Sunscreens Prevent Cancers — And Wrinkles

I’m usually quite proud of my Irish ancestry, but one unfortunate vestige of that heritage is pasty white skin that sunburns quite easily. When my mother was pregnant with me and my twin brother, the doctors discovered a large melanoma on her leg which required immediate surgery. Fortunately everyone turned out just fine, but my family history and skin color certainly put me at higher risk of developing melanoma and other skin cancers. In fact, studies have shown that getting painful blistering sunburns during childhood is a major risk factor for melanomas, squamous cell carcinomas and basal cell carcinomas later in life. This is why it’s up to parents to protect their children from the sun’s harmful effects.

Sunscreen UVA UVB broad spectrumWhat are the essentials for sun protection? For infants under 6 months of age, the American Academy of Pediatrics doesn’t recommend any direct sun exposure, as their skin is especially pale and vulnerable. For most children and adults, a combination of sunscreens, proper clothes, and avoidance of peak times from 10am-4 PM (or following your local UV Index) are the major ways to avoid damage.

How effective are clothes? These should be a first line of defense for all ages, but a plain white t-shirt only has a Sunburn Protection Factor of 7, so you could still burn quite easily through this. Most other clothes, if thicker and darker, would offer a more protective SPF 15 or higher. But I still know all too painfully well that even a dark t-shirt won’t be enough if I’m out all day swimming and playing outside.

This is when sunscreens come in handy. A good sunscreen has been shown to decrease risk for skin cancers, most impressively with squamous cell carcinomas. One Australian study showed a 40% decrease in these cancers when using a broad spectrum SPF-16 sunscreen. The evidence for protection against the much deadlier melanomas actually isn’t so strong, with the best study published in 2010 in the Journal of Clinical Oncology. This randomized controlled trial followed 1,600 persons over 10 years in Australia, a region with the world’s highest rates of skin cancers. Those who routinely used sunscreen had a 73% reduction in invasive melanoma, although the accompanying editorial questions its statistical significance. Still, I agree with their conclusion that, “the question of its efficacy with respect to melanoma prevention should no longer deter scientists or clinicians from recommending sunscreen use…In addition to sunscreen use, excess exposure to ultraviolet rays should be avoided, clothing should be used to shield skin from the sun, and sun-safe environments should be used for outdoor recreation. In addition, sunscreen use should be paired with regular self-examination of the skin.”

Sunscreen also helps prevent wrinkles and aging of the skin, as was just proven for the first time. This study followed 903 Australians for almost five years, and those who used daily broad spectrum SPF-15 had no detectable increase in skin aging.

But what exactly defines a good sunscreen? Right now your local market probably has an entire wall selling dozens of brands in bright plastic, offering a range of SPF and customized for babies, women’s faces, men… on and on, a confusing mess for us consumers. We can cut through a bit of this with the basics:

Buy a broad-spectrum: just because it says SPF-50 or even 70 doesn’t mean it’s wonderful, as the SPF rating system only measures sunburns from UV-B sunlight and not UV-A sunlight. UV-A rays don’t cause your classic lobster-red burn but it is much more sinister, penetrating deeper into your skin layers and causing more subtle and permanent precancerous DNA damage. This is why it’s crucial to buy sunscreen that follows the US FDA’s new rules and literally says “broad spectrum” on the label. This means it contains ingredients covering both UV-A and UV-B

Get SPF 30, and don’t waste your money with SPF-50 and higher: SPF-15 is a good start since it blocks 93% of UVB, but I agree with the American Academy of Dermatology to use SPF-30 as a standard. SPF-50 and above may seem impressive but clinically offer miniscule extra protection over SPF-30. SPF-30 already blocks 97% of UVB and SPF-50 only one percent more, at 98%. In fact, it’s so misleading for consumers that the EU has banned any labels over SPF-50, and the US FDA is also finalizing this long overdue limitation.

Use more than you think is enough: Research has shown a large percentage of us don’t use enough each time we apply it, and thus aren’t getting the proper protection. A typical adult should be using 1 ounce (30 ml) each time for head to toe protection.

