Thursday, April 6, 2017

What's all the fuss about trendy grains?

By Alexandra Locke & Rebecca Williams

What’s all the fuss about ancient grains?

You can’t have failed to notice the recent media hype given to a group of little grains, commonly referred to as ‘ancient grains’ and are frequently touted as being considerably more nutritious than traditional grains such as wheat, oats and rye – more than likely to justify their often considerable price tags. These trendy grains are now a selling point for many products on supermarket shelves and are commonplace on restaurant and café menus.

But with so much conflicting information out there, do you really get more bang for your buck when investing in trendy grains over traditional grains, such as oats, wheat and rye? We’ve compared the nutrient profiles of some of the most well-known traditional and trendy grains to find out which group packs a superior nutritional punch!

But first, what do we mean by ‘trendy’ grains?

Trendy grains have actually been around for years but have only recently enjoyed a surge in popularity, in part due to increasing numbers of people looking for alternatives to wheat. Many of these grains, including quinoa, amaranth and buckwheat aren’t even ‘true’ grains but actually belong to the seed family and are known as pseudo-cereals. Many people think pseudo-cereals are nutritionally superior to the traditional grain, but they actually offer similar benefits to ‘true’ grains and are used in much the same way.

So do trendy grains really contain more protein?

One of the most common misconceptions is that trendy grains have much higher levels of protein than traditional grains, but they’re actually very similar.  Whilst trendy grains quinoa and amaranth do indeed top the list for protein content in our grain comparison, traditional wheat comes in a close third with a hefty 13.4g of protein per 100g, closely followed by rye.

Another misconception is that quinoa is the only grain to contain the complete spectrum of amino acids – in fact, all grains contain complete amino acids with quinoa having only slightly higher levels!

Did you know? Quinoa is pronounced ‘keen-wah.’

What about fat?

Traditional grains steal the show on this one with brown rice, rye, barley and wheat being lower in fat than trendy grains. And there’s further good news for wheat, with recent Australian research showing that Australian adults with the highest intakes of core grain foods, including breads and breakfast cereals made from wheat, had a similar waist circumference and no difference in Body Mass Index (BMI) compared to those with the lowest core grain food intake(1) While oats top the list with the highest total fat levels in our comparison, much of this is healthy fat.

Surely trendy grains have more fibre than wheat or rye?

Again, traditional grains top the list with rye containing a whopping 14.6g of fibre per 100g, followed by wheat and barley, whilst trendy grains sorghum, quinoa and amaranth lag behind with around half the fibre content of rye.

Many people are surprised to learn that the leading sources of fibre in the Australian diet are actually breads and breakfast cereals, most of which are wheat based.(2) What’s more, whole grain wheat, oats and rye can help to promote good gut health due to their prebiotic fibres(3,4)  which encourage growth and activity of  health promoting bacteria in the gut.(5-7)

What about wheat?

Contrary to common perception, wheat is a particularly nutritious grain, even when compared to trendy grains like quinoa. Although wheat’s taken a hammering in recent years with many people avoiding gluten or cutting out carbs, this nutritious grain is easily accessible and readily found in many breads and breakfast cereals.  And several recent studies have shown that individuals who regularly consume whole grains (mostly wheat based) are at a reduced risk of developing Type 2 Diabetes, compared to those who eat less.(8-10)
To give you an idea of how two of the most well-known grains stack up, we’ve compared their nutrient profiles below…


Wheat (g per 100g)
Quinoa (g per 100g)
Protein
13.4
14.1
Fat
1.4
6.1
Fibre
12.2
7
Carbohydrate
60.1
64.1
Iron
11.0
4.6

Did you know? Some grains, including amaranth, buckwheat and quinoa aren’t actually grains at all but belong to the seed family and are occasionally referred to as pseudo-cereals.

So what’s the verdict?

