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Self Care Pharmacy Blog

Archive for October, 2015

 

Goodnight, Sleep Tight, Make Sure Your Blood Pressure is Right

Friday, October 30th, 2015

By: AJ OliverMoon_by_Adam_Cebula

Take a quick moment to think about your typical nightly routine. It most likely includes actions such as washing your face, showering, brushing your teeth or setting aside your outfit for the next day. If you are someone who has been diagnosed with high blood pressure (hypertension), adding the task of taking your medication may prove more beneficial to your health. In 2011, a new study reported by Harvard Health Publications claimed that taking your daily blood pressure medications at night will help lower the reading in those diagnosed with high blood pressure.1 Although that sounds like a no brainer, it is important to note that those not diagnosed with hypertension experience blood pressure readings that alternate based on the time of day. Getting out of bed is the hardest part of the day but once you do get out of bed, blood pressure rises. Before you start getting scared that your blood pressure will reach sky high before you start eating lunch, do not worry because your blood pressure will remain steady. Guess when your blood pressure will be at its lowest? Yep, you guessed it – it is lowest at night, usually between midnight and three or four o’ clock in the afternoon.1 This phenomenon is called “dipping”. However, people with high blood pressure experience “non-dipping,” meaning their blood pressure does not decrease at night – making the finding above important.2

Unfortunately, the same hormone that contributes to hypertension also increases the release of sugars from the liver and lowers insulin sensitivity.2 The combination causes an increase of risk for Type 2 diabetes in those who have hypertension. This was investigated in a study published in the Journal of Human Hypertension.3  In the study of 2,012 people with high blood pressure, half of the participants were instructed to take their blood pressure medications at night while the other half were instructed to take these medications in the morning.4 They monitored the participants for six years over which time 171 of the participants developed Type 2 diabetes.2 The researchers found that the half who took the blood pressure medications at night before going to bed had lowered their blood pressure more than those who took it in the morning.4 Additionally, these same participants also had a 57 percent lower risk for diabetes. Therefore, study authors concluded that taking a blood pressure medication before going to bed could benefit those who have hypertension by lowering blood pressure readings at night and decrease the risk of developing diabetes.1 However, with these studies there is a point that is important to note. Authors found that some older participants taking their blood pressure medications at night had critically low readings in the morning when trying to rise out of bed causing an increased risk of falls.1

Considering the evidence, taking blood pressure medication at night appears to be effective for improvement in blood pressure and risk of diabetes. However, it is necessary to take the proper precautions before starting blood pressure medications at night. Contact your doctor and pharmacist to see if you are suitable for taking blood pressure medications at night. Also, make sure that you use the same methods as you would use if you were to take these medications during the day. For instance, be sure to make a list of all the blood pressure medications taken.5 Also, try to get a good understanding of the side effects of your medications, not all blood pressure medications should be taken at night. For example, blood pressure medications like hydrochlorothiazide and Lasix are within a class of medications called diuretics.6 One of the side effects of diuretics is an increase in the volume of urine, which may result in multiple trips to the bathroom throughout the night.  For the medications you do take at night, make it a routine to take it at the same time every day.5 Do not alternate between taking the medications at night and during the day. Finally, keep your doctor informed and get your blood pressure checked regularly. If your primary care physician says you are good to go for taking your blood pressure medications at night then get to it! This may be a hard change and a lot to keep in mind. What are some ways to remind yourself to take these medications at the same time every night as well as reminding yourself to check your blood pressure? Do you think that taking blood pressure medication at night would be helpful for you?

