A Breakfast Worth Skipping

9780761154938One of the new diet books on the scene is The Big Breakfast Diet by Daniela Jakubowicz, MD,  an endocrinologist in Venezuela.

The book is based on a study Dr. Jakubowicz and colleagues presented a few years ago at the Endocrine Society’s 90th annual meeting.  Her research got some media attention in 2008 when it was originally presented, including this WebMD article that wisely raised some concerns about adopting this approach.  Dr. Michael Eades also thoroughly reviewed the study’s abstract on his blog and pinpointed several major flaws in the research and called her methodology into question (plus, he reminded readers that this study was presented as a poster session at a conference and not published in a peer-reviewed medical journal, where it would be scrutinized more heavily and likely rejected).

Now the research has been expanded into a book and surprisingly it made Time’s Top 10 Notable Diet Books. The publisher sent me a copy to review, and I must say, I was floored.  I think the press release was particularly alarming.

The headline:  Doughnuts! Ice cream! Pizza! Load up and lose! Finally, a diet based on indulgence, not restriction.

It did make me want to open up the book, which is an offensive-looking paperback that features a pink-haired cartoon woman with green go-go boots surrounded by an array of recommended breakfasts.  The subhead is “Eat big before 9 a.m. and lose big for life.”  First of all, calories can’t tell time, so the 9 a.m. deadline was meaningless to me.  Then came the daily formula for a big breakfast:  7 parts protein + 2 parts carbohydrate + 2 parts fats + always eat your breakfast sweet!  The seven sample breakfasts (glorified in full-color photos with recipes) included:

  • Pepperoni pizza topped with melted mozzarella, plus a blackberry smoothie and a sumptuous slice of red velvet cake
  • A toasted turkey and cheese sandwich, served with a rich banana shake a dish of strawberry ice cream
  • Broiled cowpoke steak with a piquant Parmesan spread, plus a hearty citrus shake, two slices of bread and chocolate chip cookies
  • Pancakes with ricotta cheese drizzled with berry syrup, served with a side of crispy Canadian bacon, plus a watermelon smoothie and chocolate of your choice (6 Hershey kisses are pictured)

Come on, what gives?  It seems you can eat chocolate, ice cream, cookies, cake and doughnuts for breakfast as long as you aim for a 600-calorie morning meal and eat before 9:00 a.m., according to Dr. Jakubowicz, who writes danielaJak.that many of her patients in Venezuela typically lose 25 pounds in 30 days on this plan.  No need to count calories, she claims.  Her big breakfast theory was the focus of a popular diet book in South America that  translates to Not Another Diet! Wonder if  this book came first and she conducted the study to try and validate her diet?  Who knows.

Now her diet is hitting the U.S. with the title of The Big Breakfast Diet with promises of pizza and chocolate for breakfast. The diet doc claims that her weight-loss plan can:

  • Rev up your metabolism
  • Help you burn more calories by day and more fat at night
  • Satisfy your hunger all day
  • Crush those diet-derailing cravings for sweets
  • Give you energy to burn
  • Allow you to feel alert and refreshed, rather than sluggish and foggy, when you wake up
  • Reduce your risk for serious health conditions such as type 2 diabetes and heart disease
  • Reduce migraines

So where did this all start? The book is based on one study that Dr. Jakubowicz conducted with 94 overweight women.  She divided the women into two groups:  one was on a Low Carbohydrate Diet the other ate the Big Breakfast Diet. Here are the details:

  • Low Carbohydrate Diet
    17 g carbs (12%), 51 g protein (35%)  78 g fat (53%) = 1,085 calories  per day
    Calories were more evenly spaced throughout the day, with the fewest calories at breakfast (about 290 calories)
  • Big Breakfast Diet
    97 g carbs (41%), 93 g protein (39%), 46 g fat (20%) = 1,240 calories per day
    Largest number of calories were eaten at breakfast (610 calories), with only 235 calories consumed at dinner

This was an 8-month study — 4 months of weight-loss and 4 months of weight maintenance (although the parameters of the weight maintenance phase are unclear).  At the end of 4 months, both groups lost weight.  No surprise with the severe calorie restrictions.  In fact, when I do the math, the calorie levels are even lower than reported.  I came up with 974 calories for the Low Carb Diet and 1,174 calories for the Big Breakfast Diet.   That’s crazy low in calories, and the carbs are really too low in both diet plans.  Not sure how any one could even get out of bed eating only 17 grams of carbs a day.

