There are so many disadvantages to eating whole grains it’s a wonder why we started eating them in the first place.
"Study of human skeletal remains from archaeological contexts shows that the introduction of grains and other cultigens, and the increase in their dietary focus, resulted in a decline in health and alterations in activity and lifestyle. [...] This change in diet and acquisition of food led to a decline in quality of life for most human populations in the last 10,000 years."
- Clark Spencer Larson, Anthropologist, Ohio State University
Executive Summary
- Why we started eating grains and why they became such an important staple food is a mystery because they are not the most nutritious or easy-to-farm plants.
- Grains have been in the human diet for over 105,000 years.
- We’ve used them to make alcohol for at least 13,000 years.
- As city-states formed, taxes needed to be raised. Grains became currency.
- Archaeological data shows that when humans became farmers their health and height suffered mainly because of nutrient deficiencies.
- Grains are full of anti-nutrients that block the uptake of the nutrients within.
- Simple processes evolved to reduce these anti-nutrients.
- Modern processing typically skips these processes, leaving whole grains high in anti-nutrients.
- Modern cross-pollination of grains has reduced the nutrient content and increased toxic elements from pollution.
- Glyphosate, the world’s most popular farming chemical kills healthy human gut flora.
- Chemical cocktails exist within most grains. Their accumulative effects are unknown and understudied.
- Farming chemical usage grows every year.
- Most farming chemicals are used on grains.
- Farming chemicals are linked to a host of diseases of modernity, including dementia, CVD and cancer.
- 107 farming chemicals have been measured accumulating in children.
- Grains are susceptible to fungal infections, the mycotoxins from which are poisonous.
- Gluten causes and or worsens certain autoimmune conditions.
- There is evidence of serious psychosis being caused by a reaction to gluten. The removal of gluten stopped the psychosis.
- Other diseases made worse or caused by gluten include IBD, depression, skin conditions, asthma, IBS and autoimmune conditions.
- Grains are not as nutritious as we’re told because of the poor bioavailability of their nutrients.
- Bioavailability cannot be taken into account, but research generally shows micronutrients are very poorly absorbed from whole grains and other plants, especially in combination.
- Nutrients in grains are exaggerated by our most prestigious dietary institutions.
- They are only rich in carbohydrates and fibre.
- The protein in grains is not complete. It’s classified as a poor-quality protein.
- Dietary institutions use observational research only for their support of whole grains.
- Observational research does not allow such confidence. It is weak by nature and riddled with bias.
- Most people still choose refined grains.
- 57% of the British diet is junk food. 40% of junk foods are made from grains.
- Observational research shows associations between many positive health outcomes and eating whole grains.
- These associations are generally not supported by intervention trials which are much more powerful.
- Whole grains are high in fibre.
- It’s possible to eat too much fibre, worsening constipation and nutrient deficiencies.
- There is plenty of fibre in green leafy vegetables or other plants.
- One of the world’s most senior epidemiologists, Dr John Ioannidis, is highly critical of nutrition research, especially observational studies. He calls for an overhaul to stop all of the confusion which seems only to infect humans when it comes to knowing what to eat.
Introduction
The world’s leading nutrition experts, from universities to government panels and everything in between, extols the virtues of whole grains, even adding the prefix ‘healthy’. Grains have been a part of the human diverse diet for at least 105,000 years. We’ve been making alcohol from them for at least 13,000 years, at least 3000 years before their domestication.
Something about grains has pulled us in, intertwining our fates, but why? There are so many plants that are more nutritious, and easier to farm and protect than grains, it’s hard to understand why they have become such a large fraction of our diets. Our infatuation with grains may have been rooted in addiction before being used as a tool to build city-states, a system in which we live today. Grains were the first currency. They became an easily taxable product, predictable in every way and harvested at the same time each year. Fields of wheat cannot be hidden from tax inspectors like tubers resting underground until needed, just an hour or two before consumption. Grains need a lot of processing to give up their nutrients and, even then, are not well absorbed, despite what we’re told. Every year the world uses more farming chemicals than the year before.
Pollution, additional chemicals and cross-pollination all contribute to the decline in the quality of grains. These chemicals, both natural and synthetic, are being linked with diseases including dementia, cardiovascular disease and cancer—the big three. Other conditions include autoimmune illnesses and mental health problems from anxiety to psychosis. Our most prestigious dietary institutions use only weak observational papers to support their claims that whole grains are healthy. Interventional trials only compare whole grains to refined grains, and the findings generally do not support the observational research.
Another huge issue is the truth about bioavailability, which is much worse than we’re led to believe. However, research into this existential problem is not forthcoming. Could it be that such research would shame the current advice to ‘base our meals around healthy whole grains and other starchy carbohydrates?’
Nutrition research needs overhauling.
Why did humans start eating grains?
Why did humans start eating grains?
After all, they’re not the most nutritious of plants; their cultivation requires back-breaking labour, and they pin people to one location, come what may. They’re vulnerable to weather changes, blights, and good old-fashioned adversaries who can destroy crops for as far as the eye can see as easily as light a candle. Grains have inbuilt toxins, they can develop other lethal ones at any stage of their cultivation, processing and storage and, nowadays, are drenched in farming chemicals sometimes for no other reason than to dry them out just before harvesting. Besides toxic agents, grains contain a lot of energy, poor-quality protein, hard-to-access nutrients, and inflammatory triggers that can ruin lives.
But despite these unassailable truths, grains have been a part of the human diet for at least ten times longer than dairy. Every conventional dietary institution sings the same song. Eat whole grains for a healthy, long life, they tell us. Base your meals around whole grains because they’re a ‘complete package’ brimming with nutrients and righteousness.
But are whole grains a healthy food? When and why did humans begin eating them? Why did they become a staple food, and what is the evidence to buttress such wholesale support from academics, industry and government alike?
Let’s start at the beginning.
Grain basics
Grains are the seeds of various types of grasses known as cereals. We’ll divide them into two groups: gluten (specifically gliadin) containing cereals, including wheat (all types), rye, and barley. And naturally gluten-free ones, including rice, corn, oats and buckwheat. The most popular grains in the world are rice, wheat, corn (maise), oats, barley and rye. In the UK, wheat is our favourite.
Each grain is called a kernel, which comprises three major parts:
- Bran: This is the most fibrous part and contains most of the micronutrients.
- Germ: This is the reproductive part, which sprouts into a new plant. It also contains vitamins and fats.
- Endosperm: Contains mainly carbohydrates as starch.
Modern grain refining leaves only the endosperm high in energy with few of the original nutrients. No one is arguing that unfortified refined grains are a healthy food, so our major focus in this article will be on whole grains.
The precise definition of whole grains has remained murky.
Generally speaking, whole grains contain the whole kernel, including the bran, germ, and endosperm, making them more nutritious than the refined, unfortified version.
The history of grains in the human diet
In some circles, the Paleo Diet community, for example, grains are considered a very recent addition to the human diet within about 10,000 years.
Therefore, they believe we haven’t adapted to digest them, and so they cause inflammatory issues. [2] Whilst there is truth to this, humans have used simple processes to make grains edible—discussed later. But, whether being edible qualifies them as a deserved nutritious staple food or something people chose for other reasons, is yet to be discerned. We’ll look back at the evidence of grains in the human diet to see if it gives us any clues as to why they have become such indispensable crops.
The earliest known evidence for grain consumption dates back to 105,000 years Before Common Era (BCE). [3]
Archaeologists working in a cave site in Mozambique found starchy residues on stone tools with which Middle Stone Age people used to grind wild sorghum, a naturally gluten-free cereal. For the first evidence of bread making, we have to jump over 90,000 years to about 12,000 BCE.[4] A meticulous archaeologist discovered the world’s oldest breadcrumbs by examining the remains of an ancient fireplace.[5]
A much smaller leap through time carries us to about 11,000 BCE when researchers discovered evidence for the storage of wild grains in modern-day Jordan, on the Dead Sea coast.[6]
So, people have been eating grains for tens of millennia, but why?
Why choose grains?
According to archaeological research, there is no evidence of true domestication of grains and other plants before the Younger Dryas period (12,900 to 11,700 years BCE).[7]
The Younger Dryas period was a sudden drop in global temperature at the end of the last major ice age. After this, the world’s temperature became milder, arguably making life easier for our ancestors but bringing other challenges. Unable to adapt, many of the large, fatty mammals known as megafauna, on which our ancestors had almost exclusively existed, vanished.[8] Humans, the most adaptable species ever to walk the earth, had to live up to that claim and change along with our environment or risk going the way of the woolly mammoth.
Our diets had to change.
Humans were forced to incorporate a wide range of plants, including grains and animals, which were much leaner than the megafauna. Some areas were easier to exist in than others. Inside an area known as the Fertile Crescent (within the Middle East), three great rivers, the Nile, Tigris and Euphrates, flooded annually carrying vast amounts of nutrients from mountain ranges to river deltas, dumping them into soil.[9]
These areas exploded with life.
Humans built little settlements on mounds to protect them from the flood waters and gave them access to the rich soils and abundant flora and fauna, some of which would literally come to their doors.[10] Humans in these lush areas became settled but, due to a lack of necessity, didn’t domesticate anything until, as the theory goes, ecological pressures shifted, and they began to manage their surroundings to a greater extent. This wasn’t done in a generation or two but over hundreds. People had gradually started domesticating plants and animals, in what we would recognise today as small-scale farming. But it is a mystery why they decided on grains over other foods that offer easier cultivation, less processing to make edible, more nutrients and more energy per KG.
13,000 years ago, before domestication, people were storing and fermenting wild grains to make alcohol for rituals and feasts.[11] Since then, alcohol has been central to human culture; some even believe it helped fuel the development of arts, languages and religion.[12]
James Scott, PhD, Professor of Anthropology at Yale University, forwards a compelling argument in his book Against the Grain: A Deep History of the Earliest States.[13] As people settled in these lush areas, populations increased far beyond hunter-gatherer communities, and collections of grass huts multiplied to become villages, towns, and eventually city-states. States need governance, which the local population must pay for with taxes. Grains, specifically barley, became the first recorded currency.[14] Tax collectors could assess ahead of time, recording the information on clay tablets; writing was born.[15] Harvests were predictable, unlike other potential crops, which could grow and stay underground, all but hidden, waiting to be dug up and eaten within an hour or two. Scott argues that grains enslaved us to these city-states.
A bondage in which we remain.
Brutal farming
Before modern state formation, it’s important to realise that people went back and forth for millennia along a continuum with nomadic hunting and gathering at one end and settled farming at the other, dependent on the existential ecological pressures in which they found themselves.[16]
It’s easy to believe that swapping hunting and gathering for farming represented a step up the civilisation ladder, each leading us out of that hard life and into an easier one to the wonders of today. The trouble with that theory is that being a farmer is much tougher than being a hunter-gatherer. For starters, crops are vulnerable to attack by weeds and pests. In Ancient Sumeria, about 6000 years ago, farmers used a sulphur compound as a pesticide.[17]
Compared to farmers, hunter-gatherers spend a fraction of their time working.
In just 17 hours a week, the Ju/’hoansi bushmen in Africa were able to hunt and gather an average of 2,300 calories worth of protein-rich, nutritious wild food.[18] In his essay The Worst Mistake in the History of the Human Race, Jared Diamond shares insights from the Hadza nomadic hunter-gatherers and Kalahari bushmen, some of the last hunter-gatherer tribes in existence.[19]
Diamond says these bushmen gather all their necessary sustenance in about fifteen hours a week. The Professor of Geography notes that the bushmen enjoy ample sleep and plenty of leisure time, and they expressed no desire to emulate their more labour-intensive farmer neighbours.
Hunting and gathering is healthier than farming.
Comparison studies of early farmers and ancient hunter-gatherer societies in the exact locations but separated by millennia provide excellent insights into how farming affected their health. Compared to the hunter-gatherers living 6,500 years earlier, the farmers lived much shorter lifespans with increased rates of infant mortality and greater prevalence of iron deficiency anaemia.[20] Enduring 50% more tooth infections and spinal deformities from the repetitive nature of farming, these ‘more advanced’ settled people suffered from infectious diseases as a result of poor animal husbandry and malnutrition.[21]
The farmers were also shorter than their ancient forebears.
Human height took a hit
About 16,000 years ago, the average height of males in Europe was 5 feet 9 inches, and the average height of women was 5 feet 2 inches.
As groups of people transitioned into farmers, their average height plummeted to 5 feet, 3 inches for men and 5 feet for women.[22] Until recently—because height is directly related to the amount and quality of protein we and our mothers consume—[23]our average height has recovered in Europe.[24] However, in low-income countries where animal foods are expensive and rare—replaced in large part by grains—their average height has decreased.[25] This trend seems to be infectious, spreading into the United States, where the average height is beginning to shrivel in low socio-economic groups. These groups struggle to nourish themselves because grain-based junk foods are cheap, convenient and ubiquitous, whilst whole foods, including animal produce, are much more expensive.[26] Will the UK and Europe follow the US’s lead and begin to shrink?
We’ll have to wait and see.
Farming brought with it back-breaking labour, disease, dysfunction, reduced stature and, for better or worse, sedentism and, eventually, state formation. At the heart of farming was grain cultivation. Why our ancestors chose grains above easier-to-farm and nutritious crops will remain a mystery, and it doesn’t matter for our purposes. We know that grains have been a part of the human diet since well before the advent of farming and domestication, and we know that our health has suffered because of it.
We also know that grains contain anti-nutrients, which can explain, in part, why our health and stature continue to suffer.
Anti-nutrients in grains
Anti-nutrients are chemical compounds within plants.
They protect the plant from pathogens and other threats to their survival.[27]
Grains, like seeds within fruits, use these chemical defences to safely deliver at least a fraction of themselves through some animal’s digestive tract before being deposited in a steaming pile of fertiliser somewhere distant from the parent plant. Anti-nutrients also prevent nibbling herbivores from eating the entire plant, chemically encouraging them to move on to something else.
