Bread and Health

Obesity. Bloating. Bowel problems. Headaches. It's blamed for everything these days - so should you stop eating bread?

Bread is often the food people crave the most

From hot buttered toast to the simple sandwich, bread was once the staple of the British diet. But today it’s suffering from a serious image crisis — it’s become something of a health bogeyman, a food to be avoided and resisted.
Sales have been dropping since the Seventies. In 1974 the average Briton got through 2.2lb (1,029g) of bread a week, but now it’s 1½lb (700g).
Largely that’s because many people are now convinced they suffer from wheat intolerance or an allergy to gluten (the protein found in wheat).
A survey by the University of Portsmouth last year found that one in five British adults believes they are allergic to a food, with most blaming wheat.
Bread is being held responsible for a range of symptoms, including fatigue, stomach pain, bloating and headaches.
Meanwhile, low-carb diets such as Atkins and Dukan haven’t helped either — the claims that carbohydrates cause blood sugar levels to rise, preventing the body from burning fat, have put many off their lunchtime sandwich.
Yet despite this, bread is often the food people crave the most.

Ask any dieter to name their greatest weakness and it will be toast in the morning or that irresistible basket of warm rolls on the restaurant table.
But is it really so bad for us? And why has our relationship with this basic food become so dysfunctional? We talked to the experts.

YOUR BRAIN IS HOOKED ON BREAD

Sometimes only a bacon sarnie will do — but why exactly is that? The simple answer is that bread appears to make us feel better.
‘When carbohydrates such as bread are broken down to glucose, they trigger the production of the brain chemical serotonin, also known as the happy hormone,’ says Helen Bond, of the British Dietetic Association.
That’s why a toasted teacake or muffin tastes so good at teatime.
‘The body has a natural dip in serotonin levels around 4pm,’ she explains. ‘Bread is a great way to give yourself a bit of a boost.’

THE MODERN LOAF WE CAN’T STOMACH

For some experts the day it all went wrong was in 1961 when something called the Chorleywood Baking Process was introduced — this breadmaking technique uses three times as much yeast as before and so reduces the time needed for fermentation.
It means a loaf can be baked in just one hour, and also has a longer shelf life — as a result 76 per cent of the bread we eat today is made this way.
Unfortunately, critics say that this reduced fermentation time means yeasts have less time to be broken down and therefore could upset the delicate balance of bacteria in the gut, triggering digestive problems. 
Jonathan Brostoff, professor of allergies at King’s College, London believes the so-called ‘one-hour loaf’ may have more yeast and additives left in, meaning more risk of irritation.
He is now looking at whether making breads in different ways affects the types of bacteria found in the gut and the impact on health.
Andrew Whitley, a baker with 30 years’ experience and author of the book Bread Matters, champions sourdough bread, which takes between ten and 24 hours to rise and doesn’t require bakers’ yeast.
‘Allowing bread to ferment this long ensures the proteins that make up the gluten are pre-digested so the stomach doesn’t have to work so hard,’ he says.
‘This has been proven in the lab and in feeding experiments. I see a lot of people who say they can eat my bread, but not factory bread.’
He adds that most modern bread contains enzymes and stabilisers known as processing aids to keep it ‘squidgy’ for longer.
‘These make the proteins harder to break down — we’ve engineered bread to be at its most indigestible.’

