More white rice, more diabetes risk

Over 20 million people in the United States (about 8% of the population) have type 2 diabetes.1 Worldwide prevalence of diabetes in adults is about 6%, and Asian countries have somewhat higher rates (9% in China and Korea, and 11% in Japan).2,3 This is interesting to consider. In spite of considerably more overweight and obesity in the USA and our dangerous diet, there is considerably more diabetes in China, Korea and Japan. This is mostly because of white rice.

White rice. Flickr: Calgary Reviews

Type 2 diabetes arises out of insulin resistance, a state in which the body’s cells cannot respond properly to insulin – a hormone that allows for the transport of glucose into the body’s cells and storage of the energy contained in that glucose. Carrying excess fat and eating high glycemic load (GL) foods contribute to the development of insulin resistance (and of course, eating high glycemic foods contributes to weight gain).

Refined carbohydrates like white rice, devoid of fiber to slow down absorption of sugars, raise blood glucose more and faster than their intact, unprocessed counterparts. The effect of a food on blood glucose is indicated by its glycemic index (GI) – a 1-100 measure of the blood glucose response per gram of carbohydrate. Glycemic load (GL), a related indicator, takes into account both the GI and the carbohydrate content of a typical portion size.

A new meta-analysis has explored the link between white rice and diabetes
An analysis of four prospective studies on white rice consumption and diabetes has recently been published – it included 2 studies in Asian populations and 2 in Western populations. In Asian countries, where white rice is a staple food, the average intake of white rice was 3-4 servings per day, and in Western countries the average was 1-2 servings per week. A comparison of the highest vs. lowest white rice intake groups yielded a 55% increase in diabetes risk in Asians, and a 12% increase in Westerners. Overall, the researchers found that each daily serving of white rice increased the risk of diabetes by 11%.4


This new research serves to remind us: High-glycemic, nutrient-depleted, refined carbohydrates (like white rice) are more than just empty calories – they are disease-causing foods.

Westerners on average ate less than one daily serving white rice – but what about the other high-GL foods that Americans eat daily? White pasta, white potato, and white bread are also high in GL and therefore likely to be just as dangerous. It’s no wonder that U.S. diabetes rates have tripled in the past 30 years, and are expected to double or even triple by 2050.2
 

Food

Glycemic Load

(High = 20 and above; Low = 1-10)

White potato (1 medium baked) 29
White rice (1 cup cooked) 26
White bread (1 bagel, 3.5 in. diameter) 24
White pasta (1 cup cooked) 21
Chocolate cake (1/10 box cake mix + 2T frosting) 20
Black rice (1 cup cooked) 14
Butternut squash (1 cup cooked) 8
Green peas (1 cup cooked) 8
Lentils (1 cup cooked) 8
Black beans (1 cup cooked)5 6

 

Indeed, more and more research is demonstrating potato consumption is associated with diabetes, and this association was found to be most likely due to glycemic load (not due to preparation or added fats). Substituting 1 serving of whole grains per day with potatoes was estimated to increase diabetes risk by 30%.6 Also, in a 6-year study of 65,000 women, those with diets high in refined carbohydrates from white bread, white rice, and pasta were 2.5 times as likely to be diagnosed with type 2 diabetes compared to those who ate lower-GL foods such as intact whole grains and whole wheat bread.7  

Not just diabetes – cancer too
High GL foods have dangers that reach beyond diabetes. Diets including large quantities of high GL foods increase the risk of several chronic diseases including diabetes, heart disease, and cancers.8 Let’s make it clear: white rice, white flour products, and white potatoes are foods that should not be central in our diets. Low-nutrient, high glycemic foods are not only unfavorable from the perspective of weight gain and diabetes, but could also contribute significantly to cancer by causing excessive insulin secretion. High insulin levels in the blood can promote the growth of cancer cells, in part by interacting with the receptor for insulin-like growth factor 1 (IGF-1).9 A recent study of Korean women found that each daily serving of white rice increased breast cancer risk by 19%.10 Similarly, a recent U.S. study found a link between starch consumption and breast cancer recurrence.11 Diabetics are 30% more likely to develop colorectal cancer, 20% more likely to develop breast cancer, and 82% more likely to develop pancreatic cancer than non-diabetics. This increased risk of cancer observed in diabetics is thought to be due in part to cancer-promoting effects of insulin therapy.12,13

In the past, white rice was looked upon as a healthful, low fat staple in a vegetarian diet. We have progressed in knowledge and science and it is clear that white rice can no longer be considered healthful, or even neutral – it is a disease-causing food. The damaging effects of high-GL foods have been brought to light, and we now know that the most healthful carbohydrate sources are those that minimize glycemic effects – beans, peas, intact whole grains, and starchy vegetables.
 