Phytic Acid (Phytate):
Phytic acid is one of the most common anti-nutrients found primarily in whole wheat, barley, rice and corn.[28]
We can’t digest it because we lack the enzyme phytase to break it down.[29] Phytic acid ‘strongly binds’ to minerals, including iron, zinc, magnesium, and calcium, inside our digestive tracts and reduces their absorption.[30] Iron and zinc deficiencies are endemic in developing countries, affecting a third of the world’s population. Eating grains without deactivating the phytic acid worsens these deficiencies. Researchers in the journal Science suggest avoiding eating unprocessed grains with main meals to prevent phytic acid from blocking mineral absorption.[31]
In 1979, researchers studied to what extent phytic acid could block zinc uptake in a meal.[32] They tested oysters, rich in zinc, with black beans and oysters with corn tortillas, which were middling and high in phytic acid, respectively. The results were surprising.
The more phytic acid in the meal, the more zinc uptake was blocked. (Soloman et al, 1979)
The corn tortillas blocked almost all of the available zinc from the oysters. Indeed, three hours after eating, as you can see by the lowest line on the chart above, the tortillas managed to sink zinc levels below baseline, i.e. beneath the starting level of zinc. In other words, the phytic acid in corn removed more zinc from the body than the oysters added.
The meal of oysters and black beans, lower in phytic acid, correspondingly blocked less zinc. Interestingly, the corn used to make the tortillas was lime-soaked, which should have deactivated the phytic acid.
Lectins
Lectins are resistant to human digestion and, like phytic acid, can block the absorption of nutrients.
Whole grains are a concentrated source of lectins. They can trigger different parts of the immune system and, in some people, worsen their autoimmunity.[33] In animal models, they worsen intestinal inflammation and permeability (known as ‘leaky gut’) as well as activating the immune system and increasing the likelihood of food allergies and intolerances.[34] These negative changes in the gut compromise the absorption of vitamin B12, important fats including the fat-soluble vitamins (A, D, E, and K) and proteins, potentially stunting growth.[35]
Oxalates
Oxalates, including oxalic acid, bind to minerals, including sodium, potassium, calcium, iron, and magnesium and reduce their absorption.[36]
The miniature glass-like shards are in grains and other fruits and vegetables in varying amounts. Animal livers, including humans, contain some because they’re produced as a natural part of metabolism. Oxalates defend the plant from soil pollution.[37] A healthy gut flora should break down a reasonable level of oxalates without causing symptoms.[38] But, small amounts of oxalates are absorbed through the intestine and colon.[39] Together with gut dysfunction, which is common, or when excessive amounts are consumed—think green smoothies with almond ‘milk’ and whole grain toast for breakfast every day—they contribute to 80% of our kidney stones.[40]
Buckwheat, a gluten-free grain, is probably the highest oxalic acid-containing grain.[41]
Gluten
Whilst not a true anti-nutrient, gluten, found in wheat, barley, rye, and other grains, is a protein that can cause problems for individuals with coeliac disease (an autoimmune disease) or non-coeliac gluten sensitivity, leading to inflammation and intestinal damage; discussed later. Gluten is not completely broken down in the human gut; these partially broken down proteins, called peptides, can cause myriad symptoms. Total levels of gluten found in heirloom grain varieties—often termed ‘ancient’—including einkorn, emmer, and spelt are typically about the same as in modern versions of wheat.[42]
However, the type of gluten in modern varieties is different, lending itself to a lighter, more bubbly bread, which is a hit with consumers but may be harder to digest.[43]
One such peptide, gliadorphine, can be problematic for totally different reasons.
Gliadorphine—from the words gliadin (the problematic protein inside gluten) and ‘orphine’ from the word morphine—is a peptide that attaches to opiate receptors in the gut, which then create opioid-like compounds[44] which travel to the brain mimicking the effect, albeit less intense, of opioid drugs including morphine, street name heroin.[45] When trying to remove gliadin-containing grains, including wheat, rye, barley, and products made with them, people can experience signs of withdrawal.
This makes people resistant to removing gluten-containing grains.
Other anti-nutrients in grains worth covering
Tannins can bind to nutrients, including iron and proteins forming substances that can cause digestive distress and nutrient deficiencies if not made up elsewhere in the diet.[46]
Providers of food aid considering anti-nutrient deactivation for their charitable donations.[47] Given that iron is the single most prevalent nutrient deficiency in the world and billions of people fail to get enough protein, anything blocking these critical nutrients is a major concern.[48] Healthy people with robust gut flora should be able to break down tannins without an issue.[49]
Starving people don’t have healthy gut floras.[50]
Protease inhibitors are compounds found in grains and other foods that interfere with our ability to use the enzyme protease to break down and absorb proteins.[51]
Plants use protease inhibitors as a defence against pests and microbial infections by interfering with their miniature digestive abilities.
Traditional processes can reduce or deactivate many of these plant chemicals.
Niacin deficiency (vitamin B3) can kill.
Traditional processing of grains
In 1493, a year after Christopher Columbus ‘discovered’ America, corn found its way into Europe as part of what would later become known as the Columbian Exchange.[52] After years of hybridization—the process of cross-pollinating plants to improve certain characteristics for human usage—corn became a staple crop in Europe where it proved hardier than many native grains.
But, what failed to arrive with it was the knowledge of how to absorb the nutrients within.
Soaking
In Europe, as corn took off in popularity, a disease began ripping through villages and towns like some pernicious plague.[53]
The niacin deficiency (vitamin B3) disease is known as Pellagra, which is characterised by the four ‘Ds’: dermatitis, diarrhoea, dementia, and death. What Central American cultures had learned from experience was skipped by the Europeans; corn needs soaking in lime water, a process called nixtamalisation, which unlocks the nutrients within.[54] It wasn’t until the 20th century that scientists discovered the cause of pellagra and the simple remedies of appropriate food preparation and or a diverse diet, including animal produce, which contains bioavailable niacin nixtamalisation not required.[55] Today, pellagra is rare except where food aid is distributed, and people exist on nothing but one or two types of grain for months at a time.[56]
Sprouting
If soaking in water or another solution isn’t enough to disarm the anti-nutrients, the next step is to sprout the grain.
Sprouting is when the kernel's germ begins turning into the next generation of plants. Water acts as a chemical signal to the kernel, which begins breaking down the now unnecessary protective anti-nutrients, allowing it to sprout. This process can last from a single day to several days, depending on how much sprouting is required and its usage afterwards. Breads made from sprouted grains are much more digestible and nutritious precisely because of the deactivation of anti-nutrients unlocking the micronutrients held within.[57]
In essence, sprouting transforms a grain into a vegetable.
Fermentation
As mentioned, humans have fermented grains since before domestication to make alcohol. However, fermentation has more than one benefit. Traditional ‘sourdough’ bread uses fermentation to make bread rise. People were flying before modern baker's yeast had been invented.[58] The real benefit of sourdough lies within the enzymatic breakdown of anti-nutrients which releases micronutrients and renders the product more digestible and filling.[59] Sourdough bread also has less impact on blood sugar.[60]
Cooking
The simple act of cooking also increases nutrient bioavailability in grains, but not by much.[61]
To get the most out of grains, they should be soaked, sprouted for a day or two, and milled into whole flour, sourdough fermented for at least 72 hours before being baked. That’s an incredible amount of work for a food that, kilogram for kilogram, isn’t as nutritious as fruit or tubers and doesn’t come close to matching the nutrients found inside animal produce.
Animals lacking tools also have to process grains to digest them. They do it with their organs.
When you don’t have tools, evolve
Birds, including chickens and turkeys, have gizzards, which are thickly muscled chambers in their digestive tracts.
They swallow small stones inside the gizzard which churns both the stones and grains, creating a rough kind of whole-grain flour ready for further chemical processing. Ruminants, like goats, cows and sheep, perform multiple steps. Grinding in the mouth followed by soaking and fermenting in multiple stomach chambers. One of these, the rumen, contains microorganisms that ferment and break down grains and other fibrous plants which feed themselves and their ruminal bacteria. In an ultimate act of betrayal inside the final stomach chamber, ruminants consume their symbiotic bacteria as a ready protein source. This explains why some herbivores can be positively Herculean in muscular size and strength.
These internal processes, external for humans, evolved to make a problematic food edible.
But these processes do not create a superfood.
When famines loomed large, our starving distant ancestors likely discovered these processes through blood, sweat, tears and ripping gut pain whilst being forced to consume anything and everything in their environment. Today, modern industrial processes steamroll over these traditional steps. Convenience and profit trump nutrients. But—because most people are omnivores and have at least some nutritious foods in their diet—the nutrient shortfalls caused by improperly prepared whole grains have been obscured and made up for by other more nourishing foods, fortification and supplementation.
Anti-nutrients aside now, modernity has more to answer for regarding diminishing grain quality.
An increase in quantity at the cost of quality
Cross-pollination
In the 1950s Nobel Laureate Norman Borlaug cross-pollinated wheat and rice varieties to create higher yields with more disease resistance called ‘dwarf’ varieties.
Today, 99% of the world’s wheat is Borlaug’s creation. Coming at a time of explosive population growth and famine as well as advances in chemical fertilisers and the idea that big is always better when it comes to farming, Borlaug’s cross-pollination techniques—which became a part of the ‘Green Revolution’ a technological farming movement designed to increase food production around the world—saved thousands from famine in poorer countries, including India and Pakistan.[62]
But, with an increase in quantity came a reduction in quality.
Toxic agents in grains
In India, a team of scientists examined the changes in the new grain’s mineral content between 1960, after its introduction, until 2010.[63]
They found a notable reduction in crucial minerals like iron (minus 30% in rice and 19% in wheat) and zinc (minus 33% in rice and 27% for wheat). As well as reductions in phosphorus, calcium and copper. Also, other beneficial elements like nickel and silicon were reduced. Conversely, there was an increase in the toxic metal pollutants used by local industry such as arsenic, chromium, barium, strontium, and aluminium in rice. When cells lack sufficient minerals, they become more susceptible to absorbing toxic metals from soils simply because there’s space for them—like free spaces in a car park. This also happens in human mineral-deficient cells, leading to poisoning and susceptibility to disease.[64] Modern cross-pollinated grains and the chemicals sprayed on them may have been a boon for production, but they’re a double-edged sword.
The wound from which we’re only just beginning to feel.
Danger! Do not enter! But fine to eat apparently.
The pollutants found in grains aren’t just absorbed from the soil.
Every year, the world sprays more chemicals on crops than the year before, and the problems don’t end there.[65] Grains are susceptible to picking up other ‘natural’ toxins at every production stage.
Firstly, let’s look at one of the most controversial agricultural chemicals today.
Glyphosate
Glyphosate, aka Roundup, is the world’s most popular herbicide and crop desiccant (dryer).
Engineered in the 1970s by Monsanto, now a part of Bayer, the market in 2024 is estimated to be worth $9.14 billion and is expected to reach $13.11 billion by 2029.[66] In 2015, the International Agency for the Research on Cancer, a division of the World Health Organisation, classified glyphosate as a ‘probable carcinogen’ based on human evidence of exposure and rigorous animal experiments.[67]
In 2017, the state of California, USA, listed glyphosate as a known carcinogen.[68]
In 2018, a judge fined Monsanto $289 million for not providing enough information about the toxicity of their hit product to a groundskeeper who later developed cancer. By 2020, the chemical giant had paid out $10 billion to claimants with similar stories of glyphosate poisoning. According to the New York Times, within just three years, Monsanto (Bayer) had added another $2 billion for an estimated 50,000 claimants.[69] Despite judges and juries accepting claimants' evidence, the specifics remain largely undisclosed outside courtrooms.
One challenge in proving glyphosate's toxicity to humans is that the chemical pathway on which it exerts its action does not occur in mammals. Because of this fact, vested parties have proclaimed the chemical’s innocence. Glyphosate is principally a herbicide, but it also has strong antibacterial properties.[70]
But here’s the thing: humans have more bacterial cells than human cells.
In a way, we’re only 43% human.[71]
The vast proportion of bacteria that exist within humans resides in our guts. Recent research has shown that in mice, at lower than acceptable daily intakes, glyphosate damages gut flora, triggering the immune system and increasing inflammation.[72] Only clinical trials on animals can be conducted to test the toxicity of glyphosate or any chemical under question because running a trial on humans is unethical. So, observational studies will have to do until more people die, forcing politicians to disentangle themselves from the companies poisoning everyone.
One study that included collecting samples from kids living near large farms in China but was otherwise observational found over 92% of them were urinating out glyphosate.[73] The higher their levels, the more biomarkers of kidney injury they exhibited. The Environmental Working Group (EWG), a non-profit specialising in research and advocacy in agricultural subsidies, toxic chemicals, drinking water pollutants, and corporate accountability, have recently tested for glyphosate in grain-based products. Testing 28 conventionally grown oat products, all 28 of them tested positive for glyphosate, with 26 being above the group’s safe level.[74] All the kids' breakfast cereals tested were unsafe; the gold medal went to Quaker Oatmeal Squares, with 18 times the EWG’s safe level. Testing organic oat products yielded more reassuring results; about one-third of the 16 tested positive.
The US Food and Drug Administration (FDA) tested corn and found glyphosate in 63% of the samples below their safety level—a level now considered far too low by the EWG, set well before any successful court cases against the biotech behemoth. The government agency's failure to test for glyphosate in wheat or oats, given its use as a desiccant just before harvesting, is alarming.[75]
Unsurprisingly, the EWG’s analysis of wheat products found all 12 of their samples were contaminated by glyphosate. In addition, an analysis by the Canadian Food Inspection Agency found the herbicide in between 80-90% of their wheat samples.[76]
Back in the 1970s, the truth about DDT—a chemical insecticide that was poisoning people and the environment and which persists today—finally came out.[77] Lobby groups and their swollen legal teams working for DDT manufacturers, including Monsanto, resisted the negative evidence about their cash cow chemical until the very last.
It’s the same with glyphosate.
