482016

1

Julie Miller Jones PhD LN CFS CNS

Fellow ICC and AACCI

Professor Emerita

St Catherine University

jmjonesstkateedu

ARE NEW WHEAT VARIETIES REALLY

MAKING US FAT AND SICK

March 19 2016

WHAT THIS TALK WILL

COVER

bull Review claims that humans did not evolve to eat grains and wheat

bull Review data on whether the wheat has changed

bull Review claims that modern agricultural processes cause toxic effects

bull Review claims suggesting that wheat especially new varieties are toxic and cause obesity chronic disease and brain disorders

bull Look at the controversy and grain and carbohydrate (CHO) recommendations

bull Discuss some aspects that have changed

bull Highlight the contribution of grains to diet quality vs potential dietary problems with the omission of wheat grains and other carbohydrate staples in terms of nutrition cost and food supply issues

We should be eating like the cavemen ndash

bring on the mastodon steaks

Grains are not needed

Modern grains are killing you

GMO crops and modern plant

breeding is killing us

CLAIM HUMANS DID NOT

EVOLVE TO EAT GRAINS

Claim Humans Did Not Evolve to Eat Grains

bullHumans -eating grains gt100000 yrsbullDental record evidence bullHominids were and are omnivoresbull Cooked grain DNA in dental calculus of

Paleolithic humansbull Cave and cooking evidence bull Grains (sorghum wild maize others) found in

cavesbull Grain DNA on stone tools and in cooking pots

indicate processing and cooking of grains Caves in Iraq and the Low Countries the Americas

Henry A et al Ethology and Sociobiology 15 219ndash35 Unger P The known the unknown and the unknowable

DOI1010160162-3095(94)90015-9

Claim Humans Did Not Evolve to Eat Grainsbull With the advent of agriculture

bull Humans evolved to have 6 copies of amylase bull other primates - 2 copies

bull Amylase amp cooking of CHO enabled ready supply of glucose to the brain

bull Cooked CHO foods may have enabled evolution by

increasing the brain size of humans

httpnewssciencemagorgevolution201210raw-food-not-enough-feed-big-brainsnewsnationalgeographiccom121026-human-cooking-ehellip- A surge in human brain size about 18 million years ago is linked to the innovation of cooking

482016

2

What Was Life Like in the Paleo Periodbull Average lifespan ~ 37 years

bull Paleo people were 65-85 vegetarians more meat in colder climates

bull Our ancestors did eat grains and legumes

bull Early humans ate very much like modern pigs and bear - getting calories to survive

bull httpwwwdailymailcouksciencetecharticle-2878166Scientists-slam-caveman-diet-say-early-humans-just-ate-couldhtmlixzz42Kv1U4Ur

CLAIM PALEO DIETS ARE BETTER FOR YOU

CLAIM GRAINS GLUTEN-CONTAINING CARBOHYDRATE STAPLES ARE BAD FOR THE HUMAN DIET

Recommendations for Carbohydrates (CHO)and CHO Staples

bull Dietary recommendations - most countries health promotion orgs

bull Food guidelines recommend grains as a food group

bull CHO grain staples - Base of pyramid diet

bull 45-65 of E (up to 75of E) bull Australia New Zealand Dietary Guidelines bull European Food Safety Authoritybull UK Scientific advisory Committee on Nutritionbull US Dietary Guidelines US Institute of Medicinebull Singapore Health Promotion Boardbull Indian Healthbull Health promotion bodies such as heart cancer and diabetes associations

bull World Health Organization Food amp Agriculture Organization (WHOFAO)

bull ldquothe macronutrient that humans need in the largest quantityrdquobull Montagnese C et al Nutrition 2015 31908-915 Radhika G et al Public Health Nutr 2011

14591-8httpwwwhpbgovsgHOPPortalhealth-article2638

Dietary Guidance - Central European Example

CLAIM MODERN WHEAT HAS BEEN BRED (TRADITIONAL AND GENETICALLY) TO BECOME TOXIC AND FATTENING

482016

3

Breeding Has Changed Everything Edible

httpcdnfoodbeastcoms3amazonawscomcontentwp-contentuploads201309V8XnPeQjpg

Breeding Has Changed Everything Edible

httpwwwfoodinsightorgfoods-before-now-gmo-biotechnology

Breeding Has Changed Everything Edible

httpwwwfoodinsightorgfoods-before-now-gmo-biotechnology

Claim Wheat Has BeenChanged to Be Problematic

bull ldquoWheat we eat these days isnt the wheat your grandma hadhellip Itrsquos an 18-inch tall plant created by genetic research in the rsquo60s and rsquo70srdquo Davis

bull No significant changes

Kasarda USDA Albany 2013

Chibbar U Saskatchewan 2015

HealthGrain EU 2013

16

So Jack were these some seeds Norman Borlaug sold you

bullFACT Triticum aestivum is found in many shapes sizes

bull Ancientmodern wheat ndash straw 12rdquo t- 60rdquo (USDA-National Small Grains Collection)

bull Height genes do not code for glutens and gliadins

17

37 ancestral and modern varieties of wheat Red fife dating from 1860 to newest variety tested 2007 Grown in 2013 and in 2014 Photo Credit U Sask- Hucl et al

Wheat Protein (Gluten) Levels Unchanged

copyChibbar et al 2015 over 150 yrs ldquoAnalysis of a variety of heritage and modern wheatstarch shows very little difference hellipvaried from 56 (Apex 1937) to 69 (Superb 2001)

