Welcome to Season 10, Episode 5, of the Troubleshooting Innovation podcast. Joanie Spencer, editor-in-chief for Commercial Baking, is spending this season with Julie Miller Jones, a member of the Grain Foods Foundation Scientific Advisory Board, and Charlotte Martin, registered dietitian and consultant for the Grain Foods Foundation. They’re debunking bread myths to help bakers develop delicious, healthy grain-based products — and help them educate consumers on the health benefits of bread. Sponsored by Lallemand.
In this final episode, we close out the season with a discussion around the benefits of grain foods on women’s health.
Learn more about this season here, and listen to Troubleshooting Innovation on Apple, Spotify and Google.
Joanie Spencer: Hi Julie and Charlotte. Thanks so much for spending this final episode with me.
Charlotte Martin: Thanks again for having us.
Spencer: So, this is, I think I saved probably the most important topic for last, and that is women’s health. In doing research on this topic, I discovered how important this is as a woman. So I’m very excited to dive into this with you. The first thing I want to talk about is something called “shortfall nutrients,” and these are the ones that Americans typically under-consume. My question for you both is: Why is it so important for women to know and understand the shortfall nutrients?
Martin: Yeah. Well yes, the shortfall nutrients are the nutrients that many Americans are just not getting enough of. This includes nutrients like calcium, potassium, fiber, vitamin D. It’s particularly crucial for women to be aware of the shortfall nutrients because women have unique nutritional needs at different stages of their life, whether it’s during childbearing years, or pregnancy or lactation. So, for example, getting enough folic acid is essential for women of childbearing age to help prevent birth defects. And then iron supports healthy blood cell production, which is crucial, given that women can lose a significant amount during menstruation. Bread and grains in general play a significant role in this context; they contribute to our overall diet quality by providing these key essential and shortfall nutrients. Enriched grains, for example, are a top source of folic acid in the American diet. And then refined grain foods actually account for almost 40% of the dietary fiber intake in the American diet.
Julie Miller Jones: And the absorbable iron. The iron is more absorbable from a refined grain than it is from a whole grain. That’s why one of the reasons that the dietary guidelines ask for people to have half their grains whole, because they know about this difference in absorbability and the difference in the enrichment of the B vitamins. Just as a historical, to show how important the nutrients that are in refined grains are, to women and to all, is that in World War II, when the soldiers came in to be recruited, they found that they were low in all the B vitamins. That’s what caused the enrichment of flour. Very rarely do you hear about B vitamin deficiency diseases. That was not true in the 1940s. And it just shows how effective the enrichment of flour has been, in that those aren’t on the list of shortfall nutrients. So folate now is not on the list of shortfall nutrients, and it’s due to the industry and government partnership to address the problems through a food that everybody eats. They chose bread and grains and cereals because everybody eats it.
Spencer: It’s like you’re reading my mind, Julie. That literally was the next question I was going to ask you because we did talk about the enrichment of flour and the impact on Americans’ health. So again, like, how is this enrichment specifically impacting women’s health, especially in terms of women of childbearing age?
Martin: Julie, correct me if I’m wrong, but the FDA mandated that manufacturers add folic acid to the enriched bread and grain products in the late ’90s. Correct?
Miller Jones: Yes.
Martin: And so that was to reduce the risk of neural tube defects in newborns. And folic acid, which is the synthetic form of folate, is important for many things, but it’s crucial for DNA synthesis and repair, which makes it essential for cell growth and reproduction. And so, I don’t know the exact numbers — and Julie might know more about this — but this public health initiative led to a significant decrease in the incidence of these birth defects in the United States. So, for women, this means that consuming enriched grain products alongside a balanced diet can help ensure they’re getting enough folic acid to support a healthy pregnancy, even before conception and in the early weeks that follow, which are times when many women might not yet be aware they’re pregnant, and they’re not taking prenatal vitamins.
