Breakfast Time!

In yesterday’s newsletter, we asked you for your health-related opinions on the timings of meals.

But what does the science say?

Quick recap on intermittent fasting first:

Today’s article will rely somewhat on at least a basic knowledge of intermittent fasting, what it is, and how and why it works.

Armed with that knowledge, we can look at when it is good to break the fast (i.e. breakfast) and when it is good to begin the fast (i.e. eat the last meal of the day).

So, if you’d like a quick refresher on intermittent fasting, here it is:

Intermittent Fasting: We Sort The Science From The Hype

And now, onwards!

One should eat breakfast first thing: True or False?

True! Give or take one’s definition of “first thing”. We did a main feature about this previously, and you can read a lot about the science of it, and see links to studies:

The Circadian Rhythm: Far More Than Most People Know

In case you don’t have time to read that now, we’ll summarize the most relevant-to-today’s-article conclusion:

The optimal time to breakfast is around 10am (this is based on getting sunlight around 8:30am, so adjust if this is different for you)

It doesn’t matter when we eat; calories are calories & nutrients are nutrients: True or False?

Broadly False, for practical purposes. Because, indeed calories are calories and nutrients are nutrients at any hour, but the body will do different things with them depending on where we are in the circadian cycle.

For example, this study in the Journal of Nutrition found…

❝Our results suggest that in relatively healthy adults, eating less frequently, no snacking, consuming breakfast, and eating the largest meal in the morning may be effective methods for preventing long-term weight gain.

Eating breakfast and lunch 5-6 h apart and making the overnight fast last 18-19 h may be a useful practical strategy.❞

~ Dr. Hana Kahleova et al.

Read in full: Meal Frequency and Timing Are Associated with Changes in Body Mass Index

We should avoid eating too late at night: True or False?

False per se, True in the context of the above. Allow us to clarify:

There is nothing inherently bad about eating late at night; there is no “bonus calorie happy hour” before bed.

However…

If we are eating late at night, that makes it difficult to breakfast in the morning (as is ideal) and still maintain a >16hr fasting window as is optimal, per:

❝the effects of the main forms of fasting, activating the metabolic switch from glucose to fat and ketones (G-to-K), starting 12-16 h after cessation or strong reduction of food intake❞

~ Dr. Françoise Wilhelmi de Toledo et al.

Read in full: Unravelling the health effects of fasting: a long road from obesity treatment to healthy life span increase and improved cognition

So in other words: since the benefits of intermittent fasting start at 12 hours into the fast, you’re not going to get them if you’re breakfasting at 10am and also eating in the evening.

Summary:

• It is best to eat breakfast around 10am, generally (ideally after some sunlight and exercise)
• While there’s nothing wrong with eating in the evening per se, doing so means that a 10am breakfast will eliminate any fasting benefits you might otherwise get
• If a “one meal a day, and that meal is breakfast” lifestyle doesn’t suit you, then one possible good compromise is to have a large breakfast, and then a smaller meal in the late afternoon / early evening.

One last tip: the above is good, science-based information. Use it (or don’t), as you see fit. We’re not the boss of you:

• Maybe you care most about getting the best circadian rhythm benefits, in which case, prioritizing breakfast being a) in the morning and b) the largest meal of the day, is key
• Maybe you care most about getting the best intermittent fasting benefits, in which case, for many people’s lifestyle, a fine option is skipping eating in the morning, and having one meal in the late afternoon / early evening.

Take care!

Cannabis Myths vs Reality

We asked you for your (health-related) opinion on cannabis use—specifically, the kind with psychoactive THC, not just CBD. We got the above-pictured, below-described, spread of responses:

• A little over a third of you voted for “It’s a great way to relax, without most of the dangers of alcohol”.
• A little under a third of you voted for “It may have some medical uses, but recreational use is best avoided”.
• About a quarter of you voted for “The negative health effects outweigh the possible benefits”
• Three of you voted for “It is the gateway to a life of drug-induced stupor and potentially worse”

So, what does the science say?

A quick legal note first: we’re a health science publication, and are writing from that perspective. We do not know your location, much less your local laws and regulations, and so cannot comment on such. Please check your own local laws and regulations in that regard.

Cannabis use can cause serious health problems: True or False?

True. Whether the risks outweigh the benefits is a personal and subjective matter (for example, a person using it to mitigate the pain of late stage cancer is probably unconcerned with many other potential risks), but what’s objectively true is that it can cause serious health problems.

One subscriber who voted for “The negative health effects outweigh the possible benefits” wrote:

❝At a bare minimum, you are ingesting SMOKE into your lungs!! Everyone SEEMS TO BE against smoking cigarettes, but cannabis smoking is OK?? Lung cancer comes in many forms.❞

Of course, that is assuming smoking cannabis, and not consuming it as an edible. But, what does the science say on smoking it, and lung cancer?

