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Are Grain Free Diets Healthy?

Bowl of oatmeal with blueberries in it

Are grain free diets healthy, or do they increase the risk for heart disease?

As we will learn in this post, the answer depends on a number of different factors and is likely to vary greatly from individual to individual. Genetics, socioeconomic, the type of grains consumed, and ethnicity all play a role in how we respond to grains in the diet.

Whole grains and the Black community

For example, the traditional diets of African populations were primarily vegetarian, relying on whole grains such as sorghum, millet, rice and yams. As such, the African continent has been primarily vegetarian largely before it was trendy in the West. Because whole grains were an epigenetic staple of African communities for generations, a grain free diet for many members of the Black community might force reliance on options that aren’t as well suited to their genetics. We know that African Americans are much less likely to see high triglycerides, but more likely to suffer from heart disease overall and heart disease at an early age. Nutrition researchers have suggested that greater consumption of whole grains could reduce the incidents of heart disease in the Black community. One of the topics we are passionate about and focused on at Gene Food is personalizing nutrition advice in order to empower communities, like the Black community, that are often overlooked in the scientific research. As such, I want to start by emphasizing that grain free diets are not a viable one-size fits all solution.

Insulin resistance and diet

With that said, let’s announce a principle that will provide a “strategic guidepost” for many of us as we decide whether we want to eat grains.

Insulin sensitivity is often greatest in the morning. 1

Put simply, we do the best job of using the “carb fuel” from foods like oats and sweet potatoes (even toast) in the morning. As the day wears on, the carbs we eat aren’t as rapidly burned for energy and the body tends to store what it can’t use, first as glycogen and then as triglycerides.

Elevated serum levels of triglyceride, again not as often an issue for African Americans, both immediately after a meal in the “post prandial” period, and over the long haul, increase the risk for heart disease. 2

If blood sugar is the reason you are shying away from grain, the timing of when you eat grain heavy meals could make a difference to your overall state of health.

Refined grains vs. whole grains

Refined grains are made from milled flours. By contrast, whole grains come largely unprocessed in their natural form and contain ample amounts of fiber.

As we’ve written in previous blog posts, the healthiest carbohydrate sources are ones that retain fiber.


Because fiber rich foods make their way through the stomach and small intestine to the colon where they ferment and feed the “good guy” microbes in our gut. By contrast, refined grains are absorbed in the small intestine where they spike blood sugar and cause inflammation.

When researching grain free diets, keep in mind that there is a major difference between simple refined carbs and whole grains that feed the microbiome.

Common reasons people go grain free

Theories in timing of insulin sensitivity notwithstanding, grain free diets are growing in popularity for both humans and even for dogs.


  1. Weight loss – low carb diets help some people lose weight;
  2. Insulin resistance and type 2 diabetes – some find blood sugar is easier to control when they remove grain, especially processed grains 3 ;
  3. Lectin and autoimmunity – celiac is the big one here, but consistent with Dr. Gundry style protocols, some people find they are sensitive to the proteins in grains, especially wheat and the cereal grains 4 ;
  4. Pesticides – sadly, many popular grain products contain growing levels of toxins such as glyphosate;
  5. Heart health – grain heavy diets can spike triglyceride levels in some people with genetic predispositions. 5

So, the million dollar question – should you go grain free?

Let’s briefly summarize the major positions for and against.

The anti-grain camp

On one side of the aisle you have the Mark Sisson / Dr. Gundry / Dr. Hyman / Dr. Perlmutter camp – for the most part, their position is no grains ever.

To quote Dr. Hyman, head of functional medicine at the Cleveland Clinic:

You don’t have to eat grains to be healthy. In fact, you might be healthier if you didn’t.

Why does Dr, Hyman take this position?

For some people, the proteins in grain can trigger chronic illness, and or raise blood sugar to unhealthy levels triggering insulin resistance, a “metabolic gateway” to type 2 diabetes. 6

The argument here is that it’s not the burger, it’s the bun that is causing Americans to be ill.

It’s true that some of us see our health decline when we eat a high carb diet, especially when lots of processed wheat is on the menu. Celiac and gluten sensitivity are real problems plaguing millions of Americans, some of whom have no idea grains are the culprit behind their nagging health issues.

And despite what more balkanized plant based nutrition camps lead you to believe, some of us see health decline when we eat grains at all. Lectins tend to get all the attention, but sadly, many grain products in America contain nontrivial levels of a carcinogenic pesticide called glyphosate.

But here’s the rub – taking grains entirely out of the diet can be an issue for some of us because of the foods that inevitably replace grains, not necessarily because grains are so healthy in and of themselves.

Just as not all of us can thrive eating grain, not everyone does well on the high fat diets many who eschew grains tend to turn to.

In the Gene Food scoring matrix, the following diets are often implemented grain free or close to grain free:

However, these diets are not all high in saturated fat either.

Those with ApoE4, those who tend to hyper absorb cholesterol, or those who have a genetic predisposition to some degree of familial hypercholesterolemia, may not be able to follow the full monty low carb orthodoxy and maintain optimal health. In other words, to you the reader at home – yes, there is a new paradigm when it comes to dietary cholesterol, and also yes, bacon and eggs every morning might shorten your life.