Don’t stay out longer: Many doctors are concerned that people, especially children, stay out in the sun longer after applying sunscreen and actually increase their risks for melanomas, forgetting to reapply as directed or not using enough in the first place.

Use it all year: this may surprise many, but the AAD also recommends this. Ultraviolet rays are much weaker during other times of year but can still add up to skin damage. You should at least consider always using a daily facial moisturizer which also has at least SPF-15 and apply on your face, ears and neck. I’ve used daily facial aftershave with SPF-20 since my college days, in winter or in summer.

Sunscreens also have many approved chemicals to choose from, which further confuses your consumer choices. Some groups, especially the Environmental Working Group, claim that two common ingredients in sunscreens, oxybenzone and retinyl palmitate (from vitamin A) are harmful to health and thus should not be included in sunscreens. For example, on their web page describing oxybenzone’s dangers, they state toxic issues with “hormone disruption; reproductive effects and altered organ weights in chronic feeding studies; high rates of photo-allergy; limited evidence of altered birth weights and increased odds of endometriosis in women.” However, not one governmental FDA bans these substances, and no major medical organization agrees with their warnings. The majority of research the EWG cites are done on animals or in test tubes and not on humans, and no major research with humans has shown serious dangers. Both of these chemicals have been, and continue to be, approved as safe by the US, the EU and Canada even after more than 20 years of usage. The American Academy of Pediatrics’ position statement on sunscreens has no specific warning against these or any other FDA approved chemicals for sunscreens. The American College of Dermatology published an updated statement last summer restating their support of these two ingredients.

Fortunately, even if you still remain concerned about these ingredients, there are hundreds of sunscreens available which don’t have either of these and can offer excellent broad spectrum coverage for both you and your children. Oxybenzone isn’t even as effective as other chemicals such as avobenzone, so you could search for that instead. And you don’t need retinyl palmitate because it doesn’t even block sunlight and is only added to allegedly help with photo-aging. The American Academy of Pediatrics specifically recommends products with with zinc oxide or titanium dioxide, as they are physical barriers and don’t get absorbed. If you want more consumer guidance, you can read the independent test results from Consumer Reports or also the sunscreen ingredients guide from Consumer Search, which also reviews natural sunscreens.

Here’s a fun and helpful infographic regarding sunscreens and other summer safety tips, from the folks at Maternity Glow:

 

A 7 Minute Workout That Really Works

“Maximum Results With Minimal Investment”. It sounds like a shady late night infomercial, but it’s actually the subtitle of a recentreview article from the American College of Sports Medicine’s Health & Fitness Journal. Titled High Intensity Circuit Training Using Body Weight, it made worldwide headlines, especially after the New York Times picked up on it. It discusses the hot topic of high intensity interval training, which essentially means a very short burst of intense exercise plus quick breaks. So instead of the recommended 150 minutes a week of moderate exercise or 90 minutes of strong exercise, you could spend 15 of HIIT, three times a week — and get similar health benefits. Is it too good to be true?

Let’s step back a minute and review the benefits of exercise. Most guidelines, including those from the U.S. CDC, recommend a combination of aerobic activity and muscle strengthening activity based on extensive research showing strong evidence of exercise lowering risks of early death; coronary heart disease; strokes; high blood pressure; diabetes; colon and breast cancer, among others. Even 90 minutes of moderate exercise lowers your risk of premature death by 20%; more is better but the effects start to tail off after 300 minutes, maxing out at 40% reduction.

