Breakfast, the most important Meal
Why are you still eating only a bowlful of Cereals?
A study conducted in Britain in the ’90s, which included 5000 16–17 year-old teenagers, and the consumption of (“any”) Breakfast cereals, concluded that teenagers who did not consume breakfast cereals “did not achieve the Recommended National Intake” (RNIs) for Riboflavin (Vitamin B2), Vitamin B6 and Folate; however, it failed to mention if those teenagers had any breakfast at all. (Crawley, HF. 1993)
It is a true fact that supplementing breakfast cereals with vitamins and minerals in which most of the population is known to be deficient – usually following government recommendations* – has had a great impact on kids especially, reducing greatly some of the common deficiencies due to the regular intake of low-to-very-low-nutrient density meals.
What does Fortification means?
Food fortification refers to the addition of micronutrients to processed foods. In many situations, this strategy can lead to relatively rapid improvements in the micronutrient status of a population, and at a very reasonable cost, especially if advantage can be taken of existing technology and local distribution networks. Since the benefits are potentially large, food fortification can be a very cost-effective public health intervention.
“Fortification of food with micronutrients is a valid technology for reducing micronutrient malnutrition as part of a food-based approach when and where existing food supplies and limited access fail to provide adequate levels of the respective nutrients in the diet. In such cases, food fortification reinforces and supports ongoing nutrition improvement programmes and should be regarded as part of a broader, integrated approach to prevent Micronutrient Malnutrition, thereby complementing other approaches to improve micronutrient status.” Claims the World Health Organisation.
However, this refers principally to populations in developing regions of the world. In industrialised countries, widespread malnutrition, and low intake of some specific nutrients, are mainly due to the increased consumption of mass-produced and processed foods (well-known for their very low nutrient content and high content in Transfat), or by strict dietary choices (such as vegetarianism and Veganism: Low B12 – and elevated Homocysteine levels (Waldmann, A. et al. 2005; Aśok, CA. 2003; Kirchheimer, S. 2003) –, Iron, Co-Q10, EPA and DHA intake (perfect assimilable form of omega-3 Fatty Acids) (Mezzano, D. et al. 1999; Reddy, S. et al. 1994; Ågren, JJ. et al. 1995; Krajcovicova-Kudlackova, M. et al. 1995), increased Lectins consumption; low-fat diet ( EPA/DHA intake, which may lead to hormonal imbalances, higher Simple Carbohydrate intake), and high or low-protein Diets), and chronic stress.
More than 2 billion people in the world today suffer from micronutrient deficiencies caused largely by a dietary deficiency of vitamins and minerals. The public health importance of these deficiencies lies upon their magnitude and their health consequences, especially in pregnant women and young children, as they affect foetal and child growth, cognitive development and resistance to infection.
“Micronutrient malnutrition […] has long-ranging effects on health, learning ability and productivity and has high social and public costs leading to reduced work capacity due to high rates of illness and disability. Overcoming micronutrient malnutrition is therefore a precondition for ensuring rapid and appropriate national development.
This was the consensus reached at the FAO/WHO International Conference on Nutrition (ICN) in December 1992, where 159 countries endorsed the World Declaration on Nutrition, pledging “to make all efforts to eliminate... iodine and vitamin A deficiencies” and “to reduce substantially... other important micronutrient deficiencies, including iron.” Exposes the WHO (World Health Organization) and FAO (Food and Agriculture Organization of the United Nations) report (Allen, L. et al. 2006), adding: “Underpinning these strategies is the realisation that when there is a dietary deficiency in any one nutrient, there are likely to be other nutrient deficiencies as well.
Consequently in the long-term, measures for the prevention and control of micronutrient deficiencies should be based on diet diversification and consumer education about how to choose foods that provide a balanced diet, including the necessary vitamins and minerals.
Fortification of food can make an important contribution to the reduction of micronutrient malnutrition when and where existing food supplies and limited access fail to provide adequate levels of certain nutrients in the diet.”
“In the long-term, measures for the prevention and control of micronutrient deficiencies
should be based on diet diversification and consumer education about how to choose foods
that provide a balanced diet, including the necessary vitamins and minerals.”
The report accentuated the principle of malnutrition and how to avoid micronutrients deficiencies: “Increasing dietary diversity is the preferred way of improving the nutrition of a population because it has the potential to improve the intake of many food constituents – not just micronutrients – simultaneously. Ongoing research suggests that micronutrient-rich foods also provide a range of antioxidants and Probiotic substances that are important for protection against selected non-communicable diseases and for enhancing immune function.”
