© FAB and AHDB 2013 Bread and Health Separating fact from fiction.

© FAB and AHDB 2013 Learning Objectives To review the evidence surrounding bread and its health effects. To understand the role of bread in a healthy, varied diet. To consider the following questions: Are starchy foods, including bread, fattening? I heard that bread causes bloating – is this true? Are there people who should avoid bread? Is it true that many people suffer from wheat allergies? I heard that bread contains salt and that we should reduce our salt intake – does this mean I should reduce my bread intake?

© FAB and AHDB 2013 Bread and body weight – the facts Carbohydrate is the main macronutrient provided by bread. One gram of carbohydrate provides half the energy (kilojoules) of one gram of fat! Because most starchy foods are high in carbohydrate, and low in fat, they generally provide less energy than foods that are low in carbohydrate but high in fat. 17 kJ 37 kJ Energy per gram

© FAB and AHDB 2013 Bread and body weight – the facts Carbohydrate is the body’s preferred fuel – avoiding carbohydrate can leave the body feeling less energetic and tired. Too much energy from any source will lead to weight gain, (e.g. fat or carbohydrate). Having a diet which provides less energy, and being physically active, is the best way to maintain or achieve a healthy weight. Energy in Energy out

© FAB and AHDB 2013 Bread and body weight – the facts Foods that contain carbohydrate (e.g. bread) provide other important nutrients such as fibre, calcium, iron, zinc, magnesium, thiamine and folate, so avoiding these types of foods means missing out on these nutrients. People who have higher intakes of carbohydrate as a proportion of energy, particularly starchy carbohydrate, are typically slimmer than those who have low intakes.

© FAB and AHDB 2013 Low-carbohydrate diets Low-carbohydrate diets have become very popular among those trying to lose weight. But they are not a healthy way to lose weight. Although low-carbohydrate diets are effective in reducing body weight in the short-term, they are not more effective than other approaches of weight loss in the long run (such as a healthy and balanced, energy-reduced diet).

© FAB and AHDB 2013 Low-carbohydrate diets This means that trying to lose weight with a low-carbohydrate diet is generally a quick fix, rather than a long-term solution. But more importantly, low-carbohydrate diets are not a healthy way to lose weight as they are low in fibre and can be low in important nutrients. Common side effects of low-carbohydrate diets are bad breath, constipation and sluggishness.

© FAB and AHDB 2013 Low-carbohydrate diets Rather than eliminating a food group from the diet, it is better to maintain a balanced diet and be physically active. This will help to achieve or maintain a healthy body weight.

© FAB and AHDB 2013 Bread and bloating – the facts There is no evidence that bread causes bloating in healthy people, no matter if produced in a traditional way or in a modern way. Bread provides fibre, which is fermented in the colon by bacteria located there. This produces gas, which some people may wrongly perceive as ‘bloating’, but it is actually a sign of a well functioning gut (Weichselbaum, 2012). Weichselbaum E (2012) Does Bread cause bloating? Nutrition Bulletin Volume 37, Issue 1, Volume 37, Issue 1, pages 30–36. Free to download from http://onlinelibrary.wiley.com/doi/10.1111/j.1467-3010.2011.01943.x/abstract

© FAB and AHDB 2013 Bread and bloating – the facts This is normal and after a few days the gut usually adapts to the larger amounts of fibre and symptoms disappear. Drinking plenty of fluid and being physically active help to avoid bloating. Some people who typically have a low fibre intake and suddenly increase their intake, for example by eating more wholemeal bread, may produce more gas and suffer from distension and discomfort – which may be perceived as bloating.

© FAB and AHDB 2013 Bread and bloating – the facts People who have low fibre intakes are more likely to suffer from constipation. Many people perceive constipation as ‘being bloated’. In this case, increasing fibre intake, for example by eating more wholemeal bread, can help alleviate the symptoms.

© FAB and AHDB 2013 Conditions related to bread – the facts Wheat allergy -This is a reaction of the immune system to specific wheat proteins. -Diagnosis is made using a skin test or a blood test called a radioallergosorbent test (RAST). -It causes symptoms such as respiratory and gastrointestinal symptoms and dermatitis. -Wheat allergy sufferers have to exclude wheat from their diet.

