“The best lies contain a kernel of truth.”

—T. Colin Campbell, The Low-Carb Fraud

“I’ll have the bacon cheeseburger, but hold the bun.”

“I don’t eat grains; they make you fat.”

“Don’t blame the butter for what the bread did.”

Maybe you’ve heard statements like this from family, friends, or acquaintances. Maybe you’ve even uttered them yourself. One of the most popular and powerful dietary trends of the past couple of decades is the “low-carb” movement, which has inspired millions of Americans to shun carbohydrate foods.

Technically carbohydrates are sugar molecules found in many different foods, particularly sugars, starches, and fibers. They are one of the human body’s primary sources of energy, and play an important role in any healthy, optimal diet. While carbohydrates are an element of most foods, especially plants, the colloquial term carbs is commonly used to refer to foods like sugars, grains and grain products, and starchy vegetables. From Atkins to South Beach to the Zone to today’s best-selling authors like Gary Taubes, Nina Teicholz, and Mark Hyman, popular diets have portrayed these foods as the cause of myriad health problems, from obesity to diabetes to brain diseases. They encourage people to cut out grains, starchy vegetables, and sometimes beans and other legumes, while eating more protein, in the form of animal foods and fat. Attracting millions, these diets have captured a surprisingly large mindshare.

How did America conclude that carbs are the root of all dietary evil? Is rejecting foods like rice, wheat, potatoes, or corn a sound decision? Is it scientific? As with many dietary movements, there are some important kernels of truth amid the claims of the low-carb advocates; there are also plenty of misleading notions. How do we sort the wheat from the chaff when it comes to these ancient foods that have long formed the bulk of human diets?

Whole Grains and Half-Truths

Bread, beans, cookies, corn, rice, cupcakes, oatmeal, yams, potatoes, corn syrup, pasta, candy, table sugar. If you eat a strict low-carb diet, all of those foods will be off the menu, or at least make only rare appearances. Do you see the problem here? Some of these foods are not like the others. Yes, they may all share a common macronutrient, carbohydrates, but the focus on that alone obscures the much more important distinction that is at the heart of this book’s dietary philosophy: the difference between whole foods and highly processed foods.

The low-carb people have one thing right: highly processed, refined carbohydrate foods spell disaster for health. Humans love carbohydrates—they are the body’s preferred energy source. Approximately 50% of the calories Americans eat come from this food category,1 and that is actually on the low side of USDA recommendations.² Unfortunately, we love carbs so much that we’ve come up with endless delicious delivery systems for the sugars and starches we crave. We subject them to industrial processes, manipulating and refining them until something comes out that no longer resembles the original food at all.

Like all processed foods, highly refined carbohydrates lack fiber and healthful micronutrients, while delivering a condensed load of calories. The body essentially can’t distinguish them from white sugar (empty calories devoid of any nutritional value), and treats them just as poorly, leading to weight gain and a host of related problems. The growing recognition of the dangers of highly processed foods in general, many of which are in fact refined carbohydrates, has helped drive the low-carb movement forward.

“Carbs are bad” is, in this sense, a half-truth. Yes, highly processed carbs are something we would all do well to avoid. But in the name of protecting people against the evils of refined carbohydrates, the low-carb movement has created an enormous amount of confusion about the role of unprocessed carbohydrate foods, robbing millions of Americans of the tremendous proven health benefits of whole grains, beans, and starchy vegetables. Furthermore, it has encouraged those same people to increase their consumption of animal foods, with all its well-documented health risks.

There is a universe of difference between a box of sugary processed oat-flour cereal and a bowl of steel-cut oats, between the white flour in a cupcake and the whole grains in traditional bread. All are high-carbohydrate foods. But the purveyors of low-carb diets too often act as if the term carbohydrate were synonymous with refined, processed foods loaded with extra fat and sugar. Both in popular diet books and supposedly rigorous scientific studies comparing the effects of different diets on health, authors often don’t distinguish clearly enough between foods in whole forms and the much less nutritious processed versions. Yes, a control group in a study may eat carbohydrates instead of fats, but what kind of carbs? If it’s cookies and cupcakes, we shouldn’t be surprised when they don’t fare so well. That answer makes all the difference when it comes to the results of the study, just as it does when it comes to your health and the food on your plate.

The history of the modern low-carb movement can be traced to the outsize influence of Dr. Robert Atkins and the empire he created, beginning with his 1972 book, Dr. Atkins’ Diet Revolution. In it he advises people to shun carbs, and eat more protein and fat. He encourages people to eat animal foods in abundance, including butter, lard, and bacon, and discourages fruits and green vegetables.

