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White Foods
The Worthy and the Worrisome

by Matilde Parente, MD

People who care about nutrition — which includes many people with diabetes, and those who are trying to lose weight — are often on the lookout for rules to follow that might lead to better food habits. These rules can consist of anything from avoiding hydrogenated oils to filling half of one’s plate with vegetables. But not every rule that gains the public’s attention is equally helpful, or necessarily helpful at all.

One of the more confusing pieces of dietary advice to emerge in recent years is to avoid white-colored foods. You may be wondering whether there is any evidence to support such a rule. If there is, does it apply to all white foods, or just certain ones? And what does being white have to do with it, anyway?

Like other slogans that distill complex information into catchy phrases, calls to avoid white foods contain a kernel of wisdom. When used as verbal shorthand for limiting refined carbohydrates, avoiding white foods makes dietary sense. After all, many low-nutrient-value, calorie-dense foods are made with white sugar and/or white flour, such as sugary drinks and many baked goods. But whiteness does not relegate a food to junk status. Rather, excessive calories, saturated fat, and forms of processing that destroy nutrients are what should provoke health-minded individuals to white out certain white foods.

On that basis, a no-white-foods eating plan should not mean scrapping foods such as parsnips, white fish, or onions. Balanced consumption of unprocessed, wholesomely prepared white foods can be part of any healthy diet. This article examines white foods that can easily be part of a diabetes-friendly diet, and those that are best avoided or consumed in limited amounts.

Color coding
For several years now, the nutritional spotlight has been shining on colorful produce, as study after study has shown health benefits associated with blueberries, tomatoes, and other brightly colored foods.

While antioxidant- and nutrient-rich “rainbow foods” are good for you, the flip side — that foods lacking in color are bad for you — does not hold true. On the surface, foods that are white or pale-colored might appear to be boring and somewhat short on flavor. White’s basic blandness may lend credence to the notion that white foods are nutritionally empty and to be avoided.

But nutrient profiles of many white foods tell another story. Nature’s animal, plant, and fungus kingdoms boast a number of white superstars that fit right in alongside the garden’s color guard.

White foods to limit
The most widely shunned white food ingredients are sugar and white flour. (Also cited at times is salt, which raises a different health issue, discussed later on.) These ingredients and the often nutrient-poor, carbohydrate-rich, highly processed products in which they appear have contributed to the rising daily caloric intake among Americans, which today averages 200–300 calories more than a generation ago.

Common dietary sources of sugar and white flour include candy, cookies, pastries, breakfast cereals, pasta, white bread, and breading for fried foods. People with diabetes should approach these foods with caution —not because of the whiteness of their ingredients, but rather because of their high carbohydrate and low nutrient and fiber content. Remember that metabolism is color-blind when it comes to metabolizing brown versus white sugar.

Potatoes are sometimes grouped with sugar and white flour as a food to avoid. After all, potatoes have a high glycemic index (GI) of 85 — meaning they raise blood glucose quickly and high after eating — and a medium-size potato contains 30 grams of carbohydrate. Potatoes are also often turned into high-fat, high-calorie foods, from French fries to buttery mashed potatoes. Yet potatoes naturally contain no fat and are rich in fiber, potassium, B vitamins, vitamin C, iron, magnesium, and other trace elements — all that and protein, too.

A few easy cooking and serving tricks can help lower the glycemic index of potatoes, thereby slowing their digestion and conversion to glucose in the bloodstream. For example, try mashing the starchy potato flesh with an equal amount of a pulpy vegetable such as broccoli, celery root, or cauliflower. Combining potatoes with a low-carbohydrate, fiber-rich vegetable helps lower the glycemic index of a potato dish and makes it more filling. Use a vinegar- or lemon-juice-based dressing in a potato salad to slow its digestion. By chilling your salad overnight in the refrigerator, some of the potato starch will resist digestion and behave more like fiber than digestible carbohydrate.

When you eat potatoes, be sure to eat their fiber-rich skins (as long as you are not affected by gastroparesis, or slowed stomach emptying). Most of the five grams of fiber in a medium, five-ounce potato is insoluble. This fiber type is high in cellulose, which does not dissolve in water and is not digested in the intestines. Foods high in insoluble fiber help promote satiety, or a feeling of fullness; bulk up stools; and aid in regular bowel movements.

