The recent government announcement of an extension of a programme which gives children breakfast in school, sponsored by a dairy and a cereal company, throws up several issues and questions for me as a health researcher with a nutrition background. Not all of these issues are directly nutrition-related.
There is the issue of why we need to be doing this in the first place. Of course there are those whose budget constraints are such that just simply buying enough food is difficult, and there are wider socioeconomic issues to deal with here. But the fact is many of the children arriving at school are not always coming from the poorest of the poor families, suggesting it isn’t always a money thing. Indeed, a disturbing trend I have seen in the last decade, is an increasing number of people for whom food and healthy nutrition just isn’t important. Many of these people are also parents.
I have presented to a room of adults spanning Baby Boomers, Gen X, and Gen Y, proselytising for a return to the cooking of real food at home, only to have the youngest adults in the room – the Gen Y’s – stare at me blankly and look really nervous – because many (most) of them are not native to cooking from scratch, have never known butter or full-fat milk, and worst, a good percentage couldn’t name certain vegetables or boil an egg. I have also performed personal consults with people whose food and lifestyle habits are so poor, and they are so run down, that they literally do not become functional in any way, shape, or form, before lunchtime. If these very same people are parents, and combined with budget pressures, you can soon see how some children are packing themselves out the door in the morning without so much as even a bowl of cereal in their stomachs.
So the answer has had to become a government-sanctioned response to supply that bowl of cereal, on behalf of parents, at the school. A not insignificant step for the Government to take given their feelings toward the Nanny State; this is a government which, after all, threw out the idea of schools only being able to provide healthy food in the tuck shop because it was a Nanny State policy hangover from the previous government and impinged on an individual’s right to decide what they eat.
Whilst I support the intention of the Government and its partners, I have concerns regarding the application. Specifically, I take issue with the provision of a processed cereal from one of the partners involved, Sanitarium, and the long-term health implications of this. Now, right out of the blocks, I know that my stance here might invoke some criticism. I am, after all, about to make a case for why one of New Zealand’s staple breakfast foods is nothing more than junk food in drag. Many people will be challenged by this. Many people won’t believe it. And many people, even if they do believe it, will think it healthier for the children to have something than to starve each morning. I’ll answer this, in due course, by suggesting we are not without alternatives which allow us to achieve the same positive outcome without the health risk.
Under current New Zealand tax law, Sanitarium (and subsidiary companies), being wholly owned by the Seventh Day Adventist church, and registered as a religious charity organisation, pays no income tax on a significant annual turnover. It is allowed to do this as a company which purports to advance the religion it represents, which, according to Sanitarium’s CEO in a recent national television news interview, is achieved via the advancement of health. To this end, Sanitarium invests heavily in what it deems health foods (all in keeping with the largely vegetarian doctrines of the Seventh Day Adventist church), and in cafés and corporate health companies. Leaving aside the tax issue, it is the provision of what I would describe as an ill-health food, a wheat-based cereal, to this breakfast in schools programme, which I take the biggest issue with.
Wheat (and other cereal grains) is a ubiquitous substance in the Western diet. We consume it in its most obvious forms, such as breads and cereals (including Weetbix), and we consume it blindly where components of wheat are added to the ingredients of the likes of sauces, drinks, etc. It is the consummate example of a substance which we have believed, almost without question, to be an entirely healthful substance. I say “almost” because there is a body of evidence, which is growing slowly but surely, that calls into question this healthful premise.
A recent review does an excellent job of summarising the main concerns with wheat and its related substances . The focus is largely on how the consumption of wheat products can increase inflammation levels in the body, and how this chronic inflammatory response can be a key driver of many of the chronic diseases we are grappling with in our society.
Inflammation is the response of the immune system triggered by pathogens (such as bacteria or a virus), injury, or via noxious stimuli – things getting into our body that shouldn’t be there. When a trigger remains, or when immune cells are continuously activated (as they might well be when we are consuming something noxious as part of our regular diet), an inflammatory response may become self-sustainable and chronic. Chronic inflammation has been associated with many medical and psychiatric disorders, including cardiovascular disease, metabolic syndrome [obesity], cancer, autoimmune diseases, schizophrenia and depression.
Many factors can influence the extent to which we are predisposed to the effects of chronic inflammation, including genetic vulnerability, stress and poor dietary patterns. Of the dietary factors associated with inflammation, we know that there are issues with the amount of vegetable oils we are consuming (altering our omega6:omega3 ratio), and a high intake of added sugars. Less well appreciated is that other substances in our daily food, like those found in wheat and other cereal grains, are also capable of activating pro-inflammatory pathways.
