Does Skipping Breakfast Cause Heart Attacks?

Certain nutrition basics appear to be timeless regardless of your diet: Eat breakfast. Eat fruits and vegetables. Don’t feast on sugary foods on a regular basis.

All of this was indisputable until intermittent fasting came into the picture, and the importance of breakfast was brought into question. Or more accurately, the timing of meals was analyzed in a new way. If you’re not familiar with this style of eating, intermittent fasting focuses on control over your appetite. It’s an approach that has several variations, such as offering an eating window during the day (think “Lean Gains 16/8” where you only eat for 8 hours a day), or days where you don’t eat at all. (A la Eat Stop Eat, with one weekly 24-hour fast.) Some methods even combine fasting modalities with certain types of training (As was prescribed in Engineering the Alpha.) Each approach is designed to take advantage of the growing evidence of the benefits of fasting, an area that is admittedly still young in terms of research.

Although intermittent fasting became synonymous with being an anti-breakfast diet, it’s an inaccurate generalization of a style of eating that attempts to remove rules (you must eat breakfast within 30 minutes of waking!) and replace it with a simplified approach that offers flexibility. For example, you can still wake up, eat breakfast at 9 and then stop your meals at 5. This would be considered intermittent fasting. Or you could have breakfast 5 days a week and fast one day per week. This is also intermittent fasting. [Eds. note: I practice a style of intermittent fasting—and wrote a best-selling book that shares an IF style diet—but I do not think it’s the only diet approach or the best for everyone. Every eating style should be dependent on an individual’s goals.]

Whether you practice intermittent fasting or not, it’s important to know that you don’t have to eat a meal at any particular time of the day. Just as it’s ridiculous to insinuate that having a meal after 6 pm will make you fat, it’s just as careless to make a blanket statement saying you must eating upon waking and enjoy a big breakfast.

Some people don’t do well when they are forced to eat first thing in the morning. Others prefer this style and find that it helps them prevent overeating. Both models work, with the main message being your eating schedule should fit into a sustainable lifestyle pattern. Saying “breakfast is the most important meal of the day” is a misnomer; every meal is the most important, and your food choices are much more important than the times you eat.

But I heard Skipping Breakfast is Bad For Your Heart…

Fasters and non-fasters should be able to get along just fine—if not for some dangerously misleading research that was recently published. Scientists from the Harvard School of Public Health (or maybe more accurately the PR department at the school) made the all-too-broad claim that skipping breakfast was tied to an increase in heart attacks and coronary heart disease.

Wait.

One.

Second.

Skipping breakfast does what?

After a close look at the study design and the results, that conclusion couldn’t be more inaccurate or misleading. If you only look at the study abstract, it appears that skipping breakfast leads to a 27% increase in heart issues. That’s what you’ll hear in the news and see published at all the main outlets. What a shame.

After a close analysis, here’s what the research really found:

• The study compared more than 23,000 breakfast eaters to a little more than 3,000 breakfast skippers.
• The incidence rate of heart attacks in breakfast eaters was 5.77% whereas the incidence rate for the skippers was just 5.05%. In other words, those who ate breakfast had a 14% higher incidence of cardiovascular problems during the duration of the study. Not quite what the press release suggests. But wait, there’s more.
• The study becomes even more interesting when you review the lifestyle behaviors of the subjects. As we all know, smoking isn’t good for your health and is tied to heart disease. So that would be an important variable to consider when drawing any correlational conclusions between a behavior (skipping breakfast) and a health condition (heart attacks). In research we call these confounding variables, and all too often they are completely ignored. This study was no exception. From the subjects used, breakfast skippers were three times more likely to smoke than breakfast eaters. (And no, this does not mean skipping breakfast leads you to smoking). Naturally, it would be fair to question: Is it skipping breakfast that’s causing the heart issues or the smoking? This study was not designed in a way that could answer that question, but it needs to be asked.
• The smoking relationship wasn’t the only red flag. The breakfast skippers also exercised less, consumed more alcohol, and sat on their ass and watched more TV per week. All of these factors could easily be tied to an increase in heart disease, but instead it was breakfast that received all the attention.
• If that wasn’t enough, the “fasters” were also more likely to be single. This is important because prior research shows that single men are likely to more stress and heart issues.

I could go on—such as discussing how the real variable in this study appears to be age—but that would be belaboring the point. When the study was adjusted for factors including high cholesterol and diabetes, blood pressure, and BMI, the link between skipping breakfast and the increased risk of heart attack was no longer statistically significant.

Or in layman’s terms, there was no connection between fasting and heart attacks.

To Breakfast or Not to Breakfast: The Choice is Yours

I’m a big fan of science, but I take much of it with a grain of salt. We need to use research to test informed ideas, not twist results to scare people and complicate health decisions and daily behaviors. It’s very easy to look at data and make association conclusions and find links between seemingly unrelated behaviors. But unless a study directly tests for that and can prove some sort of causation, it doesn’t benefit anyone to spread information (and panic) to the mass media that won’t provide any real service.

If a man who doesn’t eat breakfast starts eating tomorrow, there is no guarantee that he will lessen his chance of having a heart attack. In fact, if you take the hard numbers of this study, just 1 out of every 292 breakfast skippers have heart disease and 1 out of every 249 breakfast eaters have it. Do these numbers really mean anything?

As always, we must continue to keep an eye on what science tells us and learn so that we can become healthier, but we also must be critical enough to ask the questions that allow us to draw the line between a cool statistic and reality.

So eat breakfast. Or don’t eat breakfast. Choose the one that works for you based on whether you feel better, have more energy, want to gain muscle, lose fat, or know if one eating pattern will give you more control over your diet.  But don’t make that choice based out of fear that isn’t rooted in valid claims that will impact your health.