A healthy breakfast that includes high-fiber cereal can not only help keep diabetes, heart disease, and stroke at bay, it can also help you achieve and maintain a healthy weight.

Research suggests that breakfast eaters are leaner than those who skip the morning meal, with one study reporting that missing breakfast was associated with a fourfold increase in the risk of obesity. High-fiber cereals are central to breakfast's health benefits and can help you reduce the risk of heart disease, stroke, diabetes, and even intestinal polyps and colon cancer. Look for breakfast cereals that provide at least 6 grams of fiber per serving, but make sure your choice is low in sugar (less than 10 grams per serving). Add nonfat milk and bananas, berries, or apple slices to create a tasty meal.

You needn't limit your morning menu to high-fiber cereals, but wise choices are important. Stick to whole-grain or pumpernickel breads for toast; opt for trans-fat-free soft margarines or cholesterol-lowering spreads that contain plant stanols. Eggs needn't be banned from the breakfast table, but are better reserved for the occasional brunch, particularly for people with diabetes. In one study, men with diabetes who ate more than one egg a day were twice as likely to develop cardiovascular problems. To date, there is no solid evidence that organic eggs or brands high in omega-3 fats offer any particular health benefits—and they still count as eggs. Many typical breakfast foods (hash browns, bacon, croissants) have too much fat or salt—and fast-food breakfasts have too much of everything, except the fiber that adds the real punch to breakfast's health benefits.

A little experimentation—a whole grain cereal one day, pumpernickel toast with peanut butter the next—can help you find the combination of foods that make breakfast a welcome start to your day. For more information on ways to improve your eating habits, order our special health report, Healthy Eating: A guide to the new nutrition. www.health.harvard.edu/HE

Q: I’ve been reading about anxiety lately, but I don't see much mention of the herb kava. I’ve been using it, and I thought its effectiveness for anxiety was widely accepted. Why don't many articles cover it?

A: Kava is a popular herbal treatment. Marketed as a “natural alternative” to anti-anxiety medication, it became one of the best-selling herbal supplements in the United States. In November of 2001, however, German public health officials announced they had traced 24 cases of severe liver damage to the use of kava-containing products. In December of that same year, Germany and Switzerland banned the sale of such over-the-counter supplements. In March 2002, the FDA issue a warning about severe liver damage related to the use of kava-containing supplements.

Extracted from the roots of the pepper plant, Piper methysticum (“intoxicating pepper”), kava (also known as kava kava) has been used in the South Pacific for thousands of years to treat asthma, headache, and urinary infections, and as a sleep aid. Traditionally, the root is mashed or chewed and mixed with water or coconut milk to make a drink. Kava is said to induce pleasant and calm feelings. The source of the drink’s soothing effect is thought to be kavapyrones or kavalactones, natural substances extracted from the root that are also put in supplements. It’s still unclear why kava, used safely for so many years in the South Pacific, appears to be toxic. It may be that the whole root, diluted in a drink, is not, but that the extract of kavapyrones is more concentrated. Or perhaps chemicals inadvertently mixed in the supplements are toxic.

Kava has not been banned in the United States (German regulators are considering making it a prescription drug). However, it should be used with caution. If you decide to continue using kava supplements, tell your doctor. You should not use kava if you are or may become pregnant, have liver disease, take drugs with known adverse effects on the liver (for example, cholesterol-lowering statins), or if you regularly consume alcohol.

Celeste Robb-Nicholson, M.D.
Editor in Chief, Harvard Women's Health Watch
www.health.harvard.edu/women