What’s the best course of action to take if you suspect you might be sensitive to gluten? First off, do not go on a gluten-free diet. If you suffer from chronic irritable bowel-type symptoms, such as bloating, abdominal pain, and irregular bowel habits, ask your doctor about getting a formal evaluation for celiac disease. If you have celiac, then go on a strict gluten-free diet. If you don’t have the disease, the current recommendation is that you first try a healthier diet that includes more fruits, vegetables, whole grains, and beans, all the while avoiding processed foods.45 The reason people may feel better on a gluten-free diet—and therefore conclude they have a problem with gluten—is because they’ve suddenly stopped eating so much fast food and other processed junk. In other words, if you eat a deep-fried Twinkie and your stomach aches, it may not be the gluten.
If a healthy diet doesn’t help, I suggest you try to rule out other causes of chronic gastrointestinal distress. When researchers have studied PWAWGs—that’s what they’re called in the medical literature: People Who Avoid Wheat and/or Gluten—they’ve found that about one-third of them didn’t appear to have gluten sensitivity but instead had other conditions like an overgrowth of bacteria in their small intestines, were fructose or lactose intolerant, or had a neuromuscular disorder like gastroparesis or pelvic floor dysfunction.46 After each of these is ruled out as well, then I’d suggest people suffering from chronic, suspicious symptoms try a gluten-free diet.
No current data suggest that the general population should try to avoid gluten, but for those with celiac disease, a wheat allergy, or a wheat sensitivity diagnosis, gluten-free diets can be a lifesaver.47
Eat Whole . . . Within Minutes
Eating whole grains should be more than just swapping out white bread for whole wheat and white rice for brown. There is a wonderful universe of whole grains out there. You may have tried quinoa, but what about kañiwa or fonio? Even wild rice (which is not actually even rice) may not sound as wild as the grain called freekeh. Have fun and try some amaranth, millet, sorghum, or teff to expand the amber waves of your horizon. Buckwheat is my mum’s favorite.
As with vegetables, use color to make decisions at the supermarket. If you have a choice, pick red quinoa over white quinoa, blue sweetcorn over yellow, and yellow sweetcorn over white. Beyond just comparing antioxidant content, there’s experimental evidence to suggest that pigmented rice—red, purple, or black—has benefits over brown. For example, in addition to having about five times more antioxidants,48 colored rice varieties have shown greater anti-allergy activity in vitro,49 as well as superior anticancer effects against breast cancer50 and leukemia cells.51
For convenience’s sake, there are a number of quick-cooking grains: amaranth, millet, regular oats, quinoa, and teff can all be prepared in less than twenty minutes. For grains that take longer, such as barley, farro, or steel-cut oats, consider cooking a big pot in advance on the weekend so you can simply reheat for your meals throughout the week. Or get a rice cooker—you can buy one for less than £13.
Whole-wheat pasta cooks in about ten minutes. Improved production technologies have created a new generation of whole-grain pastas that no longer have the rough and mealy texture of yesteryear. My favorite brand is Bionaturae because of its deliciously nutty taste—try it with my Eight Check-Mark Pesto.
Dr. Greger’s Eight Check-Mark Pesto
60 g fresh basil leaves
30 g freshly toasted walnuts
2 cloves fresh garlic
¼ of a peeled lemon
¼ teaspoon lemon zest
¼ inch of fresh turmeric root (or ¼ teaspoon turmeric powder)
70 g pinto beans
60 ml water or liquid from bean tin
1 tablespoon white miso
Pepper to taste
Combine all ingredients in a food processor. Blend until smooth. Scoop onto 150 g of cooked whole-grain pasta.
