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1.0 out of 5 stars Extraordinary claim not backed up by evidence, October 15, 2013
By Alice Friedemann (Oakland, California) - See all my reviews
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Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar--Your Brain's Silent Killers (Hardcover)
The blurb for this book reads: "carbs are destroying your brain. And not just unhealthy carbs, but even healthy ones like WHOLE GRAINS can cause dementia, ADHD, anxiety, chronic headaches, depression, and much more".
Wow! This is such an incredible claim, and there is not one shred of evidence in the book to back it up. Here are some of the reasons why:
#1: Mediterranean & DASH diets both recommend whole grains
These diets have lots of carbohydrates and LOWER dementia, blood pressure, cancer, strokes, heart attacks, and so on.
People eating a Mediterranean diet are among the longest-lived on earth and they've been studied for decades. Italy has the 4th longest lifespan in the world!
U.S. News and World report has a fantastic overview and details of the best diets (and worst). The DASH and Mediterranean diets were considered to be the best diets by experts across many fields There were 22 experts - mainly physicians and professors of food science and nutrition, who evaluated and ranked a variety of diet plans based on: how easy to follow, ability to produce short and long-term weight loss, nutritional completeness, safety, and prevent diabetes and heart disease. The Paleo diet came in dead last.
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#2 If whole grains or carbohydrates caused any of these maladies, it would be headline news on Time magazine, medical journals, the New York Times, and TV news.
But it isn't.
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#3 Grains have been the basis of civilization for over 10,000 years. We evolved to eat grain. So did dogs. Two-thirds of people on the planet depend on grains to get enough calories.
Our genetics have even changed to adapt to this -- anyone with ancestors from a farming region has up to 7 times as many amylase genes to digest starch as a hunter-gatherer. Read The 10,000 Year Explosion: How Civilization Accelerated Human Evolution to learn more about how we evolved faster the past 10,000 years than the previous 6 million years to adapt to the new agricultural diet (and milk, etc).
One of the top peer-reviewed science journals in the world, Science Magazine, has an article titled "Diet Shaped Dog Domestication" published 23 January 2013. DNA from wolves and dogs was obtained, and the most surprising difference between wolves and dogs was that dogs were highly evolved to digest starch, with 4 to 30 copies of the amylase gene, which breaks down starch in the intestine. Wolves only have 2 copies, which means amylase genes in dogs are 28 times as active than in wolves, making dogs 5 times better at digesting starch than wolves. The same is true of people - Europeans, Americans, Japanese and other cultures that eat a lot of grains have much higher numbers of copies of amylase genes than people who eat starch-poor diets like the Mbuti in Africa.
"We have adapted in a very similar way to the dramatic changes that happened when agriculture was developed," concluded evolutionary geneticist Erik at Uppsala University in Sweden.
"Axelsson thinks these results support the idea that wolves began to associate with humans who were beginning to settle down and farm. Waste dumps provided a ready source of food, albeit not meat, the usual diet. Thus early dogs that evolved more efficient starch digestion had an advantage".
I thought a paleo diet made sense many years ago, and was both surprised and delighted to discover we'd evolved to eat grains and legumes in mere millenia. Grains and legumes are the basis of civilization and always will be, since grains don't need refrigeration and can last past several bad harvests. The Buddha said to avoid attachment, and this applies not just to things but ideas.
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#4 Before agriculture, most cultures, even Native Americans, ate lots of carbohydrates.
In California, half the diet of most hunter-gatherer tribes was acorns. Tribes across America depended heavily on acorns, as well as tribes across the Eurasian continent. Acorns are 43% carbohydrate. Whole wheat is 68% carbohydrate - but grains and lentils are only a quarter of the food plate, while Native Americans were depending on them for half of their diet. So it's 6 of one, half a dozen of the other.
Bits of starch grains have been found on the grinding stones from 30,000 year old sites in Italy, Russia, and the Czech Republic, where our ancestors made flour from ground up plants, combined it with water and made a pita bread on stones heated in fires. Our ancestors were smart to grind roots so the flour could be stored or carried, since often game animals were seasonal and no meat was to be had many times of the year.
Eating carbohydrates could go back for millions of years. Fossil hominids had such sturdy premolar teeth it's believed they were probably used to open seeds and chew starchy underground tubers and bulbs. Even Neanderthals ate starch, which we know from studying the plaque on their teeth.
