Sigh. The headlines last week were filled with talk of how the latest study showed that eating low glycemic index (GI) foods, which don’t raise blood sugar levels quickly, rather than high glycemic foods, had no effect on health. A critical look at the way the study was conceived, planned and analyzed is necessary here.
Since When is Pasta Low Glycemic?
The biggest problem with this study is that grains and potatoes were used in both the low GI and high GI groups. Why bother using non-starchy vegetables in the low glycemic group when you include high glycemic grains, rice, pasta and potatoes in that group? Or high fiber in all groups? The degree of processing of whole grains also makes a huge difference on the glycemic index. Most whole wheat breads these days are made from flours ground so fine that they affect the blood sugar levels, sometimes more than a candy bar. The GI of a whole grain product today cannot just be gleaned from a chart in an old text book, which is what the researchers used. Gut microbes and pre-biotics were not even discussed at all.Wheat also is the food MSG was first isolated from because it is high in the amino acid glutamate, which directly tells the pancreas to release insulin. Type I diabetics often have antibodies to the enzyme GAD that gets rid of excess glutamate. So there may be other reasons to exclude wheat in at least one group when studying sugar, glycemic load, glycemic index, insulin, obesity and health.
A Distinction Without a Difference
This latest study seemed designed to find the outcome desired. In the introduction, what is considered “healthful” is spelled out up front: “a healthful diet rich in whole grains, vegetables, and fruits“ which biases the study from the very beginning. The study researchers also only used diets their associates already came up with, like the DASH diet and did not even consider the typical American diet. The differences in glycemic load were so slight or incremental as to be hardly noticeable, which is what was reported. It reminded me of studies comparing a dose of one drug against a slightly higher dose of that same drug. Or two similar drugs against each other, but never against a totally different therapy that might call into question the expensive drug du jour. The difference in the diets regarding GI was so small as to be barely noticeable although they claimed it was a ”large contrast". The foods they chose to call low GI, which included white rice, pasta or potatoes were laughable. The study headlines don’t reflect the actual data when it comes to the low carb diets, which did have a definite impact on health and showed in the results despite the fact that a real low carb diet contains from 10% to 30% of calories, not 40%, which was used in the study. The media chose to focus only on GI and not the low carb results, which were significant. Also, the differences between fructose and glucose which impact the body differently were not considered.Low Carb Diets
Even though I was trained in nutrition and food science, if I didn’t try a true low carbohydrate diet under the care of a health counselor associated with my local hospital, I might be tempted to dismiss claims of low carbohydrate effects on health, but I did. I was told since I was 18 I had to watch my cardiovascular health, I even lost a kidney a few years back and the diets doctors always told me to try were low salt, low fat. But never, never did they say, carbohydrates were a problem. That could be due to the fact that Ansel Keyes, who terrified everyone about butter, did not disclose while he was on his anti-fat crusade, that his laboratory had been funded by the sugar industry as far back as 1944. The establishment researchers who carried out this study may simply have been trying to protect the advice they have been giving out for years.Why “More” Whole Grains?
Decades of low fat, low sodium advice from misguided health policy and scant science resulted in a diet after surgery for me that called for 7, yes, seven servings of carbohydrates a day. That’s what happens when you limit protein and fat. That’s what’s left for kidney patients. “More whole grains”. What always gets me riled is the impulse of health news journalists to throw the word “more” in front of an admonition to eat whole grains. We are eating quite enough, thank you. The truth is we need more artichokes and asparagus, not more bread.The Real Mediterranean Diet
If you look at a true Mediterranean diet, it has more vegetables and more meat, and much of the cheese is full fat. An Italian will wax absolutely rhapsodic about artichokes, broccoli rabe, and escarole, or capicola (“Gabagool” if you’ve seen the Sopranos) and prosciutto. Low fat? Have you seen sopressata? Or Burrata, which is basically mozzarella drowning in cream? In Italy, mozzarella comes from water buffalo, and is full fat.Before the Pasta
Anti-pasto is just as important as pasta. More so. It is often our favorite course. Italians eat meat, provolone, mozzarella and non-starchy vegetables like red roasted peppers, pepperoncini, pickled cauliflower, celery, mushrooms, artichokes and olives before they eat pasta. Protein and fiber first will cause you to eat less simple carbs. That is why they call it anti-pasto. The order in which you eat your meal matters. A soup course, which was always on the menu every night for my grandfather from Perugia, also cuts pasta intake. An Italian who eats antipasto which includes vegetables and meat as well as soup before their pasta will eat less pasta than an American who sits down to an enormous bowl of pasta with jarred, sugar-laden tomato sauce or a deep dish pizza with breadsticks on the side. Italians know how to pace their meals for good reason and eat moderate amounts because they eat a very wide variety of foods. If you gorge yourself on the first course you will run out of room by the third and there are still two more to go. My husband learned the hard way at his first holiday dinner with my family, small amounts of many things gets you to dessert, which is usually only served at holidays. If you do it right, and you’re lucky, you might have room for a mini cannoli and an espresso. I think that’s why Italian pastries are so tiny.Greek food is also not low in dairy, fat, or red meat. What about Feta? Lamb anyone? Last time I checked, lamb was pretty rich, and is considered red meat. Have you ever had baklava? Very rich. Roasted vegetables, however are on every plate. The rice is basically to serve the grilled meat on. Yogurt is everywhere.
