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  #1   ^
Old Fri, Sep-21-12, 09:02
Demi's Avatar
Demi Demi is offline
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Default Bread – the staff of life or the stuff of nightmares?

Quote:
From Dr Briffa's blog
21 September, 2012

Bread – the staff of life or the stuff of nightmares?

I was away for most of this week and, as a result, this on-line article (and several similar ones) passed me by. It focuses on the ‘research’ conducted by Dr Aine O’Connor of the British Nutrition Foundation and published in its ‘journal’ – the Nutrition Bulletin [1]. I’ve not read the article itself, but here’s the abstract (summary).

Quote:
Despite being a staple food in the UK for centuries, bread consumption has fallen steadily over the last few decades. Average consumption now equates to only around 2–3 slices of bread a day. As well as providing energy, mainly in the form of starch, bread contains dietary fibre and a range of vitamins and minerals. The National Diet and Nutrition Survey (NDNS) of adults suggests that it still contributes more than 10% of our daily intake of protein, thiamine, niacin, folate, iron, zinc, copper and magnesium; one-fifth of our fibre and calcium intakes; and more than one-quarter of our manganese intake. Therefore, eating bread can help consumers to meet their daily requirements for many nutrients, including micronutrients for which there is evidence of low intake in some groups in the UK, such as zinc and calcium. This paper gives an overview of the role of bread in the UK diet, its contribution to nutrient intakes and current consumption patterns in different population groups.
The tone of the articles spawned by this research and the (likely) press release that accompanied, people who have eschewed bread in search of better health are deluded idiots. Plus, they’re putting themselves at perilous danger of nutritional deficiencies. And this has to be right, of course, because it comes from a ‘nutrition scientist’.

So, let’s get a few things straight. First of all, bread is not a particularly nutrient dense food, and it also contains things (like digestion inhibitors and phytates) that impair our ability to absorb nutrients from it anyway.

The fact that: “The National Diet and Nutrition Survey (NDNS) of adults suggests that it still contributes more than 10% of our daily intake of protein, thiamine, niacin, folate, iron, zinc, copper and magnesium; one-fifth of our fibre and calcium intakes” may sound impressive, but these figures exist only by virtue of the fact that, although declining, bread consumption is still relatively high. The fact remains that there’s nothing in bread that cannot be had more healthily elsewhere in the diet. Superfood it ain’t.

The issue of wheat sensitivity needs dealing with too, because repeatedly we are told by people like Dr O’Connor that it’s a minor and rare concern. Often this view is based on the prevalence of coeliac disease (sensitivity to gluten). However, research suggests that it is possible to be sensitive to gluten but not have coeliac disease. In other words, even if tests exclude coeliac disease, that does not mean that person will have no ill effect from eating gluten. Over the years, I have seen literally hundreds of patients who, on reduction or elimination of wheat from their diets, have seen significant improvement in a range of symptoms including abdominal bloating, other digestive symptoms including indigestion. Of course, some people (maybe Dr O’Connor) will tell us that such improvement can only be in their heads. They might be right, but the consistency of the improvement seen on elimination of wheat suggests to me there’s something in it.

Another potential problem with bread is that it’s made mainly of starch, and starch is sugar (starch is comprised of chains of glucose molecules). Now, the extent to which bread disrupts blood sugar levels is about the same as table sugar (also known as sucrose, which is half glucose and half fructose). So, munching down on a sandwich at lunch, for instance, is quite likely to induce quite a sugar high, that may well get the body pumping out insulin, the effect of which can be to drive blood sugar levels to sub-normal levels in the mid-late afternoon. The end result can be fatigue, mental lethargy, and perhaps a desire to raid the biscuit tin or take a trip to the vending machine.

When people take bread out of their lunch, the usual end result is for people to feel significantly more energised and productive through the afternoon. I say ‘usual’, but actually it’s hardly ever not the case. Again, perhaps it’s all in their heads and a major placebo response is going on. However, once again, the predictability and consistency of the improvement suggests to me that it’s something that deserves our consideration and has validity.

As I said earlier, I haven’t read Dr O’Connor’s article, but her scientific credentials lead me to suspect at least some of her line of argument will be ‘where’s the evidence’ for the harmful effects of bread? In my experience, the evidence is all around and evident to those who:

1. have benefitted from the removal of bread/wheat from their diets

2. see patients who consistently benefit from bread/wheat from their diets and are prepared listen to what their patients tell them

By the way, I fall into both categories. When I eat wheat the usual response in very noticeable digestive discomfort and fatigue.

