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GRAINS FOR THE HEALTH OF IT: Increasing Grains and Whole Grains Consumption
as a Strategy for Health
Sheraton Four Points Minneapolis Metrodome September 20–21, 2001
Symposium Proceedings
Sponsored by the University of Minnesota and the Wheat Foods Council
Table of Contents Executive Summary .............................................................................................. Page 1 Symposium Program ............................................................................................. Page 5 Introductions .......................................................................................................... Page 9 Part I: Grain Physiology and Chemistry ............................................................ Page 15
Why Grains and Whole Grains? Why Now? ......................................... Page 15 Dr. Julie Miller Jones
Physiology and Health Benefits of Whole Grains: Antioxidants, Phenolics, Lignans, and Phytochemicals .......................... Page 21
Dr. Joanne Slavin Anatomy of a Whole Grain Health Claim ............................................... Page 27
Dr. Len Marquart Part II: Grain Chemistry and Intakes .................................................................. Page 31
Anatomy of a Cereal Grain ..................................................................... Page 31 Dr. Gary Fulcher
Health Effects of Newly Recognized Grain Constituents ....................... Page 37 Dr. Gene Miller
Participant Interaction ............................................................................. Page 41 Dr. David Kritchevsky
Whole and Enriched Grains: How Do They Measure up as Functional Foods? ........................................................... Page 45
Sue Borra
Audience/Panel Interaction — Where Do We Go from Here? ............... Page 51 Dr. David Klurfeld and Dr. Marla Reicks Part III: Changing Behavior and Getting the Population to Eat More Grains ... Page 55
Plenary Session — Barriers to Grains and Whole Grains Consumption ............................................................. Page 55 Gary Jensen
Breakout Session I: Behavior and Change ............................................. Page 61 Changing Consumption — Models for Affecting Change .......... Page 61 Dr. Leslie A. Lytle
The Consumer and Behavior Changes ........................................ Page 65 Sue Borra
Changing Food Behaviors Starts Early ....................................... Page 71 Mary Begalle
Breakout Session II: Grains and the Food Industry ............................... Page 75
Effects of Processing on Nutritive and Physiological Impact of Grains ................................................... Page 75
Dr. Debi Rogers
Unique Beneficial and Processing Properties of Grains ............. Page 79 Kent Salisbury, Warren Formo, and Tom Jorgens
Plenary Session — Learning from the 5 A Day Model .............. Page 87 Fran Doring
Call to Action: Ways to Increase Grains and Whole Grains Awareness and Consumption .................................................................. Page 89
Speaker Biographies ............................................................................................ Page 91 Program Sponsors ............................................................................................... Page 97
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EXECUTIVE SUMMARY
Introduction Millions of people each year suffer from the debilitating and potentially life-threatening effects of cancer, stroke, and heart disease. Yet, the average consumer eats less than one serving of whole grain foods daily — the very foods that may help prevent these diseases, as well as help control diabetes and help with weight management. Unfortunately, even enriched grain foods often are overlooked as the leading way to help prevent neural tube birth defects. In an effort to break down the barriers between grains and whole grains consumption and their benefits, health practitioners, academics, industry leaders, and association representatives gathered at the “Grains for the Health of It” conference, Sept. 20–21, 2001, in Minneapolis. The conference provided an in-depth review of the nutrition and health benefits of grains, while giving participants practical ways to help affect behavior change. Discussion Highlights The conference brought together key representatives from industry, government, academia, and the health community to discuss increasing grains and whole grains consumption as a strategy for health — including grain physiology and chemistry, consumer intake, and changing behavior — to encourage the population to eat more grains. Key issues addressed during the conference included the following: Benefits of Grains and Whole Grains • Both whole and enriched grains are necessary in a healthful diet. • Whole grains, specifically the bran and germ of the grain, carry antioxidant activity
throughout the digestive tract, offering a kind of protection that may match or exceed that of fruits and vegetables. A diet that includes whole grains has been associated with reduced risk for certain cancers, stroke, and diabetes, as well as heart disease, and may be associated with a lower incidence of obesity.
• The addition of folic acid to enriched grains in 1998 has decreased neural tube birth defects 19 percent in the past three years in the United States. Folic acid also may assist in reducing risk factors for coronary disease and some cancers.
Recommended/Actual Consumption • The American Heart Association, Dietary Guidelines for Americans, and Healthy
People 2010 all recommend that consumers choose a variety of grains, including whole grains, and that they consume at least six servings a day.
• Epidemiological studies have shown that inclusion of two to three servings of whole grain foods daily has been shown to decrease the incidence of diabetes, heart disease, stroke, and some cancers by at least 25 percent.
• Goals for whole grain consumption include increasing the percentage of Americans who meet the grain recommendations of the U.S. Department of Agriculture (USDA) Food Guide Pyramid, as well as increasing the percentage of adults, teens, and children who eat whole grain foods.
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• Currently, well less than 10 percent of the U.S. population is meeting the goals of the Food Guide Pyramid, and the average consumer eats less than one serving of whole grain foods daily, with 20 percent of adults and 40 percent of teens and children never eating whole grain foods.
Barriers to Consumption • Surveys show consumers consider six barriers to be major reasons their families do
not consume more whole grain bread — color of the inside, price, softness, texture, dryness, and taste (in order of importance). Lack of ability to determine what is a whole grain product was another barrier.
Ways to Increase Consumption • Additional consumer education, scientific research, and government policy are
needed to reinforce the Food and Drug Administration (FDA)-approved whole grain health claim on products: “Diets rich in whole grains and other plant foods that are low in total fat, saturated fat, and cholesterol may reduce the risk of heart disease and some cancers.”
• To increase consumer consumption of grains and whole grains, we need to educate the consumer and deliver clear, concise, positive, and consumer-tested messages.
• A whole grain seal also may help consumers identify whole grain products, thereby increasing awareness and consumption.
• Consumer preferences and needs can help drive the baking industry to create new whole grain products. An ideal whole grain product would meet consumer preferences and be processed to retain the phytochemicals and nutrients.
Conclusions and Recommendations Symposium participants and speakers brainstormed ways the industry could work together to increase grains and whole grains awareness and consumption. Participants agreed the creation of a coalition was needed to address key grain issues, from public policy to consumer education. Responsibilities and action steps for the coalition included the following: • Seek funding for consumer research to probe deeper into consumers’ understanding
and attitudes about whole grains and healthful eating, as well as funding for scientific research to back up and make health claims.
• Develop consumer-friendly messages to educate the public about the importance of including enriched grains in their diets because of the many benefits of folic acid.
• Develop consumer messages based on the strength of existing research and modify those messages as new research findings emerge.
• Put the definitions and messages for grains and whole grains in consumer language, emphasizing the recommendation that three grains servings a day should be from whole grains.
• Educate consumers, as well as health professionals and the industry, about the health benefits of whole grains, giving them a compelling reason to choose whole grains.
• Partner with physicians and nutritionists to convey and reinforce whole grain findings and messages to both consumers and the media.
• Reinforce to government agencies the scientific background to justify the positioning of grain foods at the base of the Food Guide Pyramid.
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• Encourage food manufacturers to develop new whole grain products that are accessible and acceptable to consumers.
• Develop alliances with school food service and retail food chains to continue momentum and availability of grains and whole grains.
Call to Action The health benefits of grains and whole grains in particular are so compelling, the “Grains for the Health of It” participants and sponsors agree there needs to be an all-out effort mounted to educate consumers on the health benefits and to encourage increased consumption. To do this, we need a joint effort by health, food, and nutrition professionals, including industry, government, and health promotion organizations. As part of this effort, we need support from nutrition educators in industry, academia, and government to develop clear and consistent messages in consumer language to communicate the positive health benefits of grains and whole grains. We need to work with industry leaders to increase their knowledge of the benefits of whole grains and encourage them to overcome barriers to the inclusion of more whole grains in their products, as well as continue to develop fortified products to meet consumers’ needs. We need government demonstration grants and promotion efforts analogous to the 5 A Day program for fruits and vegetables that can help consumers recognize and consume more grains and whole grains. The purpose of this call to action is to increase communication among interested parties and to look for new ways to break down barriers to promote grains and whole grains consumption, while supporting the promotional and educational efforts of existing grain-based associations, such as the Wheat Foods Council and state grain commissions. By forming and moving forward with a partnership to improve grains and whole grains awareness and consumption, we can evaluate what we have learned through this symposium, conduct further research, and commit to promoting grains and whole grains as a strategy for health. We need all segments to work together for a healthier American population. • If you are a health promotion or government organization interested in promoting the
health benefits of and funding research for whole grains, then this coalition is for you. • If you are a company executive or an association that supports grains consumption
and are interested in breaking down whole grain barriers and expanding your current product line, then this coalition is for you.
• If you are an educator that wants increased discussion about grains and whole grains, then this coalition is for you.
• If you are a food or health professional interested in helping shape public policy regarding grains and whole grains, then this coalition is for you.
To join the “Grains for the Health of It” coalition’s call to action, please contact Julie Miller Jones, Ph.D., L.N., C.N.S., College of St. Catherine, at (651) 690-6664 or [email protected], or the Wheat Foods Council at (303) 840-8787, for more information.
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SYMPOSIUM PROGRAM Thursday, Sept. 20, 2001
11:30 a.m. Lunch, Welcome, and Introductions Joe Warthesen, Ph.D., Department Head, Food Science and Nutrition, University of Minnesota David Jacobs Jr., Ph.D., Professor, School of Public Health, Division of Epidemiology, University of Minnesota
Part I: Grain Physiology and Chemistry: Are grains a new functional food or an unsung, underutilized whole food?
Moderators: Gary Fulcher, Ph.D., Professor and Chair of Cereal Chemistry and Technology, University of Minnesota Julie Miller Jones, Professor, Ph.D., L.N., C.N.S., Professor, College of St. Catherine
12:50–1:20 p.m. Why Grains and Whole Grains? Why Now? Julie Miller Jones, Ph.D., L.N., C.N.S., Professor, College of St. Catherine
1:25–1:50 Physiology and Health Benefits of Whole Grains Joanne Slavin, Ph.D., R.D., Professor, University of Minnesota
1:55–2:25 Anatomy of a Whole Grain Health Claim Len Marquart, Ph.D., Senior Scientist, Bell Institute of Health and Nutrition, General Mills
2:30–2:50 Break
Part II: Grain Chemistry and Intakes
Moderator: Mitch Kanter, Ph.D., Director of Discovery, Nutraceuticals Business Unit, Cargill
2:50–3:15 p.m. Anatomy of a Cereal Grain Gary Fulcher, Ph.D., Professor and Chair of Cereal Chemistry and Technology, University of Minnesota
3:20–3:35 Health Effects of Newly Recognized Grain Constituents: Antioxidants, Phenolics, Lignans, and Phytochemicals Gene Miller, Ph.D., Principal Scientist, James Ford Bell Technical Center, General Mills
3:40–3:55 Participant Interaction Moderator: David Kritchevsky, Ph.D., Wistar Institute
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4:00-4:20 Break
4:20-4:40 Whole and Enriched Grains: How Do They Measure Up as Functional Foods? Sue Borra, R.D., Senior Vice President and Director of Nutrition, International Food Information Council; President, American Dietetics Association
4:45–5:15 Audience/Panel Interaction (Discussion of options after hearing the data) — Where Do We Go from Here? Moderator: Joanne Slavin, Ph.D., Professor, University of Minnesota Panel Members: • David Klurfeld, Ph.D., Professor and Chairman, Department of
Nutrition and Food Science, Wayne State University • Marla Reicks, Ph.D., R.D., Associate Professor and Extension
Nutritionist, University of Minnesota
Evening Program with American Association of Cereal Chemists (AACC)
6:00 p.m. Cocktails and Dinner 7:45 A Whole Grains Retrospective in Words and Keyboard
David Kritchevsky, Ph.D., Wistar Institute
Friday, Sept. 21, 2001
Part III: Changing Behavior and Getting the Population to Eat More Grains
7:45–8:20 a.m. Continental Breakfast — A Grain Feast
8:20–8:30 Welcome Marla Reicks, Ph.D., R.D., Associate Professor, University of Minnesota
8:35–9:00 Plenary Session — Barriers to Grains and Whole Grains Consumption Gary Jensen, Senior Vice President of Marketing, Sara Lee Bakery Division
Breakout Session I: Behavior and Change Moderator: Judi Adams, M.S., R.D., President, Wheat Foods Council
9:05–9:25 a.m. Changing Consumption — Models for Effecting Change Leslie Lytle, Ph.D., R.D., Professor, School of Public Health, University of Minnesota
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9:30–10 The Consumer and Behavior Changes Sue Borra, R.D., Senior Vice President and Director of Nutrition, International Food Information Council; President, American Dietetics Association
10:05–10:25 Changing Food Behaviors Starts Early Mary Begalle, Director of Food and Nutrition Services, Minnesota School Food Service Association
Breakout Session II: Whole Grains and the Food Industry
9:05–9:25 a.m. Effects of Processing on Nutritive and Physiological Impact of Grains Debi Rogers, Ph.D., Director, Cereal Chemistry (Education), American Institute of Baking; Adjunct Professor, Kansas State University
9:30–10:25 Unique Beneficial and Processing Properties of Grains
• Barley — Tom Jorgens, President, PolyCell Technologies • Oats — Kent Salisbury, Milling Expert, Quaker Oats Co. • Corn — Warren Formo, Program Manager, Minnesota Corn
Growers Association
10:25–10:45 Break
10:45–11:15 Plenary Session — Learning From the 5 A Day Model Fran Doring, M.P.H., R.D., Minnesota Department of Health
Breakout Groups
11:15–11:45 a.m. Call to Action: Ways to Increase Grains and Whole Grains Awareness and Consumption Industry — Education, Marketing, Advertising, and Labeling • Jean Storlie, M.S., R.D., Manager, Nutrition, and Health
Communications, Bell Institute of Health and Nutrition, General Mills
• Cathy Kapica, Ph.D., R.D., L.D., F.A.C.N., Director of Nutrition Education, Quaker Oats Co.
• Kathy Wiemer, Manager, Nutrition and Regulatory Policy, James Ford Bell Technical Center, General Mills
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Industry — Ideation for Taste, Quality, and Convenience • Gary Fulcher, Ph.D., Professor and Chair, Cereal Chemistry and
Technology, University of Minnesota • Gary Jensen, Senior Vice President of Marketing, Sara Lee
Bakery Division • Debi Rogers, Ph.D., Director, Cereal Chemistry Education,
American Institute of Baking; Adjunct Professor, Kansas State University
Extension Agents, Dietitians, and Consumers • Marla Reicks, Ph.D., R.D., Associate Professor,
University of Minnesota • Sharon Davis, Home Baking Association
Academicians and Researchers • David Klurfeld, Ph.D., Wayne State University
11:50–12:15 Audience/Panel Interaction — From Conference to Partnership
Moderator: Julie Miller Jones, Ph.D., L.N., C.N.S., Professor, College of St. Catherine
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INTRODUCTIONS To make an impact on consumers’ health with whole wheat or whole grain foods, then consumption once a month is not going to be enough. Consumption needs to be on a very regular basis. We need to address the reasons why people eat any type of food: convenience, economics, distribution, perceived health benefits, and probably most important of all, taste. But whole grains are not just about taste and use. History and research illustrate there is biological evidence that whole grains are good for you. Whole grains represent a biological and behavioral bridge to health and also to etiologic mechanisms and chronic diseases. The key is to look for ways to encourage consumption of grains and whole grains, giving consumers reasons to eat whole grains and take advantage of their benefits.
Presentation by Joe Warthesen, Ph.D., University of Minnesota
When it comes to grains, somebody has to make the ingredients, somebody has to grow the grain, somebody has to figure out what grain to grow, and in today’s technology, somebody has to figure out what sort of design we want in a grain to make a consumer benefit. It goes back to the genetics of grains, but it also goes the other direction because whole grain foods are worthless nutritionally unless they are consumed. They have to be consumed for a lot of different reasons — economics, convenience, perceived health benefits, or lack of detrimental effects. But most of all, they probably have to taste good.
I have a couple of examples of foods that are either nutritional or sensory disasters that might serve as examples for what
this conference is about. The first is the holiday treat — lutefisk. Lutefisk is cod soaked in lye and it is a holiday treat talked about by a lot, but only consumed by a few people. The other one is a deep-fat-fried-battered candy bar, which is a treat at the state fair. We can forgive a lot of that nutritional or sensory assault because these are once-a-year foods. At the same time, if you are going to have an impact with whole wheat or whole grain foods, once a year or even once a month is not going to work. Consumption has to be on a very regular basis, which means all these factors of convenience, economics, distribution, and taste have to be addressed for that to happen.
The official USDA Food Guide Pyramid has bread, rice, cereal, and pasta at the bottom, and recommends six to 11 servings per day. That is a strong endorsement of grains and grain products.
However, recently there was a proposed modified pyramid by Walter Willet, which gives more prominence to whole grain foods. The Willet pyramid recommends whole grain foods at most meals, which is a very strong endorsement for whole grains. The other interesting thing is white rice, white bread, and pasta have been elevated on his Pyramid to a less favorable level.
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The difference in the two pyramids likely will lead to discussions on the importance and placement of whole grains in the diet, along with topics of taste, consumption, and even a definition of what are whole grain foods.
Presentation by David Jacobs Jr., Ph.D., University of Minnesota
First of all, what are whole grains? Grains are seeds of grasses, including wheat, oats, rye, rice, barley, and corn. There also is spelt, triticale, millet, and others beside the ones that we customarily eat. We eat them in breads, rice, pastas, breakfast cereals, and cakes, for example.
Grain has a bran, a germ, and an endosperm. The bran and the germ are a relatively small portion of the grain by weight, but the lion’s share in terms of bioactive constituents. One of the most salient features in the endosperm is the white space shown in the picture of the kernel of wheat — it is all the starch. There are some cell walls, but the endosperm is much less rich in nutrients and in botanically active ingredients than the bran or the germ. I like to think about botanical structure of the foods when I am eating. What is the particular part of the plant or of the animal doing for the organism that it is supporting? And what is some of the potential for what it might do for me as a consumer?
The function of the bran and germ is to support the new grain plant until it roots, which means it has to ward off invaders and prepare the plant to root. That means there are enzymes, signal transducers, and all the other things living cells have, plus some things that most animals do not have. For example, the bran has naturally occurring chemicals that function as pesticides, fungicides, and a lot of things that may help human beings fight inflammatory challenges. The endosperm, on the other hand, is primarily a food sack for the potential seedling, so it is very energy-rich but contains little fiber.
What about the topic of whole grains in the diet? Could we “sell” whole grains? Why don’t we just make bread with 100 percent whole grain and not do any of the refined grains? There are, of course, differences between whole and refined grains in terms of consumer perceptions and uses.
First of all, there are different baking properties. Whole grains absorb more water and breads made with them are heavier and do not rise as readily as breads made with refined grains. Some of my Norwegian friends complain about Norwegian grains, in which there is an 80 percent extraction rate of the whole kernel compared to 70 percent and 75 percent extraction rate in the United States. They say, “It is just hard to make a good cake out of Norwegian refined grains.” There also is the issue of “mushiness” because of the soluble fiber in whole grains, as well as differences in taste and texture.
Certainly you could make cookies, bread, and pancakes with whole grains.
Bran and germ:17% of weight 80% of fiber Few calories Has most of the biologically active compounds in the grain
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And, you can think about using refined grains as a kind of “glue.” For example, a whole grain could include 10 percent refined grains to hold all the whole grains together. These are the possibilities we need to, and will, consider during the conference.
Now just a little bit on the use, the sociology, and the politics of whole grains. The idea that whole grains might be good for you was prevalent when Sylvester Graham originated graham flour in 1830. Around the mid to late 1800s, flour milling was introduced, making refining easy. This led to industrial consolidation and mass production of refined grain products, decreasing the use and consumption of whole grains in the United States. Then in the 1950s, 1960s, and 1970s, Dennis Burkett did research in Africa noting that native people who ate a natural foods diet were not getting Western diseases. In 1995 to 1999, we did epidemiologic reviews and some respective studies of whole grains and cancer, coronary heart disease, diabetes, and total death. In 1998, folate was added to enriched white flour in the United States, which has helped decrease neural tube birth defects. Then in 2000, there were explicit recommendations in the USDA Dietary Guidelines for Americans that suggested several servings each day of whole grain foods.
Here in the United States, grain consumption has gone down and up through the years.
U.S. Food Disappearance Data
Total Grain Per Capita Availability
Year lb/yr1909-13 291Steady decrease1970-74 135 (77% wheat)Steady increase 1994 199 (65% wheat)
U.S. Food Disappearance DataWhole Wheat Per Capita Availability
Year lb/yr1917-1919 8-10 (~5% of grain)1920-1953 no data1954 2.1 1972 0.8 (< 1% of grain)1990 2.3 (~ 1% of grain)
Oats Per Capita Availability1960-1987 3-5 lb/yr (2.5%)1988-1994 9.2 lb/yr (5%)
Norway: 4x and Finland 8x more whole grain than U.S.
But, whole grains are not just about taste and use. There is biological evidence that whole grains are actually good for you. The first thing about whole grains and disease is epidemiology. As an epidemiologist, I may be making fun of myself to say we ask fuzzy questions, but I do so to clarify what epidemiology can and cannot offer. If I asked you how much dark bread you ate a day during the past year, how close could you actually get to an accurate number? But that is, in fact, the question I have to ask if I want to find out about whole grains. We ask the questions, “Do you eat breakfast cereal? How many servings a day? What breakfast cereal is it usually?” Well, there is a lot that is lost in that, but it gets you in the general ballpark. By asking these few questions, “Do you eat dark bread? What breakfast cereal do you usually eat? Do you eat brown rice?”, we discover key information, as we did in the case of Iowa women.
In 1998, folate was added to enriched white flour in the United States, which has helped decrease neural tube birth defects.
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Here we showed that after 10 years of follow-up, the women who consumed the most whole grain foods had approximately half the total mortality of women who rarely consumed whole grain foods; this difference is in part directly attributable to the whole grain itself, and in part to other health behaviors typical of whole grain eaters in the United States.
Prospective Studies Find Lower Total Mortality in Whole Grain and Whole Meal Eaters
38,470 Iowa women, aged 55-69, followed for 10 years
Quintile of Whole Grain Intake1 2 3 4 5 P-value
Serv/week 0-3.5 4-7 7.5-10 10.5-18 >18 for trend
Person-years 68,262 68,672 64,761 66,329 64,980
Total mortalityCases 914 705 583 523 595
Adjusted HRR (effect of grain only)1.00 0.95 0.87 0.81 0.86 0.005
HRR = Hazard Rate Ratio Jacobs, Am J Pub Health, 1999
Total Mortality Reduction Is Even Greater if the Influence of Behaviors Related to Whole Grain
Intake Is Not Removed 38,470 Iowa women, aged 55-69, followed for 10 years
Quintile of Whole Grain Intake P-value 1 2 3 4 5
for trend
Unadjusted HRR (effect of grain and related behaviors)1.00 0.76 0.65 0.55 0.64 <0.0001
HRR = Hazard Rate Ratio Jacobs, Am J Pub Health, 1999
The seven-country study also was conducted between 1960 and 1985, led by Ancel Keys. We used it to evaluate any connections between whole grain intake and mortality on the ecologic level.
