Kurt G. Harris MD

The PāNu approach to nutrition is grounded on clinical medicine and basic sciences disciplined by knowledge of evolutionary biology and paleoanthropology. The best evidence from multiple disciplines supports eating an animal-based diet high in fat, low in cereal grains and relatively low in carbohydrate.

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« Acetaminophen and the War on Drugs | Main | 1) Eliminate sugar and refined carbohydrates like white flour. »
Wednesday
Jul012009

Where are all the healthy whole grains?

 

"I can’t get enough of this awesomeness. By far my favorite snackaroo. If I’m not paying attention I will polish off a box of these babies in one sitting." - grain enthusiast #1 

"Yum! I feel so healthy eating these." -grain enthusiast #2

These are actual comments posted by aficionados of Kashi 7-Grain crackers - the hippest vegan food accessory extant since Starbucks started closing stores.

When I propose the extirpation of grains from the diet, the question everyone asks is "what about the healthy whole grains...how can you say not to eat them?".

Among the nutrition obsessed, if not the general population, the indictment of sugar, HFCS and white flour is met with almost bored acceptance. The fact that sugars and "refined"carbohydrates constitute a threat to health seems to hold some residual cultural sway due to the "organic" and "natural" prejudices that accompanied the countercultural vibe of the 1960s. Of course, many of those who agree with the evils of white sugar and flour happily munch on bagels, eat breakfast cereals and pancakes, and mainline sugar in their ridiculously hypersweetened $5 coffee beverages (It's lowfat, you know) as if these foods were not perfect vectors for the sugar and refined carbs they must imagine stupid people somewhere (not them) are eating straight from the glass containers in kitchens, probably in benighted squalid midwestern towns.

Like me, many have drunk the kool-aid of Gary Taubes, and are now convinced that metabolic syndrome and cancer may relate to insulin levels, and suspect that fructose unmoored from its pre-agricultural history as a seasonal attractant to get us to eat small fruit that was originally a lot of work to chew may indeed be a perversely addictive metabolic poison. Yet, many so enlightened still seem averse to canning all grains.

In my last post, I ended by proposing:

"Increase Fats to 65-70%, and cut out all residual grains, legumes, and starchy vegetables like potatoes, corn and rice so that only the green salads and non starchy veggies are left. This will get carbs down to 10% (roughly 50g per day) and absolutely minimize glucose, fructose and insulin effects."

I will now try to demonstrate two things: Firstly, if you agree that in a food- abundant environment we can keep our insulin levels low with this regime, then it will be very hard to achieve this without eliminating grains. Second, there is no downside to eliminating the few remaining "healthy whole grains" after the white sugar and flour are gone because there never were any in the first place.

Lets' start with the Kashi 7 grain crackers.

 

Nutrition Facts:

Serving Size: 15 Crackers (30g)

Servings Per Container: About 8

 

Amount/Serving

%Daily Value*

Calories 130

Calories from Fat 30

 

Total Fat 3g

5%

Saturated Fat 0g

0%

Trans Fat 0g

0%

Cholesterol 0mg

0%

Sodium 160mg

7%

Total Carbohydrate 22g

7%

Dietary Fiber 2g

8%

Sugars 3g

Protein 3g

 

 

Vitamin A

0%

Vitamin C

0%

Calcium

2%

Iron

4%

 

We see 130 Kcal in 30 g (15 crackers, hope you already ate lunch so you can stop at 15) with 23% of calories from fat, 67% calories from carbohydrate, and 9 % protein. 

At first blush, if you were a lipophobic follower of Dr. Ornish, this might look ideal. On closer inspection, we see that this fat percentage is about 2-3 times higher than in some of the less snack-like wholesome whole grain foods we discuss later. What could account for this? Do you suppose these crackers are impregnated with Tallow or lard? I doubt it, that would not make for an Ingrid Newkirk approved snack. Turns out it's industrial vegetable oils - according to the label, rapeseed oil (canola) and sunflower oil, the latter of which is particularly rich in rich in pro-inflammatory Omega 6 PUFAs.

Strike one against healthy whole grains crackers.

Shall 67% of calories from carbs ( bad for insulin regulation) and a parsimonious fraction of Proteins be strikes two and three?

But wait, what kind of protein is coming from these 7 wholesome grains?

