Potential Risks to Skipping Breakfast

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By Carly Smith, BS, MPH(c) 

Potential Risks to Skipping Breakfast

Many people know the saying, “Breakfast is the most important meal of the day” yet fasting until noon (one type of intermittent fasting) has become popular and mainstream. While it may be beneficial for some, Stanford Lifestyle Medicine physicians and researchers caution new fasters and want to highlight some important considerations for those thinking about skipping breakfast.

“Limiting the time frame that calories are consumed has become a popular dietary strategy to improve health and aid in weight management. Fasting until noon is one of these popular strategies,” says Jonathan Bonnet, MD, MPH Stanford Lifestyle Medicine Physician. “For some, this may work well, however, the preponderance of evidence suggests that weight loss is modest and no more beneficial than overall caloric restriction.”

Side Effects of Skipping Breakfast

Delaying the first meal of the day until noon falls into the category of time-restricted eating. Although this eating pattern may help someone reduce their overall caloric intake, it may also lead to disruptive changes to their circadian rhythm, which could negatively affect sleep, as well as insulin sensitivity and glucose uptake.

In a recent review, researchers discussed the potential impacts of skipping morning-time breakfast. The review reported associations between skipping breakfast and an increased risk of developing obesity or type 2 diabetes. These studies primarily focused on the short-term effects of introducing the morning fasting behavior into one’s routine, however, the long-term effects of habitually fasting until noon are still being studied.

Feeding the Circadian Rhythm

Eating breakfast early in the morning is one signal that influences the genetic pathways underlying the circadian oscillations in the gut, which are critical for predicting daily energy levels and jump-starting metabolism. Thus, skipping breakfast could weaken the signaling of these clock genes and could be one reason why some people that fast until noon experience higher hunger levels throughout the day.

 “Skipping breakfast impacts numerous circadian signals within the body that may be suboptimal,” says Dr. Bonnet. “If someone wanted to try a time-restricted approach, they may experience more benefits from having an earlier eating window (to include a more substantial breakfast) with limited late-night food consumption.”

While research is still trying to understand how impactful these circadian changes are long-term, it is possible that irregular or inadequate fueling of the body may negatively affect one’s body weight, glucose metabolism, and overall health. Thus, it may be more beneficial for one’s health to prioritize consistently eating meals at the same time every day.

“From a circadian perspective, regularity is key,” says Jamie Zeitzer, PhD, Stanford University Professor and member of the Stanford Lifestyle Medicine Sleep team. “The circadian system anticipates signals, like food intake, at certain times of the day and synchronizes gut activity in response.”

Not All Fasting is Bad

Fasting until noon is just one type of eating pattern and not all types of fasting have negative health effects. There are other forms of intermittent fasting that are currently being studied in longevity science due to their ability to build resilience to stress and diseases. For individuals facing obesity and related chronic diseases, time-restricted eating approaches (that maintain the morning fasting window), have not been shown to be significantly more beneficial for weight loss than those following overall caloric restriction methods.

“For those with weight-related cardiometabolic conditions like Type 2 Diabetes, most forms of weight loss can improve their condition,” says Dr. Bonnet. “Finding a way to create a sustainable caloric deficit to lose weight is a challenge, so if some variant of intermittent fasting works for them, it may be the key to start improving their overall health.”

Anyone considering any form of intermittent fasting or time-restricted eating should consult with their physician to make sure that it is the healthiest decision for them both physically and mentally.

 

The Impact of the Western Diet on Diverticulitis

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By Maya Shetty, BS

Recognizing the vital connection between colorectal health and diet has never been more important, given the escalating prevalence of colorectal diseases in Western societies. According to Cindy Kin, MD, MS, a colorectal surgeon at Stanford, many of these conditions are preventable and are linked to the dietary patterns we develop early in life.

“Many people in the US have a chronically low fiber diet high in inflammatory foods beginning in childhood that leads to microbiome dysbiosis, as well as actual structural changes to the gastrointestinal tract,” says Dr. Kin. “Over time, this leads to numerous colorectal diseases, some of which are irreversible and require surgery.” 

One specific condition that has seen a significant increase in prevalence in the last 50 years is diverticulosis, characterized by the formation of irreversible outpouchings in the colon. This condition affects approximately one in three individuals aged 50-59 and virtually everyone over the age of 90 in the US.

Diverticulosis itself does not cause symptoms, and most patients only find out about them when they have a colonoscopy. However, anyone with these diverticular outpouchings is at risk of developing diverticulitis, a painful disease triggered by perforations in one or more diverticula. Diverticulitis may range in severity from mild to severe and life-threatening, depending on the size of the perforation. A tiny pinhole perforation that seals itself quickly might cause a little pain and inflammation that can be treated with oral antibiotics. On the other end of the spectrum, a larger perforation that leaks air and stool into the surrounding abdominal cavity can make someone so sick that they would need to have emergency surgery.  

“Three to five million people get some sort of treatment for diverticulitis per year in the US,” says Dr. Kin, “A proportion of those people need surgery, making diverticulitis one of the most common reasons for colon surgery.”