“Increasing dietary diversity is the preferred way of improving the nutrition of
a population because it has the potential to improve the intake of many food
constituents – not just micronutrients – simultaneously.”
For infants, ensuring a diet of breast milk is an effective way of preventing micronutrient deficiencies. In much of the developing world, breast milk is the main source of micronutrients during the first year of life (with the exception of iron). Exclusive breastfeeding for the first 6 months of life and continuation into the second year should thus be promoted. Moreover, all lactating women should be encouraged to consume a healthful and varied diet so that adequate levels of micronutrients are secreted in their milk. After the age of 6 months, it is important that the complementary foods provided to breast-fed infants are as diverse and as rich in micronutrients as possible. (Allen, L. et al. 2006)
What is the difference between Fortification and Supplementation?
“Supplementation is the term used to describe the provision of relatively large doses of micronutrients, usually in the form of pills, capsules or syrups. It has the advantage of being capable of supplying an optimal amount of a specific nutrient or nutrients, in a highly absorbable form, and is often the fastest way to control deficiency in individuals or population groups that have been identified as being deficient.” (Allen, L. et al. 2006)
This definition, given by the World Health Organisation, does not take into consideration the strength nor the form in which the micronutrient is supplemented, as many forms such as Carbonate, is not – or in very minimal amount – assimilable. Furthermore, supplementations are based on RNIs and may not suit every individual requirement. But it is right in saying that a diverse and balance diet is the answer to prevent deficiencies, in both Macronutrients and Micronutrients, including, Vitamins and Minerals, while adding precious Phytonutrients, such as Carotenoids, Flavonoids, Glucosinolates, Phytoestrogens, etc.
What should a breakfast be made of?
Many people and many different countries have a different idea of breakfast and indeed enjoy a variation of many dishes. For example, in the Middle East, Kefir/Laban, or cheese, such as feta, Halloumi, Paneer-style curdled (goat or cow’s) milk; raw vegetables, including tomato, cucumber, olives; fresh herbs, etc. In the Far East, rice is still a breakfast staple, which may be served with stewed meat, or a vegetable curry.
In the Westernised World it is acceptable to bypass breakfast altogether, eating-on-the-go (e.g. Coffee and a doughnut), or have conventional dairy with breakfast cereals for convenience and practicality (no wash-up necessary, but a bowl and a spoon).
Although, attitudes are changing, the general population still expects that breakfast should not be time-consuming, and easy to prepare, influenced mainly by constant TV advertising campaigns and their claims that fortified cereals and milk are good.
Today, health-conscious people are leaning towards Gluten-Free Cereal Porridge with Cereal/Nut milk, or homemade granolas with sheep or raw goat yogurt/Kefir.
The perfect breakfast option should be one that has virtually near-zero impact on Glucose Blood Level and give a sensation of satiety (fuller for longer) until the next meal. To lower the impact on Sugar blood Level, a breakfast should contain Protein, Complex Carbohydrates (slower-absorption of Glucose, especially when combined with Protein) from wholegrain Cereals, and Fibre, whole fruits and Berries.
A study confirmed that Complex Carbohydrates (lentils), compared to a meal made with bread (also a Complex Carbohydrate), have very distinct impact on Blood Glucose Levels, and Insulin Production. While “lentils produced a significant 71% reduction in the blood glucose area and flattened the plasma insulin […] by comparison with the bread,” bread, containing a quarter of the carbohydrates impacted very little Blood Glucose Levels “but resulted in a significantly impaired blood glucose response to lunch.” (Jenkins, DJ. et al. 1982). Therefore, not all Carbohydrates are identical when it comes to Insulin Response and Blood Sugar Levels, and careful choice must be given when looking for the right kind of breakfast.
Breakfast should also be adapted to each individual, as much in choice and in portion size, and the calorific requirement to calorie expenditure ratio must be adequate. Despite this, breakfast should, as every other meal, be based on nutrient-dense foods.
