GRAINS FOR THE HEALTH OF IT:

Increasing Grains and Whole Grains Consumption

as a Strategy for Health

Sheraton Four Points Minneapolis Metrodome

September 20–21, 2001

Symposium Proceedings

Sponsored by the University of Minnesota

and the Wheat Foods Council
 Table of Contents

Executive Summary .............................................................................................. Page 1

Symposium Program ............................................................................................. Page 5

Introductions .......................................................................................................... Page 9

Part I: Grain Physiology and Chemistry ............................................................ Page 15

Why Grains and Whole Grains? Why Now? ......................................... Page 15

Dr. Julie Miller Jones

Physiology and Health Benefits of Whole Grains:

Antioxidants, Phenolics, Lignans, and Phytochemicals .......................... Page 21
Dr. Joanne Slavin

Anatomy of a Whole Grain Health Claim ............................................... Page 27

Dr. Len Marquart

Part II: Grain Chemistry and Intakes .................................................................. Page 31

Anatomy of a Cereal Grain ..................................................................... Page 31

Dr. Gary Fulcher

Health Effects of Newly Recognized Grain Constituents ....................... Page 37

Dr. Gene Miller

Participant Interaction ............................................................................. Page 41

Dr. David Kritchevsky

Whole and Enriched Grains: How Do They

Measure up as Functional Foods? ........................................................... Page 45
Sue Borra

Audience/Panel Interaction — Where Do We Go from Here? ............... Page 51

Dr. David Klurfeld and Dr. Marla Reicks

Part III: Changing Behavior and Getting the Population to Eat More Grains ... Page 55

Plenary Session — Barriers to Grains

and Whole Grains Consumption ............................................................. Page 55
Gary Jensen
 Breakout Session I: Behavior and Change ............................................. Page 61

Changing Consumption — Models for Affecting Change .......... Page 61

Dr. Leslie A. Lytle

The Consumer and Behavior Changes ........................................ Page 65

Sue Borra

Changing Food Behaviors Starts Early ....................................... Page 71

Mary Begalle

Breakout Session II: Grains and the Food Industry ............................... Page 75

Effects of Processing on Nutritive and

Physiological Impact of Grains ................................................... Page 75
Dr. Debi Rogers

Unique Beneficial and Processing Properties of Grains ............. Page 79

Kent Salisbury, Warren Formo, and Tom Jorgens

Plenary Session — Learning from the 5 A Day Model .............. Page 87

Fran Doring

Call to Action: Ways to Increase Grains and Whole Grains

Awareness and Consumption .................................................................. Page 89

Speaker Biographies ............................................................................................ Page 91

Program Sponsors ............................................................................................... Page 97

EXECUTIVE SUMMARY

Introduction
Millions of people each year suffer from the debilitating and potentially life-threatening
effects of cancer, stroke, and heart disease. Yet, the average consumer eats less than one
serving of whole grain foods daily — the very foods that may help prevent these diseases,
as well as help control diabetes and help with weight management. Unfortunately, even
enriched grain foods often are overlooked as the leading way to help prevent neural tube
birth defects.

In an effort to break down the barriers between grains and whole grains consumption and
their benefits, health practitioners, academics, industry leaders, and association
representatives gathered at the “Grains for the Health of It” conference, Sept. 20–21, 2001,
in Minneapolis. The conference provided an in-depth review of the nutrition and health
benefits of grains, while giving participants practical ways to help affect behavior change.

Discussion Highlights
The conference brought together key representatives from industry, government,
academia, and the health community to discuss increasing grains and whole grains
consumption as a strategy for health — including grain physiology and chemistry,
consumer intake, and changing behavior — to encourage the population to eat more
grains. Key issues addressed during the conference included the following:

Benefits of Grains and Whole Grains

• Both whole and enriched grains are necessary in a healthful diet.
• Whole grains, specifically the bran and germ of the grain, carry antioxidant activity
throughout the digestive tract, offering a kind of protection that may match or exceed
that of fruits and vegetables. A diet that includes whole grains has been associated
with reduced risk for certain cancers, stroke, and diabetes, as well as heart disease,
and may be associated with a lower incidence of obesity.
• The addition of folic acid to enriched grains in 1998 has decreased neural tube birth
defects 19 percent in the past three years in the United States. Folic acid also may
assist in reducing risk factors for coronary disease and some cancers.

Recommended/Actual Consumption
• The American Heart Association, Dietary Guidelines for Americans, and Healthy
People 2010 all recommend that consumers choose a variety of grains, including
whole grains, and that they consume at least six servings a day.
• Epidemiological studies have shown that inclusion of two to three servings of whole
grain foods daily has been shown to decrease the incidence of diabetes, heart disease,
stroke, and some cancers by at least 25 percent.
• Goals for whole grain consumption include increasing the percentage of Americans
who meet the grain recommendations of the U.S. Department of Agriculture (USDA)
Food Guide Pyramid, as well as increasing the percentage of adults, teens, and
children who eat whole grain foods.

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• Currently, well less than 10 percent of the U.S. population is meeting the goals of the
Food Guide Pyramid, and the average consumer eats less than one serving of whole
grain foods daily, with 20 percent of adults and 40 percent of teens and children never
eating whole grain foods.

Barriers to Consumption
• Surveys show consumers consider six barriers to be major reasons their families do
not consume more whole grain bread — color of the inside, price, softness, texture,
dryness, and taste (in order of importance). Lack of ability to determine what is a
whole grain product was another barrier.

Ways to Increase Consumption

• Additional consumer education, scientific research, and government policy are
needed to reinforce the Food and Drug Administration (FDA)-approved whole grain
health claim on products: “Diets rich in whole grains and other plant foods that are
low in total fat, saturated fat, and cholesterol may reduce the risk of heart disease and
some cancers.”
• To increase consumer consumption of grains and whole grains, we need to educate
the consumer and deliver clear, concise, positive, and consumer-tested messages.
• A whole grain seal also may help consumers identify whole grain products, thereby
increasing awareness and consumption.
• Consumer preferences and needs can help drive the baking industry to create new
whole grain products. An ideal whole grain product would meet consumer
preferences and be processed to retain the phytochemicals and nutrients.

Conclusions and Recommendations

Symposium participants and speakers brainstormed ways the industry could work
together to increase grains and whole grains awareness and consumption. Participants
agreed the creation of a coalition was needed to address key grain issues, from public
policy to consumer education. Responsibilities and action steps for the coalition included
the following:
• Seek funding for consumer research to probe deeper into consumers’ understanding
and attitudes about whole grains and healthful eating, as well as funding for scientific
research to back up and make health claims.
• Develop consumer-friendly messages to educate the public about the importance of
including enriched grains in their diets because of the many benefits of folic acid.
• Develop consumer messages based on the strength of existing research and modify
those messages as new research findings emerge.
• Put the definitions and messages for grains and whole grains in consumer language,
emphasizing the recommendation that three grains servings a day should be from
whole grains.
• Educate consumers, as well as health professionals and the industry, about the health
benefits of whole grains, giving them a compelling reason to choose whole grains.
• Partner with physicians and nutritionists to convey and reinforce whole grain findings
and messages to both consumers and the media.
• Reinforce to government agencies the scientific background to justify the positioning
of grain foods at the base of the Food Guide Pyramid.

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• Encourage food manufacturers to develop new whole grain products that are
accessible and acceptable to consumers.
• Develop alliances with school food service and retail food chains to continue
momentum and availability of grains and whole grains.

Call to Action
The health benefits of grains and whole grains in particular are so compelling, the
“Grains for the Health of It” participants and sponsors agree there needs to be an
all-out effort mounted to educate consumers on the health benefits and to encourage
increased consumption.

To do this, we need a joint effort by health, food, and nutrition professionals, including
industry, government, and health promotion organizations. As part of this effort, we need
support from nutrition educators in industry, academia, and government to develop clear
and consistent messages in consumer language to communicate the positive health
benefits of grains and whole grains. We need to work with industry leaders to increase
their knowledge of the benefits of whole grains and encourage them to overcome barriers
to the inclusion of more whole grains in their products, as well as continue to develop
fortified products to meet consumers’ needs. We need government demonstration grants
and promotion efforts analogous to the 5 A Day program for fruits and vegetables that
can help consumers recognize and consume more grains and whole grains.

The purpose of this call to action is to increase communication among interested parties
and to look for new ways to break down barriers to promote grains and whole grains
consumption, while supporting the promotional and educational efforts of existing
grain-based associations, such as the Wheat Foods Council and state grain commissions.

By forming and moving forward with a partnership to improve grains and whole grains
awareness and consumption, we can evaluate what we have learned through this
symposium, conduct further research, and commit to promoting grains and whole grains
as a strategy for health. We need all segments to work together for a healthier
American population.

• If you are a health promotion or government organization interested in promoting the

health benefits of and funding research for whole grains, then this coalition is for you.
• If you are a company executive or an association that supports grains consumption
and are interested in breaking down whole grain barriers and expanding your current
product line, then this coalition is for you.
• If you are an educator that wants increased discussion about grains and whole grains,
then this coalition is for you.
• If you are a food or health professional interested in helping shape public policy
regarding grains and whole grains, then this coalition is for you.

To join the “Grains for the Health of It” coalition’s call to action, please contact
Julie Miller Jones, Ph.D., L.N., C.N.S., College of St. Catherine, at (651) 690-6664
or jmjones@stkate.edu, or the Wheat Foods Council at (303) 840-8787, for
more information.

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4
SYMPOSIUM PROGRAM

Thursday, Sept. 20, 2001

11:30 a.m. Lunch, Welcome, and Introductions

Joe Warthesen, Ph.D., Department Head, Food Science and
Nutrition, University of Minnesota
David Jacobs Jr., Ph.D., Professor, School of Public Health,
Division of Epidemiology, University of Minnesota

Part I: Grain Physiology and Chemistry: Are grains a new functional food or an unsung,
underutilized whole food?

Moderators: Gary Fulcher, Ph.D., Professor and Chair of Cereal Chemistry and
Technology, University of Minnesota
Julie Miller Jones, Professor, Ph.D., L.N., C.N.S., Professor,
College of St. Catherine

12:50–1:20 p.m. Why Grains and Whole Grains? Why Now?

Julie Miller Jones, Ph.D., L.N., C.N.S., Professor, College of St. Catherine

1:25–1:50 Physiology and Health Benefits of Whole Grains

Joanne Slavin, Ph.D., R.D., Professor, University of Minnesota

1:55–2:25 Anatomy of a Whole Grain Health Claim

Len Marquart, Ph.D., Senior Scientist, Bell Institute of Health and
Nutrition, General Mills

2:30–2:50 Break

Part II: Grain Chemistry and Intakes

Moderator: Mitch Kanter, Ph.D., Director of Discovery, Nutraceuticals

Business Unit, Cargill

2:50–3:15 p.m. Anatomy of a Cereal Grain

Gary Fulcher, Ph.D., Professor and Chair of Cereal Chemistry and
Technology, University of Minnesota

3:20–3:35 Health Effects of Newly Recognized Grain Constituents:

Antioxidants, Phenolics, Lignans, and Phytochemicals
Gene Miller, Ph.D., Principal Scientist, James Ford Bell
Technical Center, General Mills

3:40–3:55 Participant Interaction

Moderator: David Kritchevsky, Ph.D., Wistar Institute

5
4:00-4:20 Break

4:20-4:40 Whole and Enriched Grains: How Do They Measure Up as

Functional Foods?
Sue Borra, R.D., Senior Vice President and Director of Nutrition,
International Food Information Council; President,
American Dietetics Association

4:45–5:15 Audience/Panel Interaction (Discussion of options after hearing

the data) — Where Do We Go from Here?
Moderator: Joanne Slavin, Ph.D., Professor, University of Minnesota

Panel Members:
• David Klurfeld, Ph.D., Professor and Chairman, Department of
Nutrition and Food Science, Wayne State University
• Marla Reicks, Ph.D., R.D., Associate Professor and Extension
Nutritionist, University of Minnesota

Evening Program with American Association of Cereal Chemists (AACC)

6:00 p.m. Cocktails and Dinner

7:45 A Whole Grains Retrospective in Words and Keyboard

David Kritchevsky, Ph.D., Wistar Institute

Friday, Sept. 21, 2001

Part III: Changing Behavior and Getting the Population to Eat More Grains

7:45–8:20 a.m. Continental Breakfast — A Grain Feast

8:20–8:30 Welcome
Marla Reicks, Ph.D., R.D., Associate Professor, University of Minnesota

8:35–9:00 Plenary Session — Barriers to Grains and Whole Grains Consumption

Gary Jensen, Senior Vice President of Marketing,
Sara Lee Bakery Division

Breakout Session I: Behavior and Change

Moderator: Judi Adams, M.S., R.D., President, Wheat Foods Council

9:05–9:25 a.m. Changing Consumption — Models for Effecting Change

Leslie Lytle, Ph.D., R.D., Professor, School of Public Health,
University of Minnesota

6
9:30–10 The Consumer and Behavior Changes
Sue Borra, R.D., Senior Vice President and Director of Nutrition,
International Food Information Council; President, American
Dietetics Association

10:05–10:25 Changing Food Behaviors Starts Early

Mary Begalle, Director of Food and Nutrition Services,
Minnesota School Food Service Association

Breakout Session II: Whole Grains and the Food Industry

9:05–9:25 a.m. Effects of Processing on Nutritive and Physiological Impact of Grains

Debi Rogers, Ph.D., Director, Cereal Chemistry (Education),
American Institute of Baking; Adjunct Professor, Kansas State University

9:30–10:25 Unique Beneficial and Processing Properties of Grains

• Barley — Tom Jorgens, President, PolyCell Technologies
• Oats — Kent Salisbury, Milling Expert, Quaker Oats Co.
• Corn — Warren Formo, Program Manager, Minnesota Corn
Growers Association

10:25–10:45 Break

10:45–11:15 Plenary Session — Learning From the 5 A Day Model

Fran Doring, M.P.H., R.D., Minnesota Department of Health

Breakout Groups

11:15–11:45 a.m. Call to Action: Ways to Increase Grains and Whole Grains
Awareness and Consumption

Industry — Education, Marketing, Advertising, and Labeling

• Jean Storlie, M.S., R.D., Manager, Nutrition, and Health
Communications, Bell Institute of Health and Nutrition,
General Mills
• Cathy Kapica, Ph.D., R.D., L.D., F.A.C.N., Director of
Nutrition Education, Quaker Oats Co.
• Kathy Wiemer, Manager, Nutrition and Regulatory Policy,
James Ford Bell Technical Center, General Mills

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 Industry — Ideation for Taste, Quality, and Convenience
• Gary Fulcher, Ph.D., Professor and Chair, Cereal Chemistry and
Technology, University of Minnesota
• Gary Jensen, Senior Vice President of Marketing, Sara Lee
Bakery Division
• Debi Rogers, Ph.D., Director, Cereal Chemistry Education,
American Institute of Baking; Adjunct Professor,
Kansas State University

Extension Agents, Dietitians, and Consumers

• Marla Reicks, Ph.D., R.D., Associate Professor,
University of Minnesota
• Sharon Davis, Home Baking Association

Academicians and Researchers

• David Klurfeld, Ph.D., Wayne State University

11:50–12:15 Audience/Panel Interaction — From Conference to Partnership

Moderator: Julie Miller Jones, Ph.D., L.N., C.N.S., Professor,
College of St. Catherine

8
INTRODUCTIONS
To make an impact on consumers’ health
with whole wheat or whole grain foods,
then consumption once a month is not
going to be enough. Consumption needs
to be on a very regular basis. We need
to address the reasons why people eat
any type of food: convenience,
economics, distribution, perceived
health benefits, and probably most
important of all, taste.
But whole grains are not just about taste
and use. History and research illustrate
there is biological evidence that whole
grains are good for you. Whole grains
represent a biological and behavioral
bridge to health and also to etiologic
mechanisms and chronic diseases. The
key is to look for ways to encourage
consumption of grains and whole grains,
giving consumers reasons to eat
whole grains and take advantage of
their benefits.
Presentation by Joe Warthesen, Ph.D.,
University of Minnesota
When it comes to grains, somebody has
to make the ingredients, somebody has
to grow the grain, somebody has to
figure out what grain to grow, and in
today’s technology, somebody has to
figure out what sort of design we want in
a grain to make a consumer benefit. It
goes back to the genetics of grains, but it
also goes the other direction because
whole grain foods are worthless
nutritionally unless they are consumed.
They have to be consumed for a lot of
different reasons — economics,
convenience, perceived health benefits,
or lack of detrimental effects. But most
of all, they probably have to taste good.
I have a couple of examples of foods that
are either nutritional or sensory disasters
that might serve as examples for what
9
this conference is about. The first is the
holiday treat — lutefisk. Lutefisk is cod
soaked in lye and it is a holiday treat
talked about by a lot, but only consumed
by a few people. The other one is a
deep-fat-fried-battered candy bar, which
is a treat at the state fair. We can forgive
a lot of that nutritional or sensory assault
because these are once-a-year foods.
At the same time, if you are going to
have an impact with whole wheat or
whole grain foods, once a year or even
once a month is not going to work.
Consumption has to be on a very regular
basis, which means all these factors of
convenience, economics, distribution,
and taste have to be addressed for that
to happen.
The official USDA Food Guide Pyramid
has bread, rice, cereal, and pasta at the
bottom, and recommends six to 11
servings per day. That is a strong
endorsement of grains and grain products.
However, recently there was a proposed
modified pyramid by Walter Willet,
which gives more prominence to
whole grain foods. The Willet pyramid
recommends whole grain foods at most
meals, which is a very strong
endorsement for whole grains. The
other interesting thing is white rice,
white bread, and pasta have been
elevated on his Pyramid to a less
favorable level.
The difference in the two pyramids
likely will lead to discussions on the
importance and placement of whole
grains in the diet, along with topics of
taste, consumption, and even a definition
of what are whole grain foods.
Presentation by David Jacobs Jr., Ph.D.,
University of Minnesota
First of all, what are whole grains?
Grains are seeds of grasses, including
wheat, oats, rye, rice, barley, and corn.
There also is spelt, triticale, millet, and
others beside the ones that we
customarily eat. We eat them in breads,
rice, pastas, breakfast cereals, and cakes,
for example.
Bran and germ:
17% of weight
80% of fiber
Few calories
Has most of
the biologically
active
compounds in
the grain
Grain has a bran, a germ, and an
endosperm. The bran and the germ are a
relatively small portion of the grain by
weight, but the lion’s share in terms of
bioactive constituents. One of the most
salient features in the endosperm is the
white space shown in the picture of the
kernel of wheat — it is all the starch.
There are some cell walls, but the
endosperm is much less rich in nutrients
and in botanically active ingredients than
the bran or the germ. I like to think
about botanical structure of the foods
when I am eating. What is the particular
part of the plant or of the animal doing
for the organism that it is supporting?
And what is some of the potential for
what it might do for me as a consumer?
10
The function of the bran and germ is to
support the new grain plant until it roots,
which means it has to ward off invaders
and prepare the plant to root. That
means there are enzymes, signal
transducers, and all the other things
living cells have, plus some things that
most animals do not have. For example,
the bran has naturally occurring
chemicals that function as pesticides,
fungicides, and a lot of things that may
help human beings fight inflammatory
challenges. The endosperm, on the other
hand, is primarily a food sack for the
potential seedling, so it is very
energy-rich but contains little fiber.
What about the topic of whole grains in
the diet? Could we “sell” whole grains?
Why don’t we just make bread with
100 percent whole grain and not do any
of the refined grains? There are, of
course, differences between whole and
refined grains in terms of consumer
perceptions and uses.
First of all, there are different baking
properties. Whole grains absorb more
water and breads made with them are
heavier and do not rise as readily as
breads made with refined grains. Some
of my Norwegian friends complain
about Norwegian grains, in which there
is an 80 percent extraction rate of the
whole kernel compared to 70 percent
and 75 percent extraction rate in the
United States. They say, “It is just hard
to make a good cake out of Norwegian
refined grains.” There also is the issue
of “mushiness” because of the soluble
fiber in whole grains, as well as
differences in taste and texture.
Certainly you could make cookies,
bread, and pancakes with whole grains.
And, you can think about using refined
grains as a kind of “glue.” For example,
a whole grain could include 10 percent
refined grains to hold all the whole
grains together. These are the
possibilities we need to, and will,
consider during the conference.
Now just a little bit on the use, the
sociology, and the politics of whole
grains. The idea that whole grains might
be good for you was prevalent when
Sylvester Graham originated graham
flour in 1830. Around the mid to late
1800s, flour milling was introduced,
making refining easy. This led to
industrial consolidation and mass
production of refined grain products,
decreasing the use and consumption of
whole grains in the United States.
Then in the 1950s, 1960s, and 1970s,
Dennis Burkett did research in Africa
noting that native people who ate a
natural foods diet were not getting
Western diseases. In 1995 to 1999, we
did epidemiologic reviews and some
respective studies of whole grains and
cancer, coronary heart disease, diabetes,
and total death. In 1998, folate was
added to enriched white flour in the
United States, which has helped decrease
neural tube birth defects. Then in 2000,
there were explicit recommendations in
the USDA Dietary Guidelines for
Americans that suggested several
servings each day of whole grain foods.
Here in the United States, grain
consumption has gone down and up
through the years.
In 1998, folate was added
to enriched white flour in
the United States, which
has helped decrease
neural tube birth defects.
11
U.S. Food Disappearance Data
Total Grain Per Capita Availability
Year lb/yr
1909-13 291
Steady decrease
1970-74 135 (77% wheat)
Steady increase
1994 199 (65% wheat)
U.S. Food Disappearance Data
Whole Wheat Per Capita Availability
Year lb/yr
1917-1919 8-10 (~5% of grain)
1920-1953 no data
1954
1972
2.1
0.8 (< 1% of grain)
1990 2.3 (~ 1% of grain)
Oats Per Capita Availability
1960-1987 3-5 lb/yr (2.5%)
1988-1994 9.2 lb/yr (5%)
Norway: 4x and Finland 8x more whole grain than U.S.
But, whole grains are not just about taste
and use. There is biological evidence
that whole grains are actually good for
you. The first thing about whole grains
and disease is epidemiology. As an
epidemiologist, I may be making fun of
myself to say we ask fuzzy questions,
but I do so to clarify what epidemiology
can and cannot offer. If I asked you how
much dark bread you ate a day during
the past year, how close could you
actually get to an accurate number? But
that is, in fact, the question I have to ask
if I want to find out about whole grains.
We ask the questions, “Do you eat
breakfast cereal? How many servings a
day? What breakfast cereal is it
usually?” Well, there is a lot that is lost
in that, but it gets you in the general
ballpark. By asking these few questions,
“Do you eat dark bread? What breakfast
cereal do you usually eat? Do you eat
brown rice?”, we discover key
information, as we did in the case of
Iowa women.
Here we showed that after 10 years of Age-adjusted, 25-year, All Causes, Percent Dead
follow-up, the women who consumed Is Not Least Where Whole Grain Food Is Common
Men aged 40-59, baseline 1957-1964, 16 cohorts, seven countries study
the most whole grain foods had Cohort Country Whole Grain Total Mortality
Cereals, g/d (rank) per 100
approximately half the total mortality of Slavonia
East Finland
Croatia
Finland
76
288 (5)
61.0
59.7
women who rarely consumed whole Zrenjanin
Ushibuka
Serbia
Japan
399 (3)
0
57.9
51.5
grain foods; this difference is in part West Finland
Velika Krsna
Finland
Serbia
268 (6)
686 (1)
50.3
50.0
Crevalcore Italy 0 49.8
directly attributable to the whole grain Zutphen Netherlands 64 48.0
Montegiorgio Italy 0 46.2
itself, and in part to other health US Railroad
Dalmatia
USA
Croatia
24
202 (7)
45.1
43.3
behaviors typical of whole grain eaters Corfu
Rome Railroad
Greece
Italy
450 (2)
8
40.4
39.7
Tanushimaru Japan 0 39.4
in the United States. Crete Greece 380 (4) 31.4
Belgrade Serbia 131 29.5

Prospective Studies Find Lower Total Mortality

in Whole Grain and Whole Meal Eaters In this study, some people were eating
38,470 Iowa women, aged 55-69, more whole grains as a culture and some
followed for 10 years
were not. We see no relationship
Quintile of Whole Grain Intake

Serv/week
1
0-3.5
2
4-7
3
7.5-10
4
10.5-18
5
>18
P-value
for trend
between whole grains and mortality.
Person-years 68,262 68,672 64,761 66,329 64,980
Apparently, other cultural features play a
Total mortality
role; for example, high saturated fat
Cases 914 705 583 523 595
consumption in Finland and endemic
Adjusted HRR (effect of grain only)
1.00 0.95 0.87 0.81 0.86 0.005 infections lung diseases in Yugoslavia in
HRR = Hazard Rate Ratio Jacobs, Am J Pub Health, 1999
the 1960s and 1970s. These data
reinforce the conclusion that whole
grains are a piece of the puzzle, but they
are not the only answer in the puzzle.
Total Mortality Reduction Is Even Greater if the
Influence of Behaviors Related to Whole Grain
Intake Is Not Removed What about the issue of feeding studies
38,470 Iowa women, aged 55-69, followed for 10 years and the causal inference? In a feeding
study, we know 95 percent of everything
Quintile of Whole Grain Intake P-value
1 2 3 4 5
for trend that goes into participants’ mouths.
What we see is an influence of what
Unadjusted HRR (effect of grain and related behaviors)
1.00 0.76 0.65 0.55 0.64 <0.0001 whole grains have on intermediate risk
factors. Mark Pereira and I did a whole
HRR = Hazard Rate Ratio Jacobs, Am J Pub Health, 1999 grain feeding study with 11 overweight,
hyperinsulinemic, non-diabetic adults.
We fed them all their food for 12 weeks.
The seven-country study also was We did a crossover with six weeks on
conducted between 1960 and 1985, whole grains and six weeks on refined
led by Ancel Keys. We used it to grains. The results: We found that
evaluate any connections between consumption of commercially available
whole grain intake and mortality on the whole grain foods increased satiety and
ecologic level. remed insulin and PAI-1, a factor
important in thrombolysis. It may have
reduced body weight.

