Just when you thought your patients' favorite sugary cereals were completely devoid of nutrients, recent gold stamps, flashy logos, and attractive packaging peg these former boxes of empty calories into seemingly "good," even "excellent" sources of whole grain!

But wait: Cynthia Harriman, director of food and nutrition strategies for the Whole Grains Council, a nonprofit consumer group in Boston, warns shoppers to use caution before filling their shopping carts with anything and everything featuring grain on the packaging. "Take a closer look at the labels and you may find there's not a single whole grain in them." Labels can declare that products contain grains, even when said grains have been heavily processed and stripped of most of the original nutrients and nearly all of their fiber. Harriman adds, "Even white flour is made from grain, after all."¹

When the U.S. Department of Agriculture (USDA) released the 2005 Dietary Guidelines for Americans, recommending that Americans consume at least 3 ounces of whole grain products per day, it seems food companies began a frenzied campaign to promote the whole grain in their products. However, according the USDA Web site, breads, cereals and pastas that feature "multigrain," "stone-ground wheat," "100% wheat," "cracked wheat," "seven-grain," or "bran" are usually" not whole grain products at all.

What constitutes a whole grain?

Somewhere between the amber waves of grain and America's manufacturing plants, the rich, wholesome connotation of whole grain loses its punch as so many vitamins and minerals are stripped away. Beginning with its basic structure before harvest, raw grain is simply the entire seed, or kernel, of a plant. One seed is made up of three key parts: the bran, the germ and the endosperm. Grains are considered "whole" when these three, key components remain intact through the refining process.

The tough outer layer protecting the inner grain from disease, chemicals, insects and the elements is called the bran. The bran contains a variety of B vitamins, antioxidants, and, of course, fiber. The germ also contains several B vitamins along with protein, minerals and healthy fats. Finally, and most importantly for survival, the endosperm provides food, or energy to the grain, allowing it to retrieve water and nutrients from the soil while sending sprouts upward into the sunlight. This, the largest part of the grain, contains carbohydrates, proteins and small amounts of vitamins and minerals.²

Refining and processing usually strips the grain of its bran and germ, leaving little more than the endosperm. And even though some processors enrich their finished products with added vitamins or minerals, truly whole grains are much healthier, full of protein, fiber, and naturally-occurring vitamins and minerals. So, after they are cracked, split, stone-ground or milled, products claiming to contain whole grain must offer virtually the same proportions of bran, germ and endosperm as the harvested kernel did before it was processed in order to rightfully be labeled whole grain.² A common misconception about unrefined whole grains is that they taste bland or gritty. In fact, whole grains are usually neither dry nor gritty because they are combined with ingredients that add moisture. It seems that all foods considered "healthy," like whole grains, are thought of by some as being flavorless.

Whole grain lovers enjoy the subtle, "nutty" flavor, choosing whole grain foods as part of their healthy diet.

Why should we eat whole grains?

Modern advertising has made whole grain seem like a revolutionary idea! The truth is, whole grains have been a large part of the human diet for some 10,000 years. Even Hippocrates, considered the father of modern medicine, noted the many health benefits and medicinal uses of whole grain sometime during the fourth-century B.C.³

Recently, the 2005 Dietary Guidelines for Americans placed increased emphasis on whole grains, suggesting that all adults get at least half their grains from whole grain sources. And if the USDA isn't convincing enough, recent studies have shown the tremendous health benefits of incorporating more whole grains into the daily diet. Whole grains have been shown to reduce the risk of metabolic syndrome in middle-aged and older adults;⁴ they slow the buildup of plaque on the artery walls⁵ and cut the risk of heart disease among adults by up to 20 percent;⁶ they contain as many or more protective antioxidants as are found in fruits and veggies;⁷ they cut the risk of diabetes;⁸ and whole grains help many lose weight!⁹ Clearly, whole grains deserve their rightful place in the American diet, But how much of this good thing is enough?

The USDA recommends through the Dietary Guidelines that Americans consume at least 48 grams of whole grain products daily; but who thinks in grams? As an easier way to illustrate to your patients what a proper serving of whole grain looks like, encourage them to eat three "ounce-equivalents" of breads, cereals or other 100 percent whole grain foods. Let them know that, generally, one slice of whole wheat bread or a bowl of whole grain breakfast cereal each weighs about an ounce.²

Patients must remember, too, that a mix of whole grains and refined grains is not a bad thing! The USDA recommends that most Americans eat six servings of grain per day, of which three should be from whole grain sources. In fact, a mix introduces many delicious choices and tastes to the daily diet. Patients just have to eat more of, for instance, a product containing 50 percent refined grain and 50 percent whole grain, in order to reach the recommended three ounce-equivalents.

