Challenging Dogma - Spring 2008

...Using social sciences to improve the practice of public health

Sunday, April 20, 2008

A Health Food Framing Fallacy: How the Public Health Promotion of Whole Grains Will Make Us Sicker - Michele Tassinari

The typical American diet has been identified as one of the reasons the US spends the most on health care yet ranks below other nations in numerous health outcomes. After two generations, immigrants develop the same rate of disease as Americans, evidence that “the chief cause of this health crisis is poor and imbalanced diets” (1-5). According to the Surgeon General, “your choice of diet can influence your long-term health prospects more than any other action you might take”. Heart disease, cancer, stroke and diabetes have been the leading causes of death in the US for decades. Sixty one percent of these deaths are attributable to diet (6-13).

Whole grains which are framed as health foods, are touted as being helpful in preventing cancer, cardiovascular disease, diabetes, obesity and several other diseases. However, for an estimated 42% of the population, whole grains have just the opposite effect and actually cause illness. An estimated 15% of the population has a wheat sensitivity (1 in 7 people) and an additional 30% react to gluten, a protein in wheat (14-15). The popularity of the Atkins diet was due to the elimination of bread-based carbohydrates. Atkins resulted in people discovering how much better they felt without wheat-based products, which were the underlying cause of their health problems (16). Overall, close to half of the population experiences negative health problems due to food products containing wheat.

The public health normative re-educative approach to promoting whole grains in place of refined grains for better health is misguided. It will aggravate and increase the morbidity and mortality rates whole grains are being advertised to ameliorate.

“Wheat between the lines”: What Health claims and the Whole Grain Council fail to mention

Research clearly indicates substances in whole wheat grains can interfere with not only animal but also human metabolism. Public health officials fail to take into account wheat’s tendency to aggravate body function among those with and without sensitivities (17-22). For those with wheat sensitivities, consuming wheat reduces the quality of daily life and eventually becomes fatal.

The symptoms of wheat sensitivities are vast and eclectic. They can be minor, annoying symptoms like runny nose, itchy skin, extreme fatigue, a feeling of insatiable hunger, mouth cankers, joint problems, stomach issues like bloating, cramps, gas, constipation or overly frequent bowel movements, depression, trouble concentrating, memory problems, headaches, general unwell feelings, and lactose intolerance. Children with wheat sensitivities tend to have behavioral problems, trouble in school, learning and concentrating problems, eczema, dental enamel defects, increased cavities, anemia and other nutritional deficiencies, continual colds or frequent sickness. Interestingly, children with autism and ADD have shown improvement when placed on a gluten free diet. Teens and adults, in addition to the issues children may face, may additionally experience acne/rashes, extreme mood swings and behaviors, migraines, anxiety and depression, eating disorders, blood sugar problems that can lead to diabetes, difficulty gaining, losing, or maintaining a healthy weight, circulation problems in hands and feet, and arthritis. Women may experience delayed menarche and cycle irregularities, frequent yeast infections, polycystic ovary syndrome, infertility, miscarriages, intrauterine growth retardation, low birth weight babies, and loss of bone mineral density (15,18,23-29).

Wheat may also be the culprit behind America’s large appetite. Wheat contains a protein called gluten. Digestion of gluten containing food produces exorphins, peptides with morphine-like activity that can interact with the central nervous system opiate receptors. Opiate peptides in the brain are involved in motivation, emotion, attachment, behavior, the response to stress and pain, and the control of food intake (30). Those with wheat sensitivities have a stronger opiate response during digestion, resulting in a feel- good “high” sensation, which leads to an urge for more. There is biological truth behind the phrase “comfort foods”. When not regularly consumed, fatigue, irritability, restlessness, a ravenous hunger, brain fog and other similar “crashing” withdrawal symptoms occur, ultimately resulting in a carbohydrate-based food craving/addiction. Many blame their inability to limit certain foods on a lack of willpower, but the true culprit may be an underlying wheat-induced opiate response.

The gluten protein is also found in barley, rye and often oats. The gluten content of products is increasing, in the effort to add more fiber and whole grains to food. Gluten is great for baking and manufacturing food. It has sticky and elastic properties that make products more heat resistant, malleable, and elastic. Gluten makes bread fluffier, gives pizza the right texture, and results in cakes, cookies and pastries that are moist, spongy, and aesthetically pleasing.