References:

  1. LeWine H. Taking blood pressure pills at bedtime may prevent more heart attacks, strokes. Harvard Health Publications. October 25, 2011. http://www.health.harvard.edu/blog/taking-blood-pressure-pills-at-bedtime-may-prevent-more-heart-attacks-strokes-201110253668. Accessed October 29, 2015.
  2. Thompson D. Timing your blood pressure med right might prevent diabetes. News & View. September 24, 2015. http://news.health.com/2015/09/24/taking-blood-pressure-drugs-at-night-may-help-prevent-type-2-diabetes/. Accessed October 29, 2015.
  3. Hermida RC, Ayala DE, Mojón A, Smolensky MH, Portaluppi F, Fernández,J.R. Sleep-time ambulatory blood pressure as a novel therapeutic target for cardiovascular risk reduction. J Hum Hypertens. 2014;28(10):567-574. Accessed October 29, 2015.
  4. Bakalar N. Hypertension drugs may be more effective if taken at night. Well. October 2, 2015. http://well.blogs.nytimes.com/2015/10/02/hypertension-medicines-are-best-taken-at-night/?ref=health&_r=1. Accessed October 29, 2015.
  5. Web M. D. Taking high blood pressure drugs properly. http://www.webmd.com/hypertension-high-blood-pressure/how-take-blood-pressure-medicine-properly-why-you-should. Accessed October 29, 2015.
  6. Drugs.com. Diuretics. http://www.drugs.com/drug-class/diuretics.html.

Darker Isn’t Always Better

Thursday, October 29th, 2015

By: Maame Debrah-Pinamang, PharmD Student

ChocolateFor years, the scientific world has been shouting to the masses about the benefits of eating dark chocolate. The health benefits of dark chocolate have been extensively studied to provide us with the knowledge that habitual consumption of dark chocolate will lead to lower risk of cardiovascular disease, raise your high density lipoprotein levels (good cholesterol), as well as provide antioxidant properties to keep you looking younger, longer.1 Evidence such as this has led people to choose dark chocolate over regular milk chocolate. What if that’s not necessarily the case? Recently, there was an article stating that milk chocolate provides the same benefits of dark chocolate, as well as an increase in research on what the health benefits of dark chocolate come from, and whether the heart benefits that dark chocolate has is present in other types of chocolate.2 Besides color and taste, there is very little difference between dark and milk chocolate. Different companies include different levels of sugar and cocoa powder in their formulations, although the FDA sets standards for what cocoa levels constitute each type of chocolate. In order to be considered milk chocolate, the piece of chocolate must not contain less than 10% chocolate liquor, and at least 12% milk ingredients. For dark chocolate, the required amount of chocolate liquor is greater than or equal to 35%.3

A recent study analyzed the chocolate consumption of over 20,000 people for a period of 11 years, on average. Participants consumed a median of 4.6 grams (about 1.25 individual squares on a standard bar of Hershey’s chocolate) of chocolate per day, and had their cardiovascular health assessed.4 The data used in the first study looked at the effects on HDL and LDL with the participants self-reporting their consumption of chocolate. Participants that consumed a higher amount of chocolate had an increase in cardiovascular health, a lower body mass index (BMI), as well as lower blood pressure. However, the self-reporting of chocolate consumption leads to errors in reporting and inconsistent measurements. The study also failed to report the specific type of chocolate the participants consumed, making it difficult to pinpoint the exact cause of the reduced health risks. In order to produce a more reliable study, the researchers should have produced a specified amount of chocolate to each participant as well as recording the specific kind of chocolate.

Of the more common types of chocolate, dark chocolate is more extensively studied for the benefits that it may provide, but that kind of chocolate may be irrelevant. In a similarly conducted study in Japan, researchers gave participants 13, 19.5, and 26 grams of chocolate per day.5 Similar to the first study, those who ate more chocolate saw a greater increase in cardiovascular health. Those who ate at least 13 grams of chocolate per day found approximately 3.23 mmol/L decrease in LDL cholesterol. Some limitations of the study was that the study participants were given cocoa powder, which is not readily available to most people, as well as the cocoa powder being added to hot water, and not taken as a piece of chocolate that is easily available to all people.

