Wholegrains: Emerging Concepts, Controversies and Alternatives


Intake of wholegrain foods has been associated in large prospective cohort studies with decreased rates of diseases such as type 2 diabetes, ischaemic heart disease and hypertension. Multiple mechanisms for the protectiveness of wholegrain foods have been reported. Health authorities in western countries recommend wholegrains as one of the major food sources in a healthy diet, otherwise rich in vegetables, legumes and low-fat dairy. However, the existing evidence for the intake of wholegrains is highly subject to confounding. Many of the results seen in the prospective cohort studies have not been borne out in randomised controlled trials or good-quality meta-analyses. The recommended intake of wholegrains suggested in some countries is well above what there is evidence for. Products labelled wholegrain have variable quantities of the intact grain and differ widely in their effect on blood glucose. Excessive quantities may add to glycaemic load, and anti-nutrients in wholegrains may have adverse health consequences. With the rate of diabetes and obesity increasing, some researchers have questioned the role of grains as part of a healthy diet. Palaeolithic diets, those that are more in keeping with our evolutionary legacy, contain no grains or dairy, but are rich in vegetables, meat, fish and eggs, with the inclusion of some tubers. Smaller trials in animals and humans comparing a palaeolithic diet to a grain-based diet show improved metabolic profiles in the former.

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C. Haywood and J. Proietto, "Wholegrains: Emerging Concepts, Controversies and Alternatives," Food and Nutrition Sciences, Vol. 3 No. 8, 2012, pp. 1156-1161. doi: 10.4236/fns.2012.38152.

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The authors declare no conflicts of interest.