Ingredients:

UNBLEACHED WHEAT FLOUR, KASHI SEVEN WHOLE GRAINS AND SESAME® FLOUR (WHOLE: OATS, HARD RED WINTER WHEAT, RYE, LONG GRAIN BROWN RICE, TRITICALE, BARLEY, BUCKWHEAT, SESAME SEEDS), EVAPORATED CANE JUICE, TOASTED WHOLE WHEAT, EXPELLER PRESSED SUNFLOWER AND/OR CANOLA OIL, RYE, TOASTED SESAME SEEDS, WHEAT BRAN, WHEY, HONEY, NATURAL LEAVENINGS (POTASSIUM BICARBONATE, SODIUM ACID PYROPHOSPHATE, MONOCALCIUM PHOSPHATE), BARLEY, WHOLE OATS, STONE GROUND WHOLE WHEAT, MALT EXTRACT, SEA SALT, YELLOW CORNMEAL, MILLET, ONION POWDER, HORSERADISH POWDER, RICE FLOUR, MIXED TOCOPHEROLS (NATURAL VITAMIN E).

We see Wheat, Rye, Barley, and Triticale, four gluten grains - maybe these crackers should be called gluten nips.

So Kashi 7 grains crackers, like most food made from grains, is mostly carbohydrates, and would be even richer in carbs but for questionable industrial oils added. The remainder is protein that is dominated by Gluten

Let's leave aside the Gluten concerns temporarily and keep looking for these wholesome, healthy grains.

In the spirit of good Popperian science, I will try to falsify my hypothesis by ignoring the gluten and leaky gut issue and look for the evidence most likely to falsify my hypothesis that there really are no healthy grains.

I suppose it was a bit unsporting to pick on a cracker, even a wholesome 7 grain heathy one ( Yum, I feel so healthy eating these!)

So let's segue to a group likely to put the best possible spin on the health benefits of whole grains.

 

 

The vegetarian society lists the following as the macronutrient composition of whole wheat flour:

Nutritionally, 100g whole wheat provide 14g protein, 2.2g fat, 69.1g carbohydrate, 2.3g fibre, 3.1mg iron, 36mg calcium.”

56 (16%) protein            20 kcal (8%) fat             276 kcal (78%) carb  

So compared to the gluten nips, we have gone up to 78% carbs and we have gone down to a level of total fat (8%) incompatible with life. If you fed this to your child as her primary source of calories, she would suffer nutritional deficiencies and have trouble myelinating her brain and nervous system unless supplemented with fats. Needless to say, the little fat there is is mostly PUFA and heavily weighted towards inflammatory O-6s.

Next, let's go to the Weston A. Price Foundation.

I am picking WAPF for a reason. My approach might actually be considered close to WAPF, but without grains. Dr. Mary Enig is, I believe, affiliated with them and she has done a lot to rehabilitate healthy fats. In addition, WAPF is actually a sound source of nutritional information on many other matters. I only disagree with them on grains.

Let's see what they recommend. If there really are healthy grains, who else would know better where to find them?

Lori Lipinski of WAPF compiles a table for us with specific brand-name suggestions to help us add back healthy whole grains after we have purged the evil sugar and white flour from our diet.

Chart Here

This looks pretty helpful. Let's look up some of these specific products and see if they look healthier than the crappy white bread and the disappointing gluten nips.

Alvarado Street Bakery Whole Wheat Bread - Sprouted


WAPF, based on meticulous research by Weston Price in the early part of the 20th century, recommends that grains be sprouted to reduce the activity of phytates, which are storage forms of the mineral phosphorus that bind other mineral nutrients and reduce their bioavailability. One might argue that once the grain is sprouted it is actually now a small vegetable and not a seed, and I am sure the fraction of folks who are grain enthusiasts who make sure their grains are sprouted is miniscule, but let's not quibble. We'll accept this as a "best practice" that we could adopt and we will assume Alvarado Street can handle everyone in the developed world ordering their bread.

What do we get? Here is Alvarado sprouted wheat bread:

38g serving

Insoluble fiber 3g (8% by weight)

Protein 4g                              (18%)

Carbohydrate 17 g                   (76%)                   Sugar 3g (3%)

Fat 0.5g                                 (5%)

It is 76% carbohydrate, 18% protein and 5% fat.