Cohort Country Whole Grain Total MortalityCereals, g/d (rank) per 100
Slavonia Croatia 76 61.0East Finland Finland 288 (5) 59.7Zrenjanin Serbia 399 (3) 57.9Ushibuka Japan 0 51.5West Finland Finland 268 (6) 50.3Velika Krsna Serbia 686 (1) 50.0Crevalcore Italy 0 49.8Zutphen Netherlands 64 48.0Montegiorgio Italy 0 46.2US Railroad USA 24 45.1Dalmatia Croatia 202 (7) 43.3Corfu Greece 450 (2) 40.4Rome Railroad Italy 8 39.7Tanushimaru Japan 0 39.4Crete Greece 380 (4) 31.4Belgrade Serbia 131 29.5
Age-adjusted, 25-year, All Causes, Percent DeadIs Not Least Where Whole Grain Food Is Common
Men aged 40-59, baseline 1957-1964, 16 cohorts, seven countries study
In this study, some people were eating more whole grains as a culture and some were not. We see no relationship between whole grains and mortality. Apparently, other cultural features play a role; for example, high saturated fat consumption in Finland and endemic infections lung diseases in Yugoslavia in the 1960s and 1970s. These data reinforce the conclusion that whole grains are a piece of the puzzle, but they are not the only answer in the puzzle.
What about the issue of feeding studies and the causal inference? In a feeding study, we know 95 percent of everything that goes into participants’ mouths. What we see is an influence of what whole grains have on intermediate risk factors. Mark Pereira and I did a whole grain feeding study with 11 overweight, hyperinsulinemic, non-diabetic adults. We fed them all their food for 12 weeks. We did a crossover with six weeks on whole grains and six weeks on refined grains. The results: We found that consumption of commercially available whole grain foods increased satiety and remed insulin and PAI-1, a factor important in thrombolysis. It may have reduced body weight.
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0 2 4 6
Fast
ing
insu
lin (µ
U/m
l)
p < 0.01
Time (weeks)
Fasting Insulin Concentration During Whole (squares) and
Refined (diamonds) Grain Diets
Pereira, Jacobs et al. AJCN, 2001, in press
refined whole
20304050607080
0 2 4 6
PAI
-1 a
ntig
en (n
g/m
l)
p < 0.001
Time (weeks)
PAI-1 Antigen Concentration During Whole (squares) and
Refined (diamonds) Grain Diets
Pereira, Jacobs et al. AJCN, 2001, in pressrefined whole
0
5
10
15
20
0 2 4 6
Serum Enterolactone at Baseline and During Whole and Refined Grain Feeding
n = 11
Jacobs, Pereira, Adlercreutz et al., submitted, Brit J Nutr, 2001
p < 0.01
Weeks on diet
nmol
/L
refined whole
Whole grains are probably causally related to reduced disease. The epidemiologic data are fuzzy, but remarkably, a few questions can distinguish life from death. The ecological data do not relate to etiology of disease, but they do reinforce the view that additional dietary and lifestyle factors are involved in the reduction of chronic diseases. And the feeding data established that some specific whole grain foods have at least biologic activity of relevant variables in humans.
Whole grains are a biological and behavioral bridge to health and also to etiologic mechanisms and chronic diseases.
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PART I: GRAIN PHYSIOLOGY AND CHEMISTRY
Why Grains and Whole Grains? Why Now? Originally, we learned grains were good for us because of their calorie and energy contributions; then we discovered grains were a good source of fiber; now we are focused on grains as a good source of phytochemicals. The American Heart Association, the Dietary Guidelines for Americans, and Healthy People 2010 all recommend consumers choose a variety of grains, including whole grains, and choose at least six servings per day. But only 1 percent to 3 percent of the U.S. population is meeting the USDA Food Guide Pyramid recommendations. We need to take a look at the foods people are eating, from cereals to breads, and consider what we can do to encourage whole grains consumption. At the same time, we should not lose sight of the nutritional benefits that fortified grain foods have provided. We need to develop appropriately processed whole grain products that meet consumers’ needs and tastes.
Presentation by Julie Miller Jones, Ph.D., L.N., C.N.S., College of St. Catherine
In the old view of grains, grandma told us they were good for us, but we really did not set much store in it other than they gave us calories and were a source of energy. Then we discovered they were a source of fiber. So we really focused on the fiber and we basically forgot the rest of the grain. Now we know that grains also are a great source of phytochemicals.
• In the Bible, they talked about bread being the staff of life.
• Then, Sylvester Graham’s wife baked a cracker, which bears his name. Unfortunately, many graham crackers are not whole grain even though they carry the Graham name.
• Flour milling was born somewhere in the late 1830s.
• Later, we learned we could eliminate beriberi and pellagra in the United States with enrichment. When recruits came to enlist for World War II, we started enriching flour, because we realized that iron, riboflavin, niacin, and thiamine were deficient in many recruits.
• Grains were part of the Basic Four in the early 1960s.
• When we began chronic disease research, a lot of the material about fiber came up in the early 1970s. In 1984, Kellogg took the brave step of doing the ad for All-Bran®, which eventually allowed a change in nutrition labeling and health claims for soluble fiber and insoluble fiber.
• In 1992, we got a new Food Guide Pyramid, which includes grains at the base.
• In the 1990s, we had an oats health claim, folate fortification, and also a whole grain health claim.
• The 2000 Dietary Guidelines for Americans elevated the role of grains and placed emphasis on whole grains.
• Finally, the 2010 Healthy People objective is to increase whole grains consumption, with a recommendation that at least three grain servings a day should be whole grains.
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What we are hoping for in the future is some way to increase people’s consumption of grains and all of the nutrients that go with them.
Bran = roughage• Fiber• B vitamins• Trace minerals
Endosperm = energy• Carbohydrate
– Resistant starch
– Some fiber– Inulin
• Protein• Some B vitamins
Germ = nutrients• B vitamins• Vitamin E• Trace minerals• Phytochemicals• Unusual/unsaturated lipids
Nutrients in the Grain
We are seeing a lot of interest in resistant starch, inulin, as another component of the endosperm, and some of the phytochemicals and unusual fatty acids. Four of the top 10 sources of carbohydrates for children and adolescents are 1) yeast bread, 2) ready-to-eat cereals, 3) cakes/cookies/quick breads/donuts, and 4) pasta. All of these groups can contribute more than 2 percent of the energy to the diets of children and adolescents. We can talk about how this can have a very positive effect depending on what people choose, or it can have some negative impacts on the diet depending on what people choose. Many people look at grains and grain-based foods and say, “Well, they really are not good for people.” But what is interesting is a study that was conducted by Gibson on children in the United Kingdom, in which breakfast cereals were the major grain source in the diet. In that study, those people with the top third intake of breakfast cereals had a lower proportional intake of non-milk extrinsic sugars.
In terms of top 10 contributors of protein according to the Children’s Continuing Survey of Food Intakes by Individuals (CSFII) 1994-1996, 1998 data, ready-to-eat cereals and pasta rank high. Popcorn also can be among the top contributors of fat. We also need to take a look at when people are eating different foods. For example, fortified cereals also are eaten at non-breakfast events. It is important to think about what kinds of cereals or what kinds of choices people can make for snacks. So, even if we are talking about cereals, which are not whole grains necessarily, they often provide fiber and are a source of other nutrients. A study by Hill in 1994 showed ready-to-eat cereals were the best sources of iron and B vitamins across all incomes and all age categories. According to Subar et al. Pediatrics, October 1998, ready-to-eat cereals provided 27 percent of the iron in the diets of children, yeast bread provided 13 percent, and beef only 8 percent. So I think it surprises a lot of people that fortified cereals really do have an important nutritional impact.
If we look at zinc and children, meat is first, milk is second, and ready-to-eat cereals are third. Actually, zinc really is more readily available from a highly refined, corn-based cereal than it is from a whole grain one. So, we not only have to talk about what is there, but how bioavailable it is. And because it is very tightly bound to the phytate in the whole grain, I strongly recommend a mix of grains and whole grains, because zinc may be there, but it is not available to the body.
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Another way to look at it is what children and adolescents are deficient in, and a number of different surveys have shown them to be deficient in iron, vitamin E, folate, C, or B6. Again, if we look at what fortified cereals give to the diet, they are exactly those things. Fortification increased all nutrients, except calcium, in any age and gender group that we looked at, especially in children.
Fortified Cereal Boosts Nutriture of Children/Adolescents
• Deficiencies in certain groups – Iron – Vitamin C– Vitamin E – Vitamin B6
– Folate
• Fortification of breakfast cereals – Increased vitamin and mineral intakes (France,
Ireland, United Kingdom, and Spain)
Serra-Majem Public Health Nutr, 2001 Feb;4(1A):101-107
Fortified Cereal Boosts Nutriture of Children
• Fortification ���� all nutrients except Ca++ – Age/gender groups– Especially in children
• Boosted median or 25th percentile intakes from below to >>> RDA
• Cereals responsible for nearly all the intake of nutrients from fortified foods
CSFII n>11,000
Brener et al. 2001 Cereals were by far the No. 1 contributor to fortified foods; in a way, greater than orange juice or any other kinds of products that may be fortified. Adolescent girls are the worst nourished set of the population; they are deficient in iron, folate, and calcium. Those not consuming breakfast cereals, such as in a study of Irish adolescents, had lower intakes of riboflavin, folate, iron, niacin, and B12.
Fortified Ready-to-eat Cereal andNutriture of Adolescents
• NOT consuming fortified breakfast cereals (U.S. NHANES follow-up study) — Ireland
• Daily intakes below the lower reference nutrient intake – Riboflavin – Niacin– Folate – Vitamin B12
– Iron (girls)
McNulty et al. Arch Dis Child 1996 Dec;75(6):474-8 Ready-to-eat cereal consumers had higher carbohydrate intakes, lower intakes of fat, and were more likely to eat less than 30 percent of calories coming from fat.
Fortified Ready-to-eat Cereal and Nutriture of Children and Adults
• RTE cereal consumers
– Higher intakes of CHO
– Lower intakes of fat
– More likely to eat <30% of calories as fat
Nicklas et al. 1995, Albertson and Tobelmann One exciting thing is the relationship between fortification of enriched grain foods and neural tube birth defects. The data, which came out this year, showed that before fortification the rate of neural tube defects per 100,000 live births was 37.8, and after fortification, that dropped to 30.5. It was a 19 percent drop total and a 13 percent drop if the people were only seen medically in the last trimester. But in either case, this drop, especially with the 13 percent drop in the last trimester, strongly suggests the fortification of enriched grain foods was the reason.
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There are several surveys showing the benefits of consuming cereals. If we look at adults, if we look at kids, and if we look at different kinds of surveys that collect data in different ways, users of breakfast cereals, overall, had greater plasma folate, which is related to lower homocysteine and, of course, lower homocysteine is related to lower rates of coronary disease.
Cereal Boosts Nutriture
• 1,100 French people, aged 2-65• High-energy breakfasts associated with:
– Ready-to-eat (RTE) cereals– Greater proportion of energy
from carbohydrate– Lower proportion of energy from fat– Higher intakes of vitamins and minerals
Cereal Boosts Nutriture
• 1,100 French people, aged 2-65• High-energy breakfasts associated with:
– Positive impact on nutritional status — all ages– Lower serum cholesterols– Improved indices of nutritional status
• Serum vitamin B1 (in children and adolescents)• Vitamin B2 and beta carotene (in adults)
If we look at French people, who eat a high-energy breakfast (which interestingly they call using ready-to-eat cereals), they had a greater percentage of energy from carbohydrate, less from fat and more vitamins and minerals, lower serum cholesterols, and greater B1 and B2.
Cereal Boosts Nutriture
• Regular cereal breakfast ~2 oz N = 209 Finns– � intake of total/saturated fatty acids– Small � serum cholesterol
Eur J Clin Nutr 1999 Sep;53(9):716-721
• The effect of breakfast cereal on diet and serum cholesterol: a randomized trial inNorth Karelia, Finland
Kleemola P, Puska P, Vartiainen E, Roos E, Luoto R, Ehnholm C
If you go from France to Finland, regular breakfast cereal consumption decreased the intake of total fats and saturated fats, showed and a small decrease in serum cholesterol among cereal eaters.
Cereal Boosts General Health
• 262 U.K. adults, aged 20-85
• If consumed breakfast cereal every day vs. less
– Reported better mental health
– Reported better physical health
– Association was still present with demographic factors, indicators of lifestyle (such as smoking), or other aspects of diet
Smith 1999 If cereals were consumed every day among adults in the United Kingdom, they were reported to have better mental and physical health, and these data held up despite all the other associations you might look at in epidemiology. Ready-to-eat cereals were the top 10 contributors of 17 of 18 nutrients in CSFII.
Does the Diet Need Added Nutrients in Cereal and Other Products?
• Ontario survey — 30,000 and >7,000 immigrants– Low incidence of micronutrient deficiency
– Asian immigrants — more likely to be deficient • Thiamin • Riboflavin • Niacin • Iron• Calcium
– Those things commonly added to cerealPomerleau et al. Prev Med 1998 Jan-Feb;27(1):41-9
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We looked at Canadian data, in which there was a low incidence of micronutrient deficiency among people living in Ontario, but Asian immigrants to Canada tended to be deficient in thiamine, niacin, calcium, riboflavin, and iron. This might be attributed to a dietary pattern that is reliant heavily on white rice and would be less likely to include fortified cereals.
Fortified Ready-to-eat Cereal andNutriture of Elderly
• Framingham — 885 elderly
• RTE were major contributors to folate intake – Cold breakfast cereals (13.3%)
– Multivitamins (12.8%)
– Orange juice (12.4%)
Tucker et al. J Nutr 1996 Dec;126(12):3025-31 If you look at Framingham data of the elderly, ready-to-eat cereals are again a major contributor of folate, along with multivitamins and orange juice. Folic acid supplementation not only is good for preventing neural tube defects, but it may help cardiovascular health. It potentially could decrease ischemic heart disease by as much as 40 percent and showed some relationship with the decreased incidents of colon cancer. The U.S. National Health and Nutrition Examination Survey (NHANES III, 1994-1998) did a follow-up study evaluating the death and hospitalization records of 8,000 coronary heart disease patients, and there was an inverse association of riboflavin, iron, and magnesium. Fiber, total fiber, and especially cereal fiber have been associated with decreased risk of myocardial infarction and, particularly, cereal fiber.
Fiber and Incidence of Coronary Heart Disease (CHD)
• >21000 Finnish smokers
• Fiber ���� risk of coronary events and coronary deaths
• Median intake, 34.8 g/d vs. 16.1 g/d
• Cereal fiber stronger association than vegetable or fruit fiber
Rimm et al. JAMA 1996 Feb 14;275(6):447-451 If we look at Finnish smokers, cereal fiber also reduced or had a stronger association in reduction of risk of coronary disease. Most importantly, the median intake in the highest group was 34.8 grams of fiber a day. In the nurses’ study, which showed no effect of fiber on colon cancer, the highest intake in the group of nurses eating the most fiber was about 24 grams a day. Basically, what it said was no American nurse eats enough fiber to have any impact. Because if they are eating one and a half times that amount, even their lowest group is eating what nearly the highest group was eating in the American diet.
Cereal Nutrients and Cancer
• Colorectal cancer patients habitually ate significantly less– Cereal fiber
– Riboflavin
– Calcium
– Phosphorus
Arbman et al. Cancer 1992 Apr 15;69(8):2042-8
In another study, colorectal cancer patients ate habitually less cereal, fiber, riboflavin, calcium, and phosphorus.
Fiber intake in the United States is much lower than Finland at approximately 15 grams a day. Cereal is important to fiber intake and provides about a third of fiber intake for the elderly.
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What is interesting is while most of the population is decreasing the amount of fiber they eat, African-Americans of low socio-economic status have started to increase their ready-to-eat cereal and, particularly, high-fiber cereal intake. What are we doing, what kind of message are they getting, why are they doing that, and why isn’t the rest of the population joining them?
The range of fiber intake in the United States per day, depending on food choices, can be from 9 grams to 50 grams a day.
Fiber Intake — USA Obese
• Normal 18.8 g/d
• Moderately 13.3
• Severely 13.7
Diet records N = 50/group
Alfieri et al. Obes Res 1995, 3:541
The American Heart Association, the Dietary Guidelines for Americans, and Healthy People 2010 all say to choose a variety of grains, including whole grains, and choose at least six servings per day. If you meet the Food Guide Pyramid recommendations, you get adequate micronutrients and fiber, and your fat and sugars are at goal levels. But only 1 percent to 3 percent of the U.S. population is meeting the Pyramid recommendations. So, we are failing to climb the Pyramid, we are failing to eat the recommended number of servings, and somewhere between 43 percent and 72 percent failed to meet the recommendations in any one of the groups.
The American Diet:Failing to Climb the Pyramid —
Another View• 1989-1991 survey CSFII
• >3,000 youth, 2-19 years
• ~30% met the grain recommendations
• Only 1% met all
• Pediatrics 1997 Sep;100(3 Pt 1):323-329 1998 May;101(5):952-3
• Munoz KA, Krebs-Smith SM, Ballard-Barbash R, Cleveland LE
Cleveland et al. Am.J.Clin.Nutr.1997; 65(suppl):1254S-1263S
What do we do to encourage grain, including whole grain, consumption? Some people think that whole grains have to be freshly cut from the head of the wheat plant and we are supposed to sit there and chew on them. And we know that nobody is going to do that. What we need to talk about is appropriately processed grain products. We expect people to eat normal things. We expect them to eat bread. We do not expect them to eat a pile of twigs and berries because they are not going to do that. Whole grains can be processed; they need not be intact. What I would like you to think about is keeping grains at the base of the Pyramid. Whole grains are great, but refined grains also do a whole bunch of great things for the diet, particularly fortified refined grains.
The American Heart Association, the Dietary Guidelines for Americans, and Healthy People 2010 all say to choose a variety of grains, including whole grains, and choose at least six servings per day.
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Physiology and Health Benefits of Whole Grains There are positives and negatives with all grains, whether whole, processed, fortified, or refined. The perfect product would probably be one that was processed to retain the phytochemicals and nutrients. But if people will not eat it, it has no nutritional value. Recent literature on whole grains shows a consistency in finding that whole grains are protective — just look at cardiovascular disease, strokes, diabetes, and cancer. Some of the research priorities for whole grains include agreement on a continuum of grain types, so we can move forward in these studies and improve dietary instruments. Improved dietary tools should allow for improved studies of grain intake and disease. Presentation by Joanne Slavin, Ph.D., R.D., University of Minnesota
The health benefits of whole grains are associated with the bran, the germ, and the endosperm. So why do we take the grain apart in the first place? When we mill things to make them white, we get rid of the bran and the germ layer, and we lose some nutrients in that process.
It is all about taste and desirability. It needs to be something people will eat. I have three kids and do they eat a whole grain? Not if they know it. Given a choice, most people choose white bread over whole wheat bread. We need to understand that in the refining process we are improving texture, flavor, and appearance, as well as shelf life. We also have to think of practical issues of how to get people to eat whole grains.
It is important to remember there are not really good grains that are whole and bad grains that are white. We need to think of a continuum. Whole, unrefined grain is often considered the king of the grains. Unfortunately, nobody can eat it and we do not make it into a product, so it has some problems. Then there are processed, whole grains, in which we have to do something to the grain to make it into a product. And there are processed, fortified whole grains in which we can add things back. After all, we are scientists and technologists who can fix things and make them better. And there are fortified, refined grains, which are pretty much what the average person lives on. Then there are refined grains without fortification.
There are positives and negatives with all of these grains. The positives of an unprocessed, whole grain — it is most concentrated in nutrients and phytochemicals. It is effective in laxation and has direct effects on the gut. There is no question it has a lower glycemic index; if you cannot digest it, how are you going to alter the glycemic index? Our digestive enzymes and digestive secretions cannot attack it, thus it cannot affect the glycemic index. As for the negatives, it is the same thing. We cannot get anything out of it. So if there are phytochemicals in the grain and it is whole and it leaves the body intact, obviously those phytochemicals were there, but they did not get into the body and they cannot have any health effect. Then we have to consider the desirability for consumers. How many consumers choose unprocessed, whole grains?
In terms of processed refined grains, what are some of the positives? People like the taste. They also have digestible, quick energy, of which nutritionists go back and forth on the positives.
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A lot of refining originally had to do with making nutrients available for people so we could actually get them into their bodies. Grain foods served as a good vehicle for fortification. Fortification was a way we could affect public policy — if we cannot educate people to make them eat what we want them to eat, add the needed elements to something they like to eat. What are the potential negatives? Obviously, over consumption; if we like it, we can eat too much of it. They also are lower in phytochemicals. And when we process something, refine it, and make it more available to digestive enzymes, we would expect more of a glycemic response.
What is the perfect grain product? I think the perfect one would be processed to retain the phytochemicals and nutrients. We want phytochemicals and nutrients in there as much as possible, but if people will not eat it, it has no nutritional value at all. We have to make sure people are willing to eat it and the nutrients and phytochemicals are bioavailable. As we find out how phytochemicals are useful to the body, we need to actually deliver them. If it is going to taste terrible to keep the outer layer on, we can take parts of it out and reformulate it. We have food processors that can do those things. There is no reason to be a purist and say it has to be exactly as it came from the field, because that is not practical and it is really of no use to consumers.
Diet is one of the world’s most complicated exposures. As an epidemiologist, if I want to take a snapshot of you and what you ate today, it is difficult. It would be nice if I could shine a light through you and you would turn purple if you had three servings a day of whole grains.
But I do not have that kind of skill or that kind of a test. That is one of the frustrations when we look at grains and grain intake and disease. Improved dietary tools should allow studies of grain intake and disease, especially the diseases of interest, including cardiovascular, cancer, diabetes, obesity, and autoimmune diseases. Right now, what we can do is basically find out from a food frequency what people have already reported. Did they consume dark bread, brown bread, higher fiber bread, whole grain bread, and whole grain cereal? It is difficult for us to get a great snapshot on whole grain intake or grain intake, because that is really the data we have — some type of food frequency that people have filled out and estimated, “How many times do you eat whole grain breads in a week?” It is difficult to develop a detailed database of grains exposure. Despite the limitations, we must use the tools we have.
Recent studies show there are different ways to ask the question, “How protective are whole grains?” One approach that has been taken fairly recently is looking at dietary patterns. Rather than say, “Okay, we are going to do a food frequency, try to take your diet and cut it into little pieces, and then look at whole grains and nutrients,” let’s just look at your dietary patterns and the number of servings that you took in. Most people have an easier time figuring that out. What they find in these studies
A lot of refining originally had to do with making nutrients available for people so we could actually get them into their bodies.
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is if people do consume recommended foods, including whole grains, there is reduced mortality.