The Growing Prevalence of Diverticulitis in the US

Diverticulosis became a known problem in the US in the early 1900s, coinciding with major technological advancements, such as fertilizers, preservatives, and factory farming. These advancements caused significant changes in the American diet. Regular consumption of high-fiber, farm-fresh whole foods was replaced by processed foods lacking in essential nutrients. Diets also became increasingly saturated with meats, fats, and sugars, replacing fruits, vegetables, and whole grains. As our diets followed this trend and became more “Westernized,” cases of diverticulitis significantly increased. 

This US-specific increase in diverticulitis is in stark contrast to the nearly negligible incidence found in regions of the world where diets are rich in fiber. In Asian countries, where the diet is becoming more influenced by Western culture, we observe a rising incidence of diverticulitis in the last 30 years. “Diverticulitis is almost entirely a disease of our Westernized diet, low in fiber and high in ultra-processed foods and saturated fat,” says Dr. Kin.

What to Eat (and Not to Eat) to Reduce the Risk of Diverticulitis

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Fiber

Dietary fiber, found in various forms in vegetables, legumes, and whole grains play a critical role in maintaining soft, easily eliminable stool. Conversely, diets lacking in fiber often lead to hard smaller-caliber stools and constipation, prompting the colon to work extra hard to move it through. Years of  sustained high pressure within the colon is thought to be the root cause of diverticulosis, the presence of outpouchings in the wall of the colon. These outpouchings, or diverticula, form as the colon is squeezing so hard that it pushes out a portion of its own wall. The diverticula are weaker than the rest of the colon wall, and are more prone to bleeding and perforations. Research has consistently demonstrated that diets rich in fiber are strongly associated with a reduced risk of developing diverticular disease.

For many years, the widespread recommendation for those with diverticular disease was to avoid nuts, seeds, and popcorn due to the perceived risk of these foods getting trapped in the diverticular outpouchings. However, research suggests this is not the case and eating these foods may actually reduce one’s risk of developing diverticular disease due to their fiber content. “In all my years operating on diverticulitis, I have never seen a popcorn kernel or a sunflower seed poking out of a diverticulum causing a perforation, yet patients continue to steer clear of these fiber-rich foods due to this persistent diet myth,” says Dr. Kin.

Dr. Kin’s recommended daily fiber intake for women is 30-35 grams and 35-40 grams for men. While there are numerous fiber supplements available to help reach this daily goal, Dr. Kin recommends getting your fiber from dietary sources because foods that naturally contain fiber offer a multitude of advantages that extend beyond digestive health, such as lowering cholesterol and weight management to lower the risk of heart disease, stroke, diabetes, and other chronic diseases.

“If your body is not used to a high-fiber diet, gradually add fiber into your daily meals to allow your body to adjust over a couple weeks,” cautions Dr. Kin. “For most people, the gassiness that can happen with eating more fiber will get better pretty quickly, so don’t give up! A little gas upfront for a lifetime of colon health is a small price to pay.”

Processed Foods

Processed foods often lack the essential dietary fiber that whole unprocessed foods naturally provide. Additionally, the overconsumption of refined sugars and saturated fats in processed foods has been associated with several adverse health effects, including changes in gut microbiota composition and an increased risk of inflammation within the gastrointestinal tract. These factors can further exacerbate the risk of diverticular disease development.

Red Meats

Diets high in red meat are linked to diverticulitis, with a large-scale study finding the risk increasing by 18 percent for every additional serving of processed red meat. Red meat is associated with inflammation within several internal organs, and excessive consumption over time has numerous health consequences, including deteriorating colorectal health.

To prevent diverticulitis and several other colorectal diseases, Dr. Kin highly recommends “adopting a whole food, plant-based diet for its exceptional combination of high fiber content and nutrient-dense antioxidant  properties.”

 

How female runners can improve speed and safety | 90 Seconds w/ Lisa Kim – Stanford Medicine

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The idea that a leaner body makes for a faster stride is common among distance runners. But it’s inaccurate and sets a dangerous ideal. Runners who are excessively lean are prone to injuries, infectious diseases, mental health problems and loss in bone density, said Michael Fredericson, MD, a professor of orthopaedic surgery who has served for decades as the Stanford University track team head physician. Female runners are more likely to suffer these effects, he noted.

During his career as the head team physician, Fredericson has seen so many athletes with problems related to low body weight — including bone stress injuries, menstrual irregularity and osteoporosis, or loss of bone density — he decided to study ways to prevent it.

How long does it take to run a marathon? – TODAY

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Michael Fredericson, a practicing physician and director of the Physical Medicine and Rehabilitation division of Stanford University, tells TODAY.com that long-distance running is unique from other forms of cardio as it strengthens muscle fibers, “which makes your muscles increasingly fatigue-resistant,” he says. He adds that research also shows that first-time marathoners “experience beneficial reductions in blood pressure and aortic stiffness equivalent to approximately a four-year decrease in vascular age.”

