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Dear Laura,

I read your letter and am here to help.  With all the recent hype about Wheat Belly and gluten-free diets, it is hard not to think there must be real science supporting the trend.

Wheat’s biggest foe for the last two years has, without a doubt, been Dr. William Davis, cardiologist and author of the book Wheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health.

What’s so wrong with wheat, anyway?  We all recognize that the Mediterranean countries have successfully been eating wheat as part of a healthy, balanced diet for centuries.  I thought it was worthwhile to put Wheat Belly to the test and take a closer look at the claims in the book.

Wheat Belly – The Good

Wheat Belly does contain some interesting and accurate scientific information.

WheatBellyTruths

  • We’re a carb nation – Most Americans (probably myself included) eat far too many carbohydrates, including wheat, and don’t come close to eating enough fruits and vegetables.  When I ask my obese patients to take me through their daily diets, most eat 1-2 servings of fruits or vegetables a day, which is far less than the recommended 5-13 servings.  If you’re eating a 2000 calorie diet, you need 9 servings (about 4 ½ cups) of fruits and veggies a day. And no, ketchup does not count as a vegetable.
  • We eat too much – As the book points out, too many calories and carbs contribute to obesity, diabetes and high cholesterol – all of which contribute to the #1 cause of death in women (and men, for that matter) – heart disease (see here).  So it follows that cutting back on calorie-dense carbs will certainly lead to weight loss and improvements in cholesterol and blood glucose numbers.  Though this could also be done just by decreasing portions of all foods, not just carbs or wheat.
  • Celiac Disease is attributable to wheat – This is the one disease mentioned in the book that actually IS attributable to wheat but is rare (U.S. prevalence is 0.71%) (see here).  Most people do not have this condition, characterized by diarrhea and malabsorption, which can be diagnosed on a simple blood test.  Irritable bowel syndrome (IBS) and other GI woes are unlikely related to wheat, though there may be a non-celiac IBS-like condition that responds to a gluten-free diet (see here).  But before you decide to eliminate wheat, check with your doctor.

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Wheat Belly – The Bad and The Ugly

Dr. Davis makes numerous outrageous health claims about wheat in his book, and here is just a sampling:outrageouswb

The first two claims above are completely unfounded, and Dr. Davis takes huge leaps of logic to reach these conclusions.  Simply put, the science does not support those two particular arguments.

The other claims in the list above are all related to carrying excess body weight and cannot be attributed to wheat alone.  And here lies the major flaw of the book – it’s being overweight, not wheat, that is actually wreaking havoc on our bodies.

Let’s take inflammation as an example.  Dr. Davis points out visceral (belly) fat functions as an organ in the body – an inflamed organ that releases inflammatory cytokines into the bloodstream.  These cytokines are cell signaling molecules that invoke a number of responses.  For starters, they worsen arthritis and add to pancreatic injury that is already occurring in diabetics and pre-diabetics.

magic inflammationThere are many more examples of this sort of logic in Wheat Belly.  But the bottom line is, wheat ≠ inflammation ≠ obesity ≠ the root of all evil.

My most recent patient success story actually didn’t have anything to do with wheat.  I have a patient who was drinking 130 ounces of Dr. Pepper a day. That’s 1625 calories per day of liquid love handles!  Not surprisingly, when he cut that out and stopped eating fast food, he lost 13 pounds in two months.  And even with this relatively small absolute weight loss, his cholesterol improved and his pre-diabetes vanished.

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The Whole Story about Whole Grains

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Unfortunately, Dr. Davis leaves out an important part of wheat’s story – the proven health benefits of whole grain wheat and other whole grains.

Consuming whole grains has been associated with:

  • Lower cholesterol
  • Decreased risk for diabetes
  • Lower risk of heart disease and all-cause mortality

Why are whole grains (including wheat) superior to refined grains?  It most likely has to do with glycemic index, the rate at which blood sugar rises after eating certain foods.  Whole grains still contain the bran and germ (fiber) that are removed in the grain refining process.  While refined grains – white flour, white rice – have a high glycemic index (rapidly spike blood sugar levels), whole grains are generally lower glycemic index.  A good rule of thumb – the more fiber in a food, the lower the glycemic index.  Spikes in blood sugar associated with ingestion of high glycemic index foods lead to metabolic syndrome – high cholesterol, insulin resistance, and obesity.  And the reverse is also true – eating lower glycemic index foods like whole grains, fruits, and vegetables lowers this risk of these conditions (see here).