Once again, it is mostly carbohydrate (even more than the gluten nips) and the fat content is a pitiable 5%, making it look like the vegetarian society was concerned to make it more attractive to we lipophiles, as they high-balled generic whole wheat flour at a robust 8% fat content. 

We can pretend the protein isn't mostly poisonous gluten that it isn't incomplete in its amino acid complement (both true) and say the protein content is fairly healthy at 18%. But who are we kidding? it's mostly gluten.

Let's try one more from the WAPF recommended list:

 Eden Foods Kamut and Buckwheat Rigatoni

 

Here is Eden organic Kamut and Buckwheat Rigatoni. Maybe whole grain pasta with no wheat in it will fare better than bread.

55g serving 200 kcal

5g fiber (10% by weight)

Protein 9 g                             (18%)

Carbohydrate        39g              (78%)                  3 g sugars (6%)

Fat                      1.5 g total    (7%)

Sat Fat .35g                           (1.6%)                MUFA 400 mg (2%)

PUFA .66g                            (3%)        O-3 43 mg   (0.2%)         O-6 598 mg (2.7%)         O-6:O-3 ratio 14:1

 

Again, 78% carbs, 18% protein, and a slightly more healthy fat content at 7%. But let's look closer at the fats:

SFA (1.6%) MUFA (2%) and PUFA (3%).  That's a lot of PUFA, but more importantly, look at the 6:3 ratio.

14:1 O-6 to O-3 is very pro-inflammatory - not good. And although Buckwheat is not really wheat and is gluten free, Kamut is a gluten grain. So there's that pesky gluten issue again.

So let's try one last time. We've tried crackers, bread and pasta. How about organic, whole grain brown rice.

Lundberg Organic Brown Rice


49 g serving 170 kcal

3 g fiber      (6 % by weight)

Protein 4g                              (9%)

Carbohydrate 38g                    (89%) 

Fat 1.5 g                                (8%)

OK, best so far in total fat, but still pathetic. Protein now quite low, and if you want diabetes, we now have the highest carb fraction, at 89%, that we have seen so far.

How does this compare to the evil white bread I ate with lots of meat and whole milk as a kid?

White Bread - Wonder Classic


0% fiber

26g slice 60 kcal

Protein 2 g                             (13%)

Carbohydrate 13g                    (87%)                             2 g sugar (13%)

Fat 0.5 g                                (7.5%)

The wonder bread wins in the gut-irritating gluten category, but otherwise not much different from brown rice.

Brown rice wins if you think indigestible carbohydrates ("fiber") are somehow good for you. I've yet to see any evidence that they are.

What about vitamins? Well, there are more vitamins in the whole wheat versions but none of these grains, processed or otherwise, can come close to animal products if you want complete sources of both macronutrients and micronutrients. If you want micronutrients after your artificially enriched flour is gone from your diet, you will get them best with meat and green vegetables. 

I am still waiting for someone to show me a shred of evidence that there is anything essential we can only get from grains, gluten or not . 

Grains are all high-carbohydrate foods that are deficient in healthy fats, lacking in vitamins compared to other sources, and have proteins that are poison to a large segment of the population.

The only way to get a "wholesome healthy whole grain" is to put the words "wholesome" and "healthy" in front of the words "whole grain". The rest is just a fantasy made necessary by our culture's long history of dependence on cereal grains, juiced by politically correct forces that were created in the 1970's by George McGovern's meddling, the demonization of fat and meat as decadent, and the confluence of these forces with Aquarian Rousseauist fantasies of a lost utopia where no animals need to die.

 

PS: More on Gluten in the future. But one reader has asked; how much gluten is too much?

The simple answer is to never have to ask the question. Eliminate grains and you will never have to read a label or even know which grains have gluten in them. Your pancreas will thank you even if your jejunum does not care.

Cheat with fructose laden blueberries or sucrose in your espresso, not gluten-grain laden cake.

Reader Comments (31)

Very interesting comparisons. I've been following this sort of eating plan for a while now, but from time to time I really miss my buttered toast with avocado, and I look longingly at the Ezekiel Bread (sprouted whole grains) and wonder if it might be an acceptable splurge. Guess not, huh?

May I ask what you mean by those "who may have drunk the kool-aid of Gary Taubes"? You're not suggesting that Taubes's information is poison, are you? I'm not snarking, here. I'm really asking.