The takeaway message is that whilst many trendy grains do offer certain nutritional benefits, traditional grains offer comparable nutrients and in some cases have a more substantial nutrient profile. But whether you’re a fan of traditional or trendy grains or enjoy both, what’s important is ensuring we eat core grain foods 3-4 times a day and make at least half either high fibre or whole grain.  Our infographic shows why we should be eating more whole grains…


To benefit from the range of nutrients both traditional and trendy grains offer, mix it up every once in a while and enjoy a variety of grains as part of a balanced diet. And for recipe inspiration using both traditional and trendy grains, visit our website. 

References

1.     Fayet-Moore F, Petocz P, McConnell A, Tuck K, Mansour M. The Cross-Sectional Association between Consumption of the Recommended Five Food Group “Grain (Cereal)”, Dietary Fibre and Anthropometric Measures among Australian Adults. Nutrients. 2017;9(2):157.
2.     ABS. Australian Health Survey: Nutrition First Results - Foods and Nutrients, 2011-12. Australian Bureau of Statistics, 2014.
3.     Shewry PR, Hey SJ. The contribution of wheat to human diet and health. Food Energy Secur. 2015;4(3):178-202.
8.     Brouns FJPH, van Buul VJ, Shewry PR. Does wheat make us fat and sick? Journal of Cereal Science. 2013;58(2):209-15.

New Research Reveals That Eating Core Grain Foods Doesn't Affect Your Waistline!


 Key takeouts from the research:
  • Australian adults with the highest intakes of core grain foods, which is the leading source of carbohydrate in our diets, had similar waist circumferences and BMI’s compared to those with the lowest intakes of core grain foods¹.
  • Adults who avoid core grain foods are at risk of missing out on essential nutrients including fibre, which is beneficial for good gut health².
New results from a survey of over 9,000 Australian adults, published last week in the journal Nutrients, found that eating core grain foods isn’t linked to the size of your waistline. Adults with the highest intakes of core grain foods - which includes bread, breakfast cereals and pasta – had similar waist circumferences and BMI’s compared with adults who had the lowest core grain intakes.

This ground breaking analysis of the 2011-12 National Nutrition and Physical Activity Survey, commissioned by the Grains & Legumes Nutrition Council (GLNC), found that not only was higher consumption of these grain foods not linked to a higher waist size, but grain consumers actually had a healthier diet and lifestyle pattern compared to those who avoided core grain foods¹.

The analysis of this research also demonstrated what many people have forgotten – grain foods are an essential source of fibre in our diet and Australians who eat more core grain foods have significantly higher fibre intakes than those who limit or avoid them. Emerging evidence also suggests that fibre-rich carbohydrate foods promote good gut health², which may ultimately have a favourable effect on health and chronic disease risk.

Overall grain consumption has declined over the last decade, with many Australians actively limiting gluten or carbohydrates - 42% of Australians report that they limit grain foods to assist with weight loss³. Many of these worrying trends are driven by widespread misconceptions and a lack of understanding about the multiple health benefits of grain foods.  

Rebecca Williams, Nutrition Manager and Accredited Practising Dietitian at GLNC explains the risks of limiting grain foods “Adults who limit healthy sources of carbohydrate - including core grain foods - end up putting themselves at risk of missing out on essential nutrients, such as fibre, folate, thiamine, iron, magnesium and zinc.”

“This new research highlights that we don’t need to cut back on grain foods like bread and pasta for weight management and actually, by doing so, people are putting their health at risk by not getting enough fibre.”

“It’s important that we don’t blindly follow the latest diet trends in search of a quick fix - choosing quality grain foods can have favourable effects on nearly every area of our health.”

Core grain foods, particularly those which are whole grain or high in fibre, provide a multitude of health benefits and choosing just three of our six serves of grain foods a day as whole grain or high fibre options, can help to reduce our risk of cardiovascular disease and some cancers4-8.

What’s more, it’s easy to get the recommended six serves of grain foods every day by enjoying a bowl of high fibre breakfast cereal in the morning, a wholemeal sandwich for lunch and a stir-fry with rice for dinner. Take a look at our serve size infographic below to see what constitutes a serve. 