482016

4

Gliadin ndashA new protein

Davis claim Gliadin is a new toxic protein and opiate

1745 studies of wheat proteins - Italy

1820 Gliadin - German chemists Osborne and Voorhees

1893 chemical constitution of gliadin and glutenin

1915 Osborne amp Mendel gliadin maintains life but would not promote growth without other plant proteins

19The chemistry of gliadin ndash Springer

Springer Science+Business Mediaby AL Patey - 1978

Gliadin ndashAn opiate

bull Food Proteins ndash NIH in vitro study 1979

bull Proteins digestive enzymes acid ndash wheat

bull milk soy rice spinach

ldquoeverybody else is susceptible to the gliadin protein that is an opiate This thing binds into the opiate receptors in your brain and in most people stimulates appetite such that we consume 440 more calories per day 365 days per yearrdquo

bull 46 lbs yr

20

Claim lsquoAncient Wheatsrsquo less Immunogenicbull lsquoAncientrsquo Graziella Ra and Kamut vs

modern durum accessions Cappelli Flaminio Grazia and Svevo1

bull ldquohellippresent results cannot confirm that ancient durum wheats would be less CD-toxic In conclusion we strongly advice celiac patients from consuming ancient wheats includinghelliprdquo3

bull not less allergenic by blot and pin prick tests2

1Šuligoj T Gregorini A Colomba M Ellis HJ CiclitiraPJ Evaluation of the safety of ancient strains of wheat in coeliac disease reveals heterogeneous small intestinal T cell responses suggestive of coeliac toxicity Clin Nutr 2013 321043-9

2Simonato B1 Pasini G Giannattasio M Curioni AAllergenic potential of Kamut wheat Allergy 2002 57653-4

Total gliadin and α-gliadin determination by indirect ELISA1

lsquoAncientrsquo

3Colomba MS Gregorini A Are ancient durum wheats less toxic to celiac patients A study of α-gliadin from Graziella Ra and Kamut ScientificWorldJournal 20122012837416

Claim Ancient Wheats Are More Nutritious

bull Emmer (Triticum dicoccum) and einkorn (T monococcum) T timopheevi T palaeo-colchicum T macha compared to other wheats from the same region

ldquoThe data do not support an overall superiority of primitive forms but evidenced interesting potentially exploitable between- and within-species variabilityrdquo

bullAdvantages Einkornbull Rich in proteins and lipids (mostly unsaturated fatty acids)bull Fructans (+ prebiotic and ndashFODMAP) bull Zinc and iron - bioavailability Carotenoids and tocols

conjugated polyphenols alkylresorcinols and phytosterolsbull Low β-amylase and lipoxygenase activities (less oxidation

during storage etc)

bullDisadvantages bull Low dietary fiberbull Wheat 115-183 of dry matter (dm) vs Einkorn and emmer

wheats 72-128 of dm durum and spelt wheats(107-155 of dm

Hidalgo A1 Brandolini A Nutritional properties of einkorn wheat (Triticum monococcum L) J Sci Food Agric 2014 94601-12 Benincasa P Galieni A ManettaAC Pace R Guiducci M Pisante M Stagnari 2 Phenolic compounds in grains sprouts and wheatgrass of hulled and non -hulled wheat species J Sci Food Agric 2015951795-803 Giambanelli E Ferioli F Koccedilaoglu B Jorjadze M Alexieva I Darbinyan N DAntuono LF A comparative study of bioactive compounds in primitive wheat populations from Italy Turkey Georgia Bulgaria and Armenia J Sci Food Agric 2013933490-501 Gebruers K Dornez E Boros D Fraś A Dynkowska W Bedo Z Rakszegi M Delcour JA Courtin C Variation in the content of dietary fiber and components thereof in wheats in the HEALTHGRAIN Diversity Screen J Agric Food Chem 2008 569740-9

Food Allergies Intolerances and Sensitivities Defined

bull Food Allergy an IgE mediated reaction to a food protein causing histamine release

bull Food Autoimmune reaction caused by the activation of a gene (celiac)

bull Food Intolerance reaction to a metabolite or ingredient such as lactose caffeine or tyramine (aged cheeses and Asian fermented sauces)

bull Food Sensitivity reaction to food component that is not an allergic chemical or autoimmune response

Celiac disease is an autoimmune disease not an allergy

Digestion and Gut Health The First Point of Wellness

Digestion of all the bodily functions is the one which exercises the greatest influence on the mental state of an individualrdquo

Jean-Anthelme Brillat-Savarin (1755-1826)

482016

4

Gliadin ndashA new protein

Davis claim Gliadin is a new toxic protein and opiate

1745 studies of wheat proteins - Italy

1820 Gliadin - German chemists Osborne and Voorhees

1893 chemical constitution of gliadin and glutenin

1915 Osborne amp Mendel gliadin maintains life but would not promote growth without other plant proteins

19The chemistry of gliadin ndash Springer

Springer Science+Business Mediaby AL Patey - 1978

Gliadin ndashAn opiate

bull Food Proteins ndash NIH in vitro study 1979

bull Proteins digestive enzymes acid ndash wheat

bull milk soy rice spinach

ldquoeverybody else is susceptible to the gliadin protein that is an opiate This thing binds into the opiate receptors in your brain and in most people stimulates appetite such that we consume 440 more calories per day 365 days per yearrdquo

bull 46 lbs yr

20

Claim lsquoAncient Wheatsrsquo less Immunogenicbull lsquoAncientrsquo Graziella Ra and Kamut vs

modern durum accessions Cappelli Flaminio Grazia and Svevo1

bull ldquohellippresent results cannot confirm that ancient durum wheats would be less CD-toxic In conclusion we strongly advice celiac patients from consuming ancient wheats includinghelliprdquo3

bull not less allergenic by blot and pin prick tests2

1Šuligoj T Gregorini A Colomba M Ellis HJ CiclitiraPJ Evaluation of the safety of ancient strains of wheat in coeliac disease reveals heterogeneous small intestinal T cell responses suggestive of coeliac toxicity Clin Nutr 2013 321043-9

