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Home , Paleolithic diet, Refined grains

4/8/2016

WHAT THIS TALK WILL • Review claims that humans did not evolve to eat and . COVER • Review data on whether the wheat has changed. ARE NEW WHEAT • Review claims that modern agricultural processes cause toxic effects. VARIETIES REALLY • Review claims suggesting that wheat especially, new varieties, are toxic and MAKING US AND cause , chronic disease and brain SICK? disorders. • Look at the controversy and and (CHO) recommendations • Discuss some aspects that have changed • Highlight the contribution of grains to Julie Miller Jones, PhD, LN, CFS, CNS quality vs potential dietary problems with Fellow ICC and AACCI the omission of wheat, grains and other Professor Emerita carbohydrate staples in terms of , St. Catherine University cost and food supply issues. [email protected] March 19, 2016

We should be eating like the cavemen – bring on the Grains are not mastodon steaks. needed

GMO crops and modern is killing us Modern grains are killing you. CLAIM: HUMANS DID NOT EVOLVE TO EAT GRAINS

Claim: Humans Did Not Evolve to Eat Grains Claim: Humans Did Not Evolve to Eat Grains •Humans -eating grains >100,000 yrs • With the advent of agriculture • Dental record evidence • Humans evolved to have 6 copies of • Hominids were and are • other primates - 2 copies • Cooked grain DNA in dental calculus of • Amylase & cooking of CHO enabled ready supply of glucose to the humans brain • Cave and cooking evidence* • Cooked CHO foods may have enabled by • Grains (sorghum, wild , others) found in increasing the brain size of humans caves • Grain DNA on stone tools and in cooking pots http://news.sciencemag.org/evolution indicate processing and cooking of grains. /2012/10/raw-food-not-enough-feed- *Caves in Iraq and the Low Countries; the Americas big-brains Henry, A. et al. Ethology and Sociobiology 15 : 219–35.; Unger, P. The known, the unknown and the unknowable news.nationalgeographic.com/.../121026 DOI:10.1016/0162-3095(94)90015-9. -human-cooking-e…- A surge in human brain size about 1.8 million years ago is linked to the innovation of cooking

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What Was Life Like in the Paleo Period • Average lifespan ~ 37 years • Paleo people were 65-85% vegetarians; more in colder climates • Our ancestors did eat grains and . • Early humans ate very much like modern pigs and bear - getting calories to survive CLAIM: PALEO DIETS ARE BETTER FOR YOU

• http://www.dailymail.co.uk/sciencetech/article-2878166/Scientists-slam- caveman-diet-say-early-humans-just-ate-could.html#ixzz42Kv1U4Ur

Recommendations for (CHO) and CHO Staples • Dietary recommendations - most countries /health promotion orgs • Food guidelines recommend grains as a food group • CHO/ grain staples - Base of pyramid/ diet • 45-65% of E (up to 75%of E) • Australia / New Zealand Dietary Guidelines • European Food Safety Authority CLAIM: GRAINS/ • UK Scientific advisory Committee on Nutrition • US Dietary Guidelines / US Institute of Medicine -CONTAINING • Singapore Health Promotion Board • Indian Health CARBOHYDRATE • Health promotion bodies such as heart, cancer and associations

STAPLES ARE BAD FOR • World Health Organization/ Food & Agriculture Organization (WHO/FAO) THE HUMAN DIET • “the macronutrient that humans need in the largest quantity.” • Montagnese C et al Nutrition. 2015 ;31:908-915. Radhika G, et al Public Health Nutr. 2011 ;14:591-8;http://www.hpb.gov.sg/HOPPortal/health-article/2638

Dietary Guidance - Central European Example

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

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Breeding Has Changed Everything Edible Breeding Has Changed Everything Edible

http://cdn.foodbeast.com.s3.amazonaws.com/content/wp- http://www.foodinsight.org/foods-before-now-gmo-biotechnology content/uploads/2013/09/V8XnPeQ.jpg

Claim: Wheat Has Been Breeding Has Changed Everything Edible Changed to Be Problematic

• “Wheat we eat these days isn't the wheat your grandma had… It’s an 18-inch tall plant created by genetic research in the ’60s and ’70s.” Davis • No significant changes Kasarda, USDA Albany 2013 Chibbar, U. Saskatchewan 2015 HealthGrain EU 2013 So Jack, were these some Norman Borlaug sold you?

http://www.foodinsight.org/foods-before-now-gmo-biotechnology 16

Wheat Protein (Gluten) Levels Unchanged • FACT: Triticum aestivum is found in many shapes / sizes.