The pro-grain camp

On the other side of the grain debate sits the Ornish / Gregor / Esselstyn / Joel Kahn camp – whole grains at every meal. Their pro-grain position is tied to large scale epidemiology indicating diets higher in whole grains confer modest reduction in risk for chronic illness when compared to the standard American diet. 7

Eating oats has been shown to lower levels of LDL-C, an important biomarker for cardiovascular risk. 8

Dr. Esselstyn, also of the Cleveland Clinic, takes the exact opposite position on grain from his colleague Dr. Hyman.

For those with robust ability to deal well with dietary carbohydrate (and who actually stick with a diet that is entirely whole grain as opposed to refined grain / flour based), and who are not sensitive to the proteins in cereal grains, this style of eating could and does work.

In the Gene Food scoring matrix, the following diets are often very high in whole grains:

In our case, we slot people into diets that incorporate lots of whole grains when genetics indicate they do a better job with blood sugar clearance and triglycerides. The theory here is that there are people who are genetically predisposed to greater insulin sensitivity throughout the day.

But the grain heavy camp has some challenges.

Dr. Ornish and Esselstyn effectively recommend Vegan diets across the board. But, how many people can stay 100% Vegan (as these doctors suggest) and get adequate calories? A theme seems to be emerging – when you eliminate huge categories of foods from your diet getting adequate calories and nutrients becomes more difficult. It also becomes more likely you will have to overeat other types of foods.

If you’re trying to lose weight, that’s one thing, but if you have are predisposed to being thin, and skew plant based to optimize lipids, you will rapidly shrink to a skeleton (Vegan bodybuilding propaganda notwithstanding) eating nothing but whole food plant based.

In other words, on the insanely strict Esselstyn style diets you will likely be forced to add in some processed carbs to maintain body weight.

In turn, eating processed carbs can increase heart disease risk in some people (usually to the triglyceride side of the lipid fence) just the same as an excess of saturated fat can bump up cholesterol (in those with a genetic predisposition).

The grain middle ground

So what are we to do?

Grain free and high fat is not a long term solution for people who trend towards higher blood pressure and poor lipids on Paleo and Keto style diets.

On the flip side, some people have autoimmune like reactions to cereal grains. 4 Even when they are able to eat grain, a strict Vegan diet ultimately puts them in a state of caloric and nutrient deficiency.

Sounds like quite the nutritional quagmire.

Welcome to the grain middle ground, friends! The place where you avoid grains you’re sensitive to, but eat the ones your body tolerates at the times when it tolerates them best. For example, some people who are sensitive to wheat can eat brown rice and quinoa. Especially if your ancestors ate these foods, it may be a good option for you as well.

Here’s how to craft a personalized approach to grains.

Questions to ask about your body and grains

The first question to ask yourself is this: are you one of the people who is sensitive to grains themselves or are you someone who is experiencing blood sugar problems and high triglycerides when eating a grain heavy diet?

Keep in mind you could have both issues. Also keep in mind that you may have a grain sensitivity now, after say a course of antibiotics, but that sensitivity could lessen as your microbiome repopulates.

When searching for a “hard grain sensitivity,” Celiac or documented gluten sensitivity is an obvious first place to look.

Next, the blood sugar angle. Look at your lab tests. What does fasting insulin, fasting glucose and HbA1c look like?

Important note: Don’t ignore what happens to your blood sugar immediately after eating grain. This “post prandial” period can be more dangerous for inflammatory signaling than longer term metrics like HbA1c. 9 Unfortunately, the only way to truly know what your blood sugar is doing after a grain heavy meal (or after any meal) is to measure blood sugar in real time using a continuous blood glucose monitor.

Next, to the fat side of the coin, when you eat a high fat diet, do you see big upticks in cholesterol markers like LDL-C?

If your blood sugar numbers are out of range (but cholesterol is normal) and you are inflamed, you may be looking at a situation where you can achieve a better state of health by limiting consumption of grain, or exclusively eating grain in morning when you are most insulin sensitive.

It’s unlikely you’re sensitive to all grains

It’s fundamentally important to identify as best as possible whether the grain problem is a blood sugar problem (which is an immune system problem by itself) or a more insidious fundamental grain sensitivity. If it is a grain sensitivity, don’t throw the baby out with the bath water. Just because you are sensitive to oats it does not follow that you can’t eat buckwheat or rice.

If you skew towards high cholesterol when you go high fat and low carb, it’s likely you want to hold on to grains as a source of nutrition that won’t threaten lipids from the fat side of the aisle.

Especially if there is no autoimmune issue and blood sugar is the challenge, try heating grains, letting them cool overnight and then re-heating in the morning. This will cause the foods to form resistant starch and lower the glycemic response when you eat them the next morning.

Keeping a grain meal in your diet, for example morning oats, can be a nice step towards managing LDL-C even if you plan to eat a lower carb diet the rest of the day.

Good luck out there!

John O'Connor

John O'Connor is the founder of Gene Food, a nutrigenomic startup helping people all over the world personalize nutrition. John is the host of the Gene Food Podcast and a health coach trained at Duke's Integrative Medicine Program. Read his full bio here.

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