Why not try a traditional Egg Sandwich on Wholemeal as a quick and delicious way to increase your whole grains!

To find out more about the benefits of grain foods and carbohydrates, watch GLNC’s myth-busting webinar on low-carb diets or visit our website.

References
  1. Fayet-Moore F, Petocz P, McConnell A, Tuck K, Mansour M. The Cross-Sectional Association between Consumption of the Recommended Five Food Group “Grain (Cereal)”, Dietary Fibre and Anthropometric Measures among Australian Adults. Nutrients. 2017;9(2):157.
  2. Jones JM, Peña RJ, Korczak R, Braun HJ. CIMMYT Series on Carbohydrates, Wheat, Grains, and Health: Carbohydrates, Grains, and Wheat in Nutrition and Health: Their Relation to Digestion, Digestive Disorders, Blood Glucose, and Inflammation. Cereal Foods World. 2016;61(1):4-17.
  3. GLNC 2014 Consumption & Attitudes Study. Unpublished: 2014.
  4. Zong G, Gao A, Hu FB, Sun Q. Whole Grain Intake and Mortality From All Causes, Cardiovascular Disease, and Cancer: A Meta-Analysis of Prospective Cohort Studies. Circulation. 2016;133(24):2370-80.
  5. Aune D, Keum N, Giovannucci E, Fadnes LT, Boffetta P, Greenwood DC, et al. 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. 2016;353. 
  6. Chen G-C, Tong X, Xu J-Y, Han S-F, Wan Z-X, Qin J-B, et al. Whole-grain intake and total, cardiovascular, and cancer mortality: a systematic review and meta-analysis of prospective studies. The American journal of clinical nutrition. 2016.
  7. Wei H, Gao Z, Liang R, Li Z, Hao H, Liu X. Whole-grain consumption and the risk of all-cause, CVD and cancer mortality: a meta-analysis of prospective cohort studies. British Journal of Nutrition. 2016;116(03):514-25.
  8. Benisi-Kohansal S, Saneei P, Salehi-Marzijarani M, Larijani B, Esmaillzadeh A. Whole-Grain Intake and Mortality from All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Advances in Nutrition: An International Review Journal. 2016;7(6):1052-65


Thursday, February 9, 2017

The First 1,000 Days of Life: The Link Between Nutrition & the Gut Microbiome


by Rebecca Williams, APD

The first 1,000 days of life, spanning conception to the age of two, are increasingly being recognised as a critical window where a child’s environment, including the impact of nutrition, can significantly influence their long-term risk of non-communicable disease. So much so that research suggests environmental factors in infancy may have a greater impact on disease risk than even genetics or environmental influences later in life(1).  Specifically gut microbial composition and early nutrition have been shown to play a critical role.

Gut microbial composition is unique to every individual and is thought to be strongly influenced by a number of environmental factors, including method of delivery (vaginal or Caesarean section), the mother’s diet, whether a child is breast or formula fed and also the time and method of introduction of solid foods(1). Breast fed infants, for example, are exposed to more than 700 species of bacteria through their mother’s milk, as well as a range of oligosaccharides (prebiotic fibres) which stimulate the growth of beneficial gut bacteria(2).

It's been suggested that the establishment of the gut microbiome during the first 1,000 days is important for the development of ‘immune fitness’ and may result in a subsequent reduction of disease risk(1). The link between gut microbiota and health is influenced via short chain fatty acids such as butyrate and acetate - both produced when the gut microbiota ferment (or break down) the prebiotic fibres in our diets(4). Butyrate is thought to have anti-inflammatory effects, decrease rapid rates rates of cell reproduction and may have an ability to enhance the colonic immune response(6, 7) whilst also appearing to reduce intestinal pH which helps to prevent the growth of harmful bacteria(8)

In contrast, a reduction in the diversity and composition of gut microbiota in early life could result in an increased risk of developing non-communicable diseases in later life, including allergic diseases such as asthma, eczema and food allergies, autoimmune diseases such as multiple sclerosis, metabolic disorders including obesity and cardiovascular disease and other immune conditions such as inflammatory bowel disease(1).

