If you have social media or a television, I'm sure you've heard the news: EATING PASTA WILL HELP YOU LOSE WEIGHT when added to a Mediterranean diet approach ! At least that's what a recent "study" from Italy that was published in the Nutrition & Diabetes Journal on July 4th suggests. We can all rejoice, right? Not so fast. Before you get caught up in the click bait headlines that are probably overflowing on your news feeds and make yourself a big bowl of penne with vodka sauce, let's take a deeper look at the "study" in question and dissect what the data reveals (Pssst, it reveals absolutely nothing).
The study involved two different Italian populations. The first population, referred to as the Moli-sani participants, consisted of 24,326 enrolled subjects and looked into data collected between March 2005 and April 2010. A large population and a long period of time.... that's good, right?
The second population, referred to as the INHES participants (Italian Nutrition & Health Survey), consisted of 9,319 men and women and looked at data from dates ranging from November 2010 to November 2013. Again, not bad.
So what's the problem?
Well for starters let's take a deeper look at the two groups of participants.
Of the 24,325 participants, only 14,402 actually participated in the study due to the remaining (approximately) 10,000 participants being excluded. Exclusions are common in studies for several reasons, mostly to lessen the generality and focus in on a specific population. I have no problem with that.
However, the media channels that are sharing this study conveniently aren't sharing these exclusions with the public, perpetuating the narrative that eating pasta will not contribute to weight gain. These exclusions are extremely important for the public to be aware of before they begin to adding pasta back in to their lives on a consistent basis.
Here are some of the reasons that participants were excluded from the study:
1) Non Caucasians were excluded from the study.
2) Participants who were not born in Italy were excluded from the study.
3) Those being nutritionally treated for diabetes, hypertension, and
hyperlipidemia were excluded from the study (this is a normal exclusion.
generally, individuals with prior issues/diseases are excluded from studies unless the study is specifically targeting that issue/disease).
The importance of these Exclusions
The biggest issue I have with these exclusions is that it leaves a major lack of diversity. I don't have a problem with the study as much as I have a problem with how the media is covering it. As we now understand from current research, there is a large amount of genetic variance when it comes to nutrition and disease. In other words, some cultures are more equipped to handle certain nutrients than other cultures. For example, it's well understood that African Americans have almost double the chance of getting diabetes than whites in America. Sure there are other contributing issues such as economics that we could get into, but now isn't the time. The point is that using one study that only looks at Italians and their consumption of pasta should not be used to speak for everyone.
Additionally, most media outlets are leaving out the most important factor: The subjects were following a Mediterranean Diet and only consuming pasta as a "side dish". In other words, there were plenty of healthy fats including fish and olive oil with a small amount of carbohydrate dense foods such as pasta.
Let's move on to the data collection methods of this study and where some problems could arise ....
Data Collection: Moli-sani Participants
Moli-sani participants were asked to fill out food frequency questionnaires to determine usual nutritional intakes for the previous year. The questionnaires were used to estimate frequency of consumption, average amounts of food (grams per day), and caloric intake daily. The problem lies in the fact that food frequency questionnaires are about as reliable as an eyewitness to a crime is in court. I'm sure you've seen an episode of Law and Order or two and heard that eyewitnesses are often times not a trustworthy source of information. The same goes for food frequency questionnaires. Asking someone to estimate their intake of food for a year is nearly an impossible task to complete accurately.
Data Collection: INHES
Similarly to the Moli-sani group, participants of the INHES group were asked to estimate their intake via various survey style methods. The data collected by the researchers relied on information provided by participants during phone interviews, with no actual scientific measurements or experiments being conducted. Additionally, the members of the INHES group were sent a picture booklet with sample portion sizes to adhere to. Basically, the subjects were guessing how much they were eating.
The Interesting Contradiction by Nutrition "Experts"
It's well understood in the scientific community that food frequency questionnaires are one of the "weakest" forms of data collection when it comes to statistical certainty. This is because the data that is collected relies solely on participants memory, proper calculations, and honesty. However, even though this study relies completely on survey information, it has gained steam in the media as well as with many nutrition "experts". I find this interesting particularly because much of the nutrition information proving that saturated fat intake is not related in any way to heart disease or stroke has been written off due to it's unreliability.
A meta-analysis of prospective cohort studies that was published in 2010 in The American Journal of Clinical Nutrition found there was NO ASSOCIATION between saturated fat consumption and cardiovascular disease. This meta-analysis reviewed 21 other studies involving a total of 347,747 subjects over the span of 23 YEARS !
Interestingly, this study has been pushed aside and labeled as unreliable, while the pasta study is flourishing and gaining positive press. The meta-analysis involved far more subjects and much longer follow-up period than the pasta study, yet is somehow being viewed as less reliable.
Perhaps this has something to due with our love for pasta (and carbohydrates overall). It seems as though we are cherry-picking information that fits our subconscious agenda to eat our favorite foods without acknowledging its true effect on our physiology. As Dr. William Davis mentions in his book "Wheat Belly", we are literally addicted to wheat and we do not want to acknowledge it. Wheat has the ability to bind to the opiate receptors in our brain and form an addiction similar to substances like heroin, morphine, and Oxycontin. While we don't feel that same "high" from wheat, the addiction is still exists due to it's ability to act on our opiate receptors. In fact, wheat withdrawal is a real issue and is classified by symptoms such as fatigue, brain fog, and depression. Furthermore, administering opiate blocking pharmaceutical drugs such as naloxone or naltrexone trigger a withdrawal process from wheat because it is not able to attach to our opiate receptors due to the opiate blocking drugs doing their job.
Besides it's opiate like effect, wheat also has the ability to increase intestinal permeability in just about every person who consumes it according to modern research. Gliadin, a protein molecule found in wheat, is able to penetrate the gut lining and trigger an inflammatory response in seemingly about 95% percent of the population (depending on what study you are looking at), NOT JUST PEOPLE WITH CELIAC'S. The pasta study fails to look at any blood work from subjects and does not take into account the inflammatory cascade that takes place from consuming gliadin consistently.
As you can see, nutrition "experts" are contradicting themselves here. Dietary questionnaires are reliable .... but only when it suits their agenda. Is there more to this? Is this our addiction talking? Are politics and agricultural subsidies involved in the massive media coverage of this pasta/weight loss study? Do we just love pasta so much that we are trying to convince ourselves that it's healthy? The answer is probably all of the above.
Once again, I do not blame the pasta study and certainly am not labeling it useless. Sure, this study has plenty of limitations, but no study can account for all possible variables. It's up to us as consumers to interpret information and be responsible with which media outlets we expose ourselves to.
Additionally, the study stated that those who ate pasta adhered to more of a strict Mediterranean diet than those who didn't eat pasta. THIS IS KEY !!! This means that sure, the people had some pasta, but in general, they ate healthier overall ! The overall healthy eating is what lead to the weight loss, NOT THE PASTA! In other words, the non pasta eaters ate less of a Mediterranean diet, less healthy fats, and more food that's terrible for you that just so happened to not be pasta. It's no wonder why the non pasta group didn't lose as much weight as the pasta eating group.
In my opinion, the study is actually very telling. The study shows that if you start incorporating a good amount of healthy fats and start to view carbohydrate dense food like pastas as a side dish that you eat sparingly, you will probably experience some benefit when compared to your previous eating habits. Problems arise when you start making pasta (wheat in particular) your main course and leave out the healthy fats and abundance of dark green leafy veggies.
In conclusion, I would recommend a diet rich in healthy fats, veggies, and a tiny amount of pasta on the side instead of the Standard American Diet (SAD) any day.