January2011: Rediscovering Breakfast

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We all know to eat a good breakfast: Breakfast gives a good start to the day and honors the bodys natural bio-rhythms and bio-chemistry (see November and December 2010 newsletters). But, somehow life takes over and breakfast is generally the meal that a busy schedule crowds out. Most people eat lunch because lunch hour is programmed in by schools and the workplace. Dinner becomes the major meal because it can be enjoyed without the time pressures of immediate commitments. Evening is often the only time to savor food with family and friends. So, it is only natural to eat the majority of calories in the evening when we are not rushed. And, it is only natural to eat an extra helping at night when we tell ourselves that we will make up for it by skipping breakfast the next morning.

What is a good breakfast? It is anything that sustains you throughout the morning. The test of a good breakfast isHow do you feel at 10-11 oclock? If you do heavy outdoor physical labor, you may need relatively more carbohydrates (and fats in winter) than if you sit at a desk, where you may need slower-burning, sustaining whole grains, proteins and fats. In general, a good rule of thumb for any meal, including breakfast, is to aim for one-third of all calories to be spread evenly over the three macronutrientsproteins, carbohydrates, and (traditional) fats.

Eating Upside-Down
Planning to eat a good breakfast really begins the night before. We sow the seeds of a good breakfast when we eat early enough and lightly enough in the evening so that we wake up hungry. We also sow the seeds of a good breakfast when we retire 30-60 minutes earlier than we might otherwise so that we can use this time at daybreak for breakfast. Think of it as an investment in morning productivity. The fact that more than 80% of retired people eat breakfast suggests that many more of us would eat breakfast if we allocated the time to do so.

Eating a good breakfast also starts with planning in advance, perhaps the day or evening or weekend before, to have something delicious to wake up to. This could be any balanced protein/fat/carbohydrate combination that appeals to you piping hot whole-grain porridge with dried fruits and nuts and butter/cream/milk; lentil or split pea soup with hearty whole grains or accompanied with whole grain bread, organic peanut butter muffins, or banana-nut oatmeal treats; a chicken sandwich on sourdough bread; a can of wild sockeye salmon mixed with whole grains and leftover soup or vegetables; or, of course, eggs fixed in any way to suit your fancy. Egg custard, a favorite of many children, can be breakfast with a whole grain muffin. One of my own favorites is to have a bowl of steel cut oats with a couple of poached eggs mixed in. Eggs are nutritious and the combination of protein and fat provides real staying power. Baking muffins and preparing soups can be done on weekends; whole grain hot cereals can be cooked overnight in a rice cooker or even in a thermosthermos oatmealto be taken with you. If you are trying to cut back on coffee, think savory rather than sweet foods. A sweet muffin demands coffee far more than a bowl of lentil soup or a chicken sandwich. [See recipes that follow.]

Crowding out Breakfast
Skipping breakfast was rarely an issue a century ago when women worked at home caring for children and when homemaking was seen to have value. The tendency to skip meals traces the entry of women and mothers into the labor force. According to the most recent data from 2008, 60% of all women are in the labor force. Mothers with children under 18 have the highest participation rate of any broad group (71%), and of subgroups of working mothers, the highest rate by far (78%) is by mothers with children aged 6-17. [The next highest at 63% is by mothers with children under 6. The lowest rate, 53%, of any group is by women with no children under 18 in the household.]

Today, time-squeezed two-income households as well as the ready availability of boxed breakfast cereals, prepared breakfast snacks such as Pop-Tarts, and fast-food breakfast options help explain the movement of modern households away from the family breakfast table to a morning grab and go or just go lifestyle. Over 40% of Americans aged 18-54 regularly skip breakfast, and more than half of all adults view breakfast as a mere mini-meal, snack, or simply a beverage. Surveys also suggest that one-third of all teens and one-fifth of all children regularly skip breakfast, while half of all children report that they sometimes skip breakfast. Children are inclined to skip breakfast if their parents do. (Breakfast Research and Statistics).

Breakfast mattersfor adults. Skipping breakfast is associated with eating more fat-rich, high-energy calories throughout the rest of the day. A Harvard Study suggests that people who skip breakfast are four times more likely to become obese. Avoiding breakfast is associated not only with weight-gain, but also with higher cholesterol and elevated insulin (National Heart Lung and Blood Institute Growth and Health Study), and even cancer (Cancer Research UK).