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Sources:

http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/health-gains-from-whole-grains/

http://summaries.cochrane.org/CD006061/whole-grain-foods-for-the-prevention-of-type-2-diabetes-mellitus

Wheat Belly – Final Exam

In my book, there’s nothing wrong with incorporating whole wheat as part of a healthy diet.  In Dr. Davis’s book, on the other hand, there are plenty of anecdotes of miraculous “cures” for his patients who eliminate wheat from their diets.

I don’t doubt the Wheat Belly stories, just the reasons behind them.

So why might people feel better after eliminating wheat?

  • They lose weight – Restricting anything you are prone to overeat (Cheez-Itz, Oreos, pasta) will help you lose weight.
  • They get a higher proportion of their calories from protein – What’s left after you eliminate the bread from your lunchtime sub?  A salad with lean protein. This increase in the proportion of calories from protein leads to greater satiety.  Simply put, protein fills you up more than carbs.
  • They increase fiber intake – Because of their fiber and water content, fruits and vegetables also make you feel full, similar to protein.  For example, which do you think would fill you up more – four Oreo cookies -OR- five cups of romaine lettuce topped with a carrot, a tomato, and a cucumber with an apple on the side?  (They both have approximately 220 calories.)  Fiber also helps relieve constipation and IBS symptoms.

220 calories

Final Exam:

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Extra Credit

I would be remiss without mentioning another fashionable argument against wheat.  Yes, “Wheat contains antinutrients” seems to be quite the common catch phrase these days.

  • It’s true.  Wheat contains phytic acid, aka phytate, the storage form of a plant’s phosphorus.  As do all plants.  When something that contains pyhtate is eaten, phytic acid binds to certain minerals in the gastrointestinal tract, and too many bound minerals can lead to mineral deficiencies (severe mineral deficiencies could eventually result in osteoporosis or rickets).
  • By dry weight, nuts (particularly brazil nuts, almonds, and walnuts) generally contain more phytic acid than similar amounts of grains and legumes (see here).  Phytic acid is also present in coconut meat.
  • Research is constantly evolving regarding the healing compounds of plants.  Despite all the bad PR surrounding phytic acid, it may have some potential health benefits.  Phytochemicals have been known to exhibit potent antioxidant activity (see here).  Preliminary research also shows that it can stop growth of certain breast cancers (see here).

The anti-nutrient argument is an argument against excessive ingestion of wheat, legumes, or nuts, not an argument against these foods in absolute terms.  You will likely maintain a balance between high-phytate foods versus the nutrients affected by phytate if you are eating a wide variety of foods in your diet.

In fact, the risk that any adult in the U.S. would suffer severe manifestations of nutritional deficiencies is exceedingly rare.  In my eight years of interacting with patients, I have only seen one case of severe nutritional deficiency – we diagnosed a patient with scurvy (vitamin C deficiency) and later found out his diet consisted of only the meat portion of Salisbury steak TV dinners.

Above all, keep in mind that “wheat-free” is one in a long line of America’s fad diet obsessions.  And diets are only effective so long as you can maintain them your entire life.

A more sustainable approach is balance – a variety of fruits, vegetables, whole grains, and lean proteins.

Michael Pollan says it best: “Eat food.  Not too much.  Mostly plants.” … including whole grains.

Mary Sig

Sensible science complete

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Mary is a regular guest contributor to Good Not Perfect.  Mary grew up in Kansas City – raised by two science lovers – and met Laura and Emily during her stint as a Hoosier in college.  She currently lives in Denver with her husband and two daughters and works as a physician in internal medicine.  She aspires to be one of those women still running 10Ks in their 70s, and her bucket list includes visiting all 59 U.S. National Parks.

13 Comments on Examining Wheat Belly – Sensible Science

  1. Love this! Thanks, Mary for your objective and scientific review. I hope people will consider your logic with as much (or more) weight as they do all the anti-wheat nonsense!

  2. Thank you for your analysis. When my husband and I married 16 years ago he introduced me to whole grains. He had a wheat grinder and we made 100% whole wheat bread and whole wheat tortillas. We only eat whole wheat pasta and brown rice. My sister in law shared barley with me as well.
    It took a while to learn to cook these regularly but I did. My children rarely have anything but whole grains. I can say they are healthier (fewer colds, sniffles, “bugs”) than other kids their ages.
    I’m not saying that the occassional white bread doesn’t find it’s way into our home, but it is far and few.
    Whole grains are great. But I think people have become lazy because there are a few steps to properly preparing them.