A key life stage for infants which also has a significant influence on the colonisation and diversity of gut bacteria during infancy, is the introduction of solid foods:(3) foods that contain prebiotic fibres such as fructo-oligosaccharides, galacto-oligosaccharides and resistant starch support the growth and activity of beneficial gut bacteria(4). Demonstrating the link further, a recent Australian study found that infants could access the benefits of prebiotics at a younger age than previously thought, with babies as young as seven months showing increased microbial diversity following consumption of resistant starch from solid foods(5).

As outlined in the Infant Feeding Guidelines, solid foods should be introduced at around six months to meet an infant’s increasing nutritional and developmental needs. So in order to positively influence gut bacteria, it's important to ensure they're fed a balanced diet when beginning solid foods - introducing a variety of plant foods such as grains, legumes, fruit and vegetables as their first foods will ensure a varied intake of prebiotic fibres(9). It's also important to ensure that the introduction of solid foods is complemented with an increase in water intake to prevent issues such as constipation, helping to promote good digestive health.

Emerging research demonstrates the importance of nutrition during the first 1,000 days of life, with this initial period increasingly being recognised as a key influencer for long-term healthOnce established in this critical window, the composition of the gut microbiota remains relatively stable throughout our adulthood, but can be altered as a result of bacterial infections, antibiotic treatment and long-term dietary changes.

This evidence suggests that the establishment of a healthy and diverse gut microbiome is essential to promote immune health and reduce risk of chronic disease in later life not only during infancy, but also emphasises the critical role of nutrition on our gut microbiota as we move through all life stages.

To find out more on the benefits of grains and legumes throughout all life stages and for recipes and more, visit our website here.

References

1. Tang M. Abstract: Role of Nutrition in Tolerance Development. Unpublished. 2016.
2.  Rodríguez JM, Murphy K, Stanton C, Ross RP, Kober OI, Juge N, et al. The Composition of the Gut Microbiota Throughout Life, with an Emphasis on Early Life. Microbial Ecology in Health and Disease. 2015;26:10.3402/mehd.v26.26050.
3. Johnson CL, Versalovic J. The Human Microbiome and Its Potential Importance to Pediatrics. Pediatrics. 2012;129(5):950-60.
4. Slavin J. Fiber and Prebiotics: Mechanisms and Health Benefits. Nutrients. 2013;5(4):1417-35.
5. Gopalsamy GL, Christophersen CT, Bird AR, Young G. Abstract: Infants Can Ferment Resistant Starch Shortly After Wearning Which Changes Faecal Metabolite and Microbial Profiles. Unpublished. 2016.
6. Bi Y, Qin N, Yang R. Human microbiota: a neglected "organ" in precision medicine. Infectious Diseases and Translational Medicine. 2015;1(2).
7. Scott KP, Gratz SW, Sheridan PO, Flint HJ, Duncan SH. The influence of diet on the gut microbiota. Pharmacol Res. 2013;69(1):52-60.
8. Flint HJ, Scott KP, Louis P, Duncan SH. The role of the gut microbiota in nutrition and health. Nat Rev Gastroenterol Hepatol. 2012;9(10):577-89.
9. Halmos EP, Christophersen CT, Bird AR, Shepherd SJ, Gibson PR, Muir JG. Diets that Differ in Their FODMAP Content Alter the Colonic Luminal Microenvironment. Gut. 2015;64(1):93-100.

