A Matter of Life

To Eat or Not to Wheat

Dr Ambrish Mithal is chairman and head, Endocrinology and Diabetes Division at Medanta, The Medicity, Gurgaon
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The grain of truth in spite of better alternatives

OF LATE, several of my patients have sought advice about giving up wheat and wheat products. Usually it is those struggling to lose weight; sometimes it is those who have stomach-related complaints like bloating or diarrhoea. The internet is flooded with dramatic articles blaming wheat as the chief ill that plagues human health in modern times. It is important, therefore, to sift the wheat from the chaff.

The human race exists today as a result of cultivation. Without it, it is likely that food would have become scarce. Wheat cultivation is thought to have started in the eastern Mediterranean and central Asian region, and reached India around 6,500 BCE. Just three plants—rice, maize and wheat—provide more than half the world’s energy. Wheat is the staple for one-third of the earth’s population and provides about 20 per cent of the total dietary calories and proteins worldwide. It has been the staple for many of us born and brought up in India.

Why is wheat facing so much flak these days? There are several reasons. First, the high glycemic index/‘wheat belly’ concern. It has been suggested that wheat consumption causes blood glucose to rise quickly, leading to a surge of insulin, which stimulates appetite, leading to abdominal weight gain and diabetes. There is an element of truth in this, as the wheat we consume now is different from that consumed by our ancestors. We now partake processed grains and miss out on the fiber-rich bran and mineral-rich germ layer so that we end up eating the starchy core. Use of genuine whole grain wheat takes care of this. It is nutritious; it is absorbed relatively slowly and does not stimulate the appetite. It will not result in abdominal obesity, provided the overall calorie intake is kept within recommended limits.

The second criticism of wheat is the presence of ‘lethal’ peptides such as Amylopectin A that supposedly force people to over-eat. These peptides break down starch found in wheat kernel to promote rapid absorption. Scientific evidence of wheat addiction or overeating is not convincing. No grain with a ‘killer’ peptide could have been consumed for centuries.

The third theory propounded by wheat critics is that the human genome is not designed to handle cereals, implying that it is incapable of evolving. These groups recommend the Paleo diet (meat and vegetables), which was consumed more than 10,000 years ago. Evidence for this claim is also flimsy. It is prudent to remember that the lifespan of people in the Paleolithic period was probably about 30 years. Moving to a Paleo (or Atkins) diet will provide transient benefits as the calories will decline substantially. But leaving out some food groups completely is not recommended. Long-term adherence to such diets remains a challenge.

The fourth point is regarding Celiac disease and gluten intolerance. Celiac disease is caused by an autoimmune reaction to wheat proteins like gliadin (a component of gluten) and is increasingly diagnosed, even in India—the overall prevalence is still below 1 per cent. Gluten intolerance may be common, but actual numbers are hard to ascertain as there is no reliable diagnostic test. Inflammation of the intestine leads to poor absorption of food, chronic diarrhoea and nutritional deficiencies. Both these groups need to give up wheat/gluten and take treatment under the guidance of a physician. Lastly, some have linked (with very little evidence) wheat consumption to a host of other neurological conditions like dementia and schizophrenia, and autoimmune conditions like arthritis.

Why do some people improve ‘metabolically’ and lose weight when they go off wheat despite not having celiac disease? If you go off cereals completely, your calorie intake will decline substantially. You will lose weight and diabetes control will improve. But the effect is transient and it is not because of wheat deprivation. If you try replacing wheat with rice, you will probably put on weight, as several of my patients do. Overall reduction in calorie intake while maintaining a balanced diet, along with increased physical activity, is the only solution to combating obesity and diabetes. Yet, it is incredibly hard to implement as it entails behavioural change. People, therefore, are always looking for a quick fix. Which is why simplistic, single food item theories (like giving up wheat) abound.

It’s not time to give up on wheat just yet. Consuming whole, bran-rich wheat is fine as long as it is within your prescribed dietary limits. Traditional Indian grains like millets and amaranth or South American grains like quinoa are great cereal choices. Irrespective of WhatsApp messages, chappatis will not become extinct in our lifetime.