Popcorn is a whole grain that takes less than five minutes to prepare. A hot-air popper is another inexpensive, useful appliance. There’s an endless variety of savory, sweet, and spicy toppings you can use. I like the combination of chlorella and nutritional yeast. (In my family, the green color earned it the name “zombie corn.”) By lightly misting air-popped popcorn with a spray bottle, you can get dry seasonings to stick. I like to spritz with balsamic vinegar. Be sure to stay away from artificial butter flavorings. Originally, we thought the artificial butter flavor chemical diacetyl was just an occupational health hazard, resulting in the deaths of workers who handled the chemical from a condition that became known as “popcorn lung.”52 Now we know consumers are also at risk, given a case series of serious lung disease thought to be caused by butter-flavored microwave popcorn consumption.53
There are even one-minute whole-grain options: fully precooked bowls and pouches of brown rice and quinoa that can be microwaved and don’t even need to be refrigerated—just heat and eat.
The Five-to-One Rule
If you buy packaged grain products, anything labeled on the front with words like “multigrain,” “stone-ground,” “100% wheat,” “cracked wheat,” “seven-grain,” or “bran” is usually not a whole-grain product. They’re trying to distract you from the fact that they’re using refined grains. Here, color may not help. Ingredients like “raisin juice concentrate” are used to darken white bread to make it look healthier. Even if the first word in the ingredients list is “whole,” the rest of the ingredients could be junk.
I suggest using the Five-to-One Rule. When buying healthier, whole-grain products, look at the Nutrition Facts label on the package and see if the ratio of grams of carbohydrates to grams of dietary fibre is five or less (see figure 7). For example, let’s see if 100 percent whole-wheat Wonder Bread passes the test: Per serving, the package lists 30 grams of carbohydrates and 3 grams of fibre. Thirty divided by 3 is 10. Well, 10 is more than 5, so the 100 percent whole-wheat Wonder Bread goes back on the shelf even though, technically, it’s a whole-grain product. Compare that to Ezekiel bread, a sprouted-grain bread based on a biblical verse. It has 15 grams of carbohydrates and 3 grams of fibre, and, just like that, passes the test. So do Ezekiel english muffins, which taste great with fruit-only jam and nut butter. Though the science on the potential benefits of sprouted grains is still in its infancy, available data looks promising.54
Apply the same Five-to-One Rule to breakfast cereals, another grocery category that can lull you into believing nearly everything is healthy. Multi-Grain Cheerios, for example, sounds good, but it has a ratio over 7. And then it just goes downhill from there with Frosted Cheerios and Fruity Cheerios, which have carbohydrate-to-fibre ratios that exceed 10. Compare that with Uncle Sam cereal, sliding in with a ratio under 4. Others that make the cut include some no-added-sugar puffed-grain cereals like puffed barley, but the healthiest whole grains are the least processed, the so-called intact grains.
Figure 7
Even though wheat berries, shredded wheat, whole-wheat flour, and puffed-wheat cereal may all be 100 percent whole wheat, they are handled by the body very differently. When grains are ground into flour or puffed, they are digested more rapidly and more completely. This increases their glycemic index and leaves fewer leftovers for the friendly flora down in your colon.
Researchers have experimented with this by splitting people into two groups. One group ate nuts, seeds, and beans more or less intact. The other group ate the same exact foods, but ground into flours and pastes. The first group ate nuts instead of nut butters, whole chickpeas instead of hummus, and muesli instead of muesli ground into a cream-of-wheat texture. Note that both groups were eating whole foods, just in different forms.
What happened? The intact-whole-grain diet group doubled their stool size, which was significantly greater than that of the ground-whole-grain group, even though they were eating the same foods in the same quantities.55 How is that possible? There is so much more left over for your gut flora to eat when you eat your grains intact. Few people realize that the bulk of stool
is not undigested food but pure bacteria—trillions and trillions of bacteria.56 That may be why you get an increase of nearly two ounces of stool for every one ounce of fibre you eat. That’s not just water weight—you’re feeding your good bacteria so they can be fruitful and multiply.57
As the study demonstrated, when you eat grains intact, even if you chew your food thoroughly, pieces of whole seeds and grains transport starch and other goodies all the way down to your colon for your flora to feast on.58 But when grains are unnaturally processed into flour, almost all of the starch is digested in the small intestine, and you end up starving your microbial self. When that happens regularly, it can result in dysbiosis, an imbalance in which bad bacteria can take over and increase your susceptibility to inflammatory diseases or colon cancer.59 The moral of the story: Whole grains are great, but intact whole grains may be even better.