Breakfast mattersfor children. Skipping breakfast is particularly hard on children, who cannot limp like adults through the morning on coffee. A Reading University study of 12-year-olds found that skipping breakfast caused reaction times to drop to the level of a typical 70-year old. On the positive side, a Harvard/Mass General study of school children in Baltimore and Philadelphia found that children who ate breakfast received better grades, were more focused, and showed improved psycho-social behaviors compared to children who rarely ate breakfast.

What do Americans typically eat for breakfast? For those adults who eat breakfast at home, coffee, boxed cereals (three-quarters of which are high in sugar), and fruit juice (75%- 80% sugar) head the list of products consumed most frequently (Breakfast Research and Statistics). For 6-12 year-olds who eat breakfast, three-quarters choose what they eat, with 90% regularly consuming ready-to-eat (RTE) cereals. According to a Yale University study, RTE cereal companies spend more than $160 million a year marketing breakfast cereals to children, who typically view 642 television cereal advertisements a year. The Yale study found that boxed breakfast cereals marketed to children have 85% more sugar, 65% less fiber, and 60 percent more sodium than those advertised to adults.

Clearly it is not enough just to eat breakfast, if by breakfast we mean stimulants and sugar in the form of coffee, cold cereal, and juice. Such a breakfast does not meet the 10-11 oclock test criteria of a good breakfast: Research indicates that a high-glycemic breakfast such as a bagel, cold cereal, or instant oatmeal creates a blood sugar spike, followed by a sharp drop in blood sugar, a kind of hyper-/hypoglycemic rollercoaster. The bodys hyper-insulin response to the surge in glucose from a high-glycemic breakfast leaves blood sugar actually lower two hours after breakfast than at the fasting/waking level prior to eating breakfast (Lioger, et al., 2009). In other words, eating a high-glycemic breakfast can leave you hungrier by mid-morning than when you woke up, thus creating the desire for a high-energy mid-morning snack. Lioger found that subjects consuming a standard high-glycemic breakfast cereal consumed 53% more calories over the rest of the day compared to subjects who ate a whole-grain breakfast. Put simply, high-glycemic breakfasts lead to snacking and the tendency to over-eat at the next meal.

Boxed Breakfast CerealCentury-Ago Good Intentions, a Modern Day Mixed Blessing
As often happens in life, innovative products developed for one problem can contribute to another. In 1863, Dr. James C. Jackson who managed the Sanitarium in Dansville, NY developed Grandula, the forerunner of our modern RTE cereal. A dense nodule of bran made edible only by overnight soaking, it was designed to relieve the gastrointestinal problems brought about by the low-fiber beef and pork breakfasts typically consumed by our ancestors more than a century ago.

In the years following the development of Grandula, the Kellogg brothers serving at the Battle Creek, Michigan Sanitarium worked on their own grain-based breakfast options. In 1896, they discovered a cereal flaking process and a cereal that Will Kellogg patented (1906) with its new name Corn Flakes. Soon thereafter came pasteurized milk and the development of waxed-paper box liners. With these, both Kellogg and competitor C.W. Post (Grape-nuts and Post Toasties) had the essentials to grow and expand the RTE breakfast cereal market into what we know todaya booming $10 billion business with a cereal for just about any taste and with expansive grocery store shelf space to dwarf most any other product category, with the occasional exception of cookies and soft drinks.

High-Glycemic Boxed CerealsBlame not just Sugar, but also the Botanical Degradation of Grains
The problem with many RTE breakfast cereals is that because they are readily digestible, they inherently contribute blood sugar issuesand, elevated blood sugar over time can lead to insulin resistance and diabetes. Because RTE cereals generally lack protein and traditional fats they may be questioned as the building block of a sustaining breakfast, especially for children. The Center of Disease Control estimates that one of every three Caucasian children and one of every two children who are Black, Hispanic, Native-American, or Asian-American born in the United States after the year 2000 will develop diabetes. Boxed cereal can put children at risk of mid-morning hunger and fatigue and set the stage for caffeinated soft drinks and overeating later in the day.