Despite finding little support in the medical or nutritional communities, Atkins’ controversial book, and its 1992 follow-up, sold more than fifteen million copies, one of the best-selling diet books ever.

Atkins coined the phrase low carb, and his success likely inspired the current glut of similar diets. Some have grown more sophisticated and evolved their overall message from Atkins, but they still contain many of the basic elements. They tell us to eat more fats and protein, including more meat, and to beware of carbohydrates.

There is also a consistent effort to frame sugar as the primary problem in the Standard American Diet, almost as if sugar’s sacrifice could redeem every other dietary vice. This “sacrificial nutrient” approach is a common theme in the diet world. Just give up X, we are told, and you can freely eat everything else from A to Z. If X happens to be something you like but is not your favorite food, sometimes the trade-off seems worth it. Hence, the attraction of the Atkins diet and its successors isn’t necessarily in the avoidance of carbs. It is in the welcome justification to enjoy butter, cheese, bacon, steak, and other animal foods without guilt. Unfortunately, healthy nutrition is a much more holistic process and doesn’t work this way. As much as refined sugar may deserve crucifixion, it can’t die for all our dietary sins!

Even critics acknowledge that low-carb diets can result in weight loss. When the body has fewer carbs to burn, it begins to burn fat, a condition known as ketosis. This means that your body burns fat as fuel instead of glucose, its preferred energy source, and that can result in temporary weight loss. People often feel nauseated after some time on this diet, which leads to lower calorie intake over time, further increasing weight loss. However, low-carb diets are notoriously hard to stay on (perhaps due to the lack of truly satiating foods like whole grains, beans, and starchy vegetables) and so weight loss is often temporary, as people “fall off the wagon.”

While many low-carb diets are promoted as a healthy means of losing weight, they are in fact associated with higher all-cause mortality in both men and women.3 Indeed, you would be hard-pressed to find any significant scientific evidence that an Atkins-like diet has good health outcomes over the long term, and it has certainly not been shown to reverse chronic disease. Even temporary weight loss can be matched and probably far exceeded over the long term by a healthier whole foods, plant-based diet that includes whole grains, beans, and starchy vegetables.

Don’t Fear the Starch

“All large populations of trim, healthy people, throughout human history, have obtained the bulk of their calories from starch,” declares the man on stage, as several hundred people listen closely in the packed auditorium. Dr. John McDougall is addressing a crowd of doctors, health professionals, and health seekers who gather twice a year near his home in Santa Rosa, California, for an Advanced Study Weekend to learn the latest on the benefits of a whole foods, plant-based diet.

For several decades McDougall has been sounding the alarm about the dangers of the Standard American Diet and placing particular emphasis on the benefits of starch-based carbohydrates as essential to human health. “Examples of thriving people include Japanese and Chinese in Asia eating sweet potatoes, buckwheat, and/or rice, Incas in South America eating potatoes, Mayans and Aztecs in Central America eating corn, and Egyptians in the Middle East eating wheat,” he explains. “Over the past century there has been an escalating trend in Western societies of people abandoning starchy plant foods for low-carbohydrate meat and dairy foods. A worldwide epidemic of obesity, heart disease, diabetes, and cancer has followed this dietary change.”⁴

Here McDougall soon encountered the essential contradiction of modern medicine—that while he could help his patients with infections and injuries, there was little he could do to ameliorate the chronic conditions—diabetes, arthritis, obesity, heart disease, and cancer—that they were suffering from. And his curious mind noticed an important truth about his patients in Hawaii—that while you might expect chronic disease to be correlated with aging, the younger generations were in fact much worse off than the older ones. The reason was not mysterious. Younger generations had increasingly adopted American-style eating habits. They were fatter and sicker. What did the older generations eat? Rice and vegetables were the foundation of their diet, while their children and grandchildren were adding meat, dairy, and processed foods to their plates at high rates.

McDougall’s search for answers led him back to the library. He combed through medical and scientific journals for more information on the nutritional patterns he had witnessed in his own patients, and soon amassed a significant body of research showing that a diet based on starch foods, combined with fruits and vegetables, led to optimal health outcomes largely free of chronic disease.

As McDougall discovered, in stark contrast to the current cultural concern about carbs, many civilizations had based their entire diets around starch foods. All of the Blue Zones, as we explained in a previous chapter, relied on corn, yams, or grains for a large percentage of calories—with impressive health outcomes. Those populations experience low obesity, low dementia, and low chronic disease—quite the opposite of what carb-phobic authors would have you believe. As McDougall writes in his book The Starch Solution: Eat the Foods You Love, Regain Your Health, and Lose the Weight for Good!, “Throughout civilization and around the world, six foods have provided our primary fuel—barley, corn, millet, potatoes, rice, and wheat.”5 Beans, sweet potatoes, and oats could probably be made honorary members of this list.