The Low Carb Diet group lost the most weight after 4 months (average of 28 lbs), compared to the Big Breakfast Diet (average of 23 lbs).  However (and I guess this is the big catch), the Big Breakfast Diet women lost even more weight during the maintenance phase (an additional 17 lbs), while the Low Carb dieters regained some of their weight (average of 18 lbs).  At the end of 8 months, here’s how it looked:  Low Carb Diet group lost an average of 9 pounds, but the Big Breakfast Diet group lost an average of nearly 40 pounds.  It seems the low carb dieters were more likely to abandon their routine in the maintenance phase (who wouldn’t with only 1,000 calories and 12% carbs!), while most of the big breakfast eaters kept it up and continued to lose weight.

So what does this tell us?  What’s the takeaway?

  • The dieters lost weight because of the calorie restriction, not because of any magic formula of carbs-protein-fat or the timing of the meals.  The author downplays the importance of calories, but at the end of the day, that’s why people in the study lost weight.  Recent studies have shown that the mix of macronutrients (carbs, protein & fat) has far less impact on weight loss compared to calorie levels.  Dr. Jakubowicz says there’s no need to count calories, but calories do count.
  • But it’s not just about total calories, you need to look at the quality of those calories.  Cake, ice cream and cookies are not how you want to spend the restricted amount of calories allowed on the diet.  There’s little emphasis on choosing nutrient-rich foods that will enhance your health, and not simply impact the number on the scale.  Greater importance is put on balancing carbs-protein-fat and making sure you eat at least 600 calories in the morning and get in your breakfast sweet each day — with a list that includes brownies, jelly beans and peanut butter cups.
  • The author claims that loading up on sweets in the morning with satisfy your sweet tooth so you won’t crave sweets later in the day.  She talks a lot about “addiction” to carbohydrates, insulin resistance and hormones. The Big Breakfast Diet group did report being less hungry after their morning meal — but who wouldn’t after eating 600 calories.  The same benefit can be gained by adding some protein to your breakfast, which can help with satiety and appetite control.
  • I do like the focus on the importance of breakfast.  It’s true that breakfast eaters tend to have an easier time managing their weight, and breakfast skippers tend to make up for those lost calories by eating more throughout the day.  But this book promotes the wrong type of breakfast.  Where are the whole grains — which have also been linked to healthier weights.  The doc is so focused on carbs-protein-fat ratios and front-loading the day that she’s missed the boat when it comes to nutrition.  I support the idea of a big breakfast, but let’s give people better ideas on what a quality breakfast really looks like.
  • I don’t mind having more calories skewed to breakfast.  Some studies have shown that a larger breakfast and a smaller dinner may help with weight management (compared to a small breakfast and big dinner).  In fact, it’s one of Michael Pollan’s Food Rules:  “Breakfast like a king, lunch like a prince, dinner like a pauper.” Although other studies suggest a calorie is a calorie, no matter what time of day it’s consumed.  And many people have better luck managing their weight by eating smaller, more frequent meals and snacks that are evenly spaced throughout the day.  Even so, a larger breakfast is not my beef.  But with such a limited number of calories — and no emphasis on the quality of foods chosen — your dinner would need to be limited to 235 calories.  That’s too much of a pauper to me.

This is just the kind of diet book I hate to see get published.  It’s written by an M.D. so people are likely to trust the advice.  Plus, the diet seems to be validated by research, which is so convincing.  The language lures you in because you think you can eat ice cream every day for breakfast and look like the actress Eva Mendes, who is quoted on the back cover.  Unfortunately, the book may sell a lot of copies — like it did in South America.  But I’m hoping that people will realize that The Big Breakfast Diet is worth skipping.

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