Whittaker A, Dinu M, Cesari F, et al. A khorasan wheat-based replacement diet improves risk profile of patients with type 2 diabetes mellitus (T2DM): a randomized crossover trial [published online ahead of print February 8, 2016]. Eur J of Nutr. doi:10.1007/s00394-016-1168-2.
To determine if a diet with products made with organic ancient khorasan wheat (Triticum turgidum subsp turanicum) could provide additive protective effects in reducing glucose, insulin, lipid, and inflammatory risk factors, and in restoring blood redox balance in type 2 diabetes mellitus (T2DM) patients compared to diet with products made with modern organic wheat.
Design and Participants
A randomized, double-blind crossover trial with 2 intervention phases on 21 patients (14 females, 7 males). The volunteers were randomly divided into 2 groups. Each group was asked to consume products (bread, pasta, crackers, and biscuits) made using semi-whole flour from organic wheat that was from either ancient khorasan wheat or modern wheat (control) for 8 weeks, in a random order. The participants did not know the nature of the wheat products they were given but were told not to eat any other wheat product during the intervention period. They were also told not to make any significant lifestyle changes in diet, exercise, or other habits (such as smoking) during the entire trial period. An 8-week washout period was implemented between the interventions. During this time the volunteers were free to eat whatever they desired. At the beginning and end of each intervention, all participants were examined and had blood drawn for analysis between 7 a.m. and 9:30 a.m. after an overnight fasting period. Participants were asked not to engage in strenuous physical activity during the day before the examination.
First, data were analyzed using paired t tests for significant differences between changes observed at baseline and after intervention for each variable tested for each intervention period (test and control diet).
The metabolic risk profile improved from baseline only after the khorasan wheat intervention period, as measured by a reduction in total cholesterol (mean reduction -3.7%; P=0.047), LDL cholesterol (-3.4%; P=0.049), insulin (-16.3%; P=0.045), and blood glucose (-9.1%; P=0.049). Similarly, there was a significant reduction in circulating levels of reactive oxygen species (ROS), vascular endothelial growth factor (VEGF), and interleukin-1 receptor antagonist (IL-1RA), and a significant increase of total antioxidant capacity (+6.3%; P=0.049). No significant differences from baseline were noted after the modern control wheat intervention phase.
Moreover, in order to compare the effect of organic khorasan products vs baseline and vs the control products, a general linear model for repeated measurements, after adjustment for age and gender, modifiable risk factors, diet quality, and antidiabetic medication was performed. The change was significantly different (P<0.05) for total and LDL cholesterol, insulin, and homeostatic model assessment (HOMA) index. (The HOMA index is a method used to quantify insulin resistance and pancreatic beta cell function.)
The present study is the fourth in a series of published studies that demonstrate the health-promoting benefits of organic ancient khorasan wheat, benefits that are not evident in organic modern wheat (the control). The studies in this series were designed in a similar way, using human volunteers. The first study considered the effect of ancient and modern wheat on cardiovascular risk parameters of healthy volunteers.1 The second study focused on participants who had moderate cases of irritable bowl syndrome (IBS).2 The third study looked at cardiovascular disease.3
Simply changing the diet from modern to ancient wheat may improve the health of those who suffer from chronic disease.
Even though these trials were small, the results were so consistent that they lend credibility beyond that normally attributed to small studies. In each study, ancient wheat was associated with significant decreases in markers for inflammation and significant increases in antioxidant capacity. Patients with IBS experienced a significant global improvement in the extent and severity of symptoms, such as bloating, abdominal distention, abdominal pain, frequency, tiredness, and satisfaction of stool consistency, with a consequent improvement in quality of life. In these patients, cholesterol, blood sugar, and insulin levels decreased while serum magnesium increased. Because most chronic diseases are linked with inflammation, and the ancient grain substitution decreases inflammation, simply changing the diet from modern to ancient wheat may improve the health of those who suffer from chronic disease.
The size of the patient population was small, and the study will have to be conducted on a larger population to verify results. Furthermore, blood pressure variations were not taken into account. However, because there was a range of response for traditional risk factors for vascular complications in this small T2DM population, and despite this variation, there were overall significant changes in various parameters, the changes could be independently attributed to the khorasan wheat substitution. Body weight did not change significantly during the trial, suggesting that participants adhered to their normal consumption of carbohydrates and that the beneficial effects were not associated with weight loss, but with the type of grain consumed.
A diet with ancient khorasan wheat compared to modern wheat provided additive protection in reducing total and LDL cholesterol, insulin, blood glucose, ROS production, and some inflammatory risk factors. All these are key factors that may help to control or prevent secondary complications due to T2DM.
Conflict of Interest Disclosure
The author is founder of Kamut International, and is responsible for introducing the ancient grain KAMUT® brand khorasan wheat to a global market. The study this abstract and commentary is based on was conducted in Italy by the University of Florence in collaboration with the Careggi University Hospital of Florence, and was sponsored by the KAMUT® project.