2Simonato B1 Pasini G Giannattasio M Curioni AAllergenic potential of Kamut wheat Allergy 2002 57653-4

Total gliadin and α-gliadin determination by indirect ELISA1

lsquoAncientrsquo

3Colomba MS Gregorini A Are ancient durum wheats less toxic to celiac patients A study of α-gliadin from Graziella Ra and Kamut ScientificWorldJournal 20122012837416

Claim Ancient Wheats Are More Nutritious

bull Emmer (Triticum dicoccum) and einkorn (T monococcum) T timopheevi T palaeo-colchicum T macha compared to other wheats from the same region

ldquoThe data do not support an overall superiority of primitive forms but evidenced interesting potentially exploitable between- and within-species variabilityrdquo

bullAdvantages Einkornbull Rich in proteins and lipids (mostly unsaturated fatty acids)bull Fructans (+ prebiotic and ndashFODMAP) bull Zinc and iron - bioavailability Carotenoids and tocols

conjugated polyphenols alkylresorcinols and phytosterolsbull Low β-amylase and lipoxygenase activities (less oxidation

during storage etc)

bullDisadvantages bull Low dietary fiberbull Wheat 115-183 of dry matter (dm) vs Einkorn and emmer

wheats 72-128 of dm durum and spelt wheats(107-155 of dm

Hidalgo A1 Brandolini A Nutritional properties of einkorn wheat (Triticum monococcum L) J Sci Food Agric 2014 94601-12 Benincasa P Galieni A ManettaAC Pace R Guiducci M Pisante M Stagnari 2 Phenolic compounds in grains sprouts and wheatgrass of hulled and non -hulled wheat species J Sci Food Agric 2015951795-803 Giambanelli E Ferioli F Koccedilaoglu B Jorjadze M Alexieva I Darbinyan N DAntuono LF A comparative study of bioactive compounds in primitive wheat populations from Italy Turkey Georgia Bulgaria and Armenia J Sci Food Agric 2013933490-501 Gebruers K Dornez E Boros D Fraś A Dynkowska W Bedo Z Rakszegi M Delcour JA Courtin C Variation in the content of dietary fiber and components thereof in wheats in the HEALTHGRAIN Diversity Screen J Agric Food Chem 2008 569740-9

Food Allergies Intolerances and Sensitivities Defined

bull Food Allergy an IgE mediated reaction to a food protein causing histamine release

bull Food Autoimmune reaction caused by the activation of a gene (celiac)

bull Food Intolerance reaction to a metabolite or ingredient such as lactose caffeine or tyramine (aged cheeses and Asian fermented sauces)

bull Food Sensitivity reaction to food component that is not an allergic chemical or autoimmune response

Celiac disease is an autoimmune disease not an allergy

Digestion and Gut Health The First Point of Wellness

Digestion of all the bodily functions is the one which exercises the greatest influence on the mental state of an individualrdquo

Jean-Anthelme Brillat-Savarin (1755-1826)

482016

5

Digestion and Gut HealthldquoWe should start thinking

about diets not only from the perspective of what we should eat but what we should be feeding our entire gut microbial systemshellip

The gut microbiome has been linked to many diseases including obesity cancer and inflammatory bowel diseaserdquo

~Jeff Leach founder of the Human Food Project and co-founder of American Gut

bull Human body has 10 trillion cells

bull Microbes outnumber human cells 101

~1 - 3 of body

200 lb Adult has 2- 6 lbs bacteria

Human MicrobiomeA Vital Role in Human Health

bull Influenced bybull Diet ndash esp fiber vs readily available carbs (CHO)bull Fiber feeds the gut MObull Phytochemicals used by MO

bull Type of birth - Vaginal vs Cesareanbull Breast fed or notbull Use of antibioitics and other drugs

bull Greater diversity of types of MO assoc with better healthbull ldquo there is not just one way to be healthy there doesnrsquot have to be one or two lsquojust rightrsquo gut

communities but rather a range of lsquojust finersquo communitiesrdquohellip As predictable the gut flora is probably dynamic and most influenced by the diet As a matter of fact the type of diet (vegetarian or non-vegetarian) decides the percentage count of Bacteroides spp Bifidobacterium spp etc in the gut florardquo

~Huse a researcher in Human Microbiome Project (HMP)

Source Huse S et al2012 PLoS ONE 7 (6) DOI 101371journalpone0034242

Microbiome Diversity Balance

bull Assoc with the Immune Systembull Allergies amp Asthmabull Crohnrsquos disease amp Colitisbull Obesity amp Diabetesbull Cancer riskbull Heart disease

bull Poop transplants by changing microbes bull Rats changed susceptibility to heart attacksbull Lean rats became obese and vise versa

