Sugar for breakfast

We were reviewing Stuart's diet because of his persistent small LDL, low HDL, modestly elevated triglycerides, and blood sugar of 107 mg/dl.

"I've changed my diet, doc. No kidding. We never fry our foods. No butter, no goodies. I don't know what else I can possibly do."

"Okay. Let's review your diet. What did you have for breakfast?"

"Orange juice, a big glass. Gotta get my potassium. Then cereal like Cheerios or Shredded Wheat, sometimes Kashi or Raisin Bran, always in skim milk. Gotta have my one slice of toast, no butter. I'll put some fruit preserves on it. You know, real fruit. Only whole wheat bread, never white. On Sundays, we always go out for pancakes, but now we order only whole wheat."

Many of us have gotten into a peculiar habit: Having what amounts to pure sugar for breakfast. Perhaps there's a little fiber thrown in with it, but many people indulge in breakfasts that are sugar and plenty of it. That's precisely what Stuart is doing: A breakfast that, while it doesn't contain a huge amount of sugar outside of the orange juice, is promptly converted to sugar. If we were to check his blood sugar just after his standard breakfast, it would rise substantially.

This pattern has become deeply ingrained into the American psyche. Some people will act like I've suggested we overthrow the government when I suggest that breakfast cereals need to be eliminated from their lives. We all share memories of Tony the Tiger, the leprechaun on Lucky Charms ("They're magically delicious!), reading the brightly colored boxes often including games and prizes. Breakfast cereals seem as American as apple pie. But the wheat and corn content ensures a big rise in blood sugar, the sort that create small LDL, low HDL, etc.--all the patterns Stuart is showing--and make us fat.

Orange juice? Too much sugar all at once. Get your potassium from whole vegetables and fruits, not from orange juice. (Bananas are another problem source of potassium for similar reasons despite being a whole fruit.)

Toast? Any diabetic who monitors their blood sugar after meals will tell you: Even one slice of bread, ANY bread, skyrockets blood sugar. Add the fruit preserves made with sugar syrup and it's doubly worse.

Pancakes? Even if made with plenty of fiber, blood sugars go absolutely berserk after a meal like this, especially if maple syrup is added.

In other words, the seemingly healthy breakfast Stuart eats guarantees that he fails to control all his patterns that contribute to his coronary plaque growth.

After I pointed out Stuart's dietary faux pas, he asked, "Then what the heck can I eat?"

"There's actually lots of good choices: Eggs (preferably free-range, if available, or the 'omega-3' enriched) or Egg Beaters; oat products, but true oat products like slow-cooked oatmeal, or the best of all, oat bran, used as a hot cereal; ground flaxseed as a hot cereal with added fruit, berries, nuts; a handful of raw almonds, walnuts, pecans; some cheese, preferably traditional fermented cheese and not processed; low-fat cottage cheese; low-fat yogurt that you flavor yourself with berries and nuts; raw seeds like sunflower and pumpkin.

"Try and save some of your dinner foods for breakfast. For instance, save some green peppers and onions from your salad and put it in your scrambled eggs along with some olive oil. Save some of the chicken and add it to your breakfast. Save some of the cooked vegetables and have them as they are. You'll be surprised how filling dinner foods can be when eaten for breakfast."

It's not that tough. But Stuart and many other people need to break the hold that the food manufacturers have created. If you're hoping to seize hold of your heart scan score, get rid of the sugar foods in your morning, even the ones cleverly disguised as healthy.

Comments (17) -

  • Anonymous

    9/3/2007 3:30:00 PM |

    This is such good advice. My mildly diabetic mother's blood sugar is 210 mg/dL two hours after a breakfast consisting of a small bowl of cornflakes, skim milk, banana, and orange juice. For anyone with blood sugar problems or insulin resistance, glucose tolerance is at its absolute worst in the morning, and improves later in the day. Even in the absence of other dietary changes, avoiding the all-sugar breakfast is a good first step toward getting hunger, weight, and lipid abnormalities under control.

  • Anne

    9/3/2007 10:26:00 PM |

    What about brown rice? I fix brown rice with cinnomon and raisins and nuts(no sugar is added). I react to egg white so sadly eggs are out for me.