Our bodies easily and efficiently use the energy contained in starch. We break down complex carbohydrates over time into simple sugars, providing sustained energy for living. Perhaps most importantly, starch foods can be very satiating (see chapter 2). As a result we tend to consume fewer calories when we adopt a whole foods diet that is rich in starches. These foods also provide us with a particular type of fiber, resistant starch that has all kinds of intestinal benefits. They are full of vitamins and minerals, a source of both nutrients and energy.

McDougall has little patience for vegan or plant-based diets that emphasize other vegetables at the expense of starches. “People try to eat diets centered around kale, broccoli, cauliflower, celery, and so on,” he declares, “and it doesn’t work! You must have starch as the center of your meal plan. Once you get the starch foods as the centerpiece, then everything works.”⁶

In his research McDougall stumbled upon the work of several people who seemed to confirm his intuitions about the power of carbohydrate-rich diets, including Walter Kempner, a German refugee who conducted research at Duke University in the 1930s and got remarkable results treating patients with his famous Rice Diet. While his prescription of white rice, sugar, fruit, fruit juices, vitamins, and iron⁷ is not a diet we’d recommend to anyone with better options, Kempner’s dramatic results—which included the reversal of diabetes, heart disease, obesity, arthritis, hypertension, and more—run strongly counter to conventional low-carb theories.

Another significant influence was Denis Burkitt, an Irish doctor who spent much of his career in Uganda after World War II. His contributions include raising awareness of the important role of fiber (found only in plant foods). He recognized that the diseases present in African rural hospitals were very different from Western ones, and he hypothesized that the high fiber in the African diet of the time might play a role in protecting people from common Western ailments, which were rare in Uganda and, in fact, all of Africa. His conviction was that many chronic diseases were entirely preventable, and fiber intake was key—which he summed up in a simple equation: Big stools = small hospitals. Small stools = big hospitals.

Nathan Pritikin (see chapter 5) was perhaps McDougall’s greatest nutritional influence. In 1978 someone gave him a set of Pritikin’s lectures on audiotape. For this young doctor asking serious questions about the state of the American nutritional orthodoxy, Pritikin’s example was like finding gold—an important confirmation of his own experience in the sugar plantations of Hawaii. Four decades later McDougall has gone on to help thousands of patients get off the chronic disease train, all while publishing books, papers, and newsletters, and providing an educational platform to enable experts and laypeople alike to explore the power of food as medicine.

Indeed, his center in Santa Rosa has served as something of an incubator for the larger plant-based nutrition movement for several decades. In addition to his Advanced Study Weekends, which combine education with inspiration, he welcomes a steady flow of people to his weeklong intensives. A 2014 study published in Nutrition Journal tracked more than sixteen hundred patients who had attended these intensives, and found that average weight loss in just one week was three pounds, average cholesterol reduction was 22 mg/dL, and nearly 90% of patients were able to get off blood pressure and diabetic medications.⁸ And McDougall proudly emphasizes that participants get to eat as much as they like during the week. The overflowing buffet has become famous, with many recipes straight from the kitchen of Mary McDougall, his wife and collaborator. Front and center at every meal are whole grains and starchy vegetables.

Grappling with Grains and Gluten

Walk into any grocery store these days and briefly examine the row upon row of foods proclaiming themselves “gluten-free,” and you would be excused for thinking that we are in the midst of a nationwide epidemic of disease and that gluten is the proven culprit. While today’s low-carb diets and philosophies build on Atkins’ approach, their arguments often emphasize gluten as playing a key role in making Americans fat, sick, and stupid.

So what is gluten? As the comedian Jimmy Kimmel demonstrated in a hilarious and revealing 2014 video, even many people who don’t eat it don’t know what it is. Gluten is a mixture of proteins found in wheat and a number of other grains, including barley and rye. It’s the substance that makes bread and grains chewy. If you’ve ever kneaded dough, it’s what gives it that elastic feeling.

A number of books, including Wheat Belly by Dr. William Davis and Grain Brain by Dr. David Perlmutter, have risen to the top of best-seller lists by blaming wheat in general and gluten specifically for America’s chronic diseases, obesity rates, and even mental disorders—from Alzheimer’s to schizophrenia to autism. Davis, a cardiologist, goes so far as to claim that wheat has killed more people than all wars combined. Perlmutter declares that gluten sensitivity “represents one of the greatest and most underrecognized health threats to humanity.”9 This kind of dramatic hyperbole is not uncommon in the “war on wheat” subculture. Is it justified?