12
 Fasting Insulin Concentration Whole grains are probably causally
During Whole (squares) and related to reduced disease. The
Refined (diamonds) Grain Diets epidemiologic data are fuzzy, but
remarkably, a few questions can
Fasting insulin (µU/ml)
28

26
distinguish life from death. The
24
p < 0.01 ecological data do not relate to etiology
of disease, but they do reinforce the view
22
0 2 4 6 that additional dietary and lifestyle
Time (weeks)
factors are involved in the reduction of
refined whole
chronic diseases. And the feeding data
Pereira, Jacobs et al. AJCN, 2001, in press
established that some specific whole
grain foods have at least biologic activity
PAI-1 Antigen Concentration of relevant variables in humans.
During Whole (squares) and
Refined (diamonds) Grain Diets Whole grains are a biological and
80 behavioral bridge to health and
PAI-1 antigen (ng/ml)

70
60
also to etiologic mechanisms and
p < 0.001
50 chronic diseases.
40
30
20
0 2 4 6
Time (weeks)
refined whole
Pereira, Jacobs et al. AJCN, 2001, in press

Serum Enterolactone at Baseline and

During Whole and Refined Grain Feeding
n = 11
20

15 p < 0.01
nmol/L

10

0
0 2 4 6
Weeks on diet refined whole

Jacobs, Pereira, Adlercreutz et al., submitted, Brit J Nutr, 2001

13
14
PART I: GRAIN PHYSIOLOGY
AND CHEMISTRY
Why Grains and Whole Grains?
Why Now?
Originally, we learned grains were good
for us because of their calorie and
energy contributions; then we
discovered grains were a good source of
fiber; now we are focused on grains as a
good source of phytochemicals.
The American Heart Association, the
Dietary Guidelines for Americans, and
Healthy People 2010 all recommend
consumers choose a variety of grains,
including whole grains, and choose at
least six servings per day. But only
1 percent to 3 percent of the U.S.
population is meeting the USDA Food
Guide Pyramid recommendations.
We need to take a look at the foods
people are eating, from cereals to
breads, and consider what we can do to
encourage whole grains consumption.
At the same time, we should not lose
sight of the nutritional benefits that
fortified grain foods have provided.
We need to develop appropriately
processed whole grain products that
meet consumers’ needs and tastes.
Presentation by Julie Miller Jones,
Ph.D., L.N., C.N.S., College of
St. Catherine
In the old view of grains, grandma told
us they were good for us, but we really
did not set much store in it other than
they gave us calories and were a source
of energy. Then we discovered they
were a source of fiber. So we really
focused on the fiber and we basically
forgot the rest of the grain. Now we
know that grains also are a great source
of phytochemicals.
15
• In the Bible, they talked about bread
being the staff of life.
• Then, Sylvester Graham’s wife
baked a cracker, which bears his
name. Unfortunately, many graham
crackers are not whole grain even
though they carry the Graham name.
• Flour milling was born somewhere
in the late 1830s.
• Later, we learned we could eliminate
beriberi and pellagra in the
United States with enrichment.
When recruits came to enlist for
World War II, we started enriching
flour, because we realized that iron,
riboflavin, niacin, and thiamine were
deficient in many recruits.
• Grains were part of the Basic Four in
the early 1960s.
• When we began chronic disease
research, a lot of the material about
fiber came up in the early 1970s. In
1984, Kellogg took the brave step of
doing the ad for All-Bran®, which
eventually allowed a change in
nutrition labeling and health claims
for soluble fiber and insoluble fiber.
• In 1992, we got a new Food Guide
Pyramid, which includes grains at
the base.
• In the 1990s, we had an oats health
claim, folate fortification, and also a
whole grain health claim.
• The 2000 Dietary Guidelines for
Americans elevated the role of grains
and placed emphasis on whole grains.
• Finally, the 2010 Healthy People
objective is to increase whole grains
consumption, with a recommendation
that at least three grain servings a day
should be whole grains.
What we are hoping for in the future is
some way to increase people’s
consumption of grains and all of the
nutrients that go with them.
Nutrients in the Grain
Bran = roughage
• Fiber
• B vitamins
• Trace minerals
Germ = nutrients
• B vitamins
• Vitamin E
• Trace minerals
• Phytochemicals
• Unusual/unsaturated lipids
We are seeing a lot of interest in
resistant starch, inulin, as another
component of the endosperm, and some
of the phytochemicals and unusual
fatty acids.
Four of the top 10 sources of
carbohydrates for children and
adolescents are 1) yeast bread,
2) ready-to-eat cereals,
3) cakes/cookies/quick breads/donuts,
and 4) pasta. All of these groups can
contribute more than 2 percent of the
energy to the diets of children and
adolescents. We can talk about how this
can have a very positive effect
depending on what people choose, or it
can have some negative impacts on the
diet depending on what people choose.
Many people look at grains and
grain-based foods and say, “Well, they
really are not good for people.” But
what is interesting is a study that was
conducted by Gibson on children in the
United Kingdom, in which breakfast
cereals were the major grain source in
the diet. In that study, those people with
the top third intake of breakfast cereals
had a lower proportional intake of
non-milk extrinsic sugars.
In terms of top 10 contributors of protein
according to the Children’s Continuing
Survey of Food Intakes by Individuals
(CSFII) 1994-1996, 1998 data,
ready-to-eat cereals and pasta rank high.
Popcorn also can be among the top
contributors of fat.
Endosperm
= energy We also need to take a look at when
• Carbohydrate
– Resistant
people are eating different foods. For
starch
– Some fiber
example, fortified cereals also are eaten
– Inulin at non-breakfast events. It is important
• Protein
• Some B vitamins to think about what kinds of cereals or
what kinds of choices people can make
for snacks. So, even if we are talking
about cereals, which are not whole
grains necessarily, they often provide
fiber and are a source of other nutrients.
A study by Hill in 1994 showed
ready-to-eat cereals were the best
sources of iron and B vitamins across
all incomes and all age categories.
According to Subar et al. Pediatrics,
October 1998, ready-to-eat cereals
provided 27 percent of the iron in the
diets of children, yeast bread provided
13 percent, and beef only 8 percent.
So I think it surprises a lot of people that
fortified cereals really do have an
important nutritional impact.
If we look at zinc and children, meat is
first, milk is second, and ready-to-eat
cereals are third. Actually, zinc really is
more readily available from a highly
refined, corn-based cereal than it is from
a whole grain one. So, we not only have
to talk about what is there, but how
bioavailable it is. And because it is very
tightly bound to the phytate in the whole
grain, I strongly recommend a mix of
grains and whole grains, because zinc
may be there, but it is not available to
the body.
16
Another way to look at it is what
children and adolescents are deficient in,
and a number of different surveys have
shown them to be deficient in iron,
vitamin E, folate, C, or B6. Again, if we
look at what fortified cereals give to the
diet, they are exactly those things.
Fortification increased all nutrients,
except calcium, in any age and gender
group that we looked at, especially
in children.
Fortified Cereal Boosts Nutriture
of Children/Adolescents
• Deficiencies in certain groups
– Iron – Vitamin C
– Vitamin E – Vitamin B6
– Folate
• Fortification of breakfast cereals
– Increased vitamin and mineral intakes (France,
Ireland, United Kingdom, and Spain)
Serra-Majem Public Health Nutr, 2001 Feb;4(1A):101-107
Fortified Cereal Boosts
Nutriture of Children
• Fortification
all nutrients except Ca++
– Age/gender groups
– Especially in children
• Boosted median or 25th percentile intakes
from below to >>> RDA
• Cereals responsible for nearly all the intake
of nutrients from fortified foods
CSFII n>11,000
Brener et al. 2001
Cereals were by far the No. 1 contributor
to fortified foods; in a way, greater than
orange juice or any other kinds of
products that may be fortified.
Adolescent girls are the worst nourished
set of the population; they are deficient
in iron, folate, and calcium. Those not
consuming breakfast cereals, such as in a
study of Irish adolescents, had lower
intakes of riboflavin, folate, iron, niacin,
and B12.
17
Fortified Ready-to-eat Cereal and
Nutriture of Adolescents
• NOT consuming fortified breakfast cereals
(U.S. NHANES follow-up study) — Ireland
• Daily intakes below the lower reference
nutrient intake
– Riboflavin – Niacin
– Folate – Vitamin B12
– Iron (girls)
McNulty et al. Arch Dis Child 1996 Dec;75(6):474-8
Ready-to-eat cereal consumers had
higher carbohydrate intakes, lower
intakes of fat, and were more likely to
eat less than 30 percent of calories
coming from fat.
Fortified Ready-to-eat Cereal and
Nutriture of Children and Adults
• RTE cereal consumers
– Higher intakes of CHO
– Lower intakes of fat
– More likely to eat <30% of calories as fat
Nicklas et al. 1995, Albertson and Tobelmann
One exciting thing is the relationship
between fortification of enriched grain
foods and neural tube birth defects. The
data, which came out this year, showed
that before fortification the rate of neural
tube defects per 100,000 live births was
37.8, and after fortification, that dropped
to 30.5. It was a 19 percent drop total
and a 13 percent drop if the people were
only seen medically in the last trimester.
But in either case, this drop, especially
with the 13 percent drop in the last
trimester, strongly suggests the
fortification of enriched grain foods was
the reason.
There are several surveys showing the
benefits of consuming cereals. If we
look at adults, if we look at kids, and if
we look at different kinds of surveys that
collect data in different ways, users of
breakfast cereals, overall, had greater
plasma folate, which is related to lower
homocysteine and, of course, lower
homocysteine is related to lower rates of
coronary disease.
Cereal Boosts Nutriture
• 1,100 French people, aged 2-65
• High-energy breakfasts associated with:
– Ready-to-eat (RTE) cereals
– Greater proportion of energy
from carbohydrate
– Lower proportion of energy from fat
– Higher intakes of vitamins and minerals
Cereal Boosts Nutriture
• 1,100 French people, aged 2-65
• High-energy breakfasts associated with:
– Positive impact on nutritional status — all ages
– Lower serum cholesterols
– Improved indices of nutritional status
• Serum vitamin B1 (in children and adolescents)
• Vitamin B2 and beta carotene (in adults)
If we look at French people, who eat a
high-energy breakfast (which
interestingly they call using ready-to-eat
cereals), they had a greater percentage of
energy from carbohydrate, less from fat
and more vitamins and minerals, lower
serum cholesterols, and greater B1
and B2.
18
Cereal Boosts Nutriture
• Regular cereal breakfast ~2 oz N = 209 Finns
–
intake of total/saturated fatty acids
– Small
serum cholesterol
Eur J Clin Nutr 1999 Sep;53(9):716-721
• The effect of breakfast cereal on diet and
serum cholesterol: a randomized trial in
North Karelia, Finland
Kleemola P, Puska P, Vartiainen E, Roos E, Luoto R, Ehnholm C
If you go from France to Finland, regular
breakfast cereal consumption decreased
the intake of total fats and saturated fats,
showed and a small decrease in serum
cholesterol among cereal eaters.
Cereal Boosts General Health
• 262 U.K. adults, aged 20-85
• If consumed breakfast cereal every day vs. less
– Reported better mental health
– Reported better physical health
– Association was still present with demographic factors,
indicators of lifestyle (such as smoking), or other
aspects of diet
Smith 1999
If cereals were consumed every day
among adults in the United Kingdom,
they were reported to have better mental
and physical health, and these data held
up despite all the other associations
you might look at in epidemiology.
Ready-to-eat cereals were the top
10 contributors of 17 of 18 nutrients
in CSFII.
Does the Diet Need Added Nutrients
in Cereal and Other Products?
• Ontario survey — 30,000 and
>7,000 immigrants
– Low incidence of micronutrient deficiency
– Asian immigrants — more likely to be deficient
• Thiamin • Riboflavin
• Niacin • Iron
• Calcium
– Those things commonly added to cereal
Pomerleau et al. Prev Med 1998 Jan-Feb;27(1):41-9
We looked at Canadian data, in which
there was a low incidence of
micronutrient deficiency among people
living in Ontario, but Asian immigrants
to Canada tended to be deficient in
thiamine, niacin, calcium, riboflavin, and
iron. This might be attributed to a
dietary pattern that is reliant heavily on
white rice and would be less likely to
include fortified cereals.
Fortified Ready-to-eat Cereal and
Nutriture of Elderly
• Framingham — 885 elderly
• RTE were major contributors to folate intake
– Cold breakfast cereals (13.3%)
– Multivitamins (12.8%)
– Orange juice (12.4%)
Tucker et al. J Nutr 1996 Dec;126(12):3025-31
If you look at Framingham data of the
elderly, ready-to-eat cereals are again a
major contributor of folate, along with
multivitamins and orange juice. Folic
acid supplementation not only is good
for preventing neural tube defects, but it
may help cardiovascular health. It
potentially could decrease ischemic heart
disease by as much as 40 percent and
showed some relationship with the
decreased incidents of colon cancer.
The U.S. National Health and Nutrition
Examination Survey (NHANES III,
1994-1998) did a follow-up study
evaluating the death and hospitalization
records of 8,000 coronary heart disease
patients, and there was an inverse
association of riboflavin, iron, and
magnesium. Fiber, total fiber, and
especially cereal fiber have been
associated with decreased risk of
myocardial infarction and, particularly,
cereal fiber.
19
Fiber and Incidence of Coronary
Heart Disease (CHD)
• >21000 Finnish smokers
• Fiber
risk of coronary events and
coronary deaths
• Median intake, 34.8 g/d vs. 16.1 g/d
• Cereal fiber stronger association than vegetable
or fruit fiber
Rimm et al. JAMA 1996 Feb 14;275(6):447-451
If we look at Finnish smokers, cereal
fiber also reduced or had a stronger
association in reduction of risk of
coronary disease. Most importantly, the
median intake in the highest group was
34.8 grams of fiber a day. In the nurses’
study, which showed no effect of fiber
on colon cancer, the highest intake in the
group of nurses eating the most fiber
was about 24 grams a day. Basically,
what it said was no American nurse eats
enough fiber to have any impact.
Because if they are eating one and a half
times that amount, even their lowest
group is eating what nearly the highest
group was eating in the American diet.
Cereal Nutrients and Cancer
• Colorectal cancer patients habitually ate
significantly less
– Cereal fiber
– Riboflavin
– Calcium
– Phosphorus
Arbman et al. Cancer 1992 Apr 15;69(8):2042-8
In another study, colorectal cancer
patients ate habitually less cereal, fiber,
riboflavin, calcium, and phosphorus.
Fiber intake in the United States is much
lower than Finland at approximately
15 grams a day. Cereal is important to
fiber intake and provides about a third of
fiber intake for the elderly.
What is interesting is while most of the
population is decreasing the amount of
fiber they eat, African-Americans of low
socio-economic status have started to
increase their ready-to-eat cereal and,
particularly, high-fiber cereal intake.
What are we doing, what kind of
message are they getting, why are they
doing that, and why isn’t the rest of the
population joining them?
The range of fiber intake in the
United States per day, depending on
food choices, can be from 9 grams to
50 grams a day.
Fiber Intake — USA Obese
• Normal 18.8 g/d
• Moderately 13.3
• Severely 13.7
Diet records N = 50/group
Alfieri et al. Obes Res 1995, 3:541
The American Heart Association, the
Dietary Guidelines for Americans, and
Healthy People 2010 all say to choose a
variety of grains, including whole grains,
and choose at least six servings per day.
If you meet the Food Guide Pyramid
recommendations, you get adequate
micronutrients and fiber, and your fat
and sugars are at goal levels. But only
1 percent to 3 percent of the U.S.
population is meeting the Pyramid
recommendations. So, we are failing to
climb the Pyramid, we are failing to eat
the recommended number of servings,
and somewhere between 43 percent
and 72 percent failed to meet the
recommendations in any one of
the groups.
20
The American Diet:
Failing to Climb the Pyramid —
Another View
• 1989-1991 survey CSFII
• >3,000 youth, 2-19 years
• ~30% met the
grain recommendations
• Only 1% met all
• Pediatrics 1997 Sep;100(3 Pt 1):
323-329 1998 May;101(5):952-3
• Munoz KA, Krebs-Smith SM,
Ballard-Barbash R, Cleveland LE
Cleveland et al. Am.J.Clin.Nutr.1997; 65(suppl):1254S-1263S
What do we do to encourage grain,
including whole grain, consumption?
Some people think that whole grains
have to be freshly cut from the head of
the wheat plant and we are supposed to
sit there and chew on them. And we
know that nobody is going to do that.
What we need to talk about is
appropriately processed grain products.
We expect people to eat normal things.
We expect them to eat bread. We do not
expect them to eat a pile of twigs and
berries because they are not going to do
that. Whole grains can be processed;
they need not be intact. What I would
like you to think about is keeping grains
at the base of the Pyramid. Whole
grains are great, but refined grains also
do a whole bunch of great things for the
diet, particularly fortified refined grains.
The American Heart
Association, the Dietary
Guidelines for Americans,
and Healthy People 2010
all say to choose a variety
of grains, including whole
grains, and choose at least
six servings per day.
Physiology and Health Benefits of
Whole Grains
There are positives and negatives with
all grains, whether whole, processed,
fortified, or refined. The perfect product
would probably be one that was
processed to retain the phytochemicals
and nutrients. But if people will not eat
it, it has no nutritional value.
Recent literature on whole grains shows
a consistency in finding that whole
grains are protective — just look at
cardiovascular disease, strokes,
diabetes, and cancer.
Some of the research priorities for
whole grains include agreement on a
continuum of grain types, so we can
move forward in these studies and
improve dietary instruments. Improved
dietary tools should allow for improved
studies of grain intake and disease.
Presentation by Joanne Slavin, Ph.D.,
R.D., University of Minnesota
The health benefits of whole grains are
associated with the bran, the germ, and
the endosperm. So why do we take the
grain apart in the first place? When we
mill things to make them white, we get
rid of the bran and the germ layer, and
we lose some nutrients in that process.
It is all about taste and desirability. It
needs to be something people will eat.
I have three kids and do they eat a whole
grain? Not if they know it. Given a
choice, most people choose white bread
over whole wheat bread. We need to
understand that in the refining process
we are improving texture, flavor, and
appearance, as well as shelf life. We
also have to think of practical issues of
how to get people to eat whole grains.
21
It is important to remember there are not
really good grains that are whole and
bad grains that are white. We need to
think of a continuum. Whole, unrefined
grain is often considered the king of the
grains. Unfortunately, nobody can eat it
and we do not make it into a product, so
it has some problems. Then there are
processed, whole grains, in which we
have to do something to the grain to
make it into a product. And there are
processed, fortified whole grains in
which we can add things back. After all,
we are scientists and technologists who
can fix things and make them better.
And there are fortified, refined grains,
which are pretty much what the average
person lives on. Then there are refined
grains without fortification.
There are positives and negatives with
all of these grains. The positives of an
unprocessed, whole grain — it is most
concentrated in nutrients and
phytochemicals. It is effective in
laxation and has direct effects on the gut.
There is no question it has a lower
glycemic index; if you cannot digest it,
how are you going to alter the glycemic
index? Our digestive enzymes and
digestive secretions cannot attack it, thus
it cannot affect the glycemic index. As
for the negatives, it is the same thing.
We cannot get anything out of it. So if
there are phytochemicals in the grain and
it is whole and it leaves the body intact,
obviously those phytochemicals were
there, but they did not get into the body
and they cannot have any health effect.
Then we have to consider the desirability
for consumers. How many consumers
choose unprocessed, whole grains?
In terms of processed refined grains,
what are some of the positives? People
like the taste. They also have digestible,
quick energy, of which nutritionists go
back and forth on the positives.
A lot of refining originally had to do
with making nutrients available for
people so we could actually get them
into their bodies. Grain foods served as
a good vehicle for fortification.
Fortification was a way we could affect
public policy — if we cannot educate
people to make them eat what we want
them to eat, add the needed elements to
something they like to eat. What are the
potential negatives? Obviously,
over consumption; if we like it, we can
eat too much of it. They also are lower
in phytochemicals. And when we
process something, refine it, and
make it more available to digestive
enzymes, we would expect more of
a glycemic response.
What is the perfect grain product?
I think the perfect one would be
processed to retain the phytochemicals
and nutrients. We want phytochemicals
and nutrients in there as much as
possible, but if people will not eat it, it
has no nutritional value at all. We have
to make sure people are willing to eat it
and the nutrients and phytochemicals are
bioavailable. As we find out how
phytochemicals are useful to the body,
we need to actually deliver them. If it is
going to taste terrible to keep the outer
layer on, we can take parts of it out and
reformulate it. We have food processors
that can do those things. There is no
reason to be a purist and say it has to
be exactly as it came from the field,
because that is not practical and it is
really of no use to consumers.
Diet is one of the world’s most
complicated exposures. As an
epidemiologist, if I want to take a
snapshot of you and what you ate today,
it is difficult. It would be nice if I could
shine a light through you and you would
turn purple if you had three servings a
day of whole grains.
22
A lot of refining originally
had to do with making
nutrients available for
people so we could actually
get them into their bodies.
But I do not have that kind of skill or
that kind of a test. That is one of the
frustrations when we look at grains and
grain intake and disease. Improved
dietary tools should allow studies of
grain intake and disease, especially the
diseases of interest, including
cardiovascular, cancer, diabetes, obesity,
and autoimmune diseases. Right now,
what we can do is basically find out
from a food frequency what people have
already reported. Did they consume
dark bread, brown bread, higher fiber
bread, whole grain bread, and whole
grain cereal? It is difficult for us to get a
great snapshot on whole grain intake or
grain intake, because that is really the
data we have — some type of food
frequency that people have filled out and
estimated, “How many times do you eat
whole grain breads in a week?” It is
difficult to develop a detailed database
of grains exposure. Despite the
limitations, we must use the tools
we have.
Recent studies show there are different
ways to ask the question, “How
protective are whole grains?” One
approach that has been taken fairly
recently is looking at dietary patterns.
Rather than say, “Okay, we are going to
do a food frequency, try to take your diet
and cut it into little pieces, and then look
at whole grains and nutrients,” let’s just
look at your dietary patterns and the
number of servings that you took in.
Most people have an easier time figuring
that out. What they find in these studies
is if people do consume recommended to be the combination, but that also
foods, including whole grains, there is makes it very difficult to study. How do
reduced mortality. we get at it?