These sticky and elastic properties also make gluten difficult to digest. As wheat travels through the small intestine, the gluten particles can linger and adhere to the walls of the small intestine causing the body’s immune system registers the gluten proteins as invaders. The cells of the small intestine are attacked and killed in the process. The major function of the small intestine is to absorb macro and micro-nutrients. The presence of gluten leads to malabsorption of many nutrients, including the three most common supplements for women:iron, folate and calcium (31-36). Compounding the damage, undigested gluten can be absorbed into the bloodstream, eliciting a systemic autoimmune response injuring the tissues and organs throughout the entire body. Gluten can cause multi-system ailments “that affects not only the gastrointestinal tract but also the hematologic, endocrine, dermatologic, neurologic, reproductive, and orthopedic systems”. It is suspected as “the root cause of many cancers, autoimmune diseases, neurological diseases, chronic pain syndromes, psychiatric and other brain disorders, and premature death. There is also a clear causal connection with some cases of osteoporosis, epilepsy, learning disorders, attention deficit disorders, infertility, miscarriage, premature births, and chronic liver disease” (15,18) .

Whole Grain Havoc: The One-Sided Policy Perspective
"Diets rich in whole grain foods and low in total fat, saturated fat, and cholesterol, may help reduce the risk of heart disease and certain cancers". This phrase is commonly seen and heard today in newspapers, magazines, on tv, on food packages and from professional nutrition experts. “Whole grains” is a term used loosely by the general public and by officials to mean wheat. For example, the Whole Grain Council states that in one year whole grain flour production increased by 26%. In fine print at the bottom of the page, it is noted that the term whole grain flour is in reference to wheat flour (37). Public health officials are promoting the benefits of increased whole grain consumption on several levels, from mass media advocacy to policy changes

In 1997, the FDA first began to tout the health benefits of whole grains, from preventing heart disease and diabetes to helping maintain a healthy weight. Content claims, statements on food labels that proclaim a relationship between eating a food and that food promoting health or helping prevent disease (due to some ingredient or nutrient in it) were authorized. Health and nutrition claims are based on current published scientific statements from "a scientific body of the United States with official responsibility for public health protection or research directly related to human nutrition” and must not “exceed the disqualifying amounts of nutrients that may increase the risk of a disease or health-related condition in the general population” (38).

Yet, in the late 1980s, a similar effort was made to advocate low-fat products to aid in weight loss, control blood pressure and promote health. Food labels nationwide proclaimed reduced and low fat content and people avoided fat across the nation. A decade after the low fat campaign, the Center for Disease Control declared an “obesity epidemic” in America. The low fat fad employed downstream framing by only conveying the negative side of fats. The public, unaware that certain fats are beneficial and necessary for proper body function, avoided all fats, which was an unhealthy, erroneous and detrimental diet.

The same limited perspective downstream framing technique is being used to aggressively promote the consumption of whole grains. In 2005, the modification of the food pyramid was hailed as a major advance over the outdated version of the 1980s because it now boasts that “consuming at least three servings of whole grains per day can reduce the risk of diabetes and coronary heart disease and may help with weight maintenance. Thus, daily intake of three or more servings of whole grains per day is recommended, preferably by substituting whole grains for refined grains”. However, the pyramid still advocates 6 or more servings of bread products, ultimately remaining static in its recommended diet composition (39-40).

The perception of whole wheat as a wholesome, nutritious food is being pushed on the policy, economic and social levels. It is true that whole grains have more fiber, more nutrients and antioxidants and a lower glycemic index than refined grains. However, similar to the low-fat framing, this one-sided promotion of whole wheat will neither promote health nor healthy eating habits.

Wheat woes: The Bias in the Science
Public health is based on the logic that “it is better to err on the side of prudence even if it means persuading us all to engage in an activity, eat a food or take a pill that does nothing for us and ignoring, for the moment, the possibility that such as action could have unforeseen harmful consequences” (41). Public health officials are overlooking the negative evidence and avidly linking increased whole grain consumption to decreased disease outcomes.