I don’t feel inclined to wait for evidence that smashing someone in the face with a polo mallet causes pain and suffering, and I feel pretty much the same about bread.

I suppose it should not go unremarked that the British Nutrition Foundation is supported by various factions within the food industry, and this organisation is sometimes less than transparent about where it gets its money from and the obvious conflicts of interest here. See here for more on this.

References:

1. O’Connor A. An overview of the role of bread in the UK diet. Nutrition Bulletin 2012;37(3):193–212
http://www.drbriffa.com/2012/09/21/...-of-nightmares/
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  #2   ^
Old Fri, Sep-21-12, 09:45
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teaser teaser is offline
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Quote:
suggests that it still contributes more than 10% of our daily intake of protein


This is the part that wakes me up screaming in the middle of the night. Basic, run of the mill (I have to stop doing this) flour has ten percent protein. So if her figures are right, people in Britain must be eating a) an all wheat diet, b) a diet fortified in wheat proteins or c) a diet supplemented highly in foodstuffs devoid of protein... cornstarch, corn syrup, sugar, alcohol...

which would of course increase the percentage of various micronutrients coming largely from fortified wheat flour as well.

And in this dietary background, she's all that concerned that people get in their daily wheat? Bigger fish to fry.

Plus wheat sucks.
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  #3   ^
Old Fri, Sep-21-12, 10:13
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WereBear WereBear is offline
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Quote:
Originally Posted by teaser
Plus wheat sucks.


Can't agree more.

I used to think it was my own adolescence that spelled my doom; my hormones went nuts and made me fat. But now, I wonder:

That was the '70's, and the introduction of High Fructose Corn Syrup and genetically modified wheat happened right around the same time.

Is this how you turn a stringbean child into an overweight adolescent? Science says, Yes!
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  #4   ^
Old Fri, Sep-21-12, 10:32
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teaser teaser is offline
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Um, I misread ten percent of intake as protein as ten percent of diet as wheat protein... probably in ketosis, brain not working right.

But still. Wheat sucks.
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  #5   ^
Old Fri, Sep-21-12, 21:17
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mike_d mike_d is offline
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Likely nightmares. I sometimes have dreams about eating bread; but something always happens, or I awake before actually eating it.
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  #6   ^
Old Sat, Sep-22-12, 02:55
Minimum my Minimum my is offline
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Quote:
Originally Posted by WereBear
Can't agree more.

I used to think it was my own adolescence that spelled my doom; my hormones went nuts and made me fat. But now, I wonder:

That was the '70's, and the introduction of High Fructose Corn Syrup and genetically modified wheat happened right around the same time.

Is this how you turn a stringbean child into an overweight adolescent? Science says, Yes!



I've been doing some reading recently, How We Get Fat, Wheat Belly etc. I know that I don't tolerate wheat well, I've known it for years, I was skinny as a child (born 1971) and by the mid eighties I got big, just as my mum had introduced a low-fat diet...huh? I lived in Malaysia for 4 years in my early twenties and hardly touched wheat and came back at my lowest weight since I was around 11. A few months later with wheat back in my diet I had a face covered in ezcema and I was piling the weight back on.

Since eliminating wheat from my diet in mid August I've lost 11lbs and my bloating, IBS and ezcema have all gone, as has the depression that was becoming more and more frequent.

For me, it's a no brainer.
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  #7   ^
Old Sun, Sep-23-12, 17:41
M Levac M Levac is offline
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From Wikipedia:
http://en.wikipedia.org/wiki/Fortified_bread
Quote:
Food fortification or enrichment is the process of adding micronutrients (essential trace elements and vitamins) to food. It can be purely a commercial choice to provide extra nutrients in a food, or sometimes it is a public health policy which aims to reduce numbers of people with dietary deficiencies in a population.

Diets that lack variety can be deficient in certain nutrients. Sometimes the staple foods of a region can lack particular nutrients, due to the soil of a region, or because of the inherent inadequacy of the normal diet. Addition of micronutrients to staples and condiments can prevent large-scale deficiency diseases in these cases.