One thing is to come up with an in vitro

Diet Quality and Mortality or a model system. Let us look at the
antioxidant content of different grains
• Large cohort study for breast cancer screening
(42,254 women, aged 61.1 years)
and how whole grains are different from
• Food frequency and calculation of Recommended other types of grains. There are studies
Food Score (RFS) — sum of number of foods in which we could feed various grains to
consumed from Dietary Guidelines
• Consumption of recommended foods, including
experimental animals and measure end
whole grains, significantly reduced all points. And in human studies, we could
cause mortality
feed various grains to humans and
measure end points. These are classical
J Am Med Assoc 283:2109, 2000
nutrition techniques to get information
about what diet does for us.
Whole Grains and Heart Disease:
Risk/Mortality What are the challenges? In nutrition,
we want to isolate something so we can
• Prospective cohort study of 44,000 men
– 30%
risk of MI with each 10 g increase in cereal fiber
do the study. How do you do that with
intake (Rimm et al., 1996) whole grains? Grains are just one part of
• Iowa Women’s Health Study of over 34,000 women
– 30% to 36%
risk of ischemic heart disease by eating
the diet, so if I wanted to do a study, do I
at least 1 serving of whole grain foods per day take all fruits and vegetables out because
(Jacobs et al., 1999)
• Harvard Nurses’ Health Study of over 75,000 I only want to know what grains do to
women me? Then the question is, “Should we
– 25%
risk of coronary heart disease by eating
approximately 3 servings/day (Liu et al., 1999) use grains that are commercially
available or those where we control the
planting, harvesting, processing, etc.?”
Whole Grains and Cancer:
Epidemiological Studies If you look at grains and antioxidants
only, there is no question this is a very
• Gastrointestinal cancers
– A meta-analysis of 40 studies credible, biologically plausible
– 21% to 43% lower risk for cancer with high mechanism that whole grains do have
intakes of whole grains (Jacobs et al., 1998)
• Hormone dependent cancers
a lot of antioxidant activity.
– One meta-analysis showed a 10% to 40% risk
reduction with the highest intake of whole grain
foods (Chatenoud et al., 1998)
Average Antioxidant Activity

Common Vegetables
Common Fruits

What is in this whole grain that makes it White Bread

Rice Cereals
beneficial? We have the traditional Corn Cereals
nutrients — vitamins, minerals, proteins, Whole Grain Bread

resistant starch, and antioxidants, as well Whole Grain Cereals

0 500 1,000 1,500 2,000 2,500 3,000

as inulin, phytates, lignans or Trolox Equivalents/100g

phytoestrogens, plants sterols, stanols,
and plant phenolics. Where do you
start? Is it any one of these or is it the
combination? There is no question it has
23
 Effect of Lignans
Antioxidant Activity Per Serving
on Hormonal Response
Serving Trolox
Product • Grain intake linked to higher excretion of
(grams) Equivalents/Serving
Whole grain 41* 1,150* urinary lignans (Adlercreutz et al., 1986)
cereal • Serum enterolactone level biomarker for
Vegetables 120 540 reduced CHD risk (Vanharanta, 1999)
• Phytoestrogen biomarkers linked to breast
Fruit 120 1,440 cancer risk (Zheng, 1999)
Whole wheat 50 1,000
bread
* Average for eight whole grain breakfast cereals

How would you actually translate that Unfortunately, there are not very many
into a feeding study? One published of these studies.
study looked at a whole foods diet and
different biological measures. They How can we look at glycemic response
compared a whole foods diet to a of grains? Generally, greater particle
refined foods diet. In each category, size equals less glucose response, less
they went with a whole grain. They refining equals less glucose response,
used whole fruits vs. the juices and tried and high levels of soluble fiber equals
within each category to make those less glucose response. Corn and rice can
decisions. What they found were some either be high or low glycemic foods
interesting results, in which whole food depending on the food form and the
diets improved lipids, antioxidants, and amylose content. Amylose has a lower
colon function. glycemic response than amylopectin.
Basically, glycemic index is not going to

BWhole Food Diet Improves Lipids, be the answer to our prayers. It is not
asically, glycemic index is
Antioxidants, and Colon Function going to answer all of our questions
not goingwhole
• Compared tofoodsbedietthe answer
including whole
because it is very complicated and
difficult to measure.
to our prayers. It is not
grains to refined food diet
– Whole foods lowered total and LDL cholesterol
going to answer
– Antioxidant all of our
enzymes decreased There was a classic study where they
looked at glucose insulin response with
questions because it is very
– Colon function improved
whole grains, cracked grains, course
complicated and difficult flour, and fine flour.
to
Brucemeasure.
et al., J Am Coll Nutr 19:61, 2000

Whole Grains and Glucose Response

Whole Food Diet Improves Lipids,
• Glucose/insulin response: whole grains <
Antioxidants, and Colon Function cracked grains < coarse flour < fine flour
• Compared whole foods diet including whole • Oat-based meals saw smaller glucose and
grains to refined food diet insulin responses than wheat- or
– Whole foods lowered total and LDL cholesterol maze-based meals
– Antioxidant enzymes decreased • In vitro starch digestion was fastest with the
– Colon function improved grain products with smallest particle size

Heaton et al., 1988

Bruce et al., J Am Coll Nutr 19:61, 2000

24
The results: in vitro starch digestion was phytochemicals, has been shown to have
fastest in the grain products with the a role in these diseases.
smallest particle size. There was another
study done at the U.S. Department of
Future Research
Agriculture (USDA). Blood Sugar
Whole Grain Cardiovascular Regulation/
Component Cancer Disease Diabetes

Effect of Particle Size of Whole Fiber

Oligosaccharides
x
x
x
x
x

Grain Flour on Glucose Response Flavonoids

Inositol
x
x
x

Lignans x
• Compared glucose to breads made from white, Phenolics x x
Phytates x x x
whole wheat, and ultra-fine whole wheat Phytoestrogens x
Protease Inhibitors x
• Glucose response higher with glucose solution Saponins x x
than breads, but no differences among breads Selenium x
Tocopherols x x x
• Particle size does not affect glucose response Magnesium x x
Zinc x

Some of the research priorities for grains

Behall et al. J Am Coll Nutr 1999;18:591
In this study, particle size did not affect
glucose response. You would expect a
difference, but glucose response in this
case did not show up to be different
between those breads. And we do not
know why.
Soluble fiber is important, but we cannot
explain it all with soluble fiber. Fiber is
a really important part of it, but other
things, such as antioxidants and
phytoestrogens, probably have a role.
And when it comes to cancer risks and
gastrointestinal cancers, it is once again
the fiber story, just put in under a whole
grain umbrella. There appears to be
some type of synergy between the
different whole grain components that
affect glucose.
In terms of where we need to go from
here, obviously, whole grains are
complicated. If you look at some of the
phytochemicals that have been shown to
be protective against some of the
diseases we have talked about, there are
a lot of biologically plausible
mechanisms. This can be rewarding or it
also can be overwhelming. What is the
most productive thing to look at? Any
one of these compounds, these
25
include agreement on a continuum of
grain types, so we can move forward in
these studies and improve dietary
instruments to estimate intake of grains.
Another area for research is in
processing effects. There is no question
processing is important. It makes foods
that we are going to eat, that we want to
eat, and it probably makes things more
bioavailable, which is key. Plus, we
need to consider clinical studies of
mechanism and grain exposure and
disease studies.
Epidemiology studies consistently find
protection from whole grain
consumption. The mechanisms for this
protection include large bowel effects,
antioxidants, alteration in glucose
metabolism, weight loss, hormonal
effects, and the biological effects of the
many compounds in whole grains.
It is not any single one that is going to
hit the home run here; it is a bunch of
singles and a lot of bunting that is going
on, and in the end we are going to win.
It really is the package that is the
important thing.
26
Anatomy of a Whole Grain
Health Claim Approved NLEA Health Claims
There are basically two types of health
• Soluble fiber and • Fiber-containing grain
claims — the Nutrition Labeling and heart disease products, fruits, vegetables,
• Saturated fat, and cancer
Education Act (NLEA) and Food and cholesterol, and • Calcium and osteoporosis
heart disease
Drug Administration Modernization Act • Whole oats, psyllium,
• Sodium and hypertension
• Folic acid and neural
(FDAMA). An NLEA claim requires a and heart disease* tube defects*
• Fat and cancer • Sugar alcohols and
rigorous scientific process to determine • Fruits, vegetables, dental caries*
and cancer
whether there is a relationship between • Soy protein and
heart disease*
a nutrient or food and a disease end * Approved since FDA’s original ruling on health claims in 1993

point. A FDAMA health claim is a much

quicker process in which a company can
make an intent to use a claim and the Regulatory Timeline
FDA has 120 days to respond on
whether they would permit that claim. NLEA DSHEA FDAMA
Passed Passed Passed

1990 1993 1994 1995 1996 1997 1998 1999 2000

In terms of the whole grain health claim,
it benefits consumers because they are NLEA
Health
Oat
Health
Oat
Health
Oat
Health
Psyllium
Health
Whole
Grain
DSHEA
Struct-
Claim Claim Claim Claim Claim Health Funct
exposed to the health benefits and are Petition Proposal Claim Claims
+ + +
better able to identify whole grain foods. Psyllium 9 Soy
Health FDAMA Health
It benefits companies because it gives Claim
Petition
Claims
Rejected
Claim

them the incentive to develop and

promote whole grain products.
Because of the gap between whole grain
consumption and recommended intake,
the whole grain health claim needs
continued support scientifically, as well
as from a policy point of view, as we
begin to educate consumers and
professionals on the benefits of whole
grains and whole grain products.
Presentation by Len Marquart, Ph.D.,
Senior Scientist, General Mills
When we look at health claims, there are
basically two types — the traditional
health claim and the new FDAMA
health claim. In 1993, NLEA defined a
health claim as “any claim that expresses
or implies the relationship between a
nutrient and a disease.” NLEA approved
seven different health claims and
established a petition process for
approving new claims, which were
later added.
27
What kind of evidence do we need to
support a health claim? There is a
rigorous scientific process that needs to
be conducted to determine whether there
is a relationship between a nutrient or
food and a disease end point. How is
that determined? There are the clinical
intervention studies, which are the gold
standard, and include well-controlled
studies to demonstrate that a particular
component in a food has an impact on
disease. The observational studies can
be used primarily in whole food types of
claims. If you look at whole grains
related to heart disease and cancer, much
of the data came from observational
studies. There also are meta-analysis or
research synthesis studies. In the oats
health claim, as well as the whole grain
claim, there was a need for
meta-analysis where data is compiled.
Finally, there are animal and in vitro
studies, looking at mechanistic reasons
why the particular food or nutrient might
be beneficial.
There also are certain criteria that are
used by the FDA to determine whether
the quoted studies are beneficial.
They look at the various design and
methodology. They determine whether
or not there is enough information on the
particular nutrient. They will look at the
end point, such as blood cholesterol, and
also get into whether the overall studies
are representative of the U.S. population.
For example, with Quaker Oats in 1995,
the company submitted a petition in June
to go further than the whole foods
soluble fiber claim established in 1993,
and extend the claim that there is a
particular component in oats that may
lower blood cholesterol and lower risk
for heart disease. They were looking at
a particular product and looking at
20 grams of oatmeal or 13 grams of oat
bran. Within this particular serving,
there would need to be 1 gram of beta
glucan per serving and it also would
have to be relatively low in fat and
provide 3 grams of beta glucan on a
daily basis. As far as the data that was
put forth, we know there were
37 studies the FDA allowed and they
went through the criteria mentioned
above. Of those 37 studies, 17 of those
supported the data linking beta glucan to
reduced risk for coronary heart disease,
where four of the others were not
sufficient, five were equivocal, and
11 showed no relationship. A variety of
oatmeal forms and oat bran were used in
the various studies. Various types of
additional studies also were conducted.
28
Oat/Heart Disease Health Claim:
Scientific Evidence
• 37 of 41 submitted clinical trials accepted
by FDA
- 17 studies demonstrate cholesterol-lowering by
oatmeal/oat bran

8 were Hypercholesteremics/usual diet

6 were Hypercholesteremics/low-fat diet

2 were Normocholesteremics/usual diet

1 was Normocholesteremics/low-fat diet
- 4 not long enough in duration
- 5 were equivocal
- 11 showed no effect on serum lipids
Oat/Heart Disease Health Claim:
Scientific Evidence
• Various forms of oatmeal and oat bran foods
used in the clinical studies
• Additional scientific evidence
- Dose-response study: 3 g of soluble fiber from
beta glucan 5% decrease in total cholesterol
- Meta-analysis (13 studies) supports
cholesterol-lowering effect of oats
- Epidemiological data supports inverse
relationship between fiber intake and coronary
heart disease (CHD)
The FDA concluded there was sufficient
data based upon primarily clinical
studies stating there was a link between
oat-based products and reduced risk for
heart disease, primarily through
cholesterol lowering. During the
120-day comment period, evidence was
submitted to broaden the health claim to
include other types of oat products that
may have a cholesterol-lowering effect.
The final rule stated there would be
3 grams of beta glucan as a requirement,
but the amount of beta glucan per
serving was lowered. So instead of
1 gram, they recommended .75 grams of
beta glucan per serving of oats. As a
result, they needed to increase the
number of servings, so it was four
servings of oats per day to consume the
recommended level of 3 grams of beta
glucan. The model claim was then
published in the Federal Register:
“Soluble fiber from foods such as [whole
grain oats or product name] as part of a
diet low in saturated fat and cholesterol
may reduce the risk of heart disease.”
This is a traditional type of health claim
and can take a year and a half to two
years to pass through the claim process.
In terms of an FDAMA health claim, it
is a much quicker process in which the
company can notify the FDA of the
intent to use a claim; then the FDA has
120 days to respond and indicate
whether they would allow or permit that
claim. The important part is the FDA
does not relax the scientific standards,
but it does allow for a shorter time
period to allow a health claim. As far as
the criteria, a statement from a federal
scientific body (NIH; USDA; National
Heart, Lung, and Blood Institute
[NHLBI]) must be identified, be
published and currently in effect, state a
relationship between a nutrient and a
disease or health-related condition,
reflect consensus of the scientific body,
and be based on the scientific body’s
deliberative review of evidence.
While the recommended intake for
whole grains is usually three servings
daily, Americans eat an average of one
whole grain serving a day. If we look at
consumers and ask them what a whole
grain is, they cannot tell you. On top of
that, consumers have no idea there is a
relationship between whole grains and
reduced risk for heart disease and
cancer. What General Mills did was to
identify the statement that related whole
grains to reduced risk for heart disease
and cancer, which was identified in the
Diet and Health Report from 1989.
We reviewed the science, looked at the
subsequent research, and finally
submitted the notification in
March 1999.
29
If we look at the notification that was
sent to FDA, we agreed there was
substantial evidence, primarily
epidemiological evidence, that whole
grains along with other plant foods
would be prudent to lower risk for heart
disease and cancer. As far as the
particular research studies, 24 of
26 studies indicated there was a lower
risk of coronary heart disease with
whole grain/cereal fiber consumption.
Supporting Scientific Evidence:
Whole Grain and CHD
• 24 of 26 research studies support the
relationship between whole grain and CHD
• Four large epidemiological studies show
risk of CHD related to whole grain
intakes
- Iowa Women’s Study
- Finnish Men
- Harvard Health Professionals Study
- Harvard Nurses’ Health Study
Whole Grain and CHD:
Clinical Trials
Whole grain oats
total and LDL cholesterol
• Van Horn (1986)
• Van Horn (1988)
• Davidson (1991)
• Hunninghake (1989, 1997)
Supporting Scientific Evidence:
Whole Grains and Cancers
Whole grains and certain cancers
• 37 case-control studies
• One ecologic study
• Three review articles
• Meta-analysis of 40 case-control studies
Cereals/cereal fiber and colon cancer
• 24 studies support
• 7 do not support
In terms of the health claim
requirements, we looked at what would
be the American Association for Clinical
Chemistry’s (AACC) definition of whole
grains, in which you must have the bran,
germ, and endosperm in the proportion
that naturally occurs in the grain, and it
must contain 51 percent whole grain by
weight of the final product. This is a
fairly substantial amount of whole grain,
but it needs to be at a level that would be
efficacious, and needs to be low in fat,
saturated fat, and cholesterol to meet the
other health claim requirements. The
FDA’s role was then to review the
notification and examine the various
scientific issues and policy, and consult
with other agencies to make sure there
was agreement among the different
federal agencies that there was a link
between whole grains, heart disease, and
cancer. In the end, the claim basically
reads, “Diets rich in whole grains and
other plant foods and low in total fat,
saturated fat, and cholesterol may reduce
the risk of heart disease and some
cancers.” With this process, you are
looking at six months, a relatively short
period compared to the traditional
process, where you are looking at a year
and a half to two years.
The implications of the whole grain
health claim? It benefits government
and public health policy because it
helps consumers achieve dietary and
health goals and may contribute to
overall reduction of chronic disease
risk. It benefits consumers because
they learn the health benefits of whole
grains and helps them to identify
whole grain foods. And it benefits
companies because it gives them the
incentive to develop and promote
whole grain products.
30
In reality, we know there is a gap
between whole grain consumption and
recommended intake. We need to be
looking at enhancing the scientific
evidence and solidifying policy,
including the Dietary Guidelines for
Americans and the Food Guide Pyramid.
What we find is if you have good
science and you have the tools to
promote healthy food choices, you can
gain some mileage from the industry
perspective. To capitalize on a health
claim, you need a recognized product,
strong public relations, and an effective
advertising campaign. Good timing also
is beneficial. Using the traditional oats
and coronary heart disease health claim
as an example, sales of Cheerios® went
up approximately 5 percent. If we look
at the health claim related to whole
grains and coronary heart disease and
cancer, there are a number of different
cereal and snack products that meet the
claim, and for about three months after
the release of the claim, these products
went up by about 7 percent on average in
terms of sales volume. Looking ahead,
it is important we continue to build the
whole grain issue scientifically, as well
as from a policy point of view, and begin
to educate consumers and health
professionals as to the benefits of whole
grains, along with all grain products.
PART II: GRAIN CHEMISTRY
AND INTAKES
Anatomy of a Cereal Grain
Every component in a cereal grain is
synthesized and stored in a unique way,
a unique structure, and a unique
location. When we look at the central
portion of the kernel of wheat, the vast
majority of the grain is starchy
endosperm, but it is the outer portion of
the kernel — primarily bran — that
contains a large percentage of
the many functional, biologically
active compounds.
The component attracting attention these
days is the cell wall. In wheat, the cell
walls contain large amounts of
arabinoxylan, a high molecular weight
viscous polymer that provides a
significant amount of soluble fiber.
In oats and barley, the cell walls also
contain significant amounts of
mixed-linkage beta glucan, which is
similarly viscous and the primary
component of the fiber in these grains.
We really do not know as much as we
need to about the physiological
functionality of those polymers, nor do
we know much about how those
polymers interact with each other in
terms of nutritional value.
We must also recognize that the outer
coverings may be highly colored and
contain a wide array of stringent,
intensely flavored compounds that do
not always present the most appealing
taste. There is a wide range of
opportunities in processing the
beneficial components in the starchy
endosperm and the beneficial
components in the outer coverings.
31
Presentation by R. Gary Fulcher, Ph.D.,
Professor and Chair of Cereal Chemistry
and Technology, University of Minnesota
When discussing whole grains, we are
concerned with both processing and
nutritional quality. A critical point to
keep in mind is that every component in
a cereal grain is synthesized and stored
in a unique way, a unique structure, and
a unique location. We have had many
decades of essentially “farming” some of
the larger and more homogeneous
components of the grain, notably the
starchy endosperm, which provides the
functional proteins for dough, and starch
for an extraordinarily large number of
common food products. Yet, when we
speak of nutritional quality and
consumer appeal, we are led to serious
considerations of some of the many
other minor components, including the
various fiber components, minerals,
vitamins, enzymes, antioxidants, and
flavor compounds. We see wide arrays
of nutrients that are stored in relatively
low concentrations but which, in fact,
are rather critical to the nutritional
qualities of grains.
Let us take a tour quickly through some
of these kernels. When we examine the
central portion of the wheat or barley
kernel, the vast majority of the grain,
about 75 percent of it, is starchy
endosperm. And while there are many
things to be said about starch, those that
interest us most are the constituents
outside the starchy endosperm — the
surrounding protective layers (mostly
bran) and the germ. That is where a
huge percentage of the very functional,
biologically active compounds reside.
There also are components in the starchy
endosperm, such as the non-starchy
polysaccharides (arabinoxylans and
glucans) that also provide some
interesting biological activities.
But consider also that there are between
six and 11 distinct cellular structures in
these non-endosperm tissues, every one
of which is biochemically distinct. The
distinctions may be subtle, but they are
chemically different from each other
and, therefore, we should expect them to
be functionally different.
The non-endosperm components also
include several viable tissues, such as
the aleurone layer and scutellum, both of
which are capable of generating
significant amounts of hydrolytic
enzymes. When we get into a discussion
of whole grain utilization, whether it is a
nutritional utilization or a process
utilization, we are dealing with
chemistries that are both complex and
very different from the starch and the
protein chemistries that we have been
exploiting for so many years.
Barley, as well as oats, contains a
collection of structures that comprise the
husks or hulls. These are essentially
cellulosic or hemicellulosic and they
contain a number of additional
compounds, including many of the
antioxidants and much of the insoluble
fiber. As we view many of these outer
coverings as candidates for a trip
through the gut, we are really looking at
the same kinds of materials that
ultimately are responsible for at least
some of the protection of the grain. It
takes a powerful fungus to penetrate the
outer coverings and insects and birds are
often similarly dissuaded from digesting
the outer layers. The mammalian gut
also encounters difficulty in digesting
these layers when they are not
extensively processed, and we certainly
need to understand their chemistry in
order to optimize the use of the many
nutrients contained therein. Removing
husks from barley by pearling has been a
very traditional approach and there also
32
are many genotypes that are considered
“hulless” because they lose their hulls
during threshing. The latter are not as
widely grown, but they are receiving a
great deal of attention because of their
nutritional advantages (often including a
high level of soluble fiber). In
combination with aleurone and germ
tissues, it is the protective layers that are
in many ways those which contribute
most to whole grain chemistry and
nutritional quality. It is the removal of
those outer layers that produces
“refined” grain products.
The cell walls, which are the essential
structures that surround and define all
cells in a grain (including hulls), in the
case of wheat tend to be largely
arabinoxylans — very high molecular
weight polymers of arabinose and xylose
(for oats and barley, the majority of the
cell wall is mixed-linkage beta glucan).
We really do not know as much as we
need to know about the physiological
functionality of either of these polymers.
Nor do we know very much about how
those polymers interact with each other
in terms of nutritional quality. They
exist in very low concentrations (only
perhaps 2 percent to 6 percent of the dry
weight of the whole grain), but it is these
materials that are supposedly responsible
for cholesterol reduction.
Moreover, one cannot assume the glucan
polymers from oats are functionally the
same as the glucan polymers in barley or
wheat. They are, in fact, quite different;
at least in the extracted materials we are
able to produce in the laboratory. Some
have high viscosity, some have low
viscosity, and some are able to produce
gels when processed appropriately.
When you begin to do experiments in a
nutritional context, it is important to
know first of all where the material came
from and, secondly, some of its
polymeric properties (these materials
differ genetically). The following image
represents a portion of a barley kernel
that we have treated microscopically to
reveal the mixed-linkage beta glucan.
Barley Kernel Treated
Microscopically to Reveal the
Mixed Linkage Beta Glucan
In the cell walls surrounding each cell,
the beta glucan is highly concentrated
and intermingled with an array of several
other polymers, including arabinoxylans,
galactomannans, proteins, phenolic
acids, and a number of other minor
constituents. Consequently, it is difficult
to discuss just one component when
assessing nutritional efficacy of “soluble
fiber” or any other grain constituent.
We also encounter quite different ratios
of these different polymers in different
parts of the grain. When you are
consuming only endosperm material in
wheat, oats, or barley, you are
consuming one type of complex material
with respect to its cell wall polymers.
When you then include such things as
the aleurone layer or the other bran
layers, you are changing the composition
quite dramatically.
The history of our interest in beta
glucans in nutrition actually began
in the chicken coop. If you feed
excessive amounts of barley or other
grains with high beta glucans to
33
chickens, you generate the so-called
“sticky-droppings” syndrome.
Consequently, there has been incentive
to develop low beta glucan barleys for
the feed industry.
“It looks like a bad case of beta glucans to me!”
Similarly, low beta glucan barley is
prized in the malting industry in order to
avoid excessive viscosity in processing;
we have a long record of concerted
attempts to reduce beta glucans in
barley. On the other hand, it is
becoming increasingly clear that dietary
soluble fibers, such as beta glucans,
assist in cholesterol reduction, modified
glycemic responses, and perhaps even
immune stimulation. There is no
question that beta glucans from other
organisms can stimulate the immune
system quite dramatically and we are
exploring the potential for similar effects
from cereal glucans.
Barley beta glucan is a very unique
molecule. It is similar to cellulose in
being predominantly a beta 1-4 glucose
polymer but the inclusion of occasional
1-3 linkages confers a high degree of
solubility, which makes it very unlike
cellulose: similar composition, slightly
different arrangement, and a very high
molecular weight, but it also is very
viscous and very hydrophilic.
The following slide shows an oat kernel
that has been cut in half and treated so
we can see the mixed-linkage beta
glucans. The distribution of beta
glucans, not just between species, but
also within a species, can be distinctly
different, and we constantly hear
concerns from industry relating to
inconsistent processing. Part of the
reason is you get quite different glucan
concentrations in different fractions as
you go through any processing system.
Half of Oat Kernel Treated to Reveal
the Mixed Linkage Beta Glucan
But all oats are not the same and all
barleys are not the same. There is
extensive variability. Can you have
different distributions within the kernel
within a variety? It is very much a
function of genetics, but it also is very
much a function of the production
conditions. There are many things you
can do in processing that will allow you
to increase the beta glucan
concentrations, not just the barley. If we
start with the barley and process via
pearling, we are simply abrading the
outer surfaces to produce more and more
of the inner portion of the kernel as we
continue processing. With this simple
approach, one can nearly double the
whole grain glucan levels going from
first to last pearling fractions. Barley
flours are commercially available that
can approach 25 percent mixed-linkage
beta glucan, which is exceptionally high
in a product generated during dry
processing.
34
Several companies also are making both
oat and barley beta glucan for
commercial use, and feeding trails that
are underway with these products should
assist in further defining their
physiological effects.
It is important to recognize the solubility
and the molecular organization of these
glucans can be quite different from one
genotype to another. We have examined
this a number of different times, but it is
quite clear that the ratio of water-soluble
to sodium hydroxide-soluble glucan in
different barleys ranges from 5:1 to
0.5:1, which is a tremendous indicator of
variation in molecular organization.
If we follow the progress of barley
fractions through the gut, we can
visualize the gradual digestion of
proteins and starch, with a concomitant
increase in both bran content and in
viscosity due to the soluble beta glucans
(which are not digested in the small
intestine). At the end of the small
intestine, therefore, one encounters only
undigested bran in a viscous, glucan-rich
matrix. It is not until the cecum and
colon, at least in small mammals, that
one visualizes more complete reduction
in molecular weight, viscosity, and
cellular structure.
While much of the preceding discussion
describes events relating to gut
responses to soluble polymers, such as
beta glucans (arabinoxylans should
respond similarly, perhaps), we must
remember this represents only a small
amount of the total weight of the grain,
as well as being only a small fraction of
its chemical diversity. In most
conventional processing systems (flour
milling, malting, and ethanol
production), the major contributor to the
final product is endosperm-derived.
In contrast, the material we manage to
strip from the grain either before or after
further processing (for example, bran
and germ) represents as much as
25 percent of the dry weight of the
mature grain. Furthermore, these tissues
express more chemical and biological
activity than almost other part of the
grain. That is what we discard, by and
large, with the “refinement” approach.
Each one of the compounds discarded by
milling represents a portion of the
biological activity of the mature grain,
and the list of compounds is enormous.
Wheat bran, for example, is one of the
richest natural sources of niacin known,
and this important B vitamin is
accompanied by several others,
including thiamine, riboflavin,
pantothenic acid, and a very large
number of antioxidant molecules, such
as ferulic, coumaric, and related
phenolic acids. In addition, there are
significant reserves of calcium,
magnesium, potassium, phosphorus, and
iron, and the nutritional quality of bran
and germ protein is significantly better
than most endosperm proteins. The
tissues also produce a variety of
hydrolytic enzymes, and the cell walls
that surround each of the bran and germ
cells are major sources of both soluble
and insoluble fiber. The literature also
hints at antibiotic activity as well.
Bran and germ express considerable
molecular compartmentalization that is
visible at every stage of any mechanical
or digestive processing system, and this
generates significant challenges for the
processor and nutritionist. But there is
little doubt the challenge of improving
the palatability, solubility, storage
characteristics, and especially the
nutritional quality will be rewarded in
both physiological and economic terms.
For most common cereal grains,
nearly 100 percent of the important
phytochemicals and nutraceuticals are
synthesized and stored in structures
(bran and germ) that comprise only
20 percent to 25 percent of the mature
grain, and they return only 5 percent
to 8 percent of the economic value of
the crop in question. This is hardly a
balanced ratio in light of the current
concerns about obesity, diabetes, and
cardiovascular disease!

