In search of wheat: We bake einkorn bread

With the assistance of dietitian and health educator, Margaret Pfeiffer,MS RD CD, author of Smart 4 Your Heart and very capable chef and breadmaker (previously, before she gave up wheat), we made a loaf of bread using Eli Rogosa's einkorn wheat. Recall that einkorn wheat is the primordial 14-chromosome wheat similar to the wild wheat harvested by Neolithic humans and eaten as porridge.

The essential question: Has wheat always been bad for humans or have the thousands of hybridization experiments of the last 50 years changed the structure of gluten and other proteins in Triticum aestivum and turned the "staff of life" into poison? I turn to einkorn wheat, the "original" wheat unaltered by human manipulations, to figure this out. While einkorn wheat is still a source of carbohydrates, is it something we might indulge in once in a while without triggering the adverse phenomena associated with modern wheat?   

Here's what we did:

This is the einkorn grain as we received it from Eli's farm. This was enough to make one loaf (approximately 3 cups).











The einkorn grain is a dark golden color. I tried chewing them. They taste slightly nutty. They soften as they sit in your mouth.





Here's Margaret putting the einkorn grain into the electric grinder.









We tried to grind the grain by hand with mortar and pestle, but this proved far more laborious than I anticipated. After about 15 minutes of grinding, this is what I got:



Barely 2 tablespoons. That's when Margaret fired up the electric grinder. (I can't imagine having to grind up enough flour by hand for an entire family. Perhaps that's why ancient cultures were thin despite eating wheat. They were just exhausted!)

We added water, salt, and yeast, then put the mix into an electric breadmaker to knead the dough and keep it warm.

We let the dough rise for 90 minutes, much longer than conventional dough. The einkorn dough "rose" very little. Margaret tells me that most dough made with conventional flour rises to double its size. The einkorn dough increased no more than 20-30%.

The einkorn dough also distinctly smelled like peanut butter.





After rising, we baked the dough at 350 degrees F for 30 minutes. This is the final product.

Because I want to gauge health effects, not taste, the bread we made had no added sugar or anything else to modify taste or physiologic effect.

On first tasting, the einkorn bread is mildly nutty and heavy. It had an unusual sour or astringent taste at the end, but overall tasted quite good.

Next: What happens when we eat it? I'm going to give the einkorn bread (I've got to make some more) to people who experience acute reactions to conventional wheat and see if the einkorn does the same. I will also assess blood sugar effects since, after all, hybridizations or no, it is still a carbohydrate.



Margaret Pfeiffer's book is available on Amazon:

Ezekiel said what?

Some people are reluctant to give up wheat because it is talked about in the Bible. But the wheat of the Bible is not the same as the wheat of today. (See In search of wheat and Emmer, einkorn and agribusiness.) Comparing einkorn to modern wheat, for example, means a difference of chromosome number (14 chromosomes in einkorn vs. 42 chromosomes in modern strains of Triticum aestivum), thousands of genes, and differing gluten content and structure.

How about Ezekiel bread, the sprouted wheat bread that is purported to be based on a "recipe" articulated in the Bible?

Despite the claims of lower glycemic index, we've had bad experiences with this product, with triggering of high blood sugars, small LDL, and triglycerides not much different from conventional bread.

David Rostollan of Health for Life sent me this interesting perspective on Ezekiel bread from an article he wrote about wheat and the Bible. David argues that the entire concept of Ezekiel bread is based on a flawed interpretation.

"I Want to Eat the Food in the Bible."


Are you sure about that?

Some people, still wanting to be faithful to the Bible, will discard the "no grain/wheat" message on the basis of biblical example. After all, God told Ezekiel to make bread, he gave the Israelites "bread from heaven," and then Jesus (who is called the "Bread of Life"!) multiplied bread, and even instituted the New Covenant with what? Bread and wine! If you're going to live the Bible, it seems that bread and/or wheat is going to play a part.

But this is unnecessary. Sure, the Bible can and does tell us how to live, but this doesn't mean that everything in the Bible is meant to be copied verbatim. Applying the Bible to our lives requires wisdom, not a Xerox machine.

The Bible was written in a historical context, and the setting happened to be an agricultural one. Because of this, the language used to describe blessing spoke of things like fields full of grain, or barns overflowing with wheat. Had the Bible been written in the context of a hunter-gatherer culture, the language describing blessing probably would have been about the abundance of wild game, or baskets full of vegetables. Whatever is most valuable in your time and in your culture is a blessing. God accommodated His message to the culture as it existed at the time. This is done throughout Scripture.

There is a danger, then, in merely copying what the Bible says, instead of extracting the principles by which to live. Take the above example of Ezekiel, for instance. There's a whole product line in health food stores called "Ezekiel Bread" that supposedly copies the recipe given in Ezekiel 4:9. This is from the website:

"Inspired by the Holy Scripture verse Ezekiel 4:9., 'Take also unto thee Wheat, and Barley, and beans, and lentils, and millet, and Spelt, and put them in one vessel, and make bread of it...'"

Believing that this "recipe" has some kind of special power just because it's in the Bible is ridiculous. How ridiculous is it? I'll tell you in a moment, but first let me say that this is why it's so important not to confuse descriptives with prescriptives. Is the Bible telling a story, or is it telling us to do something? We would be well-advised not to confuse the two.

In the case of the Ezekiel Bread, what is going on in the passage? There's a siege going on, with impending famine, and Ezekiel is consigned to eating what was considered back then to be some of the worst possible food. It was basically animal chow. But that's not the worst thing going on in this passage. Apparently, when the makers of Ezekiel Bread were gleaning their inspiration for the perfect recipe, they stopped short
of verse 12:

"And thou shalt eat it as barley cakes, and thou shalt bake it with dung that cometh out of man, in their sight."