Pasta, like potatoes, is shunned by some people as a “bad” white food. But prepared al dente, or firm to the bite, the GI for pasta falls at the lower end of pasta’s 30 to 60 range. As with any carbohydrate, portion control is important for people with diabetes and those looking to lose weight.

Newer, tastier choices in whole-wheat pasta offer a nutritious alternative to the classic variety. These pastas usually contain more protein and fiber than regular dry pasta. Soba, a Japanese noodle made from buckwheat, is a tasty, fiber-rich, and often gluten-free choice that is lower in carbohydrate and calories than regular wheat-based pasta. Buckwheat also contains more protein than most grains.

Try bulking up pasta by serving it with low-carbohydrate vegetables, and go easy on salty or calorie-laden sauces. To make a satisfying, one-dish meal, add a modest amount of lean protein, such as lentils, chicken, shrimp, or scallops. For a low-fat sauce, use a splash of the pasta’s cooking water to “cream” a small amount of ricotta cheese into your pasta. Or for a fresh, wholesome dressing, use a lemon, herb, and olive oil mixture.

Bread, like potatoes, is frowned upon by some people as a source of quickly digested carbohydrate. Again, paying attention to portion size and whether a bread is made from whole grains can steer you toward healthy choices. White rice also often comes under fire, despite lower rates of diabetes and overweight in many Asian countries where rice is a staple. Americanized versions of Asian cuisine, often perceived as healthier dining choices, can come with a high sodium load and large amounts of white rice. As with bread, limit your intake — including that of more nutritious, higher-fiber brown rice. Select rice with a lower GI than plain, long-grain white rice, such as jasmine, basmati, brown, or parboiled or converted rice.

Consider limiting the carbohydrate load of your meal by replacing bread, pasta, or rice with barley, lentils, or beans. These three lower-GI foods make filling, nutritious partners to nonstarchy vegetables and lean meats, whether in soups, side dishes, or main dishes. Remember that all carbohydrate-containing foods, whether white or brown, can add up to push your daily carbohydrate intake beyond desirable limits.

Salt
Salt sometimes shows up on lists of white foods to avoid. Indeed, recent studies have confirmed that most Americans consume too much salt. A 2012 study by the Centers for Disease Control and Prevention (CDC) reported an average intake of nearly 3,300 milligrams (mg) of sodium per day, not counting salt added at the table. About half of all sodium consumed came from 10 food categories, with breads, cold cuts, pizza, poultry, soups, sandwiches, and cheeses leading the pack.

Although the recommended general-population upper limit for daily sodium intake is 2,300 mg, most American adults are advised to stay within an upper limit of only 1,500 mg sodium per day, or the amount in about one-half teaspoon of table salt. This lower limit applies to all adults 51 or older, people with diabetes, African-Americans, and people with high blood pressure or chronic kidney disease. Eating too much salt has been linked to an increased risk of death or disability from high blood pressure, stroke, and heart disease.

To reduce your daily sodium intake, use the sodium content information on packaged or processed food labels to help guide you to lower-sodium choices. Limit the number of meals you eat in restaurants, if possible, or request no-salt-added or reduced-sodium dishes. Best yet, prepare more foods from scratch using fresh produce, low-sodium proteins, and naturally salt-free flavoring ingredients such as herbs and spices.

White foods to enjoy
White beans, such as cannellini, Great Northern, and garbanzo (chickpeas), are diabetes-friendly foods that warrant a place at the table. As an inexpensive and vegetarian protein option, beans are also rich in B vitamins, fiber, iron, potassium, and other nutrients. Beans are also filling, and the soluble fiber in them helps to regulate blood cholesterol levels. Try serving protein-rich dips of mashed white beans, lemon, garlic, and herbs with cut-up, crunchy vegetables.

Cheese appears on some bad-white-foods lists. While cheeses high in sodium or saturated fat are best limited or avoided, there are some lower-sodium and lower-fat choices. Ricotta cheese has a creamy texture and a nutrient profile that boasts protein, calcium, vitamin A, and folate. Low-fat and skim products are widely available. Try adding ricotta to pasta along with tomatoes and vegetables to create a nutritious, rich-tasting dish.