The first important truth to acknowledge is that some people have celiac disease and as a result are highly gluten intolerant. When they eat gluten, they suffer damage to the small intestine (visible on a biopsy) that can lead to a host of ills, including unhealthy weight loss and the inability to absorb nutrients. This is a genetic autoimmune disorder, and estimates of the population affected tend to be low, around 1%.¹⁰ However, that is still several million people who need to be very aware of the dangers of ingesting gluten. For celiac sufferers, a gluten-free diet is essential, although there is no reason these people should not consume other healthy carbohydrate foods like nonglutenous whole grains and starchy vegetables.

The question then arises: How much of the explosion of concern about gluten sensitivity in the rest of the population is legitimate? In recent years nutrition experts have come to recognize that there is indeed a population of individuals that is sensitive to gluten and/or allergic to wheat but who do not have celiac disease. For these people, ingesting gluten may trigger physical symptoms such as abdominal pain, bloating, diarrhea, constipation, bone or joint pain, headaches, and fatigue. There is some evidence that their sensitivities can affect their mood and mental state as well. Again, estimates as to the size of this cohort are relatively low, around 1% or perhaps slightly higher.¹¹ Unfortunately, these individuals have often gone undiagnosed in the medical system.

These two populations—celiac sufferers and gluten-sensitive people—do not, however, come anywhere near to accounting for America’s great gluten freak out. The number claiming either gluten intolerance or an allergy to wheat far exceeds the actual estimates of sufferers (which would add up to little more than 2%). Researchers estimate that as many as 30% of American adults are choosing to cut down on or avoid gluten, and an even higher percentage believe gluten-free foods are healthier options.¹² Are these people misguided? In one double-blind, controlled Italian study, patients claiming nonceliac gluten intolerance were tested, under very rigorous conditions, and 86% were clearly shown to have nothing of the sort.¹³

Interestingly, we’ve observed that often, when people who believe themselves to be gluten sensitive try a whole foods, plant-based diet, they feel better regardless of whether they restrict gluten (possibly incriminating the other unhealthy foods they have now stopped eating as the true cause of their symptoms).

To understand the processing journey that takes a health-promoting whole grain and turns it into a health risk, let’s use the example of wheat. To obtain the edible wheat grain or kernel, the inedible husk is removed from the grain after harvesting. A wheat kernel is made up of the outer layer of bran, the inner layer of endosperm, and a seed germ. Each element brings nutritional benefits to the table—the endosperm is made up of mostly starchy carbohydrates; the germ is the part of the kernel involved in reproduction and contains a powerful mix of vitamins, minerals, and nutrients; and the bran contains the helpful fiber that is so important to the overall nutritional package of plant foods.

In a whole grain food, the entire wheat kernel is used. If it is whole grain flour, the entire kernel is milled, so it still has the nutrients and fiber. That is far preferable to a refined grain or white flour, where only the endosperm is ground, leaving a starchy carbohydrate with some nutrients, but without many of the other nutritional elements that make a whole grain a nutritional powerhouse. Plus refined grains are often combined with other unhealthy ingredients, such as sugar and oil. There is evidence that while whole grain consumption is associated with less abdominal fat in adults, refined grain consumption is just the opposite.19

Read food labels carefully when buying grain-based products. Some foods are labeled as containing whole grains, but check the percentage before you put them in your shopping basket—they may not be 100% whole grain. Others use terms like multigrain, which simply means that they contain more than one type of flour—and they can all be refined. Even those that do actually use whole wheat or whole grain ingredients too often add plenty of other questionable substances—enough to make the whole package a nutritional no-no.

This brings us back, once again, to our first rule: choose whole foods instead of highly processed foods. For example, choose brown rice over white, or whole wheat pasta over refined alternatives. Choose whole grain breads, ideally made with coarse-ground flour and with a high ratio of fiber to carbohydrates (see “Tips for Reading Food Labels” here for more advice on choosing breads). As always, grains in their intact form are the healthiest choice. Remember, the closer a grain is to its original intact whole form, the more nutritional benefits it will likely bestow.