In order to gain all the heart benefits of chocolate, each person should attempt to get approximately 1.5 grams of chocolate per day. Although a consistent consumption of chocolate could provide an increase in heart health, the benefits may not apply to everyone. Different health conditions may not allow for self-care with chocolate consumption. Given the results of the research, it is inconclusive that the impact of dark chocolate on heart health is greater than milk chocolate. The studies performed in the articles allow a safe assumption that either kind of chocolate would provide the same benefits.  The health benefits stemming from cocoa powder and not from the color of the chocolate allow for a greater range of chocolate that will provide heart healthy benefits. The recommended daily amount of chocolate from The Cleveland Clinic Wellness is 1.5 to 3 ounces to ensure maximum heart benefits from chocolate (Godiva sells chocolate in 1.5 ounce size).6 The small amount of chocolate provides us with right correct amount of chocolate to ensure heart health, without the excess sugar that comes with eating too much chocolate. Although it is important to take self-care measures to reduce your risk of heart disease, do not rely solely on chocolate as your cardiologist. Before beginning any self-care regimens, contact your primary care provider to ensure that the measures you are starting are safe and the best options for your needs.

 

References

  1. Kwok, C. S. et al. Habitual Chocolate Consumption and Risk of Cardiovascular Disease Among Healthy Men and Women. British Medical Journal. 2015.
  2. Wanjek, Christopher. “Even Milk Chocolate is Good for you, According to new Study” Huffington Post. June 16, 2015. Accessed October 14, 2015.
  3. Hershey’s. Types of Chocolate. Available at: http://web.archive.org/web/20090126124820/http://hersheys.com/nutrition/chocolate.asp Accessed October 28, 2015.
  4. Smit, H. J., Gaffan, E. A., Rogers, P.J. Methylxanthines are the psycho-o Kondo. pharmacologically active constituents of chocolate. 2004; (176)3-4:412-19.
  5. Baba, S, et al. Plasma LDL and HDL Cholesterol and Oxidized LDL Concentrations Are Altered in Normo- and Hypercholesterolemic Humans after Intake of Different Levels of Cocoa Powder. The Journal of Nutrition. 2007;137(6): 1436-1441.
  6. Cleveland Clinic Wellness. Eating Chocolate can be Healthy. Available at: http://www.clevelandclinicwellness.com/Promos/Pages/Chocolate.aspx#. Accessed October 28, 2015.

Sugar and Spice

Wednesday, October 28th, 2015

By: Micah Bernard800px-Ground_cinnamon

Cinnamon. What comes to mind when you hear that word? Cinnamon buns, cinnamon glazed apples, snickerdoodles? It’s no secret that cinnamon and sugar are a great pair! But is there more to the relationship between sugar and cinnamon than just the great taste?

People with pre­diabetes or type 2 diabetes must be very careful to manage blood sugar levels. This can be achieved by following a special diet, losing weight, exercising, and taking medications such as metformin. Now there is a common spice that is being investigated as a supplement to help control blood sugar. In 2013, NPR published an article stating that cinnamon can help lower blood sugar.1 But is this claim backed up by science? Researchers in the last few years have been studying the impact of cinnamon on the management of blood sugar and have had promising results.
In 2003, researchers sought to determine if cinnamon could improve blood glucose levels in people with type 2 diabetes.2 In this study of 60 people with type 2 diabetes ranging in age from 45 to 58, subjects took either a placebo or one of three amounts of cinnamon: 1, 3, or 6 grams each day. After 40 days, the results showed that cinnamon in any of the three doses helps lower blood glucose levels 18­-29%, while no significant changes were reported in the placebo groups.

Another study in 2006 of 79 diabetic patients looked at whether cinnamon extract helps improve glycemic control in patients with type 2 diabetes.3 Each person either received a capsule of 3 grams of cinnamon or a placebo three times a day for 4 months. The results showed that the reduction in fasting blood glucose levels in the patients receiving cinnamon (10.3%), was significantly greater than in the control group, who had a reduction of only 3.4%. However, no significant differences were seen in hemoglobin A1c, which is an indicator of average blood sugar levels over the past three months.