There's a few assumptions here. First, there's the idea that a physiological deficiency is always the result of a dietary deficiency, i.e. if we suffer from a deficiency, the cause is the lack of this nutrient in the food we eat. This can be true, but it can also be true that the deficiency is caused not by a lack of something, but by the presence of something. For example, glucose displaces vitamin C in certain cells, which means we must consume more vitamin C to compensate, or we suffer from this particular physiological deficiency. However, removing the dietary glucose also treats the physiological deficiency by finally allowing the dietary vitamin C - however little there is - to perform its physiological functions. Most animals can produce vitamin C, we can't. This suggests that we must get it from our diet, but the amount we can usually get from our diet without refining and processing is far lower than what those animals can produce every day. This further suggests that we don't actually need to consume much of this same nutrient, if we don't do anything that interferes with its functions physiologically.

Second, there's the idea that we must eat a varied diet to ensure an adequate intake of essential nutrients, because there's the other idea which says no single food can provide all essential nutrients. Never mind that most animals do fine with an extremely limited diet, some containing only a single food item. I don't really know where the idea comes from, maybe it's derived from the first assumption above. I'm pretty sure it hasn't been tested much except perhaps with the Bellevue all-meat trial. Several traditional populations eat a very limited diet - like the Masai or the isolated populations observed by Weston Price - yet maintain good health anyway.

Third, there's the idea that the things we eat can be deficient in those same essential nutrients for various reasons like soil depletion. This is very easy to refute. The essential nutrients for ourselves, are also essential for the things we eat. Take vitamin B12 for example. We must consume it, but the cows we eat don't have to. Yet B12 is equally essential for those cows. This means if they suffer a physiological deficiency for B12, they will suffer the symptoms too. And if this deficiency is absolute, they will not remain healthy or live for very long. This means if those cattle and crops are healthy, they must surely contain an adequate amount of essential nutrients for themselves, therefore an adequate amount of those same essential nutrients for ourselves.

In the case of bread, it's a staple food for many populations. When we take all the assumptions above, it makes sense to fortify bread if there is an epidemic of deficiencies. However, since it is a staple food but not a traditional staple food (wheat is a modern food on the evolutionary scale), it's equally possible that the deficiencies we're trying to prevent are caused by this same staple food, not because some nutrients are lost to processing, but because of whatever remains after processing, indeed even without any processing. So it makes equal sense to not eat bread in the first place.

Last edited by M Levac : Sun, Sep-23-12 at 17:47.
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  #8   ^
Old Thu, Sep-27-12, 02:55
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Demi Demi is offline
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Quote:
From Dr Briffa's blog
26 September, 2012

The head of the British Nutrition Foundation responds to my blog post on bread, and I have a few words for her too

Last week one of my blog posts focused on a widely reported ‘news’ story which concerned the supposed value of bread in the diet. These reports appear to have followed the publication of an article in the Nutrition Bulletin, the ‘journal’ of an organisation called the British Nutrition Foundation (BNF). I admitted at the time that I hadn’t read the article and was basing my comments on the news pieces and abstract. Subsequently, Professor Judy Buttriss, Director General of the BNF, left the following comment on my site:

Quote:
Dr Briffa refers to a review compiled by Dr Aine O’Connor of the British Nutrition Foundation (BNF), which was peer reviewed and published in Nutrition Bulletin this year. The review references a total of 83 published scientific research papers, drawing conclusions from their combined findings. Dr Briffa acknowledged that he has not, himself, read the review and BNF would urge him to do so.

Contrary to Dr Briffa’s views, the Foundation provides information about its diverse sources of funding and indeed its governance – details are contained in its Annual Reports which are available online: http://www.nutrition.org.uk.

BNF does not endorse companies or brands. It works with a broad range of organisations in both the public and private sectors, that share an interest in communication of evidence-based nutrition information, to inform decisions and policies on nutrition for public health benefit. Again details are publicly available in its Annual Reports.

In Dr O’Connor’s review, ‘An overview of the role of bread in the UK diet’, BNF clearly refers to funding as follows: The British Nutrition Foundation is grateful to Warburtons for financially supporting time spent on the preparation of this review. However, the views expressed in this article are those of the author alone, and Warburtons has not been involved in writing or shaping any of the contents.

Prof Judy Buttriss
Director General
British Nutrition Foundation.
In a personal email to me, she sent a similar message but also attached a copy of the article which appeared in the Nutrition Bulletin. Here, again, she urged me to read the article. I’m glad I did. What I found was much worse than I ever imagined…

Professor Buttriss tells us that the review references “83 published scientific papers”. The article does have 83 references, but several of these are not what we regarded as ‘published scientific papers’. Some, for example, are government-derived data on food intakes in the UK, and one is a book. This may seem picky, but what it suggests to me that while I may not have read the article prior to my blog post last week, perhaps Professor Buttriss had not read the paper in its entirely either.

