Grains and Health: Misinformation and...
Transcript of Grains and Health: Misinformation and...
Grains and Health: Misinformation and MisconceptionsDB Sheats and JM Jones, St. Catherine University, St. Paul, MN, USA
ã 2016 Elsevier Ltd. All rights reserved.
Topic Highlights
• Claims suggest that wheat is the product of genetic research
and that we are eating genetically altered wheat. In reality,
genetically modified wheat is not sold legally anywhere in
the world.
• Claims suggest that wheat and its gluten have changed and
that is why celiac disease, an autoimmune disorder, is on
the rise. While celiac disease rates are increasing, and theo-
ries abound, no one is uncertain as to why.
• Claims suggest that wheat is addictive. There are no data to
support claims that removing wheat from the diet results in
withdrawal symptoms.
• Claims suggest that wheat causes uncontrollable overeat-
ing. Existing data show that ingestion of wheat protein
causes the release of satiety hormones.
• Claims suggest that wheat ingestion leads to a host of
mental health issues. There are scanty scientific data to
support these claims.
• Claims suggest that wheat causes obesity and diets that
eliminate wheat and other carbohydrates are the most effec-
tive way to lose weight. In reality, any significant weight loss
that occurs with these diets is due to the reduction in total
calories from any source, not just wheat or carbohydrates.
• Claims suggest that the elimination of wheat from the diet
results in the cure or improvement of many health condi-
tions. In reality, many of these conditions are made better
by weight loss and not specifically the elimination of wheat.
• Claims suggest that the nutrient contribution of wheat and
grains can easily beobtained fromother food groups.While it
is true that these nutrients are found in other foods, studies
on nutritional quality indicate that diets without whole and
enriched grains are often lacking in these nutrients.
• Food and nutrition professionals need to be able to counter
unfounded theories about wheat and other grains with
sound science and unbiased, critical thinking.
Learning Objectives
• To identify current controversies surrounding wheat, grains,
and health.
• To describe scientific evidence regarding wheat, grains, and
health.
• To understand the important role that food and nutrition
professionals play in dispelling common misinformation
and misconceptions about wheat and grains.
Introduction
Recently, grain consumption, especially wheat, has been
blamed for obesity, diabetes mellitus, other chronic diseases,
food addiction, and impaired brain function. Popular press
books such as Wheat Belly by William Davis, the Paleo Diet by
Loren Cordain, and Grain Brain by David Perlmutter and other
authors and food bloggers claim that eliminating grains is the
key solution to improving health. A review of nutrition and
medical literature suggests a different scenario. This article pro-
vides a review of the scientific evidence regarding grains and
health to dispel misinformation and misconceptions. This
piece will focus on wheat because it has been subject to the
most misinformation.
Wheat Breeding and Genetics
Wheat originated in the Middle East thousands of years ago.
According to the Food and Agriculture Organization (FAO),
wheat is grown on more land area than any other commercial
crop and continues to be the most important food grain source
for humans. Together, rice, wheat, and corn provide over half
of the world’s calories.
Popular press authors and food bloggers suggest that wheat
is the product of genetic research, and today, we are eating
genetically altered wheat. They contend that wheat and its
gluten have changed and our bodies can no longer digest the
modified grains of today, and that is why people are having so
much difficulty digesting wheat and why celiac disease, an
autoimmune disorder, is on the rise.
It is alleged that modern wheat has changed to be less
healthy because of breeding practices. In fact, wheat breeding
is an age-old practice. Significant advances in plant breeding
occurred in the 1940s with the work of Norman Borlaug and
others, using traditional techniques (non-genetically modified
organisms). Lines selected provide increased yield through
disease, drought, and insect resistance, especially in developing
countries. Despite assertions to the contrary, these lines were
produced by crossing wheat varieties with other wheat varieties
from all over the globe. In 1970, Dr Borlaug with his so-called
green revolution won the Nobel Peace Prize for his wheat and
grain breeding programs, which produced grains with high
yields that grow under a wide variety of conditions and help
address world food supply challenges.
