Whole grains and half truths

(For followers of the Heart Scan Blog, below is a re-posting of a recent post. I've moved it up to make it accessible to a number of patients that I asked to look at this post for some conversation about the concept of wheat-free diets.)

TV ads, media conversations, magazine articles, even advice from the American Heart Association and USDA (a la Food Pyramid) all agree: eat more whole grains, get more fiber.

What happens when you follow this advice to add more and more whole grains to your diet? Look around you: People gain weight, they become pre-diabetic and diabetic. Lipids and lipoprotein patterns emerge: increased triglycerides and VLDL, reduced HDL, small LDL. Blood sugar goes up, inflammatory responses are ignited. You feel crumby, cancer risk is increased.

"Official" agencies have urged us to eat more grains, get more fiber and most Americans have complied. We now have a nationwide health disaster that will eventually lead to more people with coronary plaque, more heart disease, more heart attack, more heart procedures.

This is why I've been urging patients to go wheat-free. It has proven an extraordinarily and surprisingly effective strategy for:

1) rapid and profound weight loss
2) raising HDL and reducing triglycerides, VLDL, and small LDL
3) reducing blood sugars, pre-diabetes and diabetes

So here I (re-) post just a sampling of the comments sent by readers of the Heart Scan Blog who have given this idea a try.

Barbara W said:

It's true! We've done it. My husband and I stopped eating all grains and sugar in February. At this point, we really don't miss them any more. It was a huge change, but it's worth the effort. I've lost over 20 pounds (10 to go)and my husband has lost 45 pounds (20 to go). On top of it, our body shapes have changed drastically. It is really amazing. I've got my waist back (and a whole wardrobe of clothes) - I'm thrilled.

I'm also very happy to be eating foods that I always loved like eggs, avocados, and meats - without feeling guilty that they're not good for me.

With the extremely hot weather this week in our area, we thought we'd "treat" ourselves to small ice cream cones. To our surprise, it wasn't that much of a treat. Didn't even taste as good as we'd anticipated. I know I would have been much more satisfied with a snack of smoked salmon with fresh dill, capers, chopped onion and drizzled with lemon juice.

Aside from weight changes, we both feel so much better in general - feel much more alert and move around with much greater flexibility, sleep well, never have any indigestion. We're really enjoying this. It's like feeling younger.

It's not a diet for us. This will be the way we eat from now on. Actually, we think our food has become more interesting and varied since giving up all the "white stuff". I guess we felt compelled to get a little more creative.

Eating out (or at other peoples' places) has probably been the hardest part of this adjustment. But now we're getting pretty comfortable saying what we won't eat. I'm starting to enjoy the reactions it produces.

Weight loss, increased energy, less abdominal bloating, better sleep--I've seen it many times, as well.

Dotslady said:

I was a victim of the '80s lowfat diet craze - doc told me I was obese, gave me the Standard American Diet and said to watch my fat (I'm not a big meat eater, didn't like mayo ... couldn't figure out where my fat was coming from! maybe the fries - I will admit I liked fries). I looked to the USDA food pyramid and to increase my fiber for the constipation I was experiencing. Bread with 3 grams of fiber wasn't good enough; I turned to Kashi cereals for 11 years. My constipation turned to steattorrhea and a celiac disease diagnosis! *No gut pains!* My PCP sent me to the gastroenterologist for a colonscopy because my ferritin was a 5 (20 is low range). Good thing I googled around and asked him to do an endoscopy or I'd be a zombie by now.

My symptoms were depression & anxiety, eczema, GERD, hypothyroidism, mild dizziness, tripping, Alzheimer's-like memory problems, insomnia, heart palpitations, fibromyalgia, worsening eyesight, mild cardiomyopathy, to name a few.

After six months gluten-free, I asked my gastroenterologist about feeling full early ... he said he didn't know what I was talking about! *shrug*

But *I* knew -- it was the gluten/starches! My satiety level has totally changed, and for the first time in my life I feel NORMAL!