bull Assoc with Stress Personality Germ-free mice amp rats are more

vulnerable to stress

bull Mice Warm and friendly vs aggressive and stand-offish strains

bull Assoc with Cognition and Behavior

bull High fat high protein diets reduce memory acuity executive functioning

bull Markers of inflammation affect entire body incl brain

Gut Bacteria Through the Lifecycle

Source Ottman et al Frontiers Cellular Infection Micro 2012 21-10

Low Acid Bacterial OvergrowthDietary Dysbiosis amp Disease

Low stomach acid allows

1 Pathogenic bacteria to survive and populate the gut dysbiosis

2 Contributes to weak tight junctions leaky gut

3 Proteins cross the gut trigger immune reactions

Dysbiosis microbial imbalance in the GI tract

Gut Permeability Opening the Door to Many Health Problems

482016

6

LLERGIES ANTACIDS MICROBESCARBOHYDRATES amp WHEAT

AIntestinal Microbes and Allergy

Clostridia Enterobacteriaceae

Staphylococci

Lactobacillus Bifidobacterium

Source Noval Rivas M et al J Allergy Clin Immunol 2013 Jan131201-12

Decreased risk

Increased Risk

Prevalence of Food Allergy

Mast Cell

bull Up to 35 believe they have food allergy

bull ~35 confirmed by oral food challenge

bull 10-fold lower prevalence

Source httpwwwjacionlineorgarticleS0091-6749(07)00991-8abstract Rona RJ et al

Journal of Allergy and Clinical Immunology 2007 120638-646

Top Food Allergens bull Children

Milk `25

Eggs 15

Peanuts 14 Nuts 11

Wheat 04

Soy 04

Fish 01 amp Shellfish 01

Sesame 01

Adults

Shellfish 20

Peanut 06

Tree nuts 05

Wheat 05

Fish 04

Sesame 01

Fruit vegetable est01 - 43

Wheat allergy in entire population under 05

34

Source Waserman S amp Watson W Allergy Asthma Clin Immunol 20117 Suppl 1S7 Sicherer amp Sampson 2010 Chafen et al JAMA 20103031848-56

80 outgrow by teen years

Wheat Allergy ndash What Is It

bull A classic allergy usually to the seed storage proteins

ndash27 wheat proteins have been identified

bull Glutenins (wheat glutelin) most frequent allergens

bull Gliadins most severe allergens

ndash γ-gliadin

ndash ω-5 gliadin - Wheat dependent exercise induced anaphylaxis (WDEIA)

bull Albumins and maybe some globulins and enzymes

ndash α-amylasetrypsin inhibitor family in wheat barley and rye flour

35

Source Mills et al Plant Food Allergens2007 Blackwell

Wheat Allergy Symptoms

bull IgE Immunoglobulin response

bull Mast cells release histamine after binding with IgE

bull Eczema amp hives swelling

bull Asthma amp hay fever-like symptoms cough

bull Tiredness

bull GI symptoms

bull Rare anaphylactic shock

ndashNeurological

ndashJointmuscle pains arthritis

ndashOther IBS

36Source Holloway et al Practitioner 2011255(1741)19-22

482016

6

LLERGIES ANTACIDS MICROBESCARBOHYDRATES amp WHEAT

AIntestinal Microbes and Allergy

Clostridia Enterobacteriaceae

Staphylococci

Lactobacillus Bifidobacterium

Source Noval Rivas M et al J Allergy Clin Immunol 2013 Jan131201-12

Decreased risk

Increased Risk

Prevalence of Food Allergy

Mast Cell

bull Up to 35 believe they have food allergy

bull ~35 confirmed by oral food challenge

bull 10-fold lower prevalence

Source httpwwwjacionlineorgarticleS0091-6749(07)00991-8abstract Rona RJ et al

Journal of Allergy and Clinical Immunology 2007 120638-646

Top Food Allergens bull Children

Milk `25

Eggs 15

Peanuts 14 Nuts 11

Wheat 04

Soy 04

Fish 01 amp Shellfish 01

Sesame 01

Adults

Shellfish 20

Peanut 06

Tree nuts 05

Wheat 05

Fish 04

Sesame 01

Fruit vegetable est01 - 43

Wheat allergy in entire population under 05

34

Source Waserman S amp Watson W Allergy Asthma Clin Immunol 20117 Suppl 1S7 Sicherer amp Sampson 2010 Chafen et al JAMA 20103031848-56

80 outgrow by teen years

Wheat Allergy ndash What Is It

bull A classic allergy usually to the seed storage proteins

ndash27 wheat proteins have been identified

bull Glutenins (wheat glutelin) most frequent allergens

bull Gliadins most severe allergens

ndash γ-gliadin

ndash ω-5 gliadin - Wheat dependent exercise induced anaphylaxis (WDEIA)

bull Albumins and maybe some globulins and enzymes

ndash α-amylasetrypsin inhibitor family in wheat barley and rye flour

35

Source Mills et al Plant Food Allergens2007 Blackwell

Wheat Allergy Symptoms

bull IgE Immunoglobulin response

bull Mast cells release histamine after binding with IgE

bull Eczema amp hives swelling

bull Asthma amp hay fever-like symptoms cough

bull Tiredness

bull GI symptoms

bull Rare anaphylactic shock

ndashNeurological

ndashJointmuscle pains arthritis

ndashOther IBS

36Source Holloway et al Practitioner 2011255(1741)19-22

482016

7

Allergy amp Acid Suppression

Antacids and anti-ulcer drugs

bull stomach acid leads to protein digestion and

potential allergic reaction

bullPromote IgE formation by dietary protein fragments

Milk potato celery carrots apple orange wheat rye

Sensitivities lingered gt 3+ mo after antacid use

Sources Untersmayr et al FASEB J 2005 Apr19(6)656-8Dehlink E et al Clin Exp Allergy 200939246-53 Diesner et al Wien Med Wochenschr 2012 Dec162(23-24)513-8McCarthy DM Curr Opin Gastroenterol 2010 Nov26(6)624-31