It is also alleged that genetic modification of wheat has
made it less healthy and has changed the gluten proteins.
This is untrue for two reasons. First, no ill effects can come
from genetically modified wheat because there is none sold
legally anywhere in the world. Second, recent studies from
USDA labs and labs at the University of Saskatchewan and
studies in Europe using grains from seed banks going back as
far as Canadian Red Fife in 1857 show wheat gluten has not
changed.
Concern has been raised about the use of hybrid dwarf
wheats. They now comprise 99% of the wheat grown world-
wide. Short-straw naked (dwarf) wheats are one of the
Encyclopedia of Food Grains http://dx.doi.org/10.1016/B978-0-12-394437-5.00078-4 1
advances that were part of the green revolution. They increased
yield for two reasons: (1) wheat varieties with long, spindly
straws lodge, meaning that the kernel head is heavy and falls to
the ground, making harvest difficult, and (2) shorter straw
means that inputs, for example, water and nutrients, go into
making wheat kernels rather than straw.
Popular press authors imply that new wheat varieties and
their proteins are unique or harmful in some way. Further, they
posit that 5% of the proteins in wheats are unique, meaning
they are found in neither parent, and that this unexpected
genetic rearrangement results in altered proteins with poten-
tially toxic effects. It is important to consider that plants can
only express proteins that they have the genetic code to pro-
duce. Creating a unique protein requires a mutation of the
DNA or RNA. While environmental conditions can promote
or inhibit the expression of certain proteins, it cannot code for
proteins that are not in the genome. Therefore, hybridization
of wheat does not create unique proteins.
Ancient wheats such as einkorn are held as models of what
we should eat because they have not been hybridized and
because of their protein makeup. In fact, one author says that
einkorn contains 28% protein compared with average protein
contents of 12–15% inmodern wheats and that ancient wheats
did not cause the symptoms that new varieties do. However,
studies carried out at the University of Saskatchewan where
ancient and other varieties of wheat were grown on adjacent
plots actually show that the crude protein content of einkorn is
18% and that of other ancient and modern varieties had pro-
tein values ranging from 16.3% to 17.5%. This fits well with
the USDA World Wheat Collection, which shows approxi-
mately a threefold variation in protein content of wheat from
7% to 22%, with one-third of this under genetic control and
two-thirds of this controlled by environmental conditions.
Celiac and Related Disorders
Celiac disease is on the rise, as are other autoimmune diseases,
in Western countries. This fact is documented in the scientific
literature. Studies by Mayo Clinic gastroenterologist Joe
Murray and colleagues compared celiac titers in blood samples
from the recent US Air Force recruits with stored blood
samples taken from recruits more than 50 years ago. The
analysis showed 0.2% of recruits had the gene for celiac disease
in 1950 compared with 0.9% of recent recruits, which is a
quadrupling of the incidence rate. Data from Finland also
show an increase from 1% to 2% or a doubling of the rate of
celiac disease incidence in that population. While celiac disease
rates are increasing, it is uncertain whether this is due in part to
better identification and awareness of the disease, as well as a
myriad of other dietary, immunologic, and environmental
changes, especially those that impact the microorganisms and
integrity of the gut. Some theories include the ‘clean’ theory,
poor diets overall, overuse of antibiotics and other drugs espe-
cially acid-lowering drugs, lack of breast-feeding, and frequent
use of Cesarean sections.
Davis and other popular press authors posit that the reason
for the increase in celiac disease is attributed to the fact that
celiac disease-triggering proteins are expressed at higher levels
in current wheat varieties than found 50 years ago. Such
authors suggest that high-molecular-weight (HMW) glutenins
and higher levels of gliadin of modern wheat are the problem.
While studies show that the immune system reacts to break-
down products of HMW glutenins, data are lacking that show
that these proteins trigger more reactions than those of ancient
wheats or even wheat varieties from 50 years ago. Interestingly,
gliadins are found in higher amounts in ancient versus modern
wheats.