In combination, these components

express profound biological activity,
much of which is merely a reflection of
their function in the developing and
mature grain. They are the primary
constituents of “dietary fiber” and
frequently are overlooked as sources
of beneficial nutrients beyond their
common use as laxation aids.

35
36
Health Effects of Newly Recognized
Grain Constituents — Antioxidants,
Phenolics, Lignans, and Phytochemicals
Whole grains contain many important
nutritional components, including
antioxidants. The insoluble fiber is
somewhat unique among plants in that it
has up to, and sometimes more than,
1 percent phenolic acids. When you eat
grains with insoluble fiber, along with
the fiber is an antioxidant. Research
suggests when you eat a whole grain
product, you have antioxidant activity
that is carried completely through your
digestive track, which offers a kind of
protection you probably do not see from
most fruits and vegetables.
There are other compounds, such as lignan,
which may be converted to enterodiol or
enterolactone in the colon and is available
to compete with estrogen to reduce the risk
of cancer. All grains also contain
tocotrienols, which are known to inhibit
cancer, reduce cholesterol, and have
positive effects on factors leading to heart
disease. There also are sterols that can
block cholesterol absorption and have been
suggested to have several other functional
effects, such as reducing conversion of
secondary bile acids relating to colon
cancer. Overall, there are a variety of
interactive mechanisms dependent on each
other and that can act synergistically.
Presentation by Gene Miller, Ph.D.,
Principal Scientist, General Mills
As scientists, we get compulsive about
understanding, “Why is it better for you”
and “What might be part of the
explanation?” The perspective I would
like to challenge is that fiber is the
mainstay of the whole grain benefit
to health.
37
Looking at the Food Guide Pyramid,
I would reiterate that grains are an
important part of a healthy diet. When
we eat grains, we eat processed foods.
We do not eat raw grains and we do not,
with very small exceptions, eat intact
whole grains; oatmeal being, perhaps,
the best example of intact whole grains.
In terms of whole grains consumption,
there is different data in the literature,
but if you look at products that qualify as
a whole grain product, perhaps it is
5 percent or less. We really do not
consume a lot of whole grains and, in
fact, there is a lot of room to improve on
our diet. The kinds of products that
provide whole grain are largely bread,
breakfast cereals, and snack crackers.
Bread, because we eat so much of it, is
the single most important intake of
grain products.
Looking at grains, when you remove the
bran, you remove about 75 percent of all
the phytonutrients. With the bran layer
and the germ go most of the nutrients,
including the fiber. If you look at the
bran cells, you will see they are very
thick cells. Some degree of processing
is certainly important.
Cellular Structure
A B
Pericarp
Nucellus
Phytin crystal
Nucleus
Seed coat
Aleurone
Protein body
Cell wall
layer
Starch
Protein Inner
bodies (starchy)
Protein body Sub-aleurone endosperm
layer Cell Wall
Starch
BRAN CELL WALLS ARE THICK, PROTECTIVE LAYERS
And the microflora in our colon is
certainly important. If you have a Microflora Interactions
“Healthful” Microflora
microflora that is adapted to fiber, it is
Grain Short Chain
going to be much more effective in Fiber Fatty Acids Epithelium,
cholesterol
Cell Bound “Free” synthesis
releasing the contents of these cells. Phytonutrients Phytonutrients

Whole grains do contain a lot of Lignans Phytoestrogens Breast, colon,

prostate cancer
important nutritional components. Bound
Antioxidants
“Free”
Antioxidants Epithelial
protection

Phytin Inositol Cell reversion

Whole Grain Phytonutrients Sphingolipids Sphingosine Cell growth,

Fiber
Vitamins &
Minerals Antioxidants
Unsaturated
Fatty Acids
Tocotrienols
Phytosterols Sphingolipids
COLON MICROFLORA IS AN IMPORTANT FACTOR
I would like to bring into the picture the
microflora, because if these
phytonutrients are not released to your
body, then they are not going to do you
any good. Several of them, such as the
lignans, are not bioactive except by
colon microflora activity, which
converts them to phytoestrogens.
Without that happening, it does not
make any difference how many lignans
you take in, they all will be of no use to
your body. The same thing is true for
phytin, sphingolipids, and the
antioxidants. The efficacy of the fiber
also depends to some extent on
microflora. There is such a thing as a
healthful microflora (one that is adapted
to fiber) and I would contrast that to an
unhealthful microflora that has adapted
to a diet high in protein and fats. So it
makes a big difference what your colon
sees over the course of your life.
cholesterol
synthesis
Microflora
There literally are hundreds of
antioxidants in our diet. Some are very
Lignans
potent and some are very weak. The
Phytin primary property we think about when
we talk about antioxidants is to prevent
disease initiation by free radicals we
breathe in the air, consume in our food,
and that our body produces as part of our
normal metabolic processes. There are
mechanisms to control the free radicals
so they do not hurt our body, but that
does not happen 100 percent of the time.
Free radicals are extremely reactive, so
they immediately attack whatever they
contact first, which could be DNA,
proteins, or lipids. This has
consequences of tissue damage. There
are repair mechanisms but, over the
course of time, this can lead to a variety
of disease states such as cancer, heart
disease, and diseases that we associate
with aging. Obviously, if you prevent
the free radical attack in the first place,
that is the best way to defend your body
from some of these diseases and to
reduce their incidence. Therefore,
antioxidants or free radical scavengers
certainly have an important part to play.
Fruits and vegetables have received a lot
of attention for their antioxidant activity
and their importance to health because
of that.

38
Look at the contribution that whole grain
cereals might make. In this case, we Antioxidant Consumption
analyzed not just an extract of the food,
Trolox
but we mixed up the whole food and, Product Servings Equivalents
(gm) Per Serving
therefore, had a reflection of all the Whole Grain Cereal 40 * 1,150 *
antioxidants, soluble and insoluble. In Vegetables 120 540
the case of grains, that makes quite a Fruit 120 1,440
difference. In comparison, whole Whole Wheat Bread 50 1,000
* Average for eight whole grain RTE breakfast cereals
grain foods, such as whole grain bread
and whole grain cereals, have ANTIOXIDANT ACTIVITY OF WHOLE GRAIN PRODUTS IS
SIMILAR TO FRUIT AND VEGETABLES ON A SERVING BASIS
considerably more antioxidant activity
than fruits and vegetables.
that have insoluble fiber, you also get
antioxidants. And, in fact, this fiber is
Average Antioxidant Activity* quite reactive as an antioxidant and
measuring it separately, that can be
Common Vegetables

Common Fruits
easily demonstrated.
White Bread

Rice Cereals

Corn Cereals
Bound Antioxidants
Whole Grain Bread

Whole Grain Cereals

0 500 1,000 1,500 2,000 2,500 3,000

* Analysis by Diphenyl picrylhydrazyl. µmoles Trolox Equivalents/100 grams

WHOLE GRAIN PRODUCTS ARE HIGH IN ANTIOXIDANT ACTIVITY

If you take that in the context of

consumption and look at average serving
size, you get a very good dose of WHOLE GRAIN, INSOLUBLE FIBER HAS POTENT ANTIOXIDANT ACTIVITY

antioxidant activity that compares very

well to fruits and vegetables. The best
source of antioxidant activity among the What happens with grain antioxidants
fruits and vegetable field is berries, but and health? Well, it would suggest when
we do not eat a lot of berries. Nuts are you eat a food that has whole grain, the
pretty good, but we do not eat a lot of antioxidants, water-soluble, fat-soluble,
nuts. And some of the legumes are very and insoluble fiber can act as free radical
good. As the mainstay of our diet, scavengers immediately in your
grains are certainly a good source intestine. The water-soluble and
of antioxidants. fat-soluble fibers are available to be
absorbed. And in your colon, dependent
The thing that is unique and important on the microflora, there may be the
for grains is the insoluble fiber, the hydrolysis of the phenolic acids that are
hemicellulose of grain products, is covalently bonded to fiber. This means
somewhat unique among plants in that it when you eat a whole grain product, you
has up to, and in some cases more than, have antioxidant activity that is carried
1 percent phenolic acids. These completely through your digestive tract.
phenolic acids are on the side chains and
in the course of cross-linking between
phenolic groups they render the fiber
insoluble. So when you eat grains
39
In regard to some of the other Within the body, they are not absorbed
compounds, Adlercreutz (Finland) had unless hydrolyzed in the colon.
promoted the possibility that lignans are Sphingolipids function in several ways,
converted to enterodiol or enterolactone but also are related to function as a
in the colon, which then is available to second messenger and control cell
compete with estrogen and does, in fact, growth and cholesterol synthesis.
reduce the risk of cancer. Phytin or Overall, there is quite a variety of
phytic acid has labored under the title of interacting mechanisms dependent on
being an “anti-nutrient,” but it also has each other.
some potentially very positive value.
The phytin metabolites and inositol
phosphates have been studied Serum Cholesterol
Synthesis
extensively as second messengers in the
Storage
regulation of cell growth. The intake of Diet
Cholesterol
Absorption
Cholesterol Membrane Synthesis
Concentration Steroid Synthesis
inositol compounds increases the body’s
Bile Acid
pool and the ability to provide these
Excretion
materials to various cells. In the colon,
Absorption Synthesis Excretion
the microflora also can hydrolyze the • Diet load • Tocotrienols • Unsaturated FA • Fiber

phytin and make it bioavailable. The • Fiber

• Sterols
• Sterols
• Sphingolipids
• SCFA
• Insulin

efficacy of phytin to your body is MULTIPLE FACTORS INFLUENCE SERUM CHOLESTEROL

certainly dependent on the microflora,
not just whether the grain was processed.
In conclusion, whole grain foods are
Tocotrienols, likewise, have had a great
good for you. You live longer and
deal of study. All grains contain
healthier. Why? In addition to fiber,
tocotrienols, which are known to inhibit
there are many phytonutrients and these
cancer, reduce cholesterol, and have
phytonutrients, at least potentially, can
positive effects on factors leading to
act synergistically. Collectively, there
heart disease. Although there are other
may be a significance you do not see
sources, grains are the main source in
individually. The colon is a very
our daily diet. They also are strong
important part of the overall picture that
antioxidants. Benecol™ and Take
we do not talk about as much when we
Control® are products based on plant
focus on the phytonutrients, but their
sterols, stanols, and esters. Grains also
efficacy in large part is dependent on the
contain these compounds and they have
microflora. Finally, antioxidants are
the same functionality. They can block
present throughout our digestive tract
cholesterol absorption and have been
when we eat whole grains and, therefore,
suggested to have a number of other
offer a kind of protection that you
functional effects, such as reducing
probably do not see from most fruits
conversion of secondary bile acids in
and vegetables.
relation to colon cancer. Looking at
sphingolipids, it is not really known if
these are essential beyond what our body
can produce. They are very interesting
compounds that are an essential part of
soluble membranes. There are many
different forms of the water-soluble
fraction of this molecule.

40
Participant Interaction
Following are select participant
comments and questions from the
participant interaction session, with an
opening statement by David Kritchevsky,
Ph.D., Wistar Institute.
Opening by David Kritchevsky, Ph.D.,
Wistar Institute
Until quite recently, antioxidants were
considered the savior of the nation.
Then, we found in studies on smokers
that when they were given either
vitamin E or carotene supplement, their
tumors actually got worse. At the time,
I thought this might be due to a
pharmaceutical interaction and you
should get your compounds like
antioxidants from the grocery not the
pharmacy. Now, there have been several
studies of heart disease with
post-menopausal women that again
suggest that antioxidants, if anything,
are harmful. In the current issue of
Arteriosclerosis, Thrombosis, and
Vascular Biology, there is an editorial by
Lewis Kuller, who is an epidemiologist
at the University of Pittsburgh,
suggesting, “Why don’t we just forget
about antioxidants?”
The question is, “Are we at the threshold
of being perceived by the public as a
bunch of bumblers who do not know
what they are doing, because here we
have been pushing something and
suddenly it does not work? Or, is it
because of the way the studies were
done or the supplements themselves and
when they were given?” I am still a firm
believer you need these dietary
components. We tend to try and bring
everything down to the lowest common
denominator. For instance, the whole
fiber hypothesis was that a diet rich in
fiber is healthful. That does not mean
adding fiber to a low-fiber diet and it
41
does not consider all the other
substances that are in fiber, many of
which we do not even know about yet.
One of the salubrious things in recent
epidemiology is that we are starting to
look at dietary patterns instead of
individual dietary components, because
we do not eat dietary components, we
eat a whole diet. We have to start telling
the public that we are not talking about
individual components, but the total diet
and possible interactions among
nutrients. Scientists and dietitians have
a pretty good idea of what we are talking
about, but the public does not. The
public is very fickle and once they
decide you do not know what you are
doing, even when you bring them the
truth, it will not be accepted. You may
remember a number of years ago, there
was a big flap about oat bran. Oat bran
was considered the savior of mankind,
until one particular paper appeared
which said it was of no value.
Immediately everyone did a 180-degree
turn on oat bran. I was supposed to be
on an ABC news program and they sent
the car over to pick me up. As we are
driving over to the studio, the driver
says, “What are you going to talk
about?” And I said, “The oat bran
thing.” He said, “I hope you don’t take
this personally, but I don’t think you
people know what the hell you are
doing.” This is something we need to
avoid, because when the good advice
comes, it will not be believed. We have
to provide the public with a better
explanation of how science works. Data
are analyzed and explanations presented
based on knowledge and experience.
The amazing thing is not how often we
are wrong, it is how often we are right.
Participant Comment
Is there a biological explanation for why
the antioxidants, beta carotene
particularly as a pharmaceutical, might
have gone awry? What has been
suggested by some people in Norway at
the Institute of Nutrition in Oslo is that
the antioxidant system is extremely
complex and it is always a balance.
It is run by enzymes, exogenous
antioxidants, and damage protectors.
The beta carotene may accumulate as a
pro-oxidant. Once it has been oxidized,
how do you get rid of it? That is the
suggestion — that beta carotene
probably accumulated and was a
pro-oxidant and ended up doing damage.
So, when we talk about getting your
antioxidants from a food source, it is a
good thing because you get a mix of
items, so no one single compound
predominates and does some harm.
Participant Question
If we are going to change to a whole
grain diet, perhaps there is a need to
educate consumers on the storage issue.
What are they finding about the storage
of whole grains?
Participant Comment
When it comes to whole grain products,
there are a lot of grains that are quite
stable and are easy to use — then there
are some that are natural and organic
with no preservatives and minimal
processing. Whole grain storage can be
more difficult, but it is not impossible.
Breakfast cereals are a good example
that whole grain products have a good
shelf life. It can be done in most cases
but, if you try to use products under the
condition that you could never use a
preservative, period, then you limit the
shelf life a little further. However, if
there was a market, I think industry
would address the challenge and the
products would get better and better.
42
Participant Question
What do you think of the utility of
glycemic response as a measure of
health status of a particular food? And
building on the whole issue of
“syndrome X,” what is your current feel
on insulin as a trigger?
Participant Comment
The glycemic index is just another effort
to find some kind of a common clue that
allows you to start judging food and
diets. It is a concept developed a long
time ago, and now it is getting a lot of
attention because of the general feeling
that both heart disease and cancer
development go through the juncture of
insulin — that hyperinsulinemia may be
the key to both of those. In my opinion,
the glycemic index has not been shown
to do anything except maybe give you a
slight prediction of risk in some cases.
That is why we talk about risk factors.
In Las Vegas, they are called odds.
I think “syndrome X” is apparently a
real thing that arises from our
preoccupation with cholesterol.
Cholesterol is very important but there
are other things it can do. This is one of
the problems the public has in dealing
with cholesterol — you need it worse
than it needs you. The public thinks it is
some kind of a foreign substance that
can be taken out of the diet. There are a
lot of aspects of cholesterol metabolism
that may be public health aspects that
have not very often been considered.
For instance, how much does dietary
cholesterol raise blood cholesterol? And
the answer is, if you do not have
saturated fat in the diet — practically nil.
There is still a lot to be learned because
we keep getting these new theories. We
do not know what triggers a heart attack.
When I started in this field, life was
simple. You ate cholesterol, it got in
your artery, and you died — period.
Now you have all these little proteins This means re-labeling. We have to
that move it in, move it out, and move explain on the product labels what we
something else, all of which play a role, mean by whole grain, and we have to
all of which can be affected by diet and use a standard set of words. For
other factors. So it has become example, we have rolled oats, rye hops,
tremendously more complicated. and cracked wheat. Which of them are
whole? It turns out that all three of them
Participant Question are whole, but then organic becomes
If we are going to form a coalition and confusing. Organic is a major
do some interventions to help people eat competitor for whole and organic is not
more whole grains, what kind of necessarily whole. Our consumer is
questionnaire could we develop to help never going to be able to answer the
us measure whole grain intake fairly question, “Are you eating a processed
simply and fairly accurately? whole grain, an intact whole grain, or a
processed, refined grain?” So we have a
Participant Comment really big educational job to do just in
Actually, the question about “do you eat the question, “What is a whole grain and
dark bread” is a good question. It is not how do you know whether you ate one?”
the best question in the world, because
pumpernickel is colored and molasses is
not a whole grain. Generally, the breads
consumers eat that are more whole grain
in our culture are darker. Specific types
of breakfast cereal have been very
successful. People can name a breakfast
cereal and we look it up in the list of
cereals; if it is whole grain, they
probably eat other whole grain cereals.
Brown rice is another good one. We
could go on and say, “Do you avail
yourself of the whole grain pastas or
whole grain flour? Do you make your
own cookies? Do you make your
own pancakes? We could ask
those questions, but almost no one
does that now, so it is not that
useful epidemiologically.

In the future, we want a questionnaire

that will last the next 10 years when
everybody is eating whole grains. To be
more precise, you need to increase the
vocabulary of the participants in our
studies and increase the vocabulary of
the general public.

43
44
Whole and Enriched Grains:
How Do They Measure Up as
Functional Foods?
Scientific debates that were once
conducted within the scientific and
health communities now are taking place
in the media. While the media may be
covering health and nutrition stories
more so today, that does not mean
consumers have a better understanding
of health and nutrition.
Today’s consumers are confused about
nutrition, but also recognize that
nutrition plays a greater role in health
than some other factors. Consumers are
concerned about heart disease, cancer,
diabetes, and their weight.
If the goal is to get consumers to
increase consumption of whole grains,
then we need to start with the consumer
and figure out what consumers need to
know to have a healthful diet. We need
to talk to consumers to find out what is
going to work, how that information is
going to be communicated, and why
people are going to recognize and
understand it.
Presentation by Sue Borra, R.D.,
Vice President, International Food
Information Council
If the goal is to get consumers to
increase consumption, we always should
start with the consumer. At the
International Food Information Council
(IFIC), we do a lot of work
understanding the mindset of consumers
as they are talking about nutrition,
health, and food safety. The work we do
is supported by the broad-based food,
beverage, and agricultural industries.
How does the science, research, and
policy get to that endpoint: the
consumer? Many years ago, you would
45
start with research based on the disease
of the moment. That information would
filter down to other doctors and health
professionals and then, eventually, to the
patient who is the consumer. Nowadays,
it is quite different. We have a wellness
approach. The way information is
getting packaged and delivered to
consumers has changed, with health
professionals and today’s media playing
a larger role. Today, the scientific
debates that were once conducted
within the scientific and health
communities are taking place in the
media. This also is what is feeding
into some of the consumer confusion,
because science is meant to be debated
— it is gray and ever changing.
Where are consumers getting
their information?
Where Do Consumers Get
Their Nutrition Information?
Television 48%
Magazines
Newspapers 18%
47%
Reference/General Books 12%
Family/Friends 11%
Doctors 11%
Internet 6%
Radio 5%
ADA Trends Survey 2000
In 1995, we started doing what we called
Food for Thought Research at IFIC. It
was an opportunity to take a snapshot
look at what kind of food and nutrition
and food safety stories were out in the
media during a period of time. We took
the period of May through July and
looked at what was coming out of
39 news media outlets, 12 magazines,
9 newspapers, wire services, and local
and national television stations; this
year, for the first time, we looked at
some online news sites.
Interestingly, in the last round of 1999 Below is a snapshot in USA Today a
data, functional foods were one of the couple years ago asking about the “types
top areas reported on by the media. The of media stories that most adults
story may not have specifically said find confusing.”
“functional foods” but, if it discussed
food for risk reduction, antioxidants, Snapshot of Diet and Health
etc., it was included in that category. Coverage in Consumer Magazines:
Jan.– May 2001
Herbs & Caffeine 2%
Obesity 1% each
herbals Wellness during
Eating disorders Food 6% pregnancy 2%
Food for Thought III Health info on safety
7%
Dietary fats &
cholesterol 2%
the Internet
Sugars & Food sensitivity 2%
FUNCTIONAL FOODS RISE TO THE TOP sweeteners
Physical activity 2%
Food & animal
Functional foods
Oral health Diet & weight
29%
Glycemic index loss
29% of ALL discussions 11%
Children’s
General
wellness & nutrition &
disease physical
prevention activity
Functional Foods (6%) Disease Risk Reduction (13%) International Food 20% 11%
Information Council
Vitamin & Mineral Intake (4%) Antioxidants (3%)
Fiber Intake (4%)

Feb. 23, 99
USA Today USA SNAPSHOTS®
A look at statistics that shape our lives
Confusing Health News
Types of media health stories (print and/or broadcast)
To compare the data between 1995, that the most adults say they find confusing:
1997, and 1999, we looked at what the Vitamins/ supplements 52 %
Nutrition 50%
stories claimed was the source of the Alternative health medicine 41%
Cancer 38%
benefit. And 57 percent of all the Alternative treatment 35%
for serious conditions
benefit claims in these stories were Heart disease
Elderly health issues
31%
31%
tied to some functional component in Depression 29%
Alternative procedures 29%
the food. Diabetes 20 %
0 10 20 30 40 50 60