A recent study that ran statistical tests on data from ten randomized controlled trials studying cinnamon’s effect on blood glucose found that cinnamon decreased fasting blood glucose levels by 24.59 mg/dl.4 There was no significant difference in the patients’ hemoglobin A1c. The study was unable to determine what the optimal dose of cinnamon or duration of treatment; this is an area where further research is needed.

How does cinnamon do it? Researchers do not fully know how cinnamon works, but they believe it may increase the body’s levels of and sensitivity to insulin, the hormone that helps your cells take sugar out of the blood stream, thereby lowering blood sugar levels.5 In addition, cinnamon may slow the emptying of the stomach, so there is less of a spike of sugar in the bloodstream.6 There is debate among researchers about what dose of cinnamon should be used to manage blood sugar.

As with any supplement, it is important to check with your doctor before adding cinnamon to your diet. If, after talking to your doctor, you decide to see if cinnamon works for you, it is important to choose the right kind of cinnamon. Cinnamon comes in two varieties, Cassia and Ceylon. Cassia is the more common type found in many supermarkets, however in higher doses, such as those used to control blood sugar, coumarin isolates (not to be confused with the blood thinner Coumadin) found in cinnamon can cause liver damage.1 The Ceylon variety of cinnamon has only trace amounts coumarin isolates, making it safer for the liver.7 So, if you plan to supplement your blood sugar management with cinnamon, ask a pharmacist to help you correctly select the Ceylon variety.

While researchers still do not fully agree on the effectiveness of cinnamon as a supplement for controlling blood sugar in type 2 diabetics and pre­diabetics, many recent studies show promising results. The effects of cinnamon may not be enough to replace a drug intended to control blood sugar, but those with pre­diabetes or diabetes may find it a useful supplement to help manage their condition.

What are your thoughts on using a natural supplement to manage a health condition?

Sources:

1. Aubrey A. Cinnamon Can Help Lower Blood Sugar, But One Variety May Be Best. NPR 2013. Accessed October 15, 2015.
2. Khan A, Safdar M, Ali khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003;26(12):3215­8.
3. Mang B, Wolters M, Schmitt B, et al. Effects of a cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest. 2006;36(5):340­4.
4. Allen RW, Schwartzman E, Baker WL, Coleman CI, Phung OJ. Cinnamon use in type 2 diabetes: an updated systematic review and meta­analysis. Ann Fam Med. 2013;11(5):452­9.
5. Kaiser C. Cinnamon’s Effect in Diabetes Uncertain. Cinnamon’s Ef ect in Diabetes Uncertain 2013. Accessed 2015.
6. Hlebowicz J, Darwiche G, Björgell O, Almér LO. Effect of cinnamon on postprandial blood glucose, gastric emptying, and satiety in healthy subjects. Am J Clin Nutr. 2007;85(6):1552­6.
7. Johannes L. Little Bit of Spice for Health, but Which One? WSJ 2013. Accessed 2015.

A Natural Approach to Preventing Gestational Diabetes

Monday, October 26th, 2015
image courtesy of freedigitalphotos.net

By Katie Woodward, PharmD Student

You are having a new baby! Congratulations! You’ve probably already had several opportunities to answer that age-old question, “What gender are you hoping for?” And it is likely you responded with something like, “I don’t care as long as my baby is healthy!” Thanks to new scientific research, your chances of delivering a healthy baby are constantly improving.

We are going to play a quick game of “Bad News/Good News.” The bad news: gestational diabetes may cause complications in your pregnancy. Several factors may put you at risk of developing gestational diabetes. If diabetes runs in your family, if you are overweight, not very active, or over the age of 40 you are at risk of developing gestational diabetes.1 Gestational diabetes can cause jaundice, high birth weight, trauma during birth, increase necessity for C-section, and increase likelihood of obesity or diabetes in the child.1,2 Gestational diabetes also puts a new mother at risk of developing Type 2 Diabetes, which can require insulin injections and other treatments to control.

