Your Body, Your Health

Whole Grain Foods and Diabetes

Bridging The Whole Grain Consumption Gap: Facts and Fallacies
By: Lori Fromm, M.S., R.D. and Jean Storlie, M.S., R.D.

For many dietitians, whole grains are old news. We have known that whole grains provide fiber and promote digestive health for almost 30 years. Why is there renewed interest in whole grain foods? During the last decade new research has linked consumption of whole grains to reduced risk of chronic disease, specifically heart disease and some types of cancer and diabetes. As a result, the importance of eating more whole grains is being emphasized in several major nutrition guidelines and policies. The 2000 Dietary Guidelines split grains into a separate guideline, placing an emphasis on whole grains with their statement "choose more grains, especially whole grains." And finally, the Healthy People 2010 objectives include a target of three servings of whole grains daily.

It is fairly obvious that whole grain foods have important health benefits, yet on average, Americans consume less than one serving of whole grains each day. Why the gap? Most consumers do not understand what "whole grain" really means and they are confused about how to spot foods made from whole grains. Dietitians can clear up the confusion and misinformation surrounding whole grains and provide practical information to urge their clients to eat more whole grain food.

Emerging Evidence
Research in recent years has uncovered some significant health implications related to consumption of whole grain foods. The health benefits of whole grains come from the "whole grain package" and not just individual components. The fiber, vitamins, minerals and hundreds of phytochemicals found in whole grains appear to work together in powerful ways to protect against chronic diseases like cardiovascular disease, certain cancers and diabetes. Although the exact mechanisms are unknown, scientific evidence suggests that regular consumption of whole grains is linked to a reduced risk of certain diseases. When it comes to whole grains, the "whole" is truly greater that the sum of its parts.

What Is A Whole Grain Food?
Whole grain foods are those made from the entire grain kernel-bran, germ and endosperm. For instance, whole wheat flour, some breakfast cereals, brown rice and oatmeal are considered whole grain foods.

How Can You Tell If A Food Is Made From Whole Grains?
Look for the words "whole " or "whole grain" before the grain’s name in the ingredient list. This tells you that the food is made from the entire grain. The whole grain should be the first ingredient listed. Look for whole grain health statements such as, "Diets rich in whole grain foods and other plant foods that are low in total fat, saturated fat and cholesterol may help reduce risk of heart disease and certain cancers."

Can Processed Foods Be Whole Grain?
Yes. Processed foods like cereals and crackers are a convenient source of whole grains. Processing a whole grain ingredient does not destroy the whole grain. If all the parts of the grain are used in processing, the food can still be considered whole grain.

What Is The Difference Between Whole Grain And Fiber?
Whole grains and fiber go hand-in-hand. A whole grain is literally the whole kernel of grain, which includes the bran, germ and endosperm. Fiber-which helps to promote regularity-is found in the bran and germ portions of the grain kernel. These parts of the grain are usually removed when grains are milled to produce regular white flour.

Are All Whole Grain Foods Good Sources Of Fiber?
Labeling regulations allow a food to be called a "good source of fiber" if the food contains 10 to 19 percent of fiber or more per serving. The amount of naturally occurring fiber varies according to the whole grain source. For example, wheat naturally contains more fiber than rice. In addition, other factors affect the fiber content of whole grain foods, including:

- The amount of bran - Whole grain foods contain the endosperm and germ as well as the fiber-rich bran. Bran cereals, for example, contain mostly the bran portion, so the fiber content is usually higher as compared to whole grain cereals.

- The product’s density - Generally, denser whole grain products contain more fiber. Dense cereals-such as granola-contain more fiber in the same volume as a puffed or flake cereal, even if these less dense cereals are made from whole grains.

- The product’s moisture content - Food products with higher moisture content will inherently have less fiber per serving. For example, breads have higher moisture content and thus less fiber per serving compared to crackers and cereals.

Whole Grain Myths And Misinformation

Promoting increased whole grain intake also involves combating myths and misinformation. The practical tips and messages that follow help to break down the carriers of confusion created by common myths and misinformation. Even though some foods are processed, such as crackers and ready-to-eat cereals, they are still excellent sources of whole grains.

Most grain foods, including whole grains, are naturally low in fat and cholesterol. It is the spreads, toppings and sauces that can add significant fat and calories.