But very few of us achieve even 30 minutes a week, much less the 90 or 150 minutes recommended. Physical inactivity is one of the world’s leading risk factors for disease, ranked #6 in the USA and #10 in China. That’s why any research showing benefits with less time committment is crucial for our modern societies, all increasingly less active. HIIT got its first boost in 1996 when a Japanese research team led by Professor Izumi Tabata compared moderate intensity training of 60 minutes versus a 4 minute high intensity training on stationary bikes. The HIIT group not only had a similar increase in aerobic activity but also had a much better improvement in anaerobic activity. One study published in 2011 from the Department of Kinesiology and Health Education, Southern Illinois University tested overweight college students and found that just one 15 minute session of high intensity activity changed their resting energy expenditure (metabolic rate) for 72 hours. This was just as effective as a more routine 35 minute workout. Another study from the Faculty of Medicine, University of New South Wales showed that a 15 minute HIIT workout three times a week, compared to more traditional longer workouts, actually had better outcomes losing total body fat as well as insulin resistance. I consider these latter improvements very significant as diabetes continues to skyrocket right along with obesity in most countries.

When it comes to exercise, I confess I am much more sloth-like than a fitness freak, so I love the idea of a quick fix for health which actually works. I first heard about HIIT last autumn and started to do a 5 minute routine each morning. I went all out for 30 seconds performing as many squat thrusts as I could, then took 10 second breaks, then repeated 10 times for a total of 5 minutes. I confess that I stopped this routine after a month, as I do with most of my ambitions for exercise. But I definitely had felt stronger and more alert during those weeks, and I certainly felt that achy muscle sensation after these sessions. Last week I started this newly publicized 7 minute routine, combining 30 second intervals with circuit training. With circuit training, you rotate your exercises between focused muscle groups, and finishing the entire routine ideally will have covered all muscle groups. You can choose any exercises for HIIT, but one additional benefit of this particular cycle is that you don’t need any weights or machines, just your own body, a wall and a chair. You can perform this anywhere, from your hotel room to your office and home. Here’s an image of the routine, from the original New York Times page:

Each exercise should be done for 30 seconds, with 10 seconds of rest in between, for a total of 7 minutes and 30 seconds. You could also repeat this cycle one of two more times for added benefit. It’s important to take these very short breaks as it increases the healthy metabolic response. You will definitely need help keeping track of these seconds, and I found a wide collection of apps for smartphones and tablets which can be custom set to beep at the correct intervals. Just search your app store for HIIT, Tabata or “interval timer” and take your pick.

The key here is to really push yourself, not take a leisurely pace. In terms of intensity, most of these research papers’ recommendations mention “unpleasant” or “discomforting”. Many papers also mention something called VO2max, which is officially measured using oxygen sensor machines but otherwise generally correlates to 100% of your maximum heart rate. Thus we all should know our maximum heart rate, and fortunately this is easy to calculate. You can find online calculators, otherwise you can do the calculation yourself. The formula for maximum workout heart rate, calculated in a 2001 research paper, = 208 – .7 * age.  For example, I am 45 years old and my maximum heart rate (VO2max) is 208 -.7*45 = 177 beats per minute. If I wanted to reach the 150 minutes a week goal of moderate exercise, my target heart rate for moderate exercise would be 60% of max: 0.6 x 177 = 106 beats per minute. The recommended target for more intense exercise is 80% of max, which for me is 142. I usually get up to this rate with a thirty minute treadmill or elliptical machine workout, and quite honestly it didn’t feel too uncomfortable at all. For the more aggressive HIIT therapy, shooting for 90-100% maximum heart rate works out to 159-177 beats per minute. After I performed the above routine I definitely felt a bit “unpleasant” with a pulse of over 160 — exactly where I should be.

So now I’ve finally run out of excuses for not exercising. I can simply get up 10 minutes earlier each day or just be more efficient in the morning, and perform one or two cycles of this routine, ideally three times a week. Add this to my bicycling to and from my clinic and I can finally hold my head up high when I give my standard lifestyle lecture to my patients.

I think this type of evidence-based exercise research is powerful and certainly has altered my usual speech to patients. I previously would always mention the usual recommended minutes of exercise (150 moderate, 90 intense) but now can make it even more appealing: 15 minutes, three times a week. Certainly this wouldn’t appeal to people who already exercise or play sports. And data is still lacking on the long-term benefits and risk reductions from HIIT. But for the silent majority like myself who do almost no activity, HIIT routines are clearly far better than nothing, and could save millions of lives worldwide.