Keeping Our Finger on the Pulse: The Phenomenal Success of the International Year of Pulses

By Alexandra Locke
A recent analysis of research has revealed that 2 out of 3 Australians simply don’t think to include pulses and legumes in their diet¹ and with 2016 being deemed the peak of the fashionable paddock to plate movement - a trend which prioritises local ingredients and whole foods - it seemed only fitting that the United Nations named 2016 as the International Year of Pulses (IYP): a year dedicated to raising public awareness of the humble pulse.
One key objective of IYP was to heighten public awareness of the nutritional benefits of pulses as part of a sustainable agricultural system, moving towards global food security and nutrition - a message which has been supported by both the Grains & Legumes Nutrition Council (GLNC) and Pulse Australia, playing key roles in the promotion of pulses to both industry and consumer audiences. As a result of these communications, pulses are now having their moment in the limelight with many celebrity chefs and foodie influencers adopting their use as a staple ingredient in everyday and high end cuisine.
Moving into 2017, the true impact of IYP is just being revealed, showing that the influence has been felt on a global scale. It’s clear that the hard work that went into planning this momentous year has been worthwhile, raising awareness of pulses and their benefits for both health and environment. 2016 saw a 51% increase in media mentions of pulses in Australia in comparison to 2015², which has helped communicate these messages to a global audience of over 4 billion - a significant achievement given the initial aim was to reach 30-40 million people.
On the back of a record breaking crop in 2016, the raised awareness of pulses presents opportunities to add wider value to Australian pulse crops. Processors and retailers have seen the benefit too, specifically via an increase in canned pulse sales with total pulses seeing positive growth in both value and volume over the last 12 months in Australia, up 0.3% to a total value of $58.3 million and 7.9% to a total of 20 million kg respectively².
A consistent problem that those involved in the pulse industry consistently face, whether grower, manufacturer or retailer and which IYP succeeded in addressing, is public perception that pulses can be difficult to prepare and are limited in both flavour and usability. Pulse advocate and celebrity chef Simon Bryant used IYP’s momentum to help change this consumer perception, with key activities throughout the year including recipe development, alongside demonstrations to help communicate the versatility of pulses.
Alongside growing consumer awareness, manufacturers are now taking advantage of this momentum by looking for increasingly innovative ways to include legumes into their products; including a line of mung bean spreads as a low allergen alternative to nut butters and a range of roasted chickpeas and fava beans as an alternative to traditional snack products. And many other producers have incorporated pulses into snack bars, crackers and energy bites amongst others – clearly opportunities abound for those willing to think outside the box.
Whilst IYP is now officially over, foundations have been set in place to ensure this momentum is continued - Global Pulse Day, an annual celebration on January 18th will help to maintain public awareness over 2017 and beyond, alongside the continued efforts of all those invested in IYP. The results of 2016 have demonstrated the success that an initiative such as this can have on improving health, sustainability and food diversity on a global scale and the future looks bright to ensure that pulses become an integral and sustainable part of our food chain.
To access a whole host of resources on pulses, including teaching aids, fact sheets and more, visit the Pulses website here. For more recipes and information on the nutritional benefits of pulses visit GLNC's website here.
international year of pulses supported by glnc and pulse australia

References

1. 2014. GLNC Consumption & Attitudes Study. Unpublished.
2. 2017: 2016 International Year of Pulses: Australian Outcomes Report. Unpublished.

Monday, February 6, 2017

Should We Still Be Eating Wheat

By Helen Tran, APD

Wheat has featured in the human diet for more than 8,500 years, but more recently the media has led us to question if wheat is good for our health. A recent example of this manipulation of consumer perception is the documentary ‘What’s with Wheat?’ hosted by Australian Nutritionist, Cyndi O’Meara.

But it’s true that wheat isn’t tolerated by a small subset of the population, including those with diagnosed coeliac disease, a wheat allergy or non-coeliac wheat sensitivity, so we’ve taken a look at what the science says for the rest of us.

Does wheat cause a rise in coeliac disease and wheat sensitivity?