Diet Quality and Mortality
• Large cohort study for breast cancer screening (42,254 women, aged 61.1 years)
• Food frequency and calculation of Recommended Food Score (RFS) — sum of number of foods consumed from Dietary Guidelines
• Consumption of recommended foods, including whole grains, significantly reduced all cause mortality
J Am Med Assoc 283:2109, 2000
Whole Grains and Heart Disease: Risk/Mortality
• Prospective cohort study of 44,000 men– 30% ���� risk of MI with each 10 g increase in cereal fiber
intake (Rimm et al., 1996)• Iowa Women’s Health Study of over 34,000 women
– 30% to 36% ���� risk of ischemic heart disease by eating at least 1 serving of whole grain foods per day (Jacobs et al., 1999)
• Harvard Nurses’ Health Study of over 75,000 women– 25% ���� risk of coronary heart disease by eating
approximately 3 servings/day (Liu et al., 1999)
Whole Grains and Cancer:
Epidemiological Studies• Gastrointestinal cancers
– A meta-analysis of 40 studies– 21% to 43% lower risk for cancer with high
intakes of whole grains (Jacobs et al., 1998)• Hormone dependent cancers
– One meta-analysis showed a 10% to 40% risk reduction with the highest intake of whole grain foods (Chatenoud et al., 1998)
What is in this whole grain that makes it beneficial? We have the traditional nutrients — vitamins, minerals, proteins, resistant starch, and antioxidants, as well as inulin, phytates, lignans or phytoestrogens, plants sterols, stanols, and plant phenolics. Where do you start? Is it any one of these or is it the combination? There is no question it has
to be the combination, but that also makes it very difficult to study. How do we get at it?
One thing is to come up with an in vitro or a model system. Let us look at the antioxidant content of different grains and how whole grains are different from other types of grains. There are studies in which we could feed various grains to experimental animals and measure end points. And in human studies, we could feed various grains to humans and measure end points. These are classical nutrition techniques to get information about what diet does for us.
What are the challenges? In nutrition, we want to isolate something so we can do the study. How do you do that with whole grains? Grains are just one part of the diet, so if I wanted to do a study, do I take all fruits and vegetables out because I only want to know what grains do to me? Then the question is, “Should we use grains that are commercially available or those where we control the planting, harvesting, processing, etc.?”
If you look at grains and antioxidants only, there is no question this is a very credible, biologically plausible mechanism that whole grains do have a lot of antioxidant activity.
Average Antioxidant Activity
0 500 1,000 1,500 2,000 2,500 3,000
Whole Grain Cereals
Whole Grain Bread
Corn Cereals
Rice Cereals
White Bread
Common Fruits
Common Vegetables
Trolox Equivalents/100g
Antioxidant Activity Per Serving
* Average for eight whole grain breakfast cereals
1,00050Whole wheat bread
1,440120Fruit
540120Vegetables
1,150*41*Whole grain cereal
Trolox Equivalents/Serving
Serving (grams)Product
How would you actually translate that into a feeding study? One published study looked at a whole foods diet and different biological measures. They compared a whole foods diet to a refined foods diet. In each category, they went with a whole grain. They used whole fruits vs. the juices and tried within each category to make those decisions. What they found were some interesting results, in which whole food diets improved lipids, antioxidants, and colon function.
Effect of Lignans on Hormonal Response
• Grain intake linked to higher excretion of urinary lignans (Adlercreutz et al., 1986)
• Serum enterolactone level biomarker for reduced CHD risk (Vanharanta, 1999)
• Phytoestrogen biomarkers linked to breast cancer risk (Zheng, 1999)
Unfortunately, there are not very many of these studies.
How can we look at glycemic response of grains? Generally, greater particle size equals less glucose response, less refining equals less glucose response, and high levels of soluble fiber equals less glucose response. Corn and rice can either be high or low glycemic foods depending on the food form and the amylose content. Amylose has a lower glycemic response than amylopectin. Basically, glycemic index is not going to be the answer to our prayers. It is not going to answer all of our questions because it is very complicated and difficult to measure.
There was a classic study where they looked at glucose insulin response with whole grains, cracked grains, course flour, and fine flour.
Whole Grains and Glucose Response
Whole Food Diet Improves Lipids, Antioxidants, and Colon Function
• Compared whole foods diet including whole grains to refined food diet– Whole foods lowered total and LDL cholesterol– Antioxidant enzymes decreased– Colon function improved
Bruce et al., J Am Coll Nutr 19:61, 2000
Basically, glycemic index is not going to be the answer to our prayers. It is not going to answer all of our questions because it is very complicated and difficult to measure.
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Whole Food Diet Improves Lipids, Antioxidants, and Colon Function• Compared whole foods diet including whole
grains to refined food diet– Whole foods lowered total and LDL cholesterol– Antioxidant enzymes decreased– Colon function improved
Bruce et al., J Am Coll Nutr 19:61, 2000
• Glucose/insulin response: whole grains < cracked grains < coarse flour < fine flour
• Oat-based meals saw smaller glucose and insulin responses than wheat- or maze-based meals
• In vitro starch digestion was fastest with the grain products with smallest particle size
Heaton et al., 1988
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The results: in vitro starch digestion was fastest in the grain products with the smallest particle size. There was another study done at the U.S. Department of Agriculture (USDA).
Effect of Particle Size of Whole Grain Flour on Glucose Response
• Compared glucose to breads made from white, whole wheat, and ultra-fine whole wheat
• Glucose response higher with glucose solution than breads, but no differences among breads
• Particle size does not affect glucose response
Behall et al. J Am Coll Nutr 1999;18:591
In this study, particle size did not affect glucose response. You would expect a difference, but glucose response in this case did not show up to be different between those breads. And we do not know why.
Soluble fiber is important, but we cannot explain it all with soluble fiber. Fiber is a really important part of it, but other things, such as antioxidants and phytoestrogens, probably have a role. And when it comes to cancer risks and gastrointestinal cancers, it is once again the fiber story, just put in under a whole grain umbrella. There appears to be some type of synergy between the different whole grain components that affect glucose.
In terms of where we need to go from here, obviously, whole grains are complicated. If you look at some of the phytochemicals that have been shown to be protective against some of the diseases we have talked about, there are a lot of biologically plausible mechanisms. This can be rewarding or it also can be overwhelming. What is the most productive thing to look at? Any one of these compounds, these
phytochemicals, has been shown to have a role in these diseases.
Future ResearchBlood Sugar
Whole Grain Cardiovascular Regulation/Component Cancer Disease Diabetes
Fiber x x xOligosaccharides x xFlavonoids x xInositol xLignans xPhenolics x xPhytates x x xPhytoestrogens xProtease Inhibitors xSaponins x xSelenium xTocopherols x x xMagnesium x xZinc x
Some of the research priorities for grains include agreement on a continuum of grain types, so we can move forward in these studies and improve dietary instruments to estimate intake of grains. Another area for research is in processing effects. There is no question processing is important. It makes foods that we are going to eat, that we want to eat, and it probably makes things more bioavailable, which is key. Plus, we need to consider clinical studies of mechanism and grain exposure and disease studies.
Epidemiology studies consistently find protection from whole grain consumption. The mechanisms for this protection include large bowel effects, antioxidants, alteration in glucose metabolism, weight loss, hormonal effects, and the biological effects of the many compounds in whole grains. It is not any single one that is going to hit the home run here; it is a bunch of singles and a lot of bunting that is going on, and in the end we are going to win. It really is the package that is the important thing.
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Anatomy of a Whole Grain Health Claim There are basically two types of health claims — the Nutrition Labeling and Education Act (NLEA) and Food and Drug Administration Modernization Act (FDAMA). An NLEA claim requires a rigorous scientific process to determine whether there is a relationship between a nutrient or food and a disease end point. A FDAMA health claim is a much quicker process in which a company can make an intent to use a claim and the FDA has 120 days to respond on whether they would permit that claim. In terms of the whole grain health claim, it benefits consumers because they are exposed to the health benefits and are better able to identify whole grain foods. It benefits companies because it gives them the incentive to develop and promote whole grain products. Because of the gap between whole grain consumption and recommended intake, the whole grain health claim needs continued support scientifically, as well as from a policy point of view, as we begin to educate consumers and professionals on the benefits of whole grains and whole grain products. Presentation by Len Marquart, Ph.D., Senior Scientist, General Mills When we look at health claims, there are basically two types — the traditional health claim and the new FDAMA health claim. In 1993, NLEA defined a health claim as “any claim that expresses or implies the relationship between a nutrient and a disease.” NLEA approved seven different health claims and established a petition process for approving new claims, which were later added.
Approved NLEA Health Claims
• Soluble fiber and heart disease
• Saturated fat, cholesterol, and heart disease
• Whole oats, psyllium, and heart disease*
• Fat and cancer• Fruits, vegetables,
and cancer
• Fiber-containing grain products, fruits, vegetables, and cancer
• Calcium and osteoporosis• Sodium and hypertension• Folic acid and neural
tube defects*• Sugar alcohols and
dental caries*• Soy protein and
heart disease*
* Approved since FDA’s original ruling on health claims in 1993
NLEA Passed
NLEA Health Claim
Oat Health Claim
Petition
Oat Health Claim
Proposal
Psyllium Health Claim
Petition
FDAMA Passed
PsylliumHealth Claim
9 FDAMA Claims
Rejected
Whole Grain Health Claim
Regulatory Timeline
1990 1993 1995 1996 1997 1999 2000
DSHEA Struct-Funct Claims
19981994
DSHEA Passed
Oat Health Claim
+ +Soy
Health Claim
+
What kind of evidence do we need to support a health claim? There is a rigorous scientific process that needs to be conducted to determine whether there is a relationship between a nutrient or food and a disease end point. How is that determined? There are the clinical intervention studies, which are the gold standard, and include well-controlled studies to demonstrate that a particular component in a food has an impact on disease. The observational studies can be used primarily in whole food types of claims. If you look at whole grains related to heart disease and cancer, much of the data came from observational studies. There also are meta-analysis or research synthesis studies. In the oats health claim, as well as the whole grain claim, there was a need for meta-analysis where data is compiled. Finally, there are animal and in vitro studies, looking at mechanistic reasons why the particular food or nutrient might be beneficial.
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There also are certain criteria that are used by the FDA to determine whether the quoted studies are beneficial. They look at the various design and methodology. They determine whether or not there is enough information on the particular nutrient. They will look at the end point, such as blood cholesterol, and also get into whether the overall studies are representative of the U.S. population.
For example, with Quaker Oats in 1995, the company submitted a petition in June to go further than the whole foods soluble fiber claim established in 1993, and extend the claim that there is a particular component in oats that may lower blood cholesterol and lower risk for heart disease. They were looking at a particular product and looking at 20 grams of oatmeal or 13 grams of oat bran. Within this particular serving, there would need to be 1 gram of beta glucan per serving and it also would have to be relatively low in fat and provide 3 grams of beta glucan on a daily basis. As far as the data that was put forth, we know there were 37 studies the FDA allowed and they went through the criteria mentioned above. Of those 37 studies, 17 of those supported the data linking beta glucan to reduced risk for coronary heart disease, where four of the others were not sufficient, five were equivocal, and 11 showed no relationship. A variety of oatmeal forms and oat bran were used in the various studies. Various types of additional studies also were conducted.
Oat/Heart Disease Health Claim: Scientific Evidence
• 37 of 41 submitted clinical trials accepted by FDA- 17 studies demonstrate cholesterol-lowering by
oatmeal/oat bran� 8 were Hypercholesteremics/usual diet� 6 were Hypercholesteremics/low-fat diet � 2 were Normocholesteremics/usual diet� 1 was Normocholesteremics/low-fat diet
- 4 not long enough in duration- 5 were equivocal- 11 showed no effect on serum lipids
Oat/Heart Disease Health Claim: Scientific Evidence
• Various forms of oatmeal and oat bran foods used in the clinical studies
• Additional scientific evidence- Dose-response study: 3 g of soluble fiber from
beta glucan 5% decrease in total cholesterol- Meta-analysis (13 studies) supports
cholesterol-lowering effect of oats- Epidemiological data supports inverse
relationship between fiber intake and coronary heart disease (CHD)
The FDA concluded there was sufficient data based upon primarily clinical studies stating there was a link between oat-based products and reduced risk for heart disease, primarily through cholesterol lowering. During the 120-day comment period, evidence was submitted to broaden the health claim to include other types of oat products that may have a cholesterol-lowering effect. The final rule stated there would be 3 grams of beta glucan as a requirement, but the amount of beta glucan per serving was lowered. So instead of 1 gram, they recommended .75 grams of beta glucan per serving of oats. As a result, they needed to increase the number of servings, so it was four servings of oats per day to consume the recommended level of 3 grams of beta glucan. The model claim was then published in the Federal Register:
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“Soluble fiber from foods such as [whole grain oats or product name] as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease.” This is a traditional type of health claim and can take a year and a half to two years to pass through the claim process.
In terms of an FDAMA health claim, it is a much quicker process in which the company can notify the FDA of the intent to use a claim; then the FDA has 120 days to respond and indicate whether they would allow or permit that claim. The important part is the FDA does not relax the scientific standards, but it does allow for a shorter time period to allow a health claim. As far as the criteria, a statement from a federal scientific body (NIH; USDA; National Heart, Lung, and Blood Institute [NHLBI]) must be identified, be published and currently in effect, state a relationship between a nutrient and a disease or health-related condition, reflect consensus of the scientific body, and be based on the scientific body’s deliberative review of evidence.
While the recommended intake for whole grains is usually three servings daily, Americans eat an average of one whole grain serving a day. If we look at consumers and ask them what a whole grain is, they cannot tell you. On top of that, consumers have no idea there is a relationship between whole grains and reduced risk for heart disease and cancer. What General Mills did was to identify the statement that related whole grains to reduced risk for heart disease and cancer, which was identified in the Diet and Health Report from 1989. We reviewed the science, looked at the subsequent research, and finally submitted the notification in March 1999.
If we look at the notification that was sent to FDA, we agreed there was substantial evidence, primarily epidemiological evidence, that whole grains along with other plant foods would be prudent to lower risk for heart disease and cancer. As far as the particular research studies, 24 of 26 studies indicated there was a lower risk of coronary heart disease with whole grain/cereal fiber consumption.
Supporting Scientific Evidence: Whole Grain and CHD
• 24 of 26 research studies support the relationship between whole grain and CHD
• Four large epidemiological studies show risk of CHD related to whole grain
intakes - Iowa Women’s Study- Finnish Men- Harvard Health Professionals Study- Harvard Nurses’ Health Study
Whole Grain and CHD: Clinical Trials
Whole grain oats ���� total and LDL cholesterol• Van Horn (1986)• Van Horn (1988)
• Davidson (1991)
• Hunninghake (1989, 1997)
Supporting Scientific Evidence: Whole Grains and Cancers
Whole grains and certain cancers• 37 case-control studies• One ecologic study• Three review articles• Meta-analysis of 40 case-control studies
Cereals/cereal fiber and colon cancer• 24 studies support• 7 do not support
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In terms of the health claim requirements, we looked at what would be the American Association for Clinical Chemistry’s (AACC) definition of whole grains, in which you must have the bran, germ, and endosperm in the proportion that naturally occurs in the grain, and it must contain 51 percent whole grain by weight of the final product. This is a fairly substantial amount of whole grain, but it needs to be at a level that would be efficacious, and needs to be low in fat, saturated fat, and cholesterol to meet the other health claim requirements. The FDA’s role was then to review the notification and examine the various scientific issues and policy, and consult with other agencies to make sure there was agreement among the different federal agencies that there was a link between whole grains, heart disease, and cancer. In the end, the claim basically reads, “Diets rich in whole grains and other plant foods and low in total fat, saturated fat, and cholesterol may reduce the risk of heart disease and some cancers.” With this process, you are looking at six months, a relatively short period compared to the traditional process, where you are looking at a year and a half to two years.
The implications of the whole grain health claim? It benefits government and public health policy because it helps consumers achieve dietary and health goals and may contribute to overall reduction of chronic disease risk. It benefits consumers because they learn the health benefits of whole grains and helps them to identify whole grain foods. And it benefits companies because it gives them the incentive to develop and promote whole grain products.
In reality, we know there is a gap between whole grain consumption and recommended intake. We need to be looking at enhancing the scientific evidence and solidifying policy, including the Dietary Guidelines for Americans and the Food Guide Pyramid. What we find is if you have good science and you have the tools to promote healthy food choices, you can gain some mileage from the industry perspective. To capitalize on a health claim, you need a recognized product, strong public relations, and an effective advertising campaign. Good timing also is beneficial. Using the traditional oats and coronary heart disease health claim as an example, sales of Cheerios® went up approximately 5 percent. If we look at the health claim related to whole grains and coronary heart disease and cancer, there are a number of different cereal and snack products that meet the claim, and for about three months after the release of the claim, these products went up by about 7 percent on average in terms of sales volume. Looking ahead, it is important we continue to build the whole grain issue scientifically, as well as from a policy point of view, and begin to educate consumers and health professionals as to the benefits of whole grains, along with all grain products.
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PART II: GRAIN CHEMISTRY AND INTAKES
Anatomy of a Cereal Grain Every component in a cereal grain is synthesized and stored in a unique way, a unique structure, and a unique location. When we look at the central portion of the kernel of wheat, the vast majority of the grain is starchy endosperm, but it is the outer portion of the kernel — primarily bran — that contains a large percentage of the many functional, biologically active compounds. The component attracting attention these days is the cell wall. In wheat, the cell walls contain large amounts of arabinoxylan, a high molecular weight viscous polymer that provides a significant amount of soluble fiber. In oats and barley, the cell walls also contain significant amounts of mixed-linkage beta glucan, which is similarly viscous and the primary component of the fiber in these grains. We really do not know as much as we need to about the physiological functionality of those polymers, nor do we know much about how those polymers interact with each other in terms of nutritional value. We must also recognize that the outer coverings may be highly colored and contain a wide array of stringent, intensely flavored compounds that do not always present the most appealing taste. There is a wide range of opportunities in processing the beneficial components in the starchy endosperm and the beneficial components in the outer coverings.
Presentation by R. Gary Fulcher, Ph.D., Professor and Chair of Cereal Chemistry and Technology, University of Minnesota When discussing whole grains, we are concerned with both processing and nutritional quality. A critical point to keep in mind is that every component in a cereal grain is synthesized and stored in a unique way, a unique structure, and a unique location. We have had many decades of essentially “farming” some of the larger and more homogeneous components of the grain, notably the starchy endosperm, which provides the functional proteins for dough, and starch for an extraordinarily large number of common food products. Yet, when we speak of nutritional quality and consumer appeal, we are led to serious considerations of some of the many other minor components, including the various fiber components, minerals, vitamins, enzymes, antioxidants, and flavor compounds. We see wide arrays of nutrients that are stored in relatively low concentrations but which, in fact, are rather critical to the nutritional qualities of grains.
Let us take a tour quickly through some of these kernels. When we examine the central portion of the wheat or barley kernel, the vast majority of the grain, about 75 percent of it, is starchy endosperm. And while there are many things to be said about starch, those that interest us most are the constituents outside the starchy endosperm — the surrounding protective layers (mostly bran) and the germ. That is where a huge percentage of the very functional, biologically active compounds reside. There also are components in the starchy endosperm, such as the non-starchy polysaccharides (arabinoxylans and glucans) that also provide some interesting biological activities.
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But consider also that there are between six and 11 distinct cellular structures in these non-endosperm tissues, every one of which is biochemically distinct. The distinctions may be subtle, but they are chemically different from each other and, therefore, we should expect them to be functionally different.
The non-endosperm components also include several viable tissues, such as the aleurone layer and scutellum, both of which are capable of generating significant amounts of hydrolytic enzymes. When we get into a discussion of whole grain utilization, whether it is a nutritional utilization or a process utilization, we are dealing with chemistries that are both complex and very different from the starch and the protein chemistries that we have been exploiting for so many years.
Barley, as well as oats, contains a collection of structures that comprise the husks or hulls. These are essentially cellulosic or hemicellulosic and they contain a number of additional compounds, including many of the antioxidants and much of the insoluble fiber. As we view many of these outer coverings as candidates for a trip through the gut, we are really looking at the same kinds of materials that ultimately are responsible for at least some of the protection of the grain. It takes a powerful fungus to penetrate the outer coverings and insects and birds are often similarly dissuaded from digesting the outer layers. The mammalian gut also encounters difficulty in digesting these layers when they are not extensively processed, and we certainly need to understand their chemistry in order to optimize the use of the many nutrients contained therein. Removing husks from barley by pearling has been a very traditional approach and there also
are many genotypes that are considered “hulless” because they lose their hulls during threshing. The latter are not as widely grown, but they are receiving a great deal of attention because of their nutritional advantages (often including a high level of soluble fiber). In combination with aleurone and germ tissues, it is the protective layers that are in many ways those which contribute most to whole grain chemistry and nutritional quality. It is the removal of those outer layers that produces “refined” grain products.
The cell walls, which are the essential structures that surround and define all cells in a grain (including hulls), in the case of wheat tend to be largely arabinoxylans — very high molecular weight polymers of arabinose and xylose (for oats and barley, the majority of the cell wall is mixed-linkage beta glucan). We really do not know as much as we need to know about the physiological functionality of either of these polymers. Nor do we know very much about how those polymers interact with each other in terms of nutritional quality. They exist in very low concentrations (only perhaps 2 percent to 6 percent of the dry weight of the whole grain), but it is these materials that are supposedly responsible for cholesterol reduction.
Moreover, one cannot assume the glucan polymers from oats are functionally the same as the glucan polymers in barley or wheat. They are, in fact, quite different; at least in the extracted materials we are able to produce in the laboratory. Some have high viscosity, some have low viscosity, and some are able to produce gels when processed appropriately.
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When you begin to do experiments in a nutritional context, it is important to know first of all where the material came from and, secondly, some of its polymeric properties (these materials differ genetically). The following image represents a portion of a barley kernel that we have treated microscopically to reveal the mixed-linkage beta glucan.
Barley Kernel Treated Microscopically to Reveal the Mixed Linkage Beta Glucan
In the cell walls surrounding each cell, the beta glucan is highly concentrated and intermingled with an array of several other polymers, including arabinoxylans, galactomannans, proteins, phenolic acids, and a number of other minor constituents. Consequently, it is difficult to discuss just one component when assessing nutritional efficacy of “soluble fiber” or any other grain constituent. We also encounter quite different ratios of these different polymers in different parts of the grain. When you are consuming only endosperm material in wheat, oats, or barley, you are consuming one type of complex material with respect to its cell wall polymers. When you then include such things as the aleurone layer or the other bran layers, you are changing the composition quite dramatically.
The history of our interest in beta glucans in nutrition actually began in the chicken coop. If you feed excessive amounts of barley or other grains with high beta glucans to
chickens, you generate the so-called “sticky-droppings” syndrome. Consequently, there has been incentive to develop low beta glucan barleys for the feed industry.
“It looks like a bad case of beta glucans to me!”
Similarly, low beta glucan barley is prized in the malting industry in order to avoid excessive viscosity in processing; we have a long record of concerted attempts to reduce beta glucans in barley. On the other hand, it is becoming increasingly clear that dietary soluble fibers, such as beta glucans, assist in cholesterol reduction, modified glycemic responses, and perhaps even immune stimulation. There is no question that beta glucans from other organisms can stimulate the immune system quite dramatically and we are exploring the potential for similar effects from cereal glucans.
Barley beta glucan is a very unique molecule. It is similar to cellulose in being predominantly a beta 1-4 glucose polymer but the inclusion of occasional 1-3 linkages confers a high degree of solubility, which makes it very unlike cellulose: similar composition, slightly different arrangement, and a very high molecular weight, but it also is very viscous and very hydrophilic.
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The following slide shows an oat kernel that has been cut in half and treated so we can see the mixed-linkage beta glucans. The distribution of beta glucans, not just between species, but also within a species, can be distinctly different, and we constantly hear concerns from industry relating to inconsistent processing. Part of the reason is you get quite different glucan concentrations in different fractions as you go through any processing system.