Contrary to some beliefs, whole grains are not dry or gritty. Whole grain foods have a pleasant "nutty" flavor and in some cases-such as breads-may be denser. Help consumers learn to appreciate these aspects of whole grains either alone or with low fat additions.

Adding whole grain foods to the diet does not have to be complex and consumers can reap enormous rewards from a simple change. With practical tips and explanations, dieticians can educate consumers on whole grain and help to decrease the whole grain gap.

What is Diabetes?
Diabetes, in its simplest sense, means that your blood sugar is too high, also known as hyperglycemia. Your blood always has some sugar in it to use as energy, however, if it gets too high it can be damaging. High blood sugar happens when the body has too little insulin, which regulates blood sugar, or when the body can't use insulin properly. Untreated diabetes could potentially lead to blindness, leg amputations, heart attacks, kidney disease and/or strokes.

Diabetes is among the top ten killers of adults and the leading cause of blindness in the United States. There are two major forms of diabetes mellitus and both are characterized by high blood glucose and either insufficient or ineffective insulin.

Insulin enhances the cells uptake of food in the form of amino acids, glucose, and fatty acids after a meal. Insulin helps to maintain blood glucose within a normal range and stimulates protein synthesis, fat synthesis and glycogen synthesis (storage form of glucose) in the liver and muscle.

The less common type of diabetes is type I diabetes, also known as insulin-dependent diabetes mellitus (IDDM). It accounts for 20% of all cases. In this type of diabetes, the pancreas loses its ability to synthesize the hormone insulin. Without insulin, when a person with IDDM eats carbohydrate and absorbs the glucose from it, the glucose remains in the blood, even though the body’s cells are starving for glucose. The person must inject insulin to assist the cells in taking up the needed glucose from the blood.

Type II diabetes, or adult-onset diabetes accounts for 80% of all cases and is characterized by insulin resistance. What this means is that insulin is present in the blood, often in normal or high amounts but it is not able to move glucose into the cells effectively. As a result, the blood glucose rises to high. Insulin resistance is usually a result of obesity. When you become overweight and your fat cells enlarge, those cells become sluggish in response to insulin. The larger the fat cells become, the more insulin resistant they become and the more obese the person. People with this type of diabetes often continue to overeat due to their cells’ resistance to insulin—i.e. the individual feels starved because insulin is unable to move glucose into the cells so feels compelled to eat more and more. Blood glucose remains in the blood and rises higher and higher. The excess glucose stimulates the body to produce more and more insulin—much more than is needed under normal circumstances. When your fat cells finally respond, a veritable tidal wave of glucose floods into your fat cells enlarging them further.

If diabetes is not controlled, its effects can be severe and include impaired circulation leading to diseases of the feet and legs, often necessitating amputation; kidney disease, sometimes requiring hospital care or a kidney transplant; impaired vision or blindness; nerve damage; skin damage; stokes and heart attacks. The cause of these problems is due to fatty blockage or destruction of capillaries that the feed the body organs. As a result, tissues die from lack of nourishment.

There are warning signs for diabetes. These include excessive urination and thirst, glucose in the urine and abnormally high glucose tolerance test results. Other symptoms include cravings for food, especially sweets, frequent infections of the skin, gums, vagina or urinary tract and vision disturbances. Additional signs of diabetes are pain in the legs, feet or fingers, itching, drowsiness, and weight loss with nausea.

Am I At Risk?
Evaluate yourself for diabetes using some of the warning factors below: please consult your doctor if you have any questions.

• Family history of diabetes
• Over 45 years of age
• History of Gestational Diabetes or delivery of a baby over 9 pounds
• Race/Ethnicity of African American, Hispanic American, Native American, Asian American or Pacific Islanders Descent
• Consistently High Blood Pressure
• Inactivity, not exercising enough
• High Cholesterol
• Obesity
• Smoking

Am I Experiencing Any Symptoms?
You may experience some of these symptoms with high blood sugars. Some people have high blood sugars and may not feel any or feel different symptoms. It is always best to consult your personal physician.

• frequent urination
  
• extreme fatigue
  
• great thirst
  
• extreme hunger
  
• dry itchy skin
  
• achy crampy legs
  
• blurred vision
  
• numbness / tingling in hands / feet
  
• cuts / slow healing bruises
  
• frequent and/or recurring bladder / skin / gum infections
  
• sexual difficulties
  
• dramatic weight loss
  
• irritability

The information provided herein should not be used for diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions.