Breakfast is crucial to good health, for all ages. But it also has to be nutritious and that's where the marketing message can lead us astray, says nutritional toxicologist Dr Peter Dingle.

A Smart Start The word breakfast simply means "breaking the fast". Since breakfast is the meal we eat after our longest period of rest it has special significance to our metabolism. Just as getting enough sleep is important to a person's performance during the day, eating a good breakfast is equally important. It provides the vital nourishment and energy we need to start and carry out our day.

In today's fast-paced society, breakfast tends to be neglected or substituted with highly processed foods stripped of nutritional goodness. This corresponds with unprecedented obesity, chronic disease and a culture of fast and busy lifestyles. The beneficial effects of breakfast include physical performance, psychological health and cognitive ability. A morning meal can decrease hunger throughout the morning resulting in less snacking. Research has also suggested that breakfast consumption is associated with lower mortality and reduced susceptibility to physical illness. In one study, people who ate breakfast every day tended to have high energy and were relaxed rather than tense. The study showed a link between breakfast habits and measures of stress and emotional distress.

Regular consumption of breakfast is associated with higher intelligence scores in primary school children through to the elderly. It improves memory and cognitive function, contributing positively to mood and mental health.

Breakfast can enhance mood through the supply of micronutrients and amino acids in the cellular biochemistry cycle. Protein is an essential building block for your body and mind. Proteins are made up of smaller units called amino acids. One essential function for amino acids is in the construction of the brain's neurotransmitters - the chemicals that tell your brain what to do. Without the right amino acids in every main meal (three meals per day) your brain does not receive the proper messages. It cannot produce serotonin, the "feel good chemical" if there is none of the amino acid tryptophan; it cannot produce dopamine, the stabilising brain chemical, if there is no tyrosine. If cysteine and methionine are not present, it can't produce taurine, the calming neurotransmitter. Without these amino acids and the right digestion in a healthy gut, your brain gets lots of mixed messages and you can experience increased incidence of chronic mental illnesses including depression, anxiety and ADHD. Another important aspect of breakfast is that because it is harder to keep an eye on the food kids eat away from home - at school or at their friends' homes - it is more important than ever for kids to have a particularly nutritious breakfast. For some children, this may be the most nutritious meal of the day, and is therefore essential to long-term health and the avoidance of chronic disease.

While eating breakfast is crucial to maintaining good health, eating the right type of food is equally important. Research and the supermarket shelves show the ubiquity of over-processed breakfast foods. Breakfast food processing has fundamentally altered seven crucial nutritional characteristics of the ancestral diet: fibre content, glycemic load, fatty acid composition, macronutrient composition, micronutrient density, acid-base balance and sodium-potassium ratio. Research has also shown that processing of cereals and bakery products may enhance their allergenic potential.

These foods are highly refined, low nutrient level cereals, and their associated high Glycemic Index (GI), salt and fat put unnecessary additional stress on the body and increase the risk of chronic disease such as obesity, diabetes and some forms of cancer.

Many processed cereals have very high sodium content, such as typical Corn Flakes with 780mg/100grams of food - about 70 times the level of oats. Sugar is also added in large amounts to many cereals, especially those aimed at the children's market. Some of these cereals may contain up to 50 per cent sugar by weight. Despite the claims made by many breakfast food companies, there is little proof that any benefit is gained from eating their processed cereals. Starting the day with a breakfast of high fat, high sodium and high sugar overloads the body with adrenaline, resulting in "poor concentration, insomnia, fluctuating "highs" and "lows", energy drops, food cravings, uneven weight, feelings of stress and inevitably, chronic life-threatening illness."1. Processed or ready-to-eat breakfast foods which are low in nutrients and high in salt, sugar and carbohydrates have been associated with obesity, heart failure, stress and mental health problems.

A largely ignored concept is that processing also destroys the nutrient value or density of the foods. Grains can lose somewhere between 51.1 per cent and 93.8 per cent of their vitamin and mineral content when they are processed. Putting back a few B vitamins does not provide a substitute for what has been removed. However, although fortification may make up for some nutrient inadequacy, the question that should be asked is why has it become a normal requirement? While fortification has benefits, under no circumstances should the fortification of foods replace real nutrition. The control of micronutrient deficiencies might seem a realisable goal, but attention should be given to why the need for food fortification has occurred in the first place.