Food for Thought III The bottom line is — they are confused
SOURCE OF BENEFIT
about everything.
57% of all benefit claims are tied to functional components

1999 1997 1995 A cartoon showing a broadcaster

Consumer functional foods 20%
Increase vitamins/minerals 11%
Eat fruits and vegetables 11%
Increase antioxidants 6%
Decrease fat intake 6%
Increase intake of soy products 5%
Increase fiber intake 4%
We also looked at snapshots of
consumer magazine coverage, which
largely focused on functional foods.
The media may be covering health and
nutrition stories more so today, but that
does not mean the consumer has a better
understanding of health and nutrition.
18% 14% explaining that scientists were studying
10% 11% links between estrogen and heart attacks
9% 11%
9% 9% while a woman is reading an article
7% 8% about estrogen reducing heart attacks
— —
says a lot about the consumer confusion.
8% —
That is probably what we have to look at
as we communicate more and more of
our research through the media. When
you look at things like consumer
communication, you really need to do a
consumer-based approach. We need to
understand what they are dealing with in
their lives, how they are choosing foods,
and what their lives are all about. And
you need to talk to them about their
attitudes and their behaviors.
46
In the case of functional foods, we
started getting calls from media saying,
“We want to do a story on
phytochemicals” or “We want to do a
story on antioxidants.” We found it was
Americans Have Positive Attitudes
About Nutrition, Health
• 93% of Americans say they have moderate
to great control over their health

consumer-driven, as opposed to science • 93% believe certain foods have health

driven, as was traditionally the case.
What we have used as a working
definition for the concept of functional
foods is, “Foods that may provide a
health benefit beyond basic nutrition.”
This gets you out of thinking of just
vitamins and minerals — nutrients we
know about — and gets you started
thinking about those functional
components and what they might be.
To begin to try to understand how
consumers were thinking about this, we
conducted both qualitative and
quantitative research, including focus
groups beginning in 1996 and
quantitative consumer surveys in 1998
and 2000.
Tracking Consumer Attitudes
Quantitative Consumer Surveys
1998 and 2000
benefits that may reduce the risk of disease
or other health concerns
While Americans are confused and
frustrated about nutrition, they do
have a positive feeling about it. They
know it is important, and they have a
value attached to it.
Interestingly, we see this interest in
terms of eating foods for health increases
as we age and differs between men
and women.
Age as a Factor of Eating Food
for a Specific Health Benefit
Older Boomers Still Setting the Trend
55+ Years
70 35-54 Years
Percent Eating Functional Foods

60
18-34 Years
50
• Positive attitudes about nutrition, health
40
• Shift toward adding “good” vs.
30
eliminating “bad”
20
• Incorporating more functional foods 10
• Consumers want to learn more 0
IFIC 2000

The Gender Gap

Women Men

Consumer Perception: Food/nutrition play “great” role 79% 68%

Consumption Changes Health professional
49% 30%
most believable
From 1998 to 2000
Primary shopper 81% 42%
“Very interested” in
Percent who are eating up to three foods learning more
51% 41%
for their functional health benefits

1998 52% IFIC 2000

2000 59%

47
All of this impacts the messages you will
Are You Aware of an
need to communicate in terms of who
Association Between …
your audience is.
78%

People also think nutrition plays a 61%

52%
greater role in health than some 48%
38%
other factors. 21%

Nutrition Plays a Greater Role in Calcium and Antioxidants and Soy Protein and
Maintaining or Improving Health Osteoporosis Cancer Heart Disease
IFIC 2000 Yes No
74% 74%
64% 63%
What are consumers concerned about?
41% 39%
Top health concerns include heart
disease/heart attack at 32 percent,
cancer at 31 percent, diabetes at
Food/Nutrition Exercise Family Health 14 percent, weight at 14 percent,
History
1998 2000
nutrition/diet at 13 percent, and blood
IFIC 2000 pressure at 8 percent. Diabetes is
definitely entering the psyche and it will
In fact, that is an opportunity to be interesting to see if that is changed in
communicate more about the important the coming years because of some of
role of physical activity in health. That the new data out on the prevalence
message has not really gotten through to of diabetes.
the public as well as the food message
has, and we have more opportunities We also asked consumers about some of
there. We also are seeing a shift in how the specific functional food types of
people are trying to look at food — components and issues related to health
removing the bad and adding the good. to gauge their level of awareness.
And a shift in consumer awareness of
foods may reduce risk of disease, which
has decreased in some cases. Effectiveness of Food/Component
and Disease Link
Shift From Removing the 1%
5%
Not at all/probably not effective
May or may not be effective
19%
1%
Probably is effective
“Bad” to Adding the “Good” Definitely is effective
34%
Q: Over the past five years, what changes have 12% 4%
49%
you made to improve or maintain your health?
45%
29%
1998 2000
46%
Consuming less fat 36% 24% Calcium and Osteoporosis
Antioxidants and Cancer
55%
Eating more vegetables 20% 22%
IFIC 2000 Soy Protein and Heart Disease
Eating more fruit 10% 13%
Exercising 14% 12%
But we still have some opportunities to
IFIC 2000 get out more information out in those
areas. Consumers still have questions
about efficacy and I think those are
probably, in some respect,
healthy questions.

48
While health claims do require gold
standards of science, they have absolutely
no standards in consumer understanding.
Unfortunately, most of these messages go
right over the heads of consumers. In fact,
they do not even think the government has
anything to do with them. As you know,
there is a health claim on folate and neural
tube defects — “healthful diets with
adequate folate may reduce a woman’s
risk of having a child with brain or spinal
cord birth defect.” There was a study
published in the Journal of Pediatrics.
When they initiated the study, birth defects
were almost twice the current national
averages, about 19 cases per 10,000 births.
They implemented a communications
campaign encouraging the consumption of
more folic acid using TV, radio,
billboards, and magazines. By the end of
1998, they had fewer than 10 cases per
10,000 births. Another study, published in
the Journal of the American Dietetic
Association, looked at low-income
pregnant women in Atlanta, Ga. Eighty
percent of the subjects did not take
preconception supplements and, in this
group, 57 percent said they had heard of
folate, but only 26 percent knew why it
was important. But through the
fortification of grains, 77 percent were
able to achieve the recommended
amounts. I think what is important after
you see the science is to address the
question, “What do consumers know about
this?” In 1999, Opinion Research
Corporation asked if people knew
something or a lot about fiber, calcium,
and folic acid. Of these 1,000 people,
90 percent said they knew something or a
lot about fiber, 90 percent said they knew
something or a lot about calcium, and only
56 percent said they knew something or a
lot about folic acid.
49
Survey participants also were asked
whether calcium, fiber, and folic acid
individually were extremely or very
important to the diet. Ninety percent said
calcium was very important or somewhat
important, 83 percent said fiber was very
important or somewhat important, but of
the 56 percent who said they new
something or a lot about folic acid, only
half said it was important or somewhat
important in the diet. When they explored
a little bit more about folic acid and its
specific health benefits, pregnancy and
birth defects were the No. 1 thing they
could mention, unprompted.
Consumers and Folic Acid:
Specific Health Benefits of Getting
Enough Folic Acid (Unprompted)
Base: Those who know a lot
or know something about
folic acid
Pregnancy/birth defects 25%
Vitamin mentions 8%
Good for blood 3%
Good for heart 3%
Aids digestion 2%
Don’t know 40%
Caravan® Opinion Research Corporation International December 1999
This just gives you an idea of where
consumers are. What we have to figure
out is what do consumers need to know
to have a healthy diet. Not everything
we may think is important in the science
and health community needs to be
detailed for consumers. As you
approach this communications
opportunity or behavior change
opportunity, I think we are seeing a shift
in the public, and they are looking for
something good to do. Because they
have been bombarded so much by the
“eat it and die” mentality, they are
anxious to get a good news message.
A majority of the consumers believe
they do control their health, so we can
play into that and show how grains
might be helpful. They still believe
nutrition plays a large role and has a
value, even though they find it
confusing. Most importantly, one
message will not fit all. If we take a
“Three Are Key” approach, we are going
to have to do a lot of consumer testing to
find out what is going to work, how that
is going to be communicated, and if
people are going to recognize and
understand it. I think it is an exciting
beginning of a journey.

50
Audience/Panel Interaction — Where
Do We Go from Here?
Following are select participant
comments and questions from the panel
interaction session, with opening
statements by David Klurfeld, Ph.D.,
Wayne State University, and
Marla Reicks, Ph.D., R.D.,
University of Minnesota
David Klurfeld, Ph.D., Wayne
State University
One of the problems and one of the
opportunities in getting consumers to eat
whole grain foods is that the biggest
single source of calories in our diet is
white bread, rolls, and crackers. You
can get whole grains into those kinds of
foods. The second biggest category is
donuts, cakes, and cookies. You cannot
get a lot of whole grains into those, but
you can make muffins, bagels, and pasta.
To grab consumer interest and
acceptance, the food industry might want
to think about intermediate type products
— something like whole grain “lite” that
has a portion of whole grain products
in it.
Many of us have heard of
Walter Willett’s version of the
Food Guide Pyramid and his approach to
grains. Unfortunately, part of the
problem is we do not eat according to
the current Food Guide Pyramid. So I
am not sure changing the Food Guide
Pyramid and separating whole grains at
the bottom and refined grains at the top
is a productive approach. The industry
will cannibalize itself if it goes in
that direction.
51
Willett’s aversion to refined grains is
based almost exclusively on the
glycemic index, which was developed
primarily as a research tool. A lot of
people are trying to apply it now to
whole diets, but it does not really work
for whole diets. You can calculate a
glycemic mix for a specific meal, but if
you ask someone what they ate
yesterday, you do not know if they ate a
slice of cheese with the white bread or
not, so you do not know how that cheese
affected the bread. My response to those
who tout the glycemic index is that
bacon and eggs is a very low glycemic
breakfast, and I do not think Willett
would be very happy with people eating
bacon and eggs for breakfast.
One of the important points for
academics to answer is, “is the whole of
the grain the sum of its parts, or is it
greater?” And I suspect it is greater.
One of the problems in addressing this is
there are lots and lots of components
and, as researchers, we are
pigeon-holers. We want to dig that little
hole deeper and deeper and narrower and
narrower until we find that single
nutrient and then put it in a pill. That
has not always been successful and, in
fact, has been seemingly unsuccessful in
the past. One of the issues with whole
grain, or any other intact food, is the
benefit derived from something other
than a single nutrient? Is it the physical
characteristics of the food itself as it
passes through your digestive tract? Is it
the viscosity of the food? Is it the fact
you have low abrasive stools and that is
why you have less colon cancer? Is it
because you have changed the
microflora in your intestine?
Then the question becomes, “How will
these whole grains be sold to
consumers? Is it through a health
benefit?” That is really the only
message you are sending. You are not
going to tell them it tastes better,
because most of them do not think it
tastes better, even if it does. Is it lighter
and fluffier? Whiter and brighter? All
the Tide® detergent commercials apply
to selling food. One of the possibilities
with whole grains is the idea of selling
satiety as a factor — eat this and you
will not eat as much. That does not
seem to be a selling point these days,
because the American food industry has
essentially embraced bulk and quantity
over taste. And I think health benefits
really are a two-edged sword. There is
the usual response if it tastes good — it
is bad for you and vice versa.
We also need to know the value of
intermediate endpoints. A year and a
half ago, there were two papers in the
New England Journal of Medicine on
colon polyps and recurrence of polyps.
Neither study was successful in reducing
recurrence of colon polyps and the
headlines read, “Diet has Nothing to do
with Colon Cancer.” That is not the
case. You need to be very specific about
what the endpoints were. I think one of
the lessons from both of those studies
combined is maybe polyps are not the
right endpoint for determining risk of
colon cancer. Polyps are a
pre-cancerous, benign condition that are
high risk for colon cancer. Likewise,
there has been heavy reliance in the last
five to 10 years on cell proliferation in
the colon as an indicator of risk. And
the more we learn, the less certain we
are that cell proliferation is important.
52
Marla Reicks, Ph.D., R.D., University
of Minnesota
I pose three general areas of questions
for the grains industry, educators,
dietitians, etc., to think about. What
does the industry think about the idea of
a universal seal to help consumers
identify whole grains and how would
you go about doing it? Secondly, it is
my understanding that the Dietary
Guidelines Committee did not quantify a
specific recommendation. Is that going
to be a problem for nutrition educators
or consumer educators as we try to go
forward with the “Three Are Key”
message? And last, I think some of the
CSFII data shows there are some
segments of the population, lower
income, ethnically diverse audiences
who eat maybe half of the one serving
that the average American eats. Do you
have any thoughts on types of foods we
can promote to these audiences that
would help them increase whole grain
intake, especially given the fact they are
at higher risk for chronic diseases for
which we know whole grains can
be beneficial?
Participant Question
Consumer education is so critical to the
outcome we are trying to find here but
the reality is, we have fewer and fewer
consumer educators within the industry,
grocery stores, schools, and county
programs at the grassroots. Where
do you see the future of consumer
education heading?
Participant Comment
Where is the future of consumer
education? If I look at my colleagues
who are dietetic professionals, more and
more dietetic professionals are looking
into doing more outreach and working
with consumers and looking at different
venues to consider. It may be in a health
club environment and it may be in other
areas we are not even thinking about
today. I do see, especially in our
younger professionals coming into the
profession, less interest in a clinical
environment and more in outreach
environments. A lot of these folks are
going into media positions themselves.
Think about the power of the dietitian
reporter, the television dietitian writer,
etc. Those are the opportunities out
there. There are still going to be great
changes in the way we practice our
profession and, while it may be different,
we have to make sure we keep track of it
so it is still as good as we have had or
perhaps better in the future.
Participant Comment
I think it is good to hear a culture can
change. When I was a product
developer, we were taught there were
three things driving a product — cost,
quality, and convenience. I believe that
list may have grown and I think health is
probably a driver, too, but those three
are still primary. You can do all the
education in the world, but if it does not
taste good and people do not like it, it is
not going to fly. That is the biggest
thing I think we need to overcome and
the biggest challenge we have in getting
more whole grains into the diet.
Participant Question
With the “Three Are Key” message, do
we have enough science to push that? I
think the Five A Day program is a good
paradigm. How much evidence was
there when they started? I do not think
53
there is any downside to pushing
“Three Are Key,” but I am not sure the
science is there yet. I would like to
know if anybody in the audience feels
strongly one way or the other about three
servings a day?
Participant Comment
You are right that the science is not
there, but I am not sure at this point in
time if it makes a big difference. If
consumers are only consuming one
serving a day currently, it is going to
take some time for them to triple
consumption. I am not sure we have to
have science to say three is good,
because it is going to take a while to get
there anyway. We also need to be
careful to remind consumers all grains
are good and not turn them off by saying
they should only eat whole grains.
Participant Question
Science is elusive and, as we see in the
media, it is really difficult to portray
exactly what truth is. It seems to be
prudent at this time to encourage
more whole grains. Now, how many
servings is tough. Three seems like a
reasonable thing. It is much more than
people are eating right now and maybe it
is achievable. Those are the kinds of
considerations that are important, more
so than how much you should eat. A
number of these things should come into
consideration as we choose what
message exactly to give and particularly
the question of what to say about the
number of servings.
54
PART III: CHANGING BEHAVIOR AND
GETTING THE POPULATION TO EAT
MORE GRAINS
Plenary Session — Barriers to Grains
and Whole Grains Consumption
Several consumer studies have been
conducted to quantify the current usage
of whole grain breads and quantify the
importance of selected barriers to whole
grain bread consumption. The fact is,
20 percent of adults and 40 percent of
teens and kids never eat whole grain
bread, and consumption averages for
whole grain breads are just three to four
times a week.
The majority of respondents considered
six barriers to be major reasons that
their families do not consume more
whole grain bread. No. 1: color of the
inside, followed by price, softness,
texture, moisture or dryness, and
perhaps surprisingly last was taste.
Another barrier not specifically related
in the data is low consumer awareness,
which is driven by confusion of what
qualifies as a whole grain product.
What are the strategies to overcome
those barriers? Educate the consumer,
build relevance with the target
consumer, and develop innovative
products to attract key targets.
Presentation by Gary Jensen,
Senior Vice President of Marketing,
Sara Lee Bakery Division
Of the top 10 universal product codes
(UPCs) in supermarkets, nine are
fresh-baked breads. Five are white and
the other four are soft varieties, but only
one is called whole wheat; and none are
hardy or super-premium products that
we would consider to be whole grains
according to the definitions we used in
the symposium. You might be interested
55
to know the No. 1 one bakery UPC is
actually a Thomas plain English muffin.
And, you do not get to a whole wheat
muffin until you get down to No. 7, and
that is a Nature’s Own product.
Category Overview
Of the top 10 fresh baked good UPCs in supermarkets*
• Nine are fresh baked breads
• Five are white breads
• The other four are soft varieties
• Only one is whole wheat
• None are hearty super premium products
Thomas English Muffins Plain (12 oz.) Wonder White Round Top (22 oz.)
Sunbeam White Sandwich (24 oz.)
Merita White Round Top (20 oz.)
Homepride Butter Top Wheat (24 oz.)
Butternut White Sandwich (20 oz.)
Homepride Butter Top Wheat (20 oz.) Nature’s Own Whole Wheat (20 oz.
Nature’s Own Honey Mrs Baird’s White Sandwich 24 oz.
Wheat Split Top (20 oz.)
*Bread, Buns, Rolls, English Muffins, and Bagels: 61,000 UPCs
IRI Infoscan 52 weeks ending July 7, 2001
Looking a little further into sales in
supermarkets by UPC, only five of the
top 50 fresh bakery UPCs are whole
wheat bread products. But the good
news is the growth of these products is
five times the top 50 growth rate of fresh
bread, buns, rolls, English muffins, and
bagels representing 61,000 UPCs for the
bakery category in supermarkets across
the United States today — a staggering
number. They are up about .08 of a
percent in terms of unit sales. The top
50 are up 4.2 percent, but the whole
wheat breads, those five UPCs, three of
which we call soft variety, are up almost
22 percent. So there are some good
things going on with whole wheat bread.
Bread is a very mature category. In fact,
in U.S. supermarkets, the annual
household penetration of bread is higher
than toilet paper. Because bread is a
mature category, it has business models
in place. There are paradigms set that
are hard to change. So we have our
work cut out for us as we go forward and
try to grow whole grains.
Several consumer studies have been
conducted from 1996 to the present,
including a July 2001 survey sampling
Twenty percent of adults and
of adults. The objectives of the survey: 40 percent of teens and kids
to quantify the current usage of whole
grain breads and quantify the importance
never eat whole grain bread.
of the selected barriers to whole grain And for those who do eat
bread consumption. Results from these whole grain bread, the
studies follow:
average consumption is only
Twenty percent of adults and three to four times per week.
40 percent of teens and kids never eat
whole grain bread. And for those who
do eat whole grain bread, the average Kids’ Influence on
consumption is only three to four Bread Purchase Patterns
times per week. It is important to • Kids exert considerable influence on the decision to
note this is “claimed” consumption; buy bread brands, especially white bread brands
people tend to overstate what they Brand Purchased Kid Influences
Primarily for Kids Brand Purchased
know they should eat and understate White Bread Brands 28.8% 57.6%
what they know they should not eat.
Soft Variety Brands 16.4% 40.5%
The other thing operating here is
Super Premium Brands 5.9% 35.4%
consumer confusion between whole
grains and just wheat breads.
EGR primary research, August 1999 sample of 1000 primary grocery shoppers in four markets

Whole Grain Bread

Consumption Patterns The research identified six need-based
• 20% of adults and 40% of teens and kids never eat segments for bread.
whole grain bread
• Claimed consumption of whole grain breads averages
3-4 times per week Head of Household
Female
Younger Kids
Male Teens at Home
Consumer Need Segmentation
Nearly every meal (14) 7.1% 9.8% 10.1% 7.4%
At least once a day (7) 24.6 19.0 15.5 19.5 • Proprietary research identifies six need-based
Several times a week (3) 26.5 23.1 16.4 15.9 segments for bread: Kid Fluenced is the largest
Less often (1) 18.6 20.7 15.3 15.6
Never 19.7 21.1 42.1 39.8 Segment Size
Not familiar with Households Dollar Sales
not asked not asked
whole grain breads 3.2 5.5
Average per week 3.8 3.8 3.2 3.1 Kid Fluenced 20% 24%

Specialty Nuts 17% 18%

July 13-15, 2001, TeleNation telephone survey among a nationally representative random digit
dial sample of 1000 adults 18+ Grocery Gourmets 16% 17%

Necessary Eaters 16% 13%

Kids exert considerable influence on the Brown Baggers 15% 14%

decision to buy brands, especially white On Dealers 14% 13%

bread brands, with kids’ influence even EGR 1999 Segmentation Study

more important than price in many

cases. Kids are going to be a key to The kids segment profile is the heaviest
unlocking this opportunity for bread-buying segment — white bread
whole grains growth. buyers, family and kid oriented, some
homebodies, convenience-minded, but
willing to pay for value-added benefits.
Looking at the whole grain bread user
profile, we see something very different.

56
For average eating occasions per week Average Eating Occasions Per Week
by census region, the lowest average by Household Income
• Consumption tends to be higher among the lowest
consumption of whole grain bread is in (driven at least partially by retirees) and the highest
the South, which is much lower than the income segments
4.2
Northeast and the Midwest. Survey
4
3.4 3.4
Average
3.8
Average Eating Occasions Per Week
by Census Region
• Lowest average consumption of whole grain
bread is in the South Under $25K $25K-50K $50K-75K $75K+
Survey 4.2 4.1 3.5 3.9 July 13-15, 2001, TeleNation telephone survey among a nationally representative random
Average digit dial sample of 1000 adults 18+
3.8

When evaluating changes in whole grain

consumption patterns during the past
12 months, several groups claimed to be
Northeast Midwest South West eating more whole grains — including
July 13-15, 2001, TeleNation telephone survey among a nationally representative random digit
dial sample of 1000 adults 18+ kids 12 and younger and Midwesterners.
Those who reported they were eating
So, you begin to see a little bit of an less tended to be from the South.
opportunity perhaps developing by Overall, whole grain consumption did
census region. not change for more than 70 percent of
adults, teens, and kids surveyed. The
Average eating occasions per week by strongest net increase was seen among
age of household tends to peak over kids under 12.
time, up to 5.1 occasions per week
among those over 65.
Consumption vs. Year Ago
Average Eating Occasions Per Week • Whole grain bread consumption did not change
for over 70% of adults, teens, and kids
by Age of Household
• Whole grain bread consumption tends to increase • Strongest net increase is among kids 12 and younger
with age, peaking at 5.1 occasions per week among Head of Household Younger Kids
those 65+ Female Male Teens at Home
5.1
Eating more 13.4% 11.8% 6.6% 13.0%
Survey 4.2 whole grain bread
Average 3.4 3.6 3.6 About same as year ago 72.7 77.9 82.9 78.8
3.8 3.2
Eating less 12.0 8.5 6.8 5.0

Net change +1.4 +3.3 -.2 +8.0

(% more – % less)

July 13-15, 2001, TeleNation telephone survey among a nationally representative random digit
dial sample of 1000 adults 18+
18-24 25-34 35-44 45-54 55-64 65+
Head of Household Age
July 13-15, 2001, TeleNation telephone survey among a nationally representative random digit
dial sample of 1000 adults 18+.
In terms of consumption vs. a year ago
by census region, the highest increase
Occasions per household income tend to appears to be in the Midwest. And, the
be higher among the lowest and the highest level of eating less was, once
highest income segments, with retirees again, in the South.
likely occupying the lower end.

57
 Consumption vs. a Year Ago Generally, consumers do not
by Census Region understand the difference between
• Highest net increase in whole grain bread wheat bread and whole grain bread.
consumption appears to be in the Midwest There also is a limited availability of
• Highest level of “eating less” is in the South
whole grains — about 5 percent, based
Northeast Midwest South West
on our estimation. And, I am going to
Eating more whole grain 12.1% 17.7% 12.7% 7.4%
About same as year ago 76.4 75.0 70.7 81.9 criticize our own industry a little bit and
Eating less 9.4 4.6 14.9 9.8 say our promotional efforts are fairly
Net change +2.7 +13.1 -2.2 -2.4 weak. Other industries spend more than
(% more – % less)

July 13-15, 2001, TeleNation telephone survey among a nationally representative random digit
we do to get the message out.
dial sample of 1000 adults 18+

Industry Promotion Spending

We also talked with consumers about the
actual barriers to eating more whole Eggs 15.7

grain breads and we were surprised by Pork 16

some of the findings. The majority of Beef 30

the respondents considered six barriers Dairy/Cheese 29

to be major reasons that their families do Dairy/Milk 180

not use more whole grain bread. What
Bread/Rolls 0.35
was most surprising, was the rankings $0 $20 $40 $60 $80 $100 $120 $140 $160 $180 $200

of the barriers: No. 1: color of the Million dollars

inside, followed by price, softness, Fleishman-Hillard

texture, moisture or dryness, and

taste. In previous studies, taste and Now, I would like to shift to some
texture or taste and softness have been potential strategies to break down the
the top barriers. But, the “color of the barriers (in our potential target
inside” finding may present an segments), the number of people within
additional consideration to examine from those segments, and how their current
a product standpoint. whole grain bread usage varies.