References:
1. American Diabetes Association: Diabetes statistics [http://www.diabetes.org/diabetes-basics/diabetes-statistics/]
2. World Health Organization. Diabetes Fact Sheet. [http://www.who.int/mediacentre/factsheets/fs312/en/ ]
3. IDF Diabetes Atlas: Fifth Edition. International Diabetes Federation; 2011.
4. Hu EA, Pan A, Malik V, et al: White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. BMJ 2012;344:e1454.
5. Atkinson FS, Foster-Powell K, Brand-Miller JC: International tables of glycemic index and glycemic load values: 2008. Diabetes Care 2008;31:2281-2283.
6. Halton TL, Willett WC, Liu S, et al: Potato and french fry consumption and risk of type 2 diabetes in women. Am J Clin Nutr 2006;83:284-290.
7. Salmeron J, Manson JE, Stampfer MJ, et al: Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA 1997;277:472-477.
8. Barclay AW, Petocz P, McMillan-Price J, et al: Glycemic index, glycemic load, and chronic disease risk--a meta-analysis of observational studies. Am J Clin Nutr 2008;87:627-637.
9. Gallagher EJ, LeRoith D: The proliferating role of insulin and insulin-like growth factors in cancer. Trends Endocrinol Metab 2010;21:610-618.
10. Yun SH, Kim K, Nam SJ, et al: The association of carbohydrate intake, glycemic load, glycemic index, and selected rice foods with breast cancer risk: a case-control study in South Korea. Asia Pac J Clin Nutr 2010;19:383-392.
11. Emond JA, Patterson RE, Pierce JP: Change in Carbohydrate Intake and Breast Cancer Prognosis. In San Antonio Breast Cancer Symposium, vol. Presentation #P3-09-01; 2011.
12. Pollak M, Russell-Jones D: Insulin analogues and cancer risk: cause for concern or cause celebre? Int J Clin Pract 2010;64:628-636.
13. Experts call for further research into the relationship between insulin therapy and cancer. 2010. EurekAlert! http://www.eurekalert.org/pub_releases/2010-03/w-ecf030210.php. Accessed October 20, 2011.


 

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Comments (27) Read through and enter the discussion with the form at the end
Beth@WeightMaven - April 2, 2012 11:16 AM

Or maybe not? According to What Reading that White Rice and Diabetes Study Actually Told Me by Dr. Yoni Freedhoff:

"this study does not in any formative way, shape or form have the strength to draw any conclusions whatsoever on the specific impact white rice has on the risk of developing type 2 diabetes."

Annette Chambers - April 2, 2012 12:51 PM

Thank you for making this information available regarding white rice. White rice seems to be in many menu selections when eating out. I am now aware that white rice is not a wise choice.

David Griffin - April 2, 2012 1:20 PM

Correct me if I am wrong but were not some of the Chinese in "The China Study" almost imune to heart disease, cancer and diabetis while still eating white rice as a staple. I believe from what I have read that it is white rice or potatoes PLUS meat and oil and processed foods that leads to disease and not white rice or potatoes alone.

If you read enough your will find that everyting is bad for you but it seems to me in tring to find the common denomenator that white rice is the least of our worries. Fat, Oil, too much protein, Processed foods and manufactured food being a much bigger worry.

Bob Luhrs - April 2, 2012 2:53 PM

Green peas, I always like them, but confused:
What is the ANDI score for them? I have seen 80, 90, 8, all different ratings from Dr. Fuhrman's charts for green peas. I know they aren't as rich as greens, but ... what is the actual ANDI for green peas?

dianne dreer - April 2, 2012 6:02 PM

Yes I do believe that white rice is not so good for us and other white foods...I have tried to change to brown rice and not so much pasta and potatoes, it is hard as I do love these foods. I also am trying to change to the Halleluah diet...Thank you. Dianne Dreer

Peter T - April 2, 2012 6:38 PM

When making white rice, most of the fiber is stripped away. It makes sense that this would be a unnatural food for the body which would be quickly converted to sugar, similar to the affect of other simple sugars such as table sugar.

Mr. B - April 2, 2012 8:07 PM

What kinds of rice are diabetic friendly?

Wild rice?
Basmati rice?
Brown rice?

Anyone know the Glycemic Load
on those?

