Doctors, are you frustrated by failed attempts to convince your heart patients to follow your sound advice on lifestyle improvements? Are you exhausted from trying to figure out why they won’t stop eating junk and start eating heart-healthy foods just like you are recommending?
Stand back, please. I think I have finally figured out WHY YOUR PATIENTS WON’T LISTEN!
It’s because no sooner do doctors start advising that something is good for heart patients, that it seems other doctors start advising that not only is it NOT good for us, but it might even be downright dangerous! And vice versa.
Eggs are bad for us. No wait, eggs are okay after all.
Fat is bad for us. No, wait…
Oatmeal is a healthy breakfast food. No, wait…
You read that right, my heart sisters. Oatmeal! Oatmeal is now apparently off the ‘nice’ list, according to Dr. Mark Hyman, author of many best-selling diet books, and somebody who calls himself a functional medicine specialist at the Functional Medicine Clinic at Cleveland Clinic (where you can order his $300 10-Day Detox Combo supplement pack from the Dr. Hyman Store). Hyman has now decreed that the humble bowl of hot oatmeal, long beloved by Grandmas and expert dietitians alike, is no longer a good breakfast food choice.
He seems to base this warning on a small 1999 obesity study(1) that he called “amazing”, a study undertaken with 12 boys (did I mention that this study was small?) Twelve boys is hardly a study, by the way. At my house, it is a birthday party.
I first learned of this study in an online oatmeal warning on Twitter based on Hyman’s latest best-selling diet book, that essentially warned:
“Oatmeal is not health food. Oatmeal spikes your sugar and makes you hungrier.”
So I asked Dr. Glen Pyle, University of Guelph Professor of Molecular Cardiology, about this theory. He told me about a number of scientific studies that had found just the opposite of what Dr. Hyman’s anti-oatmeal warnings claim: specifically, that oatmeal can actually decrease glucose spikes. For example, he cited one 2015 paper published in the food science journal Nutrients (Hou et al) that reviewed nine separate studies, each suggesting that “oatmeal reduced post-meal glucose and insulin responses compared to other control meals.”
I am not a research scientist (but I did spend 20 years of my life living with one – does that count at all?)
I am however a heart patient who has fretted about how I can personally make better decisions about choosing better food – and eating far less sugar – while at the same time not turning into a preachy food nag nobody wants to sit beside.
It’s all about small steps. As the late tennis legend Arthur Ashe once advised:
“Start where you are, use what you have, do what you can.”
Using a methodology that researchers would call n=1 (studying just one person – me!), I concluded that my own bowl of steel cut oatmeal with milk, fruit and assorted nuts and seeds easily keeps me going until 1 p.m. with nary a hunger pang, no matter how busy I am that morning.
But could I be unwittingly spiking my blood sugar, as Dr. Hyman insists? And what does that mean anyway?
Where I live (in British Columbia, Canada), my go-to resource for nutrition or food science questions is our 811 Dial-A-Dietitian information phone line (it’s a free public service, along with 24/7 Dial-A-Nurse).
Thank you Canada, commie pinko land of socialized medicine!
The registered dietitian on the phone explained to me that glycemic index (GI) is a value out of 100 that scientists assign to foods based on how slowly or how quickly those foods cause increases in blood glucose (blood sugar) levels. The higher the GI numbers, the more they can impact those blood sugar “spikes”.
My steel-cut oatmeal has a GI of 42. Compared to many other breakfast options, that’s pretty good (e.g. instant oatmeal =79, watermelon =79; a slice of white bread =75; Special K cereal =84). But as those living with Type 1 diabetes already know, other factors like stress, illness, exercise, excitement – even weather! – can also have an effect on blood sugar levels, so focusing only on GI numbers and sugar spikes may not be entirely useful.
And as the dietitian reassured me, my steel-cut oats are a complex carbohydrate high in B-Vitamins, magnesium, phosphorus, zinc, manganese, selenium, iron, calcium and protein, while low in salt, sugar, and fat. As if that’s not already great enough, oats also contain both soluble and insoluble fibre, which helps to reduce low-density lipoprotein (LDL, the “bad” cholesterol), and makes us feel fuller, not hungrier when we finish eating them.
When I say “oatmeal”, by the way, I don’t mean those little packages of instant oatmeal, which are a highly processed food-like material that can contain up to four teaspoons of sugar in a single serving package. I look at instant oatmeal as the gateway to real oats down the road (much like Baby Duck was my sicky-sweet wine of choice back in art college until I discovered dry red wine).
