What breakfast makes you live longer?

What breakfast makes you live longer?

What does it mean to make healthy lifestyle choices? For example, although many Spaniards eat sweet cakes for breakfast, the country’s life expectancy is one of the highest in Europe. Does a long healthy life depend on healthy choices, or on resilience?

During my last holiday in Spain, we visited old friends close to Madrid. Unfortunately, my 1-year-old son had to spend two nights in hospital. It turned out to be nothing life-threatening, and medical care was good, so my worries were soon tempered. However, on the first morning in hospital, my concerns shifted from the health of my son to the health of the Spanish population. While I expected the hospital to serve a nutritious breakfast, they actually gave the children chocolate milk and Maria biscuits. I was quite amazed. Did they not know about the “breakfast guidelines”, suggesting a meal with whole grains, fruit and a skimmed dairy product? I soon learned from my friend that sweet cakes are in fact a staple breakfast for many Spanish. I figured that a nation that starts the day with so much sugar is probably not very healthy.

(Healthy) life expectancy compared

I started thinking about other Spanish living habits, such as their late bed-time and regular wine consumption. I assumed these habits would affect their life expectancy, and so, once home, I started searching for numbers to compare Dutch and Spanish (healthy) life expectancy. I was again surprised:

The Spanish have a slightly higher average life expectancy than the Dutch: 83.4 versus 81.8. Even more surprisingly, their healthy life expectancy is much higher, especially for women: Spanish women versus Dutch women: 66.5 vs 57.8; Spanish men versus Dutch men: 65.9 vs 62.8.

What can explain this gap in healthy life expectancy?

European measurements

Since 2004 the same method for calculating healthy life expectancy has been used all over Europe. Still, comparing healthy life expectancy between countries calls for caution. The method that defines whether a person is in good health is based on the subjective question: For at least the past six months, to what extent have you been limited because of a health problem in activities people usually do? Severely limited; limited, but not severely; not limited at all”. After translation into the local language, this question might be interpreted slightly different across countries. Also, local culture might influence what is labelled as “activities people usually do”, and what counts as “severely limited”. Indeed, a study that compared how this general question related to more specific questions about daily activities (essential, such as feeding oneself, versus instrumental, such as preparing the meal) found subtle differences between countries. However, a difference between Spain and the Netherlands of ~3 years for men and ~9 years for women can hardly be explained by Dutch people (especially women) complaining more (the Dutch are indeed good at complaining, but not that good).


So I compared lifestyle differences between the Netherlands and Spain that might relate to the discrepancy in healthy life expectancy. Of course, one can’t exclude every possible contributing factor, but for the obvious ones that I (and people I discussed this with) thought of, I found no major differences between the two countries (see the list below). Also, the difference doesn’t seem to be explained by environmental factors, such as air pollution (depending on measurement) or amount of sunlight (Sweden ranks highest in healthy life expectancy, making sunlight unlikely to be the defining difference). The only difference that stood out, and that many people mentioned as a possible explanation when I asked their view on this, was stress. Dutch people suffer more from work-related stress than Spaniards. Of course, stress alone cannot cause such a big difference in healthy life expectancy (and why would women suffer more from stress, for instance?), but it might be part of the explanation.

Contributing to a healthy generation

As part of my work, I am involved in a think tank set up by the Vereniging Samenwerkende Gezondheidsfondsen to devise a program for a healthier next generation. One of the core elements of the program is to increase resilience among young people, so that it’s easier for them to make healthy lifestyle decisions (healthy diet, enough sleep and relaxation, no substance use (or abuse), healthy social relations, and enough physical activity). Of course, avoiding substance abuse and taking care of your body is always a good choice. However, my search into healthy life expectancy made me wonder whether such a broad factor as resilience might actually be more important than the individual healthy choices one makes during the day. For example, being more resilient could make you less susceptible to harmful stress. Resilient people can probably allow themselves some treats, but without overindulging. Having a cookie for breakfast doesn’t mean you should eat cookies all day: finding a balance between health and (unhealthy) fun is easier when you’re more resilient.

No recipe for a long healthy life

Although the Dutch Nutrition Center prescribes whole grains and a skimmed dairy product for breakfast, apparently many Spaniards thrive on their starting the day with cookies and chocolate milk. For them, this is a habit that is probably balanced throughout the rest of the day. It is clear that the full answer to why the Spanish live so much longer, healthier lives than the Dutch is still unknown. Yet, living a (happy) healthy life may well be more about finding out what gives us mental energy: maintaining a good balance and being resilient is healthier than stressing, for example over the details of our lifestyle choices.



Sofia Goncalves

Interesting article. A couple of other factors could be contributing to the less perceived stress at work as well, for instance the 'siësta' that people have inbetween their (working)day. Besides this the mediterranean diet is considarabily healthy as compared to the Dutch one e.g. they eat fruit, vegetables, olive oil and fresh fish. So after an unhealthy breakfast, they may indeed balance it out with healty habits. From my own experience by working in Portugal there was always one hour (in some jobs two hours) to be able to have your lunch in a relaxed way and to let go of thoughts on workactivities during that time, I think this is similar in Spain.

Annelinde Vandenbroucke

Thank you for your comment! I think the siësta might indeed contribute to less stress. However, I have read that nowadays, less people actually sleep during siësta, and that the irregular hours cause difficulties with combining family life and work. But that might be a new generation issue because of the two-income households. And still, taking some time to really detach from work is probably good for your work-stress level. It's nice that you experienced this in Portugal. As for the diet, I am not sure whether it is still healthier nowadays (it used to be I believe), but the percentage obesity in Spain is higher (16% versus 13% in the Netherlands). Perhaps being obese from "healthier" food is not as bad for your health as from "unhealthy" foods, but I'm not a medical doctor, so I wouldn't know! Interesting to think about though.

Alex Broadbent

This is great. It gives me several thoughts. One is that various dietary fads may actually owe some apparent effectiveness to the fact that they just allow people to chill out a bit. E.g. "go low carb - but eat all the bacon you want!" This makes bacon-lovers happy and they stop obsessing about food. Second, it may be not so much STRESSING about food as simply THINKING about it. This might lead people to eat more. The Spaniards just eat what they want and thus don't get obsessed with it. Third, maybe there's a desire-satisfaction cycle that gets set up by deprivation and then cracking, with a net gain in calories. Fourth, anecdotally, I have in the last couple of years started following my nose a lot more in terms of what to eat: e.g. even if it's supposed to be good or at least ok to eat eggs often, I just feel like it's not, and so I don't and hey presto, I lose loads of weight. Or: I know I'm not supposed to have sugar for breakfast but I like muesli with yoghurt and plenty of honey. Again, seems not to make me fat. I know it's anecdotal, but still, I do think there's some connection with what you're saying here. Thanks for the thoughts!

Annelinde Vandenbroucke

Thank you as well! Yes, obsession with food is difficult and the phenomenon of gaining and losing weight due to overly strict diets is very well known of course. Don't overdo dieting and stick to whatever fits your individual needs seems wise. Like you say, you have specific things your body reacts to, and I think we all have that. Research often only gives averages, but nobody actually functions exactly as that average. It's difficult to find out what is best for your own body though, especially with relatively little time most people have to extensively monitor this. So I believe sticking to averages and overall healthy tips is a smart thing to do, but then finding your own "comfort food" helps you keep your balance.