Natalie - April 2, 2012 10:24 PM

I think that we should stop comparing the way the east and west eats because we are genetically different. It's the same with the way a female and male body works, it's all different. The way we tolerate, accept, process foods is different. I'm not saying that we shouldn't try different foods, I think we need to stop preaching on what type of foods is best/better generally. Everything in moderation.

However one commonality is that it seems like eating like our ancestors did is the proper way rather than all the fast food junk that we're being fed now a days. Stay true to eating habits of our ancestors, simple, from the earth and whole without additives or anything fancy.

Henning Lützen - April 3, 2012 2:39 AM

As rise is over 7000 years old and has been the main food for over half of the earths population. I doubt that these test's is a fact. In China the number of diabetes 2 has raised during the last few years and its certainly because of change in the food and no exercise. All together the American way of living. I agree with David Griffin.

Mia - April 3, 2012 3:50 AM

Oh wow... How serendipitous that I'd be reading this while in Shanghai airport, waiting for my flight to Changchun... I have been worried about what I'll eat while I'm here (it's my first time)... Here's to hoping I can find many steamed veggies!

Deana Ferreri, Ph.D. - April 3, 2012 4:05 PM

Bob - the value of 8 given here is for Glycemic Load, not ANDI. In Eat for Health the ANDI of green peas is listed as 75.

Mr. B - wild rice has not been measured. Black rice has a GL of 14 from the table above. Brown rice is variable, but averages in the 20s. Basmati rice is usually milled (white).

Joel Fuhrman, M.D. - April 3, 2012 4:26 PM

It never ceases to amaze me how much the conventional population wants to bury their head in the sand and deny everything about nutritarian eating that can reverse and prevent disease and extend human lifespan. The commenters that find their way to this blog to “teach” their world view of nutrition and aim to contradict mine with the most convoluted arguments is a perfect example. Any study that shows high glycemic foods, meats, oils, increased eating frequency, high protein intake, some will look to find flaws in the studies to disavow any need to make dietary changes. A little knowledge goes a long way to inflict confusion. Keep in mind it is never just one study that begets my advice. Many of the commenters above illuminate the attempt people make to rationalize their dietary preferences with merely a shred of support on their side. Here they are defending that an almost empty calorie, low fiber, high glycemic, processed food, (with no significant micronutrient load) is not really a harmful actor, in spite of its link to breast cancer and diabetes in multiple studies and that it has the profile of foods that drive cancer development.

Certainly you can believe anything you want and go ahead, eat every hour, eat all the meat, cheese, oil, white rice and olive oil you want, it is your right. However, my work is not geared for the mass market; it is designed to inform people of the ideal diet-style to push the envelope of human longevity in those seeking such information (and to maximize weight loss and disease reversal). In other words, I do not water-down the recommendations to make it more widely acceptable.

This blog mostly exists to support those who understand my basic scientific principles and teachings. I appreciate the commenters who have read Eat To Live or some of my other books, so they at least have a framework to understand the basic premises of nutritarian nutrition, including micronutrient density, phytochemicals, food addiction, caloric restriction, resistant starch, metabolic efficiency, and the effect of foods on cancer-promoting hormones, such as insulin and IGF-1.

Yes, Asians are more sensitive to a high glycemic diet than those of European descent, but so are overweight Americans with metabolic syndrome, diabetic, or diabetic prone. For example in Korea, they always ate white rice, but now with more processed foods and all that white rice (40 percent of calories), they have almost double the diabetes risk at the same body weight as Americans. That does not exonerate white rice. Certainly without the processed foods and fast foods, the rice alone (with much more vegetables) would not cause as much disease, but that is still not the point, it is a weakness, not a strength in the diet.

So Beth, the article you linked was biased and faulty, please do not post those opinions here. David, regardless if ice cream or bacon is worse, that does not make white rice a healthy, longevity promoting food. The Chinese diet is not one we aim to emulate to maximize longevity, but we can learn something from those studies, in spite of their limitations. Dianne, you are on the wrong website, this is not the Halleluiah Diet. Natalie, your nutritional rationalizations are dangerous and everything in moderation is the perfect formula for cancer. I use science, logic and evidence to enable people to live considerably longer and better than our primitive ancestors and for those who choose to, to maximize their protection against cancer.

mike rubino - April 3, 2012 8:40 PM

Good post Dr F, as Danny Devito said in Twins, after Arnold Scwharzenegger had knocked out his enemy ," You mess with me you mess with my entire family !"