It’s suggested that modern wheat varieties created by genetic research, has led to the addition of a ‘new’ protein in wheat called gliadin, which in turn has led to an increase in the number of people with Coeliac disease and wheat sensitivity. But this notion is flawed. All varieties of wheat contain gliadin, including ancient and modern varieties, suggesting that we have always been exposed to gliadin in our diets.(1,2)

Similarly, results from a study examining data from the 20th and 21st centuries in the United States do not support the theory that wheat breeding has caused a rise in gluten content in wheat.(3) Another theory is that fructan in wheat has increased, but once again there is no well-designed research to support this. In one study, some ancient wheat species had a higher fructan content than modern wheat species.(4)

Overall, the evidence does not support the notion that modern wheat has a higher gliadin, gluten or fructan content compared to ancient varieties. It may be likely that the rise in coeliac disease and wheat sensitivity in the last 50 years comes from improvements in detection methods and an overwhelming increase in our awareness of how specific foods make us feel.

Does eating wheat lead to obesity and type 2 diabetes?

The relatively recent abundance of wheat products on our supermarket shelves has been identified as one factor responsible for the global increase in incidences of obesity and overweight. Whilst it’s tempting to find a single culprit for this very concerning trend, it is an oversimplification. This assertion overlooks the multiple interacting factors that can contribute to weight gain, including genetics, individual psychology, environment, dietary intake and level of physical activity.(1,5)

Contrary to this claim, a recent analysis of the Australian National Nutrition Survey found that people who eat the recommended amount of core grain food each day are no more likely to be overweight than those who limit grain foods. Research also shows those people who eat whole grains, including whole grain wheat, have been shown to have the least amount of abdominal fat accumulation compared to those people who eat refined grains or limit all grains.(6) In fact, eating foods made with whole grain wheat may have positive effects on long term weight management.(1)

Currently, there is no clear evidence that wheat (whole grain or refined) is associated with an increased risk of type 2 diabetes. In fact, well-designed studies show that individuals who regularly eat whole grains (most of which are wheat based) are at a reduced risk of developing type 2 diabetes, compared to those who eat the least.(1,8,9)

The protective effects of whole grain wheat comes from the dietary fibre, vitamins, minerals and phytochemicals it contains. So to reduce our risk of type 2 diabetes, the answer doesn’t lie in cutting out wheat completely, but in choosing whole grain and high fibre wheat foods instead with an aim to increase our intake of whole grains, including whole grain wheat.

Does eating wheat cause inflammation?

It’s been proposed that plant defense proteins called amylase trypsin inhibitors may cause chronic inflammation and activate the immune system(10-12) but there is currently no evidence which supports this theory.

There is however, mounting evidence to suggest that higher intakes of whole grains may be protective against cardiovascular disease, hypertension, metabolic disorders and specific cancers. (13,14) Prebiotic fibres in fibre-rich grains stimulate the production of short chain fatty acids, such as butyrate, that have been shown to enhance the intestinal barrier function.(15)

This limited research shows that further research is needed before definitive conclusions can be drawn about the effects of wheat on inflammation.

Does eating wheat change the behaviour of children with Autism Spectrum Disorders?

More and more parents of children with Autism Spectrum Disorders (ASD) are adopting a gluten free diet to manage their child’s behaviour.(16) It’s been hypothesised that children with ASD may have a leaky gut and peptides of gluten in gluten-containing foods could enter the central nervous system. The theory suggests that gluten peptides may intensify brain opioid activity and disrupt normal brain function.(16) Scientific evidence for the leaky gut theory remains inconclusive and evidence to either support or refute the use of a gluten free diet for managing ASD is inadequate.

In the absence of evidence of an effect of gluten on ASD, it is not recommended that children are placed on a gluten-free diet as this diet has been shown to be deficient in nutrients that are important for a child’s growth and development, including B vitamins, iron, zinc and magnesium.

Instead it’s recommended that time and resources would be best spent on more robustly designed interventions.(17) Until more evidence is available, a gluten free diet should only be adopted by children with coeliac disease or wheat sensitivity.

So what’s the bottom line?

Given the evidence, there appears to be no benefit in removing wheat from the diets of the general population. In fact, eating whole grain foods, predominately those that are wheat-based, have been shown to reduce chronic disease risk and are a leading source of essential nutrients in the Australian diet including fibre, B vitamins, iron, magnesium and iodine. Although more research is required to identify the specific link between wheat (whole grain and refined) and health outcomes, it appears that wheat may not negatively affect our health like the many claims that appear consistently in the media.