Miller Jones: Yeah, the neural tube is formed in the first two weeks. And so most people don’t know they’re pregnant. And therefore, the folate status of the woman when she conceives is critical. The March of Dimes named fortification of folate as one of the most important public health measures of the last century, up there with antibiotics and certain kinds of vaccinations. That’s how important it was. And so I think people take it for granted. What scares me is that people often buy flours that may not have the enrichment package. They may buy, particularly often organic flours, because all of the additives or all of the fortificants (the nutrients that are added to fortify) are deemed as additives. Therefore, some organic products are not enriched and fortified. And people think that buying organic may be better for them. But it may actually, in fact, not be. I should just add folate that is really, really important because it helps in the formation of the DNA. The other one that’s really critical is B12. And so we have some women who go on a non-bread diet, and if they are vegan — B12 is found only in animal products — so this could be incredibly problematic for vegan women who decide that they should not eat enriched grain products, because they would not be getting the B12 needed to form DNA, and they would not be getting the folate needed to form DNA.
Spencer: That sort of speaks to what we talked about last week. Elimination types of diets can be counterproductive to what you’re trying to achieve with your health.
Miller Jones: You know, they think gluten-free … for some reason, they got the idea that gluten-free is better for them. And that, then, also puts them in not getting the enriched and fortified products. So that’s problematic.
Spencer: Right. When consumers sort of try to educate themselves and, I think we really talked about this in the beginning of the podcast season as well, that people seek out information that they want to hear. And they don’t seek out balanced information. So, when they hear, ‘Well, this is bad for you don’t eat it’ … they’re not really getting the other side of the story of what happens when you don’t consume these foods, then you need to supplement with X, Y and Z. So I do think there is this opportunity. And I think Charlotte, you mentioned it last week, an opportunity to say, ‘This is why we put this in our bread. This is why this is in here.’ And I didn’t really personally understand the whole attitude of pregnant women saying, ‘Well, I can’t eat that because I’m pregnant.’ And it’s sort of like, what’s the big deal until you’re pregnant? And then you’re like, ‘Oh, I’m harvesting a life. Everything that I put in my body is really important.’
And I think there’s this great opportunity to communicate that in advance of pregnancy, because you’re right, that’s another thing I didn’t really realize was when you make the decision that you’re ready to start trying to have children, you should treat your body as if you’re pregnant, because for the first four to six weeks that you’re pregnant, you don’t know you are and it’s a critical time in gestation. So this is a really good opportunity for baking brands to tout those women’s health benefits and why it’s important. I love the idea around ‘why.’
Miller Jones: They can talk about healthy moms, healthy kids, because we also see young children being fed things that I would not recommend being fed on a regular basis so that it’s an opportunity to start kids out right. And you’re having healthy moms and healthy kids.
Martin: I agree. The Grain Foods Foundation obviously does a very good job of putting that messaging out there. But, you know, bread manufacturers … I don’t see them talking about that, really. And I think that’s a missed opportunity there.
Spencer: Okay, so we have talked several times about protein, and how it’s really popular in diet and food culture these days, especially like last week talking about sandwiches and the types of meat that you add to a sandwich. But I feel like fiber is having a bit of a moment, too. And I say that as a 52-year-old woman, that I’m hyper-aware of fiber these days. Why is this nutrient so important for women? And what would you say are the benefits of bread and other grain-based foods in terms of fiber?
Miller Jones: I’d first like to say that we have got it so wrong, in that the average man gets 30% more protein than he needs. And the average woman gets 12-15% more protein than she needs. And yet, everybody thinks, ‘Protein is good for me, protein is good for me.’ Too much protein can be like anything else: It can be problematic. And yet, everybody tries to get more protein. They say they’re trying to get more fiber, but they don’t. And partly, they don’t because they don’t know where to find it. In some surveys, believe it or not, if you ask people — one was even done with an MD — where they asked them, “Where do you get fiber?” They said meat. Because they could see the fibers. So we talked about muscle fiber, and that confused people. Dietary fiber is not muscle fiber. Even a doctor got it wrong. So dietary fiber is only from plants, and we have to tell people that. The major source in the US diet is not fruits and vegetables; it’s grains. Fruits and vegetables are second. And a lot of people say, ‘Well, I eat a lot of fruits and vegetables.’ Well, they lie there too, because they don’t. They especially don’t think about white bread. An average slice of white bread has one gram of fiber in it. You eat six of them, that’s six grams of the 25 that are recommended.