Dr. Yoni Freedhoff - April 4, 2012 5:08 AM

Dear Mark,

As the author of the article you've labeled, "bias and faulty", would love to hear your description of my bias, and of the article's faults.

Clearly if it's as terrible as you infer, it should be easy for you to steer me right.

Sincerely,
Yoni Freedhoff

Dani S (Ph.D) - April 4, 2012 5:46 AM

Hi,

Interesting article. Though I miss a critical review of the evidence. For example, the meta-analysis you mention is actually a poor piece of evidence. A meta-analysis is only as good as the studies it uses and the lack of consideration of the other dietary components (i.e. it does not account for dietary confounders) means interpretation is clouded. This is a common issue in nutritional epidemiology papers on both sides of the argument. The western 12% increase in risk is also not significant as far as I can see.

Love to see a blog summarising a systematic, balanced and critical review of the literature (if you get the time or have one already).

Thanks

Mike Howard - April 4, 2012 9:57 AM

I too, Dr. Fuhrman am interested in a specific critique of Dr. Freedoff's views on the subject.

From an evidence-based and critical eye, it would appear that Yoni has actually brought up some glaring flaws in the study.

I'm left wondering who is actually the one burying their heads in the sand.

MarieC - April 4, 2012 11:11 AM

I am a fan of you and your work.

However, I do not understand who you are referring to when you say...

"Here they are defending that an almost empty calorie, low fiber, high glycemic, processed food, (with no significant micronutrient load) is not really a harmful actor, in spite of its link to breast cancer and diabetes in multiple studies and that it has the profile of foods that drive cancer development."

Who exactly are you talking about?

Are you talking about those who are promoting the typical American diet as I don't know anyone who is doing that. Even the recent USDA Food Plate promotes whole grains over refined grains and a switch to a more plant based, nutrient dense diet. So, it can't be them.

Are you talking about those who promote a low carb, high protein diet? They do not include rice, let alone white rice, let alone carbs so it can't be them.

Are you talking about other low fat plant based programs like Dr McDougall's, Dr Esselstyn or Dr Barnard? If so, as you should well know, they may allow for white rice on occasion but they clearly do not promote a diet that is based on white rice, nor one that is a "mostly empty calorie, low fiber, high glycemic, processed food, with no significant micronutrient load" diet.

I went to a 10 day program and was never served white rice or white flours but instead was served a variety of fruits, vegetables, whole grains and beans, peas and lentils and recipes made from them. There were a few white potatoes but they were only served a few times a week and only as one of the options at the meal. Since I went and have been following the program, I have been able to get off all my medications, including those for diabetes.

Thank you.

Mike - April 4, 2012 11:34 AM

"it is designed to inform people of the ideal diet-style to push the envelope of human longevity in those seeking such information (and to maximize weight loss and disease reversal). In other words, I do not water-down the recommendations to make it more widely acceptable."

Curious statement... better tell those Okinawan centenarians to stop eating rice IMMEDIATELY so they can, you know... extend their lives.

mike rubino - April 4, 2012 1:45 PM

marie , I took the 'here ' comment to mean the above commenters were defending a poor diet right here on Dr Fs blog.

carfree - April 4, 2012 3:28 PM

Dr. Yoni Freedhoff,
Perhaps your research is faulty. Please note: MARK Fuhrman was the OJ detective. This blog is Dr. JOEL Fuhrman's.

Joel Fuhrman, M.D. - April 5, 2012 9:10 AM

My comments are directed to the contrarians making comments “here” on my blog defending white rice and attempting to deny the relationship between white rice and diabetes. There is a significant body of literature, not just this one study referenced above that documents the disease-promoting contribution of low-nutrient, low fiber, high glycemic foods, specifically white rice, white flour and sweets. These foods have no place in the ideal dietary protocol for reversing disease and maximizing longevity. Certainly, those interested can read more about this and other references in my books. The flaw, if any, in the meta-analysis is that it actually under-estimates the diabetic promoting effects of white rice in the Asian diet. For example if we carefully review the diabetic incidence data from Korea, we find where we have 68 percent of our US population overweight or obese, in Korea only 30.6 percent of the population is overweight or obese. The average Korean eats 800 calories of white rice a day, and the overweight Koreans eat more than 1000 calories from white rice, which is important to explain why they have higher incidence of diabetes in Korea compared to the US and higher rates of diabetic complications and diabetic related deaths, at a much lower body weight compared to American diabetics. Plus promoting diabetes is only the tip of the iceberg, low nutrient, high glycemic foods promote cancer too. The respected Harvard researchers who conducted this meta-analysis did not claim their data was perfect, as no study is, but they were clear that it is consistent and supportive of findings from earlier studies and on other refined, high glycemic foods when eaten as a dietary staple. If any of you want to impugn the data in this meta-analysis which had reasonable controls, I suggest you send your analysis to the journals and authors for consideration, for their comments. If your critique has even a shred of insight it will be published and properly critiqued by the authors. There are dietary dogmatists of all persuasion and some come here, but sorry, I am not going to devote more time to this thread as I have to prioritize and I do not see this issue as even controversial.

