Journal of Pharmacy and Pharmacology 5 (2017) 821-826

doi: 10.17265/2328-2150/2017.11.005
D DAVID PUBLISHING

Bread and Health

Kourkouta, L.1, Koukourikos, K.2, Iliadis, C.3, Ouzounakis, P.4, Monios, A.5 and Tsaloglidou, A.6
1. Nursing Department, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki 574 00, Greece
2. Nursing Department, Technological Educational Institute of Thessaloniki, Thessaloniki 574 00, Greece
3. Private Diagnostic Health Center of Thessaloniki, Thessaloniki 54623, Greece
4. General Hospital of Alexandroupoli, Alexandroupoli 68100, Greece
5. 7th High School of Athens, Athens 11634, Greece
6. Nursing Department, Technological Educational Institute of Thessaloniki, Thessaloniki 574 00, Greece

Abstract: Introduction: Bread is a food full of flavors and nutrients and continues to be the basis of our daily diet. Aim: The aim of this
review was the investigation of bread’s usefulness in our daily dietary chain and health in general. Material-Method: Extensive review
of the recent literature was conducted in electronic databases (Medline, Scopus, and Google Scholar) through the Association of
Hellenic Academic Libraries (HEAL-Link) using the appropriate key words: bread, health, disease as well as a combination of them.
Results: Bread is an excellent source of complex carbohydrates that provide the body with the energy needed. Although bread is a basic
food of everyday human nutrition, it is implicated in a variety of situations that burden the human body, such as obesity. However, this
happens only when it is consumed in very large quantities and when it is part of an unbalanced diet. Conclusions: Bread, when is
consumed in balanced quantities can give the body plenty of nutrients essential for its good function.

Key words: Bread, health, disease.

1. Introduction unlike East Asia, where the main food is rice [3, 4].
The bread, therefore, a food with awesome variety of
Bread or in Greek “artos” was considered in the past
flavors and nutrients remains the basis of our daily diet.
as the most important human good after health and
However, it is accused of contributing to weight gain
water. The origin of the term “artos” is ancient Greek:
etc. [5, 6].
it comes from the verb “ararisko” which means connect,
The purpose of this review is to highlight the
match, put together or “artio” which means brew, and
importance of using bread in our daily food chain and its
prepare. The modern term “bread” derived from the
contribution to the promotion of our health in general.
ancient verb “psoo” meaning rub and it is diminutive of
the word “psomys” (→ bread = little bit, bite). Its 2. Methods
history begins thousands years ago and unfolds in the
The search for the sources of this review was made
depths of centuries [1, 2].
on the Internet from specific databases such as Medline,
It belongs to the traditional diet, especially that of the
PubMed, Google Scholar, and the Hellenic Academic
poor. It believed to be the most complete and cheap
Libraries Association (HEAL-Link). The search
food and basic auxiliary food in times of extreme food
included research articles of the last, mainly decades,
poverty. It is the main food in Europe but also in the
about bread and nutrition, its characteristics, its
cultures of America, Middle East and North Africa,
nutritional value and its advantages. The criterion of
exclusion of the articles was language other than Greek
Corresponding author: Kourkouta Lambrini, Ph.D.,
professor, research fields: history of nursing, ethics and and English. The keywords that they used were: bread,
deontology. health and disease.
822 Bread and Health

