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PART ONE
WHEAT: THE UNHEALTHY WHOLE GRAIN
CHAPTER 1
WHAT BELLY?
The scientific physician welcomes the establishment of a standard loaf of bread made according to the best scientific evidence. . . . Such a product can be included in diets both for the sick and for the well with a clear understanding of the effect that it may have on digestion and growth.
Morris Fishbein, MD, editor, Journal of the American Medical Association, 1932
IN CENTURIES PAST, a prominent belly was the domain of the privileged, a mark of wealth and success, a symbol of not having to clean your own stables or plow your own field. In this century, you don't have to plow your own field. Today, obesity has been democratized: Everybody can have a big belly. Your dad called his rudimentary mid-twentieth-century equivalent a beer belly. But what are soccer moms, kids, and half of your friends and neighbors who don't drink beer doing with a beer belly?
I call it wheat belly, though I could have just as easily called this condition pretzel brain or bagel bowel or biscuit face since there's not an organ system unaffected by wheat. But wheat's impact on the waistline is its most visible and defining characteristic, an outward expression of the grotesque distortions humans experience with consumption of this grain.
A wheat belly represents the accumulation of fat that results from years of consuming foods that trigger insulin, the hormone of fat storage. While some people store fat in their buttocks and thighs, most people collect ungainly fat around the middle. This "central" or "visceral" fat is unique: Unlike fat in other body areas, it provokes inflammatory phenomena, distorts insulin responses, and issues abnormal metabolic signals to the rest of the body. In the unwitting wheat-bellied male, visceral fat also produces estrogen, creating "man breasts."
The consequences of wheat consumption, however, are not just manifested on the body's surface; wheat can also reach deep down into virtually every organ of the body, from the intestines, liver, heart, and thyroid gland all the way up to the brain. In fact, there's hardly an organ that is not affected by wheat in some potentially damaging way.
PANTING AND SWEATING IN THE HEARTLAND
I practice preventive cardiology in Milwaukee. Like many other midwestern cities, Milwaukee is a good place to live and raise a family. City services work pretty well, the libraries are first-rate, my kids go to quality public schools, and the population is just large enough to enjoy big-city culture, such as an excellent symphony and art museum. The people living here are a fairly friendly bunch. But . . . they're fat.
I don't mean a little bit fat. I mean really, really fat. I mean panting- and-sweating-after-one-flight-of-stairs fat. I mean 240-pound 18-year-old women, SUVs tipped sharply to the driver's side, double-wide wheelchairs, hospital equipment unable to accommodate patients who tip the scales at 350 pounds or more. (Not only can't they fit into the CT scanner or other imaging device, you wouldn't be able to see anything even if they could. It's like trying to determine whether the image in the murky ocean water is a flounder or a shark.)
Once upon a time, an individual weighing 250 pounds or more was a rarity; today it's a common sight among the men and women walking the mall, as humdrum as selling jeans at the Gap. Retired people are overweight or obese, as are middle-aged adults, young adults, teenagers, even children. White-collar workers are fat, blue-collar workers are fat. The sedentary are fat and so are athletes. White people are fat, black people are fat, Hispanics are fat, Asians are fat. Carnivores are fat, vegetarians are fat. Americans are plagued by obesity on a scale never before seen in the human experience. No demographic has escaped the weight gain crisis.
Ask the USDA or the Surgeon General's office and they will tell you that Americans are fat because they drink too many soft drinks, eat too many potato chips, drink too much beer, and don't exercise enough. And those things may indeed be true. But that's hardly the whole story.
Many overweight people, in fact, are quite health conscious. Ask anyone tipping the scales over 250 pounds: What do you think happened to allow such incredible weight gain? You may be surprised at how many do not say "I drink Big Gulps, eat Pop Tarts, and watch TV all day." Most will say something like "I don't get it. I exercise five days a week. I've cut my fat and increased my healthy whole grains. Yet I can't seem to stop gaining weight!"
HOW DID WE GET HERE?
The national trend to reduce fat and cholesterol intake and increase carbohydrate calories has created a peculiar situation in which products made from wheat have not just increased their presence in our diets; they have come to dominate our diets. For most Americans, every single meal and snack contains foods made with wheat flour. It might be the main course, it might be the side dish, it might be the dessert--and it's probably all of them.