The glycemic index (GI) is one way to assess RTE cereals. It was developed by D.J. Jenkins in 1981 to measure (on a scale of 0 to 100+, with glucose=100) the rise of blood sugar after ingesting a specific food. The glycemic index of a low-sugar breakfast cereal can exceed many of the high-sugar varieties: What elevates blood sugar is not just the sugar content of a cereal but also how the grains are processed to make them more quickly digestible. Rolling, flaking, puffing, and cooking (as in gelatinized oatmeal flakes) makes the starch in grains readily accessible to digestive enzymes and thus quickly digestible. Starch converts to simple glucose molecules more rapidly than fructose/glucose sugar.

Many favorite low-sugar cereals have high glycemic indices, which means that eaten alone, they can elevate blood sugar to leave behind hunger,hypoglycemia, and fatigue. This is because any process that alters the botanical structure of whole grainsrolling, flaking, puffing, milling, and cooking (as in the gelatinization of oat flakes)renders carbohydrates more digestible. In so doing, the digestive system is called upon to do less work and expend relatively less energy in processing food, so glucose enters the blood stream with greater speed. This is why the blood sugar impact of a breakfast cereal cannot be gauged by its sugar content alone. Puffing oats for Cheerios or rice for Rice Krispies and Rice Chex; flaking corn for Corn Flakes; and shredding wheat for Shredded Wheat are all examples. Several ideas are illustrated in the table below: (1) low-sugar cereals, the first column, can have higher GIs than sugar-laden varieties listed, center; (2) aside from sugar, the degree of botanical degradation of a grain, in this case oats, (the first three cells of the right-most portion of the table), affects GI; and (3) simply puffing brown rice for rice cakes can increase the GI by 60% (last two table entries). The key idea is that just because a RTE cereal is low in sugar does not mean it will have a moderate effect on blood sugar.

Cheerios 74 1 Frosted Flakes 55 11 Steel-Cut Oats 42 0
Rice Krispies 82 3 Raisin Bran 66 20 Old-Fash. Oats 50 0
Corn Flakes 92 2 Fruit Loops 69 13 Instant Oatmeal 66 0
Shredded Wheat 84 0 Coco Pops 77 11 Rice Cakes 80 0
Rice Chex 89 2 Corn Pops 80 14 Brown Rice 50 0

Cooking also affects the GI of rolled grains such as rolled oats. Raw rolled oats (used in cookies) have a lower GI than when cooked. This is because, while starch granules are not water soluble, they easily absorb water and swell when heated. The structure is then altered in a process known as gelatinization. When gelatinized, as when raw rolled oats are transformed by water and heat into gelatinous oatmeal, the surface area of starch granules becomes greatly exposed to digestive enzymes. This increases the speed of digestion and absorption, resulting in an elevated glycemic response. Oatmeal is best topped with butter, a poached egg, cream, milk, nutsany protein/fat combination of your choosing that will contain the blood sugar effect so that you are not left hungry by mid-morning.

Pathways4Health Breakfast Recipes: Middle Ground between Pork Belly and RTE Cereal

Apple-Blueberry Bread Pudding
4 eggs, beaten
2 cups milk or nut/seed milk
cup honey or maple syrup
1 T. cinnamon
1 T. vanilla
3 cups whole-grain bread in cubes
1 cup dried blueberries
1 cup chopped apple; pear; or plum

1. In a large bowl, mix together the first 5 ingredients.
2. Place bread cubes in a greased, 8-9 round baking dish and sprinkle with dried fruit and nuts and the apple; pear; or plum.
3. Pour wet ingredients over all assembled ingredients and bake in a pre-heated 350 degree oven, 35-40 minutes.

Amaranth with Wild Blueberries and Almonds

Amaranth and almonds are both high in protein and blueberries are rich in anti-oxidants.
This simple recipe is one of my favorites. It can be made in large batches, cooked the evening before, and freezes well. Adding a whole grain like wheat berries helps to lower the glycemic index.
1 cup amaranth
3 cups water
1 cup dried wild blueberries or other dried fruit
1 cup chopped almonds, or other nuts/seeds

1. Place amaranth, water, and berries in a sauce pan. Bring to a boil, stir, cover, and let simmer about 25 minutes, stirring occasionally until liquid is absorbed.
2. For additional texture, add cooked brown rice, millet, buckwheat, or wheat berries when amaranth is fully cooked.

