Visceral fat not only produces abnormally high levels of inflammatory signals but is also itself inflamed, containing bountiful collections of inflammatory white blood cells (macrophages).10 The endocrine and inflammatory molecules produced by visceral fat empty directly into the liver (via the portal circulation draining blood from the intestinal tract), which then responds by producing yet another collection of inflammatory signals and abnormal proteins.
In other words, in the human body, all fat is not equal. Wheat belly fat is an especially bad fat. The belly is not just a passive repository for excess pizza calories; it is, in effect, an endocrine gland much like your thyroid gland or pancreas, albeit a very large and active endocrine gland. (Ironically, Grandma was correct forty years ago when she labeled an overweight person as having a “gland” problem.) Unlike other endocrine glands, the visceral fat endocrine gland does not play by the rules, but it follows a unique playbook that works against the body’s health.
So a wheat belly is not just unsightly, it’s also dreadfully unhealthy.
GETTING HIGH ON INSULIN
Why is wheat so much worse for weight than other foods?
The essential phenomenon that sets the growth of the wheat belly in motion is high blood sugar (glucose). High blood sugar, in turn, provokes high blood insulin. (Insulin is released by the pancreas in response to the blood sugar: The higher the blood sugar, the more insulin must be released to move the sugar into the body’s cells, such as those of muscle, liver, and fat cells.) When the pancreas’s ability to produce insulin in response to blood sugar rises is exceeded, diabetes develops. But you don’t have to be diabetic to experience high blood sugar and high insulin: Non-diabetics can easily experience the high blood sugars required to cultivate their very own wheat belly, particularly because foods made from wheat so readily convert to sugar.
High blood insulin provokes visceral fat accumulation, the body’s means of storing excess energy. When visceral fat accumulates, the flood of inflammatory signals it produces causes tissues such as muscle and liver to respond less to insulin. This so-called insulin resistance means that the pancreas must produce greater and greater quantities of insulin to metabolize the sugars. Eventually, a vicious cycle of increased insulin resistance, increased insulin production, increased deposition of visceral fat, increased insulin resistance, etc., etc., ensues.
Nutritionists established the fact that wheat increases blood sugar more profoundly than table sugar forty years ago. As we’ve discussed, the glycemic index, or GI, is the nutritionist’s measure of how much blood sugar levels increase in the 90 to 120 minutes after a food is consumed. Whole wheat bread has a GI of 72, while plain table sugar has a GI of 59 (though some labs have gotten results as high as 65). In contrast, kidney beans have a GI of 51, grapefruit comes in at 25, while non-carbohydrate foods such as salmon, eggs, and walnuts have GIs of zero: Eating these foods has no effect on blood sugar. In fact, with few exceptions, few foods have as high a GI as foods made from wheat. Outside of dried fruits such as dates and figs, the only other foods that have GIs as high as wheat products are dried, pulverized starches such as cornstarch, rice starch, potato starch, and tapioca starch. (It is worth noting that these are the very same carbohydrates used to make “gluten-free” foods. More on this peculiar and maddening situation later.)
Because wheat and grain carbohydrate, the uniquely digestible amylopectin A, causes a greater spike in blood sugar than virtually any other food—more than a candy bar, table sugar, or ice cream—it also triggers greater insulin release. More amylopectin A means higher blood sugar, higher insulin, more visceral fat deposition … bigger wheat belly. Or rye belly, barley belly, corn belly, and oat belly.
Throw in the inevitable drop in blood sugar (hypoglycemia) that is the natural aftermath of high insulin levels, and you see why irresistible hunger so often results, as the body tries to protect you from the dangers of low blood sugar. You scramble for something to eat to increase blood sugar, and the cycle is set in motion again, repeating every two hours.
Factor in your brain’s response to the euphoric exorphin effects induced by wheat (and the potential for withdrawal if your next “fix” is missed), and it’s no wonder the wheat belly encircling your waist continues to grow and grow.
MEN’S LINGERIE IS ON THE SECOND FLOOR
Wheat belly is not just a cosmetic issue, but a phenomenon with real health consequences. In addition to producing inflammatory hormones such as leptin, visceral fat is also a factory for estrogen production in both sexes, the very same estrogen that confers female characteristics on girls beginning at puberty, such as widening of the hips and growth of the breasts. Estrogen levels are oddly jacked up by visceral fat of the wheat belly and peculiar and unwanted effects in both women and men follow.
