My dislike of many starchy carbs like bread, potato, rice, pasta and breakfast cereals is based on a body of evidence which suggests that the gluts of insulin their eating induces can speed our path to conditions such as obesity and type 2 diabetes. And, despite all this talk about their ‘nutritious’ nature, the fact remains that they leave a lot to be desired on this front too.
I most recently covered the hazards of consuming too may blood sugar and insulin disruptive carbs in by blog post of 28th November. Specifically, I focused here on two studies which found links between high glycaemic index (GI)/glycaemic load (GL) diets and an increased risk of type 2 diabetes. The post which followed this focused on a study which found that a low GI diet, compared to a high GI diet, brought benefits for health quite quickly.
After this particular post a commenter sprung to the defense of high GI foods, claiming that the fact that the Japanese eat a lot of rice (a high GI food) and are healthy proves that high GI foods cannot be bad for us.
I thought I’d write about this today because this comment came in over the weekend and I hear similar lines of argument quite a lot. The question usually goes along the lines of: “If starchy foods are so bad, how come the Mediterranean/Chinese/French diet which is full of pasta/rice/French bread is so healthy?�
Firstly, I think that we sometimes have a very stereotypical image of some traditional diets. The French do eat French bread, but most of their diet is actually made up of quite natural, unprocessed foods. The same is true of the Italians, who when they eat pasta, actually tend to eat it as a starter rather than a main course. And while the Chinese do eat rice, again, they eat a lot of other foods too including vegetables, fish and meat. I can’t find any good data on the overall GI/GL of the diets of these or other nations. If we had some, maybe we’d see that the stereotypical view we have of their diets is far from accurate.
But even if these nations do eat a stack of starch and at the same time enjoy good health and longevity, what would this tell us? The fact is health and longevity are the products of many, many different factors. Some negative influences may be ‘offset’ by more positive ones. So, for instance, perhaps rice does make up a fair proportion of the Chinese diet, but maybe the Chinese are generally an active bunch, and this may be helping to protect against any damage that rice might reek in the body.
When examining the effects food (or anything else) has on health, it’s important to isolate the factor you want to assess and, as much as possible, keep everything else the same. one way of doing this is to look within a population, and see what relationship there is, in this case, between the GI/GL of the diet and health. When such studies are done, there is quite compelling evidence which demonstrates that we eat a high GI/GL diet at our peril. The post of 28th November alone highlights two studies which support this concept.
Turning our attention back to the Japanese for a moment, does the evidence show that rice is as benign a food as some would have us believe? Well, rather predictably, the answer is no. Earlier this year saw the publication of a study in the European Journal of Clinical Nutrition which looked at the relationship between GI and GL and body mass index (BMI) in Japanese women aged 18-20 [1]. The study found that higher GI and GL diets were associated with higher BMI. The differences in BMI were small (but statistically significant), but then again, young Japanese ladies do tend to be on the slim side. Further evidence for the not-so-benign nature of starch in the Japanese diets comes from a study which found the consumption of a high GI diet to be associated with adverse effects on risk markers for cardiovascular disease such as blood fat and insulin levels [2].
Pointing to the Japanese diet as proof of one’s ideological standpoint is not scientific, and is essentially not much more scientifically rigorous than claiming that because your grandpa Joe smoked and lived to be 100, smoking cannot be harmful to health. Come to think of it, Japanese men smoke a lot, but it hasn’t stopped them having one of the best life expectancies in the World…
References:
1. Murakami K, et al. Dietary fiber intake, dietary glycemic index and load, and body mass index: a cross-sectional study of 3931 Japanese women aged 18-20 years.
Eur J Clin Nutr. 2007;61(8):986-95
2. Amano Y, et al. Correlation between dietary glycemic index and cardiovascular disease risk factors among Japanese women. Eur J Clin Nutr. 2004;58(11):1472-8.
I think you’ve touched upon the right area. Rice is a carrier food, and since it’s often combined with fresh, natural items, the fact you’re taking the fresh, natural items can probably negate any of the potential flaws of rice.
If rice/bread wasn’t consumed, maybe nothing nutritious else would be. It appears to be about maintaining a generally balanced diet and lifestyle in the end.
Hi there dr. Briffa. This is what Mary Enig, PhD, and Sally Fallon have to say about the japanese diet:
“In Okinawa, where the average life span for women is 84 years-longer than in Japan-the inhabitants eat generous amounts of pork and seafood and do all their cooking in lard.22 None of these studies is mentioned by those urging restriction of saturated fats.