Anthropologist Frank Marlowe studied the eating patterns of 478 groups around the globe. He found that no matter where you live, at least a third of your diet is going to come from plants (and in many places nearly all of your diet), so the idea our ancestors were mainly carnivorous is not true.
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#5 We already know what the causes of dementia and Alzheimer's are from tens of thousands of studies. Carbohydrates have nothing to do with it.
The risks are: Being over 65, genetic (5%), female (women live longer), severe or repeated head trauma, lack of exercise, smoking, high blood pressure, high blood cholesterol, poorly controlled diabetes, not enough fruits & vegetables, lack of social engagement
People at a lower risk have higher levels of formal education, a stimulating job, mentally challenging hobbies like reading or playing a musical instrument, and lots of social interactions.
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#6 Thousands of studies over 50 years that show whole grains can reduce your risk of stroke by up to 36%, heart disease by up to 28%, and type 2 diabetes up to 30%
The March 2008 issue of Consumer Reports says that eating whole grains is the #1 action you can take to improve your health (besides quitting smoking).
According to the World Health Organization Global Burden of disease 2010 study, the 16th leading cause of early death and disability is not eating enough whole grains (The Lancet).
Whole grains also appear to lessen or lower the risk of: Artery-narrowing plaque, Asthma, Atherosclerosis, Blood pressure, Cancer: Bladder, Breast, Colon, Esophagus, Gallbladder, Kidney, Liver, Larynx, Non-Hodgkin's lymphoma, Ovarian, Pancreatic, Prostate, Rectal, Stomach; C-reactive protein, lower LDL Cholesterol and triglycerides, Constipation, Diabetes, Diverticulitis, Gallstones, Gastrointestinal disorders, Gum disease, Hemorrhoids, Hypertension, Inflammatory diseases, Macular degeneration, Metabolic syndrome, Obesity, Varicose veins of the legs, Weight regulation (loss), lower BMI, and increase your life span (wholegraincouncil).
In 2010, the American Society for Nutrition brought researchers together to review the evidence of whole grain health benefits. Current scientific evidence shows that whole grains play an important role in lowering the risk of chronic diseases like coronary heart disease, diabetes, and cancer, and also contribute to body weight management and gastrointestinal health. The findings were published as a supplement to The Journal of Nutrition in May 2011
In 2004 (Nutrition Research Reviews, May 2004; Vol 17: 99-110), Dr. Joanne Slavin of the University of Minnesota published a comprehensive article that reviewed and compiled scores of recent studies on whole grains and health, to show how whole-grain intake is protective against cancer, cardiovascular disease, diabetes and obesity.
The wholegrainscouncil has thousands of studies listed at their "health studies on whole grains" and "What are the health benefits" pages. If you think the wholegrainscouncil is a biased institution then you need to counter with peer-reviewed scientific evidence, not name-calling.
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#7 Did Perlmutter single-handedly disprove decades of peer-reviewed studies in both medicine and nutrition?
I can't find any reference(s) in his book to support his claims. Nor did the the New York Times, the 2 top scientific magazines Science and Nature, NBC, ABC, CBS, The Lancet, The New England Journal of Medicine, the Mayo Clinic, or any other medical or science journal.
There are very few 2013 references. Many of those are non-science references (i.e. Dr. Oz, cookbook author Mark Bittman - my favorite cookbook author, but the citation is not a peer-reviewed study) and most of his scientific references that have anything to do with wheat are for people with celiac disease (1-2% of the population) or sensitive to gluten, at most 7% of people.
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#8 the references that do exist only apply to the 1% with celiac disease or 5% with gluten intolerance
So if there's a grain of truth to anything he's saying, it doesn't apply to those of us in the 90% majority. But I don't know if I can believe anything he's saying, and it's too much work to sort the wheat from the chaff.
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#9 Testimonials are not proof. Only peer-reviewed science in top-tier journals counts
Most of Perlmutter's "proof" are the testimonials of patients.
Testimonials are NOT SCIENCE --and Dr. Perlmutter MUST know this if he has an advanced degree.
Only double blind studies that can be repeated are valid evidence. Because people forget what they've eaten, or over/under estimate what they've eaten, the reports of people in scientific studies are the least reliable, and this isn't even a scientific study, it's his patients who probably like him or they'd go to another doctor.
The most trustworthy studies look at the diets of millions of people across nations or large groups of people over decades. Many studies of national diet and thousands of people have shown many benefits from eating whole grains for decades.
If you want to seriously debate the merits of this book, you need to counter with peer-reviewed science, not attack my character or invent something I wrote and then rebut an argument I never made.