Barriers to Eating More Potential Target Segments

Whole Grain Breads
Current Whole Grain
• The majority (60%+) of respondents consider each (in Millions) Bread Usage
of the six listed barriers to be a “major” reason that
Kids 6-12 31.7 40% Never
their families do not eat more whole grain breads
• “Color of Inside” ranks #1; “Taste” ranks #6 Teens 13-17 26.6 40% Never
Major Reason Minor Reason Not a Reason
Color of the Inside 82.6 9.2 6.8
Young Adults 18-24 25.5 Low But Growing
Price 72.2 14.9 11.7

Softness 71.8 11.8 14.9 Older Adults 55+ 60.3 Relatively High
Texture 70.9 13.5 13.7

Moisture or Dryness 70.1 13.1 15.1

Taste 60.9 12.8 25.5

July 13-15, 2001, TeleNation telephone survey among a nationally representative random digit U.S. Census Bureau, Census 2000
dial sample of 1000 adults 18+

Another barrier that is not specifically So, who do you pick? Well, one of the
related to the data is low consumer biggest difficulties with marketing is that
awareness, which is driven by confusion. you maintain a discipline to “try not to
be all things to all people all the time.”
We need to select our targets carefully.

58
If we were giving the guidance, we
would select adults who never eat or
who eat whole grains less than once a
week, teens and kids who never eat the
product, and the South, where the lowest
average consumption occurs. There are
some key barriers common across
each group.
• No. 1: Lack of understanding of
whole grain benefits driven by a low
awareness. People may not consume
whole grains because they simply do
not understand the importance of
whole grains within the diet. There
also is confusion, for which we as an
industry are partly to blame, because
we tend to treat all breads as equal
when they really are not.
• No. 2: Not relevant to their lifestyle.
People may be aware but not
interested, or may not be consuming
whole grains because whole grain
products/brands are not relevant to
them and their lives.
• No. 3: Current whole grain product
profile. People may not appreciate
the profile. Perhaps they are aware
and they have tried whole grain
products, but they reject them. They
are not coming back to repeat
purchase because of color, price,
softness, texture, etc.
What are the strategies to help overcome
some of those barriers? For barrier
No. 1: lack of understanding, the
business strategy would be education of
the consumer on the value and the
benefit of whole grains. It is not new,
but that is what it is going to take.
Another strategy would be to
differentiate whole grains from other
breads. We also brainstormed some
tactical ideas to implement these
strategies, which include a special whole
grain section in grocery stores, an
American Bakers Association-sponsored
educational effort (whole grain icon on
59
bag), a school education program,
employing doctors and nutritionists to
convey new whole grain health findings,
partnerships with health magazines,
and health expos and events to
create awareness.
For the second barrier, a lack of
relevance, the obvious strategy is to
build relevance with the correct
consumer target. Tactical ideas to
implement this strategy include
developing a special whole grain section
in stores, involving the consumer with a
cause or meaningful association
(i.e., young adults and environmental
issues; kids/teens and the X Games).
For the third barrier, the current whole
grain product profile, the strategy is to
develop innovative products to attract
key targets. The tactical ideas include
fun, great-tasting products (whole grain
cinnamon swirl bread, IronKids® whole
grain bread, whole grain graham
crackers, whole grain cookies) and
portable products (whole grain bagel
bites, whole grain cheesecake bites) for
kids; and half loaves of whole grain
varieties and the introduction of new
international whole grain varieties
(quinoa) for adults; as well as
development of a softer, lighter color
whole grain bread for the South. The list
goes on and on.
I was shopping with my wife in a place
called the Galleria in St. Louis a couple
of weeks ago and I went to one of those
coffee shops to get a coffee. I noticed,
as I was standing in line, that there were
six people in front of me — all teenage
girls. And I am thinking to myself, what
are six teenage girls doing buying
coffee? Their coffee did not exactly
look like my coffee. It had whipped
cream and sprinkles and a straw. But
part of the retail success in coffee comes
from the fact that they are attracting that
consumer or that target audience. So,
what are the whipped cream and
sprinkles and straws for the bakery
business? How do we reach out and
touch them with transitional products?
I heard somebody say something about a
jelly whole grain donut. Sounds funny,
but I do not know that that is too bad of
an idea. I do not think it is realistic to
expect them to just make the leap from
white bread to whole grain breads. We
are going to have to develop products to
make that easier.

60
BREAKOUT SESSION I: BEHAVIOR
AND CHANGE
Changing Consumption — Models for
Affecting Change
There are several strategies geared
toward changing behavior. Azjen’s
Theory of Planned Behavior (TPB) is a
well-researched behavior change theory
at the individual level. This theory
assumes that behavior change is
predicted by people’s intention to
change behavior, their attitude toward
the behavior, and their perceptions of
the control they have over enacting
the behavior.
Ecological models ask broader
questions about our behavior. These
models assume that intrapersonal,
socio-cultural, and physical factors
influence our behaviors in synergistic
and reciprocal ways.
Psychosocial factors are primarily the
individual level factors, including
knowledge, motivation, attitudes,
and skills.
All of these approaches must be
considered in an effort to increase the
consumption of grains and whole grains.
Presentation by Leslie A. Lytle, Ph.D.,
Professor, University of Minnesota
This presentation has three
primary purposes:
1. To share insights into behavior
change at the individual level, using
the Theory of Planned Behavior as
the exemplar.
2. To share insights into behavioral
change at the population level, using
an Ecological Model as an exemplar.
61
3. To apply such theoretical models to
increase the consumption of
whole grains.
Individual behavior change: Examples
of behavior change strategies that are at
the individual level include
patient/practitioner interactions, many
educational and instructional
interactions, and media messages
designed to affect consumer choice.
These types of strategies are primarily
active strategies that require the
individual to make some change or
behave in some way. For example, an
intervention strategy that tries to get an
individual to start eating a breakfast that
includes a whole grain cereal is an active
strategy. Active interventions often
require the individual to possess some
knowledge, motivation, positive attitude,
or behavioral skill. Many of our
traditional nutrition education
approaches focus on affecting
knowledge and have had limited success.
Knowledge is a necessary, but not
sufficient, condition for change.
Ajzen’s Theory of Planned Behavior
(TPB) is a well-researched behavior
change theory at the individual level.
The theory assumes that behavior
change is predicted by: people’s
intention to change behavior, their
attitude toward the behavior, how they
believe others view the behavior, and
their perceptions of the control they have
over enacting the behavior. This control
might include physical barriers to
making the behavior change, but also
includes perceptions of self-efficacy
or competence in making the
behavior change.
Applying TPB to whole grain
consumption might be operationalized
as follows:
Behavioral target: I make sandwiches
for my family using whole grain bread
or rolls.
Attitude: “I will like the taste of
sandwiches made with whole
grain breads.”
Subjective Norm: “My husband will
complain about the change in bread
on sandwiches.”
Perceived control: “Whole grain rolls
will be more expensive than white rolls.”
Intention: “The next time I go to the
store, I will buy whole grain buns or
bread for sandwiches at home.”
The extent to which attitudes, subjective
norm, and perceived behavioral control
facilitate one’s decision or intention to
behave in a prescribed way, predicts
how likely it is that the behavior
will occur.
Our theoretical models that focus on
individual behavior change have limited
success. Only about 30 percent of the
variance in eating behaviors is explained
by psychosocial constructs. Our
psychosocial models work best when we
ask them to explain more specific
behavior (i.e., choosing whole grain
breads for sandwiches) than they do for
broader aspects of dietary behavior
(eating more servings from the
breads and grains group of the
Food Guide Pyramid).
62
Ecological models: ecological models
ask broader questions about our
behavior. Ecological models assume
that intrapersonal, socio-cultural, and
physical factors influence our behaviors
in synergistic and reciprocal ways. As
such, ecological models provide for the
possibility of passive interventions, or
interventions where the individual does
not need to make a choice and may not
even know that some element of a
familiar product is different. An
example of a passive intervention is
folate supplementation of grains.
Possible passive intervention strategies
to increase the population’s consumption
of whole grains would be: 1) adding a
proportion of whole grain flour to all
refined grain products, or 2) restricting
choices in restaurants and other food
service operations.
Applying ecological models to whole
grain consumption might be
operationalized as follows:
Physical environment: This refers to
access and availability. Are tasty whole
grain options available in stores, at
home, and at work or school? Do all
segments of the population have equal
access to the products (cost, availability
in stores)?
Socio-cultural factors: How do we
move from a white bread culture to a
whole wheat pita bread culture? How do
we make eating whole grain cereals the
normal or cool thing to eat for a student
in a school breakfast program? Who are
our role models for eating whole grain
products and how do we support and
reinforce the selection of whole grain
products?
Psychosocial factors: These are
primarily the individual level factors
previously mentioned, including:
knowledge, motivation, attitudes, and
skills. The difficulty in enhancing the
population’s skills in being able to
recognize a whole grain product should
not be underestimated. How does the
consumer know they are eating a whole
grain product? Even the concept “whole
grain” is a bit abstract, meaning that it
will be more difficult for people to know
exactly what they are supposed to do and
how they are supposed to do it
(assuming that they are motivated
enough to want to make a change)!

Recommendations:
1. Do not rely solely on
knowledge-based nutrition
education to increase consumption
of whole grain products.
2. Consider taste, as well as the
social, cultural, and physical
environmental influences.
3. Look to social marketing for ideas on
changing consumer behavior.
4. Attempt to find passive, as well as
active intervention approaches.

63
64
The Consumer and Behavior Changes
While the concepts of “food” and
“nutrition” fit together for dietitians,
consumers often view it as a battle
between “food” and “nutrition.”
Consumers tend to be frustrated and
confused by all of the diet information
and misinformation in the media. The
good news is that nutrition is still a
value that is important to consumers.
When designing a consumer
communications program, it is important
to look at the needs and understanding
of the people you are trying to serve with
this information. We need to talk in a
language that makes sense to people,
that captures their attention, and gets to
the outcomes we are looking for in terms
of change. There is an opportunity to
find new ways to engage in discussions
on nutrition and embark on a new
campaign to increase consumption of
grains and whole grains.
Presentation by Sue Borra, R.D.,
Vice President, International Food
Information Council (IFIC)
What do consumers think? What do
they feel? How are they dealing with all
this information about food and nutrition
and health? And, how can we learn
from that and do a better job as we
are trying to communicate and
influence them?
For nutritionists and dietitians, the
concept of the word “food” and the word
“nutrition” go together. They are like
peanut butter and jelly — you cannot
separate them. But when the consumer
looks at these two words, they look at
them a bit differently. It is “food” vs.
“nutrition.” It is, “If I eat healthy, it is
going to taste bad.”
65
This is going to be a difficult challenge
for us to overcome because there is a
certain ingraining that has put food and
nutrition on more of a battlefield than a
cooperative field.
In June 2000, we went to the streets of
Chicago and interviewed consumers.
We asked them questions about food and
nutrition and health to get their opinions.
First, as they were milling around the
street we asked them questions such as,
“What do you think about food?” At the
beginning, when they talked about food
and their favorite foods, they smiled and
their faces lit up. Some of their
comments included the following:
“Ah, I love to eat. When my family gets
together, we eat a lot.”
“I like meat, ice cream, Italian food,
Chinese food, lasagna, fish; I
eat everything.”
“Anything they say is not good for you,
that’s what I like.”
“The best food is broccoli.”
The conversation then turned to
nutrition and the reactions and
comments changed:
“The hype right now may be
carbohydrates are bad, but next year, it
might be no, take in more carbohydrates.
One says eat it, one says don’t eat it.
It’s good one year and it’s bad the
next year.”
“They say that butter is high in
cholesterol. Recently, they came out
with a study how margarine is worse
than butter. So which story is
true then?”
“There have been so many articles about
food in the media that I’m sick and tired
of seeing it, frankly.”
“They never say anything bad
about broccoli.”
The subject of nutrition has been high on
the minds of consumers. The question
we need to answer now is, “How do we
need to look at and deal with it before it
goes much further?”
In 1998, we conducted qualitative
research with female food gatekeepers.
We talked to them about dietary fat and
we looked at the dietary fat guideline to
gauge their opinions. Our question was,
“How can we talk to you about it in a
way that makes sense?” As a warm-up
question for these focus groups, we
decided to say, “Tell us about your
eating patterns.” The question was,
“How many of you in this room feel
100 percent comfortable with the way
you eat and your eating patterns?” How
many people do you think we got in all
these focus groups to raise their hand as
100 percent comfortable? Zero. We
then went to the other end and asked,
“How many of you are 100 percent
uncomfortable with your eating
patterns?” With this question, they were
somewhere in the middle, between
highly comfortable and totally
uncomfortable. We said, “So you are
telling us you are feeling a discomfort
about your eating patterns. Tell us what
that feels like.” These were the
emotions they described:
“When I think about my eating patterns,
I feel guilty. I worry about it. I worry
about what I’m doing for myself and my
family. I feel helpless.”
66
“You know, sometimes it really makes
me angry when all these things are
going on and I’m really trying to do the
right things for myself and my family.”
We were behind the glass ... we did not
expect this, as this was one of those
throwaway warm-up questions. We
thought, “Oh, my heavens! Look at
what our nutrition messaging has done to
consumers. We have left them with a
guilt package that is unbelievable and we
need to change this conversation. We
need to focus on the positive and get
them to be empowered.” You want
people to say, “You know, I may not be
doing everything, but I really think I can
do it.” We were not hearing that from
these people. So, we went back to the
streets in Chicago and we asked people,
“Tell us what you think about some of
these negative nutrition messages that
you are hearing out there.” This
reinforces the idea that, in developing a
campaign for whole grains, we need to
emphasize the positives of whole grains,
but not against the negatives of refined
grains, because this is what I am afraid
the outcome will be:
“When I hear stories about this is bad
for me, or I shouldn’t drink coffee, or I
shouldn’t eat butter, I shouldn’t eat
bacon, or ... I ignore them.”
“I’ve been eating these things all my life,
and I’m going to continue eating them.”
“I’m the gatekeeper of my mouth. I
think I have common sense to know what
is good and what is not good to eat.”
“If someone tells me there are foods that
are bad for me that I should never eat,
I’d probably feel deprived.”
That gives a small impression of the
frustration and how consumers are
dealing with some of the information
that is out there. While we see
confusion, the good news is that
nutrition is still a value and it is still
important to people.
In the ADA Trends Survey from 2000,
85 percent of consumers said diet and
nutrition are important to them
personally. But when you say, “What
have you done to make significant
changes to achieve a healthful diet,”
only 28 percent said they were able to do
something to make significant changes.
I think the problem for many years has
been that nutritional communications are
a one-way street. I have been one of
those dietitians as guilty as the rest.
Back when I started my career working
with the supermarkets, I would sit at my
desk and write a consumer publication
about how consumers should have
calcium in their diet or whatever might
be the topic of the day. I would type it
out on my typewriter, take it to be
designed into a brochure, then distribute
it to the world. That is very much a one-
way street of communications. Nobody
ever looked at it, said it made sense, or
that they understood it. My nutrition
professors probably would have loved
whatever I said. In essence, we have
been very good about getting
information out, but we need to take
what we do as “nutrition-speak” and
turn that into “consumer-speak.” We
need to talk in a language that makes
sense to people, really captures their
attention, and gets the outcomes that we
are looking for in terms of change. It is
really time for a new nutrition
conversation with consumers. It is an
opportunity for us to find new ways to
engage in discussions on
communications about nutrition and
embark on a new campaign to increase
67
consumption of grains, particularly
whole grains.
We all know what we want to say.
We know what we want consumers
to do. To illustrate this point, the
Dietary Guidelines for Americans are an
example of what we want to say; we
want people to do those things. But the
Dietary Guidelines for Americans are
not consumer messages — they are
directionals. They are ways to get to an
endpoint, but they really were never
designed to be consumer messages.
So, we have to take the concept that is in
the dietary guidelines, or in a grains
message, and turn that into what
consumers want to hear.
The message development model I am
going to share with you recently was
published in the June issue of
The Journal of the American Dietetic
Association in regard to the dietary fat
messaging work we did.
Step 1. Define the issues
• What do you want to achieve?
• Demographics: Who is
your audience?
• Psychographics: What does your
audience think and why?
Step 2. Develop initial message concepts
• Be positive.
• Address sources of discomfort
with eating.
• Empower consumers to
make changes.
Step 3. Assess message concepts
• “What does this message mean
to you?”
• “Does this message motivate you?”
• “Does it fit with other things you
want in life?”
Step 4. Fine-tune messages
Step 4: Fine-tune Messages
Develop Initial
Message
Concepts
(Step 2)
Define Issues Assess
Message
(Step 1)
Concepts
Focus Groups (Step 3)
Focus Groups
Step 5. Validate messages
• Quantitative acceptance of the
message to confirm the message
resonates with the audience.
As an example, at IFIC, we were
working with fat messages and we
started off with the message from the
Dietary Guidelines of 1995 that said,
“Choose a diet low in fat, saturated fat,
and cholesterol.” When we went and
talked to women about this message,
they said, “Oh, yeah, I know that.” And,
they did understand the concept of it.
When we asked, “What does that mean
to you?” Their responses were, “That
means a terrible diet; a diet with no fat
has no taste. I would not want to eat it.”
So they understood the concept, but
what it meant to them was not a good
thing in terms of eating, taste, and their
lifestyles. So, we went back and worked
on them and came up with a different
message. “Foods with fat can fit.
Moderate, do not eliminate.” This made
sense to them. They said, “Oh, I can
have fat?” That was a revelation, by the
way, because a few years ago they had
heard that zero was the amount of fat
you should have in your diet. We also
talked to them about moderation and
what that means, and they understood it
means they have to take some control.
We did the same thing with sugars. We
took the original Dietary Guideline that
stated, “Choose a diet moderate in
sugars” and made it into, “You can
include sweet foods in moderation as
Fine Tune
part of a healthy eating plan,” and,
Messages “Most kids love sweets: show them how
(Step 4)
to enjoy them in moderation.”
Validate Finally, we asked consumers about the
Messages
(Step 5)
revised, more consumer-friendly
Quantitative messages on fat and sugar in which we
Survey
followed the five-step process. Here’s
what they had to say:
“I agree with that. I think everyone
needs a little bit of fat.”
“I could do that. I think that sounds
great. It would make me feel a lot
more comfortable.”
“If they say that fat can stay in my diet
as long as it’s moderated, then
I’m okay.”
“I like it because it appeals to the
common sense instead of being a guilty
kind of a message. It sounds like the
message is trusting me to make my own
decisions about nutrition.”
We found consumers used the word
“moderation” a lot. That is where our
opportunity for education is, especially
with tough concepts such as dietary fat
and sugars. That is where you need to
really get specific with tips. You really
need to give them visuals on what you
mean by moderation; what does that
look like?
68
There is a variety of ways you can
do that:
• Keep tips positive, short, and simple.
• Be specific, describe an action.
• Address what is in it for consumers.
• Do not perpetuate the “good
food/bad food” myth.
Just remember this quip from an
advertising guru, “The consumer is
king.” To close, the consumers need to
have the last word. Here is what they
had to say:
“You only live once and I say, ‘Eat up
and enjoy it.’”

Here are some examples from the “Practice what you preach.”
Dietary Guidelines Alliance “It’s All
About You” kit: “Allow people to make
educated decisions.”
• Enjoy your steak twice as much. Eat
half in the restaurant and take the “And eat broccoli, I guess. Then you
rest home to enjoy the next day. don’t have to worry.”
• Set an example for your children.
Order a small to medium soft drink
instead of an extra large, and skip
the refills.
• Create your own breakfast cereal.
Mix together two, three, even four
cereals. Choose at least one that says
“high in fiber” on the box.

Food has so many meanings for us in our

lives, and everyone has their favorite
food. We have to accommodate
everything there is about foods and the
role they play in our culture and our
lives. It is on all of our shoulders to
make sure that our messages are clear
and concise and directed to consumers.
Using tested messages is certainly one
way to do that. Every one of us in this
room has an opportunity to help and
work with the media as that predominant
vehicle for getting the information out.

Overall, put the consumer first, front,

and center, in whatever you do. We
cannot lose sight of our science. Do not
get me wrong; if we do our work based
around the needs and wants of the
consumers, we will be successful. When
we lose sight of what the consumer
needs and wants, that is where we are
going to have some challenges.

69
70
Changing Food Behaviors
Starts Early
Children receive many opportunities for
nutritious meals through the Federal
Child Nutrition Programs. However,
school foodservice still faces many
challenges in providing for the health
and well-being of the nation’s children,
including decreased funding and
increased use of school vending
machines. Programs such as Fitness
Fever® and the School Meals Initiative
have helped school foodservice make an
impact. Recognizing the importance of
partnerships, image, and public
relations also has helped the school
foodservice segment adapt to and
address the needs of today’s schools and
school children.
Presentation by Mary Begalle, R.D.,
S.F.N.S., American School Food
Service Association
The Federal Child Nutrition Programs
provide many opportunities for children
to receive nutritious meals. The
programs administered most often by
schools include the National School
Lunch Program, which includes school
lunches and after-school snacks; the
School Breakfast Program; and the Food
Distribution Program, which provides
surplus agricultural commodities to
schools. Many schools also offer the
Summer Food Service Program, which
provides meals to low-income children
when school is not in session and the
Child and Adult Care Food Program,
which provides meals for young children
in child care programs. However, there
are many challenges facing school
foodservice in its goal of providing for
the health and well-being of our
nation’s children.
In 1996, Congress discontinued the
funding for the Nutrition Education and
71
Training Program. This funding cut has
severely hampered the ability of school
foodservice to provide nutrition
education and teach children good eating
habits. This has occurred at the same
time that there has been a substantial
increase in the sale of foods of minimal
nutritional value in vending machines
and school stores. As many schools face
budget shortfalls, school administrators
increasingly are looking for other
sources of funding. Far too often,
administrators are competing with the
federal nutrition programs for the
student food dollar. While this needed
revenue is used for good purposes, such
as funding student activities, it comes at
the cost of promoting poor nutrition and
health. Many school foodservice
directors find that selling a la carte foods
helps to contribute to their bottom line as
school boards are demanding solvency
in the foodservice fund. Schools find
that the Summer Food Service Program
and the Child and Adult Care Food
Program are administratively
burdensome, inhibiting program
participation and growth. The Child and
Adult Care Food Program also
experienced substantial budget cuts with
the welfare reform of the mid 1990s.
While there are many challenges in
school foodservice, there also are many
opportunities. In Minnesota, we have
created a wonderful public/private
partnership in our Fitness Fever
Program. Fitness Fever is the most
successful health promotion program in
Minnesota history. Fitness Fever targets
elementary school children and their
parents to increase their physical activity
and improve their nutrition. Fitness
Fever occurs every year during the
month of February. It is successful
because it focuses on sound principles of
health and wellness and it is fun.
Fitness Fever is supported by a
community partnership of business,
nonprofit organizations, and state
agencies. Another big success story is
the American School Food Service
Association’s (ASFSA) Nutrition
Advisory Councils. Nutrition Advisory
Councils involve students in school
foodservice and educates them about the
importance of good nutrition. Many
Councils sponsor a variety of activities,
including community health fairs,
food drives, menu specials, and
educational materials.
In 1996, Congress passed the Healthy
Meals for Healthy Americans Act, which
required all schools to meet the Dietary
Guidelines for Americans. That led to
the School Meals Initiative — a set of
regulations that now require schools to
offer menus meeting the dietary
guidelines. In Minnesota, we do the
nutrient analysis as a state agency by
partnering with our University of
Minnesota Nutrition Coordinating
Center. Every year, 20 percent of the
lunch menus in Minnesota are analyzed,
as they are across the country. And,
schools are doing a good job of meeting
those guidelines. Parents will look at the
menu sometimes and say, “Pizza.
Hamburgers. These are not healthy
foods.” Yet, these are healthy menus.
Schools are doing some passive,
behind-the-scenes work to find lower-fat
ground beef or buy pizza that has fewer
calories. The good thing about the
School Meals Initiative is it did increase
the grains and breads requirement in
school meal patterns. They were added
to get the calories up because schools
were challenged to bring the fat
content down.
72
Another opportunity is the School
Breakfast Program. We have done a lot
in Minnesota to increase school
breakfast programs. That is the one area
in schools where there is a tremendous
opportunity for growth. Nationally, the
average participation rate for school
breakfast runs about 12 percent to
14 percent. One of the barriers to
participating in school breakfast
programs is that parents actually think it
is a program for low-income kids, while
they perceive school lunches as being for
all kids. The breakfast program started
in the late 1970s and initially was
targeted at inner cities and a low-income
population. But through a lot of research
from the last 10 years, the results show
that kids who eat school breakfast
actually do better in school. As a result,
Minnesota has provided additional state
funding to promote school breakfast
programs. Now, what the schools have
to do in order to earn that additional state
funding is to integrate breakfast into
their school day, so they need to make
breakfast accessible to all students. We
have some schools that actually serve
breakfast in the classroom in the
morning while attendance is being taken,
which has resulted in some high
participation rates. Last year, statewide,
taking into account all of our schools,
our breakfast participation went up to
about 46 percent. We hope to increase
that by another 10 percent next year.
When school breakfasts are made part of
the school day, our research shows it
reduces the barrier of thinking that the
program is only for low-income kids.