Goat, mozzarella, and cottage cheeses can also be diabetes-friendly food choices when consumed in moderation. Ounce per ounce, most goat cheeses are lower in sodium and saturated fat than hard cheeses. Cottage and mozzarella cheeses vary widely in sodium content. Check the Nutrition Facts panels on cheese labels to select lower-sodium cheeses.

White-fleshed fruits and vegetables are perfect for nearly anyone’s healthy diet. Tasty, white-fleshed apples and pears provide vitamins, phytochemicals, hydration, slowly released energy, and fiber. Reams of scientific literature demonstrate the health benefits of both white-fleshed and colorful fruits. A 2011 study from the Netherlands examined the risk of stroke over several years among more than 20,000 adults. The researchers found that a higher intake of fruits and vegetables, particularly of apples and pears, was associated with a lower risk of stroke.

Bananas are another white-fleshed fruit that can be a part of a healthy diet. A six- to seven-inch banana contains 23 grams of carbohydrate and nearly 3 grams of fiber that is mostly soluble. Bananas are rich in vitamins and minerals and are a good source of potassium, packing 362 milligrams into a small serving. A potassium-rich diet is associated with better cardiovascular health, including lower blood pressure and a lower risk of stroke. The GI of bananas spans the intermediate range, with less ripe bananas ranking at the lower end.

Many white vegetables make up for what they lack in color with plenty of nutrients and flavor. Parsnips, for example, are a low-calorie root vegetable that are high in fiber and other nutrients. Try replacing potatoes with parsnips in soups, stews, and mash recipes, or roast them in the oven to enhance their natural sweetness and earthy flavor. Other white-fleshed root vegetables that can act as healthful and easy side dishes — requiring minimal preparation beyond boiling, mashing, or roasting — include turnips, rutabagas, and celery root.

Cauliflower is another nonstarchy white vegetable that takes to simple food preparation methods such as steaming, braising, or boiling. And when it comes to pale plants, don’t forget cabbage, onions, and garlic.

Certain mushrooms bring an added nutritional benefit to the table: vitamin D. The California-based company Monterey Mushrooms, working with the United States Department of Agriculture, exposes mushrooms to ultraviolet light. The light converts a chemical precursor found naturally in some types of mushrooms to vitamin D itself — much like our skin converts precursor molecules to the sunshine vitamin. Vitamin D in mushrooms is stable to grilling. Produce giant Dole is also bringing vitamin-D-rich portobello mushrooms to groceries nationwide.

Milk and milk products such as yogurt are sold in a range of enriched, reduced-fat, and lactose-free varieties. In addition to bone-benefiting calcium and vitamin D (when fortified), milk provides high-quality protein, hydration, and slowly released energy. Unsweetened cow’s milk, whether skim or whole, has a GI below 55, or within the low range.

Plant-based milk alternatives such as soy milk, almond milk, and others may contain added sugars or sweeteners such as barley malt syrup, rice syrup, and evaporated cane juice. These are metabolized just like white sugar, so use the overall sugar content as a guide when shopping. Smarter choices include unsweetened plant milks fortified with vitamin B12, vitamin D, and calcium.

When buying yogurt, beware of sweetened varieties, which can have a very high sugar content. Greek-style yogurt offers an alternative to regular yogurt, with more protein and less sugar and carbohydrate per serving. Carbohydrate and sugar counts for yogurt often vary within a brand or by flavor, so read labels. To save money and boost your nutrient intake, flavor any plain yogurt with fresh fruit. Greek yogurt also makes a good alternative to sour cream or mayonnaise in potato salads and similar dishes. Use it to add protein, creaminess, and a tangy kick to dressings.

White meats and fish are lean sources of protein. Beware of white sauces that undo leanness by adding fat, salt, and calories. Request or prepare lighter sauces made with olive oil, lemon, and herbs. Inspect labels on packaged chicken and preseasoned white meats for sodium content.

Beyond color
Like any maxim based more on simplicity than sense, the call to avoid white foods has left many people puzzled about the relationship between whiteness and nutritional value. Consider the no-white-foods slogan simply a reminder to keep sugar, refined carbohydrates, and salt in check. Meanwhile, keep your eyes and mind open to the many nutrient-rich white foods — and foods of all colors — that can be part of a healthy, well-balanced diet.

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