I feel like I disturbed a hornet's nest of True Believers, a religious Paleo diet cult. Hey, I'm not trying to take your bacon away -- believing in bacon makes more sense than believing any of the 3,000 plus Gods you can choose from across the various main and tribal religions.
But as Eric Schlosser showed in Fast Food Nation: The Dark Side of the All-American Meal there are ethical and ecological repercussions to consider. So before you fry up that next pan of bacon, you might find that Raising a Stink: The Struggle over Factory Hog Farms in Nebraska (Our Sustainable Future) will give you food for thought.
Bacon, eggs, and red meat do not lead to a long life. Quite the opposite: According to the World Health Organization's "Global Burden of Disease 2010″ study, American causes of early death and disability are: High total cholesterol #9, Diet high in processed meat #12, Diet high in red meat #32
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#10 What is Perlmutter's motivation?
At amazon.com I have been accused of profiting somehow from my 1-star review of this book. This is called an "ad hominem" attack because it distracts people from my 11 criticisms by not addressing any of them. (By the way I don't work -- I'm retired, make no money from my book about home made whole grain & legume chips & crackers, and don't care if I ever do. I'm way too busy with other activities, such as volunteering to take 4th & 5th graders from the inner city on hikes at Audubon Canyon Ranch near Bolinas, blogging about nutrition and other food related topics at my website, etc. My grandfather was a nutrition professor at the University of Chicago so I've been interested in this topic for a long time. He died before he could publish his book about the extent to which a well-fed an army was likely to win a battle. Napoleon thought good food was essential and had first-rate bakers making high-quality bread for soldiers on the front-lines).
So these strange attacks on me rather than my arguments and accusations that I was somehow doing this to make money brought up another argument I hadn't thought of, so I went back to this review to add what's below.
In murder mysteries the killer is often found by discovering a motivation. Why would Perlmutter slam WHOLE GRAINS rather than white flour? And he's not the only one doing this, which makes me all the more suspicious that the industrial food companies are funding people who speak out against whole grains.
Why would they do that?
The basis of processed food is using unhealthy cheap ingredients. Fat, sugar, salt and white flour are almost as cheap as water. Read my review of Salt Sugar Fat: How the Food Giants Hooked Us at wholegrainalice.
If there's anyone who makes money off of this, it would be the processed food industry, and they'd do it by sponsoring "experts" to slam whole grains so they can keep using cheap unhealthy white flour. There are many ways to do this, one would be making lucrative speaking engagements on TV, radio, and conferences available to Perlmutter and other "experts" who slam whole grains. The multi-billion dollar food industry has a very strong motive to fight whole grains because they're quite expensive compared to white flour, have a shorter shelf life, and are more trouble to predictably make "perfect" because whole wheat varies in protein and other content.
But there are many other ways that corporations pay "experts" and also keep it a secret. The best book on this is Bending Science: How Special Interests Corrupt Public Health Research. Also see Merchants of Doubt: How a Handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Global Warming
Basically Perlmutter is making a claim that refutes thousands of studies of the health benefits of whole grains -- he deserves to be criticized just like those who deny climate change, evolution, or that tobacco causes cancer.
Why didn't Perlmutter criticize white flour?
White flour has had the bran and germ removed so it's just a starch. It no longer behaves like flour, so up to 30 chemicals are added (many of them banned in Europe -- see my article at wholegrainalice). White flour has no fiber, up to 88% of 21 vitamins and minerals are removed (they're mostly in the missing bran & germ), and all the essential healthy oils, and most of the protein too.
David Kessler, former head of the FDA, writes in The End of Overeating: Taking Control of the Insatiable American Appetite that more than any other product, baked goods have more sugar, salt, and fat than other products to hide these sour, bitter chemical flavors.
I can understand that the average person is totally confused by all the advice out there and wouldn't know that testimony counts for nothing, but Dr. Perlmutter knows he can't refute decades of studies showing the benefits of whole grains. Health claims for whole grains are one of the few claims allowed by the FDA. It's how two-thirds of people in the world get enough calories to survive.
So to blame dementia etc., on wheat when he knows full well that other factors are mainly to blame, now why would he do that? Yet another way to make money off of this quack idea is obvious - to sell this book to gullible new age, Dr. Oz, Andrew Weil, gluten-free and Paleo diet followers.
A third way to make money, in addition to corporate money and selling this book is that he's on the advisory board of the company that makes the Protandim pill he recommends taking.