 

My New York Times Chinese version is here.

Alcoholism: A Family Scourge

I miss my father. He should be around to be granddad to my wonderful boys, helping me raise them to be good men. But he’s not around, dying far too early, from alcoholic cirrhosis of the liver. Only in his mid-60’s, he was a wonderfully warm-hearted man with a deep belly laugh, very much the average-guy Martin Crane to my Frasier Crane-like stuffiness. But he was also an alcoholic who slowly drank himself to death.

I have countless fond memories of us over the years, but I also have nightmare memories of holding his hand as he died in the hospital, in a coma, his skin yellow and lungs filled with fluid as his kidneys and liver finally gave up from the years of toxic abuse. These are memories that no child should have — but so many do.

My father

Why is alcoholism such a scourge to society? When compared to many other common diseases such as heart disease, alcoholism has a much more devastating social effect — not just on that person, but also their family, who painfully watch for years, helplessly, as their loved one slides into decline. Yes, many diseases are terrible and affect others; smoking can cause secondhand smoke diseases to family members. But alcoholism is a sad disease, and it’s those bad memories that really haunt families of alcoholics — memories of being afraid as we weave across wintry roads as dad drives home tipsy; memories of mom crying as dad refuses to hand over the car keys; memories of watching his belly get bigger and his memory weakening as his liver starts to fail.

So as we honor Alcohol Awareness Month this April, I’d like to use this opportunity to spread the word about alcoholism, hopefully to help a few people out there.

The first step, as anyone in 12-step programs will tell you, is to admit there may be a problem. If you’re not sure, just answer these four simple questions:

  1. Have you ever felt you needed to Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt Guilty about drinking?
  4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

If you’ve answered “yes”  to 2 or more, then you indeed may have a problem with alcoholism and may already be causing liver damage. These questions above are called the “CAGE questionnaire” and are used by doctors as a screening tool for alcoholism.

What If You May Be Alcoholic?

First of all, congratulations if you’re honest enough to admit you may have a problem. Secondly, you need to know that you are not alone, and many people and organizations can help you:

  • Your family doctor can check out your liver and kidney health.
  • Some newer medicines, like naltrexone, may actually help you quit drinking; your doctor can discuss these with you.
  • Twelve step programs such as Alcoholics Anonymous aren’t for everyone, and there’s contradictory evidence as to how effective they are. But for many recovering alcoholics, they’ve been a source of strength, all over the world. You can find a list of AA sites in the US here.
  • Psychologists and psychiatrists can help you in many ways, from quitting drinking to processing underlying stresses and depression, to fixing family and job problems related to your drinking.

    dad on the twins second birthday
    My dad with us, at 2 years old. That’s me on the right (I think)

My Dad’s Legacy

Clearly, living through my dad’s illness has had a profound influence on me as a doctor, and I do find myself drawn to these patients. I’m sure it’s partly an effort to make up for what I couldn’t do for my own dad.

But despite all the pain of those later years, my strongest memories are the good ones. I will always remember his laugh, and to this day I vividly remember how he could light up a room. I’d like to end with a poem from Ralph Waldo Emerson, which we used at his wake:

To laugh often and much;
to win the respect of intelligent people
and the affection of children;
to appreciate beauty;
to find the best in others;
to leave the world a bit better
whether by a healthy child,
a garden patch, or a redeemed
social condition; to know even
one life has breathed easier
because you have lived.
This is to have succeeded.

Diabetes: Healthy Lifestyle Choices Are Key

I’ve been a family doctor for fifteen years, and one of the more dramatic changes I’ve noticed is a big spike in the incidence of prediabetes and diabetes, in all age groups. I had worked in China for ten years until last summer, and all us family doctors at my Beijing clinic weren’t surprised at all with the 2013 paper published in JAMA confirming the frightening reality in China: more than half of all adults in China now are prediabetic. Even worse, 11.2% have diabetes, giving China the dubious distinction of having the highest prevalence of diabetes in the world — higher than in the USA, an extraordinary statement given the far higher rate of obesity in the USA. As this epidemic spreads,  I felt a timely urgency to share my advice on how to avoid this disease – or at least to slow it down.

