Pronouncements that grain products are inherently unhealthful continue to proliferate.
But there's good evidence that whole grains are generally healthful, and it continues to accumulate.
You will have noticed the distinction we just made between grain products and whole grains.
People generally attack grain products for two reasons: as a source of gluten, and as a sickening, fattening food group.
Let's examine these points one at a time.
Is gluten a problem for most people?
Gluten is the major protein complex in wheat, barley, and rye, and it consists of protein compounds called gliadins and glutenins.
(See our sidebar, "Celiac disease versus gluten sensitivity”.)
We focused on Australian studies showing that people who thought they were gluten sensitive were actually reacting to a group of complex carbohydrates in grains called FODMAPs.
FODMAPs are also abundant in garlic, onions, milk products, and foods naturally high in fructose, such as honey, apples, mangoes, and watermelon.
versus gluten sensitivity
People with celiac disease suffer actual damage to their stomach linings when they consume gluten.
In contrast, people with "non-celiac gluten sensitivity” or NCGS can suffer a range of unpleasant symptoms affecting their gut, brain, and/or joints, but don't suffer actual damage to their tissues.
The available evidence shows that a diagnosis of NCGS – as opposed to celiac disease – has to first exclude the presence of celiac disease or wheat allergy.
To date, none of the existing tests for NCGS have been scientifically validated.
Standard tests for NCGS look for abnormal reactions to the two major proteins in gluten, called alpha gliadin and transglutaminase-2.
However, tests that include more of the proteins found in wheat, barley, and rye may reveal sensitivities undetected by tests that only cover those two proteins.
Most authorities agree that you probably do have NCGS if you test free of celiac disease and wheat allergy, but suffer symptoms when you eat gluten and experience relief when you stop eating gluten.
(It's critical to differentiate gluten-sensitivity from FODMAPs-sensitivity, because if you unnecessarily avoid non-grain foods rich in FODMAPs you may reduce a highly beneficial "probiotic" gut/colon bacteria called Bifidobacteria).
Since publishing that article last fall, we've come across evidence that gluten sensitivity may afflict more people than the Australian studies suggested.
That evidence comes from a placebo-controlled Iranian clinical trial conducted in a group of IBS (irritable bowel syndrome) patients.
The results showed that symptoms improved in 84% of those who followed a gluten-free diet, but improved in only 26% of those who had gluten in their diet (Shahbazkhani B et al. 2015).
Those findings should be taken with caution, because the participants were already suffering from a serious, diagnosed gut disorder.
Nonetheless, it's probably true that a significant percentage of the American population suffers from a sensitivity to gluten, other proteins, or FODMAPs in wheat, barley, and rye.
And either sensitivity could make your life truly miserable unless you avoid foods containing them.
But the recent fad for gluten-free foods has misled many into thinking that wheat, barley, and rye are inherently unhealthful.
This is unfortunate, both because whole grains are actively healthful for most people, and because many gluten-free foods are not particularly healthful, but benefit from the (generally bogus) aura of health associated with foods labeled "gluten-free”.
And, when consumed in moderation in their whole, unrefined forms, naturally gluten-free grains such as oats, corn, rice, and quinoa are perfectly healthful.
Buckwheat is often used as gluten-free substitute for wheat, barley, and rye, but actually isn't a grain at all.
Instead, buckwheat "grain" is the fruit of this flowering bush. And, like whole wheat, corn, and brown, red, black, or purple rice, buckwheat's antioxidant content rivals that of colorful fruits and vegetables.
Are grains healthful or unhealthful?
Aside from people who are sensitive to gluten – or who suffer from celiac disease or wheat allergy – is there any good reason to avoid grains?
To be sure, refined grain products such as white flour consist largely of empty calories, and the body metabolizes their starchy, nearly fiber-free carbohydrates much as it does sugars.
This means that food products in which refined grains (e.g., white flour) predominate promote inflammation, diabetes, brain fog, and obesity, among other bad things.
So white-flour products are about as unhealthful as sugars, and should be strictly limited in anybody's diet.
These include the many products misleadingly labeled "whole wheat” or "multigrain”, in which white flour or wheat flour (refined wheat flour) is the first ingredient listed.
Clearly, white flour, regardless of its source grain, is an inherently unhealthful food that becomes genuinely dangerous to health when consumed to excess … as far too many Americans do.
But it's equally apparent that whole grains are not nutritionally equivalent to white flour or to misleadingly labeled blends of white flour and whole grains.
In fact, study after study continues to link diets high in whole grains to lower rates of like heart disease and diabetes, and to lower rates of early death.
Why are whole grains generally healthful?
In addition to healthful fibers, whole grains abound in the same kinds of polyphenol antioxidants that give colorful fruits and vegetables their "super food” reputations.
And epidemiological studies almost invariably find that diets high in whole grains reduce the risk of chronic diseases and death from chronic diseases.
For example, three recent epidemiological (diet-health) studies support earlier indications along these lines.
We reported on two of these three epidemiological studies earlier this year, in The Healthy Skeptic: Do Grains Help or Harm Health?
: see the sections titled "Study #2: Large study links whole grains to lower death risk” and "Study #3: Nordic diet rich in whole rye found healthful”.
The third recently published study involved 367,442 Americans aged 50 to 71 who were free of significant disease at its outset.
After adjusting for other known risk factors, the results linked diets high in whole grains to significantly lower risks of death from any cause, including cancer, cardiovascular disease, diabetes, respiratory disease, infections, and more.
The participants who reported comparatively high intakes of whole grains were 17% less likely to die during the course of the study, while those who reported eating the most whole grains were 48% less likely to die.
Fiber appeared to play a key role, since the participants with the highest intakes from grains were 15% to 34% less likely to die during the study.
Switching one serving of refined grains per day with one serving of whole grains was linked to an 8% lower risk of death from cardiovascular disease.
And replacing one serving of red meat per day with one serving of whole grains was linked to a 20% lower risk of dying from cardiovascular disease.
As its lead author, Harvard professor Qi Sun, said, "This study further endorses the current dietary guidelines that promote whole grains as one of the major healthful foods for prevention of major chronic diseases.”
It's hard to disagree with him!
- Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014 Jan;146(1):67-75.e5. doi: 10.1053/j.gastro.2013.09.046. Epub 2013 Sep 25.
- Shahbazkhani B, Sadeghi A, Malekzadeh R, Khatavi F, Etemadi M, Kalantri E, Rostami-Nejad M, Rostami K. Non-Celiac Gluten Sensitivity Has Narrowed the Spectrum of Irritable Bowel Syndrome: A Double-Blind Randomized Placebo-Controlled Trial. Nutrients. 2015 Jun 5;7(6):4542-54. doi: 10.3390/nu7064542.
- Staudacher HM, Lomer MC, Anderson JL, Barrett JS, Muir JG, Irving PM, Whelan K. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr. 2012 Aug;142(8):1510-8. doi: 10.3945/jn.112.159285. Epub 2012 Jun 27.
- Staudacher HM, Whelan K, Irving PM, Lomer MC. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet. 2011 Oct;24(5):487-95. doi: 10.1111/j.1365-277X.2011.01162.x. Epub 2011 May 25.