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    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

    Diagrams redrawn by Martin Brown

    Cover design by Keenan

    Terence Kealey asserts the moral right to be identified as the author of this work.

    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.

    All rights reserved under International and Pan-American Copyright Conventions. By payment of the required fees, you have been granted the non-exclusive, non-transferable right to access and read the text of this e-book on-screen. No part of this text may be reproduced, transmitted, down-loaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins.

    Source ISBN: 9780008172343

    Ebook Edition © December 2016 ISBN: 9780008172350

    Version: 2016-11-29

    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

    How I discovered that breakfast is dangerous

    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.

    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

    We all ‘know’ that breakfast is the most important meal of the day and that we should eat it like kings, lunch like princes and dine like paupers, but we know these things only because people have told us so. Who are these people?

    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 complemente

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