July 1, 2009 | Unregistered CommenterWilla Jean

Hello Willa Jean

I was among the first to drink the Taubes Kool-aid!

What I mean is many agree about insulin but cling to the veneration of grains.

Maybe I'll edit the essay to make that clearer.

July 1, 2009 | Unregistered CommenterKurt G. Harris MD

Hello,

I was introduced to your original PaNu blog by CrossFit Coronado's site and have been reading ever since, great stuff!

The last sentence of this post left me with a question. I know there are some that recommend cheat meals or cheat/free days for the psychological and social aspects of following a strict regimen which is in contrast to most of the public. Would you advocate planned "free" meals, possibly with certain rules or are the cheat guidelines only for situations if/when one's willpower breaks? From your statement here and in the post about alcohol, it would seem gluten avoidance is paramount but I'm wondering what else you would advise.

Thanks again for all the in-depth information you share!

July 1, 2009 | Unregistered CommenterMarcus

Hello Marcus

It seems to me there is a huge difference between cheating and planning to cheat.

I don't recommend planning to cheat at all, but that doesn't mean it won't happen now and then.

My point was only that a little fructose treat without gluten contamination is less worrisome than toast or cake.

I disagree with the cheat /reward/ free day concept completely.

Why condition yourself to believe you are being deprived by not eating garbage?

It seems kind of like having a marlboro red once a week as part of your smoking cessation program.

You wouldn't be a failure if you had a smoke once in a while, but that is a completely different mindset than planning for that saturday afternoon with a cigarette.

As far as the social aspects, how are we to start a new dietary paradigm if we keep reinforcing the values of the old one?

I say fly your freak flag high and refuse to eat the birthday cake. Tell people why it's garbage and you don't eat it rather than confusing them by looking fit and healthy and demonstrating you are still willing to eat crap to make them comfortable.

If they ostrasize you, start having barbecues with paleo folks.

July 1, 2009 | Registered CommenterKurt G. Harris MD

Ok, so if the diet general recommendation is "The best evidence from multiple disciplines supports eating a high fat animal-based diet low in carbohydrates and cereal grains.". What are the guidelines? I enjoy my grains, i.e. PB sandwich, but have no problem striking a better balance.

July 1, 2009 | Unregistered CommenterMichael Burns

Interesting! I was talking with my lady about the Dr. Eades post on fiber that he linked to in his blog this week, suggested she check out your site (which she really liked) and here you go with more back up. Is the issue with grain fiber, or fiber in general? It seems that due to gluten and phytates it's all in the grains, but both this post and the one I refered to of Dr. Eades, it seems like you both infer that fiber is itself not particularly necessary. Elaboration would be appreciated., even if it's just pointers to research. Eades blog is here:

http://www.proteinpower.com/drmike/fiber/a-cautionary-tale-of-mucus-fore-and-aft/

July 1, 2009 | Unregistered CommenterCraig

Craig

Briefly, fiber is undigestible carbohydrate. The best you can do with it is pass it into your colon, where it can feed and nurture excess bacteria, creating methane gas and disturbing your colonic motility, thereby causing irritable bowel syndrome (IBS) and creating discomfort and social embarrassment.

Grains have fiber when whole but little when not. As there is no evidence that fiber is beneficial (covered well by Taubes in GCBC) that is just another "advantage" of whole grains that is really a disadvatage.

The more important issues with whole grains are 1) Antinutrients like lectins and gluten and phytates and 2) Too high in carbs (70-90%)

And note that the more "whole" the grain, the more lectins and useless fiber, so whole grains have a better glycemic index than processed, but are actually worse in terms of lectins and IBS.

July 1, 2009 | Registered CommenterKurt G. Harris MD

Thanks! That's kind of what I was leaning towards- need to re-read GCBC.

July 1, 2009 | Unregistered CommenterCraig

Michael

Click on "get started"

July 1, 2009 | Unregistered CommenterKurt G. Harris MD

Kurt,

I found your blog thanks to Chris H. from Conditioning Research.
I'm very much enjoying your well written posts.

I have said it many times before, most people think I'm weird, they comment that I'm in great shape and yet refuse to even listen to what i have to say about my way of eating. Lately I've been pointing people to your blog for information. Maybe it wlll help them..........
Thanks again.