Since the International Agency for the Research on Cancer’s 2015 report classifying glyphosate as a probable carcinogen, ‘It quickly became evident that separating science from politics and economic interests would be difficult for glyphosate.’ writes the researcher Manolis Kogevinas in the British Medical Journal.[78] He continues, ‘[the classification] led to unprecedented lobbying by Monsanto.’ According to OpenSecrets, using data from the Senate Office of Public Records, in 2017, Bayer felt the need to spend nearly $14 million on lobbying efforts. In 2022, they spent nearly $6.5 million, closer to their average yearly spend, pressuring weak politicians for favourable legislation.[79] Modern grains are drenched in glyphosate.
It’s a great money maker but it’s terrible for health.
Chemical cocktails
Pesticide use is on the increase.
Foodwatch International is an independent, non-profit organisation that advocates for consumer rights in the food industry. It focuses on exposing unethical food production practices, promoting transparency and food safety, and championing the right to safe and good quality food for all consumers.
In their 2023 report entitled The Dark Side of Grains: Unmasking Pesticide Use in Cereal Crops, they write:
‘Pesticide[80] products often contain multiple active ingredients; in practice, several products are frequently applied together. Over a crop season, numerous applications may occur, and depending on the crop and crop rotation, the same area may be treated with various pesticides. The presence of multiple chemicals, including heavy metals, radioactive materials, plasticisers, flame retardants, drugs, and antibiotics, in foods or leaking into the environment is commonly referred to as a “chemical cocktail”. The adverse effects of the simultaneous presence of chemical cocktails are not considered in the official pesticide risk assessment, which is based on the erroneous assumption that people and the environment are exposed to only one chemical at a time.’[81]
Over 300 active chemicals are approved for use in arable farming in the UK and Europe.
As you can see from the Our World in Data chart below, the vast majority of arable land is used for cereal production; globally wheat and rice are the most common and drink most of the chemicals.
Since 1990, pesticide use—technically an umbrella term including pesticides, herbicides and fungicides—on grains in the UK has nearly doubled.[82]
In 2017, the UK government tested 3,357 samples of rice and bread revealing chemical cocktails in more than half and a quarter respectively.[83] Bread (wheat), rice, rye flour and rye grain all contained a chemical cocktail.
Dementia, including Parkinson’s and Alzheimer’s disease, is associated with pesticide usage based on both observational studies and laboratory research.[84] Various types of cancer have been associated with pesticide use for decades.[85] Also, diabetes, amyotrophic lateral sclerosis (ALS), birth defects, and reproductive disorders. There is also circumstantial evidence linking other chronic diseases like respiratory problems, particularly asthma and chronic obstructive pulmonary disease (COPD), cardiovascular diseases such as plaque build-up in arteries and coronary artery disease, chronic kidney diseases, painful autoimmune diseases like lupus and rheumatoid arthritis, chronic fatigue syndrome, and accelerated ageing.[86]
In a 2023 study, scientists monitored 107 chemicals accumulating in children.[87]
They discovered that 95% of the participants had these universally toxic substances with 'concerning properties,' cumulatively becoming 'critical' despite not surpassing the considered safe levels of any individual chemical.
But pollutants and farming chemicals are not the only toxins we should be worried about in grains.
Mycotoxins
Mycotoxins are toxic substances made by specific types of fungi that can contaminate grains at any stage of their production, from growing in the field to harvesting, handling, storing, and processing.[88]
They have the potential to lead to acute poisoning, fatalities, and long-term illnesses, including cancer, weakened immune systems, stunted growth, and birth defects in humans, farm animals, and household pets.[89] They’re not reliably reduced by the simple processes we’ve already discussed, so prevention by attentive handling at every stage is key. Aflatoxins are the most common type to infect grains.
The International Agency for Research on Cancer has classified certain aflatoxins as group 1 carcinogens, meaning they have been shown to cause cancer in humans.[90] Other aflatoxins are group 2, making them probably carcinogenic. Globally, grains infected by mycotoxins cost billions of dollars every year. Mycotoxins are a major concern to the global livestock industry.[91] Grain-based animal feed has bentonite clay added to absorb mycotoxins within the feed and throughout the animal’s digestive system.[92]
Without this addition, animals can become sick and even die.
In developing countries, millions of people are made critically ill by mycotoxins. Indeed, aflatoxins are ranked sixth in the top 10 major health threats worldwide.[93] In Africa, 86% of corn and peanut samples contain at least four mycotoxins.[94] In the USA, anything between 3.4% to 76% of corn samples contained at least one mycotoxin.[95] In developed countries, frequent testing of grains is required to ensure mycotoxins remain under a certain acceptable level.[96] These add to the existing chemical cocktail, the effects of which remain to be seen.
Chemical cocktails and mycotoxins aside, many grains contain gluten, which for some, many even, is an existential threat to their health without them knowing it.
Epidemics by gluten
Coeliac disease
For reasons unknown, the incidences of coeliac disease are increasing globally.[97]
Coeliac disease is an autoimmune disorder where ingesting gluten damages the small intestine. About 1 in 100 people in the UK have been diagnosed with coeliac disease, although it is likely that many people have it without realising it whilst they search for other causes of their hard-to-pin-down symptoms.[98]
Gluten causes an immune reaction that harms the lining of the small intestine, impairing nutrient absorption and increasing deficiencies. Obvious symptoms include vomiting, diarrhoea, bloating, and weight loss. Less obvious ones are only now being revealed. There is no treatment other than avoidance of gluten, which is found in wheat (all varieties), rye, barley and anything made from them, including bread, beer, biscuits, sauces and many other products.
Non-coeliac gluten sensitivity
Non-coeliac gluten sensitivity (NCGS) was a make-believe disorder.
This required psychological help rather than the interventions of a medical doctor. This of course turned out to be dead wrong.[99] NCGS is a condition where individuals experience symptoms similar to those of coeliac disease after consuming gluten, but they do not test positive for coeliac disease or wheat allergy. Like coeliac disease, the only remedy is avoidance of gluten.[100]
Gluten in mental health illnesses and psychosis
A paper entitled Mood Disorders and Gluten: It’s Not All in Your Mind! reviewed the literature and found that a gluten-free diet ‘significantly improved depressive symptoms.’[101]
People who suffer psychological conditions like schizophrenia, autism, or bipolar disorder are more likely to have gluten antibodies in their blood compared to the average person.[102] This means they have an inflammatory immune response every time they eat gluten. In individuals with schizophrenia, the levels of gluten antibodies can be as much as four times higher than in those without the condition.[103] Exactly what role this allergic reaction is playing is yet to be defined, but it suggests that gluten is acting as a trigger to some of the most life-changing psychological conditions people face.
For people with these conditions and raised gluten antibodies, does removing gluten help?
Numerous documented cases show individuals with schizophrenia and autistic spectrum disorders experiencing improvements when following gluten-free diets.[104] In a thorough 2015 case study, a 14-year-old girl from Sicily exhibited severe psychotic symptoms like hallucinations, paranoia, and suicidal thoughts.[105] Despite a negative wheat allergy test, the girl’s doctors removed gluten from her diet. Her severe psychotic symptoms vanished within a week. Adding gluten back in, her hallucinations, headaches, and psychosis returned within 24 hrs. Nine months of a gluten-free diet later, she had no psychological episodes and, according to her mother, is ‘a normal girl again’.
Gluten triggers anxiety
A mounting wave of research is unveiling the profound two-way connection between the gut microbiome and the central nervous system.[106] When gluten triggers intense inflammation in the gut, it throws the central nervous system into chaos, manifesting as anxiety—a striking reminder of the deep interplay between what we eat and how we feel.
One study involving 23 participants revealed that 13% experienced a noticeable drop in anxiety after embracing a gluten-free diet, underscoring the potential mental health impact of eliminating gluten.[107]
Celiac disease and mental health
A review of eight studies assessed intervention techniques aimed at improving mental health and gluten-free diet adherence in coeliac patients. The findings were striking—each study revealed significant improvements in participants' understanding of coeliac disease and their ability to stick to a gluten-free diet, which in turn led to a marked reduction in anxiety and depression symptoms.
These mental health benefits endured at a three-month follow-up, with several studies also targeting the behavioural and cognitive challenges that often contribute to dietary non-adherence and its psychological toll.[108]
Inflammatory bowel disease (IBD)
Certain components in grains, especially in modern, everyday yeast-fermented—not traditional sourdough—bread made from wheat and rye, can exacerbate inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, by increasing inflammation in genetically susceptible individuals.[109] Remember that sourdough is not a get-out-of-jail-free card for those with IBD, but it may be easier to digest for some.
For non-coeliac gluten-sensitive people, gluten can make the intestines more permeable than is healthy. Gluten can trigger immune responses leading to inflammation in the gut and beyond, causing nutrient malabsorption, potential nutrient deficiencies and weight loss.[110] In 2023, scientists published research in the journal Frontiers in Nutrition recommended IBD patients reduce or eliminate gluten and swap it for rice, a naturally gluten-free grain, to reduce gut inflammation.[111] Sprouted and fermented millet, another naturally gluten-free grain, may have a positive effect on gut flora and, therefore, could be a valuable food for those with IBD, or at least not a terrible one like gluten-containing grains.[112]
A gluten-free diet may benefit psoriasis,[113] asthma,[114] eczema,[115] IBS,[116] arthritis,[117] hypertension,[118] and a host of other conditions, including sleep and quality of life.[119] Eliminating gluten-containing grains for those with hard-to-manage chronic health issues may be a powerful therapy.
Remember that there is no such thing as a grain deficiency because nutrients can easily be found elsewhere.
How nutritious are whole grains, anyway?
Public Health England recommends we, ‘Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates; choosing whole grain versions where possible’. They suggest that you ‘Start your day with a whole grain breakfast cereal[...]have a sandwich for lunch and round off your day with potatoes, pasta or rice as a base for your evening meal.’[120]
If our public health experts recommend we base our meals around whole grains and other starchy carbohydrates, they must be nutritious, right? According to Harvard T.H. Chan School of Public Health:
‘whole grains offer a “complete package” of health benefits[...]The bran is the fibre-rich outer layer that supplies B vitamins, iron, copper, zinc, magnesium, antioxidants, and phytochemicals[...]The germ is the core of the seed where growth occurs; it is rich in healthy fats, vitamin E, B vitamins, phytochemicals, and antioxidants. The endosperm is the interior layer that holds carbohydrates, protein, and small amounts of some B vitamins and minerals.’[121]
We’ve bolded things which we’ll address later.
Whole grains are nothing close to a ‘complete package’ of anything except carbohydrates; see the image below:
Zoe Harcombe, PhD, a nutrition scientist and researcher, compared 100 grams of five whole-grain foods, including whole-grain wheat flour, brown rice, whole-wheat spaghetti pasta, oats and whole-wheat bread with chicken liver, sardines, eggs, sunflower seeds and kale. 100 grams of each of the last five provide all the Reference Nutrient Intake (RNI)[122] for a day.[123] For starters, Harcombe tells us, no whole grains contain complete protein, vitamin A (as retinol or carotene), or vitamins B12, vitamin C or vitamin D. And, compared with many other foods, they’re not a great source of anything except selenium and manganese. Two large portions of whole grains will give you 350 calories and the RNI of those two minerals, which are easily sourced in other ‘real’ foods.[124] You need to eat more nutritious foods to achieve the RNI of other micronutrients.
Attempting to hit your micronutrient RNIs from whole grains supplies excess energy.
Harcombe writes that to achieve your RNI of calcium from whole grain bread, you’d need to eat a kilogram of it, that’s 2300 calories—more than a day’s worth for women and only 200 calories short for men. Sardines will give you the RNI of calcium in just 540 calories. To achieve your RNI of B6 from brown rice, you get 1250 calories. Alternatively, you can eat 220 liver calories to hit the same total. Roughly the same amount of liver will also give you the RNI of iron.
Whole grains cannot be called nutrient-dense, but they frequently are.
Take oats, for example. For some reason, Healthline.com calls them a ‘good source of protein’.[125] They can be called energy-dense, carbohydrate-rich, and fibre-rich, but they are not a good source of protein. See the comparison chart below.
These numbers can be extrapolated to all grains, give or take. In other words, they are high in energy, mostly from carbohydrates, they contain poor-quality protein and few accessible nutrients, and, most egregious of all, whole grains are sold to us as health foods.
In reality, they’re fueling the obesity epidemic.
But another issue is being systematically ignored by our dietary institutions, government agencies, and most nutritionists and dieticians around the globe. It demands the question: How many of the nutrients in grains are we absorbing?
The truth about bioavailability
Never let anyone tell you that bioavailability has been meaningfully factored into nutrient totals.
It is simply not true. A nutrient's bioavailability is the amount that becomes available to your body's tissues after it has been eaten and gone through the digestive processes. The amount listed and the amount that goes into your cells are different.
They’re not even close!
It’s important to note that nutrition databases cannot definitively give us the bioavailability of nutrients in foods because there are so many variables. For some people, the bioavailability of a nutrient increases when the body's stores are low.[127] The reverse is also true. Our gut flora also determines in part the bioavailability of nutrients.[128]All of the chemicals in our meals, not just individual foods, both good and bad, natural and synthetic, interplay together, making bioavailability a dynamic and highly individualised system.[129] Processing and cooking also determine nutrient absorption. Consider that one slice of whole wheat bread isn’t exactly the same as another.
But, given the commonalities of micronutrient deficiencies in both developed and developing worlds, for entirely different reasons, you might expect that discovering more about the actual bioavailability of our nutrients from foods, especially those our dietary institutions tell us to ‘base our meals around’ would be a priority.[130]
And you’d be dead wrong.
Researchers admit that ‘human and animal [bioavailability] studies are expensive and limited by the large amount of potential food bioactive compounds’.[131] So, in vitro (test tube and petri dish experiments) and computer modelling research are suggested whilst science advances enough to determine true in vivo (inside of a living human being) bioavailability.
So, whilst we wait for science to advance and tell us what we already know about the poor bioavailability of nutrients from our staple foods, let’s look at what research does exist about bioavailability.
