Dietitian Kristi King reviewed Wheat Belly for the Academy of Nutrition and Dietetics (AND), full text here.

Among her comments:

” . . . there is very little guidance as to what are appropriate substitutions during meals, therefore, one who does not review this diet with a registered dietitian could potentially set themselves up for vitamin and mineral deficiencies, such as B vitamins, calcium, and vitamin D just to name a few.”

“Review this diet with a registered dietitian”? Is she serious? This is indeed consistent with the agenda that the Academy has been pursuing for many years, trying to make dietary advice the exclusive province of registered dietitians. (Witness the lawsuit waged against North Carolina Paleo blogger, Steve Cooksey, by the North Carolina Board of Dietetics and Nutrition. I’ve also talked to several dietitians who formerly played important insider roles in the Academy: They all described efforts to legislate making dietitians the ONLY people legally able to provide dietary advice.)

As is often the case with the dietary community, the response lacks real insight and understanding of the issues. Ms. King’s primary concern with the Wheat Belly arguments seems to be potential for nutritional deficiencies. Is this any merit behind this claim? Will we all suffer nutritional deficiencies that impair health by eliminating wheat?

Of course not, provided you replace the lost calories of wheat with truly healthy foods, such as vegetables, nuts, seeds, meats, poultry, fish, etc. If you do something stupid and replace calories with energy bars, tortilla chips, instant soup mixes, or gluten-free foods made with junk carbohydrates cornstarch, rice flour, potato starch, or tapioca starch, then, yes, there may be deficiencies long-term. But not if you rely on real, single-ingredient foods.

Let’s take her claims of deficiencies one-by-one:

–B vitamins–B vitamins, such as riboflavin, folates, niacin, thiamine, B6 and B12, are plentiful in foods such as meats, nuts, and seeds. For example, 4 oz of chicken breast provides nearly 6-fold more vitamin B6 than two slices of whole wheat bread, 4 oz of tuna over 10-fold more. Folates are important B vitamins with 261 mcg in 1 cup cooked spinach, 41 mcg in two eggs, 90 mcg in one cup of fresh avocado, compared to the 50 mcg in two slices of whole wheat bread. Similar analyses can be done for every other B vitamin with the same result: Intake is the same or, more often, increased minus wheat.
–Vitamin D–This is an absurd criticism, as most wheat products have zero vitamin D. The occasional fortified products tend to provide something like 40 units per serving, a relatively trivial quantity, usually of the non-human form, ergocalciferol (D2), not the more effective human form, cholecalciferol (D3). Humans were meant to obtain vitamin D from sun exposure, but modern lifestyles of wearing clothes covering the majority of skin surface area, indoor living, combined with the expected loss of ability to activate vitamin D in the skin, create deficiency in the majority of modern people, especially as we age. Modest quantities of vitamin D can be obtained through consumption of fish (e.g., 154 units cholecalciferol in 3 oz canned tuna, 900 units cholecalciferol in 6 oz salmon), and egg yolks (82 units cholecalciferol in 2 eggs). In other words, it is almost impossible to obtain sufficient vitamin D as cholecalciferol from the diet. You can get some sun, though the yield in vitamin D diminishes as we get older, or take truly meaningful doses of vitamin D supplementation as cholecaliferol, or vitamin D3, to make up for the habits of modern life, e.g., 6000 units per day, a dose sufficient to raise 25-hydroxy vitamin D levels to the 60-70 ng/ml range (150-175 nmol/L). Whether or not a few wheat-based products contain some ergocalciferol can make a difference . . . well, that’s pretty dopey.
–Calcium–On the surface, Ms. King is absolutely correct: Calcium fortification of breads, for instance, can provide 300-400 mg calcium. Compare this to the 180 mg in a cup of cooked broccoli, 240 mg in a cup of cooked spinach, 125 mg in a cup of arugula, 200 mg in an ounce of most cheeses. So calcium from wheat products might indeed make an important contribution to total daily intake . . . but NOT if restoration of vitamin D is factored in. Correct common deficiency of vitamin D and intestinal calcium absorption is substantially increased; see Heaney et al for one such study. In other words, this notion that everybody needs to obtain 1200 mg total calcium per day needs to be reconsidered in light of the new vitamin D data that suggests something like 600-800 mg calcium per day may be more than enough. And note that calcium supplementation is also being increasingly associated with increased heart attack risk, e.g., this large German study.

The important issues of gliadin-derived exorphin/opiates and their varied mind effects, the high glycemic potential of amylopectin A, the alterations introduced into wheat germ agglutinin that make it a powerful intestinal toxin, the allergies being generated by new forms of alpha amylase inhibitors–ALL ignored. I’d love to hear the Academy’s rebuttal/defense of these issues.

As I often expect from dietitians, NONE of these sorts of deeper insights are discussed or entertained, just a bland recitation from the perspective of traditional dietary dogma. She did not bring up the “fiber deficiency” argument, so that is something I will tackle in an upcoming Wheat Belly Blog post. Don’t worry: You will not be fiber-deficient!

Let’s not forget that, of the 2.4 million years humans have inhabited earth (if we date the appearance of Homo species to the transition between largely herbivorous Australopithecines to omnivorous Homo habilis/rudolfensis), we have consumed grains for 0.4% of that time, a mere blink on the evolutionary timeline of adaptation to life on earth. Those first grains, of course, were wild grains, not the stuff of agribusiness.