Wheat has become the national icon of health: "Eat more healthy whole grains," we're told, and the food industry happily jumped on board, creating "heart healthy" versions of all our favorite wheat products chock- full of whole grains.
The sad truth is that the proliferation of wheat products in the American diet parallels the expansion of our waists. Advice to cut fat and cholesterol intake and replace the calories with whole grains that was issued by the National Heart, Lung, and Blood Institute through its National Cholesterol Education Program in 1985 coincides precisely with the start of a sharp upward climb in body weight for men and women. Ironically, 1985 also marks the year when the Centers for Disease Control and Prevention (CDC) began tracking body weight statistics, tidily documenting the explosion in obesity and diabetes that began that very year.
Of all the grains in the human diet, why only pick on wheat? Because wheat, by a considerable margin, is the dominant source of gluten protein in the human diet. Unless they're Euell Gibbons, most people don't eat much rye, barley, spelt, triticale, bulgur, kamut, or other less common gluten sources; wheat consumption overshadows consumption of other gluten- containing grains by more than a hundred to one. Wheat also has unique attributes those other grains do not, attributes that make it especially destructive to our health, which I will cover in later chapters. But I focus on wheat because, in the vast majority of American diets, gluten exposure can be used interchangeably with wheat exposure. For that reason, I often use wheat to signify all gluten-containing grains.
The health impact of Triticum aestivum, common bread wheat, and its genetic brethren ranges far and wide, with curious effects from mouth to anus, brain to pancreas, Appalachian housewife to Wall Street arbitrageur.
If it sounds crazy, bear with me. I make these claims with a clear, wheat- free conscience.
NUTRI-GROAN
Like most children of my generation, born in the middle of the twentieth century and reared on Wonder Bread and Devil Dogs, I have a long and close personal relationship with wheat. My sisters and I were veritable connoisseurs of breakfast cereal, making our own individual blends of Trix, Lucky Charms, and Froot Loops and eagerly drinking the sweet, pastel-hued milk that remained at the bottom of the bowl. The Great American Processed Food Experience didn't end at breakfast, of course. For school lunch my mom usually packed peanut butter or bologna sandwiches, the prelude to cellophane-wrapped Ho Hos and Scooter Pies. Sometimes she would throw in a few Oreos or Vienna Fingers, too. For supper, we loved the TV dinners that came packaged in their own foil plates, allowing us to consume our battered chicken, corn muffin, and apple brown betty while watching Get Smart.
My first year of college, armed with an all-you-can-eat dining room ticket, I gorged on waffles and pancakes for breakfast, fettuccine Alfredo for lunch, pasta with Italian bread for dinner. Poppy seed muffin or angel food cake for dessert? You bet! Not only did I gain a hefty spare tire around the middle at age nineteen, I felt exhausted all the time. For the next twenty years, I battled this effect, drinking gallons of coffee, struggling to shake off the pervasive stupor that persisted no matter how many hours I slept each night.
Yet none of this really registered until I caught sight of a photo my wife snapped of me while on vacation with our kids, then ages ten, eight, and four, on Marco Island, Florida. It was 1999.
In the picture, I was fast asleep on the sand, my flabby abdomen splayed to either side, my second chin resting on my crossed flabby arms.
That's when it really hit me: I didn't just have a few extra pounds to lose, I had a good thirty pounds of accumulated weight around my middle. What must my patients be thinking when I counseled them on diet? I was no better than the doctors of the sixties puffing on Marlboros while advising their patients to live healthier lives.
Why did I have those extra pounds under my belt? After all, I jogged three to five miles every day, ate a sensible, balanced diet that didn't include excessive quantities of meats or fats, avoided junk foods and snacks, and instead concentrated on getting plenty of healthy whole grains. What was going on here?
Sure, I had my suspicions. I couldn't help but notice that on the days when I'd eat toast, waffles, or bagels for breakfast, I'd stumble through several hours of sleepiness and lethargy. But eat a three-egg omelet with cheese, feel fine. Some basic laboratory work, though, really stopped me in my tracks. Triglycerides: 350 mg/dl; HDL ("good") cholesterol: 27 mg/dl. And I was diabetic, with a fasting blood sugar of 161 mg/dl. Jogging nearly every day but I was overweight and diabetic? Something had to be fundamentally wrong with my diet. Of all the changes I had made in my diet in the name of health, boosting my intake of healthy whole grains had been the most significant. Could it be that the grains were actually making me fatter?