• Ancient/modern wheat – 12” t- 60” (USDA-National Small Grains Collection) • Height genes do not code for and gliadins

37 ancestral and modern varieties of wheat Red fife dating from 1860 to newest variety ©Chibbar et al. 2015 over 150 yrs “Analysis of a variety of heritage and modern wheat tested 2007. Grown in 2013, and in 2014 Photo Credit: U Sask- Hucl et al starch shows very little difference ….varied from 56 % (Apex 1937) to 69% (Superb 2001) 17

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Gliadin –A new protein Gliadin –An opiate

Davis claim: Gliadin is a new toxic protein and opiate. • Food Proteins – NIH in vitro study 1979 1745 studies of wheat proteins - Italy 1820 Gliadin - German chemists Osborne and Voorhees • Proteins, digestive enzymes, acid – wheat 1893 chemical constitution of gliadin and glutenin • milk, soy, , spinach 1915 Osborne & Mendel gliadin maintains life but would not promote growth without other plant proteins

“everybody 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 year.” • 46 lbs/ yr

The chemistry of gliadin – Springer .Springer Science+Business Media 19 20 by AL Patey - 1978

Claim: Ancient Are More Nutritious Claim: ‘Ancient Wheats’ less Immunogenic • • ‘Ancient’ Graziella Ra and Kamut vs (Triticum dicoccum) and einkorn (T. monococcum), T. timopheevi, T. palaeo-colchicum, T. macha compared to other wheats from the same region Total gliadin and α-gliadin determination by “The data do not support an overall superiority of primitive forms, but evidenced interesting, potentially modern accessions Cappelli, exploitable, between- and within-species variability.” indirect ELISA.1 Flaminio, Grazia and Svevo1 • Advantages Einkorn • “…present results cannot confirm that • Rich in proteins and lipids (mostly unsaturated fatty acids) ancient durum wheats would be less CD-toxic. In conclusion, we strongly • Fructans (+ prebiotic and –FODMAP) advice celiac patients from consuming • and - bioavailability?; Carotenoids and tocols; ancient wheats including…”3 conjugated polyphenols, alkylresorcinols and phytosterols • not less allergenic by blot and pin prick 2 • Low β-amylase and lipoxygenase activities (less oxidation tests during storage etc) • Disadvantages 1Šuligoj T, Gregorini A, Colomba M, Ellis HJ, Ciclitira ‘Ancient’ • Low PJ. Evaluation of the safety of ancient strains of wheat in reveals heterogeneous • Wheat 11.5-18.3% of dry matter (dm) vs Einkorn and emmer small intestinal T cell responses suggestive of wheats 7.2-12.8% of dm; durum and wheats(10.7-15.5% of coeliac toxicity. Clin Nutr. 2013 ;32:1043-9;. 3Colomba MS, Gregorini A. Are ancient durum wheats dm 2Simonato B1, Pasini G, Giannattasio M, Curioni A. less toxic to celiac patients? A study of α-gliadin from Graziella Ra and Kamut. ScientificWorldJournal. Allergenic potential of Kamut wheat. Allergy. 2002 Hidalgo A1, Brandolini A. Nutritional properties of (Triticum monococcum L.). J Sci Food Agric. 2014 ;94:601-12; Benincasa P, Galieni A, Manetta 2012;2012:837416 AC, Pace R, Guiducci M, Pisante M, Stagnari 2. Phenolic compounds in grains, sprouts and of hulled and non-hulled wheat species. J Sci Food Agric. ;57:653-4 2015;95:1795-803; Giambanelli E, Ferioli F, Koçaoglu B, Jorjadze M, Alexieva I, Darbinyan N, D'Antuono LF. A comparative study of bioactive compounds in primitive wheat populations from Italy, Turkey, Georgia, Bulgaria and Armenia. J Sci Food Agric. 2013;93:3490-501.: 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 ;56:9740-9.