Half of Oat Kernel Treated to Reveal the Mixed Linkage Beta Glucan
But all oats are not the same and all barleys are not the same. There is extensive variability. Can you have different distributions within the kernel within a variety? It is very much a function of genetics, but it also is very much a function of the production conditions. There are many things you can do in processing that will allow you to increase the beta glucan concentrations, not just the barley. If we start with the barley and process via pearling, we are simply abrading the outer surfaces to produce more and more of the inner portion of the kernel as we continue processing. With this simple approach, one can nearly double the whole grain glucan levels going from first to last pearling fractions. Barley flours are commercially available that can approach 25 percent mixed-linkage beta glucan, which is exceptionally high in a product generated during dry processing.
Several companies also are making both oat and barley beta glucan for commercial use, and feeding trails that are underway with these products should assist in further defining their physiological effects.
It is important to recognize the solubility and the molecular organization of these glucans can be quite different from one genotype to another. We have examined this a number of different times, but it is quite clear that the ratio of water-soluble to sodium hydroxide-soluble glucan in different barleys ranges from 5:1 to 0.5:1, which is a tremendous indicator of variation in molecular organization.
If we follow the progress of barley fractions through the gut, we can visualize the gradual digestion of proteins and starch, with a concomitant increase in both bran content and in viscosity due to the soluble beta glucans (which are not digested in the small intestine). At the end of the small intestine, therefore, one encounters only undigested bran in a viscous, glucan-rich matrix. It is not until the cecum and colon, at least in small mammals, that one visualizes more complete reduction in molecular weight, viscosity, and cellular structure.
While much of the preceding discussion describes events relating to gut responses to soluble polymers, such as beta glucans (arabinoxylans should respond similarly, perhaps), we must remember this represents only a small amount of the total weight of the grain, as well as being only a small fraction of its chemical diversity. In most conventional processing systems (flour milling, malting, and ethanol production), the major contributor to the final product is endosperm-derived.
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In contrast, the material we manage to strip from the grain either before or after further processing (for example, bran and germ) represents as much as 25 percent of the dry weight of the mature grain. Furthermore, these tissues express more chemical and biological activity than almost other part of the grain. That is what we discard, by and large, with the “refinement” approach.
Each one of the compounds discarded by milling represents a portion of the biological activity of the mature grain, and the list of compounds is enormous. Wheat bran, for example, is one of the richest natural sources of niacin known, and this important B vitamin is accompanied by several others, including thiamine, riboflavin, pantothenic acid, and a very large number of antioxidant molecules, such as ferulic, coumaric, and related phenolic acids. In addition, there are significant reserves of calcium, magnesium, potassium, phosphorus, and iron, and the nutritional quality of bran and germ protein is significantly better than most endosperm proteins. The tissues also produce a variety of hydrolytic enzymes, and the cell walls that surround each of the bran and germ cells are major sources of both soluble and insoluble fiber. The literature also hints at antibiotic activity as well.
In combination, these components express profound biological activity, much of which is merely a reflection of their function in the developing and mature grain. They are the primary constituents of “dietary fiber” and frequently are overlooked as sources of beneficial nutrients beyond their common use as laxation aids.
Bran and germ express considerable molecular compartmentalization that is visible at every stage of any mechanical or digestive processing system, and this generates significant challenges for the processor and nutritionist. But there is little doubt the challenge of improving the palatability, solubility, storage characteristics, and especially the nutritional quality will be rewarded in both physiological and economic terms. For most common cereal grains, nearly 100 percent of the important phytochemicals and nutraceuticals are synthesized and stored in structures (bran and germ) that comprise only 20 percent to 25 percent of the mature grain, and they return only 5 percent to 8 percent of the economic value of the crop in question. This is hardly a balanced ratio in light of the current concerns about obesity, diabetes, and cardiovascular disease!
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Health Effects of Newly Recognized Grain Constituents — Antioxidants, Phenolics, Lignans, and Phytochemicals Whole grains contain many important nutritional components, including antioxidants. The insoluble fiber is somewhat unique among plants in that it has up to, and sometimes more than, 1 percent phenolic acids. When you eat grains with insoluble fiber, along with the fiber is an antioxidant. Research suggests when you eat a whole grain product, you have antioxidant activity that is carried completely through your digestive track, which offers a kind of protection you probably do not see from most fruits and vegetables. There are other compounds, such as lignan, which may be converted to enterodiol or enterolactone in the colon and is available to compete with estrogen to reduce the risk of cancer. All grains also contain tocotrienols, which are known to inhibit cancer, reduce cholesterol, and have positive effects on factors leading to heart disease. There also are sterols that can block cholesterol absorption and have been suggested to have several other functional effects, such as reducing conversion of secondary bile acids relating to colon cancer. Overall, there are a variety of interactive mechanisms dependent on each other and that can act synergistically. Presentation by Gene Miller, Ph.D., Principal Scientist, General Mills As scientists, we get compulsive about understanding, “Why is it better for you” and “What might be part of the explanation?” The perspective I would like to challenge is that fiber is the mainstay of the whole grain benefit to health.
Looking at the Food Guide Pyramid, I would reiterate that grains are an important part of a healthy diet. When we eat grains, we eat processed foods. We do not eat raw grains and we do not, with very small exceptions, eat intact whole grains; oatmeal being, perhaps, the best example of intact whole grains.
In terms of whole grains consumption, there is different data in the literature, but if you look at products that qualify as a whole grain product, perhaps it is 5 percent or less. We really do not consume a lot of whole grains and, in fact, there is a lot of room to improve on our diet. The kinds of products that provide whole grain are largely bread, breakfast cereals, and snack crackers. Bread, because we eat so much of it, is the single most important intake of grain products.
Looking at grains, when you remove the bran, you remove about 75 percent of all the phytonutrients. With the bran layer and the germ go most of the nutrients, including the fiber. If you look at the bran cells, you will see they are very thick cells. Some degree of processing is certainly important.
Cellular Structure
BRAN CELL WALLS ARE THICK, PROTECTIVE LAYERS
NucellusPhytin crystal
NucleusProtein body
Cell wall
Protein body
Starch
A BPericarpSeed coat
Aleurone layer
Sub-aleuronelayer
Starch
Proteinbodies
Cell Wall
Inner(starchy)endosperm
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And the microflora in our colon is certainly important. If you have a microflora that is adapted to fiber, it is going to be much more effective in releasing the contents of these cells. Whole grains do contain a lot of important nutritional components.
Microflora
SphingolipidsPhytosterols
Vitamins & Minerals Antioxidants
Fiber
UnsaturatedFatty Acids Lignans
Tocotrienols Phytin
COLON MICROFLORA IS AN IMPORTANT FACTOR
Whole Grain Phytonutrients
I would like to bring into the picture the microflora, because if these phytonutrients are not released to your body, then they are not going to do you any good. Several of them, such as the lignans, are not bioactive except by colon microflora activity, which converts them to phytoestrogens. Without that happening, it does not make any difference how many lignans you take in, they all will be of no use to your body. The same thing is true for phytin, sphingolipids, and the antioxidants. The efficacy of the fiber also depends to some extent on microflora. There is such a thing as a healthful microflora (one that is adapted to fiber) and I would contrast that to an unhealthful microflora that has adapted to a diet high in protein and fats. So it makes a big difference what your colon sees over the course of your life.
Cell BoundPhytonutrients
GrainFiber
Lignans
BoundAntioxidants
Phytin
Sphingolipids
Microflora Interactions“Healthful” Microflora
“Free”Phytonutrients
Short ChainFatty Acids
Phytoestrogens
“Free”Antioxidants
Inositol
Sphingosine
Epithelium,cholesterol synthesis
Breast, colon,prostate cancer
Epithelialprotection
Cell reversion
Cell growth, cholesterol synthesis
There literally are hundreds of antioxidants in our diet. Some are very potent and some are very weak. The primary property we think about when we talk about antioxidants is to prevent disease initiation by free radicals we breathe in the air, consume in our food, and that our body produces as part of our normal metabolic processes. There are mechanisms to control the free radicals so they do not hurt our body, but that does not happen 100 percent of the time. Free radicals are extremely reactive, so they immediately attack whatever they contact first, which could be DNA, proteins, or lipids. This has consequences of tissue damage. There are repair mechanisms but, over the course of time, this can lead to a variety of disease states such as cancer, heart disease, and diseases that we associate with aging. Obviously, if you prevent the free radical attack in the first place, that is the best way to defend your body from some of these diseases and to reduce their incidence. Therefore, antioxidants or free radical scavengers certainly have an important part to play.
Fruits and vegetables have received a lot of attention for their antioxidant activity and their importance to health because of that.
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Look at the contribution that whole grain cereals might make. In this case, we analyzed not just an extract of the food, but we mixed up the whole food and, therefore, had a reflection of all the antioxidants, soluble and insoluble. In the case of grains, that makes quite a difference. In comparison, whole grain foods, such as whole grain bread and whole grain cereals, have considerably more antioxidant activity than fruits and vegetables.
Average Antioxidant Activity*
0 500 1,000 1,500 2,000 2,500 3,000
Whole Grain Cereals
Whole Grain Bread
Corn Cereals
Rice Cereals
White Bread
Common Fruits
Common Vegetables
WHOLE GRAIN PRODUCTS ARE HIGH IN ANTIOXIDANT ACTIVITY
* Analysis by Diphenyl picrylhydrazyl. µmoles Trolox Equivalents/100 grams
If you take that in the context of consumption and look at average serving size, you get a very good dose of antioxidant activity that compares very well to fruits and vegetables. The best source of antioxidant activity among the fruits and vegetable field is berries, but we do not eat a lot of berries. Nuts are pretty good, but we do not eat a lot of nuts. And some of the legumes are very good. As the mainstay of our diet, grains are certainly a good source of antioxidants.
The thing that is unique and important for grains is the insoluble fiber, the hemicellulose of grain products, is somewhat unique among plants in that it has up to, and in some cases more than, 1 percent phenolic acids. These phenolic acids are on the side chains and in the course of cross-linking between phenolic groups they render the fiber insoluble. So when you eat grains
Antioxidant Consumption
Product Servings (gm)
TroloxEquivalentsPer Serving
Whole Grain Cereal 40 * 1,150 *
Vegetables 120 540
Fruit 120 1,440
Whole Wheat Bread 50 1,000* Average for eight whole grain RTE breakfast cereals
ANTIOXIDANT ACTIVITY OF WHOLE GRAIN PRODUTS ISSIMILAR TO FRUIT AND VEGETABLES ON A SERVING BASIS
that have insoluble fiber, you also get antioxidants. And, in fact, this fiber is quite reactive as an antioxidant and measuring it separately, that can be easily demonstrated.
Bound Antioxidants
WHOLE GRAIN, INSOLUBLE FIBER HAS POTENT ANTIOXIDANT ACTIVITY
What happens with grain antioxidants and health? Well, it would suggest when you eat a food that has whole grain, the antioxidants, water-soluble, fat-soluble, and insoluble fiber can act as free radical scavengers immediately in your intestine. The water-soluble and fat-soluble fibers are available to be absorbed. And in your colon, dependent on the microflora, there may be the hydrolysis of the phenolic acids that are covalently bonded to fiber. This means when you eat a whole grain product, you have antioxidant activity that is carried completely through your digestive tract.
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In regard to some of the other compounds, Adlercreutz (Finland) had promoted the possibility that lignans are converted to enterodiol or enterolactone in the colon, which then is available to compete with estrogen and does, in fact, reduce the risk of cancer. Phytin or phytic acid has labored under the title of being an “anti-nutrient,” but it also has some potentially very positive value. The phytin metabolites and inositol phosphates have been studied extensively as second messengers in the regulation of cell growth. The intake of inositol compounds increases the body’s pool and the ability to provide these materials to various cells. In the colon, the microflora also can hydrolyze the phytin and make it bioavailable. The efficacy of phytin to your body is certainly dependent on the microflora, not just whether the grain was processed. Tocotrienols, likewise, have had a great deal of study. All grains contain tocotrienols, which are known to inhibit cancer, reduce cholesterol, and have positive effects on factors leading to heart disease. Although there are other sources, grains are the main source in our daily diet. They also are strong antioxidants. Benecol™ and Take Control® are products based on plant sterols, stanols, and esters. Grains also contain these compounds and they have the same functionality. They can block cholesterol absorption and have been suggested to have a number of other functional effects, such as reducing conversion of secondary bile acids in relation to colon cancer. Looking at sphingolipids, it is not really known if these are essential beyond what our body can produce. They are very interesting compounds that are an essential part of soluble membranes. There are many different forms of the water-soluble fraction of this molecule.
Within the body, they are not absorbed unless hydrolyzed in the colon. Sphingolipids function in several ways, but also are related to function as a second messenger and control cell growth and cholesterol synthesis. Overall, there is quite a variety of interacting mechanisms dependent on each other.
Serum Cholesterol
CholesterolConcentration
Synthesis
Bile Acid
Excretion
StorageMembrane SynthesisSteroid Synthesis
AbsorptionDietCholesterol
MULTIPLE FACTORS INFLUENCE SERUM CHOLESTEROL
• Diet load• Fiber• Sterols
Synthesis
• Fiber• Unsaturated FA• SCFA• Insulin
• Tocotrienols• Sterols• Sphingolipids
Absorption Excretion
In conclusion, whole grain foods are good for you. You live longer and healthier. Why? In addition to fiber, there are many phytonutrients and these phytonutrients, at least potentially, can act synergistically. Collectively, there may be a significance you do not see individually. The colon is a very important part of the overall picture that we do not talk about as much when we focus on the phytonutrients, but their efficacy in large part is dependent on the microflora. Finally, antioxidants are present throughout our digestive tract when we eat whole grains and, therefore, offer a kind of protection that you probably do not see from most fruits and vegetables.
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Participant Interaction Following are select participant comments and questions from the participant interaction session, with an opening statement by David Kritchevsky, Ph.D., Wistar Institute.
Opening by David Kritchevsky, Ph.D., Wistar Institute
Until quite recently, antioxidants were considered the savior of the nation. Then, we found in studies on smokers that when they were given either vitamin E or carotene supplement, their tumors actually got worse. At the time, I thought this might be due to a pharmaceutical interaction and you should get your compounds like antioxidants from the grocery not the pharmacy. Now, there have been several studies of heart disease with post-menopausal women that again suggest that antioxidants, if anything, are harmful. In the current issue of Arteriosclerosis, Thrombosis, and Vascular Biology, there is an editorial by Lewis Kuller, who is an epidemiologist at the University of Pittsburgh, suggesting, “Why don’t we just forget about antioxidants?”
The question is, “Are we at the threshold of being perceived by the public as a bunch of bumblers who do not know what they are doing, because here we have been pushing something and suddenly it does not work? Or, is it because of the way the studies were done or the supplements themselves and when they were given?” I am still a firm believer you need these dietary components. We tend to try and bring everything down to the lowest common denominator. For instance, the whole fiber hypothesis was that a diet rich in fiber is healthful. That does not mean adding fiber to a low-fiber diet and it
does not consider all the other substances that are in fiber, many of which we do not even know about yet.
One of the salubrious things in recent epidemiology is that we are starting to look at dietary patterns instead of individual dietary components, because we do not eat dietary components, we eat a whole diet. We have to start telling the public that we are not talking about individual components, but the total diet and possible interactions among nutrients. Scientists and dietitians have a pretty good idea of what we are talking about, but the public does not. The public is very fickle and once they decide you do not know what you are doing, even when you bring them the truth, it will not be accepted. You may remember a number of years ago, there was a big flap about oat bran. Oat bran was considered the savior of mankind, until one particular paper appeared which said it was of no value. Immediately everyone did a 180-degree turn on oat bran. I was supposed to be on an ABC news program and they sent the car over to pick me up. As we are driving over to the studio, the driver says, “What are you going to talk about?” And I said, “The oat bran thing.” He said, “I hope you don’t take this personally, but I don’t think you people know what the hell you are doing.” This is something we need to avoid, because when the good advice comes, it will not be believed. We have to provide the public with a better explanation of how science works. Data are analyzed and explanations presented based on knowledge and experience. The amazing thing is not how often we are wrong, it is how often we are right.
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Participant Comment Is there a biological explanation for why the antioxidants, beta carotene particularly as a pharmaceutical, might have gone awry? What has been suggested by some people in Norway at the Institute of Nutrition in Oslo is that the antioxidant system is extremely complex and it is always a balance. It is run by enzymes, exogenous antioxidants, and damage protectors. The beta carotene may accumulate as a pro-oxidant. Once it has been oxidized, how do you get rid of it? That is the suggestion — that beta carotene probably accumulated and was a pro-oxidant and ended up doing damage. So, when we talk about getting your antioxidants from a food source, it is a good thing because you get a mix of items, so no one single compound predominates and does some harm.
Participant Question If we are going to change to a whole grain diet, perhaps there is a need to educate consumers on the storage issue. What are they finding about the storage of whole grains?
Participant Comment When it comes to whole grain products, there are a lot of grains that are quite stable and are easy to use — then there are some that are natural and organic with no preservatives and minimal processing. Whole grain storage can be more difficult, but it is not impossible. Breakfast cereals are a good example that whole grain products have a good shelf life. It can be done in most cases but, if you try to use products under the condition that you could never use a preservative, period, then you limit the shelf life a little further. However, if there was a market, I think industry would address the challenge and the products would get better and better.
Participant Question What do you think of the utility of glycemic response as a measure of health status of a particular food? And building on the whole issue of “syndrome X,” what is your current feel on insulin as a trigger?
Participant Comment The glycemic index is just another effort to find some kind of a common clue that allows you to start judging food and diets. It is a concept developed a long time ago, and now it is getting a lot of attention because of the general feeling that both heart disease and cancer development go through the juncture of insulin — that hyperinsulinemia may be the key to both of those. In my opinion, the glycemic index has not been shown to do anything except maybe give you a slight prediction of risk in some cases. That is why we talk about risk factors. In Las Vegas, they are called odds.
I think “syndrome X” is apparently a real thing that arises from our preoccupation with cholesterol. Cholesterol is very important but there are other things it can do. This is one of the problems the public has in dealing with cholesterol — you need it worse than it needs you. The public thinks it is some kind of a foreign substance that can be taken out of the diet. There are a lot of aspects of cholesterol metabolism that may be public health aspects that have not very often been considered. For instance, how much does dietary cholesterol raise blood cholesterol? And the answer is, if you do not have saturated fat in the diet — practically nil. There is still a lot to be learned because we keep getting these new theories. We do not know what triggers a heart attack. When I started in this field, life was simple. You ate cholesterol, it got in your artery, and you died — period.
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Now you have all these little proteins that move it in, move it out, and move something else, all of which play a role, all of which can be affected by diet and other factors. So it has become tremendously more complicated.
Participant Question If we are going to form a coalition and do some interventions to help people eat more whole grains, what kind of questionnaire could we develop to help us measure whole grain intake fairly simply and fairly accurately?
Participant Comment Actually, the question about “do you eat dark bread” is a good question. It is not the best question in the world, because pumpernickel is colored and molasses is not a whole grain. Generally, the breads consumers eat that are more whole grain in our culture are darker. Specific types of breakfast cereal have been very successful. People can name a breakfast cereal and we look it up in the list of cereals; if it is whole grain, they probably eat other whole grain cereals. Brown rice is another good one. We could go on and say, “Do you avail yourself of the whole grain pastas or whole grain flour? Do you make your own cookies? Do you make your own pancakes? We could ask those questions, but almost no one does that now, so it is not that useful epidemiologically.
In the future, we want a questionnaire that will last the next 10 years when everybody is eating whole grains. To be more precise, you need to increase the vocabulary of the participants in our studies and increase the vocabulary of the general public.
This means re-labeling. We have to explain on the product labels what we mean by whole grain, and we have to use a standard set of words. For example, we have rolled oats, rye hops, and cracked wheat. Which of them are whole? It turns out that all three of them are whole, but then organic becomes confusing. Organic is a major competitor for whole and organic is not necessarily whole. Our consumer is never going to be able to answer the question, “Are you eating a processed whole grain, an intact whole grain, or a processed, refined grain?” So we have a really big educational job to do just in the question, “What is a whole grain and how do you know whether you ate one?”
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Whole and Enriched Grains: How Do They Measure Up as Functional Foods? Scientific debates that were once conducted within the scientific and health communities now are taking place in the media. While the media may be covering health and nutrition stories more so today, that does not mean consumers have a better understanding of health and nutrition. Today’s consumers are confused about nutrition, but also recognize that nutrition plays a greater role in health than some other factors. Consumers are concerned about heart disease, cancer, diabetes, and their weight. If the goal is to get consumers to increase consumption of whole grains, then we need to start with the consumer and figure out what consumers need to know to have a healthful diet. We need to talk to consumers to find out what is going to work, how that information is going to be communicated, and why people are going to recognize and understand it.
Presentation by Sue Borra, R.D., Vice President, International Food Information Council
If the goal is to get consumers to increase consumption, we always should start with the consumer. At the International Food Information Council (IFIC), we do a lot of work understanding the mindset of consumers as they are talking about nutrition, health, and food safety. The work we do is supported by the broad-based food, beverage, and agricultural industries.
How does the science, research, and policy get to that endpoint: the consumer? Many years ago, you would
start with research based on the disease of the moment. That information would filter down to other doctors and health professionals and then, eventually, to the patient who is the consumer. Nowadays, it is quite different. We have a wellness approach. The way information is getting packaged and delivered to consumers has changed, with health professionals and today’s media playing a larger role. Today, the scientific debates that were once conducted within the scientific and health communities are taking place in the media. This also is what is feeding into some of the consumer confusion, because science is meant to be debated — it is gray and ever changing.
Where are consumers getting their information?
Where Do Consumers Get Their Nutrition Information?
ADA Trends Survey 2000
5%
6%
11%
11%
12%
18%
47%
48%Television
Magazines
Newspapers
Reference/General Books
Family/Friends
Doctors
Internet
Radio
In 1995, we started doing what we called Food for Thought Research at IFIC. It was an opportunity to take a snapshot look at what kind of food and nutrition and food safety stories were out in the media during a period of time. We took the period of May through July and looked at what was coming out of 39 news media outlets, 12 magazines, 9 newspapers, wire services, and local and national television stations; this year, for the first time, we looked at some online news sites.
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Interestingly, in the last round of 1999 data, functional foods were one of the top areas reported on by the media. The story may not have specifically said “functional foods” but, if it discussed food for risk reduction, antioxidants, etc., it was included in that category.
FUNCTIONAL FOODS RISE TO THE TOP
Functional Foods (6%) Disease Risk Reduction (13%)Vitamin & Mineral Intake (4%) Antioxidants (3%)Fiber Intake (4%)
Food for Thought III
29% of ALL discussions
To compare the data between 1995, 1997, and 1999, we looked at what the stories claimed was the source of the benefit. And 57 percent of all the benefit claims in these stories were tied to some functional component in the food.
SOURCE OF BENEFIT57% of all benefit claims are tied to functional components
1999 1997 1995Consumer functional foods 20% 18% 14%Increase vitamins/minerals 11% 10% 11%Eat fruits and vegetables 11% 9% 11%Increase antioxidants 6% 9% 9%Decrease fat intake 6% 7% 8%Increase intake of soy products 5% — —Increase fiber intake 4% 8% —
Food for Thought III
We also looked at snapshots of consumer magazine coverage, which largely focused on functional foods.