As such, it’s important not to rely solely on claims appearing in the media but consider the positives and negatives of all available evidence. After all, it’s up to us to make the best decision for our health.

For more information on the multiple benefits of wheat and whole grains, download the GLNC Grains for Health Report here or visit our website for recipes, factsheets and more here.

References

1.    Brouns FJPH, van Buul VJ, Shewry PR. Does wheat make us fat and sick? Journal of Cereal Science. 2013;58(2):209-15.
2.    Prandi B, Tedeschi T, Folloni S, Galaverna G, Sforza S. Peptides from gluten digestion: A comparison between old and modern wheat varieties. Food Research International.
3.    Kasarda DD. Can an increase in celiac disease be attributed to an increase in the gluten content of wheat as a consequence of wheat breeding? Journal of agricultural and food chemistry. 2013;61(6):1155-9.
4.    Ziegler JU, Steiner D, Longin CFH, Würschum T, Schweiggert RM, Carle R. Wheat and the irritable bowel syndrome – FODMAP levels of modern and ancient species and their retention during bread making. Journal of Functional Foods. 2016;25:257-66.
5.    Newell B, Proust K, Dyball R, McManus P. Seeing obesity as a systems problem. New South Wales Public Health Bulletin. 2007;18(12):214-8.
6.    Molenaar EA, Massaro JM, Jacques PF, Pou KM, Ellison RC, Hoffmann U, et al. Association of lifestyle factors with abdominal subcutaneous and visceral adiposity: the Framingham Heart Study. Diabetes care. 2009;32(3):505-10.
7.    Aune D, Norat T, Romundstad P, Vatten LJ. Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis of cohort studies. European Journal of Epidemiology. 2013;28(11):845-58.
8.    Wu H, Flint AJ, Qi Q, van Dam RM, Sampson LA, Rimm EB, et al. Association Between Dietary Whole Grain Intake and Risk of Mortality: Two Large Prospective Studies in US Men and Women. JAMA Intern Med. 2015.
9.    Kucek LK, Veenstra LD, Amnuaycheewa P, Sorrells ME. A Grounded Guide to Gluten: How Modern Genotypes and Processing Impact Wheat Sensitivity. Comprehensive Reviews in Food Science and Food Safety. 2015;14(3):285-302.
10. Cuccioloni M, Mozzicafreddo M, Ali I, Bonfili L, Cecarini V, Eleuteri AM, et al. Interaction between wheat alpha-amylase/trypsin bi-functional inhibitor and mammalian digestive enzymes: Kinetic, equilibrium and structural characterization of binding. Food chemistry. 2016;213:571-8.
11. Junker Y, Zeissig S, Kim S-J, Barisani D, Wieser H, Leffler DA, et al. Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4. The Journal of experimental medicine. 2012;209(13):2395-408.
12. Jones JM, Peña RJ, Korczak R, Braun HJ. CIMMYT Series on Carbohydrates, Wheat, Grains, and Health: Carbohydrates, Grains, and Wheat in Nutrition and Health: Their Relation to Digestion, Digestive Disorders, Blood Glucose, and Inflammation. Cereal Foods World. 2016;61(1):4-17.
13. Aune D, Keum N, Giovannucci E, Fadnes LT, Boffetta P, Greenwood DC, et al. 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. 2016;353.
14. Brahe LK, Astrup A, Larsen LH. Is butyrate the link between diet, intestinal microbiota and obesity-related metabolic diseases? Obesity Reviews. 2013;14(12):950-9.
15. Christison GW, Ivany K. Elimination diets in autism spectrum disorders: any wheat amidst the chaff? Journal of developmental and behavioral pediatrics : JDBP. 2006;27(2 Suppl):S162-S71.


16. Hurwitz S. The Gluten-Free, Casein-Free Diet and Autism: Limited Return on Family Investment. Journal of Early Intervention. 2013;35(1):3-19.