Food Allergies, Intolerances, and Digestion and Gut Health: Sensitivities Defined The First Point of Wellness

• Food Allergy*: an IgE mediated reaction to a food protein causing histamine release "Digestion, of all the bodily • Food Autoimmune: reaction caused functions, is the one which by the activation of a gene (celiac) exercises the greatest • Food Intolerance: reaction to a influence on the mental state metabolite or ingredient such as of an individual.” lactose, caffeine, or tyramine (aged cheeses and Asian fermented sauces) • Food Sensitivity: reaction to food Jean-Anthelme Brillat-Savarin component that is not an allergic, (1755-1826) chemical or autoimmune response

*Celiac disease is an autoimmune disease not an allergy

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Human Microbiome A Vital Role in Human Health Digestion and Gut Health • Human body has 10 trillion cells “We should start thinking • Microbes outnumber human cells 10:1 about diets not only from • Influenced by ~1 - 3 % of body the perspective of what we • Diet – esp. fiber vs readily available carbs (CHO) 200 lb. Adult has 2- 6 lbs bacteria should eat, but what we • Fiber feeds the gut MO should be feeding our entire • Phytochemicals used by MO • gut microbial systems…. Type of birth - Vaginal vs. Cesarean • Breast fed or not The gut microbiome has been • Use of antibioitics and other drugs linked to many diseases, including obesity, cancer, • Greater diversity of types of MO assoc. with better health • “ there is not just one way to be healthy, there doesn’t have to be one or two ‘just right’ gut and inflammatory bowel communities, but rather a range of ‘just fine’ communities”…As predictable, the gut flora is disease....” 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 flora.” ~Huse, a researcher in Human Microbiome Project (HMP) ~Jeff Leach, founder of the Human Food Project and co-founder of American Gut. Source: Huse, S. et al.2012 PLoS ONE, 7 (6) DOI: 10.1371/journal.pone.0034242

Microbiome Diversity / Balance Gut Bacteria Through the Lifecycle • Assoc. with the Immune System • Allergies & Asthma • Crohn’s disease & Colitis • Obesity & Diabetes • Cancer risk • Heart disease • Poop transplants by changing microbes • Rats changed susceptibility to heart attacks • Lean rats became obese and vise versa • Assoc. with Stress, Personality Germ-free mice & rats are more vulnerable to stress • Mice: Warm and friendly vs. aggressive and stand-offish strains • Assoc. with Cognition and Behavior • High fat/ high protein diets reduce memory acuity; executive functioning

• Markers of inflammation  affect entire body incl. brain Source: Ottman et al. Frontiers Cellular Infection Micro. 2012; 2:1-10

Low Acid, Bacterial Overgrowth Gut Permeability: Opening the Door to Dietary Dysbiosis & Disease Many Health Problems

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

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Intestinal Microbes and Allergy

LLERGIES, ANTACIDS, Clostridia, MICROBES,CARBOHYDRATES & Enterobacteriaceae, A WHEAT Decreased Staphylococci risk

Lactobacillus Increased Bifidobacterium Risk

Source: Noval Rivas M et al. J Allergy Clin Immunol. 2013 Jan;131:201-12

Prevalence of Food Allergy Top Food Allergens • Children % Adults % Mast Cell: • Up to 35% believe they Milk `2.5* Shellfish 2.0 Eggs 1.5* Peanut 0.6 have food allergy Tree nuts 0.5 Peanuts 1.4 / Nuts 1.1 Wheat 0.5 • ~3.5% confirmed by oral Wheat 0.4* Fish 0.4 food challenge Soy 0.4* Sesame 0.1 • 10-fold lower prevalence Fish 0.1 & Shellfish 0.1 / est. Sesame 0.1 0.1 - 4.3 in entire * 80% outgrow by teen years population under 0.5% Source: http://www.jacionline.org/article/S0091-6749(07)00991-8/abstract; Rona RJ et al. Journal of Allergy and Clinical Immunology 2007, 120:638-646 Source: Waserman S & Watson W. Allergy Asthma Clin Immunol. 2011;7 Suppl 1:S7; Sicherer & Sampson, 2010; Chafen et al, JAMA. 2010;303:1848-56. 34