The media may be covering health and nutrition stories more so today, but that does not mean the consumer has a better understanding of health and nutrition.
Below is a snapshot in USA Today a couple years ago asking about the “types of media stories that most adults find confusing.”
Snapshot of Diet and Health Coverage in Consumer Magazines:
Jan.– May 2001
International Food Information Council
Caffeine 2%
Physical activity 2%
Herbs & herbals
6%Wellness duringpregnancy 2%
Dietary fats &cholesterol 2%
Food sensitivity 2%
Obesity
Eating disorders
Health info on the Internet
Sugars & sweeteners
Food & animal
Oral health
Glycemic index
1% each
Functional foods29%
Children’snutrition &physical activity
11%
Diet & weight loss11%
General wellness &
disease prevention
20%
Foodsafety
7%
USA SNAPSHOTS®A look at statistics that shape our lives
Confusing Health NewsTypes of media health stories (print and/or broadcast) that the most adults say they find confusing:
202929
3131
3538
4150
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0 10 20 30 40 50 60
Diabetes
Alternative procedures
Depression
Elderly health issues
Heart disease
Cancer
Alternative health medicine
Nutrition
Vitamins/ supplements %
%%
%
%%%
%%
%
Alternative treatment for serious conditions
The bottom line is — they are confused about everything.
A cartoon showing a broadcaster explaining that scientists were studying links between estrogen and heart attacks while a woman is reading an article about estrogen reducing heart attacks says a lot about the consumer confusion. That is probably what we have to look at as we communicate more and more of our research through the media. When you look at things like consumer communication, you really need to do a consumer-based approach. We need to understand what they are dealing with in their lives, how they are choosing foods, and what their lives are all about. And you need to talk to them about their attitudes and their behaviors.
Feb. 23, 99 USA Today
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In the case of functional foods, we started getting calls from media saying, “We want to do a story on phytochemicals” or “We want to do a story on antioxidants.” We found it was consumer-driven, as opposed to science driven, as was traditionally the case. What we have used as a working definition for the concept of functional foods is, “Foods that may provide a health benefit beyond basic nutrition.” This gets you out of thinking of just vitamins and minerals — nutrients we know about — and gets you started thinking about those functional components and what they might be.
To begin to try to understand how consumers were thinking about this, we conducted both qualitative and quantitative research, including focus groups beginning in 1996 and quantitative consumer surveys in 1998 and 2000.
Tracking Consumer AttitudesQuantitative Consumer Surveys
1998 and 2000
• Positive attitudes about nutrition, health• Shift toward adding “good” vs.
eliminating “bad”• Incorporating more functional foods• Consumers want to learn more
Consumer Perception: Consumption Changes
From 1998 to 2000
Percent who are eating up to three foods for their functional health benefits
1998 52%2000 59%
Americans Have Positive Attitudes About Nutrition, Health
• 93% of Americans say they have moderate to great control over their health
• 93% believe certain foods have health benefits that may reduce the risk of disease or other health concerns
While Americans are confused and frustrated about nutrition, they do have a positive feeling about it. They know it is important, and they have a value attached to it.
Interestingly, we see this interest in terms of eating foods for health increases as we age and differs between men and women.
Age as a Factor of Eating Food for a Specific Health Benefit
18-34 Years
35-54 Years55+ Years
0
10
20
30
40
50
60
70
Perc
ent E
atin
g Fu
nctio
nal F
oods
Older Boomers Still Setting the Trend
IFIC 2000
The Gender Gap
41%51%“Very interested” in learning more
42%81%Primary shopper
30%49%Health professional most believable
68%79%Food/nutrition play “great” role
Women Men
IFIC 2000
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All of this impacts the messages you will need to communicate in terms of who your audience is.
People also think nutrition plays a greater role in health than some other factors.
Nutrition Plays a Greater Role in Maintaining or Improving Health
74% 74%64% 63%
41% 39%
Food/Nutrition Exercise Family HealthHistory
1998 2000IFIC 2000
In fact, that is an opportunity to communicate more about the important role of physical activity in health. That message has not really gotten through to the public as well as the food message has, and we have more opportunities there. We also are seeing a shift in how people are trying to look at food — removing the bad and adding the good. And a shift in consumer awareness of foods may reduce risk of disease, which has decreased in some cases.
Shift From Removing the “Bad” to Adding the “Good”
12%14%Exercising
13%10%Eating more fruit
22%20%Eating more vegetables
24%36%Consuming less fat
20001998
Q: Over the past five years, what changes have you made to improve or maintain your health?
IFIC 2000
Are You Aware of an Association Between …
78%
21%
48% 52%
38%
61%
Calcium andOsteoporosis
Antioxidants andCancer
Soy Protein andHeart Disease
Yes NoIFIC 2000
What are consumers concerned about? Top health concerns include heart disease/heart attack at 32 percent, cancer at 31 percent, diabetes at 14 percent, weight at 14 percent, nutrition/diet at 13 percent, and blood pressure at 8 percent. Diabetes is definitely entering the psyche and it will be interesting to see if that is changed in the coming years because of some of the new data out on the prevalence of diabetes.
We also asked consumers about some of the specific functional food types of components and issues related to health to gauge their level of awareness.
Effectiveness of Food/Component and Disease Link
Calcium and Osteoporosis
1%
45%49%
5%
Soy Protein and Heart Disease
4%
29%
55%
12%
Not at all/probably not effectiveMay or may not be effectiveProbably is effectiveDefinitely is effective
Antioxidants and Cancer
1%
34%
46%
19%
IFIC 2000 But we still have some opportunities to get out more information out in those areas. Consumers still have questions about efficacy and I think those are probably, in some respect, healthy questions.
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While health claims do require gold standards of science, they have absolutely no standards in consumer understanding. Unfortunately, most of these messages go right over the heads of consumers. In fact, they do not even think the government has anything to do with them. As you know, there is a health claim on folate and neural tube defects — “healthful diets with adequate folate may reduce a woman’s risk of having a child with brain or spinal cord birth defect.” There was a study published in the Journal of Pediatrics. When they initiated the study, birth defects were almost twice the current national averages, about 19 cases per 10,000 births. They implemented a communications campaign encouraging the consumption of more folic acid using TV, radio, billboards, and magazines. By the end of 1998, they had fewer than 10 cases per 10,000 births. Another study, published in the Journal of the American Dietetic Association, looked at low-income pregnant women in Atlanta, Ga. Eighty percent of the subjects did not take preconception supplements and, in this group, 57 percent said they had heard of folate, but only 26 percent knew why it was important. But through the fortification of grains, 77 percent were able to achieve the recommended amounts. I think what is important after you see the science is to address the question, “What do consumers know about this?” In 1999, Opinion Research Corporation asked if people knew something or a lot about fiber, calcium, and folic acid. Of these 1,000 people, 90 percent said they knew something or a lot about fiber, 90 percent said they knew something or a lot about calcium, and only 56 percent said they knew something or a lot about folic acid.
Survey participants also were asked whether calcium, fiber, and folic acid individually were extremely or very important to the diet. Ninety percent said calcium was very important or somewhat important, 83 percent said fiber was very important or somewhat important, but of the 56 percent who said they new something or a lot about folic acid, only half said it was important or somewhat important in the diet. When they explored a little bit more about folic acid and its specific health benefits, pregnancy and birth defects were the No. 1 thing they could mention, unprompted.
Consumers and Folic Acid: Specific Health Benefits of Getting Enough Folic Acid (Unprompted)
40%Don’t know2%Aids digestion3%Good for heart3%Good for blood8%Vitamin mentions
25%Pregnancy/birth defects
Base: Those who know a lot or know something about
folic acid
Caravan® Opinion Research Corporation International December 1999
This just gives you an idea of where consumers are. What we have to figure out is what do consumers need to know to have a healthy diet. Not everything we may think is important in the science and health community needs to be detailed for consumers. As you approach this communications opportunity or behavior change opportunity, I think we are seeing a shift in the public, and they are looking for something good to do. Because they have been bombarded so much by the “eat it and die” mentality, they are anxious to get a good news message.
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A majority of the consumers believe they do control their health, so we can play into that and show how grains might be helpful. They still believe nutrition plays a large role and has a value, even though they find it confusing. Most importantly, one message will not fit all. If we take a “Three Are Key” approach, we are going to have to do a lot of consumer testing to find out what is going to work, how that is going to be communicated, and if people are going to recognize and understand it. I think it is an exciting beginning of a journey.
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Audience/Panel Interaction — Where Do We Go from Here? Following are select participant comments and questions from the panel interaction session, with opening statements by David Klurfeld, Ph.D., Wayne State University, and Marla Reicks, Ph.D., R.D., University of Minnesota
David Klurfeld, Ph.D., Wayne State University
One of the problems and one of the opportunities in getting consumers to eat whole grain foods is that the biggest single source of calories in our diet is white bread, rolls, and crackers. You can get whole grains into those kinds of foods. The second biggest category is donuts, cakes, and cookies. You cannot get a lot of whole grains into those, but you can make muffins, bagels, and pasta. To grab consumer interest and acceptance, the food industry might want to think about intermediate type products — something like whole grain “lite” that has a portion of whole grain products in it.
Many of us have heard of Walter Willett’s version of the Food Guide Pyramid and his approach to grains. Unfortunately, part of the problem is we do not eat according to the current Food Guide Pyramid. So I am not sure changing the Food Guide Pyramid and separating whole grains at the bottom and refined grains at the top is a productive approach. The industry will cannibalize itself if it goes in that direction.
Willett’s aversion to refined grains is based almost exclusively on the glycemic index, which was developed primarily as a research tool. A lot of people are trying to apply it now to whole diets, but it does not really work for whole diets. You can calculate a glycemic mix for a specific meal, but if you ask someone what they ate yesterday, you do not know if they ate a slice of cheese with the white bread or not, so you do not know how that cheese affected the bread. My response to those who tout the glycemic index is that bacon and eggs is a very low glycemic breakfast, and I do not think Willett would be very happy with people eating bacon and eggs for breakfast.
One of the important points for academics to answer is, “is the whole of the grain the sum of its parts, or is it greater?” And I suspect it is greater. One of the problems in addressing this is there are lots and lots of components and, as researchers, we are pigeon-holers. We want to dig that little hole deeper and deeper and narrower and narrower until we find that single nutrient and then put it in a pill. That has not always been successful and, in fact, has been seemingly unsuccessful in the past. One of the issues with whole grain, or any other intact food, is the benefit derived from something other than a single nutrient? Is it the physical characteristics of the food itself as it passes through your digestive tract? Is it the viscosity of the food? Is it the fact you have low abrasive stools and that is why you have less colon cancer? Is it because you have changed the microflora in your intestine?
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Then the question becomes, “How will these whole grains be sold to consumers? Is it through a health benefit?” That is really the only message you are sending. You are not going to tell them it tastes better, because most of them do not think it tastes better, even if it does. Is it lighter and fluffier? Whiter and brighter? All the Tide® detergent commercials apply to selling food. One of the possibilities with whole grains is the idea of selling satiety as a factor — eat this and you will not eat as much. That does not seem to be a selling point these days, because the American food industry has essentially embraced bulk and quantity over taste. And I think health benefits really are a two-edged sword. There is the usual response if it tastes good — it is bad for you and vice versa.
We also need to know the value of intermediate endpoints. A year and a half ago, there were two papers in the New England Journal of Medicine on colon polyps and recurrence of polyps. Neither study was successful in reducing recurrence of colon polyps and the headlines read, “Diet has Nothing to do with Colon Cancer.” That is not the case. You need to be very specific about what the endpoints were. I think one of the lessons from both of those studies combined is maybe polyps are not the right endpoint for determining risk of colon cancer. Polyps are a pre-cancerous, benign condition that are high risk for colon cancer. Likewise, there has been heavy reliance in the last five to 10 years on cell proliferation in the colon as an indicator of risk. And the more we learn, the less certain we are that cell proliferation is important.
Marla Reicks, Ph.D., R.D., University of Minnesota
I pose three general areas of questions for the grains industry, educators, dietitians, etc., to think about. What does the industry think about the idea of a universal seal to help consumers identify whole grains and how would you go about doing it? Secondly, it is my understanding that the Dietary Guidelines Committee did not quantify a specific recommendation. Is that going to be a problem for nutrition educators or consumer educators as we try to go forward with the “Three Are Key” message? And last, I think some of the CSFII data shows there are some segments of the population, lower income, ethnically diverse audiences who eat maybe half of the one serving that the average American eats. Do you have any thoughts on types of foods we can promote to these audiences that would help them increase whole grain intake, especially given the fact they are at higher risk for chronic diseases for which we know whole grains can be beneficial?
Participant Question Consumer education is so critical to the outcome we are trying to find here but the reality is, we have fewer and fewer consumer educators within the industry, grocery stores, schools, and county programs at the grassroots. Where do you see the future of consumer education heading?
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Participant Comment Where is the future of consumer education? If I look at my colleagues who are dietetic professionals, more and more dietetic professionals are looking into doing more outreach and working with consumers and looking at different venues to consider. It may be in a health club environment and it may be in other areas we are not even thinking about today. I do see, especially in our younger professionals coming into the profession, less interest in a clinical environment and more in outreach environments. A lot of these folks are going into media positions themselves. Think about the power of the dietitian reporter, the television dietitian writer, etc. Those are the opportunities out there. There are still going to be great changes in the way we practice our profession and, while it may be different, we have to make sure we keep track of it so it is still as good as we have had or perhaps better in the future.
Participant Comment I think it is good to hear a culture can change. When I was a product developer, we were taught there were three things driving a product — cost, quality, and convenience. I believe that list may have grown and I think health is probably a driver, too, but those three are still primary. You can do all the education in the world, but if it does not taste good and people do not like it, it is not going to fly. That is the biggest thing I think we need to overcome and the biggest challenge we have in getting more whole grains into the diet.
Participant Question With the “Three Are Key” message, do we have enough science to push that? I think the Five A Day program is a good paradigm. How much evidence was there when they started? I do not think
there is any downside to pushing “Three Are Key,” but I am not sure the science is there yet. I would like to know if anybody in the audience feels strongly one way or the other about three servings a day?
Participant Comment You are right that the science is not there, but I am not sure at this point in time if it makes a big difference. If consumers are only consuming one serving a day currently, it is going to take some time for them to triple consumption. I am not sure we have to have science to say three is good, because it is going to take a while to get there anyway. We also need to be careful to remind consumers all grains are good and not turn them off by saying they should only eat whole grains.
Participant Question Science is elusive and, as we see in the media, it is really difficult to portray exactly what truth is. It seems to be prudent at this time to encourage more whole grains. Now, how many servings is tough. Three seems like a reasonable thing. It is much more than people are eating right now and maybe it is achievable. Those are the kinds of considerations that are important, more so than how much you should eat. A number of these things should come into consideration as we choose what message exactly to give and particularly the question of what to say about the number of servings.
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PART III: CHANGING BEHAVIOR AND GETTING THE POPULATION TO EAT MORE GRAINS
Plenary Session — Barriers to Grains and Whole Grains Consumption Several consumer studies have been conducted to quantify the current usage of whole grain breads and quantify the importance of selected barriers to whole grain bread consumption. The fact is, 20 percent of adults and 40 percent of teens and kids never eat whole grain bread, and consumption averages for whole grain breads are just three to four times a week. The majority of respondents considered six barriers to be major reasons that their families do not consume more whole grain bread. No. 1: color of the inside, followed by price, softness, texture, moisture or dryness, and perhaps surprisingly last was taste. Another barrier not specifically related in the data is low consumer awareness, which is driven by confusion of what qualifies as a whole grain product. What are the strategies to overcome those barriers? Educate the consumer, build relevance with the target consumer, and develop innovative products to attract key targets.
Presentation by Gary Jensen, Senior Vice President of Marketing, Sara Lee Bakery Division
Of the top 10 universal product codes (UPCs) in supermarkets, nine are fresh-baked breads. Five are white and the other four are soft varieties, but only one is called whole wheat; and none are hardy or super-premium products that we would consider to be whole grains according to the definitions we used in the symposium. You might be interested
to know the No. 1 one bakery UPC is actually a Thomas plain English muffin. And, you do not get to a whole wheat muffin until you get down to No. 7, and that is a Nature’s Own product.
Category OverviewOf the top 10 fresh baked good UPCs in supermarkets*• Nine are fresh baked breads• Five are white breads• The other four are soft varieties• Only one is whole wheat• None are hearty super premium products
*Bread, Buns, Rolls, English Muffins, and Bagels: 61,000 UPCs
Thomas English Muffins Plain (12 oz.) Wonder White Round Top (22 oz.)Sunbeam White Sandwich (24 oz.) Homepride Butter Top Wheat (24 oz.)Merita White Round Top (20 oz.) Butternut White Sandwich (20 oz.)Homepride Butter Top Wheat (20 oz.) Nature’s Own Whole Wheat (20 oz.Nature’s Own Honey Mrs Baird’s White Sandwich 24 oz.Wheat Split Top (20 oz.)
IRI Infoscan 52 weeks ending July 7, 2001
Looking a little further into sales in supermarkets by UPC, only five of the top 50 fresh bakery UPCs are whole wheat bread products. But the good news is the growth of these products is five times the top 50 growth rate of fresh bread, buns, rolls, English muffins, and bagels representing 61,000 UPCs for the bakery category in supermarkets across the United States today — a staggering number. They are up about .08 of a percent in terms of unit sales. The top 50 are up 4.2 percent, but the whole wheat breads, those five UPCs, three of which we call soft variety, are up almost 22 percent. So there are some good things going on with whole wheat bread.
Bread is a very mature category. In fact, in U.S. supermarkets, the annual household penetration of bread is higher than toilet paper. Because bread is a mature category, it has business models in place. There are paradigms set that are hard to change. So we have our work cut out for us as we go forward and try to grow whole grains.
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Several consumer studies have been conducted from 1996 to the present, including a July 2001 survey sampling of adults. The objectives of the survey: to quantify the current usage of whole grain breads and quantify the importance of the selected barriers to whole grain bread consumption. Results from these studies follow:
Twenty percent of adults and 40 percent of teens and kids never eat whole grain bread. And for those who do eat whole grain bread, the average consumption is only three to four times per week. It is important to note this is “claimed” consumption; people tend to overstate what they know they should eat and understate what they know they should not eat. The other thing operating here is consumer confusion between whole grains and just wheat breads.
not asked not asked
Nearly every meal (14) 7.1% 9.8% 10.1% 7.4%At least once a day (7) 24.6 19.0 15.5 19.5Several times a week (3) 26.5 23.1 16.4 15.9Less often (1) 18.6 20.7 15.3 15.6
Never 19.7 21.1 42.1 39.8Not familiar with whole grain breads 3.2 5.5Average per week 3.8 3.8 3.2 3.1
Whole Grain Bread Consumption Patterns
• 20% of adults and 40% of teens and kids never eat whole grain bread
• Claimed consumption of whole grain breads averages 3-4 times per week Head of Household Younger Kids
Female Male Teens at Home
July 13-15, 2001, TeleNation telephone survey among a nationally representative random digit dial sample of 1000 adults 18+
Kids exert considerable influence on the decision to buy brands, especially white bread brands, with kids’ influence even more important than price in many cases. Kids are going to be a key to unlocking this opportunity for whole grains growth.
Kids’ Influence on Bread Purchase Patterns
• Kids exert considerable influence on the decision to buy bread brands, especially white bread brands
Brand Purchased Kid InfluencesPrimarily for Kids Brand Purchased
EGR primary research, August 1999 sample of 1000 primary grocery shoppers in four markets
White Bread Brands
Soft Variety Brands
Super Premium Brands
28.8%
16.4%
5.9%
57.6%
40.5%
35.4%
The research identified six need-based segments for bread.
Consumer Need Segmentation• Proprietary research identifies six need-based
segments for bread: Kid Fluenced is the largest
Kid Fluenced
Specialty Nuts
Grocery Gourmets
Necessary Eaters
Brown Baggers
On Dealers
20%
17%
16%
16%
15%
14%
24%
18%
17%
13%
14%
13%
Segment Size
Households Dollar Sales
EGR 1999 Segmentation Study
The kids segment profile is the heaviest bread-buying segment — white bread buyers, family and kid oriented, some homebodies, convenience-minded, but willing to pay for value-added benefits. Looking at the whole grain bread user profile, we see something very different.
Twenty percent of adults and 40 percent of teens and kids never eat whole grain bread. And for those who do eat whole grain bread, the average consumption is only three to four times per week.
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For average eating occasions per week by census region, the lowest average consumption of whole grain bread is in the South, which is much lower than the Northeast and the Midwest.
Average Eating Occasions Per Week by Census Region
• Lowest average consumption of whole grain bread is in the South
July 13-15, 2001, TeleNation telephone survey among a nationally representative random digit dial sample of 1000 adults 18+
4.2 4.1 3.93.5
Northeast Midwest South West
Survey Average
3.8
So, you begin to see a little bit of an opportunity perhaps developing by census region.
Average eating occasions per week by age of household tends to peak over time, up to 5.1 occasions per week among those over 65.
Average Eating Occasions Per Weekby Age of Household
• Whole grain bread consumption tends to increase with age, peaking at 5.1 occasions per week among those 65+
3.64.2
5.1
3.43.2
3.6
18-24
Survey Average
3.8
25-34 35-44 45-54 55-64 65+
Head of Household AgeJuly 13-15, 2001, TeleNation telephone survey among a nationally representative random digit dial sample of 1000 adults 18+.
Occasions per household income tend to be higher among the lowest and the highest income segments, with retirees likely occupying the lower end.
Average Eating Occasions Per Week by Household Income
• Consumption tends to be higher among the lowest (driven at least partially by retirees) and the highest income segments
4
3.4
4.2
3.4
Under $25K $25K-50K $50K-75K $75K+
Survey Average
3.8
July 13-15, 2001, TeleNation telephone survey among a nationally representative random digit dial sample of 1000 adults 18+
When evaluating changes in whole grain consumption patterns during the past 12 months, several groups claimed to be eating more whole grains — including kids 12 and younger and Midwesterners. Those who reported they were eating less tended to be from the South. Overall, whole grain consumption did not change for more than 70 percent of adults, teens, and kids surveyed. The strongest net increase was seen among kids under 12.
Consumption vs. Year Ago• Whole grain bread consumption did not change
for over 70% of adults, teens, and kids• Strongest net increase is among kids 12 and younger
Head of Household Younger KidsFemale Male Teens at Home
July 13-15, 2001, TeleNation telephone survey among a nationally representative random digit dial sample of 1000 adults 18+
Eating more 13.4% 11.8% 6.6% 13.0%whole grain bread
About same as year ago 72.7 77.9 82.9 78.8
Eating less 12.0 8.5 6.8 5.0
Net change +1.4 +3.3 -.2 +8.0(% more – % less)
In terms of consumption vs. a year ago by census region, the highest increase appears to be in the Midwest. And, the highest level of eating less was, once again, in the South.