    I have found soup for breakfast is great too. My favorite is a home made chicken and vegetable.
    Anne

  • Dr. Davis

    9/3/2007 11:42:00 PM |

    Excellent point.

  • Dr. Davis

    9/3/2007 11:45:00 PM |

    Hi, Anne--

    The soup idea is great.

    However, the brown rice depends on how severe your patterns are. If you are a small LDL, low HDL, higher blood sugar person, or have excessive tummy weight, then the more you reduce high or moderate glycemic index foods, the better will be your response.

  • DietKing2

    9/4/2007 12:19:00 AM |

    It's also very tempting to reach for that bowl of cereal because even with the added cup of skim milk the calorie count barely touches 200--many think they're doing themselves a favor by going this route instead of two large eggs (any style) which ironically will pull you just above the 150 calorie range, will satisfy your hunger better, and keep your blood sugar steady, if not on the lowerish side.  I've learned to really enjoy them, too.
    Adam

  • DietKing2

    9/4/2007 12:31:00 PM |

    Dr. Davis,
    Saw this article this morning and thought of you and your site;
    better to not have to deal with any of this in the first place, nu?
    Unreal how this issue keeps going back and forth.
    Adam

    http://apnews.myway.com/article/20070902/D8RDE7500.html

  • Anonymous

    9/4/2007 2:28:00 PM |

    Great breakfast post- very helpful! Can we get a post about lunch, dinner, dessert and snacks?
    Thanks- Greg

  • Dr. Davis

    9/4/2007 9:40:00 PM |

    Yes. If there's one conclusion I favor, if given a choice, the best stent is NO stent.

  • Ortcloud

    9/5/2007 1:36:00 AM |

    Amen, thank you for this post. Whenever I go out to breakfast I look around and I am in shock at what people eat for breakfast. Big stack of pancakes, fruit, fruit juice syrup, just like you said. This is not breakfast, this is dessert ! It has the same sugar and nutrition as a birthday cake, would anyone think cake is ok for breakfast ? No, but that is exactly the equivalent of what they are eating. Somehow we have been duped to think this is ok. For me, I typically eat an omelette when I go out, low carb and no sugar. I dont eat wheat but invariably it comes with the meal and I try to tell the waitress no thanks, they are stunned. They try to push some other type of wheat or sugar product on me instead, finally I have to tell them I dont eat wheat and they are doubly stunned. They cant comprehend it. We have a long way to go in terms of re-education so keep up the good work doc.

    -ortcloud

  • Anonymous

    9/6/2007 6:04:00 AM |

    Hmmm...I've read in many places that egg yolk is GOOD for you...as long as it isn't cooked (much).  They say that it oxidizes the cholesterol.  I've found that softboiled eggs or even fried (low temp, only good oil (very small amount) to be best.  

    What do you know about the health effects of cooked eggs...or over cooked proteins in general?  Thanks!
    Pete

  • Dr. Davis

    9/6/2007 12:10:00 PM |

    Pete--
    Sorry, not familiar with that issue. Do you have any further info?

  • Bix

    9/7/2007 3:03:00 PM |

    "Then what the heck can I eat?"

    That sentence right there.  That's the crux.

    You gave some excellent alternatives.  But the breakfast cereal mindset runs deep.  Deep.

  • Anna in San Diego, CA

    9/22/2007 7:29:00 AM |

    Amen to the advice to get rid of the converting-to-sugar breakfast foods.  But why do you recommend reduced fat foods?    Fat is a good source of energy for the day and holds off mid-morning hunger pangs.

    Like others, I became bored with bland supermarket eggs every day, even premium so-called free-range eggs.  But now I get truly free range eggs from a little hobby farm in my county and I love 3 eggs every day!   The taste is fantastic because the chickens don't eat vegetarian chow all day, instead they eat grasses and run around chasing down grasshoppers, etc.  

    Over-easy in plenty of good butter, lowish heat with a lid until the white are just set and the yolks are still runny.  The day just isn't right without them.

  • Dr. Davis

    9/22/2007 12:46:00 PM |

    Great point with your free-range--truly free-range--eggs.

    I only specify the low-fat with regard to the dairy products, principally because of caloric density.