[1] American Association of Cereal Chemists, “AACC International Defines Whole Grain,” 2012. http://www.aaccnet.org/definitions/wholegrain.asp
[2] L. Cordain, S. B. Eaton, A. Sebastian, N. Mann, S. Lindeberg, B. A. Watkins, J. H. O’Keefe and J. Brand-Miller, “Origins and Evolution of the Western Diet: Health Implications for the 21st Century,” American Journal of Clinical Nutrition, Vol. 81, No. 2, 2005, pp. 341-354.
[3] L. E. Cleveland, A. J. Moshfegh, A. M. Albertson and J. D. Goldman, “Dietary Intake of Whole Grains,” Journal of the American College of Nutrition, Vol. 19, Suppl. 3, 2000, pp. 331S-338S.
[4] National Health and Medical Research Council Australia, “Dietary Guidelines for Australian Adults,” 2003. www.nhmrc.gov.au
[5] United States Department of Agriculture, “Dietary Guidelines for Americans,” 2012. www.dietaryguidelines.gov
[6] A. H. Mokdad, B. A. Bowman, E. S. Ford, F. Vinicor, J. S. Marks and J. P. Koplan, “The Continuing Epidemics of Obesity and Diabetes in the United States,” JAMA, Vol 286, No. 10, 2001, pp. 1195-1200. doi:10.1001/jama.286.10.1195
[7] K. A. Harris and P. M. Kris-Etherton, “Effects of Whole Grains on Coronary Heart Disease Risk,” Current Atherosclerosis Reports, Vol. 12, No. 5, 2010, pp. 368-376. doi:10.1007/s11883-010-0136-1
[8] I. Flight and P. Clifton, “Cereal Grains and Legumes in the Prevention of Coronary Heart Disease and Stroke: A Review of the Literature,” European Journal of Clinical Nutrition, Vol. 60, No. 10, 2006, pp. 1145-1159. doi:10.1038/sj.ejcn.1602435
[9] P. Koh-Banerjee and E. B. Rimm, “Whole Grain Consumption and Weight Gain: A Review of the Epidemiological Evidence, Potential Mechanisms and Opportunities for Future Research,” Proceedings of the Nutrition Society, Vol. 62, No. 1, 2003, pp. 25-29. doi:10.1079/PNS2002232
[10] D. Kritchevsky, “Epidemiology of Fibre, Resistant Starch and Colorectal Cancer,” European Journal of Cancer Prevention : The Official Journal of the European Cancer Prevention Organisation (ECP), Vol. 4, 1995, pp. 345-352. doi:10.1097/00008469-199510000-00003
[11] J. S. L. de Munter, F. B. Hu, D. Spiegelman, M. Franz and R. M. van Dam, “Whole Grain, Bran, and Germ Intake And Risk of Type 2 Diabetes: A Prospective Cohort Study and Systematic Review,” Plos Medicine, Vol. 4, 2007, pp. 1385-1395. doi:10.1371/journal.pmed.0040261
[12] S. M. Liu, M. J. Stampfer, F. B. Hu, E. Giovannucci, E. Rimm, J. E. Manson, C. H. Hennekens and W. C. Willett, “Whole-Grain Consumption and Risk of Coronary Heart Disease: Results from the Nurses’ Health Study,” American Journal of Clinical Nutrition, Vol. 70, No. 3, 1999, pp. 412-419.
[13] S. M. Liu, J. E. Manson, M. J. Stampfer, K. M. Rexrode, F. B. Hu, E. B. Rimm and W. C. Willett, “Whole Grain Consumption and Risk of Ischemic Stroke in Women—A Prospective Study,” JAMA, Vol. 284, No. 12, 2000, pp. 1534-1540. doi:10.1001/jama.284.12.1534
[14] L. Wang, J. M. Gaziano, S. Liu, J. E. Manson, J. E. Buring and H. D. Sesso, “Whole-and Refined-Grain Intakes and the Risk of Hypertension in Women,” American Journal of Clinical Nutrition, Vol. 86, No. 2, 2007, pp. 472-479.
[15] T. T. Fung, F. B. Hu, M. A. Pereira, S. Liu, M. J. Stampfer, G. A. Colditz and W. C. Willett, “Whole-Grain Intake and the Risk of Type 2 Diabetes: A Prospective Study in Men,” American Journal of Clinical Nutrition, Vol. 76, No. 3, 2002, pp. 535-540.
[16] A. J. Flint, F. B. Hu, R. J. Glynn, M. K. Jensen, M. Franz, L. Sampson and E. B. Rimm, “Whole Grains and Incident Hypertension in Men,” American Journal of Clinical Nutrition, Vol. 90, No. 3, 2009, pp. 493-498. doi:10.3945/ajcn.2009.27460
[17] M. K. Jensen, P. Koh-Banerjee, F. B. Hu, M. Franz, L. Sampson, M. Gronbaek and E. B. Rimm, “Intakes of Whole Grains, Bran, and Germ and the Risk of Coronary Heart Disease in Men,” American Journal of Clinical Nutrition, Vol. 80, No. 6, 2004, pp. 1492-1499.
[18] P. Koh-Banerjee, M. V. Franz, L. Sampson, S. M. Liu, D. R. Jacobs, D. Spiegelman, W. Willett and E. Rimm, “Changes in Whole-Grain, Bran, and Cereal Fiber Consumption in Relation to 8-y Weight Gain among Men,” American Journal of Clinical Nutrition, Vol. 80, No. 5, 2004, pp. 1237-1245.
[19] A. Schatzkin, T. Mouw, Y. Park, A. F. Subar, V. Kipnis, A. Hollenbeck, M. F. Leitzmann and F. E. Thompson, “Dietary Fiber and Whole-Grain Consumption in Relation to Colorectal Cancer in the NIH-AARP Diet and Health Study,” American Journal of Clinical Nutrition, Vol. 85, No. 5, 2007, pp. 1353-1360.
[20] A. T. Chan and E. L. Giovannucci, “Primary Prevention of Colorectal Cancer,” Gastroenterology, Vol. 138, No. 6, 2009, pp. 2029-2040. doi:10.1053/j.gastro.2010.01.057
