October 23, 2007

More Bad Science: Cereal for Breakfast

Your friends in the grain business have been busy promoting the latest study that supposedly shows that eating "whole grain breakfast cereal" prevents heart failure.

Whole Grains Do a Heart Good

As reported in U.S. News and World Report: "Compared to those who ate no whole-grain cereal, men who consumed 2 to 6 servings per week saw their risk of heart failure fall by 21 percent, while those who ate 7 or more servings per week reaped a 29 percent reduction in risk, the researchers reported in the Oct. 22 issue of the Archives of Internal Medicine."

What's wrong with this study?

Well, for starters, we know nothing else about the weight, diets, ethnic heritage, and lifestyle of these people who ate whole grain cereal for breakfast, but it is very likely that they ate those breakfasts because they have been touted as "healthy" and that eating the cereal rather than causing the outcome was a marker for a lifestyle high in exercise, weight control, ethnic background, and other behaviors likely to impact health.

Using the same logic, you might be able to prove that people who owned a specific brand of running shoe had a lower "risk" of heart failure. Did owning the running shoe cause the health outcome? No. If you buy that running shoe and wear it while watching TV you won't improve your health.

The other big problem here, as usual is that you are comparing people eating one high carb breakfast with others eating an even higher carb breakfast. So yes, I'm willing to believe that eating granola for breakfast might be healthier than eating Sugar Frosted Flakes, but I'd really like to see what happens when you compare people eating the grain breakfasts with those eating NO carbs at breakfast.

Most importantly, the study did not separate out people with Diabetes from those with normal glucose tolerance. We know for a fact that anyone with Type 2 diabetes who eats a grain cereal for breakfast is likely to see their highest blood sugar of the day after breakfast, because of the natural increase in insulin resistance we all experience in the morning. And we also know that cumulative exposure to high blood sugar leads to bad health outcomes. In addition, people with diabetes are more likely to experience heart attacks--not being measured here--rather than heart failure, which usually develops in people who survive heart attacks.

This raises an important point: The condition being studied was "heart failure"--a condition in which people suffer weakened heart muscles--rather than heart attack, and that the measurement being used was "risk of" which is very different from "incidence of".

The Risk statistic is used to amplify very slight differences between the incidence of a condition in large groups of people, and is almost always used to make a very small effect look more significant. If you reduce the number of people in a group of 100,000 who get a heart attack from 10 to 8 you've made a huge difference in risk but a very small difference in incidence. But if you are trying to promote a drug or product, citing risk rather than incidence makes your product look like it makes a huge difference when it doesn't.

These studies seem to be more of the same kind of "let's prove what we believe to be true by ignoring rigorous analysis of the data" research that Gary Taubes highlights so brilliantly in his book, Good Calories, Bad Calories.

By the way, the nutritionists in the article recommend that you eat your high carb whole grain cereal with high carb low fat skim milk and fruit. More proof, if you needed it, that religious beliefs can not be challenged by logically supported argument. Sadly, no matter how densely documented the truth might be (and Taubes documents it to the point where it exhausts even ME, which makes me wonder exactly who his target reader must be!) the belief in the value of the high carb/low fat diet will not go away no matter how much more rigorous research shows it to be a flop.

Meanwhile, if you have diabetes and are tempted to breakfast on granola with skim milk and bananas, by all means do so. Just be sure to measure your blood sugar at 1 hour and 2 hours after eating. If you can get normal blood sugar values at those times (under 140 at 1 hour, under 120 at 2 at a bare minimum--under 100 at 2 hours is better) keep eating like that. If you can't, consider switching to a low carb breakfast of ground flax, protein powder pancakes, eggs, or meat.

15 comments:

Scott said...

More pseudo science. Its sad, as the FDA (as well as the USDA, not to mention the FTC) are supposed to regulate this but we can't count on these agencies to regulate much of anything these days!

In fact, the notion of "breakfast being the most important meal of the day" is a myth that may have been true for farmers who worked in the fields all day, but holds far less relevance in a modern, industrialized society such as our own. There's nothing wrong with skipping breakfast ... I generally prefer to skip it and my health and energy levels have not suffered as a result.

renegadediabetic said...

I used to eat plenty of "healty" whole grains and whole grain cereal with skim milk. It didn't curb my cravings. It didn't help me attain, much less maintain a normal body weight. AND, it didn't help me avoid diabetes.

Thanks for exposing the BS.

nonegiven said...

On the Larry King show he said he hoped people would read it and then give it to their doctors.

Barb said...

Do you have a recipe for the flaxseed pancakes? Barb

Jenny said...

Barb,

The flaxseed and the pancakes are two separate items.

I make a flaxseed hot cereal by mixing Bob's Red Mill Ground Flax Seed with protein powder and wheat bran.

The pancake recipe is here:

http://www.phlaunt.com/lowcarb/19060001.php

Paul Anderson said...