I also view my bowl of oatmeal as a base (in the same way you might look at rice as the base for a chicken stir-fry). Once the oatmeal is in the bowl, it’s a blank canvas, awaiting a colourful load of fruit (e.g. mine always includes a chopped-up apple and berries), almonds, walnuts, pumpkin seeds, and any other heart-healthy addition I can find in my kitchen.
When I asked Dr. Yoni Freedhof (founder of Ottawa’s non-surgical Bariatric Medical Institute, a teacher of medicine at the University of Ottawa, and a blogger on his highly recommended Weighty Matters site) what he thought about this oatmeal warning, here’s what he tweeted back to me:
(To read more about quackademic medicine, and Hyman’s definition of functional medicine as “a hidden movement sweeping across the globe!” – which, honestly, must be a pretty slow sweep if it’s hidden – plus his argument with basic germ theory, read this).
Here’s the thing: oatmeal for breakfast is not necessarily what I want to eat. It’s what I have decided to eat, upon thoughtful reflection, because it’s healthier for me than what I really want to eat for breakfast, which includes things like fluffy cinnamon peach pancakes piled with whipped cream and lots of pure Canadian maple syrup – maybe with a side of nice crispy bacon. Now, THAT is the breakfast I dream about. . .
Oatmeal may not be healthier for me compared to a (*gag*) kale smoothie, but it’s a significant improvement compared to what I really wish I could eat every morning.
Keep in mind, my heart sisters, that I grew up in a big Ukrainian family in which my entire childhood was fueled by our traditional dietary trinity based on butter, bacon and, of course, sour cream (finished off with a gooey homemade butter tart or two).
We considered dill pickles to be a vegetable dish in our family.
Later, as a grown-up newlywed, my idea of breakfast was picking up a sweet coffee and a Tim Hortons maple dip on my way to work. Paradoxically, as a Mum of two children several years later, I fed my kids super-healthy homemade everything since the day they first started eating solid foods, thanks to my well-loved and dog-eared copy of La Leche League’s classic Whole Foods for the Whole Family. But I lived with a double standard for myself whenever left to my own culinary devices (or when out with my girlfriends celebrating anything!)
INTERESTING BUT SLIGHTLY IRRELEVANT FUN FACT: My own grandmother in Manitoba (ditto on the Ukrainian diet preferences, of course) lived well into her 90s, having outlived three husbands. Almost until the very end, she did her own gardening, home baking and canning as if she were still on that prairie farm taking care of her family of 12 children! And I’d bet my next squirt of nitro spray that not for one single moment of her entire life did that woman worry about whether or not she should eat fewer carbs. . .
Meanwhile, thanks to learning more about the joys of the delicious Mediterranean diet since my heart attack, I have been making small but important changes to the way I shop and cook, little by little. Yes, even vegetables! A significant improvement!
But now this doc is telling all of us that oatmeal is no longer good for us?!
Here’s my own takeaway message for now: the way to convince people to adopt heart-healthy options is NOT to issue sweeping anti-oatmeal blanket warnings based on a 12-boy study.
And we’re talking about oatmeal here. Not Pop Tarts. . .
CAROLYN’S ‘NIGHT-BEFORE’ OATMEAL RECIPE
Well, actually this is my dear Seattle friend Tony’s recipe, passed on to me. Steel-cut oatmeal and oat groats (the least processed kind of oats) generally take a lot longer to cook than highly processed instant oatmeal (just add boiling water) – but Tony’s recipe speeds things up by starting the night before at bedtime: for each serving, boil one cup of water with 1/3 cup of steel-cut oats. As soon as the water comes to a rolling boil, take the pot off the stove, put the pot lid on, and go to bed. Thank you, Tony! ♥
The next morning, perfectly cooked oatmeal is ready to reheat and top with berries, almonds, any other heart-healthy stuff you can find. It is easy, colourful and absolutely yummy.
And as my grandmother would say: “This will stick to your ribs!”
(1) High Glycemic Index Foods, Overeating, and Obesity”.
SHAMELESS PLUG FROM CAROLYN: ♥ I wrote more about how and why heart patients tend to respond to behaviour change motivators (or not!) in Chapter 7 of my book, “A Woman’s Guide to Living With Heart Disease” (Johns Hopkins University Press, 2017).
Q: Do you still consider oatmeal to be part of a healthy breakfast?
- Dear Cleveland Clinic: It’s food, not poison, for crying out loud!
- Heart-smart food rules: your dietary dos and don’ts
- Food trends: why we eat the way we do
- When “nudging” doesn’t work to change patient behaviour
- Why don’t we listen to doctors’ heart-healthy advice?
- Do you fear change? Then don’t have a heart attack
- De-junk your kitchen to start heart-smart eating
- Why you’ll listen to me, but not your doctor