Oats—the best of a bad bunch
Healthline.com gives us the following list of nutrients in unfortified ‘regular’ oats for their article 9 Health Benefits of Eating Oats and Oatmeal.[132] The data for these oats vs the whole grain steel cut versions are much more complete; some of the nutrients are higher some are lower, but we’re happy to use them as our example and mention when the whole grain version is notably better.[133]
Wow, just look at all those nutrients.
Research on specific foods like oats and their nutrient bioavailability in vivo is lacking, so we’ve adjusted the nutrient totals above according to the information on the National Institutes of Health (NIH) fact sheets and any detailed research we can find on absorption rates from whole foods.
In the top table, we’re promised 63.91% of our daily RNI of manganese from a portion of oats. But because bioavailability is between 1% - 5%, the totals absorbed are more likely to be between 0.65% - 3.2% of our RNI—see the table below.
And so on.
Oats no longer seem like the nutritional powerhouse they’ve been touted as. Perhaps Healthline.com should have entitled their article 9 Mediocre Benefits of Oats and Oatmeal. Generally, it’s fair to extrapolate similar absorption rates for grains and be more accurate than the database nutrient totals. But, the truth is, it’s impossible to know precisely how much of any given nutrient someone is absorbing. There are just too many variables.
Let’s cover some other benefits mentioned by Harvard,[143] bolded in the How nutritious are whole grains, anyway?
‘Healthy’ Fats & Vitamin E—A 50-gram portion of whole grain oats has about 3 grams of fat, the vast majority of that is the omega 6 fatty acid linoleic acid.[144] You can read about what we think of linoleic acid in our vegetable oils (se[n]ed oils) blog. As you can imagine, we don’t feel that adding the word ‘healthy’ before it changes anything, especially given the oil’s propensity to oxidise when exposed to normal household levels of heat (cooking), moisture, light and air.[145]
The vitamin E in oats—higher in whole grain versions—will protect against some linoleic acid oxidation for about 7 months in whole grains and between 1 and 2 in refined versions.[146] A 50-gram whole grain portion of oats contains about 1.4 mg of vitamin E, which is ~9% of the RNI per day.[147] Unsurprisingly, the type of vitamin E found in oats is not the most bioavailable form.[148]
Carbohydrates—We can all agree that oats, whole grain and refined, are very high in carbohydrates, nearly 70%. This is true of all grains. About 55% of oats come in the form of starch which is broken down quickly into sugar. If you’re interested in sugar, read our article about i[o]t. About 12% of the total carbohydrate is fibre, about 4 grams of which is beta-glucan, which may have some impressive health benefits, including balancing the blood sugar, which typically spikes after eating a bowl of porridge.[149] Whether or not the beta-glucan in oats is better for blood sugar than not eating the oats in the first place is beyond the scope of this article.
Protein—Whole grain oats are about 12.5% incomplete protein, meaning they fall short of adequate amounts of the nine essential amino acids humans must obtain from their diet. Using the Digestible Indispensable Amino Acid Score (DIAAS) system of protein quality, oats get a 60 out of 100.[150] This categorises it as a low-quality protein. So, why Healthline.com calls it high-quality must boil down to wishful thinking.
For comparison, pure whey protein (dairy) scores 100 DIAAS. Sprouting increases the bioavailability of protein slightly, particularly the amino acids lysine and tryptophan.[151]Trying to get enough protein from mixing grains with different amino acid profiles together, as vegetarians are want to do, provides a huge number of calories via carbohydrates, few bioavailable nutrients and an abundance of anti-nutrients.
Iron and Zinc, the world’s most common deficiencies
Using a 50-gram large portion of whole grain steel cut oats this time, see the difference in totals vs potential bioavailable amounts for men and women.
Malting, which is the combination of soaking, sprouting and then drying the oats before cooking, increased the bioavailability of zinc and iron from 12% to 18% and 4% to 6%, respectively.[152]
So, ‘traditional’ processing improves the digestibility of the micronutrients but not by a huge margin.
Observational research
Refined grains are the most popular
There is a lot of negative press about refined ‘white’ grains.
Despite these reports, they comprise a considerable proportion of the average person’s diet. 1/5th of the population in the UK doesn’t eat any whole grains, instead opting for refined versions like white bread, pasta and white rice.[153] Ultra-processed foods, aka junk foods, make up 57% of the average British person’s diet.[154] Of which 40% is made from grains.[155]
Fortunately for them, refined grains are legislated to contain certain micronutrients added during processing. Synthetic forms used in the fortification of ‘white’ varieties often provide greater amounts than the unfortified whole-grain versions.[156] Fortification has been an important addition to refined grains, which, without these synthetic micronutrients, are essentially just carbohydrates.[157] Harvard T.H. Chan School of Public Health scares people into swapping refined grains for whole grains; they write on their website, ‘People who follow a diet rich in whole grains also live longer compared with those who eat foods made from refined grains.’[158]
Associations from observational studies
Researchers observing large cohorts of people over long periods compare those who eat refined grains with those who eat whole grains. As a reminder, observational research cannot show causal relationships between particular foods and outcomes, only associations which should then form the basis of interventional trials to test if that relationship is existential.
Using observational research, epidemiologists have associated eating refined grains with a host of diseases, including obesity,[159] all-cause mortality (dying for any reason within a specified period), cardiovascular disease,[160] chronic inflammation via changes to the gut flora,[161] insulin resistance (at the heart of diabetes),[162] overeating,[163] and more.[164]
On their website page devoted to whole grains, Harvard University’s T.H. Chan School of Public Health uses nothing but observational data to support their position that whole grains are some kind of health panacea. Observational research links do not prove that whole grains are healthy and refined grains are unhealthy because the research is so easily confounded.
The healthy and unhealthy user biases are just two confounding factors.
Healthy and unhealthy user bias
Someone choosing whole grains over refined grains is a ‘healthy user’; probably a health-conscious person who makes many healthy lifestyle decisions.
They are less likely to smoke, binge drink, eat lots of added sugars, overeat in general and be overweight, amongst other things. A healthy user is more likely to choose whole grains—based on their belief that they’re more nutritious than refined grains. They’re more likely to exercise, get outside, manage stress, and generally follow a much healthier lifestyle than those who choose refined grains.
Researchers try to account for this bias, but they cannot exclude it in any meaningful way.[165]
One study published in the Journal of General Internal Medicine assessed the effects of the healthy user bias, recommending:
‘A healthy scepticism when encountering what seems like surprisingly large beneficial effects of preventive therapies. Readers must first assess the plausibility of results.’[166]
The unhealthy user bias is the opposite of the healthy user bias.
The weight of the observational evidence proclaims whole grains to be healthy and refined grains not to be.
Typically, researchers will compare the results of observational studies with interventional, randomised controlled trials (RCTs). There are many examples of observational data signposting in one direction only for the intervention trials to reveal it as a wrong turn.
Sometimes, the truth is buried; other times, policymakers quietly make the necessary alterations to their previous advice.[167] Take cholesterol, for example; for decades, the advice from the American Heart Association experts—which echoed worldwide—was to reduce dietary cholesterol to prevent it from raising our blood levels. However, in 2020, they admitted that the observational data to which they were so attached was ‘likely heavily contributed to by residual confounding’.[168] In other words, eating cholesterol was not raising people’s blood levels despite what their observational data signposted.
The truth was revealed by RCTs back in the 1950s, but it was ignored for decades before quiet policy change.[169]
Observational nutrition research has some gaping methodological holes. Despite that, dietary institutions use it repeatedly as if it provides strong evidence for something. The media loves reporting it because they can make sensationalist headlines.[170] Dr John Ioannidis, a professor of medicine and epidemiology at Stanford Medical School, publishes paper after paper admonishing nutrition research, especially his own area of expertise in epidemiology (observational science).[171] He writes that:
‘Currently, many published research findings are false or exaggerated, and an estimated 85% of research resources are wasted.’[172]
In an interview, Ioannidis doesn’t hold back,
‘The biggest problem is that the vast majority of studies are not experimental, randomised designs. Simply observing what people eat—or even worse, what they recall they ate—and trying to link this to disease outcomes is, moreover, a waste of effort. These studies need to be largely abandoned. We’ve wasted enough resources and caused enough confusion, and now we need to refocus. Funds, resources and effort should be dispensed into fewer, better-designed, randomised trials.’[173] (Emphasis added).
So, does intervention trial data consistently tally with observations about whole grains?
Grain based randomised control trials (RCTs)
The most striking thing about grain research is that none compares whole-grain diets with no-grain diets. All of the research compares whole-grain diets with refined grains.
Obesity
Reviews of observational data suggest that people eating whole grains but not refined grains are less likely to be obese.[174] One review and meta-analysis looked at twelve observational studies and nine intervention trials.[175] The weight of the observational papers found a significant correlation between consuming whole grains and a reduced body mass index.
But, the nine intervention trials found no such link.[176] Another review and meta-analysis of 22 RCTs writes, ‘In conclusion, our findings did not support current recommendations of whole-grain intake in attempts to control obesity measures.’[177]
Metabolic Syndrome
Observational data has been linking refined grain consumption with metabolic syndrome for decades. One paper also associated a reduced risk of the syndrome, which includes diabetes, high blood pressure, obesity, stroke and cardiovascular disease, with greater consumption of whole grains compared to refined grains.[178]
A review of 32 RCTs found whole grain consumption was beneficial on fasted blood sugar levels—high fasted blood sugar is a marker of poor metabolic health—but only for metabolically healthy people. The other markers of metabolic syndrome were unaltered by the consumption of whole grains.[179]
Cardiovascular Disease
A 2016 review and meta-analysis of 45 observational studies found a weak association between increased whole grain consumption and reduced risk of cardiovascular disease, cancer and death.[180]
A review and meta-analysis of 25 RCTs concluded there is insufficient evidence to recommend replacing refined grains with whole grains to improve cardiovascular outcomes, despite slight improvements in LDL cholesterol, a marker of cardiovascular disease.[181]
A Cochrane Review paper of nine RCTs found no evidence of improved cholesterol between whole grain and refined grain groups.[182] Incidentally, the authors also found a high risk of bias and a short trial duration in the available literature. They highlighted a need for high-quality RCTs before recommending whole grain benefits on cardiovascular disease and its markers.
Further, the Women's Health Initiative Randomised Controlled Dietary Modification Trial (2006), including 48,835 postmenopausal women aged 50 to 79, found that recommendations to increase fruits, vegetables and whole grains in the diet did not significantly reduce cardiovascular risk factors. The authors suggested a more focused diet and lifestyle intervention would be needed to improve the disease risk.[183]
Inflammation
Trial data does show a reduction in markers of inflammation when swapping refined grains for whole grain versions, but only in people who had raised levels to begin with.[184] This is most likely due to a reduction in ultra-processed foods (junk food) when making swaps—if you swap a Danish pastry for a slice of sprouted rye bread, no one should be surprised when your inflammatory markers drop.
Another review of 31 RCTs found the same reduction of inflammatory markers, again, only in those with raised markers going into the trial—most often obese people.[185]
In defence of whole grains
Fibre
A huge analysis included 52 RCT meta-analyses covering 47,197 subjects, which showed significant associations between fibre intake and improved blood sugar, blood pressure, reduced LDL cholesterol, and a marker of inflammation.[186] Other meta-analyses of RCTs showed fibre improved constipation by adding bulk to the stool.[187]
Fibre lowers LDL cholesterol by binding to it in the gut and carrying it out of the body. The mechanisms for reducing blood pressure are indirect. They may include helping to reduce obesity, improving the gut flora, binding onto sodium in the gut, which raises blood pressure in about a third of salt-sensitive people,[188] and reducing LDL cholesterol and the possibility of oxidised cholesterol plaque buildup in the arteries. Fibre’s binding qualities assist detoxification via the elimination of toxic byproducts in the gut via stool.[189]
As mentioned, much of the observational research supports the consumption of whole grains for healthy outcomes. Grains are an important source of calories for millions of people in developing countries. Fortification provides an important source of nutrients for those in both developed countries—because of poor choices—and developing countries—because of no choices.
Whole grains do have an anti-inflammatory role when compared to refined grains.
Is fibre all that?
The subject of fibre is one of those dietary untouchables.
It’s a ‘settled science’ not to be debated. Dietary institutions fail to address any nuances in fibre consumption or anything else. It’s worth mentioning that Public Health messages can’t address nuances; they must be simple. Black and white. Unhealthy or healthy. But for truth-seeking individuals, one such nuance is the fact that it’s possible to overeat fibre, resulting in a reduction in nutrient intake and an increase in constipation.[190] Both of these downsides are unheard of by most people. Fibre binds to nutrients as it binds to cholesterol, carrying them out of the body.
The definition of a nutrient, according to the Oxford English Dictionary, is something that serves as ‘nourishment; possessing nutritious qualities.’[191] Fibre does not enter our ‘body proper.’ Its role is exclusively inside the gut lumen—the space inside the digestive tract that starts in our mouth and finishes at our anus. So, although it’s often grouped with nutrients, fibre isn’t one, at least not like vitamins and minerals are. Fibre simply doesn’t enter our cells.
Fibre does, however, feed certain intestinal floras. But if that qualifies it as a nutrient, it’s not a human one. And, if nourishing certain gut microbes qualifies it as a human nutrient, then glyphosate should be accepted as a human poison and banned immediately.
Much of the observational research showing the benefit of high fibre intake may easily demonstrate that when healthy users choose more fibre, they eat fewer junk foods. When a reduction in inflammation is shown by comparing whole grain diets to refined grain ones, this reduction in ultra-processed foods, which are inflammatory, is probably the mechanism.[192]
For this article, we don’t need to argue about the virtues of fibre one way or the other because it’s so easy to obtain from elsewhere in the diet. Green leafy vegetables, the most nutrient-dense class of edible plant, can provide plenty without anyone needing a single mouthful of grains.
Wrap up
It’s impossible to know why humans have become so attached to grains.