Um...what? Well, there was a good reason for this. God was judging His people, and by polluting this really bad bread with dung (which was a violation of Mosaic law; Lev. 5:3), He was saying that they were no different from the unclean Gentiles.

So why would we take this story and extrapolate a bread recipe from it? Beats me. If you were going to be consistent, though, here's what you'd have to end up with:



Let that be a lesson to you. We don't just go and do everything that we see in the Bible.

Low-carb gynecologist

I met infertility specialist, Dr. Michael Fox, on Jimmy Moore's low-carb cruise just this past March.

Dr. Fox is quiet and unassuming, but had incredible things to say about his experience with carbohydrate restriction in female infertility and pregnancy. While readers of The Heart Scan Blog already know that I advocate a diet free of wheat, cornstarch, and sugar for heart health and correction of multiple lipoprotein abnormalities, it was fascinating to hear how a similar approach seems to yield extraordinary benefits in this entirely unrelated area of female health. Obviously, female infertility and pregnancy are unrelated to heart health, but the extraordinary benefits witnessed by Dr. Fox in this area suggest that some fundamental lessons in human physiology can be learned. The results are so incredible that we are all sure to hear more about this approach as experience grows.

So I tracked Dr. Fox down in his busy Jacksonville, Florida practice to fill us in on some details.

WD: Dr. Fox, could you tell us something about yourself and what led you to use carbohydrate restriction in your female patients?

MF: I have been in practice as a reproductive endocrinologist for 15 years. During that time, I have seen our specialty move from a broad based practice of reproductive endocrinology to a narrow IVF [in vitro fertilization] focus, with patients being pushed through IVF in a cookie-cutter fashion without any emphasis on non-medical therapy.

Our focus has been to remain as a broad practice where we individualize care and attempt in every case to achieve pregnancy short of IVF. Five years ago, this continued quest for better care led us into the insulin resistance, low-carbohydrate metabolic world that has transformed our practice, although our practice offers all aspects of reproductive endocrinology including sub-specialized minimally invasive surgery, and all available infertility options.


WD: I have been intrigued by your comments about improved fertility with the low-carb diet. Could you elaborate on this?

MF: Yes, five years ago, as more information regarding Polycystic Ovarian Disease or Syndrome (PCOD/S) and its relationship to insulin resistance (high insulin levels) was emerging, we had a simple realization. As we've known for some time, insulin stimulates excess male hormone levels in the ovary, which disrupts ovulation and fertility. Then our job was to lower or virtually eliminate high insulin levels. Again, in simple fashion, we looked at physiology and realized that insulin is released only in response to dietary carbohydrates. Thus, elimination of carbohydrates should resolve the problem. This, in fact, is the effect that we have seen.

In our previous approaches to PCOD, we utilized oral ovulation medicines generating pregnancy rates in the 40% range overall. Now, with the nutritional approach, for those patients that follow our recommendations, our pregnancy rates are over 90%! This has dramatically reduced the need for in vitro fertilization in these patients.

To extend this idea further, we first started with relative low-carbohydrate diets, such as the South Beach diet, but quickly realized this didn't produce a metabolic effect. Over time, it has borne out that only the very low-carbohydrate diet (VLCD) approach produces significant metabolic change. Our impression then was that the current U.S. nutritional exposure probably increases insulin levels and that this has a detrimental effect on fertility.

To counter this effect, we now recommend the VLCD to all fertility patients and their spouses. The pregnancy rates do seem much better overall, as well as seeing a reduction in miscarriage rates. For the first time at our national meeting last year, there were three articles that showed improved pregnancy rates in patients without PCOD or insulin resistance in IVF when Glucophage was used. This drug decreases insulin. This supports the idea that our entire population is subjected to fertility-reducing high-carbohydrate diet.

WD: Do you see any other changes in these patients on the diet?

MF: Yes. All metabolic parameters, as well as many common complaints, improve. Cholesterol and triglyceride levels improve, while "good" HDL cholesterol levels increase. Weight drops at a pace of 12 lbs per month very steadily and we have many many patients who have experienced 50lb wt loss. Blood pressure decreases steadily in these patients and we are often able to get them off of cholesterol and blood pressure medicines. Common symptoms such as anxiety, sleep disturbances, decreased energy, migraine headaches and depression all dramatically improve. Again we can often get patients off depression and migraine suppression medications. So this approach helps in a multitude of areas.



WD: I was also interested in hearing more about your experience with morning sickness and the effects of a low-carb diet. Could you tell us more about this? Also, any thoughts on why this happens?

MF: As we continued to expand our thoughts about VLCD and fertility/pregnancy, we began to extend the nutritional approach into pregnancy. We know that pregnancy hormones dramatically worsen insulin resistance that is responsible for the condition, gestational diabetes. If insulin resistance is worsened, then reactive hypoglycemia is worsened. One of the biggest symptoms of hypoglycemia is nausea. So, in response to this, we have counseled our patients on the diet in pregnancy and have found a dramatic reduction in nausea. We recommend snacking every two hours in pregnancy.

The other "traditional" issue in pregnancy are cravings. These also likely stem from hypoglycemia. I have had many husbands tell us later that their wives, in contrast to friends etc, were calm and not moody or anxious during their pregnancies. Hypoglycemia probably is a serious issue for the fetus as well and may be the "signal" that turns on the insulin-resistant gene. Many theorists feel this might be an activated gene during the pregnancy.


WD: Do you use any unique approaches to the low-carbohydrate approach, e.g., inclusion of dairy, meal frequency, "induction" strategies (i.e., induction to the diet, not of labor!), etc.?

