Wheat Belly

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Wheat Belly is a strange book. I find it quite bizarre that it has so many ardent defenders. When I criticized an interview with the author. Dr. William Davis, a week ago, several people rushed to defend him and were angry that I would dare remark on something I haven't read. It's weird because his blog kind of fell off the paleo radar some time back when he started harping on about AGEs in butter, saturated fat being bad for you, and red meat causing colon cancer. This whole debate is a perfect example of why blogs have the potential to be so much better than non-fiction books. Wheat Belly contains ideas that have been extensively debated in the ancestral health blogosphere and found wanting, as well as ideas presented uncontroversially that are the subject of bitter controversies in the blogosphere at the moment*. Besides that, most of the good information here can easily be found in well-written blog posts by experts on their respective subjects. 

But people told me I couldn't write about Davis' thesis without reading the book and attacked me for commenting on his interview, so I read it. 

I'm glad to see Dr. Davis is on board with the idea that saturated fat and red meat are good for you, but just because someone loves meat and despises wheat doesn't mean we should add them to the canon of books that are valuable in the paleo community. 

Unlike many other books I've reviewed positively that do belong in the canon, this book is marketed as a weight-loss diet book. The title is the first clue, with its emphasis on obesity. The subtitle is "lose the wheat, lose the weight, and find your path back to health." It's a mantra repeated again and again in the book, with very little proof to back it up. Wheat-free is not a weight loss diet and even Dr. Davis knows this. I know he does because he ends up recommending a low-carb paleo-ish diet. He says that gluten-free substitutes for things like bread and pasta will have effects similar to real bread and pasta. Hmm, so was wheat even really the issue in the first place? This book is essentially a re-packaged nouveau Atkins, with the wheat-free gimmick riding on the back of the growing gluten-free trend. 

What is really striking about this book for me is how much it resembles vegan polemics, such as The China Study, Skinny Bitch, and Diet for a New America. Like those books, this book will initially have many converts, but it will not stand the tests of scientific scrutiny. 

Nearly everyone in the paleo/ancestral health community eschews wheat. As I will expound on, there are many things that make wheat a food to avoid. Strangely enough, most of those things are absent from this book. Davis has built a elaborate mythology based on his own fringe theory about the unique evils of modern Dwarf wheat. It's a hypothesis, but it's too premature to have based a book on it. Because of this mythology, many of the problems with wheat that were first identified by pioneers like Dr. Staffan Lindeberg in his magnum opus Food and Western Disease are conspicuously absent. They have been replaced by rampant fear-mongering about technology and scare-stories. 

God forbid we criticize the wheat of the old days, the wheat of the Bible, the wheat are our ancestors supposedly "thrived on." Sorry folks, I've seen skeletons from "thriving" ancestors, peasants from 1600 Swedish or farmers from 1500 Britain and I'm here to say that these toothless pock-marked stunted people were not exactly thriving. 

Davis mentions Ötzi as an example of someone healthy because while they he ate the ancient wheat, he also ate lots of alkalizing veggies, which somehow made up for it. Missing is the mention of Ötzi's mouth full of tooth decay and stunting.

What a sexy man!

The other mummies are missing too, the Egyptian mummies who enjoyed ancient wheat, as well as health problems we are all familiar with today such as atherosclerosis, though whether it has to do with wheat is up for debate. 

In the 10,000-year journey from innocent, low-yield, not-so-baking-friendly einkorn grass to high-yield, created-in-a-laboratory, unable-to-survive-in-the-wild, suited-to-modern-tastes dwarf wheat, we’ve witnessed a human engineered transformation that is no different than pumping livestock full of antibiotics and hormones while confining them in a factory warehouse. Perhaps we can recover from this catastrophe called agriculture, but a big first step is to recognize what we’ve done to this thing called “wheat.”
 

So based on paleopathology, I'm not on board with calling einkorn innocent, even the Bible has mixed feelings about it "In the sweat of thy face shalt thou eat bread, till thou return unto the ground; for out of it wast thou taken: for dust thou art, and unto dust shalt thou return." 