It helps me to think of diabetes as a modern lifestyle disease, mostly caused by all developing countries’ gains in weight, less physical activity, and changes in diet. Diabetes now is a global pandemic. Tens of millions of people have diabetes, and many people are undiagnosed because they’ve never been tested. There are two types of diabetes, and type 2 diabetes accounts for 90 to 95 percent of diagnosed diabetes in adults.

Prediabetes concerns us doctors because it means you are at extremely high risk of developing diabetes in the next few years. Studies show that a prediabetic person has a 25% risk of developing diabetes within three years, and a majority within ten years. The greatest risk factor by far is overweight and obesity. Having a BMI under 23 is ideal, and a BMI of 25 increases your lifetime risk of diabetes by 600%. A BMI of 30 increases your risk by 4,000% — that’s 40 times the risk! That’s an extraordinary number which should worry us all, since in the USA over two thirds of adults are overweight and over a third are obese.

But here’s the good news: the crucially important message for everyone is that you have great control over whether or not you develop full diabetes. You should think of prediabetes as an early warning sign by your body, a major wake up call that whatever you’ve been doing to your body isn’t too healthy. Most people with prediabetes fit one or more of these three major risk factors: body mass index (BMI) over 25; lack of enough exercise; and unhealthy food choices as well as portion sizes.

So let’s say that you’re one of the many people who has prediabetes: what can you do right now to help? If you follow the three lifestyle steps below, you can lower your risk more than half! One of the most important public health research studies ever, the Diabetes Prevention Program, proved that lifestyle changes worked better than pills in reducing progression to diabetes. Lifestyle changes lowered a prediabetic person’s risk by 58% over three years — much better than the 31% improvement with a daily pill (metformin).

So what are these magic steps? Without further ado:

  1. Lose weight. Weight gain and obesity are the top causes of type 2 diabetes, and losing weight is now proven to be the most effective prevention. In the DPP study, the goal was to lose at least 7% of your body weight. Your goal should be to lose 5-10% of your body weight.
  2. Exercise. Exercise may not directly cause much weight loss, but exercising muscles absorb sugars much more effectively. This is why exercising is crucial to help control sugars, both in a prediabetic as well as in diabetics. How much exercise is enough? We usually recommend 150 minutes a week of moderate exercise, but any amount is better than nothing. Also, as I mentioned in an earlier column, shorter, more intense workouts can help as much as moderate exercise.
  3. Proper diet. Healthy food choices also are crucial to control your sugars. One of the most common misperceptions about diabetes and prediabetes is that it’s “a sugar problem” and you must cut down on sweets and desserts. The bigger culprit are total starches — pastas, breads, rice and potatoes. In all these cases, processed versions are never as healthy as the originals.

Here are a few quick tips on nutrition:

  • Brown is always better than white: Processed white bread and flour have lost all the nutritious fiber which helps regulate your bowels as well as your sugar spikes after a meal. If you love your carbs, at least try to switch to whole wheat pastas, breads and rice.
  • Portion control: Total calories are also important, as most likely you are taking in a bit more than you realize. These extra calories will get deposited as fat, which leads to more risk of diabetes.
  • Cut back on sodas, beer and juices: All of these are empty calories, full of processed sugars which stress out your liver and pancreas. These unhealthy carbs, especially in sodas, are a major cause of obesity and diabetes in both children and adults.

Type 2 diabetes is partly genetic, so no matter how healthy you are, it still may be inevitable. But these above steps are always good advice for all of us. Another great thing about these healthy life changes is that they also dramatically reduce your risk of heart disease, many cancers, and early deaths from all causes.

Don’t get discouraged — you have control over the next steps!

Not Sleeping Well? Here’s My Advice.

This week, March 6 – 13, is National Sleep Awareness Week, so it’s a good time to review healthy sleep habits. I see a lot of adults and teens in my clinic who are chronically tired and have troubles sleeping — both falling asleep and staying asleep.