There’s a lot less research about this when it comes to cannabis, compared to tobacco. But, there is some:

❝Results from our pooled analyses provide little evidence for an increased risk of lung cancer among habitual or long-term cannabis smokers, although the possibility of potential adverse effect for heavy consumption cannot be excluded.❞

Read: Cannabis smoking and lung cancer risk: Pooled analysis in the International Lung Cancer Consortium

Another study agreed there appears to be no association with lung cancer, but that there are other lung diseases to consider, such as bronchitis and COPD:

❝Smoking cannabis is associated with symptoms of chronic bronchitis, and there may be a modest association with the development of chronic obstructive pulmonary disease. Current evidence does not suggest an association with lung cancer.❞

Read: Cannabis Use, Lung Cancer, and Related Issues

Cannabis edibles are much safer than smoking cannabis: True or False?

Broadly True, with an important caveat.

One subscriber who selected “It may have some medical uses, but recreational use is best avoided”, wrote:

❝I’ve been taking cannabis gummies for fibromyalgia. I don’t know if they’re helping but they’re not doing any harm. You cannot overdose you don’t become addicted.❞

Firstly, of course consuming edibles (rather than inhaling cannabis) eliminates the smoke-related risk factors we discussed above. However, other risks remain, including the much greater ease of accidentally overdosing.

❝Visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected.❞

Note: that “more frequent” for inhaled cannabis, is because more people inhale it than eat it. If we adjust the numbers to control for how much less often people eat it, suddenly we see that the numbers of hospital admissions are disproportionately high for edibles, compared to inhaled cannabis.

Or, as the study author put it:

❝There are more adverse drug events associated on a milligram per milligram basis of THC when it comes in form of edibles versus an inhaled cannabis. If 1,000 people smoked pot and 1,000 people at the same dose in an edible, then more people would have more adverse drug events from edible cannabis.❞

See the numbers: Acute Illness Associated With Cannabis Use, by Route of Exposure

Why does this happen?

• It’s often because edibles take longer to take effect, so someone thinks “this isn’t very strong” and has more.
• It’s also sometimes because someone errantly eats someone else’s edibles, not realising what they are.
• It’s sometimes a combination of the above problems: a person who is now high, may simply forget and/or make a bad decision when it comes to eating more.

On the other hand, that doesn’t mean inhaling it is necessarily safer. As well as the pulmonary issues we discussed previously, inhaling cannabis has a higher risk of cannabinoid hyperemesis syndrome (and the resultant cyclic vomiting that’s difficult to treat).

You can read about this fascinating condition that’s sometimes informally called “scromiting”, a portmanteau of screaming and vomiting:

Cannabinoid Hyperemesis Syndrome

You can’t get addicted to cannabis: True or False?

False. However, it is fair to say that the likelihood of developing a substance abuse disorder is lower than for alcohol, and much lower than for nicotine.

See: Prevalence of Marijuana Use Disorders in the United States Between 2001–2002 and 2012–2013

If you prefer just the stats without the science, here’s the CDC’s rendering of that:

Addiction (Marijuana or Cannabis Use Disorder)

However, there is an interesting complicating factor, which is age. One is 4–7 times more likely to develop a substance abuse disorder, if one starts use as an adolescent, rather than later in life:

See: Likelihood of developing an alcohol and cannabis use disorder during youth: Association with recent use and age

Cannabis is the gateway to use of more dangerous drugs: True or False?

False, generally speaking. Of course, for any population there will be some outliers, but there appears to be no meaningful causal relation between cannabis use and other substance use:

Is marijuana really a gateway drug? A nationally representative test of the marijuana gateway hypothesis using a propensity score matching design

Interestingly, the strongest association (where any existed at all) was between cannabis use and opioid use. However, rather than this being a matter of cannabis use being a gateway to opioid use, it seems more likely that this is a matter of people looking to both for the same purpose: pain relief.

As a result, growing accessibility of cannabis may actually reduce opioid problems:

• Cannabis as a Gateway Drug for Opioid Use Disorder
• Association between medical cannabis laws and opioid overdose mortality has reversed over time

Some final words…

Cannabis is a complex drug with complex mechanisms and complex health considerations, and research is mostly quite young, due to its historic illegality seriously cramping science by reducing sample sizes to negligible. Simply put, there’s a lot we still don’t know.

Also, we covered some important topics today, but there were others we didn’t have time to cover, such as the other potential psychological benefits—and risks. Likely we’ll revisit those another day.

Lastly, while we’ve covered a bunch of risks today, those of you who said it has fewer and lesser risks than alcohol are quite right—the only reason we couldn’t focus on that more, is because to talk about all the risks of alcohol would make this feature many times longer!

Meanwhile, whether you partake or not, stay safe and stay well.