It makes sense that our ancestors tried to eat everything in their environment when the pressure was on. Put simply, grains were a starvation food. Through trial and error, early people realised that grains needed to be simply processed before they could go on the menu. What kept them on the menu is anyone’s guess.
Perhaps the addictive compounds in gluten-containing grains played a role in their popularity. In the same vane, perhaps a serendipitous accident when fermenting grains gave birth to alcohol and another addictive quality came to the fore. Then, as James Scott convincingly argues, they became the only crop upon which cities and states could be built. At that point, human and grain destinies became intertwined. It’s fun to think about these things, but no one knows why we relied so heavily on crops that were not the best at anything. Not the most nutritious or easiest to farm or keep from spoiling. But they were a quantifiable, taxable currency.
As mentioned throughout, the research supposed to show the benefits of whole grain consumption is almost always observational. RCTs that show benefits compare whole grains with refined grains, which is like comparing any whole food with junk food. Of course, there is a quantifiable benefit to this swap! It is categorically not proof that whole grains are healthy, only that they are healthier than unfortified refined grains and junk.
Where are the RCTs that pit whole grains against no grains?
We suspect that researchers wouldn’t like the information from a study comparing whole grains with no grains, like accepting the low bioavailability of the touted nutrients in whole grains. New data may make their advice for the past 40 years or so look, at best, misguided and, at worst, inept and negligent. Nutrition research needs an overhaul.
Grains don’t provide nutrients that can’t be easily sourced elsewhere in the developed world. In the developing world, famine is an existential threat but this has much more to do with poverty than food shortages. Grains are handed out, not because they’re a nutritious food, but because Western nations, often the USA, produce surplus amounts and because they’re easily transported and stored.
There are many reasons to avoid grains and not many to eat them beyond their convenience, low cost and moreishness.
References
[1] Larsen, C. S. (2006). The agricultural revolution as environmental catastrophe: Implications for health and lifestyle in the Holocene. Quaternary International, 150(1), 12-20. https://doi.org/10.1016/j.quaint.2006.01.004
[2] Ballantyne, S. (2023). Why grains are bad--part 1, lectins and the gut. The Paleo Mom. available online at: https://www.thepaleomom.com/why-grains-are-bad/ Last accessed on 15th December 2023.
[3] Julio Mercader (2009) Mozambican Grass Seed Consumption During the Middle Stone Age. Science 326, 1680-1683. DOI:10.1126/science.1173966
[4] 12,000 BCE (Before Common Era) means 14,023 years ago. (2023)
[5] Gonzalez Carretero, L., Ramsey, M. N., Fuller, D. Q., & Richter, T. (2018). Archaeobotanical evidence reveals the origins of bread 14,400 years ago in northeastern Jordan. Proceedings of the National Academy of Sciences, 115(31), 7925-7930. https://doi.org/10.1073/pnas.1801071115
[6] Kuijt, I., & Finlayson, B. (2009). Evidence for food storage and pre-domestication granaries 11,000 years ago in the Jordan Valley. Proceedings of the National Academy of Sciences, 106 (27), 10966-10970. https://doi.org/10.1073/pnas.0812764106
[7] The selective breeding and management of crops to propagate preferential traits for human usage.
[8] Ben-Dor, Miki. (2019). How carnivorous are we? The implication for protein consumption. Journal of Evolution and Health. 3. 10.15310/2334-3591.1096.
[9] Due to the installation of dams and other manmade structures, these rivers no longer flood like they did before human intervention.
[10] James C. Scott, (2017) Against the Grain: A Deep History of the Earliest States, Yale University Press, New Haven and London. pp. 39 – 40.
[11] Liu, L., Wang, J., Rosenberg, D., Zhao, H., Lengyel, G., & Nadel, D. (2018). Fermented beverage and food storage in 13,000 y-old stone mortars at Raqefet Cave, Israel: Investigating Natufian ritual feasting. Journal of Archaeological Science: Reports, 21, 783-793. https://doi.org/10.1016/j.jasrep.2018.08.008
[12] Curry, A. (2017) Our 9,000-Year Love Affair With Booze. National Geographic. Available online: https://www.nationalgeographic.com/magazine/article/alcohol-discovery-addiction-booze-human-culture Last accessed: 22nd January 2024.
[13] James C. Scott, (2017) Against the Grain: A Deep History of the Earliest States, Yale University Press, New Haven and London.
[14] Powell, M. (1996). Money in Mesopotamia. Journal of the Economic and Social History of the Orient, 39(3), 224-242. Retrieved February 1, 2021, from http://www.jstor.org/stable/3632646
[15] Adams, R.M. (2008) An Interdisciplinary Overview of a Mesopotamian City and its Hinterlands. Cuneiform digital Library Journal pp.1-23
[16] Tsui, Y. (2012). SWINGING BETWEEN NOMADISM AND SEDENTARISM: A CASE STUDY OF SOCIAL AND ENVIRONMENTAL CHANGE IN THE NOMADIC SOCIETY OF THE ALTAY STEPPES, XINJIANG. Nomadic Peoples, 16(1), 50-67. Retrieved January 28, 2021, from http://www.jstor.org/stable/43123899
[17] M. L. Flint et al., (1981) Introduction to Integrated Pest Management. Plenum Press, New York.
[18] Heinz, H. J. (1966) Social organization of the !Ko Bushmen. Master’s thesis. Department of Anthropology, University of South Africa, Pretoria.
[19] Jared Diamond, "The Worst Mistake in the History of the Human Race," Discover Magazine, May 1987, pp. 64-66. [Online] Available at: https://www.discovermagazine.com/planet-earth/the-worst-mistake-in-the-history-of-the-human-race Last accessed: 19th December 2023.
[20] Cassidy, C.M. (1980) Nutrition and Health in Agriculturalists and Hunter-Gatherers: a Case Study of the Prehistoric Populations. Nutritional Anthropology. Pleasantville, NY: Redgrave. [Online] At: https://core.tdar.org/document/113447/nutrition-and-health-in-agriculturalists-and-hunter-gatherers-a-case-study-of-the-prehistoric-populations-in-nutritional-anthropology
[21] Goodman, Alan & Lallo, J. & Armelagos, George & Rose, J.C.. (1984). Health Changes at Dickson Mounds, Illinois (950-1300 A.D.); Nissen, H., J., (1998) The Early History of the Ancient Near East, 9000–2000 B.C. University of Chicago Press. Chicago. pp.130.
[22] Hermanussen, M. (2003) “Stature of early Europeans,” Hormones, 3(2), pp. 175–178. Available at: http://www.hormones.gr/pdf/Stature_europeans.pdf.
[23] Grasgruber, P. et al. (2016) “Major correlates of male height: A study of 105 countries,” Economics & Human Biology, 21, pp. 172–195. doi: 10.1016/j.ehb.2016.01.005.
[24] Max Roser, Cameron Appel and Hannah Ritchie (2021) - “Human Height” Published online at OurWorldInData.org. Retrieved from: 'https://ourworldindata.org/human-height' [Online Resource]
[25] Headey, D., Hirvonen, K. and Hoddinott, J. (2018), Animal Sourced Foods and Child Stunting. American Journal of Agricultural Economics, 100: 1302-1319. https://doi.org/10.1093/ajae/aay053
[26] Van Damm, A. (2023) Why Are Americans Getting Shorter? The Washington Post. Available online at: https://www.msn.com/en-us/money/careers/why-are-americans-getting-shorter/ar-AA1lxTl7 Last accessed on 15th December 2023.
[27] Mishra A., Behura A., Mawatwal S., Kumar A., Naik L., Mohanty S.S., Manna D., Dokania P., Mishra A., Patra S.K., et al. Structure-function and application of plant lectins in disease biology and immunity. Food Chem. Toxicol. 2019;134:110827. doi: 10.1016/j.fct.2019.110827.
[28] Science Direct (2023) Antinutrients. Science Direct. Available online: https://www.sciencedirect.com/topics/food-science/antinutrients Last accessed: 20th December 2023.
[29] Gupta, R. K., Gangoliya, S. S., & Singh, N. K. (2015). Reduction of phytic acid and enhancement of bioavailable micronutrients in food grains. Journal of food science and technology, 52(2), 676–684. https://doi.org/10.1007/s13197-013-0978-y
[30] Bohn, L., Meyer, A. S., & Rasmussen, S. K. (2008). Phytate: impact on environment and human nutrition. A challenge for molecular breeding. Journal of Zhejiang University. Science. B, 9(3), 165–191. https://doi.org/10.1631/jzus.B0710640
[31] Bohn, L., Meyer, A. S., & Rasmussen, S. K. (2008). Phytate: impact on environment and human nutrition. A challenge for molecular breeding. Journal of Zhejiang University. Science. B, 9(3), 165–191. https://doi.org/10.1631/jzus.B0710640
[32] Solomons, N. W., Jacob, R. A., Pineda, O. & Viteri, F. (1979). Studies on the bioavailability of zinc in man: Absorption of zinc from organic and inorganic sources*. J LAB CLIN MED, 94, 335.
[33] Vojdani A. (2015). Lectins, agglutinins, and their roles in autoimmune reactivities. Alternative therapies in health and medicine, 21 Suppl 1, 46–51.
[34] Alatorre-Cruz J.M., Pita-López W., López-Reyes R.G., Ferriz-Martínez R.A., Cervantes-Jiménez R., Carrillo M.D.J.G., Vargas P.J.A., López-Herrera G., Rodríguez-Méndez A.J., Zamora-Arroyo A., et al. Effects of intragastrically-administered Tepary bean lectins on digestive and immune organs: Preclinical evaluation. Toxicol. Rep. 2017;5:56–64. doi: 10.1016/j.toxrep.2017.12.008.
[35] Gong T., Wang X., Yang Y., Yan Y., Yu C., Zhou R., Jiang W. Plant Lectins Activate the NLRP3 Inflammasome To Promote Inflammatory Disorders. J. Immunol. 2017;198:2082–2092. doi: 10.4049/jimmunol.1600145.
[36] Petroski, W., & Minich, D. M. (2020). Is There Such a Thing as “Anti-Nutrients”? A Narrative Review of Perceived Problematic Plant Compounds. Nutrients, 12(10). https://doi.org/10.3390/nu12102929
[37] Franceschi V.R., Nakata P.A. CALCIUM OXALATE IN PLANTS: Formation and Function. Annu. Rev. Plant Boil. 2005;56:41–71. doi: 10.1146/annurev.arplant.56.032604.144106.
[38]Abratt, V. R., & Reid, S. J. (2009). Oxalate-Degrading Bacteria of the Human Gut as Probiotics in the Management of Kidney Stone Disease. Advances in Applied Microbiology, 72, 63-87. https://doi.org/10.1016/S0065-2164(10)72003-7
[39] Savage G., Vanhanen L.P., Mason S., Ross A.B. Effect of Cooking on the Soluble and Insoluble Oxalate Content of Some New Zealand Foods. J. Food Compos. Anal. 2000;13:201–206. doi: 10.1006/jfca.2000.0879.
[40] Worcester, E. M., & Coe, F. L. (2010). Clinical practice. Calcium kidney stones. The New England journal of medicine, 363(10), 954–963. https://doi.org/10.1056/NEJMcp1001011
[41] Harvard (2008) Oxalate Content of Foods; Department of Nutrition, Harvard T.H. Chan School of Public Health; https://regepi.bwh.harvard.edu/health/nutrition.html Last accessed: 21st December 2023.
[42] Brouns, F., Geisslitz, S., Guzman, C., Ikeda, T. M., Arzani, A., Latella, G., Simsek, S., Colomba, M., Gregorini, A., Zevallos, V., Lullien-Pellerin, V., Jonkers, D., & Shewry, P. R. (2022). Do ancient wheats contain less gluten than modern bread wheat, in favour of better health?. Nutrition bulletin, 47(2), 157–167. https://doi.org/10.1111/nbu.12551
[43] Anjum, F. M., Khan, M. R., Din, A., Saeed, M., Pasha, I., & Arshad, M. U. (2007). Wheat gluten: high molecular weight glutenin subunits--structure, genetics, and relation to dough elasticity. Journal of food science, 72(3), R56–R63. https://doi.org/10.1111/j.1750-3841.2007.00292.x
[44] Rueda-Ruzafa, Lola & Cruz, Francisco & Cardona, Diana & Hone, Arik & Molina, Guadalupe & Sánchez-Labraca, Nuria & Roman, Pablo. (2020). Opioid system influences gut-brain axis: Dysbiosis and related alterations. Pharmacological Research. 159. 104928. 10.1016/j.phrs.2020.104928.
[45] Woodford K. B. (2021). Casomorphins and Gliadorphins Have Diverse Systemic Effects Spanning Gut, Brain and Internal Organs. International journal of environmental research and public health, 18(15), 7911. https://doi.org/10.3390/ijerph18157911
[46] Hendek Ertop M, Bektaş M. Enhancement of bioavailable micronutrients and reduction of antinutrients in foods with some processes. Food Heal 2018; 4(3): 159-5.
[47] Joseph, M. et al. (2018) IMPROVING THE NUTRITIONAL VALUE OF FOODS IN THE USAID FOOD AID BASKET: OPTIMIZATION OF MACRO AND MICRONUTRIENTS, FOOD MATRICES, NOVEL INGREDIENTS AND FOOD PROCESSING TECHNOLOGIES: A Report from the Food Aid Quality Review. United States Agency for International Development. Available online at: https://pdf.usaid.gov/pdf_docs/PA00T7SW.pdf Last accessed: 5th January 2024.