MF: Yes. As I'm sure everyone who works in the VLCD world does, we also have some tricks to make this work better. My biggest push, although hard to get patients to agree, is to see a counselor along with our follow-up in order to deal with "addictive behaviors" and "stress eating" that so many of our patients relate to us. Good stress management and cognitive behavioral therapy go a long way in helping this become a permanent change.

We also really push frequent calorie intake or "snacking." I think again that hypoglycemia produces an inborn drive to "cure" or "fix" starvation and leads to dramatic overeating. We have a short list of snacks that we recommend. The concept of hunger is offered as a failure of the program. We aim to eliminate hunger, as it represents hypoglycemia. The analogy I use is, if you drove your car until you ran out of gas before you ever sought to find gas, your life would be miserable. So it is the same with your metabolic engine: If you let it run out, the measures your system takes to fix it are very detrimental to life and certainly to nutritional health.

Our other big push is fat. People can wrap themselves around protein and vegetables, but they totally miss the high-fat (animal fat) part of the conversation. We have to really push that aspect. In regards to dairy, we allow for non-processed cheeses and minimal milk. An alternative is to mix about 4 oz whole milk with 4 oz of heavy whipping and 4 oz of water to create a "milk" with less sugar. Similarly, shakes and smoothies can be made with heavy whipping cream with pure whey protein powder added to create a liquid meal for those who "don't have time" to cook.


WD: Thanks, Dr. Fox. We look forward to hearing more about your approach in future.

Contact information:

Michael D. Fox, MD
Jacksonville Center
Reproductive Medicine
www.JCRM.org
Phone 904-493-2229

Track Your Plaque reduces healthcare costs 35%

Allow me to wear my Track Your Plaque hat for this post.

Mr. Richard Rawle is CEO of Utah company, Tosh, Inc. Mr. Rawle has been an avid follower of the Track Your Plaque program and has introduced the program to company employees. Here's what he has to say about the experience:

“Our company has been utilizing the principles of TYP [Track Your Plaque] for over a year and has experienced great results that have positively impacted the lives of our employees and our health care costs.

Since we began our wellness program, we have presented the TYP diet and lifestyle guidelines to all of our employees and their families. Although the overwhelming majority of our employees do not have cardiovascular issues, the preventative nature of TYP is too important not to be utilized. The TYP principles along with our increased focus on healthy living have already changed our group’s blood chemistry. HDL levels in particular have increased significantly and resulted in a large percentage of our employees having HDL levels of 60 or higher. Vitamin D levels have substantially increased and LDL levels have significantly decreased in the majority of our employees. Subsequently, in the 12 months just ended, our health care costs are some 35% less than other groups of comparable size and age.

I believe the TYP program has been an integral part of the success of our company's vast improvement in employee health/wellness, resulting in significant health care cost reductions."

Richard Rawle
CEO Tosh Inc.


Track Your Plaque saves lives. Track Your Plaque also saves money . . . lots of it. Despite the upfront costs of some additional blood testing and a heart scan, the dramatic reduction in need for medications, reduced heart attack, diabetes, and many other chronic conditions add up to a huge cost savings, much as Tosh, Inc. employees have enjoyed.

The Federal government has been looking towards large hospital systems to lead the way in healthcare delivery, systems that employ their physicians and possess economies of scale. But I say the answer to reducing healthcare costs will NEVER be found in hospital systems. Healthcare cost savings will be realized by delivering truly effective health solutions directly to people themselves, much as we do in Track Your Plaque.

In search of wheat

Many people ask: "How can wheat be bad if it's in the Bible?"

Wheat is indeed mentioned many times in the Bible, sometimes literally as bread, sometimes metaphorically for times of plenty or freedom from starvation. Moses declared the Promised Land "a land of wheat, and barley, and vines, and fig trees, and pomegranates; a land of oil olive, and honey" (Deuteronomy 8:8).

Wheat is a fixture of religious ceremony: sacramental bread in the Eucharist of the Christian church, the host of the Holy Communion in the Catholic church, matzoh for Jewish Passover, barbari and sangak are often part of Muslim ritual. Wheat products have played such roles for millenia.

So how can wheat be bad?

What we call wheat today is quite different from the wheat of Biblical times. Emmer and einkorn wheat were the original grains harvested from wild growths, then cultivated. Triticum aestivum, the natural hybrid of emmer and goatgrass, also entered the picture, gradually replacing emmer and einkorn.

The 25,000+ wheat strains now populating the farmlands of the world are considerably different from the bread wheat of Egyptians, different in gluten content, different in gluten structure, different in dozens of other non-gluten proteins, different in carbohydrate content. Modern wheat has been hybridized, introgressed, and back-bred to increase yield, make a shorter stalk in order to hold up to greater seed yield, along with many other characteristics. Much of the genetic work to create modern wheat strains are well-intended to feed the world, as well as to provide patent-protected seeds for agribusiness.

What is not clear to me is whether original emmer, einkorn, and Triticum aestivum share the adverse health effects of modern wheat.

Make no mistake about it: Modern wheat underlies an incredible range of modern illnesses. But do these primitive wheats, especially the granddaddy of them all, einkorn, also share these effects or is it a safe alternative--if you can get it?

I've ordered 2 lb of einkorn grain, unground, from Massachusetts organic farmer, Eli Rogosa, who obtained einkorn seed from the Golan Heights in the Middle East. We will be hand-grinding the wheat and making einkorn bread. We will eat it and see what happens.

Super-carbohydrate

Wheat starches are composed of polymers (repeating chains) of the sugar, glucose. 75% of wheat carbohydrate is the chain of branching glucose units, amylopectin, and 25% is the linear chain of glucose units, amylose.