Martin: Yeah. I think the average American gets in only about half the daily recommended amount, whereas — as Julie mentioned — they get plenty of protein. I agree, fiber is finally having its well-deserved moment, at least I hope, this year. And speaking to the benefits of fiber, particularly for women, so … fiber plays a crucial role in supporting digestive health, as we know. It also aids in weight management and reducing the risk of chronic diseases like diabetes and heart disease. Heart disease is leading cause of death for women in the US and can affect women at any age. Also, for women, a fiber-rich diet may help promote healthy estrogen regulation and protect against breast cancer. To add to its role in supporting digestive health, it may also help alleviate, in some people, symptoms of irritable bowel syndrome, which is more prevalent in women than men. So, bread and other grain-based foods are very valuable sources of dietary fiber, as Julie mentioned, and with whole grains — white, as well, provides fiber — but with whole grains, they retain all parts of the grain kernel, including that fiber-rich outer layer. So they do retain some more fiber and can contribute greatly to that daily fiber intake. I think that these grain-based products and bread, in particular, are very important for women’s health.
Miller Jones: And I think we need to do a better job telling people about it. Because you mentioned earlier, if there’s a few grains of oatmeal on the top of the bread loaf, people think they’ve gotten a whole grain bread. If it has any color in it, they don’t know that could be entirely due to the addition of caramel color.
When I did the first whole grain and dietary fiber conference back in 2001, the international one, I went to people and I said, ‘Would you be a an exhibitor at our conference?’ The man is standing in front of all of these boxes of oatmeal, and he said, ‘Why would we? It’s not a whole grain.’ He thought because the oatmeal had a light color, it wasn’t a whole grain. A lot of people don’t know that the white whole wheat has as much fiber as the dark whole wheat. I used to make my son mad when I’d go to the Subway and order a sandwich. They asked me if I wanted the white or the wheat, and I said, ‘Well, what’s the white made out of?’ And he said, ‘Mom, just buy your sandwich!’ But people don’t know that the wheat is not whole wheat. They think that when it says wheat, it is whole wheat. And that’s been for almost 25 years, we’ve been trying to get this message across. And we need to penetrate better because people are still really, really confused about what’s a whole grain product.
Spencer: And I think you tapped into something, Julie, saying that we are talking about fiber a lot more, but we don’t know how to consume the fiber. To Charlotte’s point, fiber supports gut health and I think we’re in an era where we finally can have those open conversations about gut health. It’s not a taboo topic anymore, and there’s research that shows the connection between gut health and overall health. Here’s another opportunity for baking brands to tout those fiber benefits and how these grain foods can support gut health if people aren’t going to naturally make that assumption on their own.
Miller Jones: No, they associate … because grains can have FODMAPs. And FODMAPs are chemicals which are fermented by the bacteria, they actually may be good for you. But a lot of fermentation in your gut is uncomfortable. And so, some people say, ‘Well, I don’t eat any bread or grain because it makes me have gas.’ And I then say, ‘Well, okay, do you want colon cancer later, or gas now?’ It seems like when you put the choice that way, that you try to adjust your diet so that you can increase the amount of fiber that the fermentation and the production of the short chain fatty acids actually make healthy colonic cells. And so our skittishness about gas, I think, is one of the problems that we have in terms of convincing people that this is actually good for you.
Spencer: Another thing that we sort of touched on with women’s health is cardiovascular health. We just celebrated Women’s Heart Health Awareness last month, in February. So, I think it’s a good time to talk about the relationship between refined grains and cardiovascular health. Can you guys sort of walk me through what that relationship is?
Miller Jones: Well, the big study by On, which is a meta-analysis of the existing studies done up through 2016 — and the ones that have been subsequently — still show that eating about three servings a day of whole grain lowers your risk of cardiovascular and coronary heart disease. What those same studies say, which has not been widely reported, is that refined grains neither raise nor lower the risk. The risk is zero. And that’s very different from what is being reported. In fact, the risk is actually one, and anything that has a number over one is raising the risk, and anything with a number less than one is lowering the risk.
And so I’m sad because people have not really gotten the idea that, thank goodness, the dietary guidelines got. And that is, it’s the mix of grains that really makes the healthy diet. And that’s what we have data for. People who ate three servings of whole grain and three to four of refined grain were the least likely to have heart disease and the least likely to have diabetes. But unfortunately, those aren’t picked up in the headlines. It’s not the ‘dog bites man.’ That story doesn’t get picked up. ‘Refined grains don’t raise the risk’ doesn’t get picked up as a story, even though it’s in the conclusion of those very well vetted studies. It only picked up that whole grains lowers your risk, it doesn’t pick up that refined grains didn’t raise the risk.
