Health

Dr MICHAEL MOSELY says eating your biggest meal in the day does matter

You’ve probably heard the claim that if you want to lose weight you should ‘breakfast like a king, lunch like a prince, and dine like a pauper’.

The suggestion is that by doing this, you will burn more calories and improve your metabolic heath (i.e. keep your blood sugar levels and blood cholesterol in a healthy range).

It certainly makes sense to me because eating this way fits in better with our bodies’ natural daily rhythms, which are driven in large part by our internal body clocks.

In other words, you need food first thing to power you through the morning, and you don’t want to be filling your belly at night when your body is preparing for sleep.

But a recent study, published in the journal Cell Metabolism, found that, to much surprise, when you eat doesn’t seem to make much difference to how many calories you burn or how well your body processes the sugar and fat in the meal you have just eaten.

Researchers from the University of Aberdeen recruited 30 healthy, overweight men and women and asked them to follow a diet where they would spend four weeks eating most of their calories in the morning or the evening, and then switching over.

The meals, which were provided by the scientists, were high in protein and relatively low in carbs (30 per cent of their calories came from protein, 35 per cent from carbs and 35 per cent, fat).

As they were on a tightly controlled high-protein diet, the volunteers lost a decent amount of weight (3.3kg, around half a stone on average) — at least in part because eating more protein keeps you fuller by reducing levels of the hunger hormone, ghrelin.

You’ve probably heard the claim that if you want to lose weight you should ‘breakfast like a king, lunch like a prince, and dine like a pauper’. The suggestion is that by doing this, you will burn more calories and improve your metabolic heath (i.e. keep your blood sugar levels and blood cholesterol in a healthy range), writes Michael Mosley

But they lost just as much, just as fast, whether they were eating a big breakfast or a big dinner. There was also no difference when it came to the impact on their blood sugar levels, which improved just as much whichever diet they were on.

The only real difference was that when they ate a large breakfast, they felt less hungry during the day than when they ate a slap-up dinner.

I was really surprised by these findings because a slew of previous studies has found that when you eat makes a big difference.

For example, one study carried out in 2013 by Tel Aviv University in Israel, involving 93 overweight women with raised blood sugar levels, found that those eating a big breakfast lost nearly 2.5 times more weight (an average of 8.7kg or 19lb) than those who ate a big dinner (an average of 3.6kg or 8lb).

The women were asked to stick to a low-calorie diet where they either ate most of their food in the morning or the evening.

Those in the big breakfast group had significantly lower levels of ghrelin, were less hungry and reported less desire to snack later in the day than those in the big dinner group.

And that could help explain the difference between the findings of this study and the more recent one by the University of Aberdeen. The Israeli study was a ‘real world’ one, in other words it was less tightly monitored so people snacked when they felt hungry, something that didn’t happen in the Aberdeen study.

Another big difference was that in the Israeli study, the group who had a big breakfast had much bigger falls in their levels of blood sugar and blood fats than those who’d eaten a large dinner, suggesting bigger reductions in their risk of type 2 diabetes and heart disease.

In fact, the women who ate more at night actually saw the levels of their average blood fats across the day rise, despite their weight loss, which is clearly a bad thing.

A few years ago, I did a self-experiment for a TV documentary to compare the impact of eating the same food in the morning or evening — and my findings were similar to those of the Israeli scientists.

I started by eating a classic British breakfast (bacon, egg and sausage) at 10am, and then, after a 12-hour fast, I ate the same meal again at 10pm.

I had blood tests taken before and then every 20 minutes after eating these meals.

After my morning meal, my blood sugar and blood fat levels shot up, then fell rapidly, which is what you would expect. But after eating the same meal in the evening those levels shot up and then stayed up for several hours.

That is partly because after eating all that fatty, sugary food in the morning I went for a brisk walk, which helped burn off some of those calories, which didn’t happen in the evening.

But it is also the case that when we eat late at night our body isn’t as good at releasing the hormone insulin, and it’s insulin’s job to help your cells take up glucose.

So eating late at night puts you at greater risk of type 2 diabetes.

