The Whole Grain Guide (from the March 1997 issue of the HealthLetter)

And researchers who did ask for specifics are just beginning to sort out the whole from the refined grains.

"In the Iowa Women's Health Study, we see a lower risk of heart disease in people who consume dark, but not white, bread," says Lawrence Kushi, a University of Minnesota epidemiologist. (Even if some of the "dark" bread isn't whole grain, some of it is.) "But we haven't looked at breakfast cereals, and we haven't looked at cancers yet."

• Confounding. "People who eat whole grains may also be eating more fruits and vegetables," says Slavin.

• Limited intakes. It's tough to find a lower risk of disease among wholegrain-eaters if few people eat them. "Most of the data we have is from Europe, because hardly anybody consumes whole grains in the U.S.," says Slavin. Canadians may eat slightly more, she adds.

In 1986, Harvard's Walter Willett and co-workers asked roughly 80,000 female nurses to fill out diet questionnaires. By 1992, 915 of the nurses were diagnosed with non-insulin dependent diabetes, the kind that usually occurs in adults.

Then the researchers used two measures to compare the nurses who were later diagnosed with diabetes with the nurses who weren't: fiber intake and "glycemic load." Glycemic load estimates how much carbohydrate the nurses ate and how much those carbs raised levels of glucose and insulin in their blood.

GOOD GRAINS

Uncle Ben's may be convenient. But "enriched" white rice, the only kind most Americans are used to eating, is nutritionally bankrupt. Sure, you get the three B-vitamins and iron that are added to all enriched grains. But you lose the fiber, magnesium, vitamins E and B-6, copper, zinc, and who-knows-what phytochemicals that are in the whole grain. The solution: Be adventurous. Try brown rice instead of plain white. You can even get brown basmati or quick-cooking brown rice. Or give amaranth, buckwheat groats (kasha), or whole grain bulgur a try.

"In general, less-refined foods like intact whole grains and legumes are less-rapidly digested, so they enter the system more slowly," says Thomas Wolever, a University of Toronto fiber expert. "That dampens down insulin secretion and puts less stress on the system." Less insulin means a lower glycemic load.

In theory, that should lower the risk of diabetes, which occurs when the body secretes more and more insulin as a person's insulin loses its effectiveness.

Willett's results: "We found that the risk of diabetes increased about two-and-a-half-fold in women who had the highest glycemic load and the lowest fiber intake," he says. "Women who ate the most sugar and refined starches, like white bread, pasta, and potatoes, had the highest risk."

But Willett can't say exactly what parts of the foods made the difference. "It looks like fiber has some independent benefit," he says. "But the magnesium or some other nutrients that come with the whole grain may also matter."

So far, it's largely the fiber in whole grains that has caught the attention of heart disease researchers.

For example, in a recent study of more than 43,000 U.S. male dentists, veterinarians, and other health professionals, those who reported eating an average of 29 grams of fiber a day had a 41 percent lower risk of heart attack than those who averaged 12 grams a day. Fiber from grains -rather than fruits or vegetables -- was "most strongly associated with a reduced risk," noted the researchers.

And among nearly 22,000 Finnish men, those who ate roughly 35 grams of fiber a day, much of it from whole grain rye bread, not the refined rye eaten here-had a 31 percent lower risk of heart disease than those who ate an average of 16 grams a day, which is close to the average for American men.

The Bread & Cracker Box

Pepperidge Farm Natural Whole Grains Crunchy Grains bread is mostly whole grain. Pepperidge Farm Light Style Seven Grain bread isn't. Nabisco Reduced Fat Triscuits and Wheat Thins are all or mostly whole grain. Nabisco Wheatsworth crackers aren't. Marketers seem bent on feeding us white flour while making us think we're eating whole grains. Here are some tips to see through their schemes: If you don't like the taste of whole wheat bread or crackers, try a brand that lists a whole grain first in the ingredient list. (That means the bread is mostly whole grain.) Remember: "wheat flour" and "unbleached wheat flour" are not whole grain. Don't rely on fiber numbers to find whole grains. Breads, especially "light" loaves, may have added processed fiber from peas or other foods. It may help prevent constipation and diverticulosis, but it doesn't have the "package" of antioxidants and phytochemicals in whole grains. Read labels carefully. Whole wheat and oatmeal are whole grains. But "oatmeal bread" and crackers that are "made with whole wheat" are mostly refined. Here's what the words usually mean when they appear on the front of bread and cracker labels. It's whole grain if the front label says: rye (crispbread crackers), whole grain, or whole wheat. It's mostly reflned grain if the front label says: cracked wheat, made with whole grain, made with whole wheat, multi-grain, oat bran, oatmeal, pumpernickel, rye (breads), seven-bran, 12-bran, etc., seven-grain, nine-grain, etc., stoned wheat, wheat, wheatberry, whole bran.