Marc
www.feelgoodeating.blogspot.com

Hi Marc

Thanks for your support.

I get the same thing all the time. If observed with my shirt off, I am accused of being a "runner".
Yet when when I tell them I was 15 lbs heavier when my running mileage was 32 miles a week (now it is less than 10) they refuse to believe it's the diet. My Brother-in-law Jason, who works out at crossfit coronado and is a Navy Seal, relates that men 15-20 years his junior constantly ask him how he is so fit. Their jaws drop when he tells them its 80% diet and only 20% crossfit.

July 2, 2009 | Unregistered CommenterKurt G. Harris MD

Hi Kurt,

Thanks for this superlative blog and the lucid writing. Would you mind doing a post about exercise and its place in the PaNu lifestyle? It would be very helpful if you provide pointers to the kinds of exercises we should adopt since there are no many injury related issues due to people spending so much time in the gym.

BTW, I owe you a testimonial. However, I still am not 100% PaNu because of my south asian heritage and the heavy preponderance of grains and other carbohydrates (rice and "roti"). However, I am getting there.

July 2, 2009 | Unregistered CommenterVic

Thank You, Vic

I will post more about exercise in the future. I obviously have opinions on a lot of things, but I don't like to shoot from the hip.

Briefly, I think 80 -90% of health is diet and I think exercise is to enhance your function (fitness) and for fun. Function and fun are important but exercise per se is not all that healthy without your diet squared away first.

I am trying to strike a balance between science, social criticism and health advice.

I am by no means an expert on exercise, but I will post more opinions about exercise with time.

In the mean time, try Chris's blog conditioningresearch.com and robb wolf.

July 2, 2009 | Registered CommenterKurt G. Harris MD

I switched to a low refined carb, high nutrition diet last year, and the effects on health are really remarkable.

There seems to be considerable support for a diet high saturated fat (Western Price Org, Mary Egnid, John Yudkin) . Do you have a response to the article below linking saturated fat to insulin response?

http://www.medicalnewstoday.com/articles/64692.php

Thanks for a great Blog

Jonny

July 3, 2009 | Unregistered CommenterJonny

Hi Jonny

If you email me a full text original article referred to (not the MSM review) I will read it - I don't have access to anything but the abstract.

Insulin resistance is complex and in my opinion, is not actually the disease itself.
IR in response to abnormally high insulin levels and glucose levels is a marker for high glucose and insuliin levels. There is clearly more than one kind of of insulin resistance, and laboratory maneuvers to induce IR do not necessarily equate to the chronic kind that is a marker of metabolic syndrome in humans.

I find studies in humans like the following much more convincing when evaluating the effects of a high fat diet

http://www.ncbi.nlm.nih.gov/pubmed/19082851?ordinalpos=18&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

July 3, 2009 | Registered CommenterKurt G. Harris MD

Further thoughts

This is the problem with using drugs to treat the "disease" of insulin resistance - the IR is an adaptation to the nutritional disease, not the cause of it! Have you notice how new diabetes drugs seem to raise mortality?

Kind of like that failed HDL lowering blockbuster drug that worked wonderfully to raise your HDL to super-healthy levels but increased your chance of dropping dead.

July 3, 2009 | Registered CommenterKurt G. Harris MD

I must comment about one of your comments. "Why condition yourself to believe you are being deprived by not eating garbage?" Thank you Dr. Harris! This is exactly the way I've felt for a few years, but have been unable to articulate the thought. Friends and family members seem to be astounded by how little cheating I do on paleo eating. If cake, bread, pasta, etc. are garbage why waste time and screw yourself up pschologically by feeling deprived? Condition yourself to love and enjoy all the good and natural nutritious food avalable. I am taking your advice and raising my freak flag high. My son has called me a freak for several years now. I finally got to him though. He's been eating paleo for about 6 months and is doing well. And one more thing, we had a BBQ with paleo folks this weekend. Who needs a bun on those burgers? Lettuce works and so does a fork.

July 6, 2009 | Unregistered CommenterRon Kelley

Hi Kurt,

You said "Insulin resistance is complex and in my opinion, is not actually the disease itself.
IR in response to abnormally high insulin levels and glucose levels is a marker for high glucose and insuliin levels. There is clearly more than one kind of of insulin resistance, and laboratory maneuvers to induce IR do not necessarily equate to the chronic kind that is a marker of metabolic syndrome in humans."