Feeling satisfied with less is a prominent effect in my experience, too. You need to eat less, you're driven to snack less, less likely to give in to those evil little bedtime or middle-of-the-night impulses that make you feel ashamed and guilty.

An anonymous (female) commenter said:

My life changed when I cut not only all wheat, but all grains from my diet.

For the first time in my life, I was no longer hungry -no hunger pangs between meals; no overwhelming desire to snack. Now I eat at mealtimes without even thinking about food in between.

I've dropped 70 pounds, effortlessly, come off high blood pressure meds and control my blood sugar without medication.

I don't know whether it was just the elimination of grain, especially wheat, or whether it was a combination of grain elimnation along with a number of other changes, but I do know that mere reduction of grain consumption still left me hungry. It wasn't until I elimnated it that the overwhelming redution in appetite kicked in.

As a former wheat-addicted vegetarian, who thought she was eating healthily according to all the expert advice out there at the time, I can only shake my head at how mistaken I was.

That may be a record for me: 70 lbs!!

Stan said:

It's worth it and you won't look back!

Many things will improve, not just weight reduction: you will think clearer, your reflexes will improve, your breathing rate will go down, your blood pressure will normalize. You will never or rarely have a fever or viral infections like cold or flu. You will become more resistant to cold temperature and you will rarely feel tired, ever!

Ortcloud said:

Whenever I go out to breakfast I look around and I am in shock at what people eat for breakfast. Big stack of pancakes, fruit, fruit juice syrup, just like you said. This is not breakfast, this is dessert ! It has the same sugar and nutrition as a birthday cake, would anyone think cake is ok for breakfast ? No, but that is exactly the equivalent of what they are eating. Somehow we have been duped to think this is ok. For me, I typically eat an omelette when I go out, low carb and no sugar. I dont eat wheat but invariably it comes with the meal and I try to tell the waitress no thanks, they are stunned. They try to push some other type of wheat or sugar product on me instead, finally I have to tell them I dont eat wheat and they are doubly stunned. They cant comprehend it. We have a long way to go in terms of re-education.

Yes. Don't be surprised at the incomprehension, the rolled eyes, even the anger that can sometimes result. Imagine that told you that the food you've come to rely on and love is killing you!

Anne said:

I was overweight by only about 15lbs and I was having pitting edema in my legs and shortness of breath. My cardiologist and I were discussing the possible need of an angiogram. I was three years out from heart bypass surgery.

Before we could schedule the procedure, I tested positive for gluten sensitivity through www.enterolab.com. I eliminated not only wheat but also barley and rye and oats(very contaminated with wheat) from my diet. Within a few weeks my edema was gone, my energy was up and I was no longer short of breath. I lost about 10 lbs. The main reason I gave up gluten was to see if I could stop the progression of my peripheral neuropathy. Getting off wheat and other gluten grains has given me back my life. I have been gluten free for 4 years and feel younger than I have in many years.

There are many gluten free processed foods, but I have found I feel my best when I stick with whole foods.

Ann has a different reason (gluten enteropathy, or celiac disease) for wanting to be wheat-free. But I've seen similar improvements that go beyond just relief of the symptoms attributable to the inflammatory intestinal effects of gluten elimination.

Wccaguy said:

I have relatively successfully cut carbs and grains from my diet thus far.

Because I've got some weight to lose, I have tried to keep the carb count low and I've lost 15 pounds since then.

I have also been very surprised at the significant reduction in my appetite. I've read about the experience of others with regard to appetite reduction and couldn't really imagine that it could happen for me too. But it has.

A few weeks ago, I attended a party catered by one of my favorite italian restaurants and got myself offtrack for two days. Then it took me a couple of days to get back on track because my appetite returned.

Check out Jimmy Moore's website for lots of ideas about variations of foods to try. The latest thing I picked up from Jimmy is the good old-fashioned hard boiled egg. Two or three eggs with some spicy hot sauce for breakfast and a handful of almonds mid-morning plus a couple glasses of water and I'm good for the morning no problem.