How Much is Enough?

According to the National Sleep Foundation’s research, here’s the amount of sleep we need:

  • Newborn (0-3 months): 14-17 hours
  • Infant (3-12 months): 12-15 hours
  • Toddler (1-2 years): 11-14 hours
  • Preschool (3-5 years): 10-13 hours
  • School age (6-13 years): 9-11 hours
  • Teenager (14-17 years): 8-10 hours
  • Adult (18-64 years): 7-9 hours
  • Older adult (>65 years): 7-8 hours

One of the main problems with insufficient sleep is the daytime sleepiness, an obvious consequence of not sleeping enough. A fascinating series of tests in children showed that insufficient sleep and daytime sleepiness both lead to worse school performance. Most of these children went to bed at 9-9:30 am and almost all got up at 7 am, causing a daily sleep debt of 1/2-1 hour for many children. While that may seem like a small amount, like any debt, it must be paid back, and most children cannot recover all of this lost time by sleeping late on weekends.

One good bit of news from the same study describes how delaying school start times even by just a half hour can significantly improve sleep duration and daytime sleepiness. In their interventional study with six primary schools in Shanghai, delaying school openings from 7:30 to 8 or 8:30 gave the children almost an hour of extra sleep — and more importantly, less complaints of daytime sleepiness. This fits with studies in other parts of the world and supports the growing movement, led by pediatricians, to delay school opening times to 8:30 am. Just doing this could allow better sleep and improved test scores for all students!

Besides school performance, poor sleep also leads to an increased risk of overweight and obesity in children (as well as adults). A 2007 meta-analysis of 36 studies across the world showed a strong, independent association between short sleep duration and weight gain in children, which continues into adulthood.

For adults,  poor sleep can cause long-term problems with high blood pressure, depression, diabetes and obesity. It can also cause dangers such as sleeping behind the wheel or more errors at work (medical training and internships are notorious for this, as are night shift workers driving home).

My tips for sleeping well

Get all screens out of the bedroom. Technology is changing so quickly that it’s difficult for research to keep up. But it’s clear that many people are having a lot more sleeping troubles when using their iPads and cell phones at bedtime. It’s partly because their backlight alters our sleep hormones, but also it’s distracting us with answering text messages even after lights out. I think a great general rule, for adults and kids, is no screen time two hours before bedtime (that includes TV), and definitely get all screens out of your bedroom while you sleep.

Exercise often — but early. Exercise has been shown to improve sleep habits, but only if done at least four hours before bedtime. Otherwise, you still may have too much metabolic energy and will have trouble falling asleep. This is also a good tip for kids who are having sports practices late into the night.

Avoid alcohol and smoking before sleeping. Alcohol is a major cause of insomnia for many. Drinks will certainly make you sleepy, but your body will rebound and wake you up in the middle of the night. It’s far better to have only a drink or two, at least 2 hours before bedtime. Smoking causes the same problems; that initial relaxation quickly wears off and the nicotine stays in your system for hours.

Caffeine is another major cause of poor sleep. As we get older, we cannot handle the triple-shot cappuccinos which we had in college, and it’s very common to have poor sleep with any caffeine drinking after lunchtime. So if you’re having light sleep, definitely take a look at your caffeine habits first; any tea, sodas or coffee after lunch may be keeping you awake. If you must have your afternoon coffee, at least try to switch to decaf.

Other tips include not staying in bed if you can’t sleep. If you can’t fall asleep, after 20 minutes of trying you should get up and try to relax in another room. Staying longer in bed generally makes you more anxious, making it even harder to fall back asleep.

Take a nap. Napping, even if only 20-30 minutes when needed, has been shown to have great benefit for short term memory and concentration. As I get older, I definitely lag more in the afternoon, and a 15 minute power nap at lunch really helps me get through a busy clinic afternoon (as does a lighter lunch).

