This Facts About explains and gives examples of grains and starchy vegetables. We list foods with a guide for selecting an appropriate portion size and provide recommendations for incorporating healthy changes into your diet.

What are the recommended servings of grains & starchy vegetables per day?

• 4 -11 servings per day. For optimal health, we recommend only whole grains versus milled, processed or refined grains.

What are whole grains?

Grains are the seeds of plants. Whole grains contain all parts of the grain, including the bran, endosperm and germ.

• Bran. Forming the outer layer of the seed, the bran is a rich source of niacin, thiamin, riboflavin, magnesium, phosphorus, iron and zinc. The bran also contains the majority of the seed's fiber.
• Germ. A concentrated source of niacin, thiamin, riboflavin, vitamin E, magnesium, phosphorus, iron and zinc. The germ also contains protein and fat.
• Endosperm. Also called the kernel, the endosperm makes up the bulk of the seed. It contains most of the grain's protein and carbohydrate and has small amounts of vitamins and minerals.

What are milled, processed and refined grains?

• Unlike whole grains that contain at least part of their bran and germ layers, milled, processed and refined grains have both the bran and germ removed during processing; therefore all of the nutrients in these layers are also removed.
• They are often “enriched” which means nutrients that were lost during food processing are added back. For example, B vitamins, lost when wheat is refined, are added back to white flour during processing. However, even after enrichment, milled grains do not have as many nutrients as whole grains, and they do not provide as much fiber, if any.
  
• While whole grains are preferred, adding fiber -rich foods to milled or processed grains can lower the glycemic impact and moderate fluctuations in blood sugar. Therefore, foods such as pasta and white rice can be part of a healthy diet when combined with high fiber foods such as vegetables or beans.
• Examples of milled grains are white rice and white flour.

What are starchy vegetables?

• Starchy vegetables include corn, potatoes (all kinds including sweet), winter squash, plantains, and yucca (cassava root)
• These vegetables are higher in starch than other vegetables and are metabolized in your body more like a grain
• They are often used as the central starchy part of a meal, for example: mashed potatoes or polenta (milled corn)
• When used whole, they provide ample fiber and nutrients
• Their primary function is to provide energy for the body, especially the brain and the nervous system. The body breaks down starches into glucose, which the body uses for energy.

Why choose whole grains and starchy vegetables?

• They are rich sources of fiber and naturally low in fat
• An important source of vitamins and minerals, such as B vitamins, Vitamin E, folate, selenium, zinc and iron
• They contain a variety of phytochemicals and antioxidants
• They help form the foundation of healthy eating
• There is a wide variety to choose from
• Tend to have a low glycemic index, which helps to regulate blood sugar levels
• Associated with reduced risk of type 2 diabetes, constipation, diverticulitis, obesity, heart disease and some tyepes of cancer

Try replacing refined, processed and milled grains with a whole grain alternative

Specific Considerations

What is the glycemic index (GI)?

The glycemic index measures how different types of carbohydrate foods affect blood glucose (blood sugar) levels. The higher a food ranks on the glycemic index, the faster it increases glucose in the blood. Eating more than the recommended servings of foods high on the glycemic index can lead to loss of sensitivity to insulin, the hormone needed to allow blood sugar to enter cells for use as fuel. This "insulin resistance" promotes weight gain and type 2 diabetes.

• The glycemic index ranks carbohydrates on a scale from 0 to 100 according to the rate and extent that the sugars from these carbohydrates enter the blood and cause blood sugar levels to rise after eating
• Carbohydrates that breakdown quickly have the highest glycemic indexes
• Carbohydrates that breakdown slowly have low glycemic indexes

What is the glycemic load (GL)?

• GL builds on the glycemic index concept to provide a measure of total glycemic response to a food or meal based on serving size
• GL = GI (%) x grams of carbohydrate per serving

GI and GL Range Values

Milled Grains and GI

When the fiber is removed from grains during the milling process, the refined carbohydrate that remains is converted to glucose by the body much more quickly during digestion. Therefore the milling process increases the GI of a particular grain, for example:

Fiber in the prevention of chronic disease

Constipation
Fiber adds bulk, aiding the movement of food through the gut, thus preventing constipation

Diverticulitis
Fiber also helps reduce the risk of diverticulitis, a condition in which small pouches in the colon wall may become infected

Type 2 Diabetes
Foods with a low glycemic index and high fiber, like many whole grains and starchy vegetables, do not raise blood sugar levels as quickly as milled and processed choices. Therefore, they are associated with a lower risk of type 2 diabetes. Low glycemic index foods are often high in fiber and include legumes, whole fruits, oats, bran and whole grain cereals.

Heart Disease
Fiber reduces fat and cholesterol absorption leading to lower total and LDL (bad) cholesterol levels

Obesity
Because insoluble fiber is indigestible and passes through the body virtually intact, it provides few calories. Since the digestive tract can handle only so much bulk at a time, and since fiber-rich foods are more filling than other foods, people on high fiber diets tend to eat less. Insoluble fiber also may hamper the absorption of calorie-dense dietary fat.

Cancer
Whole grains contain phytochemicals and antioxidants that can help lower your risk for cancer. Also, the fiber in whole grains can help move potential cancer- causing compounds through the intestines faster, reducing their chances of being reabsorbed into the body.