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#11 Perlmutter knows other factors are to blame
And get this -- only a very small number of his citations are about grains, the title of this book. And only one chapter, the rest are about fats, statins, sleep, fasting, and other topics.
Conclusion
The only way to protect yourself from bad ideas is to understand what bad versus good evidence is, develop critical thinking skills, and read about a topic. If you don't know what we know and how we know it, or have a basic understanding of nutrition, then you may fall prey to any quack that sounds good to you. Inoculate yourself by reading a nutrition textbook. My favorite by far (and I've looked through hundreds of textbooks at the University of California library) is Nutrition for Health and Health Care. Get it from a university library, or buy an older edition, the basics don't change much.
One of the comments says that wheat has a gluten content 500 times what it was in the past which "disturbs the digestive tract by making it more permeable and "leaky" even in people who aren't gluten-sensitive". Another said they are "enriched" with chemical laden "nutrients" and it's not the same as it used to be. Another that mutagenesis has changed the wheat somehow. Prove these statements with peer-reviewed references, the more the better, and I'll change my mind.
I noticed that the 3 Most Helpful Customer Reviews that appear on the main page, which few people would click past to reach this review, are written by Amazon Vine Reviewers. According to episode #492 of National Public Radio's "Planet Money", they receive the items reviewed for FREE. This would lead to positive reviews in two different ways -- the obvious one is that we are wired as human beings to be return gifts (that's why the Hare Krishna's liked to hand out flowers at the airport), and #2 the reviewers get to pick which items they want to review out of many -- so they're going to pick books that they might be interested in. I spent a good deal of time looking at the books and products these reviewers reviewed, and they tended to give nearly all four or five star reviews, and they write thousands of them, across thousands of not just books, but all the other products they get for free. I wonder if maybe Amazon is picking Vine reviewers by those that highly rate most products so they can sell more books (or whatever).
Perlmutter also buys into the Paleo diet, which has been soundly shown to be a fantasy (see my book review of Paleofantasy: What Evolution Really Tells Us about Sex, Diet, and How We Live )
Here's what the Whole Grains Council had to say about this book:
Celiac disease and gluten intolerance are real and serious issues. People with celiac disease (1-2% of the population) or non-celiac gluten intolerance (estimated at about 6% of the population) can indeed have medical issues not only with their digestive systems but with other organs including the brain, and these people will benefit from removing the four gluten grains - wheat, barley, rye and triticale - from their diets.
Even the 7-10% of people with a reaction to gluten, however, can continue to enjoy all the non-gluten grains: amaranth, buckwheat, corn, millet, oats (if certified as non-contaminated), quinoa, rice, sorghum, teff, and wild rice. The rest of the population can enjoy these ten grains along with the four gluten grains. Leading medical researchers in the area of gluten intolerance and celiac disease attest that there is no need for 90 percent or more of our population to avoid any grains.
Put simply, there is no evidence for the idea we should all avoid all grains. Perlmutter must realize this himself, since Grain Brain contradicts its main premise that all grains are injurious to brain health, and recommends eating, in moderation, "amaranth, buckwheat, rice (brown, white [sic], wild), millet, quinoa, sorghum, teff and [gluten-free] oats."
In fact, evidence for the health benefits of whole grains is well-documented at the whole grains council website - and was touted by Grain Brain's author in his earlier book The Better Brain which included foods like whole grain couscous, oatmeal, spelt pasta, and quinoa-stuffed peppers throughout its menu plans. In an interview promoting The Better Brain on CBN-TV, for instance, Perlmutter advocated replacing junk food with "real food such as unprocessed whole grains and fruits and vegetables." He does not acknowledge or explain his flip-flop in Grain Brain, giving us no clue why he has now turned against what he previously acknowledged to be sound science.
While Grain Brain goes off the deep end in imagining that the very real health problems of the 7-10% of the population with gluten intolerance or celiac disease somehow extend to all of us, the book rightfully details many important components of good health that Oldways and the Whole Grains Council have long supported. These include the key roles of physical activity and sleep; the essential contribution of good fats; the value of the Mediterranean Diet (which Perlmutter cites as "very similar to my dietary protocol"); and the importance of avoiding inflammation and choosing carbohydrates with a low glycemic impact.
Our advice? Don't let Grain Brain scare you away from appropriate-size portions of healthy forms of whole grains (yes, a whole grain cookie is still a cookie!). Enjoy a balanced diet including a delicious variety of real, whole foods, an approach followed in traditional diets backed up by proven science, like those championed by Oldways.
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