Friday, October 4, 2013

Are Whole Grains Healthy Or Bad For You?


Grain-bashing and anti-wheat sentiments seem to be all the rage these days. It’s not much of an exaggeration to say some people think grains are the cause of all of society’s ills.

In this article, we will examine both sides of the argument, who is making the arguments, what the evidence says and finally, why it doesn’t matter in the real world.

The USDA defines grains as: “Any food made from wheat, rice, oats, cornmeal, barley or other cereal grains.” Examples are bread, pasta, oatmeal, breakfast cereals, tortillas and grits. Whole grains contain all parts of the kernel, including the bran, germ and endosperm. Refined grains undergo a process that removes the bran and the germ.
Grains Are Bad For You – The Anti-Grain Argument

Here are a few of the arguments the anti-grain camp make, though the list of grains’ purported evils is much more extensive:

Grains were not regularly consumed for most of human history. Therefore, humans lack the ability to digest and utilize grains, essentially making them a toxin.

Note: It is true that grains were not consumed for the vast majority of human history. However, evolution is constant, and it is completely reasonable to believe that humans have indeed evolved mechanisms over the past 10,000 years to digest wheat and grains, and that’s assuming humans weren’t able to digest them in the first place, a claim which also has no evidence behind it.
Gluten, a protein component of grains, causes adverse reactions in the majority of people, ranging from water retention, weight gain, fatigue, and memory issues, to severe, chronic illnesses like heart disease and cancer.

Note: Celiac disease, a condition in which the body views gluten as an “invader” and fights it with its immune system, is becoming significantly more common. (The reason for this is unknown.) Celiac disease is diagnosed by removing a tiny portion of intestine and looking at it under the microscope. Additionally, certain blood tests can reflect Celiac.1

However, a growing number of experts believe that certain individuals can have sensitivity to gluten without having actual Celiac Disease. For example, Alessio Fasano, MD, who heads the Center for Celiac Research at the University of Maryland, has concluded through his research that around 18,000,000 Americans (between 5 and 6%) have some degree of gluten sensitivity. On the other side of the argument, research from the Columbia University Celiac Disease Center found rates much lower, around 0.55%. Once again, research has been inconclusive and until biologic markers are found that can diagnosis the disorder, the true prevalence will not be known. Still, if you think you may be sensitive to gluten, then by all means try a gluten free diet and see how your body responds.
Grains cause a massive spike in insulin leading to diabetes and obesity.

Note: The processing of grains, which removes what many believe to be the “healthy” part of the grain, yields a product which elicits a much greater insulin response. Whole grains, on the other hand, cause significantly less insulin release. Furthermore, while excess insulin certainly promotes fat storage, fat gain occurs when more calories are consumed than expended. Spikes in insulin can temporarily trigger fat accumulation, but in the setting of an overall calorie deficit, this will quickly be reversed and the net effect will be fat loss.
 Grains contain a chemical called Phytic acid, which binds to minerals such as calcium, leaching them from the GI tract and contributing to bone weakness and osteoporosis.

Note: A large research study examined this hypothesis and concluded that Phytic acid does not affect bone density or markers of calcium absorption.

Grains contain “antinutrients”, which are plant-based defense mechanisms that interfere with digestion and allow the absorption of toxic materials into the bloodstream.

Note: While antinutrients can certainly be detrimental to good health, there is evidence that certain antinutrients actually have health promoting properties. For instance, phytic acid, lectins, phenolic compounds, amylase inhibitors and saponins have been shown to reduce the blood glucose and insulin responses to starchy foods. In addition, phytic acid, phenolics, saponins, protease inhibitors, phytoestrogens and lignans have been related to reduced cancer risks.3

When traditional cultures consumed grains, they were always soaked or fermented first, and/or allowed to sprout (or grow), which in theory makes them more digestible and increases nutrients.4 Again however, there is conflicting evidence. Some research has shown sprouted grains have no greater nutrition than unsprouted.5

Grains Are Healthy – The Pro-Grain Argument

Whole grains contain an abundance of nutrients and fiber which contribute to a healthy, balanced diet.

Whole grain intake promotes satiety, or the feeling of fullness, making it easier to consume fewer calories and maintain a healthy weight.6

Research clearly shows that diets high in whole grains decrease risk of diabetes, heart disease, certain cancers and high blood pressure.7 8

There is no evidence that diets containing gluten do harm to people without Celiac Disease.

Research suggests that people who consume diets high in whole grains tend to have healthier weights and gain less weight over time than those who don’t.9 10

You can see that the claims are often completely contradictory.
Who Believes Grains Are Bad For You?

On one hand, there are well-respected and knowledgeable PhDs, medical doctors and dietitians who believe that grain consumption is detrimental to health. In researching the anti-grain argument on the web, however, it became very clear that many of the websites bashing grains were personal blogs and group web pages run by people with little to no scientific background or training. This doesn’t discredit them automatically, but brings up an interesting point. I found that scientific support of their conclusions was either lacking, or taken from bits and pieces of different research papers (mostly out of context) and combining it with theory.
Who Believes Grains Are Healthy?

This group of people was made up mostly of physicians, epidemiologists (people who study the patterns, causes and effects of health and disease conditions in defined populations) and researchers. Cites and sources espousing the benefits of grains include the Mayo Clinic, Centers of Disease Control and Prevention, National Institutes of Health, and the Harvard School of Public Health. Their stance is backed by large volumes of peer-reviewed literature, including huge review studies examining thousands and thousands of people. Could all of these establishments be misguided or part of a larger conspiracy as the anti-grainers would have you believe?

It is not out of the realm of possibility, and certainly it is possible that the research doesn’t tell the whole story. Take fat, for example. Until relatively recently, the traditional medical establishment viewed dietary fat as the cause a host of diseases and encouraged people to essentially avoid it at all costs. This turned out to be inaccurate, so it is important to look at the bigger picture and take all research with a grain of salt.
 So, Should You Eat Grains?

Let’s look at this in the real world, using a patient of mine to illustrate my point. I saw a woman who underwent extensive allergy testing. She came into my office with a list of 32 foods she was “allergic to.” One of them was garlic. She explained that she had been eating garlic her entire life without noticing any negative consequences. After getting the results, she completely eliminated garlic from her diet for 30 days and noticed no change in anything.

She asked if she could start eating it again. I said yes. And here is the problem with tests like that- just because you are technically “allergic” to something may or may not have any real-world relevance. If a food turns up positive but you suffer no ill effects from consuming it, then what does eliminating it do? On the other hand, if eating a particular food makes you feel sluggish or sick, or makes you retain water, are you going to continue eating it because your allergy test came up negative for that food? I hope not.
Recommendations:

If you think you react poorly to grains, then try eliminating them from your diet and see what happens. If you feel better, then don’t eat them.
If you don’t eat grains, be sure you are getting the nutrients and fiber grains contain from other sources.[11. Grains have multiple benefits to the bowels: grains help bulk up stool and help keep patients regular, avoiding hemorrhoids, etc. and has been associated with a lower incidence of colon cancer as well.
If you notice no change or negative consequences from eating grains (decreased exercise tolerance or performance, increased hunger, constipation), then by all means include grains in your diet.
As with anything, use common sense and make your decision based on your personal results, and not what an “expert” tells you to do, especially with something as controversial as this.

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