[48] WHO (2024) Anaemia. World Health Organisation (WHO). Available online at: https://www.who.int/health-topics/anaemia#tab=tab_1 Last accessed on: 4th January 2024; Semba R. D. (2016). The Rise and Fall of Protein Malnutrition in Global Health. Annals of nutrition & metabolism, 69(2), 79–88. https://doi.org/10.1159/000449175
[49] Muñoz, R. (2014). Bioactive compounds produced by gut microbial tannase: Implications for colorectal cancer development. Frontiers in Microbiology, 5, 121517. https://doi.org/10.3389/fmicb.2014.00684
[50] Iddrisu, I., Monteagudo-Mera, A., Poveda, C., Pyle, S., Shahzad, M., Andrews, S., & Walton, G. E. (2021). Malnutrition and Gut Microbiota in Children. Nutrients, 13(8), 2727. https://doi.org/10.3390/nu13082727
[51] Kårlund, A., Paukkonen, I., Gómez-Gallego, C., & Kolehmainen, M. (2021). Intestinal Exposure to Food-Derived Protease Inhibitors: Digestion Physiology- and Gut Health-Related Effects. Healthcare (Basel, Switzerland), 9(8), 1002. https://doi.org/10.3390/healthcare9081002
[52] Nunn, N., & Qian, N. (2010). The Columbian Exchange: A history of disease, food, and ideas. Journal of Economic Perspectives, 24(2), 163–188. https://doi.org/10.1257/jep.24.2.163
[53] Carpenter K. J. (1983). The relationship of pellagra to corn and the low availability of niacin in cereals. Experientia. Supplementum, 44, 197–222. https://doi.org/10.1007/978-3-0348-6540-1_12
[54] Urizar Hernández, A. L., & Bressani, R. (1997). Efecto de la nixtamalización del maíz sobre el contenido de ácido fítico, calcio y hierro total y disponible [The effect of lime cooking of corn on phytic acid, calcium, total and ionizable iron content]. Archivos latinoamericanos de nutricion, 47(3), 217–223.
[55] Hampl, J. S., & Hampl, W. S., 3rd (1997). Pellagra and the origin of a myth: evidence from European literature and folklore. Journal of the Royal Society of Medicine, 90(11), 636–639. https://doi.org/10.1177/014107689709001114
[56] Siddiqui, F., Salam, R. A., Lassi, Z. S., & Das, J. K. (2020). The Intertwined Relationship Between Malnutrition and Poverty. Frontiers in public health, 8, 453. https://doi.org/10.3389/fpubh.2020.00453; Latham, J. (2000) There's enough food for everyone, but the poor can't afford to buy it. Nature. 404, 222 https://doi.org/10.1038/35005264; De Oliveira AP, Antonio S (2020) Pellagra: A Report of Two Cases. Med Case Rep Vol.6 No.2: 138
[57] Benincasa, P., Falcinelli, B., Lutts, S., Stagnari, F., & Galieni, A. (2019). Sprouted Grains: A Comprehensive Review. Nutrients, 11(2), 421. https://doi.org/10.3390/nu11020421
[58] Gélinas, P. (2010). Mapping Early Patents on Baker’s Yeast Manufacture. Compr. Rev. Food Sci. Food Saf. 9, 483–497. doi: 10.1111/j.1541-4337.2010.00122.x
[59] Rizzello, C. G., Portincasa, P., Montemurro, M., Di Palo, D. M., Lorusso, M. P., De Angelis, M., Bonfrate, L., Genot, B., & Gobbetti, M. (2019). Sourdough Fermented Breads are More Digestible than Those Started with Baker's Yeast Alone: An In Vivo Challenge Dissecting Distinct Gastrointestinal Responses. Nutrients, 11(12), 2954. https://doi.org/10.3390/nu11122954
[60] Demirkesen-Bicak, H., Arici, M., Yaman, M., Karasu, S., & Sagdic, O. (2021). Effect of Different Fermentation Condition on Estimated Glycemic Index, In Vitro Starch Digestibility, and Textural and Sensory Properties of Sourdough Bread. Foods (Basel, Switzerland), 10(3), 514. https://doi.org/10.3390/foods10030514
[61] Slavin, J. L., Jacobs, D., & Marquart, L. (2000). Grain processing and nutrition. Critical reviews in food science and nutrition, 40(4), 309–326. https://doi.org/10.1080/10408690091189176
[62] Chouby, j. (2023) Green revolution reduced nutrition profile of grains. The Indian Express. Available online: https://www.newindianexpress.com/xplore/2023/dec/09/green-revolution-reduced-nutrition-profile-of-grains-2639898.html Last accessed: 5th January 2024.
[63] Debnath, S., Dey, A., Khanam, R., Saha, S., Sarkar, D., Saha, J. K., Coumar, M. V., Patra, B. C., Biswas, T., Ray, M., Radhika, M. S., & Mandal, B. (2023). Historical shifting in grain mineral density of landmark rice and wheat cultivars released over the past 50 years in India. Scientific Reports, 13(1), 1-16. https://doi.org/10.1038/s41598-023-48488-5
[64] Goyer RA. Nutrition and metal toxicity. Am J Clin Nutr. 1995;61(3 Suppl):646S-650S. doi:10.1093/ajcn/61.3.646S
[65] Statista (2023) Agricultural consumption of pesticides worldwide from 1990 to 2021. Statista Research Department. https://www.statista.com/statistics/1263077/global-pesticide-agricultural-use/ Last accessed: 23rd January 2024.
[66] Mordor Intelligence (2024) Glyphosate Market Size & Share Analysis - Growth Trends & Forecasts (2024 - 2029). Mordor Intelligence. Available online: https://www.mordorintelligence.com/industry-reports/glyphosate-herbicide-market Last accessed: 9th January 2024.
[67] IARC (2015) IARC Monographs Volume 112: evaluation of five organophosphate insecticides and herbicides. International Agency for the Research on Cancer. Available online: https://www.iarc.who.int/wp-content/uploads/2018/07/MonographVolume112-1.pdf Last accessed: 9th January 2024.
[68] OEHHA (2017) Glyphosate Listed Effective July 7, 2017, as Known to the State of California to Cause Cancer Available online: https://oehha.ca.gov/proposition-65/crnr/glyphosate-listed-effective-july-7-2017-known-state-california-cause-cancer Last accessed: 9th January 2024.
[69]Farrell, M. (2023) Years After Monsanto Deal, Bayer’s Roundup Bills Keep Piling Up. The New York Times. Available online: https://www.nytimes.com/2023/12/06/business/monsanto-bayer-roundup-lawsuit-settlements.html Last accessed: 9th January 2024.
[70] Singh, S., Kumar, V., Gill, J. P. K., Datta, S., Singh, S., Dhaka, V., Kapoor, D., Wani, A. B., Dhanjal, D. S., Kumar, M., Harikumar, S. L., & Singh, J. (2020). Herbicide Glyphosate: Toxicity and Microbial Degradation. International journal of environmental research and public health, 17(20), 7519. https://doi.org/10.3390/ijerph17207519
[71] Sender, R., Fuchs, S., & Milo, R. (2016). Revised Estimates for the Number of Human and Bacteria Cells in the Body. PLoS biology, 14(8), e1002533. https://doi.org/10.1371/journal.pbio.1002533
[72] Lehman, P. C., Cady, N., Ghimire, S., Shahi, S. K., Shrode, R. L., Lehmler, H., & Mangalam, A. K. (2023). Low-dose glyphosate exposure alters gut microbiota composition and modulates gut homeostasis. Environmental Toxicology and Pharmacology, 100, 104149. https://doi.org/10.1016/j.etap.2023.104149
[73] Liu, J., Wang, L., Li, S., Lin, Z., Yang, G., & Miao, Z. (2024). Association of urine glyphosate levels with renal injury biomarkers in children living close to major vegetable-producing regions in China. Science of The Total Environment, 912, 168677. https://doi.org/10.1016/j.scitotenv.2023.168677
[74] EWG (2019) Roundup for Breakfast, Part 2: In New Tests, Weed Killer Found in All Kids’ Cereals Sampled. Environmental Working Group. Available online: https://www.ewg.org/news-insights/news-release/2018/10/roundup-breakfast-part-2-new-tests-weed-killer-found-all-kids Last accessed: 9th January 2024.
[75] EWG (2017) FDA Glyphosate Testing Conspicuously Skips Oats, Wheat Products. Environmental Working Group. Available online: https://www.ewg.org/news-insights/news-release/fda-glyphosate-testing-conspicuously-skips-oats-wheat-products Last accessed: 9th January 2024.
[76] Touton, A. (2019) Concerning Pesticides Found In Over A Third Of Popular Food In Canada. MTL Blog. Available online: https://www.mtlblog.com/concerning-pesticides-found-in-a-third-of-popular-food-in-canada Last accessed: 9th January 2024.
[77] Piera M. Cirillo, Michele A. La Merrill, Nickilou Y. Krigbaum, Barbara A. Cohn; Grandmaternal Perinatal Serum DDT in Relation to Granddaughter Early Menarche and Adult Obesity: Three Generations in the Child Health and Development Studies Cohort. Cancer Epidemiol Biomarkers Prev 1 August 2021; 30 (8): 1480–1488. https://doi.org/10.1158/1055-9965.EPI-20-1456
[78] Kogevinas M. Probable carcinogenicity of glyphosate. BMJ. 2019;365:l1613. Published 2019 Apr 8. doi:10.1136/bmj.l1613
[79] OpenSecrets (2023) Client Profile: Bayer AG. https://www.opensecrets.org/federal-lobbying/clients/summary?cycle=2022&id=D000042363
[80] Pesticides refers to literal pesticides, but also fungicides and herbicides applied to crops.
[81] Neumeister, L. Botzki, A., Rohwedder, J. (2023) The Dark Side of Grains: Unmasking pesticide use in cereal crops. Foodwatch. Available online: https://www.foodwatch.org/fileadmin/-INT/pesticides/2023-10-09_foodwatch_Report_Dark_Side_of_Grain.pdf Last accessed: 11th January 2024.
[82] Soil Association & Pesticide Action Network UK (2019) How pesticide mixtures may be harming human health and the environment. Soil Association. https://www.soilassociation.org/media/19535/the-pesticide-cocktail-effect.pdf Last accessed: 11th January 2023.
[83] Soil Association & Pesticide Action Network UK (2019) How pesticide mixtures may be harming human health and the environment. Soil Association. https://www.soilassociation.org/media/19535/the-pesticide-cocktail-effect.pdf Last accessed: 11th January 2023.
[84] Aloizou AM, Siokas V, Vogiatzi C, et al. Pesticides, cognitive functions and dementia: A review. Toxicol Lett. 2020;326:31-51. doi:10.1016/j.toxlet.2020.03.005
[85] Dich J, Zahm SH, Hanberg A, Adami HO. Pesticides and cancer. Cancer Causes Control. 1997;8(3):420-443. doi:10.1023/a:1018413522959
[86] Mostafalou S, Abdollahi M. Pesticides and human chronic diseases: evidences, mechanisms, and perspectives. Toxicol Appl Pharmacol. 2013;268(2):157-177. doi:10.1016/j.taap.2013.01.025
[87] UBA (2023): Deutsche Umweltstudie zur Gesundheit von Kindern und Jugendlichen 2014–2017 (GerES V Teil 1:
Human-Biomonitoring). UMWELT UND GESUNDHEIT 02/2023. https://www.umweltbundesamt.de/sites/default/
files/medien/479/publikationen/uug_02-2023_deutsche_umweltstudie_zur_gesundheit_von_kindern_und_
Jugendlichen_2014-2017.pdf
[88] Neme, K., & Mohammed, A. (2017). Mycotoxin occurrence in grains and the role of postharvest management as a mitigation strategies. A review. Food Control, 78, 412-425. https://doi.org/10.1016/j.foodcont.2017.03.012
[89]
[90] IARC . A Review of Human Carcinogens. Volume 100F. International Agency for Research on Cancer; Lyon, France: 2012. Monographs on the evaluation of carcinogenic risks to humans: Chemical agents and related occupations; pp. 224–248.
[91] Santos Pereira, C., C Cunha, S., & Fernandes, J. O. (2019). Prevalent Mycotoxins in Animal Feed: Occurrence and Analytical Methods. Toxins, 11(5), 290. https://doi.org/10.3390/toxins11050290
[92] Rychen, G., Aquilina, G., Azimonti, G., Bampidis, V., Bastos, L., Bories, G., Chesson, A., Cocconcelli, P. S., Flachowsky, G., Gropp, J., Kolar, B., Kouba, M., López-Alonso, M., Mantovani, A., Mayo, B., Ramos, F., Saarela, M., Villa, R. E., Wallace, R. J., . . . Puente, S. L. (2017). Safety and efficacy of bentonite as a feed additive for all animal species. EFSA Journal, 15(12), e05096. https://doi.org/10.2903/j.efsa.2017.5096
[93] Wild C.P. Aflatoxin Exposure in Developing Countries: The Critical Interface of Agriculture and Health. Food Nutr. Bull. 2007;28:S372–S380. doi: 10.1177/15648265070282S217.
[94] Sangare-Tigori B., Moukha S., Kouadio H.J., Betbeder A.-M., Dano D.S., Creppy E.E. Co-occurrence of aflatoxin B1, fumonisin B1, ochratoxin A and zearalenone in cereals and peanuts from Côte d’Ivoire. Food Addit. Contam. 2007;23:1000–1007. doi: 10.1080/02652030500415686.
[95] Weaver A.C., King W.D., Verax M., Fox U., Kudupoje M.B., Mathis G., Lumpkins B., Yiannikouris A. Impact of Chronic Levels of Naturally Multi-Contaminated Feed with Fusarium Mycotoxins on Broiler Chickens and Evaluation of the Mitigation Properties of Different Titers of Yeast Cell Wall Extract. Toxins. 2020;12:636. doi: 10.3390/toxins12100636.
[96] WHO (2023) Mycotoxins. World Health Organisation. Available online: https://www.who.int/news-room/fact-sheets/detail/mycotoxins Last accessed: 9th January 2023.
[97] King JA, Jeong J, Underwood FE, et al. Incidence of Celiac Disease Is Increasing Over Time: A Systematic Review and Meta-analysis. Am J Gastroenterol. 2020;115(4):507-525. doi:10.14309/ajg.0000000000000523
[98] Guts UK (2023) Coeliac Disease Factsheet. Guts UK Charity. Available online: https://gutscharity.org.uk/advice-and-information/conditions/coeliac-disease/ Last accessed 12th January 2024.