To upset the delicate balance of our immune system, systemically, problematic food components need the ability to cross the defensive barrier formed by our gut, which, along with its digestive functions, is there to protect us from any substances which we may ingest and which may predispose us to harm if they were allowed to directly enter our system. The intestinal barrier allows the uptake of nutrients and protects from damage of harmful substances from the gut. When the barrier function is disrupted, there is an increased passage of dietary and microbial antigens interacting with cells of the immune system.
It is through this disruption of our gut barrier that we largely see the effects of grains such as wheat. Most people will be familiar with active disease states, such as coeliac disease, which preclude people from consuming wheat-based products containing gluten. Becoming more accepted is the non-coeliac disease state of gluten sensitivity, whereby people without coeliac disease still see a resolution of a large number symptoms (gut and non-gut related) through steering clear of the same wheat-based foods.
But what is only really just becoming apparent is that these same components in wheat can cause gut barrier dysfunction even in otherwise healthy subjects. Researchers are actively pursuing the theory that it is this repeated breaching of the gut barrier, and the subsequent inflammation which can, over time, see the development of health issues – most of which most people do not equate with anything to do with the gut (such as psychiatric issues, asthma, or cardiovascular disease).
According to this recent review, gliadin peptides (derived from gluten) initiate intestinal permeability thereby enabling gliadin and other dietary and microbial agents to cross into systemic circulation, which by interacting with the immune system give rise to inflammation. In this manner, a vicious cycle is created in which, as a consequence of the persistent presence of pro-inflammatory mediators, intestinal permeability will increase even further. The incursion into the systemic circulation of these agents have been observed in autoimmune and inflammatory diseases like coeliac disease, multiple sclerosis, asthma and inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, schizophrenia and certain types of cancer.
Gluten isn’t the only problematic substance at play here. Substances known as the lectins have also been shown to stimulate cells of the immune system and increase intestinal permeability. In wheat, the main lectin is a compound known as wheat germ agglutinin (WGA). Lectins are present in a variety of plants, especially in seeds, where they serve as defence mechanisms against other plants and fungi. Because of their ability to bind to virtually all cell types and cause damage to several organs, lectins are widely recognized as anti-nutrients within food. Most lectins are resistant to heat and the effects of digestive enzymes, and are able to bind to several tissues and organs.
WGA induces inflammatory responses by immune cells, and after ingestion, WGA is capable of crossing the intestinal barrier. This would suggest that wheat is able to perform a one-two punch to our gut integrity and immune function via gluten and WGA compounds. But is this really that significant in terms of health?
Most studies on whole grains would tend to suggest that they are beneficial to our health, at least in terms of cardiovascular disease risk. The problem here is that not all studies are equal in their ability to determine whether something is healthful or harmful. Observational studies are just that – observations. They do not actually perform any intervention to test whether something is causing harm or adding to health. Such observational studies are always full of confounding factors.
In such a Scandinavian study, the intake of whole grains was directly associated with the length of education, the intake of vegetables, fruits, dairy products, fish, shellfish, and inversely associated with smoking, BMI and the intake of white bread, alcohol, cakes and biscuits. In other words, if you are well-educated, eat a lot of vegetables and fruits, don’t smoke, maintain a normal weight, do not drink, and do not consume junk food, you were more likely to be the type of person who also consumed whole grain foods. But none of this tells us what is causing the healthful effects. Good quality studies attempt to control these confounding factors, but with the consequence that most of the associations are attenuated or become insignificant. That is, when you statistically correct for all the other variables at play, the purported benefits of whole grains disappear.
Then we have the issue of just what a whole grain is. Most of the research conducted on whole grains and cardiovascular disease benefit (largely funded by whole grain producers themselves) find only a weak benefit for whole grain oats and no other whole grain . Even one of the lead professors from the University of Sydney was recently forced to admit that we are being “hoodwinked” by the term “whole grains”, admitting that it is most likely the other lifestyle factors which go with someone who cares enough about their health to make them choose a whole grain product that is actually driving the health benefits we typically associate (and which whole grain producers like to market) with whole grain breads and cereals .
