Welcome to Season 10, Episode 2, 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 episode, we tackle the myth around bread’s connection to the glycemic index.

Learn more about this season here, and listen to Troubleshooting Innovation on Apple, Spotify and Google.

Joanie Spencer: Hi, Julie. Hi, Charlotte. Thanks for joining me again this week.

Charlotte Martin: Thanks for having us again.

Spencer: This is an interesting one for me. There’s a sentiment that circulates among consumers that if they’re diabetic or they’re concerned about their blood sugar they should avoid bread. This feels a little bit misguided. Can you help me unpack this and understand what’s the truth here?

Martin: This idea that those with diabetes or those concerned about their blood sugar should completely avoid bread is definitely misguided. The key here is not to avoid bread, but to make informed choices about the type of bread, the quantity or portion size consumed, and, of course, what you consume it with. Bread, like any other carb-rich food, can impact blood sugar levels, but the effect depends greatly on the type of bread.

For instance, whole grain breads are richer in fiber which helps slow the absorption of carbs and therefore dampens the blood sugar response. Also pairing bread with healthy fats, proteins and/or more fiber can help slow the absorption of carbs even more leading to a more gradual rise in blood sugar. An example of that would be good old avocado toast, a slice of bread with fiber-rich avocado on top, a protein-rich egg and maybe some greens on top. The takeaway here is not to fear bread but to understand how to incorporate it wisely into a balanced diet, especially for those managing diabetes or who are concerned about their blood sugar levels.

Spencer: Julie, do you have anything to add about the truth behind this?

Julie Miller Jones: I think Charlotte said it very well. I am not a proponent of the glycemic index at all. I think the glycemic response of a person is very important, but the glycemic index has a lot of flaws in it. In fact, there was a study with hundreds of people and meals, it showed that the glycemic index was not a good predictor of what would happen when people ate things. For instance, one person had a banana, which has sugar in it, and as we would expect the blood sugar went way up; another person, it was completely flat. A cookie for that person that was completely flat went way up and a cookie for the person who ate the banana was completely flat.

It really is a very poor predictor for people who are normal or who have diabetes as to what is going on. The International Glycemic Index Registry from the University of Sydney shows that if you just type in white bread, you can get a glycemic index from extremely low — like, 30 — and you can get them at over 100, which is extremely high. Most of them are between 55 and 75, putting them in the moderate, or if they’re over 70 in the high level. I really think it does not make any sense to look at the glycemic index and that diabetics, especially those who have continuous glucose monitors, see what a particular food does to their glycemic index.

What we know is if we take bread, potatoes or other carbohydrate things, and we put some, as Charlotte mentioned, healthy fat on them, then the glycemic index goes much lower. We need to look at the whole meal again. All of the glycemic indices are done on students, usually in the 20s or 30s. They use 10 of them, and I would say they are not representative at all of the population. So, the index is very flawed and is useful in research but not useful as a meal-planning tool. People should really know more about what it does to their blood glucose.

Some diabetics need a slow-acting carbohydrate to act so that when they wake up in the morning, they don’t have low blood sugar. Therefore, eating a peanut butter sandwich at night, or an avocado toast at night might be ideal. People need to know what really makes them healthier.

Spencer: Charlotte, I’m interested in tapping into your experience as a dietitian. I think the conversations that you have with individual consumers would be very useful for bread producers. How are you advising people who have these kinds of concerns? I’m curious: Is this a hard assumption to change? What do you hear consumers saying about blood sugar concerns?

Martin: Blood sugar is a hot topic on social media these days. So, you have a lot of people without diabetes, who are wearing CGMs to monitor their blood sugar levels throughout the day. We touched on this last episode; a lot of people have become carbophobes for many reasons. It’s very hard right now to change the assumption that bread can’t fit into a weight management or blood sugar management diet.

I do mostly nutrition education on social media, so I’m talking to a lot of people at once. What I like to do is highlight the research that shows that grain intake is linked to cardiometabolic benefits, including weight loss, blood sugar management, and then also educate them on how to shop for more nutritious grain products like breads. This might involve education on reading a nutrition label — which a lot of people don’t know how to interpret — and understanding ingredient lists. I find that to be effective. I am just constantly reiterating that pretty much anything can fit into a diet if the majority of your diet is made up of nutrient-dense, mostly plant-based foods.

Spencer: Do you get to see metaphorical light bulbs go off when you’re educating people through social media on how to read a nutrition label? Are you getting good responses on that?

