1. E XTERNALITIES FROM G RAIN C ONSUMPTION : A S URVEY Matthew Metzgar, PhD SUNY Alfred State College

2. I NTRODUCTION The USDAs MyPyramid plan recommends grain consumption for all Americans For an average female, 6 ounces of grain per day are recommended, split equally between whole and refined grains Grains are generally thought to have positive effects on health With public healthcare spending rising to record levels, dietary guidelines should be crafted to maximize health and decrease spending 2

3. P OSITIVE E XTERNALITIES OF W HOLE G RAINS Consumption of whole grains has an inverse correlation with chronic disease Cardiovascular Disease Type 2 diabetes Hypertension Whole grain consumption is also correlated with lower body weight in adults Whole grain consumption is inversely related to a number of cancers – stomach, bladder, kidney, and colorectal cancers 3

4. P OSITIVE E XTERNALITIES OF R EFINED G RAINS Refined grains are fortified with vitamins and minerals to prevent certain disease conditions Refined grain fortification were successful in eliminating beriberi and pellagra Iron fortification in refined grains has been effective in preventing anemia Folic acid fortification in refined grains has helped reduce neural tube defects 4

5. R EFINED G RAINS Consumption of refined grains versus whole grains has different impacts on chronic disease There is no relationship between refined grain consumption and cardiovascular disease Consumption of refined grains has no impact or may increase the risk of type 2 diabetes Refined grain consumption has no effect on hypertension 5

6. N EGATIVE E XTERNALITIES OF R EFINED G RAIN Consumption of refined grains has an unclear impact on body weight with some studies showing it may increase the risk of obesity Refined grain consumption increases the risk of certain cancers – stomach, large bowel, esophagus, oral cavity, and the larynx 6

7. N EGATIVE E XTERNALITIES OF G RAINS Celiac disease – an autoimmune disease where a person has an immune reaction to the protein gluten which is found in the specific grains wheat, rye, and barley The prevalence of celiac disease is approximately 1% of large populations Celiac disease is four times as common as it was 50 years ago Celiac disease is often undiagnosed and leads to significantly increased health care costs 7

8. A UTOIMMUNE D ISEASES Gluten has been implicated in a number of other autoimmune conditions Gluten can increase intestinal permeability and may trigger a variety of autoimmune diseases The prevalence of autoimmune disease in the U.S. is approximately 3.2 percent This is roughly the same prevalence as cancer 8

9. A UTOIMMUNE D ISEASES Type 1 Diabetes Gluten is hypothesized to be a trigger Two studies show a gluten-free diet produces positive outcomes for subjects with Type 1 Diabetes Rheumatoid Arthritis Similarities to celiac disease Two studies show positive effects of a gluten-free diet Psoriasis Markers of latent celiac disease are present in patients with psoriasis Gluten-free diet can improve outcomes 9

10. M ENTAL H EALTH Sensitivity to gluten has been linked to neurological problems Gluten sensitivity has been linked to depression Sensitivity to gluten may impact schizophrenia A gluten-free diet led to a dramatic reduction in symptoms for a subset of schizophrenia patients 10

11. A STHMA AND A LLERGIES A growing number of children have wheat hypersensitivity Exposure to gluten may increase the risk of asthma in these children Children with sensitivity to wheat later developed sensitivity to pollen 25.3% of patients with allergic rhinitis had a positive skin prick test to a mix of cereals 11

12. D ISCUSSION Recommending 50% whole grain and 50% refined grain consumption may lead to uncertain outcomes Based on some evidence, this mix may actually lead to negative outcomes Recent research shows that as the share of refined grain consumption increases, so does the risk of obesity Benefits of whole grains in terms of reduced weight decrease as refined grain consumption increases 12

13. D ISCUSSION Refined grain consumption does have positive benefits and reduces health care spending on certain conditions: Anemia Neural tube defects 13

14. D ISCUSSION Recommending grains for everyone while ignoring celiac disease creates negative externalities Given a prevalence rate of 1% and the US population of around 300 million, this estimates that 3 million Americans have celiac disease This group may or may not be aware of their condition and is being given dietary recommendations to consume a substantial amount of grains 14

15. D ISCUSSION Fassano (2009) recommended for mass screening of celiac disease Shamir (2006) showed that this screening would be cost-effective Adding screening for celiac disease to the current dietary recommendations could result in more efficient public policy 15

16. D ISCUSSION Gluten sensitivity creates negative health outcomes in a variety of areas: Mental Health Asthma Allergies An alternative dietary recommendation could be to deemphasize the gluten-containing grains: wheat, barley, and rye This would protect those with gluten sensitivity This change may be difficult since wheat flour is currently consumed in large amounts 16

17. E CONOMIC B URDEN The economic burden of major diseases is quite substantial: Cardiovascular Disease - $149 billion Type 2 Diabetes - $159 billion Hypertension - $73.4 billion Cancer - $228.1 billion Obesity - $215 billion 17

18. E CONOMIC B URDEN The economic burden of conditions negatively affected by grain consumption is also significant Celiac Disease – unknown Type 1 Diabetes - $14.4 billion Rheumatoid Arthritis - $39.2 billion Psoriasis - unknown Asthma - $12.7 billion Allergies - $1.2 billion Mental Health - $317.6 billion 18

19. C ONCLUSION Is recommending grain consumption for all Americans good public policy? More research is needed into the relationship between grains and disease conditions Replacement foods must be considered in alternative dietary recommendations Fruits and vegetables have the highest nutrient density but are also more expensive Alternative dietary guidelines may be able to improve public health and reduce the economic burden of disease 19

20. T HANK Y OU Matthew Metzgar, PhD SUNY Alfred State College