Studies which show benefits of whole grains over refined grains aren’t much better than studies which show smoking filtered cigarettes are better than smoking them without filters. That is if they find a benefit at all. Many readers would be surprised to know that they quite often fail to find any difference at all. From the recent review paper;
The substitution of whole grain (mainly based on milled wheat) for refined grains products in the daily diet of healthy moderately overweight adults for six weeks did not affect insulin sensitivity or markers of lipid peroxidation and inflammation. Consistent with these finding are the results of Brownlee et al., who showed that infrequent whole-grain consumers, when increasing whole grain consumption (including whole wheat products), responded with no improvements of the studied biomarkers of cardiovascular health, including insulin sensitivity, plasma lipid profile and markers of inflammation. The substitution of refined cereal grains and white bread with three portions of whole wheat food or one portion of whole wheat food combined with two servings of oats significantly decreased the systolic blood pressure and pulse pressure in middle-aged, healthy, overweight men and women, yet none of the interventions significantly affected systemic markers of inflammation.”
We have an increasing number of studies showing the efficacy of dietary practices which eschew all grains from the diet completely. One such dietary framework is the Paleo diet;
In healthy sedentary humans, the short-term consumption of a paleolithic type diet improved blood pressure and glucose tolerance, decreased insulin secretion, increased insulin sensitivity and improved lipid profiles. Glucose tolerance also improved in patients suffering from a combination of ischemic heart disease and either glucose intolerance or type 2 diabetes and who had been advised to follow a paleolithic diet. Control subjects who were advised to follow a Mediterranean-like diet based on whole grains, low-fat dairy products, fish, fruits and vegetables did not significantly improve their glucose tolerance despite decreases in weight and waist circumference. Similar positive results on glycemic control were obtained in diabetic patients when the paleolithic diet was compared with the diabetes diet. Participants were on each diet for three months, whereby the paleolithic diet resulted in a lower BMI, weight and waist circumference, higher mean HDL, lower mean levels of hemoglobin A1c, triacylglycerol and diastolic blood pressure, though levels of CRP were not significantly different. Although the paleolithic diet studies are small, these results suggest that, together with other dietary changes, the withdrawal of cereal grains from the diet has a positive effect on health.”
In full disclosure, I follow such a way of eating myself, it is the main strategy I take when undertaking personal nutrition consultations in my private practice, and something I spend far too many hours researching. We are seeing an increasing number of health professionals go down a similar pathway, with evermore doctors, nutritionists, and university researchers now putting their hands up to say they eat this way and advocate their patients do too. It is a way of eating that is tried and tested.
Other health professionals, who cannot see a life beyond the almighty grain, will argue that a diet sans grains is a diet that is missing a substantial amount of nutrition. In truth, there isn’t a single nutrient – not one – that you might get from grains (and I say might as much of the supposed nutrition in grains is largely unavailable to the body – ingestion is not absorption), that you cannot get from a diet rich in vegetables, fruits, meats, eggs, fish, nuts and seeds; indeed, you actually get much more from these foods than you will ever get from grains.
Which brings me back to my original gripe with Weetbix being put into schools under the guise of being a healthy breakfast, and earning a company, which already enjoys a tax-exempt status, much state-sponsored free publicity. We produce some of the highest-quality dairy products in the world, so give the kids a glass of milk. We produce some of the best quality apples in the world, so give the kids an apple each. And we have a growing free-range egg industry, so organise to give the kids a couple of boiled eggs each for breakfast.
Eggs, milk, and a piece of fruit for breakfast. Three high-quality foods which will achieve exactly what we want this programme to achieve, at a much reduced risk to the future health of those receiving it. There will be no future health time bomb that we will face as a nation from giving children eggs, milk, and fruit for breakfast.
The cost? I’m sure we could get the egg producers and the apple & pear board to partner such a deal. They would be foolish not to. I would imagine the relative costs to be similar to the Weetbix and milk deal (no word on who is supplying the sugar that will inevitably be added to this breakfast). Should such a breakfast cost more, then I would imagine that making Sanitarium pay company taxes for the privilege of selling not-so-healthy foods to New Zealanders, would more than cover the cost.
- de Punder, K.; Pruimboom, L. The Dietary Intake of Wheat and other Cereal Grains and Their Role in Inflammation. Nutrients 2013, 5, 771-787.
- Kelly SAM, Summerbell CD, Brynes A, Whittaker V, Frost G. Wholegrain cereals for coronary heart disease. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005051. DOI:10.1002/14651858.CD005051.pub2.
- Glycemic Index News. “Food For Thought” October 2010. http://ginews.blogspot.com.au/2010/10/food-for-thought.html Accessed May 2013.