Both amylopectin and amylose are digested by the salivary and stomach enzyme, amylase, in the human gastrointestinal tract. Amylopectin is more efficiently digested to glucose, while amylose is less efficiently digested, some of it making its way to the colon undigested.

Amylopectin is therefore the “complex carbohydrate” in wheat that is most closely linked to its blood sugar-increasing effect. But not all amylopectin is created equal. The structure of amylopectin varies depending on its source, differing in its branching structure and thereby efficiency of amylase accessibility.

Legumes like kidney beans contain amylopectin C, the least digestible—hence the gas characteristic of beans, since undigested amylopectin fragments make their way to the colon, whereupon colonic bacteria feast on the undigested starches and generate gas, making the sugars unavailable for you to absorb.

Amylopectin B is the form found in bananas and potatoes and, while more digestible than bean amylopectin C, still resists digestion to some degree.

The most digestible is amylopectin A, the form found in wheat. Because it is the most readily digested by amylase, it is the form that most enthusiastically increases blood sugar. This explains why, gram for gram, wheat increases blood sugar to a much greater degree than, say, chickpeas.

The amylopectin A of wheat products, “complex” or no, might be regarded as a super-carbohydrate, a form of highly digestible carbohydrate that is more efficiently converted to blood sugar than nearly all other carbohydrate foods.

Emmer, einkorn, and agribusiness

10,000 years ago, Neolithic humans did not obtain wheat products from the bagel shop, grocery store, or Krispy Kreme. They obtained wheat by locating a nearby wild-growing field of wild emmer or einkorn wheat grass, then harvesting it with their stone sickles.

Neolithic humans, such as the Natufians of the Fertile Crescent, carried their freshly-cut wheat home, then ground it by hand using homemade mortar and pestle. As yeast-raised bread was still some 5000 years in the future, emmer and einkorn wheat was not used to bake bread, but was consumed as a porridge in bowls. Einkorn has the simplest genetic code of 14 chromosomes, while emmer has 28 chromosomes.

A third variety of wheat appeared on the scene around 9000 years ago, a natural hybridization between emmer and goat grass, yielding the 42-chromosome Triticum aestivum species. Egyptians learned how to cause wheat to rise around 3000 BC, yielding bread, rather than the unleavened flatbreads of their predecessors.

From the original three basic varieties of wheat available to Neolithic man, over the past 30 years wheat has exploded to over 25,000 varieties. Where did the other 24,997+ strains come from?

In the 1980s, thousands of new wheat strains arose from hybridization experiments, many of them conducted in Mexico. Then, in the late 1980s, genetic engineering quietly got underway in which geneticists inserted or deleted single genes, mostly designed to generate specific characteristics, such as height, yield per acre, drought resistance, but especially resistance to various pesticides and weed killers. The fruits of these efforts were introduced into the market in 1994. Most of the genetically modified foods were thought to be only minor modifications of the unmodified original and thus no safety testing in animals or humans was conducted.

We now have many thousands of wheat strains that are different in important ways from original emmer, einkorn, and Triticum aestivum wheat. Interestingly, it has been suggested that einkorn wheat fails to provoke the same immune response characteristic of celiac disease provoked by modern wheat gluten, suggesting a different amino acid structure in gluten proteins. Another difference: Emmer wheat is up to 40% protein, compared to around 12% protein for modern wheat.

In other words, the wheat of earlier agricultural humans, including the wheat of Biblical times, is NOT the wheat of 2010. Modern wheat is quite a different thing with differing numbers of chromosomes, different genes due to human manipulation, varying gluten protein composition, perhaps other differences.

Somewhere in the shuffle and genetic sleight-of-hand that has occurred over the last 30 years, wheat changed. What might have been the "staff of life" has now become the cause of an incredible array of diseases of "wheat" intolerance.

Near-death experience with nattokinase

This is a true story that I personally witnessed.

A 60-some year old man heard that nattokinase "thinned the blood." So he had been taking it for the past 6 months.

One week before he came to see me, he abruptly became quite breathless. He was unable to walk more than 20 feet or bend over to tie his shoes due to the breathlessness.

He came to see me in the office. I was alarmed by how breathless he was without signs of heart failure or other obvious explanation. I sent him for an immediate CT pulmonary angiogram. Within 30 minutes, we had the diagnosis: a large "saddle" pulmonary embolus, meaning a large blood clot that straddled the right and left main pulmonary arteries. One wrong move and . . . bang! He would have been dead within a couple of minutes, since a large clot can completely occlude the large arteries feeding the lung, essentially corking any blood circuiting through the lungs and back to the left side of the heart. (Causing, incidentally, electromechanical dissociation, in which the heart keeps beating for a few minutes but no blood is being pumped. CPR can keep you alive for a few minutes, then it's over.)

When I advised the patient of the diagnosis (after initiating the REAL anticoagulants), he said, "But I was taking nattokinase!"

Exactly. Blood clots are no laughing matter. They are potentially fatal events. Betting your life on some company's advertisement is nothing short of foolish.

Anyone who reads The Heart Scan Blog knows that I am an avid supporter of nutritional supplements. I even write articles and consult for the supplement industry. But I truly despise hearing unfounded marketing claims that some supplement companies will make in the pursuit of a fast buck.

There is no doubt that we need better, safer methods to deal with dangerous blood clots, whether in the lung, pelvis, or other areas. But, before anyone takes a leap based on the extravagant marketing claims made by a supplement manufacturer, you want to be damn sure there are real data--not marketing claims, REAL data--before you use something like nattokinase in place of a proven therapy.

Don't confuse the very interesting, though unpalatable, natto with nattokinase. Natto contains vitamin K2 and some other interesting compounds, including nattokinase.