I'm also a little different from some in this sector of the blogosphere because I'm relatively pro-technology. I have a degree in agriculture, so telling me that a food is "herbicided, fertilized, cross-bred, gassed, and hybridized", "genetically altered", "unique proteins," or that wheat has "undergone extensive agricultural genetics-engineered changes" is hardly terrifying to me, as this describes almost all seeds on the market today. It seems to be anti-technology scare-mongering, preying on the agricultural ignorance of the average consumer. He cites a few studies that show that modern wheat has been bred to produce more potentially-allergenic proteins like gluten, but fails to cite any evidence that truly connects it with the problems he sees wheat causing. I can conceive that it might have to do with increased celiac, but the connection to bellies seems rather tenuous. He does cite some data showing that celiac disease is increasing in an American population, but what about places where it has decreased? The truth is there are many theories about increasing celiac disease (lack of breastfeeding, increased antibiotic use) and it's hard to know whether or not dwarf wheat is the issue, particularly considering the absence of studies on the subject. 

And are we still talking about "alkalizing" foods? The whole idea that you have to balance "acidifying" and "basic" foods in your diet is quite popular among vegans as well and has been used to criticize paleo diets because they are full of "acidifying" foods. 

What happens if acids from meat consumption are not counterbalanced by alkaline plants and the pH scales are tipped even more to the acidic side by grain products such as wheat? That’s when it gets ugly. Diet is then shifted sharply to that of an acid-rich situation. The result: a chronic acid burden that eats away at bone health.

Luckily for those of us not worrying about balancing our meat with vegetables, numerous studies have shown that protein can actually help improve bone density, whereas stereotypically alkalizing diets can lead to low bone mass. There is less focus on net acid load and more on adequate consumption of vitamins (like D) and minerals, as well as their bioavailability. 

Bioavailability, a focus in most paleo books, is strangely missing from the pages of this book, which is a serious problem in my opinion. Paleo darling phytate is only mentioned in respect to soy. The myopic focus on wheat prevents Davis from seeing the bigger picture of digestive health, as high levels of phytate are common both to wheat and to some of the foods featured in his recipes such as quinoa flakes, pumpkin seeds, and various nut flours. The odds are wheat isn't bad for bones because it's "net acid," but because it hinders absorption of minerals through anti-nutritional factors, which include not only phytate, but fiber. Unfortunately, Davis is still on the fiber bandwagon:

This is, after all, how primitive hunter-gatherer cultures—the cultures that first taught us about the importance of dietary fiber—obtained their fiber: through plentiful consumption of plant foods, not bran cereals or other processed fiber sources. Fiber intake is therefore not a concern if wheat elimination is paired with increased consumption of healthy foods.

The problem is that the idea that "primitive" culture taught us that is rather outdated. It's not the fiber that matters, it's the gut health. Focus on fiber for the sake of fiber can decrease gut health and impair vitamin and mineral metabolism. 

And while it is quite amusing that the glycemic index of whole grain bread was 72, the glycemic index is also quite controversial, and not just its relevance to health either. The thing is that since that 1981 value he uses was published, more data has been gathered on the glycemic index of whole grains and it's not always consistent. If there is something special about wheat spiking blood sugar, why do some wretched coarser breads measure in the low thirties and forties (lower than many fruits and sweet potatoes), and so many gluten free breads measure so much higher? Davis mentions that the latter is often made from extremely refined processed rice, tapioca, and corn. And thus we have the answer- highly digestible carbohydrates, no matter what their provenance, are high glycemic. And sadly for the sheeple who fall for anything whole grain, food scientists have been hard at work re-engineering "whole grain" bread so it's nice and soft, but still technically whole grain, despite the fact that it's refined carbs in brown clothing. However, now that they've realized people are on to them, they've changed track and are now vigoriously engineering low-glycemic starch, so I'm predicting in the next five years the GI of the average whole wheat bread will drop significantly. 

Whether or not this actually matters is a subject of rather acrimonious debate of which others have written more expertly, but I'll just quote Lindeberg for now "However, the main cause of an individual’s inability to limit blood sugar rise after eating carbohydrates remains obscure, and it is questionable if dietary glucose/starch per se plays a causative role." It's curious that he cites the Kitavans as an example of an acne-free culture, when the glycemic index values for Pacific native starches range from 25 to 78. He must not have got the memo that says that if you are promoting a low-carb diet you have to make a jab about how the Kitavan data is flawed or irrelevant considering what a threat it is to the low-carb panacea diet being sold. Also, the idea that eating carbs like bread leads to AGE formation is a simplification of the issue at best.

One section is about gluten cerebral ataxia. Indeed, this is a terrible condition, but what does it have to do with the relevance of a gluten-free diet for the average person? It reminds me of scare-stories about beef or shellfish allergies in vegan polemics. Like the sodium azide in his interview that I criticized in my last post, it's a clever literary device- mention something scary about a food in juxtaposition with recommending that people not eat that food. It's clever because you don't actually do anything incorrect by saying directly that eating bad food causes scary thing or that scary thing has any real relevance to the consumption of bad food for the average person, but nevertheless, you get to scare people. In Skinny Bitch this is done with mad cow disease, an extremely rare condition which they mention in order to scare people away from eating meat. 