Now, for the good news: new research has demonstrated that myo-inositol is a supplement you can take which significantly decreases your chances of developing gestational diabetes, even if you are at high-risk.3 For those already diagnosed with gestational diabetes, taking a myo-inositol supplement can help decrease your need for insulin, make you more likely to carry the baby to term, and decrease your infant’s chances of developing hypoglycemia.3 Standard treatment for gestational diabetes requires the patient to check blood sugar levels in the morning and after meals, which can require several needle sticks per day as well as the purchase of a glucometer, test strips, and lancets.4 Insulin injections are also used to help control the blood sugar in up to 20% of women with gestational diabetes.4

A research study published in the Journal of Maternal-Fetal and Neonatal Medicine was designed as a prospective, double-blind, randomized controlled clinical trial which compared a placebo group to a group of mothers who supplemented with myo-inositol twice daily.3 The myo-inositol group had significantly better outcomes including lower maternal BMI, longer gestation at the time of delivery, and decreased abnormal oral glucose tolerance test results. The oral glucose tolerance test is the standard screening measure for gestational diabetes.  One limitation was that the study was relatively small. Some of the data may have been statistically significant if there had been more women involved in the study; for instance, the myo-inositol group had a lower incidence of neonatal hypoglycemia, but the data was not quite strong enough to be statistically significant. Another interesting statistic is that 21% of women in the placebo group required insulin therapy, while only 3% of women in the myo-inositol group required insulin therapy. While larger studies may be needed to validate this data, this study demonstrated that at least 50% of women who take myo-inositol may benefit from the treatment.3 Since the current standard of care for prevention of gestation diabetes is diet change and monitoring blood sugar, myo-inositol may be an easy and beneficial way to minimize complications from gestational diabetes.  It also has a promising potential to minimize the requirement of insulin injections.

Since it is a compound naturally found in both your body and your baby’s body, you can safely consume myo-inositol supplements.5 The product may be a little bit difficult to find in grocery stores, but it can be found in combination products or ordered online. According to research, the supplement is best if taken 2000 mg twice daily (make sure you separate the doses by at least six hours.)One product can be purchased from Fairhaven Health6 where you can get a 60-day supply for less than $20.* Myo-inositol is often combined with another compound called D-chiro inositol, which has also been demonstrated to assist with gestational diabetes.7 The combination product is called Ovasitol and it can be purchased online from Theralogix Nutritional Science Company, but it must be ordered online and can cost up to $1 per day ($90 for a 90 day supply.)8 Another product to consider is called Sensitol, and it contains D-chrio inositol, myo-inositol, and alpha lipoic acid. The product can be ordered online and a thirty day supply is $52.9

Gestational diabetes can have some scary consequences for you and your baby. Based on the evidence, I would recommend that any mother who has increased risk of gestational diabetes should discuss supplementation with myo-inositol with their medical provider.   It could help prevent or minimize problems associated with gestational diabetes. Myo-inositol may be expensive and may not be easily accessible to all; since it is commonly used as a preventative supplement, do you think that pregnant women at high risk for developing gestational diabetes should consider it as an option?

*The manufacturer suggests that the drug be taken four times daily, but in studies, the 2000 mg dose was only recommended twice daily.3 Also, this will help decrease the cost of the drug.

**Note: The Cochrane Collaboration is working on a new study to further describe the dosing and efficacy of myo-inositol as a treatment/ prevention method for gestational diabetes and it should be released soon.