isaac mario - April 8, 2012 2:41 PM

i do beleive you dr.joel furhman.im one of your fan.i was treated high blood pressure at early age of 35 and took pills for four years and have a family history of high blood and diabetics.i take this as an oppurtunity to say thank you for having the couraged and concerns to all people about their medical problems despite to your critics.Its been a long time,i been looking for the answer in my part because im sick and tired taking high blood pressure medication for long long time and argued to my primary doctor why he wants me to take th e pills forever since my blood was already down to normal and all the blood words is normal including kidney functions .. since im very picky too to my foods with no process foods,animal products sweets and breads and it was at the back of my mind thinking what will happen to me in the future for 20 years more at the age of 55 is theres a make sense why im taking the pills forever? i guess absolutely not and why i should take that pills forever and not make sense for me or the pills itself makes me sicker ...since i watched you at kqed channell i finally found the answer even do i never buy yet your ETL books i already got the idea and more knowledge to me especially for the using of SALTS etc. and im a free salts now and not craving for a salty food because i did an alternative salts like lemon or chili and cooked my own,and blended fruits and vegestables i descipline more myself and exercise.and right now,i already got the freedom of medications thru the help of Dr.joel furhman without you doc i never had the courage and knowledge to quit that medications since my primary doctor scared me to stop that medications and now i finally got it and controlled my bood pressure to normal and monitoring every other day and i m very happy about the results.i still have the plan to buy your ETL books for more knowledge you're amazing and wonderful Dr. joel furhman...sometimes i tried to share to my co workers about the natural thing i done and to locate your sites to those who have the medical problems but ended only to arguments bec.they most beleived in medications and they dont have the couraged to stop eating those delicious food soucre of animal products,process foods etc.once again,more power to you Dr.joel furhman and im sure i can all this to my whole family...long live sir..

Saab - April 13, 2012 1:37 AM

Dr. Fuhrman,

How do we get all the bio-available essential nutrients in correct amounts without using supplements if we eat a vegetable based diet without any animal products at all. Is it possible? I would really like to know this because I'm currently on the McDougall diet, and have not lost a pound, only gained a few plus a few inches on my waistline, and I'm following his recommendations, and not my own interpretation of it. The low-carbohydrate activists are telling me to eat more meat because they claim that it does not cause cancer, heart disease, or obesity, and than it contains all the essential nutrients including ones that cannot be obtained from plant foods. However, I wish to adopt your ETL lifestyle, but I need a lot of help and information in order to do so.

Thank you,
Saab

Edith - April 13, 2012 11:58 AM

Well, I agree with the facts that white Rice, White Potato, White Pasta and anything that is processed, is not a very good selection of food.
If one was to speak about staying healthy, wild rice, brown rice, vegetables, fruit, legumes, nuts and anything that needs the body to work to break it down is a better choice.
For example, I have arthritis with two of my fingers, and after juicing veggies & fruit, the pain went away and I can bend them. And, that was after a full week of juicing !!

Dino - April 22, 2012 5:55 PM

Hi Dr. Furhman, I am a little confused. I am Italian and saying we shouln't eat pasta is like telling me to stop breathing. Can I at least substitute white flour to maybe spelt or some other type of flour that won't hurt me? Just want to say that you are an inspiration in my life and plan to change my way of eating but just taking longer than I expected because it just seems a bit difficult to eliminate certain foods. I thank God for people like you.

Mike R - April 25, 2012 11:03 AM

Dino, Macaroni ends up in the limited category , whole wheat etc better than that made with white flour . So you can have it infrequently , but you have to watch the sauce you put over it.

Dr Scott B Rapahel - August 2, 2013 12:03 AM

I find it amusing That Dr Furhman and Dr McDougall have been butting heads about this starch issue for years. The one thing we all agree on is, simple carbs like white flour, white rice, and white pastas as well as any and all processed foods should not even be called food.

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