Jenny,

I have seen this before, and it does seem to be counter intuitive to everything we are taught.

All of the BMI stats I have seen for diabetics have one thing in common: those other the age of 60 have lower BMI's than those of a yoounger age. Its quite a noticeable feature. At first this came as a big surprise to me. Then I came to the conclusion that those who lived to a later age - 60+, were the ones that had a lower BMI.

Those with higher BMI's were, regrettably not around to be included in the stats. Either that, or they all discovered the secret to losing weight in their dotage.

To add a degree of balance, even for the older age group the average BMI's, from memory, are around the 26/27 level.

One anecdotal observation, at least here in the UK. You very rarely, if ever, see many elderly obese men. I am defining elderly as over 65. This could be because they simply don't get out and about much. I suspect its because they don't generally liver to agreat age.

But once again, isn't this yet another are where the prevailing orthodoxy quite simply ignores the basic data.

What does Taubes say on this. I heard an excerpt from a recent interview where he definitely implied that the leaner the better - that surpus body fat was a bad and unnatural thing.

Having lost about 2 stone mayself, and maintained it for about 18 months, I personally find my quality of life greatly improved, and my general health, touch wood, has been better. If nothing else, I feel a great deal more mobile.

Paul.

pericles said...

Well well well, I have eaten cereals all my life and used no fat milk no sugar and 65 g minus fiber ..also ate beans everyday,for 2 years the drs.commented wow your overweight but your trigl hdl ldl blood pressure are so good normal and better than befor...I exercise 1 hr every day mild walking BUT!!!my blood glucose kept on climbing slowly Silly me I thought I beat this.. Frightened by the high numbers after all the sessions classes blood tests I had improved in one are due to diet and exercise managing meats etc..But was going sideways in the liver test and glucose game.

I started taking my glucose 6 times a day the night time rise scared me ,the rise after portions of cereal and fiber were counted was high and Persistent.. I reasoned if a {LITTLE}rice compared to normal did the same then it must be some kind of sugars ??? I`m not smart so I started eating beans a pepper brocoli an egg for breakfast in a few days by managing my portions and eating every 4 + hrs I`m good to go ...sooo happy.
Still have the weight and liver enzymes but my cereal sweets potatoes and rice along without big portions IS the way for me now.The struggle is not over BUT hope is alive as I read the challenge here to the cereals as a culprit with the milk,I know for others it may not be so but I feel so good and they took me off my medication to let this follow thru and see if I can get my weight down .
Let us choose life ,like the coach said I eat to live not live to eat,so thanks for the affirmation by logic here: it seems so right, may we all inspire each other.

J said...

If you read the actual paper, the researchers saw impact of breakfast cereal after accounting for exercise, race, body weight, vitamin use, smoking, known hypertension and numerous other risk factors. Read before you comment!

Anonymous said...

Unfortunately, the original title "More Bad Science" applies to the original post as well. As "J" pointed out in that comment, the article did apparently did not read (or chose to ignore)the details of the original article showing that the variables she cited had been controlled for. But she also selectively picked from the literature she chose to cite. For example, in a huge study from Harvard's Brigham and Women's Hospital, they authors found a decreaing INCIDENCE of type 2 diabetes (DM) with increasing consumption of cereals, with the greatest effect related to utilization of whole-grain cereals.

Jenny said...

Eat cereal. Test your blood sugar. Eat eggs. Test your blood sugar. Use your head.

It's possible that eating cereal is better than drinking cokes with homefries and pancakes, and to that extent people who ate cereal might develop less diabetes than people who ate much worse. But it's a matter of comparing bad to worse.

People with diabetes who cut carbs out of their breakfast entirely see MUCH better results than those eating cereal.

AntaresChild said...

"I make a flax seed hot cereal by mixing Bob's Red Mill Ground Flax Seed with protein powder and wheat bran."

Hi Jenny,

Could you kindly tell me exactly how to prepare this hot cereal? Thank you very much!

Jenny said...

AntaresChild, I don't use a strict recipe, I just take a small cylindrical canister about halfway up with the flaxmeal, then I add in a about 3 scoops of whey protein powder, another few tablespoons of bran, and then I stir it up until it's mixed. I put a few scoops of the mixture (the ones from the Protein Poweder) into a bowl, pour in enough boiling water to turn it into hot cereal and eat it. Sometimes I put a little cream in it. Or nuts.

AntaresChild said...

Thanks very much Jenny! I'll give it a try!

glamorous said...

flax cereal with whey protein? that sounds absolutely disgusting. yuk. i understand regular cereal isn't a good choice, but instead of flax, I guess I could just go eat some dirt down by the side of the road, it'd probably taste better and wouldn't raise my blood sugar either.

Jenny said...

Glamorous,

Sounds like you've run into rancid flax. The Bob's Red Mill ground flax, if kept in the fridge tastes a bit nutty, but mostly like Wheatena. The whey protein blends in and you can't taste it. It just gives it some protein.