This is very sophisticated and I'm coming to the same conclusions. The other thing that's interesting is that elevated postprandial insulin doesn't lead to insulin resistance. That's demonstrated by the long-term glycemic index diet trials, in which postprandial insulin response was higher in the high GI group, but over time (1 year +) there were no differences in insulin sensitivity that developed. Pathological insulin resistance is probably caused by something neolithic- I suspect primarily sugar, wheat and omega-6/3 imbalance- as suggested by the clinical trials of "paleo"-type diets. "Paleo" carbs and certain grain/legume foods don't seem to have the ability to cause it, even if they're high-GI and eaten in large amounts.

July 7, 2009 | Unregistered CommenterStephan

Hello Stephan

I am sure there is some down- regulation of insulin receptors in response to chronic hyperinsulinemia per se, but as you suggest, there is more likely something neolithic at the core of metabolic syndrome. I suspect them in pretty much the same order you do but wheat might be first. Wouldn't it be funny, though, if the "neolithic substance" turned out to be something we've eaten for 2 million years?

What if it's Fructose?

This, to me, reinforces my metabolic milieu paradigm, that emphasiszes metabolism over the Cordain -like food lists that just ask what could they have eaten? (bugs yes and milk no, etc.) Fructose (linked to glucose at least) is paleolithic historically, but in our food abundant environment is metabolic poison. The quantitative becomes qualitative.

Oxygen is necessary to animal life but causes, well, oxidation and is poisonous in high concentration.

Insulin is the evil messenger we can't live without. we need it but it causes cancer and early degeneration.

Fructose is the sirens calling us to sweet pleasure, but until modern fruit and industry, we were safely tied to the mast. Paleolithic sucrose was chewing coca leaves, HFCS is crack cocaine and it's everywhere.

As far as wheat, I am trying to stay poetic but there is just no damned excuse for wheat!

As far as paleo carbs, I am not out to purge carbs, but once the wheat and potatoes are gone, I just don't see a downside to low (10-20%) carb consumption. Maybe some day I'll be convinced that without gluten grains and fructose, there is no difference between 10% carbs and 30%, and that wheat and fructose matter more - it might well turn out that way. I don't count or measure a lot so "don't eat sugar, wheat, or vegetable oil" would be an easy heuristic.

PS - Could it be in the glycemic index trials that they were on the flat part of the curve? Maybe with lower carb consumption (bigger differential in insulin levels integrated over time) there might have been an effect. It's hard to imagine that lowering insulin levels dramatically doesn't improve IR, even if fructose poisoning and WGA intake is held constant.

I am sure you can provide me with a link to one of your posts discussing those trials: )

July 7, 2009 | Unregistered CommenterKurt G. Harris Md

Hi Kurt,

I'm willing to consider the possibility that high-carb isn't ideal for health. I think the benefits of eating more than 20% carb are probably mostly in the convenience/price/enjoyment department. My current view is that eating a lot of carbohydrate is a stressor among others, that the body can tolerate well under the right circumstances. Those circumstances do not include the modern American diet. So restricting carbohydrate is effective in our diet context, but it's hard to say whether that's due to reducing carbohydrate per se or reducing gluten grains and sugar.

My feeling, based on the controlled trials of paleo-type diets, is that the bulk of the effect comes from the latter, although there may also be a contribution from carbohydrate reduction. It would be nice to see a trial where they compared a paleo-type diet to a normal diet with identical macronutrient ratios. I suggested that to Dr. Staffan Lindeberg last time we communicated, but I doubt it will ever happen.

Here is a literature review I did of the long-term controlled trails on the glycemic index, followed by interpretation/speculation:

http://wholehealthsource.blogspot.com/2009/03/its-time-to-let-go-of-glycemic-index.html
http://wholehealthsource.blogspot.com/2009/03/more-thoughts-on-glycemic-index.html

July 8, 2009 | Unregistered CommenterStephan

Hi Stephan

I am planning another post coming up about gluten - not to jump the gun but my nascent theory is that celiac disease is a just special case of gluten intolerance characterized by an an adaptive immune response in the gut. This is probably not unique but it needs to be articulated more.