Martin: Yes, and one of the videos I did was on reading nutrition labels for bread. If you’re trying to find a 100% whole grain bread can be so confusing with all the different labels such as multi-grain and whatnot. Then when you’re looking at the ingredient list, and it says ‘wheat flour.’ I even for so long just assumed wheat flour meant whole wheat. So, things like looking for a certain fiber-to-carb ratio on the packaging. I think a lot of people are like, ‘Oh okay, this is easier than I thought. This makes sense.’

Spencer: So that leads me to my next question. Julie, you talked about the glycemic index, it’s impacted by so many different factors. When we’re looking at bread, it can be impacted by things such as processing, flour types or other ingredients that are included in a formula. What do bakers need to know about their products and the ways that they’re made? And how do they impact these types of consumers?

So, if you take your knowledge of how subjective the glycemic index is and you pair it with Charlotte’s knowledge of how people are reading labels and responding to what labels say, how do bakers need to see how it’s impacting people’s choices?

Miller Jones: While I gave you the example of people who were at the extremes and why the glycemic index didn’t work for everyone, there are some things can help lower glycemic index, and beadmakers can include those. One is resistant starch, which lowers blood sugar. Things like beta glucan, which comes from oats, not only lowers blood sugar, but it also lowers blood cholesterol. Beta glucan is a type of fiber, and other fibers may also help do that.

The use of large chunks or pieces, so seedier breads. I love them, and I know that people want their grain bread just as smooth as they can get it, but seedier breads and chunks or kernels of grains are processed in the body more slowly. Some studies show that if they want to change processing, the way you can make resistant starch and there are those kinds of biscuits that you can buy that are for breakfast that don’t raise your blood sugar. They do that by heating and cooling, heating and cooling, heating and cooling.

There are processing techniques that you can do with the flour or the starch that can slow down its absorbability. Those kinds of breads that have a denser texture, they did 10 minutes of kneading versus 15 and show that 15 minutes of kneading slowed down the release of the starch from the bread per se. Now I know every minute on the floor costs money, but if people could say that it was a lower glycemic index, it might be worth the gain.

Or you could talk to your supplier and see if they can provide that resistant starch piece or flour blend. I think both Charlotte and I have mentioned before these are ways you help reduce the glycemic response, and that may slow the rate at which glucose goes into the body. The airiest bread you have means that the enzyme can easily penetrate. That’s why you take French bread, which is flour, water, yeast and salt and pasta, which is flour, water and salt. Pasta, because the texture is very compact, has a very low glycemic index. It has the same ingredients with an airy texture has a high glycemic response.

So, can you alter the texture somewhat, so that it’s still very palatable, but it’s a little denser and harder for the enzyme to penetrate? Adding butter or a healthy oil also slows down. Sourdough. Bringing your pH of the crumb away from neutral by sourdough or adding acid will actually lower the glycemic response.

Spencer: Those are some great hidden gems, especially in ideas of how bakers can process their bread to really enhance the health benefits. I love that.

I participated in the webinar that you did with the Lallemand workforce, which I loved. One of my favorite things was just seeing employees at Lallemand getting excited about the things that they learned about bread, which was really cool. One thing that you both said is that whole-grain bread consumption was associated with a reduced risk of Type 2 diabetes. I found that to be very interesting. I was wondering if you could elaborate on that for me.

Martin: I believe that was my talking point from the webinar. I had mentioned a study that examined the relationship between bread consumption and the risk of Type 2 diabetes, and it was done on over 400,000 participants. It found that higher bread consumption — this was mostly with whole grain bread — was associated with a reduced risk of Type 2 diabetes.

Those with the highest intake of whole grain bread had a 20% lower risk of Type 2 diabetes. But it also found that the highest intake group for total bread — both whole and enriched white bread — had a 17% lower risk of Type 2 diabetes. I think that just goes to show that all bread can be included in a healthy diet, as long as you do make it a priority to include some whole-grain bread in there.

Miller Jones: One of the cohorts in that group is the Iowa Women’s Health Study, and those people who ate 2.7 servings, almost three, of whole grain bread had the lowest risk of Type 2 diabetes and a whole bunch of other things. But they actually had a total of about just six servings of bread, and that’s one of the reasons that the dietary guidelines say make half your grains full.

The other reason is they want people to eat fortified enriched grains because of the nutrients that they carry. They’re better absorbed from fortified enriched refined grains than some of the minerals, and even vitamins, are from the whole grain. So, you get better absorption, and you actually have the diabetes win. Other health risks are lower too, so I think that’s a really exciting piece of information. They also do way better than people who eat no grain, by the way.

Spencer: I think we need to get that message out more aggressively.

Miller Jones: Yeah, there’s a study where they looked at the people who ate no grain and just about every metric did worse.