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July 13-15, 2001, TeleNation telephone survey among a nationally representative random digit dial sample of 1000 adults 18+
Consumption vs. a Year Ago by Census Region
• Highest net increase in whole grain bread consumption appears to be in the Midwest
• Highest level of “eating less” is in the South
Northeast Midwest South West
Eating more whole grain 12.1% 17.7% 12.7% 7.4%
About same as year ago 76.4 75.0 70.7 81.9
Eating less 9.4 4.6 14.9 9.8
Net change +2.7 -2.2 -2.4(% more – % less)
+13.1
We also talked with consumers about the actual barriers to eating more whole grain breads and we were surprised by some of the findings. The majority of the respondents considered six barriers to be major reasons that their families do not use more whole grain bread. What was most surprising, was the rankings of the barriers: No. 1: color of the inside, followed by price, softness, texture, moisture or dryness, and taste. In previous studies, taste and texture or taste and softness have been the top barriers. But, the “color of the inside” finding may present an additional consideration to examine from a product standpoint.
Barriers to Eating More Whole Grain Breads
• The majority (60%+) of respondents consider each of the six listed barriers to be a “major” reason that their families do not eat more whole grain breads
• “Color of Inside” ranks #1; “Taste” ranks #6
60.9
70.1
70.9
71.8
72.2
82.6
12.8
13.1
13.5
11.8
14.9
9.2
25.5
15.1
13.7
14.9
11.7
6.8
Taste
Moisture or Dryness
Texture
Softness
Price
Color of the Inside
Major Reason Minor Reason Not a Reason
July 13-15, 2001, TeleNation telephone survey among a nationally representative random digit dial sample of 1000 adults 18+
Another barrier that is not specifically related to the data is low consumer awareness, which is driven by confusion.
Generally, consumers do not understand the difference between wheat bread and whole grain bread. There also is a limited availability of whole grains — about 5 percent, based on our estimation. And, I am going to criticize our own industry a little bit and say our promotional efforts are fairly weak. Other industries spend more than we do to get the message out.
0.35
180
29
30
16
15.7
$0 $20 $40 $60 $80 $100 $120 $140 $160 $180 $200
Bread/Rolls
Dairy/Milk
Dairy/Cheese
Beef
Pork
Eggs
Million dollars
Industry Promotion Spending
Fleishman-Hillard
Now, I would like to shift to some potential strategies to break down the barriers (in our potential target segments), the number of people within those segments, and how their current whole grain bread usage varies.
U.S. Census Bureau, Census 2000
Potential Target Segments
Kids 6-12
Teens 13-17
Young Adults 18-24
Older Adults 55+
(in Millions)Current Whole Grain
Bread Usage40% Never
40% Never
Low But Growing
Relatively High
31.7
26.6
25.5
60.3
So, who do you pick? Well, one of the biggest difficulties with marketing is that you maintain a discipline to “try not to be all things to all people all the time.” We need to select our targets carefully.
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If we were giving the guidance, we would select adults who never eat or who eat whole grains less than once a week, teens and kids who never eat the product, and the South, where the lowest average consumption occurs. There are some key barriers common across each group. • No. 1: Lack of understanding of
whole grain benefits driven by a low awareness. People may not consume whole grains because they simply do not understand the importance of whole grains within the diet. There also is confusion, for which we as an industry are partly to blame, because we tend to treat all breads as equal when they really are not.
• No. 2: Not relevant to their lifestyle. People may be aware but not interested, or may not be consuming whole grains because whole grain products/brands are not relevant to them and their lives.
• No. 3: Current whole grain product profile. People may not appreciate the profile. Perhaps they are aware and they have tried whole grain products, but they reject them. They are not coming back to repeat purchase because of color, price, softness, texture, etc.
What are the strategies to help overcome some of those barriers? For barrier No. 1: lack of understanding, the business strategy would be education of the consumer on the value and the benefit of whole grains. It is not new, but that is what it is going to take. Another strategy would be to differentiate whole grains from other breads. We also brainstormed some tactical ideas to implement these strategies, which include a special whole grain section in grocery stores, an American Bakers Association-sponsored educational effort (whole grain icon on
bag), a school education program, employing doctors and nutritionists to convey new whole grain health findings, partnerships with health magazines, and health expos and events to create awareness.
For the second barrier, a lack of relevance, the obvious strategy is to build relevance with the correct consumer target. Tactical ideas to implement this strategy include developing a special whole grain section in stores, involving the consumer with a cause or meaningful association (i.e., young adults and environmental issues; kids/teens and the X Games).
For the third barrier, the current whole grain product profile, the strategy is to develop innovative products to attract key targets. The tactical ideas include fun, great-tasting products (whole grain cinnamon swirl bread, IronKids® whole grain bread, whole grain graham crackers, whole grain cookies) and portable products (whole grain bagel bites, whole grain cheesecake bites) for kids; and half loaves of whole grain varieties and the introduction of new international whole grain varieties (quinoa) for adults; as well as development of a softer, lighter color whole grain bread for the South. The list goes on and on.
I was shopping with my wife in a place called the Galleria in St. Louis a couple of weeks ago and I went to one of those coffee shops to get a coffee. I noticed, as I was standing in line, that there were six people in front of me — all teenage girls. And I am thinking to myself, what are six teenage girls doing buying coffee? Their coffee did not exactly look like my coffee. It had whipped cream and sprinkles and a straw. But part of the retail success in coffee comes
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from the fact that they are attracting that consumer or that target audience. So, what are the whipped cream and sprinkles and straws for the bakery business? How do we reach out and touch them with transitional products? I heard somebody say something about a jelly whole grain donut. Sounds funny, but I do not know that that is too bad of an idea. I do not think it is realistic to expect them to just make the leap from white bread to whole grain breads. We are going to have to develop products to make that easier.
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BREAKOUT SESSION I: BEHAVIOR AND CHANGE Changing Consumption — Models for Affecting Change There are several strategies geared toward changing behavior. Azjen’s Theory of Planned Behavior (TPB) is a well-researched behavior change theory at the individual level. This theory assumes that behavior change is predicted by people’s intention to change behavior, their attitude toward the behavior, and their perceptions of the control they have over enacting the behavior.
Ecological models ask broader questions about our behavior. These models assume that intrapersonal, socio-cultural, and physical factors influence our behaviors in synergistic and reciprocal ways. Psychosocial factors are primarily the individual level factors, including knowledge, motivation, attitudes, and skills. All of these approaches must be considered in an effort to increase the consumption of grains and whole grains. Presentation by Leslie A. Lytle, Ph.D., Professor, University of Minnesota This presentation has three primary purposes: 1. To share insights into behavior
change at the individual level, using the Theory of Planned Behavior as the exemplar.
2. To share insights into behavioral change at the population level, using an Ecological Model as an exemplar.
3. To apply such theoretical models to increase the consumption of whole grains.
Individual behavior change: Examples of behavior change strategies that are at the individual level include patient/practitioner interactions, many educational and instructional interactions, and media messages designed to affect consumer choice. These types of strategies are primarily active strategies that require the individual to make some change or behave in some way. For example, an intervention strategy that tries to get an individual to start eating a breakfast that includes a whole grain cereal is an active strategy. Active interventions often require the individual to possess some knowledge, motivation, positive attitude, or behavioral skill. Many of our traditional nutrition education approaches focus on affecting knowledge and have had limited success. Knowledge is a necessary, but not sufficient, condition for change. Ajzen’s Theory of Planned Behavior (TPB) is a well-researched behavior change theory at the individual level. The theory assumes that behavior change is predicted by: people’s intention to change behavior, their attitude toward the behavior, how they believe others view the behavior, and their perceptions of the control they have over enacting the behavior. This control might include physical barriers to making the behavior change, but also includes perceptions of self-efficacy or competence in making the behavior change.
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Applying TPB to whole grain consumption might be operationalized as follows: Behavioral target: I make sandwiches for my family using whole grain bread or rolls. Attitude: “I will like the taste of sandwiches made with whole grain breads.” Subjective Norm: “My husband will complain about the change in bread on sandwiches.” Perceived control: “Whole grain rolls will be more expensive than white rolls.” Intention: “The next time I go to the store, I will buy whole grain buns or bread for sandwiches at home.” The extent to which attitudes, subjective norm, and perceived behavioral control facilitate one’s decision or intention to behave in a prescribed way, predicts how likely it is that the behavior will occur. Our theoretical models that focus on individual behavior change have limited success. Only about 30 percent of the variance in eating behaviors is explained by psychosocial constructs. Our psychosocial models work best when we ask them to explain more specific behavior (i.e., choosing whole grain breads for sandwiches) than they do for broader aspects of dietary behavior (eating more servings from the breads and grains group of the Food Guide Pyramid).
Ecological models: ecological models ask broader questions about our behavior. Ecological models assume that intrapersonal, socio-cultural, and physical factors influence our behaviors in synergistic and reciprocal ways. As such, ecological models provide for the possibility of passive interventions, or interventions where the individual does not need to make a choice and may not even know that some element of a familiar product is different. An example of a passive intervention is folate supplementation of grains. Possible passive intervention strategies to increase the population’s consumption of whole grains would be: 1) adding a proportion of whole grain flour to all refined grain products, or 2) restricting choices in restaurants and other food service operations. Applying ecological models to whole grain consumption might be operationalized as follows: Physical environment: This refers to access and availability. Are tasty whole grain options available in stores, at home, and at work or school? Do all segments of the population have equal access to the products (cost, availability in stores)? Socio-cultural factors: How do we move from a white bread culture to a whole wheat pita bread culture? How do we make eating whole grain cereals the normal or cool thing to eat for a student in a school breakfast program? Who are our role models for eating whole grain products and how do we support and reinforce the selection of whole grain products?
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Psychosocial factors: These are primarily the individual level factors previously mentioned, including: knowledge, motivation, attitudes, and skills. The difficulty in enhancing the population’s skills in being able to recognize a whole grain product should not be underestimated. How does the consumer know they are eating a whole grain product? Even the concept “whole grain” is a bit abstract, meaning that it will be more difficult for people to know exactly what they are supposed to do and how they are supposed to do it (assuming that they are motivated enough to want to make a change)! Recommendations: 1. Do not rely solely on
knowledge-based nutrition education to increase consumption of whole grain products.
2. Consider taste, as well as the social, cultural, and physical environmental influences.
3. Look to social marketing for ideas on changing consumer behavior.
4. Attempt to find passive, as well as active intervention approaches.
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The Consumer and Behavior Changes While the concepts of “food” and “nutrition” fit together for dietitians, consumers often view it as a battle between “food” and “nutrition.” Consumers tend to be frustrated and confused by all of the diet information and misinformation in the media. The good news is that nutrition is still a value that is important to consumers. When designing a consumer communications program, it is important to look at the needs and understanding of the people you are trying to serve with this information. We need to talk in a language that makes sense to people, that captures their attention, and gets to the outcomes we are looking for in terms of change. There is an opportunity to find new ways to engage in discussions on nutrition and embark on a new campaign to increase consumption of grains and whole grains. Presentation by Sue Borra, R.D., Vice President, International Food Information Council (IFIC)
What do consumers think? What do they feel? How are they dealing with all this information about food and nutrition and health? And, how can we learn from that and do a better job as we are trying to communicate and influence them?
For nutritionists and dietitians, the concept of the word “food” and the word “nutrition” go together. They are like peanut butter and jelly — you cannot separate them. But when the consumer looks at these two words, they look at them a bit differently. It is “food” vs. “nutrition.” It is, “If I eat healthy, it is going to taste bad.”
This is going to be a difficult challenge for us to overcome because there is a certain ingraining that has put food and nutrition on more of a battlefield than a cooperative field.
In June 2000, we went to the streets of Chicago and interviewed consumers. We asked them questions about food and nutrition and health to get their opinions. First, as they were milling around the street we asked them questions such as, “What do you think about food?” At the beginning, when they talked about food and their favorite foods, they smiled and their faces lit up. Some of their comments included the following:
“Ah, I love to eat. When my family gets together, we eat a lot.”
“I like meat, ice cream, Italian food, Chinese food, lasagna, fish; I eat everything.”
“Anything they say is not good for you, that’s what I like.”
“The best food is broccoli.”
The conversation then turned to nutrition and the reactions and comments changed:
“The hype right now may be carbohydrates are bad, but next year, it might be no, take in more carbohydrates. One says eat it, one says don’t eat it. It’s good one year and it’s bad the next year.”
“They say that butter is high in cholesterol. Recently, they came out with a study how margarine is worse than butter. So which story is true then?”
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“There have been so many articles about food in the media that I’m sick and tired of seeing it, frankly.”
“They never say anything bad about broccoli.”
The subject of nutrition has been high on the minds of consumers. The question we need to answer now is, “How do we need to look at and deal with it before it goes much further?” In 1998, we conducted qualitative research with female food gatekeepers. We talked to them about dietary fat and we looked at the dietary fat guideline to gauge their opinions. Our question was, “How can we talk to you about it in a way that makes sense?” As a warm-up question for these focus groups, we decided to say, “Tell us about your eating patterns.” The question was, “How many of you in this room feel 100 percent comfortable with the way you eat and your eating patterns?” How many people do you think we got in all these focus groups to raise their hand as 100 percent comfortable? Zero. We then went to the other end and asked, “How many of you are 100 percent uncomfortable with your eating patterns?” With this question, they were somewhere in the middle, between highly comfortable and totally uncomfortable. We said, “So you are telling us you are feeling a discomfort about your eating patterns. Tell us what that feels like.” These were the emotions they described: “When I think about my eating patterns, I feel guilty. I worry about it. I worry about what I’m doing for myself and my family. I feel helpless.”
“You know, sometimes it really makes me angry when all these things are going on and I’m really trying to do the right things for myself and my family.” We were behind the glass ... we did not expect this, as this was one of those throwaway warm-up questions. We thought, “Oh, my heavens! Look at what our nutrition messaging has done to consumers. We have left them with a guilt package that is unbelievable and we need to change this conversation. We need to focus on the positive and get them to be empowered.” You want people to say, “You know, I may not be doing everything, but I really think I can do it.” We were not hearing that from these people. So, we went back to the streets in Chicago and we asked people, “Tell us what you think about some of these negative nutrition messages that you are hearing out there.” This reinforces the idea that, in developing a campaign for whole grains, we need to emphasize the positives of whole grains, but not against the negatives of refined grains, because this is what I am afraid the outcome will be: “When I hear stories about this is bad for me, or I shouldn’t drink coffee, or I shouldn’t eat butter, I shouldn’t eat bacon, or ... I ignore them.”
“I’ve been eating these things all my life, and I’m going to continue eating them.”
“I’m the gatekeeper of my mouth. I think I have common sense to know what is good and what is not good to eat.”
“If someone tells me there are foods that are bad for me that I should never eat, I’d probably feel deprived.”
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That gives a small impression of the frustration and how consumers are dealing with some of the information that is out there. While we see confusion, the good news is that nutrition is still a value and it is still important to people.
In the ADA Trends Survey from 2000, 85 percent of consumers said diet and nutrition are important to them personally. But when you say, “What have you done to make significant changes to achieve a healthful diet,” only 28 percent said they were able to do something to make significant changes. I think the problem for many years has been that nutritional communications are a one-way street. I have been one of those dietitians as guilty as the rest. Back when I started my career working with the supermarkets, I would sit at my desk and write a consumer publication about how consumers should have calcium in their diet or whatever might be the topic of the day. I would type it out on my typewriter, take it to be designed into a brochure, then distribute it to the world. That is very much a one-way street of communications. Nobody ever looked at it, said it made sense, or that they understood it. My nutrition professors probably would have loved whatever I said. In essence, we have been very good about getting information out, but we need to take what we do as “nutrition-speak” and turn that into “consumer-speak.” We need to talk in a language that makes sense to people, really captures their attention, and gets the outcomes that we are looking for in terms of change. It is really time for a new nutrition conversation with consumers. It is an opportunity for us to find new ways to engage in discussions on communications about nutrition and embark on a new campaign to increase
consumption of grains, particularly whole grains.
We all know what we want to say. We know what we want consumers to do. To illustrate this point, the Dietary Guidelines for Americans are an example of what we want to say; we want people to do those things. But the Dietary Guidelines for Americans are not consumer messages — they are directionals. They are ways to get to an endpoint, but they really were never designed to be consumer messages. So, we have to take the concept that is in the dietary guidelines, or in a grains message, and turn that into what consumers want to hear.
The message development model I am going to share with you recently was published in the June issue of The Journal of the American Dietetic Association in regard to the dietary fat messaging work we did.
Step 1. Define the issues • What do you want to achieve? • Demographics: Who is
your audience? • Psychographics: What does your
audience think and why?
Step 2. Develop initial message concepts • Be positive. • Address sources of discomfort
with eating. • Empower consumers to
make changes.
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Step 3. Assess message concepts • “What does this message mean
to you?” • “Does this message motivate you?” • “Does it fit with other things you
want in life?” Step 4. Fine-tune messages
Step 4: Fine-tune Messages
Develop Initial Message Concepts (Step 2)
Fine Tune Messages (Step 4)
Define Issues (Step 1)
Focus Groups
Assess Message Concepts(Step 3)
Focus Groups
Validate Messages (Step 5)
Quantitative Survey
Step 5. Validate messages • Quantitative acceptance of the
message to confirm the message resonates with the audience.
As an example, at IFIC, we were working with fat messages and we started off with the message from the Dietary Guidelines of 1995 that said, “Choose a diet low in fat, saturated fat, and cholesterol.” When we went and talked to women about this message, they said, “Oh, yeah, I know that.” And, they did understand the concept of it. When we asked, “What does that mean to you?” Their responses were, “That means a terrible diet; a diet with no fat has no taste. I would not want to eat it.” So they understood the concept, but what it meant to them was not a good thing in terms of eating, taste, and their lifestyles. So, we went back and worked on them and came up with a different message. “Foods with fat can fit. Moderate, do not eliminate.” This made sense to them. They said, “Oh, I can
have fat?” That was a revelation, by the way, because a few years ago they had heard that zero was the amount of fat you should have in your diet. We also talked to them about moderation and what that means, and they understood it means they have to take some control. We did the same thing with sugars. We took the original Dietary Guideline that stated, “Choose a diet moderate in sugars” and made it into, “You can include sweet foods in moderation as part of a healthy eating plan,” and, “Most kids love sweets: show them how to enjoy them in moderation.” Finally, we asked consumers about the revised, more consumer-friendly messages on fat and sugar in which we followed the five-step process. Here’s what they had to say:
“I agree with that. I think everyone needs a little bit of fat.”
“I could do that. I think that sounds great. It would make me feel a lot more comfortable.”
“If they say that fat can stay in my diet as long as it’s moderated, then I’m okay.”
“I like it because it appeals to the common sense instead of being a guilty kind of a message. It sounds like the message is trusting me to make my own decisions about nutrition.”
We found consumers used the word “moderation” a lot. That is where our opportunity for education is, especially with tough concepts such as dietary fat and sugars. That is where you need to really get specific with tips. You really need to give them visuals on what you mean by moderation; what does that look like?
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There is a variety of ways you can do that: • Keep tips positive, short, and simple. • Be specific, describe an action. • Address what is in it for consumers. • Do not perpetuate the “good
food/bad food” myth. Here are some examples from the Dietary Guidelines Alliance “It’s All About You” kit: • Enjoy your steak twice as much. Eat
half in the restaurant and take the rest home to enjoy the next day.
• Set an example for your children. Order a small to medium soft drink instead of an extra large, and skip the refills.
• Create your own breakfast cereal. Mix together two, three, even four cereals. Choose at least one that says “high in fiber” on the box.
Food has so many meanings for us in our lives, and everyone has their favorite food. We have to accommodate everything there is about foods and the role they play in our culture and our lives. It is on all of our shoulders to make sure that our messages are clear and concise and directed to consumers. Using tested messages is certainly one way to do that. Every one of us in this room has an opportunity to help and work with the media as that predominant vehicle for getting the information out.
Overall, put the consumer first, front, and center, in whatever you do. We cannot lose sight of our science. Do not get me wrong; if we do our work based around the needs and wants of the consumers, we will be successful. When we lose sight of what the consumer needs and wants, that is where we are going to have some challenges.
Just remember this quip from an advertising guru, “The consumer is king.” To close, the consumers need to have the last word. Here is what they had to say:
“You only live once and I say, ‘Eat up and enjoy it.’”
“Practice what you preach.”
“Allow people to make educated decisions.”
“And eat broccoli, I guess. Then you don’t have to worry.”
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Changing Food Behaviors Starts Early Children receive many opportunities for nutritious meals through the Federal Child Nutrition Programs. However, school foodservice still faces many challenges in providing for the health and well-being of the nation’s children, including decreased funding and increased use of school vending machines. Programs such as Fitness Fever® and the School Meals Initiative have helped school foodservice make an impact. Recognizing the importance of partnerships, image, and public relations also has helped the school foodservice segment adapt to and address the needs of today’s schools and school children.
Presentation by Mary Begalle, R.D., S.F.N.S., American School Food Service Association
The Federal Child Nutrition Programs provide many opportunities for children to receive nutritious meals. The programs administered most often by schools include the National School Lunch Program, which includes school lunches and after-school snacks; the School Breakfast Program; and the Food Distribution Program, which provides surplus agricultural commodities to schools. Many schools also offer the Summer Food Service Program, which provides meals to low-income children when school is not in session and the Child and Adult Care Food Program, which provides meals for young children in child care programs. However, there are many challenges facing school foodservice in its goal of providing for the health and well-being of our nation’s children.
In 1996, Congress discontinued the funding for the Nutrition Education and
Training Program. This funding cut has severely hampered the ability of school foodservice to provide nutrition education and teach children good eating habits. This has occurred at the same time that there has been a substantial increase in the sale of foods of minimal nutritional value in vending machines and school stores. As many schools face budget shortfalls, school administrators increasingly are looking for other sources of funding. Far too often, administrators are competing with the federal nutrition programs for the student food dollar. While this needed revenue is used for good purposes, such as funding student activities, it comes at the cost of promoting poor nutrition and health. Many school foodservice directors find that selling a la carte foods helps to contribute to their bottom line as school boards are demanding solvency in the foodservice fund. Schools find that the Summer Food Service Program and the Child and Adult Care Food Program are administratively burdensome, inhibiting program participation and growth. The Child and Adult Care Food Program also experienced substantial budget cuts with the welfare reform of the mid 1990s.
While there are many challenges in school foodservice, there also are many opportunities. In Minnesota, we have created a wonderful public/private partnership in our Fitness Fever Program. Fitness Fever is the most successful health promotion program in Minnesota history. Fitness Fever targets elementary school children and their parents to increase their physical activity and improve their nutrition. Fitness Fever occurs every year during the month of February. It is successful because it focuses on sound principles of health and wellness and it is fun.
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Fitness Fever is supported by a community partnership of business, nonprofit organizations, and state agencies. Another big success story is the American School Food Service Association’s (ASFSA) Nutrition Advisory Councils. Nutrition Advisory Councils involve students in school foodservice and educates them about the importance of good nutrition. Many Councils sponsor a variety of activities, including community health fairs, food drives, menu specials, and educational materials.
In 1996, Congress passed the Healthy Meals for Healthy Americans Act, which required all schools to meet the Dietary Guidelines for Americans. That led to the School Meals Initiative — a set of regulations that now require schools to offer menus meeting the dietary guidelines. In Minnesota, we do the nutrient analysis as a state agency by partnering with our University of Minnesota Nutrition Coordinating Center. Every year, 20 percent of the lunch menus in Minnesota are analyzed, as they are across the country. And, schools are doing a good job of meeting those guidelines. Parents will look at the menu sometimes and say, “Pizza. Hamburgers. These are not healthy foods.” Yet, these are healthy menus. Schools are doing some passive, behind-the-scenes work to find lower-fat ground beef or buy pizza that has fewer calories. The good thing about the School Meals Initiative is it did increase the grains and breads requirement in school meal patterns. They were added to get the calories up because schools were challenged to bring the fat content down.
