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Journal of Pharmacy and Pharmacology 5 (2017) 821-826
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.
Bread or in Greek “artos” was considered in the past
as the most important human good after health and
water. The origin of the term “artos” is ancient Greek:
it comes from the verb “ararisko” which means connect,
match, put together or “artio” which means brew, and
prepare. The modern term “bread” derived from the
ancient verb “psoo” meaning rub and it is diminutive of
the word “psomys” (→ bread = little bit, bite). Its
history begins thousands years ago and unfolds in the
depths of centuries [1, 2].
It belongs to the traditional diet, especially that of the
poor. It believed to be the most complete and cheap
food and basic auxiliary food in times of extreme food
poverty. It is the main food in Europe but also in the
cultures of America, Middle East and North Africa,
Corresponding author: Kourkouta Lambrini, Ph.D.,
professor, research fields: history of nursing, ethics and
unlike East Asia, where the main food is rice [3, 4].
The bread, therefore, a food with awesome variety of
flavors and nutrients remains the basis of our daily diet.
However, it is accused of contributing to weight gain
etc. [5, 6].
The purpose of this review is to highlight the
importance of using bread in our daily food chain and its
contribution to the promotion of our health in general.
The search for the sources of this review was made
on the Internet from specific databases such as Medline,
PubMed, Google Scholar, and the Hellenic Academic
Libraries Association (HEAL-Link). The search
included research articles of the last, mainly decades,
about bread and nutrition, its characteristics, its
nutritional value and its advantages. The criterion of
exclusion of the articles was language other than Greek
and English. The keywords that they used were: bread,
health and disease.
Bread and Health
3. History of Bread
Known as “the essence of life”, bread is already
made from 10.000 B.C. at the dawn of Neolithic period
and the spread of agriculture, where the seeds were the
main ingredient of bread. The first bread in a form
similar to the current one is found in Egypt in some of
the oldest surviving papyriin which instructions for
bread-making process are included. It was also written
there that the delay of the pyramids construction was
due to insufficient supply of bread to the workers [7, 8].
Bread was also widely known in Ancient Greece,
where, among other things, the ritual bread called
“psadista” was prepared from flour, oil and wine and
was offered to the gods. In general, barley bread was
produced. Solon also reports that wheaten bread was
produced only on festive days. Hesiod, Homer,
Herodotus and other important historians and writers
have been referred to bread. Moreover, since the 5th
century B.C., Athenians could buy bread from bakeries,
while in Rome the bakeries just appeared in the 2nd
century. Romans were also the ones who created the
first ovens in their craft form, especially during the
time of Emperor Trajan (87-117 AD), where a mass
production of bread was observed .
The importance of bread was recognized since that
era, a fact reflected in the term “opso/prosfagi” which
means the food that one eats with bread, as a
supplement used for the rest of the meal .
Bread was also used as a symbol in many religions.
It is reported in the Old Testament that when Israelites
left Egypt and found themselves in the wilderness, God
sent them a kind of bread called “manna” and the
people survived thanks to it . In the New Testament,
the miracle of Christ, in which Christ with five breads
and two fish was able to feed five thousand people, is
mentioned . Christ also likened himself as bread to
his disciples and anyone who could eat it, he would
have eternal life. In the Secret Supper Jesus blessed the
bread, cut it into pieces and said, “take, eat, that is my
The Industrial Revolution (18th-19th century)
brought rapid technological breakthroughs and
significant changes in bakery. The production of new
hard-grained cereals in America made it necessary to
create stronger mills than that of watermills and
windmills. The construction of roller mills that could
grind hard wheat, led to the production of whiter flour.
New varieties of wheat promising good quality bread
were also studied and discovered. 
The Code of Food, Beverage and Shared Objects
defines as “bread”, the product prepared by baking in
special furnaces and under defined conditions of mass
consisting of wheat flour, water, dough and a small
amount of salt (Article 111, 2nd Edition, April 2014).
Raw materials used for the bread production available
for consumption should meet the terms and provisions
of the Code. Where flour from another cereal or a
mixture of cereal flour has been used for making
bread, this bread must bear the name of such cereals,
such as wheat bread with rye .
Flour is the main material in making of bread and its
properties depend significantly on the properties of the
grain from which it is produced. The chemical
composition of the flour depends on the degree of
milling. Increasing the degree of milling reduces the
percentage of starch and increases the components
present in the bark such as inorganic ingredients,
insoluble fiber and vitamins [16, 17].
Wheat is the only cereal whose flour has the ability
to form dough when contacted with water. As a result,
flour has the exclusive property of shaping the structure
and appearance of bakery products .
Flour consists of proteins, starch and other
carbohydrate lipids, fiber, water and ash as well as low
levels of vitamins, minerals and enzymes . Its
proteins, gliadins and glutenins interact with each other
when mixed with water creating the gluten grid. The
grid has the ability to bind the gases produced during
fermentation or produced by chemical blowing agents
in the form of bubbles and it swells causing the
Bread and Health
bloating of the dough . The amount of protein
contained in the flour determines the amount of gluten
to be formed, which, in turn determines the strength,
shape and structure of the dough. Hard wheat has
higher protein content than soft and therefore the first is
used in bread production, as mentioned above . In
addition to the proteins that constitute 10-12% of the
flour, most of it consists of starch (70-75%), while
water is about 14%. It is also composed of non-starch
polysaccharides (2-3%), with arabinoxylans and fats at
a similar rate. Although at low contents, these
ingredients are necessary for the production and quality
of the bread .