[99] Barbaro, M. R., Cremon, C., Stanghellini, V., & Barbara, G. (2018). Recent advances in understanding non-celiac gluten sensitivity. F1000Research, 7, F1000 Faculty Rev-1631. https://doi.org/10.12688/f1000research.15849.1
[100] Sergi, C., Villanacci, V. & Carroccio, A. Non-celiac wheat sensitivity: rationality and irrationality of a gluten-free diet in individuals affected with non-celiac disease: a review. BMC Gastroenterol 21, 5 (2021). https://doi.org/10.1186/s12876-020-01568-6
[101] Busby, E., Bold, J., Fellows, L., & Rostami, K. (2018). Mood Disorders and Gluten: It's Not All in Your Mind! A Systematic Review with Meta-Analysis. Nutrients, 10(11), 1708. https://doi.org/10.3390/nu10111708
[102] Rudzki, L., & Szulc, A. (2018). "Immune Gate" of Psychopathology-The Role of Gut Derived Immune Activation in Major Psychiatric Disorders. Frontiers in psychiatry, 9, 205. https://doi.org/10.3389/fpsyt.2018.00205
[103] Severance, E. G., Gressitt, K. L., Alaedini, A., Rohleder, C., Enning, F., Bumb, J. M., Müller, J. K., Schwarz, E., Yolken, R. H., & Leweke, F. M. (2015). IgG dynamics of dietary antigens point to cerebrospinal fluid barrier or flow dysfunction in first-episode schizophrenia. Brain, behavior, and immunity, 44, 148–158. https://doi.org/10.1016/j.bbi.2014.09.009
[104]Bressan, P., & Kramer, P. (2016). Bread and Other Edible Agents of Mental Disease. Frontiers in human neuroscience, 10, 130. https://doi.org/10.3389/fnhum.2016.00130
[105] Lionetti, E., Leonardi, S., Franzonello, C., Mancardi, M., Ruggieri, M., & Catassi, C. (2015). Gluten Psychosis: Confirmation of a New Clinical Entity. Nutrients, 7(7), 5532–5539. https://doi.org/10.3390/nu7075235
[106] Simpson, C. A., Diaz-Arteche, C., Eliby, D., Schwartz, O. S., Simmons, J. G., & Cowan, C. S. M. (2021). The gut microbiota in anxiety and depression – A systematic review. Clinical Psychology Review, 83, 101943. https://doi.org/10.1016/j.cpr.2020.101943
[107] Harper, L., & Bold, J. (2018). An exploration into the motivation for gluten avoidance in the absence of coeliac disease. Gastroenterology and hepatology from bed to bench, 11(3), 259–268.
[108] Poslt Königová, Michaela et al. “The effectiveness of gluten-free dietary interventions: A systematic review.” Frontiers in psychology vol. 14 1107022. 22 Mar. 2023, doi:10.3389/fpsyg.2023.1107022
[109] da Silva, M.T.B., dos Santos, A.A. Proinflammatory Effects of Wheat and Rye in an IBD Model: Give Us Not Our Daily Bread. Dig Dis Sci 67, 4324–4325 (2022). https://doi.org/10.1007/s10620-022-07466-z
[110] Balakireva, A. V., & Zamyatnin, A. A. (2016). Properties of Gluten Intolerance: Gluten Structure, Evolution, Pathogenicity and Detoxification Capabilities. Nutrients, 8(10), 644. https://doi.org/10.3390/nu8100644
[111] Hou, Y., Wang, S., Zhou, K., & Dai, S. (2023). Comparison and recommendation of dietary patterns based on nutrients for Eastern and Western patients with inflammatory bowel disease. Frontiers in Nutrition, 9, 1066252. https://doi.org/10.3389/fnut.2022.1066252
[112] Zhang, Y., Liu, W., Zhang, D., Yang, Y., Wang, X., & Li, L. (2021). Fermented and Germinated Processing Improved the Protective Effects of Foxtail Millet Whole Grain Against Dextran Sulfate Sodium-Induced Acute Ulcerative Colitis and Gut Microbiota Dysbiosis in C57BL/6 Mice. Frontiers in nutrition, 8, 694936. https://doi.org/10.3389/fnut.2021.694936
[113] Bhatia, B. K., Millsop, J. W., Debbaneh, M., Koo, J., Linos, E., & Liao, W. (2014). Diet and psoriasis, part II: celiac disease and role of a gluten-free diet. Journal of the American Academy of Dermatology, 71(2), 350–358. https://doi.org/10.1016/j.jaad.2014.03.017
[114] Nurmatov, U., Devereux, G., & Sheikh, A. (2011). Nutrients and foods for the primary prevention of asthma and allergy: systematic review and meta-analysis. The Journal of allergy and clinical immunology, 127(3), . https://doi.org/10.1016/j.jaci.2010.11.001
[115] Celakovská, J., Ettlerová, K., Ettler, K., Vanecková, J., & Bukac, J. (2011). The effect of wheat allergy on the course of atopic eczema in patients over 14 years of age. Acta medica (Hradec Kralove), 54(4), 157–162.
[116] Hajiani, E., Masjedizadeh, A., Shayesteh, A. A., Babazadeh, S., & Seyedian, S. S. (2019). Comparison between gluten-free regime and regime with gluten in symptoms of patients with irritable bowel syndrome (IBS). Journal of family medicine and primary care, 8(5), 1691–1695. https://doi.org/10.4103/jfmpc.jfmpc_464_18
[117] Bruzzese, V., Scolieri, P., & Pepe, J. (2021). Efficacy of gluten-free diet in patients with rheumatoid arthritis. Reumatismo, 72(4), 213–217. https://doi.org/10.4081/reumatismo.2020.1296
[118] Lim, P. O., Tzemos, N., Farquharson, C. A., Anderson, J. E., Deegan, P., MacWalter, R. S., Struthers, A. D., & MacDonald, T. M. (2002). Reversible hypertension following coeliac disease treatment: the role of moderate hyperhomocysteinaemia and vascular endothelial dysfunction. Journal of human hypertension, 16(6), 411–415. https://doi.org/10.1038/sj.jhh.1001404
[119] Henriques, H. K. F., Fonseca, L. M., de Andrade, K. S., Shivappa, N., Hébert, J. R., Ferreira, A. V. M., & Alvarez Leite, J. I. (2022). Gluten-Free Diet Reduces Diet Quality and Increases Inflammatory Potential in Non-Celiac Healthy Women. Journal of the American Nutrition Association, 41(8), 771–779. https://doi.org/10.1080/07315724.2021.1962769
[120] PHE (2018) The Eatwell Guide. Public Health England. Available online: https://assets.publishing.service.gov.uk/media/5ba8a50540f0b605084c9501/Eatwell_Guide_booklet_2018v4.pdf Last accessed: 15th January 2024.
[121] The Nutrition Source (2019) Whole Grains. Harvard T.H. Chan School of Public Health. Available online: https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/whole-grains/ Last accessed: 8th January 2024.
[122] RNI is close enough to be the UK version of the recommended daily allowance (RDA), which is a US measure.
[123] Harcombe, Z. (2014) Healthy Whole Grains—Really?! Dr Zoe Harcombe Ph.D. https://www.zoeharcombe.com/2014/04/healthy-whole-grains-really/ Last accessed: 23rd January 2024.
[124] Real food generally refers to whole foods and not industrially processed foods, including refined grains and products.
[125] Palsdottir, H. (2023) 9 Health Benefits of Eating Oats and Oatmeal. Healthline. Available online: https://www.healthline.com/nutrition/9-benefits-oats-oatmeal Last accessed: 19th January 2024.
[126] USDA (2018) Cereals, oats, regular and quick, not fortified, dry. Food Data Central. United States Department of Agriculture. Available online: https://fdc.nal.usda.gov/fdc-app.html#/food-details/173904/nutrients; USDA (2023) Beef, ribeye, steak, boneless, choice, raw. Food Data Central. United Sates Department of Agriculture. https://fdc.nal.usda.gov/fdc-app.html#/food-details/2646172/nutrients
[127] Said HM. Thiamin. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopaedia of Dietary Supplements. 2nd ed. London and New York: Informa Healthcare; 2010:748-53.
[128] Hadadi, N., Berweiler, V., Wang, H., & Trajkovski, M. (2021). Intestinal microbiota as a route for micronutrient bioavailability. Current opinion in endocrine and metabolic research, 20, 100285. https://doi.org/10.1016/j.coemr.2021.100285
[129] Rein, M. J., Renouf, M., Cruz-Hernandez, C., Actis-Goretta, L., Thakkar, S. K., & da Silva Pinto, M. (2013). Bioavailability of bioactive food compounds: a challenging journey to bioefficacy. British journal of clinical pharmacology, 75(3), 588–602. https://doi.org/10.1111/j.1365-2125.2012.04425.x
[130] Beal, T., & Ortenzi, F. (2022). Priority Micronutrient Density in Foods. Frontiers in nutrition, 9, 806566. https://doi.org/10.3389/fnut.2022.806566; Reider, C. A., Chung, R. Y., Devarshi, P. P., Grant, R. W., & Hazels Mitmesser, S. (2020). Inadequacy of Immune Health Nutrients: Intakes in US Adults, the 2005-2016 NHANES. Nutrients, 12(6), 1735. https://doi.org/10.3390/nu12061735
[131] Marze, S. (2017). Bioavailability of Nutrients and Micronutrients: Advances in Modeling and In Vitro Approaches. https://doi.org/10.1146/annurev-food-030216-030055
[132] Palsdottir, H. (2023) 9 Health Benefits of Eating Oats and Oatmeal. Healthline. Available online: https://www.healthline.com/nutrition/9-benefits-oats-oatmeal Last accessed: 19th January 2024.
[133] USDA (2018) Cereals, oats, regular and quick, not fortified, dry. Food Data Central. Available online: https://fdc.nal.usda.gov/fdc-app.html#/food-details/173904/nutrients Last accessed: 19th January 2024.
[134] NIH (2021) Manganese: Fact Sheet For Health Professionals. National Institutes of Health. Available online: https://ods.od.nih.gov/factsheets/Manganese-HealthProfessional/ Last accessed 19th January 2024.
[135] Adema AY, de Borst MH, Ter Wee PM, Vervloet MG, Consortium N. (2015) Dietary and pharmacological modification of fibroblast growth factor-23 in chronic kidney disease. J Ren Nutr: 24:143–50.
[136] Bohn, T., Davidsson, L., Walczyk, T., & Hurrell, R. F. (2004). Fractional magnesium absorption is significantly lower in human subjects from a meal served with an oxalate-rich vegetable, spinach, as compared with a meal served with kale, a vegetable with a low oxalate content. The British journal of nutrition, 91(4), 601–606. https://doi.org/10.1079/BJN20031081
[137] NIH (2023) Copper Fact Sheet for Health Professionals. National Institutes of Health. Available online: https://ods.od.nih.gov/factsheets/Copper-HealthProfessional/#en3 Last accessed: 18th January 2024.
[138] Larsson, M., Rossander-Hulthén, L., Sandström, B., & Sandberg, A. S. (1996). Improved zinc and iron absorption from breakfast meals containing malted oats with reduced phytate content. The British journal of nutrition, 76(5), 677–688. https://doi.org/10.1079/bjn19960075
[139] Larsson, M., Rossander-Hulthén, L., Sandström, B., & Sandberg, A. S. (1996). Improved zinc and iron absorption from breakfast meals containing malted oats with reduced phytate content. The British journal of nutrition, 76(5), 677–688. https://doi.org/10.1079/bjn19960075
[140] NIH (2023) Folate Fact Sheet for Health Professionals. National Institutes of Health. Available online: https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/ Last accessed: 17th January 2024.
[141] Agte, V., Jahagirdar, M., & Chiplonkar, S. (2005). Apparent absorption of eight micronutrients and phytic acid from vegetarian meals in ileostomized human volunteers. Nutrition (Burbank, Los Angeles County, Calif.), 21(6), 678–685. https://doi.org/10.1016/j.nut.2004.11.007
[142] Tarr, J. B., Tamura, T., & Stokstad, E. L. (1981). Availability of vitamin B6 and pantothenate in an average American diet in man. The American journal of clinical nutrition, 34(7), 1328–1337. https://doi.org/10.1093/ajcn/34.7.1328
[143] The Nutrition Source (2019) Whole Grains. Harvard T.H. Chan School of Public Health. Available online: https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/whole-grains/ Last accessed: 19th January 2024.
[144] USDA (2022) Oats, whole grain, steel cut. Oats Food Data Central. Available at: https://fdc.nal.usda.gov/fdc-app.html#/food-details/2346397/nutrients Last accessed: 19th January 2024.
[145] Tait, S., & Galliard, T. (1988). Oxidation of linoleic acid in doughs and aqueous suspensions of wholemeal flours: Effects of storage. Journal of Cereal Science, 8(1), 55-67. https://doi.org/10.1016/S0733-5210(88)80049-3
[146] Rasane, P., Jha, A., Sabikhi, L., Kumar, A., & Unnikrishnan, V. S. (2015). Nutritional advantages of oats and opportunities for its processing as value added foods - a review. Journal of food science and technology, 52(2), 662–675. https://doi.org/10.1007/s13197-013-1072-1
[147] Institute of Medicine (US) Panel on Dietary Antioxidants and Related Compounds. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington (DC): National Academies Press (US); 2000. 6, Vitamin E. Available from: https://www.ncbi.nlm.nih.gov/books/NBK225461/
[148] Szewczyk, K., Chojnacka, A., & Górnicka, M. (2020). Tocopherols and Tocotrienols—Bioactive Dietary Compounds; What Is Certain, What Is Doubt? International Journal of Molecular Sciences, 22(12), 6222. https://doi.org/10.3390/ijms22126222
[149] Aoe S. (2021). Beta-Glucan in Foods and Health Benefits. Nutrients, 14(1), 96. https://doi.org/10.3390/nu14010096
[150] Herreman, L., Nommensen, P., Pennings, B., & Laus, M. C. (2020). Comprehensive overview of the quality of plant- And animal-sourced proteins based on the digestible indispensable amino acid score. Food science & nutrition, 8(10), 5379–5391. https://doi.org/10.1002/fsn3.1809
[151] Kaukovirta-Norja A, Wilhemson A, Poutanen K. Germination: a means to improve the functionality of oat. Agr Food Sci. 2004;13:100–112.