Instead of a puffed brown-rice cereal, how about just brown rice? Brown rice for breakfast may sound weird, but warm bowls of grains are traditional breakfast foods in many parts of the world. There are savory versions, or you can sweeten it up with fresh, frozen, dried, or freeze-dried berries. There are online sites where you can buy freeze-dried strawberries in bulk for less than 65 pence per 160 grams.
Oats
Oatmeal, of course, is the classic whole-grain breakfast. Just as cruciferous vegetables and flaxseeds harbor beneficial compounds found in abundance nowhere else, oats contain a unique class of anti-inflammatory compounds called avenanthramides. They’re thought to be responsible in part for the fresh odor and flavor of oats60 as well as the ability of oatmeal lotion to relieve skin itching and irritation.61 Studies on human skin fragments from plastic surgery that were subjected to inflammatory chemicals reveal that oatmeal extract can suppress inflammation62—so much that oatmeal now appears to be the treatment of choice for certain serious chemotherapy-induced skin rashes.63 Ironically, two of the cancer cell lines found to be resistant to that type of chemotherapy64 were found to be sensitive to avenanthramides in vitro, suggesting that people should be applying oatmeal to their insides as well.65 Oatmeal is more than just a whole grain.66
Oatmeal is my go-to breakfast when I travel. If there isn’t a nearby Starbucks where I can pick up some oatmeal, I prepare instant oatmeal with dried fruit in the coffeemaker in my hotel room. At home, if you want to spice up your oatmeal routine, Google “savory oatmeal” for all sorts of interesting dishes involving sautéed mushrooms, herbs, spinach, curry, roasted vegetables—you name it!
The Daily Dozen calls on you to eat three servings of whole grains a day. This might seem like a lot, but when you look at the actual size of those recommended servings, it’ll be a snap for you to succeed. Just one pasta dish at an Italian restaurant may average the equivalent of six servings!67 A morning oatmeal habit is a great way to kick-start your day, and then there are a variety of quick-cooking whole grains that serve as convenient, filling ways to fight chronic disease risk all day long.
Beverages
Dr. Greger’s Favorite Beverages
Black tea, chai tea, vanilla chamomile tea, coffee, earl grey tea, green tea, hibiscus tea, hot chocolate, jasmine tea, lemon balm tea, matcha tea, almond blossom oolong tea, peppermint tea, rooibos tea, water, and white tea
Serving Size:
One glass (12 ounces)
Daily Recommendation:
5 servings per day
There are plenty of dietary guidelines for eating, but what about for drinking? The Beverage Guidance Panel was assembled to provide “recommendations on the relative health and nutritional benefits and risks of various beverage categories.” The panel included such heavyweights as Dr. Walter Willett, chair of the nutrition department at Harvard University School of Public Health and professor of medicine at Harvard Medical School.
The panel’s nutrition experts ranked beverage categories on a six-tier scale from best to worst. Unsurprisingly, fizzy drinks ranked last. Whole milk, meanwhile, was grouped with beer, with a recommendation for zero ounces a day. Their justification included concerns about links between milk and prostate cancer, as well as aggressive ovarian cancer, perhaps “related to its well-documented effect on circulating concentrations of insulin-like growth factor 1.” (See chapter 13.) Tea and coffee—preferably without creamer or sweetener—tied as the number-two healthiest beverages, second only to water, the top-ranked drink.1
Water
More than two thousand years ago, Hippocrates said, “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.”2 Water is the healthiest beverage to drink—but how much is too little, and how much is too much? Water has been described as a “neglected, unappreciated and under researched” subject,3 but many of the studies extolling the need for proper hydration have been funded by the bottled water industry.4 It turns out the oft-quoted “drink at least eight glasses of water a day” recommendation actually has little underpinning scientific evidence.5
The eight-a-day recommendation can be traced back to a 1921 paper in which the author measured his own urine and sweat output and determined he lost about 3 percent of his body weight in water a day, which comes out to about eight glasses.6 Consequently, for the longest time, water requirement guidelines for humanity were based on just one person’s urine and sweat measurements.
