Carbohydrates: A Grain of Truth

  • Grains are a type of carbohydrate also known as cereals, are members of the grass (Gramineae) family of plants and produce a fruit, or caryopsis, which is commonly referred to as a kernel, grain, or berry.
  • When it comes to carbohydrates whole-grain foods are a healthy choice because they contain nutrients, fiber and other healthy plant compounds found naturally in the grain. When grains are ground into flours or milled, the process removes the bran, germ, dietary fiber, iron and many B vitamins.
  • Pseudograins are not true grains and are derived from broad leaf plants and not grasses and are an excellent source of nutrient-dense, gluten-free 100% “whole” grain and are ideal for people with food allergies.

The most important thing to consider is the type of carbohydrate not necessarily the percentage of carbohydrate in the diet. High quality carb choices are found in whole grain foods like whole wheat bread, rye, barley and quinoa (a pseudograin) compared to lower quality carb choices found in highly refined white bread or French fries.

Whole grain or refined grain

A whole grain product according to the Food and Drug Administration (FDA) refers to any mixture of bran, endosperm and germ in the proportions one would expect to see in an intact grain. Examples include whole-wheat flour, bulgur (cracked wheat), oatmeal, whole cornmeal, and brown rice. According to a 2006 FDA report a food product must contain at least 51 percent of whole grains by weight to be labeled “whole grain.” Compared with intact whole grains, processed or “refined” whole grains will have lower fiber and nutrient levels. Multigrain and whole grain are not interchangeable terms since multigrain does not specify whole grain but only means that a food contains more than one type of grain. “Refined” grains are more likely to trigger weight gain, inflammation and blood-sugar imbalances and act more like sugar. Some examples of refined grain products are: white flour, de-germed cornmeal, white bread, white rice.

Refining wheat creates flour is a process that strips away more than half of wheat’s B vitamins, 90 percent of the vitamin E, and virtually all of the fiber. Similarly finely ground grain is more quickly digested with a spike in insulin and more impact of blood sugar that’s why more coarsely ground steel oats have less of an impact on blood sugar than whole wheat berries. Whole grains instead of refined grains are also associated with lower total cholesterol, LDL (the “bad” cholesterol), triglycerides, and insulin levels. Avoidance of highly processed carbohydrates in favor of a diet rich in whole-grains would be expected to reduce the risk for cardiovascular disease. In addition to typical whole grains one can also consider pseudograins (false grains) and ancient grains that share similar health benefits and are gluten-free.

Health outcomes with whole-grains

Phytoestrogens (plant estrogens) are commonly found in whole grains may protect against some cancers. Better digestive Health is another consideration since the fiber in whole grains helps prevent constipation also helps prevent diverticular disease. An 18 year study of more than 160,000 women also showed a 30% lower rate of new type 2 diabetes with an average of 2-3 servings of whole grains a day compared to those who rarely ate whole grains. Prevention of diabetes is possible with increased whole grain (brown rice) ingestion simply substituted for white rice.

The Harvard-based Nurses’ Health Study, compared women who ate 2 to 3 servings per week of whole-grain products (mostly bread and breakfast cereals) compared to those who ate less than 1 serving and after 10 years were 30 percent less likely to have a major cardiovascular event such as heart attack or die from heart disease. A group of 7 studies (called a meta-analysis) that looked at whole grain consumption found those who ate 2.5 or more servings of whole-grain foods a day compared with those who ate less than 2 servings a week showed a 21% lower rate of heart attack, stroke, or coronary bypass or angioplasty/ stent procedure.

Pseudograins: “ancient” grains

Pseudograins are not true grains and are derived from broad leaf plants and not grasses and are an excellent source of nutrient-dense, gluten-free 100% “whole” grain and are ideal for people with food allergies or intolerances and the more than fifty percent of Americans with prediabetes and diabetes.

Amaranth, quinoa, wild rice, and buckwheat are technically not grains but pseudograins (and botanically not in the grain family) and also known as ancient, heritage or heirloom grains -their use date back thousands of years.

Amaranth was a highly valued nutrition staple in Aztec culture nearly 8,000 years ago. Amaranth is an excellent source of high-quality protein, fiber, calcium, magnesium, iron, copper, and phytosterols. Quinoa considered “sacred” by the Incas is considered by many the “super grain” and contains all eight essential amino acids, making quinoa a complete protein food. It can contain up to 50% more protein than common grains. Quinoa is a healthy food choice and an easy-to-prepare substitute to white rice or couscous or a high-protein breakfast food mixed with almonds, or berries.

Clearly whole grains (and pseudograins) have health benefits when consumed as part of a healthy nutrition pattern. The American Society of Nutrition in a scientific statement agrees that whole grains high in fiber or fiber-rich bran do reduce disease. They are particularly important choices for those with insulin resistance conditions like prediabetes, diabetes and polycystic ovary syndrome (PCOS).


Like everything else details are important when making choices. Avoid pitfalls, read labels and buy whole grains that are high in fiber and without unhealthy additives. Look for breads, pastas, and other products that explicitly state “100% whole grain” or “100% whole wheat.” The choice of cooking whole grains can also be important.

A good example is from a 1999 study by Ludwig that compared a breakfast of instant oatmeal (whole oats that were rolled and steamed so that they cook quickly) compared to steel-cut oatmeal with sliced but not steamed whole oats. The instant oats triggered greater blood sugar spikes despite similar calories and fiber content and this was associated with less feelings of fullness or satiety. This was associated with a subsequent 50% greater caloric intake than those eating the steel-cut oats. With so many Americans putting inches around their middle and the epidemic of prediabetes and diabetes thinking about carbohydrate quality may improve your health.

Sun Q, et al. White rice, brown rice, and risk of type 2 diabetes in US men and women Arch Intern Med. 2010;170:961-9

Mellen PB, et al. Whole grain intake and cardiovascular disease: A meta-analysis. Nutr Metab Cardiovasc Dis. 2007

Liu S, et al. Whole-grain consumption can lower the risk of coronary heart disease: results from the Nurses’ Health Study. Am J of Clin Nutr. 1999;70:412-9