Until menopause, adult females have high levels of estrogen. Surplus estrogen, however, produced by visceral fat adds considerably to breast cancer risk, since estrogen at high levels stimulates breast tissue.11 Thus, increased visceral fat on females has been associated with as much as fourfold increased risk for breast cancer. Breast cancer risk in postmenopausal women with the visceral fat of a wheat belly is double that of slender, non-wheat-belly-bearing postmenopausal females.12 Despite the apparent connection, no study—incredibly—has examined the results of a wheat-free, lose-the-visceral-fat-wheat-belly diet and its effect on the incidence of breast cancer. If we simply connect the dots, a marked reduction in risk would be predicted.
Males, having only a tiny fraction of the estrogen of females, are sensitive to anything that increases estrogen. The bigger the wheat belly in males, the more testosterone is converted to estrogen by visceral fat tissue via the aromatase enzyme. Since estrogen stimulates growth of breast tissue, elevated estrogen levels can cause men to develop larger breasts—those dreaded “man boobs,” “man cans,” or, for you professional types, gynecomastia.13 Levels of the hormone prolactin are also increased substantially by visceral fat.14 As the name suggests (prolactin means “stimulating lactation”), high prolactin levels stimulate breast tissue growth and milk production. To make matters worse, one of the exorphin breakdown products of wheat gliadin, called the B5 pentapeptide, is another potent stimulator of the pituitary gland’s release of prolactin in males.15
Enlarged breasts on a male are therefore not just the embarrassing body feature that your annoying nephew snickers at, but B-cup evidence that estrogen and prolactin levels are increased due to the inflammatory and hormonal factory hanging around your waist, as well as peculiar digestive by-products of gliadin that make your body do things it should not.
An entire industry has emerged to help men embarrassed by their enlarged breasts. Male breast reduction surgery is booming, growing nationwide at double-digit rates. Other “solutions” include special clothing, compression vests, and exercise programs. (Maybe Seinfeld’s Kramer wasn’t so crazy when he invented the mansierre.)
Increased estrogen, breast cancer, man boobs … all from the bag of bagels shared at the office.
CELIAC DISEASE: A WEIGHT LOSS LABORATORY
As noted earlier, the one ailment to which wheat has been conclusively linked even among conventional dietary thinkers is celiac disease. Celiac sufferers are counseled to remove wheat products and other gluten-containing grains from their diet, lest all manner of nasty complications of their disease develop. What can their experience teach us about the effects of wheat elimination? In fact, there are unclaimed gems of important weight loss lessons to be gleaned from clinical studies of people with celiac disease who remove wheat gluten–containing foods.
The lack of appreciation of celiac disease among physicians, coupled with its many unusual presentations (for example, fatigue or migraine headaches without intestinal symptoms), means an average delay of eleven years from symptom onset to diagnosis.16, 17 Some celiac sufferers therefore develop a severely malnourished state due to impaired nutrient absorption at the time of diagnosis. This is especially true for children with celiac disease, who are often both underweight and underdeveloped for their age.18
Some celiac sufferers become positively emaciated before the cause of their illness is determined. A 2010 Columbia University study of 369 people with celiac disease enrolled 64 participants (17.3 percent) with an incredible body mass index of 18.5 or less.19 (A BMI of 18.5 in a 5-foot-4 female would equate to a weight of 105 pounds, or 132 pounds for a 5-foot-10 male.) Years of poor nutrient and calorie absorption, worsened by frequent diarrhea, leave some celiac sufferers underweight, malnourished, and struggling just to maintain weight.
Elimination of wheat gluten removes the offensive agent that destroys the intestinal lining. Once the intestinal lining regenerates, better absorption of vitamins, minerals, and calories becomes possible, and weight begins to increase due to improved nutrition. Such studies document the weight gain with wheat removal experienced by underweight, malnourished celiac sufferers.