Professor Buttriss also draws our attention to the fact that the article is peer-reviewed. Peer review is a process by which suitably experience/qualified individuals read and assess articles prior to publication. However, in the very first paragraph of the article we see these lines:

Quote:
Since 1942, all UK wheat flour except wholemeal flour has been fortified with calcium carbonate (to provide calcium at a time when dairy products were rationed and the phytate content of flour was high; impeding calcium absorption) and thiamine to white flour. Since 1953, thiamine, niacin and iron have been restored to white flour (to ensure the micronutrient composition of white flour closely resembles wholemeal flour) and millers were freed from producing only high extraction flour.
The first sentence does not seem properly constructed, and the second makes reference to thiamine being added to flour in 1953 even through the previous sentence states that its addition started in 1942. I’m wondering what sort of a job the reviewers were doing. Did all of them miss these errors so early on in the article? And this is before we even get on to the subject of the (I think) bias inherent in the article (see below).

Professor Buttriss tells us that the BNF’s ‘diverse sources of funding’ which can be found in its annual reports. She links to the BNF site, but not the part of it that contains the relevant information. This suggests to me that she is perhaps less keen to have people actually accessing this information than she would like to appear. But I might be wrong.

She starts the paragraph by saying: “Contrary to Dr Briffa’s views, the Foundation provides information about its diverse sources of funding and indeed its governance…”

I suppose she’s referring to this line in my blog post: “I suppose it should not go unremarked that the British Nutrition Foundation is supported by various factions within the food industry, and this organisation is sometimes less than transparent about where it gets its money from and the obvious conflicts of interest here.” But after this comment I linked to this article in the Independent newspaper which contains the following passage:

Quote:
However, the organisation’s 39 members, which contribute to its funding, include – beside the Government, the EU – Cadbury, Kellogg’s, Northern Foods, McDonald’s, PizzaExpress, the main supermarket chains except Tesco, and producer bodies such as the Potato Council. The chairman of its board of trustees, Paul Hebblethwaite, is also chairman of the Biscuit, Cake, Chocolate and Confectionery Trade Association.

Critics say the foundation’s dependence on the food industry is reflected in its support for the views promoted by industry and that it is not fully transparent about its funding.

The foundation is holding a conference next month on the science of low-calorie sweeteners, which aims to “separate fact from fiction”. The web page for the event says “intense sweeteners have been available as a means of reducing sugar intake for more than a century” but the perceptions of them “can be somewhat negative”. The conference aims to “explore the facts behind the stories and see where low-calorie sweeteners fit into today’s foodscape.”

The web page doesn’t say, though the information is available elsewhere on the website, that the foundation is financially supported by Tate & Lyle, British Sugar, Ajinomoto (maker of AminoSweet), and McNeil Consumer Nutritionals (maker of Splenda).

A foundation press release in February said people could shake off the winter blues by drinking more fluids. It didn’t say that its donors include Danone (producer of Evian, Volvic, and Badoit), Coca-Cola, Pepsi, Innocent, Twinings, Nestlé, and various yoghurt drink manufacturers. A footnote mentions the food industry as one of the foundation’s funding sources.

Joe Harvey of the Health Education Trust, a charity promoting health education for young people, said: “Organisations like the British Nutrition Foundation which want to be seen as offering independent advice should avoid donations from the food industry or be much more up front about them so the public are aware of the involvement. It is naive to take industry money and believe there is no quid pro quo.
I feel there’s a clear conflict of interest with the BNF, and that concerns about transparency are legitimate, and it seems I’m not the only one. Perhaps Professor Buttriss would care to comment.

Professor Buttriss does leave the best for last, when she draws our attention to the fact that Warburtons “financially [supported] time spent on the preparation of the review.” So, let’s not mince our words and tell it straight: A bread manufacturer has funded a review which lauds the supposed nutritional attributes of bread. This, despite the fact that, as I stated in my original blog post, superfood it ain’t. And then there’s plenty about bread we should be wary of.