[152] Larsson, M., Rossander-Hulthén, L., Sandström, B., & Sandberg, A. S. (1996). Improved zinc and iron absorption from breakfast meals containing malted oats with reduced phytate content. The British journal of nutrition, 76(5), 677–688. https://doi.org/10.1079/bjn19960075
[153] Mann KD, Pearce MS, McKevith B, Thielecke F, Seal CJ. Low whole grain intake in the UK: results from the National Diet and Nutrition Survey rolling programme 2008–11. British Journal of Nutrition. 2015;113(10):1643-1651. doi:10.1017/S0007114515000422
[154] Rauber, F., Louzada, M. L. D. C., Martinez Steele, E., Rezende, L. F. M., Millett, C., Monteiro, C. A., & Levy, R. B. (2019). Ultra-processed foods and excessive free sugar intake in the UK: a nationally representative cross-sectional study. BMJ open, 9(10), e027546. https://doi.org/10.1136/bmjopen-2018-027546
[155] Gupta, S., Hawk, T., Aggarwal, A., & Drewnowski, A. (2019). Characterising Ultra-Processed Foods by Energy Density, Nutrient Density, and Cost. Frontiers in nutrition, 6, 70. https://doi.org/10.3389/fnut.2019.00070
[156] Olson, R., Gavin-Smith, B., Ferraboschi, C., & Kraemer, K. (2021). Food Fortification: The Advantages, Disadvantages and Lessons from Sight and Life Programs. Nutrients, 13(4), 1118. https://doi.org/10.3390/nu13041118
[157] Dwyer, J. T., Wiemer, K. L., Dary, O., Keen, C. L., King, J. C., Miller, K. B., Philbert, M. A., Tarasuk, V., Taylor, C. L., Gaine, P. C., Jarvis, A. B., & Bailey, R. L. (2015). Fortification and health: challenges and opportunities. Advances in nutrition (Bethesda, Md.), 6(1), 124–131. https://doi.org/10.3945/an.114.007443
[158] T.H.Chan (2021) How important are whole grains in my diet? T.H.Chan School of Public Health. Available online: https://www.health.harvard.edu/staying-healthy/how-important-are-whole-grains-in-my-diet Last accessed: 19th January 2024.
[159] Saris, W., Foster, G. Simple carbohydrates and obesity: Fact, Fiction and Future. Int J Obes 30 (Suppl 3), S1–S3 (2006). https://doi.org/10.1038/sj.ijo.0803522
[160] Swaminathan, S., Dehghan, M., Raj, J. M., Thomas, T., Rangarajan, S., Jenkins, D., Mony, P., Mohan, V., Lear, S. A., Avezum, A., Lopez-Jaramillo, P., Rosengren, A., Lanas, F., AlHabib, K. F., Dans, A., Keskinler, M. V., Puoane, T., Soman, B., Wei, L., Zatonska, K., … Yusuf, S. (2021). Associations of cereal grains intake with cardiovascular disease and mortality across 21 countries in Prospective Urban and Rural Epidemiology study: prospective cohort study. BMJ (Clinical research ed.), 372, m4948. https://doi.org/10.1136/bmj.m4948
[161] Spreadbury I. (2012). Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity. Diabetes, metabolic syndrome and obesity : targets and therapy, 5, 175–189. https://doi.org/10.2147/DMSO.S33473
[162] López-Alarcón, M., Perichart-Perera, O., Flores-Huerta, S., Inda-Icaza, P., Rodríguez-Cruz, M., Armenta-Álvarez, A., Bram-Falcón, M. T., & Mayorga-Ochoa, M. (2014). Excessive refined carbohydrates and scarce micronutrients intakes increase inflammatory mediators and insulin resistance in prepubertal and pubertal obese children independently of obesity. Mediators of inflammation, 2014, 849031. https://doi.org/10.1155/2014/849031: Zuñiga, Y. L., Rebello, S. A., Oi, P. L., Zheng, H., Lee, J., Tai, E. S., & Van Dam, R. M. (2014). Rice and noodle consumption is associated with insulin resistance and hyperglycaemia in an Asian population. The British journal of nutrition, 111(6), 1118–1128. https://doi.org/10.1017/S0007114513003486
[163] Ludwig, D. S., Majzoub, J. A., Al-Zahrani, A., Dallal, G. E., Blanco, I., & Roberts, S. B. (1999). High glycemic index foods, overeating, and obesity. Pediatrics, 103(3), E26. https://doi.org/10.1542/peds.103.3.e26
[164] Yu, D., Shu, X. O., Li, H., Xiang, Y. B., Yang, G., Gao, Y. T., Zheng, W., & Zhang, X. (2013). Dietary carbohydrates, refined grains, glycemic load, and risk of coronary heart disease in Chinese adults. American journal of epidemiology, 178(10), 1542–1549. https://doi.org/10.1093/aje/kwt178
[165] Kaiser, P., Arnold, A. M., Benkeser, D., Hirsch, C. H., Psaty, B. M., & Odden, M. C. (2018). Comparing methods to address bias in observational data: Statin use and cardiovascular events in a US cohort. International Journal of Epidemiology, 47(1), 246-254. https://doi.org/10.1093/ije/dyx179
[166] Shrank, W. H., Patrick, A. R., & Brookhart, M. A. (2011). Healthy user and related biases in observational studies of preventive interventions: a primer for physicians. Journal of general internal medicine, 26(5), 546–550. https://doi.org/10.1007/s11606-010-1609-1
[167] Begley, S. (2017) Records Found in Dusty Basement Undermine Decades of Dietary Advice. Scientific American. Available online: https://www.scientificamerican.com/article/records-found-in-dusty-basement-undermine-decades-of-dietary-advice/ Last accessed: 19th January 2024.
[168] Carson JAS, Lichtenstein AH, Anderson CAM, et al. Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association. Circulation. 2020;141(3):e39-e53. doi:10.1161/CIR.0000000000000743
[169] Keys, A. (1952) Human Atherosclerosis and the Diet. Circulation. 5:115–118; https://doi.org/10.1161/01.CIR.5.1.115
[170] Tajika, A., Tsujimoto, Y., Onishi, A., Tsutsumi, Y., Funada, S., Ogawa, Y., Takeshima, N., Hayasaka, Y., Iwakami, N., & Furukawa, T. A. (2023). Twenty-year follow-up of promising clinical studies reported in highly circulated newspapers: a meta-epidemiological study. BMJ health & care informatics, 30(1), e100768. https://doi.org/10.1136/bmjhci-2023-100768
[171] Stanford (2023) John PA Ioannidis Profile. Stanford University. https://profiles.stanford.edu/john-ioannidis Last accessed: 25th January 2024; Ioannidis JPA. The Challenge of Reforming Nutritional Epidemiologic Research. JAMA. 2018;320(10):969–970. doi:10.1001/jama.2018.11025
[172] Ioannidis JPA (2014) How to Make More Published Research True. PLoS Med 11(10): e1001747. https://doi.org/10.1371/journal.pmed.1001747
[173] Armitage, H. (2018) 5 Questions: John Ioannidis calls for more rigorous nutrition research. Stanford Medicine. https://med.stanford.edu/news/all-news/2018/07/john-ioannidis-calls-for-more-rigorous-nutrition-research.html
[174] Guo, H., Ding, J., Liang, J., & Zhang, Y. (2021). Associations of Whole Grain and Refined Grain Consumption With Metabolic Syndrome. A Meta-Analysis of Observational Studies. Frontiers in nutrition, 8, 695620. https://doi.org/10.3389/fnut.2021.695620
[175] A meta-analysis is a review of the raw data from a study, not just the paper’s findings, which can be interpreted differently by researchers.
[176] Maki, Kevin & Palacios, Orsolya & Koecher, Katie & Sawicki, Caleigh & Livingston, Kara & Bell, Marjorie & Mckeown, Nicola. (2019). The Relationship Between Whole Grain Intake and Body Weight: Results of Meta-analyses of Observational Studies and Randomized Controlled Trials (FS18-07-19). Current Developments in Nutrition. 3. 10.1093/cdn/nzz041.FS18-07-19.
[177] Sadeghi, O., Sadeghian, M., Rahmani, S., Maleki, V., Larijani, B., & Esmaillzadeh, A. (2020). Whole-Grain Consumption Does Not Affect Obesity Measures: An Updated Systematic Review and Meta-analysis of Randomized Clinical Trials. Advances in Nutrition, 11(2), 280-292. https://doi.org/10.1093/advances/nmz076
[178] Esmaillzadeh, A., Mirmiran, P., & Azizi, F. (2005). Whole-grain consumption and the metabolic syndrome: a favorable association in Tehranian adults. European journal of clinical nutrition, 59(3), 353–362. https://doi.org/10.1038/sj.ejcn.1602080
[179] Li, Z., Yan, H., Chen, L., Wang, Y., Liang, J., Feng, X., Hui, S., & Wang, K. (2022). Effects of whole grain intake on glycemic control: A meta-analysis of randomized controlled trials. Journal of diabetes investigation, 13(11), 1814–1824. https://doi.org/10.1111/jdi.13866
[180] Aune, D., Keum, N., Giovannucci, E., Fadnes, L. T., Boffetta, P., Greenwood, D. C., Tonstad, S., Vatten, L. J., Riboli, E., & Norat, T. (2016). Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies. BMJ (Clinical research ed.), 353, i2716. https://doi.org/10.1136/bmj.i2716
[181] Marshall, S., Petocz, P., Duve, E., Abbott, K., Cassettari, T., Blumfield, M., & Fayet-Moore, F. (2020). The Effect of Replacing Refined Grains with Whole Grains on Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with GRADE Clinical Recommendation. Journal of the Academy of Nutrition and Dietetics, 120(11), 1859–1883.e31. https://doi.org/10.1016/j.jand.2020.06.021
[182] Kelly, S. A., Hartley, L., Loveman, E., Colquitt, J. L., Jones, H. M., Al-Khudairy, L., Clar, C., Germanò, R., Lunn, H. R., Frost, G., & Rees, K. (2017). Whole grain cereals for the primary or secondary prevention of cardiovascular disease. The Cochrane database of systematic reviews, 8(8), CD005051. https://doi.org/10.1002/14651858.CD005051.pub3
[183] Howard, B. V., Van Horn, L., Hsia, J., Manson, J. E., Stefanick, M. L., Wassertheil-Smoller, S., Kuller, L. H., LaCroix, A. Z., Langer, R. D., Lasser, N. L., Lewis, C. E., Limacher, M. C., Margolis, K. L., Mysiw, W. J., Ockene, J. K., Parker, L. M., Perri, M. G., Phillips, L., Prentice, R. L., Robbins, J., … Kotchen, J. M. (2006). Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA, 295(6), 655–666. https://doi.org/10.1001/jama.295.6.655
[184] Rahmani, S., Sadeghi, O., Sadeghian, M., Sadeghi, N., Larijani, B., & Esmaillzadeh, A. (2019). The Effect of Whole-Grain Intake on Biomarkers of Subclinical Inflammation: A Comprehensive Meta-analysis of Randomized Controlled Trials. Advances in Nutrition, 11(1), 52-65. https://doi.org/10.1093/advances/nmz063
[185] Milesi, G., Rangan, A., & Grafenauer, S. (2021). Whole Grain Consumption and Inflammatory Markers: A Systematic Literature Review of Randomised Control Trials. Nutrients, 14(2), 374. https://doi.org/10.3390/nu14020374
[186] Fu, L., Zhang, G., Qian, S., Zhang, Q., & Tan, M. (2022). Associations between dietary fiber intake and cardiovascular risk factors: An umbrella review of meta-analyses of randomized controlled trials. Frontiers in Nutrition, 9, 972399. https://doi.org/10.3389/fnut.2022.972399
[187] van der Schoot, A., Drysdale, C., Whelan, K., & Dimidi, E. (2022). The Effect of Fiber Supplementation on Chronic Constipation in Adults: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. The American journal of clinical nutrition, 116(4), 953–969. https://doi.org/10.1093/ajcn/nqac184
[188] Balafa, O., & Kalaitzidis, R. G. (2021). Salt sensitivity and hypertension. Journal of Human Hypertension, 35(3), 184-192. https://doi.org/10.1038/s41371-020-00407-1
[189] Ioniță-Mîndrican, C. B., Ziani, K., Mititelu, M., Oprea, E., Neacșu, S. M., Moroșan, E., Dumitrescu, D. E., Roșca, A. C., Drăgănescu, D., & Negrei, C. (2022). Therapeutic Benefits and Dietary Restrictions of Fiber Intake: A State of the Art Review. Nutrients, 14(13), 2641. https://doi.org/10.3390/nu14132641
[190] Ioniță-Mîndrican, C. B., Ziani, K., Mititelu, M., Oprea, E., Neacșu, S. M., Moroșan, E., Dumitrescu, D. E., Roșca, A. C., Drăgănescu, D., & Negrei, C. (2022). Therapeutic Benefits and Dietary Restrictions of Fiber Intake: A State of the Art Review. Nutrients, 14(13), 2641. https://doi.org/10.3390/nu14132641
[191] OED (2023) Nutrient. Oxford English Dictionary. https://www.oed.com/search/dictionary/?scope=Entries&q=nutrient Last accessed: 25th Janurary 2024
[192] Tristan Asensi, M., Napoletano, A., Sofi, F., & Dinu, M. (2023). Low-Grade Inflammation and Ultra-Processed Foods Consumption: A Review. Nutrients, 15(6), 1546. https://doi.org/10.3390/nu15061546