What I conclude from all this is that the adage ‘breakfast like a king, lunch like a prince, and dine like a pauper’ still stands and that paying attention to when you eat, as well as what you eat, can play an important role in improving your health.

But don’t expect miracles and be aware that there is no single diet that will suit everyone.

I personally find the best way to keep the weight off is to have a protein-rich breakfast (my favourites include scrambled eggs and smoked salmon or kippers) and avoid evening snacking, particularly the sort that is done mindlessly, late at night, in front of the television.

I always enjoyed the sight of Boris Johnson at the Despatch Box, hair on end, waving his hands theatrically, but I also wondered whether his unkempt hair was just part of a carefully cultivated image.

Well it turns out that ‘uncombable hair syndrome’, really is a thing. It’s a genetic disorder and those affected typically have blond or silvery hair that grows out from the scalp in different directions and just won’t lie flat.

Scientists at the University of Bonn in Germany identified some of the genes involved and hope to develop a blood test to spot affected children.

It has no other side-effects and typically youngsters grow out of it by the age of 12.

I always enjoyed the sight of Boris Johnson at the Despatch Box, hair on end, waving his hands theatrically, but I also wondered whether his unkempt hair was just part of a carefully cultivated image (stock image)

I always enjoyed the sight of Boris Johnson at the Despatch Box, hair on end, waving his hands theatrically, but I also wondered whether his unkempt hair was just part of a carefully cultivated image (stock image)

Anti-cancer benefits of exercise 

Cancer is normally seen as a disease of old age, but new research by Brigham and Women’s Hospital in the U.S. has identified a dramatic rise globally in cancers of the breast, colon, oesophagus, kidney, liver and pancreas in the under-50s.

This trend began in 1990 and shows no sign of stopping. The researchers believe that sleep deprivation, increasingly sedentary lifestyles and a diet of ultra-processed foods, which in turn leads to obesity, are some of the reasons for this surge.

The benefits of being more active were illustrated by a recent University of Bristol study, involving more than 131,000 women. It showed that doing some form of vigorous activity three or more days a week was associated with a 38 per cent lower risk of developing breast cancer.

Exercise protects by, among other things, reducing chronic inflammation and strengthening our immune system.

Exercise protects by, among other things, reducing chronic inflammation and strengthening our immune system (stock image)

Exercise protects by, among other things, reducing chronic inflammation and strengthening our immune system (stock image)

What on-screen doctors will always miss   

When was the last time you saw a doctor, face-to-face? One of the most dramatic changes in the NHS since the onset of Covid has been an increasing reliance on the use of telemedicine.

A report last year found that in many parts of England fewer than half of patients now get face-to-face appointments, with the rest having to speak to their GPs via telephone or video calls.

Like it or loathe it, we are going to be seeing even more of telemedicine, not least because it means doctors can see more patients in less time. But how accurate is it?

In a recent study, researchers at the Mayo Clinic in the U.S. analysed the results of more than 97,000 telemedicine appointments, comparing the accuracy of these diagnoses with a follow-up in-person appointment. Though the overall accuracy of the telemedicine diagnosis was 87 per cent, it very much depended on what the problem was (stock image)

In a recent study, researchers at the Mayo Clinic in the U.S. analysed the results of more than 97,000 telemedicine appointments, comparing the accuracy of these diagnoses with a follow-up in-person appointment. Though the overall accuracy of the telemedicine diagnosis was 87 per cent, it very much depended on what the problem was (stock image)

In a recent study, researchers at the Mayo Clinic in the U.S. analysed the results of more than 97,000 telemedicine appointments, comparing the accuracy of these diagnoses with a follow-up in-person appointment. Though the overall accuracy of the telemedicine diagnosis was 87 per cent, it very much depended on what the problem was.

When it was an ear, nose or throat problem, the doctors working remotely got it right only 65 per cent of the time. With cancer or mental illness, however, they were right 97 per cent of the time. Specialists were also more likely to reach a correct diagnosis remotely than GPs.

Apart from this disparity in diagnosis, I fear an over-reliance on telemedicine will weaken doctor-patient relationships, which play a big part in the successful outcome of any consultation.

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