Acid Suppression amp Allergy

bull Acid suppression while In utero associated in offspring (Swedish cohortgt29000)

ndashAllergy (OR 143)

ndashChildhood asthma (OR 151)

Source Dehlink E et al Clin Exp Allergy 200939246-53 Diesner et al Wien Med Wochenschr 2012162513-8

ELIAC GLUTEN SENSITIVITY LEAKY GUT AND DYSBIOSISC

Causal Factors for Celiac Symptoms

1 Gluten2 Genetics (gt97)

ndash HLA-DQ-2ndash HLA-DQ-8

3 Trigger - stress traumandash Surgeries pregnancy etc

ndash Viral infections

4 Intestinal Permeabilityndash Emerging Factor ndash ldquoLeaky Gutrdquo

Celiac Incidence

bull US Average (healthy people) 1 in 133 only 1 4700 diagnosed

ndashHigher if Scandinavian Irish parts of Middle East 1 in 50-60

ndashEst African Hispanic- and Asian-Americans 1 in 236

bull In people with related gut symptoms 1 in 56

ndash1st-degree relatives 1 in 22

ndash2nd-degree relatives (aunt cousin) 1 in 39

bull Incidence is increasing 2 to 5x higher

Based on the presence of tissue trans-glutaminase antibodies

ndash No continuous data relating to the incidence of celiac disease in the US population on a year-by-year basis

Sources Fasano wwwuchospitalsedupdfuch_007937pdfAlberto Rubio-Tapia Amer J Gastro 2012 DOI 101038ajg2012219 Riddle et al Am J Gastroenterol 2012 Aug107(8)1248-55

bull Abdominal pain (IBS) 68

bull Eczema rash 40

bull Headache 35

bull ldquoFoggy mindrdquo 34

bull Fatigue 33

bull Diarrhea 33

bull Depression 22

bull Numbness in

extremities 20

bull Joint pains 11

42

Source Center for Celiac Research in Baltimore- Dr Alessio Fasano 2004-2010 3475896 patients- 6 fulfilled criteria for GS

No validated or agreed upon test for non-celiac gluten sensitivity

482016

8

1 Increased awareness better diagnostics

bullRecognition of gluten sensitivity controversial

2 Bacterial overgrowth medications age

3 Salt intake1

4 Increased autoimmune diseases overall

bullClean theory or hygiene hypothesis2

1Wu et al Nature doi101038nature11984 2013 Kleinewietfeld M Nature

doi101038nature11868 2013 Yosef N et al Nature

doi101038nature11981 2013

2Fumagalli et al J Exp Med 2009206(6)1395-408 Brooks et al Curr Opin

Allergy Clin Immunol 2013 Feb13(1)70-7 Frei et al Allergy 201267(4)451-61 Laci and Penagos Nestle Nutr Workshop Ser Pediatr Program 201168169-83

Theories about Increasing Prevalence of Celiac Autoimmunes

Theories about Increasing Prevalence of Celiac

5 Infant amp Early Feeding Practices

bull Gradual introduction of gluten - 4 and 7 mo risk

bull Celiac disease

bull Gluten allergies

bull Type 1 diabetes (another auto-immune disease)

Introducing gluten while breastfeeding appears to be protective in some studies not all

33 of babies born by Caesarian

6 Foodborne infections and viruses trigger autoimmune diseases

44

Sources Silva et al Acta Meacutedica Portuguesa 2011 December 24 Suppl 41035-40 ldquoDiversification in the first year of food liferdquo Laci and Penagos Nestle Nutr Workshop Ser Pediatr Program 201168169-83

Theories about Increasing Prevalence of Celiac

7 Short fermentations for bread vs sourdough breakdown the offending peptides free gluten additive

8 Agronomic practices fertilizers growing conditions specific varieties

9 Poor diets overall low fiber folate vitamins too many calories

10 Change in the gut microbiome may increase autoimmune diseases

45

Sources Million et al Int J Obes (Lond) 2013 Mar 5 Sung et al NeurogastroenterolMotil 2013 Mar 22 Ceseviciene 2012 Grove 2009 Katz 2011 Rizzello 2007 Belz 2012

CLAIM WHEAT GRAINS AND CARBS CAUSE OBESITY AND CHRONIC DISEASE

47

Obesity CHOGrains Alleged as Culprits

0

5

10

15

1963-1965

1971-1974

1976-1980

1988-1994

1999-2000

Prevalence of Obesity

Ogden et alJAMA 2002 288 1728 Cavadini et alArch Dis Child 2000 8318

0

10

20

30

40

50

60

1965 1977 1989-1991

1994-1996

Dietary Fat

CHO

48

Obesity CHOGrains Alleged as Culprits

482016

9

Wheat Consumption Trends Do Not Follow Obesity Trends 1830-2010

Source Kasarda DD J Agric Food Chem 2013 Feb 1361(6)1155-9

Available Calories Have Increased

~ 600 Kcal more overall ~200 calories more each from fat and CHO 50 calmore from sweeteners

Grain Intake Is Flat or Decreasing as Obesity Climbs

52httpwwwfaoorgdocrep005ac911eac911e05htm

lsquoMake Half Your Grains WholersquoLowest Visceral Abdominal Fat

McKeown et al Am J Clin Nutr 2010 921165-71

Framingham Heart

Study (n=2834)53

Claim No Gluten Grain (Paleo) Diet Reduces Diabetes Metabolic Syndrome

bull Systematic review- 16 cohorts Type 2 Diabetes (T2DM) Risk

bull 3 svd (minimum 48g) whole grain (WG) Relative risk (RR) = 068

bull Inverse associations

bull WG including WG bread

bull Branbull Refined grains RR= 095

bull gt3000 children adolescents in Tehran

bull No association with

bull low CHO diet score and incidence of MetS

bull MetS components

bull risk from energy dense snacks

Eslamian et al Arch Iran Med 201417417-22 Aune D et al Eur J Epidemiol 2013 28845-58