"We see an effect of fiber," says Willett, who worked on both studies. "But that doesn't mean that if you strip it out and concentrate it in pills, it will have the same benefit, because you've left out important things that go with the fiber."

Among those things are antioxidants, which may delay or slow the damage that oxygen wreaks on cholesterol-damage that makes the cholesterol more likely to clog arteries.

"The bran contains a lot of minerals, and some-like selenium, copper, and manganese are components of antioxidant enzymes," says researcher Lilian Thompson of the University of Toronto.

Those aren't the only antioxidants in whole grains. "Phenolic acids are located in the bran layer," adds Slavin. "And whole grains are concentrated sources of vitamin E and phytic acid."

Diets that are high in wheat bran or other sources of fiber cut the incidence of colon tumors in animals given carcinogens. But in people, some studies see a link between fiber and colon cancer and some don't. To settle the question, the National Cancer Institute (NCI) has launched the Polyp Prevention Trial. It's putting 1,000 people on a low-fat diet that includes 18 grams of fiber a day for every 1,000 calories the participants eat. After four years, the NCI will compare the number of colon polyps (which often become cancerous) in the 1,000 fiber-eaters to the number of polyps in 1,000 people on a typical (low-fiber) North American diet.

But since half of the fiber comes from fruits and vegetables and the other half from grains, the trial is testing not just fiber, but fiber-rich foods.

"It's really a test of a cancer-prevention diet that's low in fat, high in fiber and high in fruits and vegetables," says the NCI's Elaine Lanza. "There are so many phytochemicals, it could take years to sort out which ones matter."

It's also possible that whole grains could prevent other cancers. Toronto's Thompson is especially interested in the phytoestrogens (plant estrogens) and lignans in whole grains.

Some researchers have suggested that lignans and phytoestrogens may take estrogen's place in breast cells, but that they do less damage because they are weak.

But so far, there isn't good evidence that women who consume more fiber from grains have a lower risk of breast cancer.

"And there are no prospective studies where we feed people lignans or phytoestrogens and measure their effect on breast cancer risk," adds Thompson.

"Bread -- it's a great way to go!" That's what Australian researchers in New South Wales called their campaign to boost whole grain bread consumption in a small retirement community.

After four months, sales of whole grain bread rose 58 percent and laxative sales dropped 49 percent in the community where the campaign was carried out (there was no change in a nearby community that had no campaign)."

"The general conclusion is that bran or fiber is beneficial for preventing constipation," says Walid Aldoori, a former Harvard researcher who is now at the Whitehall-Robins pharmaceutical company in Toronto.

That's also true for diverticulosis, which occurs when pockets form in the large intestine. Experts estimate that in North America, a third of people over 45 and two-thirds of those over 85 have it. The vast majority have no symptoms, but others experience constipation, diarrhea, flatulence, pain, bleeding, or inflammation (diverticulitis).

In 1994, Aldoori and co-workers examined the fiber intakes of nearly 48,000 male health professionals. The men who consumed an average of 32 grams of fiber a day were 42 percent less likely to report symptoms of diverticular disease than the men who averaged 13 grams a day.

Fiber from fruits and vegetables appeared to offer more protection than fiber from grains, but that may be because the study counted the small amounts of fiber in white bread, pasta, white rice, and other refined grains, which may not be beneficial, says Aldoori. "We did see that bran was associated with a reduced risk of diverticular disease."

And that makes sense, he adds. "Bran has the fiber that increases bulking, reduces transit time, and reduces pressure in the colon." Refined grains don't.