For everyone else, gluten is simply a dose- response gut poison,. Non-celiacs therefore may not need 100% gluten avoidance to improve their health.. This would account for why low carb diets work in eliminating atopy, etc., even if the person did not have celeiac disease. When folks go low carb, the general anti-inflammatory effect may not be eliminating carbs per se but gluten/ WGA. After all, if you cut out white flour from the SAD, you have cut gluten by about 60%. That is why step 1 of PaNu will stay step one even if the neolithic trigger all turns out to be wheat.

I think the issue with fructose is simply artifical bioavailability.

Socially, going gluten free is an order of magnitude harder than just going low carb. I'll blog more about that in the future - our commmunity needs some preaching to the choir to help deal with the dominance of grains in our culture

The 12 steps work for people with no mention of carb ratios at all. I don't sweat if it is 5% or 25% carbs as long as the rules are followed. We are pretty much on the same page, I suspect I am just more of a habitual carnivore and that no doubt is obvious.

I think going hyper-steffanson and weighing liver portions to avoid the glycogen is a bit nuts, but I also don't understand the "what can I eat that is not wheat to get some more carbs" and I suspect there is sometimes some pure glucose addiction going on there ( I get some of that "eat some more" urge with nuts, actually)

I personally feel much calmer and less craving of anything with my carbs around 10% than 20%.

Thanks for the links. I am also looking into the COX and COX II issue some more since you brought that up.

July 8, 2009 | Unregistered CommenterKGH

re: "Socially, going gluten free is an order of magnitude harder than just going low carb."

just say you've got celiac disease. [for the times when you don't want to get into a long discussion about nutrition]

July 8, 2009 | Unregistered Commenterjeff klugman

That is the best strategy for restaurants Jeff, and one upside to the semi-infatuation in the media with gluten-free diets that seems to be afoot. I am just waiting for the AMA to call gluten free a "fad diet" : )

July 8, 2009 | Registered CommenterKurt G. Harris MD

Hi Kurt,

It sounds like we have some of the same thoughts on gluten. I'll look forward to your post. I write about it as well from time to time; my main post was this one if you're interested:

http://wholehealthsource.blogspot.com/2008/12/gluten-sensitivity-celiac-disease-is.html

I agree with you on the fructose issue, it would be hard to argue that modest amounts from fruit are unhealthy. I also think diet context influences the susceptibility to fructose-induced damage. There was a study in rats where they gave them metabolic syndrome with large amounts of fructose, but the effects were greatly blunted by feeding fish oil. Here is the reference for the COX-2 study I brought up earlier:

http://wholehealthsource.blogspot.com/2008/12/gluten-sensitivity-celiac-disease-is.html

Thanks for an interesting blog.

July 9, 2009 | Unregistered CommenterStephan

Oops, the reference is here:

http://www.ncbi.nlm.nih.gov/pubmed/19247274

July 9, 2009 | Unregistered CommenterStephan

I agree with you about the nutritional content of grains.

But I live in a predominately vegetarian country, India. People are vegetarians culturally and religiously.

So what does a vegetarian do who understands that the grain is not nutritious. They still must not eat any meat.

Traditionally our food was not that bad. It was mostly freshly ground oats/millet flat bread and lentil soup eaten with lots of vegetables and lots of Butter Oil.

The vegetables were traditionally cooked in butter oil or mustard oil, depending on the region and wealth.

The grain and lentil provided them with complete protein and little bit of minerals. Vegetables provided them with still more vitamin and minerals. Butter oil and mustard oil provided them a good balance of Omega 3 and Omega 6, along with decent amounts of EPA and DHA. The butter oil also provided them with the important fat soluble vitamins. Refined sugar was not available, and jaggery was not available all year round. It was used only during the festival season. This made them reasonably healthy not optimal but still healthy.

Presently everything has gone bad. People eat refined oils instead of the healthy butter oil and not so bad mustard oil. People eat too much of sugar all year round. People also does not stay in the sun for long. They don't even have enough vegetables. They also have started to drink bottled water. The food still is not as bad as in say US. Because the sugar is still not that much. Oil is still not that much. People still walk in the open sometimes. They still don't use too much of refined grains. The bottled water is not completely mineral poor. They do eat balanced protein. Non-traditional vegetarians don't have a concept of balanced protein.