The relative good health of the Japanese, who have the longest life span of any nation in the world, is generally attributed to a lowfat diet. Although the Japanese eat few dairy fats, the notion that their diet is low in fat is a myth; rather, it contains moderate amounts of animal fats from eggs, pork, chicken, beef, seafood and organ meats. With their fondness for shellfish and fish broth, eaten on a daily basis, the Japanese probably consume more cholesterol than most Americans.
What they do not consume is a lot of vegetable oil, white flour or processed food (although they do eat white rice.) The life span of the Japanese has increased since World War II with an increase in animal fat and protein in the diet.23 Those who point to Japanese statistics to promote the lowfat diet fail to mention that the Swiss live almost as long on one of the fattiest diets in the world. Tied for third in the longevity stakes are Austria and Greece-both with high-fat diets.24”
I believe the full artcile can be found on http://www.westonaprice.org/ (i didn’t take it from there)
Also, I suspect that young Japanese may not have the longevity that their grandparents and great-grandparents have. Increasingly, young Japanese eat Western fast food, and more refined, manufactured products.
The currently alive older generations lived through periods of nutritional deprivation during WWII, plus many were not urban-born, but spent significant amounts of their youth in the rural regions, eating local, seasonal unprocesessed foods. There is an asociation of some caloric restriction with longevity, as well. This is hardly scientific, either, but when I visited Tokyo and Yokahama in 1999, I was struck by the high number of very stooped, very elderly people in Japan, with pronounced dowager’s humps, etc. Not a scientific study, I know, but I couldn’t help but wonder if the dietary deprivation of their younger years during WWI wasn’t causitive of this condition of microfractures in the spine. Young Japanese now are far taller than previous generations (Westerners have the general impression that Asians are small). But increased calories due to higher standards of living in recent generations have probably increased the average height of Asians and Japanese in particular more than anything else. I also noticed a lot of missing teeth in the elderly Japanese, which is again, a symptom of nutritional inadequacies at critical times. And Japan is also experiencing a steep rise in childhood obesity, though it is not as pronounced as in the US and Europe yet.
Additionally, Asian countries tend to have far more reverence for their elderly citizens than Western countries. Aging parents often live with theier adult children, which ensures that they are eating properly as well as supported emotionally. This contrasts greatly with some Western countries, where the elderly live on their own more often and nutrition declines as their cooking interest/abilities decline.
I think your point that there are many complex dietary, lifestyles, cultural, and economic factors contributing to overall health and longevity in Asian countries in contrast to the West, is a very good one. We shouldn’t be overly influenced by only one factor.
Dr B ” Firstly, I am honoured to have a full article dedicated to my comment.
I think your article is excellent and clearly points out that it doesn’t seem to matter a jot what you consume (rice, fags etc) as long as you stay active and get the correct balance of fresh food (I also bet they don’t consume a huge excess of calories which I believe is the true reason for why people get fat).
Let’s promote the message!
James, your musings here are as subjective and hopelessly unscientific as the ones that triggered this post. Not dissimilar, actually, from the comments that can come from those that uphold nutritional ideologies that defy both science and common sense.
Dear Dr Briffa,
I’m very confused. I thought that pasta, even white pasta, was one of the lowest-GI foods available, and have been eating it religiously for this reason. Have I been completely wrong to do so? Please let me know.
Many thanks,
Ariane
John – I hope you take my comments as just that, musings. Discribing my comments as hopelessly unscientific is somewhat stating the obvious. I have no time to do any research on this point (nor do I care to). You talk about common sense but discount the fact that a lot of your ideas are against the advice of the WHO/FSA/Dietitians. Surely common sense would suggest that you are wrong and they are right?
Anyway, glad to see you’re off the Dietitian/FSA bashing!