I find myself thinking about lunch not because I'm really hungry but out of habit.

The cool thing too now is that the more I do this, the more I'm just not tempted much to do anything but this diet.

Going wheat-free, along with a reduction in processed sugary foods like Hawaiian Punch, sodas, and candy, is the straightest, most direct path I know of to lose weight, obtain all the health benefits listed by our commenters, as well as achieve the lipoprotein corrections we seek, like reduction of small LDL particles and rise in HDL, in the Track Your Plaque program.

Comments (13) -

  • Emily

    11/14/2007 10:59:00 AM |

    Diet is an important measure in preventing the diabetes. Look around you: People gain weight, they become pre-diabetic and diabetic. Lipids and lipoprotein patterns emerge: increased triglycerides and VLDL, reduced HDL, small LDL. Blood sugar goes up, inflammatory responses are ignited. You feel crumby, cancer risk is increased.

  • Anonymous

    11/14/2007 1:17:00 PM |

    Speaking of wheat in the diet, I'd strongly urge anyone suspicious of gluten enteropathy, or "celiac disease," to get the Enterolab blood test, which has replaced endoscopy as the "gold standard" for diagnosis (don't let the gastroenterologist tell you otherwise). Quality of life is profoundly preserved through early diagnosis, and the medical community is largely clueless on this issue. -Keith.

  • Ted Christopher

    11/15/2007 8:42:00 PM |

    No.   I eat a lot of whole grains (as part of vegan diet).  What is the health-upshot?  I have a little over 5% body fat, a resting heart rate of about 50, and a cholesterol level a little over 100.  And the diet is easily digested and I'm very active.  And I am more concerned about getting hit by a meteorite than getting diabetes or having heart problems. You can read a good relevant write-up here

    Perhaps there are some people with a specific allergy problem with a given grain (such as wheat), but the comments above are way off.

    The diet I'm describing has profoundly helpful affects on both the heart and diabetes front as someone like McDougall's work makes clear.

  • Dr. Davis

    11/15/2007 10:35:00 PM |

    I'm afraid that you are the occasional exception. These comments do not apply to everybody. Just the majority.

  • John

    11/16/2007 8:28:00 AM |

    I'd appreciate a little clarity around what is meant by "grains" Whole grains cover a wide range of
    different types ... wheat, rye, oats, etc. Are they all "bad"? You have mentioned flax (a grain)
    for example as being "good". So which is which?
    I ran across a grain called Salba promoted by a health food store as a healthy alternative for
    those allergic to wheat ... but it's still "grain".

  • Dr. Davis

    11/16/2007 12:18:00 PM |

    It depends on what you are trying to accomplish.

    Some people who are exquisitely sensitive to any grain can do well by restricting themselves to ground flaxseed, barley, and some of the more obscure wheat "alternatives" in small quantities like quinoa, sorghum, and bulghur.

    However, some people just need dramatically reduce wheat only and can do quite well.

    Some people, e.g., those at true ideal weight with Lp(a) and no small LDL, don't benefit by a grain restriction at all.

    I'd estimate that 70% of people would fall into the first or second category.

  • Anonymous

    11/17/2007 10:55:00 PM |

    I can't argue with your results, but as a physician with a very strong interest in nutrition I have to disagree with your conclusions. In most cases it isn't the wheat that is harmful but the processing that strips it of its nutritional value, or the other junk like partially hygdrogenated fats found in the wheat containing products. Your simplified message works well for those that lack nutritional sophistication but is an unnecessary limitation for those with more nutrititional knowledge and the discipline to use it(such as the vegan commenter, Keith).