  3. My first response to this is someone who doesn’t want to be wrong about something. I guess you’ve never asked someone who HAS done this. So here’s my two cents. I have been on every diet from counting calories, low fat, weight watchers, you name it. Now I’ve been doing this for six months – no grains and low carb. Before starting I had a lot of health problems. I had interstitial cystitis (IC), Irritable bowl (IBS), horrible acne, depression, anxiety to the point of panic attacks, incredible stress, mood swings, now energy, PMS was horrible (I even had hot flashes), and to top it all off I was morbidly obese. So first off, most of those diseases don’t just go away with weight loss, if they ever go away. Well I’m here to tell you that within five days IC and IBS went away entirely. Then all mental issues and PMS went away. Now I’ve also been able to, in 6 months, drop 65lbs. My husband has dropped two sizes and his stress and depression has vanished. I had an ADHD friend, who by no means needed to loose weight, had amazing improvements in his ADHD in tree days, that no pill could do. Also another FYI for the low fat dieters: the guy that pushed it was a vegetarian. Also do you have any clue to what GMO is? Did you know that they haven’t even tested the safety for GMO on health or even safety? Also, why is eating processed, unnatural foods and fats healthier than what a hunter gatherer ate? The people that support a low fat diet contradict themselves by saying people with diabetes should manage they’re carbohydrate intake, but should still eat quite a bit o carbohydrates. I’m sure you didn’t know this, your body actually needs cholesterol to function. It’s found in ever cell in your body. The only time LDL is even bad for you is when they become small LDL particles, which is caused by eating too many carbohydrates. I don’t have time to go into any further detail other than, do a little more research other than just bashing a book. Also have you even tried it? Give it five days and see if it doesn’t help. If you don’t notice anything, eat what you always have and see if you don’t feel worse.

    • I’m glad to hear you’ve made a positive step for your health, have lost weight, and are feeling great. Cutting back on carbs is definitely an effective way to do that. And as the piece discusses, adding more fruits and vegetables boosts your vitamin and antioxidant intake, and the fiber and water content keep you full as well.

  4. Mary, did you actually read the book?

    Because to take just one point, Dr Davis CLEARLY refers to several studies in the footnotes of the book:
    1)
    Dohan FC. Wheat “consumption” and hospital admissions for schizophrenia during WW2. A preliminary report. 1966 Jan;18(1)7-10

    2)
    Dohan FC. Coeliac doiseases and schizophrenia. BritMed 1973 July 7; 51-52

    3)
    Dohan FC. Hypothesis: Genes and neuroactive peptides from food as cause of schizophrenia. In:Costa and Trabucchi M eds: Advances in Biochemical Pharmacology, New York:Raven Press 1980. 535-48

    4)
    Vlissides DN, Venulet A, Jenner A. A DOUBLE-BLIND GLUTEN-FREE/GLUTENLOAD CONTROLLED TRIAL INA SECURE WARD. (capitalised for emphasis, mine) Br J Psych 1986 447-52.

    If all your research is this sloppy you’re going to mislead and make many people sick.

  5. Odd I have knocked off a lot of wheat products and Cholesterol and diabetes levels have gone into reverse. Tells me one hell of a lot and no I am not following the diet to the letter.

  6. Shanda and Jill have already pointed out much of what I wanted to say, but I’ll add my own story.
    I was about 35 – 45 lbs overweight for the last 25 years depending on the amount of exercise I was doing. Prior to 1990 I was a thin person, but when I hit age 30 or so I began, inexplicably, gaining weight. I simply attributed it to age, but it seemed to happen so suddenly. I have tried several different diets over the years, have been an avid runner even training for and running a half marathon in 2012. No matter how much running and watching my diet I did I couldn’t ever lose the extra weight. Even on a low carb diet (which included whole grains on a very limited basis) I could not lose the pounds. That is until the day I quit eating wheat ! Once I made that decision, I literally lost nearly a pound a day for over a month. I went from 209 to 176. My blood pressure, which had become a problem, dropped significantly. My joint pain in my knees, which I also attributed to age and running, completely went away. I can think more clearly and I’m not so sleepy at work during the day. I also have more energy and I’m far more satisfied between meals.
    You seriously need to rethink your entire argument against what Dr. Davis has to say because you are dead wrong. I have encountered too may stories like my own and even more extreme stories for this to be a coincidence.

  7. Mary,
    You must explain about GM wheat and science. That’s what wheat belly doc claims. You missed the point. He never against non GM wheat.
    You failed. Ha

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