Wheat Allergy – What Is It? Wheat Allergy Symptoms

• A classic allergy, usually to the storage proteins • IgE Immunoglobulin response –27 wheat proteins have been identified • Mast cells release histamine after binding with IgE • Glutenins (wheat glutelin): most frequent allergens • Eczema & hives, swelling • Gliadins: most severe allergens • Asthma & hay fever-like symptoms, cough – γ-gliadin • Tiredness – ω-5 gliadin - Wheat dependent exercise induced anaphylaxis (WDEIA) • GI symptoms • Albumins and maybe some globulins and enzymes – α-amylase/trypsin inhibitor family in wheat, and rye • Rare: anaphylactic shock –Neurological –Joint/muscle pains  arthritis –Other IBS Source: Mills et al Plant Food Allergens 2007 Blackwell 35 Source: Holloway et al. Practitioner. 2011;255(1741):19-22 36

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Allergy & Acid Suppression Acid Suppression & Allergy

Antacids and anti-ulcer drugs: • Acid suppression while In utero associated in offspring (Swedish • stomach acid leads to  protein digestion and cohort>29,000) potential allergic reaction –Allergy (OR 1.43) • Promote IgE formation by dietary protein fragments –Childhood asthma (OR 1.51)  Milk, potato, celery, carrots, apple, orange, wheat, rye  Sensitivities lingered > 3+ mo. after antacid use

Sources: Untersmayr et al FASEB J. 2005 Apr;19(6):656-8 Dehlink E, et al. Clin Exp Allergy. 2009;39:246-53; Source: Dehlink E et al. Clin Exp Allergy. 2009;39:246-53; Diesner et al. Wien Med Diesner et al Wien Med Wochenschr. 2012 Dec;162(23-24):513-8 Wochenschr. 2012;162:513-8 McCarthy DM Curr Opin Gastroenterol. 2010 Nov;26(6):624-31

Causal Factors for Celiac Symptoms

ELIAC, GLUTEN SENSITIVITY, LEAKY 1. Gluten C GUT AND DYSBIOSIS 2. Genetics (>97%) – HLA-DQ-2 – HLA-DQ-8 3. Trigger - stress, trauma – Surgeries, pregnancy, etc. – Viral infections 4. Intestinal Permeability – Emerging Factor – “Leaky Gut”

Celiac Incidence

• US Average (healthy people): 1 in 133; only 1: 4700 diagnosed –Higher if Scandinavian, Irish, parts of Middle East: 1 in 50-60 • Abdominal pain • Fatigue 33% – Est. African, Hispanic- and Asian-Americans: 1 in 236 (IBS) 68% • 33% • In people with related gut symptoms: 1 in 56 • Eczema, rash 40% • Depression 22% –1st-degree relatives : 1 in 22 • Headache 35% • Numbness in –2nd-degree relatives (aunt, cousin) : 1 in 39 • “Foggy mind” 34% extremities 20% • Incidence is increasing: 2 to 5x higher • Joint pains 11% Based on the presence of tissue trans-glutaminase antibodies – No continuous data relating to the incidence of celiac disease in the U.S. population on a year-by-year basis Source: Center for Celiac Research in Baltimore- Dr. Alessio Fasano 2004-2010; 347/5896 patients- 6% fulfilled criteria for GS Sources: Fasano, www.uchospitals.edu/pdf/uch_007937.pdf No validated or agreed upon test for non-celiac gluten sensitivity.. Alberto Rubio-Tapia, Amer J Gastro, 2012; DOI: 10.1038/ajg.2012.219; Riddle et al Am J Gastroenterol. 2012 Aug;107(8):1248-55 42