Researchers may still be gathering evidence that whole grains protect against heart disease, cancer, and diabetes. But they aren't waiting to urge people to eat more.

"Whole grains are more wholesome," says the University of Toronto's Meera Jain. "You have a better chance of getting the vitamins, minerals, fiber, phytoestrogens, lignans, antioxidants, and other unknown factors that you lose when grains are refined."

And there's another reason to eat whole grains. "They add more texture and flavor to the diet," says Harvard's Walter Willett. But, he adds, "most Americans haven't experienced good whole grain products.

"In Germany, a whole grain pumpernickel bread is moist, not dry, and it has good flavor. We have a lot of work to do in exposing people to good whole grain products."

PASTA PERFECT

People may be confused about whether their breads and cereals are whole grain, but when it comes to pasta, they know. It's usually not.

You can't even find whole grain pasta in most supermarkets. But specialty and health food stores have a burgeoning supply.

Try DeCecco, DeBoles, or Eden whole wheat spaghetti or linguine. They were much less chewy and gritty than we expected. DeBoles adds some Jerusalem artichoke to lighten its texture.

If they're still too chewy for your taste, try Eden's 50/50 line of pastas. It's half whole wheat and half white flour. You (and your kids) won't know the difference.

You can also try pasta made of spelt or kamut, two ancient whole grains that are making a comeback. They're relatives of wheat, but are well-tolerated by wheat-sensitive people.

Some people find that whole grain pastas taste better with sauces that go beyond the usual tomato. See page 14 for a white-bean-based recipe that we liked.

If you can't find whole grain pastas in your supermarket, try calling these numbers (better yet, get your supermarket to call):

Cleopatra's Kamut (818) 964-2324	Hodgson Mill (217) 857-6491
DeBoles (800) 749-0730	Pritikin (201) 338-0300
DeCecco (212) 582-6500 ext. 21	Vita Spelt (517) 351-9231
Eden (800) 248-0301	Westbrae (310) 886-8200

CEREAL NUMBERS

Take Honey Nut Cheerios and Puffed Kashi. Both are whole grain, but each has only a gram or two of fiber per serving. Why? It depends on:

• How much bran. Whole grain cereals (like shredded wheat) have less fiber than bran cereals (like AllBran). That's because the whole grain includes the endosperm (white flour) and germ as well as the fiber-rich bran. So there's less room for the bran.

• How much sugar. The added sugar in a cereal like Honey Nut Cheerios takes the place of some of the whole grain. The less grain, the less fiber.

• How dense. Some cereals are less dense than others. Puffs (like Puffed Kashi) and flakes (like Grape-Nuts Flakes) have less fiber than denser cereals (like Grape-Nuts or All-Bran). That's because a serving of dense cereal contains more cereal.

1. Look for cereals that are whole grain and high in fiber. Fiber clearly helps prevent constipation, and it may cut the risk of heart disease, diverticulosis, and cancer. So it's worth looking for higher-fiber whole grain cereals (five grams or more per serving).

2. Think of bran cereals as whole grain. Technically, they're not (since the germ and endosperm are missing). But they are a concentrated source of the bran that's missing from the refined grains that most of us eat. Think of wheat germ as whole grain, too. It may be only part of the whole grain ... but it's a good part that we seldom eat.

3. Make your granola low-fat. Most cereals are low in fat. Now you can get lowfat versions of granola and muesli, its untasted European counterpart.

4. Minimize sugar. Sugar doesn't just threaten your teeth. It also replaces some of the whole grain you could be eating.

Which cereals are whole and which are refined? Here's a list of some popular brands.

Cold Cereals		Hot Cereals
Whole grain	Mostly refined grain	Whole grain	Mostly refined grain
Cheerios	Basic 4	Oat bran	Cream of rice
Granola or muesli	Corn flakes	Oatmeal	Cream of wheat
Grape-Nuts	Frosted Flakes	Quaker Multigrain	Grits
Nutri-Grain	Just Right	Ralston High Fiber
Raisin bran	Kix, Corn Pops	Roman Meal
Shredded wheat	Product 19	Wheatena
Total	Puffed wheat
Wheat germ	Rice Krispies
Wheaties	Special K

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