482016

10

55

Whole Grain Coronary Heart Disease

Tang G et al Am J Cardiol 2015115(5)625-9Jacobs et al 1999

Liu et al 1999 Steffan et al 2003 Mozaffarian et al JAMA 2003Tang et al

3 sv ~ 50 g WGd

36 risk ndash 1 svd

25 - 28 risk

Iowa Womenrsquos Health N=35000

ARIC Men Women N~16000

Nursesrsquo Health Study N~75000

Elderly N=3500

22 risk ndash 3 svd

2015 meta analysisndash 15 cohorts 3 case-control ngt 400000

Claim ldquoGrain Fiber Unnecessaryrdquo

bull Davis amp Paleo other fibers will do the same job

NIH-AARP Diet amp Health Study 367442 older Americans

bull High cereal fiber intake 19 lower risk of all-cause mortality

bull 15ndash34 lower risk of disease-specific mortality

ldquoDietary fiber from grains but not from other sources was significantly inversely related to total and cause-specific death in both men and womenrdquo

Gonzalez CA Riboli E Eur J Cancer 2010462555-62 AMA Park Y et al Archives of internal medicine 20111711061-1068 Huang T et al BMC Medicine 20151359

57

Claim Fibers from All Sources Have the Same Impact

bullDF amp Small Intestinal Cancer RR

bullTotal Dietary Fiber 079 ns

bullGrain Fiber 051 P lt 001

bullWhole Grain foods 059 P lt 006

NIH AARP Ngt 500000

Schatzkin et al Gastroenterology 2009 1351163-7

Imagehttpi0wpcomwwwlowfodmapdietscomwp-contentuploads201410Caveman-Paleo-Diet-e1412900015791jpgresize=4002C289

Claim Vegetable Fibers Will Do the Job

FIBER LAXATION

per g fiber fed

Wheat bran 54

Psyllium 40

Oats 34

Corn 33

Legumes 22

Pectin 12

RS2 resistant starch 11

Inulin 10

59Cummings JH 1993 CRC Handbook of Dietary Fiber in Human Nutrition

Low-carb diets Higher all-cause mortalityMeta-analysis - 17 studies - 272216 people in

4 cohort studies

bull All-cause mortality - high low-carb score RR = 131

bull Similar for low carbhigh protein

bull Low-carb diets were associated with a significantly higher risk of all-cause mortality

bull limited observational studies

bull long-term outcomes are needed

Noto H et al PLoS One 20138(1)e55030

482016

11

Affordability and Nutritional Quality of No Grain Gluten Free Paleo

bullGluten - free diets ndash can cost 242 more

bull May be less nutritious and may not be fortified and are more costly

bullPaleo and Grain ndashfree diets - meats seafood fruits vegetables and nutsbull USDA data 93 income needed for Paleolithic diet that meets all

daily recommended intakes

bull Inadequate Ca++or and cereal legume fiber

bull USDA ldquonot feasible for low-income consumersrdquoMetzgar M et al Nutr Res 201131444-51

Grains and the World Food Supply

Crop Yields ndash Wheat vs Ancient GrainsbullWheat 50 buacre

3000 lbs of grain

bullSpelt 2400 lbs naked grain

bullEmmer Farro 1900 lbsEinkorn 1500 lbs

Durum Einkorn

Protein (g) Unit Area by Crop

With permission

Grains carbohydratestaples deliver much needed protein

Nutritional Contribution of Grains

CerealPseudocereal

Calories m2 Protein (kgha)

Maize (corn) 1847 415

Oats 1508 384

Rice (paddy) 1482 307

Triticale 1256 470

Amaranth 1133 418

Wheat 1083 423

Rye 914 271

Teff 605 226

Sorghum 529 165

Millet 345 105

Quinoa 275 109

Traditional Grains

bull gt1000 kcal per square meter

bull gt400 kg protein ha

Hunger Math World Hunger by the Numbers Conte R 2013

Non-grain

Soybean 1029 870

Lentils 322 244

Green Beans 229 127

Conclusionsbull We did evolve to eat grains

bull Wheat has not changed but we have Many possibilities including aspects that cause changes in the microbiome increase all autoimmune diseases

bull Around 5 of the population should avoid wheat and or gluten

bull Grains and grain fiber are unique and protective to health

bull Diets without gluten and grains may be inadequate Need careful planning and may lack cereal fiber

bull Elimination of grains bodes problems for 2050 in terms of the world food supply

482016

9

Wheat Consumption Trends Do Not Follow Obesity Trends 1830-2010

Source Kasarda DD J Agric Food Chem 2013 Feb 1361(6)1155-9

Available Calories Have Increased

~ 600 Kcal more overall ~200 calories more each from fat and CHO 50 calmore from sweeteners

Grain Intake Is Flat or Decreasing as Obesity Climbs

52httpwwwfaoorgdocrep005ac911eac911e05htm

lsquoMake Half Your Grains WholersquoLowest Visceral Abdominal Fat

McKeown et al Am J Clin Nutr 2010 921165-71

Framingham Heart

Study (n=2834)53

Claim No Gluten Grain (Paleo) Diet Reduces Diabetes Metabolic Syndrome

bull Systematic review- 16 cohorts Type 2 Diabetes (T2DM) Risk

bull 3 svd (minimum 48g) whole grain (WG) Relative risk (RR) = 068

bull Inverse associations

bull WG including WG bread

bull Branbull Refined grains RR= 095

bull gt3000 children adolescents in Tehran

bull No association with

bull low CHO diet score and incidence of MetS

bull MetS components

bull risk from energy dense snacks

Eslamian et al Arch Iran Med 201417417-22 Aune D et al Eur J Epidemiol 2013 28845-58

