Breakfast and Coronary Heart Disease

One of this days I heard in the CBC radio about a new research that supposedly found evidences that skipping breakfast is linked with Coronary Heart Disease. Then I found the news here. I tracked down the actual paper and it was good to know it is available for free.

The first thing I thought when I heard it in the radio was that likely people who are busy at work, who work more, who are more dedicated, engaged at work, these are the ones who may skip the breakfast and their crazy routine may also cause CHD. The second thin I thought is something I have thought before many times and it is that in the history of human evolution we were hunter gatherers for most of the time. And it seems to me that a hunter gatherer would not have right times to eat. If they happened to kill something in the afternoon, they would eat at that time. If they did not hunt anything they would not eat anything. This is just my perception, though, but I believe it sort of make some sense. If so, our body would have evolved in a way that it would be used to irregular eating patterns, maybe with long fasting periods and times of food abundance.

So, in my head the research results were not making sense in two ways. I wanted to read the paper. It turned out that I liked the paper; I think they did a good job exploring confounders, but I am not sure they addressed my confounder, the crazy routine thing. They actually included two related information: Full-time employment and Stress at work. But I don't think these are the same thing as I mentioned above. I think among workers, not necessarily full-time, you may have those workers that are more engaged. They are not necessarily stressed because these are the folks who dedicate themselves to work, as if the work is their life, their past time. And I say that because I used to wake up and go straight running and then to work, with no breakfast, and that was because I could not stand the idea of getting there late. Then I would stay late too, always involved with the work. After changing my job I started having breakfast... Anyways, they did a good job looking at counfounders and mediators and it seems they did what they could, but one can only look at so many variables.

Upon reading the paper another thing started bothering me: skipping breakfast is, according to the paper, also associated with many other things that are not so good. Obesity, smoking, no physical activity, full-time job, hypertension, alcohol use. That seems to indicate that skipping breakfast is a sort of indicator of a not so good lifestyle in the sense that it is caused by/is part of this lifestyle and doesn't cause it. It seems to make more sense to think that both skipping breakfast and CHD are caused by this sort of lifestyle construct.

Finally, there was also some association between late night eating and CHD, which was not in the media and to me it enforces the fact that it is not a causal relationship. We have also to consider that the sample had only physicians, although a lot of them, and that it is important to replicate these associations before trusting them too much.

I think it is complicated to prove one way or another, though, and because of that more care should be taken when reporting these things. They emphasize too much the causal link and as I see this is questionable. When this sort of thing falls on the hands of the mass media, different people will interpret things different ways, and it can be transformed in some health myth. And talking about health myths, I've often and for a long time heard that eating at night leads to more weight gain because you go to sleep and don't burn what you ate. The paper also says this is a myth, I mean, that there are some researches favouring and other opposing such a claim. We need to be careful on what we believe. This is not to say I am criticizing the paper. My opinion, for what it is worth, is that this is a piece of information and other pieces will join this one in the future and the process should help us to understand the association or lack of association between eating habits and health conditions. But care should be put on reporting such findings in the non-scientific  environment, not to make things misleading.