What are the health concerns associated with grains?

Gluten Intolerance

Celiac disease (CD) is also known as gluten intolerance. Gluten is the common name for the proteins in specific cereal grains that are not tolerated in persons with CD. These proteins are found in all forms of wheat (including durum, semolina, spelt, kamut, einkorn, and faro), and related grains, rye, barley, and tritcale. When individuals with CD ingest gluten, the villi, tiny hair-like projections in the small intestine that absorb nutrients from food are damaged. This is due to an immune reaction to gluten. Damaged villi interfere with the body's ability to absorb basic nutrients - proteins, carbohydrates, fats, vitamins, minerals, and, in some cases, water and bile salts.

Pesticide Use

Pesticides are chemicals that are used to control pests that destroy crops. They are used in the production of most crops sold in the United States. These chemicals may increase your risk for cancer or other chronic diseases and should be limited in your diet.

Choose Organic

We recommend organic grains because they contain less pesticide residue. We believe they also provide better flavor and are a better nutritional choice than conventionally grown produce.

Organic food is produced by farmers who emphasize the use of renewable resources and the conservation of soil and water to enhance environmental quality for future generations. Organic food is produced without using most conventional pesticides, petroleum-based fertilizers, or sewage sludge-based fertilizers, bio-engineering, or ionizing radiation. Organic systems replenish and maintain soil fertility, eliminate the use of toxic and persistent pesticides and fertilizers, and build biologically diverse agriculture.

How can you get more fiber and whole grains into your diet?

1. Reduce the amount of refined grains you eat. A good way to be sure a food item contains whole grains is to look at the fiber content-3 or more grams of fiber per serving is recommended.
2. Use breakfast cereals based on oats, barley and bran for breakfast or a snack.
3. Use “grainy” breads made from whole seeds.
4. Eat brown rice instead of white rice.
5. Experiment with cooking various whole grains like quinoia, barley and millet.
6. When buying bread products, read the label. If you see the word enriched, the product probably does not contain whole grains.
7. Wheat flour and whole wheat flour are not the same! Look for whole grain, stone ground, whole ground, whole wheat flour, whole oat flour or whole barley flour.
8. When eating a milled or processed grain, add foods with plenty of fiber (fruits, vegetables, legumes or whole grains) to lower glycemic impact.
9. Many foods are now available in whole wheat / whole grain versions: pasta, couscous, frozen waffles, pancake mixes, crackers, bagels and pretzels.

This Facts About document is published by Monica Myklebust, MD, and Jenna Wunder, MPH, RD, at University of Michigan Integrative Medicine Clinical Services. Our mission is to care for people using an Integrative Medicine model that reaffirms the importance of relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches to achieve optimal health and healing.

Resources

Celiac Disease
Celiac Disease Foundation
www.celiac.org
Accessed April 7, 2006

Enriched, Fortified:  What’s the Difference?
American Dietetic Association
www.eatright.org
Accessed April 7, 2006

Fiber – Start Roughing It!
Nutrition Source, Harvard School of Public Health
www.hsph.harvard.edu
Accessed April 7, 2006

Get on the Grain Train
USDA Center for Nutrition Policy and Promotion
www.usda.gov
Accessed April 7, 2006

Glycemic Index, Glycemic Load & Cancer Risk
Dixon, S.
Nutrition Cancer Information, LLC
www.cancernutritioninfo.com
Accessed April 7, 2006

Hot Topic:  Glycemic Index
American Dietetics Association
www.eatright.org
Accessed April 7, 2006

How to Eat Healthy Carbohydrates
Dixon, S.
Cancer Nutrition Information, LLC
www.cancernutritioninfo.com
Accessed April 7, 2006

Organic Food Standards and Labels:  The Facts
USDA Agricultural Marketing Service
www.ams.usda.gov
Accessed April 7, 2006

Whole Grains for Healthful Eating
American Dietetic Association
www.eatright.org
Accessed April 7, 2006

Whole Grains:  Reap the Rewards
Mayo Clinic
www.mayoclinic.com
Accessed April 7, 2006

 Original Research and Review Articles

Adom KK and Liu RH.  Antioxidant activity of grains.  Journal of Agricultural and Food Chemistry. 2002;50:6182-6187.

Anderson JW, et al.  Carbohydrate and fiber recommendations for individuals with diabetes:  a quantitative assessment and meta-analysis of the evidence.  Journal of the AmericanCollege of Nutrition.  2004;23(1):5-17.

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Jenkins DJA, et al.  Glycemic index:  an overview of implications in health and disease.  American Journal of Clinical Nutrition.  2002;76(suppl):266s-273s.

Liese AD, et al.  Whole-grain intake and insulin sensitivity:  the insulin resistance atherosclerosis study.  American Journal of Clinical Nutrition.  2003;78:965-971.

Liu RH.  Potential synergy of phytochemicals in cancer prevention:  mechanism of action.  Journal of Nutrition.  2004;134:3479s-3485s.

Liiu S et al.  Relation between changes in intakes of dietary fiber and grain products and changes in weight and development of obesity among middle-aged women.  American Journal of Clinical Nutrition.  2003;78:920-927.

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