For us to be successful
in the area of nutrition
education and to change
kids’ eating behaviors,
it does take a partnership.
It cannot be just
one segment.
Other opportunities we have focus on the
role of advocacy and public policy.
ASFSA has a very strong voice in
Washington. In fact, one of the reasons
why we did not lose funding from the
school lunch program in 1996 through
welfare reform is that Congress was
bombarded with good information about
the benefits of the program from
ASFSA. We worked diligently to
increase our focus on the legislative
agenda and protect funding at all levels.
For the past few years, we have been
talking to Congress about the Nutrition
Education and Training Program and if
they do not want to fund that program,
then we need to come up with a new
educational program that can be
successful in schools. We are doing a
lot of outreach and forging of
partnerships as well. For us to be
successful in the area of nutrition
education and to change kids’ eating
behaviors, it does take a partnership.
It cannot be just one segment. Kids
only eat one meal a day, 175 to
180 times a year, at school. So it is
really a bigger picture in getting them to
make or understand the choices they are
making and getting the parents to
understand the choices of good nutrition.
We can impact it somewhat, but if those
principles are not reinforced in the
home, we are fighting a losing battle.
73
Plus, so many schools have to offer a lot
of choices now to kids just to attract
them to their school lunch program.
Once you start introducing choices, kids
can mix and match and put together
combinations that may not be as good as
the ideal, one-menu approach. We have
tried to raise the awareness about the
importance of good nutrition by sending
a lot of materials to parents, particularly
on our breakfast research.
Image and public relations is another
area the ASFSA is focusing on because,
oftentimes, the public image of school
meal programs is based on what adults
remember it looked like when they were
in school. We encourage parents to
come in and see the way school nutrition
programs are operating today. To
determine our areas of focus in terms of
public image in Minnesota, we did focus
groups with high school students. I can
tell you it was almost painful for us to
publish that report because it has some
information in there for school
foodservice directors and school
administrators that is difficult to read.
(The report is available at the Minnesota
Department of Children, Families &
Learning — Food and Nutrition Service
Web site https://fns.state.mn.us.) We
really think it is important that we are
listening to our students and their needs,
so that we can make improvements in
our programs to attract students to eating
nutritious school meals.
74
BREAKOUT SESSION II: WHOLE
GRAINS AND THE FOOD INDUSTRY
Effects of Processing on Nutritive and
Physiological Impact of Grains
For bakers, the driving factors to
product creation are consumer interests
and needs, not nutrition. In the baking
process, bakers are focused on mixing,
fermentation, the make-up procedure,
and the baking itself.
For a baker, adding whole grains or
adding fibers can create challenges in
the baking process. Particle size affects
hydration, which can affect fermentation
time, etc. There are some ways to
address those challenges, including
pretreatment of grain and infrared
processing. Overall, processing needs
to be optimized technically and
nutritionally so products can be
developed that are acceptable to
consumers and, therefore, bakers.
Presentation by Debi Rogers, Ph.D.,
American Institute of Baking
In the baking industry, nutrition and
health advantages are not the driving
factors. Bakers are making different
breads because they perceive that people
like variety. Trying to respond to
customer needs and that competitive
edge, as in every market, generates
interest in the products. Those are the
reasons bakers are making whatever
product they are making and not
thinking about nutrition.
The mixing process is about uniformly
incorporating the ingredients and
hydrating, which is a big issue with
whole grains. Hydrating everything
efficiently is a big problem. During this
process, we concentrate on developing
the gluten for proper handling quality
and gas retention. The gluten structure
75
sets the structure for the volume of the
bread, which is critical to a baker.
Anything that interferes with gluten
development is going to be interfering
with volume. Bakers also use gluten
film to trap air cells to create the crumb
structure. Most production nowadays is
what we call a sponge-and-dough. We
mix part of the flour, water, and yeast,
let it set for approximately four hours,
then add the rest of the ingredients. We
mix it and go on through the processing.
So, we generally have two mixing
stages involved.
There also are key developments that
occur in fermentation. Developing
flavor is a primary thing. Consumers are
always looking for flavor development,
leavening, and getting air cell expansion.
But again, we have to have that gluten
structure to retain the air cells.
The make-up procedure goes quickly
after this — dividing, rounding,
sheeting, molding, panning, and
proofing. Usually a mixer may hold
2,000 pounds of dough or more, so we
are not talking small scale. We have
large amounts of quantity and mass
coming out every eight or 10 minutes.
It is divided into the individual pieces,
whether those are one pound, a
half-pound, or bigger sizes. Then there
is rounding to make that nice, smooth
skin on it. We used to always say we
needed intermediate proof, but it you
talk to bakers today, that intermediate
proof is getting shorter and shorter. We
then sheet the dough, flatten it out, and
roll it into whatever size and shape of
product we want. Molding is not adding
mold to it, but it is shaping the loaf. We
put it in the pan, then allow it to proof,
which is just continued fermentation.
We allow it to come up almost to
volume under controlled temperature
and humidity; then we bake it.
During the baking process, we get this
nice little oven spring, hopefully. The
yeast is going to be killed, proteins
denatured, starch gelatinized, and all
kinds of things happen. We get
browning and we have this nice
wonderful product we call bread. Then,
we have the last stage a lot of us forget
about. We have to let the bread cool so
we can slice it and get it into a package.
Depending on the bakery, cooling
usually involves letting the bread
circulate overhead. Cooling bread to the
slicing temperature of 90°F to 110°F
usually takes about 45 to 75 minutes.
That is the commercial process.
To a baker, it really does not matter if
we are talking about adding whole grains
or adding fibers. The same principles
are going to apply from a baker’s
perspective in terms of key added fiber
properties. Particle size is extremely
critical. And, everything we look at
nutritionally may be just the opposite
from the baking side. Particle size
affects how things are going to hydrate,
which requires water. We can
compensate other ingredients that are
taking water away from the gluten. The
problem with a large particle is that it is
going to hydrate slowly. During the
fermentation time, those particles are
continuing to suck up water for all the
wonderful reasons that, physiologically,
we want to have them in there. But by
the time we get ready to sheet that
dough, it is going to be so dry and stiff
that it is going to tear. We put in more
water at the mixer so when we get to the
sheeting and molding process, we can
handle it. Then, it is really soft, sticky,
and very difficult to mix. It takes longer
to mix, which slows down your
processing and translates into more
money. You cannot have as many
doughs coming out in an hour.
76
Color is a big issue for consumers and,
from a baker’s viewpoint, we are
looking for particles that are not very
noticeable. We do not want them to be
really dark or show up too much because
that detracts from what the customer is
going to see. In terms of the volume
impact, most whole grain additions are
going to decrease volume, which is not
necessarily bad. But again, consumers
are used to a certain loaf weight and
size. So, our choices are to use a smaller
pan or put in more weight. But, both are
going to change customer’s perceptions
of what they are used to seeing. This
also will impact what the crumb looks
like on the inside of that loaf. Because
of lack of expansion, the air cells are
going to be a different size and shape.
While consumers consider softness,
texture, and dryness, this translates into
abrasiveness from a baker’s perspective.
Whole grain bread can be rough stuff.
You do not want a dry and gritty
sandwich. If you want crunchy peanut
butter, you want the peanut butter to be
crunchy, not the bread. So there is this
texture issue — the abrasiveness in the
mouth — that can cause problems.
Bakers also have to consider the
abrasiveness to equipment. Every time
we mould, cut, and divide, the
abrasiveness wears the equipment
differently than a softer bread.
Flavor is another consideration. Whole
wheat taste can be viewed as bitter.
Maybe we can look at the hard white
wheats as a lead-in to bring consumers
some different products without quite as
much bitter flavor. Obviously, we need a
steady supply to the bakery for whatever
whole grain product we are using. Cost is
a big thing, as well, as profit margins in a
bread plant are very low, while the cost of
some of these whole grain products
generally are a bit higher.
Although nutrition is not a primary
driving factor for bakers, soluble vs.
insoluble fiber can play into the
processing functionality — what is
going to absorb water, what is going to
cause tightness/stickiness in that
dough, etc.
Which grains do we consider? Rye,
corn, oats, barley, rice, amaranth — the
list goes on and on. Maybe some of
smaller grains might be ones the
consumer may look at more favorably
because we are going to see small
pieces. It is not going to change the
physical color of that product nearly as
much. Some of the little ones like
quinoa might be a good idea.
Combinations are another consideration.
You could put in up to 25 percent of
whole grains by weight of the flour.
Once we get to higher levels, like
35 percent to 40 percent by weight to try
to get to the whole grain claim, we start
creating big problems as far as the
processing. I am not saying that it
cannot be done, but it is going to be
difficult. Consumers may look at a list
of grains or products and not know
which are whole grains and which are
not. A lot of bakers do not know
what would qualify for whole grain
products either.
With particularly the whole grain
product, the true whole grain product,
there are some ways to get around some
of the baker’s biggest challenges. And
that is to do some pretreatment of the
grain. Of course, that affects the cost.
There is steaming, infrared processing,
or micronizing, which is a short-time
high temperature, kind of like
ultra-pasteurization. You process it with
water and heat and then partially
pregelatinize the starches so you will
have faster absorption when you put the
77
particle into the product. Then the baker
has more control. Reduced microbial
and enzymatic activity is another big
issue. Many times, as with whole grains,
as we are hydrating them, the enzymes
that are in those grains may be impacting
dough functionality, with protease and
amylase being the primary two.
Although nutrition is not a
primary driving factor for
bakers, soluble vs.
insoluble fiber can play into
the processing functionality
— what is going to absorb
water, what is going to
cause tightness/stickiness
in that dough, etc.
So if we heat-treat it, then we are
reducing that problem and we may be
softening the texture a little bit. This can
help when we get to slicing. When
whole grains go through the baking
process, they absorb some water, but
they are still pretty hard. This hardness
can really dull the slicers, which creates
downtime and costs in changing blades.
But if the grains are precooked, then we
actually soften the texture and may not
have quite that much problem.
Besides pretreating and precooking some
of these whole grain products, we also
make some processing modifications via
enzymes. Cellulase is going to break
down cellulose, and the hemicellulose,
pentosanase, and xylanase are going to
break down those wonderful
hemicellulose structures, generally
taking insoluble fiber and converting it
more to soluble fiber, which makes the
dough easier to process. It has been a another sheeted product and we run into
great addition for the baker, but the a lot of color issues with noodles.
question then becomes, “What is the
nutritional value?” Remember that we want to offer the
consumer a wide variety of these health
We also have challenges in bringing products that have a desired impact. But
whole grains into other products in we have to remember, only the foods
addition to bread. Consider crackers. that are going to be eaten will have any
If we are talking about a saltine functionality. And the foods that
type of cracker, we’re looking at a consumers do not choose or leave in
sponge-and-dough fermentation much their cupboards forever are not doing
like the bread system. If we are talking anybody any good. So the processing
about a snack cracker, it is probably has to be optimized technically and
chemical-leavened, so it is a much nutritionally, so that we make products
shorter processing time period. Either acceptable to consumers, which will
way, you are mixing the dough and make bakers interested in making them.
sheeting it. Many times, the final
cracker sheet is one to two millimeters
thick prior to baking. What is the
thickness of some of these whole grains
we are trying to put in there? We are
going to be tearing the sheets and trying
to roll these whole grains through. As
you are sheeting, dough cannot stick to
the rolls and whole grains can bring in a
stickiness issue. We expect products
such as crackers to have a very long
shelf life, so we have to consider the
rancidity issues with some of the
whole grains.

With cookies, such as oatmeal or a

chocolate chip, you drop it onto a pan
and it spreads. The fiber certainly
impacts the spread ratio, which impacts
if it is going to fit in your package.
Texture also is an issue. Many times we
use whole grains as a topping on the
crackers or cookies to avoid these issues,
but that makes it difficult to make the
weight claim for a whole grain product.
We can make whole grain muffins
without too much of a challenge. It can
be a benefit to have the increased
viscosity because we are trying to retain
gas by the viscosity of the batter to give
us the cell structure. Noodles are

78
Unique Beneficial and Processing
Properties of Grains
Oats, barley, corn, and rye each possess
unique properties in terms of processing
and benefits.
With oats, there are several implications
to over- and under-processing. All
common forms of oats — steal-cut
groats, flakes, and oat flour — are
nutritionally equivalent. Protein tends
to be higher in oats than most other
common grains. Oats also contain
important components, including beta
glucans and antioxidants.
Historically, corn has not played a large
role in processing for food uses.
Two-thirds of the corn in the
United States is used in the production
of meat, with another 15 percent of corn
used in food. Corn probably has been
the most prominent grain in the news in
terms of genetic enhancement.
Barley, which has been around in the
human diet for at least 8,000 years, is a
rich source of antioxidants, vitamins,
fiber, protein, and other nutrients.
However, a lot of those are lost in
processing. Barley is probably the
richest source of beta glucan in grains.
Companies are working to bring the
benefits of barley to consumers.
Oats — Presentation by Kent Salisbury,
Director, Milling R&D, The Quaker
Oats Company
In the food processing area, as in most
industries, there are a lot of implications
to over-processing and under-processing.
This is certainly true in the milling field
and oat milling in particular. The oat
miller himself has to walk a very fine
line between over-processing and
under-processing.
79
The first major step in the oat milling
process is cleaning; this is a very critical
step. The idea is to separate the clean,
whole oats from anything else that is in
there. In the case of the cleaning step, if
you over-process, then the result is you
are losing good oats along with the
contaminants. That obviously would
have a negative yield impact to the mill.
If you are under-processing in this area,
you obviously have contaminants
that are remaining with the oats
and will have finished product
quality implications.
The next major step is the hulling, which
is simply the removal of the hull from
the kernel, which we call a groat. It is an
oat when it has the hull on it; it is a groat
when you take the hull off of it. The
hulling step is the process which
separates those two components. The
removal of the hull is accomplished by
impact. Because the hulling operation is
never 100 percent (we are pretty happy
when we can get above 85 percent), it is
necessary to send these groats, which
still have a few oats mixed in with them,
to length graders.
The next step is called thermal processing.
This is the killing, drying, or conditioning,
whatever term you want to use, but this is
a critical step in the milling of oats. The
clean groats are first passed through
steamers where live steam is used to
inactivate the enzymes. The ones we are
most concerned about are those
fat-splitting enzymes, such as lipase,
peroxidase, and lipoxygenase. The steam
is very effective at inactivating those
enzymes without changing the character of
the groats. There is very little, if any,
gelatinization that occurs in that step.

All common forms of oats,
whether they are steel-cut
groats, old-fashioned
flakes, quick flakes, instant
flakes, or if they have oat
flour that is made from
ground groats or ground
flakes, are nutritionally
equivalent.
The oats then fall directly through what we
call the kiln or the dryer, where the groats
pass across steam-filled radiators while air
is pulled through the grain at the same
time. This reduces the moisture and helps
develop the good, toasted-oat flavor that
oatmeal has. If you over-process in this
area, the thermal energy will accelerate the
use of the antioxidants and have a definite
effect on shelf life. Under-processing
in the kiln will leave active enzymes
present in the groats that can have some
flavor implications later on. You will
not develop the characteristic desired
oat flavor that you want in the
finished product.
The next major step is the cutting and
flaking. Our cleanest groat streams
normally bypass the cutting system, so
they are being processed as whole groats
and they are steamed and flaked. At that
point, they become “old-fashioned”
flakes or long-cooking flakes. The
groats that still have oats left in them are
sent to the cutting plant. We use
low-capacity drum cutters to cut the
groats into thirds. In the process of
doing that, the oats that are still there
become hulled and the hulls are
removed. The process for cutting
includes a screening step to take any
fines out that are created and also a
80
grading step that takes any of the uncut
groats back to the cutters. The groats are
then steamed a second time, which gives
you another shot at the enzymes. This
steamy step is really to soften and
condition the groat so it will pass
through the flaking rolls and provide a
quality flake. The flakes then fall
directly from the steamers through large,
smooth flaking rolls. Following flaking,
there is a screening step and a cooling
step. When you have too high of a feed
rate through the steaming and flaking
process, the groats are not conditioned
properly and you will get ragged looking
flakes. If the feed rate through this part
of the system is too low, you will have
excess steaming of the cut groats and the
small pieces can become gelatinized.
When they go through the flaking roll,
other flakes will stick to them, and you
will have a collection of gelatinized
masses.
What are some of the other challenges
that oat millers face? The high incoming
oat moisture is a problem in that it
requires different kilning conditions.
What that means is you have to slow
everything down to get the proper
temperature profile and the proper
moisture after kilning.
There are some unique benefits of oats.
The products from oat milling, as
traditionally consumed, are whole
grains. All common forms of oats,
whether they are steel-cut groats,
old-fashioned flakes, quick flakes,
instant flakes, or if they have oat flour
that is made from ground groats or
ground flakes, are nutritionally
equivalent. Protein tends to be higher in
oats than in most of the other common
grains. Protein is not something that is a
big issue for us as processors or in the
marketing of our products.
The fat content of the rolled oat product
is generally higher than other common
whole grains. It is in the area of
7 percent to 8 percent, but it is high in
unsaturated fats. Oats are an excellent
source of beta glucan, a soluble fiber;
obviously, much is known about this. It
is concentrated in the alurone layer, but
it also is contained in the cell walls and
in the endosperm. So, in a way, it is
throughout the whole groat kernel.
Antioxidants, soluble forms of phenolic
antioxidants, have been extracted from
the alurone layer of groats. Also, two of
the three major categories are found only
in oat products.
No discussion of oat milling or oats
would be complete without talking about
oat bran. Oat bran is not a whole grain
and it is not all bran. Several years ago,
the American Association of Cereal
Chemists created the Oat Products
Subcommittee. The initial task this
group completed was to develop a
definition for oat bran. Based on this
definition, oat bran can be up to
50 percent of the groat. And you
compare that to wheat bran, for example,
which is mostly all bran that is about
12 percent to 16 percent of the whole
kernel. The subcommittee’s definition
was adopted by the FDA when the
regulations regarding health claims were
issued. Oat bran can be up to 50 percent
of the groat but, more importantly, it has
to provide at least 5 percent beta glucan
and 16 percent total dietary fiber. Both
of these are on a moisture-free basis.
What the millers are looking for in new
varieties, most importantly, is superior
yields for the farmers. This has
traditionally been the focus of oat
breeders for many, many years. The
new varieties have to be better than what
is out there currently and they have to be
tailored for the areas in which they are
81
going to be planted. If you are going to
plant oats, for example, in areas that are
subjected to rust disease, they have to
have rust protection in them. Secondly,
they need to provide superior yields for
the processors. And third, they are
looking for composition that meets the
required FDA definitions that processors
or companies need to support the
health-related claims. The oats have to
meet these requirements, no matter
where they come from. Even if we end
up buying oats from overseas, they have
to provide this level of nutritional
composition or we really cannot use
them in our products because of the
requirements of the health claim.
Corn — Presentation by Warren Formo,
Program Manager, Minnesota Corn
Growers Association
Historically, corn has not played a huge
role in processing for food uses. While
that has been an obstacle, it also has
presented some interesting opportunities
for us as an industry. Right now, if you
go in a grocery store, the corn industry is
well represented at the meat counter.
Two-thirds of the corn in this country is
used in the production of meat, so that
has been a large focus of the industry.
The production of food uses less than
15 percent of the corn grown in this
country. Of that 15 percent, well over
half of it is used in nutritive sweeteners
in liquid form or in alcoholic beverages.
Up to this point, the processing of corn
for foods has not received a lot of
attention. So, I was very interested to
address the potential that exists for using
corn in whole grain foods.
There are many different types of corn
raised on farms across the country.
While the vast majority is your typical
No. 2 yellow corn, there also are white
corns, blue corns, and black corns that
are used almost exclusively in the
production of processed foods — corn
chips, cereals, those types of things. The
industry is growing, so there is potential
for corn to play a more prominent role.
The No. 2 yellow corn that is used in
foods is primarily in the meat industry
and in the liquid sweetener and
beverage industry.
One of our thrusts has been to close the
gap that exists between the farmer and the
consumer. Corn has probably been the
most prominent grain in the news in terms
of genetic enhancement. While we
certainly embrace biotechnology and the
genetic enhancement it offers, some of the
events that have occurred up to this point
have been unfortunate. Also, all of the
advancements to date have been
agronomic and have not benefited the
farmer to a great degree because, while
they have increased productivity and in
some ways lowered their costs, they also
have increased the general corn supply and
lowered its price. But, we do see several
genetic enhancements that can have
impacts on the value of corn. Some of
those include increased nutritional value.
Through certain genetic packages, we can
almost double the protein content of corn.
Currently, corn ranges from about
6 percent to 12 percent protein. We are
working on ways to maximize that
12 percent range, and then push it up into
the 13 percent to 14 percent range. We are
doing that through a combination of
genetics and management. Within current
farming practices, we can increase the
protein simply by how we manage the
corn and it is primarily the nutrients that
are applied to those plants. More accurate
placement of nutrients protects ground
82
water and reduces erosion and also
contributes to higher quality grain. We
have just launched a massive study on how
the farmer can influence grain quality with
his management practices, and we expect
within the next three or four years to have
information we can use as we try to target
more of the corn into the food industry.
Another interesting thing we are
working on is taking the whole kernel,
processing it, and using different parts in
different ways. In Minnesota, about
20 percent of corn currently is being
In the future, we are going
to need to use corn in
different ways. That
also allows us to look
differently at how we are
processing corn.
used in processing for ethanol for fuel,
which needs the starch from the corn
kernel. For the past 20 years, the
manufacturers, as they process the corn,
have ground it finely, run it through a jet
cooker, then ferment the entire corn
kernel to make fuel ethanol. We are
finding that we can separate the corn
ahead of that process, so basically all we
are doing is taking out the starch and the
fats, they go into the fermentation
process for fuel ethanol, and we are left
with a very high-protein, high-fiber food
product. We see a great potential use for
this product.
In the future, we are going to need to use
corn in different ways. That also allows
us to look differently at how we are
processing corn. We are trying to find
out through consumer awareness surveys
what the ideal product would be. Would
it be higher protein? Would it be higher
fiber? Would it have different vitamin
profiles? We are trying to find out
through genetics and through processing
what the possibilities are. At each step
of the processing, we remove something
else and magnify the concentration of
what is left. For example, in the ethanol
processing plant scenario, the dried
distiller’s grains with solubles that are
left are a modified corn product where
all the minerals and vitamins end up.
And so, it is something that has a
tremendous amount of potential.
Corn growers began recognizing about
two or three years ago that there was
such a wide distance between the farmer
and the consumer. We felt it was
important to begin to understand how we
could, without bypassing processors,
work together to deliver a better product.
With that in mind, we have begun to
host consumer groups together with
producer groups to find out their
interests. Food safety is a big one,
because corn is typically grown as a
large volume, bulk commodity,
harvested in large amounts, delivered to
the local grain elevators, and trucked to
millers and food processors.
Historically, what happened to that corn
down the road was not real high on the
producer’s mind. We are starting to see
a lot more direct delivery and
contracting. In fact, the vast majority of
the food uses of corn are contracted
before the corn is ever planted. The end
user knows where it is going to be grown
and how it is going to be harvested and
transported, in an attempt to minimize
contamination risks. That is a way we
are trying to close some of those gaps
and make it a little bit more efficient and
a better product to the consumer.
83
Barley — Presentation by Tom Jorgens,
President, PolyCell Technologies
Our focus at PolyCell is on developing
bioactive solutions for human and
animal nutrition and health. As part of
that focus, we have been working with
several international partners to develop
leading-edge methods to extract and
apply selective bioactive components of
barley for a range of nutrition and health
uses. The products we are working with
are a beta glucan isolate that is in the
75 percent range, a high beta glucan
concentrate (23 percent), a barley/bran
concentrate, and a waxy starch
concentrate. The processing methods
used, to the extent possible, try to retain
the whole grain attribute, and we think
allow many opportunities for blending
some of those features into desired
results in processed foods.
Barley has been around as a part of the
human diet for at least 8,000 years.
Traditionally, it has been a major bread
and cereal grain. It was the primary fuel
for the Roman army, but is best known
today as the source of the malt used in
making beer. Current U.S. food
consumption is slightly more than one
pound per capita and is increasing at a
modest rate, probably in relationship to
the effort to get whole grains as a greater
part of the diet. The grain is a very rich
source of antioxidants, vitamins, fiber,
protein, and other nutrients. However,
we lose some of those along the way
in processing.
If you are looking for the nutritional
values, varieties make a big difference.
On one hand, we have the malting barley
varieties that the breeders have worked
on over the years to lower the level of
beta glucan, for example, because the
brewers do not want it in their process.
The same is true for barley as a feed
source around the world, since animal
nutritionists seek to reduce
non-digestible components, like beta
glucan, that do not provide energy for
the animals. In a sense, efforts to
expand human food applications are sort
of “going against the grain.” Often, they
depend on specialized varieties that have
enhanced combinations of beta glucan,
tocopherols, tocotrienols, and other traits
useful in food and nutrition.
Fortunately, a number of plant breeding
centers around the world are making
substantial progress on improving these
desired outcomes in their varieties.
The key bioactive component of interest
in barley is beta glucan. It is found in
some varieties in high concentrations,
which provide the richest source among
the cereal grains. The bran fraction also
is rich in tocopherols and tocotrienols
and insoluble fiber. Barley also can be a
good source of waxy starch and
phenolic acids.
In terms of health effects, there are
several dozen studies that have been
conducted around the world with barley
beta glucans. They have been
consistently shown to be effective in
LDL cholesterol reduction, typically
showing a decrease of 7 percent to
13 percent. In terms of blood glucose
modulation, clinical studies have shown
barley beta glucan slows the rate of
carbohydrate digestion and glucose
absorption, helping to modulate blood
sugar levels. There also is evidence of
an immune effect that actually has
several modes of action. This is an
emerging area of science. New studies
also are showing barley beta glucans
stimulate immune function both directly
in the bloodstream and in topical
applications, and by increasing
short-chain fatty acid production through
84
fermentation in the colon. They are a
significant source of antioxidant activity
and provide a satiety effect that can
contribute to weight loss.
Over 30 clinical studies have been
conducted on various aspects of barley
beta glucan efficacy, with more currently
in process. There is a important study
going on right now by the USDA ARS
Human Nutrition Labs, with the support
of the National Barley Foods Council.
The study includes a trial of 24 male
subjects using a 3-gram and a 6-gram
barley beta glucan dosage, focusing on
cholesterol and other parameters. They
have recently completed the feeding part
of that trial and are analyzing it. They
are working on an effort to establish a
barley health claim comparable to the
oat health claim.
Polycell has been involved in some
studies of the beta glucan isolate, which
is known as Glucagel™. A trial was
conducted at the Auckland Medical
School in New Zealand, which showed a
reduction of 9 percent in a group (males
of 35 and older) at risk for
Cardiovascular Disease (CVD). We
have a trial that is about to get underway
at the University of Minnesota that will
look at cholesterol, glycemic response,
and immune aspects. And, there is a
trial in progress in Canterbury,
New Zealand, that is assessing
cholesterol and body mass effects in a
CVD at-risk population.
Beta glucan is a functional food
ingredient from the food technology
side. It is a soluble fiber, so it goes
readily into solution. It is a strong
hydrocolloid that absorbs about 20 times
its volume in water. The material is a
bland, light-beige powder that is quite
neutral in flavor. It functions as a fat
replacer for such things as dairy foods.
The barley beta glucans readily form
soft, thermo-reversible gels, and they
retain their functionality under most
common food processing conditions that
we have seen in our experiments.