The Science behind the rational of Breakfast:
Franca Marangoni of the University of Modena and Reggio Emilia, and fourteen other medical doctors, paediatrician, Nutritionist and Dietitian, some specialised in Diabetes and Obesity, made the following conclusion:
“An increasing scientific evidence, obtained in several Countries with different dietary habits, shows that regular breakfast consumption is associated with better health status at any age
Notwithstanding this evidence, both systematic reviews of the literature and statistical investigations on population samples support the notion that the first meal of the day is the most underestimated, and often completely neglected. According to 47 observational studies on break- fast habits, carried out in the US and in Europe, about 10-30% of children and adolescents regularly skip breakfast. This detrimental practice progressively increases from childhood to adulthood. […] Only about 30% (of the population) eat a quantitatively and qualitatively appropriate meal at the beginning of the day. Every morning, most adults just drink a cup of coffee or a cappuccino. There is an increasing trend towards standing-up and hurried breakfasts, eaten out of home, with little attention paid to the meal composition.” (Marangoni, F. et al. 2009)
After prolonged night fast, breakfast must first provide readily available energy to support the body with the morning activities and those of the day. Skipping breakfast may worsen early morning operations, leading to lower rates of intellectual performance and endurance in the case of physical exercise. In children, adequate breakfast is associated with improved memory performance, attention, ability in problem solving, and better comprehension during reading and listening. Performance is comparatively more efficient not only immediately after consuming breakfast, but also throughout the following hours, as also observed
A large number of studies demonstrates that those who habitually have breakfast are less predisposed to overweight and obesity, and that normal-weight adolescents, who often skip breakfast, are as likely to experience an increase of body mass index (BMI) as adults. Skipping breakfast is related to overweight more than alcohol drinking and even more than physical inactivity, in particular among the younger subjects. (Marangoni, F. et al. 2009) - follow link below for complete and instructive Medical Journal Extract.
* The term “market-driven fortification” is applied to situations whereby a food manufacturer takes a business-oriented initiative to add specific amounts of one or more micronutrients to processed foods. Although voluntary, this type of food fortification usually takes place within government-set regulatory limits (World Health Organisation)
Allen, L. et al. (2006). In: Allen, L. de Benoist, B. Dary, O. Hurrell, R. Guidelines on food fortification with micronutrients. France: World Health Organization and Food and Agricultural Organization of the United Nations. pp. 3–341 .
Aśok, CA. (2003). Vegetarianism and vitamin B-12 (Cobalamin) deficiency. The American Journal of Clinical Nutrition. 78 (1), p. 3–6. Available at: http://ajcn.nutrition.org/content/78/1/3.full
Ågren, JJ. et al. (1995). Fatty Acids composition of Erythrocytes, Platelets and Serum Lipids in strict Vegans. Lipids. 30, pp. 365–369.
Crawley, HF. (1993). The role of breakfast cereals in the diets of 16–17-year-old teenagers in Britain. Journal of Human Nutrition and Dietetics. 6 (3), pp. 205–216.
Jenkins, DJ. et al. (1982). Slow release dietary carbohydrate improves second meal tolerance. The American Journal of Clinical Nutrition. 35 (6), pp. 1339–1346. Available at: http://ajcn.nutrition.org/content/35/6/1339.short.
Kirchheimer, S. (2003). Vegetarian Diet and B12 Deficiency. Available: http://www.webmd.com/food-recipes/20030618/vegetarian-diet-b12-deficiency. Last accessed 24th Oct 2015.
Krajcovicova-Kudlackova, M. et al. (1995). Levels of Lipid Peroxidation and Antioxidants in Vegetarians. European Journal of Epidemiology. 11, pp. 207–211.
Marangoni, F. et al. (2009). A consensus document on the role of breakfast in the attainment and maintenance of health and wellness. Acta bio-medica : Atenei Parmensis. 80, pp. 166–171. Available at: http://www.ceereal.eu/documents/marangoni.pdf
Mezzano, D. et al. (1999). Vegetarians and cardiovascular risk factors: Hemostasis, inflammatory markers and plasma homocysteine. Thrombosis and Haemostasis. 81, pp. 913–917.
Reddy, S. Sanders, TA. Obeid, O. (1994). The influence of maternal vegetarian diet on essential fatty acids status of the new born. European Journal of Clinical Nutrition. 48, pp. 358–368.
Waldmann, A. et al. (2005). German Vegan Study: Diet, Life-Style Factors, and Cardiovascular Risk Profile. Annals of Nutrition and Metabolism. 49 (6), pp. 366–372. Available at: http://www.karger.com/Article/Abstract/88888
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