Rethinking Our Daily Bread
Los Angeles Times
July 29, 2002
By Patricia King

William Watson thought he had a healthy diet and a healthy lifestyle. He went to the gym for cardio and weight training workouts three times a week. Just about every day, he ate what he thought was a hearty breakfast: oatmeal, to which he would add flaxseed and barley, and sometimes whole-grain toast as well.

But the 41-year-old was worried about his health, particularly because his mother has Type 2 diabetes. He had some of the risk factors for diabetes as well. "I had this potbelly I couldn't get rid of," said William, of Tucson. "I was puzzled that I couldn't lose the weight."

About a year ago, following the advice of a nutritional counselor, William drastically cut back on the grains in his diet and added more vegetables and fruit. These days his breakfast is likely to be hard-boiled eggs, stir-fried vegetables and berries. He doesn't eat bread, though he eats the rice in sushi and an occasional serving of pasta.

On his new diet, William's potbelly started to recede in a matter of weeks. He lost 12 pounds effortlessly and muses on the irony that he had to change his "healthy" diet to feel better: "Isn't it funny? I wasn't eating Cap'n Crunch. I thought I was doing good."

For more than a decade, health-conscious consumers such as William have been chowing down on as many low-fat oatmeal pancakes and pieces of 12-grain bread as they could. They were motivated by a steady drumbeat of good-news studies that found that whole grains that include the bran, the germ and the endosperm protect against a number of diseases and the undeniable fact that valuable nutrients and fiber disappear when grains are refined.

But a growing number of nutritionists, obesity researchers and consumers, annoyed by their seemingly intractable extra pounds, are taking a second look at once sacrosanct whole grains. In this age of soaring rates of Type 2 diabetes and obesity, says Shari Lieberman, a nutritionist from Connecticut's University of Bridgeport and author of "Dare to Lose," "We all need to limit our consumption of grains--even whole grains."

Susan Bowerman, assistant director of the Center for Human Nutrition at UCLA, says the backlash against whole grains is yet another nutritional pendulum swing, this time away from fat-phobic, whole grain-centric diets that did not solve many of their adherents' weight problems: "People forgot that fat-free does not mean calorie-free."

Better Carbohydrates

The move away from whole grains is not a 180-degree turn away from the mantra "the whiter the bread the sooner you're dead." In other words, no one's recommending that Americans ditch whole-grain bread in favor of Wonder Bread.

Instead, an increasingly vocal group of nutrition experts is telling Americans to load up on vegetables and fruits rather than whole grains because you get more bang for your carbohydrate calories.

Bowerman, coauthor of the book "What Color Is Your Diet?," which recommends seven servings of fruits and vegetables a day, says such a diet delivers--with relatively few calories--phytochemicals that reduce the risk of a number of diseases, including cancer, diabetes and heart disease.

It's not just the calories in grains that are a concern. Some researchers believe that people who have trouble controlling their weight should eat carbohydrates that fall on the low end of the glycemic index, a method of calculating how quickly a food can spike blood sugar.

A diet emphasizing foods that rank high or moderate on the glycemic index, such as many grain-based foods, can lead to high levels of the "hunger hormone," insulin.

In a 1999 study published in the American Academy of Pediatrics medical journal Pediatrics, Dr. David Ludwig, an assistant professor of pediatrics at Harvard Medical School and director of the obesity program at Children's Hospital Boston, found that obese children downed 38% more calories after a moderate-glycemic meal of steel-cut oats than they did after a vegetable omelet and fruit meal designed to keep blood sugar levels low. When the meal contained high-glycemic, refined, instant oatmeal, the obese children ate a whopping 83% more. All of the meals contained the same number of calories. "From a hormonal standpoint, all calories are not alike," says Ludwig.

Ludwig is one of several critics of the USDA's Food Pyramid, which is a fixture in schools. Though the U.S. Department of Agriculture has been recommending a relatively modest three servings of whole grains a day since 1993, its Food Pyramid recommends a whopping six-to-11 servings of grains a day and doesn't distinguish between whole grains and nutritionally inferior refined grains.

Ludwig's alternative, the Low Glycemic Index Pyramid, banishes high-glycemic, refined grains to the least-often-consumed tip of the pyramid. Whole grains, whose glycemic index is generally lower than their refined counterparts because their fiber slows absorption of them, are one tier down from the top.

On Ludwig's pyramid, just as on the so-called California Cuisine Pyramid developed by UCLA, fruits and vegetables are the new nutritional stars displacing the USDA's six-to-11 servings of grains in the wide, "eat most frequently" base.

Like UCLA researchers, Ludwig says you can eat lots of nutrient-rich, fiber-rich vegetables and fruit without blowing your daily calorie allowance and, he adds, without elevating your blood sugar excessively. Even carrots, which score high on the glycemic index for a 1 1/2-pound serving, actually score low when adjusted to a real-life serving size.

A Natural Limit

Dr. Walter C.Willett, chairman of the nutrition department at the Harvard School of Public Health, agrees that refined grains should be eaten sparingly but he does not worry that people will overdo whole grains. "In some ways grains are self-limiting as they are very filling and because too many will cause abdominal discomfort and flatus, and people will naturally cut back," he says.

Grain critics say those intestinal symptoms appear because the human digestive system has not adapted to lots of grains in the diet. Only 10,000 years ago, a mere evolutionary blip in the 2.5 million years that humans have been on Earth, the main sources of carbohydrates were vegetables and fruits, not grains: "We have had very little evolutionary experience eating grains," says Loren Cordain, an anthropological nutritionist at Colorado State University in Fort Collins and author of "The Paleo Diet."

Some nutritionists fault whole grains on other fronts. For example, fiber-rich whole grains contain phytate, which blocks the absorption of minerals, including zinc, iron and calcium.

Dr. Harold Sandstead, a professor at the University of Texas in Galveston who has chronicled the role of phytate in blocking zinc absorption, notes: "There is justification for concern about recommending diets including large amounts of unrefined cereals or minimally refined cereals."

But Florida dietitian and co-author of "Eat to Stay Young" Susan Mitchell wishes Americans were eating enough whole-grain fiber to worry about too much phytate. According to a USDA survey, Americans average only one serving of whole grains a day. "To be blunt," says Mitchell, "what I find is lots of people who have such a low intake of fiber that they have tons of hemorrhoids and tons of constipation."

And although Bowerman recommends cutting back on grains to lose weight, she recommends whole grains in moderation because they contain beneficial fiber and disease-fighting phytonutients.

In 1997 the Food and Drug Administration acknowledged the cholesterol-lowering ability of the soluble fiber from whole oats by allowing a label that said that they "may reduce the risk of heart disease." In 1999 the FDA went further, allowing products that contain at least 51% whole grain to carry a label that says they may protect against heart disease and some cancers.

The FDA was reacting, says David Jacobs, an epidemiologist at the University of Minnesota, to "overwhelming" evidence that whole grains protect against disease, as do fruits and vegetables. "Both whole grains and fruits and vegetables are healthy foods. They should not be in competition with each other."

For most Americans, they're not. While nutritionists and the most health-conscious consumers debate the relative merits of whole grains and fresh fruits and vegetables, most Americans stick to widely denounced highly processed foods. In fact, fresh fruits, vegetables and whole grains are among those rare foods that even notoriously overindulgent Americans show no signs of overeating.