Another opportunity is the School Breakfast Program. We have done a lot in Minnesota to increase school breakfast programs. That is the one area in schools where there is a tremendous opportunity for growth. Nationally, the average participation rate for school breakfast runs about 12 percent to 14 percent. One of the barriers to participating in school breakfast programs is that parents actually think it is a program for low-income kids, while they perceive school lunches as being for all kids. The breakfast program started in the late 1970s and initially was targeted at inner cities and a low-income population. But through a lot of research from the last 10 years, the results show that kids who eat school breakfast actually do better in school. As a result, Minnesota has provided additional state funding to promote school breakfast programs. Now, what the schools have to do in order to earn that additional state funding is to integrate breakfast into their school day, so they need to make breakfast accessible to all students. We have some schools that actually serve breakfast in the classroom in the morning while attendance is being taken, which has resulted in some high participation rates. Last year, statewide, taking into account all of our schools, our breakfast participation went up to about 46 percent. We hope to increase that by another 10 percent next year. When school breakfasts are made part of the school day, our research shows it reduces the barrier of thinking that the program is only for low-income kids.
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Other opportunities we have focus on the role of advocacy and public policy. ASFSA has a very strong voice in Washington. In fact, one of the reasons why we did not lose funding from the school lunch program in 1996 through welfare reform is that Congress was bombarded with good information about the benefits of the program from ASFSA. We worked diligently to increase our focus on the legislative agenda and protect funding at all levels. For the past few years, we have been talking to Congress about the Nutrition Education and Training Program and if they do not want to fund that program, then we need to come up with a new educational program that can be successful in schools. We are doing a lot of outreach and forging of partnerships as well. For us to be successful in the area of nutrition education and to change kids’ eating behaviors, it does take a partnership. It cannot be just one segment. Kids only eat one meal a day, 175 to 180 times a year, at school. So it is really a bigger picture in getting them to make or understand the choices they are making and getting the parents to understand the choices of good nutrition. We can impact it somewhat, but if those principles are not reinforced in the home, we are fighting a losing battle.
Plus, so many schools have to offer a lot of choices now to kids just to attract them to their school lunch program. Once you start introducing choices, kids can mix and match and put together combinations that may not be as good as the ideal, one-menu approach. We have tried to raise the awareness about the importance of good nutrition by sending a lot of materials to parents, particularly on our breakfast research.
Image and public relations is another area the ASFSA is focusing on because, oftentimes, the public image of school meal programs is based on what adults remember it looked like when they were in school. We encourage parents to come in and see the way school nutrition programs are operating today. To determine our areas of focus in terms of public image in Minnesota, we did focus groups with high school students. I can tell you it was almost painful for us to publish that report because it has some information in there for school foodservice directors and school administrators that is difficult to read. (The report is available at the Minnesota Department of Children, Families & Learning — Food and Nutrition Service Web site https://fns.state.mn.us.) We really think it is important that we are listening to our students and their needs, so that we can make improvements in our programs to attract students to eating nutritious school meals.
For us to be successful in the area of nutrition education and to change kids’ eating behaviors, it does take a partnership. It cannot be just one segment.
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BREAKOUT SESSION II: WHOLE GRAINS AND THE FOOD INDUSTRY Effects of Processing on Nutritive and Physiological Impact of Grains For bakers, the driving factors to product creation are consumer interests and needs, not nutrition. In the baking process, bakers are focused on mixing, fermentation, the make-up procedure, and the baking itself.
For a baker, adding whole grains or adding fibers can create challenges in the baking process. Particle size affects hydration, which can affect fermentation time, etc. There are some ways to address those challenges, including pretreatment of grain and infrared processing. Overall, processing needs to be optimized technically and nutritionally so products can be developed that are acceptable to consumers and, therefore, bakers.
Presentation by Debi Rogers, Ph.D., American Institute of Baking
In the baking industry, nutrition and health advantages are not the driving factors. Bakers are making different breads because they perceive that people like variety. Trying to respond to customer needs and that competitive edge, as in every market, generates interest in the products. Those are the reasons bakers are making whatever product they are making and not thinking about nutrition.
The mixing process is about uniformly incorporating the ingredients and hydrating, which is a big issue with whole grains. Hydrating everything efficiently is a big problem. During this process, we concentrate on developing the gluten for proper handling quality and gas retention. The gluten structure
sets the structure for the volume of the bread, which is critical to a baker. Anything that interferes with gluten development is going to be interfering with volume. Bakers also use gluten film to trap air cells to create the crumb structure. Most production nowadays is what we call a sponge-and-dough. We mix part of the flour, water, and yeast, let it set for approximately four hours, then add the rest of the ingredients. We mix it and go on through the processing. So, we generally have two mixing stages involved.
There also are key developments that occur in fermentation. Developing flavor is a primary thing. Consumers are always looking for flavor development, leavening, and getting air cell expansion. But again, we have to have that gluten structure to retain the air cells.
The make-up procedure goes quickly after this — dividing, rounding, sheeting, molding, panning, and proofing. Usually a mixer may hold 2,000 pounds of dough or more, so we are not talking small scale. We have large amounts of quantity and mass coming out every eight or 10 minutes. It is divided into the individual pieces, whether those are one pound, a half-pound, or bigger sizes. Then there is rounding to make that nice, smooth skin on it. We used to always say we needed intermediate proof, but it you talk to bakers today, that intermediate proof is getting shorter and shorter. We then sheet the dough, flatten it out, and roll it into whatever size and shape of product we want. Molding is not adding mold to it, but it is shaping the loaf. We put it in the pan, then allow it to proof, which is just continued fermentation. We allow it to come up almost to volume under controlled temperature and humidity; then we bake it.
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During the baking process, we get this nice little oven spring, hopefully. The yeast is going to be killed, proteins denatured, starch gelatinized, and all kinds of things happen. We get browning and we have this nice wonderful product we call bread. Then, we have the last stage a lot of us forget about. We have to let the bread cool so we can slice it and get it into a package. Depending on the bakery, cooling usually involves letting the bread circulate overhead. Cooling bread to the slicing temperature of 90°F to 110°F usually takes about 45 to 75 minutes. That is the commercial process.
To a baker, it really does not matter if we are talking about adding whole grains or adding fibers. The same principles are going to apply from a baker’s perspective in terms of key added fiber properties. Particle size is extremely critical. And, everything we look at nutritionally may be just the opposite from the baking side. Particle size affects how things are going to hydrate, which requires water. We can compensate other ingredients that are taking water away from the gluten. The problem with a large particle is that it is going to hydrate slowly. During the fermentation time, those particles are continuing to suck up water for all the wonderful reasons that, physiologically, we want to have them in there. But by the time we get ready to sheet that dough, it is going to be so dry and stiff that it is going to tear. We put in more water at the mixer so when we get to the sheeting and molding process, we can handle it. Then, it is really soft, sticky, and very difficult to mix. It takes longer to mix, which slows down your processing and translates into more money. You cannot have as many doughs coming out in an hour.
Color is a big issue for consumers and, from a baker’s viewpoint, we are looking for particles that are not very noticeable. We do not want them to be really dark or show up too much because that detracts from what the customer is going to see. In terms of the volume impact, most whole grain additions are going to decrease volume, which is not necessarily bad. But again, consumers are used to a certain loaf weight and size. So, our choices are to use a smaller pan or put in more weight. But, both are going to change customer’s perceptions of what they are used to seeing. This also will impact what the crumb looks like on the inside of that loaf. Because of lack of expansion, the air cells are going to be a different size and shape. While consumers consider softness, texture, and dryness, this translates into abrasiveness from a baker’s perspective. Whole grain bread can be rough stuff. You do not want a dry and gritty sandwich. If you want crunchy peanut butter, you want the peanut butter to be crunchy, not the bread. So there is this texture issue — the abrasiveness in the mouth — that can cause problems. Bakers also have to consider the abrasiveness to equipment. Every time we mould, cut, and divide, the abrasiveness wears the equipment differently than a softer bread.
Flavor is another consideration. Whole wheat taste can be viewed as bitter. Maybe we can look at the hard white wheats as a lead-in to bring consumers some different products without quite as much bitter flavor. Obviously, we need a steady supply to the bakery for whatever whole grain product we are using. Cost is a big thing, as well, as profit margins in a bread plant are very low, while the cost of some of these whole grain products generally are a bit higher.
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Although nutrition is not a primary driving factor for bakers, soluble vs. insoluble fiber can play into the processing functionality — what is going to absorb water, what is going to cause tightness/stickiness in that dough, etc.
Which grains do we consider? Rye, corn, oats, barley, rice, amaranth — the list goes on and on. Maybe some of smaller grains might be ones the consumer may look at more favorably because we are going to see small pieces. It is not going to change the physical color of that product nearly as much. Some of the little ones like quinoa might be a good idea. Combinations are another consideration.
You could put in up to 25 percent of whole grains by weight of the flour. Once we get to higher levels, like 35 percent to 40 percent by weight to try to get to the whole grain claim, we start creating big problems as far as the processing. I am not saying that it cannot be done, but it is going to be difficult. Consumers may look at a list of grains or products and not know which are whole grains and which are not. A lot of bakers do not know what would qualify for whole grain products either.
With particularly the whole grain product, the true whole grain product, there are some ways to get around some of the baker’s biggest challenges. And that is to do some pretreatment of the grain. Of course, that affects the cost. There is steaming, infrared processing, or micronizing, which is a short-time high temperature, kind of like ultra-pasteurization. You process it with water and heat and then partially pregelatinize the starches so you will have faster absorption when you put the
particle into the product. Then the baker has more control. Reduced microbial and enzymatic activity is another big issue. Many times, as with whole grains, as we are hydrating them, the enzymes that are in those grains may be impacting dough functionality, with protease and amylase being the primary two.
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Although nutrition is not a primary driving factor for bakers, soluble vs. insoluble fiber can play into the processing functionality — what is going to absorb water, what is going to cause tightness/stickiness in that dough, etc.
o if we heat-treat it, then we are educing that problem and we may be oftening the texture a little bit. This can elp when we get to slicing. When hole grains go through the baking rocess, they absorb some water, but hey are still pretty hard. This hardness an really dull the slicers, which creates owntime and costs in changing blades. ut if the grains are precooked, then we ctually soften the texture and may not ave quite that much problem.
esides pretreating and precooking some f these whole grain products, we also ake some processing modifications via
nzymes. Cellulase is going to break own cellulose, and the hemicellulose, entosanase, and xylanase are going to reak down those wonderful emicellulose structures, generally aking insoluble fiber and converting it ore to soluble fiber, which makes the
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dough easier to process. It has been a great addition for the baker, but the question then becomes, “What is the nutritional value?”
We also have challenges in bringing whole grains into other products in addition to bread. Consider crackers. If we are talking about a saltine type of cracker, we’re looking at a sponge-and-dough fermentation much like the bread system. If we are talking about a snack cracker, it is probably chemical-leavened, so it is a much shorter processing time period. Either way, you are mixing the dough and sheeting it. Many times, the final cracker sheet is one to two millimeters thick prior to baking. What is the thickness of some of these whole grains we are trying to put in there? We are going to be tearing the sheets and trying to roll these whole grains through. As you are sheeting, dough cannot stick to the rolls and whole grains can bring in a stickiness issue. We expect products such as crackers to have a very long shelf life, so we have to consider the rancidity issues with some of the whole grains.
With cookies, such as oatmeal or a chocolate chip, you drop it onto a pan and it spreads. The fiber certainly impacts the spread ratio, which impacts if it is going to fit in your package. Texture also is an issue. Many times we use whole grains as a topping on the crackers or cookies to avoid these issues, but that makes it difficult to make the weight claim for a whole grain product. We can make whole grain muffins without too much of a challenge. It can be a benefit to have the increased viscosity because we are trying to retain gas by the viscosity of the batter to give us the cell structure. Noodles are
another sheeted product and we run into a lot of color issues with noodles.
Remember that we want to offer the consumer a wide variety of these health products that have a desired impact. But we have to remember, only the foods that are going to be eaten will have any functionality. And the foods that consumers do not choose or leave in their cupboards forever are not doing anybody any good. So the processing has to be optimized technically and nutritionally, so that we make products acceptable to consumers, which will make bakers interested in making them.
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Unique Beneficial and Processing Properties of Grains Oats, barley, corn, and rye each possess unique properties in terms of processing and benefits.
With oats, there are several implications to over- and under-processing. All common forms of oats — steal-cut groats, flakes, and oat flour — are nutritionally equivalent. Protein tends to be higher in oats than most other common grains. Oats also contain important components, including beta glucans and antioxidants.
Historically, corn has not played a large role in processing for food uses. Two-thirds of the corn in the United States is used in the production of meat, with another 15 percent of corn used in food. Corn probably has been the most prominent grain in the news in terms of genetic enhancement.
Barley, which has been around in the human diet for at least 8,000 years, is a rich source of antioxidants, vitamins, fiber, protein, and other nutrients. However, a lot of those are lost in processing. Barley is probably the richest source of beta glucan in grains. Companies are working to bring the benefits of barley to consumers.
Oats — Presentation by Kent Salisbury, Director, Milling R&D, The Quaker Oats Company
In the food processing area, as in most industries, there are a lot of implications to over-processing and under-processing. This is certainly true in the milling field and oat milling in particular. The oat miller himself has to walk a very fine line between over-processing and under-processing.
The first major step in the oat milling process is cleaning; this is a very critical step. The idea is to separate the clean, whole oats from anything else that is in there. In the case of the cleaning step, if you over-process, then the result is you are losing good oats along with the contaminants. That obviously would have a negative yield impact to the mill. If you are under-processing in this area, you obviously have contaminants that are remaining with the oats and will have finished product quality implications.
The next major step is the hulling, which is simply the removal of the hull from the kernel, which we call a groat. It is an oat when it has the hull on it; it is a groat when you take the hull off of it. The hulling step is the process which separates those two components. The removal of the hull is accomplished by impact. Because the hulling operation is never 100 percent (we are pretty happy when we can get above 85 percent), it is necessary to send these groats, which still have a few oats mixed in with them, to length graders.
The next step is called thermal processing. This is the killing, drying, or conditioning, whatever term you want to use, but this is a critical step in the milling of oats. The clean groats are first passed through steamers where live steam is used to inactivate the enzymes. The ones we are most concerned about are those fat-splitting enzymes, such as lipase, peroxidase, and lipoxygenase. The steam is very effective at inactivating those enzymes without changing the character of the groats. There is very little, if any, gelatinization that occurs in that step.
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grading step that takes any of the uncut groats back to the cutters. The groats are then steamed a second time, which gives you another shot at the enzymes. This steamy step is really to soften and condition the groat so it will pass through the flaking rolls and provide a quality flake. The flakes then fall directly from the steamers through large, smooth flaking rolls. Following flaking, there is a screening step and a cooling step. When you have too high of a feed rate through the steaming and flaking process, the groats are not conditioned properly and you will get ragged looking
All common forms of oats, whether they are steel-cut groats, old-fashioned flakes, quick flakes, instant flakes, or if they have oat flour that is made from ground groats or ground flakes, are nutritionally equivalent.
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he oats then fall directly through what we all the kiln or the dryer, where the groats ass across steam-filled radiators while air s pulled through the grain at the same ime. This reduces the moisture and helps evelop the good, toasted-oat flavor that atmeal has. If you over-process in this rea, the thermal energy will accelerate the se of the antioxidants and have a definite ffect on shelf life. Under-processing n the kiln will leave active enzymes resent in the groats that can have some lavor implications later on. You will ot develop the characteristic desired at flavor that you want in the inished product.
he next major step is the cutting and laking. Our cleanest groat streams ormally bypass the cutting system, so hey are being processed as whole groats nd they are steamed and flaked. At that oint, they become “old-fashioned” lakes or long-cooking flakes. The roats that still have oats left in them are ent to the cutting plant. We use ow-capacity drum cutters to cut the roats into thirds. In the process of oing that, the oats that are still there ecome hulled and the hulls are emoved. The process for cutting ncludes a screening step to take any ines out that are created and also a
flakes. If the feed rate through this part of the system is too low, you will have excess steaming of the cut groats and the small pieces can become gelatinized. When they go through the flaking roll, other flakes will stick to them, and you will have a collection of gelatinized masses.
What are some of the other challenges that oat millers face? The high incoming oat moisture is a problem in that it requires different kilning conditions. What that means is you have to slow everything down to get the proper temperature profile and the proper moisture after kilning.
There are some unique benefits of oats. The products from oat milling, as traditionally consumed, are whole grains. All common forms of oats, whether they are steel-cut groats, old-fashioned flakes, quick flakes, instant flakes, or if they have oat flour that is made from ground groats or ground flakes, are nutritionally equivalent. Protein tends to be higher in oats than in most of the other common grains. Protein is not something that is a big issue for us as processors or in the marketing of our products.
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The fat content of the rolled oat product is generally higher than other common whole grains. It is in the area of 7 percent to 8 percent, but it is high in unsaturated fats. Oats are an excellent source of beta glucan, a soluble fiber; obviously, much is known about this. It is concentrated in the alurone layer, but it also is contained in the cell walls and in the endosperm. So, in a way, it is throughout the whole groat kernel. Antioxidants, soluble forms of phenolic antioxidants, have been extracted from the alurone layer of groats. Also, two of the three major categories are found only in oat products.
No discussion of oat milling or oats would be complete without talking about oat bran. Oat bran is not a whole grain and it is not all bran. Several years ago, the American Association of Cereal Chemists created the Oat Products Subcommittee. The initial task this group completed was to develop a definition for oat bran. Based on this definition, oat bran can be up to 50 percent of the groat. And you compare that to wheat bran, for example, which is mostly all bran that is about 12 percent to 16 percent of the whole kernel. The subcommittee’s definition was adopted by the FDA when the regulations regarding health claims were issued. Oat bran can be up to 50 percent of the groat but, more importantly, it has to provide at least 5 percent beta glucan and 16 percent total dietary fiber. Both of these are on a moisture-free basis.
What the millers are looking for in new varieties, most importantly, is superior yields for the farmers. This has traditionally been the focus of oat breeders for many, many years. The new varieties have to be better than what is out there currently and they have to be tailored for the areas in which they are
going to be planted. If you are going to plant oats, for example, in areas that are subjected to rust disease, they have to have rust protection in them. Secondly, they need to provide superior yields for the processors. And third, they are looking for composition that meets the required FDA definitions that processors or companies need to support the health-related claims. The oats have to meet these requirements, no matter where they come from. Even if we end up buying oats from overseas, they have to provide this level of nutritional composition or we really cannot use them in our products because of the requirements of the health claim.
Corn — Presentation by Warren Formo, Program Manager, Minnesota Corn Growers Association
Historically, corn has not played a huge role in processing for food uses. While that has been an obstacle, it also has presented some interesting opportunities for us as an industry. Right now, if you go in a grocery store, the corn industry is well represented at the meat counter. Two-thirds of the corn in this country is used in the production of meat, so that has been a large focus of the industry. The production of food uses less than 15 percent of the corn grown in this country. Of that 15 percent, well over half of it is used in nutritive sweeteners in liquid form or in alcoholic beverages. Up to this point, the processing of corn for foods has not received a lot of attention. So, I was very interested to address the potential that exists for using corn in whole grain foods.
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There are many different types of corn raised on farms across the country. While the vast majority is your typical No. 2 yellow corn, there also are white corns, blue corns, and black corns that are used almost exclusively in the production of processed foods — corn chips, cereals, those types of things. The industry is growing, so there is potential for corn to play a more prominent role. The No. 2 yellow corn that is used in foods is primarily in the meat industry and in the liquid sweetener and beverage industry.
One of our thrusts has been to close the gap that exists between the farmer and the consumer. Corn has probably been the most prominent grain in the news in terms of genetic enhancement. While we certainly embrace biotechnology and the genetic enhancement it offers, some of the events that have occurred up to this point have been unfortunate. Also, all of the advancements to date have been agronomic and have not benefited the farmer to a great degree because, while they have increased productivity and in some ways lowered their costs, they also have increased the general corn supply and lowered its price. But, we do see several genetic enhancements that can have impacts on the value of corn. Some of those include increased nutritional value. Through certain genetic packages, we can almost double the protein content of corn. Currently, corn ranges from about 6 percent to 12 percent protein. We are working on ways to maximize that 12 percent range, and then push it up into the 13 percent to 14 percent range. We are doing that through a combination of genetics and management. Within current farming practices, we can increase the protein simply by how we manage the corn and it is primarily the nutrients that are applied to those plants. More accurate placement of nutrients protects ground
water and reduces erosion and also contributes to higher quality grain. We have just launched a massive study on how the farmer can influence grain quality with his management practices, and we expect within the next three or four years to have information we can use as we try to target more of the corn into the food industry.
Another interesting thing we are working on is taking the whole kernel, processing it, and using different parts in different ways. In Minnesota, about 20 percent of corn currently is being
used in processing for ethanol for fuel, which needs the starch from the corn kernel. For the past 20 years, the manufacturers, as they process the corn, have ground it finely, run it through a jet cooker, then ferment the entire corn kernel to make fuel ethanol. We are finding that we can separate the corn ahead of that process, so basically all we are doing is taking out the starch and the fats, they go into the fermentation process for fuel ethanol, and we are left with a very high-protein, high-fiber food product. We see a great potential use for this product.
In the future, we are going to need to use corn in different ways. That also allows us to look differently at how we are processing corn. We are trying to find out through consumer awareness surveys what the ideal product would be. Would
In the future, we are going to need to use corn in different ways. That also allows us to look differently at how we are processing corn.
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it be higher protein? Would it be higher fiber? Would it have different vitamin profiles? We are trying to find out through genetics and through processing what the possibilities are. At each step of the processing, we remove something else and magnify the concentration of what is left. For example, in the ethanol processing plant scenario, the dried distiller’s grains with solubles that are left are a modified corn product where all the minerals and vitamins end up. And so, it is something that has a tremendous amount of potential.
Corn growers began recognizing about two or three years ago that there was such a wide distance between the farmer and the consumer. We felt it was important to begin to understand how we could, without bypassing processors, work together to deliver a better product. With that in mind, we have begun to host consumer groups together with producer groups to find out their interests. Food safety is a big one, because corn is typically grown as a large volume, bulk commodity, harvested in large amounts, delivered to the local grain elevators, and trucked to millers and food processors. Historically, what happened to that corn down the road was not real high on the producer’s mind. We are starting to see a lot more direct delivery and contracting. In fact, the vast majority of the food uses of corn are contracted before the corn is ever planted. The end user knows where it is going to be grown and how it is going to be harvested and transported, in an attempt to minimize contamination risks. That is a way we are trying to close some of those gaps and make it a little bit more efficient and a better product to the consumer.
Barley — Presentation by Tom Jorgens, President, PolyCell Technologies
Our focus at PolyCell is on developing bioactive solutions for human and animal nutrition and health. As part of that focus, we have been working with several international partners to develop leading-edge methods to extract and apply selective bioactive components of barley for a range of nutrition and health uses. The products we are working with are a beta glucan isolate that is in the 75 percent range, a high beta glucan concentrate (23 percent), a barley/bran concentrate, and a waxy starch concentrate. The processing methods used, to the extent possible, try to retain the whole grain attribute, and we think allow many opportunities for blending some of those features into desired results in processed foods.