Hi John.
a quick question. from what i know about high sugar foods are that they are bad full stop. But we all need sugar so i thought slow sugars such a grains and vegetables are ok and eating them with protein slows them down even more. From what i understand about Japanese eating is that it’s not eating slow sugars that cause diabetes, but rather fat. They say that too much fat thickens the blood and slows the rate of sulin getting into and around the blood. This cause the body to panic and produce more and you end up then this low blood sugar after a short high. Plus hard fats tend to stay around the center of the body and clog up the pancreas and effect it’s function. They say this makes the pancreas over work and gives up eventually. I read that tests have show that often people with type 2 diabetes often have more insulin in there blood than most normal people (insulin resistance) and it the fats that stops it working. Because the fats has clogged the blood. From what i understand a low GL diet helps, but because of the high fat the minute you have sugar again your body can’t cope with it. Also they say your body is always storing fat so to much causes a fatty liver which makes things worse. The Japanese idea i think is that if you eat little amounts of fat, your blood is clean and moves faster and then insulin and your pancreas works better. Also they say your body can produce it own cholesterol when needed.
i do understand thought that we all have a different metabolic type so some people burn fat faster and better, so of course this could change things again slightly.
note – I’m not disagreeing with what you have written but i just thought i would ask you about what i have read.
what do you think.
i’m not a doctor, this is just what i have read.
many many thanks, keep up the good work
frank
James
“I have no time to do any research on this point (nor do I care to).”
“You talk about common sense but discount the fact that a lot of your ideas are against the advice of the WHO/FSA/Dietitians.
Surely common sense would suggest that you are wrong and they are right?”
It is your seeming disinterest in the evidence that means you are in really no position to judge ‘right’ from ‘wrong’. This site partly exists to reveal nutritional fallacies, wherever they come from. If you would rather be ‘spoon-fed’ your nutritional information and swallow it without thinking, you may be better off elsewhere…
If you want to engage on intelligently (be warned, this might require you to take an interest in science), please do so.
Ariane
The GI of pasta ranges considerably – and generally is in the 35-60 range. While opinion on where the bands for ‘fast’, ‘medium’ and ‘slow’ sugar release should be varies, most individuals would view pasta as a moderate-GI food. It’s also worth bearing in mind that the more you eat of it, the higher its glycaemic ‘load’. If you were keen to reduce the GI/GL of your diet, you might want to look to foods that are naturally low in carb (e.g. meat, fish, vegetables other than the potato).
Hi John,
Thanks a lot for explaining – and apologies for my impatience!
I very much enjoy your posts and read them regularly.
Ariane
Hi Frank
If by ‘we all need sugar’ you mean we all need to get sugar from our diet, then I’m going to have to disagree. The body can make sugar (glucose) from other things (e.g. amino acids from protein). So, actually, technically speaking, the need for sugar/starch/carb in the diet is none.
On the Japanese question, there is no doubt in my mind that it is possible to overeat anything, including fat. However, let’s not lose sight of the fact that the more insulin we secrete, the more likely we are to develop insulin resistance and perhaps type 2 diabetes. Recent studies linking high GI/GL diets and increased risk of diabetes support this view. And for those who already have developed these issues, it does stand to reason that the less carb one eats, the lower blood sugar levels will tend to be (and the less likely it is that medication will be required).
I agree with you entirely on your point about metabolic types, and this is thoroughly dealt with in my book The True You Diet.
Thanks
John
Hi Dr Briffa
I found this article very interesting. I visited Tokyo earlier this year and what struck me most about the Japanese was their attitude (to life rather than food).
It seems to be a very non-judgemental culture, very much “live and let live”. People seem very calm, respectful and indeed “Zen”!
Similarly, with the “Manana” attitude in the Mediterraean.
A friend and I once observed 2 Spainish buisnessman lunching. They were waiting for their bill after asking for it twice, but the waiter kept walking past them. They laughed every time and were very relaxed. We quipped “No one will die of a heart attack in this country!” imagining the same senario in this country.
I really do think that our stressful impatient “now” culture is adding to the acceralation of ill health and our inability to resist diseases, that other cultures seem to handle…..
Still trying to fight my carb addiction
Mrs J
James. Dieticians ideas are 25 years out of date and nutritionists do not agree with them. THe sort of diet they recommend can cause diabetes. What we are ‘meant’ to eat is what we would eat if there were no processing, no shops, less cultivation. THis is frsh meat, fish, fruit, nuts, veg. The more processed the food the worse it is. Weight gain is complicated and can be caused by all sorts of things apart from calories, such as low thyroid, food intolerance, candida which affets the thyroid, toxicity and on and on.
Hi Dr B,
Would welcome your thoughts on the impending “year of the potato” (www.potato2008.org). According to newspaper reports, not especially relable I realise, the potato is being consummed, more and more, in the developing world, instead of rice! The year of the spud will presumably push this!