Flour is the main ingredient of bread and creates the
grid around which the other ingredients mix in proper
proportions to form the dough . The wheat is,
furthermore, the only cereal whose flour has the ability
to form dough when it comes into contact with water.
As a result, the wheat flour has the exclusive property
of shaping the structure and appearance of bakery
5. Bread’s Nutritional Value
Since bread is a basic food of the daily human
nutrition, various attempts have been made to prepare
various types of it.
Wheat flour is the main ingredient of bakery. Hard
wheat has high protein content and the corresponding
flour is used to make bread and other goods, such as
croissants, donuts etc. Soft wheat has low protein
content and the corresponding flour is used for pastry
preparations such as cakes, biscuits, etc. 
Some types of bread, such as the whole grain bread,
have high fiber content, which enhances the digestive
system’s action. Rye has the largest amount of dietary
fiber and as a result its products have a lower glycemic
index compared to wheat products, making them
suitable for diabetics .
From a nutritional point of view, the barley seed is
low in fat, high in dietary fiber and contains essential
amino acids in an amount equal to or greater than other
cereals. As such, barley flour is a beneficial food for
health. In particular, barley b-glucans are proven to
reduce blood cholesterol and glycemic load [22-23].
B-glucan, which, as mentioned above, has a positive
effect on health, is contained exclusively in barley and
no in other cereals. In addition, barley is a source of
tocoles (tocopherols and tocotrienols) that they have
antioxidant activity .
Corn flour is used to produce a variety of bakery
products, such as bread, cakes, donuts and other
products, most notably baby foods. It has high vitamin
A content, almost ten times more than the other cereals,
but it is also rich in carotenoids (lutein and zeaxanthin
constitute 70% of carotenoids in corn) that act as
antioxidants [25, 26].
Whole wheat flour also contains a significant
percentage (up to 75%) of higher amounts of vitamins,
minerals, antioxidants, fiber and other nutrients than
that of commonly processed wheat flour, as these
components are concentrated in the outer parts of the
fruit [27, 28].
The increased demand for bread products also
contributed to the manufacture of its functional
products such as shown in Table 1:
6. Advantages—Disadvantages of Bread
The bread therefore represents an excellent source of
complex carbohydrates, which provide the body the
energy it needs and play an important role in balancing
blood glucose levels .
Most types of bread contain low-value, low-fat
vegetable protein. They also contain B vitamins,
vitamin E and trace elements such as iron, potassium,
calcium and selenium, that are greatly provided in the
body. Vitamin B contributes significantly to the protein
metabolism and cell replacement, vitamin E is an
active antioxidant, iron is essential for growth and cell
oxygenation and potassium for the balanced function
of the cells. The calcium contributes to bone density
and Selenium is a powerful antioxidant .
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
. In all cases, and especially in celiac disease, treatment is the lifelong exclusion of gluten from nutrition.
. This created the need to produce gluten-free bread that should have quality features like those of the
common wheat flour. The majority of gluten-free products are of lower quality to that of common wheat flour.
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
atients experience lactose intolerance due to inadequate lactase production from damaged villi of the small
2. Bread with
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)
1924/2006, 2006) the bread is characterized as a product rich in fiber and therefore positively affects the
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 .
3. Bread with low
or no added salt
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,
the decrease of the cardiovascular disease risk [37, 38]. According to European legislation, a food is labeled
“low in salt” when it contains less than 0.3% salt . 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 .
However, bread is implicated in various conditions
that burden the human body, as in the case of obesity.
Bread contributes to obesity only when consumed in
very large quantities and when it is part of an
unbalanced diet. Obesity is also associated with
diabetes mellitus . Bread has a high glycemic index,
greatly increasing sugar and insulin secretion, which in
turn adds to obesity. In a balanced diet, carbohydrates
should be about 50% and 2 slices of whole-wheat bread
per day can be conveniently included in the daily diet
Gluten, which is contained in bread, causes celiac
disease in gluten-sensitive people when they consume
bread. They present diarrhea, weight loss,
undernutrition, anemia, osteopenia, psychiatric
disorders such as irritability and others. These patients
should avoid eating grains containing gluten, such as
barley, rye, oats and wheat [42, 43].
Bread eaten in balanced quantities not only does not
contribute to obesity, but can provide the body with
plenty of nutrients essential for its good function. Thus,
when incorporated into a generally balanced, nutritious
diet, it can play an important role in helping consumers
to achieve and maintain the objective of intake of
specific calories daily.
Consumers, moreover, require today healthy, but
also pleasant pastries. It is necessary to continue
research in this field in order to prove the beneficial
effects of their action on the body and health in general.
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