482016

10

55

Whole Grain Coronary Heart Disease

Tang G et al Am J Cardiol 2015115(5)625-9Jacobs et al 1999

Liu et al 1999 Steffan et al 2003 Mozaffarian et al JAMA 2003Tang et al

3 sv ~ 50 g WGd

36 risk ndash 1 svd

25 - 28 risk

Iowa Womenrsquos Health N=35000

ARIC Men Women N~16000

Nursesrsquo Health Study N~75000

Elderly N=3500

22 risk ndash 3 svd

2015 meta analysisndash 15 cohorts 3 case-control ngt 400000

Claim ldquoGrain Fiber Unnecessaryrdquo

bull Davis amp Paleo other fibers will do the same job

NIH-AARP Diet amp Health Study 367442 older Americans

bull High cereal fiber intake 19 lower risk of all-cause mortality

bull 15ndash34 lower risk of disease-specific mortality

ldquoDietary fiber from grains but not from other sources was significantly inversely related to total and cause-specific death in both men and womenrdquo

Gonzalez CA Riboli E Eur J Cancer 2010462555-62 AMA Park Y et al Archives of internal medicine 20111711061-1068 Huang T et al BMC Medicine 20151359

57

Claim Fibers from All Sources Have the Same Impact

bullDF amp Small Intestinal Cancer RR

bullTotal Dietary Fiber 079 ns

bullGrain Fiber 051 P lt 001

bullWhole Grain foods 059 P lt 006

NIH AARP Ngt 500000

Schatzkin et al Gastroenterology 2009 1351163-7

Imagehttpi0wpcomwwwlowfodmapdietscomwp-contentuploads201410Caveman-Paleo-Diet-e1412900015791jpgresize=4002C289

Claim Vegetable Fibers Will Do the Job

FIBER LAXATION

per g fiber fed

Wheat bran 54

Psyllium 40

Oats 34

Corn 33

Legumes 22

Pectin 12

RS2 resistant starch 11

Inulin 10

59Cummings JH 1993 CRC Handbook of Dietary Fiber in Human Nutrition

Low-carb diets Higher all-cause mortalityMeta-analysis - 17 studies - 272216 people in

4 cohort studies

bull All-cause mortality - high low-carb score RR = 131

bull Similar for low carbhigh protein

bull Low-carb diets were associated with a significantly higher risk of all-cause mortality

bull limited observational studies

bull long-term outcomes are needed

Noto H et al PLoS One 20138(1)e55030

482016

11

Affordability and Nutritional Quality of No Grain Gluten Free Paleo

bullGluten - free diets ndash can cost 242 more

bull May be less nutritious and may not be fortified and are more costly

bullPaleo and Grain ndashfree diets - meats seafood fruits vegetables and nutsbull USDA data 93 income needed for Paleolithic diet that meets all

daily recommended intakes

bull Inadequate Ca++or and cereal legume fiber

bull USDA ldquonot feasible for low-income consumersrdquoMetzgar M et al Nutr Res 201131444-51

Grains and the World Food Supply

Crop Yields ndash Wheat vs Ancient GrainsbullWheat 50 buacre

3000 lbs of grain

bullSpelt 2400 lbs naked grain

bullEmmer Farro 1900 lbsEinkorn 1500 lbs

Durum Einkorn

Protein (g) Unit Area by Crop

With permission

Grains carbohydratestaples deliver much needed protein

Nutritional Contribution of Grains

CerealPseudocereal

Calories m2 Protein (kgha)

Maize (corn) 1847 415

Oats 1508 384

Rice (paddy) 1482 307

Triticale 1256 470

Amaranth 1133 418

Wheat 1083 423

Rye 914 271

Teff 605 226

Sorghum 529 165

Millet 345 105

Quinoa 275 109

Traditional Grains

bull gt1000 kcal per square meter

bull gt400 kg protein ha

Hunger Math World Hunger by the Numbers Conte R 2013

Non-grain

Soybean 1029 870

Lentils 322 244

Green Beans 229 127

Conclusionsbull We did evolve to eat grains

bull Wheat has not changed but we have Many possibilities including aspects that cause changes in the microbiome increase all autoimmune diseases

bull Around 5 of the population should avoid wheat and or gluten

bull Grains and grain fiber are unique and protective to health

bull Diets without gluten and grains may be inadequate Need careful planning and may lack cereal fiber

bull Elimination of grains bodes problems for 2050 in terms of the world food supply

482016

10

55

Whole Grain Coronary Heart Disease

Tang G et al Am J Cardiol 2015115(5)625-9Jacobs et al 1999

Liu et al 1999 Steffan et al 2003 Mozaffarian et al JAMA 2003Tang et al

3 sv ~ 50 g WGd

36 risk ndash 1 svd

25 - 28 risk

Iowa Womenrsquos Health N=35000

ARIC Men Women N~16000

Nursesrsquo Health Study N~75000

Elderly N=3500

22 risk ndash 3 svd

2015 meta analysisndash 15 cohorts 3 case-control ngt 400000

Claim ldquoGrain Fiber Unnecessaryrdquo

bull Davis amp Paleo other fibers will do the same job

NIH-AARP Diet amp Health Study 367442 older Americans

bull High cereal fiber intake 19 lower risk of all-cause mortality

bull 15ndash34 lower risk of disease-specific mortality

ldquoDietary fiber from grains but not from other sources was significantly inversely related to total and cause-specific death in both men and womenrdquo

