Saturday, November 18, 2006

Please Eat White Bread

Even Wonder Bread knows whole grains are healthier. They of course still have their original recipe, but now you can also choose 100% whole grain wonder bread and something they call whole grain white.

The evidence on the benefits of whole grains are as impressive as the evidence on the risks of refined grains.

Using the Nurses Health Study and the Health Professionals Follow-up Study, perhaps the two most important epidemiological studies in history, Dr. Walter Willett and his colleagues have shown that diets higher in whole grains reduce the risk of both diabetes and heart disease by 30% while also reducing the risk of stroke by 20%.

A more recent study revealed that diets highest in whole grains carried with them HALF the risk of developing metabolic syndrome (a constellation of high blood pressure, insulin resistance and high cholesterol).

Conversely, in those same studies, diets highest in white bread, white rice, french fries and cooked potatoes were all associated with increased risk of diabetes and in the study looking at metabolic syndrome, diets highest in refined carbohydrates carried with them DOUBLE the risk of its development.

Why then does Health Canada want us to eat so much of the white stuff?

The exact wording on the draft Guide states, "Make half your choices whole grain each day" which of course directly implies that the other half be refined.

Dr. Walter Willett, in viewing the April 2006 draft Canada's Food Guide had this to say,

"refined grains have little nutritional value and thus provide empty calories, reduce HDL cholesterol, raise triglycerides, are thus not surprisingly related to higher risks of type 2 diabetes and coronary heart disease. Refined grains should be on the list of foods to minimize, along with saturated fat."
So again you might wonder, why exactly is Health Canada pushing the refined grains?

Amazingly when trying to explain themselves to a reporter from the Citizen, Health Canada officials claimed that the reason they recommend half our grains come from refined carbohydrates was due to refined flour's mandatory fortification with folic acid and its affect on the incidence of neural tube defects.

I spoke with Dr. Godfrey Oakley about this, he's one of the world's experts on folic acid fortification. There's no doubt that folic acid fortification of refined grains is one of the greatest public health triumphs of our time as mandatory fortification has silently reduced the risk of neural tube defects like spina bifida in our children.

In recounting the history of folic acid fortification Dr. Oakley noted that Health Canada was very much opposed to fortification when it became mandatory in the United States in 1996 but due to pressure from the grain industry (who were already fortifying their products in the much larger market share of the United States) acquiesced and in 1998 made fortification mandatory in Canada as well.

Despite this irony (certainly Health Canada is entitled to learn from their own mistakes), the argument is hollow and it really highlights the shortsightedness of worrying more about nutrients than about foods.

While there's no doubt that reducing the incidence of neural tube defects is an important public health concern, I certainly wouldn't want to make the argument that it was more important than minimizing diabetes and heart disease.

To put some numbers to this, since the introduction of mandatory folic acid fortification in refined flours, the incidence of open neural tube defects in Ontario has dropped from 1.13 per 1,000 pregnancies to 0.58 per 1,000 pregnancies.

On the other hand, according to Health Canada, roughly 1 in 16 Canadians currently have diabetes, a number expected by the World Health Organization to reach 1 in 9 by the year 2025. Health Canada estimates diabetes currently costs Canadians close to $9 billion dollars a year.

Heart disease according to Health Canada is,
"the number one killer in Canada. It is also the most costly disease in Canada, putting the greatest burden on our national health care system."
1 in 2 Canadians die due to heart disease.

So what do you think are more important public health targets? Diabetes and heart disease or open neural tube defects?

Does it make sense to you to recommend the consumption of refined carbohydrates to minimize the risk of open neural tube defects at the expense of increasing the rates of heart disease and diabetes? Would it not make sense to recommend diets higher in whole grains to decrease the risk of diabetes and heart disease and perhaps at the same time recommend a pennies-a-day multivitamin?

Frankly, we shouldn't have to choose! There should be nothing stopping Health Canada from mounting a vocal and tireless campaign to fortify our whole grains with folic acid, allowing them then to recommend we minimize our consumption of diabetes and heart disease inducing refined flours and still consume enough folic acid to decrease our risk of open neural tube defects.

The fact that Health Canada is not doing so again begs the question how much politics and the food industry influence their decisions.

Tomorrow: All Fat is Bad - Fat phobia still runs rampant at Health Canada.

Last Friday: Consultation? What Consultation - I suppose if by consultation you mean what fonts you like, then yes, there was an extensive consultative process