We are in the process of bringing the

benefits of barley to the consumer. The
Glucagel is being developed under a
joint venture for functional food,
nutraceuticals, cosmetics, and health
care uses and is now beginning
commercial production. PolyCell is
working with a Canadian company to
produce and distribute a barley beta
glucan concentrate, a bran fraction, and a
waxy starch that is not on the market.
We have several research links in terms
of applications, as well as basic
technology development. There also are
several other people around the world
who are working on various aspects of
the application of barley and to try to get
that consumption level of barley above a
pound per capita.

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86
Plenary Session — Learning From the
5 A Day Model
The 5 A Day for Better Health Coalition
serves as a foundation for illustrating
how and why to build a coalition, then
manage that coalition once it is created.
Coalitions require a great deal of effort
and support — from potential members
and similar credible organizations.
If development of a coalition is
appropriate for a specific situation, the
maintenance of that coalition is key.
Clear and timely messages,
supported by facts and enthusiastic
coalition members, are key to
reaching consumers.
Presentation by Fran Doring, M.P.H.,
R.D., Minnesota Department of Health,
Minnesota 5 A Day Coalition
The 5 A Day for Better Health Coalition
has been alive and well since 1991. If
we are going to build a grains coalition,
we need to talk about what is a coalition,
why we build a coalition, and do you
really need a coalition. Then, we need to
go about building, caring for, and
feeding that coalition.
What is a coalition? According to the
American Heritage College Dictionary,
it is an alliance or a close association of
groups formed to advance a common
interest. Why do we want to build a
coalition? No. 1: there is strength in
numbers. We may want to advance a
goal, gather talent and expertise to help
disperse our message, and provide a
broad base of information to lend
credibility to our efforts.
Should you form a coalition? If your
answer is yes, it is important to remember
the job is too big for one organization to
take on alone. The base of support for the
message needs to be broad. Other
organizations that have a similar message
87
or goal need to join. You need to have the
staff to support your efforts. And, your
organizations and others involved need to
be able to lend credibility to the efforts. If
your answer is no, it is because the job is
small, the base of support is narrow, and
you are the only one with the message.
Coalitions require a great deal of effort.
To build a coalition, you need to ask the
following questions:
• Who has similar goals and
messages? Can you go to other
organizations like your own? Can
you go to non-profit organizations?
• Are these credible groups?
• How big should your group be? It
must be big enough to do the work,
but not so big that it is unwieldy.
• Will the members be able to work
together or do you have people with
diametrically opposed viewpoints on
the same issue?
• What about individual vested
interests? Are there any conflicts?
• Can you support the coalition with
clerical support, meeting locations,
and so forth?
• Can you address the “What’s in
it for me?” perspective from
coalition members?
Once you form a coalition, it is
extremely important to address the “care
and feeding” of that coalition. You need
to start out with a clear and timely
message. With the 5 A Day for Better
Health Coalition, that message was very
clear, to the nutritionists at least — we
wanted people to eat five servings of
fruits and vegetables every day. I have a
lot of people who are non-nutrition types
who have told me, “You cannot possibly
eat five servings of fruits and vegetables
a day. It is impossible.” And I said,
“But what is your idea of a serving?”
Some of them think if they have a huge
chef salad that is one serving. Not true.
The key is in the portion sizes. A cup of
leafy greens is a serving; a chef salad
could be two to three servings. So there
is still a lot of confusion even around a
basically simple message.

You need to back your coalition’s

message with facts. You need to spread
out the work with small working groups
and you need to be prepared to support
the work being done. This can be fairly
time consuming. You need clerical
support, meeting rooms, time, phone
support, and mailings. In the case of
5 A Day, there is no extra funding for
this. It is all done with existing staff.
This means burnout can happen, so you
may need to rotate members in and out of
the coalition as needed. One of the things
we have found in most of our meetings is
“feed them and they will come.”

Overall, the message needs to be

positive, possible, and timely. The
coalition members need to take
ownership in the message and the
process. And, the coalition leadership
needs to provide sufficient support for
the activities of the coalition. It is
especially true when we deal with
87 county health agencies. They need to
have ownership of this in order to buy
in. As my boss says, “Your next step,
once you have decided you are going to
form your coalition, is to go forth and do
good works.”

88
CALL TO ACTION: WAYS TO INCREASE
GRAINS AND WHOLE GRAINS AWARENESS
AND CONSUMPTION
To conclude the conference, symposium
participants and speakers were asked to
divide into industry segments to discuss
ways the industry could work together to
increase grains and whole grains
awareness and consumption. Many in
the grains industry agree that grains and
whole grains data are in the same place
the 5 A Day data were when that
nutrition outreach effort began.
The “Grains for the Health of It”
conference brought together a group of
people who do not necessarily meet with
one another; so in some ways, we have
formed the first stages of a coalition.
The objective of the breakout groups was
to determine the next steps in terms of
developing a coalition to support
these efforts.
Questions for the breakout
groups included:
• How is a coalition the best way to
encourage increased grains/whole
grains consumption?
• How can you, in your job, be part of
this effort?
• What are the barriers to your
industry or your phase of the
industry to being part of this?
• What should the message be?
• Do we need more focus groups and
research about what the message
should be?
• How do we package the data and
move that information from the
laboratory to the consumer?
• How do we change behavior?
• Where do we go from here?
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Breakout Group Responses
Industry — Education, Marketing,
Advertising, and Labeling
• Put consumers first and spend time
and money digging deeper into
consumer understanding about whole
grains, healthful eating, etc. Do not
elevate whole grains at the expense
of enriched grains, which many
consumers enjoy.
• Develop some sort of whole grain
exchange (similar to the diabetic
exchange), so the industry could
define a standard serving, including a
possible nutrient content claim for
whole grains.
• Educate consumers, as well as health
professionals and millers, about the
health benefits of whole grains,
giving them a compelling reason to
choose whole grains, before the
industry starts talking about how to
identify a whole grain food.
Industry — Ideation for Taste, Quality,
and Convenience
• Put the definition for whole grains into
consumer language; the issue then
becomes whether you can say something
is a whole grain if you cannot make the
health claim. (For instance, should a
product high in fat or sugar content still
be called a whole grain product, not as a
health claim issue but in terms of
advertising and education?).
• Make whole grains fun, especially if you
are trying to encourage consumption
among kids.
• Consider increasing consumer
consumption and interest in whole
grains by trying incremental
increases in whole grain percentages
in products.
• Educate consumers to expand the • Move forward with a “Three Are
grains category to include Key” coalition before the science is
under-recognized grains and more definitive because of time concerns;
non-traditional products. also, we need to defend all types of
grains placed at the base of the Food
Extension Agents, Dietitians, Guide Pyramid.
and Consumers
• Develop consistent training
regarding what is a whole grain,
incorporating the
portion-size message.
• Focus on early intervention as the
most effective way to reach
consumers, also using child
connections with parents as an
opportunity to convey an attached
message and use parents as models.
• Do more consumer research
regarding “Three Are Key,” because
none has been done to date, and
consider not using a number because
it immediately sends the consumer
into a paroxysm of calculating.

Academicians and Researchers

• Recognize that definition is
important, noting the
AACC-approved definition is
understandable to food scientists but
uninterpretable to consumers, whose
awareness is critical.
• Understand that in research areas,
quantitation of health food and
whole grain intake is very
problematic because the questions
that exist do not capture that food
group; there are no biomarkers
available for it.
• Consider convincing the industry,
rather than telling people they need
to eat “X” servings of whole grains a
day. The industry could develop a
product that would depend on a
higher extraction rate for flour.

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SPEAKER BIOGRAPHIES

Mary Begalle, Director of Food and Nutrition Services, Minnesota Department of

Children, Families & Learning. Mary Begalle oversees the administration of the
National School Lunch Program, the National School Breakfast Program, the Child and
Adult Care Food Program, the Summer Food Service Program, and the Food Distribution
Program in Minnesota. The annual budget for Food and Nutrition Service is
$175 million. Prior to joining the department, she was a school foodservice director for
14 years, having worked most recently for Independent School District 196 in
Rosemount-Apple Valley-Eagan, Minnesota. She is an active member of the Minnesota
School Food Service Association.

Susan T. Borra, R.D., Senior Vice President and Director of Nutrition, International
Food Information Council. Susan Borra is senior vice president and director of
nutrition at the International Food Information Council (IFIC) in Washington, D.C., a
nonprofit organization that communicates sound, science-based information on nutrition
and food safety to health professionals, educators, government officials, media, and
consumers. She currently serves as president of the American Dietetic Association
(ADA) and is a past chairman of the ADA Foundation. She has served as
secretary/treasurer of the ADA Board of Directors. She has a bachelor’s degree in
nutrition and dietetics from the University of Maryland and is a registered dietitian.

Sharon P. Davis, Consumer Education Consultant. Sharon has a Bachelor of Science

degree in family and consumer sciences education, Iowa State University, and is
currently a consumer education consultant (1993 to present). Clients include: Hershey
Foods, Home Baking Association/Wheat Foods Council, Kansas Wheat Commission,
Nebraska and Ohio Soybean Boards, and West Virginia Child Nutrition Services.
Spokesperson services include consumer and professional education sessions for child
and adult food programs, and media resource person. She has conducted over
400 education seminars provided for international, national, regional, state, and
local audiences.

Warren Formo, Program Manager, Minnesota Corn Growers Association.

Warren Formo is the program manager for the Minnesota Corn Growers Association
(MCGA). Warren studied Agricultural Economics at the University of Minnesota before
joining his family in a farm corporation in which he was active until 1999. He also
served on the MCGA board of directors from 1995 through 1999, where he first became
involved in agricultural issues. In his current role with the MCGA, he is responsible for
evaluating policy, legislation, and regulatory issues.

91
Gary Fulcher, Ph.D., Professor, University of Minnesota. R. Gary Fulcher, Ph.D., is a
professor and chair of Cereal Chemistry and Technology at the University of Minnesota
(1989 to present). He has an M.Sc. degree in biology from Carleton University, Ottawa,
Canada, and a Ph.D. degree in botany from Monash University, Melbourne, Australia.
Prior to his position at the University of Minnesota, he served as research coordinator,
Grains and Oilseeds and as senior research scientist at Agriculture Canada, Ottawa,
Canada (1984-1989).

David Jacobs, Ph.D., Professor, School of Public Health, Division of Epidemiology,

University of Minnesota. David Jacobs is a biostatistician and cardiovascular
epidemiologist. He is co-principal investigator of CARDIA, a national longitudinal study
of the evolution of cardiovascular risk in young adults. He directs studies of whole grain
intake and the occurrence of chronic diseases. He has been a statistical analyst or
co-investigator in experiments involving the interrelationships of drugs, diet, and
exercise. He also has worked with studies of cancer and infectious disease outcomes and
with drug and behavioral intervention studies.

Gary L. Jensen, Senior Vice President, Marketing, Sara Lee Bakery Division.
Gary Jensen is responsible for marketing all of Earthgrains’ domestic bakery products.
In this role he manages a variety of related functions, including market research, brand
management, new product development, promotions, marketing services, and public
relations on branded products. He began his career at Earthgrains in 1986 as a group
marketing manager. He also has served as vice president, Sales & Marketing, of the
Diversified Group; senior vice president, Sales, Western Region; and senior vice
president, National Accounts. He earned a B.S. degree in business administration at the
University of Texas, Dallas. Earthgrains was purchased by Sara Lee in 2001.

Julie Miller Jones, Ph.D., L.N., C.N.S., Professor, College of St. Catherine. Julie Jones,
a board-certified and licensed nutritionist, received her B.S. degree from Iowa State University
and her Ph.D. in home economics/food science and nutrition from the University of Minnesota.
Currently, she is professor of nutrition in the Department of Family, Consumer and Nutritional
Sciences at the College of St. Catherine in St. Paul. She has twice been named St. Catherine’s
outstanding professor and has been named by the alumnae as a professor who made a
difference in people’s lives. She holds the 3M Endowed Chair in Science from 2000 to 2003.

Tom Jorgens, CEO, PolyCell Technologies. Tom Jorgens is CEO of PolyCell

Technologies, a bioscience technology company developing innovations for human and
animal health and nutrition. His business focus is on identification and development of
proprietary technologies to extract and apply bioactive compounds in functional foods,
nutraceuticals, and pharmaceutical markets. He is leading company efforts to forge
technical and business alliances on production and marketing of beta glucans and other
components of barley grain that are known to convey health benefits.

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Cathy Kapica, Ph.D., R.D., L.D., F.A.C.N., Director, Nutrition Education,
Quaker Oats Company. Cathy Kapica is director-nutrition education for The Quaker
Oats Company. She assumed this role in September 1999. Before joining Quaker, she
was on faculty at Finch University of Health Sciences/The Chicago Medical School in
North Chicago. She is a registered dietitian, a fellow of the American College of
Nutrition, and is certified in family and consumer science. She attended Loyola
University where she earned a B.S. degree in biology. She graduated with a Master of
Science degree in clinical nutrition from Rush University and a Doctor of Philosophy
degree in public health sciences from the University of Illinois.

David Klurfeld, Ph.D., Professor and Chair, Department of Nutrition and Food
Science, Wayne State University. David Klurfeld received M.S. and Ph.D. degrees in
pathology from the Medical College of Virginia in Richmond, Va. He was employed as
a research associate and assistant professor from 1979-1986 at The Wistar Institute in
Philadelphia and from 1989-1992 as an associate professor of nutrition in Surgery,
University of Pennsylvania School of Medicine. Since 1992, he has been employed as
professor and chairman, Department of Nutrition & Food Science, Wayne State
University, Detroit. Publications include more than 140 diet and chronic diseases.

David Kritchevsky, Ph.D., Wistar Institute. David Kritchevsky is a professor and a

Caspar Wistar Scholar at the Wistar Institute in Philadelphia and a professor of
biochemistry in the School of Veterinary Medicine of the University of Pennsylvania.
He received his B.S. and M.S. degrees in chemistry from the University of Chicago and
Ph.D. in chemistry from Northwestern University. After post doctorates in Zurich,
Switzerland, and Berkeley, Calif., he spent five years in the industry before joining the
Wistar Institute in 1957. He is past president of the AIN and the Society of Experimental
Biology and Medicine. He is an internationally recognized expert on cancer,
atherosclerosis, and cholesterol metabolism. He wrote the first book on cholesterol
(1958) and co-authored the first book on sitosterol (1981). He has authored or
co-authored more than 400 research papers, numerous book chapters, and abstracts. He
serves as consulting editor for Atherosclerosis and is a member of a number of editorial
boards, including Lipids. Among other prestigious awards, he has received the
Supelco-ACOS Research Award; the Auenbrugger Medal, University of Graz, Austria;
and the Borden Award from the AIN.

Leslie Lytle, Ph.D., R.D., Professor, School of Public Health University

of Minnesota. Leslie Lytle received an undergraduate degree in medical dietetics from
Penn State University, a master’s degree in education with an emphasis in nutrition from
Purdue University, and her doctorate in health behavior and health education from the
University of Michigan. She is a professor in the Division of Epidemiology in the
School of Public Health at the University of Minnesota. She does research in developing
and evaluating theory-based interventions to promote health behaviors in children
and adolescents.

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Len Marquart, Ph.D., Sr. Scientist, Bell Institute of Health and Nutrition,
General Mills. Len Marquart is a senior scientist with the Bell Institute of Health and
Nutrition at General Mills. He, along with his colleagues, was instrumental in securing
the first authoritative health claim for whole grains, coronary heart disease, and cancer.
He has collaborated extensively with academic researchers to examine the role of whole
grain intake on risk for heart disease, cancer, and diabetes. He is a graduate of Syracuse
University and the University of North Carolina.

Gene Miller, Ph.D., Principal Scientist, James Ford Bell Technical Center General
Mills, Inc. Gene Miller has academic degrees in organic chemistry and biochemistry. He
has been employed by General Mills in the research area for 32 years. Currently, he works in
the breakfast cereal division and conducts research in the areas of antioxidant analysis in
cereals and other foods; breakfast cereals and lipid oxidation; breakfast cereals, vitamins, and
minerals; and in the past, breakfast cereals and dental caries.

Marla Reicks, Ph.D., R.D., Associate Professor and Extension Nutritionist, University
of Minnesota. Marla Reicks has an M.S. and Ph.D. degree in nutrition from Iowa State
University. She has been a registered dietitian for 25 years and has been on the faculty in the
Department of Food Science and Nutrition and an Extension Nutritionist for the University
of Minnesota extension service for the past 11 years. Her research and extension program
interests include using behavior change theories to influence fruit, vegetable, and grains
consumption in low-income minority populations, school meal, and weight control programs.

Debi Rogers, Ph.D., Director, Cereal Chemistry (Education), American Institute

of Baking. Deborah E. (Debi) Rogers received her degree from Kansas State University
(M.B.A. in business and Ph.D. in cereal science). She is currently the director, Cereal
Chemistry (Education), American Institute of Baking and an adjunct assistant professor at
Kansas State University. Industry-extension activities include numerous presentations at
American Institute of Baking seminars and short courses, and consulting to a variety of
companies. Research interests are starch chemistry, cereal protein chemistry, and
dough rheology.

Kent Salisbury, Milling Expert, Quaker Oats Co. Kent Salisbury is director of
milling, R&D, for the Quaker Oats Company at their Barrington, Ill., Research Laboratory.
He has 39 years of R&D experience with Quaker Oats, focusing on oat and corn milling
research and the utilization of cereal grains in the development of hot cereals, RTE cereals,
mixes, and corn goods. He received a degree in grain science from Kansas State University
and began his career with Quaker following graduation. He is a member of the American
Association of Cereal Chemists, serving on the Dietary Fiber Committee and as a charter
member of the Oat Products Committee.

94
Joanne Slavin, Ph.D., R.D., Professor, University of Minnesota. Joanne Slavin is a
registered dietitian and received a Ph.D., in nutritional sciences at the University of
Wisconsin-Madison. Since 1981, she has been a professor of nutrition at the University of
Minnesota in St. Paul. She is a frequent source for the media on topics ranging from sports
nutrition, diet and cancer, carbohydrates and dietary fiber, and women’s health. She teaches
courses in human nutrition, sports nutrition, and diet and disease at the University of
Minnesota. She has presented more than 250 invited scientific lectures on topics ranging
from sports nutrition to diet and cancer. Her research has generated more than $5 million
dollars in competitive research grants from the National Cancer Institute, the
U.S. Department of Agriculture, commodity groups, and corporations. She is the author of
more than 100 scientific publications and numerous book chapters and review articles.

Jean Storlie, M.S., R.D., Manager, Nutrition and Health Communications,

Bell Institute of Health and Nutrition, General Mills. Jean Storlie is a registered
dietitian with an M.S. degree in adult fitness/cardiac rehabilitation from the University
of Wisconsin-LaCrosse and a B.S. degree in community-medical dietetics from
Viterbo College in LaCrosse. She spent the first 12 years of her career working in the
areas of wellness, fitness, and health promotion, spearheading a number of lifestyle
change programs.

Joe Warthesen, Ph.D., Professor and Head, Department of Food Science and
Nutrition, University of Minnesota. Joe Warthesen received his M.S. in food science
from the University of Minnesota and Ph.D. in food science from Oregon State
University. He has been on the faculty at the University of Minnesota since 1974. He
has served as director of the Minnesota-South Dakota Dairy Foods Research Center
since1987 and has been department head since 1998. His research interests are in the
area of food chemistry and involve the use of HPLC methods to determine the
degradation and formation of food chemicals during processing, storage, and preparation.

Kathy Wiemer, Senior Manager, Bell Institute of Health and Nutrition,

General Mills. Kathy Wiemer has been employed at General Mills for 23 years and is
currently senior manager in the Bell Institute of Health and Nutrition. In her current
position, she is responsible for ensuring that General Mills’ products comply with
existing government and corporate nutrition regulations and policies. She leads the
development of corporate positions and comments to government regulatory agencies on
nutrition issues and serves as a liaison with these agencies, trade associations, and health
professional organizations in the area of nutrition. Kathy currently serves on the
American Heart Association’s Industry Nutrition Advisory Panel (INAP), the Executive
Council of the Institute of Food Technologist’s (IFT) Nutrition Division, and the Board
of Directors of the Wheat Foods Council. She serves on several technical committees of
the International Life Sciences Institute (ILSI) and the International Food Information
Council (IFIC). Kathy is a Licensed and Registered Dietitian and a member of the
American Dietetic Association (ADA), the Dietitians in Business and Communications
practice group of the ADA, and the Minnesota Dietetic Association.

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PROGRAM SPONSORS

The “Grains for the Health of It” conference was brought to you by the University of
Minnesota and the Wheat Foods Council. Additional sponsors include:

Platinum Sponsors
• General Mills

Silver Sponsors
• Quaker Oats

Bronze Sponsors
• American Bakers Association
• Cargill
• ConAgra
• Sara Lee Bakery Division
• Hodgson Mills
• Kellogg
• National Barley Foods Council
• Kansas Wheat Commission
• North American Millers’ Association

Endorser
• American Association of Cereal Chemists

97