  • Anonymous

    9/23/2007 8:47:00 PM |

    I have a question about Liver cleansing.  I saw an AD on the internet about a product to cleanse the liver and wonder if it is a good idea.  I have small LDL.
    Peg

  • Dr. Davis

    9/23/2007 11:40:00 PM |

    Sorry, Peg, but these products tend to be scams.

  • buy jeans

    11/2/2010 7:59:39 PM |

    Orange juice? Too much sugar all at once. Get your potassium from whole vegetables and fruits, not from orange juice. (Bananas are another problem source of potassium for similar reasons despite being a whole fruit.)

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A glycation rock and a hard place

A glycation rock and a hard place

Advanced Glycation End-products, or AGEs, the stuff of aging that mucks up brains, kidneys, and arteries, develop via two different routes: endogenous (from within the body) and exogenous (from outside the body).

Endogenous AGEs develop via glycation. Glycation of proteins in the body occurs when there are glucose excursions above normal. For instance, a blood glucose of 150 mg/dl after your bowl of stone-ground oatmeal causes glycation of proteins left and right, from the proteins in the lens of your eyes (cataracts), to the proteins in your kidneys (proteinuria and kidney dysfunction), to skin cells (wrinkles), to cartilage (brittle cartilage followed by arthritis), to LDL particles, especially small LDL particles (atherosclerosis).

At what blood sugar level does glycation occur? It occurs even at "normal" glucose levels below 100 mg/dl (with measurable long-term cardiovascular effects as low as 83 mg/dl). In other words, some level of glycation proceeds even at blood glucose levels regarded as normal.

There's nothing we can do about the low-level of glycation that occurs at low blood sugar levels of, say, 90 mg/dl or less. However, we can indeed do a lot to not allow glycation to proceed more rapidly, as it inevitably will at blood sugar levels higher than 90 mg/dl.

How do you keep blood sugars below 90 mg/dl to prevent excessive glycation? Avoid or minimize the foods that cause such rises in blood sugar: carbohydrates.

What food increases blood sugar higher than nearly all other known foods? Wheat.

Comments (15) -

  • soiltosustenance

    1/12/2011 3:19:52 PM |

    I have been doing some experiments with Blood Glucose control over the past 2 months and have made a huge difference by cutting out grains completely.  Between the reduction in carbs and the addition of some moderate strength training, I have been able to eliminate BG spikes above 150 (now normal highs are in the 120s) and the duration is shorter as well.

  • Anonymous

    1/12/2011 5:01:24 PM |

    Dr Davis I as a neurosurgeon scientist completely agree with you about carbs wheat and glycation but from the literature of diabetics I am far more concerned with lipid peroxidation from PUFA's.  Espcially the omega 6 and 9's which are known to cause six times the "glycation" that glucose does.  I believe a meta analysis was done for Circulation recently and it caused a firestorm in the AHA ACA because of sponsorship issues.  I am more concerned with the guidelines we physcians need to advocate than guidelines that are subject to market forces more than scientific ones.

    Dr. K

  • Anonymous

    1/12/2011 10:05:44 PM |

    Dr. K,

    I tried to find that meta analysis in Circulation and couldn't find it. Could you please provide the reference. Thanks

  • Anonymous

    1/12/2011 11:15:11 PM |

    I have to say I've found giving up wheat, even cutting down substantially, to be damn difficult because it's so widespread and simple habit. I aim for more lean meats and things like rice for carbs, but so dearly love my breakfast cereal and pizza!

    Does anyone have thoughts on aminoguanidine relative to the glycation issue. I took it for some months a few years ago until it got a bit too pricey.

  • revelo

    1/13/2011 12:37:42 AM |

    If wheat and omega-9 fatty acids are so unhealthy, why do the southern europeans live so long? Wheat and olive oil are a huge part of the traditional Mediterranean diet.

  • Anonymous

    1/13/2011 3:55:31 AM |

    Meta-analysis Reveals “Heart Healthy Omega-6 Fat” Increases Risk of Heart Disease
    Bottom Line: The research upon which the American Heart Association based their "eat-your-omega-6-fat" advisory, is fatally flawed, according to the results of a meta-analysis study, which showed that a steady diet of omega-6 polyunsaturated fatty acids increases the risk of heart disease and death, especially for women [1]. British J Nutr. Dec 2010.

