Most of us probably know that we should not be haphazardly skipping meals. If you are not aware of the risks associated with that habit and glaucoma, a new study mentioned below raises serious questions.
Beyond this, the study also raises questions about intermittent fasting and glaucoma. I address both topics in this post.
This new study shows that skipping breakfast increased the risk of developing glaucoma in the (Japanese) study population.
Association between lifestyle habits and glaucoma incidence: a retrospective cohort study - PubMed
Conclusions: Moderate body mass index, having breakfast, avoiding late dinner, limiting alcohol intake to <2.5 units/day, and regular exercise were associated with a reduced risk of developing glaucoma in the Japanese population. These findings may be useful for promoting glaucoma prophylaxis.
This study contains several results that need careful consideration. For many of you, the study raises more questions than it answers -- as per comments here (Obesity, High Alcohol Intake, Skipping Meals Increases Glaucoma Risk : AskGlaucoma) and in the email discussion group.
For many people practicing intermittent fasting, the practice amounts to skipping breakfast. But is that the same definition used in the study above? No, not exactly. With intermittent fasting, you are intentionally eating with a chosen timing and frequency, and (hopefully) being consistent. In contrast, this study defined skipping breakfast as:
skip breakfast three or more times a week
That definition includes people who, for example, would normally prefer to eat breakfast but find themselves forced to skip it three or more times a week. That is not equivalent to the way most people practice intermittent fasting.
However, there is plenty of evidence (some of it stretching back quite far) implicating skipping breakfast and eating a late dinner with worse health outcomes. I appreciate the opening quote of this study:
"Eat breakfast like a king, lunch like a prince and dinner like a pauper" (Adelle Davis, 1904-1974) is a concept that appears to align with some contemporary evidence concerning the appropriate proportioning of daily meals.
For some people (not everyone), the practice of intermittent fasting amounts to skipping breakfast and eating most of their calories at the end of the day. Plenty of research shows that's not an ideal pattern (for glaucoma or any other health outcome).
Outside of cognitive fitness and neuroprotection, we have other reasons to be concerned about skipping breakfast, such as this 2013 study on heart disease.
Men who skipped breakfast had a 27% higher risk of CHD compared with men who did not
We also know that skipping meals elevates blood glucose levels and causes a delayed insulin response, both unhealthy conditions. Then we have this 2023 study that found a relationship between all-cause mortality (deaths due to all reasons) and skipping meals.
Conclusions: In this large, prospective study of US adults aged 40 years or older, eating one meal per day was associated with an increased risk of all-cause and CVD mortality. Skipping breakfast was associated with increased risk of CVD mortality, whereas skipping lunch or dinner was associated with increased risk of all-cause mortality. Among participant with three meals per day, a meal interval of ≤4.5 hours in two adjacent meals was associated with higher all-cause mortality.
These and other studies raise important questions around intermittent fasting and health. I'm not going to try to answer them all here.
However, I will offer some advice based on the lessons we can draw from many studies on the beneficial effect of dietary ketosis on neurological fitness. For optimal cognitive fitness, prevention of dementia and prevention of all types of neurodegeneration in the CNS, when we skip a meal (intentionally or not), we should be supplementing with exogenous ketones (βHB) at that time so that neurons maintain a steady supply of cellular energy. Furthermore, βHB (beta-hydroxybutyrate) reduces insulin resistance (increases insulin sensitivity) and helps balance blood glucose, both of which can be upset when we skip a meal.
I believe the evidence is sufficient to conclude that, for those of us living with glaucoma, it is not worth the risk of skipping meals without supplying our neurons with a suitable cellular energy substrate. There are a few ways to do that, but supplementing with βHB is almost certainly the best option in this situation.
βHB easily crosses the blood-brain-barrier and can provide the CNS (brain, optic nerve) with the majority of its energy needs. Ketone supplementation (e.g., βHB) improves cognitive performance in healthy individuals after a minimum of 2-3 weeks, even with no change in their habitual diet. (Ashton et al., 2021)
Beyond the context of intermittent fasting or haphazard meal skipping, I believe the combination of exogenous ketone supplements and a healthy, neuro-enhancing diet offers great potential for cognitive fitness, brain health, neuroprotection, focus, memory, attention and more. (Stay tuned for more posts on the NeuroFit Diet.)
This approach was not possible prior to the commercial availability of beta-hydroxybutyrate (βHB) supplements in recent years. The post below goes into more detail on dietary ketosis, βHB and glaucoma, and shares some history on how my thinking on this topic evolved over time:
The Best Neuronal Bioenergetic Substrate for Glaucoma - Pyruvate or BHB? | Ask FitEyes