“This site partly exists to reveal nutritional fallacies, wherever they come from”
No John – this site exists wholly to flog your books. Just as a matter of interest what does “the UK’s top nutrition doctor” actually mean? And exactly how many hours nutrition education do doctors get?
“Weight gain is complicated and can be caused by all sorts of things apart from calories, such as low thyroid, food intolerance, candida which affets the thyroid, toxicity and on and on.”
Blooming Hell Hilda – where did you get that pile of whack job psuedoscientific bollocks from?
That ought to get me censored faster than an ant at an aardvark convention. Or possibly a dietitian making a strong rational argument against you.
See censored.
Dr. B.
Having been diagnosed with high blood pressure 4 years ago (and “pre-diabetic”), I decided to move to a country, where such diseases are virtually unknown. I have lived in Cambodia now, for nearly three years. Since then, my blood preesure is now back to normal. Less than 3% of the local populace suffer from blood pressure (a contributory factor in many cases of diabetes). But, 100% live on a staple diet of rice. With Monty Python, it was spam, spam, spam, with everything. In Cambodia, its rice wiith everything. Furhtermore, you have to search far and wide, for an obese local.
I’m no epedemiologist, but my observations are as follows:-
1). Cambodians in general, abide by natures clock. Most, are in bed by ten at night, and up around six in the morning.
2). They receive a healthy dose of sunlight everyday of their lives.
3). In my humble opinion, its what you eat with the rice makes the big difference. As with Japan, fish is eaten almost on a daily basis. Mainly, fresh water fish, such as catfish. A normal Cambodian breakfast consists of rice “porridge”, with fish, fresh green vegetables, and fruit.
Eating is a major daily social occasion for Cambodians. As dusk falls, you can see the local markets and food stalls begin to fill up. People sit outside, with various family members and friends, enjoying a host of dishes, which are shared. Again its rice, fish, a little pork or beef, and loads of more fresh fruit. Additionally, its interesting to note how much energy Cambodians expend during their nocturnal binges, that can go on for two hours or more.
Lastly, exercise. You wont find many Cambodians at the gym. Their natural lifestyle means they are far more physically active than your average westerner. Here, I would seriously argue, that the greatest health hazard we know today, is not surplus rice, or fats, but the soporific effect of the TV screne. A drug as dangerous to our health, as any opiate abuse.
Tony Valenti.
Hilda – are you for real? You think people that have been trained in giving nutitional advice are effectively killing people? I think you need a reality check. I also expect that “THis is frsh meat, fish, fruit, nuts, veg” is part of what Dietitian’s recommend. What diet would you recommend to an alcoholic/drug user? Someone who is dying? Someone who currently eats 50 mars bars a day comfort eating? These are the people Dietitians will see every day in the NHS. It’s not all fat camp etc and they have to give advice that is achievable!
Dr B – my interest in science is wide and varied – hope you find this response more in line with what you expect. Also, whether you support Dietitians or not, please put Hilda right on what she is saying, you know what she’s saying is wrong!
Shane Western
If you have an issue with something I have written, can I encourage you to take a reasoned, logical, intelligent – dare I say it, scientific – approach? And can I ask you to moderate your language please?
Also, your posts have come from the same IP address as another poster ‘Eva’. I don’t have an issue with individuals wanting to protect their identity, but I do have a problem with (as it appears here) someone posting under more than one alias. Can you clarify if this is the case here?
James
You seem to know a lot about dietetic practice, and recently attempted to vindicate the quite commonplace dietetic practice of recommending the consumption of relatively high GI foods. I suspect that this is what Hilda was referring to when she suggests standard dietetic advice may speed one’s path to diabetes. Recent evidence has shown that high GI/GL diets are linked with an increased risk of diabetes. So, if my assumptions about what she was referring to are correct, then her opinion seems reasonable to me.
The questions you ask about what Hilda would recommend to a alcoholic, drug user, etc are irrelevant to the matter at hand, I think.
And as for science, once again your answer is completely bereft of it. You claim that your interest in science is ‘wide and varied’. What a shame you never see fit to use any of it in your comments.
Sainsbury are selling a new type of specially developed potato that has a lower GI. It’s called the Vivaldi (for some reason). It has over a third less carbohydrate than usual.
It also has less than half the calories of other spuds. Not sure that’s such a good idea if you want it to fill you up.
Allied Laboratory Services tests suggest that on average it has 26% less carbohydrate and 33% fewer calories.