Gluten-containing grains are also implicated in non-celiac
gluten sensitivity (NCGS). This newly recognized disorder has
no medically agreed-upon test to confirm a diagnosis, and
therefore, its existence and incidence are subject to much
debate. The best estimates are that 4–6% of the population
may have NCGS. NCGS is thought to be present in about 5%
of irritable bowel syndrome cases and may cause the rash,
dermatitis herpetiformis, which can be seen in some celiac
patients.
Allergens
Wheat has long been categorized as one of the ‘big eight’
allergens (the most common allergens in Western countries).
Despite beliefs that the incidence is much higher, only 0.5% of
children and adults in the United States suffer from wheat
allergy, which can be caused by any number of proteins in
wheat. Glutenins are the most frequent allergens, but gliadins,
especially gamma-gliadin, result in the most severe allergic
reactions. A particular protein, omega-5 gliadin, is responsible
for wheat-dependent, exercise-induced anaphylaxis and may
be the offending protein in the wheat allergies of young chil-
dren. There are also reported allergies to albumins, globulins,
and enzyme inhibitors. Interestingly, delayed introduction of
solid foods including grains such as wheat and rye has been
found to be responsible for greater allergic sensitization in
young children.
Addiction and Overconsumption of Food
Popular press authors and bloggers suggest that wheat is the
world’s most destructive dietary ingredient because during its
digestion, it breaks down into peptides that act as exorphins
(exogenous opioids). These authors assert that wheat is unique
in this role. Studies conducted by the National Institutes of
Health (NIH) in 1979 show that digestion of wheat proteins
can produce peptides that interact with opioid receptors.
However, the claim that wheat is unique in this regard is
incorrect, as these same studies show that other food proteins
also produce peptides that interact with opioid receptors.
Hydrolysates of milk proteins (alpha-, beta-, or kappa-casein;
alpha-lactalbumin; beta-lactoglobulin; and lactotransferrin)
show the highest opioid activity. In addition to milk proteins
and wheat gluten, rice albumin, bovine serum albumin, and
even a protein from spinach all produce peptide fragments
capable of interacting with opioid receptor ligands. It is impor-
tant to consider that the studies indicating wheat’s possible
opioid potential were conducted either in vitro or by feeding
the preformed peptides, not by feeding wheat itself. Studies
feeding wheat foods, not hydrolysates, must be conducted to
2 FOOD GRAINS AND THE CONSUMER | Grains and Health: Misinformation and Misconceptions
determine the actual effects of peptides from gluten digestion.
Some studies have also reported beneficial effects of these
peptides. If bioavailable, they have the potential to help con-
trol blood pressure and to improve learning performance.
Another theory promulgated by popular press authors and
bloggers is that wheat opioids are highly addictive causing
individuals to lack control of their eating, with subsequent
removal of wheat from the diet producing withdrawal symp-
toms. The controls over hunger and satiety are complex being
affected by many mechanisms from physical feelings of full-
ness (stomach distention) to neuroendocrine, psychosocial,
and sensory factors. While some suggest specific foods such
as sugars and fats are addictive, supporting evidence is
weak and scarce, with no human data. Similarly, there are no
data to support claims that removing wheat from the diet
results in withdrawal symptoms.
Claims from Davis and others that wheat causes uncontrol-
lable overeating conflict with existing data that show wheat
protein ingestion causes the release of satiety hormones chole-
cystokinin and glucagon-like peptide 1. Wheat and pea pro-
teins show a stronger ability than other sources to stimulate the
release of both hormones. Some data suggest that consump-
tion of proteins such as those in gluten may be a good dietary
strategy for weight management.