Finding the whole

Around the same time the 2005 Dietary Guidelines were released, packages and food labels began to note more visibly the whole grain supposedly found in their products. Exposed to so much clever marketing, it's easy for patients to assume they're getting much more whole grain in their diets than they truly are. A quick glance at the list of ingredients is one way patients can find out whether their favorite "cracked wheat" sandwich bread really offers all the whole grain it claims to. If the first ingredient listed contains the word "whole" (e.g., "whole grain", "whole wheat", "stoneground whole", "whole wheat flour", "whole oats"), it is safe to assume the product is predominantly whole grain – containing all parts of the grain. If "whole" doesn't appear until the second ingredient on the list, the product may contain as little as 1 percent or as much as 49 percent whole grain.

"Wheat flour," "semolina," "durum wheat," "organic flour," or "multigrain" require a bit more investigation. These terms may accurately describe what's inside, but some parts of the grain may be missing, which means you're missing the benefits of truly whole grain. Finally, wording such as "enriched flour," "degerminated," "corn meal," "bran," or "wheat germ" never describe whole grain products.² Patients should also note that many products feature whole grain as the first ingredient, followed by a long list of less-than-healthy additives. For example, the list of ingredients on a box of General Mills' Cinnamon Toast Crunch includes whole grain wheat as the first item, and sugar as the second.¹² That means sugar could comprise up to 49 percent of the box's contents! Proceed to the checkout stand at your own peril.

Contrary to popular belief, color is not necessarily an indication that a product contains whole grain.¹¹ For example, bread is often brown in color because molasses, caramel, cocoa or brown coloring has been added as an ingredient; not necessarily because it contains a significant amount of whole grain. Plus, some whole grains aren't brown at all, so foods made from them may not be brown, even though the product is 100 percent whole grain. Remember to look for "whole" at the top of the list of ingredients.

To make life easier on consumers, The Whole Grains Council is doing their part to clearly distinguish "good", "excellent", and "100% whole grain" sources with gold stamps affixed to products that contain one half serving (8 grams) of whole grain, one full serving (16 grams) of whole grain, or one full serving of whole grain with all grains left whole, respectively. Labeled products range from tortillas and bagels to veggie burgers and home baking mixes.¹⁰ And as of January 2006, 47 companies had begun using the stamp on 561 products, according to Oldways Preservation Trust, a Boston-based consumer education group.

Companies who want to display these stamps on their products can find more information on steps and compliance at www.wholegrainscouncil.org/FAQstampMFRS.html.

Recently, the U.S. Food and Drug Administration released a non-binding draft guidance that encourages companies to make statements that are "truthful and not misleading" about the amount of whole grain in their foods. And though the administration has not taken a stance, specifically, on the use of the "good," "excellent" or "100%" stamps, the whole grain stamp program surpasses normal requirements of the terms "good source" and "excellent source," as good sources denote products offering 17 percent of the USDA-recommended daily consumption, and excellent sources are products containing at least 33 percent of the daily goal set by the USDA.² It is ultimately the goal of the Whole Grains Council to help consumers comply more easily with the USDA 2005 Dietary Guidelines for Americans. Today, more than 600 products from 51 companies have entered the compliance process with the Whole Grains Council, in hopes of displaying the whole grain stamp on their products.²

What is amaranth, anyway?

Once your patients understand the benefits and recommended daily intake of whole grains, the next step is showing them where to find some variety and how to incorporate various grains into meals and even classic recipes. Some of the most commonly consumed whole grains are wheat, oatmeal and popcorn, since sources like amaranth, bulgar, quinoa, and spelt soundwellboring. But, actually, ancient grains like amaranth are packed with nutrients and often carry a unique flavor. The Whole Grains Council offers a list of lesser-known grains, their description and health benefits at www.wholegrainscouncil.org/WGAtoZ.html.

Inform your patients that including more whole grain in their day-to-day diets is much easier than it may seem. Small substitutions yield substantial health rewards. The Whole Grains Council offers a few tips for quick reference:

• In your regular recipes for baked sweets, substitute half of the white flour with whole wheat flour.
• Add half a cup of cooked bulgar, wild rice or barley to stuffing.
• Eat more tabbouleh and other whole grain salads!
• Enrich your favorite canned soups with a half cup of cooked wheat or rye berries, wild rice, brown rice or sorghum.
• Buy whole grain pastas, or even one of the part whole-grain, part white blends.
• Use whole corn meal in your cornbread recipe.
• Try breakfast cereals with grains like kamut, kasha (buckwheat) or spelt listed first on the ingredient list.
• As a side dish for grilled steaks, chicken, or pork, substitute your regular rice pilaf for a brown rice or amaranth pilaf prepared the same way.

Once an assortment of whole grains begins making its way into a patient's routine, healthy substitutions, like the ones listed above, will become healthy standards!

Written by Julie Engebretson