Gonzalez CA Riboli E Eur J Cancer 2010462555-62 AMA Park Y et al Archives of internal medicine 20111711061-1068 Huang T et al BMC Medicine 20151359

57

Claim Fibers from All Sources Have the Same Impact

bullDF amp Small Intestinal Cancer RR

bullTotal Dietary Fiber 079 ns

bullGrain Fiber 051 P lt 001

bullWhole Grain foods 059 P lt 006

NIH AARP Ngt 500000

Schatzkin et al Gastroenterology 2009 1351163-7

Imagehttpi0wpcomwwwlowfodmapdietscomwp-contentuploads201410Caveman-Paleo-Diet-e1412900015791jpgresize=4002C289

Claim Vegetable Fibers Will Do the Job

FIBER LAXATION

per g fiber fed

Wheat bran 54

Psyllium 40

Oats 34

Corn 33

Legumes 22

Pectin 12

RS2 resistant starch 11

Inulin 10

59Cummings JH 1993 CRC Handbook of Dietary Fiber in Human Nutrition

Low-carb diets Higher all-cause mortalityMeta-analysis - 17 studies - 272216 people in

4 cohort studies

bull All-cause mortality - high low-carb score RR = 131

bull Similar for low carbhigh protein

bull Low-carb diets were associated with a significantly higher risk of all-cause mortality

bull limited observational studies

bull long-term outcomes are needed

Noto H et al PLoS One 20138(1)e55030

482016

11

Affordability and Nutritional Quality of No Grain Gluten Free Paleo

bullGluten - free diets ndash can cost 242 more

bull May be less nutritious and may not be fortified and are more costly

bullPaleo and Grain ndashfree diets - meats seafood fruits vegetables and nutsbull USDA data 93 income needed for Paleolithic diet that meets all

daily recommended intakes

bull Inadequate Ca++or and cereal legume fiber

bull USDA ldquonot feasible for low-income consumersrdquoMetzgar M et al Nutr Res 201131444-51

Grains and the World Food Supply

Crop Yields ndash Wheat vs Ancient GrainsbullWheat 50 buacre

3000 lbs of grain

bullSpelt 2400 lbs naked grain

bullEmmer Farro 1900 lbsEinkorn 1500 lbs

Durum Einkorn

Protein (g) Unit Area by Crop

With permission

Grains carbohydratestaples deliver much needed protein

Nutritional Contribution of Grains

CerealPseudocereal

Calories m2 Protein (kgha)

Maize (corn) 1847 415

Oats 1508 384

Rice (paddy) 1482 307

Triticale 1256 470

Amaranth 1133 418

Wheat 1083 423

Rye 914 271

Teff 605 226

Sorghum 529 165

Millet 345 105

Quinoa 275 109

Traditional Grains

bull gt1000 kcal per square meter

bull gt400 kg protein ha

Hunger Math World Hunger by the Numbers Conte R 2013

Non-grain

Soybean 1029 870

Lentils 322 244

Green Beans 229 127

Conclusionsbull We did evolve to eat grains

bull Wheat has not changed but we have Many possibilities including aspects that cause changes in the microbiome increase all autoimmune diseases

bull Around 5 of the population should avoid wheat and or gluten

bull Grains and grain fiber are unique and protective to health

bull Diets without gluten and grains may be inadequate Need careful planning and may lack cereal fiber

bull Elimination of grains bodes problems for 2050 in terms of the world food supply

482016

11

Affordability and Nutritional Quality of No Grain Gluten Free Paleo

bullGluten - free diets ndash can cost 242 more

bull May be less nutritious and may not be fortified and are more costly

bullPaleo and Grain ndashfree diets - meats seafood fruits vegetables and nutsbull USDA data 93 income needed for Paleolithic diet that meets all

daily recommended intakes

bull Inadequate Ca++or and cereal legume fiber

bull USDA ldquonot feasible for low-income consumersrdquoMetzgar M et al Nutr Res 201131444-51

Grains and the World Food Supply

Crop Yields ndash Wheat vs Ancient GrainsbullWheat 50 buacre

3000 lbs of grain

bullSpelt 2400 lbs naked grain

bullEmmer Farro 1900 lbsEinkorn 1500 lbs

Durum Einkorn

Protein (g) Unit Area by Crop

With permission

Grains carbohydratestaples deliver much needed protein

Nutritional Contribution of Grains

CerealPseudocereal

Calories m2 Protein (kgha)

Maize (corn) 1847 415

Oats 1508 384

Rice (paddy) 1482 307

Triticale 1256 470

Amaranth 1133 418

Wheat 1083 423

Rye 914 271

Teff 605 226

Sorghum 529 165

Millet 345 105

Quinoa 275 109

Traditional Grains

bull gt1000 kcal per square meter

bull gt400 kg protein ha

Hunger Math World Hunger by the Numbers Conte R 2013

Non-grain

Soybean 1029 870

Lentils 322 244

Green Beans 229 127

Conclusionsbull We did evolve to eat grains

bull Wheat has not changed but we have Many possibilities including aspects that cause changes in the microbiome increase all autoimmune diseases

bull Around 5 of the population should avoid wheat and or gluten

bull Grains and grain fiber are unique and protective to health

bull Diets without gluten and grains may be inadequate Need careful planning and may lack cereal fiber

bull Elimination of grains bodes problems for 2050 in terms of the world food supply