What about natural medicines and non-prescription pills? Many people use over the counter pills such as Tylenol PM. It does work well, in the short term, for many people — but I strongly advise not taking it regularly, as the Tylenol component is totally unnecessary and can cause liver problems if taken chronically. If you must use this medicine, please buy only the active ingredient, diphenhydramine (Benadryl) separately and only use that. As for natural medicines, melatonin works for some types of insomnia but is rarely very effective. Others may consider an herbal capsule with valerian and other compounds such as passionflower, hops or lemon balm.

 

 

Don’t Skip Breakfast! Here’s Why.

Did you know that the U.S. Center for Disease Control predicts that one third of all Americans will have diabetes by the year 2050? This scary statistic is not just an American phenomenon; many Western countries’ modernized diets have led to a diabetes epidemic. The main culprits are what you would expect: obesity and an unhealthy diet. These lifestyle patterns are set as children, and are very difficult to change later on.

So what steps can we take to prevent this? As we recognize National School Breakfast Week, one crucial step is to always have breakfast. Most of the 20-30% of children and teens skipping breakfast may think it’s no big deal, but the long-term consequences of skipping breakfast can be serious enough to warrant a big family discussion. We all know instinctively that eating breakfast is important, and research can help parents convince their kids to eat breakfast — as well as eat it themselves!

Most kids are very focused on the present, and they just won’t be motivated with any talk about health risks decades down the line.  But they’re much more open to data showing how breakfast-skippers not only gain more weight, but they also do worse in school. So if you have an overachiever child who runs out the door in the morning without breakfast, show them the studies showing that breakfast skippers perform worse in school exams.

And here’s an important tip for parents whose child is terrified of gaining weight and skips breakfast: children who skip breakfast actually end up more obese than those who eat breakfast! The main reason for this is mostly because breakfast-skippers get very hungry by lunchtime and end up binge-eating more, usually with less healthy mid-morning snacks and bigger lunch portions. Also, because their metabolism is in a partial fasting mode without breakfast, the body stores more energy from foods as fat, instead of just breaking it down to glucose for your brain and muscles.

Adults also don’t get a pass for skipping breakfast, as they get the same slow weight gain as kids do. The importance of eating breakfast was impressively covered in the Childhood Determinants of Adult Health Study. In this fascinating study from Australia, researchers asked 2,000 school children about their breakfast habits, then followed up with them 20 years later and assessed their health. The results were striking; those kids who skipped breakfast all those years had a larger waist — by 2 inches! These same kids as adults also had higher insulin levels, which leads to more diabetes. They also had higher total cholesterol and the “bad” cholesterol, LDL — both of which cause clogging of the arteries and lead eventually to heart attacks and strokes. Another long term study, this time from Japan, followed 82,000 people for 15 years and found that the breakfast-skippers have a 14% increased risk of heart disease and 18% higher risk of strokes.

And for those of you worried about diabetes, or told you are prediabetic, it’s very important to follow the usual advice to have small, frequent meals instead of one or two large meals. Another excellent study, the Health Professionals Follow-Up Study, followed 29,000 American men for 16 years, and found that the breakfast skippers had a 21% increased risk of developing diabetes.

The type of breakfast is also important. The main research suggests what is obvious to parents — that simple sugars in sweetened cereals are much less healthy than high-fiber, more complex whole-grain cereals as well as fruits, nuts, and dairy products. Those quick energy bursts from the sugary cereals give kids a quick “high” which just as quickly wears off, and their brains and body are dragging along come lunchtime.

My advice for those of you who skip breakfast because “I have no time”: at least try to have a cup of yogurt with some fresh berries and cereal in the morning. You can throw it in your bag, along with a banana, and eat it on the way to school or work. Yogurt by itself is a superfood with its calcium and probiotics, and daily yogurt actually helps you to keep your weight stable. And blueberries are packed with healthy antioxidants and fiber.

So, the next time your kids are trying to run out the door before breakfast, sit them down in front of a bowl of Wheaties with yogurt and tell them how breakfast helps with better grades as well as better health — now, and in their futures.

by family doctor Richard Saint Cyr MD