But now there’s actually extensive evidence suggesting that not drinking enough water may be associated with a variety of problems, including falls and fractures, heat stroke, heart disease, lung disorders, kidney disease, kidney stones, bladder and colon cancer, urinary tract infections, constipation, dry-eye disease, cavities, decreased immune function, and cataract formation.7 The problem with many of these studies, though, is that low water intake is also associated with several unhealthy behaviors, including low fruit and vegetable intake, more fast-food consumption, and even less “shopping at farmers markets.”8 And think about it—who drinks lots of water? People who exercise a lot. So perhaps it’s no wonder that heavy water drinkers have lower disease rates.
Only large and expensive randomized trials could definitively settle these questions. But given that water cannot be patented, such trials seem unlikely.9 As a result, we’re left with studies that just link disease with low water intake. But are people sick because they don’t drink enough water, or are they not drinking enough because they’re sick? There have been a few large prospective studies in which fluid intake was measured before disease developed. For example, a Harvard University study of nearly forty-eight thousand men found that the risk of bladder cancer decreased by 7 percent for every extra daily 250 ml of fluid consumed. A high intake of water—say, two liters a day—may reduce the risk of bladder cancer by about 50 percent, potentially saving thousands of lives.10
Probably the best evidence we have for a specific recommendation for how much water you should be drinking comes from the Adventist Health Study. Twenty thousand men and women were studied. Those who drank five or more glasses of water a day had about half the risk of dying from heart disease compared to those who drank two glasses or less daily. About half of the cohort consisted of vegetarians, so they were also getting extra water by eating more fruits and vegetables. As in the Harvard study, this protection remained even after controlling for other factors, such as diet and exercise, suggesting that water indeed was the cause, perhaps by lowering blood “viscosity” (that is, by improving blood flow).11
If protection against cancer and heart disease isn’t enough motivation, perhaps the prospect of being a better kisser will be. Brushing artificial skin against the lips of young women, researchers found that hydrated lips showed greater sensitivity to light touch.12
Based on the best evidence to date, authorities from Europe, the U.S. Institute of Medicine, and the World Health Organization recommend about two to three liters of water a day for women and two-and-a-half to four liters a day for men.13 These recommendations include water fro
m all sources, though, not solely beverages. You get about one liter from the food you eat and the water your body actually produces on its own,14 so these guidelines roughly translate into a daily recommendation for drinking one to two liters of water for women and one-and-a-half to three liters for men (assuming only moderate physical activity at moderate ambient temperatures).15
You can also get water from all the other drinks you consume, including caffeinated beverages, with the exception of stronger alcoholic drinks like wines and spirits. Coffee,16 tea,17 and beer can leave you with more water than you started with, but wine actively dehydrates you.18 Note, though, in the cancer and heart disease studies mentioned earlier, the health benefits were almost exclusively associated with increased consumption of water, not other beverages. I address the problems with alcoholic drinks in chapters 8 and 11.
Bottom line: Unless you have a condition like heart or kidney failure or your physician otherwise advises you to restrict your fluid intake, I recommend you drink five glasses of tap water a day. I prefer tap not only because it’s less economically and environmentally costly but because it may have less chemical and microbial contamination than bottled water.19
Can Drinking Water Make You Smarter?
How Not to Die Page 48