Personalized digital behaviour interventions increase short-term physical activity: a randomized control crossover trial substudy of the MyHeart Counts Cardiovascular Health Study

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Menstrual Cycle Tracking in Sports Research: Challenges, Progress, and Future Directions

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Light at night and mental health, cause or consequence?

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American College of Lifestyle Medicine Expert Consensus Statement: Lifestyle Medicine for Optimal Outcomes in Primary Care

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Changing Mindsets About Side Effects of the COVID-19 Vaccination: A Randomized Controlled Trial

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In a Pickle? Unveiling Gut-Friendly Pickles for Your Health

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By Maya Shetty, BS

By now, most people have heard about the extensive health benefits fermented foods provide. Fermented foods have become increasingly popular as research continues to reveal that their high concentration of probiotics can improve gut health, boost immunity, and enhance digestion.

“Pickles are fun, tangy, potentially health-promoting ways of eating cucumbers,” according to Dr. Marily Oppezzo, PhD, MS, Head of the Lifestyle Medicine Nutrition Pillar.

However, Dr. Oppezzo cautions that even though the beloved snack of pickles are thought to be fermented, not all of them are, hence, they don’t all have the health benefits. 

Determining whether a particular pickle brand is fermented or not can pose a challenge. In this blog, we will delve into the various pickle varieties, offer guidance on spotting fermented options at grocery stores, and highlight recommended brands to seek out.

How to Choose a Healthy Pickle?

Dr. Oppezzo says that all pickles are a healthy snack, whether they are found on the shelf of the grocery store or in the refrigerated section. However, if you’re looking for a pickle to support gut health, you’ll have to select from the pickles in the refrigerated aisle.

“The pickles that are beneficial for your gut health are the fermented ones, made by brining them in salt rather than vinegar,” says Dr. Oppezzo. “While vinegar pickling is a common method, true fermentation in brine enriches them with beneficial probiotics for your gut. How can you spot these live bacteria-packed pickles? Check out the refrigerated section of your grocery store, as they won’t be found on the regular shelf.”

As Dr. Oppezzo mentioned, pickles essentially fall into just two primary categories: pickled pickles and fermented pickles.

  • Pickled pickles (aka vinegar pickled) are produced using, as you might have already guessed, vinegar. The vinegar kills all bacteria, including the bacteria beneficial to one’s gut. This process effectively sterilizes the pickles and allows them to shelf-stable. Therefore, these pickles are found unrefrigerated in the grocery store.
  • Fermented pickles are produced using brine and go through a natural fermentation process involving bacteria that is inherent within cucumbers. These pickles contain beneficial bacteria for the gut known as probiotics, as long as they have not undergone pasteurization. The pasteurization process, which involves heat, effectively eradicates probiotics from pickles.

So, what you want to look for are unpasteurized fermented pickles, which can be found in the refrigerated section of grocery stores, often in the cheese section. It is always good to double-check the label as well. If vinegar or pasteurized is indicated on the label, chances are probiotics are absent. Instead, look for these terms on the label: “fermented,” “unpasteurized,” , “live cultures”, and/or “probiotic”. Another sign that pickles are naturally fermented are the presence of bubbles on the surface of the brining liquid – a by-product of live bacteria at work.

Dr. Oppezzo also recommends prospective buyers to “spend some time reading labels and look for ‘added sugar’ on the label to be sure you aren’t accidentally getting sugar through your pickles.”

Why are Fermented Pickles Healthier?

Probiotics Support the Microbiome

Fermented foods have a variety of health benefits due to their high concentration of probiotics, 

or beneficial microorganisms aka the “good” bacteria. The microbiome within one’s gut helps to digest food, absorb nutrients, synthesize vitamins, and regulate one’s immune system. Research consistently demonstrates that healthy, stable microbiomes that are high in diversity and beneficial microbes  are shown to reduce chronic inflammation, weight gain, and disease.

Nutritional Benefits

Fermented pickles offer a range of nutritional benefits due to the diverse array of compounds they contain. These include antioxidants like flavonoids and phenols, which fight inflammation and protect cells from oxidative stress. The pickling process may also enhance the bioavailability of these antioxidants. Additionally, pickles contain a high concentration of vitamins and minerals, specifically vitamin K, vitamin C, vitamin A, calcium, and potassium. 

Immune Benefits

Vegetables that undergo the fermentation process typically produce natural substances such as alkyl catechols. Alkyl catechols activate a defense pathway that shields against various chronic diseases linked to oxidative stress. These substances may also boost the activity of cell defense pathways that protect our body from cancer and neurodegeneration.

Be Careful of the Sodium!

Despite all these potential health benefits, pickles are not the perfect snack.

“One major downside of pickles is their high salt content,” Dr. Oppezzo cautions. “A single pickle can contain over two-thirds of the recommended daily sodium intake for an average adult. Excessive sodium can be detrimental to overall health, thus it is important to eat pickles in moderation. If you are going to have them and are watching your salt, eat after you’ve sweat a lot due to exercise or a sauna.”