Granola (yield: ~10 cups)
cup barley malt
cup hot water
1 t. salt
2 t. vanilla extract
cup melted butter, ghee, or organic unrefined coconut oil
1 cup chopped walnuts, almonds, pecans or mixture
1/2-1 cup sunflower, pumpkin, or sesame seeds
6 cups old-fashioned rolled oats
1 T. ground cinnamon, if desired
1 cup dried blueberries, cranberries, raisins, or other dried fruit, if desired.

1.In a bowl, combine first 5 ingredients.
2. In a large bowl, combine remaining ingredients.
3. Add the liquid to the dry ingredients.
4. Spread deep on a large baking pan.
5. Bake in a pre-heated 350 degree over for about 8 minutes, turning over with a spatula several times until lightly golden brown. All to completely cool.

6. Add dried fruit.

7. Store in an airtight jars.>

Buckwheat Cranberry Almond Muffins (or Squares)
cup buckwheat flour
cup stone ground whole wheat flour
1 cup water
2 t. baking powder
2 eggs, well beaten
t. salt
4-6 T. honey or maple syrup
cup coconut oil or butter, melted
2 t. vanilla
1 cup dried low-sugar cranberries
-1 cup slivered almonds.

1. In a bowl, mix dry ingredients.
2. In a separate bowl, lightly beat eggs and add and mix remaining liquids.
3. Combine and mix wet and dry ingredients.
4. Gently fold in cranberries and almonds.
5. Pour batter into a 8 square well-oiled baking pan. Bake at 350 degrees 25-30 minutes. Batter can be baked as muffins, reducing the baking time to about 20 minutes.

Barley-Oatmeal Squares
This is a true family favorite. If you dont have time to make cookies, just put the batter in a greased brownie pan and bake about 20 minutes, depending on the size of the pan and the depth of the batter.
1 cup barley flour
1 cup old-fashioned oats
2 t. baking powder
1 t. cinnamon
Pinch of salt
cup buttermilk
2-3 T. honey
1-2 eggs
1 cup chocolate chips (optional)
cup dried cranberries or other dried fruits/nuts

1. Mix wet ingredients.
2. Fold in chocolate chips, dried fruits, nuts
3. Drop by tablespoons onto a well-greased cookie sheet.
4. Bake in pre-heated 350 degree oven, about 12 minutes.

Our Favorite Pumpkin Muffins
1 cup whole wheat pastry flour
cup brown sugar
1 t. baking powder
1 t. cinnamon
t. ginger
t. salt
cup golden raisins
1 cup pumpkin puree
2 eggs

1. Mix together dry ingredients and raisins.
2. In a large bowl, mix wet ingredients.
3. Add and combine dry into wet ingredients.
4. Fill well-oiled muffin tins 2/3rds full. Bake at 400 or 15-20 minutes. Batter can also be baked in a well-greased pan, for a slightly longer time.

Naturally Sweet Oatmeal-Banana Treats
4 cups old-fashioned rolled oats
6 cups ripe bananas, mashed
2-3 cups dried fruits, chocolate chips, nuts in whatever combination you wish
1 T. vanilla flavoring
Combine all ingredients and drop by spoonfuls on an un-greased cookie sheet. Bake @ 350, ~20 minutes.

Peanut Butter/Tahini Muffins (yield: 12 muffins)
2 cups stone ground whole wheat flour
1 T. baking powder
1 t. salt
1/3 cup organic peanut or sesame seed (tahini) butter
cup melted butter, coconut oil, or cold-pressed oil

1. Mix together first 3 ingredients
2. In a separate large bowl combine the remaining ingredients.
3. Add dry to wet ingredients and gently combine.
4. Fill well-oiled muffin pans 2/3rds full and bake in a pre-heated 350 degree oven 25 minutes or until a toothpick inserted and removed is dry. If baking in a pan, allow a bit more time.

Thermos Oatmeal
In a wide-mouth well-insulated thermos, pour boiling water and seal 5 minutes to warm. Pour out water. Add 1 cup boiling water, steel cut oats, and dried fruits if desired. Stir. Let sit overnight. Enjoy the next morning with milk, butter, nuts, maple syrup, etc.