Blame the gluten?

Wheat is among the most destructive components of the human diet, a food that is responsible for inflammatory disease, diabetes, heart disease, several forms of intestinal diseases, schizophrenia, bipolar illness, ADHD, behavioral outbursts in autistic children . . . just to name a few.

But why?

Wheat is mostly carbohydrate. That explains its capacity to cause blood sugar to increase after eating, say, a turkey sandwich on whole wheat bread. The rapid release of sugars likely underlies its capacity to create visceral fat, what I call "wheat belly."

But neither the carbohydrate nor the other components, like bran and B vitamins, can explain all the other adverse health phenomena of wheat. So what is it in wheat that, for instance, worsens auditory hallucinations in paranoid schizophrenics? Is it the gluten?

First of all, what is gluten?

Gluten protein is the focus of most wheat research conducted by food manufacturers and food scientists, since it is the component of wheat that confers the unique properties of dough, allowing a pizza maker to roll and toss pizza crust in the air and mold it into shape. The distinctive “doughy” quality of the simple mix of wheat flour and water, unlike cornstarch or rice starch, for instance, properties that food scientists call “viscoelasticity” and “cohesiveness,” are due to the gluten. Wheat is mostly carbohydrate, but the 10-15% protein content is approximately 80% gluten. Wheat without gluten would lose its unique qualities that make it desirable to bakers and pizza makers. Gluten is also the component of wheat most confidently linked to immune diseases like celiac.

The structure of gluten proteins has proven frustratingly elusive to characterize, as it changes over time and varies from strain to strain. But an understanding of gluten structure may be part, perhaps most, of the answer to the question of why wheat provokes negative effects in humans.

The term “gluten” encompasses two primary families of proteins, the gliadins and the glutenens. The gliadins, one of the protein groups that trigger the immune response in celiac disease, has three subtypes: a/ß-gliadins, ?-gliadins, and ?-gliadins. The glutenins are repeating structures, or polymers, of more basic protein structures.

Beyond gluten, the other 20% or so of non-gluten proteins in wheat include albumins, prolamins, and globulins, each of which can also vary from strain to strain. In total, there are over 1000 other proteins that serve functions from protection of the grain from pathogens, to water resistance, to reproductive functions. There are agglutinins, peroxidases, a-amylases, serpins, and acyl CoA oxidases, not to mention five forms of glycerinaldehyde-3-phosphate dehydrogenases. I shouldn’t neglect to mention the globulins, ß-purothionin, puroindolines a and b, tritin, and starch synthases.

As if this protein/enzyme smorgasbord weren’t enough, food processors have also turned to fungal enzymes, such as cellulases, glucoamylases, xylanases, and ß-xylosidases to enhance leavening and texture. Many bakers also add soy flour to enhance mixing and whiteness, which introduces yet another collection of proteins and enzymes.

In short, wheat is not just a simple gluten protein with some starch and bran. It is a complex collection of biological material that varies according to its genetic code.

While wheat is primarily carbohydrate, it is also a mix of gluten protein which can vary in structure from strain to strain, as well as a highly variable mix of non-gluten proteins. Wheat has evolved naturally to only a modest degree, but it has changed dramatically under the influence of agricultural scientists. With human intervention, wheat strains are bred and genetically manipulated to obtain desirable characteristics, such as height (ranging from 18 inches to over 4 feet tall), “clinginess” of the seeds, yield per acre, and baking or viscoelastic properties of the dough. Various chemicals are also administered to fight off potential pathogens, such as fungi, and to activate the expression of protective enzymes within the wheat itself to “inoculate” itself against invading organisms.

From the original two strains of wheat consumed by Neolithic humans in the Fertile Crescent 9000 years ago (Emmer and Einkorn), we now have over 200,000 strains of wheat virtually all of which are the product of genetic manipulations that have modified the protein structure of wheat. The extraordinary complexity of wheat proteins have therefore created a huge black box of uncertainty in pinpointing which protein causes what.

But there's an easy cure for the uncertainty: Don't eat it.

Glycemic gobbledygook

The concept of glycemic index is meant to help determine what foods raise blood sugar a lot vs. what foods raise blood sugar a little. Dr. Jennie Brand-Miller's searchable database can be found here.

I have to admit that glycemic index provided me with a sense of false assurance for some years. It screwed up my health until I came to understand the issues a lot better.

For those of you just starting out in nutritional conversations, glycemic index (GI) represents a comparison of the blood glucose area-under-the-curve (AUC) over 2 hours after consuming 50 grams of the food in question compared to the AUC of glucose or white bread. Volunteers involved in developing these values are healthy people who are generally of normal weight.

Glucose, by definition, has a GI of 100. An equal quantity of sucrose (50% glucose, 50% fructose) has a GI of 60, lower than glucose. An equal quantity of whole wheat bread has a GI of 68-77 (Yes: The GI of whole wheat is higher than sucrose). Non-carbohydrate foods, such as eggs or avocado, have no GI since they do not impact on blood glucose.

Because the GI is also sensitive to how much carbohydrate is contained, the concept of Glycemic Load (GL) was introduced:

GL = (GI x amount of carbohydrate) / 100

GL is therefore the GI that incorporates the glycemic potential of the food of interest. GI does not vary with portion size; GL varies with portion size.

Let's take whole wheat pasta, a food regarded by most people as a healthy choice. Whole wheat pasta has a GI of 55--fairly low--and a GL of 29. A serving of 180 g (approximately 6 oz cooked) provides 50 g carbohydrates.

People who advocate that low-glycemic index foods would say that this is a desirable profile and should therefore replace high-glycemic index foods.