For this reason, celiac disease has traditionally been regarded as a plague of children and emaciated adults. However, celiac experts have observed that, over the past forty to fifty years, newly diagnosed patients with celiac disease are more and more often overweight or obese. One such recent ten-year tabulation of newly diagnosed celiac patients showed that 39 percent started overweight (BMI 25 to 29.9) and 13 percent started obese (BMI ≥ 30).20 By this estimate, more than half the people now diagnosed with celiac disease are therefore overweight or obese.
If we focus only on overweight people who are not severely malnourished at the time of diagnosis, celiac sufferers actually lose a substantial quantity of weight when they eliminate gluten. A Mayo Clinic/University of Iowa study tracked 215 celiac patients after wheat gluten elimination and tabulated 27.5 pounds of weight loss in the first six months in those who started obese.21 In the Columbia University study cited above, wheat elimination cut the frequency of obesity in half within a year, with more than 50 percent of the participants with a starting BMI in the overweight range of 25 to 29.9 losing an average of 26 pounds.22 Dr. Peter Green, lead gastroenterologist in the study and professor of clinical medicine at Columbia, speculates that “it is unclear whether it is reduced calories or another factor in diet” responsible for the weight loss of the gluten-free diet. With all you’ve learned, isn’t it clear that it’s the elimination of wheat that accounts for the extravagant weight loss?
Similar observations have been made in children. Kids with celiac disease who eliminate wheat gluten gain muscle and resume normal growth, but also have less fat mass compared to kids without celiac disease.23 (Tracking weight changes in kids is complicated by the fact that they are growing.) Another study showed that 50 percent of obese children with celiac disease approached normal BMI with wheat gluten elimination.24
What makes this incredible is that, beyond gluten removal, the diet in celiac patients is not further restricted. These were not purposeful weight loss programs, just wheat and gluten elimination. No calorie counting was involved, nor portion control, exercise, or any other means of losing weight … just losing the wheat. There are no prescriptions for carbohydrate or fat content, just removal of wheat gluten. It means that some people incorporate “gluten-free” foods, such as breads, cupcakes, and cookies, that cause weight gain, sometimes dramatic. (As we will discuss later, if you have a goal of weight loss or any health concerns, it will be important not to substitute one weight-increasing food, wheat, with yet another collection of weight-increasing and unhealthy gluten-free items.) In many gluten-free programs, gluten-free foods are actually encouraged. Despite this flawed diet prescription, the fact remains: Overweight celiac sufferers experience marked weight loss with elimination of wheat gluten.
Investigators performing these studies, though suspecting “other factors,” never offer the possibility that weight loss is from elimination of a food that causes extravagant weight gain—i.e., wheat.
Interestingly, these people have substantially lower caloric intake once on a gluten-free diet, compared to people not on a gluten-free diet, even though other foods are not restricted. Caloric intake measured 14 percent less per day on gluten-free diets.25 Another study found that celiac patients who strictly adhered to gluten elimination consumed 418 calories less per day than celiac patients who were non-compliant and permitted wheat gluten to remain in their diets.26 For someone whose daily caloric intake is 2,500 calories, this would represent a 16.7 percent reduction in caloric intake. Guess what that does to weight?
Symptomatic of the bias of conventional nutritional dogma, the investigators in the first study labeled the diet followed by participants recovered from celiac disease “unbalanced,” since the gluten-free diet contained no pasta, bread, or pizza but included more “wrong natural foods” (yes, they actually said this) such as meat, eggs, and cheese. In other words, the investigators proved the value of a wheat-free diet that reduces appetite and requires calorie replacement with real food without intending to or, indeed, even realizing they had done so. A recent thorough review of celiac disease, for instance, written by two highly regarded celiac disease experts, makes no mention of weight loss with gluten elimination.27 But it’s right there in the data, clear as day: Lose the wheat, lose the weight. Investigators in these studies also tend to dismiss the weight loss that results from wheat-free, gluten-free diets as due to the lack of food variety with wheat elimination, rather than wheat elimination itself. (As you will see later, there is no lack of variety with elimination of wheat; there is plenty of great food remaining in a wheat-free lifestyle.)
Removal of gliadin-derived exorphins and reduction of the insulin-glucose cycle that triggers hunger reduces total daily caloric intake by 350 to 400 calories per day, not uncommonly 1,000 or more calories—without consciously restricting calories, fats, carbohydrates, or portion size. No smaller plates, prolonged chewing, or frequent small meals. Just banishing wheat and related grains from your table.