3. History of Bread brought rapid technological breakthroughs and

significant changes in bakery. The production of new
Known as “the essence of life”, bread is already
hard-grained cereals in America made it necessary to
made from 10.000 B.C. at the dawn of Neolithic period
create stronger mills than that of watermills and
and the spread of agriculture, where the seeds were the
windmills. The construction of roller mills that could
main ingredient of bread. The first bread in a form
grind hard wheat, led to the production of whiter flour.
similar to the current one is found in Egypt in some of
New varieties of wheat promising good quality bread
the oldest surviving papyriin which instructions for
were also studied and discovered. [14]
bread-making process are included. It was also written
there that the delay of the pyramids construction was 4. Bread
due to insufficient supply of bread to the workers [7, 8].
Bread was also widely known in Ancient Greece, The Code of Food, Beverage and Shared Objects
where, among other things, the ritual bread called defines as “bread”, the product prepared by baking in
“psadista” was prepared from flour, oil and wine and special furnaces and under defined conditions of mass
was offered to the gods. In general, barley bread was consisting of wheat flour, water, dough and a small
produced. Solon also reports that wheaten bread was amount of salt (Article 111, 2nd Edition, April 2014).
produced only on festive days. Hesiod, Homer, Raw materials used for the bread production available
Herodotus and other important historians and writers for consumption should meet the terms and provisions
have been referred to bread. Moreover, since the 5th of the Code. Where flour from another cereal or a
century B.C., Athenians could buy bread from bakeries, mixture of cereal flour has been used for making
while in Rome the bakeries just appeared in the 2nd bread, this bread must bear the name of such cereals,
century. Romans were also the ones who created the such as wheat bread with rye [15].
first ovens in their craft form, especially during the Flour is the main material in making of bread and its
time of Emperor Trajan (87-117 AD), where a mass properties depend significantly on the properties of the
production of bread was observed [9]. grain from which it is produced. The chemical
The importance of bread was recognized since that composition of the flour depends on the degree of
era, a fact reflected in the term “opso/prosfagi” which milling. Increasing the degree of milling reduces the
means the food that one eats with bread, as a percentage of starch and increases the components
supplement used for the rest of the meal [10]. present in the bark such as inorganic ingredients,
Bread was also used as a symbol in many religions. insoluble fiber and vitamins [16, 17].
It is reported in the Old Testament that when Israelites Wheat is the only cereal whose flour has the ability
left Egypt and found themselves in the wilderness, God to form dough when contacted with water. As a result,
sent them a kind of bread called “manna” and the flour has the exclusive property of shaping the structure
people survived thanks to it [11]. In the New Testament, and appearance of bakery products [17].
the miracle of Christ, in which Christ with five breads Flour consists of proteins, starch and other
and two fish was able to feed five thousand people, is carbohydrate lipids, fiber, water and ash as well as low
mentioned [12]. Christ also likened himself as bread to levels of vitamins, minerals and enzymes [18]. Its
his disciples and anyone who could eat it, he would proteins, gliadins and glutenins interact with each other
have eternal life. In the Secret Supper Jesus blessed the when mixed with water creating the gluten grid. The
bread, cut it into pieces and said, “take, eat, that is my grid has the ability to bind the gases produced during
body” [13]. fermentation or produced by chemical blowing agents
The Industrial Revolution (18th-19th century) in the form of bubbles and it swells causing the
 Bread and Health 823

bloating of the dough [9]. The amount of protein cereals. As such, barley flour is a beneficial food for
contained in the flour determines the amount of gluten health. In particular, barley b-glucans are proven to
to be formed, which, in turn determines the strength, reduce blood cholesterol and glycemic load [22-23].
shape and structure of the dough. Hard wheat has B-glucan, which, as mentioned above, has a positive
higher protein content than soft and therefore the first is effect on health, is contained exclusively in barley and
used in bread production, as mentioned above [19]. In no in other cereals. In addition, barley is a source of
addition to the proteins that constitute 10-12% of the tocoles (tocopherols and tocotrienols) that they have
flour, most of it consists of starch (70-75%), while antioxidant activity [24].
water is about 14%. It is also composed of non-starch Corn flour is used to produce a variety of bakery
polysaccharides (2-3%), with arabinoxylans and fats at products, such as bread, cakes, donuts and other
a similar rate. Although at low contents, these products, most notably baby foods. It has high vitamin
ingredients are necessary for the production and quality A content, almost ten times more than the other cereals,
of the bread [20]. but it is also rich in carotenoids (lutein and zeaxanthin
Flour is the main ingredient of bread and creates the constitute 70% of carotenoids in corn) that act as
grid around which the other ingredients mix in proper antioxidants [25, 26].
proportions to form the dough [21]. The wheat is, Whole wheat flour also contains a significant
furthermore, the only cereal whose flour has the ability percentage (up to 75%) of higher amounts of vitamins,
to form dough when it comes into contact with water. minerals, antioxidants, fiber and other nutrients than
As a result, the wheat flour has the exclusive property that of commonly processed wheat flour, as these
of shaping the structure and appearance of bakery components are concentrated in the outer parts of the
products [17]. fruit [27, 28].
The increased demand for bread products also
5. Bread’s Nutritional Value
contributed to the manufacture of its functional
Since bread is a basic food of the daily human products such as shown in Table 1:
nutrition, various attempts have been made to prepare
6. Advantages—Disadvantages of Bread
various types of it.
Consumption
Wheat flour is the main ingredient of bakery. Hard
wheat has high protein content and the corresponding The bread therefore represents an excellent source of
flour is used to make bread and other goods, such as complex carbohydrates, which provide the body the
croissants, donuts etc. Soft wheat has low protein energy it needs and play an important role in balancing
content and the corresponding flour is used for pastry blood glucose levels [9].
preparations such as cakes, biscuits, etc. [9] Most types of bread contain low-value, low-fat
Some types of bread, such as the whole grain bread, vegetable protein. They also contain B vitamins,
have high fiber content, which enhances the digestive vitamin E and trace elements such as iron, potassium,
system’s action. Rye has the largest amount of dietary calcium and selenium, that are greatly provided in the
fiber and as a result its products have a lower glycemic body. Vitamin B contributes significantly to the protein
index compared to wheat products, making them metabolism and cell replacement, vitamin E is an
suitable for diabetics [20]. active antioxidant, iron is essential for growth and cell
From a nutritional point of view, the barley seed is oxygenation and potassium for the balanced function
low in fat, high in dietary fiber and contains essential of the cells. The calcium contributes to bone density
amino acids in an amount equal to or greater than other and Selenium is a powerful antioxidant [19].
824 Bread and Health

