high-protein breakfast is that the daily intake of energy: ‘was greater ( ~ 120 kcal [calories]) compared with when breakfast was skipped’.

That effect did not reach statistical significance but the trend was sinister. For all their efforts, the beef and egg producers had funded research that showed that the healthiest breakfast option of all is to skip it! But we got there only because Dr Leidy is transparently an honest person.

The state, too, promotes breakfast. Agricultural producer groups in the USA go by unusual names such as the ‘Beef Checkoff’ or the ‘Egg Checkoff’ because they are not funded by membership subscriptions but, rather, by units sold. So every head of cattle, for example, that is sold or imported in America is ‘checked off’ for a $1 tariff.⁹ This is the corporate state by which the producers have harnessed legislation to tax consumers to fund, among other activities, the producers’ marketing.

The British state is as corporate. On 24 October 2015 I typed ‘Breakfast is the most important meal of the day’ into Google, and the first item came from a friendly-looking body called Shake Up Your Wake Up. SUYWU is very keen on breakfast, opening its page with ‘Apart from providing us with energy, breakfast foods are good sources of important nutrients such as … [words in bold in the original].’ But Shake Up Your Wake Up comes from the Agriculture and Horticulture Development Board, which is a statutory levy board (annual budget £56 million) that promotes the interests of farmers.

To conclude, Big Business has big interests in breakfast, Big Business has the resources to fund big research, Big Business has a friend in big government, and Big Business need not descend to publishing falsities: it need only publish selectively to provide a false impression of the health value of breakfast.

In a letter to his friend John Reynolds, John Keats wrote on 3 February 1818 that ‘We hate poetry that has palpable design upon us’, but the problem with industrial science is that it can have impalpable designs on us. Caveat emptor.

Industrially funded research: an alternative view

I’ve presented a bleak view of industrially funded research, yet industry may sometimes be the only source of money for the investigation of unconventional truths. As Nina Teicholz chronicled in her 2014 book The Big Fat Surprise,¹⁰ by the 1960s the governmental and charitable funding agencies were so convinced that dietary fat was the cause of atherosclerosis that a heroic dissenter like John Yudkin, the author of the anti-sugar pro-fat 1972 book Pure, White and Deadly, was cornered into asking industry to support his heterodox research because no one else would.¹¹ The ruthless leader of the dietary fat consensus, Ancel Keys, could then use that industrial support to smear ‘Yudkin and his commercial backers’.¹²

In his 1776 Wealth of Nations Adam Smith argued that markets tend to be more open to new ideas than are universities or government agencies, which was echoed by Friedrich Hayek in his 1944 Road to Serfdom, where he showed how new entrants fructify markets with innovative ideas. My own 2008 book Sex, Science and Profits re-emphasised the innovative value of commercial science in challenging received wisdoms.¹³

In his recent book Pharmaphobia, moreover, Thomas Stossel, a Harvard University professor of medicine, argues that only if university medical scientists work closely with industry – a closeness that will inevitably be rewarded with consultancy fees – will medical innovation be optimised.¹⁴

Ultimately it is for the readers of a scientific paper to determine for themselves if they believe it has been biased by its funding source, and such matters of judgement cannot easily be codified.

PART THREE

Breakfast Myths

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