Foods Identified as ‘Whole Grain’ Not Always Healthy

11 January 2013
Last update: 27/03/14 11:47

Rebecca Mozaffarian
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Whole grains

New Standard Needed to Help Consumers, Organizations Choose Foods Rich in Whole Grains

Boston, MA – Current standards for classifying foods as “whole grain” are inconsistent and, in some cases, misleading, according to a new study by Harvard School of Public Health (HSPH) researchers. One of the most widely used industry standards, the Whole Grain Stamp, actually identified grain products that were higher in both sugars and calories than products without the Stamp. The researchers urge adoption of a consistent, evidence-based standard for labeling whole grain foods to help consumers and organizations make healthy choices. This is the first study to empirically evaluate the healthfulness of whole grain foods based on five commonly used industry and government definitions.

“Given the significant prevalence of refined grains, starches, and sugars in modern diets, identifying a unified criterion to identify higher quality carbohydrates is a key priority in public health,” said first author Rebecca Mozaffarian, project manager in the Department of Social and Behavioral Sciences at HSPH.

The study appears in the January 4, 2013 advanced online edition of Public Health Nutrition.

The health benefits of switching from refined to whole grain foods are well established, including lower risk of cardiovascular disease, weight gain, and type 2diabetes. Based on this evidence, the U.S. Department of Agriculture’s (USDA) 2010 Dietary Guidelines recommend that Americans consume at least three servings of whole grain products daily, and the new U.S. national school lunch standards require that at least half of all grains be whole grain-rich. However, no single standard exists for defining any product as a “whole grain.”

Mozaffarian and her colleagues assessed five different industry and government guidelines for whole grain products:

  • The Whole Grain Stamp, a packaging symbol for products containing at least 8 grams of whole grains per serving (created by the Whole Grain Council, a non-governmental organization supported by industry dues)
  • Any whole grain as the first listed ingredient (recommended by the USDA’s MyPlate and the Food and Drug Administration’s Consumer Health Information guide)
  • Any whole grain as the first ingredient without added sugars in the first three ingredients (also recommended by USDA’s MyPlate)
  • The word “whole” before any grain anywhere in the ingredient list (recommended by USDA’s Dietary Guidelines for Americans 2010)
  • The “10:1 ratio,” a ratio of total carbohydrate to fiber of less than 10 to 1, which is approximately the ratio of carbohydrate to fiber in whole wheat flour (recommended by the American Heart Association’s 2020 Goals)

From two major U.S. grocers, the researchers identified a total of 545 grain products in eight categories: breads, bagels, English muffins, cereals, crackers, cereal bars, granola bars, and chips. They collected nutrition content, ingredient lists, and the presence or absence of the Whole Grain Stamp on product packages from all of these products.

They found that grain products with the Whole Grain Stamp, one of the most widely-used front-of-package symbols, were higher in fiber and lower in trans fats, but also contained significantly more sugar and calories compared to products without the Stamp. The three USDA recommended criteria also had mixed performance for identifying healthier grain products. Overall, the American Heart Association’s standard (a ratio of total carbohydrate to fiber of ?10:1) proved to be the best indicator of overall healthfulness. Products meeting this ratio were higher in fiber and lower in trans fats, sugar, and sodium, without higher calories than products that did not meet the ratio.

“Our results will help inform national discussions about product labeling, school lunch programs, and guidance for consumers and organizations in their attempts to select whole grain products,” said senior author Steven Gortmaker, professor of the practice of health sociology.

Other HSPH authors included researchers Rebekka Lee and Mary Kennedy; Dariush Mozaffarian, associate professor in the Department of Epidemiology; and David Ludwig, professor in the Department of Nutrition.

Support for the study was provided by the Donald and Sue Pritzker Nutrition and Fitness Initiative; the Centers for Disease Control and Prevention (Prevention Research Centers grant U48DP000064, including the Nutrition and Obesity Policy, Research and Evaluation Network); the New Balance Foundation; the National Institute of Diabetes and Digestive and Kidney Diseases (K24082730); and the National Heart, Lung, and Blood Institute, National Institutes of Health (R01 HL085710).

“Identifying whole grain foods: a comparison of different approaches for selecting more healthful whole grain products,” Rebecca Mozaffarian, Rebekka Lee, Mary Kennedy, David Ludwig, Dariush Mozaffarian, and Steven Gortmaker, Public Health Nutrition, online January 4, 2013

View the full paper online for a limited period

This content is posted on behalf of Harvard School of Public Health

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3 comments

  1. Cynthia Harriman 19 February 2013 23:29

    In response to the February 14 comment from the Harvard School of Public Health Prevention Research Center, we would like to state that we appreciate their emphasis on the common ground between Oldways and their team, and on the positive role that the Whole Grains Council has played in raising awareness of the health benefits of whole grains and in encouraging food manufacturers to incorporate more whole grains into their products.

    We submit the following comments to clarify a few points:

    1. First, the skewed data issue. HSPH's study states, "Whereas the WG-Stamp predicted significantly higher sugar overall, it was not associated with significant differences in sugars when stratified by grain category. This suggests that the overall higher sugars were driven by the categories of grain products selected by industry to display the WG-Stamp, i.e., those that are also generally higher in sugars."

    It's this last sentence that is most affected by the products sampled in the study. The researchers chose products in certain categories, rather than "randomly". As we pointed out in our blog (http://wholegrainscouncil.org/newsroom/blog/2013/01/wgc-rebuts-harvard-study-stands-behind-wg-stamp), 22% of products using the Stamp in the USA are bars and cereals, while about 68% of Stamped products in the study were in these categories. While it's true that the same criteria were applied to all products in the study, we feel strongly that the mix of products sampled does not support the conclusion that industry chooses to use the Stamp more frequently on products like bars than on breads, pastas, oatmeal etc.