Table 1 Functional bread products.

Celiac disease, also known as gluten sensitization enteropathy, is a systemic autoimmune small bowel disorder
caused by the consumption of cereals (wheat, barley, rye) containing gluten in people with genetic predisposition
[29]. In all cases, and especially in celiac disease, treatment is the lifelong exclusion of gluten from nutrition.
[30]. This created the need to produce gluten-free bread that should have quality features like those of the
Gluten-free
1. common wheat flour. The majority of gluten-free products are of lower quality to that of common wheat flour.
bread
Nutritionally they have lower concentrations of protein and fiber, but also vitamins and minerals [31, 32].
These products are often also lactose-free (nondairy-basedgluten-freebread), as a large proportion of celiac
patients experience lactose intolerance due to inadequate lactase production from damaged villi of the small
intestine [33].
The benefits of dietary fiber to people’s health are indisputable. Among these, the most effective glycemic
control, cholesterol control, protection against cardiovascular disease, weight control, bowel function regulation,
and colon cancer protection have been identified [34, 35]. According to European legislation (Regulation (EC)
Bread with
2. 1924/2006, 2006) the bread is characterized as a product rich in fiber and therefore positively affects the
added fiber
physiology of the body when it contains at least 6 g per 100 g of product. Beta-glucans, the water soluble fiber
with high concentration in oats (3-8 g per 100 g dry weight) and barley (2-20 g per 100 g of dry weight), known
for the ability to increase the viscosity of the solutions, are mainly used as functional fibers [36].
The bread is a rich secret source of sodium. A slice of white, wheat bread (28 g) contains 134 mg of sodium (Na),
while a slice of rye bread (28.35 g) contains 171 mg of sodium (Na). By reducing salt content from the bread,
which is a basic food, the total intake of salt decreases resulting in lowering blood pressure and in the long term,
Bread with low
3. the decrease of the cardiovascular disease risk [37, 38]. According to European legislation, a food is labeled
or no added salt
“low in salt” when it contains less than 0.3% salt [39]. Bread products with low or no salt addition have been
studied and prepared. The taste of these products differs greatly from the taste of common bread and is not as
enjoyable to consumers as the common bread [40].

However, bread is implicated in various conditions diet, it can play an important role in helping consumers
that burden the human body, as in the case of obesity. to achieve and maintain the objective of intake of
Bread contributes to obesity only when consumed in specific calories daily.
very large quantities and when it is part of an Consumers, moreover, require today healthy, but
unbalanced diet. Obesity is also associated with also pleasant pastries. It is necessary to continue
diabetes mellitus [41]. Bread has a high glycemic index, research in this field in order to prove the beneficial
greatly increasing sugar and insulin secretion, which in effects of their action on the body and health in general.
turn adds to obesity. In a balanced diet, carbohydrates
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