There’s no reason to believe that weight loss with wheat elimination is peculiar to celiac disease sufferers. It’s true for people with gluten sensitivity and for people without gluten sensitivity. It’s true if you’re tall or short, wear a size 28 or size 6 dress, or whether you like shoes with 4-inch heels or sandals.
So when we extrapolate wheat elimination to people who don’t have celiac disease, as I have done for thousands of people and observed in the worldwide Wheat Belly community, we see the same phenomenon: immediate and dramatic weight loss, similar to that seen in the obese celiac population.
LOSE THE WHEAT BELLY
Ten pounds in fourteen days. I know: It sounds like another TV infomercial boasting the latest “lose weight fast” gimmick.
But I’ve seen it time and time again: Eliminate wheat in all its myriad forms and pounds melt away, often as much as a pound a day. No gimmicks, no subscription meals, no special formulas, no calorie counting, no “meal replacement” drinks or “cleansing” regimens required.
Obviously, weight loss at this rate can be maintained for only so long, or you’d end up a pile of dust. But the initial pace of weight loss can be shocking, equaling what you might achieve with an outright fast. I find this phenomenon fascinating: Why would elimination of wheat yield weight loss as rapid as starvation? It is due to a combination of halting the glucose-insulin-fat-deposition cycle, the natural reduction in caloric intake that results, and the loss of inflammation and, most of all, inflammatory water retention. That last phenomenon—loss of inflammatory edema—can be seen in the face, as the thousands of people who have shared their “selfies” show us. The change in facial appearance alone can be so dramatic that critics have claimed that I am finding mothers and daughters and calling them “before” and “after” photos. Nope: It’s just part of the phenomenal catalog of changes that occur with wheat elimination.
Wheat and grain elimination is, by definition, part of low-carbohydrate diets. Clinical studies are accumulating that demonstrate the weight loss advantages of low-carb diets.28, 29 In fact, the success of low-carb diets originates largely from the elimination of wheat. Cut carbs and, by necessity, you cut wheat. Because wheat dominates the diets of most modern adults, removing wheat removes the biggest problem source. (I’ve also witnessed low-carb diets fail because the only remaining carbohydrate source in the diet was wheat-containing products.)
Sugar and other carbohydrates do indeed count, too. In other words, if you eliminate wheat but drink sugary sodas and eat candy bars and corn chips every day, you will negate most of the weight loss benefit of eliminating wheat. But most rational adults already know that avoiding Big Gulps and Cherry Garcia is a necessary part of weight loss. It’s the wheat that still seems counterintuitive.
Wheat elimination is a vastly underappreciated strategy for rapid and profound weight loss, particularly from visceral fat. I’ve witnessed the wheat belly weight loss effect thousands of times: Eliminate wheat and weight drops rapidly, effortlessly, often as much as 50, 60, 100, or more pounds over a year, depending on the degree of excess weight to start. Just among the last thirty patients who eliminated wheat in my clinic, the average weight loss was 26.7 pounds over 5.6 months.
The amazing thing about wheat elimination is that removing this food that triggers appetite and addictive behavior forges a brand-new relationship with food: You eat food because you need it to supply physiologic energy needs, not because you have some odd food ingredient pushing your appetite “buttons,” increasing appetite and the impulse to eat more and more. You will find yourself barely interested in lunch at noon, easily bypassing the bakery counter at the grocery store, turning down the donuts in the office breakroom without a blink. You will divorce yourself from the helpless, wheat-driven desire for more and more and more. And you will notice that your taste perception is enhanced. Foods like candy or cake that you formerly found tasty become sickeningly and intolerably sweet. Foods that you may not have been fond of before, such as Brussels sprouts or broccoli, yield new and delicious flavors that you couldn’t sense during wheat-consuming days, all part of the broad wave of gastrointestinal healing that occurs when your diet doesn’t include wheat and its cousins, a phenomenon that we will discuss in detail. (Apply this principle to kids, by the way, and watch them ask for veggies and chicken.)
It makes perfect sense: If you eliminate foods that trigger exaggerated blood sugar and insulin responses, you eliminate the cycle of hunger and momentary satiety. Eliminate the dietary source of addictive exorphins and you are thereby more satisfied with less. Excess weight dissolves and you revert back to physiologically appropriate weight. You lose the peculiar and unsightly ring around your abdomen: Kiss your wheat belly good-bye.