You know all those studies that vegans love that say that meat causes all manner of ills? Think about how you react to those. Whenever I see them, I look to see if they've included industrial monstrosities like Slim Jims and Hormel Bacon or if they've been nice and separated out fresh meat from processed meat. In Wheat Belly, Davis usually mentions foods like Cinnabon, French crullers, or Dunkin’ Donuts when he is deriding wheat. I think the sicknesses people have from eating those foods can't be pinned on dwarf wheat. They are high-sugar, high-reward, highly processed, filled with additives, and often laced with omega-6 fats. 

A Mayo Clinic/University of Iowa study of 215 obese celiac patients showed 27.5 pounds of weight loss in the first six months of a wheat-free diet.11 In another study, wheat elimination slashed the number of people classified as obese (body mass index, or BMI, 30 or greater) in half within a year.12 Oddly, investigators performing these studies usually attribute the weight loss of wheat- and gluten-free diets to lack of food variety. (Food variety, incidentally, can still be quite wide and wonderful after wheat is eliminated, as I will discuss.)

Well, maybe those researchers are right? In fact, the results fit in nicely with food reward theory. I would be more convinced that wheat were the issue if the people had lost their wheat belly while keeping their calories constant, but the truth is that they were eating fewer calories. As food scientists work to create perfect substitutes of Cinnabon without gluten, the gluten-free advantage will fade. And sadly, enterprising paleo folks who have come up will all manner of desserts utilizing rancid nut flours and fake sugar (such as the calorically dense banana-blueberry muffins featured in Wheat Belly) are likely to have similar issues. Sadly, there is no such thing as a healthy baked good. 

My own experience with a wheat-free diet starts in 2006, when I was having terrible stomach problems. I eliminated wheat for a month, but the stomach issues actually got worse. It wasn't until I learned about the more holistic approach to gut health that I was able to eliminate them. I realized that wheat isn't just about gluten or glycemic index, but about irritating fibers and fermentable carbohydrates (FODMAPS), a characteristic that wheat also shares with many other "healthy" foods like quinoa and broccoli. Don't get me wrong, I love a good salad, but plant foods are unfortunately something I have to consume with caution because of my chronic stomach problems. Incidentally, since I live in one of the exotic food capitals of the world, I have tried several heritage wheat varieties, including farro and einkorn, and it has taken me days to recover from eating them. I have a lot of bad things to say about modern food, but at least French bread leaves me relatively unscathed since it's comparatively low in gut-destroying bad bacteria-loving fibers. My experience has been far from his catchline "Eliminate the wheat, eliminate the problem."

Even if wheat doesn't upset your stomach, the evidence is mounting that wheat germ agglutinin lectin can exacerbate insulin resistance, abnormal gut permeability, and decreased bioavailability of important nutrients. I would caution that this is tentative evidence, based on many in-vitro and animal studies rather than human studies. More work needs to be done on this subject. Here is an interesting section from Lindeberg's book:

There are many indications that cereals and beans affect glucose metabolism by means of their glycoproteins. The best studied of these is wheat lectin (WGA), a highly stable substance which escapes digestion in the gastrointestinal tract1848. Thus, it passes the gut barrier and enters the bloodstream intact1461, and thereafter it binds to several hormone receptors including the insulin receptors and other tyrosine kinase receptors (the IGF-1 and EGF receptors)1900. The binding of wheat lectin to the insulin receptor is strong and long-lasting with high molecular efficiency, suggesting that it may hinder insulin to exert its effects for many hours353,354,705,1073,1459,1640,1641. Hence, it is theoretically capable of causing insulin resistance. Further, wheat lectin increases glycolysis (metabolic breakdown of glucose) 1986 as well as fat storage544, but in contrast to insulin, which has the same effects, it does not seem to stimulate protein synthesis1460, which is relevant since loss of muscle mass (sarcopenia) has been suggested to worsen insulin sensitivity503. Rats that were fed Turkish beans (Phaseolus vulgaris) quickly lost 30% of their skeletal muscle mass, which is thought to be an effect of its lectin, phaseolus vulgaris agglutinin (PHA)1348

So perhaps there is something about wheat in its ability to degrade leptin and insulin sensitivity, but if it were based on WGA lectin it would be an issue of long-term systematic degradation rather than glycemic index. If you are just looking at the glycemic index, you might infer that if you butter the bread, halving it's GI, it's OK, but if you look at the lectin picture it's a little more suspicious. However, as you can see from the last sentence, it's not just wheat that can be a potential issue here, but every plant with bioactive lectins and that includes many seeds and nuts beloved by low-carbers. 