Martin: I think that just reiterates what we’ve been saying through every episode, that refined grains can have a place in a balanced, health-supporting diet, provided that you’re including some whole grains in there.
Spencer: I feel like we can get that message out there. It’s a mix of whole grains and refined grains. But the truth is, that’s kind of complicated. Like that’s a lot for consumers. Like they just don’t want to do the work. They don’t want to have to think about, ‘How do I get a healthy combination of these grains?’ They just kind of want somebody to do the math or do the work for them. Do you think there’s a little bit of that at play?
Miller Jones: You’re so right. Because we know that something like the DASH diet, we know it works. We know it reduces the risk of every disease I can mention. It reduces blood pressure, it reduces weight … but it’s complicated. So you have someone who writes the DASH diet or the book, it’s all available online because it was government-funded. Someone has a book and says, ‘Don’t eat X and you’ll lose 25 pounds in three weeks’ … it sells like hotcakes. Because they just tell you, ‘Okay, if you only don’t eat this, or you only do eat that, that this is going to change your life.’ And until people stop doing the magic lamp kind of give you three wishes, that’s not going to happen. And I don’t know how we can convince them. If any one of those diet books worked, you wouldn’t need any of the rest of them. Everybody wants to have lost the weight yesterday, and that’s what the book promises: this really, really fast weight loss, these really healthy children. It makes those promises and the government’s not going to promise that if you eat the DASH diet that it reduces your risk. But they want us to believe the fairy tale-ness of it, I think.
Martin: Julie, you might disagree on this, but I think when it comes to grains in particular and that messaging, not making it complicated and continuing to focus on telling consumers to make half their grains whole, I think that’s really clear, easy messaging. It doesn’t seem like we have a refined grain intake problem. Most people get enough of the refined grains; it’s really about focusing on getting more whole grains in their diet and keeping that messaging simple, like we have been.
Miller Jones: No, really, I couldn’t agree with you more. And maybe the bread industry isn’t gonna like this, but there are people who eat way too many grain servings, and they’re not whole grains. So, we need to talk about half your grains whole, and then right-sizing all your servings of food to meet your caloric need. That’s a message that’s a hard sell. It’s really a hard sell.
Martin: That’s where these manufacturers could really help with creating these breads that are either like half loaves or smaller sizes. I think the smaller size options are just wonderful.
Miller Jones: Also, I think to really encourage the regular slice of bread rather than the super-size slice of bread may also be helpful in terms of getting the health message across.
Spencer: Right. And that’s what we talked about in the very first episode, was that portion size and serving size are really important.
Martin: Yeah, I think it’s what we’ve been discussing, not necessarily completely removing enriched flours from their products, but trying to incorporate more whole grains, whole grain flours into their products, and then adding ingredients like seeds. Nuts can also enhance that nutritional profile, provide healthy fats, fiber and protein. And then reducing the amount of sodium if it’s a higher sodium product could also be beneficial, and added sugar as well.
Spencer: From a formulating standpoint, do you have any thoughts on what bakers can do to make their products more heart-friendly?
Miller Jones: Since only 4% of the population meets the fiber requirement, and we have a huge fiber gap even in the quintile that’s eating the most fiber … if people could look for some higher-fiber varietals, or use some resistant starch, or add grains that are higher in fiber or that contain beta-glucan like oats. Under 1% of men between 19 and 50 meet the fiber requirements. Basically zero. They don’t meet the fiber requirement. They don’t. They’re coming in at about half the amount of fiber that we should need. And women aren’t doing that much better. The only group that’s doing really even sort of decent, is 15% of people my age — old women — meet the fiber requirement. That’s because we’re close to God, but we’d rather not be quite that close.
And so that’s the group that makes the fiber requirement nobody else does. And this is this is problematic.
Spencer: Again, you know, I’m 52 and the minute I hit 50, it’s like fiber is part of the conversation.
Miller Jones: But we need to pick up part of the conversations of the 22-year-olds.
Spencer: I think there is opportunity especially when, like I said, with gut health and now women’s heart health really at the forefront. These are conversations that females are more willing to have out in the open. And I think that when bread producers or just grain-based food producers can create these gut-healthy and heart-healthy products, then they need to start taking part in the conversations with women who are now more open to having the conversations about how they can be more healthy in their guts and in their hearts.
