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If there is a single subject that befuddles the health-conscious eater, it is undoubtedly carbohydrates.
Most of us have seen the impressive results of at least temporarily restricting carbs, but studies examining the long-term effects of carbohydrate restriction are often ambiguous. Also, while some experts argue fervently for a low-carb lifestyle, some nutritionists still warn about the dangers of eating too much fat or protein.
So how do we know what to believe?
A full examination of the science behind carbohydrate metabolism is beyond the scope of a single blog post, and is in fact not entirely understood by the scientific community (for a thorough review of this topic read Gary Taubes’ book Good Calories, Bad Calories, which I have reviewed here).
However, there are a few things we do know about carbohydrates that are worth pointing out.
Lesson 1: Refined grains contribute to nearly every chronic disease in modern civilization.
It is universally agreed in the nutrition community that refined, processed carbohydrates are the worst things to eat on the entire planet.
And it is impossible to overstate how remarkable this is.
The nutrition community is one of the most disagreeable bunches in all of science. But across the board–from vegans like Colin Campbell to carnivores like Robert Atkins–not a single one of them considers processed carbs to be nutritionally neutral. They all consider them dangerous.
Without question, refined carbohydrates contribute to poor health.
Lesson 2: Vegetables protect against nearly every chronic disease in modern civilization.
Where things start to get more complicated is with unrefined carbohydrates, and the various iterations of this definition. There is ample evidence that the carbohydrates contained in vegetables are not harmful, and possibly beneficial.
To call these vegetable carbohydrates “fiber” is to oversimplify the science, but suffice to say that vegetables are good for you and contribute to your good health.
This is also generally agreed upon.
Lesson 3: Whole grains are different from intact grains.
Few people will argue against my first two points. But bring up whole grains and you will unleash a fury of controversy. Some people believe whole grains to be the cornerstone of any healthy diet, while others consider them superfluous and possibly detrimental to good health. You can find dozens of PhDs and MDs to back up your claims no matter what camp you align with.
So why is there so much disagreement? What does the science say?
The problem is that nutrition science conducted in free-living humans is virtually impossible to interpret. This is largely because the studies are so difficult to control and people’s behavior and self-reporting are so unreliable. Another problem is that the definition of “whole grains” has been watered down to a point where it is virtually meaningless.
One reason whole grains are hard to identify is because the US Food and Drug Administration (FDA) has created a definition that is friendly to food companies, but not to consumers.
The FDA requirements for a manufacturer to use the term “whole grain” on its label (along with the respective health claims) are as follows:
“Cereal grains that consist of the intact, ground, cracked or flaked caryopsis, whose principal anatomical components – the starchy endosperm, germ and bran – are present in the same relative proportions as they exist in the intact caryopsis - should be considered a whole grain food.” (emphasis added by me)
Get it? To be considered “whole,” grains do not actually have to be intact.
Thus food manufacturers create products using this loose definition to their advantage, demolishing grains as normal, then adding back the required ratios of grain parts (germ and bran) to meet the standard.
This is how products like Froot Loops get spiffy health labels claiming they lower heart disease when any unbiased nutrition scientist would agree that, with 41% sugar by weight, Froot Loops almost certainly contribute to heart disease.
On the other hand, there is compelling data that intact whole grains contribute to better health.
Lesson 4: Eating grains is a personal choice, not a nutritional imperative.
The good news is that it is really easy to tell the difference between fake “whole” grains and intact whole grains. If a food actually looks like a grain (i.e., it retains its original form and bran covering), then it is an intact grain. If it looks like a Cheerio, chip, loaf of bread or pasta with a “whole grain” label, then it is a fake whole grain.
People following a primal or paleo diet will argue that this difference is irrelevant and that all grains (and legumes?!) are unnecessary for good health. Personally I disagree, but remain fairly neutral on the personal choice of removing grains from the diet entirely.
Grains do not appear to be necessary for survival (Inuit tribes survive without them), but optimal nutrition may require slightly more effort than would be necessary following a traditional balanced diet.
This is generally how I feel about all healthy, restrictive regimens such as vegetarian, vegan and raw diets. You can make it work for yourself if you are willing to make sacrifices and put in the effort.
However you should be aware that for many people, myself included, cutting whole grains out of your diet completely is extremely difficult and, if you ask me, unnecessarily painful.
When making food choices about grains, the critical question is not whether or not a food is “whole” grain but whether the grain is intact. For this reason, it matters very little if you substitute “whole grain” products for regular refined products such as pasta.
Examples of intact grains are oats, barley, brown rice, whole wheat, quinoa (sort of) and faro. White rice is not a whole grain, and is closer to a refined grain than a whole grain.
For optimal health, processed and refined grains should be eaten very sparingly. Small amounts such as those eaten in traditional cultures can be part of any healthstyle, but including them is a personal choice that will depend on your own goals and preferences.
The irony is that if you are able to remove processed foods from your diet, the way you eat could probably be described as low-carb. But this label really undermines a healthstyle based on real food.
Though I eat relatively few grains compared to most Americans, I cringe when I see the shining example of low-carb living, The Atkins Diet website, with images of fake pancakes and pasta plastered all over it. If that is what low-carb is, I want nothing to do with it.
Processed food is still processed food, whether the carbohydrates have been synthetically removed or not. Stick to eating real food and you’ll never have to worry about carbs.
Do you count your carbohydrates?
Originally published November 25, 2009.