Mood, Mental ‘Fogginess,’ Autism, Attention-Deficit/Hyperactivity Disorder, and Schizophrenia
A common assertion in the popular press is that wheat inges-
tion alters mood and causes mental ‘fogginess.’ There are little
data showing that wheat consumption alters mood or mental
acuity. In a small study of patients with celiac disease, a gluten-
restricted diet failed to improve neurological symptoms. In
contrast, increased serotonin is associated with a sense of
well-being and elevates mood. In a study of malnourished
Indian primary school children, wheat biscuits added to their
diets actually improved cognitive ability. There are data sug-
gesting adding lysine to grain-based diets may reduce measures
of anxiety. In a study of Syrians with marginal diets based
primarily on wheat, the addition of lysine, wheat’s limiting
amino acid, reduced symptoms of anxiety. This study supports
the fact that complementary plant proteins are needed in grain-
based diets low in complete proteins.
Wheat is also alleged to cause of autism spectrum disorder,
attention-deficit/hyperactivity disorder (ADHD), and schizo-
phrenia. Case reports and other narratives suggest there may
be a link between autism and celiac disease. However, docu-
mentation in the medical literature is scarce. Regarding autism,
there is only one randomized clinical trial and its findings
showed no significant difference in symptoms due to gluten
removal from the diet. A review considered the ‘gold standard’
in the medical literature concluded that further large-scale,
randomized-controlled trials are needed. According to
Fasano, a noted celiac disease researcher at the Center for Celiac
Research in Baltimore, MD, while the gluten-free, casein-free
diet is one of themost popular diets for the treatment of autism,
the efficacy of this diet is inconclusive.
Similarly, studies examining the relationship between
wheat and ADHD are lacking, even though sensitivity to a
range of foods, including wheat, has been suggested in a num-
ber of case reports. Studies with very small numbers of subjects
show no improvement in ADHD symptoms with a gluten-free
diet. Screenings for celiac disease in a clinical report (no
control group) involving 67 people diagnosed with ADHD
showed the incidence to be slightly higher than the population
as a whole with 1 out of 7 (vs. slightly <1 in 10) having celiac
disease. These celiac disease-positive participants showed a
significant decrease in ADHD symptoms.
Schizophrenia’s link to gluten was noticed during World
War II when a British physician observed decreased admissions
for this disorder. Dr. Dohan theorized that this decrease corre-
lated with decreased wheat consumption imposed by rationing
and postulated links between wheat, celiac disease, and
schizophrenia. Part of the theory suggests that wheat ingestion
affects tight junctions and reduces the gut’s capacity to prevent
the entry of exogenous substances, thus allowing the develop-
ment of schizophrenia and other mental conditions. It is also
known that schizophrenia incidence increases in the presence
of any autoimmune disease or a history of severe infections. It
is thought that the antibodies produced can impact the brain.
In some studies, a subset of schizophrenia patients show ele-
vated gliadin antibodies. However, classic celiac disease diag-
nostics, either antibodies or gene markers, were not found in
higher rates in schizophrenia patients than in the public at
large.
A comprehensive review looking at the connection between
gluten and schizophrenia showed that gluten withdrawal
resulted in a drastic reduction or full remission of symptoms
but only among a small subset of schizophrenia sufferers.
Thus, in a small group of schizophrenia patients, removal of
wheat may be helpful but not the miracle cure indicated by
Davis and others.
Obesity and Weight Loss
Obesity rates have increased dramatically around the world
since the 1970s. Obesity rates in the United States have
increased by 214% since 1950. Davis and other popular press
authors note that obesity was rare in the 1950s and cited
increased wheat consumption as a cause. It is true that wheat
consumption increased from 1970 to 2000; however, it
dropped between 2000 and 2014. Importantly, these authors
failed to note that during this same period, portion size and
caloric intake have increased dramatically while physical activ-
ity has decreased and screen time has increased. In fact, in 2008
in the United States, there were on average 600 more calories
available per person than in 1970.
