Podcast Episode 120: Refined Grains & Diabetes – Guilt by Association? – Dr. Glenn Gaesser

May 15, 2019

Assessing the health impact of the way we eat is exceedingly difficult and I think we need to be careful about recommendations that are based on science that is not all that solid.”

Misguided Guidance? Do refined grains cause or increase your risk for diabetes?

Based on 11 meta-analyses, including 32 publications with data from 24 distinct cohorts, refined grain consumption is not associated with type 2 diabetes, cardiovascular disease, coronary heart disease, stroke, hypertension, cancer or death.

While refined grains are frequently characterized as unhealthy, this can be attributed to their inclusion in a dietary pattern that contains foods that are the real culprits in the link between an unhealthy dietary pattern and increased risk of a number of chronic diseases. Given this, we might consider differentiating between what could be called “indulgent grains,” which are usually fried and/or covered in sugar, and refined grains, which have been enriched and/or fortified to help alleviate shortfalls of vital nutrients including B-vitamins, folic acid, thiamin, niacin, riboflavin, and the mineral iron.

To avoid nutrient shortfalls, you can and should have your refined grains and eat them too. The most scientifically sound recommendation may be to just encourage increased consumption of whole grains, which should account for half of your grains, without specific recommendations to reduce refined grain intake.

Refined grain intake is not associated with increased risk of type 2 diabetes.”

Glenn Gaesser, PhD

Dr. Glenn GaesserGlenn Gaesser is a professor in the College of Health Solutions at Arizona State University and has had prior academic appointments at the University of Virginia and UCLA.  A Fellow of the American College of Sports Medicine, Dr. Gaesser’s research focuses on the effects of exercise and diet on cardiovascular fitness and health and his work has been published in scientific journals, trade publications, newsletters and Internet sites. As a member of the Scientific Advisory Board of the Grain Foods Foundation (GFF), Dr. Gaesser helps oversee the scientific accuracy of GFF’s research and nutrition education programming on the role of grains in a well-balanced eating pattern. He is the author of the study recently published in Advances in Nutrition, “Perspective: Refined Grains and Health: Genuine Risk, or Guilt by Association?

“Even when you include indulgent grain foods it still doesn’t increase your risk of type 2 diabetes.”

“You have this large collection of foods that are defined as refined grains. But I don’t think there’s anyone that would consider the potential health effects of cereal, pasta or slice of bread to be the same as a cookie, doughnut or sweet roll, and yet this is how they are defined. So the lack of any association between refined grain intake and diabetes may actually be distorted somewhat by the inclusion of staple and indulgent grain foods in the same definition. You could ask the question what would happen if you just look at the staple grains but none of the studies did that. So this is actually even better news for refined grains because it shows that even when you include indulgent grain foods it still doesn’t increase your risk of type 2 diabetes.”
– Dr. Glenn Gaesser

Making conclusions about what we should or should not eat based on dietary patterns is overly simplistic….and may actually be deleterious if we cut out all refined grains from our diet.”

The Bottom Line

Consumers can enjoy up to six or seven servings per day of refined grains without increasing risk for coronary heart disease, type 2 diabetes, hypertension or premature death.

Total grain consumption, both refined and whole grains, is associated with lower risk of death and not associated with higher risk of cardiovascular disease, coronary heart disease, stroke or cancer.

Eliminating enriched grain products will result in nutrient shortfalls. Refined grain foods that have been enriched and/or fortified help to alleviate shortfalls including B-vitamins, folic acid, thiamin, niacin, riboflavin, and the mineral iron.

  • Folic acid is essential for women of childbearing age to help prevent neural tube birth defects.
  • Enriched grains are the largest contributor of folic acid in the American diet.
  • Americans cannot afford to cut refined grains from their diets. More than 90 percent of American adults and children fall short of dietary fiber recommendations and 39 percent of dietary fiber comes from refined grains.

If you’re going to make a statement that is based solely on the available evidence I recommend that individuals aim to increase their whole grain consumption with no specific recommendations about changing their refined grain consumption. The average person gets about one serving of whole grains a day so they should double or triple their intake to get 2-3 servings a day. And they may actually be worse off by removing refined grains from their diet. Refined grains are not devoid of nutrients. Grains comprise more than half the fiber we consume and refined grains contribute to 2/3 or ¾ of that fiber intake – in other words we get more fiber from refined grain intake than whole grain intake.”



Advances in Nutrition Study “Perspective: Refined Grains and Health: Genuine Risk, or Guilt by Association?

You Can Have Your Refined Grains and Eat Them Too!
Don’t Refrain, Eat Your Refined Grains

You Can Eat Refined Grains from the Grain Foods Foundation

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Related Episodes:

The (Whole) Truth About Grains – Sound Bites Podcast episode #94 with Dr. Julie Miller Jones


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American Association of Diabetes Educators

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  1. Pattie Bucaccio, MS, RD, LDN on June 17, 2019 at 9:24 am

    Hi Melissa,

    I really enjoyed this episode and it makes perfect sense. It’s so hard to believe that the scientist involved with establishing the Dietary Guidelines haven’t thought to separate the staple grains from refined grains in their recommendations. Of course, when using the DGA to counsel clients the Grains food group only includes the staple grains and consumers are “expected” to know the indulgent grains belong over with the sugars/saturated fat gram suggestions (on the side bar within the MyPlate depiction.)

    • Melissa Dobbins on June 21, 2019 at 4:43 pm

      Thanks Pattie! I look forward to future research that does separate these two different types of grains!

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