References

  1. Available at: http://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2014. Accessed October 14, 2015.
  2. Brown J. Myo-inositol for preventing gestational diabetes. Cochrane Database Of Systematic Reviews [serial online]. February 2, 2015;(2)Available from: Cochrane Database of Systematic Reviews, Ipswich, MA. Accessed October 11, 2015.
  3. Matarrelli B, Vitacolonna E, Celentano C, et al. Effect of dietary myo-inositol supplementation in pregnancy on the incidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial. The Journal Of Maternal-Fetal & Neonatal Medicine: The Official Journal Of The European Association Of Perinatal Medicine, The Federation Of Asia And Oceania Perinatal Societies, The International Society Of Perinatal Obstetricians [serial online]. July 2013;26(10):967-972. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 11, 2015
  4. Available at: http://www.mayoclinic.org/diseases-conditions/gestational-diabetes/basics/treatment/con-20014854. Accessed October 21, 2015.
  5. D’Anna R, Scilipoti A, Di Benedetto A, et al. myo-Inositol supplementation and onset of gestational diabetes mellitus in pregnant women with a family history of type 2 diabetes: a prospective, randomized, placebo-controlled study. Diabetes Care [serial online]. April 2013;36(4):854-857. Available from: MEDLINE, Ipswich, MA. Accessed October 11, 2015.
  6. Available at: http://www.fairhavenhealth.com/myo-inositol.html?cmp=bing&kw=myo-inositol&utm_source=BingShopping&utm_medium=CSE&utm_campaign=myo-inositol. Accessed October 14, 2015.
  7. Costantino D, Guaraldi C. [Role of D-chiro-inositol in glucidic metabolism alterations during pregnancy]. Minerva Ginecol. 2014;66(3):281-91.
  8. Available at: http://www.theralogix.com/index.cfm?fa=products.ovasitol.default&dvsn=reprohealth. Accessed October 14, 2015.
  9. Available at: http://catalog.designsforhealth.com/Sensitol?quantity=1. Accessed October 21, 2015.

Could your phone be used for more than games?

Friday, October 16th, 2015

By: Abigail Savino

Nowadays, it seems as if everyone has a cell phone – from kids to our grandparents, they are commonplace.  So why not design an application for the phone that could help improve our health? There are fitness tracking apps and calorie counting apps that are designed to help develop healthy lifestyles, but some suggest using text messages as forms of encouragement.1 One research study tested out the power of a text message in helping people become healthier over a period of six months.256px-Texting_closeup

Researchers from Sydney, Australia studied the effectiveness of text messaging on health in patients with coronary heart disease, a cardiovascular disease where plaque builds up in the arteries slowing the flow of blood to the heart.2,3 One group of patients received a typical intervention such as modifying diet and exercise at the suggestion of their doctor.3 The other group received four text messages each week providing advice, encouragement, and support for lifestyle changes. Text messages that the participants received were selected from a bank catered to the participant’s chronic condition. Participants who were smokers received a message similar to: “Try identifying triggers that make you want a cigarette and plan to avoid them.” Those who were trying a modified dietary approach received messages such as: “Try avoiding adding salt
to your foods by using other spices or herbs.” Others told to increase physical activity received messages like: “Don’t forget physical activity is good for you! It reduces your risk of diabetes, heart attack, stroke, and their complications.” Investigators also sent texts containing information about the cardiovascular system, for example, “Studies show that stress…can increase the risk of heart disease. Please talk to a health professional if you need help.”

The primary outcome of the study was to determine the text messaging effect on cholesterol levels. After six months, the participants who partook in the text messaging intervention had an average LDL cholesterol level of 79 mg/dL which was lower than the typical intervention group who had an average of 84 mg/dL.3 The study also monitored blood pressure, body mass index (BMI), active smokers, and physical activity levels.4 These were all positively affected by the intervention – average blood pressure for the text message intervention group was 128/81 vs 136/84 for control, BMI was lower at 29 vs 30.3, and more physical activity was completed at 936.1 minutes per week compared to 642.7 minutes per week. The study also started off with 184 smokers in the text message intervention group and ended with only 88 people still smoking. Since cardiovascular disease can be managed by lifestyle changes (diet, smoking, physical activity), it is significant that the text messages focused on those areas and help explain why these results were observed.2 One limitation to the study is the small scale, which may not allow representation of the full effect of clinical outcomes. This study was conducted through a hospital facility so it is not known how generalizable this will be to the overall population. Additionally, the messages were only sent in English excluding non-English speakers, the final results were recorded through self-reporting, cost-effectiveness of the intervention was not studied, and the study was not completely blinded.