Fortification also raises the issue of "with what" to fortify. Why is it so often limited to just a few nutrients when it is well established that many nutrients work best combined with an array of other nutrients? The breakfast cereal industry has been leading the way in misleading information for decades, making spurious and confusing claims about the health benefits of their products: misleading labelling with claims about low fat, no added sugar, no cholesterol, etcetera. Some breakfast foods may even meet these claims but many are still junk food with little or no nutritional value other than lots of calories. Most of the processed breakfast foods are no better than takeaway junk food; in fact some are even worse.

The strong vested interests in the food industry have had a major impact on what we eat for breakfast, as well as our daily nutritional requirements. The food pyramid we all grew up with was developed by Kellogg's, the grain industry and the US Department of Agriculture in the early 1950s. Sure, it has changed a little, but not enough yet to reflect what we really should be eating. The Harvard School of Public Health has issued a scathing criticism of the new food pyramid.

Despite all the evidence and in the face of global concern over chronic disease and obesity, these large multi-national companies appear to be deliberately confusing the public with "nutritional" claims. The irony of this marketing is that these companies know that many of their products have virtually no dietary fibre and no nutritional value. It appears then that the uninformed or unaware consumer (especially children) is at the losing end, while the processed breakfast food and advertising companies responsible for the deceptive and disturbingly persuasive advertisements win outright with huge profits.

Rather than taking a holistic approach to nutrition claims, manufacturers have bombarded consumers with false claims and created confusion among consumers and generated international calls for regulation of the cereal industry.

Marketers have developed a language used on packaging, which cleverly leaves consumers confused over the nutritional benefits of products. For example, "% fat free" is almost twice as common as the term "low fat" on the packages of breakfast food, noting that the quantitative term "% fat free" may be seen as more attractive to consumers. Diet-conscious consumers may fail to check that the product may be full of sugar, salt or carbohydrates, which will quickly turn to fat in their systems and may have grave health implications. Or even "no added sugar" means little as the foods rapidly convert to sugar in the mouth. Given the dearth of regulation pertaining to these statements, consumers make easy prey for misleading claims when browsing the isles of supermarkets.

In a survey of 138 cereals I carried out with my students, the total number of nutrient claims across all surveyed products totalled 398. On average, three claims on every packet. The most common claim was "Good source of iron" (66%), despite the fact that the iron is not readily absorbed. The main problem is that the most bio-available iron compounds are water-soluble and these often lead to the development of unacceptable colour and flavour changes in food.

When water-soluble compounds are added to cereal flours, they often cause rancidity and, in low-grade salt, they rapidly lead to colour formation. So the cereal manufacturers include a less soluble form but still make the claim "Good source of iron."

These problems are often exacerbated by nutritional programs placing too much emphasis on commercially processed foods, which for many social and economic reasons are not appropriate for the poor and may, in fact, be contributing to their deterioration in nutritional status. Nutrition programs and policy often place too much emphasis on low cost foods. The limitations and potential dangers of relying on commercially produced, low cost foods to reduce or eliminate malnutrition have neither been adequately investigated nor put into perspective.

My recommendations are to choose a healthy cooked breakfast which includes vegetables like tomatoes and spinach, plus mushrooms, beans, fish and eggs; or choose a porridge or muesli with nuts, seeds and oats. Oats overwhelmingly come up as the only commercial grain you should be having for breakfast, simply because they are the least processed. I also occasionally make brown rice porridge with lots of nuts and fruit.

It is only the Western countries, with the highest levels of chronic disease in the world, that eat processed food for breakfast. Let's change that and start the day smart and healthy.

Recommendations:

• Encourage Australian children to eat breakfast.
• Discourage children from eating highly processed breakfast foods often high in salt and sugar and low in total nutrients.
• Eat nutrient dense foods
• Encourage children to eat oats or other unprocessed foods for breakfast.
• Encourage children to eat a cooked breakfast.
• Ensure that children have adequate protein (amino acids) in their breakfasts.

Reference 1. Holford P. 2004. New Optimum Nutrition Bible London: Piatkus Peter Dingle is Associate Professor in Health and the Environment at Murdoch University, Perth, Western Australia