    A breakfast of kamut (an ancient form of whole wheat), barley, and oat grains soaked overnight and rinsed, ground flax seed, and rice milk is low glycemic, high in protein, B vitamins, minerals, and both soluble and nonsoluble fibers. Soluble fibers improve lipid abnormalites and the insoluble fiber promotes proper digestion and colon health. It will also provide satiety easily until noon. I incorporate grains in this manner into my vegan diet. At 49 I have low blood pressure and pulse and low lipid levels and am proof that those with the nutritional knowledge and the discipline to use it need not avoid grains.

  • Dr. Davis

    11/17/2007 11:07:00 PM |

    Yes, wonderful point.

    I'm guilty of over-simplifying to make a point, though I believe a very important one.

  • G

    11/20/2007 3:39:00 PM |

    I don't recall if I have read here on this site about the JAMA study from Stanford reviewing the 4 low carb diets and finding that the most effective in pre-meno women was the Atkins in reducing LDL (they presume, small hard atherogenic), lowering TGs 30% and promoting permanent 1-yr wt loss goals.

    CONCLUSIONS:  In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight and experienced more favorable overall metabolic effects at 12 months than women assigned to follow the Zone, Ornish, or LEARN diets. While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss.


    Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women
    The A TO Z Weight Loss Study: A Randomized Trial

    Christopher D. Gardner, PhD; Alexandre Kiazand, MD; Sofiya Alhassan, PhD; Soowon Kim, PhD; Randall S. Stafford, MD, PhD; Raymond R. Balise, PhD; Helena C. Kraemer, PhD; Abby C. King, PhD

    JAMA. 2007;297:969-977.


    Context  Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately.

    Objective  To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables.

    Design, Setting, and Participants  Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women.

    Intervention  Participants were randomly assigned to follow the Atkins (n = 77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up.

    Main Outcome Measures  Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non–high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing.

    Results  Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P<.05). Mean 12-month weight loss was as follows: Atkins, –4.7 kg (95% confidence interval [CI], –6.3 to –3.1 kg), Zone, –1.6 kg (95% CI, –2.8 to –0.4 kg), LEARN, –2.6 kg (–3.8 to –1.3 kg), and Ornish, –2.2 kg (–3.6 to –0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups.

    Trial Registration  clinicaltrials.gov Identifier: NCT00079573

  • stephen_b

    11/21/2007 8:25:00 PM |

    Is the recommendation to go wheat free entirely an effort to reduce carbohydrate intake or is the claim that gluten has an impact on blood lipids in and of itself?


  • Dr. Davis

    11/21/2007 8:56:00 PM |

    Eliminating wheat reduces the carbohydrate load. But it also has the curious exaggerated effect of diminishing appetite considerably. I won't pretend to understand this phenomenon, but the appetite-stimulating property of wheat can be substantial. Removing it returns control to appetite.

  • G

    11/21/2007 10:18:00 PM |

    So Dr. D, is whole grains actually 'whole cr*p'...*pardon ze french*?  I know that personally (and I'm very physically active) that I would gain 10 lbs per year if I followed the Am Diabetes Assoc pyramid diet eating 11 servings of whole grains and 4-5 servings fruit daily (and insufficient protein and good oils like nuts/seeds, fish oil). And I did gain wt prior to going low carb!
    Have a great Thanksgiving!!  We have so much to be thankful for... including this great souce of info and commentary.

  • Dr. Davis

    11/22/2007 2:14:00 PM |

    The world has clearly gone way overboard on the whole grain kick. 6-8 servings per day of grains according to the USDA food pyramid and the ADA's diet you cite would make the majority of people gain enormous amounts of weight. I see these people every day who come to me frustrated. They're eating "right," following the standard advice and can't understand why they've gained 50 lbs over the past four years and have disastrous lipid/lipoprotein numbers, along with pre-diabetes or diabetes.

    Drop the wheat specifically and weight, as you read above, drops like a stone in the majority.

    Not everybody needs to do this. If you eat like this and are already at ideal weight with no small LDL, etc., then it may not be necessary. But I find it necessary in at least 70% of people I see.