by Sophie Turigel, NHS Dietitian
Not enough scientific research has been carried out into the daily consumption of sourdough bread instead of yeast-risen bread. We only have epidemiological evidence, as the vast majority of the French population eat sourdough bread daily in the form of the baguette. So what can we learn from the health of the French population with regards to the components of the baguette?
The French Paradox
The French population as a whole has a lower incidence of obesity, type 2 diabetes, metabolic syndrome, irritable bowel syndrome (1 - see references below) and as recently has been discovered, coeliac disease, than most western countries. Childhood obesity levels in 2012, were 13.9% in France compared to 17.8% in England (2).
These diseases stem from a multifactorial problem involving many pieces of a puzzle, including food availability, working parents, education and social pressures. The lower levels of obesity and metabolic diseases in France have often been referred to as The French Paradox. Could the humble baguette be a part of this paradox?
In France, most people still buy their bread from their local boulangerie where the baguette is made following the traditional slow method of production, using a starter bacterial culture dough mixture called levain. The translation of levain into English is sourdough.
Sourdough bread, as you may already know, is made from dough which has been fermented by a bacterial culture, often very slowly. The result of this process is that the fructans, gluten and phytates in the flour are broken down and B vitamins (including vitamin B12), as well as lactic acid, are released in the process.
During the baking process the cultured bacteria is killed and people believe that the final product is a sour-tasting bread. However, the French baguette is a light fluffy bread which does not taste sour, since the bakers have developed their recipe and baking methods for hundreds of years. The French bakers avoid to use the term sourdough and, as a matter of fact, some of the French products available in English supermarkets are labelled as ‘made with authentic levain’ and they are rather sweet, such as Brioche and milk bread rolls.
The French therefore, are eating baguette which is low in fructans, which may reduce indigestible fibres that they consume; lower in gluten, which may prevent the dormant genes for coeliac disease from being expressed or the symptoms associated with non-coeliac gluten sensitivity; and low in phytates which prevent phytic acid from binding with divalent minerals such as iron, zinc and calcium (3).
Could this be one of the reasons that there are lower levels of these metabolic diseases in France?
Popular ‘Dieting Habits’
The avoidance of bread is a common factor in many ‘fad diets. In the UK, America and Australia, people have always found one of these ‘diets’ to help them to speed up their weight loss or to help resolve their digestive issues, which may include bloating, constipation and diarrhoea. Such diets are the Atkins diet, the cabbage soup diet, the Slimfast diet, the Ketogenic diet and the Paleo diet. These help people achieve their goals in the short term but they exclude whole foods groups which are important to our long-term health.
So, inevitably, when the diet is stopped and normal eating patterns resume, the weight is regained or the digestive symptoms return (4). Analysing these diets carefully, one of their common factors is the bread. Initially it is avoided and then is reintroduced. Even with more wellrounded dietary programmes, such as Weight Watchers and Slimming World, bread intake is also reduced.
This may be an indication that people in the UK are struggling with the bread that they eat. As a nation, however, we still do love our bread; the average bread purchased in the UK is the equivalent of 60.3 loaves per person per year (5). Most of this bread is made from strong white wheat flour, water and fast-acting yeast to create quick, cheap, tasty food in around four hours.
When people from other cultures move here, they love our fresh, spongy bread to put in the toaster or have as a sandwich without realising, in some of the cases, consumption of this could increase the incidence of disease such as coeliac disease.
Increased Incidence of Coeliac Disease
Many people who move to England from Ireland develop coeliac disease and they have to switch to eating a gluten-free bread which is made from mixtures of rice, maize and sorghum flour (6).
The incidence of coeliac disease in England is thought to be 1% of the population and many people don’t have the classic symptoms of lethargy, diarrhoea or weight loss due to malabsorption. This development of coeliac disease is thought to be partly triggered by gluten in the environment and partly due to hereditary factors. In recent times, there are more people coming to clinics and dietitians spend a considerable amount of time consoling their patients, trying to encourage them to follow a strict gluten-free diet.
The statistics for coeliac disease in the French population are lower than here, at only 0.24% of the population (7). Their equivalent of Coeliac UK (Association Francaise Des Intolérants Au Gluten) has 6,000 members, compared to 60,000 at Coeliac UK. There are not many gluten-free products for sale in French supermarkets and for those who have coeliac disease, eating out in restaurants in France is very difficult, particularly with their bread baskets full of baguette on the table. This low incidence may partly be due to their bread having lower amounts of gluten in it.
The gluten-free market in England, America and Australia, however, is booming, with many products on offer in the ‘Free From’ aisles in the supermarkets. Some may believe that it is a food fad which may go away, but in this case, it may be here to stay. As well as recommending gluten-free diets for coeliacs, some fertility consultants also refer women for a glutenfree diet as they have found that it helps women to conceive.
The Low Fodmap Diet
The low FODMAP diet also involves changing the type of bread eaten. It was designed in Monash University, Australia, in 2005 and has helped many people with irritable bowel syndrome to combat their symptoms of bloating, diarrhoea, abdominal cramps and constipation (8). The principle of the diet is to avoid a list of foods and ingredients for around eight weeks and then these foods are reintroduced, group by group to find out which foods may be causing the symptoms.
The high FODMAP foods include wheat bread products which contain fructans whereas the low FODMAP bread products that have been traditionally allowed are gluten-free breads that do not contain fructans. The companies that produce gluten-free bread have had their products tested by Monash University to be certified low in FODMAPs (9) ; more products are being tested all the time and are being added to the list. There is also a new phone app to help people to choose appropriate foods when they are out shopping.
In May this year, the low FODMAP diet list was updated with the addition of two slices of sourdough bread made from wheat flour (10). This bread has been fermented by a bacterial culture, often very slowly, so that the frutans, gluten and phytates are broken down and B vitamins are released in the process (11). It is not yet recommended by dietitians in England as there is no equipment available to test breads for fructans in the UK.
Sourdough Breads in The Mediterranean Diet
Pitta bread, ciabatta and focaccia were also made with fermented wheat flour in the past and still may be in parts of rural Mediterranean regions. Many of these artisan foods are now available to buy in English supermarkets. Could part of the reason that the Mediterranean diet is so healthy be because they still eat bread which has been fermented?
With the increased number of sourdough products available, we need to carry out lots of research into whether sourdough bread and other products can help patients to treat their disease, especially if they are considering a low Carbohydrate diet, or a gluten-free diet when they are not coeliac.
References:
1. Bommelaer G1, Prevalence of irritable bowel syndrome in the French population according to the Rome I criteria Gastroenterol Clin Biol. 2002 Dec;26(12):1118-23.
2. Obesity Update 2017: The Organisation for Economic Co-operation and Development
3. S.A. Valencia-Chamorro, in Encyclopaedia of Food Sciences and Nutrition (Second Edition), 2003
4. NHS Choices UK: How to Diet
5. NABIM (National Association of British and Irish Millars)
6. N.Gujral et al. Celiac Disease: Prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol. 2012 Nov 14;18(42):6036-59. doi: 10.3748/wjg. v18.i42.6036
7. www.digestscience.com/fr/ pathologies-digestives/maladie-coeliaque
8. Monash University Melbourne Gastroenterology Department
9. Dr Schar Corporate, Burgstall Italy
10. DietvsDisease.org
11. M. Gaenzle, Encyclopedia of Food Microbiology (2nd edition) 2014 pg 309.