Food bloggers and popular press authors suggest that the
proliferation of wheat products in the diet parallels increased
weight and central obesity. Central obesity, also known as
visceral adipose tissue (VAT), has increased in the population
and is a cause for concern due to its association with higher
rates of diabetes, high blood pressure, heart disease, and cer-
tain forms of cancer. While VAT has increased, it is not true that
wheat causes this condition or that the elimination of wheat
will cure this condition. It is well documented that no one food
or food group is responsible for VAT. Instead, ingesting too
many calories of any kind coupled with too little exercise will
FOOD GRAINS AND THE CONSUMER | Grains and Health: Misinformation and Misconceptions 3
result in VAT. Recent data from the Framingham Heart Study
cohort refute claims that wheat increases VAT. Those who had
the least VAT ate two servings per day of refined grains and
three servings per day of whole grains.
For many years, various low-carbohydrate diets have been
recommended as the most effective way for individuals to lose
weight. It is not surprising that eliminating wheat from the diet
has recently been considered to be the ‘holy grail’ of weight loss
regimens using low-carbohydrate diets. While it is true that low-
carbohydrate diets have been shown to cause more rapid weight
loss thanother diets in the first 6months, these diets do not result
in greater weight loss over time. In addition, low-carbohydrate
diets often result inmore dropouts than other diets that are more
balancedanddonot eliminate entire foodgroups.Any significant
weight loss that occurswith these diets cannot be attributed to the
‘magic’ of eliminatinggrains, but instead, it is due to the reduction
in total calories from any source.
Grain Foods and the Glycemic Index
The glycemic index (GI) is a measure that compares the blood
glucose response produced by 50 g of available carbohydrate
from a food with the blood glucose response produced by 50 g
of glucose. Popular press authors and food bloggers correctly
noted that wheat bread has a GI that is higher than table sugar.
However, GI is most often misunderstood because it is used to
compare very different amounts of food. For example, 50 g of
table sugar (approximately three tablespoons) would yield
50 g of available carbohydrate. In contrast, 50 g of available
carbohydrate from whole wheat bread is much more than 50 g
of bread since bread is not all carbohydrate and not all the
carbohydrate is available. Thus, it would take 144 g of whole
wheat bread (5.1 slices at 28 g per slice) or 111 g of white bread
(3.9 slices) to yield 50 g of available carbohydrate.
Grain Foods and Other Diseases
Popular press authors and bloggers claim that elimination of
wheat from the diet results in the cure or improvement of
many conditions including diabetes, coronary heart disease,
multiple sclerosis, rheumatoid arthritis, asthma, acid reflux,
irritable bowel syndrome, ulcerative colitis, acne, and other
rashes. However, many of these conditions are made better
by weight loss, so attributing improvement to wheat removal
is overly simplistic and is likely an inaccurate deduction. A
number of meta-analyses and reviews show that those who
eat grains and whole grains have lower risk or most chronic
diseases with a recent one showing a reduction in both the risk
of cardiovascular and all-cause mortality.
Nutrient Composition of Wheat and Grains
Many diet authors bashing grains and wheat assert that the
nutrient contribution of wheat and grains can easily be
obtained from other food groups. While it is true that most
of the constituents of grains can be found in other foods, there
are some issues. For example, grains provide many of the B
vitamins. While it is true that these are found in other foods,
studies on nutritional quality indicate that diets without whole
and enriched grains are often lacking in these nutrients. The
concern is especially important for folate. Folate fortification of
grains has decreased neural tube defects and other neurological
problems in North American populations by 50% since forti-
fication of grains was mandated. Other compounds such as
betaine are found in wheat and wheat bran and germ, the
highest sources of this important phytochemical. Betaine is
not widely distributed in the foods supply and has importance
in human nutrition.
Diets without grains can have significant problems getting
adequate dietary fiber and a good mix of fiber types. Wheat
bran/fiber is used as the standard against which government
agencies test the efficacy of a fiber in terms of laxation, as it is
the fiber with significantly greater effect on laxation than fibers
from fruits and vegetables. The same fiber in barley and oats
with proved cholesterol-lowering properties is not widely found
in many fruits or vegetables, and when found, its structure is
such that it does not have cholesterol-lowering properties.