WE’RE NOT BUILT TO EAT SO MUCH

The average Brit gets through the equivalent of 60 loaves a year

Toast for breakfast, sandwiches for lunch and rolls for snacks — no wonder the average Brit still gets through the equivalent of 60 loaves a year, despite the overall drop in consumption.
Some experts say our digestive systems can’t cope with so much — explaining the rise in complaints such as irritable bowel syndrome and bloating.
‘Gluten, a type of protein, makes bread what it is,’ explains Professor Peter Whorwell, a gastroenterologist at Wythenshawe Hospital in Manchester.
‘Yet gluten is a large molecule that’s poorly digested by the gut and we don’t break it down very well.’
We make things worse by eating far too much bread.
‘It’s become the number one convenience food,’ he says. ‘It’s everywhere, and that’s part of the problem.’
‘Think of our beginnings as hunter gatherers,’ adds Professor Brostoff.
‘We didn’t have wheat back then — we had meat, fish, fruit and vegetables.  We weren’t really designed to eat all  this wheat.’
Even if you limit yourself to one harmless-looking sandwich a day, you’re still likely to be eating more than you realise, says Catherine Collins, principal dietitian at St George’s Hospital in London.
‘Often bloating is nothing to do with wheat intolerance and everything to do with portion size,’ she says. ‘Ten years ago your average sandwich would be 60g of bread — two slices of 30g each.
Now, bread often weighs more like 40g a slice, and if you’re slightly sensitive, two of those can be enough to trigger symptoms such as bloating and tummy pain.
‘Paninis are deceptive too; they may look small, but actually contain a lot of bread, squashed down.’
What’s more, she adds, nowadays we often eat lunch on the go or at the desk — meaning it’s wolfed down too quickly and we feel stuffed afterwards.

EXOTIC HOLIDAYS MAKE THINGS WORSE

A variety of modern lifestyle habits — including exotic holidays — are leaving people with a permanent  slightly raised level of sensitivity to gluten in foods like bread, says Professor Whorwell.
‘I see a lot of people who caught a tummy bug abroad which has left the gut more sensitive, so it can flare up again when they eat too much bread.
‘Any previous stomach bug, as well as foreign travel, and taking lots of medications such as antibiotics can all make our guts more sensitive.’
Bread’s large gluten molecules mean that this is one of the most likely foodstuffs to cause problems in a newly sensitive gut.

WHITE SLICED COULD BE GOOD FOR YOU

White bread is the loaf of choice for many Britons, taking up 50 per cent of all sales. But because it has a high glycaemic index (GI) there’s concern that it releases its energy too quickly, raising blood sugar levels and insulin.
Some researchers believe this could help fuel diabetes. A study by the Cancer Council of Australia which followed more than 36,000 people for four years found those who ate the most white bread were more than 30 per cent more likely to develop type-2 diabetes.
There is a suggestion that this surge in blood sugar and insulin levels could even fuel cancer cell growth.
A study published in the International Journal of Cancer in 2006 found those who eat five slices of white bread a day are almost twice as likely to develop the most common form of kidney cancer compared with those who have  one and a half slices.
Meanwhile, wholegrain foods, including wholemeal bread, have been shown to have a protective effect because they regulate the production of insulin.
But wholegrain is not necessarily best for everyone. We’re often told we need plenty of fibre for a healthy bowel. In particular, a high-fibre diet has long been prescribed for irritable bowel syndrome, a chronic bowel disorder affecting some nine million Britons and causing pain and diarrhoea as well as constipation.
But Professor Whorwell, an expert in IBS, has different ideas. A study he carried out in the Nineties revealed that high-fibre foods such as bran, and wholemeal and granary breads actually worsened symptoms. 
‘Fibre is an irritant laxative, meaning if you’ve got an already irritable bowel it will irritate it further,’ he says. ‘I often now put people with IBS on to white bread because it’s low in fibre, and 50 to 60 per cent of them improve.
‘Brown bread may be good for you if you have a normal healthy gut, but if it is sensitive you may have to balance the pros and cons depending on how bad it makes you feel.’

IT’S SPREADS THAT MAKE YOU FAT

Thanks to diets such as Dukan or Atkins, we tend to think of bread as ‘bad’ — under these regimens you either cut out or dramatically reduce your intake to help put the body into a state of ketosis in which it burns fat for energy.
But the tide may be turning. According to a new book, The Carb Lover’s Diet (which this year topped the New York Times bestsellers list) bread — specifically wholemeal — can actually help you lose weight.
‘Studies show that resistant starch can help curb cravings, control blood sugar levels and boost metabolism,’ say the authors.
Resistant starch is a compound found in wholemeal and rye breads as well as foods such as lentils, oats and potatoes. Unlike other foods it’s not absorbed into the bloodstream and instead is digested slowly — reportedly keeping you fuller for longer.
Dietitian Helen Bond says there could be some truth in this.
‘Resistant starch is digested in the large intestine, meaning it provides a slow steady release of fuel. Cut it out and you often find you’re flagging and more likely to crave a snack.’
Catherine Collins says that bread can also be a good source of vital nutrients such as calcium, adding that bread on its own is unlikely to cause significant weight gain.
‘The real problem is the high-fat things we eat with our bread. What about the slab of cheese in the middle of it, or the olive oil you dipped it in?’ she says.