Unfortunately, the current wave of concern over gluten leads too many people in unhealthy directions. Either they load up on gluten-free versions of their favorite foods, which are often more processed than the originals, packed with sugar, fat, and highly refined gluten-free flours, or they head on over to the low-carb camp, and shun all grains, glutenous or otherwise. But science to date has consistently revealed impressive health benefits associated with whole grains.14 Whole grains are healthy foods. One recent study in the BMJ shows how whole grain consumption is associated with a reduction in cancer, heart disease, respiratory disease, and infectious disease, including a 17%-reduction in all-cause mortality.¹⁵ Another study that reviewed the findings of twelve studies involving eight hundred thousand people over four decades found that the higher the consumption of whole grains, the lower the death rate—a reduction in risk of 25% for heart disease and 15% for cancer.¹⁶ Daily consumption of three portions of whole grains has even been shown to be so effective at lowering blood pressure that it could decrease the incidence of coronary artery disease by 15% and stroke by 25%.¹⁷ Whole grain consumption has been demonstrated to increase insulin sensitivity, thus reducing the risk of diabetes.¹⁸ These are just a few of the many results over the years that have confirmed, and reconfirmed, the nutritional benefits of whole grains. Indeed, the positive health evidence for whole grains continues to grow, despite the claims of fad diet books. It would be a travesty to see people continue to shun a whole host of healthy foods in order to hedge against a condition that they most likely don’t have!

We hope evidence like this convinces you not to fear wheat or other glutenous grains in whole food forms, no matter what you may read or hear. Unless you are one of the 2% to 3% with celiac disease, wheat allergy, or gluten sensitivity, you can embrace glutenous whole grains and whole grain products, including wheat, and enjoy all their benefits. Gluten is not the source of all dietary evil, nor will avoiding it be the single dietary miracle cure to all that ails you. If you decide to avoid gluten, simply choose nonglutenous whole grains, like brown rice, oats, millet, quinoa, or buckwheat. And don’t make the mistake of thinking a “gluten-free” label is a ticket to health. Gluten-free cookies are still cookies. With so many unhealthy processed foods being produced in gluten-free forms, the same principles apply to a gluten-free diet as to any optimal diet. Choose whole foods, mostly plants.

An Inflammatory Conversation

Today’s scaremongering around wheat is not just about extra calories, or the pulverized grains, or the lack of fiber, or the added fats and sugars in some forms. It’s also about the boogeyman of “inflammation.” In some diet books about wheat and grains, it’s as if the unseen evil of chronic inflammation is lurking in our body ready to attack, and all it ever needs is a smidgen of wheat! The idea is that wheat is high glycemic, which might cause higher blood sugar, and higher blood sugar might lead to inflammation, which might lead to various long-term health problems. Here again we have to tread carefully and follow the science. There is little evidence that genuinely whole wheat foods result in inflammation. In fact, quite the opposite. Diets high in whole grains have consistently been shown to reduce levels of systemic inflammation.20 On the other hand, animal foods, which are what many people tend to load up on when they reduce consumption of grains and other high-carbohydrate foods, have been shown to increase inflammation.²¹

The fear of wheat runs dangerously close to scaremongering and pseudoscience. The Grim Reaper of inflammation is not lurking behind every grain (unless, of course, actual allergies are involved, since any food you are allergic to will cause inflammation). As Dr. Michael Greger explains, “If someone says whole wheat is inflammatory, then show me a single study anywhere in a nonceliac disease population that says that. I don’t know of any. But of course, if you are talking about refined grains, it’s different. People who think they can live on vegan donuts are kidding themselves.”22 A healthy, whole foods, plant-based diet that includes whole grains is not going to negatively impact your overall blood sugar or inflammation levels. Likely it will do just the opposite.

Here’s the bottom line: The rhetoric over grains is overblown, indiscriminate, and, well, inflammatory. It has thrown out the baby of whole grains with the bathwater of more processed, refined versions. Next time your friend orders that bacon cheeseburger without the bun, “because carbs make you fat,” you’ll know that yes, refined white flour buns probably will make you fat, and sick as well, but so will the processed meat burger. Whole carbohydrate foods, however, do quite the opposite. So go ahead and order a big portion of brown rice and vegetables, or even a bean burger on a whole wheat bun, knowing that whole grains are consistently associated with good health, weight loss, and longer life.

WHOLE FOODIE TAKEAWAYS

• Carbs do not make you fat or sick, so long as they are whole foods—Know the difference between unhealthy processed carbs and healthy whole grains and starchy vegetables.

• Whole grains, starchy vegetables, and legumes should be the base of your diet—These foods are consistently associated with better health and greater satiety.

• Gluten intolerance and celiac disease are rare—Unless you are part of that 2% to 3% of the population, there is no reason you should avoid glutenous whole grains like wheat.

CHAPTER 7

The Great Grain Robbery

Rethinking the Low-Carb Trend

Whole Grains and Half-Truths

MY WHOLE FOODIE STORY

Don’t Fear the Starch

WHOLE FOODIE HERO

Grappling with Grains and Gluten

How Grains Are Processed and Why It Matters

An Inflammatory Conversation

WHOLE FOODIE TAKEAWAYS