Similar ideas have been popping up in other places in healthcare. Medicaid uses this system to give more individualized attention to their patients.5 They do this by sending appointment reminders, medication reminders, and also educational material that relates to them specifically.5 Also a study has been done with patients that have had a stroke in which the text messages were sent to remind them to take their medications, dietary and lifestyle changes, and to be in contact with a health care provider.6 This study increased appointment and medication adherence by 40%.5

Data from the research study above shows that text messaging could help to improve your health, and almost everyone has a phone so your motivation comes straight to your fingertips. If your doctor recommends you to be a part of a program like this then I suggest you strongly consider becoming a participant. If you don’t think a typical intervention approach is going to benefit your health, using this text message system could help to improve your health on your own time. It is great that they send little reminders to help motivate and remind you why it is important to follow through. Participating in something similar to this would be beneficial to improve your health as a whole. With today’s technology, this will likely become a bigger thing in the near future. Would you be willing to try using text messages as encouragement or as reminders? I know I would, everyone needs a little bit of motivation to get the ball rolling with whatever you are battling.

 

References

  1. Macfarlane S. Can A Simple Text Lower Your Cholesterol?. Diabetes Insider. 2015. Available at: http://diabetesinsider.com/can-a-simple-text-lower-your-cholesterol/39648. Accessed September 29, 2015.
  2. Heart.org. What is Cardiovascular Disease? 2015. Available at: http://www.heart.org/HEARTORG/Caregiver/Resources/WhatisCardiovascularDisease/What-is-Cardiovascular-Disease_UCM_301852_Article.jsp. Accessed October 1, 2015.
  3. Chow CK, Redfern J, Hillis GS, et al. Effect of lifestyle-focused text messaging on risk factor modification in patients with coronary heart disease: A randomized clinical trial. JAMA. 2015;314(12):1255-1263.
  4. University Herald. Texting Patients Could Lower Cholesterol, Blood Pressure. 2015. Available at: http://www.universityherald.com/articles/23954/20150923/texting-patients-could-lower-cholesterol-blood-pressure.htm. Accessed September 30, 2015.
  5. Comstock J. RCT: Text message-based program boosts adherence to appointments, medication | MobiHealthNews. Mobihealthnewscom. 2014. Available at: http://mobihealthnews.com/34749/rct-text-message-based-program-boosts-adherence-to-appointments-medication/. Accessed September 29, 2015.
  6. 6. Kamal A, Shaikh Q, Pasha O et al. Improving medication adherence in stroke patients through Short Text Messages (SMS4Stroke)-study protocol for a randomized, controlled trial. BMC Neurology. 2015;15(1). doi:10.1186/s12883-015-0413-2.

Skipping Breakfast: Do the Benefits “Outweigh” the Risks?

Friday, October 16th, 2015

By Vineeta Rao, PharmD Student Cedarville University

You have heard the concept all over the news and social media: Skipping breakfast leads to weight gain. Nutritionists and researchers have long speculated that when one skips breakfast, his hunger and lack of energy will cause a rebound-effect in which he will consume more calories by snacking than he would have if he had eaten breakfast.2 But a recent study published by the American Journal of Clinical Nutrition has found that when men and women skip breakfast, they actually consume far fewer calories compared to the days when they do eat breakfast.1

