 Recently, I've been eating breakfast out more often than usual because I was out of town on vacation for a few weeks, and I've also started doing breakfast appointments with a few of my clients at home. I realize that most restaurants cater to the general population rather than people on low-carb diets, but generally speaking there are plenty of great breakfast options at most dining establishments. However, I'm concerned that diners are being led to believe that a breakfast very high in carbs and sugar is the healthiest way to go. It's not just restaurants who do this, of course. The photo above? That's an image I purchased from Shutterstock entitled "Healthy Breakfast." But people are most likely to encounter this message at their favorite eateries. You may have never eaten at the restaurants whose menus are listed below, but I'm sure you'll find similar offerings and descriptions at breakfast places in your own city.    "Lighter/Healthy/Smart" Breakfast: Where's the Protein? Let's look at the third one, "The Health Nut Breakfast" under "Lighter Side," in terms of macronutrient composition. I took a conservative estimate of the amount of oatmeal at one and a half cups, 1 teaspoon of brown sugar, half a cup of low-fat milk, 2 Tablespoons raisins, a 3-ounce bran muffin and an 8-ounce (never-empty?!) glass of orange juice, then entered everything into the My Fitness Pal app. The grand total of carbohydrates for this meal is 129 grams, with 11 grams of fiber, for a net carb count of 118 grams, most of which are rapidly digested and absorbed into the bloodstream. On the other hand, the protein content for this meal is only 15 grams, primarily from grains, which are considered an inferior source of protein compared to the type found in animals, including eggs, dairy, and meat. Compare this to a meal of three pancakes with a quarter cup of syrup, and you'll see that the amount of net carbohydrates and protein is very similar. In my opinion, advertising the three meals above as being the best choices on the menu for the health conscious is very misleading. If someone wants to have waffles at the Waffle House and eat them with the realization that their meal isn't all that nutritious, I have no problem with that. But I do take issue with restaurants advertising carb-heavy breakfasts with juice as "healthy," because it's the people who have made a conscious decision to eat well that end up ordering them. This often results in similar high-carb meals consumed at home as well, compounding the problem. I can't count the number of people with diabetes or weight issues who have looked at me suspiciously when I've told them that their breakfast of cereal, nonfat milk, banana, and juice is exactly what they should not be starting their day with and that they'd be much better off if eating bacon and eggs instead. Begin the Day with a High-Protein Meal There have been several recent studies demonstrating the benefits of a protein-based breakfast with low to moderate carbohydrates. In one study of overweight women, those who consumed 30-40 grams of animal protein (sausage and eggs) and less than 15 grams of carbohydrate at breakfast had better satiety, lower blood glucose and insulin levels, and lower calorie intake at lunch compared to women who ate more carbohydrates and less protein in the morning (1). Studies looking at overweight children and adolescents have had similar findings with respect to high-protein breakfasts (2-3). As I stated in a previous post, getting a minimum of 25 grams of protein at each of three meals is particularly important for preventing loss of muscle mass during weight loss (4) and aging (5-6). Truly Nourishing Breakfast Options I personally think breakfast is the easiest meal for remaining low carb when dining out. It's not hard to find delicious, satiating, blood-glucose-stabilizing breakfast options -- even at restaurants whose claim to fame is pancakes or waffles -- as long as you stay away from most of the ones classified as" healthy."  Waffle House, IHOP, Bob Evans, Cracker Barrel, and other restaurants: I had a delicious very-low-carb, high-protein breakfast at the Waffle House when we visited Florida last month: poached eggs, bacon, tomato slices, and coffee with half and half -- around 7 grams of net carb for the meal. My husband tweeted about it and even got a retweet by Waffle House. Best Bets: Eggs with bacon, sausage, ham, or cottage cheese, with tomato slices on the side; or an omelette with cheese, spinach, mushrooms, chiles, bell peppers, and/or other nonstarchy vegetables. Each option provides about 10 grams digestible carbs or less for the entire breakfast* *Caution: Be careful of the scrambled eggs and omelettes at IHOP if you're watching your carbs or staying gluten free, because pancake batter is added to make them fluffy. This information is printed on the menu. Other restaurants sometimes add batter to their eggs as well, so be sure to inquire about this before ordering. Some of them may allow you to order eggs freshly made without anything added, if you ask. If they're available, you can also order a side of avocado or berries, which would further increase your meal's nutritional value yet keep net carbs fairly low.  Fine-dining restaurants typically have fantastic breakfast options, including many entrees that can easily be modified for a low-carb lifestyle. This is a lovely smoked salmon plate I ordered at the Monte Carlo Hotel in Las Vegas: smoked Pacific salmon, herbed cream cheese, capers, sliced red onion, tomatoes, and cucumbers. The only change I had to make was asking for no bagel. Again, there were less than 10 grams of net carbohydrate in the entire meal, and in addition to being delicious it was extremely nutrient dense, with omega-3 fatty acids in the salmon and several types of phytonutrients in the vegetables.  Buffets are one of the easiest and most satisfying ways to dine out for breakfast because there's usually a great variety of healthy choices, and you can control the portion sizes of each item so that you end up with a delicious, high-quality breakfast uniquely tailored to your own tastes and appetite. At left is my well-balanced breakfast from a buffet aboard a recent progressive rock music cruise (no, not the Low Carb Cruise): smoked salmon, herring, eggs with cheese and herbs, pico de gallo, and cucumbers topped with whipped cream cheese. You could also create a more traditional breakfast plate with bacon, sausage, ham, cheese or cottage cheese in place of the fish, of course.
Breakfast: In Favor of Informed Choice Again, I understand that people aren't always interested in choosing the most nourishing breakfast. Trust me, I've dined with plenty of friends and family members who fall into that camp, at least occasionally. But I object to terms like "healthy" being used to describe meals that don't deliver in terms of satiety, nourishment, or blood glucose control, and their effects on customers who order them under the assumption they're making the "best" choice. References 1. Rains TM, et al. A randomized, controlled, crossover trial to assess the acute appetitive and metabolic effects of sausage and egg-based convenience breakfast meals in overweight premenopausal women. Nutr J. 2015;14:17 2. Bauer LB, et al. A pilot study examining the effects of consuming a high-protein vs. normal-protein breakfast on free-living glycemic control in overweight/obese "breakfast skipping" adolescents. Int J Obes.(Lond). 2015 Sep;39(9):1421-4 3. Baum JI, et al. Breakfasts higher in protein increase postprandial energy expenditure, increase fat oxidation, and reduce hunger in overweight children from 8 to 12 years of age. J Nutr. 2015 Oct;145(10):2229-35 4. Soenen S, et al. Normal protein intake is required for body weight loss and weight maintenance, and elevated protein intake for additional preservation of resting energy expenditure and fat free mass. J Nutr. 2013 May;143(5):591-6 5. Paddon-Jones D, et al. Protein and healthy aging. Am J Clin Nutr. 2015 Apr 29 [Epub ahead of print] 6. Arentson-Lantz E, et al. Protein: a nutrient in focus. Appl Physiol Nutr Metab. 2015 Aug;40(8):755-61
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