It is not just about olive oil. What the Mediterranean diet is, is incredibly diverse, varied and neither all nor none of only one thing. The Mediterranean diet is a beautiful, colorful, yummy, kaleidoscope of everything you can possibly imagine, and is not low-fat, low-red meat, or low anything. Everything is literally on the table. It is an omnivore’s delight. The more types of vegetables you can cram into an anti-pasto salad, or Greek shepherd’s salad, the merrier. The more kinds of meat and cheese you can put on grandma’s heirloom holiday platter, the better. The more kinds of roasts and meats you can serve on the table together, if your guests have not given up, stuffed after the third course, the better. A roast beef and a ham? Great! Turkey and Roast Beef? Wonderful! That is what makes pinning down what the Mediterranean diet is, a fool’s errand. We also do people a disservice by reducing a diet to either vegetables or meat, or simply one ingredient, like olive oil. Most true cuisines are a mixture, and no traditional diets are strictly vegan. Mediterranean food is simply more diverse and fresher due to easy availability.
My point is this, most nutritionists have absolutely no idea what they are talking about when they mention the Mediterranean diet, or a low carb diet, or a low GI diet. And most food writers compound the error by quoting these “experts” with no critical thought.
Leap of Faith
After years of food chemistry and nutrition classes in the 1980’s, and experience in the food industry where I was indoctrinated in all the Ancel Keyes propaganda, I was extremely hesitant when my new health counselor asked me to trust her. She wanted me to eat more animal protein, more non-starchy vegetables, more soup, and no bread, pasta, rice, beans, nuts, corn or potatoes. When I asked her if that was ok for my kidney to increase my protein intake, she looked at me and asked if I really thought my current high carbohydrate diet was helping my lone little kidney. I looked down and realized she was right. Carbohydrates make you retain water, and that certainly puts a different kind of strain on my kidney, which my diuretic sort of proved. Once I started my low carb diet, my doctor took me off my diuretic. Carbs affected me much more than salt. I had never had diabetes, but it was hard to wrap my head around eating like a diabetic anyway. I had been avoiding sugar for years, using fruit and stevia instead, but giving up bread, pasta, rice, and potatoes for an Italian just seemed too hard to do.Brutal Honesty
Conventional advice had failed me, which is why I went for help and decided to trust my new health counselor. Having many food allergies, you tend to rely too heavily on a few foods and I just wasn’t losing the weight even though I wasn’t eating sugar. I was eating Italian bread because it was one of the few things that didn’t have added ingredients that I was allergic to, like soy. The food diary Linda made me keep was a crushing revelation. I would hand it to her every week and she would sadly shake her head, take out her pen, crossing out my culinary mistakes and show me the error of my ways before weighing me.The Payoff
My biggest problem? Surprisingly, not enough protein. Second biggest problem? Not enough vegetables. I was so scared of putting a strain on my kidney by eating too much protein that I wasn’t getting enough. I was also told to eliminate beans and nuts which are both a source of carbohydrate as well as starchy vegetables. Milk was out. Not because of the fat, but because of the lactose. Milk is high in lactose sugar. I had no problem changing my diet to use cream in my coffee, butter and coconut oil on my vegetables, and eating more mozzarella, bison burgers, steak, and lamb, and switching to apples and berries rather than oranges and bananas. That was what made the changes bearable. My love of Italian (Mediterranean) non-starchy artichokes, asparagus, red roasted peppers, eggplant, romaine, arugula, spinach, capers, olives and fresh tomatoes helped tremendously. Dinner was no longer meat, vegetable and starch, but simply meat, vegetable, and vegetable. After a few weeks of transitioning to a low carb diet and sticking with it for 6 months, I not only lost 50 pounds, but all my bloodwork dramatically improved to the point where my doctor asked me incredulously (as well as my friends) “What did you do?” I had not been able to get life insurance because of my previous surgeries. I tried again and not only did I get it, I was able to get a much better plan than my agent expected. This was based on the excellent blood tests.Questions
I have a lot of trouble believing that the latest GI, low carb study actually set out to find the truth by not even including a truly low carb group. I look back and regret the ten years I followed the standard (wrong) advice to eat more carbohydrates and more whole grains rather than less, which was the still the unfortunate takeaway advice of one of the researchers in the article.Advice
I don’t recommend someone attempting a low carb change without a knowledgable health counselor. Even I needed help. I’m human. A health counselor, someone up on the latest science, and a real food diary keeps you honest and focused. The brain runs on glucose (AKA blood sugar) or ketone bodies, which are made in the liver from eating coconut oil or butterfat, medium or short chain fatty acids. So you need to make sure you are getting the right mix of fuel and vitamins so your body doesn’t start dismantling muscle. It wasn’t being skinny that killed Karen Carpenter. It was heart failure. The science is updating so fast now, the old advice is getting quickly tossed out the window. Good riddance to bad advice, but I was still surprised when I saw a nutritionist quoted in the New York Times this week that had no clue that glucose is not the brain’s only fuel.The advice to eat “more whole grains” should sound ridiculous now, and so does the latest study, since grains are not necessary for human health at all. Some cultures subsisted for millennia on coconuts and fish (Kitavan), some on meat and milk (Maasai), some on raw meat alone, or whale blubber and berries (Inuit), while still others, bison, fish and berries, or even roots and insects. For millennia, humans ate whatever they could find. The latest popularity of the paleo diet has less to do with what humans did eat and more to do with de-emphasizing grains. The paleo diet eliminates grains. That goes against the agriculture industry’s reliance on GMO wheat and corn, which is why we routinely see industry-influenced articles putting down the paleo diet. Modern agriculture centered on wheat is relatively recent, in the last 10,000 years, and modern wheat is even newer since GMO varieties came out recently, but hardly necessary. It is time we stopped treating it as if it was.