Miller Jones: Well, the other thing in terms of formulation that bread manufacturers might consider would be heat-stable pre- and probiotics. And post-biotics. I think those have a buzz now, I think the buzz is justified by the scientific data backing it up. So that could hook in with women, because women are very interested in gut health, probably more so than men.
Spencer: So let’s just take a minute to celebrate consumers being open to science-backed buzzwords!
Miller Jones: That is true, that’s nice. Yeah.
Spencer: To punctuate what we’ve been talking about for these last few minutes, GFF is really emphasizing women’s health throughout their lives, from childbearing age through menopause. We’re talking about things that older women are concerned about, and we need to get younger women concerned about them too. So GFF is doing a great job of getting that word out, but when we’re talking to the industry, and we’re talking to bakers, what are the most important things for them to know, just sort of hitting the highlights, about how their products impact women and their health at any stage? If you could stand in an elevator with a baker who makes bread, what would you want them to know? Like, you need to do X, Y and Z for women.
Martin: Ultimately, nutrition plays such a pivotal role in women’s health, influencing everything from fertility and pregnancy outcomes to the management of menopause symptoms and the prevention of age-related diseases. So some of the most important things we’ve discussed are the importance of folic acid for women of childbearing age, which supports fetal development, and the need for increased iron due to menstrual blood loss or during pregnancy. And then as women transition into menopause, dietary needs shift again, with a focus on things like calcium to support bone health and mitigate that risk of osteoporosis. So whole and enriched grains help women meet their daily needs for these essential nutrients. They are just vital at every stage of life. I never really see bread being marketed as a product to support women’s health, despite the fact that it clearly does. And I think bakers have a huge opportunity here.
Miller Jones: That was so well said. I would just add, we also I think can pique the interest of young people because grains are sustainable. They’re economically and environmentally inexpensive. And I think that’s critical to women from all walks of life. And it is more and more important as we see what kinds of things are happening in terms of our climate.
Spencer: Yeah. Okay, ladies. So that pretty much wraps up the conversation around women’s health. And something that I really love about this episode is that, in the first four, we sort of attacked some misconceptions, we busted myths, but this one, I think we uncovered things that women maybe didn’t know or realize about how grain-based foods can impact their health. That’s really beneficial to bakers and producers in this industry. So I’m going to close out this season, and I’m just going to ask you for sort of some parting wisdom. What do bakers need to understand about the real impact that their products have on American consumers? If you could impart just one closing piece of wisdom, what would it be?
Martin: I think my words of wisdom would be to innovate and educate. There’s a real opportunity to make bread a health food from a consumer perspective. And that may require some innovation to be able to offer products like we’ve discussed throughout this series, like smaller, more portion-controlled slices, breads made with different whole grain flours and other ingredients like seeds, minimizing added sugars, etc. And then a really important piece is educating consumers on how bread can and should be incorporated into a balanced, nutritious diet. This isn’t just about marketing. It’s about meaningful engagement and partnership with nutrition experts like dietitians, especially those who have a platform and can really influence public perception. So, I think they have an opportunity here to leverage their expertise to communicate the health benefits of these innovations.
Miller Jones: I think there’s also a missed opportunity. Bread for those of lower socioeconomic backgrounds and certain ethnic groups provides a significant number of calories and nutrients. And somehow, [bread producers need] to get that information out and to build on it because as we move towards a plant-based, sustainable, nutritious diet, bread has got to be in the forefront. And so ways to leverage that, I think, would be a really, really good strategy for them. And just to tout the benefits of what’s there, rather than say, ‘Oh, yeah, well, we make bread.’ No, we make a significant contribution to the health and nutrition of people in this country of all socioeconomic walks of life.
Spencer: Julie, I can’t imagine a better way to close this season than those thoughts. Very poignant, very important. Thank you so much. Ladies, Charlotte and Julie, thank you for spending these five weeks with me and talking about these important topics and uncovering what consumers really need to know and how bakers can make products that are healthy, and communicate those health benefits to their end users. And it’s very important to say, thank you for your work with the Grain Foods Foundation! There’s a lot of good things going on, from communicating the benefits of bread to helping consumers build a better sandwich to helping grains sustain life for women at any stage in life. It has just been a joy and an honor to spend this time with you. Thank you so much.
Martin: Thanks again for having us, Joanie. This has been wonderful.
Miller Jones: Thank you!