I say WRONG. First of all, most of us are not slender 20-somethings. We will therefore not show the same response as a young, slender person (like the GI volunteers), but will show exagerrated blood sugar responses. So this much low-glyemic index whole wheat pasta will typically yield a blood sugar of 120-200 mg/dl in non-diabetic people, high enough to trigger glycation. Sure, a high-glycemic index food, such as white flour birthday cake with plenty of sugary icing, might trigger a blood sugar of 140-250 mg/dl, much worse. But that doesn't make the lower blood sugar following pasta any less bad--it's still terrible.

Another issue: GI is assessed over a 2-hour timeline. What if blood sugar remains high in a sustained way, say, over 6 hours? That's precisely what whole wheat pasta will do: Keep blood sugar high for an extended period.

So not only does a low-glycemic index food like pasta increase blood sugar in most of us extravagantly, it does so in a sustained way.

Lastly, low-glycemic index pasta still triggers small LDL particles to an extreme degree, as I discussed in the previous Heart Scan Blog post, Small LDL: Complex vs. simple carbohydrates.

Don't be false reassured by the notion of low GI or GL. In fact, I'd go so far as to say that NO glycemic index is a GOOD glycemic index (or load). The foods we want to dominate our diet are the foods that aren't even listed in the GI database.
AGEing gracefully

AGEing gracefully

Advanced Glycation End-products, or AGEs, have the potential to change our entire conversation about diet.

AGEs come from two principal sources:

1) Endogenous--Glucose-protein interactions that arise from high blood glucose levels

2) Exogenous--From diet

The first is sensitive to glucose levels: the higher the glucose level, the greater the AGE formation. The second depends on the quantity of AGE in the food consumed.

A compelling body of evidence points towards AGEs as an agent of aging, as well as kidney dysfunction, dementia, and atherosclerosis. Some of the observations made include:

--If AGEs are infused into an experimental animal, it develops atherosclerosis, kidney disease, and other "diseases of senescence" within weeks to months.

--In endothelial cells (cells lining arteries), AGE induces expression of adhesion molecules and inflammatory signals. In fibroblasts, AGE provokes collagen production. In smooth muscle cells, AGE triggers migration and proliferation. In monocytes and macrophages, AGEs induce chemotaxis and release of inflammation mediators. In short, AGEs have been implicated in just about every step leading to atherosclerosis.

--In humans, greater quantities of AGEs are present in diabetics, pre-diabetics and people with insulin resistance. We all know that these people develop atherosclerosis, kidney disease, cataracts, and other conditions at an accelerated rate.

--Foods containing greater quantities of AGEs cause endothelial dysfunction, i.e., artery constriction via blockade of nitric oxide and other mechanisms.

Short of taking agents that block AGE activity, how can you minimize the absorption or production of AGEs? There are two general strategies:

1) Keep blood glucose low--The Whitehall study demonstrated increased cardiovascular mortality with a postprandial (actually 2-hour post- 50-gram glucose challenge) blood sugar of 83 mg/dl. Lower blood glucose, less glycation. Less carbohydrates in the diet, the lower the blood sugar, the less the glycation. Studies like Whitehall demonstrate that glycation begins with glucose values within the normal range. Thus, aging occurs even with normal glucose levels. It occurs faster with higher glucose levels.

2) Choose and prepare foods with lower AGE content. Food content of AGEs is a major determinant of blood AGE levels. Fats and meats are the primary dietary source of AGEs, particularly if cooked at high temperature (broiling, frying). While this does not mean that meats and fats need to be avoided, it can mean that limiting serving size of meats and fats, while being selective in how they are prepared, are important. This can mean cutting your meats in thinner slices or smaller pieces to permit faster cooking, eating rare when possible (not poultry, of course), avoiding cooking with sauces that contain sugar (which enhances AGE formation). Is this an argument in favor of sashimi?

Minimizing exposure to AGEs, endogenous or exogenous, has the potential to slow the aging process, or at least to lessen the likelihood of many of the phenomena of aging.

More on this to come.

Comments (32) -

  • yoyo

    5/5/2010 11:17:44 AM |

    I'm more worried about endogenous AGEs; exogenous the evidence seems a bit more mixed.

    Are food advanced glycation end products toxic in biological systems?

    Chuyen NV, Arai H, Nakanishi T, Utsunomiya N.

    Japan Women's University, Department of Food and Nutrition, 2-8-1 Mejiro-dai, Bunkyo-ku, Tokyo 8681, Japan. nvc@fc.jwu.ac.jp
    Abstract

    Model food advanced glycation end products (AGEs) were prepared as glycated casein (GC) and glycated soy protein (GS) by the reaction of casein or soy protein with glucose at 50 degrees C, relative humidity 75% for seven days in a powder state. These browned proteins were used as materials for animal experiments. A mixture of 20% glycated proteins (GC:GS = 1:1) diet was fed to streptozotocin (STZ)-diabetic rats for 11 weeks. The results showed that: (1) fructoselysine was observed in the hepatic portal veins, arteries, and femoral veins of rats fed with glycated proteins after 2 h of feeding; (2) blood sugar of glycated protein-fed rats was lower than that of diabetic rats fed with intact protein, while HbA1C in blood and glucose in urine of both groups were similar; (3) lipid peroxidation status in serum, liver, and kidney of both groups was similar; (4) superoxide dismutase (SOD) and glutathione-S-transferase (GST) enzymatic activity in serum and liver of both groups were also similar; (5) there were no differences in degree of cataract formation and concentration of glucose, fructose, sorbitol, and lipid peroxide in the lenses of both groups. From the above results, it can be estimated that food AGEs are not toxic in biological systems, and reactive oxygen species increase in diabetic rats is not caused by glycated proteins but by other pathways.