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Theories about Increasing Theories about Increasing Prevalence of Celiac/ Autoimmunes Prevalence of Celiac 1. Increased awareness, better diagnostics 5. Infant & Early Feeding Practices • Recognition of gluten sensitivity; controversial • Gradual introduction of gluten - 4 and 7 mo  risk 2. Bacterial overgrowth: medications, age • Celiac disease • Gluten allergies 1 3. intake • Type 1 diabetes (another auto-immune disease) 4. Increased autoimmune diseases overall Introducing gluten while breastfeeding appears to be • Clean theory or hygiene hypothesis2 protective in some studies, not all 33% of babies born by Caesarian 1Wu et al., Nature, doi:10.1038/nature11984, 2013; Kleinewietfeld M. Nature, doi:10.1038/nature11868, 2013; Yosef N et al., Nature, 6. Foodborne infections and viruses: trigger doi:10.1038/nature11981, 2013. 2Fumagalli et al. J Exp Med. 2009;206(6):1395-408; Brooks et al Curr Opin autoimmune diseases Allergy Clin Immunol. 2013 Feb;13(1):70-7; Frei et al Allergy. 2012;67(4):451-61; Sources: Silva et al. Acta Médica Portuguesa, 2011 December; 24 Suppl 4:1035-40. Laci and Penagos. Nestle Nutr Workshop Ser Pediatr Program. 2011;68:169-83. “Diversification in the first year of food life.”; Laci and Penagos. Nestle Nutr Workshop Ser Pediatr Program. 2011;68:169-83 44

Theories about Increasing Prevalence of Celiac

7. Short fermentations for vs sourdough: breakdown the offending peptides; free gluten additive 8. Agronomic practices: fertilizers, growing conditions, specific varieties CLAIM: WHEAT, 9. Poor diets overall: low fiber, folate, , too many calories GRAINS AND CARBS 10. Change in the gut microbiome: may increase CAUSE OBESITY AND autoimmune diseases CHRONIC DISEASE

Sources: Million et al. Int J Obes (Lond). 2013 Mar 5; Sung et al Neurogastroenterol Motil. 2013 Mar 22. Ceseviciene 2012; Grove 2009; Katz 2011, Rizzello 2007; Belz 2012 45

Obesity, CHO/Grains Alleged as Culprits Obesity, CHO/Grains Alleged as Culprits

Prevalence of Obesity Dietary Fat CHO 60 15 50

40 10 30

20 5 10

0 0 1963 1971 1976 1988 1999 1965 1977 1989 1994 -1965 -1974 -1980 -1994 -2000 -1991 -1996

Ogden et al.JAMA 2002, 288: 1728 Cavadini et al.Arch Dis Child 2000; 83:18 47 48

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Wheat Consumption Trends Do Not Follow Obesity Trends Available Calories Have Increased 1830-2010

Source: Kasarda DD J Agric Food Chem. 2013 Feb 13;61(6):1155-9. ~ 600 Kcal more overall, ~200 calories more each from fat and CHO; 50 cal more from sweeteners

Grain Intake Is Flat or Decreasing as Obesity Climbs

http://www.fao.org/docrep/005/ac911e/ac911e05.htm 52

‘Make Half Your Grains Whole’ Claim: No Gluten/ Grain (Paleo) Diet Reduces Lowest Visceral Abdominal Fat Diabetes/ • Systematic review- 16 cohorts Type 2 Diabetes (T2DM) Risk • 3 sv/d (minimum 48g) (WG) Relative risk (RR) = 0.68 • Inverse associations • WG including WG bread • • Refined grains RR= 0.95

• >3000 children / adolescents in Tehran • No association with • low CHO diet score and incidence of MetS • MetS components • risk from energy dense snacks

Eslamian et al Arch Iran Med. 2014;17:417-22; Aune, D. et al. Eur J Epidemiol. 2013; 28:845-58. Framingham Heart McKeown et al. Am J Clin Nutr 2010; 92:1165-71 Study (n=2834) 53

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Whole Grain: Coronary Heart Disease Iowa Women’s Health N=35,000 36% risk – 1 sv/d ARIC Men/ Women N~16,000 Nurses’ Health Study N~75,000 Elderly N=3500 25% - 28%  risk