           [Here's a link to the full post http://www.scribd.com/doc/44601571 ]
    DR. K

  • Anonymous

    1/13/2011 3:57:10 AM |

    http://omega-6-omega-3-balance.omegaoptimize.com/2010/12/03/metaanalysis-reveals-heart-healthy-omega6-fat-ups-risk-of-heart-disease.aspx

  • Might-o'chondri-AL

    1/13/2011 5:01:36 AM |

    Advanced glycation of peroxidized poly-unsaturated fat rate has definitely been claimed to be significantly higher than rate of glucose advanced glycation.

    Dr. Davis' tactic of glucose control does seem easier for patients to see how they can make changes that matter. They are then more open to following his complete program.

    A recent autopsy analysis (2010) of ruptured plaque said there was always iron in there; and yet no iron in the intact plaque. Iron cleaved from the blood is a suspected activator of omega-6 lipid peroxidation at the epithelium. When the fibrin polymerizes it seems iron gets trapped.

    People's genetics make me wonder if some mega-dose multi-vitamin takers are over doing the iron; vitamin C even boosts it's uptake. Old "southern Europeans" probably never took complex vitamin pills until recently. Wheat germ has soluble iron and those old timers ate white flour products if they could.

  • D.M.

    1/13/2011 9:00:32 AM |

    @Anonymous neurosurgeon scientist.
    Isn't omega 9 MUFA rather than PUFA?
    Also there's no reason why a LCHF diet couldn't also minimise PUFA, in preference to SFA/MUFA.

  • Dr. William Davis

    1/13/2011 1:04:46 PM |

    While this post was about endogenous glycation, there is indeed a parallel path of exogenous "glycation," poorly named because many of the so-called exogenous "advanced glycation end-products" do not involve glycation.

    I agree with Dr. K that many of the exogenous factors leading to heart disease, aging, and other phenomena are those that lead to LDL oxidation. Oxidized polyunsaturates, AGEs, and oxidized cholesterol are underappreciated phenomena.

    A topic for future.

  • Anonymous

    1/13/2011 10:08:11 PM |

    Although I had given up oats and other grains because of their adverse effect on blood glucose,I had not been able to give up toast(sprouted wheat). I finally found a great solution--organic frozen green beans. They are easy to cook and go well with eggs. I have been wheat-free for about a month.I feel good and I don't get hungry as often.

  • Alberto

    1/13/2011 11:26:13 PM |

    As revelo, I am curious as how is it that italians eat tons of pasta (they use hard grains) and seem to be healthy.

  • allison

    1/14/2011 5:16:48 AM |

    Peter at Hyperlipid has written about this fasting glucose paradox in carb-restricted individuals.  

    I have been Paleo (<60 grams of carbs) for two years.  I eat no sugar, fructose or grains of any kind.  Yet my fasting glucose is 90 with all other diabetic indicators normal.  Apparently, high normal fasting glucose is common among LCHF diets.  

    I haven't researched this, but since a LCHF diet produces large, fluffy oxidation-resistant LDL, I wonder whether there is a beneficial effect downstream from glycation? Otherwise both a low fat, high carb diet and a LCHF diet would produce the same bad result.  That doesn't quite add up.

  • allison

    2/3/2011 5:28:43 AM |

    Glycation refers only to the initial step of one glucose molecule attaching to a protein without the mediation of an enzyme.  If blood glucose levels are low enough--as would be the case with a HFLC diet--the glucose and protein will disengage and no damage will be done.  If blood glucose remains elevated, the cascade to advance glycation end products will continue to protein cross-linking and all the downstream deleterious effects.  The unavoidable glycation referenced by Dr. Davis is harmless, as long as you avoid refined carbohydrates.  No conundrum there.

  • Kirk

    9/12/2012 6:58:44 PM |

    Couldn't you also keep your blood sugar low through a lot of exercise (if you're so inclined)?  60g of complex carbs going into a sedentary person with 50% bodyfat is going to have a different effect than the same 60g going into a sub-3 hour marathon runner.

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