Barley has been around as a part of the human diet for at least 8,000 years. Traditionally, it has been a major bread and cereal grain. It was the primary fuel for the Roman army, but is best known today as the source of the malt used in making beer. Current U.S. food consumption is slightly more than one pound per capita and is increasing at a modest rate, probably in relationship to the effort to get whole grains as a greater part of the diet. The grain is a very rich source of antioxidants, vitamins, fiber, protein, and other nutrients. However, we lose some of those along the way in processing.
If you are looking for the nutritional values, varieties make a big difference. On one hand, we have the malting barley varieties that the breeders have worked on over the years to lower the level of beta glucan, for example, because the brewers do not want it in their process.
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The same is true for barley as a feed source around the world, since animal nutritionists seek to reduce non-digestible components, like beta glucan, that do not provide energy for the animals. In a sense, efforts to expand human food applications are sort of “going against the grain.” Often, they depend on specialized varieties that have enhanced combinations of beta glucan, tocopherols, tocotrienols, and other traits useful in food and nutrition. Fortunately, a number of plant breeding centers around the world are making substantial progress on improving these desired outcomes in their varieties.
The key bioactive component of interest in barley is beta glucan. It is found in some varieties in high concentrations, which provide the richest source among the cereal grains. The bran fraction also is rich in tocopherols and tocotrienols and insoluble fiber. Barley also can be a good source of waxy starch and phenolic acids.
In terms of health effects, there are several dozen studies that have been conducted around the world with barley beta glucans. They have been consistently shown to be effective in LDL cholesterol reduction, typically showing a decrease of 7 percent to 13 percent. In terms of blood glucose modulation, clinical studies have shown barley beta glucan slows the rate of carbohydrate digestion and glucose absorption, helping to modulate blood sugar levels. There also is evidence of an immune effect that actually has several modes of action. This is an emerging area of science. New studies also are showing barley beta glucans stimulate immune function both directly in the bloodstream and in topical applications, and by increasing short-chain fatty acid production through
fermentation in the colon. They are a significant source of antioxidant activity and provide a satiety effect that can contribute to weight loss.
Over 30 clinical studies have been conducted on various aspects of barley beta glucan efficacy, with more currently in process. There is a important study going on right now by the USDA ARS Human Nutrition Labs, with the support of the National Barley Foods Council. The study includes a trial of 24 male subjects using a 3-gram and a 6-gram barley beta glucan dosage, focusing on cholesterol and other parameters. They have recently completed the feeding part of that trial and are analyzing it. They are working on an effort to establish a barley health claim comparable to the oat health claim.
Polycell has been involved in some studies of the beta glucan isolate, which is known as Glucagel™. A trial was conducted at the Auckland Medical School in New Zealand, which showed a reduction of 9 percent in a group (males of 35 and older) at risk for Cardiovascular Disease (CVD). We have a trial that is about to get underway at the University of Minnesota that will look at cholesterol, glycemic response, and immune aspects. And, there is a trial in progress in Canterbury, New Zealand, that is assessing cholesterol and body mass effects in a CVD at-risk population.
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Beta glucan is a functional food ingredient from the food technology side. It is a soluble fiber, so it goes readily into solution. It is a strong hydrocolloid that absorbs about 20 times its volume in water. The material is a bland, light-beige powder that is quite neutral in flavor. It functions as a fat replacer for such things as dairy foods. The barley beta glucans readily form soft, thermo-reversible gels, and they retain their functionality under most common food processing conditions that we have seen in our experiments.
We are in the process of bringing the benefits of barley to the consumer. The Glucagel is being developed under a joint venture for functional food, nutraceuticals, cosmetics, and health care uses and is now beginning commercial production. PolyCell is working with a Canadian company to produce and distribute a barley beta glucan concentrate, a bran fraction, and a waxy starch that is not on the market. We have several research links in terms of applications, as well as basic technology development. There also are several other people around the world who are working on various aspects of the application of barley and to try to get that consumption level of barley above a pound per capita.
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Plenary Session — Learning From the 5 A Day Model The 5 A Day for Better Health Coalition serves as a foundation for illustrating how and why to build a coalition, then manage that coalition once it is created. Coalitions require a great deal of effort and support — from potential members and similar credible organizations. If development of a coalition is appropriate for a specific situation, the maintenance of that coalition is key. Clear and timely messages, supported by facts and enthusiastic coalition members, are key to reaching consumers.
Presentation by Fran Doring, M.P.H., R.D., Minnesota Department of Health, Minnesota 5 A Day Coalition
The 5 A Day for Better Health Coalition has been alive and well since 1991. If we are going to build a grains coalition, we need to talk about what is a coalition, why we build a coalition, and do you really need a coalition. Then, we need to go about building, caring for, and feeding that coalition.
What is a coalition? According to the American Heritage College Dictionary, it is an alliance or a close association of groups formed to advance a common interest. Why do we want to build a coalition? No. 1: there is strength in numbers. We may want to advance a goal, gather talent and expertise to help disperse our message, and provide a broad base of information to lend credibility to our efforts.
Should you form a coalition? If your answer is yes, it is important to remember the job is too big for one organization to take on alone. The base of support for the message needs to be broad. Other organizations that have a similar message
or goal need to join. You need to have the staff to support your efforts. And, your organizations and others involved need to be able to lend credibility to the efforts. If your answer is no, it is because the job is small, the base of support is narrow, and you are the only one with the message.
Coalitions require a great deal of effort. To build a coalition, you need to ask the following questions: • Who has similar goals and
messages? Can you go to other organizations like your own? Can you go to non-profit organizations?
• Are these credible groups? • How big should your group be? It
must be big enough to do the work, but not so big that it is unwieldy.
• Will the members be able to work together or do you have people with diametrically opposed viewpoints on the same issue?
• What about individual vested interests? Are there any conflicts?
• Can you support the coalition with clerical support, meeting locations, and so forth?
• Can you address the “What’s in it for me?” perspective from coalition members?
Once you form a coalition, it is extremely important to address the “care and feeding” of that coalition. You need to start out with a clear and timely message. With the 5 A Day for Better Health Coalition, that message was very clear, to the nutritionists at least — we wanted people to eat five servings of fruits and vegetables every day. I have a lot of people who are non-nutrition types who have told me, “You cannot possibly eat five servings of fruits and vegetables a day. It is impossible.” And I said, “But what is your idea of a serving?” Some of them think if they have a huge chef salad that is one serving. Not true.
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The key is in the portion sizes. A cup of leafy greens is a serving; a chef salad could be two to three servings. So there is still a lot of confusion even around a basically simple message.
You need to back your coalition’s message with facts. You need to spread out the work with small working groups and you need to be prepared to support the work being done. This can be fairly time consuming. You need clerical support, meeting rooms, time, phone support, and mailings. In the case of 5 A Day, there is no extra funding for this. It is all done with existing staff. This means burnout can happen, so you may need to rotate members in and out of the coalition as needed. One of the things we have found in most of our meetings is “feed them and they will come.”
Overall, the message needs to be positive, possible, and timely. The coalition members need to take ownership in the message and the process. And, the coalition leadership needs to provide sufficient support for the activities of the coalition. It is especially true when we deal with 87 county health agencies. They need to have ownership of this in order to buy in. As my boss says, “Your next step, once you have decided you are going to form your coalition, is to go forth and do good works.”
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CALL TO ACTION: WAYS TO INCREASE GRAINS AND WHOLE GRAINS AWARENESS AND CONSUMPTION
To conclude the conference, symposium participants and speakers were asked to divide into industry segments to discuss ways the industry could work together to increase grains and whole grains awareness and consumption. Many in the grains industry agree that grains and whole grains data are in the same place the 5 A Day data were when that nutrition outreach effort began.
The “Grains for the Health of It” conference brought together a group of people who do not necessarily meet with one another; so in some ways, we have formed the first stages of a coalition. The objective of the breakout groups was to determine the next steps in terms of developing a coalition to support these efforts.
Questions for the breakout groups included: • How is a coalition the best way to
encourage increased grains/whole grains consumption?
• How can you, in your job, be part of this effort?
• What are the barriers to your industry or your phase of the industry to being part of this?
• What should the message be? • Do we need more focus groups and
research about what the message should be?
• How do we package the data and move that information from the laboratory to the consumer?
• How do we change behavior? • Where do we go from here?
Breakout Group Responses Industry — Education, Marketing, Advertising, and Labeling • Put consumers first and spend time
and money digging deeper into consumer understanding about whole grains, healthful eating, etc. Do not elevate whole grains at the expense of enriched grains, which many consumers enjoy.
• Develop some sort of whole grain exchange (similar to the diabetic exchange), so the industry could define a standard serving, including a possible nutrient content claim for whole grains.
• Educate consumers, as well as health professionals and millers, about the health benefits of whole grains, giving them a compelling reason to choose whole grains, before the industry starts talking about how to identify a whole grain food.
Industry — Ideation for Taste, Quality, and Convenience • Put the definition for whole grains into
consumer language; the issue then becomes whether you can say something is a whole grain if you cannot make the health claim. (For instance, should a product high in fat or sugar content still be called a whole grain product, not as a health claim issue but in terms of advertising and education?).
• Make whole grains fun, especially if you are trying to encourage consumption among kids.
• Consider increasing consumer consumption and interest in whole grains by trying incremental increases in whole grain percentages in products.
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• Educate consumers to expand the grains category to include under-recognized grains and more non-traditional products.
Extension Agents, Dietitians, and Consumers • Develop consistent training
regarding what is a whole grain, incorporating the portion-size message.
• Focus on early intervention as the most effective way to reach consumers, also using child connections with parents as an opportunity to convey an attached message and use parents as models.
• Do more consumer research regarding “Three Are Key,” because none has been done to date, and consider not using a number because it immediately sends the consumer into a paroxysm of calculating.
Academicians and Researchers • Recognize that definition is
important, noting the AACC-approved definition is understandable to food scientists but uninterpretable to consumers, whose awareness is critical.
• Understand that in research areas, quantitation of health food and whole grain intake is very problematic because the questions that exist do not capture that food group; there are no biomarkers available for it.
• Consider convincing the industry, rather than telling people they need to eat “X” servings of whole grains a day. The industry could develop a product that would depend on a higher extraction rate for flour.
• Move forward with a “Three Are Key” coalition before the science is definitive because of time concerns; also, we need to defend all types of grains placed at the base of the Food Guide Pyramid.
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SPEAKER BIOGRAPHIES Mary Begalle, Director of Food and Nutrition Services, Minnesota Department of Children, Families & Learning. Mary Begalle oversees the administration of the National School Lunch Program, the National School Breakfast Program, the Child and Adult Care Food Program, the Summer Food Service Program, and the Food Distribution Program in Minnesota. The annual budget for Food and Nutrition Service is $175 million. Prior to joining the department, she was a school foodservice director for 14 years, having worked most recently for Independent School District 196 in Rosemount-Apple Valley-Eagan, Minnesota. She is an active member of the Minnesota School Food Service Association. Susan T. Borra, R.D., Senior Vice President and Director of Nutrition, International Food Information Council. Susan Borra is senior vice president and director of nutrition at the International Food Information Council (IFIC) in Washington, D.C., a nonprofit organization that communicates sound, science-based information on nutrition and food safety to health professionals, educators, government officials, media, and consumers. She currently serves as president of the American Dietetic Association (ADA) and is a past chairman of the ADA Foundation. She has served as secretary/treasurer of the ADA Board of Directors. She has a bachelor’s degree in nutrition and dietetics from the University of Maryland and is a registered dietitian. Sharon P. Davis, Consumer Education Consultant. Sharon has a Bachelor of Science degree in family and consumer sciences education, Iowa State University, and is currently a consumer education consultant (1993 to present). Clients include: Hershey Foods, Home Baking Association/Wheat Foods Council, Kansas Wheat Commission, Nebraska and Ohio Soybean Boards, and West Virginia Child Nutrition Services. Spokesperson services include consumer and professional education sessions for child and adult food programs, and media resource person. She has conducted over 400 education seminars provided for international, national, regional, state, and local audiences. Warren Formo, Program Manager, Minnesota Corn Growers Association. Warren Formo is the program manager for the Minnesota Corn Growers Association (MCGA). Warren studied Agricultural Economics at the University of Minnesota before joining his family in a farm corporation in which he was active until 1999. He also served on the MCGA board of directors from 1995 through 1999, where he first became involved in agricultural issues. In his current role with the MCGA, he is responsible for evaluating policy, legislation, and regulatory issues.
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Gary Fulcher, Ph.D., Professor, University of Minnesota. R. Gary Fulcher, Ph.D., is a professor and chair of Cereal Chemistry and Technology at the University of Minnesota (1989 to present). He has an M.Sc. degree in biology from Carleton University, Ottawa, Canada, and a Ph.D. degree in botany from Monash University, Melbourne, Australia. Prior to his position at the University of Minnesota, he served as research coordinator, Grains and Oilseeds and as senior research scientist at Agriculture Canada, Ottawa, Canada (1984-1989). David Jacobs, Ph.D., Professor, School of Public Health, Division of Epidemiology, University of Minnesota. David Jacobs is a biostatistician and cardiovascular epidemiologist. He is co-principal investigator of CARDIA, a national longitudinal study of the evolution of cardiovascular risk in young adults. He directs studies of whole grain intake and the occurrence of chronic diseases. He has been a statistical analyst or co-investigator in experiments involving the interrelationships of drugs, diet, and exercise. He also has worked with studies of cancer and infectious disease outcomes and with drug and behavioral intervention studies. Gary L. Jensen, Senior Vice President, Marketing, Sara Lee Bakery Division. Gary Jensen is responsible for marketing all of Earthgrains’ domestic bakery products. In this role he manages a variety of related functions, including market research, brand management, new product development, promotions, marketing services, and public relations on branded products. He began his career at Earthgrains in 1986 as a group marketing manager. He also has served as vice president, Sales & Marketing, of the Diversified Group; senior vice president, Sales, Western Region; and senior vice president, National Accounts. He earned a B.S. degree in business administration at the University of Texas, Dallas. Earthgrains was purchased by Sara Lee in 2001. Julie Miller Jones, Ph.D., L.N., C.N.S., Professor, College of St. Catherine. Julie Jones, a board-certified and licensed nutritionist, received her B.S. degree from Iowa State University and her Ph.D. in home economics/food science and nutrition from the University of Minnesota. Currently, she is professor of nutrition in the Department of Family, Consumer and Nutritional Sciences at the College of St. Catherine in St. Paul. She has twice been named St. Catherine’s outstanding professor and has been named by the alumnae as a professor who made a difference in people’s lives. She holds the 3M Endowed Chair in Science from 2000 to 2003. Tom Jorgens, CEO, PolyCell Technologies. Tom Jorgens is CEO of PolyCell Technologies, a bioscience technology company developing innovations for human and animal health and nutrition. His business focus is on identification and development of proprietary technologies to extract and apply bioactive compounds in functional foods, nutraceuticals, and pharmaceutical markets. He is leading company efforts to forge technical and business alliances on production and marketing of beta glucans and other components of barley grain that are known to convey health benefits.
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Cathy Kapica, Ph.D., R.D., L.D., F.A.C.N., Director, Nutrition Education, Quaker Oats Company. Cathy Kapica is director-nutrition education for The Quaker Oats Company. She assumed this role in September 1999. Before joining Quaker, she was on faculty at Finch University of Health Sciences/The Chicago Medical School in North Chicago. She is a registered dietitian, a fellow of the American College of Nutrition, and is certified in family and consumer science. She attended Loyola University where she earned a B.S. degree in biology. She graduated with a Master of Science degree in clinical nutrition from Rush University and a Doctor of Philosophy degree in public health sciences from the University of Illinois. David Klurfeld, Ph.D., Professor and Chair, Department of Nutrition and Food Science, Wayne State University. David Klurfeld received M.S. and Ph.D. degrees in pathology from the Medical College of Virginia in Richmond, Va. He was employed as a research associate and assistant professor from 1979-1986 at The Wistar Institute in Philadelphia and from 1989-1992 as an associate professor of nutrition in Surgery, University of Pennsylvania School of Medicine. Since 1992, he has been employed as professor and chairman, Department of Nutrition & Food Science, Wayne State University, Detroit. Publications include more than 140 diet and chronic diseases. David Kritchevsky, Ph.D., Wistar Institute. David Kritchevsky is a professor and a Caspar Wistar Scholar at the Wistar Institute in Philadelphia and a professor of biochemistry in the School of Veterinary Medicine of the University of Pennsylvania. He received his B.S. and M.S. degrees in chemistry from the University of Chicago and Ph.D. in chemistry from Northwestern University. After post doctorates in Zurich, Switzerland, and Berkeley, Calif., he spent five years in the industry before joining the Wistar Institute in 1957. He is past president of the AIN and the Society of Experimental Biology and Medicine. He is an internationally recognized expert on cancer, atherosclerosis, and cholesterol metabolism. He wrote the first book on cholesterol (1958) and co-authored the first book on sitosterol (1981). He has authored or co-authored more than 400 research papers, numerous book chapters, and abstracts. He serves as consulting editor for Atherosclerosis and is a member of a number of editorial boards, including Lipids. Among other prestigious awards, he has received the Supelco-ACOS Research Award; the Auenbrugger Medal, University of Graz, Austria; and the Borden Award from the AIN. Leslie Lytle, Ph.D., R.D., Professor, School of Public Health University of Minnesota. Leslie Lytle received an undergraduate degree in medical dietetics from Penn State University, a master’s degree in education with an emphasis in nutrition from Purdue University, and her doctorate in health behavior and health education from the University of Michigan. She is a professor in the Division of Epidemiology in the School of Public Health at the University of Minnesota. She does research in developing and evaluating theory-based interventions to promote health behaviors in children and adolescents.
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Len Marquart, Ph.D., Sr. Scientist, Bell Institute of Health and Nutrition, General Mills. Len Marquart is a senior scientist with the Bell Institute of Health and Nutrition at General Mills. He, along with his colleagues, was instrumental in securing the first authoritative health claim for whole grains, coronary heart disease, and cancer. He has collaborated extensively with academic researchers to examine the role of whole grain intake on risk for heart disease, cancer, and diabetes. He is a graduate of Syracuse University and the University of North Carolina. Gene Miller, Ph.D., Principal Scientist, James Ford Bell Technical Center General Mills, Inc. Gene Miller has academic degrees in organic chemistry and biochemistry. He has been employed by General Mills in the research area for 32 years. Currently, he works in the breakfast cereal division and conducts research in the areas of antioxidant analysis in cereals and other foods; breakfast cereals and lipid oxidation; breakfast cereals, vitamins, and minerals; and in the past, breakfast cereals and dental caries. Marla Reicks, Ph.D., R.D., Associate Professor and Extension Nutritionist, University of Minnesota. Marla Reicks has an M.S. and Ph.D. degree in nutrition from Iowa State University. She has been a registered dietitian for 25 years and has been on the faculty in the Department of Food Science and Nutrition and an Extension Nutritionist for the University of Minnesota extension service for the past 11 years. Her research and extension program interests include using behavior change theories to influence fruit, vegetable, and grains consumption in low-income minority populations, school meal, and weight control programs. Debi Rogers, Ph.D., Director, Cereal Chemistry (Education), American Institute of Baking. Deborah E. (Debi) Rogers received her degree from Kansas State University (M.B.A. in business and Ph.D. in cereal science). She is currently the director, Cereal Chemistry (Education), American Institute of Baking and an adjunct assistant professor at Kansas State University. Industry-extension activities include numerous presentations at American Institute of Baking seminars and short courses, and consulting to a variety of companies. Research interests are starch chemistry, cereal protein chemistry, and dough rheology. Kent Salisbury, Milling Expert, Quaker Oats Co. Kent Salisbury is director of milling, R&D, for the Quaker Oats Company at their Barrington, Ill., Research Laboratory. He has 39 years of R&D experience with Quaker Oats, focusing on oat and corn milling research and the utilization of cereal grains in the development of hot cereals, RTE cereals, mixes, and corn goods. He received a degree in grain science from Kansas State University and began his career with Quaker following graduation. He is a member of the American Association of Cereal Chemists, serving on the Dietary Fiber Committee and as a charter member of the Oat Products Committee.
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Joanne Slavin, Ph.D., R.D., Professor, University of Minnesota. Joanne Slavin is a registered dietitian and received a Ph.D., in nutritional sciences at the University of Wisconsin-Madison. Since 1981, she has been a professor of nutrition at the University of Minnesota in St. Paul. She is a frequent source for the media on topics ranging from sports nutrition, diet and cancer, carbohydrates and dietary fiber, and women’s health. She teaches courses in human nutrition, sports nutrition, and diet and disease at the University of Minnesota. She has presented more than 250 invited scientific lectures on topics ranging from sports nutrition to diet and cancer. Her research has generated more than $5 million dollars in competitive research grants from the National Cancer Institute, the U.S. Department of Agriculture, commodity groups, and corporations. She is the author of more than 100 scientific publications and numerous book chapters and review articles. Jean Storlie, M.S., R.D., Manager, Nutrition and Health Communications, Bell Institute of Health and Nutrition, General Mills. Jean Storlie is a registered dietitian with an M.S. degree in adult fitness/cardiac rehabilitation from the University of Wisconsin-LaCrosse and a B.S. degree in community-medical dietetics from Viterbo College in LaCrosse. She spent the first 12 years of her career working in the areas of wellness, fitness, and health promotion, spearheading a number of lifestyle change programs. Joe Warthesen, Ph.D., Professor and Head, Department of Food Science and Nutrition, University of Minnesota. Joe Warthesen received his M.S. in food science from the University of Minnesota and Ph.D. in food science from Oregon State University. He has been on the faculty at the University of Minnesota since 1974. He has served as director of the Minnesota-South Dakota Dairy Foods Research Center since1987 and has been department head since 1998. His research interests are in the area of food chemistry and involve the use of HPLC methods to determine the degradation and formation of food chemicals during processing, storage, and preparation. Kathy Wiemer, Senior Manager, Bell Institute of Health and Nutrition, General Mills. Kathy Wiemer has been employed at General Mills for 23 years and is currently senior manager in the Bell Institute of Health and Nutrition. In her current position, she is responsible for ensuring that General Mills’ products comply with existing government and corporate nutrition regulations and policies. She leads the development of corporate positions and comments to government regulatory agencies on nutrition issues and serves as a liaison with these agencies, trade associations, and health professional organizations in the area of nutrition. Kathy currently serves on the American Heart Association’s Industry Nutrition Advisory Panel (INAP), the Executive Council of the Institute of Food Technologist’s (IFT) Nutrition Division, and the Board of Directors of the Wheat Foods Council. She serves on several technical committees of the International Life Sciences Institute (ILSI) and the International Food Information Council (IFIC). Kathy is a Licensed and Registered Dietitian and a member of the American Dietetic Association (ADA), the Dietitians in Business and Communications practice group of the ADA, and the Minnesota Dietetic Association.
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PROGRAM SPONSORS The “Grains for the Health of It” conference was brought to you by the University of Minnesota and the Wheat Foods Council. Additional sponsors include: Platinum Sponsors • General Mills Silver Sponsors • Quaker Oats Bronze Sponsors • American Bakers Association • Cargill • ConAgra • Sara Lee Bakery Division • Hodgson Mills • Kellogg • National Barley Foods Council • Kansas Wheat Commission • North American Millers’ Association Endorser • American Association of Cereal Chemists
