Could we get a definition of what a proper wholegrain product is? Are we talking food that literally has a WHOLE GRAIN visible in it?

And could you also explain where fruit falls into this picture of diabetes and sugar vs starch?

Thank you! Absolutely love reading your blog

What frustrates me as a doctor is people trying to find a ‘quick fix’ for their diet and vilify either carbohydrates or fats. As we health professionals know, low quality carbs (I.e refined rices/pastas/sugars) and low quality fats (trans/sats) are worse than their counterparts and there is benefit it ‘switching’ those aspects.

Portion control is probably a major contributor. People seem to have warped concepts of what ‘one serve’ of carbohydrate is. Actually surprisingly small and often patients are shocked when I describe ‘servings sizes’

However we seem to not be able to escape marketing. The florid marketing of fish oils in tablet form once omega 3/6′s were being studied is a prime example even though since then taking fish oil supplements has not shown to change CVD risk.
Subsequently I am now seeing many more whole grain products on our shelves (welcomed).

Something which is mostly ignored in he recent catalyst/fat vs sugar debates is the role of whole vegetables and fruits.
The australian dietary guidelines (which also advocate true whole grains) suggest 5 serves of vegetables and 2 serves of fruit a day. The current Australian population eats 2-3 serves of vegetables a day.

More and more we see ‘vitamins/mineral supplements’ when data suggests that these on their own can be harmful – that it is the whole composition of a food that seems to be more important.

Try to increase the quantity and quality and range of vegetables in the diet and subsequently the proportion of food that comes from carbs/fats is diminished.

We haven’t taught our population to cook and we haven’t taught our population to be active enough. We are bringing up our children in an environment of instant gratification which includes quick fixes for diet/food.

Healthy eating and a healthy lifestyle takes effort. The first intervention for ANYONE presenting to me with a risk factor for heart disease is diet and exercise. People only here what they want to here. People prefer a quick fix pill than to change their diet and lifestyle.

Link to pictorial of Aus diet guidelines: https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/N55_A4_DG_AGTHE_HiRes.pdf

In regard to carbohydrate I think Jim Mann’s conclusions are the take home message.
Professor Mann came to the following conclusions:
• A wide range of carbohydrate intakes is still acceptable, between 40-60% energy
• Legumes, pulses, fruits and ‘genuine’ wholegrains were optimal choices among carbohydrate-rich foods
• Dietary fibre was a good indicator of a healthy choice
• Rapidly digested starchy vegetables (such as potato), white rice and many breads should be limited, even some breads labelled wholegrain.

It is not just about % energy from CHO but the types of CHO foods chosen. Those less processed, more intact CHO foods are better and education on how to eat them in the right amount in a mixed meal can further lower GI with good clinical outcomes beyond weight. Their intervention study LOADD (Lifestyle Over and Above Drugs in Diabetes) support the acceptable range for CHO intake and this should be individualized for each person. Unfortunately the carbohydrate information given sometimes is only the GI information, without understanding how to apply this information. Very often people think it is a allowed/not allowed list of foods and those with a low GI can be eaten ad libitum. That is why good dietary advice is important.

If someone’s regular breakfast is jam on toast, they’re getting 3 tablespoons worth of sugar and 4 peices of white bread and a tablespoon of butter.
With advice of “eat wholegrain bread and avoid sugar”, you might convince them to have wholegrain toast with bananas (or nutella for some reason people think its healthy?) or a bowl of oats or something instead. Sub-optimal results, but you’re actually getting a step in the ‘right direction’?

The same way that I have found “no carbs after 6pm” gets a positive result for weightloss, despite limited/no sound scientific basis, because people will just drop the habit of pastries or ice cream during TV time.