I am recommending people around me to stop eating refined oil, and eat butter oil much more. Try to add it to everything. I recommend people to ferment their dough. Next step would be to ask them to sprout, freshly grind and then ferment. It is very time and effort consuming, which is a problem. Also I tell them to eat more eggs if that is not against their beliefs. This still does not help them to get Vitamin D3, Magnesium, or enough iodine.

Not much can be done to convince a traditional vegetarian. Their family hasn't had meat in generations.

July 9, 2009 | Unregistered CommenterAnand Srivastava

Dr. Kurt,

Wow, I am SO happy to have found your blog!!! It's SO refreshing to see an MD come to the conclusions you have. I would love to link to this article on my blog or even have you contribute a guest post on this very issue.

I have, over the last few months, totally eliminated grains from our diet at the recommendation of our naturopath, who is very into paleo nutrition. The changes to my body, my energy level, and digestion were almost immediate and totally stunning. Sugar and white flour are total poisons, and I agree with you that there is really no reason to eat wheat or grains.

I am so satisfied with meat and veggies. I find I eat way less than ever before and am not constantly hungry. I am thinking about your take on fructose, however. I have always thought that fructose was the least of all the evils, especially coming from fresh fruit. As we're in the height of berry season now, it's hard to resist all those great gems of nature.

Could you post a "guide for how to eat fruit"? I tend to see fruit as an occasional treat to be enjoyed seasonally, but since we're in the thick of fruit season I'm wondering how to reap the harvest without going crazy.

Also, tips on meal planning (especially breakfast, which is the only meal where I like to include a little bit of fresh fruit, in season) would be greatly appreciated!

So glad to have found you!

Stephan

I unfortunately only discovered your blog a few months ago. I have read your posts on gluten, but am working my way through your other excellent posts as well as time allows. I am finding I have read many of the same sources you quote during my own dietary evolution, but I have streak of impatience that prevented my from compiling and saving them as carefully as you have.

I thank you for your excellent work. Your explications of the papers you read are careful and rigorous. How do you find the time as a grad student? I now usually check to make sure I am not contradicted by Stephan or Peter if I am posting something speculative!

Keep up the good work and thank you for your contributions to my newborn blog. I have a few insulin sensitivity ideas I may PM you about later

July 9, 2009 | Registered CommenterKurt G. Harris MD

Hello Carrie and Welcome

You are of course encouraged to link to any of my essays or the whole blog, as it serves your purposes.

Regarding fruit, my wife just bought a quart of fresh blueberries at Sam's club and they are the size of small crabapples. Have you ever picked wild blueberries? They are quite small. Fructose is second only to gluten grains in it's ability to poison your metabolism. Fructose from sucrose or HFCS or modern frankenfruit, as far as my reading of the literature indicates, is all metabolically equivalent. How could a paleolithic food source like wild fruit contain poison? The answer is that the plant producing the fruit uses fructose as a lure to get you to eat it, and the plant does not care if it poisons your metabolism. It is the artificially selected quantity and unnatural bioavailability of fructose that makes it a metabolic poison.

We must avoid the naturalist fallacy (that what is natural is good) and recognize that nature is beautiful and is trying to kill us! It's about health, and emphatically not about traditions or paleolithic fantasies of food re-enactment.

July 9, 2009 | Registered CommenterKurt G. Harris MD

I too am attempting to wrap my mind around the very un-mainstream ideas that fiber is not neccessary for health (particularly digestion and elimination) and in fact may be harmful, and also the idea that fruitis possibly not onlnot essential to health but harmful. I just ordered GCBC and hope it willanswer some of my questions. Any other sources I should seek out? I have checked other paleo/low-carb blogs such as MDA, and "experts" but most seem to still promote fruit as good/ok.

December 27, 2009 | Unregistered Commenteremily

"Insulin resistance is complex and in my opinion, is not actually the disease itself.
IR in response to abnormally high insulin levels and glucose levels is a marker for high glucose and insuliin levels."

YES!! I think IR is a defense mechanism. Insulin receptors seem to be passive and the cells pull back receptors to prevent an "overdose" of glucose.

I get a kick when I talk to people who tell me my diet is "unhealthy" simply because I avoid grains! I know I feel better without them, but they just can't seem to accept it!

December 27, 2009 | Unregistered CommenterAlcinda Moore
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