2015 meta analysis 3 sv. ~ 50 g WG/d – 15 cohorts, 3 case-control n> 400,000 22%  risk – 3 sv/d

Tang G et al Am J Cardiol. 2015;115(5):625-9.Jacobs et al, 1999, Liu, et al., 1999; Steffan et al, 2003; Mozaffarian et al. JAMA. 2003Tang et al

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Claim: Fibers from All Sources Have the Same Claim :“Grain Fiber Unnecessary” Impact • DF & Small Intestinal Cancer RR • Davis & Paleo : other fibers will do the same job. NIH-AARP Diet & Health Study 367,442 older Americans •Total Dietary Fiber 0.79 ns • High cereal fiber intake 19% lower risk of all-cause mortality •Grain Fiber 0.51 P < 0.01 • 15–34% lower risk of disease-specific mortality •Whole Grain foods 0.59 P < 0.06 “Dietary fiber from grains, but not from other sources, was significantly inversely related to total and cause-specific death in both men and women.” NIH AARP N> 500,000

Schatzkin et al Gastroenterology 2009 135:1163-7; Gonzalez CA, Riboli E. Eur J Cancer. 2010;46:2555-62; AMA Park Y et al. Archives of internal medicine. Image:http://i0.wp.com/www.lowfodmapdiets.com/wp- 2011;171:1061-1068; Huang T et al. BMC Medicine. 2015;13:59. content/uploads/2014/10/Caveman-Paleo-Diet- e1412900015791.jpg?resize=400%2C289

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Claim: Vegetable Fibers Will Do the Job Low-carb diets; Higher all-cause mortality FIBER LAXATION Meta-analysis - 17 studies - 272,216 people in per g fiber fed 4 cohort studies Wheat bran 5.4 • All-cause mortality - high low-carb Psyllium 4.0 score RR = 1.31 Oats 3.4 • Similar for low carb/high protein Corn 3.3 • Low-carb diets were associated Legumes 2.2 with a significantly higher risk of Pectin 1.2 all-cause mortality. RS2 resistant starch 1.1 • limited observational studies Inulin 1.0 • long-term outcomes are needed

Noto H et al PLoS One. 2013;8(1):e55030.

Cummings JH. 1993. CRC Handbook of Dietary Fiber in 59

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Affordability and Nutritional Quality of No Grain/ Gluten Free/ Paleo • Gluten - free diets – can cost 242% more • May be less nutritious and may not be fortified and are more Grains and the World costly Food Supply • Paleo and Grain –free diets - , seafood, , , and nuts • USDA data 9.3%  income needed for Paleolithic diet that meets all daily recommended intakes • Inadequate Ca++or and cereal / fiber •  USDA “not feasible for low-income consumers” Metzgar M et al. Nutr Res. 2011;31:444-51.

Protein (g) /Unit Area by Crop Crop Yields – Wheat vs Ancient Grains • Wheat 50 bu/acre 3000 lbs of grain • Spelt 2400 lbs naked Grains / grain carbohydrate • Emmer Farro 1900 lbs staples deliver Einkorn 1500 lbs much needed protein

Durum Einkorn With permission

Cereal/Pseudoc Calories/ m2 Protein (kg/ha) ereal Maize (corn) 1,847 415 Conclusions Nutritional Oats 1,508 384 • We did evolve to eat grains Contribution of Rice (paddy) 1,482 307 • Wheat has not changed but we have. Many possibilities including Grains Triticale 1,256 470 aspects that cause changes in the microbiome increase all Amaranth 1,133 418 autoimmune diseases. Traditional Grains Wheat 1,083 423 • Around 5% of the population should avoid wheat and or gluten Rye 914 271 • Grains and grain fiber are unique and protective to health • >1000 kcal Teff 605 226 • Diets without gluten and grains may be inadequate. Need careful per square Sorghum 529 165 planning and may lack cereal fiber. meter Millet 345 105 • Elimination of grains bodes problems for 2050 in terms of the world • >400 kg Quinoa 275 109 food supply protein/ ha Non-grain

Hunger Math: World by Soybean 1,029 870 the Numbers. Conte, R. 2013 Lentils 322 244 Green Beans 229 127

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