Further epidemiological studies show that cereal fiber
reduces the risk of certain gut cancers while fruit and vegetable
fibers do not. These data suggest that balance as prescribed in
USDA MyPlate provides the best diet.
Conclusion
Numerous health problems including obesity, diabetes melli-
tus, other chronic diseases, food addiction, and impaired brain
function have been attributed to grains such as wheat. A review
of nutrition and medical literature reveals that there are little
evidence to support claims that wheat and grains cause adverse
health effects and chronic disease and much evidence to show
that a balanced diet that includes wheat and grains, especially
whole grains, reduces chronic disease risk and lowers overall
mortality.
Popular press authors and food bloggers claim that elimi-
nating wheat grains is essential for optimal health for all. While
it is true that wheat and other gluten-containing grains must be
eliminated for those with reactions to gluten and wheat
because of celiac disease, allergies, or other conditions, it is
not true that wheat and grain elimination is best for all.
Further, it is also true that many diets contain too many calo-
ries and grain-based desserts and snacks contribute to excess
calories, and it is not true that the grains and wheats are the
culprit. Rather, it is the poor food choices that should be
addressed. Data for elimination of grains for all are, at best,
scanty and do not show scientific rigor. Food and nutrition
professionals need to be able to counter unfounded theories
about wheat and other grains with sound science and unbi-
ased, critical thinking. This article provides a review of the
scientific evidence regarding grains and health to dispel com-
mon misinformation and misconceptions.
Exercise Assignments for Revision and Extension
• Take a specific wheat controversy and describe the scientific
evidence to support or refute this claim.
4 FOOD GRAINS AND THE CONSUMER | Grains and Health: Misinformation and Misconceptions
• Model a diet with and without grains. Calculate the nutri-
tional value of the model diet using a computer analysis to
show what nutrients might be at risk. Show what foods
would need to be consumed in larger quantities. If this
were done, what would happen to calories?
• Calculate the calories for 3 days of diets with wheat or
grains included and the calories of that same diet without
the wheat or grains. Show how much weight would likely
be lost with the elimination of these products.
• Go to a store and compare the cost, nutritional value, and
eating quality of products that are labeled as gluten- or
wheat-free with their gluten- or wheat-containing
counterparts.
Exercises for Readers to Explore the Topic Further
• Why is misinformation around diet so readily accepted?
• Show the evidence supporting the use of wheat and grains
in preventing any one of the chronic diseases. Assess this
evidence in and evaluate evidence for their nonuse.
• Assess the evidence associated with grains, carbohydrates,
and brain function. How does this evidence compare with
other nutritional impacts on the brain?
• Use the GI tables and look up the values for wheat and
grain staples such as sourdough and whole grain bread
basmati rice and pasta. Explain why such products often
with the same ingredients have varying GIs. Then look at
the amount eaten for 50 g of carbohydrate and compare
that and the nutritional quality of indulgent and other
foods with lower GIs such as candy or chocolate cake.
Using this research, explain when the GI might be useful
for food selection and when it might not yield optimal
nutrition choices.
See also: The Cereal Grains: Wheat – An Overview of the Grain thatprovides “Our Daily Bread”; Food Grains and the Consumer:Grains and Health; Food Grains: Intolerance, Allergy andDiseases: Celiac Disease; The Gluten-Free diet; Carbohydrates:Glycemic index; Food Grains: Intolerance, Allergy andDiseases: Allergens; Grain Composition and Analysis: TheComposition of Food Grains and Grain-Based Products ; Appendix:Appendix 3. Grains, Foods and Ingredients Suiting Gluten-Free Dietsfor Celiac Disease.
Further Reading
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Relevant Websites
http://www.choosemyplate.gov/grains-why.html.http://gowiththegrain.org.http://wheatfoods.org.
6 FOOD GRAINS AND THE CONSUMER | Grains and Health: Misinformation and Misconceptions