Spencer: Correct me if I’m wrong, but that’s a conversation that I don’t hear being put out there as far as you hear people say, ‘Oh, I stopped eating carbs, and all of these great things happen to me.’ But we haven’t gotten that conversation out there about when people stop consuming grains, they have a higher risk of these health issues.

Miller Jones: The one that scares me to death is the one about folic acid. There’s a study that came out of NC State, where they looked at women who were on a no-grain or a low-carb diet for the year before them conceiving. What happened was, they had a 30% higher risk of neural tube defects. Since 1998, when the US mandated that flour contain folic acid, we dropped the risk of neural tube defect and spina bifida by over 50% in North America. To know how to stop it and have it come back makes me really sad.

Spencer: Where do you think this leaves bread bakers, in terms of missing out on opportunities? How can they reach consumers who might be erroneously avoiding their products? The phrase ‘erroneously avoiding bread’ is like, the whole no-carb movement.

But when you think about it, relative to the glycemic index, if people think, ‘I have blood sugar concerns, therefore, I can’t eat bread.’ How can bakers get through this myth from a production standpoint and a marketing or communications standpoint?

Martin: I think they just really need to rely heavily on their marketing teams. There’s this big movement now of wanting to know how your food is made, and where it comes from and getting more of like a behind-the-scenes look.

I think that could work well for bread manufacturers. It could be we created this new bread product that has less of a blood sugar response because we used X flour and X baking or kneading techniques in a little behind-the-scenes look. I think consumers would appreciate that. I think it’s really the marketing teams and creating that content and putting it on their social media channels and website. I think it could be very helpful.

Miller Jones:  The other thing I would suggest is having the marketing team talk to dieticians credentialing in diabetes, or to the American Diabetes Association. Where they say, that counting carbs is what matters and they try to both debunk the myth about no grain and a lot of people hold the myth about no fruit. Both of those are needed in the right amounts by diabetics. If they could get permission to put statements from the American Diabetes Association on what people with diabetes should do, or partner with them in some sort of way that might also be a strategy that would be helpful.

Martin: I agree. I think partnering with dieticians is a great move. I’ve seen a lot of brands and bread manufacturers partner with dieticians on social media. It’s not always to necessarily promote the health benefits of bread, but I think it can be very effective.

Spencer: I probably clicked on a video and now it’s like all over my feed, especially on Instagram. I’m seeing so many ‘I’m a dietitian and this is what I eat in a day.’ These little stitches of dietitian showing this is what I’m fixing myself for breakfast and lunch. I think there’s a good opportunity from a partnership standpoint with brands to connect with dieticians and say, ‘This is how I use X bread brand to make avocado toast and these are the health benefits behind avocado toast.’

Miller Jones:  Just this week, one of the dietitians that I know posted the six ultra-processed foods you should all be eating. The number one was whole grain bread. Number two was whole grain cereals with low sugar. Number three was low-sugar yogurt. That’s the kind of thing that would be incredibly helpful.

Spencer: Absolutely. I think having some kind of partnership with a dietician or other health expert just really lends that credibility and breaks down that inherent mistrust that people have with food manufacturers. I think we have come a long way with that, especially in the past five years, and with the increased visibility of the supply chain, since the pandemic and people seeing the impact of the pandemic on the supply chain and what supply chain means. I think people have a better understanding of how foods are made and where the food comes from.

I think it’s breaking down a little bit of that barrier. I do think partnering with someone like you, Charlotte, to be able to say, ‘Here’s how bread and other grain-based foods can be part of your healthy diet, even if you are diabetic.’

Martin: I do partner with brands and not just bread or other grain products, but that is what I do. That is actually what I’m doing with Grain Foods Foundation now. Every month I create some piece of content around either dispelling a bread myth or highlighting a benefit. I should add to my list something on blood sugar management and bread for those with diabetes because I think that would be a great topic.

It gets a lot of good feedback and engagement, so I think more of that would be very helpful.

Spencer: I agree. Well, that was my last question for this episode. Thank you so much, I learned so much. I feel like I’m going to end this conversation smarter than I started it. Thank you so much to both of you for enlightening me on these myths around the glycemic index and bread and carbs’ impact on blood sugar. This was really interesting.

Next week, we are going to talk about some assumptions around sodium levels, and then also dive into what consumers think of when they hear the term ultra-processed, which is something that’s come into the American lexicon a lot lately. I’m excited to dive into that with you both. We’re going to unpack those two, clear the air and maybe have some more great advice for bakers. Thank you again for this conversation, and I look forward to speaking with you next week.