The claim that whole grains reduced the risk of cardiovascular disease was announced in 1997 after a review of sixteen studies. Fourteen showed a reduced risk, two did not (42). However, sample size, retention rates, and other causes of bias and confounding were not carefully considered. Women in these studies with the highest intake of whole grains were shown to smoke less, exercise more, drink less alcohol, and were more likely to take Hormone Replacements, showing health conscious lifestyle and behavior attitudes (43). Moreover, whole grains often, but not always, have less sugar, hydrogenated fats, food additives and other chemicals than refined products, further confounding if the effect on the body is due to whole grains or due to the lack of additives. These observational studies cannot determine causation, as the one-sided media headlines often imply.

Forty case-control studies were used to establish the relationship between whole grains and a decreased risk of cancer. Seven did not support the association. One showed an increase in thyroid cancer(44). The effects of whole grains in the body are not understood. It is not clear if apparent protection is due to one or several nutrients in combination, indicative of a more health conscious lifestyle, socioeconomic status, or an interaction with body mass and composition (45).
Diabetes and whole grain studies show mixed results (46-49). However, animal models show an increased risk of diseases, such as diabetes, and early death when fed gluten (wheat) based diets (19-22).

Some studies, in lieu of the FDA’s eager promotion of whole grains, were sponsored by food companies. For example, one study entitled “The Importance of Promoting a Whole Grain Food Message” received financial support from Sara Lee Bakery and the Wheat Foods Council (50). The United States Department of Agriculture is a prominent sponsor of major nutrition research grants. The USDA’s purpose is to regulate and promotes agriculture. Considering wheat is a major money-making crop, there is a distinct conflict of interest.

Implications for a “glutened” society: The Celiac Iceberg
As wheat continues to be ingested over the years, celiac disease can develop. Celiac disease is the most severe and extreme reaction to the gluten protein. A tiny crumb of bread is enough to trigger a deleterious immune response. Celiac disease is more than twice as common as cystic fibrosis, Crohn’s disease and ulcerative colitis combined. However, many physicians misdiagnose it as another problem like irritable bowel, or dismiss patients as hypochondriacs or overly stressed. Patients don’t associate their symptoms with the food they ate. Currently about 1 in 133 people (approximately 1% of the American population) are thought to have celiac disease, but 97% of them do not even know they have it (15,18,23). The only treatment for celiac is life-long adherence to a gluten-free diet, which is extremely challenging and frustrating in today’s society. The whole grain enhancement of foods has made it even more difficult. Foods that once were gluten-free such as Rice Krispies, soy milk, salsa, and corn chips are now fortified with whole grains.

Untreated celiacs are twice as likely to die early from cancers, diabetes, osteoporotic issues, and liver problems. Diabetes tends to co-occur with celiac disease. Women are 2 times more likely to have celiac than men. Breast cancer in the families of celiac patients is twice as common as in the general population (15,18,51-54). Morbidity rates are much higher for cancers especially colorectal and gastrointestinal cancer: which are some of the most prevalent forms of cancer. Undiagnosed and untreated celiacs have a higher risk of death than smokers (26).The current prevalence of celiac is forty times that of what was thought only 12 years ago (23,29).

Conclusion: Wheat Whiplash
Knowingly or not, most Americans are eating larger quantities of whole grains because of the many products that are now whole grain enhanced, from Lucky Charms and Pringles to whole wheat pasta and 100% wheat bread. Over 600 million metric tons of wheat is eaten annually, making it the most consumed grain (15). Health officials have a one-sided, steadfast opinion that increasing wheat in the whole grain form is the solution to the nation’s health woes. Many Americans care about their health. According to the International Food Information Council, 75% of Americans are concerned about their weight and 70% modify their diet in hopes of losing weight, often switching to whole grains with hopes of better health (55). Framing wheat as a health food when close to half the population unknowingly has an adverse reaction to it is a deleterious public health policy. Wheat may be the fundamental cause of the augmenting American morbidity and mortality rates. Public health officials are either unaware of or are failing to acknowledge the evidence that wheat is not the health food it is widely perceived to be. Continuing to promote whole wheat as part of a healthy diet will continue to demote the health of the nation.

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