Unassailable Oatmeal

Yesterday I posted an interesting link on Facebook which detailed a study in Pediatrics done on a small (n=12) group of obese, adolescent boys. The study showed that eating an oatmeal breakfast (and, it should be noted, an oatmeal lunch) versus eating a vegetable-and-cheese omelette for both meals resulted in the boys consuming more calories after lunch, when they were permitted to eat as much as they like from a selection of foods. This was an interesting study because the results were partially opposite what proponents of whole grains have been maintaining (ie, that they provide fibre and bulk in the diet, which fills you up more and lets you eat less). I say partially because they actually had two oatmeal groups - one using instant oatmeal and one using a less-refined oatmeal, both with identical toppings, and indeed the less-processed oatmeal reduced subsequent food intake more. However, both oatmeals fared poorly compared with the omelettes. This study was a rarity in nutritional research in that it was experimental in design and very tightly controlled - far fewer potential confounds than in most other studies - AND it clearly measured actual intake and actual blood glucose levels rather than reported intake and/or hunger. What I find even more interesting is that while spikes & dips in blood glucose as a result of eating cereals and other high-GI foods are pretty well-acknowledged in nutritional research, the effect of those spikes & dips on later food intake has not been so well-documented.

I apparently have a lot of friends who maintain that oatmeal is an awesome breakfast, and indeed, I was formerly a huge fan of the oatmeal, too. Easy to prepare, hot, filling, and, with a modest amount of brown sugar and maybe some raisins or other dried fruit, satisfyingly delicious. Especially the steel-cut oats. Yum. (Critics please note that I am not disputing oatmeal's yumminess. Of all the grains, it ranks second in my book only to barley for inherent deliciousness.) But I was unprepared for the angry backlash when I questioned the overall health-providing aura of the Oatmeal. It was like posting a link claiming Elizabeth May used to work for Monsanto. OMG HOW COULD YOU SAY THAT?!?!?!?! (Later clarified to "Who are you to tell me what to eat, internet nutrition sucks, everyone is an individual and *I* am very cool with oatmeal" - which are fair points, but worth looking at more closely.)

Being yummy and filling is not the same as being good for you. And just because something is FILLING doesn't mean that you'll eat less, later. If you eat oatmeal for brekkie, can you then be fine *all afternoon* if you have only a salad and a couple hard-boiled eggs for lunch? Is an afternoon snack a necessity? Now, you may feel hungry earlier towards lunchtime if you eat protein and veggies for breakfast rather than oatmeal (hard to say if this is due to faster absorption of nutrients, response to an unexpected LACK of blood glucose spike, or stretched-out tummy, or even true), but hunger levels do not necessarily dictate later appetite. I'm sure everyone has had times when they've been hungry, but were satisfied by fairly little food, and conversely sat down to dinner really not so hungry but then scarfed an 8-oz steak, baked potato with butter, and 3 helpings of cheesy broccoli anyhow. In other words, hunger isn't what we're looking at, we're looking at post-oatmeal eating. Different.

Interestingly, few if any of the Facebook oatmeal-defenders are overweight. (Massively pregnant sisters don't really count.) And as the discussion on Facebook pointed out, eating more later is not necessarily a bad thing. If you're an athlete, or if you work a physically demanding job, or your personality and food habits are such that you have a tendency to forget to eat, then you may very well want to eat a breakfast that enhances your appetite later on. This study was not aimed at providing useful information for people like this. It was aimed at people who have weight to lose, and who want to be able to decrease their overall caloric intake. Is it such a stretch to say that people like that, who are eating oatmeal for breakfast, should probably take a week or two and try something different?

The pro-oatmeal crowd kept prodding, though, and because I am ornery and a fully brainwashed paleophile I posted a link describing an old, old study showing that a single variable - oatmeal - in an adequately controlled experimental setting could account for a significant portion of dental caries in children. The reason it's an old, old study is that handy orphanages with piles of kids on which you can experiment like that don't really exist anymore. But the researchers were able to clearly show that oatmeal intake was positively associated with development of caries (cavities). Oh noes! Not the oatmeal, doing something BAD!!!! Well yeah. That particular result was most likely due to the phytate content of oatmeal, and it is possible to get around that one, but your oatmeal won't taste the same. (I like it a little sour, but I can see how that's a bit of a tough sell.)

So, two experimental studies show that oatmeal may not be the perfect breakfast food. Why get upset about that?

I think part of it is that people are sick to death of hearing that foods that were supposedly good for you aren't a panacea of healthy, or that previously "bad" stuff that was pretty easy to avoid (liver, anyone?) is actually really, really good for you and you should eat lots of it. Food ought to make us feel good. It's damned hard to feel good about eating when some nutrition dilettante tries to tell you that dear old oatmeal, which is one of the few foods that has enjoyed a good nutritional reputation since Roman times, MIGHT not be so good. If we can question oatmeal, for chrissakes, is ANYTHING sacred? (And at what point do I get labeled an orthorexic?)

The real question underlying this is, does it do us more harm than good to put our considerable, but still very flawed, scientific know-how into examining what we eat? Many good food writers (Michael Pollan among them) have noted the absence of a real "food culture" in North American society. Much of our angst about food and probably no small number of diet-related disorders is driven by sheer uncertainty about what we should eat. And it's easy to answer the "should we listen to research scientists?" with a quick "No!" because intuitively, we know that if we can stick with traditional foods - like oatmeal - that we've eaten for hundreds of years, we're good, right? Granny ate oatmeal every day and lived to be 107, etc.

Except, what if Granny *could* have lived to be 112, and maybe not had chronic hemorrhoids for the last 20 years of her life? What Granny carried a series of fortunate genes and a gutfull of awesome bacteria gleaned by accident or as a result of a borderline-unhealthy childhood obsession with being a chicken? Is her oatmeal still good for you?

See, science helps with these questions - but it doesn't answer them definitively. Science is, by its nature, always changing in its body of knowledge. As more experiments are done, more epidemiological data analyzed, and more evolutionary puzzles unraveled, our knowledge base changes, and our ideas about optimal or even healthy nutrition change. And, too, science has a human element, and human interests and even hubris can take over a whole field and distort its findings for decades through unnoticed confirmation bias, unexamined assumptions and statistical trickery for funding purposes. Nutritional science is also incredibly difficult to do WELL because we have all these inconvenient rules about experimenting on humans, and while rats and mice are convenient, they're different from us in some pretty important ways. So, it's easy to dismiss nutritional science as next to useless, and on more than one occasion I've done so too.

But if we're going to dismiss (or severely limit) direct science (ie, reading research articles) as a factor in deciding what to eat (or what not to eat), I think we also need to look really hard at what DOES influence what we eat. Government policy? Media? Advertising? Family traditions? Religious traditions? Packaging? Grocery store placement? Simple palatability? The limits of our culinary skill? Time? Is using these as rationale for what you put in your body really any better than using ever-changing scientific research findings? (It's entirely possible that it makes you a less annoying person, I'll grant that.) And if you prefer to rely on medical professionals for your dietary advice, do you ever actually ask how much training your doctor/nurse/nutritionist received, how many journals he/she subscribes to and what was the last interesting article he/she read that made him/her revise his/her views on whatever?

And does it really hurt to examine your food periodically, and ask if it's doing enough for you?

All right oatmeal fans, comments are all yours. Go for it. Justify your love for the oatmeal. Rip apart the internet nutrition, convince me I'm a loser nutrition geek who ought to have better things to do with her Sunday afternoons...