Recipes: Thinking Out-of-the-Box

Hearty Lentil Soup (yield: 10 one-cup servings)

10 cups filtered water or stock
3 cups green lentils
1/4 cup red lentils or equivalent green lentils
2 cups chopped onion
3 bay leaves
1 cup diced carrot
1 cup diced celery
2 T. minced garlic
2-4 T. olive oil

1. In a large pot, add first 4 ingredients, bring to a boil, reduce heat, cover and simmer 1 hour.
2. Add next ingredients through garlic, stir well, cover and simmer 15 minutes.
3. Add olive oil, stir, adjust to taste.

Simple Split Pea Soup (yield: 10 one-cup servings)
2 cups split peas, washed and picked over
9 cups water or stock
1 piece large piece kombu (optional)
1-2 cups diced onions
1 cup diced carrots
1 cup diced organic celery
2 t. curry powder or t. ground fennel seeds, to taste
Salt or tamari to taste

1. Wash the peas and place in a large pot with the onions, carrots, celery and stock. Bring to a boil stir, and reduce heat. Cover loosely and let simmer40-60 minutes until peas and vegetables are soft.
2. Add curry powder, fennel seeds, or other seasonings of your choice including salt if using.
3. Soup is finished when peas have cooked to a velvety smoothness. Add tamari and serve.

Thick Split Pea and Brown Rice Soup (serves 6; cooking time 1 hour)
This is adapted from Martha Rose Shulman and the combination of split peas with brown rice provides a complete protein meal. The same result can be had by serving whole grains or whole grain bread with the two simple soup options above.
1 T. butter or ghee
1 onion, chopped
1 large carrot, sliced
4 cloves garlic, minced
1 T. curry powder
2 cups split peas, picked over and washed
1 cup brown rice, washed and soaked over night
8 cups stock or water
3 bay leaves
Salt and freshly ground pepper to taste

1. Heat the butter in a large soup pot or Dutch oven and saut the onion, carrot, and the garlic with the curry powder until the onion is tender.
2. Add the split peas, rice, stock, and bay leaves and bring to a boil.
3. Reduce the heat, cover, and simmer 1 hour or until the peas are tender.
4. Check and add more water from time to time if needed if soup becomes too thick.
5. Add salt and freshly ground pepper to taste and serve.

Reading Resources

Botanical Structure of Grains and Metabolic Response:
Bjorck, I., Granfeldt, Y, Liljeberg, H., Tovar, J. & Asp, N-G. (1994). Food properties affecting the digestion and absorption of carbohydrates. American Journal of Clinical Nutrition, 59 (supplement), 699S-705S.

Juntunen, K.S., Niskanen, L.D., Liukkonen, K.H., Poutanen, K.S., Holst, J.J., & Hykkanen, H.M., (2002). Postprandial glucose, insulin, and incretin responses to grain products in healthy subjects. American Journal of Clinical Nutrition, 75 (2), 254-262.

Snow, P. & ODea, K. (1981). Factors affecting the rate of hydrolysis of starch in food. American Journal of Clinical Nutrition, 34 (12), 2721-2727.
Wrangham, R. (2009). Catching fire: how cooking made us human (pp. 58-61; 71-80; 205-206). New York: Basic Books.

High-Glycemic Carbohydrates and Overeating:
Lioger, D., Fardet, A., Foassert, P, Davicco, M.J., Mardon, J., Gaillard-Martinie, B., et al. (2009). Influence of sourdough prefermentation, of steam cooking suppression and of decreased sucrose content during wheat flakes processing on the plasma glucose and insulin responses and satiety of healthy subjects. Journal American College of Nutrition, 28 (1), 30-36.

Ludwig, D.S, Majzoub, J.A., Al-Zahrani, A., Dallal, G.E,, Blanco, I, & Roberts, S.B. High-glycemic index foods, overeating, and obesity. Pediatrics, 102 (3), e26.

Raven, G. (1979). Effects of differences in amount and kind of dietary carbohydrate on plasma glucose and insulin responses in man. The American Journal of Clinical Nutrition, 32, 2568-2578.

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