New potatoes have a lower GI too. I’m not sure if that includes the tinned kind.
It’s such a shame the way that people like to bash dietitians even though I would question how many people truly know what dietitians are trained to do. Like Western said, it’s not all about fat camp! What about the role dietitians play in the clinical setting? I would question how many nutritionists would have a clue how to feed a severely ill patient with renal failure, for exmaple. That is not meant to be a criticism of nutritionists, more pointing out that we need to recognise and respect the different roles and functions of different professionals?
I am both a nutritionist and a dietitian an I certainly do not disagree with myself hilda :p
It is stated that the Okinawan’s are the longest living race, they have the lowest rate of heart disease, strokes and cancer in the world, so it is evident that there is something we can learn about their art of healthy living. I have always wanted to be a nutritionist but due to personal decision’s in my life I was restricted in doing so. I have always researched and studied health and nutrition and it does not take a scientist to figure out what the healthy option is. Look around you and let the living evidence be the answer to our questions, about low carb, low Gi, low fat and all the other fabulous diets that are floating around that claim to be the best for us. If the okinawans are the longest living race but then argued by some that due to their low calcium consumption have other health issues, and the mediteranian diet also shows evidence of low rate of heart disease. Compare our lifestyles to theirs,its not just the Okinawan diet alone that has allowed 400 Okanawan’s reach age 100, a rate 3-6 times higher than the west its also their practice of martial arts exercises, a positive spiritual attitude, meditation which contributes to a low stress way of living, exercise is a way of life for the Okinawan’s it is connected to their spiritual beliefs which combine a reverence for nature with celebration of elders and ancestors and a “help your neighbour” ethic in the community as a strategy for life, its the best I have ever heard of and it evidently works. Its simple basics Okinawan’s rule which is done quite naturally is eat untill your 80% full as your stomach will adjust to the smaller meal, 3/4 of the plate shoul be vegies and the last 1/4 for animal product usually fish or soy.Then you have the Mediterranean diet, there is no single “Mediterranean” diet as there are approx 16 countries in the Mediterranean basin,The diet’s from this region are similar but focusing on Greece and southern Italy and relying on researched I have found found also low incidence of chronic disease. My conclusion is a combination of these two nations, who seem to be eating and doing the right thing and that is consuming meals modestly, consuming mostly vegies, fruits, proteins fish (rich in omega 3 fatty acids) ,grains,soy products (rich in healthfull compounds) called flavnoids) combined with the mediterranean which also consume vegies, fruits,nuts,legumes,olive oil,and grain based foods. Benefiting also by their consumption of fish several times a week,and lots of tomatoes, they have many beneficial and nutritional values which are known to detoxify the organisms and prevents the many appearances of many illnesses, LYCOPENE, this super component is increased when tomatoes are cooked, stick by these rules and your a winner for liife.
Jeremy,
Why is someone severely ill with renal failure? Could it be that the original diet advice received for say diabetes was somehow contributing?
“kidney disease is an inevitable result of the chronically uncontrolled blood glucose and chronic high insulin levels found with Type-2 diabetes. The most common cause of renal failure occurs in diabetics.”
“There is little doubt that a ‘healthy’ high-carb diet and subsequent high blood insulin can contribute to diabetic patients’ deteriorating kidney function; and that insulin treatment in type-2 diabetes patients may cause further injury to the kidney. A low-carb, high-fat diet, with a moderate protein intake may actually prevent renal failure in type-2 diabetics.”
http://www.second-opinions.co.uk/kidney.html
If you do a search on ‘Okinawa’ and ‘Pork’ on Google, you will find that the Japanese call Okinawa the ‘Island of Pork’ because they eat so much of it, and all the animal. The Sardinians of Ovodda also are very long lived and they also eat a lot of pork products (as all Italians do, I live in Italy, I know). It seems nutritionists haven’t ‘noticed’ that 2 of the most long-lived races in the world are heavy pork eaters.
maybe the japenese and others use alot of meat and fat in their rice dishes which lowers the gi. I went to a japenses resturant a few times once some of the workers there definitly asian were eating rice and chicken with some kind of sauce, it looked good. they were thin. fat lowers the gi by slowing the digestive process down and protein slows it even more.
personally I don’t do well on rice even brown rice so I just stopped eating it or eat it sparingly. even with meat and fat introduced to it. so I guess it depends on your overall health status and genetics too.
rose