    PMID: 16037268 [PubMed - indexed for MEDLINE]

    Unfortunately, starches have much lower AGE content. Any preparation of meat has large amounts, though still variable. This might be why high-carb diets work well for traditional societies where obesity is not common.

  • Joel

    5/5/2010 11:49:11 AM |

    Less carbs, less meats, less fats--sounds like you're just promoting calorie restriction since that doesn't leave much that you can eat in significant quantities.

  • Denny Barnes

    5/5/2010 12:16:33 PM |

    Looking forward to your future writings on AGEs. I hope you will talk about the role of fructose which can form ten times as many AGEs as glucose. Not all carbs are created equal. As a fellow T2 diabetic, I think we focus too much on blood glucose and miss the stealth carb -- frutose.  It is by far the most insidious.

    Forgive me for saying it, but I feel that the ghost of your vegetarian past still haunts your writing.  Yes, barbecued, fried and broiled meats can have way too much AGEs, especially if cooked with sweet sauces, but animal protein cooked with water has 1/10 as many AGEs. I am a happy carnivore who loves stewed meats and chicken and steamed fish.

  • Martin Levac

    5/5/2010 12:49:37 PM |

    Then there's ketosis which stimulates something called chaperone-mediated autophagy (CMA). This process is basically the recycling of junk protein. AGEs would constitute such junk. So it's not only a question of low blood glucose but of ketosis as well. Incidentally, if one eats only meat or very little carbs, then he will be in ketosis most of the time. In that sense, it doesn't matter how much AGEs come from this diet since the same diet would provide the recyclers as well. Here's the post by Eades on the subject:

    http://www.proteinpower.com/drmike/ketones-and-ketosis/ketosis-cleans-our-cells/

  • Ned Kock

    5/5/2010 1:20:12 PM |

    Supporting your point regarding endogenous AGEing, there is also reliable evidence that blood glucose control before age 55 may increase your chances of living beyond 90:

    http://healthcorrelator.blogspot.com/2010/04/blood-glucose-control-before-age-55-may.html

    However, I am yet to see reliable evidence that significant damage can be caused by ingested AGEs through cooked meat and fat (e.g., resulting from Maillard reactions).

    I don't doubt that injecting AGEs into model animals, particularly rodents, will lead to problems. But human digestion in a healthy person (e.g., no leaky gut) is another story. Moreover, cooked meat is denatured and thus rendered more easily digestible.

  • Jen

    5/5/2010 3:42:07 PM |

    Thanks for the post Dr. Davis!

    I would love to get info on what happens to the body as you are lowering your blood sugar via diet.  I have been using a monitor and feel my best at around 85 but at times crave sugar pretty bad and have energy spikes and dips.  I exercise too, so curious how this factors in?

  • Apra -- The Shaman

    5/5/2010 3:42:07 PM |

    I agree with Yoyo.  It seems to me this could be another red herring, like the dietary cholesterol nonsense.  Until they can tease apart whether the issue is due to dietary AGEs of the stuff produced from hyperglycemia then I don't necessarily see any reason to jump on an anti-meat bandwagon.

    Still, if you're truly concerned, invest in some Sous Vide equipment and cook your meat at low temperatures and don't finish it with a nice sear.

  • Stephan

    5/5/2010 6:36:09 PM |

    I just read the Whitehall study, it really didn't show that CHD mortality increases from 83 mg/dL.  That's based on their mathematical extrapolation, which didn't fit the actual data very well at the lower range of blood glucose.  According to the data itself, CHD risk didn't begin increasing until 5.7 mmol/L, or 102 mg/dL.  

    That makes sense because 83 mg/dL is totally normal fasting glucose.

  • Adolfo David

    5/5/2010 9:55:08 PM |

    Sad to say: Dr Michael Holick recommends at the end of his new book VITAMIN D SOLUTION essentially one brand of vitamin D supplements: Nature Made! :S

  • Anonymous

    5/6/2010 1:02:37 AM |

    2 things might help AGE's.
    I read that Carnosine which is a combo of 2 amino acids helps prevent glycation and many anti-aging experts recommend this supplement.
    Metformin reduces glucose production in the liver, reduces glucose absorption in the intestines and increases tissue sensitivity to actual glucose in the blood.
    Also may decrease cancer risk
    I have started these supplements in hopes of combating AGE's

  • Lori Miller

    5/6/2010 1:29:00 AM |

    Another way to cook meat quickly is by using a pressure cooker. The 1.5-pound roast I'm having for dinner was done in 20 minutes--15 probably would have been fine. The package called for roasting it for four hours in the oven.

  • Anonymous

    5/6/2010 2:05:20 AM |

    A fasting glucose of 80-109 mg/dl was optimal for CVD and overall mortality in this paper.

    http://circ.ahajournals.org/cgi/content/full/101/17/2047

  • pmpctek

    5/6/2010 2:51:51 AM |

    I've heard that Benfotiamine (200mg twice/day) is a potent AGE inhibitor.  I haven't been able to find much study on humans that backs up that claim though.

  • Anonymous

    5/6/2010 4:19:34 AM |

    Forgive my extreme ingnorance in this area, but how do meat and fats contain AGEs?

    A grilled steak? An egg fried in coconut oil? Where is the source of glucose here?

  • Fran

    5/6/2010 4:29:09 AM |

    "Fats and meats are the primary dietary source of AGEs..." I'm sorry, but this makes no sense to me... that fats and meats will increase blood sugar levels. My understanding to this point is that carbs are the cause, while good saturated fats and protein stabilize blood sugar levels.

  • Dr. John Mitchell

    5/6/2010 4:31:51 AM |

    I'd like to see references for many of your statements.