But Professor Buttriss does not engage in any meaningful way with the health-related issues I raise in my blog post at all. Is there any enlightenment to be found in the article itself? Don’t hold your breath…

To her credit, Dr O’Connor (the BNF ‘nutrition scientist’ who authored the article) tells us that bread is generally classified as a high-glycaemic index food (very destabilising for blood sugar). But nowhere in the article does she discuss the potential health hazards this poses. No mention of the symptoms of blood sugar instability, or the fact that high-GI foods are linked with diverse health issues including type 2 diabetes, cardiovascular disease and some forms of cancer. Not a word.

And what of bread’s capacity to cause food-sensitivity related issues? Not a dicky bird on this issue either. Gluten sensitivity does not even get a mention, and neither does coeliac disease. Like they don’t happen.

So, excuse me Professor Buttriss if I am left with the impression that Warburtons have paid for a favourable review of its chief product (bread). Any person with even a smattering of nutritional knowledge I suspect would see this ‘review’ as heavily biased. Your assertion that “Warburtons [had] not been involved in writing or shaping any of the contents” does not reassure me at all. Something tells me many others will feel pretty much the same way.

So, Professor, please do comment on any of the above and also perhaps answer this question: How did this review come about in the first place? Specifically, did the BNF approach Warburtons with the idea of a review which Warburtons may fund? Or did Warburtons hatch the plan and bring it to you? And maybe tell us too how much Warburton stumped up to support the “time” spent preparing the article. If you really believe the BNF is an ethical organisation and transparent in its dealings, now’s your chance to prove it.
http://www.drbriffa.com/2012/09/26/...ds-for-her-too/

Last edited by Demi : Thu, Sep-27-12 at 03:15.
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  #9   ^
Old Thu, Sep-27-12, 05:13
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amundson amundson is offline
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I very much appreciate Dr. Briffa standing up to biased research and calling it out for what it is. Bravo!!
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  #10   ^
Old Thu, Sep-27-12, 14:13
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melibsmile melibsmile is offline
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I think I love Dr. Briffa. Thanks for posting this Demi.

--Melissa
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  #11   ^
Old Sat, Oct-20-12, 02:25
Demi's Avatar
Demi Demi is offline
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Quote:
From Dr Briffa's blog
19 October, 2012


Can industry sponsorship taint health advice?

A commenter on this website yesterday made me aware of a Q and A session hosted by website netmums featuring nutritionist Fiona Hunter and sponsored by the bread manufacturer Warburton. If you’re a reasonably regular follower of this blog then you may know that I have featured Warburtons twice in recent times. First of all, this company paid the British Nutrition Foundation for an (I think) utterly biased account of the value of bread in the diet (see here and here for more on this). Then I find Warbutons also conducted a survey which makes out we’re generally wildly ignorant of appropriate sources of fibre in the diet. Not that it matters that much, because as I point out here, the sort of fibre mainly found in wholemeal and other breads (insoluble fibre) has dubious health benefits anyway.

Anyway, alerted by the commenter to the Warburton-sponsored Q and A I went to have a look (you can find it here). I came across this question and answer which I feel represents how corporate interests can get in the way of good dietary advice.



You can see a mother has written that her14-year-old daughter has irritable bowel syndrome and that symptoms appear to be triggered by bread and pasta. The most obvious explanation here is that the girl, at the very least, is intolerant to wheat. It’s possible even that she has coeliac disease (sensitivity to gluten). Fiona Hunter, however, writes that:

According to a British Nutrition Foundation report, there is no evidence to suggest that bread causes bloating or any other symptom of gastrointestinal discomfort in healthy consumers.

The underlying message here appears to be that bread is not the problem. The real problem here, as I see it, is that the mother has already told Fiona Hunter that bread is a problem (along with pasta), and she appears to have ignored this crucial piece of information and in fact attempted to steer away from it.

Fiona Hunter offers a report from the British Nutrition Foundation to allay our fears about the potential for bread to cause gastrointestinal symptoms. However, I personally would not rely on the British Nutrition Foundation for objective and balanced advice on bread. After all, it was this organisation that took money from Warburtons and produce what I believe to be an utterly biased piece of ‘research’ on the importance of bread, while failing to highlight the very real potential health issues associated with eating this food (such as its potential in coeliac disease and its very blood sugar-disruptive nature).

At the end of the day, my impression is that Fiona Hunter has not been totally upfront and honest about the fact that bread is probably a wholly inappropriate food for this girl. No mention is made of wheat or gluten sensitivity or coeliac disease. Could Fiona Hunter’s advice be in any way biased by the fact that her (I assume) sponsor makes bread? You decide.
http://www.drbriffa.com/2012/10/19/...-health-advice/
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