© FAB and AHDB 2013 Conditions related to bread – the facts Coeliac disease -This is an intolerance to gluten, a protein present in many grains. -It is diagnosed following an intestinal biopsy. -Coeliac patients must avoid gluten to avoid symptoms, which are mainly digestive problems. -Specifically formulated, gluten-free bread and other products are available for coeliac sufferers.

© FAB and AHDB 2013 Bread and bloating – the facts Coeliac disease is estimated to affect 1 in 100 people in the UK If somebody suspects that they have one of these conditions, it is important that they speak to a GP and get properly tested rather than simply avoiding cereal-based products such as bread and therefore risking insufficient nutrient intakes.

© FAB and AHDB 2013 Gluten free bread – the facts Sales of gluten-free products have grown by over 200% in the last few years, which means that more and more people now buy gluten-free products (The Grocer, 2012*). Gluten-free products have been specifically designed for people suffering from coeliac disease, but there is no benefit of avoiding gluten for people who are not sensitive to it. *Available at http://www.thegrocer.co.uk/fmcg/ambient/bakery/brown-bread-hardly-the- bakery-sector-is-brimming-with-confidence/229163.articlehttp://www.thegrocer.co.uk/fmcg/ambient/bakery/brown-bread-hardly-the- bakery-sector-is-brimming-with-confidence/229163.article

© FAB and AHDB 2013 Gluten free bread – the facts There is no health benefit to healthy individuals from swapping conventional bread with gluten-free bread. Gluten-free products are generally more expensive than conventional products.

© FAB and AHDB 2013 Bread and allergy – the facts Many people believe they have a food allergy, but it is estimated that the actual number of people who are allergic to food is much lower. Around 20% of people believe they have a food allergy, but it is estimated that only 2% actually suffer from food allergies. This means that only 1 out of 10 people who suspect they have a food allergy are in fact allergic. It also means that 9 in 10 people who think they are allergic to specific foods may be avoiding them unnecessarily.

© FAB and AHDB 2013 Bread and allergy – the facts This is also the case for wheat allergy. It is important that those who suspect an allergy go to their GP and get properly tested. Simply avoiding foods such as bread because an allergy is suspected can mean that people miss out on important nutrients.

© FAB and AHDB 2013 Bread and salt – the facts It is true that bread contains salt. Salt has a functional role to play in bread making (e.g. controlling yeast and as a stabiliser) and is required for better shelf life. In recent years, salt levels in bread have been significantly reduced. In the UK, bread now contains about 40% less salt compared to bread in the 1980s. More work is underway to further reduce salt levels.

© FAB and AHDB 2013 Bread and salt – the facts Manufacturers have been working for many years to reduce the salt content of bread. Between 2001 and 2011 the salt content of bread was reduced by about 20%. Brinsden et al. (2013)

© FAB and AHDB 2013 Bread and salt – the facts Salt levels in bread can only be lowered to a certain level, as there are technical issues that arise when too much salt is removed. Salt levels can be compared between different bread brands and types by checking the labels – these usually provide information on salt or sodium (which is a component of salt).

© FAB and AHDB 2013 Bread and salt – the facts It is not advised to exclude bread from the diet because it contains salt, as bread also provides other important nutrients. But it is important to remember that bread contains salt and counts towards the total salt intake for the day. Government recommendations state that adults and children aged 11 years and above should consume no more than 6g salt each day (SACN 2003) and younger children should have less.

© FAB and AHDB 2013 Summary There are many misconceptions about the health effects of bread. Avoiding starchy foods in the diet is not a healthy way to control body weight, and is unlikely to be effective in the long-term. There is no evidence that bread causes bloating in healthy people. Some people have to avoid bread or certain components of bread, but only a small proportion of the population is affected. If a condition relating to bread or any other food is suspected it is important to consult a GP rather than simply cutting out foods from the diet. Although bread contains some salt, it also provides other important nutrients, and it is therefore not a good idea to reduce bread intake in order to reduce salt intake.

© FAB and AHDB 2013 Bread and Health Separating fact from fiction.

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© FAB and AHDB 2013 Bread and Health Separating fact from fiction.

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