  • Bruce

    5/6/2010 4:34:46 AM |

    May I offer a little anecdotal evidence? After hearing a researcher from Australia's Baker Heart Institute describe how a low exogenous AGE diet appeared to reverse the complications of Type II Diabetes - although not Diabetic, I was intrigued enough to devise my own low-AGE regime.

    During the subsequent 5 months, with no attempt to restrict calories, I have lost nearly 15 kg, have had my total Cholesterol drop from 5.9 to 4.6, blood pressure drop from 128/88 to 110/62. Part of my strategy has been to avoid all sugars, including most fructose sources, in the interest of limiting endogenous AGE formation.

    BTW, I am 60 years (suddenly) young.

  • Michael Barker

    5/6/2010 2:57:54 PM |

    Humans have been cooking meats, at least, 100,000 years before the invention of agriculture. The fact that it is so ubiquitous suggests that we are quite adapted to this even without thinner slices or smaller portions.

  • Anonymous

    5/6/2010 3:26:07 PM |

    Marinating meat with acid (vinegar) before grilling greatly reduces the maillard reaction and the formation of AGEs in meat.

  • Peter

    5/6/2010 4:48:23 PM |

    As we learn more about food, we learn more about the downsides: fish have mercury, meat has AGE's, carbs increase insulin sensitivity, etc. If you ask an expert what to eat, each one gives you a different answer.  How can we tell truth from belief?

  • CB Predator

    5/7/2010 10:50:32 AM |

    I wanted to thank you for this great read!! I definitely enjoying every little bit of it I have you bookmarked to check out new stuff you post

  • foodnearsnellville

    5/7/2010 4:54:40 PM |

    At what point is research like this going to limit the use of sugary glazes and marinades in meats and restaurant foods?

  • Anne

    5/8/2010 12:05:57 PM |

    Could adding spices and herbs reduce the bad effects of cooked meat. The study is small and funded by McCormick. Simple Addition to Meat Helps

  • Marianne

    5/8/2010 9:22:51 PM |

    Just discovered this blog so forgive me if this has already been covered.  What about Neu5Gc?  Some recommend all mammal products be avoided as they all contain this substance and it sets up an inflammatory process in the body as humans do not have Neu5Gc and recognize it as foreign.  I  have recently been poking around at eating better (not that my past was bad!) and I have never been so confused in my entire life!!! Everyone has their own opinion and most of it is contradictory. High carb, low carb, no meat, more meat, more fish, all whole grains.  It's like a crap shoot.

  • yoyo

    5/9/2010 10:57:30 AM |

    I don't have access to the original study, but the best one i could find has the food levels of AGEs reproduced with some comments at this gentleman's blog: http://inhumanexperiment.blogspot.com/2009/09/age-content-of-foods.html

    meat, even with low heat low pH preparations, seems to be high. eggs and legumes are low for their protein content.

  • Dr. William Davis

    5/9/2010 12:25:34 PM |

    Yoyo, Joel--

    Much of the work on the AGE content of food, its absorption, and its consequences have been generated by Dr. Helen Vlassara's group in New York. The Japanese group Yoyo cites has, indeed, found some conflicting observations.

    I do not think that we can construct an "AGE-free" diet nor lifestyle, nor are the data on AGE-blockers sufficiently solid to justify taking them, in my view.

    However, this is such a fascinating line of research that I think it's worth being aware of and discussing.

  • Dr. William Davis

    5/9/2010 12:33:50 PM |

    Bruce--

    Fascinating experience!

    How did you handle the AGE in meats issue?

  • Dr. William Davis

    5/9/2010 12:36:17 PM |

    Marianne--

    Sorry, no insights into Neu5Gc.

    As I mentioned in the post, this is not a "no meat" comment. It is simply discussing the fascinating observations made by Helen Vlassara's group that, when taken as a whole, fit like a perfect puzzle piece into the question of why people with high blood sugars, e.g., diabetics and pre-diabetics, develop all the undesirable health effects they do.

  • Bruce

    5/9/2010 11:50:47 PM |

    May I add a few more comments?

    Regarding meat, I have been eating normal and even generous portions - but I purchased a steamer and slow cooker to keep the cooking temps as low as possible. There is a limit in how far you can lower exogenous AGEs unless you adopt an extreme Raw regime.

    Then, your body will still produce its baseline of indogenous AGEs. I eat virtually zero sugar except for a minimal amount of fruit - usually 2 servings or 3 per day at most.

    We're really talking about a low Maillard Reaction Products diet, then I think. AGEs are many in type and the chemistry is complex. But there is good and growing evidence that the overall mix of MRPs are toxic. One study I read stated that lowering the exogenous AGE load by 40% reduces the circulating AGEs  by 60% and at this level, the body's own ability to scavenge out these compounds recovers.

    This suggests to me that we can tolerate MRPs up to a certain level, but the western diet is increasingly loading with these compounds. I wonder if this provides a (at least) partial explanation of the obestity epidemic.

    Food has been plentiful and cheap for at least 3 generations now, yet obesity is 'exploding' at the same time that the food industry is in an 'arms race' to heighten the marketability of their products.

  • Kevin

    5/10/2010 3:38:54 PM |

    I wonder how calorie restriction affects AGEs.  Is this possibly how CR influences longevity?  

    kevin

  • Santiago

    5/10/2010 11:34:41 PM |

    Hi Dr Davis
    I've hear from some diabetics how honey doesn't seem to affect them that bad.
    I looked arround and found some studies showing that honey after eaten for a while lowers blood sugar levels improiving liver function.
    Was wondering if you have an opinion related to honey

  • Anonymous

    8/30/2010 3:50:39 PM |

    So don't eat meat or carbs.  Good advice.

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