DOWN 104 POUNDS … 20 MORE TO GO
When I first met Geno, he had that familiar look: gray pallor, tired, almost inattentive. At 5 feet 10, his 322 pounds included a considerable wheat belly flowing over his belt. Geno came to me for an opinion regarding a coronary prevention program, triggered by concern over an abnormal heart scan “score,” an indicator of coronary atherosclerotic plaque and potential risk for heart attack.
No surprise, Geno’s girth was accompanied by multiple abnormal metabolic measures, including high blood sugars well into the range defined as diabetes, high triglycerides, low HDL cholesterol, high C-reactive protein and other measures of inflammation, and several others, all contributors to coronary plaque and heart disease risk.
I somehow got through to him, despite his seemingly indifferent demeanor. I believe it helped that I enlisted the assistance of his chief cook and grocery shopper, Geno’s wife. He was at first puzzled by the idea of eliminating all “healthy whole grains,” including his beloved pasta, and replacing them with all the foods that he had regarded as no-no’s such as nuts, oils, eggs, cheese, and fatty meats.
Six months later, Geno came back to my office. I don’t think it would be an exaggeration to say that he was transformed. Alert, attentive, and smiling, Geno told me that his life had changed. He had not only lost an incredible 64 pounds and 14 inches off his waist in those six months, but he had also regained the energy of his youth, again wanting to socialize with friends and travel with his wife, walking and biking outdoors, sleeping more deeply, along with a newly rediscovered optimism. And he had laboratory values that matched: Blood sugars were in the normal range, HDL cholesterol had doubled, triglycerides dropped from several hundred milligrams to a perfect range.
Another six months later, Geno lost 40 more pounds, now tipping the scale at 218—a total of 104 pounds lost in one year.
“My goal is 198 pounds, the weight I had when I got married,” Geno told me. “Only 20 more pounds to go.” And he said it with a smile.
BE GLUTEN-FREE BUT DON’T EAT “GLUTEN-FREE”
Say what?
Gluten is the main protein of wheat, and as I have explained, it is responsible for some, though not all, of the adverse effects of wheat consumption. The gliadin protein within gluten is the culprit underlying inflammatory damage to the intestinal tract in celiac disease. People with celiac disease must meticulously avoid foods containing gluten. This means the elimination of wheat, as well as other gluten-containing grains such as barley, rye, spelt, emmer, einkorn, triticale, bulgur, and kamut. People with celiac disease often seek out “gluten-free” foods that mimic wheat-containing products. An entire industry has developed to meet their gluten-free desires, from gluten-free bread to gluten-free cakes and desserts.
However, most gluten-free foods are made by replacing wheat flour with cornstarch, rice starch, potato starch, or tapioca starch (starch extracted from the root of the cassava plant). This is especially hazardous for health and for anybody looking to drop 20, 30, or more pounds, since gluten-free foods, though they do not trigger the immune or neurological response of wheat gluten, still extravagantly trigger the glucose-insulin response that causes weight gain. Wheat products increase blood sugar and insulin more than most other foods. But remember: Foods made with cornstarch, rice starch, potato starch, and tapioca starch are among the few foods that increase blood sugar even more than wheat products. Going gluten-free and indulging in gluten-free foods can therefore cause you to replace your wheat belly with a gluten-free belly accompanied by all the awful health consequences of excessive visceral fat—not good.
So gluten-free foods are not problem-free. Gluten-free foods are the likely explanation for overweight celiac sufferers who eliminate wheat and fail to lose weight. In my view, there is no role for gluten-free foods, since the metabolic effect of these foods is little different from eating a bowl of jelly beans even if it is cleverly disguised as seven-grain bread.
Thus, wheat elimination is not just about eliminating gluten. Eliminating wheat means eliminating the amylopectin A of wheat and other grains, the form of complex carbohydrate that increases blood sugar higher than table sugar and candy bars. But you don’t want to replace wheat’s amylopectin A with the rapidly absorbed carbohydrates of powdered rice starch, cornstarch, potato starch, and tapioca starch. Avoid gluten-free foods if you are gluten-free.