[21] R. Lang and S. A. Jebb, “Who Consumes Whole Grains, and How Much?” Proceedings of the Nutrition Society, Vol. 62, No. 1, 2003, pp. 123-127. doi:10.1079/PNS2002219
[22] M. G. Priebe, J. J. van Binsbergen, R. de Vos and R. J. Vonk, “Whole Grain Foods for the Prevention of Type 2 Diabetes Mellitus,” Cochrane Database of Systematic Reviews, No. 1, 2008, Artical No. CD006061.
[23] S. A. M. Kelly, C. D. Summerbell, A. Brynes, V. Whittaker and G. Frost, “Wholegrain Cereals for Coronary Heart Disease,” Cochrane Database of Systematic Reviews, No. 2, 2007, Artical No. CD005051.
[24] I. A. Brownlee, C. Moore, M. Chatfield, D. P. Richardson, P. Ashby, S. A. Kuznesof, S. A. Jebb and C. J. Seal, “Markers of Cardiovascular Risk Are Not Changed by Increased Whole-Grain Intake: The WHOLEheart Study, a Randomised, Controlled Dietary Intervention,” British Journal of Nutrition, Vol. 104, No. 1, 2010, pp. 125-134. doi:10.1017/S0007114510000644
[25] N. F. Sheard, N. G. Clark, J. C. Brand-Miller, M. J. Franz, F. X. Pi-Sunyer, E. Mayer-Davis, K. Kulkarni and P. Geil, “Dietary Carbohydrate (Amount and Type) in the Prevention and Management of Diabetes: A Statement by the American Diabetes Association,” Diabetes Care, Vol. 27, 2004, pp. 2266-2271. doi:10.2337/diacare.27.9.2266
[26] S. Liu, J. E. Manson, J. E. Buring, M. J. Stampfer, W. C. Willett and P. M. Ridker, “Relation between a Diet with a High Glycemic Load and Plasma Concentrations of High-Sensitivity C-Reactive Protein in Middle-Aged Women,” American Journal of Clinical Nutrition, Vol. 75, No. 3, 2002, pp. 492-498.
[27] Y. Hu, G. Block, E. P. Norkus, J. D. Morrow, M. Dietrich and M. Hudes, “Relations of Glycemic Index and Glycemic Load with Plasma Oxidative Stress Markers,” American Journal of Clinical Nutrition, Vol. 84, No. 1, 2006, pp. 70-76.
[28] E. B. Levitan, N. R. Cook, M. J. Stampfer, P. M. Ridker, K. M. Rexrode, J. E. Buring, J. E. Manson and S. M. Liu, “Dietary glycemic Index, Dietary Glycemic Load, Blood Lipids, and C-Reactive Protein,” Metabolism-Clinical and Experimental, Vol. 57, 2008, pp. 437-443. doi:10.1016/j.metabol.2007.11.002
[29] J. W. J. Beulens, L. M. de Bruijne, R. P. Stolk, P. H. M. Peeters, M. L. Bots, D. E. Grobbee and Y. T. van der Schouw, “High Dietary Glycemic Load and Glycemic Index Increase Risk of Cardiovascular Disease among Middle-Aged Women—A Population-Based Follow-Up Study,” Journal of the American College of Cardiology, Vol. 50, No. 1, 2007, pp. 14-21. doi:10.1016/j.jacc.2007.02.068
[30] P. Gnagnarella, S. Gandini, C. La Vecchia and P. Maisonneuve, “Glycemic Index, Glycemic Load, and Cancer Risk: A Meta-Analysis,” American Journal of Clinical Nutrition, Vol. 87, No. 6, 2008, pp. 1793-1801.
[31] F. S. Atkinson, K. Foster-Powell and J. C. Brand-Miller, “International Tables of Glycemic Index and Glycemic Load Values,” Diabetes Care, Vol. 31, No. 12, 2008, pp. 2281-2283. doi:10.2337/dc08-1239
[32] D. L. Freed, “Do Dietary Lectins Cause Disease?” BMJ, Vol. 318, 1999, pp. 1023-1024. doi:10.1136/bmj.318.7190.1023
[33] L. Cordain, L. Toohey, M. J. Smith and M. S. Hickey, “Modulation of Immune Function by Dietary Lectins in Rheumatoid Arthritis,” British Journal of Nutrition, Vol. 83, No. 3, 2000, pp. 207-217.
[34] G. Urbano, M. Lopez-Jurado, P. Aranda, C. Vidal-Valverde, E. Tenorio and J. Porres, “The Role of Phytic Acid in Legumes: Antinutrient or Beneficial Function?” Journal of Physiology and Biochemistry, Vol. 56, No. 3, 2000, pp. 283-294. doi:10.1007/BF03179796
[35] S. Lindeberg, “Palaeolithic Diet (‘Stone Age’ Diet),” Scandinavian Journal of Nutrition, Vol. 49, 2005, pp. 75-77. doi:10.1080/11026480510032043
[36] T. Jonsson, B. Ahren, G. Pacini, F. Sundler, N. Wierup, S. Steen, T. Sjoberg, M. Ugander, J. Frostegard, L. Goransson and S. Lindeberg, “A Paleolithic Diet Confers Higher Insulin Sensitivity, Lower C-Reactive Protein and Lower Blood Pressure than a Cereal-Based Diet in Domestic Pigs,” Nutrition & Metabolism, Vol. 3, 2006, p. 39.
[37] T. Jonsson, Y. Granfeldt, B. Ahren, U.-C. Branell, G. Palsson, A. Hansson, M. Soderstrom and S. Lindeberg, “Beneficial Effects of a Paleolithic Diet on Cardiovascular Risk Factors in Type 2 Diabetes: A Randomized Cross-Over Pilot Study,” Cardiovascular Diabetology, Vol. 8, 2009, p. 35.doi:10.1186/1475-2840-8-35
[38] S. Lindeberg, T. Jonsson, Y. Granfeldt, E. Borgstrand, J. Soffman, K. Sjostrom and B. Ahren, “A Palaeolithic Diet Improves Glucose Tolerance More than a Mediterranean-Like Diet in Individuals with Ischaemic Heart Disease,” Diabetologia, Vol. 50, No. 9, 2007, pp. 1795-1807. doi:10.1007/s00125-007-0716-y

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