That moment of flabby realization began the start of a journey, following the trail of crumbs back from being overweight and all the health problems that came with it. But it was when I observed even greater effects on a larger scale beyond my own personal experience that I became convinced that there really was something interesting going on.
LESSONS FROM A WHEAT-FREE EXPERIMENT
An interesting fact: Whole wheat bread (glycemic index 72) increases blood sugar as much as or more than table sugar, or sucrose (glycemic index 59). (Glucose increases blood sugar to 100, hence a glycemic index of 100. The extent to which a particular food increases blood sugar relative to glucose determines that food's glycemic index.) So when I was devising a strategy to help my overweight, diabetes-prone patients reduce blood sugar most efficiently, it made sense to me that the quickest and simplest way to get results would be to eliminate the foods that caused their blood sugar to rise most profoundly: in other words, not sugar, but wheat. I provided a simple handout detailing how to replace wheat-based foods with other low- glycemic whole foods to create a healthy diet.
After three months, my patients returned to have more blood work done. As I had anticipated, with only rare exceptions, blood sugar (glucose) had indeed often dropped from diabetic range (126 mg/dl or greater) to normal. Yes, diabetics became nondiabetics. That's right: Diabetes in many cases can be cured--not simply managed--by removal of carbohydrates, especially wheat, from the diet. Many of my patients had also lost twenty, thirty, even forty pounds.
But it's what I didn't expect that astounded me.
They reported that symptoms of acid reflux disappeared and the cyclic cramping and diarrhea of irritable bowel syndrome were gone. Their energy improved, they had greater focus, sleep was deeper. Rashes disappeared, even rashes that had been present for many years. Their rheumatoid arthritis pain improved or disappeared, enabling them to cut back, even eliminate, the nasty medications used to treat it. Asthma symptoms improved or resolved completely, allowing many to throw away their inhalers. Athletes reported more consistent performance.
Thinner. More energetic. Clearer thinking. Better bowel, joint, and lung health. Time and time again. Surely these results were reason enough to forgo wheat.
What convinced me further were the many instances in which people removed wheat, then permitted themselves a wheat indulgence: a couple of pretzels, a canape at a cocktail party. Within minutes, many would experience diarrhea, joint swelling and pain, or wheezing. On again, off again, the phenomenon would repeat itself.
What started out as a simple experiment in reducing blood sugars exploded into an insight into multiple health conditions and weight loss that continues to amaze me even today.
A RADICAL WHEAT-ECTOMY
For many, the idea of removing wheat from the diet is, at least psychologically, as painful as the thought of having a root canal without anesthesia. For some, the process can indeed have uncomfortable side effects akin to withdrawal from cigarettes or alcohol. But this procedure must be performed to permit the patient to recover.
Wheat Belly explores the proposition that the health problems of Americans, from fatigue to arthritis to gastrointestinal distress to obesity, originate with the innocent-looking bran muffin or cinnamon raisin bagel you down with your coffee every morning.
The good news: There is a cure for this condition called wheat belly--or, if you prefer, pretzel brain, bagel bowel, or biscuit face.
The bottom line: Elimination of this food, part of human culture for more centuries than Larry King was on the air, will make you sleeker, smarter, faster, and happier. Weight loss, in particular, can proceed at a pace you didn't think possible. And you can selectively lose the most visible, insulin-opposing, diabetes-creating, inflammation-producing, embarrassment- causing fat: belly fat. It is a process accomplished with virtually no hunger or deprivation, with a wide spectrum of health benefits.
So why eliminate wheat rather than, say, sugar, or all grains in general? The next chapter will explain why wheat is unique among modern grains in its ability to convert quickly to blood sugar. In addition, it has a poorly understood and understudied genetic makeup and addictive properties that actually cause us to overeat even more; has been linked to literally dozens of debilitating ailments beyond those associated with overweight; and has infiltrated almost every aspect of our diet. Sure, cutting out refined sugar is probably a good idea, as it provides little or no nutritional benefit and will also impact your blood sugar in a negative way. But for the most bang for your buck, eliminating wheat is the easiest and most effective step you can take to safeguard your health and trim your waistline.