    2. Second, the question of what the Stamp stands for. It's true that "more whole grain" doesn't automatically guarantee a healthier product. Yet if two foods are equal in all parameters except that one is made with whole grain and the other with refined grain, the whole grain one will be healthier. There are also many definitions of healthier. As HSPH states in its comments below, products with the Stamp "had significantly lower sodium levels, were less likely to contain trans-fats, and had higher fiber." We know that researchers sometimes don't have complete control over the information included in the press release distributed for a particular study. However, we were disappointed that the HSPH press release emphasized the sugar issue without equal emphasis on these many positives, resulting in unbalanced media coverage.

    3. Finally, drawbacks to the 10:1 approach. While the study did mention some limitations to the 10:1 approach, this approach's exclusion of several whole grains – especially the whole grain corn, rice, and sorghum that celiacs and other gluten intolerant people count on most – was not mentioned and is, we think, a key point. While fiber is one of the many virtues of whole grain, it is widely understood that even the lower-fiber whole grains offer important phytonutrients and other benefits not found in their refined counterparts. We're glad that HSPH agrees that there's no perfect way to label whole grain products. Under any system, less healthy products may inadvertently slip into the tent: Froot Loops also qualify for the 10:1 ratio, with 26 grams of carbohydrate and 3 grams of fiber!

    We are always re-examining the Whole Grain Stamp program (and all Oldways programs) and reflecting on how our programs can be made more effective. We will certainly keep the HSPH study in mind as we move forward.

  2. Harvard School of Public Health Prevention Research Center 14 February 2013 16:45

    We appreciate the efforts of the Whole Grain Council to increase awareness of whole grains, and their role in encouraging food manufacturers to increase availability of whole grain products. In response to our study, the Whole Grain Council expressed several concerns and criticisms. We address these comments below.

    First, the Whole Grain Council asserts that our study is not representative of whole grain products with the Stamp, and is skewed toward products with higher sugars and calories, “especially in its selection of products using the Stamp”. The goal of our study was to empirically identify the most reliable way to help guide consumers in selecting whole grain products. We randomly sampled 545 major brand name grain products in 2 major grocery stores. We then applied five different recommended criteria for identifying whole grains to determine which criteria identified the healthiest whole grain options. All of the criteria we studied were applied to the same sample of products, therefore providing an unbiased look at each criterion. We had no pre-specified notions or intentions when we set out to do this study, and what we reported were simply what the data showed.

    Second, the Whole Grain Council states, “The Stamp was designed to denote the whole grain content of products and nothing more, and it has always been represented as such.” However, the Whole Grain Council website notes that one can, “Find healthy choices fast by choosing products that have the Whole Grain Stamp” (http://wholegrainscouncil.org/; access date 02/14/13). This website also notes: “The only program that can potentially improve public health is one that is widely adopted and used”. It seems clear that the intent of the stamp is to imply healthfulness of products, as well as improve public health.

    Given these important and laudable goals, the Whole Grain Council must be committed to an objective assessment of the performance of their stamp. But our findings demonstrate clearly that whole grain content alone is not sufficient for defining healthful grain products. Industry shouldn’t be able to add anything they wish (including large amounts of sugar) to 8 grams of whole grains and market the product as healthy. Our assessment of numerous grain products indicate that the Whole Grain Stamp might be used as a way to market less healthy products as healthy options. For example, the Whole Grain Stamp can be found on Brown Sugar Poptarts and Froot Loops, which contain 15 grams and 12 grams of sugar per serving, respectively. We believe this lack of attention to the healthfulness of products is a disservice to organizations, consumers, and parents who wish to make healthy choices.

    We do agree there is no perfect way to label whole grain products, and note these limitations in our study. For example, a manufacturer can add isolated fibers to a product full of refined grains and sugars to meet the 10:1 ratio. Thus, we recommend that the fiber included in the 10:1 ratio be naturally occurring in the product. The Whole Grain Council also notes examples of specific whole grains that do not meet to 10:1 ratio, such as brown rice. This is an interesting point, yet reveals that some whole grains such as brown rice don’t have much fiber, and may not be as healthy as other whole grains options. It was not the intent to imply that the Whole Grain Council’s Stamp be entirely replaced by the use of the carbohydrate to fiber ratio.

    Given the Whole Grain Council’s stated commitment to improving public health, we believe they should embrace our findings as a catalyst to reassess the criteria of the stamp. It was promising that Stamped products had significantly lower sodium levels, were less likely to contain trans-fats, and had higher fiber. However, to meet its goals of a true stamp of health, we would recommend that stamped products also achieve the 10:1 ratio, or have a maximum amount of sugar allowed in the formulation of the product. This would be particularly important for products such as cereals and granola/cereal bars, both of which tend to be high in sugar, and frequently display the stamp.

    For the benefit of organizations and consumers, we are pleased that our objective, scientifically-sound study has brought some clarity to the confusion and inconsistencies that exist around identifying whole grain foods. We hope that the Whole Grain Council will continue its work to incorporate healthier grain products, and that with time the bar for deserving their symbol will be raised even higher. We hope that our findings will help inform efforts to better define and identify requirements for healthier whole grain labeling policies.

  3. Whole Grains Council 15 January 2013 17:20

    While the motivation for this research is valid, we note inaccuracies that bring into serious question the study’s data and its conclusions. Oldways and the Whole Grains Council invite you to read about our point of view on the Whole Grains Council’s blog: http://wholegrainscouncil.org/newsroom/blog/2013/01/wgc-rebuts-harvard-study-stands-behind-wg-stamp

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