May 4, 2007

Healthy Whole Grains are like Healthy Filter Tip Cigarettes

Some poor victim, I mean patient, just posted on the ADA forums about a visit to the nutritionist where, having brought his A1c down from 12% to 5.8%, he was chided for not eating enough carbs!

In particular, he was told to eat 8 servings of grain each day.

I know, I know. By now I should be inured to this kind of stupidity, but reading something like this still does very bad things to my blood pressure.

The idea that people with diabetes should eat "healthy whole grains" is derived from a bunch of studies where people eating whole grains were compared to people eating junk food and found to have slightly better blood sugars. These studies are almost all funded by the companies that sell grain in one form or another. When people with diabetes eat those "healthy grains" their blood sugars may be slightly better than those eating marshmallow fluff, but their blood sugars are still much higher than is consistent with health.

This is very much like those studies that showed that filter tip cigarettes were healthier than unfiltered cigarettes. They look good until you notice that smoking any kind of cigarette causes cancer and heart disease at rates that are completely unacceptable.

But while researchers have compared the health of people who smoke with people who don't, you won't find large, well funded studies where people with diabetes who eat little or no grain of any kind are compared to people who ate these universally recommended eight servings of grain each day.

Nor will you find long term studies where they track the development of diabetic complications against grain intake over a decade. Why? Well, for starters, because such studies take a lot of money and almost all food-related research is funded by companies that sell the food being studied. It's in their interest to do small, sloppy studies, and to publicize the results of those studies only when they make their products look good. So yes, a study may "prove" that whole grain Cheerios are a "healthier" breakfast than sugar frosted flakes, but just about anything rich in protein is far better than either. Just don't wait for General Mills to fund that study.

I am old enough to remember when doctors all smoked and there were commercials on TV touting the brand that doctor's preferred. I probably won't live long enough to see the demise of the oxymoron "healthy grain".

Fortunately, you don't have to take any dietary advice on trust. Get out your meter and test those "healthy" grains. See what they do to your blood sugar. If you can stay at normal levels, eat them. If not, how about a nice cheese omelet. Afraid of the cholesterol? Relax. Eating cholesterol has no significant impact on your lipids a.k.a. Cholesterol. It is eating starch and sugar that raise the bad kinds of blood lipids.

A visitor suggested I put in a link to back up my statement about the ADA's main contributors including a lot of junk food companies.

This was discussed and documented in an earlier post on this blog complete with link to the ADA's largest contributors and some information about what they sell:

ADA Nutritional Guidelines--Keeping Diabetics Diabetic


Big Dave T said...

So no bread for us. Are you saying then, "Let them eat, pork?" I dunno. Seems instinctually wrong based on a lifetime of nutrition education.

We eat whole grain breads that are so basic the recipes for them probably come from the Middle Ages.

Hea, it kinda ticks me off that when I Google blog-search "diabetes", your blog does not come up among the ones recommended. All I get are blogs that seem to pitch products. I have to search diabetes, Jenny to find your blog. I have too many bookmarks already so I don't want to bookmark ANOTHER page.

If there's something I can do to get your diabetes blog listed among the preferred, let me know. Your's is probably the most intelligent straightest shooting diabetes blog out there.

Jenny said...


I don't eat a lot of much of anything and I do eat some grains, but only as much as will let me hit my blood sugar targets. With insulin that's about 1 slice per meal.

Thanks for the very kind word about the blog. They give me my Smile of the Day!

Re the searches. My main site is starting to sort pretty high on a lot of diabetes searches and that is causing the traffic to grow dramatically, but it took 3 years to get to that point. The blog is only a year old, so it probably will take more time.

The thing that raises the profile is links from other busy blogs. But I don't put any effort into promoting the blog, because I'm more interested in growing the main site and I'm already putting far too much time into the site since it is basically a hobby.

I suppose if one pestered other bloggers for links the ones that didn't end up hating me would add links that would improve my rankings.

So many of the high profile blogs do seem to be people earning money from the ads or selling crap. I have noticed that Google privileges blogs on the server it owns in the searches. I wonder if they also privilege blogs that have a lot of Google ads on them. I won't run their ads for a diabetes site because they are 98% exploitative garbage.

. said...

ADA's main sponsors here, page 10 -

. said...

Dear Jenny, what is the problem with this kind of epidemiological studies, that sistematicaly find negative associations between "healthy" whole grains and cardiovascular risk, even for diabetics?

Jenny said...

Great link! As they say, it's enough to make a weasel gag.

Jenny said...

The studies that find correlations between whole grains and better health outcomes are comparing people eating whole grains to people eating Froot loops and Krispy Kremes.

Beyond that whole grains are a social marker. Go to your local health food coop and check out the socio-economic status of the people buying the $5.50 loaves of bread and you'll see that the whole grains are a marker for many other lifestyle factors which include clean air, huge houses on private lots, etc. etc.

. said...

Dear Jeny, I was reading the study I quoted above and noticed what I believe are a few flaws. Diabetic women in quintile 5 (Q5) were more health conscious than those in Q1. They consumed more whole-grains, but only an average amount of 32.6 gr/day, which is a relatively small amount. They wre not eating pizza every day, I suppose. There was only 10.6% smokers in Q5, and 21.3% in Q1. Women in Q5 were also a bit more physically active. This study analyses total and cardiovascular mortality. For total mortality, after age-adjustment, relative risk of whole-grains intake in Q5 was 0.8. This is because of more whole-grains intake or of less smoking? Multivariate model 1 then adjusted for smoking, BMI, alcohol, physical activity, history of MI, menopausal/hormone and duration of DM. After this, whole-grains relative risk rised to 0.89 (0.71-1.11 at 95% confidence; and significance 0.06). Model 2 was then applied adjusting for total energy, polyunsaturated, saturated and trans fats, magnesium and folate. The total mortality RR of whole-grains intake stayed at 0.89, but the association lost its statistical significance (p = 0.11). Fiber intake also lost significance after model 2 (...)

. said...

(...) For total mortality, the authors say that "after further adjustment for lifestyle and dietary risk factors, only the association for bran intake remained significant (P for trend 0.01)". Similar situation happens for CVD mortality. After age-adjustment and model 1+2 were applied, whole-grain intake relative risk is 0.70 (0.46-1.06 at 95% confidence) but with lower significance (0.07). Multivariate model 2 didn't produce any remarkable RR changes for both CVD and total mortality. Maybe the chosen variables were a bit irrelevant in model 2. Wait a minute, did you notice they never adjusted for refined carbohydrate intake? Did I read this study correctly? To summarize, the most important aspects I find here is that final associations were not statistically powerful, whole-grain intake was small so the conclusions can not be generalized to higher intakes, and the lack of adjustment for sugar probably distorts final results. If health conscious people were eating more grains and less sugar at the same time, we can only conclude whole-grains is better than plain sugar.