Breakfastpic

In this traditional crossover study, participants were allowed to eat as they pleased and report their own eating habits to the study investigators. Investigators consulted the same patients on various occasions to obtain a report of how many meals they had eaten, what they had eaten for each meal, and what time of day they had eaten. Then, investigators examined each person’s data individually; they compared the participant’s calorie intake on the days when he or she ate breakfast to a day when he or she did not eat breakfast. Researchers also included any snacking between meals in the total calorie count. On average, men in the study consumed 247 kcal more on a breakfast day than a non-breakfast day, and women consumed 187 kcal more on a breakfast day than on a non-breakfast day.1 Apparently, snacking was not enough to make up the calories lost from skipping breakfast! If participants regularly ate a few hundred fewer calories a day, then over time, breakfast skipping actually led to weight loss rather than weight gain.

Overall, the participant’s choices in food were similar between breakfast days and non-breakfast days, with breakfast days containing more whole grains, fruits, and dairy.1 One limitation of this study is that participants reported their own diet choices.1 Thus, if a patient forgot to report a snack item, the calorie deficit calculated above would not be correct. Additionally, participants tend to change their food choices when they know that they are being monitored.

Researchers all over the world cannot seem to agree on this matter. Skipping breakfast goes against the current standard of care, but it shows compelling evidence that it may actually assist in weight loss. Although many researchers have suspected that skipping breakfast will cause people to snack more frequently and to choose unhealthy snacks that lead to weight gain, very few research studies have shown this to be true. For example, one study that expected this to be true examined the effects of skipping breakfast in children in Taiwan and did not find any connections between skipping breakfast and obesity.2

So, does this mean that we should encourage breakfast skipping as a weight-loss strategy? An editorial response to this research study says yes! Because obesity and weight gain is associated with risks for chronic diseases such as heart disease, high blood pressure, diabetes, and stroke, getting rid of this small but significant calorie intake could help to prevent such diseases.3

However, other researchers are not convinced. The study in Taiwanese children found that breakfast-skipping may not be suitable for all people. For example, this study found that children who ate breakfast regularly had better cognitive ability and academic performance than children who did not eat breakfast regularly.2

Additionally, some research studies have shown that skipping breakfast can actually increase the risk of developing Type II diabetes by decreasing insulin tolerance and raising blood sugar. When three universities in China examined the risk factors that lead to Type II diabetic patients’ condition, they found skipping breakfast was associated with an increased risk for the disease.4

So what can we learn from all these findings? In short, skipping breakfast does not appear to lead to weight gain, but the current research on other health risks and benefits of skipping breakfast is controversial. You most likely won’t have to worry about gaining weight from missing breakfast now and then due to a busy schedule, but the research is too gray to conclude that skipping breakfast is safe and healthy for everyone. One fact that remains true across all these studies is that the quality of the food you eat matters. Whether you eat breakfast or not, it is important to eat a balanced diet with whole foods, good sources of protein, and a focus on non-starchy vegetables. Nutrient-rich diets are important in healthy weight management and prevention of disease states.5

What do you think? Does the benefit of weight loss “outweigh” the possibility of potentially contributing to the development of chronic diseases?

References:

  1. Kant AK, Graubard BI. Within-person comparison of eating behaviors, time of eating, and dietary intake on days with and without breakfast: NHANES 2005-2010. Am J Clin Nutr. 2015;102(3):661-70.
  2. Ho C, Huang Y, Lo YC, Wahlqvist ML, Lee M. Breakfast is associated with the metabolic syndrome and school performance among taiwanese children. Res Dev Disabil. 2015;43–44:179-188.
  3. Levitsky DA. Breaking the feast. Am J Clin Nutr. 2015;102(3):531-2.
  4. Bi H, Gan Y, Yang C, Chen Y, Tong X, Lu Z. Breakfast skipping and the risk of type 2 diabetes: a meta-analysis of observational studies. Public Health Nutr. 2015:1-7.
  5. United States Department of Agriculture. Scientific Report of Dietary Guidelines 2015 Advisory Committee. <http://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf>