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.

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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