IS FIBRE, NOT WHEAT, TO BLAME?

Half a million Britons are thought to have coeliac disease, an auto-immune condition where gluten causes the immune system to attack the lining of the small intestine — symptoms include diarrhoea, constipation and bloating.
Coeliac disease is diagnosed by taking a biopsy of the intestine or via blood tests. Sufferers must be strict in avoiding gluten.
This is different from so-called ‘gluten intolerance’, which is linked to IBS, headaches and mood swings.
The problem, say experts, is that people are self-diagnosing both conditions. In the case of gluten intolerance, Professor Whorwell thinks it could be the fibre in bread — not gluten — that’s the real problem if you have a sensitive gut.
‘A lot of people put themselves on gluten-free diets and claim it makes them feel better. But I don’t think they feel better from cutting out gluten, it’s the cutting out fibre.
‘And gluten-free products are now starting to add fibre, so in fact these people may find they’ll start to feel worse again and we’ll come full circle.’
More controversially, Professor Whorwell believes there is a ‘grey zone’ of people who may not have full-blown coeliac disease or even a wheat intolerance, but just have a degree of sensitivity.
‘To be diagnosed as coeliac you need to have a positive blood test, followed by a positive biopsy,’ he says.
‘But I have patients who don’t have either of these yet feel much better when they cut out gluten.
‘We can’t call them coeliac, but we have to believe them. It may be they are on the cusp of coeliac disease, or have very subtle changes to the gut that we just haven’t discovered yet.’
Sarah Sleet, chief executive of the charity Coeliac UK, says: ‘Increasingly, expert doctors are discussing patients who appear to experience gut problems but don’t give positive results for coeliac disease, and gluten sensitivity is being put under the spotlight as a possible cause.
‘What is not clear is when such patients cut out gluten and feel better, is it the gluten that is a problem or proteins in the wheat?
‘Whichever it is, coeliac disease is still massively under-diagnosed and it is essential that doctors should rule it out before assuming simple sensitivity.’

THE BENEFITS OF BAKING YOUR OWN

If bread causes you problems, you need to work out which type or types it is

The experts agree that while there’s no need to assault your digestive system with wheat three times a day, our digestive systems are all different and if bread causes you problems, you need to work out which type or types it is — whether it’s all bread, high fibre wholemeal or artisan.
‘I have patients who feel better when they eat only sodabread,’ says Professor Brostoff.
‘But then I have some who need to cut out wheat completely.’
He suggests eliminating bread — and then adding each type back one by one to see how your body copes.
Andrew Whitley has a simpler and perhaps more appealing solution.
‘I call for a return to the simple pleasure of baking your own bread.
‘Bread’s got a bad name and it’s time to take back personal control of what goes into it.’

WHY FREEZING A LOAF CAN BE BAD FOR YOUR TUM

Many people put bread in the freezer to keep it fresh, but this changes its structure and should be avoided if you suffer wind and bloating, according to dietitian Catherine Collins.
‘Baking bread softens the wheat starch, breaking down its structure to make it edible. However, when you cool it again it hardens — just as mashed potato is lovely and soft when it’s warm but goes hard when it cools — and stays that way.’

When bread cools, some starch forms new bonds with other starches to become ‘resistant’ starch, she adds — this is trickier to digest.
Even if you pop it in the toaster, the resistant starch remains and can be fermented by bowel bacteria, causing more intestinal gas  and bloating than unfrozen bread.
But it’s not just home freezing that’s a bad idea. Catherine Collins explains: ‘Many artisan breads from the bakery section are made with frozen or chilled dough, and cooked again just before sale, so can cause similar problems.
‘Ironically, this isn’t true of your basic Mother’s Pride or Kingsmill types, which are simply cooked, sliced and distributed at normal temperature.’
So if bread doesn’t agree with you, avoid chilled dough products from the bakery counter and make your own bread — and never freeze it at home.