Yes, Dr. Davis has an MD, and I don't, but many MDs, such as Dr. Emily Deans(and she has commented on issues with the wheat on the brain section of the book) and Dr. Kurt Harris share my skepticism. 

And basing science on studies rather than clinical anecdotes has been one of the most important steps in scientific progress. Back when MDs ruled the scientific discourse with their clinical anecdotes, treatments such as bleeding people for sore throats (which killed George Washington) were rampant and doctors killed as many people as they saved. The advent of controlled trials and the scientific method have made modern medicine great. It's nice to hear about clinical experience and it can provide important hypotheses, but they can only tell us so much.

So what does our ancestral/paleo community embrace? Are we a big tent or a small tent? I like to optimistically view us as a big tent of skeptics and that's why I've stuck around.  There are other "real food" movements that are far less skeptical and their conferences host people selling homeopathy and electromagnetic field-blocking bracelets. I think we can hold ourselves to a higher standard and not embrace every book that comes out that tarnishes a food we don't like or espouses a low-carb diet. 

Refs from Lindeberg's book

353. Cuatrecasas, P. (1973) Interaction of wheat germ agglutinin and concanavalin A withisolated fat cells. Biochemistry 12, 1312–23

354. Cuatrecasas, P.&Tell, G.P. (1973) Insulin-like activity of concanavalin A and wheat germ agglutinin – direct interactions with insulin receptors. Proc Natl Acad Sci USA 70, 485–9.

503. Evans, W.J. (1995) What is sarcopenia? J Gerontol A Biol Sci Med Sci 50 Spec No, 5–8.

544. Freed, D.L.J. (1991) Lectins in food: their importance in health and disease. J Nutr Med 2, 45–64.

705. Hedo, J.A., Harrison, L.C. & Roth, J. (1981) Binding of insulin receptors to lectins: evidence for common carbohydrate determinants on several membrane receptors. Biochemistry
20, 3385–93.

1073. Livingston, J.N.&Purvis, B.J. (1981) The effects of wheat germ agglutinin on the adipocyte insulin receptor. Biochim Biophys Acta 678, 194–201

1348. Oliveira, J.T.A., Pusztai, A. & Grant, G. (1988) Changes in organs and tissues induced by feeding of purified kidney bean (Phaseolus vulgaris) lectins. Nutr Res 8, 943–7

1459. Purrello, F., Burnham, D.B. & Goldfine, I.D. (1983) Insulin receptor antiserum and plant lectins mimic the direct effects of insulin on nuclear envelope phosphorylation. Science 221, 462–4.

1460. Pusztai, A. (1993) Dietary lectins are metabolic signals for the gut and modulate immune and hormone functions. Eur J Clin Nutr 47, 691–9.

1461. Pusztai, A., Greer, F.&Grant, G. (1989) Specific uptake of dietary lectins into the systemic circulation of rats. Biochem Soc Trans 17, 481–2.

1640. Shechter, Y. (1983) Bound lectins that mimic insulin produce persistent insulin-like activities. Endocrinology 113, 1921–6.

1641. Shechter, Y. & Sela, B.A. (1981) Insulin-like effects of wax bean agglutinin in rat adipocytes. Biochem Biophys Res Commun 98, 367–73.

1848. Van Damme, E.J.M., Peumans, W.J., Pusztai, A. & Bardocz, S. (1998) Handbook of plant lectins: properties and biomedical applications. John Wiley, New York.

1986. Yevdokimova, N.Y. & Yefimov, A.S. (2001) Effects of wheat germ agglutinin and concanavalin A on the accumulation of glycosaminoglycans in pericellular matrix of human dermal fibroblasts. A comparison with insulin. Acta Biochim Pol 48, 563–72.

1900. Wang, X.Y., Bergdahl, K., Heijbel, A., Liljebris, C. & Bleasdale, J.E. (2001) Analysis of in vitro interactions of protein tyrosine phosphatase 1B with insulin receptors. Mol Cell Endocrinol 173, 109–20.

* arguments that have been rife with scientific references and data. Please don't tell me that they are somehow less rigorous than wheat belly, because they have just as many references and wheat belly is FULL of anecdotes. 

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